University School Research Articles

High deductible health plans and survival among cancer survivors.

11005 Background: High deductible health plans (HDHP) enable lower premiums at the expense of potentially high out-of-pocket costs. They are associated with more advanced cancer stage diagnoses and delayed or forgone care among cancer survivors. However, it is unknown how HDHPs are associated with survival among cancer survivors. Methods: Individuals ages 18-84 years with non-Medicaid insurance were identified from the 2011-2018 National Health Interview Survey (NHIS) with linked mortality files from the National Death Index. HDHP status was defined by the NHIS as a yearly deductible ≥$1200-1350 for an individual or ≥2400-$2700 for a family (values depend on survey year with increases over time). Cox proportional hazards models using age as the time scale were utilized to determine: 1) association of HDHP status with overall survival (OS) and cancer survival (CS; i.e., freedom from cancer death) among cancer survivors, and 2) how associations differed for survivors compared to those without a cancer history. Models accounted for the NHIS survey design and survey weights and were adjusted for insurance status, marital status, sex, comorbidities, education, income, national region, and cancer site and time since cancer diagnosis (if applicable). Sensitivity analyses adjusting for age at cancer diagnosis were performed using time since diagnosis as the time scale. Results: A total of 147,254 respondents were identified, 5.9% of whom were cancer survivors. 25.6% of survivors and 28.5% of individuals without a cancer history reported being insured by a HDHP at the time of NHIS participation. HDHP status was associated with worse OS (HR: 1.46, 95% CI = 1.19 - 1.79) and CS (HR: 1.34, 95% CI = 1.01 - 1.77) among cancer survivors overall in the adjusted model. HDHP status was additionally associated with worse OS among the following subgroups of cancer survivors: non-Hispanic White (HR: 1.45, 95% CI = 1.16 - 1.82), income > 400% federal poverty level (HR: 1.65, 95% CI = 1.16 - 2.36), college (HR: 1.47, 95% CI = 1.07 – 2.00) or high school (HR: 1.59, 95% CI = 1.19 - 2.12) education, and multiple cancers (HR: 1.58, 95% CI = 1.06 - 2.36), without clear patterns by sex, comorbidities, insurance, and cancer site. Sensitivity analyses provided similar results. In contrast, among adults without a history of cancer at the time of NHIS participation, HDHP status was not significantly associated with OS (HR: 1.08, 0.96 - 1.21; Pinteraction < .01) or CS (HR: 0.90, 95% CI = 0.70 - 1.14; Pinteraction < .01). Conclusions: This nationwide population-based analysis suggests that HDHPs are associated with both worse overall survival and cancer survival among cancer survivors but are not associated with survival in adults without a history of cancer. HDHPs may financially disincentivize cancer survivors from utilizing necessary medical care to optimize survivorship thereby compromising mortality and cure. Policy changes to limit the proliferation of these plans may improve cancer outcomes.

Pathway to cardiothoracic surgery: A primer for aspiring students

ObjectiveThe pathway to cardiothoracic surgery is often obscure for premedical students and aspiring applicants and requires navigating various known and unknown obstacles. Recognizing the challenges encountered on the path to a career in cardiothoracic surgery in the United States, we present this guide for students interested in the field to maximize success in their premedical, preclinical, and preresidency years. MethodsThis is a joint collaboration between the Thoracic Surgery Residents Association and the Thoracic Surgery Medical Student Association. Drawing from firsthand experiences and insights gathered from numerous student applicants and current surgical residents, a comprehensive guide was constructed for students from the point of undergraduate school to advanced training options, including super-fellowship training. ResultsSeveral intricacies to cardiothoracic surgery career planning were discussed, including differences between traditional and integrated/fast-track pathways, college and medical school selection, networking, performing during clinical rotations, extracurricular and research activities, building mentorship relationships, and pursuing alternate career and advanced training opportunities. ConclusionsFor premedical students and aspiring applicants, the road to cardiothoracic surgery requires meticulous planning, grit, and thoughtful dedication. This document consolidates firsthand insights and advice from numerous aspiring and matched applicants to serve as a comprehensive guide for students seeking a career in cardiovascular and thoracic surgery.

Preventive Efficacy of Antibiotics after Impacted Mandibular Third Molar Surgery.

