A 163-bp insertion in the Capana10g000198 encoding a MYB transcription factor causes male sterility in pepper (Capsicum annuum L.).

Male sterility provides an efficient approach for commercial exploitation of heterosis. Despite more than 20 genic male sterile (GMS) mutants documented in pepper (Capsicum annuum L.), only two causal genes have been successfully identified. Here, a novel spontaneous recessive GMS mutant, designated msc-3, is identified and characterized at both phenotypic and histological levels. Pollen abortion of msc-3 mutant may be due to the delayed tapetum degradation, leading to the non-degeneration of tetrads callosic wall. Then, a modified MutMap method and molecular marker linkage analysis were employed to fine mapping the msc-3 locus, which was delimited to the ~139.91-kb region harboring 10 annotated genes. Gene expression and structure variation analyses indicate the Capana10g000198, encoding a R2R3-MYB transcription factor, is the best candidate gene for the msc-3 locus. Expression profiling analysis shows the Capana10g000198 is an anther-specific gene, and a 163-bp insertion in the Capana10g000198 is highly correlated with the male sterile (MS) phenotype. Additionally, downregulation of Capana10g000198 in male fertile plants through virus-induced gene silencing resulted in male sterility. Finally, possible regulatory relationships of the msc-3 gene with the other two reported pepper GMS genes, msc-1 and msc-2, have been studied, and comparative transcriptome analysis reveals the expression of 16 GMS homologs are significantly downregulated in the MS anthers. Overall, our results reveal that Capana10g000198 is the causal gene underlying the msc-3 locus, providing important theoretical clues and basis for further in-depth study on the regulatory mechanisms of pollen development in pepper.

Do Growers Using Solo Fungicides Affect the Durability of Disease Control of Growers Using Mixtures and Alternations? The Case of Spot-Form Net Blotch in Western Australia.

Growers often use alternations or mixtures of fungicides to slow down the development of resistance to fungicides. However, within a landscape, some growers will implement such resistance management methods, whereas others do not, and may even apply solo components of the resistance management program. We investigated whether growers using solo components of resistant management programs affect the durability of disease control in fields of those who implement fungicide resistance management. We developed a spatially implicit semidiscrete epidemiological model for the development of fungicide resistance. The model simulates the development of epidemics of spot-form net blotch disease, caused by the pathogen Pyrenophora teres f. maculata. The landscape comprises three types of fields, grouped according to their treatment program, with spore dispersal between fields early in the cropping season. In one field type, a fungicide resistance management method is implemented, whereas in the two others, it is not, with one of these field types using a component of the fungicide resistance management program. The output of the model suggests that the use of component fungicides does affect the durability of disease control for growers using resistance management programs. The magnitude of the effect depends on the characteristics of the pathosystem, the degree of inoculum mixing between fields, and the resistance management program being used. Additionally, although increasing the amount of the solo component in the landscape generally decreases the lifespan within which the resistance management program provides effective control, situations exist where the lifespan may be minimized at intermediate levels of the solo component fungicide. [Formula: see text] Copyright © 2024 The Author(s). This is an open access article distributed under the CC BY 4.0 International license.

Examining the health and wellness of solo self-employed workers through narratives of precarity: a qualitative study.

BACKGROUND: In recent decades, there has been a significant transformation in the world of work that is characterized by a shift from traditional manufacturing and managerial capitalism, which offered stable full-time employment, to new forms of entrepreneurial capitalism. This new paradigm involves various forms of insecure, contingent, and non-standard work arrangements. Within this context, there has been a noticeable rise in Self-Employed individuals, exhibiting a wide range of -working arrangements. Despite numerous investigations into the factors driving individuals towards Self-Employment and the associated uncertainties and insecurities impacting their lives and job prospects, studies have specifically delved into the connection between the precarious identity of Self-Employed workers and their overall health and well-being. This exploratory study drew on a 'precarity' lens to make contributions to knowledge about Self-Employed workers, aiming to explore how their vulnerable social position might have detrimental effects on their health and well-being. METHODS: Drawing on in-depth interviews with 24 solo Self-Employed people in Ontario (January - July 2021), narrative thematic analysis was conducted based on participants' narratives of their work experiences. The dataset was analyzed with the support of NVIVO qualitative data analysis software to elicit narratives and themes. FINDINGS: The findings showed that people opt into Self-Employment because they prefer flexibility and autonomy in their working life. However, moving forward, in the guise of flexibility, they encounter a life of precarity, in terms of job unsustainability, uncertainties, insecurities, unstable working hours and income, and exclusion from social benefits. As a result, the health and well-being of Self-Employed workers are adversely affected by anger, anomie, and anxiety, bringing forward potential risks for a growing population. CONCLUSION AND IMPLICATIONS: Neoliberalism fabricates a 'precariat' Self-Employed class. This is a social position that is vague, volatile, and contingent, that foreshadows potential threats of the health and wellbeing of a growing population in the changing workforce. The findings in this research facilitate some policy implications and practices at the federal or provincial government level to better support the health and wellbeing of SE'd workers.

