Type of mandibular asymmetry affects changes and outcomes of bimaxillary surgery for class III asymmetry.

OBJECTIVES: Various methods have been used to classify class III asymmetry. There is little information on the use of an asymmetry index to examine soft tissue changes and outcomes for patients with class III asymmetry. This study aimed to (1) evaluate soft tissue changes and outcomes for three types of mandibular asymmetry and (2) determine if measures are associated with type of asymmetry. MATERIALS AND METHODS: Adults who consecutively underwent bimaxillary surgery using surgery-first approach for correction of class III asymmetry were divided into three groups based on type of mandibular asymmetry. This previously reported classification system is simple and mutually independent, categorizing mandibular asymmetry according to the amount and direction of ramus asymmetry relative to menton deviation: patients with a larger transverse ramus distance on the menton deviation side were divided into group 1 and group 2; group 1 (n = 45) exhibited a menton deviation larger than ramus discrepancy; group 2 (n = 11) exhibited a menton deviation less than ramus discrepancy; group 3 (n = 22) had larger transverse ramus distance contralateral to the side of the menton deviation. Soft tissue facial asymmetry indices, calculated from cone beam computed tomography images, assessed midline and contour asymmetry presurgery, changes postsurgery, and outcomes. RESULTS: Compared with groups 1 and 2, the presurgery index for contour and midline asymmetry was smallest for group 3. All the three groups had significant improvement in midline asymmetry postsurgery, and outcome measures were good; there were no differences between groups. However, contour asymmetry only improved significantly for groups 1 and 2. The outcome for contour asymmetry was fair for groups 1 and 3 and poor for group 2. CONCLUSIONS: Bimaxillary surgery significantly improved facial midline asymmetry. The type of mandibular asymmetry was associated with postsurgical changes and outcomes for contour asymmetry. CLINICAL RELEVANCE: Understanding the types of mandibular asymmetry could help clinicians to develop treatment plans and predict treatment changes and outcomes.

Integrated immediate postmortem and acute bereavement care: Competency-based entrustable professional activities for nursing.

BACKGROUND: Integrated immediate postmortem and acute bereavement care alleviates emotional distress due to losing a loved one; however, the provision of effective nursing care remains insufficient. Therefore, preparing nursing students with such skills is essential in end-of-life care education, and entrustable professional activities (EPAs) offer potential to address this gap. OBJECTIVES: To establish EPAs concerning immediate postmortem and acute bereavement care with a seven-category description for EPAs, milestones, and assessment tools. DESIGN: We used a modified Delphi method and four-step consensus-building approach to i) identifying the list of possible EPA items related to immediate postmortem and acute bereavement care based on a literature review and clinical experiences, ii) select an expert panel, iii) pool, review, and revise the EPAs, and iv) validate EPA quality using the Queen's EPA Quality rubric. Data analysis was performed via modes and quartile deviations. RESULTS: The following four major EPA components were identified: i) cultural and religious ritual assessment; ii) death preparation; iii) postmortem care; and iv) acute bereavement care. Three essential competencies were identified as highly correlated: general clinical skills, communication and teamwork capabilities, and caring. Consensus was achieved after three survey rounds. A 100 % questionnaire response rate was obtained. In the third round, all items received 4 or 5 points from >95 % of the panel members and were found to meet the quartile deviation cutoff score of <0.6, indicating that a high consensus level was established. The average Queen's EPA Quality rubric score was 62.5, with an average item score of 4.46, which was higher than the cut-off score of 4.07. Three major parts of EPAs were developed: task descriptions, milestones, and the assessment tool. CONCLUSION: The development of EPAs assessments concerning immediate postmortem and acute bereavement care may guide nursing curricula planning to bridge the gap between competencies and clinical practice.

A MedRadio-band low-energy-per-bit 4-Mbps CMOS OOK receiver for implantable medical devices.

A 4-Mbps 400-MHz On-Off Keying (OOK) receiver implemented in 0.18-um CMOS technology for implantable epilepsy sense-and-stimulation devices is presented. The proposed receiver is composed of a new current-mode full-wave envelope detector and differential cascaded gain amplifiers which is operated at MedRadio band. The fabricated receiver has power consumption of 0.27 mW and energy consumption of 0.07 nJ per bit at 4-Mbps. The sensitivity of receiver is -45.67 dBm.

Neglect and associated factors among left-behind middle school students in undeveloped area of Guangdong Province / 中国学校卫生

Objective@#To explore prevalence and associated factors of neglect among left-behind middle school students in undeveloped area of Guangdong, and to provide scientific basis for effective intervention measures.@*Methods@#A total of 1 105 middle school students were selected from Yangjiang and Qingyuan by random cluster sampling, neglect and left-behind was assessed by a self-reported questionnaire.@*Results@#The prevalence of neglect was 70.9% among left-behind middle school students aged 11-17 years in Yangjiang and Qingyuan areas. Univariate analysis suggested that high parental education, democratic and strict parenting, and frequent contacts with parents associated with low rate of neglect (P<0.05). After adjusted for gender, parental education, parenting style, contact frequency, Logistic regression analysis revealed that parenting discipline(rough, cold, capricious)(OR=2.01, 95%CI=1.23-3.26), contact with parents more than once every two weeks (OR=1.75, 95%CI=1.12-2.72) , peer or self-care (OR=1.85, 95%CI=1.04-3.30) were positively associated with neglect, while higher mother education was negatively associated with neglect.@*Conclusion@#The prevalence of neglect is high among left-behind students in Yangjiang and Qingyuan, which deserves further attention from family, community, school and government to promote healthy development.