CercleS survey: impact of the COVID-19 pandemic on foreign language teaching in Higher Education

The pandemic may well have totally changed the way foreign languages are now being taught. In March 2020 language centres (LCs) in universities needed to adjust abruptly to online teaching with minimal resources or training for teachers. Research on the topic of the impact of the pandemic on teaching started from Day 1 and to date there have been contradictions about whether online learning is effective. The CercleS survey aims to study teachers’ reflections on teaching during the pandemic and on the future of foreign language instruction in Higher Education (HE). Data were collected between March 30 and May 5, 2021, and the answers reflect the voices of 725 teachers from CercleS national associations. The findings indicate that the teachers moved flexibly into the online mode of teaching despite limitations in technological resources and the absence of training: 32.4% of the respondents declared no hardware was provided by their institution for working from home and 40.6% were not relieved from other duties. However, 66% of the teachers reported that the learning outcomes were met by modifying specific assessment criteria. Simultaneous group dynamics seemed difficult to achieve in the online format in comparison to face-to-face interactions in the traditional classroom. The acquisition of language skills, mainly speaking, was a challenge. Generally, the respondents see the benefits of a blended/hybrid mode of instruction. Implications for teaching practices and stakeholders are as follows: develop guidelines defining criteria for different formats of delivery in language education, develop workshops for teachers, negotiate conditions needed to carry out efficient and sustainable language teaching with university executive boards, offer training for sustainable online and hybrid teaching and maintain, and develop international collaboration between LCs in HE (e.g. virtual exchange, staff exchange, virtual international classrooms).

Comparative effectiveness of simultaneous and staged operations in patients with atherosclerotic lesions of carotid and coronary arteries

Objective: comparative systematic analysis of clinical trials of staged and simultaneous approaches in the surgical treatment of combined carotid and coronary stenosis based on the literature search.Material and methods. A systematic literature search was performed in PubMed/MEDLINE, Google Scholar and Scopus using predefined acceptance criteria. To compare data of simultaneous and staged surgery cumulative indicators of heart attack, stroke and mortality, expressed as percentages and absolute numbers, were analyzed; the Mantel–Hensel formula and the χ2 method were used to assess the relative risk of major adverse cardio-cerebral events development and mortality.Results. The analysis included 7 studies containing one intervention (4 simultaneous and 3 stage methods). The risk of developing myocardial infarction was RR 0.13 (95% CI 0.02–0.67) for simultaneous tactics, and RR 7.79 (95% CI 1.5–40.43) for staged tactics (p˂0.005). The risk of stroke developing was RR 1.29 (95% CI 0.56–2.99) for a simultaneous approach, and RR 0.78 (95% CI 0.33–1.8) for stage approach (p˃0.05). The risk of mortality was RR 0.77 (95% CI 0.31–1.88) for simultaneous procedures, and RR 1.3 (95% CI 0.53–3.18) for staged procedures (p˃0.05).Conclusion. Staged tactics for combined carotid and coronary stenosis may be accompanied by a significantly higher risk of myocardial infarction. There was no statistically significant difference between the groups in terms of the risk of stroke and mortality, but there was a trend towards a higher risk of stroke in the simultaneous group and a higher risk of death from all causes in the staged group.

Placental Transfusion, Timing of Plastic Wrap or Bag Placement, and Preterm Neonates

Objective Compare delivery room practices and outcomes of infants born at less than 32 weeks' gestation or less than 1,500 g who have plastic wrap/bag placement simultaneously during placental transfusion to those receiving plastic wrap/bag placement sequentially following placental transfusion. Study Design Retrospective analysis of data from a multisite quality improvement initiative to refine stabilization procedures pertaining to placental transfusion and thermoregulation using a plastic wrap/bag. Delivery room practices and outcome data in 590 total cases receiving placental transfusion were controlled for propensity score matching and hospital of birth. Results The simultaneous and sequential groups were similar in demographic and most outcome metrics. The simultaneous group had longer duration of delayed cord clamping compared with the sequential group (42.3 ± 14.8 vs. 34.1 ± 10.3 seconds, p < 0.001), and fewer number of times cord milking was performed (0.41 ± 1.26 vs. 0.86 ± 1.92 seconds, p < 0.001). The time to initiate respiratory support was also significantly shorter in the simultaneous group (97.2 ± 100.6 vs. 125.2 ± 177.6 seconds, p = 0.02). The combined outcome of death or necrotizing enterocolitis in the simultaneous group was more frequent than in the sequential group (15.3 vs. 9.3%, p = 0.038); all other outcomes measured were similar. Conclusion Timing of plastic wrap/bag placement during placental transfusion did affect duration of delayed cord clamping, number of times cord milking was performed, and time to initiate respiratory support in the delivery room but did not alter birth hospital outcomes or respiratory care practices other than the combined outcome of death or necrotizing enterocolitis. Key Points