Alone but flowing: The effects of autotelic personality and extraversion on solitary flow.

OBJECTIVE/BACKGROUND: Flow, a psychological state of intense engagement in and enjoyment of an activity, can arise during both solitary and socially interactive experiences. In the literature, whereas people high in extraversion have difficulty achieving flow in solitude, those with an autotelic personality-a combination of traits that make people prone to flow-readily experience flow in both solitary and interactive conditions. In this pre-registered experiment, we investigated whether autotelic personality mitigates the negative association between solitary flow and extraversion. METHOD: Participants and their romantic partners (final N = 368) played the game Perfection™ in three conditions (order was counterbalanced): alone (solitary condition), in the presence of their partner without interaction (mere-presence condition), and collaboratively (interactive condition). RESULTS: There were independent, positive main effects of extraversion and autotelic personality on flow experience in mere-presence and interactive conditions. However, the positive effect of extraversion on solitary flow was only significant among participants with high (vs. low) autotelic personality. In all conditions, flow experience was associated with greater low-arousal positive affect and lesser high-arousal negative affect. CONCLUSIONS: The findings shed light on the role of personality in promoting solitary flow experiences, and particularly how traits might interact to determine optimal and non-optimal conditions for achieving flow.

Reflecting on gamified learning in medical education: a systematic literature review grounded in the Structure of Observed Learning Outcomes (SOLO) taxonomy 2012-2022.

BACKGROUND: The acquisition of in-depth medical knowledge, skills, and competencies is of utmost importance when training future medical professionals. This systematic literature review delves into the empirical connection between gamified learning in medical education and the Structure of Observed Learning Outcomes (SOLO) taxonomy. METHODS: Following PRISMA guidelines, a systematic literature review was conducted in seven databases to identify empirical studies related to gamification and medical education. The literature search was limited to peer-reviewed articles published between January 2012 and December 2022. Articles focusing on games or learning technologies in a broader sense as well as research focusing on nursing or pharmacy education were excluded. RESULTS: Upon reviewing 23 qualified empirical studies that applied gamified learning strategies in medical education, 18 (78%) studies are associated with the second lowest level (uni-structural) of the SOLO taxonomy. The mid-level (multi-structural) learning outcomes are associated with three (13%) of the reviewed studies. There are five (22%) studies focusing on the second highest (relational) level of the SOLO. Only one study (4%) is associated with the highest SOLO level (extended-abstract). Finally, three (13%) studies were identified with multiple levels of the SOLO. In addition to the SOLO levels, the review found six (26%) studies emphasizing motivational and engagement support of gamified learning strategies in facilitating intended learning outcome attainment. A total of three (13%) studies, across three SOLO levels, suggested that gamified learning strategies can improve students' soft skills in medical education programs. CONCLUSION: These findings collectively emphasize the need for future research and development to design gamified learning experiences capable of fostering higher SOLO taxonomy attainment in medical education. Moreover, there is potential to extend the SOLO framework to encompass motivational and affective learning outcomes, providing a comprehensive understanding of the impact of gamified learning on medical students.

Learning with AI Language Models: Guidelines for the Development and Scoring of Medical Questions for Higher Education.

In medical and biomedical education, traditional teaching methods often struggle to engage students and promote critical thinking. The use of AI language models has the potential to transform teaching and learning practices by offering an innovative, active learning approach that promotes intellectual curiosity and deeper understanding. To effectively integrate AI language models into biomedical education, it is essential for educators to understand the benefits and limitations of these tools and how they can be employed to achieve high-level learning outcomes.This article explores the use of AI language models in biomedical education, focusing on their application in both classroom teaching and learning assignments. Using the SOLO taxonomy as a framework, I discuss strategies for designing questions that challenge students to exercise critical thinking and problem-solving skills, even when assisted by AI models. Additionally, I propose a scoring rubric for evaluating student performance when collaborating with AI language models, ensuring a comprehensive assessment of their learning outcomes.AI language models offer a promising opportunity for enhancing student engagement and promoting active learning in the biomedical field. Understanding the potential use of these technologies allows educators to create learning experiences that are fit for their students' needs, encouraging intellectual curiosity and a deeper understanding of complex subjects. The application of these tools will be fundamental to provide more effective and engaging learning experiences for students in the future.

