Loyola University Chicago

Objective Surgical resection is standard treatment for pleomorphic adenoma (PA) of the parotid gland. A small number (2–5%) of these tumors recur. Recurrence usually necessitates reoperation, which is technically challenging and puts the facial nerve (FN) at risk. The aim of this study is to characterize the recurrent parotid PA population and compare outcomes after surgery for singly recurrent and multiply recurrent tumors. Methods This study was a retrospective chart review of patients at a single tertiary care academic medical center who underwent operations for recurrent PA of the parotid gland between 2007 and 2020. Demographic data, details of surgical interventions, pre- and postoperative FN function, and recurrence rates were studied. These factors were compared between patients with singly and multiply recurrent tumors. Results Thirty-eight patients met criteria: 4 patients presented for primary PA and subsequently recurred, 26 with a first recurrence, 7 with a second recurrence, and 1 with a fourth recurrence. Multiply recurrent PAs were more likely to require at least partial nerve sacrifice at the time of reoperation (P = 0.0092). Significantly worse long-term FN outcomes were seen following surgery for multiply recurrent PA (P = 0.008). There was no significant difference between the rate of re-recurrence following first revision surgery vs second-fourth revision surgery. Time to reoperation was significantly shorter between the first and second revision surgery than between the primary surgery and first revision (P = 0.0017). Conclusion Surgery for recurrent PA incurs high risk to the FN, and this risk appears to increase in the setting of multiple recurrences.

This paper describes costs associated with establishing and delivering Early Childhood ECHO® (Extension for Community Healthcare Outcomes) program to train community-based early care providers working in Chicago’s West Side communities in identifying and addressing the most common developmental, behavioral, and social-emotional concerns in young children. Results suggest that it costs $33,120 to train 12 providers within a societal perspective and$29,584 within the funder perspective; however, the cost of program delivery decreases as additional cohorts of providers are trained. This program holds promise as a relatively affordable approach to reducing long-term costs associated with behavioral health and developmental problems and improving outcomes for children and youth.

Objective To compare cochlear implant (CI) speech perception outcomes in patients with sporadic vestibular schwannoma (VS) managed with observation, radiosurgery, or microsurgery. Study Design Retrospective review. Setting Eleven tertiary academic medical centers. Patients One hundred patients with sporadic VS who received an ipsilateral CI. Interventions Ipsilateral cochlear implantation. Main Outcome Measures Pure-tone thresholds, monosyllabic speech perception testing scores, and rates of open-set speech acquisition. Results Of the 100 patients studied, 54 underwent microsurgery, 26 underwent radiosurgery, 19 continued observation, and 1 underwent multimodal therapy. Among all patients, the median post-implantation pure-tone average was 31 dB (interquartile range [IQR] 25–39 dB) and the median monosyllabic speech perception score was 30% (IQR 0–60%) at a median of 12 months (IQR 5–25 months) post-implantation. Patients who were managed with microsurgery (median speech perception score 11%, IQR 0–52%) exhibited poorer implant outcomes overall compared with those managed with observation (median speech perception score 52%, IQR 40–72%) or radiosurgery (median speech perception score 30%, IQR 16–60%). Open-set speech perception was achieved in 61% of patients managed with microsurgery, 100% with observation, and 80% with radiosurgery. In a multivariable setting, those managed with observation ( p = 0.02) or who underwent radiosurgery ( p = 0.04) were significantly more likely to achieve open-set speech perception compared with patients who underwent microsurgery. Conclusions Cochlear implants offer benefit in selected patients with sporadic VS. Although achieved in over half of people after microsurgery, open-set speech perception is more reliably attained in patients who are treated with observation or radiosurgery compared with microsurgical resection. These data may inform patient counseling and VS tumor management in people who may benefit from implantation.

Our hands-on course introduces model checking using Temporal Logic of Actions through practical examples like the control logic for a microwave oven. Due to highly positive initial feedback from our own students, we plan to broaden our reach by partnering with other institutions.

