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Purpose To describe the anatomical and functional outcomes following use of the inverted flap technique (IFT) to close idiopathic macular holes (MH) of diameter greater than 400 μm. To compare the changes in the macular microvascularization following surgery in operated and healthy fellow eyes.Methods Retrospective study of 24 patients who underwent vitrectomy and IFT for large MH closure. The main variables were closure pattern, best corrected visual acuity (BCVA) and recovery of the external limiting membrane (ELM) and ellipsoid zone (EZ). Foveal avascular zones (FAZ) and vessel and perfusion densities, obtained by OCT angiography scans, were compared with those in healthy fellow eyes.Results Complete MH closure was achieved in 95.8% (23/24) of patients 6 months after surgery. There was a significant improvement in postoperative BCVA, from 1.0 to 0.4 logMAR (p < 0.001). The most frequent closure pattern was 1a (62.5%, 15/24), followed by 2c (12.5%, 3/24). The closure pattern was not correlated with height, minimum or maximum diameters or macular hole index (MHI) (p > 0.05). ELM and EZ recovery occurred in 87.5% and 83.3% of cases, respectively. FAZ were smaller in operated eyes than in the fellow eyes (p = 0.012). There were no differences in the vessel or perfusion densities between the operated and fellow eyes (p > 0.05).Conclusions Use of the inverted flap technique for large MH closure provides a high rate of functional and anatomical recovery. We observed a reduction in the FAZ following surgery, with no differences in the macular microvascularization parameters, suggesting that the technique is safe.

IMPORTANCE: Tracheotomies are frequently performed by nonotolaryngology services. The factors that determine which specialty performs the procedure are not defined in the literature but may be influenced by tracheotomy approach (open vs percutaneous) and other clinicodemographic factors. OBJECTIVE: To evaluate demographic and clinical characteristics associated with tracheotomies performed by otolaryngologists compared with other specialists and to differentiate those factors from factors associated with use of open vs percutaneous tracheotomy. DESIGN, SETTING, AND PARTICIPANTS: This multicenter, retrospective cohort study included patients aged 18 years or older who underwent a tracheotomy for cardiopulmonary failure at 1 of 8 US academic institutions between January 1, 2013, and December 31, 2016. Data were analyzed from September 2022 to July 2023. EXPOSURE: Tracheotomy. MAIN OUTCOMES AND MEASURES: The primary outcome was factors associated with an otolaryngologist performing tracheotomy. The secondary outcome was factors associated with use of the open tracheotomy technique. RESULTS: A total of 2929 patients (mean [SD] age, 57.2 [17.2] years; 1751 [59.8%] male) who received a tracheotomy for cardiopulmonary failure (652 [22.3%] performed by otolaryngologists and 2277 [77.7%] by another service) were analyzed. Although 1664 of all tracheotomies (56.8%) were performed by an open approach, only 602 open tracheotomies (36.2%) were performed by otolaryngologists. Most tracheotomies performed by otolaryngologists (602 of 652 [92.3%]) used the open technique. Multivariable regression analysis revealed that self-reported Black race (odds ratio [OR], 1.89; 95% CI, 1.52-2.35), history of neck surgery (OR, 2.71; 95% CI, 2.06-3.57), antiplatelet and/or anticoagulation therapy (OR, 1.74; 95% CI, 1.29-2.36), and morbid obesity (OR, 1.54; 95% CI, 1.24-1.92) were associated with greater odds of an otolaryngologist performing tracheotomy. In contrast, history of neck surgery (OR, 1.36; 95% CI, 0.96-1.92), antiplatelet and/or anticoagulation therapy (OR, 0.80; 95% CI, 0.56-1.14), and morbid obesity (OR, 0.94; 95% CI, 0.74-1.19) were not associated with undergoing open tracheotomy when performed by any service, and Black race (OR, 0.56; 95% CI, 0.44-0.71) was associated with lesser odds of an open approach being used. Age-adjusted Charlson Comorbidity Index score greater than 4 was associated with greater odds of both an otolaryngologist performing tracheotomy (OR, 1.26; 95% CI, 1.03-1.53) and use of the open tracheotomy technique (OR, 1.48, 95% CI, 1.21-1.82). CONCLUSIONS AND RELEVANCE: In this study, otolaryngologists were significantly more likely than other specialists to perform a tracheotomy for patients with history of neck surgery, morbid obesity, and ongoing anticoagulation therapy. These findings suggest that patients undergoing tracheotomy performed by an otolaryngologist are more likely to present with complex and challenging clinical characteristics.

