Neuropathy After Herniorrhaphy: Indication for Surgical Treatment and Outcome

Background: Chronic neuropathy after hernia repair is a neglected problem as very few patients are referred for surgical treatment. The aim of the present study was to assess the outcome of standardized surgical revision for neuropathic pain after hernia repair. Methods: In a prospective cohort study we evaluated all patients admitted to our tertiary referral center for surgical treatment of persistent neuropathic pain after primary herniorrhaphy between 2001 and 2006. Diagnosis of neuropathic pain was based on clinical findings and a positive Tinel's sign. Postoperative pain was evaluated by a visual analogue scale (VAS) and a pain questionnaire up to 12months after revision surgery. Results: Forty-three consecutive patients (39 male, median age 35years) underwent surgical revision, mesh removal, and radical neurectomy. The median operative time was 58min (range: 45-95min). Histological examination revealed nerve entrapment, complete transection, or traumatic neuroma in all patients. The ilioinguinal nerve was affected in 35 patients (81%); the iliohypogastric nerve, in 10 patients (23%). Overall pain (median VAS) decreased permanently after surgery within a follow-up period of 12months (preoperative 74 [range: 53-87] months versus 0 [range: 0-34] months; p<0.0001). Conclusions: The results of this cohort study suggest that surgical mesh removal with ilioinguinal and iliohypogastric neurectomy is a successful treatment in patients with neuropathic pain after hernia repai

Does instructional time at school influence study time at university? Evidence from an instructional time reform

Early-life environments can have long-lasting effects on individuals’ later life courses. Interestingly, research on the effects of school reforms has hardly adopted this perspective. Therefore, we investigate a staggered school reform that reduced the number of school years and increased weekly instructional time for secondary school students in most German federal states. We analyze this quasi-experiment in a difference-in-differences framework using nationally representative large-scale survey data on 69,513 students who attended university between 1998 and 2016. Using both TWFE and weighted-group ATT estimators, we find negative effects of reform exposure on hours spent attending classes and on self-study. Moreover, reform exposure increased the time gap between school completion and higher education entry. Our results support the view that research should examine unintended long-term effects of school reforms on individual life courses

Vocabulary, text coverage, word frequency and the lexical threshold in elementary school reading comprehension

Vocabulary knowledge is one of the most important elements of reading comprehension. Text coverage is the proportion of known words in a given text. We hypothesize that text comprehension increases exponentially with text coverage due to network effects and activation of prior knowledge. In addition, the lexical threshold hypothesis states that text comprehension increases faster above a certain amount of text coverage. The exponential relationship between text coverage and text comprehension, as well as the lexical threshold, are at the heart of text comprehension theory and are of great interest for optimizing language instruction. In this study, we first used vocabulary knowledge to estimate text coverage based on test scores from N = 924 German fourth graders. Second, we compared linear with non-linear models of text coverage and vocabulary knowledge to explain text comprehension. Third, we used a broken-line regression to estimate a lexical threshold. The results showed an exponential relationship between text coverage and text comprehension. Moreover, text coverage explained text comprehension better than vocabulary knowledge, and text comprehension increased more quickly above 56% text coverage. From an instructional perspective, the results suggest that reading activities with text coverage below 56% are too difficult for readers and likely inappropriate for instructional purposes. Further applications of the results, such as for standard setting and readability analyses, are discussed

Educational Effectiveness at the End of Upper Secondary School: Further Insights Into the Effects of Statewide Policy Reforms