The other side of tropical forest drought: do shallow water table regions of Amazonia act as large-scale hydrological refugia from drought?

Tropical forest function is of global significance to climate change responses, and critically determined by water availability patterns. Groundwater is tightly related to soil water through the water table depth (WT), but historically neglected in ecological studies. Shallow WT forests (WT < 5 m) are underrepresented in forest research networks and absent in eddy flux measurements, although they represent c. 50% of the Amazon and are expected to respond differently to global-change-related droughts. We review WT patterns and consequences for plants, emerging results, and advance a conceptual model integrating environment and trait distributions to predict climate change effects. Shallow WT forests have a distinct species composition, with more resource-acquisitive and hydrologically vulnerable trees, shorter canopies and lower biomass than deep WT forests. During 'normal' climatic years, shallow WT forests have higher mortality and lower productivity than deep WT forests, but during moderate droughts mortality is buffered and productivity increases. However, during severe drought, shallow WT forests may be more sensitive due to shallow roots and drought-intolerant traits. Our evidence supports the hypothesis of neglected shallow WT forests being resilient to moderate drought, challenging the prevailing view of widespread negative effects of climate change on Amazonian forests that ignores WT gradients, but predicts they could collapse under very strong droughts.

O funcionamento da floresta tropical é de importância global para as respostas às mudanças climáticas e é criticamente determinado pelos padrões de disponibilidade de água. A água subterrânea está intimamente relacionada à água do solo através da profundidade do lençol freático, que tem sido historicamente negligenciado em estudos ecológicos. Florestas com lençol freático raso (< 5 m) estão sub-representadas nas redes de pesquisa florestal e ausentes nas medições de fluxo de gases, embora representem ~ 50% da Amazônia e devam responder de forma diferente às secas relacionadas às mudanças globais. Aqui revisamos os padrões de profundidade do lençol freático e suas consequências para plantas, resultados emergentes, e avançamos em um modelo conceitual que integra o ambiente e as distribuições de características funcionais para prever os efeitos das mudanças climáticas. As florestas com lençol freático raso têm uma composição de espécies distinta, com árvores mais aquisitivas na obtenção de recursos e hidrologicamente vulneráveis, dosséis mais baixos e menor biomassa do que as florestas com lençol freático profundo. Durante os anos climáticos 'normais', as florestas com lençol freático raso têm maior mortalidade e menor produtividade do que as florestas com lençol freático profundo, mas durante secas moderadas, a mortalidade é amortecida e a produtividade aumenta. No entanto, durante secas severas, as florestas com lençol freático raso podem ser mais sensíveis devido às raízes superficiais e características funcionais de intolerância à seca. Nossas evidências apoiam a hipótese de que as florestas com lençol freático raso, historicamente negligenciadas, sejam resilientes à seca moderada, desafiando a visão predominante dos efeitos negativos generalizados da mudança climática nas florestas amazônicas que ignora gradientes de profundidade do lençol freático, mas prevê que elas podem entrar em colapso sob secas muito fortes.

La función de los bosques tropicales es de importancia mundial para las respuestas al cambio climático y está críticamente determinada por los patrones de disponibilidad de agua. El agua subterránea está estrechamente relacionada con el agua del suelo a través de la profundidad del nivel freático (NF), pero históricamente se há negligenciado en los estudios ecológicos. Los bosques con NF poco profundos (NF < 5 m) están subrepresentados en las redes de investigación forestal y ausentes en las mediciones de flujo de gases, aunque representan ~ 50% de la Amazonía y se espera que respondan de manera diferente a las sequías relacionadas con el cambio climático global. Aquí revisamos los patrones de NF y las consecuencias para las plantas, los resultados emergentes y avanzamos en un modelo conceptual que integra distribuciones ambientales y de rasgos funcionales para predecir los efectos del cambio climático. Los bosques con NF poco profundos tienen una composición de especies distinta, con árboles más adquisitivos en la obtención de recursos e hidrológicamente más vulnerables, dosel más bajo y menor biomasa que los bosques de NF profundo. Durante los años climáticos 'normales', los bosques con NF poco profundos tienen una mayor mortalidad y menor productividad que los bosques con NF profundos, pero durante sequías moderadas la mortalidad se amortigua y la productividad aumenta. Sin embargo, durante una sequía severa, los bosques de NF poco profundos pueden ser más sensibles debido a raíces poco profundas y rasgos de intolerancia a la sequía. Nuestra evidencia apoya la hipótesis de que los bosques de NF poco profundos, mayoritariamente desconsiderados, son resistentes a sequías moderadas, desafiando la visión predominante de impactos negativos generalizados del cambio climático en los bosques amazónicos, que ignora los gradientes de NF, pero predice que podrían colapsar bajo sequías muy fuertes.