Informal business activity is ubiquitous around the world, but it is nearly always uncaptured by administrative data, registries, or commercial sources. For this reason, there are rarely adequate sampling frames available for survey implementers wishing to measure the activity and characteristics of the sector. This article applies a well-established sampling method for rare and/or clustered populations, Adaptive Cluster Sampling (ACS), to a novel population of informal businesses. Generally, it shows that efficiency gains through the application of ACS, when compared to Simple Random Sampling (SRS), are large, particularly at higher levels of fieldwork effort. In particular, ACS efficiency gains over SRS remain sizable at higher values of initial starting samples, but with comparatively high expansion thresholds, which can reduce the fieldwork effort.

Crop breeding for mechanized harvesting has driven modern agriculture. In tomato, machine harvesting for industrial processing varieties became the norm in the 1970s. However, fresh-market varieties whose fruits are suitable for mechanical harvesting are difficult to breed because of associated reduction in flavour and nutritional qualities. Here we report the cloning and functional characterization of fs8.1, which controls the elongated fruit shape and crush resistance of machine-harvestable processing tomatoes. FS8.1encodes a non-canonical GT-2 factor that activates the expression of cell-cycle inhibitor genes through the formation of a transcriptional module with the canonical GT-2 factor SlGT-16. The fs8.1mutation results in a lower inhibitory effect on the cell proliferation of the ovary wall, leading to elongated fruits with enhanced compression resistance. Our study provides a potential route for introducing the beneficial allele into fresh-market tomatoes without reducing quality, thereby facilitating mechanical harvesting.

Twice-exceptionality (2e), broadly defined as the co-occurrence of a gift or talent and a disability, has been a part of the educational lexicon since the 1990s, although its empirical backing is limited. We conducted a comprehensive review of the empirical literature on 2e and created a simulation study of 2e. For the latter, we constructed population distribution functions that represent indicators of ability using a range of correlations and identification criteria guided by the reviewed literature. We observed the theoretical occurrence of 2e, even at its most relaxed definitions, to be much rarer than prevailing literature implies (probability = 0.148). As correlations and factor loadings increase, the prevalence estimates of 2e drop considerably. Our results demonstrated the need for a more informed, standardized, and quantifiable approach to the identification of individuals with 2e.

Purpose To report the management and outcome of a case of necrotizing scleritis due to Hormographiella aspergillata.Methods Case report.Results A 79-year-old woman developed scleral inflammation following accidental trauma with a gorse plant in her left eye. An abscess formed at the site of the injury, which was surgically drained. Filamentous fungi were identified from the abscess contents, and oral voriconazole and topical voriconazole and natamycin drops were prescribed. Phenotypic analysis confirmed the presence of Hormographiella aspergillata, with low minimum inhibitory concentrations (MIC) for voriconazole and amphotericin B. Two weeks later the patient presented with an area of necrotizing scleritis which required surgical debridement and scleral grafting. Three months later, the scleral inflammation had resolved leaving an area of scleromalacia.Conclusions Hormographiella aspergillatais a common environmental fungus that has recently emerged as a human pathogen and a rare cause of scleritis. To the best of our knowledge, this is the first report of scleritis in which a pure culture of H. aspergillatawas obtained. Successful management poses a challenge as there are limited reports on antifungal susceptibility and a combination of medical and surgical treatment is often required.

Critically ill infants and children with rare diseases need equitable access to rapid and accurate diagnosis to direct clinical management. Over 2 years, the Acute Care Genomics program provided whole-genome sequencing to 290 families whose critically ill infants and children were admitted to hospitals throughout Australia with suspected genetic conditions. The average time to result was 2.9 d and diagnostic yield was 47%. We performed additional bioinformatic analyses and transcriptome sequencing in all patients who remained undiagnosed. Long-read sequencing and functional assays, ranging from clinically accredited enzyme analysis to bespoke quantitative proteomics, were deployed in selected cases. This resulted in an additional 19 diagnoses and an overall diagnostic yield of 54%. Diagnostic variants ranged from structural chromosomal abnormalities through to an intronic retrotransposon, disrupting splicing. Critical care management changed in 120 diagnosed patients (77%). This included major impacts, such as informing precision treatments, surgical and transplant decisions and palliation, in 94 patients (60%). Our results provide preliminary evidence of the clinical utility of integrating multi-omic approaches into mainstream diagnostic practice to fully realize the potential of rare disease genomic testing in a timely manner.