For several decades, educational policy reforms have been understood as major instruments of educational governance that can impact existing educational practices, for instance, in terms of changes in teaching strategies, learning materials, and students’ achievements (Fullan, 1983). However, in contrast to their huge sociopolitical relevance, scientific evaluations of such reforms are scarce (e.g., OECD, 2015). Rigorous evaluations and deeper investigations of reforms are of special societal importance for several reasons: (a) to legitimize sometimes very controversial legislative policy decisions, which are to be implemented by the educational administration, (b) to test and minimize aspects of educational policies, which are predominantly based on normative arguments and which are now implemented as trial and error policies, and (c) to increase knowledge about when educational policy reforms and curricular programs lead to intended or unintended effects for students (e.g., Black & Wiliam, 2009; McConnell, 2010; Schaffer, Nesselrodt, & Stringfield, 1997). Moreover, formative and summative evaluations of educational policy reforms against objective standards (e.g., Campbell, 1969; Konstantopoulos & Hedges, 2008) are important for decreasing the likelihood of unintended side effects right from the start of their implementation. A systematic, empirically grounded evaluation of educational policy reforms is also of special importance in the face of the high complexity of the multilayered education system, where reforms are usually focused on impacting surface structures (e.g., Elmore, 1995) but shall actually trigger students’ individual educational processes, for instance, competence growth. For these reasons, the effects of policy reforms are generally very complicated to anticipate during the construction and implementation of the reforms (Fusarelli, 2002; Young & Lewis, 2015). In the present dissertation, I investigate a variety of central psychological factors at the student level before and after the implementation of two central educational policy reforms at the end of upper secondary school. In this project, I do not merely analyze the reforms in a loose, isolated framework, but I integrate and critically reflect on them more closely in a disciplinary context. In fact, in this dissertation, I make an attempt to integrate the four studies into a larger, more general context of educational reform, which can be addressed only in an interdisciplinary way. Therefore, this dissertation also focuses on developments in educational policy and educational science in general, which define the central foundations for introducing policy reforms in the education system. Moreover, I also focus on developments related to educational governance and discussions about the increase in demands for evidence-based policy (see Chapters 2 and 3) before outlining the need to include psychological factors and related theoretical models in reform evaluations (see Chapter 3). The two reforms that are analyzed here are the reform of upper secondary school and the G8 reform, both of which were implemented at the beginning of the new millennium in most German states. The two reforms are still critically discussed in the society and by educational policy. In doing this, I use prominent theoretical models, for instance, a model of achievement motivation (e.g., Eccles & Wigfield, 2002) in order to generate appropriate hypotheses and integrate the results of the effects of the reforms into recent research. The reform of upper secondary school mainly implemented mandatory course choice on an advanced course level in upper secondary school and therefore depicts a curricular intensification (CI) reform. The G8 reform reduced overall school time in high track schools (Gymnasium) from a total of 9 to 8 years by means of a compression of school time in terms of an increase in allocated time per week in lower secondary schools. I analyzed the reform of upper secondary school using a large representative sample from Thuringia (Additional Study Thuringia of the National Educational Panel Study) and Baden-Württemberg (TOSCA study; Blossfeld, Rossbach, & Maurice, 2011; Köller, Watermann, Trautwein, & Lüdtke, 2004; Trautwein, Neumann, Nagy, Lüdtke, & Maaz, 2010). Furthermore, I conducted the analysis of the G8 reform by considering a large representative data set from Baden-Württemberg (Additional Study Baden-Württemberg of the National Educational Panel Study; Blossfeld et al., 2011). In Study 1 (Maximizing Gender Equality by Minimizing Course Choice Options? Effects of Obligatory Coursework in Math on Gender Differences in STEM; Journal of Educational Psychology), differential effects of the upper secondary school reform on advanced math, math self-concept, and vocational interests were investigated. Furthermore, potential differences before and after the upper secondary school reform regarding the field of study at university in STEM (science, technique, engineering, and mathematics) subjects were focused on. Results showed that whereas gender differences in math achievement were lower after the reform, differences were larger on all other outcome variables. In spite of these results, no differences before or after the reform were found for the choice of the field of study at university. Study 2 (Putting All Students in One Basket Does not Produce Equality: Gender-Specific Effects of Curricular Intensification in Upper Secondary School; Manuscript submitted for publication) expanded the results of Study 1 by considering data from another German state, namely, Thuringia. In Study 2, it was possible to analyze a broader variety of student outcome measures in English reading, mathematics, biology, and physics, as well as students’ subject- specific self-concepts and interests in these subjects. The results of this study indicated no statistically significant average differences on achievement measures. However, differential effects on English reading and a higher English self-concept in favor of young men were found after the reform, whereas the reform had a negative effect on young women’s math self-concept. In Study 3 (Comparing Apples and Oranges: Reforms can Change the Meaning of Students’ Grades!; Manuscript submitted for publication), analyses of reform effects were extended to school grades. Students’ grades at the end of upper secondary school are of special importance for college and university access and later job employment. However, research