Generating Operative Workflows for Vestibular Schwannoma Resection: A Two-Stage Delphi's Consensus in Collaboration with the British Skull Base Society. Part 2: The Translabyrinthine Approach

Objective An operative workflow systematically compartmentalizes operations into hierarchal components of phases, steps, instrument, technique errors, and event errors. Operative workflow provides a foundation for education, training, and understanding of surgical variation. In this Part 2, we present a codified operative workflow for the translabyrinthine approach to vestibular schwannoma resection. Methods A mixed-method consensus process of literature review, small-group Delphi's consensus, followed by a national Delphi's consensus was performed in collaboration with British Skull Base Society (BSBS). Each Delphi's round was repeated until data saturation and over 90% consensus was reached. Results Seventeen consultant skull base surgeons (nine neurosurgeons and eight ENT [ear, nose, and throat]) with median of 13.9 years of experience (interquartile range: 18.1 years) of independent practice participated. There was a 100% response rate across both the Delphi rounds. The translabyrinthine approach had the following five phases and 57 unique steps: Phase 1, approach and exposure; Phase 2, mastoidectomy; Phase 3, internal auditory canal and dural opening; Phase 4, tumor debulking and excision; and Phase 5, closure. Conclusion We present Part 2 of a national, multicenter, consensus-derived, codified operative workflow for the translabyrinthine approach to vestibular schwannomas. The five phases contain the operative, steps, instruments, technique errors, and event errors. The codified translabyrinthine approach presented in this manuscript can serve as foundational research for future work, such as the application of artificial intelligence to vestibular schwannoma resection and comparative surgical research

Left Hemisphere Specialization for Oro-Facial Movements of Learned Vocal Signals by Captive Chimpanzees

The left hemisphere of the human brain is dominant in the production of speech and signed language. Whether similar lateralization of function for communicative signal production is present in other primates remains a topic of considerable debate. In the current study, we examined whether oro-facial movements associated with the production of learned attention-getting sounds are differentially lateralized compared to facial expressions associated with the production of species-typical emotional vocalizations in chimpanzees.Still images captured from digital video were used to quantify oro-facial asymmetries in the production of two attention-getting sounds and two species-typical vocalizations in a sample of captive chimpanzees. Comparisons of mouth asymmetries during production of these sounds revealed significant rightward biased asymmetries for the attention-getting sounds and significant leftward biased asymmetries for the species-typical sounds.These results suggest that the motor control of oro-facial movements associated with the production of learned sounds is lateralized to the left hemisphere in chimpanzees. Furthermore, the findings suggest that the antecedents for lateralization of human speech may have been present in the common ancestor of chimpanzees and humans approximately 5 mya and are not unique to the human lineage

Obesity and diabetes genes are associated with being born small for gestational age: Results from the Auckland Birthweight Collaborative study

Background: Individuals born small for gestational age (SGA) are at increased risk of rapid postnatal weight gain, later obesity and diseases in adulthood such as type 2 diabetes, hypertension and cardiovascular diseases. Environmental risk factors for SGA are well established and include smoking, low pregnancy weight, maternal short stature, maternal diet, ethnic origin of mother and hypertension. However, in a large proportion of SGA, no underlying cause is evident, and these individuals may have a larger genetic contribution. Methods: In this study we tested the association between SGA and polymorphisms in genes that have previously been associated with obesity and/or diabetes. We undertook analysis of 54 single nucleotide polymorphisms (SNPs) in 546 samples from the Auckland Birthweight Collaborative (ABC) study. 227 children were born small for gestational age (SGA) and 319 were appropriate for gestational age (AGA). Results and Conclusion: The results demonstrated that genetic variation in KCNJ11, BDNF, PFKP, PTER and SEC16B were associated with SGA and support the concept that genetic factors associated with obesity and/or type 2 diabetes are more prevalent in those born SGA compared to those born AGA. We have previously determined that environmental factors are associated with differences in birthweight in the ABC study and now we have demonstrated a significant genetic contribution, suggesting that the interaction between genetics and the environment are important

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Scale development and construct validation of a chimpanzee rating scale

textThe last two decades have seen a surge in published research on primate personality. This surge contrasts with the paucity of research over the preceding century. People interested in primate personality research come from a broad range of fields, but they are all interested in measuring primate personality in a way that is reliable, valid, and practical. This dissertation aims to describe the development and evaluation of the construct validity of a new rating scale in chimpanzees. The scale is based on a bottom-up approach to scale development and was developed using steps from both Uher (2008a,b) and Gosling (1998). As described in Chapter 3, the scale was evaluated by using it to rate 143 chimpanzees at the University of Texas MD Anderson Cancer Center Facility in Bastrop, TX. Twenty-one people who have worked with the chimpanzees between 6 months to 20 years rated the chimpanzees. Chapter 4 describes how inter-class correlation coefficients (ICCs) were used to calculate the reliability of the items on the scale. There was only one item (predictable) that turned out to not be reliable. The other 40 items were included in subsequent analyses. An exploratory factor analysis, as described in Chapter 5, was performed in order to determine the structure underlying the scale. Five methods were used to determine that a six-factor solution fit the data best. The six factors were labeled Reactivity, Dominance, Openness, Extroversion Agreeableness, and Conscientiousness based on the degree to that they correlated with other previous chimpanzees scales that used those labels. The convergent and discriminant validity of the factors was evaluated, as described in Chapter 6, by looking at the predicted relationships between each of the six factors and the variables of sex, age, rearing history, behavior in reaction to a novel stimulus, general behavior, injuries, illnesses, blood chemistry, and cortisol. The results indicate that there is a lack of evidence for convergent validity, but some evidence for discriminant validity of the new chimpanzee rating scale. The discussion in Chapter 7 focuses on the findings from the study as well as strengths and limitations of the new chimpanzee rating scale.Psycholog

The impact of atypical early histories on pet or performer chimpanzees

It is widely accepted that an animal’s early history, including but not limited to its rearing history, can have a profound impact on later behavior. In the case of captive animals, many studies have used categorical measures such as mother reared or human reared that do not account for both the influence of human and conspecific interaction. In order to account for the influence of both human and conspecific early exposure to later behavior, we collected 1385 h of data on 60 chimpanzees, of which 36 were former pets or performers, currently housed at accredited zoos or sanctuaries. We developed a unique metric, the Chimpanzee-Human Interaction (CHI) Index that represented a continuous measure of the proportion of human and chimpanzee exposure subjects experienced and here focused on their exposure during the first four years of life. We found that chimpanzees who experienced less exposure to other chimpanzees as infants showed a lower frequency of grooming and sexual behaviors later in life which can influence social dynamics within groups. We also found chimpanzees who experienced more exposure to other chimpanzees as infants showed a higher frequency of coprophagy, suggesting coprophagy could be a socially-learned behavior. These results help characterize some of the long-term effects borne by chimpanzees maintained as pets and performers and may help inform managers seeking to integrate these types of chimpanzees into larger social groups, as in zoos and sanctuaries. In addition, these results highlight the necessity of taking into account the time-weighted influence of human and conspecific interactions when assessing the impact that humans can have on animals living in captivity

Chimp cortisol dataset

Cortisol samples and CHI values for each subjec