We aimed to determine whether SNP-microarray genomic testing of saliva had a greater diagnostic yield than blood for pathogenic copy number variants (CNVs). We selected patients who underwent CMA testing of both blood and saliva from 23,289 blood and 21,857 saliva samples. Our cohort comprised 370 individuals who had testing of both, 224 with syndromic intellectual disability (ID) and 146 with isolated ID. Mosaic pathogenic CNVs or aneuploidy were detected in saliva but not in blood in 20/370 (4.4%). All 20 individuals had syndromic ID, accounting for 9.1% of the syndromic ID sub-cohort. Pathogenic CNVs were large in size (median of 46 Mb), and terminal in nature, with median mosaicism of 27.5% (not exceeding 40%). By contrast, non-mosaic pathogenic CNVs were 100% concordant between blood and saliva, considerably smaller in size (median of 0.65 Mb), and predominantly interstitial in location. Given that salivary microarray testing has increased diagnostic utility over blood in individuals with syndromic ID, we recommend it as a first-tier testing in this group.

IMPORTANCE: Fine-needle biopsy (FNB) became a critical part of thyroid nodule evaluation in the 1970s. It is not clear how diagnostic accuracy of FNB has changed over time. OBJECTIVE: To conduct a systematic review and meta-analysis estimating the accuracy of thyroid FNB for diagnosis of malignancy in adults with a newly diagnosed thyroid nodule and to characterize changes in accuracy over time. DATA SOURCES: PubMed, SCOPUS, and Cochrane Central Register of Controlled Trials were searched from 1975 to 2020 using search terms related to FNB accuracy in the thyroid. STUDY SELECTION: English-language reports of cohort studies or randomized trials of adult patients undergoing thyroid FNB with sample size of 20 or greater and using a reference standard of surgical histopathology or clinical follow-up were included. Articles that examined only patients with known thyroid disease or focused on accuracy of novel adjuncts, such as molecular tests, were excluded. Two investigators screened each article and resolved conflicts by consensus. A total of 36 of 1023 studies met selection criteria. DATA EXTRACTION AND SYNTHESIS: The MOOSE guidelines were used for data abstraction and assessing data quality and validity. Two investigators abstracted data using a standard form. Studies were grouped into epochs by median data collection year (1975 to 1990, 1990 to 2000, 2000 to 2010, and 2010 to 2020). Data were pooled using a bivariate mixed-effects model. MAIN OUTCOMES AND MEASURES: The primary outcome was accuracy of FNB for diagnosis of malignancy. Accuracy was hypothesized to increase in later time periods, a hypothesis formulated prior to data collection. RESULTS: Of 16 597 included patients, 12 974 (79.2%) were female, and the mean (SD) age was 47.3 (12.9) years. The sensitivity of FNB was 85.6% (95% CI, 79.9-89.5), the specificity was 71.4% (95% CI, 61.1-79.8), the positive likelihood ratio was 3.0 (95% CI, 2.3-4.1), and the negative likelihood ratio was 0.2 (95% CI, 0.2-0.3). The area under the receiver operating characteristic curve was 86.1%. Epoch was not significantly associated with accuracy. None of the available covariates could explain observed heterogeneity. CONCLUSIONS AND RELEVANCE: Accuracy of thyroid FNB has not significantly changed over time. Important developments in technique, preparation, and interpretation may have occurred too heterogeneously to capture a consistent uptrend over time. FNB remains a reliable test for thyroid cancer diagnosis.

Abstract:Broad-Based Black Economic Empowerment (B-BBEE) was conceived as a structural intervention to fundamentally reorganise the South African economy and address persistent economic inequalities. South Africa has the world's highest income inequality, and this is reflected by vast inequalities in salaries and wages both between high and low earners, but importantly between different race and gender groups. Despite a plethora of legislation aimed at addressing inequality in ownership (such as B-BBEE) and in the workplace (employment equity legislation), women and Black workers in South Africa continue to be paid less than men and white employees, even when doing the same work (the pay gap), and are more likely to work in precarious, low-paid jobs (occupational segregation). These factors are driven by differences in the characteristics of workers, and by structural discrimination in the economy. Conceptually, we can decompose structural discrimination into two forms–that which discriminates against people who do the same job, based on race and gender (the pay gap)– and that which discriminates indirectly by occupational segregation–blacks and women concentrated in low paying occupations. In this paper, we ask whether B-BBEE–while not explicitly a labour market intervention–has had any positive impact in reducing labour market inequalities. We review the literature on occupational segregation and the gender and race pay gaps in post-apartheid South Africa, and examine the various policy interventions, with a particular focus on B-BBEE, that have attempted to address this enduring problem.