To explore the preventive efficacy of antibiotics following surgical removal of the impacted mandibular third molars and screen the potential risk factors. A cohort trial. Place and Duration of the Study: Department of Oral and Maxillofacial Surgery, Zhejiang University School of Medicine, Stomatology Hospital, Hangzhou, China, from August 2021 to 2022. Cases with impacted mandibular third molar were divided into two groups based on antibiotics use. The primary outcome variable post-operative infection, secondary clinical parameter analgesics intake, and other variables (the operative time, the history of pericoronitis, and wound closure) were documented. The post-operative infections occurred in 3.64% (n = 12) of the 330 cases (n = 330); 3.01% in the antibiotic group (n = 166) and 4.27% in the control group (n = 164, OR = 1.44, 95% CI: 0.49 to 4.06; p = 0.54). Concerning secondary outcome measures, the analgesics that the antibiotic group took was 5.40, and the control group took was 5.95 (95% CI = -0.21 to 1.30; p = 0.16). For those with post-operative infections, the average operative time was 22.83 minutes, whereas for those without post-operative infections it was 14.87 minutes (95% CI = -0.26 to 15.67; p = 0.04). When the operative time was greater than or equal to 15 minutes, it was related to more analgesics use (95% CI: -0.43 to 1.93; p <0.05), also was the history of pericoronitis (95% CI = 0.04 to 1.54; p = 0.04). Antibiotics are unnecessary for preventing post-operative infections or minimising analgesic requirements following extraction of the impacted mandibular third molars; operative time and pericoronitis showed a suppressive influence on post-operative recovery. Impacted molars, Antibiotics, Analgesics, Operative time, Pericoronitis.

Impact of Pre-Admission Grade Point Averages on Anesthesiologist Assistant Student Performance at Emory University School of Medicine

Impact of Pre-Admission Grade Point Averages on Anesthesiologist Assistant Student Performance at Emory University School of Medicine

Business of Medicine: Developing Leaders in Academic Medicine and Learning Health Systems.

To develop healthcare professionals as clinical leaders in academic medicine and learning health system; and uncover organizational barriers, as well as pathways and practices to facilitate career growth and professional fulfillment. The Department of Medicine strategic plan efforts prompted the development of a business of medicine program informed by a needs assessment and realignment between academic departments and the healthcare system. The business of medicine leadership program launched in 2017. This descriptive case study presents its 5th year evaluation. Competencies were included from the Physician MBA program and from specific departmental needs and goals. The program hosted a total of 102 clinical faculty. We had a 37% response rate of those retained at Indiana University School of Medicine. Overall, responses conveyed a positive experience in the course. Over 80% of participants felt that they gained skills in professional reflection, professional socialization, goal orientation, critical thinking, and commitment to profession. Financial literacy was overwhelmingly the skill that was reported to be the most valuable. Finance and accounting were mentioned as the most difficult concepts to understand. Familiar concepts included communication, LEAN, and wellness related topics. One hundred percent of participants said they are utilizing the skills gained in this program in their current role and that they would recommend the course to others. Business of medicine courses are more common now with programs describing elements informed by health system operations. However, few programs incorporate aspects of wellness, equity, diversity, inclusion, and health equity. Our program makes the case for multiple ways to develop inclusive leaders through a focused five-month program. It also recognizes that to really impact the learning health system, health professionals need leadership development and leaders suited to work alongside career administrators, all aiming towards a common goal of equitable patient-centered care.

Real world effectiveness of immunotherapy combined with anti-angiogenic therapy in patients with anthracycline-resistant soft tissue sarcomas.

