Causative Relationship Research Articles

High-Fat, Western-Style Diet, Systemic Inflammation, and Gut Microbiota: A Narrative Review.

The gut microbiota is responsible for recovering energy from food, providing hosts with vitamins, and providing a barrier function against exogenous pathogens. In addition, it is involved in maintaining the integrity of the intestinal epithelial barrier, crucial for the functional maturation of the gut immune system. The Western diet (WD)—an unhealthy diet with high consumption of fats—can be broadly characterized by overeating, frequent snacking, and a prolonged postprandial state. The term WD is commonly known and intuitively understood. However, the strict digital expression of nutrient ratios is not precisely defined. Based on the US data for 1908–1989, the calory intake available from fats increased from 32% to 45%. Besides the metabolic aspects (hyperinsulinemia, insulin resistance, dyslipidemia, sympathetic nervous system and renin-angiotensin system overstimulation, and oxidative stress), the consequences of excessive fat consumption (high-fat diet—HFD) comprise dysbiosis, gut barrier dysfunction, increased intestinal permeability, and leakage of toxic bacterial metabolites into the circulation. These can strongly contribute to the development of low-grade systemic inflammation. This narrative review highlights the most important recent advances linking HFD-driven dysbiosis and HFD-related inflammation, presents the pathomechanisms for these phenomena, and examines the possible causative relationship between pro-inflammatory status and gut microbiota changes.

Tumour necrosis factor-α −308G/A polymorphism is associated with insulin secretory defects in Bangladeshi prediabetic/diabetic subjects

ObjectivesTumour necrosis factor (TNF)-α, an adipocytokine, is closely linked to impaired glucose tolerance (IGT) and insulin resistance (IR) in type 2 diabetes (T2D) subjects. The relationship between the polymorphisms in the TNF-α gene and IR in Bangladeshi prediabetes and T2D subjects has not yet been fully identified. This study aims to reveal the association between TNF-α gene polymorphism and IR in hyperglycaemic patients of Bangladeshi origin. MethodsIn our study, 106 IGT, 100 T2D, and 109 healthy subjects of Bangladeshi origin were recruited to identify the impact of TNF-α gene polymorphism at position −308 with a G>A transition using PCR and subsequent restriction fragment length polymorphism (RFLP). ResultsThe −308G>A TNF-α genotype frequency distribution within the control, IGT, and T2D groups showed a significant association (χ2 = 21.077; P = 0.001), although allele frequency distribution within the groups showed a statistically non-significant difference (χ2 = 1.696; P = 0.091). β-cell functional deficiency (HOMA-B%) was observed to be significantly (P = 0.034) lower in subjects with a variant genotype. In addition, our results indicate that the study subjects’ body mass index (BMI) and residence status were positively correlated (P ≤ 0.05) with −308G>A TNF-α gene polymorphism. ConclusionsTherefore, it can be concluded that −308G>A TNF-α gene polymorphism may have a causative relationship with lower insulin secretory capacity and higher BMI in Bangladeshi IGT and T2D populations, while the urban population's lifestyle might be associated with this polymorphism.

The Roots of Occasionalism? Causation, Metaphysical Dependence, and Soul-Body Relations in Augustine

Abstract It has long been thought that Augustine holds that corporeal objects cannot act upon incorporeal souls. However, precisely how and why Augustine imposes limitations upon the causal powers of corporeal objects remains obscure. In this paper, the author clarifies Augustine’s views about the causal and dependence relations between body and soul. He argues that, contrary to what is often thought, Augustine allows that corporeal objects do act upon souls and merely rules out that corporeal objects exercise a particular kind of causal power (that of efficient or sustaining causes). He clarifies how Augustine conceives of the kind of causal influence exercised by souls and bodies.

Occupational exposures and sarcoidosis: current understanding and knowledge gaps.

Sarcoidosis is an idiopathic granulomatous disease that primarily affects the lungs. Several lines of evidence suggest that occupational exposures are associated with disease risk. This review critically evaluates studies using the Bradford Hill criteria for causation to determine if a causal relationship can be established between occupational exposure and sarcoidosis. Large epidemiological studies have proposed multiple occupational exposures associated with sarcoidosis but lack consistency of results. Many convincing studies demonstrate an association between World Trade Center (WTC) dust and sarcoidosis, which illustrates a causal relationship based on the fulfillment of the Bradford Hill criteria. Studies describing an association between silica/metals and sarcoidosis are intriguing but fulfill a limited number of the Bradford Hill criteria and warrant further investigation before a causal relationship can be determined. Finally, we also discuss preliminary studies associating sarcoidosis phenotypes with specific occupational exposures. Using the Bradford Hill criteria for causation, we demonstrate that WTC dust has a causative relationship with sarcoidosis, which reinforces the theory that sarcoidosis is an exposure-related disease. More research is needed to determine other specific occupational exposures causing disease.