IMPORTANCE: Unilateral vocal fold paralysis (UVFP) is a common and life-changing complication of cancer, trauma, and an estimated 500 000 head, neck, and chest surgeries performed annually in the US, among other causes (eg, idiopathic). Consequent disabilities are profound and often permanent and can include severe voice, swallowing, and breathing dysfunction and concomitant anxiety, isolation, and fear. Physiological measures often correlate poorly with patient-reported disability. The measure described herein was designed to be a comprehensive, psychometrically sound UVFP-specific patient-reported outcome measure (PROM) for use in clinical trials or at point of care. OBJECTIVE: To evaluate the reliability and validity of the CoPE (vocal Cord Paralysis Experience) PROM in a nationally representative sample for both clinical and research use. DESIGN, SETTING, AND PARTICIPANTS: This survey validation study was performed at 34 tertiary care centers across the US and included English-speaking adults with unilateral vocal fold immobility confirmed via laryngoscopy. MAIN OUTCOMES AND MEASURES: Reliability (internal consistency, alternate form, and test-retest) and validity (convergent and known-group). RESULTS: In total, 613 patients (mean [SD] age, 58 [15.3] years; 394 [64.5%] women) were recruited, and 555 (92.3%) completed surveys for all time points. Internal consistency was high in the overall 22-item PROM and psychosocial, swallow, and voice subscales (Cronbach α > 0.91). Intraclass correlations for individuals between the baseline and 2-week administrations were moderate for the overall score and subscales (intraclass correlations range, 0.66-0.80). There were significant differences between the online and 2-week paper administrations for the overall score and voice and psychosocial subscales (overall scale mean: 54.4 [95% CI, 49.7-59.1] vs 48.9 [95% CI, 43.7-54.0] at 2 weeks). The confirmatory model was found to be suitably fitted based on average r2 values 0.5 or greater for subscale and overall scores. Correlations between subscales and existing PROMs (Voice-Related Quality of Life, Eating Assessment Tool, and Communication Participation Item Bank) were all greater than 0.69, and mean PROM subscale scores were significantly different across known quartiles of existing PROMs. CONCLUSIONS AND RELEVANCE: The findings of this survey validation study suggest that the CoPE PROM could serve as a psychometrically sound, comprehensive measure of UVFP-attributed disability suitable for use in clinical and research settings to assess within-person changes. The results will inform a user manual to facilitate use in clinical trials comparing the effectiveness and durability of treatments including behavioral (speech therapy), temporary (eg, injection augmentation), and permanent surgical treatments for UVFP.

IMPORTANCE: Papillary thyroid microcarcinomas (PTMCs) have been associated with increased thyroid cancer incidence in recent decades. Total thyroidectomy (TT) has historically been the primary treatment, but current guidelines recommend hemithyroidectomy (HT) for select low-risk cancers; however, the risk-benefit ratio of the 2 operations is incompletely characterized. OBJECTIVE: To compare surgical complication rates between TT and HT for PTMC treatment. DATA SOURCES: SCOPUS, Medline via the PubMed interface, and the Cochrane Central Register of Controlled Trials (CENTRAL); through January 1, 2021, with no starting date restriction. Terms related to papillary thyroid carcinoma and its treatment were used for article retrieval. This meta-analysis used the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline and was written according to the Meta-analysis of Observational Studies in Epidemiology (MOOSE) proposal. STUDY SELECTION: Original investigations of adults reporting primary surgical treatment outcomes in PTMC and at least 1 complication of interest were included. Articles evaluating only secondary operations or non–open surgical approaches were excluded. Study selection, data extraction, and risk of bias assessment were performed by 2 independent reviewers and conflicts resolved by a senior reviewer. DATA EXTRACTION AND SYNTHESIS: Pooled effect estimates were calculated using a random-effects inverse-variance weighting model. MAIN OUTCOMES AND MEASURES: Cancer recurrence and site, mortality (all-cause and disease-specific), vocal fold paralysis, hypoparathyroidism, and hemorrhage/hematoma. Risk of bias was assessed using the McMaster Quality Assessment Scale of Harms scale. RESULTS: In this systematic review and meta-analysis, 17 studies were analyzed and included 1416 patients undergoing HT and 2411 patients undergoing TT (HT: pooled mean [SD] age, 47.0 [10.0] years; 1139 [84.6%] were female; and TT: pooled mean [SD] age, 48.8 [10.0] years; 1671 [77.4%] were female). Patients undergoing HT had significantly lower risk of temporary vocal fold paralysis compared with patients undergoing TT (3.3% vs 4.5%) (weighted risk ratio [RR], 0.4; 95% CI, 0.2-0.7), temporary hypoparathyroidism (2.2% vs 21.3%) (weighted RR, 0.1; 95% CI, 0.0-0.4), and permanent hypoparathyroidism (0% vs 1.8%) (weighted RR, 0.2; 95% CI, 0.0-0.8). Contralateral lobe malignant neoplasm recurrence was 2.3% in the HT group, while no such events occurred in the TT group. Hemithyroidectomy was associated with a higher overall recurrence rate (3.8% vs 1.0%) (weighted RR, 2.6; 95% CI, 1.3-5.4), but there was no difference in recurrence in the thyroid bed or neck. CONCLUSIONS AND RELEVANCE: The results of this systematic review and meta-analysis help characterize current knowledge of the risk-benefit ratio of HT vs TT for treatment of PTMC and provide data that may have utility for patient counseling surrounding treatment decisions.