e23543 Background: Soft tissue sarcomas are a heterogeneous group of malignant tumors of mesenchymal origin with more than 50 histologic subtypes. They have distinct molecular, genetic and clinical features and account for 1% of adult malignancies, the most common being liposarcoma, undifferentiated pleomorphic sarcoma and leiomyosarcoma. Immune checkpoint inhibitors (ICIs) have limited efficacy in sarcomas compared to other solid tumors; however, they have shown some activity in certain subtypes. The use of immunotherapy in sarcoma faces many challenges due to tumor heterogeneity, scarcity of therapeutic antibodies and chimeric antigen receptors to target antigens in sarcoma subtypes. However, combining ICIs with other therapies seems to improve the therapeutic efficacy to some extent. Antiangiogenic targeted therapy has been recommended by major guidelines as the treatment of choice for second-line soft tissue sarcomas. However, there are limited results from large clinical studies on whether immunotherapy combined with antiangiogenic therapy improves the efficacy. Methods: In this real-world single-center retrospective cohort study conducted at the First Affiliated Hospital of Zhejiang University School of Medicine, the efficacy of immunotherapy combined with antivascular therapy was assessed by progression-free survival (PFS) and overall survival (OS). Safety was assessed using the Common Terminology Criteria for Adverse Events version 5.0. Results: In this study, we enrolled a total of 21 eligible patients, of which 6 were liposarcoma, 4 were leiomyosarcoma, 4 were rhabdomyosarcoma, and 7 were other types. The immunotherapy used in all patients was anti-PD-1 antibody, with bevacizumab as the antivascular therapy drug in four of them and antiangiogenic tyrosine kinase inhibitors in the others. 12(57%) patients had received one-line therapy, 9 (43%) had received ≥ second-line therapy. Median progression-free survival (mPFS) was 5.5 months and median overall survival (mOS) 16.1 months in the total population. mPFS was significantly longer in 2nd-line V.S. ≥3rd-line patients (9.6 months V.S. 3.1 months, P = 0.0007), with a tendency to be prolonged mOS in 2nd-line treatment (16.1 months V.S. 9.3 months), but with no statistically significant difference. The most common grade ≥3 adverse events were hypertension, hand-foot syndrome, and abnormal thyroid function. Conclusions: This study confirms that immunotherapy combined with antiangiogenic therapy is effective and tolerable in anthracycline-resistant soft tissue sarcomas in the real world.It is possible that use in the second line may lead to better efficacy than use in multiple lines, and more clinical studies are expected.

Comparing Video Head Impulse Testing in Patients With Acute Vestibular Dysfunction

Objective: The video head impulse test (v-HIT) can evaluate the function of all semicircular canals (SCCs) in a short period. In this work, we sought to compare v-HIT results among 2 commercially available devices, the ICS impulse (Otometrics, Denmark) (ICS) and Eye See Cam (Interacoustics, Denmark) (ESC), among individuals with unilateral vestibular disorders. Design: Retrospective study (n = 15). Setting: St. Marianna University School of Medicine Hospital. Patients: Fifteen patients with acute unilateral vestibular disorders. Intervention: Two v-HIT devices were conducted across patients to compare the results of the 2 models. Main Outcome Measures: Gain values and pathological saccades for each SCC were compared across the 2 models. Monothermal caloric testing was performed to compare alongside v-HIT gain values. Results: There was no difference between the 2 models for the evaluation of the horizontal SCCs. There was a significant negative correlation (ESC: r = −0.52, ICS: r = −0.53) between caloric testing and the gain values of the 2 models. In the vertical SCCs, the gain values of ESC were significantly higher than the gain values of ICS. Detection of catch-up saccades in vertical SCCs was similar across the 2 models. Conclusion: For the horizontal SCCs, there was no difference in test results between the 2 models. However, in the vertical SCCs, gain values were variable across the 2 devices. Larger scale studies are needed to develop normative ranges for the vertical canals.

Integration of Virtual and Traditional Medical Education: Scholarship Pivots from the COVID-19 Pandemic.

The coronavirus disease 2019 (COVID-19) pandemic required an unprecedented transformation of medical education, shifting from traditional, in-person learning to distanced, online learning. This study aimed to review changes to medical education and describe the advantages and disadvantages of virtual medical education experienced by medical students during the pandemic. An online survey study was conducted at two medical schools, University of Michigan Medical School in the United States and Koc University School of Medicine in Turkey. Medical students completed questionnaires regarding their educational experience before and during the pandemic. Survey instruments were designed to assess differences in the educational curriculum, study methods, clinical skills self-evaluations, perceptions of the quality of in-person and online learning, and overall satisfaction. A total of 184 medical students completed the survey. There was an increase in the use of online study tools since the pandemic. There was no statistically significant difference in self-reported assessments of clinical preparedness and overall clinical competence during surgical clerkship. The percentage of students interested in pursuing a career in surgery has nearly doubled from 34% to 63%. A majority of students (83%) believed that the time available for self-study and research increased during the pandemic. Fifty-two percent of students believed that online education is less efficacious than in-person education, but 86% of students still preferred a blended approach. Medical schools have continued to update their curricula following the COVID-19 pandemic. This study illustrates the transformations in medical education to ensure that the most effective and suitable teaching is delivered.

