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El artículo analiza el impacto del contenido emocional de la comunicación universitaria en los estudiantes, y su importancia para elegir el centro de movilidad. Se utilizó una muestra de 201 estudiantes españoles durante sus prácticas Erasmus. Se realizaron entrevistas, acompañadas de un experimento biométrico con el software Noldus Face Reader que analiza las expresiones faciales. Como resultado se obtuvo que el prestigio de la universidad no es tan relevante, siendo la transmisión de emociones de felicidad el elemento más importante en la comunicación universitaria para atraer talento. Se discuten los resultados y su utilidad para el marketing educativo.

Despite the current screening approach for Cushing syndrome (CS), delayed diagnosis is common due to broad spectrum of presentation, poor discriminant symptoms featured in diabetes and obesity, and low clinical index of suspicion. Even if initial tests are recommended to screen CS, divergent results are not infrequent. As global prevalence of type 2 diabetes and obesity increases, CS may not be frequent enough to back routine screening to avoid false-positive results. This represents a greater challenge in countries with limited health resources. The development of indexes incorporates clinical features and biochemical data that are largely used to provide a tool to predict the presence of disease. In clinical endocrinology, indexes have been used in Graves’ ophthalmology, hirsutism, and hypothyroidism. The use of clinical risk scoring system may assist clinicians in discriminating CS in the context of at-risk populations and, thus, may provide a potential intervention to decrease time to diagnosis. Development and validation of clinical model to estimate pre-test probability of CS in different geographic source population may help to establish regional prediction model for CS. Here, we review on the latest progress in clinical risk scoring system for CS and attempt to raise awareness for the use, validation, and/or development of clinical risk scores in CS.

Background Management of gastric adenoma and early gastric cancer requires endoscopic resection. This can often be achieved with endoscopic mucosal resection (EMR), which has been shown to be effective with a good safety profile. One disadvantage of EMR is that it is often completed piecemeal, leading to indeterminant margins and higher rates of recurrences that require additional intervention. Endoscopic submucosal dissection (ESD) is a more advanced endoscopic resection technique that has been shown to be more effective than EMR at en-bloc resection. ESD requires high technical proficiency but it is becoming more widely available in western countries. Purpose The purpose of this study is to report on the outcomes and rates of complications of gastric ESD completed in a tertiary centre in British Columbia. Method All gastric ESD was completed by a senior therapeutic endoscopist who has previously received training in Japan. Retrospective data were collected on all gastric ESD procedures done in St. Paul’s Hospital from May 7th, 2015, when the procedure first became available, to Aug 30th, 2022. Inclusion criteria were all adults who have undergone ESD for resection of a gastric lesion. Exclusion criteria were patients younger than 18. Data collected included demographic variables, polyp characteristics, procedural outcomes, and complications. Result(s) A total of 49 ESD procedures were completed. The mean size of the resected lesions was 25.3 mm (range: 5 – 100 mm). Technical success, defined as successful resection of all polypoid tissue, was achieved in 48/49 procedures (98.0%). En bloc resection was achieved in 42/48 (87.5%) completed ESD. The rate of R0 resection was also 42/48 (87.5%). Curative resection, defined as technically successful ESD with an R0 margin and no lymphovascular invasion, was achieved in 41/49 (83.7%) of the cases. In our cohort, 8 patients had adenocarcinoma, 5 of which had a curative resection with no evidence of recurrence. None of the ESD resulted in any intra-procedural or delayed perforation. 5/49 (10.2%) patients had clinically significant post-endoscopic resection bleeding. Out of 37 patients that completed follow-up, 3 (8.1%) had recurrence, and all of them were managed endoscopically. 4/49 (8.2%) of patients required surgery post-ESD. Conclusion(s) In our cohort, ESD is an effective endoscopic resection modality for gastric lesions with a high rate of technical success and curative resection. Despite a deeper plane of resection versus other endoscopic resection modalities, its complication rate remains low. Although ESD requires high technical proficiency, its favorable outcomes along with low rates of complication make ESD highly feasible for the resection of gastric lesions. Further research will be needed to study the implementation and outcomes of ESD in a western setting. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared

Background Iatrogenic perforation is arguably the most feared adverse event associated with endoscopy. Current American Society for Gastrointestinal Endoscopy (ASGE) and European Society of Gastroenterology Endoscopy (ESGE) guidelines recommend endoscopic closure as the first-line treatment strategy. Historically, this has been achieved using through-the-scope clips (TTSC). Given the emergence of alternative endoscopic closure techniques including over-the-scope clips (OTSC) and endoscopic suturing, we sought to provide an updated review of the literature. Purpose To review endoscopic closure techniques following iatrogenic perforation during screening or therapeutic endoscopy. Method Based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Guidelines, an electronic search of MEDLINE and EMBASE from June 1st, 1946 – Oct 10th, 2022 was performed. Inclusion criteria was limited to English full-text original citations, with case reports, and cohorts with < 3 patients excluded. Our primary objective was to assess complete defect closure after attempted endoscopic treatment. Outcomes were stratified by modality (TTSC, OTSC, endoscopic suturing) and chronologically based on a previous well received systematic review. Result(s) A total of 2549 citations were identified in our electronic search, of which 34 were included representing 830 perforations. Overall, successful endoscopic closure was achieved in 763 cases (91.9%). When stratified by endoscopic closure techniques, range estimates for successful endoscopic closure was 71% – 100%, 57% - 100%, and 100% for TTSC, OTSC and endoscopic suturing respectively. When stratifying chronologically, an improvement in TTSC closure was identified. Conclusion(s) Endoscopic defect closure, including TTSC, OTSC and endoscopic suturing, are effective in the management of iatrogenic perforations with increasing TTSC performance over time. It remains the primary treatment strategy for iatrogenic perforation. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared

Background The management of neoplastic lesions at the anorectal junction remains debated. Endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) have emerged as the primary endoscopic modalities of choice. Purpose We sought to compare the performance of ESD and EMR in resection of anorectal neoplasia. Method Two authors independently searched MEDLINE, EMBASE and Cochrane Libraries (Jan 2000 – Aug 2021) for citations evaluating the performance of endoscopic resection techniques (ESD, EMR) for lesions involving the anorectal junction (defined as within 20mm of the dentate line). The frequencies and 95% confidence intervals (95% CI) of technical success (complete removal of all neoplastic tissue at index procedure), clinically significant post-endoscopic resection bleeding (CSPEB), delayed perforation, recurrence and referral to surgery were assessed using random-effects modelling. Result(s) We included 11 studies (total 563 patients: 414 ESD, 149 EMR) of which nine were ESD and two were EMR studies. Technical success was achieved in 97.2% overall (95% CI 94.8%-98.5%, ESD 97.5% and EMR range 93.9%-98.0%). Clinically significant post-endoscopic resection bleeding occurred in 4.3% (95% CI 1.6%-11.1%, ESD 3.0% and EMR range 8.2%-11.0%). Delayed perforation was not identified. Recurrence at first screening colonoscopy occurred in 4.8% (95% CI 1.9%-11.7%, ESD 3.0% and EMR range 15.4%-18.4%). Referral to surgery for any reason occurred in 5.9% (95% CI 4.3%-8.0%, ESD 6.9%, EMR range 2.0%-3.0%). Conclusion(s) ESD and EMR demonstrate high frequencies of technical success but may have different rates of adverse events and recurrence. More studies investigating lesions at the anorectal junction should be conducted including head-to-head analyses between ESD and EMR for low-risk anorectal junction neoplasia. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared

The degradation of terrestrial ecosystems may change the perceived value of destinations for tourists. This article analyses tourists’ travel decisions when the land ecosystems of the destinations they are planning to visit are threatened by climate change impacts. More specifically, it analyses tourists’ willingness to pay for their holidays at island destinations endangered by the increase in forest fires, terrestrial wildlife losses, water shortages, and damages to infrastructure and cultural heritage. With this aim in mind, a discrete choice model was designed and empirically tested with a representation of European travellers, using an alternative specific conditional logistic regression. The results show that the sharp increase in the occurrence of wildfires has had the greatest negative impact on tourists’ willingness to pay for their next holiday at the affected tourist destination, followed by severe losses in terrestrial wildlife and significant damage to cultural heritage. This study highlights the importance of having accurate information on future climate change conditions impacting land attributes at the local level, not only to be more effective in the early prevention of threats to prioritise but also to confront the potential damage to the tourism economy more efficiently.