This study used simulation techniques to evaluate the technical adequacy of three methods for the identification of specific learning disabilities via patterns of strengths and weaknesses in cognitive processing. Latent and observed data were generated and the decision-making process of each method was applied to assess concordance in classification for specific learning disabilities between latent and observed levels. The results showed that all three methods had excellent specificity and negative predictive values, but low to moderate sensitivity and very low positive predictive values. Only a very small percentage of the population (l%-2%) met criteria for specific learning disabilities. In addition to substantial psychometric issues underlying these methods, general application did not improve the efficiency of the decision model, may not be cost effective because of low base rates, and may result in many children receiving instruction that is not optimally matched to their specific needs., The statutory definition of specific learning disabilities (SLD) states that the term 'means a disorder in one or more of the basic psychological processes involved in understanding or in using [...]

The cognitive attributes of Grade 1 students who responded adequately and inadequately to a Tier 2 reading intervention were evaluated. The groups included inadequate responders based on decoding and fluency criteria (n = 29), only fluency criteria (n = 75), adequate responders (n = 85), and typically achieving students (n = 69). The cognitive measures included assessments of phonological awareness, rapid letter naming, oral language skills, processing speed, vocabulary, and nonverbal problem solving. Comparisons of all four groups identified phonological awareness as the most significant contributor to group differentiation. Measures of rapid letter naming, syntactic comprehension/working memory, and vocabulary also contributed uniquely to some comparisons of adequate and inadequate responders. In a series of regression analyses designed to evaluate the contributions of responder status to cognitive skills independently of variability in reading skills, only the model for rapid letter naming achieved statistical significance, accounting for a small (1%) increment in explained variance beyond that explained by models based only on reading levels. Altogether, these results do not suggest qualitative differences among the groups, but are consistent with a continuum of severity associated with the level of reading skills across the four groups., A recent consensus report suggested that students with learning disabilities (LD) should be identified on the basis of inadequate treatment response, low achievement, and traditional exclusionary criteria (Bradley, Danielson, & [...]

Abstract. This study examined the effectiveness of a yearlong, researcher-provided, Tier 2 (secondary) intervention with a group of sixth-graders. The intervention emphasized word recognition, vocabulary, fluency, and comprehension. Participants scored [...]

General academic words are those which are typically learned through exposure to school texts and occur across disciplines. We examined academic vocabulary assessment data from a group of English‐speaking middle school students (N= 1,747). We tested how word frequency, complexity, proximity, polysemy, and diversity related to students’ knowledge of target words across ability levels. Our results affirm the strong relation between vocabulary and reading at the individual level. Strong readers were more likely to know the meanings of words than struggling readers were, regardless of the features of the academic words tested. Words with more meanings were easier for all students, on average. The relation between word frequency and item difficulty was stronger among better readers, whereas the relation between word complexity and item difficulty was stronger among less proficient readers. Our examination of academic words’ characteristics and how these characteristics relate to word difficulty across reading performance has implications for instruction.

Accidents happen for millions of reasons, but the truth is, they are all preventable. Three major causes are common in almost all accidents; not using the right tool for the [...]