Mycoplasma pneumoniae detections in children with lower respiratory infection before and during the COVID-19 pandemic: a large sample study in China from 2019 to 2022

BackgroundNonpharmaceutical interventions (NPIs) implemented to reduce the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have suppressed the spread of other respiratory viruses during the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to explore the epidemiological trends and clinical characteristics of Mycoplasma pneumoniae (MP) infection among inpatient children with lower respiratory tract infection (LRTI) before and during the COVID-19 pandemic, and investigate the long-term effects of China’s NPIs against COVID-19 on the epidemiology of MP among inpatient children with LRTI.MethodsChildren hospitalised for LRTI at the Department of Pulmonology, The Children’s Hospital, Zhejiang University School of Medicine (Hangzhou, China) between January 2019 and December 2022 were tested for common respiratory pathogens, including Mycoplasma pneumoniae (MP), Chlamydia trachomatis (CT) and other bacteria. Clinical data on age, sex, season of onset, disease spectrum, and combined infection in children with MP-induced LRTI in the past 4 years were collected and analysed.ResultsOverall, 15909 patients were enrolled, and MP-positive cases were 1971 (34.0%), 73 (2.4%), 176 (5.8%), and 952 (20.6%) in 2019, 2020, 2021, and 2022, respectively, with a significant statistical difference in the MP-positive rate over the 4 years (p <0.001). The median age of these children was preschool age (3–6 years), except for 2022, when they were school age (7–12 years), with statistical differences. Comparing the positive rates of different age groups, the school-age children (7–12 years) had the highest positive rate, followed by the preschoolers (3–6 years) in each of the 4 years. Compared among different seasons, the positive rate of MP in children with LRTI was higher in summer and autumn, whereas in 2020, it was highest in spring. The monthly positive rate peaked in July 2019, remained low from 2020 to 2021, and rebounded until 2022. Regarding the disease spectrum, severe pneumonia accounted for the highest proportion (46.3%) pre-pandemic and lowest (0%) in 2020.ConclusionTrends in MP detection in children with LRTIs suggest a possible correlation between COVID-19 NPIs and significantly reduced detection rates. The positivity rate of MP gradually rose after 2 years. The epidemic season showed some differences, but school-age children were more susceptible to MP before and during the COVID-19 pandemic.

Integration of Clinical Trial Development in Hematology-Oncology Fellowship Training.

Several barriers to physicians becoming clinical investigators exist, including inexperience, lack of available mentors, and inconsistent instructive approaches with varying degrees of participation during training. These barriers cause fewer hematology-oncology fellows to pursue academic careers. A consensus is needed on structuring education in clinical investigation paired with active participation in development of a clinical trial guided by a mentor with the goal of increasing fellow interest in clinical research and pursuit of careers in academic medicine. The clinical trial development (CTD) program was initiated at Washington University School of Medicine in St. Louis in 2002 as a hands-on learning experience for hematology and oncology fellows in the design, implementation, and publication of clinical trials. Each fellow was required to identify a mentor and propose at least 1 prospective investigator-initiated clinical trial. At the time of data abstraction in July 2023, 118 fellows had participated in the CTD program and initiated protocols in a variety of areas according to their interests. Fellows were included in data abstraction if their fellowship began in 2002 through 2021; the program is ongoing, and the most recent class will graduate in 2024. Disease types were evenly distributed between solid tumor oncology (60 [51%]) or classic and malignant hematology (58 [49%]). Ninety-three fellows (79%) obtained institutional review board approval, and 60 (65%) published their results. Among graduating fellows, 67 (66%) secured an academic faculty appointment. Fellows with institutional review board-approved projects had significantly higher odds of obtaining an academic faculty appointment (odds ratio, 4.96; 95% confidence interval, 1.54, 15.98; P = .007).Next StepsNext steps will be to further evaluate the effect of the mentorship network on early career productivity of trainees that graduate and the feasibility of extending the program to another institution.

