"Sex Seems Less Important When You Are Worried About a Deadly Virus." A Content Analysis of Reported Reasons for Changes in Sexual Behavior and Satisfaction During the COVID-19 Pandemic.

The purpose of this study is to assess how the COVID-19 pandemic impacted various sexual behaviors and levels of sexual and relationship satisfaction by performing a content analysis of participants' (N = 1051 American adults) responses to open-ended survey questions. Results revealed a variety of impacts that increased, decreased, or otherwise qualitatively changed sexual behavior and satisfaction. Major themes included emotions and mental health, changes in routines, social distancing and fears related to COVID-19, and changes in romantic relationships. These findings are contextualized within the emerging quantitative research on COVID-19 and sexuality, and areas for future research based on these findings are discussed.

Compulsive Sexual Behavior and Changes in Solitary Sexual Behaviors During the COVID-19 Pandemic.

The aim of with this brief report is to examine how the COVID-19 pandemic differentially impacted solitary sexual behaviors in those with and without clinically significant compulsive sexual behavior (CSB). A total of 944 individuals in the United States completed an online cross-sectional survey in October 2020. Participants were asked to retrospectively report their frequency of masturbation and pornography use during the pandemic and prior to the pandemic. Participants also completed assessments of CSB, depression symptoms, and experiences of financial stress caused by the pandemic. Individuals who screened positive for clinically significant CSB reported statistically significant increases in masturbation and pornography use during the pandemic. Those who screened negative for CSB reported no significant increase in masturbation and a very small, statistically significant increase in pornography use. Those screening positive for CSB also reported significantly higher levels of depression symptoms but did not report increased likelihood of experiencing financial distress due to the pandemic. This suggests that increases in masturbation and pornography use reported by some, but not all, recent studies on sexual behaviors during the COVID-19 pandemic may be driven by individuals with CSB. Future research on sexual behaviors during the pandemic should assess CSB to further clarify its relationship with sexual behavior changes.

Historiographies of surgical innovation: endoscopic endonasal pituitary surgery.

The historiography of medicine has shifted from narratives of inevitable progress, authored mainly by the medical profession, to a more complex, analytical approach in which historians place medicine in its social context. However, the history of surgery has lagged behind somewhat; Christopher Lawrence suggests this is because the recent focus on the construction of medical knowledge does not incorporate the practical aspects of surgery, which are difficult to extract from their previous linear narrative. Thomas Schlich likewise recognises that surgery is both knowledge and skill-therefore more of a 'craft' than medicine. A possible solution is aligning the history of surgery with the history of technology: analysing the interplay of instruments and human activity.This case study uses the history of endoscopic endonasal pituitary surgery to explore the historiography of surgical innovation, in the context of its heavy reliance on both technology and interdisciplinary divisions of labour. Re-enactment, evolutionary frameworks and using Social Construction of Technology methods all require close collaboration between historian and surgeon to bridge the gap between scholarship and tacit knowledge.

An otolaryngological tour of Vesalius' De Humani Corporis Fabrica.

BACKGROUND: Andreas Vesalius published his famous anatomy book, De Humani Corporis Fabrica Libri Septum (On the Fabric of the Body in Seven Books), in 1543, with a second edition in 1555. This article explores the importance of this text to contemporary ENT, by demonstrating Vesalius' fresh, precise and hands-on approach to anatomy, and examines how this developed our understanding of ENT. METHODS: A second edition of De Humani Corporis Fabrica, held in John Rylands Library, University of Manchester, was examined in its digitised form and supplemented by secondary texts. RESULTS AND DISCUSSION: Where Vesalius' predecessors were rigid in their interpretation of anatomy, confined to the instruction of the Ancients, Vesalius showed that these teachings could be analysed and built on with careful observation. This is evident in his illustrations of, and annotations on, the skull base, ossicles and thyroid gland.

A very late infection of an abdominal mesh following a pedicled TRAM flap harvest.

Pedicled transverse rectus abdominis myocutaneous (TRAM) flap is still a common procedure for breast reconstruction. To lessen the incidence of abdominal-wall abnormalities, the donor-site defect in the transverse rectus abdominis muscle is generally repaired with a prosthetic mesh. This carries the well-known risks of foreign-body implantation, the most serious of which is infection. We report here a case of a 46-year-old patient who presented with an infected mesh 6.5 years after pedicled transverse rectus abdominis myocutaneous (TRAM)-flap breast reconstruction, requiring subsequent removal of the mesh. This is the latest recorded presentation of an abdominal prosthetic mesh infection in the English literature. The onset of late mesh infection could be related to a transient systemic infection and bacteraemia.