The importance of fishing tourism for destinations is often analysed through the expenditure levels of tourists, with image, satisfaction and loyalty being under-researched areas. This article empi...

Background Endoscopic resection is the standard of care for the management of colorectal polyps. Larger and more complex polyps require endoscopic mucosal resection (EMR). While complications have been low, EMR is often piecemeal, resulting in indeterminant margins and often a higher recurrence rate. Endoscopic submucosal dissection (ESD) is an advanced endoscopic resection technique with a higher rate of en bloc resection. While more data exist for the resection of gastric lesions with ESD, ESD is becoming more widely used in western countries for the resection of colorectal lesions. Purpose The purpose of this study is to report on the outcomes and rates of complications for colorectal ESD completed in a tertiary centre in British Columbia. Method All colorectal ESD was completed by a senior therapeutic endoscopist who has previously received training in Japan. Retrospective data were collected on all colorectal ESD procedures done in St. Paul’s Hospital from July 11th, 2016, when the procedure first became available, to Aug 30th, 2022. Inclusion criteria were all adults who have undergone ESD for resection of a colorectal lesion. Exclusion criteria were patients younger than 18. Data collected included demographic variables, polyp characteristics, procedural outcomes, and complications. Result(s) A total of 39 ESD procedures were completed. The mean size of the resected lesion was 30.4 mm (range: 5 – 60 mm). Technical success, defined as successful resection of all polypoid tissue, was achieved in 35/39 procedures (89.7%). En-bloc resection was achieved in 27/35 (77.1%) of the completed ESD. The rate of R0 resection was 22/35 (62.9%). Curative resection, defined as technically successful ESD with R0 margin and no lymphovascular invasion, was achieved in 23/39 (59.0%) of the cases and the majority of the patients with non-curative resection that underwent endoscopic surveillance had no recurrence on follow-up. In our cohort, 3/39 (7.7%) patients had adenocarcinoma. None of the ESD resulted in any intra-procedural or delayed perforation. 3/39 (7.7%) patients had clinically significant post-endoscopic resection bleeding. Out of 24 patients that completed follow-up, 4 (16.7%) had recurrence at the resection site that was managed endoscopically. 4/39 (10.3%) of patients required surgery post-ESD. Conclusion(s) In our cohort, ESD is an effective endoscopic resection modality for the management of colorectal adenomas and early adenocarcinoma with a high rate of technical success and low rates of complications. Although the rate of curative resection was low, most were the result of R1 or Rx resection and a majority of the follow-ups in this subgroup demonstrated no further recurrence. The rate of en bloc resection is high, especially given the average size of adenomas in this cohort. Although ESD requires high technical proficiency, its favorable outcomes and low complication rates make ESD highly feasible for the resection of colorectal lesions. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared

Climate change is a critical sustainability challenge for islands and their main economic sectors. Rising sea levels, extreme temperatures, and drier conditions are the impacts with the most significant potential to amplify the economic damage on islands. However, their isolation and natural conditions bring about some leeway to respond to climate impacts on their terms. This paper aims to provide a local-level analysis and ranking of alternative adaptation pathways in an island context through the stakeholders’ lens. This study reviews the latest advancements in adaptation science and proposes a catalogue of adaptation and risk management options that feed a participatory assessment and ranking by local stakeholders. The research was conducted on the island of Sicily (Italy) and saw the participation of high-level experts and tourism, energy, and maritime transport representatives. It employs a sequential process of four ordered steps oriented towards adaptation planning and stakeholders’ engagement. The process reveals breaches between what stakeholders’ would prioritise when designing policy pathways and their opinion about the most beneficial and balanced adaptation programmes across the sustainability criteria. Results indicate that, according to stakeholders, the priorities are to prepare the energy, tourism, and maritime transport sectors to confront future climate-related events more efficiently. Other transformational actions to ensure long-term social-ecological resilience, which requires significant structural changes and substantial investments, are not at the core of the public needs.

