Health-Related Quality of Life After Breast Reconstruction : Comparing Outcomes Between Reconstruction Techniques Using the BREAST-Q

Background Reconstruction of the breast following mastectomy can improve patients' health-related quality of life (HRQL). We aimed to assess HRQL in women after mastectomy and breast reconstruction and to identify differences in HRQL related to the reconstruction method used. Methods A cross-sectional study was performed on patients who had undergone breast reconstruction in Helsinki University Hospital between 08/2017 and 7/2019. The postoperative HRQL was assessed using the BREAST-Q (2.0) Reconstruction Module. The results were compared between patients with different reconstruction methods using the Kruskal-Wallis test. Results A total of 146 patients were identified. Microvascular flaps (n = 77) were the most common method for primary breast reconstruction, followed by latissimus dorsi (LD) flaps (n = 45), fat grafting (n = 18) and implant reconstruction (n = 6). The satisfaction with breasts was high in all groups (median 61, IQR 49-71). The physical well-being of the chest was high regardless of the reconstructive method (median 100, IQR 80-100). However, women with fat grafting reported more adverse effects of radiation (median 17, IQR 14-17 vs. 18, IQR 17-18 for other groups, p = 0.02). Donor site morbidity was low, and patients reported high satisfaction with the back (median 66/100, IQR57-90) and abdomen (median 9/12, IQR 8-10), and physical well-being of the back (median 61/100, IQR 53-70) and abdomen (median 65/100, IQR 60-86). Conclusions The patient-reported HRQL after breast reconstruction is high. Most women report being satisfied with the reconstruction, irrespective of the reconstruction method used. The reconstruction method can thus be chosen individually in cooperation between the patient and the surgeon.Peer reviewe

Association between sagittal spinal alignment and mechanical complications after primary total hip arthroplasty : a systematic review

Objective: Total hip arthroplasty (THA) affects pelvic posture and spinal alignment. These postural changes may further predispose patients to mechanical complications (MCs) after THA. The aim of this study was to conduct a systematic review to investigate whether any high-quality studies have assessed the association between sagittal spinal alignment and MCs after primary THA. Methods: Inclusion criteria for studies were adult patients (age ≥18 years), primary THA, pre- and postoperative spinopelvic standing sagittal radiographs acquired preoperatively and at a minimum of 6-month follow-up, measurements of spinopelvic parameters, and reporting of possible MCs after THA. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Results: Six articles met the inclusion criteria. Although several studies confirmed the importance of spinal alignment when planning THA, these mainly investigated pelvic mobility as a risk factor for THA dislocation. Radiological follow-up imaging practices varied, and studies focused on different individual spinopelvic parameters. Conclusion: Based on our study findings, no conclusions can be drawn regarding the association between sagittal spinal alignment and MCs after primary THA. Further research is needed to improve our knowledge of the connection between MCs after THA and sagittal spinal alignment.publishedVersionPeer reviewe

Sustainable innovation policy advice : outlooks and key messages

Grounded in theoretical assumptions on evidence-based policy-making and participatory advice research, this chapter presents a critical reflection on and discussion of different advisory activities carried out in the CASI project, namely the assessment of sustainable innovation initiatives, policy developments and citizens’ visions.Non peer reviewe

Mechanical complications and reoperations after adult spinal deformity surgery : a clinical analysis with the GAP score

Purpose: Adult spinal deformity (ASD) surgery is prone to postoperative complications, leading to high reoperation rates. The global alignment and proportion (GAP) score is a novel method to predict mechanical complications (MC) based on the optimal parameters related to individual pelvic incidence. The aim of this study was to determine the cut-off point and the predictive value of the GAP score for those MCs that require reoperation. A secondary aim was to investigate the cumulative incidence of MCs requiring reoperation during a long follow-up period. Methods: In total, 144 ASD patients were operated at our institution due to marked symptomatic spinal deformity between 2008 and 2020. The cut-off point and the predictive value of the GAP score for the MCs that required reoperation and the cumulative incidence of reoperated MCs after index surgery were determined. Results: A total of 142 patients were included in the analysis. The risk for having an MC that required reoperation was significantly lower when the postoperative GAP score was < 5 (HR = 3.55, 95% CI: 1.40–9.02). The discriminative power of the GAP score to predict MCs that require reoperation was good with an AUC of 0.70 (95% CI: 0.58–0.81). The cumulative incidence of reoperated MCs was 18%. Conclusion: The GAP score was associated with the risk for MCs that require reoperation. The best predictive value for surgically treated MC was with the GAP score ≥ 5. The cumulative incidence of the reoperated MCs was 18%.publishedVersionPeer reviewe

Immediate versus delayed breast reconstruction : Long-term follow-up on health-related quality of life and satisfaction with breasts

