University School Research Articles

Efficacy of linaclotide in combination with polyethylene glycol for bowel preparation in Chinese patients undergoing colonoscopy polypectomy: protocol for a randomised controlled trial

BackgroundAdequate bowel preparation is essential for successful colonoscopy and polypectomy procedures. However, a significant proportion of patients still exhibit suboptimal bowel preparation, ranging from 18% to 35%. The effectiveness of...

A multicenter prospective clinical trial on the effect of domestic bone level implants on single tooth implantation and restoration

Objective: To evaluate the clinical application effects of a domestic bone-level implant system for restoring single tooth loss, and provide clinical evidence for the promotion and application of domestic implants. Methods: A prospective, multicenter clinical trial was conducted from April 2018 to January 2020 in three institutions: Department of Oral Implantology, School & Hospital of Stomatology, Wuhan University, Department of Stomatology, The First Affiliated Hospital of Zhejiang University School of Medicine, and Department of Stomatology, The Third Hospital of Hebei Medical University. The trial planned to include 100 patients for single tooth implantation and restoration, followed up for 1 year, to evaluate the implantation success rate and other related outcomes. Results: This study screened a total of 142 patients and ultimately included 100, comprising 43 males and 57 females with age of (47.0±12.2) years. Ninety-eight out of 100 patients completed a one-year follow-up (98.0%), while 2 patients terminated the trial early due to implant loosening (2.0%). After a one-year follow-up, the implants of the 98 patients were all functioning successfully, with a success rate of 98.0% (98/100). The patients were satisfied with the overall restoration effect. Conclusions: This study indicates that the domestic bone-level implant system has achieved favorable short-term clinical outcomes for single-tooth implantation and restoration.

A comparative study of a two-stage surgical approach combining coronectomy with microimplant anchorage traction for extraction of impacted mandibular third molars with different traction angles

Objective: To establish a two-stage surgical procedure of impacted mandibular third molars (IMTMs) extractions assisted by coronectomy and microimplant anchorage traction and to investigate the influencing factors of root movement and the effects of different traction angles on the clinical outcomes. Methods: Fifty-three IMTM in contact with inferior alveolar nerve (IAN) that underwent tooth extraction in the Peking University School of Stomatology from January 2022 to June 2023 were included, with coronectomy and microimplant anchorage implantation in the first stage of the surgery, root traction was achieved with orthodontic elastic and microimplant anchorages by about 600 g of force, when the IMTM root was detached from IAN, a second surgery was performed to extract the residual root. The basic information of patients and M3M, data on the microimplant anchorage implantation and traction, imaging measurements, and complications were recorded and analyzed. Results: The movement distance of the residual roots was (1.80±0.92) mm, and the duration of traction was (32.9±7.9) d. Multiple linear regression analysis showed that the residual root movement distance was significantly correlated with age, gender, number of roots, traction angle, and depth of the distal bone defect of the second molar (P<0.05). The smaller the traction angle, the more significant the movement of the residual roots (P=0.044). In one case (1.9%, 1/53), the patient experienced abnormal sensation in the lower lip 16 days after traction. Conclusions: The two-stage surgical method of combined coronectomy with rapid traction technique to extract the IMTM allows for rapid movement of the residual root and reduces the risk of IAN injury. The efficiency of root movement can be accelerated by appropriately reducing the traction angle during surgery. The traction effect can be predicted based on indicators such as age, gender, number of roots and depth of distal bone defects of second molar.

Exploring English language teacher educators’ professional development through collaborative partnership with pre-service teachers in supervised practicum

ABSTRACT This study explores the perspectives of 190 fourth-year pre-service EFL teachers across Türkiye on their definitions of ideal language teacher educators and the professional development of teacher educators based on their experiences during teaching practicum in university and practice school contexts. Data were collected through open-ended surveys and analysed qualitatively via coding (Saldana 2009) using content analysis (Patton 2015). The findings indicate that some pre-service teachers (PSTs) lack trust in their teacher educators at both schools and universities, particularly regarding the gap between theoretical knowledge and practical application during their practicum experience. Additionally, the findings suggest that language teacher educators’ professional development is enhanced by collaborating with PSTs. The results imply that language teacher educators should encourage self-reflection on their teaching practices, facilitate collaboration with PSTs, and prioritise the development of PSTs’ professional identity through partnerships with teacher educators.

