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Background National databases are a rich source of epidemiologic data for breast surgical oncology research. However, these databases differ in the demographic, surgical, and oncologic variables provided. This study aimed to compare the strengths and limitations of four national databases in the context of breast surgical oncology research. Methods The study comprised a descriptive analysis of four national databases (the National Surgical Quality Improvement Program [NSQIP], the Nationwide Inpatient Sample [NIS], the Surveillance, Epidemiology and End Results [SEER] program, and the National Cancer Database [NCDB]) to assess their strengths and limitations in the context of breast surgical oncology. The study assessed the data available in each database for female patients with a breast cancer diagnosis between 2007 and 2017, and compared patient age, ethnicity, and race distributions. Results Data from 3.9 million female patients were examined, with most patients being between 60 and 69 years of age, non-Hispanic, and white. Age, ethnicity, and race distributions were similar in the databases. The NSQIP includes data on operative details, comorbidities, and postoperative outcomes. The NIS provides health services and inpatient utilization information, but does not evaluate outpatient procedures. The SEER program provides population-based oncologic detail including stage, histology, and neoadjuvant/adjuvant treatment. The NCDB offers hospital-based oncologic information and the largest population in the study period, with approximately 2.5 million breast cancer patients. Conclusion Epidemiologic datasets offer tremendous potential for the examination of oncologic breast surgery, with each database providing unique data useful for addressing different epidemiologic questions. Understanding the strengths and limitations of each database creates a more efficient and productive research environment.

Abstract BACKGROUND: Odontoid fractures are the most common cervical spine fracture in the geriatric population; however, the treatment of type II odontoid fractures in this age group is controversial. OBJECTIVE: To compare the short-term (<3 months) mortality, long-term (≥12 months) mortality, and complication rates of patients >60 years of age with a type II odontoid fracture managed either operatively or nonoperatively. METHODS: We performed a systematic review of literature published between January 1, 2000, and February 1, 2015, related to the treatment of type II odontoid fractures in patients >60 years of age. An analysis of short-term mortality, long-term mortality, and the occurrence of complications was performed. RESULTS: A total of 452 articles were identified, of which 21 articles with 1233 patients met the inclusion criteria. Short-term mortality (odds ratio, 0.43; 95% confidence interval, 0.30–0.63) and long-term mortality (odds ratio, 0.47; 95% confidence interval, 0.34–0.64) were lower in patients who underwent surgical treatment than in those who had nonsurgical treatment, and there were no significant differences in the rate of complications (odds ratio, 1.01; 95% confidence interval, 0.63–1.63). Surgical approach (posterior vs anterior) showed no significant difference in mortality or complication rate. Similarly, no difference in mortality or complication rate was identified with hard collar or a halo orthosis immobilization. CONCLUSION: The current literature suggests that well-selected patients >60 years of age undergoing surgical treatment for a type II odontoid fracture have a decreased risk of short-term and long-term mortality without an increase in the risk of complications.

Background Prepectoral implant placement for postmastectomy breast reconstruction has increased in recent years. Benefits of prepectoral reconstruction may include lack of animation deformities and reduced postoperative pain, but its complication profile is currently unclear. This study aimed to examine the complication profile of prepectoral tissue expanders (TEs) to determine factors associated with TE loss. Methods A retrospective review was performed to identify all patients who underwent immediate prepectoral TE reconstruction from January 2018 to June 2021. The decision to use the prepectoral technique was based on mastectomy skin quality and patient comorbidities. Patient demographics, comorbidities, and operative details were evaluated. Outcomes of interest included TE loss, seroma, hematoma, infection/cellulitis, mastectomy skin flap necrosis requiring revision, and TE exposure. Logistic regression analysis was performed to identify factors associated with TE loss. Results The study identified 1225 TEs. The most frequent complications were seroma (8.7%, n = 106), infection/cellulitis (8.2%, n = 101), and TE loss (4.2%, n = 51). Factors associated with TE loss in the univariate analysis included ethnicity, history of smoking, body mass index, mastectomy weight, and neoadjuvant chemotherapy. In the multivariate regression analysis, only mastectomy weight had a positive association with TE loss (odds ratio, 1.001; p = 0.016). Conclusion Prepectoral two-stage breast reconstruction can be performed safely with an acceptable early complication profile. The study data suggest that increasing mastectomy weight is the most significant factor associated with TE loss. Further research examining the quality of the soft tissue envelope and assessing patient-reported outcomes would prove beneficial.

René Gerónimo Favaloro prided himself on being a “simple country doctor.” Born in La Plata, Argentina, Dr. Favaloro had an interest in Argentina's sociopolitical and healthcare systems beginning at a young age. He began his medical education at La Universidad Nacional de La Plata, graduating in 1949 with plans to continue his medical education in the field of surgery; however, in 1950, Dr. Favaloro temporarily resigned from his position as a surgeon to work as a country doctor in a small province of La Pampa, Argentina. It was during this time that Dr. Favaloro became acutely aware of the overwhelmingly poor state of the healthcare system in Argentina. In 1962, Dr. Favaloro redirected his focus back to his surgical interests and moved to the United States to work at the Cleveland Clinic, where he discovered the use of the saphenous vein graft for revascularization of the coronary arteries. Despite a productive medical career in the United States, Dr. Favaloro eventually brought his work back to Argentina, where his heart had always remained. Throughout the incredible milestones of his life, Dr. René Gerónimo Favaloro consistently remained a humble, gracious, and simple country doctor.

IDEA provides essential guidance and legal support for students with disabilities, yet its conceptual and systemic framework tends to promote a focus on student deficits. Thus, teachers and IEP team members may have low expectations of students with disabilities and fail to encourage the development of their talents. Lisa DaVia Rubenstein, Charles Sandifer, and Robyn Spoon propose the adoption of a conceptual framework known as the axiom of brilliance, which assumes students are brilliant. To meet students’ needs in their areas of brilliance, they recommend that educators adopt a more holistic approach that purposefully identifies student strengths and uses that information to design appropriate learning experiences.

Normal0falsefalsefalseEN-USX-NONEX-NONEMicrosoftInternetExplorer4 As a source of colonial wealth and a crucible for global culture, Jamaica has had a profound impact on the formation of the modern world system. From the island's economic and military importance to the colonial empires it has hosted and the multitude of ways in which diverse people from varied parts of the world have coexisted in and reacted against systems of inequality, Jamaica has long been a major focus of archaeological studies of the colonial period. This volume assembles for the first time the results of nearly three decades of historical archaeology in Jamaica. Scholars present research on maritime and terrestrial archaeological sites, addressing issues such as: the early Spanish period at Seville la Nueva; the development of the first major British settlement at Port Royal; the complexities of the sugar and coffee plantation system, and the conditions prior to, and following, the abolition of slavery in Jamaica. The everyday life of African Jamaican people is examined by focusing on the development of Jamaica's internal marketing system, consumer behavior among enslaved people, iron-working and ceramic-making traditions, and the development of a sovereign Maroon society at Nanny Town. Out of Many, One People paints a complex and fascinating picture of life in colonial Jamaica, and demonstrates how archaeology has contributed to heritage preservation on the island.