Differences in time to return to work among patients undergoing simultaneous versus staged bilateral total knee arthroplasty

Aims Many patients undergoing total knee arthroplasty (TKA) have severe osteoarthritis (OA) in both knees and may consider either simultaneous or staged bilateral TKA. The implications of simultaneous versus staged bilateral TKA for return to work are not well understood. We hypothesized that employed patients who underwent simultaneous bilateral TKA would have significantly fewer days missed from work compared with the sum of days missed from each operation for patients who underwent staged bilateral TKA. Methods The prospective arthroplasty registry at the Hospital for Special Surgery was used. Baseline characteristics and patient-reported outcome scores were evaluated. We used a linear regression model, adjusting for potential confounding variables including age, sex, preoperative BMI, and type of work (sedentary, moderate, high activity, or strenuous), to analyze time lost from work after simultaneous compared with staged bilateral TKA. Results We identified 152 employed patients who had undergone simultaneous bilateral TKA and 61 who had undergone staged bilateral TKA, and had completed the registry’s return to work questionnaire. The simultaneous group missed a mean of 46.2 days (SD 29.1) compared with the staged group who missed a mean total of 68.0 days of work (SD 46.1) when combining both operations. This difference was statistically significant (p < 0.001). In multivariate mixed regression analysis adjusted for age, sex, BMI, American Society of Anesthesiologists status, and type of work, the simultaneous group missed a mean of 16.9 (SD 5.7) fewer days of work compared with the staged group (95% confidence interval 5.8 to 28.1; p = 0.003). Conclusion Employed patients undergoing simultaneous bilateral TKA missed a mean of 17 fewer days of work as a result of their surgical treatment and rehabilitation compared with those undergoing staged bilateral TKA. This information may be useful to surgeons counselling employed patients with bilateral OA of the knee who are considering surgical treatment. Cite this article: Bone Joint J 2021;103-B(6 Supple A):108–112.

Simultaneous or staged operation for tandem spinal stenosis: surgical strategy and efficacy comparison

Background Tandem spinal stenosis (TSS) has a complex clinical presentation, and there is no consensus on the optimal surgical strategy. This study retrospectively compared the efficacy of different staged operations and simultaneous decompression for patients with TSS. Methods We reviewed data from 132 patients with TSS who received surgical procedures from January 2011 to June 2018. Patients were classified into three groups according to the most symptomatic area of compression (group C: first-stage surgery for cervical compression; group L: first-stage surgery for lumbar compression; group CL: simultaneous surgery for both). Medical records were reviewed for age, gender, comorbidities, operation time, combined estimated blood loss, and time of hospitalization. The JOA-C, JOA-L, NDI, and ODI scores, and complications were also examined. Results Postoperative outcomes were followed for 32.1 ± 5.4 months. There were significant differences in the re-operation rate and the interval time between the two types of staged operations (p = 0.005 and p = 0.001, respectively). There were no significant differences in gender (p = 0.639), operation time (p = 0.138), combined estimated blood loss (p = 0.116), or complications (p = 0.652) among the three groups, while the simultaneous group was significantly younger (p = 0.027), with fewer comorbidities (p < 0.001) and a shorter hospitalization time (p < 0.001). At the final follow-up, the JOA-C and JOA-L scores were increased, while the NDI and ODI scores were decreased, compared with the preoperative scores. Conclusions TSS can be effectively managed by either simultaneous or staged decompressions. First-stage surgery for cervical stenosis significantly lowers the requirement for second-stage lumbar surgery. One-stage simultaneous decompression is safe and effective with the advantage of reduce hospitalization time, without an increase in operative time or bleeding. However, the surgical indications should be strictly controlled and is recommended for younger patients with fewer comorbidities.