Introduction: Health-related quality of life (HRQL) can be improved by breast reconstruction following mastectomy. The optimal timing of the reconstruction remains unclear. Methods: A cross-sectional study on 338 women who had undergone immediate or delayed breast reconstruction between 08/2017 and 07/2019 was performed. The postoperative HRQL was assessed using the BREAST-Q Reconstruction Module and the 36-Item Short Form Survey (SF-36). Regression analysis was performed for group-wise comparison. Results: A total of 146 (43%) patients participated. Seventy-seven patients (53%) had undergone immediate, and 69 patients (47%) had delayed reconstruction. The median age was 55 years (interquartile ratio [IQR] 50–62) for the Immeda group te, and 60 years (IQR 54–65) for the delayed reconstruction group. The median follow-up time was 2.3 years (IQR 1.8–2.9). No difference between the groups was detected in satisfaction with breasts (median 61, IQR 53–71 vs. 62, IQR 46–71, p = 0.62), physical well-being of the chest (median 100, IQR 80–100 vs. 100, IQR 80–100, p = 0.95) or psychosocial well-being (median 69, IQR 54–83 vs. 62, IQR 54–74, p = 0.19). No difference was detected in the SF-36 domains either. Conclusions: The timing of the breast reconstruction does not affect the postoperative HRQL. Patients with both immediate and delayed breast reconstruction reported high satisfaction with the breast and psychosocial well-being.Peer reviewe

Demonstrating public value to funders and other stakeholders—the journey of ELIXIR, a virtual and distributed research infrastructure for life science data

Open Science is a founding principle of ELIXIR, a pan-European research infrastructure for life science data, with 21 Member countries plus the European Molecular Biology Laboratory. The mission of ELIXIR is to coordinate bioinformatics resources so that they form a single, integrated and pan-European infrastructure, which can be used freely by academic and private-sector researchers across the globe. As a recipient of public and charitable funding, ELIXIR must demonstrate its value, and the need to produce evidence in support of this is intensifying. Our practice-led journey towards demonstrating public value is articulated around five main challenges and, for each, we present our pragmatic approach for tackling it. We begin by showing how we are working towards demystifying what research infrastructures do. We then shed light on the sort of evidence our funders and other stakeholders are asking us for, how this evidence varies in nature and scope, and our tactics to satisfy them. We follow-on by providing our thoughts on possible barriers and solutions to embedding impact evaluation in our activities. Finally, we provide lessons learned, which we believe are sufficiently transferable and will be inspirational to other research infrastructures as they embark on their own journeys to demonstrate public value.publishedVersio

Minästä kiinni – Perusopetuksen oppimateriaali moninaisista identiteeteistä

Ota minästä kiinni, vahvista luokan yhteisöllisyyttä ja opasta oppilaasi kiehtovalle matkalle omiin identiteetteihinsä! Minästä kiinni ja Kielestä koppi -oppimateriaalipari sisältää toiminnallisia, yhteisöllisiä ja innostavia tehtäviä moninaisten identiteettien tarkasteluun, kielitietoiseen oppimiseen sekä monikielisten taitojen kehittämiseen. Tehtäviä tukee tiivis pedagoginen teoriaosuus. Tämän materiaalin avulla opettajan on helppo tuoda opetussuunnitelman edellyttämä kieli- ja kulttuuritietoisuus osaksi opetusta! Minästä kiinni -materiaali tarjoaa opettajalle välineitä jokaisen oppilaan moninaisuuden, identiteettien ja vahvuuksien esiintuomiseen. Lisäksi se herättelee keskustelua yksilön ja yhteiskunnan arvoista, eriarvoisuudesta sekä mahdollisuuksista. Oppimateriaalia voidaan käyttää kaikissa oppiaineissa sekä monialaisissa oppimiskokonaisuuksissa kaikilla perusopetuksen vuosiluokilla. Asioita lähestytään itseilmaisun ja yhdessä tekemisen kautta turvallisessa ilmapiirissä. Materiaali on kehitetty Turun yliopistolla yhteistyössä alan eri asiantuntijoiden ja opettajien kanssa.</p

A Balkán és az Oszmán Birodalom III. : Társadalmi és gazdasági átalakulások a 18. század végétől a 20. század közepéig : Szerbia, Macedónia, Bosznia

High-throughput molecular profiling techniques are routinely generating vast amounts of data for translational medicine studies. Secure access controlled systems are needed to manage, store, transfer and distribute these data due to its personally identifiable nature. The European Genome-phenome Archive (EGA) was created to facilitate access and management to long-term archival of bio-molecular data. Each data provider is responsible for ensuring a Data Access Committee is in place to grant access to data stored in the EGA. Moreover, the transfer of data during upload and download is encrypted. ELIXIR, a European research infrastructure for life-science data, initiated a project (2016 Human Data Implementation Study) to understand and document the ELIXIR requirements for secure management of controlled-access data. As part of this project, a full ecosystem was designed to connect archived raw experimental molecular profiling data with interpreted data and the computational workflows, using the CTMM Translational Research IT (CTMM-TraIT) infrastructure http://www.ctmm-trait.nl as an example. Here we present the first outcomes of this project, a framework to enable the download of EGA data to a Galaxy server in a secure way. Galaxy provides an intuitive user interface for molecular biologists and bioinformaticians to run and design data analysis workflows. More specifically, we developed a tool -- ega_download_streamer - that can download data securely from EGA into a Galaxy server, which can subsequently be further processed. This tool will allow a user within the browser to run an entire analysis containing sensitive data from EGA, and to make this analysis available for other researchers in a reproducible manner, as shown with a proof of concept study. The tool ega_download_streamer is available in the Galaxy tool shed: https://toolshed.g2.bx.psu.edu/view/yhoogstrate/ega_download_streamer