Surgeons’ non-transparent facemasks challenge the physician–patient relationship in the orthopedic outpatient clinic of a tertiary university hospital during the COVID-19 pandemic: a prospective cohort study of 285 patients

Background and purpose — Facemasks play a role in preventing the respiratory spread of SARS-CoV-2, but their impact on the physician–patient relationship in the orthopedic outpatient clinic is unclear. We investigated whether the type of surgeons’ facemask impacts patients’ perception of the physician–patient relationship, influences their understanding of what the surgeon said, or affects their perceived empathy. Patients and methods — All patients with an appointment in the orthopedic outpatient clinic of a tertiary university hospital during the 2-week study period were included. During consultations, all surgeons wore a non-transparent (first study week) or transparent facemask (second study week). Results of 285 of 407 eligible patients were available for analysis. The doctor–patient relationship was evaluated using the standardized Patient Reactions Assessment (PRA) and a 10-point Likert-scale questionnaire ranging from 0 (strongly disagree) to 10 (strongly agree). Results — A non-transparent facemask led to more restrictions in the physician–patient communication and a worse understanding of what the surgeon said. Patients’ understanding improved with a transparent facemask with greatest improvements reported by patients aged 65 years and older (non-transparent: 6 [IQR 5–10] vs. transparent: 10 [IQR 9–10], p < 0.001) and by patients with a self-reported hearing impairment (non-transparent: 7 [IQR 3–7] vs. transparent: 9 [IQR 9–10], p < 0.001). The median PRA score was higher when surgeons wore a transparent facemask (p= 0.003). Interpretation — Surgeons’ non-transparent facemasks pose a new communication barrier that can negatively affect the physician–patient relationship. While emotional factors like affectivity and empathy seem to be less affected overall, the physician–patient communication and patients’ understanding of what the surgeon said seem to be negatively affected

Treatment strategies for scapular spine fractures: a scoping review

Fractures of the scapular spine are relatively rare and can occur without (1) or with (2) association to a reverse shoulder arthroplasty (RSA). To date there are only limited data on the topic. The aim of this scoping review was to identify all available literature and report current treatment concepts. A scoping review was conducted by searching PubMed for relevant studies between 2000 and October 2020. All studies were included which gave detailed descriptions of the treatment strategy. A total of 21 studies with 81 patients were included for the analysis. The mean age over all patients was 62 years (range: 24 to 89 years) and 77% of the patients were female. In 19.8% of cases, the fracture occurred after a traumatic fall from standing height. Eighty-six per cent of the patients had an RSA-associated scapular spine fracture (2). These patients were older compared to group (1) (47 ± 19.6 vs. 76 ± 5.6 years, p = 0.0001) and the majority were female (85%). The majority from group (1) underwent operative treatment with plate fixation. Most patients regained full function and range of motion. RSA-associated fractures (2) were mainly treated non-operatively, with moderate clinical outcome. A high rate of nonunions was reported. Scapular spine fractures without RSA are mainly treated operatively with good clinical results. In association with RSA, scapular spine fractures are mainly treated non-operatively and lead to inferior clinical and radiological results. This scenario seems to be problematic and further research is required to sharpen treatment concepts in this group

Improvising in a crisis: an empirical study of NPD teams in the field of chemistry and chemical engineering

Organizational crises can ruin a firm’s reputation and threaten its survival. The field of chemistry and chemical engineering has experienced this from the classic example of the Tylenol scare to Deepwater Horizon. In most cases, the firm is focused on communicating outwardly with external stakeholders but what about the rest of the firm? New product development (NPD) has delivered firms successfully from such financial peril and therefore can be instrumental in being a solution to a crisis. In this study, new product development teams are investigated to see their role in delivering a firm from an organizational crisis. Using an improvisational NPD approach towards dealing with a crisis, this study looks at teams at 55 firms that are associated with the field of chemistry and chemical engineering to determine whether a perceived crisis by the NPD team can be a motivating factor on the successful outcome of the new product being developed. The results indicate that a perceived crisis by the NPD team is positively correlated with project outcomes of speed and success, brings about improvisation, but does not moderate the relationship between improvisation and NPD project outcomes

Signifying the nation in discourses about Europe:A critical discourse analysis of British newspapers