Characteristics and influencing factors of caregivers’ healthcare preferences for young children under COVID-19 lockdown: a cross-sectional study in Shanghai, China

BackgroundMissed or delayed child healthcare caused by the COVID-19 lockdown has threatened young children’s health and has had an unpredictable influence on caregivers’ child healthcare preferences. This study investigated caregivers’ child healthcare preferences and the factors that influence them among families with young children (0–3 years) during the lockdown in Shanghai.MethodsParticipants in this cross-sectional study were enrolled through random encounter sampling. Questionnaires were distributed online from June 1 to November 10, 2022, in Shanghai. A total of 477 valid questionnaires were received. The demographics of caregivers and their families, children’s characteristics, COVID-19-related information, and caregivers’ healthcare preferences were analyzed. The statistical analyses included frequency and percentage, chi-square tests, and multinomial logistic regression.ResultsCaregivers preferred child healthcare professionals in the community health service system (CHS; 47.6%) followed by hospital pediatricians (40.0%) during lockdown. Caregivers with the following characteristics preferred CHS: those with an annual household income of CNY 200,000–300,000, those whose youngest children were aged 8–12 months, and those who experienced early childhood physical development issues. Caregivers preferred hospitals if they had experienced healthcare-seeking-related difficulties in accessing professional guidance from hospital pediatricians.ConclusionsDuring pandemic lockdowns, policymakers should allocate more resources to CHS to meet caregivers’ childcare demands. Moreover, special attention should be given to the healthcare needs for CHS among families with specific demographics.Trial registrationApproval was obtained from the Ethics Committee of Shanghai Jiao Tong University School of Medicine School of Public Health (SJUPN-202,109; June 1, 2022).

Impact of group work on the hidden curriculum that induces students’ unprofessional behavior toward faculty

BackgroundHidden curriculum (HC) can limit the effects of professionalism education. However, the research on how HC triggers unprofessional behavior among medical students is scant. Furthermore, there is no established approach for how faculty members may create a context, such as an educational environment and education system, that prevents students’ unprofessional behavior. This study aimed to develop an educational approach to prevent unprofessional behavior and clarify how faculty members consider HC that triggers students’ unprofessional behavior.MethodsThe study sample comprised 44 faculty members and eight medical students from the Chiba University School of Medicine. The participants were divided into groups and asked the following question: “What attitudes, statements, and behaviors of senior students, physicians, and faculty members trigger medical students’ unprofessional behavior?” The responses were collected using the affinity diagram method. The group members discussed the causes and countermeasures for the selected attitudes, statements, and behaviors of senior students, physicians, and faculty members based on the affinity diagram. The impact of the group work on the faculty members was surveyed using questionnaires immediately after its completion and six months later. Furthermore, the cards in the group work were analyzed using content analysis.ResultsThe responses to the questionnaire on group work indicated that some faculty members (43.8%) improved HC, while others suggested conducting group work with more participants. The content analysis revealed six categories – inappropriate attitude/behavior, behavior encouraging unprofessional behavior, lack of compliance with regulations, harassment of other medical staff, inappropriate educational environment/supervisor, and inappropriate self-control – and 46 subcategories.ConclusionsThe HC that triggers students’ unprofessional behavior includes the words and actions of the educator, organizational culture, and educational environment. Group work makes faculty members aware of the HC that triggers unprofessional behavior, and induces behavioral change for HC improvement in the educational activities. Educators should refrain from using words and actions that encourage unprofessional behavior, such as personal anecdotes, as they reduce students’ learning motivation.