has shown striking differences between teacher-assigned grades and standardized student achievement. Furthermore, grades are oftentimes assigned on a norm-referenced basis and are therefore strongly oriented toward a class’ achievement composition, which changed when detracking was introduced by the CI reform. Therefore, Study 3 was focused on the research question of whether students’ standardized achievement differed between before and after the CI reform, given similar grades. Results suggested considerable differences in students’ standardized test achievement before and after the reform, given similar grades. Compared with basic courses, standardized achievement given a similar grade in core courses was higher. However, the opposite pattern was found when comparing achievement between advanced and core courses, given a similar grade. Furthermore, for math these effects were found to vary among high and low grade levels. Finally, Study 4 (The G8 reform in Baden-Württemberg: Competencies, Well-Being, and Leisure Time Before and After the Reform; Zeitschrift für Erziehungswissenschaft) is one of the first studies to investigate effects of the G8 reform at the end of upper secondary school. In contrast to the reform of upper secondary school, the G8 reform increased the time allocated in lower secondary school in order to reduce the total time spent in school by 1 year. Study 4 therefore focused on potential changes in student achievement in mathematics, English reading, biology, and physics from before to after the reform. In addition, potential effects on variables related to students’ well-being (stress and health) and leisure time use were analyzed. Differences between G8 and G9 students were found in English reading, biology, and in well-being measures in favor of the G9 students. All studies in this dissertation investigated the research questions using advanced statistical methods such as multidimensional multiple-group IRT models or structural equation models with continuous indicators and considered survey weights, missing data, and the clustered structure of the data. The reforms that the dissertation focused on were chosen specifically in order to investigate central individual aspects but also have an exemplary, more general function in the context of investigating changes in specific surface structures of the education system on specific psychological factors related to achievement. Similarly, all reforms were implemented in the highest track school, the Gymnasium, which is currently the most frequently attended school type in lower and upper secondary school. The Gymnasium is important because the results of the upper secondary school examination strongly determine whether a student is eligible to enroll in university. In the beginning of this dissertation, I will first provide a general introduction regarding the meaning and expectations of educational policy reforms. I will subsequently integrate this material into the central findings and developments of educational effectiveness research and educational governance in Chapters 2 and 3. After presenting Studies 1 to 4 in Chapter 4, I will outline the strengths and limitations and implications of the dissertation in Chapter 5.Bildungsreformen werden seit einigen Jahrzehnten als zentraler Bestandteil der politischen Steuerung des Bildungswesens verstanden, die Einfluss auf die schulische Bildungspraxis nehmen können und beispielsweise Veränderungen der bestehenden Unterrichtsstrategien, Lernmaterialien und Schülerleistungen intendieren (Fullan, 1983). Trotz ihrer hohen gesellschaftlichen Relevanz sind Bildungsreformen nur selten Gegenstand systematischer Untersuchungen (OECD, 2015). Profunde Evaluationen und vertiefende Analysen von Reformprogrammen sind von besonderer gesellschaftlicher Bedeutung, u.a. zur Legitimierung bildungspolitischer Entscheidungen sowie zur vertieften Untersuchung und Prüfung normativer Programmanteile (z.B. McConnell, 2010). Darüber hinaus ist eine systematische, empirisch fundierte Begleitforschung von Bildungsreformen in besonderer Weise relevant, da in Anbetracht der Komplexität und mehrdimensionalen Struktur des Bildungswesens Effekte von Bildungsreformen einerseits Oberflächenstrukturen betreffen (z.B. Elmore, 1995), jedoch andererseits auch individuelle Bildungsprozesse bei den Schülerinnen und Schülern auslösen und z.B. Kompetenzzuwächse bewirken sollen. Derartige Veränderungen sind ohne vertiefende wissenschaftliche Analysen nur schwer im Entwicklungsprozess der Reform zu antizipieren und im Umsetzungsprozess zu erkennen (Conley, 1994; Fusarelli, 2002; Young & Lewis, 2015). Die vorliegende Dissertation untersucht verschiedene Schülervariablen vor und nach zwei zentralen bildungspolitischen Reformprogrammen am Ende der Sekundarstufe II. Die Reformen werden zum einen in den vier Beiträgen hinsichtlich ihrer jeweiligen Spezifität sowie ihrer inhaltlichen und methodischen Qualität dargestellt. Darüber hinaus werden zum anderen die zugrundeliegenden Beiträge auch in einen größeren und im Grundsatz nur interdisziplinär zu bearbeitenden Kontext eingeordnet. Daher fokussiert die Dissertation ebenfalls zentrale bildungspolitische und wissenschaftliche Entwicklungstendenzen, die den Rahmen von reformpolitischem Handeln im Bildungssektor definieren. In Studie 1 wurden Unterschiede vor und nach der Oberstufenreform in Baden-Württemberg in Bezug auf die Leistung, das Selbstkonzept in Mathematik sowie die beruflichen Interessen der Schülerinnen und Schüler analysiert. Studie 2 erweitert diese Einblicke um Ergebnisse zur Oberstufenreform in Thüringen. In Studie 3 wird auf Grundlage der repräsentativen Datensätze der ersten beiden Studien untersucht, ob sich nach der Oberstufenreform Unterschiede in der kursspezifischen Benotung von Lehrerinnen und Lehrern, bezogen auf die standardisierte Schülerleistung, zeigen. Abschließend werden Unterschiede von Schülerinnen und Schülern vor und nach der G8-Reform in Baden-Württemberg genauer betrachtet. Die Ergebnisse der Studien unterstreichen die besondere Bedeutung der leistungsbezogenen Komposition von Schülerinnen und Schülern und deuten darauf hin, dass vergleichbare Reformprogramme in unterschiedlichen Bundesländern auch zu unterschiedlichen Ergebnismustern führen können. Zusammenfassend verweisen die Studien auf die Notwendigkeit groß angelegter, längsschnittlicher Reformstudien, die eine systematische Untersuchung intendierter und nicht intendierter Effekte ermöglichen

