Publication trends among general surgery residents, fellows, and graduates and its relationship to future academic achievement

Background: Medical research is considered a core component of Accreditation Council for Graduate Medical Education (ACGME) residency programs. Through conducting, evaluating, and applying medical research, physicians aim to improve the quality of care for patients and better health outcomes. Our study aims to determine associated factors that influence publication rates before, during, and after general surgery residency.Methods: Our cross-sectional study included a random sample of 50 general surgery residency programs. Using each program's online website, publicly available records were obtained for residents that graduated in 2013-2015. Previous publication information, h-index, medical degree, and fellowship pursued were obtained for each graduate by searching Scopus and PubMed. Microsoft Excel functions were used to calculate descriptive statistics and 95% confidence intervals.Results: Of the 30 included programs, 68 residents were analyzed for sample characteristics and publication rates. Among the 68 graduated residents, the majority, 31 (45.6%) had between 1-5 publications. Of the 68 residents, most pursued a fellowship in Minimally Invasive Surgery (14/68; 20.6%). Most research outcomes reported were during residency with a total of 150 (of 321; 46.7%) publications. Of the 321 total publications recorded, the lowest reported median was before residency.Conclusions: Our study indicated that research outcomes were more prevalent during residency when compared to research outcomes before and after residency. Given that research remains a core part of ACGME general surgery residency programs, it is important for residents to continue progressing their scientific knowledge through continued research. In conclusion, publication rates remain the highest during residency

Pengaruh Penggunaan Platform Penjualan Online Terhadap Pengembangan UMKM

UMKM atau biasa disebut Usaha Mikro Kecil dan Menengah memiliki peranan yang cukup besar bagi masyarakat Indonesia. UMKM berkontribusi 50% sampai dengan 60% dari total PDB (Produk Domestik Bruto) nasional. Salah satu program yang wajib dijalankan mahasiswa semester 6 Universitas Prasetiya Mulya adalah program KKN atau lebih sering disebut Program Community Development, bertujuan untuk mengasa keterampilan mahasiswa untuk dapat membantu UMKM di daerah-daerah  dalam pengembangan usahanya, seperti UMKM Suka Rasa dari Kuningan sebagai mitra usaha kami. Untuk mengembangkan UMKM, tentu diperlukan strategi pemasaran khusus untuk dapat meningkatkan performa usaha. Permasalahan utama Suka Rasa adalah tidak adanya strategi pemasaran sehingga penjualannya tergolong belum maksimal. Berdasarkan hasil kegiatan yang diperoleh : 1) penjualan produk UMKM Sukarasa mengalami peningkatan dalam hal B2C setelah menggunakan platform e-commerce, 2) penggunaan berbagai platform online dan media sosial memudahkan pengembangan produk UMKM Sukarasa, 3) visualisasi produk yang ditawarkan sangat berpengaruh pada penjualan mitra. Dengan strategi pemasaran pada e-commerce yang disalurkan pada mitra usaha melalui program PKM ini, dampak yang paling signifikan adalah peningkatan penjualan dari mitra Suka Rasa. Metode yang digunakan untuk menyalurkan pengetahuan kepada mitra adalah melalui advokasi pendampingan dan pelatihan yang dilaksanakan secara daring dikarenakan pandemi Covid-19

Altered transmission of HOX and apoptotic SNPs identify a potential common pathway for clubfoot.