Solo surgery in robot-assisted gastrectomy versus laparoscopic gastrectomy for gastric cancer: a propensity score-matched analysis.

BACKGROUND: Robot-assisted gastrectomy (RG) for gastric cancer is still not well standardized. This study aimed to explore the feasibility and effectiveness of solo surgery in robot-assisted gastrectomy (SRG) for gastric cancer compared to laparoscopic gastrectomy (LG). METHODS: This was a single-center retrospective comparative study between SRG and conventional LG. Between April 2015 and December 2022, 510 patients underwent gastrectomy, and data from a prospectively collected database were analyzed. We identified 372 patients who underwent LG (n = 267) and SRG (n = 105) and the remaining 138 patients were excluded because of remnant gastric cancer, esophagogastric junction cancer, open gastrectomy, concurrent surgery for concomitant malignancies, RG before starting SRG, or cases in which the author was unable to perform or supervise gastrectomy. Propensity score matching was performed at a ratio of 1:1 to reduce bias from confounding patient-related variables, and short-term outcomes were compared between the groups. RESULTS: After propensity score matching, 90 pairs of patients who underwent LG and SRG were selected. In the propensity-matched cohort, the operation time was significantly shorter in the SRG group than that in the LG group (SRG = 305.7 ± 74.0 min vs. LG = 340.3 ± 91.65 min, p < 0.0058), less estimated blood loss was observed in the SRG group than that in the LG group (SRG = 25.6 ± 50.6 mL vs. LG = 76.1 ± 104.2 mL, p < 0.0001) and postoperative hospital stay was shorter in the SRG group than that in the LG group (SRG = 7.1 ± 0.8 days vs. LG = 9.1 ± 7.7 days, p = 0.015). CONCLUSION: We found that SRG for gastric cancer was technically feasible and effective with favorable short-term outcomes, including shorter operative time, less estimated blood loss, shorter hospital stays, and lower postoperative morbidity than those in LG.

The Impact of Household Context on Self-Perceived Changes in Solo and Partnered Sexual Behaviors During the COVID-19 Pandemic: Findings from a U.S. Probability Survey.

To understand how household context factors impacted self-reported changes in solo and sexual behaviors in U.S. adults during early stages of the COVID- 19 pandemic, we conducted an online, nationally representative, cross-sectional survey of U.S. adults (N = 1010; aged 18-94 years; 62% response rate) from April 10-20, 2020. We used weighted descriptive statistics with Wilcoxon rank sign tests to understand the population prevalence and significance of self-reported changes (five-point scale: much less to much more) in 10 solo and partnered sexual behaviors. Ordinal regression was used to assess the impact of household predictor variables-including number of children at home, number of adults in home, partnership status (unpartnered, partnered and not living together, partnered and living together) and employment status (not working, employed not as essential worker, employed as essential worker). All models were adjusted for gender, age, sexual orientation, race/ethnicity, and residence location (urban, suburban, rural).All solo and partnered sexual behaviors showed some amount of significant change-increased activity for some and decreased for others-for U.S. adults during the pandemic. Not living with a partner was broadly associated with decreased affectionate partnered sexual behaviors; unpartnered adults reported increased sexting. Individuals not employed reported increased oral sex and increased consumption of sexually explicit materials as compared to non-essential workers. Number of children at home and household size were not significantly linked to self-reported behavior change. Ongoing sexual health-focused research should continue to focus on understanding how adults manage opportunities and constraints to their sexual lives in the context of a still-going pandemic. While many aspects of social life look more "normal" (e.g., many people have returned to their in-person offices and children are largely back in school), new and more-infectious strains of COVID-19 have proven that the pandemic may still yet impact daily living. Lessons learned from COVID need to include sexual health planning both for any future strains of COVID, as well as for future public health emergencies.