Cytokine clearance in serum and peritoneal fluid of patients undergoing damage control surgery with abdominal negative pressure therapy for abdominal sepsis

Objectives: Open abdomen technique with negative pressure therapy (NPT) is widely used in patients with severe abdominal sepsis. The aim of this study was to evaluate cytokine clearance in serumand peritoneal fluidduringNPT. Methods: This prospective pilot study included six patients with severe abdominal sepsis requiring discontinuity resection and NPT for 48 h followed by planned reoperation. Cytokines (IL6, IL8, IL10, TNFalpha, and IL1beta) were measured in the serum and peritoneal fluid during index operation, on postoperative days 0, 1, and 2. Results: Concentrations of cytokines in peritoneal fluid were higher than in serum. IL10 showed a clearance both in serum (to 16.6%, p=0.019) and peritoneal fluid (to 40.9%, p=0.014). IL6 cleared only in serum(to 24.7%, p=0.001) with persistently high levels in peritoneal fluid. IL8 remained high in both serum and peritoneal fluid. TNFalpha and IL1beta were both low in serum with wide range of high peritoneal concentrations. Only TNFalpha in peritoneal fluid showed significant differences between patients with ischemia vs. perforation (p=0.006). Conclusions: The present pilot study suggests that cytokines display distinct patterns of clearance or persistence in the peritoneal fluid and serumover the first 48 h of treatment in severe abdominal sepsis with NPT

Socio-emotional Skills and the Socioeconomic Achievement Gap

Empirical evidence suggests children’s socio-emotional skills—an important determinant of school achievement—vary according to socioeconomic family background. This study assesses the degree to which differences in socio-emotional skills contribute to the achievement gap between socioeconomically advantaged and disadvantaged children. We used data on 74 countries from the 2018 Programme for International Student Assessment, which contains an extensive set of psychological measures, including growth mindset, self-efficacy, and work mastery. We developed three conceptual scenarios to analyze the role of socio-emotional skills in learning inequality: simple accumulation, multiplicative accumulation, and compensatory accumulation. Our findings are in line with the simple accumulation scenario: Socioeconomically advantaged children have somewhat higher levels of socio-emotional skills than their disadvantaged peers, but the effect of these skills on academic performance is largely similar in both groups. Using a counterfactual decomposition method, we show that the measured socio-emotional skills explain no more than 8.8 percent of the socioeconomic achievement gap. Based on these findings, we argue that initiatives to promote social and emotional learning are unlikely to substantially reduce educational inequality