Insights on the contribution of doctoral research findings from a school in a South African University towards policy formulation

Translation of health research findings into policy contributes to improvement of health systems. Generally, in sub-Saharan Africa policymakers rarely use research evidence and hence policies are often not informed by research evidence. Unless published or in the case of commissioned research, doctoral health research is often not used for health policy formulation. This paper analysed the potential and utilization of doctoral research from the School of Nursing and Public Health by KwaZulu-Natal Health Department of Health. The study adopted a mixed methods approach that combined elements of qualitative and quantitative research aspects. Qualitative data was collected through content analysis of 29 theses produced in the School of Nursing and Public Health, University of KwaZulu-Natal between 2014 and 2021 and interviews held with four Department of Health personnel as policymakers. When researchers could not get information on how research questions were formulated from content analysis, they checked the student questionnaire for answers. Quantitative data was collected from 79 participants through structured questionnaires. Participants included 47 PhD graduates, 11 final year PhD students and 21 PhD supervisors. Data from content analysis and interviews was analyzed thematically while data from questionnaires was analyzed quantitatively. Eleven (52%) PhD supervisors reported that findings from 22 studies were being considered for policy development and adoption while some had resulted in policy guidelines and frameworks that can be used to formulate policies. Factors such as failure to involve the Department of Health during the formulation of research questions, inappropriate packaging of research findings, policymakers not aware of the availability of research findings, lack of commitment to the dissemination of research results by students and poor demand for research evidence by policymakers hindered the translation of PhD research findings into policy. From the 29 theses reviewed, sixteen (28%) of PhD respondents highlighted that they involved the Department of Health to formulate research questions while forty-two (72%) did not. The theses review also revealed limited identifiable information related to policy formulation. The study confirms the use of PhD research findings for policy formulation. Additionally, it highlights the factors that hinder utilization of PhD work by policymakers. Further research to understand the perspectives of policymakers on factors that contribute to utilization of PhD work as well as how the findings have contributed to policy formulation is recommended since there was not sufficient data collected from policymakers due to Covid-19 restrictions.

Developing and delivering a migraine disparities and diagnosis undergraduate medical educational program to underrepresented in medicine medical student members of the Student National Medical Association: A pilot project.

Migraine is underdiagnosed. On average, medical students have approximately 3 h of exposure to headache education throughout medical school training. Moreover, some medical students have racially-based biases in pain. There is a paucity of underrepresented in medicine (UIM) headache practitioners. UIM practitioners are more likely to practice in underserved communities and provider-patient ethnic concordance may help eliminate healthcare disparities. The Student National Medical Association (SNMA) is an organization committed to supporting current and future UIM medical students and addressing the needs of underserved communities. The goal of this project was to develop and deliver a brief Migraine Diagnosis and Disparities Undergraduate Medical Education Program (MD2UMEP) to increase awareness of migraine diagnosis and disparities in UIM medical students in the SNMA. For connecting/relationship-building with SNMA, the SNMA Region V website was reviewed. Calls were made to Wayne State University School of Medicine (WSUSOM) Office of Diversity, Equity, and Inclusion (ODEI) explaining the educational initiative with subsequent emails to the Director of WSUSOM's ODEI followed by a video-conference meeting (VCM). VCMs were conducted with two SNMA member leaders from WSUSOM. A local and regional presentation/delivery of the MD2UMEP was planned. Communication was maintained electronically. For development/delivery of the MD2UMEP, headache literature was reviewed for key concepts underpinning migraine diagnosis and migraine disparities with a focus on African Americans. Slides with talking points were developed with references. Pre- and posttest questions were drafted and made accessible via a QR code. The MD2UMEP was presented and students completed the questionnaires. Descriptive statistics were used to quantify responses. The MD2UMEP work began July 31, 2021, with program delivered in final form on October 1, 2022. A professional relationship was established with SNMA leadership. A MD2UMEP was developed then administered at the 2022 SNMA Region V Medical Education Conference. Headache medicine was introduced to UIM SNMA medical students. Anonymously, nine individuals responded to the MD2UMEP pretest questions. Eight individuals answered the posttest questions. At the program's conclusion, UIM student performance improved on seven of 10 test questions on migraine diagnosis and disparities and remained at 100% on one of 10 test questions. On two of the questions, the number correct remained the same (although percentage overall increased due to the smaller denominator). There was a higher proportion of correct responses on the posttest. There is great need for migraine diagnosis and disparities education among medical students. A new migraine diagnosis and disparities program was developed for medical students. SNMA members were receptive to the MD2UMEP and it strengthened their knowledge of migraine diagnosis and disparities. This program exposed UIM medical students to headache medicine.

Bridging the gap in medical education: comparing analysis of light microscopy and virtual microscopy in histology.