Service contractors are heavily engaged in the energy transition and decarbonisation process, designing and executing capital projects and asset upgrades that will sustain the new look economy. The next question is what can service contractors do to directly contribute to a reduction in carbon emissions and fossil fuel use? This review will examine the impact of updating our service delivery to drive down energy consumption and emissions, and plan for a future where renewable energy can power the field services we provide. Upstream Production Solutions (Upstream PS) has started on our journey of monitoring the greenhouse gas emissions for our business as per AS ISO 14064, and while we are below the 50 kt threshold for a registered reporting entity as per the Australian National Greenhouse and Energy Reporting Act 2007 , the increased awareness has helped us identify key areas where we can make positive changes in our business and directly contribute to emissions reduction: development of fit for purpose company standards; optimised selection of mobile fleet; improved planning and scheduling leading to reduced kilometres driven and emissions; and incorporating low-emissions technology options into our services. Upstream PS will share our progress as we pursue practical improvements while maintaining, and even improving, the delivery of our services.

In response to increasing interest in diploid potato (Solanum tuberosum) breeding and the production of diploid inbred hybrid potato varieties, the Breeding and Genetics section of the Potato Association of America (PAA) organized a symposium on diploid breeding that took place during the 2021 PAA annual meeting. Proceedings from that symposium are documented in this manuscript. Speakers from academia, government and industry presented their unique perspectives. Presentations covered a wide range of topics. Potential advantages of diploid breeding were introduced, and reasons to be skeptical about diploid breeding were highlighted. The impact that diploid breeding might have on the potato seed industry was discussed. Advantages for genetics research were emphasized. Aspects of tomato breeding and production were reviewed and considered as potential models for diploid potato breeding and production activities. Lastly, an industry-centered view of diploid potato breeding was provided. Taken together, these presentations are a snapshot of how diploid potato breeding was viewed in the moment, a vision for how diploid breeding might be implemented, and a thoughtful reflection on how diploid breeding and inbred hybrid varieties might change the potato variety development process and impact the potato industry.

BackgroundClinical exome sequencing typically achieves diagnostic yields of 30%–57.5% in individuals with monogenic rare diseases. Undiagnosed diseases programmes implement strategies to improve diagnostic outcomes for these individuals.AimWe share the lessons learnt from the first 3 years of the Undiagnosed Diseases Program-Victoria, an Australian programme embedded within a clinical genetics service in the state of Victoria with a focus on paediatric rare diseases.MethodsWe enrolled families who remained without a diagnosis after clinical genomic (panel, exome or genome) sequencing between 2016 and 2018. We used family-based exome sequencing (family ES), family-based genome sequencing (family GS), RNA sequencing (RNA-seq) and high-resolution chromosomal microarray (CMA) with research-based analysis.ResultsIn 150 families, we achieved a diagnosis or strong candidate in 64 (42.7%) (37 in known genes with a consistent phenotype, 3 in known genes with a novel phenotype and 24 in novel disease genes). Fifty-four diagnoses or strong candidates were made by family ES, six by family GS with RNA-seq, two by high-resolution CMA and two by data reanalysis.ConclusionWe share our lessons learnt from the programme. Flexible implementation of multiple strategies allowed for scalability and response to the availability of new technologies. Broad implementation of family ES with research-based analysis showed promising yields post a negative clinical singleton ES. RNA-seq offered multiple benefits in family ES-negative populations. International data sharing strategies were critical in facilitating collaborations to establish novel disease–gene associations. Finally, the integrated approach of a multiskilled, multidisciplinary team was fundamental to having diverse perspectives and strategic decision-making.

A pilot project on how best to promote a technical and managerial learning process in raising industry competitiveness was undertaken in Romania to facilitate restructuring within its manufacturing industry. As an economy in transition, Romanian businesses, particularly its small/medium enterprises, were encountering difficulties in undertaking successful technology transfers. The project thus focused on the need to develop 'learning networks' to hasten the absorption of 'new' manufacturing practices and consequently inspire and enable relevant industrial learning.