Clubfoot is a common birth defect that affects 135,000 newborns each year worldwide. It is characterized by equinus deformity of one or both feet and hypoplastic calf muscles. Despite numerous study approaches, the cause(s) remains poorly understood although a multifactorial etiology is generally accepted. We considered the HOXA and HOXD gene clusters and insulin-like growth factor binding protein 3 (IGFBP3) as candidate genes because of their important roles in limb and muscle morphogenesis. Twenty SNPs from the HOXA and HOXD gene clusters and 12 SNPs in IGFBP3 were genotyped in a sample composed of non-Hispanic white and Hispanic multiplex and simplex families (discovery samples) and a second sample of non-Hispanic white simplex trios (validation sample). Four SNPs (rs6668, rs2428431, rs3801776, and rs3779456) in the HOXA cluster demonstrated altered transmission in the discovery sample, but only rs3801776, located in the HOXA basal promoter region, showed altered transmission in both the discovery and validation samples (P = 0.004 and 0.028). Interestingly, HOXA9 is expressed in muscle during development. An SNP in IGFBP3, rs13223993, also showed altered transmission (P = 0.003) in the discovery sample. Gene-gene interactions were identified between variants in HOXA, HOXD, and IGFBP3 and with previously associated SNPs in mitochondrial-mediated apoptotic genes. The most significant interactions were found between CASP3 SNPS and variants in HOXA, HOXD, and IGFBP3. These results suggest a biologic model for clubfoot in which perturbation of HOX and apoptotic genes together affect muscle and limb development, which may cause the downstream failure of limb rotation into a plantar grade position

Harms reporting in systematic reviews of microvascular free flap in head and neck reconstruction

Objective: To evaluate harms reporting in systematic reviews of microvascular free flap in head and neck reconstruction.Data Sources: This cross-sectional analysis included searches from the following major databases from 2012 to June 1, 2022: MEDLINE (Pubmed and Ovid), Embase, Epistemonikos, and the Cochrane Database of Systematic Reviews.Review Methods: In a masked duplicate manner, screening was performed using Rayyan, and data was extracted using a pilot-tested Google form. AMSTAR-2 was used to appraise the methodological quality of reviews, and Corrected Covered Area was calculated to detect primary study overlap across all reviews. Reviews were then grouped in pairs of two, called dyads, and Corrected Covered Area was calculated again for each individual dyad. Dyads with high overlap (≥50%) were further investigated for accuracy of harms reporting.Results: Our initial search yielded 268 records, with 50 systematic reviews meeting inclusion criteria. A total of 46 (92%) of the included reviews demonstrated 50% or more adherence to the items assessed in our harms checklist. Our Corrected Covered Area tool revealed 0.6% primary study overlap across all reviews, and one dyad with high overlap (≥ 50%). No statistically significant relationship was observed between the completeness of harms reporting and reviews listing harms as a primary outcome, reviews reporting adherence to PRISMA, or a review’s AMSTAR rating.Conclusion: This study identifies how harms reporting in systematic reviews of microvascular free flap reconstruction of the head and neck can be improved and provides suggestions with potential to mitigate the paucity in current literature

Evaluating the reporting of patient-reported outcomes in surgical management of stress urinary incontinence in females: a cross-sectional analysis of randomized controlled trials

Background: Stress urinary incontinence (SUI) significantly reduces a woman’s quality of life (QoL). Use of patient-reported outcomes (PROs) is increasing in randomized control trials RCTs and standardization is paramount. We aim to evaluate completeness of reporting of RCTs for surgical management of SUI in females based on an adaptation of the Consolidated Standards of Reporting Trials statement with PRO extension (CONSORT-PRO).Study Design: A literature search was conducted and returns were screened using Rayyan. After title and abstract screening, a full-text screen was conducted for final inclusions. All RCTs meeting inclusion criteria were evaluated using an adaptation of the CONSORT-PRO extension checklist and the Cochrane Collaboration risk of bias assessment tool (RoB). Completion percentages of CONSORT-PRO were calculated and a bivariate regression evaluated associations between trial characteristics and CONSORT-PRO adaptation completeness.Results: After full-text screening, 43 RCTs were included for data extraction and analysis. Mean completion percentage of the CONSORT-PRO adaptation was 50.53% (SD=15.63). A total of 38 (of 43; 88.37%) RCTs received a RoB 2.0 rating of ‘some concern’. RCTs with follow-up longer than 3 months had higher CONSORT-PRO adaptation completion of statistical significance: 3-6 months(P=0.049), 6-12 months (P=0.009), greater than 12 months (P=0.021). Reporting a conflict of interest (P<0.001) and reporting no conflict of interest (P=0.048) also had statistically significant results with higher reporting completeness when compared to studies without a conflict of interest statement.Conclusions: PROs are used as measures to understand a patient’s experience with a condition. Our results suggest CONSORT-PRO adaptation reporting completeness of RCTs about surgical management of SUI in women is suboptimal. Improving reporting completeness through adherence to the CONSORT-PRO extension checklist can better inform clinical decision making and lead to improved QoL