This study aims to investigate the impact of virtual microscopy (VM) and light microscopy (LM) on the satisfaction of second-year medical students and how they affect student performance in different educational settings. The research involved 94 second-year students from Izmir Democracy University's School of Medicine, with criteria requiring enrollment in the 2021-2022 academic year and attendance of at least 80% in histology practical course. A paired two-tailed t-test was used for comparison, with a researcher-designed questionnaire for data collection. Cronbach's alpha was 0.894 for the LM questionnaire, and 0.918 for the VM questionnaire, indicating high level of reliability. LM scored higher in the questionnaire (p = 0.010), but VM showed higher exam averages (p = 0.013). The study found VM more effective in exams, with students showing high satisfaction with LM. VM's accessibility to histological preparations and its impact on learning levels and board exam success rates were noted. The study concludes that while VM is becoming essential in histology education due to its positive impact on exam performance and accessibility, LM remains highly valued by students for its hands-on experience and satisfaction levels.

Disability and the stratification of post-secondary pathways: Evidence from a large administrative linkage.

Research has linked disability to differential experiences and outcomes for students at multiple levels of education. To date, however, available data sources have prevented comprehensive analyses of the statistical relationship between disability and the pathways traveled by students through Ontario post-secondary education (PSE). Through this study, we examine this topic by leveraging a large multifaceted linkage that brings together rich administrative data from the Toronto District School Board (Grades 9-12), Ontario college and university enrollment records (2009-2018), as well as government student loans and tax records. We use these data to statistically model differences in the PSE pathways traveled by more than 33,000 TDSB students. Our analyses identify statistically significant differences in the likelihood that students with/without disabilities will travel certain PSE pathways. However, such differences shrink drastically once we control for high school-level factors (e.g., academic performance, absenteeism). We elaborate on the importance of these findings for both social stratification researchers and policymakers.

Clinical characteristics and labial gland pathological features in children with systemic lupus erythematosus complicated by Sjögren's syndrome

To study the clinical manifestations, laboratory features, and labial gland pathological features in children with systemic lupus erythematosus (SLE) complicated by Sjögren's syndrome (SS). A retrospective analysis was conducted on 102 children with SLE who underwent labial gland biopsies at Renji Hospital, Shanghai Jiao Tong University School of Medicine from January 2013 to December 2022. The children were divided into two groups based on the presence of SS: the SLE with SS group (SLE-SS; 60 children) and the SLE-only group (42 children). According to the focus score (FS) of the labial glands, children in the SLE-SS group were further subdivided into FS≥4 subgroup (26 children) and FS<4 subgroup (34 children). The clinical data of the groups were compared. Compared to the SLE-only group, children in the SLE-SS group had less skin and mucosal involvement, were more likely to have positive anti-SSA and anti-SSB antibodies, and had higher levels of rheumatoid factor (P<0.05). There was no significant difference in treatment protocols between the two groups (P>0.05). Compared to the FS<4 subgroup, the FS≥4 subgroup had more frequent musculoskeletal involvement (P<0.05), but there was no significant difference in SLE disease activity or other major organ involvement between the subgroups (P>0.05). Children with SLE complicated by SS are less likely to have skin and mucous membrane involvement and exhibit specific serological characteristics. The SLE-SS children with an FS≥4 are more likely to experience musculoskeletal involvement. However, FS is not associated with disease activity or other significant organ damage.

Oral health promotion and dental care of children with microcephaly in the context of public health

The university's fundamental mission is to be a source of scientific knowledge, technological innovation, and academic public health practices, all the while being mindful of social responsibility. But when faced with children in vulnerable clinical conditions, what would this public and professional knowledge and practice be? Currently, there is a lack of oral health education programs aimed at children with microcephaly, including a protocol for preventive dental care. This study aims to describe the field experiences of the academic team of the Dental School of the State University of Southwest Bahia in oral public health practices in children with microcephaly based on the principles of universality, equity, and integrality. Extracurricular activities provide a dialogue between the university and society, where both environments teach and learn from each other, making the university not the only place where knowledge is shared. Consequently, professors and students must understand that in order to achieve a high quality education, the implementation of extracurriculars in their academic curriculum is extremely necessary.