Comparison of Hearing Outcomes of Systemic Steroid Monotherapy and Intratympanic Steroid Combined Treatment in Idiopathic Sudden Sensorineural Hearing Loss

Background and Objectives Steroid treatment is used as a main treatment modality for sudden sensorineural hearing loss (SSNHL). Intratympanic injection of steroid (ITS) has been used and its therapeutic efficacy reported as being comparable to the systemic steroid administration (SS). This study compares the hearing outcomes of using ITS and SS simultaneously and SS alone.Subjects and Method Retrospective chart review was performed for 146 patients with SSNHL. The patients were divided into 2 groups according to the method of treatment (SS and ITS simultaneously vs. SS alone). The inclusion criteria were starting treatment within 7 days after onset, and follow up pure tone audiometry at least 4 weeks after treatment. Hearing gain for pure tone threshold of each frequency and average of 4 frequencies (500 Hz, 1000 Hz, 2000 Hz, and 4000 Hz) were compared between both groups.Results The improvement in PTA at 1-month follow-up was 27.3±20.0 dB HL in the simultaneous group and 19.1±19.5 dB HL in the SS alone group; this was not statistically significant. Complete or partial recovery at 1-month follow-up was observed in 65.3% of the simultaneous group and 69.6% of the SS alone group; this was also not significant.Conclusion There was no significant difference in hearing outcomes between the simultaneous and SS alone group. The simultaneous therapy does not appear to be superior to the SS alone therapy. Further studies using more population and longer follow-up periods are necessary.

Vertical-guided bone regeneration with a titanium-reinforced d-PTFE membrane utilizing a novel split-thickness flap design: a prospective case series

Objectives To evaluate the feasibility of a newly proposed minimally invasive split-thickness flap design without vertical-releasing incisions for vertical bone regeneration performed in either a simultaneous or staged approach and to analyze the prevalence of adverse events during postoperative healing. Materials and methods Following preparation of a split-thickness flap and bilaminar elevation of the mucosa and underlying periosteum, the alveolar bone was exposed over the defects, vertical GBR was performed by means of a titanium-reinforced high-density polytetrafluoroethylene membrane combined with particulated autogenous bone (AP) and bovine-derived xenograft (BDX) in 1:1 ratio. At 9 months after reconstructive surgery, vertical and horizontal hard tissue gain was evaluated based on clinical and radiographic examination. Results Twenty-four vertical alveolar ridge defects in 19 patients were treated with vertical GBR. In case of 6 surgical sites, implant placement was performed at the time of the GBR (simultaneous group); in the remaining 18 surgical, sites implant placement was performed 9 months after the ridge augmentation (staged group). After uneventful healing in 23 cases, hard tissue fill was detected in each site. Direct clinical measurements confirmed vertical and horizontal hard tissue gain averaging 3.2 ± 1.9 mm and 6.5 ± 0.5 mm respectively, in the simultaneous group and 4.5 ± 2.2 mm and 8.7 ± 2.3 mm respectively, in the staged group. Additional radiographic evaluation based on CBCT data sets in the staged group revealed mean vertical and horizontal hard tissue fill of 4.2 ± 2.0 mm and 8.5 ± 2.4 mm. Radiographic volume gain was 1.1 ± 0.4 cm3. Conclusion Vertical GBR consisting of a split-thickness flap and using titanium-reinforced non-resorbable membrane in conjunction with a 1:1 mixture of AP+BDX may lead to a predictable vertical and horizontal hard tissue reconstruction. Clinical relevance The used split-thickness flap design may represent a valuable approach to increase the success rate of vertical GBR, resulting in predicable hard tissue regeneration, and favorable wound healing with low rate of membrane exposure.

Medial Displacement Calcaneal Osteotomy: Loss of Correction with Varying Drilling Techniques

Category: Hindfoot Introduction/Purpose: Surgical correction of Stage 2 posterior tibial tendon dysfunction typically involves a combination of soft tissue and bony corrections, often including a medial displacement calcaneal osteotomy (MDCO). This osteotomy is often fixated utilizing two parallel screws; however, it remains unknown how much correction is lost based on various accepted drilling techniques for common fixation of this osteotomy. Our cadaveric study compares three different surgical drilling techniques, using two parallel cannulated screws for fixation, to best maintain desired translation of the MDCO. Methods: Fifteen above knee, fresh-frozen, matched pair cadaveric specimens (30 limbs) were randomized equally into three groups. Calcanealosteotomies were performed, followed by manual 10 mm medial translation of the tuberosity. Two parallel 2.5mm guide wires were advanced across the osteotomy site under fluoroscopy. The first group involved a ‘staggered’ drilling technique in which one guide wire was over drilled to the osteotomy site with a 4.5mm cannulated drill and then a 7.0 mm cannulated screw was placed across the osteotomy, followed by a second screw in similar fashion. The second, ‘simultaneous’ group consisted of over drilling both guide wires sequentially followed by placement of both screws. The third control group involved simultaneously over drilling only the near cortex, followed by placement of the 2 screws. Following screw fixation, the calcaneal tuberosity was manually translated in a lateral direction. The loss of correction was then marked and measured in millimeters. Results: All thirty cadaveric specimens underwent standard medializing calcaneal displacement osteotomy without significant variation, or complication. Loss of medialization was measured in millimeters following a manual lateral displacing force after the screw fixation of the osteotomy. The ‘simultaneous’ drilling group experienced the greatest loss of medial displacement with the mean loss of correction being 2.6 mm (range 1.37 - 3.48 mm) following manual lateral translation. The ‘staggered’ group showed an average loss of 1.16 mm (range 0.36 - 2.67 mm). The control group, that simply involved drilling of the near cortex, demonstrated the greatest maintenance of medial displacement with a mean loss of only 0.036 mm (range 0.01 - 0.06 mm). Conclusion: Our cadaveric study comparing three different drilling techniques for maintaining the intended correction following MDCO demonstrates that simultaneous over drilling of only the tuberosity near cortex prior to screw fixation was the most resistant to loss of medial displacement; whereas mean loss of correction with simultaneous drilling of both wires to the osteotomy resulted in the greatest loss of correction at an average of 26%.