IMPORTANCE: Thyroid cancer is more common in women than in men, but the associated causes of these differences are not fully understood. OBJECTIVE: To compare sex-specific thyroid cancer rates in the US to the prevalence of subclinical thyroid cancer at autopsy. DATA SOURCES: Data on thyroid cancer incidence and mortality by sex among US adults (≥18 years) were extracted from the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program (SEER) data for 1975 to 2017. Embase, PubMed, and Web of Science databases were searched for studies on the prevalence of subclinical thyroid cancer at autopsy of men and women, from inception to May 31, 2021. STUDY SELECTION: The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline was used to perform a systematic search for articles reporting the prevalence of subclinical thyroid cancer in autopsy results of both women and men. Of 101 studies identified, 8 studies containing 12 data sets met inclusion criteria; ie, they examined the whole thyroid gland, stated the number of thyroids examined, and reported results by sex. Excluded studies reported thyroid cancer in Japan after the atomic bombs or Chernobyl after the nuclear disaster; did not examine the whole thyroid gland or had incomplete information on thyroid examination methods; or did not report rates by sex. DATA EXTRACTION AND SYNTHESIS: Thyroid cancer incidence and mortality data by sex, histologic type, and tumor size were extracted from SEER. The inverse variance heterogeneity model was used to meta-analyze the prevalence and the odds ratio of subclinical thyroid cancer by sex from 8 studies (12 data sets) on thyroid cancer prevalence in autopsy results. MAIN OUTCOMES AND MEASURES: Incidence and mortality of thyroid cancer, by histologic type and tumor size; prevalence of thyroid cancer in autopsy results. RESULTS: In 2017, 90% of thyroid cancers diagnosed were papillary thyroid cancer (PTC) and in 2013 to 2017, the women to men incidence ratio for small (≤2 cm) PTC was 4.39:1. The incidence ratio approached 1:1 as cancer type lethality increased. The ratio of thyroid cancer mortality by gender was 1.02:1 and remained stable from 1992 to 2017. Results of the meta-analysis showed that the pooled autopsy prevalence of subclinical PTC was 14% in women (95% CI, 8%-20%) and 11% in men (95% CI, 5%-18%). The pooled odds ratio of subclinical PTC in women compared with men was 1.07 (95% CI, 0.80-1.42). CONCLUSIONS AND RELEVANCE: This cohort study and meta-analysis found that the belief that women get thyroid cancer more often than men is an oversimplification. The gender disparity is mostly confined to the detection of small subclinical PTCs, which are equally common in both sexes at autopsy but identified during life much more often in women than men. As the lethality of the cancer type increases, the ratio of detection by gender approaches 1:1. This phenomenon may be associated with gender differences in health care utilization and patterns of clinical thinking and can harm both women, who are subject to overdetection, and men, who may be at risk of underdetection.

Treatment of vocal fold leukoplakia is complicated because it is associated with a high rate of recurrence after excision and it has the potential for progression to malignancy. Authors have presented different approaches to management, one of which is directed serial excisional biopsies. Ideally, a topical or systemic agent could be administered to eradicate this troublesome condition. We present the case of a patient with an 8-year history of vocal fold leukoplakia treated with directed serial biopsies who was subsequently diagnosed with non-small-cell lung cancer and treated with erlotinib. He experienced a complete resolution after 2 months of erlotinib therapy for his lung cancer. Immunohistochemistry confirmed that his lesion exhibited a much higher than normal expression of epidermal growth factor receptor (EGFR), which supports the idea that EGFR antagonism may combat EGFR-avid leukoplakia. However, we caution that the clinical observation made herein is an association and should not be misconstrued as a recommendation regarding the safety, efficacy, or economy of using erlotinib for the treatment of vocal fold leukoplakia., Introduction Vocal fold leukoplakia occurs as a result of epithelial hyperkeratosis or dysplasia, and it is considered a precursor to malignant transformation. (1) Controversy exists over its natural history. It [...]

Africa’s worsening air pollution has received too little attention. We argue that actions are needed in energy transition management, transport emission regulation and waste management to protect Africa’s air quality.

Implementation of an effective new product development (NPD) system entails dedication and understanding not only of the NPD system but also with regards to the totality of the firm implementing the system. A case study of ABC Electronics, a company that designs and manufactures information technology (IT) products, shows that it effectively formulated and implemented the NPD system through appointment of an effective NPD manager, discussions with corporate management and securing the involvement of the entire work force, among others.