Receptivity to Instructional Computer-Based Feedback (RIF)

Abstract: Feedback can play a pivotal role in learning but is only effective when students use it. However, the use of feedback varies greatly from student to student and these differences must be explained. Hence, the construct receptivity to instructional feedback (RIF) was introduced to assess students’ attitudes towards and engagement with human-provided feedback in multiple English-speaking countries. However, RIF scales have not yet been used in computer-based assessment contexts nor in German-speaking countries; their application is thus limited. This study examined an adapted and translated RIF scale using confirmatory factor analysis (CFA) and exploratory structural equation modeling (ESEM). We capitalized on data sets comprising German-speaking university ( N = 464) and secondary school ( N = 1,207) students. The bifactor-CFA model showed a good model fit and revealed a general receptivity factor alongside the four specific factors: experiential attitudes, instrumental attitudes, cognitive engagement, and behavioral engagement with feedback. Scalar measurement invariance allowed for cross-gender and educational level comparisons. The relationships with broader personality characteristics were consistent with other contexts, thus indicating discriminant validity. General receptivity, cognitive engagement, and experiential attitudes positively correlated with GPA, suggesting convergent validity. Results support the stability of the RIF scale’s adaptation and translation. Assessment implications are discussed.

Analysis of risk factors associated with postoperative pancreatic fistula after robotic-assisted distal pancreatectomy

Objective: To investigate pertinent risk factors for postoperative pancreatic fistula(POPF) after robotic-assisted distal pancreatectomy(RDP). Methods: This is a retrospective cohort study. Clinical data of 1 211 patients who underwent various methods of distal pancreatectomy at the Department of General Surgery,Ruijin Hospital,Shanghai Jiaotong University School of Medicine,between January 2021 and December 2023 were retrospectively collected. Among the study participants,440 cases were in the robot-assisted group(173 males and 267 females),with an age(M(IQR)) of 55(29)years;720 cases were in the open surgery group (390 males and 330 females),with an age of 64(15)years;and 51 cases were in the laparoscopic group(17 males and 34 females),with an age of 56(25)years. These 440 patients who underwent RDP were divided into two cohorts based on the presence of clinically relevant pancreatic fistulas(grades B and C). Univariate and multivariate analysis were performed on 27 factors related to POPF. Univariate analysis methods included independent sample t-test,Mann-Whitney U test,and χ2 test,while multivariate analysis utilized binary logistic regression. Results: After stratification by pathological type,there was no significant difference in the incidence of pancreatic fistula between the robot-assisted group and the open surgery group(benign tumor:χ2=1.200,P=0.952;malignant tumor:χ2=0.391,P=0.532). The surgical duration of the RDP group (Z1=15.113,P1<0.01; Z2=4.232, P2<0.01) was significantly shorter than that of the open surgery and laparoscopic groups,so as the intraoperative blood loss (Z1=12.530,P1<0.01;Z2=2.550,P2=0.032). Postoperative hospital stay in the RDP group was significantly shorter than that in the open surgery group (Z1=10.947, P1<0.01), but not different from that in the laparoscopic group (P2>0.05). All 440 patients underwent successful surgery,of which there was only 1 case who underwent a conversion to open surgery. A total of 104 patients(23.6%) developed clinically relevant pancreatic fistulas,and no perioperative mortality was observed. Univariate analysis revealed that 6 factors were associated with POPF after RDP: gender(χ2=12.048,P=0.001),history of smoking (χ2=6.327,P=0.012),history of alcohol consumption (χ2=17.597,P<0.01),manual pancreas division (χ2=9.839,P=0.002),early elevation of amylase in drainage fluid (Z=5.187,P<0.01),and delayed gastric emptying (χ2=4.485,P=0.034). No statistically significant association with POPF was found for the remaining factors(all P>0.05).The cut-off value for the early amylase level in the drainage fluid was determined to be 7 719.5 IU/ml,with an area under curve of 0.676 determined by receiver operating characteristic curve analysis. Binary logistic regression analysis identified a history of alcohol consumption(P=0.002,95%CI:0.112 to 0.623),manual pancreas division(P=0.001,95%CI:1.446 to 4.082),early amylase level of drainage fluid ≥7 719.5 IU/ml(P<0.01,95%CI:0.151 to 0.438),and delayed gastric emptying(P=0.020,95%CI:1.131 to 4.233) as independent risk factors for POPF of RDP. Conclusions: Patients with pancreatic body and tail tumors who receive RDP therapy are at increased risk of developing a pancreatic fistula if they have a history of alcohol consumption,manual pancreas division,early elevation of amylase in drainage fluid to ≥7 719.5 IU/ml, or delayed gastric emptying.