An integrative research framework for enabling transformative adaptation

Transformative adaptation will be increasingly important to effectively address the impacts of climate change and other global drivers on social-ecological systems. Enabling transformative adaptation requires new ways to evaluate and adaptively manage trade-offs between maintaining desirable aspects of current social-ecological systems and adapting to major biophysical changes to those systems. We outline such an approach, based on three elements developed by the Transformative Adaptation Research Alliance (TARA): (1) the benefits of adaptation services; that sub-set of ecosystem services that help people adapt to environmental change; (2) The values-rules-knowledge perspective (vrk) for identifying those aspects of societal decision-making contexts that enable or constrain adaptation and (3) the adaptation pathways approach for implementing adaptation, that builds on and integrates adaptation services and the vrk perspective. Together, these elements provide a future-oriented approach to evaluation and use of ecosystem services, a dynamic, grounded understanding of governance and decision-making and a logical, sequential approach that connects decisions over time. The TARA approach represents a means for achieving changes in institutions and governance needed to support transformative adaptationThe research was supported by CSIRO Land and Water. We thank the Embassy of France in Australia and the Australian Academy of Sciences for funding the first Transformative Adaptation Research Alliance workshop in Canberra, October 27-31, 2014. We thank Craig Beatty, Mirjam Kuzee (IUCN) and Alistair Hobday (CSIRO Oceans and Atmosphere) for reviewing the manuscript and providing constructive comments. The funding partners that have supported this research include the International Climate Initiative (IKI) of the German Federal Ministry for the Environment, Nature Conservation, Building and Nuclear Safety (BMUB) and the CGIAR Research Program on Forests, Trees and Agroforestry (CRP-FTA) with financial support from the CGIAR Fun

Metformin Increases Natural Killer Cell Functions in Head and Neck Squamous Cell Carcinoma Through CXCL1 Inhibition

BACKGROUND: Metformin slows tumor growth and progression in vitro, and in combination with chemoradiotherapy, resulted in high overall survival in patients with head and neck cancer squamous cell carcinoma (HNSCC) in our phase 1 clinical trial (NCT02325401). Metformin is also postulated to activate an antitumor immune response. Here, we investigate immunologic effects of metformin on natural killer (NK) and natural killer T cells, including results from two phase I open-label studies in patients with HNSCC treated with metformin (NCT02325401, NCT02083692). METHODS: Peripheral blood was collected before and after metformin treatment or from newly diagnosed patients with HNSCC. Peripheral immune cell phenotypes were evaluated using flow cytometry, cytokine expression by ELISA and/or IsoLight, and NK cell-mediated cytotoxicity was determined with a flow-based NK cell cytotoxicity assay (NKCA). Patient tumor immune infiltration before and after metformin treatment was analyzed with immunofluorescence. NK cells were treated with either vehicle or metformin and analyzed by RNA sequencing (RNA-seq). NK cells were then treated with inhibitors of significant pathways determined by RNA-seq and analyzed by NKCA, ELISA, and western blot analyses. RESULTS: Increased peripheral NK cell activated populations were observed in patients treated with metformin. NK cell tumor infiltration was enhanced in patients with HNSCC treated with metformin preoperatively. Metformin increased antitumorigenic cytokines ex vivo, including significant increases in perforin. Metformin increased HNSCC NK cell cytotoxicity and inhibited the CXCL1 pathway while stimulating the STAT1 pathway within HNSCC NK cells. Exogenous CXCL1 prevented metformin-enhanced NK cell-mediated cytotoxicity. Metformin-mediated NK cell cytotoxicity was found to be AMP-activated protein kinase independent, but dependent on both mechanistic target of rapamycin and pSTAT1. CONCLUSIONS: Our data identifies a new role for metformin-mediated immune antitumorigenic function through NK cell-mediated cytotoxicity and downregulation of CXCL1 in HNSCC. These findings will inform future immunomodulating therapies in HNSCC