Introduction This study tests the hypothesis that self‐reported somatic symptoms are associated with biomarkers of stress, including elevated blood pressure and suppressed immune function, among Shuar adults living in the Ecuadorian Amazon. Methods Research was conducted in three Shuar communities in the Upano Valley of the Ecuadorian Amazon and included the collection of biomarkers and a structured morbidity interview. Participants self‐reported somatic symptoms such as headaches, body pain, fatigue, and other bodily symptoms. We examined whether the number of somatic symptoms reported was associated with measures of immune (Epstein–Barr virus [EBV] antibodies) and cardiovascular (blood pressure) functioning in 97 Shuar adults (37 women, 60 men; ages 18–65 years). Multivariate linear regression analyses were used to examine the relationships among somatic symptoms and stress biomarkers, controlling for age, sex, body mass index (BMI), active infection, level of education, and income. Results Controlling for relevant covariates, Shuar adults reporting the highest level of somatic symptoms (three symptoms) were more likely to exhibit elevated systolic ( β = 0.20, p = 0.04) and diastolic blood pressure ( β = 0.23, p = 0.03), in comparison to adults reporting no symptoms. Shuar adults reporting two symptoms, compared to no symptoms, were more likely to exhibit elevated EBV antibody concentrations ( β = 0.34, p = < 0.01). Conclusions These preliminary findings demonstrate that somatic symptoms reported by Shuar men and women are associated with physiological measures widely associated with chronic psychosocial stress. These findings complement the cross‐cultural literature in medical anthropology documenting the close connection between the expression of somatic symptoms and stressful life circumstances and highlight the important role that human biologists can play in exploring biocultural phenomena.

Purpose Immigrants comprise 13.7% of the United States’ population. By 2050, it is projected that 1 in 4 people will identify as immigrants. The past few years with the COVID-19 pandemic have been challenging for everyone, including immigrants. Along with facing difficulties associated with the pandemic, immigrants faced a shadow pandemic of increased domestic violence. In this study, we focus on a unique form of violence in immigrant communities, in-law abuse, which has been minimally considered in the family violence literature. This study represents a significant advance in the field by extending the examination of in-law abuse prevalence rates among male and female immigrants to include communities beyond South Asians, which have been the sole focus of prior research efforts. Methods The study (N = 419) utilized a bio-psycho-social framework to include biological (gender, age, race), psychological (stress, mental health), and social (generational position, religiosity, household responsibility and COVID family connections) factors as independent variables. The dependent variable was in-law abuse. A hierarchical regression was performed. Data was collected through researcher’s networks and Qualtrics panels. Results We observed that females experienced less in-law abuse compared to males, while the prevalence among females was notable. Stress and mental health also predicted in-law abuse among study participants. No social factors were significant. Conclusions The study has implications for building new evidence about a unique form of abuse among immigrant communities. Recommendations for service providers and policy advocates regarding diversifying the narrow “western” definition of domestic violence are discussed.

With the increasing age of the population in the USA, fall prevention events to target older patients are imperative. The American Association for the Surgery of Trauma hosted a fall prevention event at the host city of the 2023 Annual Meeting. We review the planning and implementation of this “Stop the Falls” event, in hopes that other institutions may benefit and sustainably effectuate fall prevention events for an increasingly geriatric population.

This study examines public expectations regarding Corporate Social Advocacy (CSA) using the framework of strategic issue management (SIM). A 14-item, single-factor scale was developed to measure CSA expectations, which was validated through four surveys. The CSA expectancy scale will assist businesses in effectively navigating CSA initiatives, preventing stakeholder support withdrawal, and thus bolstering organizational sustainability and social impact.