Clinical reasoning pattern used in oral health problem solving - A case study in Indonesian undergraduate dental students.

BACKGROUND: Health professionals are known to use various combinations of knowledge and skills, such as critical thinking, clinical reasoning, clinical judgment, problem-solving, and decision-making, in conducting clinical practice. Clinical reasoning development is influenced by knowledge and experience, the more knowledge and experience, the more sophisticated clinical reasoning will be. However, clinical reasoning research in dentistry shows varying results . AIMS: This study aims to observe the clinical reasoning pattern of undergraduate dental students when solving oral health problems, and their accordance with their knowledge acquisition. MATERIAL AND METHODS: This qualitative study employed the think-aloud method and the result was assessed through verbal protocol analyses. Five respondents from final year dental undergraduate students were agreed to participate. A unique hypothetical clinical scenario was used as a trigger. The audio data were transcribed, interpreted, and categorized as a clinical reasoning pattern; and the concept maps created were assessed by a Structure of Learning Outcomes (SOLO) taxonomy as knowledge acquisition. RESULTS: Observations on clinical reasoning patterns and the level of knowledge acquisition in five undergraduate dental students showed varying results. They applied clinical reasoning patterns according to their knowledge acquisition during didactical phase. Learners with inadequate knowledge relied on guessing, meanwhile learners with adequate knowledge applied more sophisticated reasoning pattern when solving problems. CONCLUSIONS: Various problem-solving strategies were encountered in this study, which corresponded to the level of knowledge acquisition. Dental institutions must set minimum standards regarding the acquisition of conceptual knowledge accompanied by improvement of clinical reasoning skills, as well as refinement of knowledge and procedural skills.

Common and distinct DNA-binding and regulatory activities of the BEN-solo transcription factor family.

Recently, the BEN (BANP, E5R, and NAC1) domain was recognized as a new class of conserved DNA-binding domain. The fly genome encodes three proteins that bear only a single BEN domain ("BEN-solo" factors); namely, Insensitive (Insv), Bsg25A (Elba1), and CG9883 (Elba2). Insv homodimers preferentially bind CCAATTGG palindromes throughout the genome to mediate transcriptional repression, whereas Bsg25A and Elba2 heterotrimerize with their obligate adaptor, Elba3 (i.e., the ELBA complex), to recognize a CCAATAAG motif in the Fab-7 insulator. While these data suggest distinct DNA-binding properties of BEN-solo proteins, we performed reporter assays that indicate that both Bsg25A and Elba2 can individually recognize Insv consensus sites efficiently. We confirmed this by solving the structure of Bsg25A complexed to the Insv site, which showed that key aspects of the BEN:DNA recognition strategy are similar between these proteins. We next show that both Insv and ELBA proteins are competent to mediate transcriptional repression via Insv consensus sequences but that the ELBA complex appears to be selective for the ELBA site. Reciprocally, genome-wide analysis reveals that Insv exhibits significant cobinding to class I insulator elements, indicating that it may also contribute to insulator function. Indeed, we observed abundant Insv binding within the Hox complexes with substantial overlaps with class I insulators, many of which bear Insv consensus sites. Moreover, Insv coimmunoprecipitates with the class I insulator factor CP190. Finally, we observed that Insv harbors exclusive activity among fly BEN-solo factors with respect to regulation of Notch-mediated cell fate choices in the peripheral nervous system. This in vivo activity is recapitulated by BEND6, a mammalian BEN-solo factor that conserves the Notch corepressor function of Insv but not its capacity to bind Insv consensus sites. Altogether, our data define an array of common and distinct biochemical and functional properties of this new family of transcription factors.

Recommendations for the integral diagnosis of chronic viral hepatitis in a single analytical extraction. / Recomendaciones para el diagnóstico integral de las hepatitis virales crónicas en una única extracción analítica.