Build-A-Genome and the “awesome power of undergraduates”

Abstract The Elizabeth W. Jones Award for Excellence in Education recognizes individuals or groups who have had significant, sustained impact on genetics education at any level, from K-12 through graduate school and beyond. The 2024 Elizabeth W. Jones Award for Excellence in Education recipient Jef Boeke considers himself a geneticist turned engineer. He transformed his landmark synthetic yeast genome project into a research-heavy teaching course, revolutionizing molecular biology and genetics education. The Build-A-Genome course was developed to teach students basic practical molecular genetics while also providing the raw materials for a global genome synthesis project, Yeast 2.0. The course evolved over two decades to reflect the changing needs and opportunities for the project and the development of new technologies. In addition to educating a generation of college and high school students in a new way, it also developed a cadre of educators who developed similar courses and projects at a wide variety of research and educational institutions.

Predicting cochlear implant performance: Impact of demographic, audiologic, surgical factors, and cochlear health

Predicting cochlear implant performance: Impact of demographic, audiologic, surgical factors, and cochlear health Amit Walia, Matt Shew and Craig A. Buchman from Washington University School of Medicine, explain the challenges of understanding variables or factors informing CI performance and how this can be addressed. Cochlear implants (CIs) are highly effective for restoring hearing in individuals with moderate-to-profound hearing loss who do not gain sufficient benefit from hearing aids. Despite being one of modern medicine’s most successful advancements, there is wide inter-individual variability in speech perception outcomes (Figure 1). The drivers of this variability are not well understood, making it difficult to set realistic expectations for patients before surgery and to evaluate potential interventions that may enhance performance post-operatively. Accurate prediction of speech perception performance after surgery could significantly impact how we assess candidates, plan postoperative aural rehabilitation, choose surgical techniques, design and fit electrodes, and segment the patient population in future CI clinical trials.

An Analysis of the Undergraduate Program of the Police School of the University of Internal Affairs

Theoretical knowledge, skills, and practical experience of the cadets, students, and graduates are essential for the implementation of the basic functions of the police organization to effectively combat crime, maintain public order, and ensure public safety. However, all of these depend on the concept of educational programs, training theories, and development trends. Therefore, we have written this article to analyze the undergraduate programs and their implementation, and to propose some improvements. The research focuses on the analysis of the undergraduate curriculum methodology at the Police School of the Internal Affairs University of Mongolia from 2000 to 2019. It involves comparing the current four specialized programs with those of the national police universities of the Russian Federation and the Republic of Korea. After conducting the analysis, we identified both problems and opportunities. We surveyed 250 graduates of the programs to compare the quality and accessibility of education at that time to the current situation which helped us identify the issues. According to the survey, 75 percent of the respondents believe that the Police Work-Law undergraduate program needs to be improved and updated while the remaining 20 percent did not feel that it needed improvement, and 5 percent were unsure. Comparative analysis of the programs finds that there has been an increase in program content and credit hours, some courses overlap, the internship period is short, and the quality and results are weak. Upon comparing similar programs in other countries, it has been identified that implementing curricula in areas such as artificial intelligence, coding, and programming can help international law schools effectively meet the challenges of 21st-century legal practice.

An Analysis of the Undergraduate Program of the Police School of the University of Internal Affairs

Theoretical knowledge, skills, and practical experience of the cadets, students, and graduates are essential for the implementation of the basic functions of the police organization to effectively combat crime, maintain public order, and ensure public safety. However, all of these depend on the concept of educational programs, training theories, and development trends. Therefore, we have written this article to analyze the undergraduate programs and their implementation, and to propose some improvements. The research focuses on the analysis of the undergraduate curriculum methodology at the Police School of the Internal Affairs University of Mongolia from 2000 to 2019. It involves comparing the current four specialized programs with those of the national police universities of the Russian Federation and the Republic of Korea. After conducting the analysis, we identified both problems and opportunities. We surveyed 250 graduates of the programs to compare the quality and accessibility of education at that time to the current situation which helped us identify the issues. According to the survey, 75 percent of the respondents believe that the Police Work-Law undergraduate program needs to be improved and updated while the remaining 20 percent did not feel that it needed improvement, and 5 percent were unsure. Comparative analysis of the programs finds that there has been an increase in program content and credit hours, some courses overlap, the internship period is short, and the quality and results are weak. Upon comparing similar programs in other countries, it has been identified that implementing curricula in areas such as artificial intelligence, coding, and programming can help international law schools effectively meet the challenges of 21st-century legal practice.

