ABSTRACT
While the global development agenda has prioritized gender equality, many challenges remain, and the COVID-19 crisis has exacerbated inequalities. Gender transformative approaches to social change have the potential to address the underlying causes of inequality. This paper draws insights from studies funded by Canada's International Development Research Centre to understand how integrating gender transformative approaches to research can support social change. The findings suggest that gender transformative research is most successful in supporting change when it analyzes and addresses the multiple causes of inequality, takes an intersectional and structural approach, embeds the research in local contexts, and engages power holders and perpetrators of inequality.
ABSTRACT
Purpose/Objectives Early diagnosis and treatment of head and neck squamous cell carcinoma (HNSCC) is paramount to improving patient prognosis. The purpose of this study was to analyze the association of patient demographic, clinical, and management variables with time to treatment initiation (TTI) and one-year survival. Additionally, we evaluated the effect of potential areas of delay, such as the COVID-19 pandemic, in association with TTI and one-year survival. Materials/Methods Medical records of patients who were diagnosed with HNSCC from 2018 to 2020 at a tertiary academic medical center were reviewed to extract demographic and clinical information. Univariate and multivariate linear and cox-regression were used to evaluate TTI and one year survival with our study variables. Kaplan Meier (KM) curves were created to evaluate the difference in hazard over time between patients diagnosed in 2019 and 2020. Results A total of 233 patients met eligibility criteria. The median time between symptom onset and presentation to a medical provider was 1 month (Interquartile range [IQR]: 0.5-3). 118 patients (50.9%) were referred to one of our academic head and neck specialists by their PCP, 37 (15.9%) by a dental provider, 32 (13.8%) through the emergency department, 26 (11.2%) by a local ENT, and 20 (8.6%) by other means. Median time for oncologic work-up was 25 days (IQR: 16-38). Median TTI was 37.5 days (IQR: 27-50.75). 21% of patients reported delays in treatment, with the top three reasons cited as concurrent medical problems (34.69%), patient deferrals (16.33%), and delayed dental exams (8.16%). Univariate analysis for TTI found a significant increase in TTI in female patients (p=0.041) and those undergoing salvage therapy (p=0.045), and chemoradiation (p=0.008). Univariate cox-regressions predicting one-year mortality found direct admission status (p=0.005), the use of pre-treatment PEG tubes (p=0.006) and tracheostomies (p=0.025) significantly increased one-year mortality. This association was not significant in a multivariate models. Other demographic and clinical variables, including smoking history, median income by zip code, distance from hospital, tumor subsite, and others, did not significantly impact TTI or one-year mortality. Hazard ratios for one-year mortality and Kaplan-Meier estimates for one-year survival were not significant when adjusted for year of diagnosis (p>0.05) and TTI quartile (p>0.05). Conclusion Our analysis determined that many patient and management variables may not significantly impact TTI and one-year survival. Patients diagnosed in 2020 showed no difference in overall survival compared to prior years, despite COVID-19. The scope for improved HNSCC management may lie in continuing to optimize care in a timely manner for those with characteristics of advanced disease, many of which were found to be predictive of one-year mortality.
ABSTRACT
Introduction: During the COVID-19 pandemic, minimizing the surgeon's exposure to aerosol-generating procedures is critical, and to our knowledge, the airflow dynamics and subsequent risk to the surgical team due to a back-flow or plume during jet ventilation has not been studied. Backgroundoriented Schlieren (BOS) imaging detects distortions in airflow to see the invisible: a density gradient creates a refractive index change in the air, which uses small shifts to the recording of a visually textured background that are revealed using imaging-processing techniques. We aimed to use the BOS technique to illustrate the airflow patterns of jet ventilation. Method: A manikin model of jet ventilation was created to mimic lung compliance in an open system. A laryngoscope was used to expose the model and was suspended. The Monsoon III high-frequency jet ventilation system (Vyaire, Chicago, Illinois, USA) was used in either a supraglottic (delivered via laryngoscope port) or infraglottic technique (Hunsaker Mon-Jet ventilation theter, Medtronic, Minneapolis, USA). Various delivery settings were tested including driving pressure, ventilation frequency, and use of a variety of suction types/position. Images were obtained with a high-speed camera, and BOS processing was performed. Plume size was measured with ImageJ software (National Institutes of Health, Bethesda, Maryland, USA). Results: We successfully used BOS imaging to demonstrate variations in plume volume during supraglottic and infraglottic techniques. Low-frequency jet ventilation (12 cycles/min) and lower driving pressures had a smaller plume than highfrequency jet ventilation (120 cycles/min) or higher driving pressures with all other settings stable. There appeared to be a higher transnasal plume during supraglottic jet ventilation. Suction position significantly affected the plume size. Conclusion: High-frequency, low-volume, infraglottic jet ventilation with dual suction appears to have a lower risk of aerosolization compared with other modes of ventilation. Higher driving pressures were correlated to plume size.