The Spanish Society of Digestive Pathology (SEPD), the Spanish Association for the Study of the Liver (AEEH), the Spanish Society of Infections and Clinical Microbiology (SEIMC) and its Viral Hepatitis Study Group (GEHEP), and with the endorsement of the Alliance for the Elimination of Viral Hepatitis in Spain (AEHVE), have agreed on a document to carry out a comprehensive diagnosis of viral hepatitis (B, C and D), from a single blood sample; that is, a comprehensive diagnosis, in the hospital and/or at the point of care of the patient. We propose an algorithm, so that the positive result in a viral hepatitis serology (B, C and D), as well as human immunodeficiency virus (HIV), would trigger the analysis of the rest of the virus, including the viral load when necessary, in the same blood draw. In addition, we make two additional recommendations. First, the need to rule out a previous hepatitis A virus (VHA) infection, to proceed with its vaccination in cases where IgG-type studies against this virus are negative and the vaccine is indicated. Second, the determination of the HIV serology. Finally, in case of a positive result for any of the viruses analyzed, there must be an automated alerts and initiate epidemiological monitoring.

Assessment model blending formative and summative assessments using the SOLO taxonomy.

INTRODUCTION: Formative assessment with emphasis on feedback has been linked to developmental purposes of assessment, whilst summative assessment is assumed to focus on judgemental and quality assurance purposes. This dichotomy is questioned but designs to blend formative and summative assessments in constructive ways are rare in health care education. MATERIALS AND METHODS: We have designed an assessment model blending formative and summative assessments. In the formative assessment at the end of a course, students' responses to real-life scenarios with questions demanding responses at the relational level of understanding were assessed at three levels of understanding (incorrect, descriptive and relational) modified after the SOLO taxonomy. Students were presented with individual feedback for each response. At the summative assessment of a subsequent course, the students' new responses were assessed underpinning a final judgement of students' performance. The assessment model was justified across three student cohorts. RESULTS: Both formative and summative assessment events of the model provided information about the levels of understanding, unique to each student. A comparison of results from the assessments demonstrated that most responses developed to a higher level of understanding. With the summative assessment, it was possible to make judgements about whether or not individual students passed the pre-set standards. CONCLUSIONS: We argue that the current assessment model presents real interdependence between formative and summative assessments and can provide information that meets the needs of students as learners, education institutes and health care organisations. The SOLO taxonomy can be used to emphasise the importance of developing and assessing cognitive complexity.

A method for assessing students' interpretations of contextualized data.

Learning to interpret data in context is an important educational outcome. To assess students' attainment of this outcome, it is necessary to examine the interplay between their contextual and statistical reasoning. We describe a research method designed to do so. The method draws upon Toulmin's (1958, 2003) model of argumentation for the first stage of qualitative data analysis and the Structure of the Observed Learning Outcome (SOLO) (Biggs & Collis, 1991) model for the second stage. Toulmin analyses help identify the justifications and expressions of uncertainty students provide in their interpretive arguments. Subsequent analyses based on the multi-modal conceptualization of SOLO help characterize the quality of student arguments relative to one another. Existing literature and an empirical example are drawn upon to explain how the Toulmin and SOLO models can be used in tandem to analyze students' interpretations of contextualized data. We also explain how pairing Toulmin and SOLO can address theoretical and practical limitations that arise when using just one of the two models on its own.

Olaparib as first line in BRCA-mutated advanced ovarian carcinoma: Is it cost-effective in Spain?

OBJECTIVE: To estimate the cost-effectiveness of olaparib after being funded by the Spanish National Health Service (SNHS) as first-line monotherapy maintenance treatment in patients with advanced high-grade serous ovarian carcinoma (HGSOC) and BRCA mutations in Spain. METHODS: A semi-Markov model with one-month cycles was adapted to the Spanish healthcare setting, using the perspective of the SNHS, and a time horizon of 50 years. Two scenarios were compared: receiving olaparib vs. no maintenance treatment. The model comprised four health states and included the clinical results of the SOLO1 study, along with the direct healthcare costs associated with the use of first-line and subsequent treatment resources (2020 €). A discount rate of 3% was applied for future cost and quality-of-life outcomes. A probabilistic sensitivity analysis (PSA) was also carried out and a cost-effectiveness threshold of €25,000 per quality adjusted life year (QALY) was considered. RESULTS: The introduction of olaparib as a first-line maintenance treatment for advanced HGSOC patients with BRCA mutations implied a cost of €131,614.98 compared to €102,369.54 without olaparib (difference: €29,245.44), with an improvement of 2.00 QALYs (5.56 and 3.57, respectively). Therefore, olaparib is cost-effective for advanced HGSOC patients with BRCA mutations, with an incremental cost-effectiveness ratio of €14,653.2/QALY. The results from the PSA showed that 92.1% of the simulations fell below the €25,000/QALY threshold. The model showed that olaparib could improve the overall survival by 2 years, vs. no maintenance treatment. CONCLUSIONS: Olaparib as first-line maintenance treatment is cost-effective in advanced HGSOC patients with BRCA mutations in Spain.