Causal relationship between educational attainment and the risk of rheumatoid arthritis: a Mendelian randomization study

BackgroundEducational attainment is moderately heritable and inversely associated with the risk of rheumatoid arthritis. However, the causality from educational attainment on rheumatoid arthritis remained unknown. Here, we aimed to determine whether educational attainment is causally associated with rheumatoid arthritis (RA) by using Mendelian randomization (MR) approach.MethodsSummary statistics data for RA were obtained from an available, published meta-analysis of genome-wide association studies (GWAS) that included 14,361 RA cases and 43,923 controls of European ancestry. The instrumental variables for educational attainment were obtained from a GWAS meta-analysis that included over 1 million individuals (N = 1,131,881) of European ancestry. MR analyses were mainly performed using the inverse-variance weighted (IVW) method. Sensitivity analyses were further performed to test the robustness of the association using the weighted median method, MR-Egger, Cochran Q test, “leave-one-out” analysis and MR-PRESSO test.ResultsA total of 387 SNPs were employed as instrumental variables in our MR analysis. Genetically predicted higher educational attainment was associated with a significantly lower risk of RA using the IVW method (odds ratio [OR] = 0.42, 95% confidence interval [CI]: 0.34–0.52; p = 1.78 × 10− 14). The weighted median method and MR Egger regression analysis yielded consistent results. The effect estimate remained robust after the outlier variants and SNPs (associated with the confounding factors) were excluded. “Leave-one-out” analysis confirmed the stability of our results. Additionally, the results suggested the absence of the horizontal pleiotropy.ConclusionsThe MR analysis supported a potential inverse causative relationship between educational attainment and the risk of RA.

Posterior fossa decompression for children with Chiari I malformation and hydrocephalus.

Chiari I malformation (CMI) and hydrocephalus often coexist, with no clear understanding of the cause-and-effect relationship. In the absence of other associated etiologies, the traditional teaching has been to treat the hydrocephalus first, partly to minimize the risk of cerebrospinal fluid (CSF) leak from CMI decompression in the setting of elevated ICP. We describe a series of consecutive pediatric patients with CMI and hydrocephalus, the majority of whom were managed with posterior fossa decompression. A retrospective review was conducted on consecutive children who presented to the senior author with both hydrocephalus and CMI, with emphasis on rationale for and outcomes of surgical intervention, including the need for additional surgery. There were 14 patients aged 2weeks to 16years (median 2years) who presented with Chiari I and hydrocephalus. Four of these underwent posterior fossa decompression without duraplasty (PFD) as first-line therapy (one of whom eventually required duraplasty), 7 had PFD with duraplasty (PFDD), 1 received a ventriculoperitoneal shunt (VPS), and two had endoscopic third ventriculostomy (ETV). Of the 11 who had PFD/D, 9 (90%) had significant symptom improvement/resolution, 7 (55%) showed decrease in ventricle size, and 1 (10%) required VPS placement for persistent hydrocephalus. Both ETV patients improved clinically, and 1 showed decrease in ventricle size. There were no pseudomeningoceles, infections, or neurological deficits. One CSF leak occurred after an ETV and was successfully treated with wound revision. In patients with both CMI and hydrocephalus, treating the CMI first in an effort to avoid a shunt can be safe and effective. In this series, PFDD in the setting of hydrocephalus did not result in CSF leak or pseudomeningocele. While limited by a small sample size, these data support a causative relationship between CMI and hydrocephalus.

The role of mechanism knowledge in singular causation judgments

Singular causation queries (e.g., “Did Mary's taking contraceptives cause her thrombosis?”) are ubiquitous in everyday life and crucial in many professional disciplines, such as medicine or law. Knowledge about general causal regularities is necessary but not sufficient for establishing a singular causation relation because it is possible that co-occurrences consistent with known regularities are in an individual case still just coincidental. Thus, further cues are helpful to establish a singular causation relation. In the present research we focus on information about mechanisms as a potent cue. While previous studies have shown that reasoners consider mechanism information as important when it comes to answering singular causation queries, no formal model has been proposed that explains why this is case. We here present a computational model that explains how causal mechanism information affects singular causation judgments. We also use the model to identify conditions that restrict the utility of mechanism information. We report three experiments testing the implications of our formal analysis. In Experiment 1 we found that reasoners systematically use mechanism information, largely in accordance with our formal model, although we also discovered that some people seem to rely on simpler, computationally less demanding reasoning strategies. The results of Experiments 2 and 3 demonstrate that reasoners have a tentative understanding of the conditions that restrict the utility of causal mechanism information.