Diese Dissertation befasst sich mit der Art und Weise, wie die nationale Identität von den Printmedien im vereinigten Königreich in der täglichen Berichterstattung über EU-bezogene Ereignisse reproduziert und vermittelt wird. Sie nimmt die traditionell besorgniserregenden Beziehungen zwischen dem Vereinigten Königreich und der EU als Ausgangspunkt, um zu untersuchen, wie die Debatten über Europa die Frage der nationalen Identität über verschiedene Zeiträume und in verschiedenen Medien geprägt haben. Diese Dissertation ist von kritischen Ansätzen zu medientexten geprägt, genauer gesagt vom Paradigma der kritischen Diskursanalyse, und stützt sich auf Arbeiten, die behaupten, dass es bei der Identitätspolitik darum geht, Unterschiede zu schaffen und die nationale "in-group" mit einer spezifischen "out-group" zu konfrontieren. Im Mittelpunkt dieser Arbeit steht die Frage, wie die britische nationale "in-group" konstruiert wird und welche Vorstellungen von der Nation im Mediendiskurs in Bezug auf die EU als vorherrschende "out-group" vorgeschlagen, bezeichnet und in den Vordergrund gestellt werden.This thesis is concerned with the ways national identity is reproduced and mediated by the print media in the United Kingdom (UK) in the daily coverage of EU-related events. It uses the traditionally apprehensive EU-UK relations as a starting point to explore how debates about Europe have shaped the national identity question throughout different periods of time and across various media outlets. This thesis is profoundly informed by critical approaches to media texts, more precisely by the paradigm of Critical Discourse Analysis (CDA) and draws on a body of research that argues that identity politics is about creating difference and confronting the national 'in-group' with a specific 'out-group'. In this regard, central to this thesis is to explore how the British national ‘in-group’ is constructed and what ideas of the nation are proposed, signified and foregrounded in news media discourse with respect to the EU as the predominant ‘out-group’

Einheit der Differenz:Hybridität, Selbstablehnung und Neuverortung in der Post-DDR-Literatur

Im Zuge des Systemumbruchs 1989/90 in Deutschland war eine ungleiche Verteilung von Definitionsmacht über das Verhältnis von Ost und West zu beobachten, die teilweise bis heute fortwirkt. In gesellschaftlichen Debatten artikulierte sich eine Defizitperspektive auf den Osten, um die Vorrangstellung des vereinten Deutschlands gegenüber der ehemaligen DDR zu legitimieren. Auch ein Teil der (Post-)DDR-Literatur wurde entwertet. Anhand ausgewählter Post-DDR-Romane wird gefragt, wie das Zusammenspiel von hegemonialen sowie marginalisierten Perspektiven und Identitäten ästhetisch verhandelt wird. Dazu werden die Konzepte "Hybridität" und "dritte Räume" des Literaturwissenschaftlers und postkolonialen Theoretikers Homi K. Bhabha herangezogen, erweitert und mit erzählanalytischen Kategorien verknüpft. Diese Publikation verortet die Post-DDR-Literatur in einem globalen Kontext und versteht sich als Beitrag zu einer machtkritisch und diversitätsorientiert ausgerichteten Literaturwissenschaft

Characterization of autofluorescence and quantitative protoporphyrin IX biomarkers for optical spectroscopy-guided glioma surgery

5-Aminolevulinic acid (5-ALA)-mediated fluorescence does not effectively depict low grade gliomas (LGG) or the infiltrative tumor portion of high-grade gliomas (HGG). While spectroscopy improves sensitivity and precision, this is currently limited by autofluorescence and a second protoporphyrin IX (PpIX) fluorescence state at 620 nm. We investigated the autofluorescence to better characterize the present spectra and thus increase PpIX quantification precision and sensitivity. This study included 128 patients undergoing surgery for malignant glioma. 5-ALA (Gliolan) was administered before anesthesia, and fluorescence was measured using a hyperspectral device. It was found that all 2692 measured spectra consisted of contributions from 620 to 634 nm PpIX, NADH, lipofuscin, and flavins. The basis spectra were characterized and their use in spectral unmixing led to 82.4% lower fitting error for weakly fluorescing areas (p < 0.001), and 92.3% fewer false positive tumor identifications in control measurements (p = 0.0065) compared to previous works. They also decreased the PpIX620 contribution, thus halving the mean Ratio620/634 (p < 0.001). The ratio was approximately 0 for HGGs and increasing for LGGs, as demonstrated previously. Additionally, the Ratio620/634, the MIB-1/Ki-67 proliferation index, and the PpIX peak blue-shift were found to be significantly related to WHO grade, fluorescence visibility, and PpIX contribution (p < 0.001), and the value of these three as quantitative biomarkers is discussed

Neural correlates of consciousness in an attentional blink paradigm with uncertain target relevance

Several event-related potentials (ERPs) have been proposed as neural correlates of consciousness (NCC), most prominently the early visual awareness negativity (VAN) and the late P3b component. Highly influential support for the P3b comes from studies utilizing the attentional blink (AB), where conscious perception of a first visual target (T1) impairs reporting a second target (T2) presented shortly afterwards. Recent no-report studies using other paradigms suggest that the P3b component may reflect post-perceptual processes associated with decisionmaking rather than awareness. However, no-report studies are limited in their awareness assessment, and their conclusions have not been tested in an AB paradigm. The present study ( N = 38) addressed these issues using a novel AB paradigm, which reduced decision-making processes by omitting a discrimination task on T2 stimuli and rendering their relevance uncertain. Nevertheless, awareness was assessed trial by trial. Comparing ERPs in response to seen versus unseen T2 stimuli revealed a VAN but no enhanced P3b regardless of whether they were marked as distinct from distractor stimuli or not. Our results corroborate the VAN and challenge the P3b as NCC despite rigorous trial-by-trial assessment of conscious perception. Thus, they support the idea that awareness emerges during early sensory processing