TEFL Students' Perceptions of Native and Non-Native EFL School Teachers and University Lecturers: A Case Study

The idea that non-native English-speaking educators are less competent than their native English-speaking counterparts when teaching language is propagated by the language ideology known as native-speakerism. The dichotomy between these two teacher groups has been addressed in various parts of the world but not in the Armenian context. This study investigates graduate students' perceptions of native/non-native EFL school teachers and faculty at an English medium university in Armenia. Collected Data shows that native and non-native educators were both viewed as meeting students' needs and providing helpful instruction. While preferences for natives were mainly in pronunciation and vocabulary, non-native lecturers, specifically local Armenians, were favored in affective areas. However, a novel finding in this investigation was the confusion over the native speaker term. The study concludes by recommending some academic implementations to offer these in- and pre-service teachers a more nuanced knowledge of the constructs involved.

Diagnostic value of ultrasonography for injury of anterior talofibular ligament and anterior inferior tibiofibular ligament distal fascicle in patients with ankle fractures.

To explore the diagnostic value of ultrasonography for injuries of anterior talofibular ligament (ATFL) and anterior inferior tibiofibular ligament distal fascicle (ATiFL-DF) in patients with ankle fractures. Clinical data of 51 patients with ankle fractures who were clinically suspected of ligament injuries and underwent ankle ultrasonography examination and arthroscopy in Sir Run Run Shaw Hospital, Zhejiang University School of Medicine from April 2019 to March 2023 were retrospectively analyzed. Using arthroscopic findings as the gold standard, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of ultrasonography in diagnosing ATFL and ATiFL-DF injuries were evaluated; and Kappa consistency test was further performed. The sensitivity and specificity of ultrasonography in diagnosis of ATFL injury were 100.0% and 92.3%, with the PPV of 92.6% and NPV of 100.0%. Ultrasonography findings exhibited excellent concordance with arthroscopic results (kappa=0.849). The sensitivity and specificity of ultrasonography in diagnosis of ATiFL-DF injury was 86.7% and 33.3%, with the PPV of 90.7% and NPV of 25.0%. But the consistence between ultrasonography and arthroscopic results was poor (kappa=0.168). Ultrasonography is a reliable diagnostic modality for assessing injuries to the ATFL in patients with ankle fractures; however, its specificity is limited when evaluating injuries to the ATiFL-DF. Therefore, ankle arthroscopy is necessary for ankle fracture patients with negative findings of ATiFL-DF in ultrasonography.

A multicenter study on the accuracy of PAX1/JAM3 dual genes methylation testing for screening cervical cancer

Objective: To explore the value of cervical cytologic DNA methylation for screening cervical cancer. Methods: This study was a prospective multicenter study conducted from May to October 2022 in Peking Union Medical College Hospital, Zhejiang Provincial People's Hospital, and the Second Affiliated Hospital of Zhejiang University School of Medicine. Women who accepted opportunistic cervical cancer screening in gynecological outpatient clinics were subjected to liquid-based thin-layer cytology testing (TCT), high-risk human papillomavirus (hrHPV) DNA testing and PAX1/JAM3 dual-genes methylation testing (PAX1m/JAM3m). Colposcopy evaluation and biopsy were offered to women according to current guidelines. The accuracies of various testing methods and their combinations were compared based on histological diagnosis. Results: A total of 1 184 samples diagnosed by histopathology were included in this study, consisting of 541 cases (45.7%) of benign cervical tissue or chronic cervicitis, 273 (23.1%) of cervical intraepithelial neoplasia (CIN) 1, 168 (14.2%) of CIN2, 140 (11.8%) of CIN3, and 62 (5.2%) of cervical cancer. The sensitivity and specificity of PAX1m/JAM3m testing for detecting CIN2 or more severe lesions (CIN2+) were 74.1% and 95.9%, respectively. The sensitivity and specificity of PAX1m/JAM3m testing for detecting CIN3+were 87.6% and 86.8%, respectively. Receiver operating characteristic curve analysis showed that, for detecting CIN3+, the area under curve of PAX1m/JAM3m testing (0.872, 95%CI: 0.847-0.897) was significantly superior to TCT testing (0.580, 95%CI: 0.551-0.610) or hrHPV testing (0.503, 95%CI: 0.479-0.515) (all P values<0.05). Conclusions: The PAX1m/JAM3m test in cervical exfoliated cells has excellent accuracy for the diagnosis of both CIN2+and CIN3+, which is superior to traditional screening protocols and screening strategies.

