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Paul Cardle,1 Saravana Kumar,1 Matthew Leach,2 Maureen McEvoy,1 Yasamin Veziari3 1Allied Health and Human Performance Unit, The University of South Australia, Adelaide, SA, Australia; 2Faculty of Health, Southern Cross University, Lismore, NSW, Australia; 3Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, SA, AustraliaCorrespondence: Paul Cardle, Email Paul.Cardle@mymail.unisa.edu.auObjective: The aim of this research was to explore the perspective, language, description, and practices of practitioners who identify as using mindfulness techniques for a range of health and clinical conditions.Methods: This study was guided by a qualitative descriptive methodology. Mindfulness practitioners from a variety of backgrounds that included medical, allied health, complementary and alternative medicine, and traditional Buddhism from across Australia were invited to share their perspectives. Semi-structured interviews were conducted via Zoom, telephone, and face-to-face which were audio-recorded and transcribed verbatim. The transcripts were thematically analysed.Results: Sixteen mindfulness practitioners from Australia self-nominated to participate in this study. Overall, the interviews revealed similarities, differences and even disagreements between participants from the different modalities regarding mindfulness. Participants from similar disciplines also reported differing perspectives and nuanced opinions. Differences appeared to stem from both participant background, training, and the overall aims of their practice.Conclusion: This research highlights the complexities of what constitutes mindfulness. This study has highlighted, across a broad cohort, that for mindfulness practitioners, their beliefs, aims, and practices are varied and influenced by a range of factors including their ideological perspectives. While the diversity and broad application of mindfulness may be one of its strengths, it may also be its weakness as its value may be diluted due to plurality of understanding and multiplicity in use. This requires careful and considered actions from mindfulness stakeholders.Keywords: mindfulness, mindfulness practices, mindfulness practitioners, mindfulness perspectives

Fardeen Bhimani,1,&ast; Sophie Lin,1,&ast; Maureen McEvoy,1,2 Arianna Cavalli,2 Liane Obaid,2 Yu Chen,1 Anjuli Gupta,1,2 Jessica Pastoriza,1,2 Areej Shihabi,1 Sheldon Feldman1,2 1Breast Surgery Division, Department of Surgery, Montefiore Medical Center, Montefiore Einstein Center for Cancer Care, Bronx, New York, USA; 2Albert Einstein College of Medicine, Bronx, New York, USA&ast;These authors contributed equally to this workCorrespondence: Sheldon Feldman, Department of Surgery, Division of Breast Surgery, Montefiore Medical Center, 1250 Waters Place, 7th Floor, Hutch Tower 1, Bronx, NY, USA, Email sfeldman@montefiore.orgBackground: Positive margins on lumpectomy specimens are associated with a twofold increased risk of local breast tumor recurrence. Prior literature has demonstrated various techniques and modalities for assessing margin status to reduce re-excision rates. However, there is paucity of literature analyzing which margin contributes to the highest re-excision rates. Therefore, the primary aim of the study was to investigate whether the nipple-ward margins resulted in a higher rate of re-excision in our patient population.Methods: A retrospective chart review was performed on patients who had re-excision surgery. Nipple-ward margin was identified by correlating radiological and pathological reports. A cut-off of more than 25% was used to demonstrate correlation between nipple-ward margin and re-excision rate.Results: A total of 98 patients’ data were analyzed, with 41 (41.8%), 14 (14.3%), 5 (5.1%), and 38 (38.8%) diagnosed with DCIS, IDC, ILC, and mixed pathology on their margins, respectively. Overall, 48% (n=47) of the positive margins were nipple-ward, with 44.7% (n=21) reporting DCIS. Upon stratification, 45 (45.9%) cases were single-margin positive, with 26 (57.8%) being nipple-ward. Furthermore, the remaining 53 (54.1%) patients had multiple positive margins, with 21 (39.6.7%) nipple-ward cases.Conclusion: Positive nipple-ward margins significantly contribute to a higher re-excision rate p < 0.001; 48% of re-excision surgeries had positive nipple-ward margins, and 57.8% of positive single-margin cases were nipple-ward. Taking an additional shave during initial lumpectomy decreases re-excision rates. However, planning a lumpectomy procedure with a more elliptical rather than a spherical resection with additional cavity shave (ie, larger volume) in the nipple-ward direction and minimizing the remaining cavity shaves so the total volume resected remains unchanged. Nevertheless, future studies with larger sample sizes are required to bolster our findings.Keywords: nipple-ward, breast cancer, re-excision, nipple-ward positive breast cancer, Shave trial, positive margins