Identification of Novel Anthracycline Resistance Genes and Their Inhibitors.

Differentially expressed genes have been previously identified by us in multidrug-resistant tumor cells mainly resistant to doxorubicin. In the present study, we exemplarily focused on some of these genes to investigate their causative relationship with drug resistance. HMOX1, NEIL2, and PRKCA were overexpressed by lentiviral-plasmid-based transfection of HEK293 cells. An in silico drug repurposing approach was applied using virtual screening and molecular docking of FDA-approved drugs to identify inhibitors of these new drug-resistant genes. Overexpression of the selected genes conferred resistance to doxorubicin and daunorubicin but not to vincristine, docetaxel, and cisplatin, indicating the involvement of these genes in resistance to anthracyclines but not to a broader MDR phenotype. Using virtual drug screening and molecular docking analyses, we identified FDA-approved compounds (conivaptan, bexarotene, and desloratadine) that were interacting with HMOX1 and PRKCA at even stronger binding affinities than 1-(adamantan-1-yl)-2-(1H-imidazol-1-yl)ethenone and ellagic acid as known inhibitors of HMOX1 and PRKCA, respectively. Conivaptan treatment increased doxorubicin sensitivity of both HMOX1- and PRKCA-transfected cell lines. Bexarotene treatment had a comparable doxorubicin-sensitizing effect in HMOX1-transfected cells and desloratadine in PRKCA-transfected cells. Novel drug resistance mechanisms independent of ABC transporters have been identified that contribute to anthracycline resistance in MDR cells.

Minimum Detectable Mass and Volume Fluxes During Magmatic Recharge at High Prominence Volcanoes: An Application to Erciyes Dağ Volcano (Turkey)

Magma reservoir recharge is widely recognised as a precursor of eruptive activity. However, the causative relationships between reservoir rejuvenation and surface observables such as gravitational potential field changes and ground deformation are still poorly understood. At intermediate and silicic intra-plate volcanoes where crustal mechanical heterogeneity combined with high-prominence are expected to fundamentally affect the crustal stress and strain relationship, protracted period of repose and absence of monitoring data raise questions about the detectability of magma recharge. Here we report results from integrated geodetic forward modelling of ground displacements and gravity changes from reservoir recharge at Erciyes Dağ, a large prominence (∼2,800 m), yet poorly studied, stratovolcano of the Central Anatolian Volcanic Province in Turkey. The most recent eruption at ∼7000 BC, close proximity to the Kayseri Metropolitan Area and absence of dedicated volcano monitoring set a precedent to explore stealth magmatic processes at the volcano. Using finite element analysis we systematically explore the influence of subsurface mechanical heterogeneities and topography on surface deformation and gravity changes from magmatic recharge of Erciyes Dağ’s reservoir. We show that whilst crustal heterogeneity amplifies ground displacements and gravity variations, the volcano’s substantial prominence has the opposite effect. For generic reservoir pressure and density changes of 10 MPa and 10 kg m−3 predicted vertical displacements vary by a factor of 5 while residual gravity changes vary by a factor of 12 between models ignoring topography or mechanical heterogeneity and those that do not. We deduce reservoir volume and mass changes of order 10–3 km3 and 1010 kg, respectively, at the detectability limit of conventional surveying techniques at the volcano. Though dependent on model assumptions, all results indicate that magma recharge at Erciyes Dağ may go undetected at fluxes 1) sufficient to maintain an active reservoir containing eruptable magma and 2) similar to those reported for intermediate/silicic volcanoes with repose times of 100–1,000s of years (e.g., Parinacota) and persistently active mafic volcanoes such as Mt. Etna and Stromboli. Our findings may be utilised to inform integrated geodetic and gravimetric monitoring at Erciyes Dağ and other large prominence silicic volcanoes and could provide early insights into reservoir rejuvenation with implications for the development of disaster risk reduction initiatives.

The Role of Uterine Natural Killer Cells on Recurrent Miscarriage and Recurrent Implantation Failure: From Pathophysiology to Treatment.