Measures to Prevent Surgical Site Infections: What Surgeons (Should) Do

Background: The present study was designed to evaluate surgeons' strategies and adherence to preventive measures against surgical site infections (SSIs). Materials and methods: All surgeons participating in a prospective Swiss multicentric surveillance program for SSIs received a questionnaire developed from the 2008 National (United Kingdom) Institute for Health and Clinical Excellence (NICE) clinical guidelines on prevention and treatment of SSIs. We focused on perioperative management and surgical technique in hernia surgery, cholecystectomy, appendectomy, and colon surgery (COL). Results: Forty-five of 50 surgeons contacted (90%) responded. Smoking cessation and nutritional screening are regularly propagated by 1/3 and 1/2 of surgeons, respectively. Thirty-eight percent practice bowel preparation before COL. Preoperative hair removal is routinely (90%) performed in the operating room with electric clippers. About 50% administer antibiotic prophylaxis within 30min before incision. Intra-abdominal drains are common after COL (43%). Two thirds of respondents apply nonocclusive wound dressings that are manipulated after hand disinfection (87%). Dressings are usually changed on postoperative day (POD) 2 (75%), and wounds remain undressed on POD 2-3 or 4-5 (36% each). Conclusions: Surgeons' strategies to prevent SSIs still differ widely. The adherence to the current NICE guidelines is low for many procedures regardless of the available level of evidence. Further research should provide convincing data in order to justify standardization of perioperative managemen

A tailored approach for the treatment of indirect inguinal hernia in adults—an old problem revisited

Purpose: A patent processus vaginalis peritonei (PPV) presents typically as an indirect hernia with an intact inguinal canal floor during childhood. Little is known however about PPV in adults and its best treatment. Methods: A cohort study included all consecutive patients admitted for ambulatory open hernia repair. In patients with a PPV, demographics, hernia characteristics, and outcome were prospectively assessed. Annulorrhaphy was the treatment of choice in patients with an internal inguinal ring diameter of <30mm. Results: Between 1998 and 2006, 92 PPVs (two bilateral) were diagnosed in 676 open hernia repairs (incidence of 14%). Eighty nine of the 90 patients were males, the median age was 34years (range: 17-85). A PPV was right-sided in 67% and partially obliterated in 66%. Forty-one patients had an annulorrhaphy and 51 patients had a tension-free mesh repair. The median operation time was significantly shorter in the annulorrhaphy group (38 vs. 48min, P<.0001). In a median follow-up period of 56months (27-128), both groups did not differ concerning recurrence (1/41 vs. 2/51), chronic pain (3/41 vs. 4/51), and hypoesthesia (5/41 vs. 9/51). There was however a clear trend to less neuropathic symptoms in favor of annulorrhaphy (0/41 vs. 5/51, P < 0.066). Conclusions: PPV occurs in 14% of adults undergoing hernia repair. In selected patients, annulorrhaphy takes less time and is associated with equally low recurrence but less potential for neuropathic symptom

Surgery for non-Covid-19 patients during the pandemic.

In the early phase of the Covid-19 pandemic, mainly data related to the burden of care required by infected patients were reported. The aim of this study was to illustrate the timeline of actions taken and to measure and analyze their impact on surgical patients. This is a retrospective review of actions to limit Covid-19 spread and their impact on surgical activity in a Swiss tertiary referral center. Data on patient care, human resources and hospital logistics were collected. Impact on surgical activity was measured by comparing 6-week periods before and after the first measures were taken. After the first Swiss Covid-19 case appeared on February 25, progressively restrictive measures were taken over a period of 23 days. Covid-19 positive inpatients increased from 5 to 131, and ICU patients from 2 to 31, between days 10 and 30, respectively, without ever overloading resources. A 43% decrease of elective visceral surgical procedures was observed after Covid-19 (295 vs 165, p&lt;0.01), while the urgent operations (all specialties) decreased by 39% (1476 vs 897, p&lt;0.01). Fifty-two and 38 major oncological surgeries were performed, respectively, representing a 27% decrease (p = 0.316). Outpatient consultations dropped by 59%, from 728 to 296 (p&lt;0.01). While allowing for maximal care of Covid-19 patients during the pandemic, the shift of resources limited the access to elective surgical care, with less impact on cancer care