Establishing Peer Consensus About the Use of Long-Term Biosynthetic Absorbable Mesh for Hernia (Grades 2-3) as the Standard of Care.

BACKGROUND: Standard synthetic and biologic meshes, often used in hernia repair, have commonly been used and each have their strengths but associated drawbacks. Long-term biosynthetic absorbable (LTBA) mesh has been developed to combine the strengths of synthetic and biologic meshes without the associated weaknesses. As a newer type of mesh, the supporting evidence base is still growing, and their optimum use has yet to be defined. This consensus was initiated to provide insight into those situations where a LTBA might be considered the Standard of Care in ventral hernia repair grades 2-3 (original classification, 2010) of the Ventral Hernia Working Group. METHODS: A steering group of expert surgeons identified 35 statements, based around the evidence supporting LTBA, surgical technique, patients type most suitable for LTBA, risk-benefit of LTBA, patient and surgeon considerations, LTBA value. Surgeons involved in hernia repair received an online survey to assess consensus with these statements. Consensus was defined as high if ≥ 70% and very high if ≥ 90% of respondents agreed. Statements that had not achieved consensus agreement were revised and these were then issued for a subsequent round. Finally, 34 statements were included. RESULTS: Two hundred fifty-five surgeons were involved. Fourteen statements (41%) achieved very high consensus, 24 achieved consensuses (≥ 70-< 90%), whilst one (3%) just failed to achieve consensus with an agreement score of 69%. CONCLUSIONS: Expert consensus opinion about the use of LTBA for hernia (Grades 2-3) as the Standard of Care was achieved. Based on the consensus scores, the steering group derived eleven keys.

Online social cohesion reflects real-world group action in Syria during the Arab Spring.

In recent years, political activists have taken to social media platforms to rapidly reach broad audiences. Despite the prevalence of micro-blogging in these sociopolitical movements, the degree to which virtual mobilization reflects or drives real-world movements is unclear. Here, we explore the dynamics of real-world events and Twitter social cohesion in Syria during the Arab Spring. Using the nonlinear methods cross-recurrence quantification analysis and windowed cross-recurrence quantification analysis, we investigate if frequency of events of different intensities are coupled with social cohesion found in Syrian tweets. Results indicate that online social cohesion is coupled with the counts of all, positive, and negative events each day but shows a decreased connection to negative events when outwardly directed events (i.e., source events) were considered. We conclude with a discussion of implications and applications of nonlinear methods in political science research.

Validating the eHealth Literacy Scale in Rural Adolescents.

PURPOSE: Given that the recent eHealth literacy literature supports the properties of the 3-factor eHealth literacy scale (eHEALS) model in samples with millennials, adults, and older adults, the appropriate next step is to establish whether the model can be reproduced in a rural adolescent sample. The purpose of this study was to evaluate the recent 3-factor model by Paige and associates with a sample of seventh-grade students. METHODS: This cross-sectional study included a subsample of students (n = 146) from 3 school districts in Appalachian Kentucky. We used confirmatory factor analysis (CFA) procedures and small sample model fit guidelines to evaluate our model, and the 1-sample bootstrap algorithm with bias-corrected and accelerated 95% confidence intervals to estimate associations among eHEALS and health and technology variables. FINDINGS: A total of 137 students, or 61% of enrolled seventh-grade students, completed the study. CFA results showed eHEALS 3-factor loadings-information awareness, information seeking, and information engagement-were high (≥0.63) and statistically significant. We observed evidence of a good model fit (root mean square error of approximation [RMSEA] = 0.07, standardized root mean square residual [SRMR] = 0.03, comparative fit index [CFI] = 0.99) and results are comparable with Paige and associates' model fit (RMSEA = 0.06, SRMR = 0.08, CFI = 0.98). Correlations showed that students with more access to technology were associated with higher information seeking (r = 0.31) and higher information engagement (r = 0.23). eHealth literacy scores did not differ by level of rurality or gender. CONCLUSIONS: The 3-factor eHEALS is a reliable and valid instrument in assessing eHealth literacy in a group of rural seventh graders from Appalachian Kentucky.

Gender in the time of COVID-19: Evaluating national leadership and COVID-19 fatalities.

In this paper we explore whether countries led by women have fared better during the COVID-19 pandemic than those led by men. Media and public health officials have lauded the perceived gender-related influence on policies and strategies for reducing the deleterious effects of the pandemic. We examine this proposition by analyzing COVID-19-related deaths globally across countries led by men and women. While we find some limited support for lower reported fatality rates in countries led by women, they are not statistically significant. Country cultural values offer more substantive explanation for COVID-19 outcomes. We offer several potential explanations for the pervasive perception that countries led by women have fared better during the pandemic, including data selection bias and Western media bias that amplified the successes of women leaders in OECD countries.