Retrospective study of the deep circumflex iliac artery flap and the vascularized fibula free flap for maxillary defect repair

ObjectivesThe deep circumflex iliac artery flap (DCIA) and vascularized fibular free flap (FFF) are mainstay flaps for maxillary defect reconstruction. This study compared the functional outcomes and success rates of these flaps to provide midface reconstruction strategies. Materials and MethodsMaxillary defects reconstructed with DCIA or FFF at the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology between May 2016 and May 2023 were retrospectively analyzed. The length, width, and height of the grafted bone segments; intermaxillary distance; buttress reconstruction rate (BRR); dental arch reconstruction rate (DAR); success rate; and dental implantation rate were compared. ResultsThe DCIA and FFF groups had 33 and 27 patients, respectively. Success rate in the DCIA group was 93.94 % and 100 % in the FFF group. The DCIA length was less than that of FFF; however, the width and height were significantly larger. 87.10 % of cases in the DCIA group were classified as Brown class b and c, 51.85 % of cases in the FFF group were classified as Brown class d. The average BRR in the DCIA group was 69.89 % ± 16.05 %, which was significantly higher than that in the FFF group. A total of 38.7 % and 11.1 % patients in the DCIA and FFF groups, respectively, had completed implantation. ConclusionDCIA has a greater width and height, and is more suitable for repairing Brown class b and c defects, providing sufficient bone for implantation, while the FFF is longer and more suitable for Brown class d defect reconstruction.

Epidemiological characteristics of early-onset colorectal cancer: a prospective cohort study from a single center

Objective: To explore the differences in distribution of colorectal cancer-related risk factors between patients with early-onset colorectal cancer (EOCRC) and those with late-onset colorectal cancer (LOCRC) in a Chinese cohort, and to provide reference and guidance for the prevention, diagnosis, and treatment of EOCRC. Methods: Using data from the National Colorectal Cancer Cohort study cohort, 5377 patients with newly diagnosed colorectal cancer (CRC) attending the Department of Colorectal Surgery and Oncology of the Second Affiliated Hospital, Zhejiang University School of Medicine from June 2018 to February 2023 were included in the study cohort. Questionnaires capturing epidemiological features, including lifestyle and dietary habits, were administered. The patients were divided into two groups, the cut-off age being 50 years. Those aged ≥50 years were defined as having LOCRC and those aged <50 years as having EOCRC. Wilcoxon (continuous variates) or χ2 tests (categorical variates) were performed to compare differences in epidemiological features. Results: A total of 3799 people who had completed the questionnaire were included in this study, 491 of whom had EOCRC and 3308 LOCRC. The response rate to the questionnaire was 70.7%. The median ages of patients in the EOCRC and LOCRC groups were 43 and 66 years, respectively. There was a higher proportion of female patients (48.5% [253/491] vs. 35.8% [1184/3308], χ2=28.8, P<0.001) in the EOCRC than the LOCRC group. Patients with EOCRC and lower body mass index (medium 22.1 kg/m2 vs. 22.9 kg/m2, W=744 793, P=0.005) and lower proportion of abdominal obesity (87.2% [428/491] vs. 93.8% [3103/3308], χ2=38.3, P<0.001). Patients with EORC significantly less commonly reported a history of hypertension (5.9% [29/491] vs. 41.6% [1375/3308], χ2=231.8, P<0.001), diabetes (1.4% [7/491] vs. 14.4% [476/3308], χ2=63.6, P<0.001) and cardiovascular and cerebrovascular diseases (0.8% [4/491] vs. 7.3% [241/3308], χ2=28.6, P<0.001). However, the proportion of patients with a family history of CRC was significantly higher (P<0.05) in the EOCRC group (10.2% [50/491] vs. 6.9% [227/3 308], χ2=6.5, P=0.010]. In terms of lifestyle, patients with EOCRC had shorter sleep duration (median: 8.0 hours vs. 8.5 hours, W=578 989, P<0.001), and were less likely to participate in physical exercise (29.5% [145/491] vs. 38.7% [1281/3308] χ2=15.0, P<0.001) or engage in physical work (65.2% [320/491] vs. 74.1% [2450/3308], χ2=16.7, P<0.001). Meanwhile, in the EOCRC group a lower percentage of patients were smokers (29.3% [144/491] vs. 42.7% [1411/3308], χ2=46.9,P<0.001) and they smoked less (median 17.6 pack/year vs. 30.0 pack/year,W=55 850,P<0.001). Fewer patients in the EOCRC group habitually drank alcohol (21.0% [103/491] vs. 38.0% [1257/3308], χ2=57.5, P<0.001) or tea (17.5% [86/491] vs. 28.7% [948/3308], χ2=26.2, P<0.001) than in the LOCRC group. Compared with the LOCRC group, patients with EOCRC had a higher frequency of intake of fresh meat, fresh fruit, eggs, and dairy products and a lower frequency of intake of preserved meat and pickled vegetables; these differences are statistically significant (all P<0.05). There was no statistically significant difference in consumption of fresh vegetables or a high-sugar diet between the two groups (both P>0.05). Conclusions: This study highlights disparities in adverse lifestyle and dietary habits between patients in China with EOCRC versus LOCRC.