EFL Pre-Service Teachers’ Problems during Teaching Assistance of Merdeka Belajar Kampus Merdeka Program

Teaching English was not an easy task. Therefore, pre-service teachers needed sufficient experience before becoming true teachers. The teaching assistance program was designed for aspiring teachers to gain that experience. However, during the implementation of this program, pre-service teachers undoubtedly encountered several problems. This study aimed to analyze the problems faced by pre-service teachers during the teaching assistance program. Three participants from the same university but different schools participated in the study. Questionnaires and interviews were used to collect data. The result showed that various problems were faced by pre-service teachers during teaching assistance. Almost all pre-service teachers encountered different problems compared to their peers during teaching assistance. However, some of them also shared similar problems. All the problems faced by pre-service teachers during teaching assistance could be categorized into two main factors. Internal factors such as inappropriate teaching method, material, media, classroom management and pre-service teachers’ proficiency. Then external factors such as problem related to students, disconnection between expectation and reality, school facility, and lack of relatedness between teaching practice alongside lectures. This was considered important to discuss so that in the future, pre-service teachers could be better prepared when they would teach directly to students at schools during teaching assistance.

Efficacy analysis of mechanical thrombectomy combined with prolonged mild hypothermia in the treatment of acute middle cerebral artery occlusion: a single-center retrospective cohort study.

To determine the efficacy of mechanical thrombectomy combined with prolonged mild hypothermia compared with conventional treatment in managing acute middle cerebral artery occlusion, and to explore whether extending the duration of hypothermia can improve neurological function. From 2018 to June 2023, a retrospective analysis was conducted on 45 patients with acute middle cerebral artery occlusion treated at the NICU of Suzhou Kowloon Hospital, affiliated with Shanghai Jiao Tong University School of Medicine. After thrombectomy, patients were admitted to the neurological intensive care unit (NICU) for targeted temperature management. Patients were divided into two groups: the mild hypothermia group (34.5-35.9°C) receiving 5-7 days of treatment, and the normothermia group (control group) whose body temperature was kept between 36 and 37.5°C using pharmacological and physical cooling methods. Baseline characteristics and temperature changes were compared between the two groups of patients. The primary outcome was the modified Rankin Scale (mRS) score at 3 month after surgery, and the secondary outcomes were related complications and mortality rate. Prognostic risk factors were investigated using both univariate and multivariate logistic regression analyses. Among 45 patients, 21 underwent prolonged mild hypothermia, and 24 received normothermia, with no significant differences in baseline characteristics between the two groups. The duration of mild hypothermia ranged from 5 to 7 days. The incidence of chills (33.3% vs. 8.3%, p = 0.031) and constipation (57.1% vs. 20.8%, p = 0.028) was significantly higher in the mild hypothermia group compared with the control group. There was no significant difference in mortality rates between the mild hypothermia and the control group (4.76% vs. 8.33%, p = 1.000, OR = 1.75, 95% CI, 0.171-17.949). At 3 month, there was no significant difference in the modified mRS (0-3) score between the mild hypothermia and control groups (52.4% vs. 25%, p = 0.114, OR = 0.477, 95% CI, 0.214-1.066). Infarct core volume was an independent risk factor for adverse neurological outcomes. Prolonged mild hypothermia following mechanical thrombectomy had no severe complications and shows a trend to improve the prognosis of neurological function. The Infarct core volume on CTP was an independent risk factor for predicting neurological function.