Experiences of faculty and students using an audience response system in the classroom.

The advent of innovative technologies, such as the audience response system, provides an opportunity to engage students and enhance learning. Based on their experiences, three nursing faculty evaluated the use of an audience response system in four distinct nursing courses through the use of informal survey results. When using the audience response system, the faculty experienced an increased perception of student attentiveness and engagement, high level of class attendance, and enhanced learning. Faculty feelings were mixed concerning the burden in adapting to increased classroom time and increased preparation time. Students' perception of the value of audience response system use was mostly positive, except when responses were included as part of the grade. The majority of the students indicated that use of the audience response system enhanced learning and was a helpful learning method when used with NCLEX-style questions. Overall, faculty believed that the benefits of student engagement and enhanced learning outweighed the burdens of incorporating this new technology in the classroom.

Acute otitis externa: Consensus definition, diagnostic criteria and core outcome set development.

OBJECTIVE: Evidence for the management of acute otitis externa (AOE) is limited, with unclear diagnostic criteria and variably reported outcome measures that may not reflect key stakeholder priorities. We aimed to develop 1) a definition, 2) diagnostic criteria and 3) a core outcome set (COS) for AOE. STUDY DESIGN: COS development according to Core Outcome Measures in Effectiveness Trials (COMET) methodology and parallel consensus selection of diagnostic criteria/definition. SETTING: Stakeholders from the United Kingdom. SUBJECTS AND METHODS: Comprehensive literature review identified candidate items for the COS, definition and diagnostic criteria. Nine individuals with past AOE generated further patient-centred candidate items. Candidate items were rated for importance by patient and professional (ENT doctors, general practitioners, microbiologists, nurses, audiologists) stakeholders in a three-round online Delphi exercise. Consensus items were grouped to form the COS, diagnostic criteria, and definition. RESULTS: Candidate COS items from patients (n = 28) and literature (n = 25) were deduplicated and amalgamated to a final candidate list (n = 46). Patients emphasised quality-of-life and the impact on daily activities/work. Via the Delphi process, stakeholders agreed on 31 candidate items. The final COS covered six outcomes: pain; disease severity; impact on quality-of-life and daily activities; patient satisfaction; treatment-related outcome; and microbiology. 14 candidate diagnostic criteria were identified, 8 reaching inclusion consensus. The final definition for AOE was 'diffuse inflammation of the ear canal skin of less than 6 weeks duration'. CONCLUSION: The development and adoption of a consensus definition, diagnostic criteria and a COS will help to standardise future research in AOE, facilitating meta-analysis. Consulting former patients throughout development highlighted deficiencies in the outcomes adopted previously, in particular concerning the impact of AOE on daily life.

Epigastric hernia following DIEP flap breast reconstruction: complication or coincidence?

OBJECTIVE: Donor site hernias are a rare but well recognised complication of deep inferior epigastric perforator (DIEP) flap breast reconstruction but there are no reported cases of epigastric hernias after such surgery. We report three patients who developed symptomatic epigastric hernias within 2-8 months after discharge from follow-up. PATIENTS AND METHODS: Patients who were referred to the Breast Plastic Surgery Clinic with symptomatic epigastric hernias following DIEP flap breast reconstruction were retrospectively reviewed. RESULTS: The three patients were aged between 50 and 70 years. Their mean BMI was 29 and none were smokers or diabetic. The incidences of other predisposing factors were: previous abdominal surgery (1/3), heavy lifting (2/3) and multiparity (2/3). They were successfully treated laparoscopically (2) or by open technique (1) confirming the CT scan findings. DISCUSSION AND CONCLUSION: The aetiology of epigastric hernias is obscure in general. The association with DIEP flap harvest may be purely coincidental. However, it appears that abdominal flap harvest predisposed these patients to epigastric hernias. One or more of the following factors may have caused either weakness of the anterior abdominal wall or increased intraabdominal pressure: * Short-term partial denervation of the rectus abdominis muscle; * Heavy lifting; * Previous surgery; obesity; multiple pregnancies; * Tight plication of the infraumbilical rectus sheath and muscle. This series of 3 symptomatic epigastric hernias following DIEP flap breast reconstruction is interesting as it documents donor site morbidity at a site distant from the exact site of flap harvest; this subject merits further detailed investigation.