The Influence of Patient Exposure to Breast Reconstruction Approaches and Education on Patient Choices in Breast Cancer Treatment.

BackgroundThe landscape of surgical and medical management and patient choices for breast cancer treatment changes as breast reconstruction and oncoplastic approaches improve and diversify. Increased access to breast reconstruction, in addition to patient education, influences the breast cancer patient. Therefore, the examination of the possible impact of reconstructive surgery on all stages of the breast cancer management per se seemed timely.MethodsPlastic surgery consults were arranged for 520 new patients diagnosed with breast cancer (2012-2016) including patients with noninvasive breast cancer but at high risk of further cancer development. To test the plastic surgery impact on patient choices regarding the management of the cancer, a subset of 90 patients was identified to test the plastic surgery impact on patient choices. These patients were referred to plastic surgery, following the first round of consultations by surgical and medical oncologists with only the preliminary oncological management plan defined. After a plastic surgery consultation, but prior to finalization of the overall oncological management plan, they were surveyed on the subject of modification of their personal choices and requests pertaining to their cancer management.ResultsIn this subset of 90 patients 40 (44%) returned to their surgical or medical oncologist considering changes of the primary management plan after their plastic surgery consultation. Twenty-six (28%) ultimately altered their plan, and the following patient-driven changes were made: mastectomy as opposed to lumpectomy (18 patients [20%]), contralateral prophylactic mastectomy (11 patients [12%]), nipple/areola removal as opposed to nipple/areola sparing suggested by the oncologists (5 patients [6%]), oncoplastic breast reduction as part of lumpectomy (5 patients [6%]), and other modifications (3 patients [3%]).ConclusionsDecisions for altering the preliminary oncologic plan or choosing a specific alternative (eg, lumpectomy plus radiation vs mastectomy) resulted from patient education on (1) reconstructive options, (2) aesthetic pitfalls and results. and (3) their interfacing with the oncological outcomes. Ultimately, plastic surgeons influence the multispecialty breast cancer management and patient decision-making process. Therefore, oncological literacy for plastic surgeons is essential to provide state-of-the-art breast cancer care and avoidance of suboptimal patient decisions

Ephrin A/EphA controls the rostral turning polarity of a lateral commissural tract in chick hindbrain

Most post-crossing commissural axons turn into longitudinal paths to make synaptic connections with their targets. Mechanisms that control their rostrocaudal turning polarity are still poorly understood. We used the hindbrain as a model system to investigate the rostral turning of a laterally located commissural tract, identified as the caudal group of contralateral cerebellar-projecting second-order vestibular neurons (cC-VC). We found that the caudal hindbrain possessed a graded non-permissive/repulsive activity for growing cC-VC axons. This non-permissiveness/repulsion was in part mediated by glycosyl-phosphatidylinositol (GPI)-anchored ephrin A. We further demonstrated that ephrin A2 was distributed in a caudal-high/rostral-low gradient in the caudolateral hindbrain and cC-VC axons expressed EphA receptors. Finally, perturbing ephrin A/EphA signalling both in vitro and in vivo led to rostrocaudal pathfinding errors of post-crossing cC-VC axons. These results suggest that ephrin A/EphA interactions play a key role in regulating the polarity of post-crossing cC-VC axons as they turn into the longitudinal axis

Effective instructional strategies and technology use in blended learning: A case study

This case study explored effective instructional strategies and technology use in blended learning (BL) in a graduate course in the USA. Varied forms of data were collected, including (1) semi-structured interviews with students, (2) mid-term and final course evaluations, (3) two rounds of online debates, (4) four weeks of online reflection journals, and (5) the instructor\u27s reflections. Thematical analysis and descriptive statistics were conducted to analyze qualitative and quantitative data respectively. Multiple methods were employed to establish trustworthiness of the study. Effective and ineffective instructional strategies and technology uses were identified in BL. The findings indicated that students valued real-time interactions with peers and the instructor. However, inappropriate asynchronous discussions were considered less effective in BL. In addition, immediate feedback from peers and the instructor motivated learners and improved the quality of their work. Learning technologies played a critical role in BL, but the use of learning technologies should be simplified and streamlined. Technical support was essential to reduce learners\u27 cognitive load

China’s Asset Management Companies as State Spatial–Temporal Strategy

Chinese authorities created four new asset management companies (AMCs) in 1999, which have since undergone profound transformations that have been influential in China’s contemporary integration into the world market. Conventional interpretations see these powerful AMCs in largely technical and asocial terms. By contrast, we employ a critical geographical analytical framework to understand the transformation of the AMCs as an expression of state spatial–temporal strategy, which involved attempts to create conditions of political economic stability now by displacing the conditions of financial instability and crisis into the future. This strategy does not come without unintended and destabilizing consequences, nor is it without class-based social and political implications

Development of Innovative, Adaptable Video Learning Modules for the Civil Engineering Classroom

As engineering and technology continue to evolve, so should the use of such innovations in engineering pedagogy. Standard course learning modules have not often utilized technology to assist in learning of engineering principles and concepts; that is, until the COVID-19 pandemic required teachers and students to use technology more frequently in a virtual teaching/learning environment. Therefore, it is even more critical now that engineering pedagogy be adapted to incorporate technology in the classroom to enhance student learning of complex engineering concepts. In this study, a team of Civil Engineering professors has set out to incorporate technology into their classrooms to help students gain a stronger understanding of the fundamental building blocks of Civil Engineering. A series of comprehensive educational video and simulation-based learning modules were created for the Civil Engineering subdisciplines of environmental, geotechnical, transportation, and structural engineering. The development and implementation of such technology-based learning modules offer new opportunities to teach students the complex concepts of Civil Engineering through visual means. The efficacy of the learning modules were evaluated through student assessment surveys for: (1) the appropriateness of the module in aiding the introduction of course content, (2) the effectiveness of the module in enhancing student understanding of course content, and (3) the overall perception of students of the module. Implementation of the modules into the classroom has shown that students responded positively to the modules, referencing the modules as both engaging and comprehensive in aiding their understanding of course content