Background
Multiple factors can affect cosmetic outcome after breast-conserving therapy. We investigated which combination of factors could optimally predict patient reported cosmetic outcome.
...Methods and materials
Dutch patients treated with BCT between 2008 and 2013 were retrospectively analysed. Demographics, tumour characteristics, and treatment-related factors were obtained from available digital medical records. Patients were asked to indicate their degree of cosmetic satisfaction using the Harvard scale. Both univariable and multivariable logistic regression analyses were performed to create a prediction model.
Results
The present study based on 220 patients shows that univariable analysis radiotherapy boost (OR 4.01 1.85–8.70,
p
≤ 0.001) and adjuvant chemotherapy (OR 2.67 1.45–4.92,
p
= 0.002) were significantly associated with unsatisfactory cosmetic outcome. In multivariable analyses, only a radiotherapy boost remained significantly associated (OR 4.08 1.76–9.49,
p
= 0.001) with poor cosmetic outcome, while adjuvant chemotherapy was no longer associated with it (OR 1.61 0.81–3.24),
p
= 0.18). These two factors, together with tumour histology and lymph node staging, showed the highest predictive values, although the predictive property of the overall model was limited (AUC = 0.69).
Conclusion
In the present study, a variety of factors is explored. However, a radiotherapy boost was the only factor that was independently associated with a poor cosmetic outcome after BCT. This finding can be used for counselling in daily clinical practice. Creation of a prediction model will require further investigation.
Tuberculosis (TB) has been repeatedly shown to have socioeconomic impacts in both individual-level and ecological studies; however, much less is known about this effect among children and adolescents ...and the extent to which being affected by TB during childhood and adolescence can have life-course implications. This paper describes the results of the development of a conceptual framework and scoping review to review the evidence on the short- and long-term socioeconomic impact of tuberculosis on children and adolescents.
To increase knowledge of the socioeconomic impact of TB on children and adolescents.
We developed a conceptual framework of the socioeconomic impact of TB on children and adolescents, and used scoping review methods to search for evidence supporting or disproving it. We searched four academic databases from 1 January 1990 to 6 April 2021 and conducted targeted searches of grey literature. We extracted data using a standard form and analysed data thematically.
Thirty-six studies (29 qualitative, five quantitative and two mixed methods studies) were included in the review. Overall, the evidence supported the conceptual framework, suggesting a severe socioeconomic impact of TB on children and adolescents through all the postulated pathways. Effects ranged from impoverishment, stigma, and family separation, to effects on nutrition and missed education opportunities. TB did not seem to exert a different socioeconomic impact when directly or indirectly affecting children/adolescents, suggesting that TB can affect this group even when they are not affected by the disease. No study provided sufficient follow-up to observe the long-term socioeconomic effect of TB in this age group.
The evidence gathered in this review reinforces our understanding of the impact of TB on children and adolescents and highlights the importance of considering effects during the entire life course. Both ad-hoc and sustainable social protection measures and strategies are essential to mitigate the socioeconomic consequences of TB among children and adolescents.
The cerebellum is increasingly recognised for its role in modulation of cognition, behaviour, and affect. The present study examined the relation between structural cerebellar damage (grey matter ...volume (GMV), white matter hyperintensities (WMHs), lacunar infarcts (LIs) and microbleeds (MBs)) and measures of cognitive, psychological (i.e. symptoms of depression and apathy) and general daily functioning in a population of community-dwelling older persons with mild cognitive deficits, but without dementia. In 194 participants of the Discontinuation of Antihypertensive Treatment in Elderly People (DANTE) Study Leiden, the association between cerebellar GMV, WMHs, LIs and MBs and measures of cognitive, psychological and general daily functioning was analysed with linear regression analysis, adjusted for age, sex, education and cerebral volume. Cerebellar GMV was associated with the overall cognition score (standardised beta 0.20 95% CI, 0.06–0.33). Specifically, posterior cerebellar GMV was associated with executive function (standardised beta 0.18 95% CI, 0.03–0.16). No relation was found between vascular pathology and cognition. Also, no consistent associations were found on the cerebellar GMV and vascular pathology measures and psychological and general daily functioning. In this population of community-dwelling elderly, less posterior cerebellar GMV but not vascular pathology was associated with worse cognitive function, specifically with poorer executive function. No relation was found between cerebellar pathology and psychological and general daily functioning.