Automated content analysis across six languages.

Corpus selection bias in international relations research presents an epistemological problem: How do we know what we know? Most social science research in the field of text analytics relies on English language corpora, biasing our ability to understand international phenomena. To address the issue of corpus selection bias, we introduce results that suggest that machine translation may be used to address non-English sources. We use human translation and machine translation (Google Translate) on a collection of aligned sentences from United Nations documents extracted from the Multi-UN corpus, analyzed with a "bag of words" analysis tool, Linguistic Inquiry Word Count (LIWC). Overall, the LIWC indices proved relatively stable across machine and human translated sentences. We find that while there are statistically significant differences between the original and translated documents, the effect sizes are relatively small, especially when looking at psychological processes.

Intraluminal mesh migration causing enteroenteric and enterocutaneous fistula: a case and discussion of the 'mesh problem'.

The use of synthetic mesh in the abdominal compartment has recently become a topic of debate as high profile public cases have called into question their safety. Several case reports have demonstrated significant complications due to intra-abdominal mesh. Furthermore, some studies have suggested that the rates of these severe complications are underestimated. We present the case of a patient who developed an enteroenteric and enterocutaenous fistulae, an abdominal wall collection and an intraperitoneal inflammatory mass from intraluminal migration of a synthetic mesh inserted during laparoscopic incisional hernia repair. We discuss the considerations and complications of using synthetic mesh for ventral hernia repair and discuss the scientific evidence behind the increasingly apparent 'mesh problem'.

SKOPE-IT (Shareable Knowledge Objects as Portable Intelligent Tutors): overlaying natural language tutoring on an adaptive learning system for mathematics.

BACKGROUND: This study investigated learning outcomes and user perceptions from interactions with a hybrid intelligent tutoring system created by combining the AutoTutor conversational tutoring system with the Assessment and Learning in Knowledge Spaces (ALEKS) adaptive learning system for mathematics. This hybrid intelligent tutoring system (ITS) uses a service-oriented architecture to combine these two web-based systems. Self-explanation tutoring dialogs were used to talk students through step-by-step worked examples to algebra problems. These worked examples presented an isomorphic problem to the preceding algebra problem that the student could not solve in the adaptive learning system. RESULTS: Due to crossover issues between conditions, experimental versus control condition assignment did not show significant differences in learning gains. However, strong dose-dependent learning gains were observed that could not be otherwise explained by either initial mastery or time-on-task. User perceptions of the dialog-based tutoring were mixed, and survey results indicate that this may be due to the pacing of dialog-based tutoring using voice, students judging the agents based on their own performance (i.e., the quality of their answers to agent questions), and the students' expectations about mathematics pedagogy (i.e., expecting to solving problems rather than talking about concepts). Across all users, learning was most strongly influenced by time spent studying, which correlated with students' self-reported tendencies toward effort avoidance, effective study habits, and beliefs about their ability to improve in mathematics with effort. CONCLUSIONS: Integrating multiple adaptive tutoring systems with complementary strengths shows some potential to improve learning. However, managing learner expectations during transitions between systems remains an open research area. Finally, while personalized adaptation can improve learning efficiency, effort and time-on-task for learning remains a dominant factor that must be considered by interventions.

Fast-track vs standard care in colorectal surgery: a meta-analysis update.

BACKGROUND: Fast-track (FT) protocols accelerate patient's recovery and shorten hospital stay as a result of the optimization of the perioperative care they offer. The aim of this review is to examine the latest evidence for fast-track protocols when compared with standard care in elective colorectal surgery involving segmental colonic and/or rectal resection. MATERIALS AND METHODS: All randomized controlled trials and controlled clinical trials on FT colorectal surgery were reviewed systematically. The main end points were short-term morbidity, length of primary postoperative hospital stay, length of total postoperative stay, readmission rate, and mortality. Quality assessment and data extraction were performed independently by two observers. RESULTS: Eleven studies were eligible for analysis (four randomized controlled trials (RCTs) and seven controlled clinical trials (CCT)), including 1,021 patients. Primary hospital stay (weighted mean difference -2.35 days, 95% confidence interval (CI) -3.24 to -1.46 days, P < 0.00001) and total hospital stay (weighted mean difference -2.46 days, 95% CI -3.43 to -1.48 days, P < 0.00001) were significantly lower for FT programs. Morbidity was also lower in the FT group. Readmission rates were not significantly different. No increase in mortality was found. CONCLUSIONS: FT protocols show high-level evidence on reducing primary and total hospital stay without compromising patients' safety offering lower morbidity and the same readmission rates. Enhanced recovery programs should become a mainstay of elective colorectal surgery.