BACKGROUND: The presence of predominant pain in the arm vs the neck as a predictor of postoperative outcomes after anterior cervical discectomy and fusion (ACDF) has been seldom reported; therefore, the purpose of this study was to determine whether patients with predominant neck pain improve after surgery compared to patients with predominant arm pain or those with mixed symptoms in patients undergoing ACDF for radiculopathy. METHODS: A retrospective cohort study was conducted on patients who underwent ACDF at a single center from 2016 to 2018. Patients were split into groups based on preoperative neck and arm pain scores: neck (N) pain dominant group (visual analog scale [VAS] neck ≥ VAS arm by 1.0 point); neutral group (VAS neck < VAS arm by 1.0 point); or arm (A) pain dominant group (VAS arm ≥ VAS neck by 1.0 point), using a threshold difference of 1.0 point. Subsequently, individuals were substratified into 2 groups based on the arm to neck pain ratio (ANR): non-arm pain dominant defined as ANR ≤1.0 and arm pain dominant (APD) defined as ANR >1.0. Patient-reported outcome measurements including Neck Disability Index (NDI), Physical Component Score-12, and Mental Component Score (MCS-12) were compared between groups. RESULTS: No significant differences between groups when stratifying patients using a threshold difference of 1.0 point. When stratifying patients using the ANR, those in the APD group had significantly higher postoperative MCS-12 (P = 0.008) and NDI (P = 0.011) scores. In addition, the APD group showed a greater magnitude of improvement for MCS-12 and NDI scores (P = 0.043 and P = 0.038, respectively). Multiple linear regression showed that the A and the APD groups were both independent predictors of improvement in NDI. CONCLUSION: Patients with dominant arm pain showed significantly greater improvement in terms of MCS-12 and NDI scores compared to patients with dominant neck pain. CLINICAL RELEVANCE: To compare the impact of ACDF on arm and neck pain in the context of cervical radiculopathy using patient-reported outcome measures as an objective measurement. LEVEL OF EVIDENCE: 3.

Background The Lower Quarter Y-Balance Test (YBT-LQ) has been shown to be reliable for assessing dynamic balance in children and adolescents. However, limited research is available about the effects of leg dominance on YBT-LQ performance in adolescents. In addition, there is no consensus on the use of maximum reach or mean reach distance being a better measure of YBT-LQ performance. Hypothesis/Purpose The purposes of this study were to determine if there is a difference in the YBT-LQ performance between the dominant and non-dominant limbs in non-athlete adolescents, and to compare the reliability of the maximum reach scores to that of the mean reach scores in this population. Study Design Prospective cohort study Methods Twenty-six healthy non-athlete adolescents (13.6 ± 1.0 years, 22 girls, 4 boys) performed the YBT-LQ on two separate days while the same investigator scored their performance. Paired t-tests were used to compare reach distances on dominant and non-dominate stance limbs. Intraclass correlation coefficients (ICC3,1) were calculated for the maximum and mean reach distances for three directions (anterior, posterolateral, posteromedial) and the composite scores on each limb. Results There was no significant difference in YBT-LQ performance between dominant and non-dominant stance limbs (p > 0.05). Overall, the between-day intra-rater reliability for maximum reach and mean reach scores was moderate-to-good for both limbs (ICC3,1 = 0.59 - 0.83), but was poor for the composite score on the dominant limb (ICC3,1 = 0.42) and maximum anterior reach on non-dominant limb (ICC3,1 = 0.48). Conclusion Limb dominance does not seem to be a factor for YBT-LQ performance in this population. The YBT-LQ appears to be a reliable tool for dynamic balance assessment in non-athlete adolescents using the individual score of each direction. The use of mean reach measures seems to slightly improve reliability, specifically the anterior reach direction, in this population. Level of Evidence Level 2b