Uterine natural killer (uNK) cells constitute a unique uterine leucocyte subpopulation facilitating implantation and maintaining pregnancy. Herein, we critically analyze current evidence regarding the role of uNK cells in the events entailed in recurrent implantation failure (RIF) and recurrent miscarriages (RM). Data suggest an association between RIF and RM with abnormally elevated uNK cells’ numbers, as well as with a defective biological activity leading to cytotoxicity. However, other studies do not concur on these associations. Robust data suggesting a definitive causative relationship between uNK cells and RIF and RM is missing. Considering the possibility of uNK cells involvement on RIF and RM pathophysiology, possible treatments including glucocorticoids, intralipids, and intravenous immunoglobulin administration have been proposed towards addressing uNK related RIF and RM. When considering clinical routine practice, this study indicated that solid evidence is required to report on efficiency and safety of these treatments as there are recommendations that clearly advise against their employment. In conclusion, defining a causative relationship between uNK and RIF–RM pathologies certainly merits investigation. Future studies should serve as a prerequisite prior to proposing the use of uNK as a biomarker or prior to targeting uNK cells for therapeutic purposes addressing RIF and RM.

A rapid systematic review of measures to protect older people in long-term care facilities from COVID-19

ObjectivesThe global COVID-19 pandemic produced large-scale health and economic complications. Older people and those with comorbidities are particularly vulnerable to this virus, with nursing homes and long term care facilities...

S1241 Prevalence of Hyperthyroidism in Patients With Non-Alcoholic Fatty Liver Disease: A Population-Based Study

Introduction: Non-Alcoholic Fatty Liver Disease (NAFLD) is currently considered as the most common cause of chronic liver disease worldwide. Risk factors for NAFLD have been well-described, including obesity, type 2 diabetes mellitus (T2DM), dyslipidemia (DLP) and metabolic syndrome. While hypothyroidism has been identified as an independent risk factor for the development of NAFLD, the presence of hyperthyroidism has not been previously explored. Our aim is to evaluate the prevalence of hyperthyroidism in patients with NAFLD and to assess if it is an independent risk factor. Methods: Our cohort’s data was obtained using a validated, large, multicenter database (Explorys Inc, Cleveland, OH, USA) aggregated from pooled outpatient and inpatient records of 26 different healthcare systems, consisting of a total of 360 hospitals in the United States, and utilizing Systematized Nomenclature of Medicine-Clinical Terms for coding. We evaluated a cohort of patients with hyperthyroidism and NAFLD. Multivariate analysis was performed to adjust for confounding risk factors including HTN, T2DM, DLP, obesity and metabolic syndrome. Statistical Package for Social Sciences (SPSS version 25, IBM Corp) was used for statistical analysis, and for all analyses a 2-sided p-value of < 0.05 was considered statistically significant. Exclusion criteria was limited to age < 18 years. Results: Among the 37,648,180 included individuals in this database who were above the age of 18 years, there were a total of 2320 patients with NAFLD (6.16 per 100,000) in the last five years (2015-2020), amongst which 50 patients (2.2%) had hyperthyroidism. Baseline characteristics of patients in this database are described in Table 1. Patients with NAFLD were more likely to have obesity, T2DM, DLP, HTN and metabolic syndrome, as is well documented in the literature. While males and females were equally affected, patients in the age group 18-65 years as well as Whites seem to be at a higher risk. Interestingly, there was a positive correlation between patients with NAFLD and hyperthyroidism, independent of the other risk factors (odds ratio 2.536) (Figure 1). Conclusion: Hyperthyroidism has a positive correlation with NAFLD, suggesting it is an independent risk factor for the development of NAFLD similar to its counterpart, hypothyroidism. Further studies are needed to delineate and confirm the causative relationship between hyperthyroidism and NAFLD.Table 1.: Rates of Cirrhosis and Fibrosis by Race and Era Table 1. Rates of cirrhosis (measured by ultrasound) in AA and non-AA patients in conjunction with fibrosis assessment by FibroScan, APRI, and FIB-4.Figure 1.: Age of HCV patients in 2002-2003 vs 2019 plotted by gender and race (AA and non-AA).