This review highlights one stream of work within the social network field, namely the work on cognitive social structures (CSS). First, CSS research is positioned within the field of social networks, ...and the key methods associated with CSS research are described. Research examining systematic biases in individuals' perceptions of social networks is covered, as is research examining the consequences of biased network perceptions (in terms of behaviors and outcomes). A research agenda is forwarded, suggesting three key directions for future research: the social capital of cognitive ties, extending and challenging network accuracy as a source of advantage and collective agency and organizational change. The overall goal is to invigorate research that moves beyond the description of cognitive social structures to an outcome-focused research paradigm.
Background
The aim of this study was to investigate which factors patients considered to be important for determining the degree of cosmetic satisfaction with regards to perceived body image after ...previous breast-conserving therapy (BCT).
Methods
Outcomes considered relevant by the patients were first identified using interviews. A questionnaire based on this group input was then devised and added to the physician-based Sneeuw questionnaire. Next, a quantitative study using this questionnaire was conducted in Dutch patients treated at least 6 months earlier for (non-) invasive breast cancer by BCT. Exclusion criteria were: previous mastectomy or BCT of the contralateral breast, BCT with nipple resection, metastatic disease, local recurrence or (previous) plastic breast surgery. Descriptive statistics were used throughout.
Results
A total of 149 patients (aged 36–87 years) completed the questionnaire. From this focus group input, the top three factors in overall importance (important or very important) for satisfaction were: ‘wearability of bra’ (67%), ‘breast sensitivity’ (59%) and ‘asymmetry’ (51%). Younger patients (< 55 years) considered ‘breast size’ to be most important, whereas ‘wearability of bra’ was most frequently reported by older patients (> 55 years). Time since BCT did not significantly influence the rating of relevant factors.
Conclusion
Patients consider ‘wearability of bra’, ‘breast sensitivity’ and ‘asymmetry’ as the most important factors when assessing their satisfaction with regards to cosmetic outcome and body image. These factors should be addressed in routine clinical practice during (pre) counseling.
We present a new theory that seeks to explain differences in the performance of men and women friendship network brokers-individuals who bridge disconnected friends. In contrast to previous ...audience-centered explanations, our phenomenological theory emphasizes how brokers construe (i.e., perceive and interpret) their networks. We contend that when women perceive themselves as brokers in friendship networks they experience threat, rooted in negative stereotypes about women brokers, which undermines their performance. Using data from a cohort of MBA students, Study 1 finds that women (but not men) exhibit lower performance when they perceive themselves as brokers in small-group friendship networks. Using data from a larger group of MBA students, Study 2 replicates this finding and rules out the possibility that underlying differences in the propensity to connect those whom one bridges may explain the observed gender-based difference in broker performance. Using an experimental design, Study 3 finds that elevated anxiety about task performance and negative social evaluations mediate the relationship between brokerage and performance for women but not for men. Women and men differ in how they psychologically construe brokerage in friendship networks, and this difference helps to account for gender differences in the performance of network brokers.
This paper proposes that gender differences in responses to recruitment rejections contribute to women's underrepresentation in top management. We theorize and show that women are less likely than ...men to consider another job with a prospective employer that has rejected them in the past. Because of women's status as a negatively stereotyped minority in senior roles, recruitment rejection triggers uncertainty about their general belonging in the executive domain, which in turn leads women to place greater weight than men on fair treatment and negatively affects their perceptions of the fairness of the treatment they receive. This dual process makes women less inclined than men to apply again to a firm that has rejected them. We test our theory with three studies: a field study using longitudinal archival data from an executive search firm, a survey of executives, and an experiment using executive respondents testing the effects of rejection on willingness to apply to a firm for another position. The results have implications for theory and practice regarding gender inequality at the labor market's upper echelons, highlighting that women's supply-side decisions to "lean out" of competition for senior roles must be understood in light of their previous experiences with employers' demand-side practices. Given the sequential nature of executive selection processes, rejection-driven differences in the willingness to compete in a given round would affect the proportion of available women in subsequent selection rounds, contributing to a cumulative gender disadvantage and thus possibly increasing gender inequality over time.