Background International travel can expose travelers to a number of health risks. Pretravel consultation (PC) helps mitigate risk and prepare travelers for health concerns that might arise. The assessment of risk, mitigation strategies, and relevance of pretravel advice is dependent on how closely travelers adhere to their planned travel itinerary and activities. We determined the proportion of returned travelers whose completed travel experiences differed from their stated travel itineraries, and identified discrepancies that significantly altered the traveler’s health risk and would have required alternative counseling during their PC. Methods We conducted a prospective cohort study at the SickKids’ Family Travel Clinic between October 2014 and November 2015. Returned travelers who completed a post-travel survey were included. Pretravel consultation assessments and post-trip surveys were compared to identify discrepant trip experiences. Results A total of 389 travelers presented to the clinic for a PC during the study period and 302 (77.6%) were enrolled. Post-travel surveys were received from 119 (39.4%) participants, representing 101 unique itineraries. The median participant age was 36.3 years (IQR 26.6–47.5) and there were 73 female travelers (61%). Most participants (n = 87,73%) were healthy as well as Canadian born (n = 84, 71%). A quarter of travelers were visiting friends and relatives (VFR) (n = 30, 25.2%). The vast majority of returned travelers (n = 109, 92%) reported discrepant trip experiences involving trip duration, countries visited, accommodations, environmental surroundings and/or activities. Almost two thirds of these individuals (n = 68, 62%) would have required alternative pretravel counseling. We did not identify any demographic or planned trip characteristics that predicted discrepant trip experiences requiring alternative pretravel counseling. Conclusions The majority of travelers reported discrepant trip experiences and the discrepancies often affected health risk. Therefore, clinicians should consider providing broader counselling during the PC as discrepancies from planned travel are common.

Mineral dust particles are one of the most abundant types of ice nucleating particles in the atmosphere. During atmospheric transport, these particles can be coated with water-soluble solutes, whic ...

This article conducts a qualitative meta-analysis of papers addressing the topic of climate change impacts on beach loss and degradation, and its relation to tourist behaviour (destination choice, willingness to re-visit, expenditure and willingness to pay). The main aim is to identify values that can be used in future research works in the context of island tourism. We found that the strong specialisation and fragmentation of data and methods limit the transferability potential of previous research analysing climate-induced effects on beaches and tourist behaviour. Researchers from different fields bring their own conceptual models which often address similar problems but use different lenses and measurement units. Among the available studies, the ones with usable potential in a value transfer context are related to willingness to pay for adaptation measures. Overall, findings confirm that a greater transparency in the methodologies used to elicit values and a multidisciplinary approach are needed to ensure a more sustainable use of the information in order to fill knowledge gaps that still hinder the study of climate change.

This paper aims to assess the relationships between tourists’ negative evaluation of key management areas in the cultural city, their overall satisfaction and future intentions. More specifically, this paper proposes a covariance-based structural equations model (CB-SEM) to assess the influence of tourists’ dissatisfaction caused by failures in tourist and cultural services, hygiene and infrastructure on their overall satisfaction with the cultural trip and their intentions to repeat it. Using data collected from 1500 tourists visiting Old Havana on a cultural trip, this paper confirms that a negative opinion on the management of hygiene, cleanliness and crowding is dominant in explaining cultural tourists’ lower levels of satisfaction. In addition, this was found to be the only factor with a negative impact on tourists’ intentions to revisit the city in the future. The results are useful for helping managers of cultural destinations to distinguish the areas that are most relevant in their attempt to promote satisfaction and loyalty in the context of cultural tourism.

Background The predicted growth of Canadians aged 65+ and the resultant rise in the demand for specialized geriatric services (SGS) requires physician resource planning. We updated the 2011 Canadian Geriatrics Society physician resource inventory and created projections for 2025 and 2030. Methods The number and full-time equivalents (FTEs) of geriatri­cians and Care of the Elderly (COE) physicians working in SGS were determined. FTE counts for 2025 and 2030 were estimated by accounting for retirements and trainees. A ratio of 1.25/10,000 population 65+ was used to predict physician resource requirements. Results Between 2011 and 2019 the number of geriatricians and COE physicians increased from 276 (235.8 FTEs) and 128 (89.9 FTEs), respectively, to 376 (319.6 FTEs) and 354 (115.5 FTEs). This increase did not keep pace with the 65+ population growth. The current gap between supply and need is expected to increase. Discussion The physician supply gap is projected to widen in 2025 and 2030. Increased recruitment and interdisciplinary team-based care, supported by enhanced funding models, and full integra­tion of COE physicians in SGS could reduce this increasing gap. In contrast to pediatrician supply in Canada, the specialist physician resources available to the population 65+ reflect a disparity.