Risk of substance use disorders among adolescents and emerging adults with type 1 diabetes: A population‐based cohort study

Adolescents and emerging adults with chronic health conditions such as type 1 diabetes mellitus (T1D) are more likely to engage in high-risk behaviors. Previous studies regarding substance use in adolescents and emerging adults with T1D are mostly derived from cross-sectional studies utilizing self-administered questionnaires and are limited by lack of population-based comparison groups. In addition, despite the rising popularity of vaping, little is known about the incidence of vaping in adolescents and emerging adults with T1D. We explored the incidence and prospective risk of substance use disorders (SUD) and vaping in adolescents and emerging adults with T1D compared to age and gender matched nondiabetic referents residing in Olmsted County, Rochester, MN. Risk of incident SUD was higher in those with T1D compared to matched referents with alcohol, marijuana, and smoked tobacco being most common substances. When stratified by gender, these differences remained significant in males, but not females. While further work is needed to delineate the causative relationships between T1D, mental health, and substance abuse, our findings confirm the critical need for substance use screening and mental health support for adolescents and emerging adults with T1D.

Contralateral pneumothorax after central line placement in COVID-19 positive patients.

Contralateral pneumothorax after percutaneous central venous catheter placement has not been previously reported. Three patients who required intubation and mechanical ventilation for acute respiratory failure due to COVID-19 were identified with a new pneumothorax on routine post-placement chest roentgenogram on the side opposite the catheter placement. Retrospective review of charts, radiographs, and laboratory studies. No causative relationship was identified between the percutaneous placement of the central venous catheters and the subsequent pneumothoraces identified on the contralateral side, other than the presence of active COVID-19 viral pneumonia. The timing of the contralateral pneumothoraces were coincidental the placement of the central venous catheters. We believe these pneumothoraces were a consequence of the pulmonary pathology of the COVID-19 virus.

Machine Learning Prediction of Liver Allograft Utilization From Deceased Organ Donors Using the National Donor Management Goals Registry.

Several machine learning classifiers were trained to predict transplantation of a liver graft. We utilized 127 variables available in the DMG dataset. We included data from potential deceased organ donors between April 2012 and January 2019. The outcome was defined as liver recovery for transplantation in the operating room. The prediction was made based on data available 12-18 h after the time of authorization for transplantation. The data were randomly separated into training (60%), validation (20%), and test sets (20%). We compared the performance of our models to the Liver Discard Risk Index. Of 13 629 donors in the dataset, 9255 (68%) livers were recovered and transplanted, 1519 recovered but used for research or discarded, 2855 were not recovered. The optimized gradient boosting machine classifier achieved an area under the curve of the receiver operator characteristic of 0.84 on the test set, outperforming all other classifiers. This model predicts successful liver recovery for transplantation in the operating room, using data available early during donor management. It performs favorably when compared to existing models. It may provide real-time decision support during organ donor management and transplant logistics.

Physics use of mathematics

Orthodox physics makes extensive use of number relation mathematics such as mapping, probability, and infinite series. This mathematics is devoid of causative relations. Other scientific disciplines such as medicine and chemistry use causative models. Using causative models would advance physics. Causation should be overtly stated in the mathematics. Causation is linked with emergence philosophy and not reductionism.

Dampening Effects of Perceived Teacher Enthusiasm on Class-Related Boredom in College Students: Longitudinal Mediation Effects of Perceived Task Value.

This study aims to explore the longitudinal mediation effects of college students’ perceived task value (PTV) between perceived teacher enthusiasm (PTE) and class-related boredom (CB). We conducted a longitudinal survey among college students from five colleges at the second (T1), sixth (T2), tenth (T3), and fourteenth week (T4) in a semester, and overall 1,371 students completed all the measurements. In the survey, a battery of questionnaires was used to measure the students’ PTE, perception of task difficulty, perception of task value, and CB. At T1, boredom proneness was measured as a control variable. Analysis of the longitudinal data showed that after controlling for the effects of boredom proneness and perceived task difficulty, students’ PTE was a significant predictor of CB, and students’ PTV played a significant mediating role in this causation relationship. The study supported the importance of the control-value theory in explaining the mitigating effect of students’ PTE on CB, especially highlighting the role of PTV.