Psychosocial impact of undergoing prostate cancer screening for men with BRCA1 or BRCA2 mutations.

OBJECTIVES: To report the baseline results of a longitudinal psychosocial study that forms part of the IMPACT study, a multi-national investigation of targeted prostate cancer (PCa) screening among men with a known pathogenic germline mutation in the BRCA1 or BRCA2 genes. PARTICPANTS AND METHODS: Men enrolled in the IMPACT study were invited to complete a questionnaire at collaborating sites prior to each annual screening visit. The questionnaire included sociodemographic characteristics and the following measures: the Hospital Anxiety and Depression Scale (HADS), Impact of Event Scale (IES), 36-item short-form health survey (SF-36), Memorial Anxiety Scale for Prostate Cancer, Cancer Worry Scale-Revised, risk perception and knowledge. The results of the baseline questionnaire are presented. RESULTS: A total of 432 men completed questionnaires: 98 and 160 had mutations in BRCA1 and BRCA2 genes, respectively, and 174 were controls (familial mutation negative). Participants' perception of PCa risk was influenced by genetic status. Knowledge levels were high and unrelated to genetic status. Mean scores for the HADS and SF-36 were within reported general population norms and mean IES scores were within normal range. IES mean intrusion and avoidance scores were significantly higher in BRCA1/BRCA2 carriers than in controls and were higher in men with increased PCa risk perception. At the multivariate level, risk perception contributed more significantly to variance in IES scores than genetic status. CONCLUSION: This is the first study to report the psychosocial profile of men with BRCA1/BRCA2 mutations undergoing PCa screening. No clinically concerning levels of general or cancer-specific distress or poor quality of life were detected in the cohort as a whole. A small subset of participants reported higher levels of distress, suggesting the need for healthcare professionals offering PCa screening to identify these risk factors and offer additional information and support to men seeking PCa screening

Multiple novel prostate cancer susceptibility signals identified by fine-mapping of known risk loci among Europeans

Genome-wide association studies (GWAS) have identified numerous common prostate cancer (PrCa) susceptibility loci. We have fine-mapped 64 GWAS regions known at the conclusion of the iCOGS study using large-scale genotyping and imputation in 25 723 PrCa cases and 26 274 controls of European ancestry. We detected evidence for multiple independent signals at 16 regions, 12 of which contained additional newly identified significant associations. A single signal comprising a spectrum of correlated variation was observed at 39 regions; 35 of which are now described by a novel more significantly associated lead SNP, while the originally reported variant remained as the lead SNP only in 4 regions. We also confirmed two association signals in Europeans that had been previously reported only in East-Asian GWAS. Based on statistical evidence and linkage disequilibrium (LD) structure, we have curated and narrowed down the list of the most likely candidate causal variants for each region. Functional annotation using data from ENCODE filtered for PrCa cell lines and eQTL analysis demonstrated significant enrichment for overlap with bio-features within this set. By incorporating the novel risk variants identified here alongside the refined data for existing association signals, we estimate that these loci now explain ∼38.9% of the familial relative risk of PrCa, an 8.9% improvement over the previously reported GWAS tag SNPs. This suggests that a significant fraction of the heritability of PrCa may have been hidden during the discovery phase of GWAS, in particular due to the presence of multiple independent signals within the same regio