Many states now mandate early screening for dyslexia, but vary in how they address these mandates. There is confusion about the nature of screening versus diagnostic assessments, risk versus diagnosis, concurrent versus predictive validity, and inattention to indices of classification accuracy as the basis for determining risk. To help define what constitutes a screening assessment, we summarize efforts to develop short (3–5 min), teacher-administered screens that used multivariate strategies for variable selection, item response theory to select items that are most discriminating at a threshold for predicting risk, and statistical decision theory. These methods optimize prediction and lower the burden on teachers by reducing the number of items needed to evaluate risk. A specific goal of these efforts was to minimize decision errors that would result in the failure to identify a child as at risk of dyslexia/reading problems (false negatives) despite the inevitable increase in identifications of children who eventually perform in the typical range (false positives). Five screens, developed for different periods during kindergarten, Grade 1, and Grade 2, predicted outcomes measured later in the same school year (Grade 2) or in the subsequent year (Grade 1). The results of this approach to development are applicable to other screening methods, especially those that attempt to predict those children at risk of dyslexia prior to the onset of reading instruction. Without reliable and valid early predictivescreening measures that reduce the burden on teachers, early intervention and prevention of dyslexia and related reading problems will be difficult.

In this cluster randomized control trial study, the authors explored the efficacy of an intervention designed to improve second‐grade English learners’ knowledge of challenging, high‐utility English vocabulary. The authors also examined whether the intervention had a differential effect on content words that differ on two attributes (cognate status and abstractness designation) and whether the effects lasted across time. Within schools, teachers were randomly assigned to treatment or control conditions, resulting in 12 treatment classrooms and 10 control classrooms. Teachers in the treatment condition developed vocabulary using six methods: interactive shared reading, direct instruction of individual words, instruction in cognate use, activities to foster word consciousness and reinforce instructed words, and use of visual and linguistic supports. Teachers in the control condition read the same books with the target vocabulary inserted into the stories. Findings on the curriculum‐based and standardized measure of vocabulary indicated that the intervention implemented for four 50‐minute lessons per week for 18 weeks was effective in helping English learners acquire challenging high‐utility school‐relevant vocabulary (Cohen’s d= 1.88 for content words; d= 0.41 for connecting words; d= 0.47 for the Test of Oral Language Development). The effects differed by word characteristics, with higher effect sizes for words that are noncognates (d= 1.57 for both concrete and abstract noncognates; d= 1.02 concrete cognates; d= 0.81 for abstract cognates). Ten months after the intervention, treatment students still outperformed control students on content vocabulary learned during the intervention (d= 1.31). This study helps validate a multifaceted approach to vocabulary intervention and research.

PurposeDysphagia occurs as a component of a wide variety of diseases and conditions. When unrecognized or poorly managed, dysphagia can result in malnutrition, volume depletion, and reduced quality of life, as well as aspiration, pneumonia, and death. This document focuses specifically on oropharyngeal dysphagia. The modified barium swallow study (MBSS) is a fluoroscopic motion study used to evaluate oropharyngeal anatomy and swallowing physiology in real time. It is typically performed by a speech-language pathologist together with a radiologist and often assisted by a radiologic technologist. Because oropharyngeal dysphagia has such a varied presentation, the guidance to diagnose and treat oropharyngeal dysphagia in the United States falls under the purview of several professional societies and organizations. However, a thorough review of available practice guidelines and appropriateness criteria issued to date reveals a deficit of up-to-date, comprehensive, evidence-based information on the diagnosis and evaluation of oropharyngeal dysphagia. Specifically, a lack of quality guidance on the ordering, performance, and reporting of the MBSS has hindered efforts to improve standardization and ensure quality continuity of care.MethodIn 2019, a group with expertise in oropharyngeal dysphagia (speech-language pathologists, radiologists, and referring physicians) convened with the goal of specifying a core set of expert recommendations/best practices to achieve a high-quality MBSS.ResultsHere, we present the results of the participants' discussions and provide consensus recommendations regarding ordering, performing, and reporting an MBSS.ConclusionThe overarching goal of this summary is to emphasize the need for and encourage the development of MBSS practice guidelines to support clinicians and patients.

Even though ladders have been around for most of recorded history, they haven't changed much in function and design since their primitive origins. This simple design is so practical almost [...]

The psychometric properties of the two halves the Washington University Sentence Completion Test (SCT) Form 81 were examined by comparing the fit of structural equation models representing parallel, tau-equivalent, and congeneric properties. Data for these models were based on item-sum scores for the two halves of the SCT and eight measures of aspects of ego development, the construct purportedly measured by the SCT. The data were from a sample of 265 adults. The results suggest that the parallel model provides both a parsimonious and good fit for the data. These results provide empirical justification for those users of the SCT who have the need for shorter, interchangeable, and reliable forms of the test.