OBJECTIVE The optimal management of neurofibromatosis type 2 (NF2)–associated meningiomas must be personalized case by case. Stereotactic radiosurgery (SRS) is one option for patients with one or multiple intracranial meningiomas associated with the NF2 mutation. In this study, the authors evaluated their single-institution experience of SRS treatment for NF2-associated meningiomas. METHODS The medical records and radiographic images of 45 patients (20 males, 213 tumors) with a median age of 53.5 (range 20–79) years who underwent SRS between 1987 and 2022 were retrospectively reviewed. The median Karnofsky Performance Status score was 80 (range 50–100). Twenty-seven patients had undergone prior resection, and 8 had undergone prior fractionated radiation therapy. The median Ki-67 proliferation index (n = 8) was 11.5% (range 9%–27.5%). The median margin dose was 13 (range 9–16) Gy. The median number of meningiomas per patient was 3 (range 1–17), and the median cumulative tumor volume treated per patient was 6.29 (range 0.10–37.70) cm ³ . RESULTS The 5-, 10-, and 15-year local tumor control (LTC) rates per tumor were 90.21%, 84.46%, and 84.46%, respectively. On multivariate analysis, a lower tumor volume was associated with better LTC (p = 0.02; HR 1.07, 95% CI 1.01–1.12). After the initial SRS, 20 (44%) patients developed a previously untreated meningioma. Patients with more meningiomas at the time of SRS had a higher rate of new meningioma development (p = 0.01; HR 1.19, 95% CI 1.04–1.37). Eighteen patients died during the follow-up interval, of which 5 deaths were related to the progression of one or more intracranial NF2-related tumors. Two (4.44%) patients developed transient adverse radiation effects. No patient developed a secondary malignancy. Eight patients required additional SRS for local tumor progression, 20 underwent SRS for new tumor development, and 4 patients underwent delayed resection of an SRS-treated meningioma. CONCLUSIONS In this case series, the LTC rates of both primary and salvage SRS exceeded 90%. However, nearly half of the patients required additional SRS for new untreated meningiomas. No significant differences in long-term LTC were found when comparing upfront versus salvage SRS for patients with NF2 meningiomas. These results establish SRS as a valuable and safe option for managing NF2-associated meningiomas.

Wicked problems pose both immediate and existential threats. Within this article we explore the underlying nature of wicked problems, including the social traps embedded in them. We deconstruct the ecosystem surrounding single‐use plastics to make key points regarding controversies and conflicting interests surrounding wicked problems. We propose that wicked problems may be reframed by unpacking the relationships between individuals and collectives and how social traps are understood in terms of time horizon, ownership, responsibility, and involvement. We argue that resolutions to social traps are paramount to resolving wicked problems in the case of single‐use plastics and to wicked problems more generally. We draw from marketing, psychology, public policy, and consumer research literature to suggest specific ways marketing can mitigate or perhaps eliminate the insidious dynamic of social traps and wicked problems, and in turn affect positive outcomes to enhance the short‐term and long‐term well‐being for many consumers and stakeholders.

Purpose Previous research points to a complex relation between social media use and mental health, with open questions remaining with respect to mediation pathways and potential sociodemographic moderators. The present research investigated the extent to which experiences of cyberbullying victimization mediate the link between greater social media use and poorer mental health in adults and whether such indirect effects are moderated by gender or age. Participants and Methods As part of a larger study, US adults (N = 502) completed an online survey that included measures of degree of social media use, cyberbullying victimization, depression, anxiety, substance use, and sociodemographic characteristics including gender and age. Results A series of moderated mediation models revealed a robust indirect effect of cyberbullying victimization on the relation between degree of social media use and mental health, such that greater social media use was associated with higher levels of cyberbullying victimization and greater cyberbullying victimization was associated with increased depression, anxiety, and likelihood of substance use. There was no evidence that the mediation effects varied between men and women. Age did, however, moderate the mediation effects for anxiety and likelihood of substance use, with stronger mediation effects emerging for younger compared to older adults. Conclusion Our findings underscore the importance of empirical investigations that shed a more nuanced light on the complex relation between social media and mental health.