The mechanisms by which DNA alleles contribute to disease risk, drug response, and other human phenotypes are highly context-specific, varying across cell types and under different conditions. Human induced pluripotent stem cells (hiPSCs) are uniquely suited to study these context-dependent effects, but to do so requires cell lines from hundreds or potentially thousands of individuals. Village cultures, where multiple hiPSC lines are cultured and differentiated together in a single dish, provide an elegant solution for scaling hiPSC experiments to the necessary sample sizes required for population-scale studies. Here, we show the utility of village models, demonstrating how cells can be assigned back to a donor line using single cell sequencing, and addressing whether line-specific signaling alters the transcriptional profiles of companion lines in a village culture. We generated single cell RNA sequence data from hiPSC lines cultured independently (uni-culture) and in villages at three independent sites. We show that the transcriptional profiles of hiPSC lines are highly consistent between uni- and village cultures for both fresh (0.46 < R < 0.88) and cryopreserved samples (0.46 < R < 0.62). Using a mixed linear model framework, we estimate that the proportion of transcriptional variation across cells is predominantly due to donor effects, with minimal evidence of variation due to culturing in a village system. We demonstrate that the genetic, epigenetic or hiPSC line-specific effects on gene expression are consistent whether the lines are uni- or village-cultured (0.82 < R < 0.94). Finally, we identify the consistency in the landscape of cell states between uni- and village-culture systems. Collectively, we demonstrate that village methods can be effectively used to detect hiPSC line-specific effects including sensitive dynamics of cell states.

The degradation of terrestrial ecosystems may change the perceived value of destinations for tourists. This article analyses tourists’ travel decisions when the land ecosystems of the destinations they are planning to visit are threatened by climate change impacts. More specifically, it analyses tourists’ willingness to pay for their holidays at island destinations endangered by the increase in forest fires, terrestrial wildlife losses, water shortages, and damages to infrastructure and cultural heritage. With this aim in mind, a discrete choice model was designed and empirically tested with a representation of European travellers, using an alternative specific conditional logistic regression. The results show that the sharp increase in the occurrence of wildfires has had the greatest negative impact on tourists’ willingness to pay for their next holiday at the affected tourist destination, followed by severe losses in terrestrial wildlife and significant damage to cultural heritage. This study highlights the importance of having accurate information on future climate change conditions impacting land attributes at the local level, not only to be more effective in the early prevention of threats to prioritise but also to confront the potential damage to the tourism economy more efficiently.

Background Neoplastic lesions at the ileocecal valve (ICV) represent a complex lesion subgroup given the unique anatomical characteristics of this location. Both endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are established techniques for colorectal neoplasia but comparative analyses for ICV lesions are lacking. Aims Evaluate the performance of EMR and ESD for ICV neoplasia. Methods Between Jan 2000 to Aug 2021, two authors independently searched MEDLINE, EMBASE and Cochrane Libraries for relevant citations evaluating the performance of either EMR and/or ESD for ICV neoplasia; defined as lesions involving at least one component of the ICV complex. The rate of technical success (complete removal of all neoplastic tissue during index procedure of those lesions deemed amenable to endoscopic resection), clinically significant post-endoscopic resection bleeding (CSPEB), delayed perforation, and recurrence were assessed. Meta-analysis was performed using a random-effects model. Results Nine studies (367 patients, 252 EMR, 115 ESD) were included in the analysis. Successful removal of all visible neoplastic tissue of those deemed amenable to endoscopic resection was 98.1% (EMR 99.6%, ESD 97.4%). Of note, only 2 studies, both assessing EMR, provided data on lesions which were not considered for endoscopic resection ranging from 5.6–23.7%. Average procedure time ranged from 45–49 minutes for EMR and 52–191 minutes for ESD. Clinically significant post-endoscopic resection bleeding occurred in 6.2% (EMR 9.4%, ESD 4.4%). Delayed perforation occurred in 0.6% (EMR 0.4%, ESD 2.0%). Recurrence occurred in 3.1% (EMR 13.2%, ESD 1.9%). Conclusions Endoscopic resection, both with EMR and ESD, demonstrates high technical success and good adverse event profiles amongst ICV neoplasia deemed amenable for endoscopic resection. Funding Agencies None