Application of 21-gene recurrence risk score in patients with breast cancer

Objective: To investigate the relationship between 21-gene recurrence risk score (21-Gene RS) and the prognosis and clinicopathological features of hormone receptor (HR) positive, HER2-negative early breast cancer patients who did not receive neoadjuvant therapy. Methods: A total of 469 patients with HR positive and HER2-negative early breast cancer who received surgical treatment in the First Affiliated Hospital, Zhejiang University School of Medicine from January 2014 to October 2017 were selected. Their clinicopathological data were retrospectively analyzed. Tumor tissue samples were collected from patients, and the expression of 21-gene was detected by reverse transcription quantitative real-time polymerase chain reaction (RT-qPCR). The 21-Gene RS was calculated according to the Trial Assigning Individualized Options for Treatment (TAILORx) RS grouping and National Surgical Adjuvant Breast and Bowel Project B-20 (NSABP B-20) RS grouping principles. Patients were divided into low (21-Gene RS<11 or 21-Gene RS<18), intermediate (11≤21-Gene RS<26 or 18≤21-Gene RS<31) and high (21-Gene RS≥26 or 21-Gene RS≥31) risk groups, and the clinicopathological features and prognostic differences of patients in different risk groups were compared. Statistical data were compared by chi-square test. Survival analysis was performed using Kaplan-Meier curve analysis and the differences between groups were compared using Log-rank test. Multivariate analysis was conducted by COX regression analysis. Results: Based on TAILORx RS grouping, the proportions of low-risk, intermediate-risk and high-risk groups among the 469 patients were 18.8% (88/469), 48.2% (226/469) and 33.0% (155/469), respectively. Based on NSABP B-20 RS grouping, the proportion of low-risk, intermediate-risk and high-risk groups were 43.1% (202/469), 37.5% (176/469) and 19.4% (91/469), respectively. The association of 21-Gene RS with histological grading, luminal typing, Ki-67 expression, and chemotherapy and treatment modalities were statistically significant (P<0.05) regardless of TAILORx RS grouping or NSABP B-20 RS grouping. Kaplan-Meier survival curve suggested poor prognosis in high-risk group (P<0.05, Log-rank test). Multivariate COX regression analysis showed that surgical method and 21-Gene RS were risk factors affecting the prognosis of patients. Conclusions: 21-Gene RS is significantly associated with the prognosis of patients with HR-positive, HER2-negative, early-stage breast cancer not receiving neoadjuvant therapy, as well as with their clinicopathological characteristics such as patients' histologic grade, luminal typing, Ki-67 expression, and whether or not they are treated with chemotherapy or other treatment modalities.The 21-Gene RS threshold of 11 and 26 or 18 and 31 can be used to grade the prognosis in Chinese patients with early-stage breast cancer. More researches are needed to guide the selection of postoperative adjuvant therapy for patients with HR-positive and HER2-negative early-stage breast cancer.

Renewable, Flexible, and Storage Capacities: Friends or Foes?

Problem definition: More than 99% of the new power generation capacity to be installed in the United States from 2023 to 2050 will be powered by wind, solar, and natural gas. Additionally, large-scale battery systems are planned to support power systems. It is paramount for policymakers and electric utilities to deepen the understanding of the operational and investment relations among renewable, flexible (natural gas-powered), and storage capacities. In this paper, we optimize both the joint operations and investment mix of these three types of resources, examining whether they act as investment substitutes or complements. Methodology/results: Using stochastic control theory, we identify and prove the structure of the optimal storage control policy, from which we determine various pairs of charging and discharging operations. We find that whether storage complements or substitutes other resources hinges on the operational pairs involved and whether executing these pairs is constrained by charging or discharging. Through extensive numerical analysis using data from a Florida utility, government agencies, and industry reports, we demonstrate how storage operations drive the investment relations among renewable, flexible, and storage capacities. Managerial implications: Storage and renewables substitute each other in meeting peak demand; storage complements renewables by storing surplus renewable output; renewables complement storage by compressing peak periods, facilitating peak shaving and displacement of flexible capacity. These substitution and complementary effects often coexist, and the dominant effect can alternate as costs change. A thorough understanding of these relations at both operational and investment levels empowers decision makers to optimize energy infrastructure investments and operations, thereby unlocking their full potential. Funding: This research was supported in part by Lilly Endowment, Inc., through its support for the Indiana University Pervasive Technology Institute. This research was also supported by Kelley School of Business, Indiana University, and Haslam College of Business, University of Tennessee. O. Q. Wu thanks Grant Thornton for their generous support. Supplemental Material: The online appendix is available at https://doi.org/10.1287/msom.2023.0068 .