Comparative study on functional outcome, complication and readmission rate in bilateral simultaneous versus staggered versus staged total knee replacement: a retrospective study

<p class="abstract"><strong>Background:</strong> An important source of debate in orthopaedic practices is the choice of performing simultaneously, staggered or staged bilateral total knee arthroplasty (BTKA). Many studies are available which compare bilateral simultaneous vs staged TKA in terms of functional outcome. But still there are no studies which include staggered BTKA (done in a single hospital stay) and compared their functional outcome, associated complication with a 90 days readmission rate.</p><p class="abstract"><strong>Methods:</strong> A retrospective review of 300 TKAs patients who underwent bilateral TKA. Patients were divided into three groups with 100 patients each in simultaneous, staggered, staged group. We use hospital electronic health records database to compare the complication and readmission rates in all three groups. Functional outcome was evaluated pre-operatively using knee society score (KSS), Western Ontario and McMaster Universities Arthritis Index (WOMAC), Oxford knee score, Kujala score and range of motion.<strong></strong></p><p class="abstract"><strong>Results:</strong> The study consists of 234 females and 66 males, among which maximum females were in a simultaneous group while male where more in staggered group. Mean age group in our study was 62.25%. ASA score of 3 was significantly more in staged group. Patient in the staggered group had a better KSS and Kujala score with better range of motion and less readmission and complication rate. Simultaneous BTKA had slightly higher complication rate.</p><p class="abstract"><strong>Conclusions:</strong> This study demonstrates that there is not big significant in functional outcome when comparing simultaneous, staged and staggered bilateral TKA, but still staggered group shows better postoperative functional outcome.</p>

Simultaneous versus staged resection for synchronous colorectal cancer liver metastases: A population-based cohort study.

3612 Background: Simultaneous resection of colorectal cancer primary and liver metastases is not performed routinely due to concerns about safety. We hypothesized that simultaneous resection has steadily increased overtime and that the outcomes are similar. Methods: Population-based cohort study of patients undergoing resection for synchronous (resection of the primary colorectal cancer and liver metastases within six months) liver metastases from 2006-2015 by linking administrative datasets in Ontario, Canada. Outcomes: post-operative complications, length of hospital stay, and overall survival. Survival for the staged group was measured from the last surgical resection to death and estimated using Kaplan Meier and compared with the log-rank test. Cox proportional hazard models were used to calculate risks for death. We aimed to identify practice patterns, outcomes of simultaneous vs. staged resections for these patients. Results: Of 2,738 patients undergoing colorectal and liver resection for colorectal cancer, 1,168 were synchronous, of which, 442 underwent simultaneous resection. Rate of synchronous disease presentation increased on average by 3% per year (p = 0.02). Median length of stay was shorter (8 vs. 11 days, p < 0.001); rate of major liver resections were lower (17% vs. 65%, p < 0.001), and 90-day post-operative mortality was higher (6% vs. 1%) for simultaneous resections. Major postoperative complications were higher in the simultaneous group (28% vs. 23%, p = 0.067), mostly due to a higher reoperation rate (6% vs. 3%, p = 0.034). Median overall survival was worse with simultaneous resection (40 months, 95%CI 35-46 vs. 78 months, 95%CI 59-86). Risks factors for worse survival were comorbidities, rurality, right-sided primary and simultaneous resection. There is selection bias that favours survival in the staged group, as patients must have survived the first operation and have stable disease in order to undergo the second operation. Conclusions: Simultaneous resection is associated with worse postoperative outcomes. Considering selection bias, randomized studies would be necessary to determine the role of simultaneous.