Solo and Partnered Sexual Behavior Among an International Sample of Adults With Spina Bifida.

BACKGROUND: Spina bifida (SB) may differentially impact adults' participation in solo and partnered sexual behaviors, but little research investigates this topic. AIM: Describe solo and partnered sexual behaviors among an international sample of adult men and women with SB. MAIN OUTCOME MEASURES: Ever participated (no/yes) and recent participation (>1 year ago/within last year) in solo masturbation, cuddled with a partner, held hands with a partner, kissed a partner, touched a partner's genital, had genitals touched by a partner, gave a partner oral sex, received oral sex from a partner, vaginal sex, anal sex, and sex toy use. METHODS: Data were drawn from a larger cross-sectional, internet-based survey assessing the sexual behaviors of an international sample of men and women with SB. We used logistic regression to examine the impact of background (gender, age, independent living, and relationship status) and health (shunt status, ambulation, and genital sensation) factors on each outcome. RESULTS: The sample consisted of 345 respondents aged 18-73 years from 26 nations. Very few (<3%) had no lifetime experience with any solo or partnered behaviors; 25.0% reported participating in all behaviors at some point in their lives. The median number of past year sexual behaviors (of 16 total) was 7. Lifetime and recent participation were associated with demographic and health factors. CLINICAL IMPLICATIONS: Despite impairment, adults with spina bifida do participate in solo and partnered sexual behaviors. Medical personnel who work with this population should include discussions about sexuality as part of routine care. STRENGTHS & LIMITATIONS: Although this research measured solo and partnered sexual behavior in large international sample of adults with spina bifida, it is limited by its cross-sectional retrospective design and non-clinical convenience sample. CONCLUSION: Despite disability, many adults with SB participate in solo and partnered sexual behavior. Medical and psychosocial supports are needed to help adults in this population enjoy sexuality in a healthy and safe manner. Hensel DJ, Misseri R, Wiener JS, et al. Solo and Partnered Sexual Behavior Among an International Sample of Adults With Spina Bifida. J Sex Med 2022;19:1766-1777.

Efficiency in image-guided robotic and conventional camera steering: a prospective randomized controlled trial.

BACKGROUND: Robotic camera steering systems have been developed to facilitate endoscopic surgery. In this study, a randomized controlled trial was conducted to compare conventional human camera control with the AutoLap™ robotic camera holder in terms of efficiency and user experience when performing routine laparoscopic procedures. Novelty of this system relates to the steering method, which is image based. METHODS: Patients undergoing an elective laparoscopic hemicolectomy, sigmoid resection, fundoplication and cholecystectomy between September 2016 and January 2018 were included. Stratified block randomization was used for group allocation. The primary aim of this study was to compare the efficiency of robotic and human camera control, measured with surgical team size and total operating time. Secondary outcome parameters were number of cleaning moments of the laparoscope and the post-study system usability questionnaire. RESULTS: A total of 100 patients were randomized to have robotic (50) versus human (50) camera control. Baseline characteristics did not differ significantly between groups. In the robotic group, 49/50 (98%) of procedures were carried out without human camera control, reducing the surgical team size from four to three individuals. The median total operative time (60.0 versus 53.0 min, robotic vs. control) was not significantly different, p = 0.122. The questionnaire showed a positive user satisfaction and easy control of the robotic camera holder. CONCLUSION: Image-based robotic camera control can reduce surgical team size and does not result in significant difference in operative time compared to human camera control. Moreover, robotic image-guided camera control was associated with positive user experience.

Sexual Subjectivity in Solo and Partnered Masturbation Experiences Among Emerging Adult Women.