Paul Cardle,1 Saravana Kumar,1 Matthew Leach,2 Maureen McEvoy,1 Yasamin Veziari1 1Allied Health and Human Performance Unit, The University of South Australia, Adelaide, SA, Australia; 2National Centre for Naturopathic Medicine, Southern Cross University, Lismore, New South Wales, AustraliaCorrespondence: Paul Cardle, Email Paul.Cardle@mymail.unisa.edu.auBackground: Chronic musculoskeletal pain (CMSP) disorders are a leading cause of disability globally, affecting up to one in three people. Mindfulness-based interventions (MBI) have become a popular treatment for CMSP. The aim of this umbrella review was to synthesise the best available research evidence for the effectiveness of MBI for adults with CMSP.Methods: Eight databases were searched from inception to 30th June 2021 for systematic reviews that examined the use of MBI in CMSP (pain experienced > 3 months) in adult populations. Two reviewers independently conducted screening and selection, data extraction, and assessment of methodological quality using The Assessing the Methodological Quality of Systematic Reviews tool (AMSTAR 2). Outcomes examined were pain, sleep quality, depression, quality of life, physical functioning, and mindfulness. Furthermore, definitions of mindfulness, and intervention parameters (mindfulness practices used, length, frequency of sessions, duration) were also reported.Results: Nineteen systematic reviews (n = 1 rated high quality, n = 1 moderate quality, n = 2 low quality and n = 15 critically low quality) examining 194 primary studies met the review criteria. Although some promising evidence was identified for the use of MBI in CMSP, the general low quality and widespread heterogeneity of included SRs and made it difficult to reach a definitive conclusion. Differences in results and outcomes amongst systematic reviews that, in many cases, had a high overlap of included RCTs, suggests fundamental differences in critical design elements that make data difficult to compare.Conclusion: This umbrella review found mixed results on the effectiveness of MBI for the management of CMSP across a range of outcomes (pain, sleep quality, depression, quality of life, physical functioning, mindfulness). Definitions of MBI varied as did parameters, which may have contributed to these mixed results. More rigorous research with stringent MBI protocols is required.Keywords: mindfulness, chronic pain, musculoskeletal disorders, chronic musculoskeletal pain, systematic reviews

This paper describes a simplified dynamic thermal model which simulates the energy and overheating performance of windows. To calculate artificial energy use within a room, the model employs the average [...]

Summary: Background: Wet dressings combined with topical corticosteroids are beneficial for patients with generalized and refractory dermatosis; however, to our knowledge, serum levels after topical corticosteroid absorption during intensive therapy have not been reported previously. Aim: To examine serum levels of triamcinolone acetonide (TAC) after topical corticosteroid application during intensive wet‐dressing therapy. Methods: We performed a retrospective study of adult patients admitted for inpatient wet‐dressing therapy from 7 November 2015 to 24 June 2016. Data were collected on sex, age, body surface area, TAC serum levels, number of wet‐dressing changes after 24 and 48 h, and type of wet dressing. Results: In total, 29 patients (14 men, 15 women) were assessed. Median [interquartile range (IQR)] age was 57 years (51.5–67.0 years) and involved body surface area was 1.98 m2 (1.88–2.15) m2. Before the 24‐hour blood draw, patients had received 1–3 dressing changes. Median (IQR) TAC level at 24 h was 0.33 µg/dL (0.20–0.58 µg/dL), with no significant difference noted between the number of dressing changes and TAC serum level. At 48 h, results of a serum TAC test were available for 22 patients with 2–6 dressing changes. Mean (IQR) serum level was 0.30 µg/dL (0.30–0.87 µg/dL). For each additional dressing change, there was an estimated 0.21 µg/dL increase in TAC serum level (95% CI 0.11–0.31; P < 0.001). TAC serum level was not significantly associated with sex, age, body surface area or dressing type. Conclusions: Intensive, inpatient wet‐dressing therapy is associated with detectable TAC serum levels. However, we suspect that topical TAC has a primarily local therapeutic effect on the skin. [ABSTRACT FROM AUTHOR]