Singularity analysis of igneous zircon U-Pb age and Hf isotopic record in the Zhongdian arc, northwest Yunnan, China: Implications for Indosinian magmatic flare-up and the formation of porphyry copper deposits

Situated in the southern part of Yidun arc in the southeastern Tibetan Plateau, the Zhongdian arc records magmatic activity that ranges from approximately 270 to 190 Ma, which is likely attributable to subduction of the Garze-Litang slab and involved steady low-volume magmatic lulls punctuated by short-lived high-volume flare-ups. Many porphyry copper deposits have been found in these magmatic rocks, but the temporal-spatial relationships among magmatism, porphyry copper deposits, and subduction processes around the Zhongdian arc have long been debated. Frequency distributions calculated from igneous zircon U-Pb ages are commonly utilized to interpret the duration of magmatic events. Recently, a new concept of fractal density and a local singularity analysis (LSA) method have been applied to analyze the geometric properties of zircon U-Pb age peak anomalies, which are linked to deeply rooted avalanches associated with short spurts of convection during the formation of supercontinents and continental crust growth. In this paper, the igneous zircon U-Pb dating data collected from the Zhongdian arc are analyzed by the LSA method from the perspective of fractal density to interpret the causational relationship between age peak and subduction process of the Garze-Litang oceanic crust. The results show that the age density around the age peak of 215 Ma can be well fitted and described by power law functions, and the strong singularity (k > 0.8) indicates the occurrence of extreme geological events. Meanwhile, systematic changes in the hafnium isotopic composition of igneous zircons with time reflect the upwelling of asthenospheric mantle materials, characterized by a rapid increase in εHf(t) values that reach the highest around the 215 Ma peak. Moreover, the log–log plot that shows the cumulative number-age distribution reveals another transitional age of 235 Ma. By comparison of the magmatic intensity between the western and eastern belts of the Zhongdian arc, it is indicated that the eastward magmatic migration might have begun at ca. 235 Ma. Combined with the previous work, we propose that the Indosinian magmatic flare-up in the Zhongdian arc might have been caused by superimposition of slab subduction, steepening of slab dip, and slab breakoff. This long-term magmatic hydrothermal evolution system and extreme singularity events also provide indispensable conditions for the formation of large-scale and high-grade porphyry copper deposits in the region. Our findings provide new insights into the subduction process of the Garze-Litang oceanic crust and Indosinian magmatic framework around the Zhongdian arc. It is believed that the LSA method has potential applications in depicting the variation of magmatic activity and predicting mineral resources.

Secondary impacts of constipation in acute lymphoblastic leukemia in U.S. children's hospitals.

Childrenwith acute lymphoblastic leukemia (ALL) suffer a litany of chemotherapy-induced side effects. Constipation secondary to vinca alkaloids, psychological stressors, and opioid use are common issues for children newly diagnosed with leukemia. This study investigated the morbidity associated with constipation including infections, mucositis, and healthcare utilization in hospitalized children with ALL receiving induction chemotherapy. We analyzed data from 48 children's hospitals in the Pediatric Health Information System, extracting patients 1-21 years of age with ALL, hospitalized for induction from October 2015 through December 2019. Data were analyzed using nonparametric statistics, and comparisons of outcomes between those with and without constipation were presented as adjusted odds ratios (aOR). We identified 2586 (56%) patients with constipation out of a total of 4622 unique ALL patients in induction. Compared to patients without constipation during induction, patients with constipation were significantly more likely to have mucositis (aOR = 2.30; p = 0.0010), perirectal issues (aOR = 3.21; p = 0.0092), or abdominal radiograph exposure (aOR = 2.40; p < 0.0001). The median length of induction hospitalization was significantly greater in those with constipation compared to those without constipation (10 days vs. 8 days; p < 0.0001). Children with ALL suffering from constipation during induction therapy have increased length of stay, mucositis, imaging, and overall healthcare utilization compared to children without constipation. Further research should explore the causative relationship between constipation and infections. Increased attention should be given to constipation management in patients with ALL at the start of induction therapy, particularly in patients with complications or prolonged hospitalizations.

Correlation between workload and teamwork among residents in DIEP Flap surgery

The goal of this study was to evaluate residents’ workload and teamwork and the correlation between their workload and teamwork subscales during deep inferior epigastric perforator (DIEP) flap surgery. Ten residents who assisted during DIEP flap procedures completed an electronic survey following each DIEP flap procedure from July 2019 to August 2020. The survey contained items from the NASA-TLX and SURG-TLX and questions to measure teamwork subscales. Across 29 surgical cases, 38 surveys were recorded. Overall, the means of workload subscales were mostly greater than 10 and less than 15 (range=020) and the means of all teamwork subscales were greater than 15 (range=0-20). Good teamwork was correlated with lower distractions (Rs= -0.36 to -0.48) and better performance (Rs=0.35 to 0.52). Also, all the teamwork subscales were highly correlated (Rs= 0.59 to 0.92). Our findings suggest that good teamwork, low distractions, and successful performance are generally observed together; however, a causative relationship could not be established based on these results.