School–university partnership for school renewal: reflections on three large, federally funded projects

PurposeIn this manuscript, we aimed to (1) illustrate the differences in school–university partnership under the school reform and renewal models and (2) describe the practice of and learning about school–university partnership by reflecting on the three large, federally funded projects, all conducted under the school renewal model.Design/methodology/approachWe used archival data from the three large, federally funded projects, synthesized our research related to school–university partnerships and developed themes for actions and learnings related to the topic of school–university partnerships.FindingsThe school–university partnerships under the school renewal model are different from that under the school reform model. School–university partnership under the school renewal model is associated with positive results for schools and the university. There are clear themes for the actions and learning in the school–university partnership under the school renewal model.Originality/valueIt is original to study school–university partnerships in the context of the school renewal model.

Transforming a synchronous community of collaborative critical inquiry into co-performing construction of professional development in education

ABSTRACT This paper reports a university instructor’s critical evaluative rethinking for inspiring teaching and re-development of a course for schoolteacher professional development at times of crisis, from local socio-political movements to the global COVID-19 pandemic. The instructional mode was expected to revitalise schoolteachers’ collaborative critical inquiry in multiple digital realities of a synchronous blended learning community when university campuses and schools were closed during the pandemic. A qualitative case study was adopted to evaluatively, critically, and collaboratively unpack the effects of rethinking in response to the challenge. The participants included the instructor and 25 schoolteachers. The findings highlight the inspired rethinking of synthesising emerging elements of collaborative critical inquiry in connection to the philosophical underpinning and practical structure of the Community of Inquiry framework. The course was innovatively infused with the interdependent presences of the framework towards transactional cycles of professional teaching and learning in the community. This sheds new light on the effects of co-performing construction of teaching towards deep learning experiences on professional development. The main implication of the co-performing construction is trustful cohesion of common professional identity for professional development across educational levels.

Impact of health insurance education program on health care professional students: An interventional study.

In the complex landscape of health care, the relationship between medical practice and health insurance is increasingly crucial for effective care delivery. This paper emphasises the importance of integrating health insurance education into medical training, focusing on its impact on patient outcomes, health care accessibility, and system sustainability. It posits that health care providers with a comprehensive understanding of health insurance can offer more informed, efficient care by adeptly navigating coverage complexities. The study utilised a pretest-post-test design with a yearlong health insurance education curriculum at Wake Forest University School of Medicine. Student participants from various medical programmes self-assessed their knowledge and comfort across 13 health insurance topics before and after the intervention. The curriculum included workshops and a capstone project, emphasising real-life patient insurance challenges. Results show statistically significant improvements in 13 participants' understanding of health insurance concepts, highlighting the curriculum's effectiveness. The findings advocate for the inclusion of health insurance education in medical curricula. Such knowledge is vital in systems with diverse insurance models, like the United States, where understanding insurance intricacies is key to patient care. The study's limitations, such as a small sample size and reliance on self-reported data, suggest the need for further research with more participants and objective measures. In conclusion, incorporating health insurance education into medical training is essential for preparing health care professionals to navigate insurance complexities, make informed treatment decisions, and guide patients effectively. This approach fosters well-rounded professionals capable of managing both medical and financial aspects of patient care, leading to more equitable and efficient health care delivery. Future research should explore the long-term effects of this education on clinical practice and patient outcomes, particularly its impact on health care costs and patient satisfaction.