Adipose tissue of human omentum is a major source of dendritic cells, which lose MHC Class II and stimulatory function in Crohn's disease.

Adipose tissue is reported to contain monocyte-like pre-adipocytes, which may mature into macrophages, contributing to local inflammation. Dendritic cells (DC) can be derived from monocytes and initiate and regulate primary immune responses. We hypothesized, therefore, that adipose tissue may provide DC involved in local immune activity. To test this, we studied cells from human omental adipose tissue samples from 17 patients with benign gynecological disease. The hypothesis that adipose tissue DC are involved in inflammatory disease was tested by comparing these cells with those from 18 patients with Crohn's disease, where hypertrophy of adipose tissue suggests involvement in disease. A high proportion of the 1.33 +/- 0.12 x 10(5) CD45-positive cells/mg, obtained from control omenta, expressed CD11c, CD1a, and CD83; costimulatory molecules CD40, CD80, and CD86; and major histocompatibility complex (MHC) Class II but little CD14, CD16, or CD33. Omental cells showing morphological characteristics of DC were also observed. Metrizamide gradient-enriched DC from these populations were potent stimulators of primary proliferation of allogeneic T cells in mixed leukocyte reactions. Increased numbers of CD45+ cells from omentum of Crohn's patients (4.50+/-1.08 x 10(5) CD45+ cells/mg) contained higher percentages of CD11c+ and CD40+ cells (80.8+/-3.8% vs. 63.4+/-6, P=0.032; 77.9+/-4% vs. 58.8+/-6.5, P=0.029, respectively), but MHC Class II and stimulatory capacity were almost completely lost (P= <0.001), suggesting innate activation but lost capacity to stimulate adaptive immune responses. Granulocytes were also present amongst the omental cells from Crohn's patients. Results indicated that omentum may provide DC, which could "police" local infections and contribute to and/or reflect local inflammatory activity.

Cardiovascular effects at multi-detector row CT colonography compared with those at conventional endoscopy of the colon.

PURPOSE: To compare the cardiovascular effects of computed tomographic (CT) colonography and conventional endoscopy in a group of patients undergoing both procedures. MATERIALS AND METHODS: A total of 144 patients underwent CT colonography followed by flexible sigmoidoscopy (40 patients) or colonoscopy (104 patients). Pulse, blood pressure, and oxygen saturation were measured before, during, and after the procedures. Forty patients also underwent continuous Holter electrocardiographic (ECG) monitoring. Periprocedural pain was assessed by using a handheld counting device. Outcome variables were assessed by using a combination of paired t testing and multilevel linear regression. RESULTS: When a spasmolytic was not used, CT colonography was associated with only a small increase in oxygen saturation (P =.03), while use of a spasmolytic caused an increase in pulse (mean increase, 19.9 beats per minute; P <.001) and diastolic blood pressure (mean increase, 5 mm Hg; P <.001). Compared with that at CT, oxygen saturation decreased significantly during and after colonoscopy and sigmoidoscopy (mean decrease after colonoscopy with sedation, 1.0%; P <.001). Systolic and diastolic blood pressure also decreased during and after colonoscopy (mean systolic decrease after colonoscopy with sedation, 16.6 mm Hg, P <.001; mean diastolic decrease after colonoscopy with sedation, 7.5 mm Hg, P <.001). Patients were 30.3 times more likely to develop bradycardia after endoscopy (95% CI: 2.65, 346; P =.006). Ventricular couplets were significantly higher at endoscopy than at CT in patients with a history of cardiac disease (odds ratio: 72.5 and 95% CI: 4.56, 1,153 at CT vs odds ratio: 14.6 and 95% CI: 0.96, 222 at endoscopy; P =.002). Patients were 1.89 times more likely to register pain during colonoscopy than during CT (95% CI: 1.06, 3.38; P =.03). CONCLUSION: CT colonography had no significant cardiovascular effect other than spasmolytic-induced tachycardia. Endoscopy-and colonoscopy in particular-causes cardiovascular effects that are largely related to sedation. CT colonography is less painful than colonoscopy and is comparable to flexible sigmoidoscopy.