This qualitative study aimed to examine the experiences and attitudes toward masturbation among emerging adult women. The study was the first to compare women's solo and partnered masturbation experiences, focusing on how feelings of pleasure, sexual desire, and a sense of empowerment-important markers of women's sexual subjectivity-varied across the two contexts. The sample consisted of 40 women between the ages of 18 and 22 years. The majority of participants identified as Latina (33%) or Black (30%) and were enrolled in community college. Semi-structured interviews about women's masturbation experiences were analyzed using thematic analysis. Women described a multitude of feelings, including pleasure but also awkwardness and guilt. Although women did not describe their masturbation practices as morally wrong, they often alluded to disliking masturbation and preferring it less to partnered sex. Whereas some attitudes and feelings (e.g., awkwardness) arose in the context of both solo and partnered masturbation encounters, others were prevalent only in one (e.g., guilt in the solo encounters). Feelings of pleasure, sexual desire, and empowerment manifested differently in the two contexts. There was more focus on self-knowledge, control, and physical pleasure in the solo encounters and more enjoyment of a partner's desire and intimacy in the partnered encounters. We examine the findings through a feminist lens and consider how race/ethnicity, sexual scripts, and contemporary societal contexts shape women's sexual lives.

Solo-surgeon pure laparoscopic donor nephrectomy using passive camera holder: IDEAL stage 2a study.

BACKGROUND: Solo-surgery can be defined as a practice of a surgeon operating alone using a camera holder, without other surgical members except for a scrub nurse. This study was designed to evaluate the feasibility and safety of solo-surgeon pure laparoscopic donor nephrectomy. METHODS: The study protocol was approved by the Institutional Review Board of Asan Medical Center, Seoul, Korea. The brief study protocol was registered on the Clinical Research Information Service site of the Korea Centers for Disease Control and Prevention. Candidates fulfilling all inclusion and exclusion criteria were enrolled in the clinical trial and underwent solo-surgeon pure laparoscopic donor nephrectomy. The feasibility was assessed by the proportion of subjects who could undergo solo-surgeon pure laparoscopic donor nephrectomy without difficulty. The perioperative complications were identified to assess the safety of solo-surgeon pure laparoscopic donor nephrectomy. RESULTS: Of the 47 potential candidates from November 2018 to August 2019, 40 were enrolled in the clinical trial and seven excluded due to declining participation. The feasibility of solo-surgeon pure laparoscopic donor nephrectomy was 100%, without an occasion of any difficulty requiring conversion to the human assisted pure laparoscopic donor nephrectomy. Fourteen intraoperative complications occurred in 10 patients. The most common intraoperative complication was spleen injury. Two of three cases classified as the Satava classification grade II were due to the incomplete stapling of endoscopic stapler. Seventy-eight postoperative complications occurred in 34 patients. The most common postoperative complication was nausea/vomiting and followed by aspartate aminotransferase/alanine aminotransferase elevation. Most postoperative complication was independent of the solo-surgery itself. CONCLUSIONS: Solo-surgeon pure laparoscopic donor nephrectomy using passive camera holder is technically feasible. In terms of safety, it is necessary to adjust the scope of surgery performed alone. Trial Registration CRIS, KCT0003458. Registered 30/01/2019, Retrospectively registered, https://cris.nih.go.kr/cris/search/detailSearch.do/15868 .

Rising living alone among the elderly in Iran: prevalence and associated factors.

BACKGROUND: This study first examines the pattern and trend of elderly living alone during the last five censuses in Iran. Then, after describing the characteristics of the elderly who live alone, it determines how social, economic, and demographic characteristics relate to the solo living of the elderly. METHODS: The data for people aged 60 and above are from two sources, including the aggregate data from five successive Iranian censuses and the individual data of 2% of the 2016 Iranian census. To determine the relative importance of variables such as sex, age, education, and activity status of the elderly, a set of logistic regression models using STATA software has been used for individual data analysis of the 2016 census. RESULTS: The proportion of older people living alone in 1986, 1996, 2006, 2011, and 2016 was 9.1, 9.0, 10.9, 14.5, and 14.9%, respectively. City residents are less likely to live alone than villagers, and women are more likely to live alone than men. The odds of living solo among Illiterate, Primary school, Secondary & High school and Holding a high school diploma elderly higher than those with university education. Being a student and homemaker increases solo living relative to employees, but pensioners reduce solo living relative to employees. Moreover, the odds of solo living of the elderly in the early and middle stages of old age is less than in late old age. Also, the variables included in the analysis explained 16% of the variation in solo living. CONCLUSION: The prevalence of elderly solo living is increasing. And this increase continues due to the fundamental decline in childbearing, changes in family structure, and the effects of culture and tradition. Also, due to the rise in life expectancy, which increases the number of years of life with the disease, and disability, the lack of relief organizations will create more difficult conditions for the older people living alone.