The traditional view that patients with hemophilia are protected against cardiovascular disease is under debate. The aim of the present study was to evaluate the presence and extent of ...atherosclerosis by coronary artery calcification score (CACS) and carotid intima media thickness (IMT) in patients with hemophilia, and to evaluate their cardiovascular risk profile.
Sixty-nine patients (51 with hemophilia A; 18 with hemophilia B) were studied median age: 52 years (interquartile range IQR 43–64). Cardiovascular risk factors and prior major adverse cardiovascular events (MACEs) were recorded. CACS was derived from electron-beam or dual-source computed tomography, and carotid IMT was assessed by ultrasound measurements and compared with age-specific reference values.
The median CACS in all patients was 35 (IQR 0–110) and the geometric mean IMT was 0.80 mm (95% confidence interval CI 0.76–0.84); neither was different from the reference values. Patients with a previous MACE (n = 9) had significantly higher CACS and IMT than patients without a previous MACE:CACS median 1013 (IQR 530–1306) vs. 0 (IQR 0–67), and IMT geometric mean 1.09 mm (95% CI 0.95–1.26) vs. 0.76 mm (95% CI 0.73–0.79), both P < 0.001. A higher calculated 10-year cardiovascular risk was related to higher IMT and CACS.
Patients with hemophilia are not protected against the development of atherosclerosis as measured by CACS and IMT. The extent of atherosclerosis is related to the traditional cardiovascular risk factors. This suggests that traditional cardiovascular risk factors should be monitored and treated in patients with hemophilia.
Cognitive impairment occurs in 40-65% of multiple sclerosis (MS) patients, typically involving complex attention, information processing speed, (episodic) memory and executive functions. It is seen ...in the subclinical radiologically isolated syndrome, clinically isolated syndrome, and all phases of clinical MS. In pediatric-onset MS cognition is frequently impaired and worsens relatively rapidly. Cognitive impairment often affects personal life and vocational status. Depression, anxiety and fatigue aggravate symptoms, whereas cognitive reserve partially protects. Cognitive dysfunction correlates to brain magnetic resonance imaging (MRI) lesion volumes and (regional) atrophy, and degree of and increase in MRI abnormalities predict further worsening. Experimental MRI indicates a crucial role for (focal) cortical lesions and atrophy, abnormal cortical integrity, and early changes in normal appearing brain tissue. Functional MRI suggests compensatory reorganization and adaptation changes in neural activities. Screening tools are the Brief Repeatable Neuropsychological Battery, Symbol Digit Modalities Test and Audio Recorded Cognitive Screen. The Minimal Assessment of Cognitive Function in Multiple Sclerosis (MS) is used for formal neuropsychological evaluation. What constitutes a clinically relevant change and how to optimally monitor cognition are issues to be settled. In relapsing-remitting MS timely and adequate disease modifying drug treatment may stabilize or possibly improve cognition. There is no evidence-based symptomatic drug treatment, nor are there optimal non-pharmacological approaches. Leisure activities enhance cognitive reserve. Cognitive rehabilitation in MS patients is still in its infancy. Cognitive behavioral therapy, exercise, and education programs are promising psychosocial interventions to improve coping and lessen cognitive symptoms.
Do women face bias in the social realm in which they are purported to excel? Across two different studies (one organizational and one comprising MBA teams), we examined whether the friendship ...networks around women tend to be systematically misperceived and whether there were effects of these misperceptions on the women themselves and their teammates. Thus, we investigated the possibility (hitherto neglected in the network literature) that biases in friendship networks are triggered not just by the complexity of social relationships but also by the gender of those being perceived. Study 1 showed that, after controlling for actual network positions, men, relative to women, were perceived to occupy agentic brokerage roles in the friendship network—those roles involving less constraint and higher betweenness and outdegree centrality. Study 2 showed that if a team member misperceived a woman to occupy such roles, the woman was seen as competent but not warm. Furthermore, to the extent that gender stereotypes were endorsed by many individuals in the team, women performed worse on their individual tasks. But teams in which members fell back on well-rehearsed perceptions of gender roles (men rather than women misperceived as brokers) performed better than teams in which members tended toward misperceiving women occupying agentic brokerage roles. Taken together, these results contribute to unlocking the mechanisms by which social networks affect women’s progress in organizations.
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