Lack of Current Recommendations for Resuming Sexual Activity Following Spinal Surgery

Cara Michelle Thomas,Howard Benjamin Levene 대한척추외과학회 2019 Asian Spine Journal Vol.13 No.3

Patients are faced with many questions surrounding the after effects of the various surgical procedures and their ability to return to preoperative activities. While patients often question whether surgery would provide alleviation of pain, weakness, and instability, they often have additional questions about sexual activity during their convalescence that are not always addressed. Although the literature shows postsurgical improvement in sexual activity in association with improved low back pain, reports vaguely address the variability in sexual activity recommendations based on anatomic location and type of spinal surgery. We conducted a PubMed search of the English language from 1990 to 2018 with the following keywords: sexual activity, postoperative, spinal fusion, spinal decompression, functional outcomes, laminectomy, rehabilitation, biomechanics, lumbar disc surgery, metabolic energy expenditure, coital position, and Oswestry Disability Index. Additional studies are needed that survey both patients and spine surgeons to examine current recommendations and to help formulate future guidelines.

Prostate Cancer Mortality and Use of 5-Alpha Reductase Inhibitors

Cara A. Foldes,Run Wang,Steven E. Canfield 대한남성과학회 2020 The World Journal of Men's Health Vol.38 No.2

Prostate cancer prevention was a goal of intense research and expenditure in the nineties through the early two-thousands. The largest prevention trial ever planned was the Selenium and Vitamin E Prostate Cancer Prevention Trial (SELECT) which enrolled 35,533 men but closed early due to futility and concern for increased prostate cancer from vitamin E [1]. A slightly different story but similar fate occurred with the Prostate Cancer Prevention Trial, which randomized 18,882 men with no clinical evidence of prostate cancer to take the 5-alpha reductase inhibitor (5-ARI) finasteride vs. a placebo [2]. The trial showed a 24.8% overall relative risk reduction in prostate cancer incidence, yet widespread use of finasteride for prevention never occurred. The reason is that the trial also showed a small but significant increase in the incidence of higher grade prostate cancer in the treatment arm, which led to a US Food and Drug Administration black box warning on the medication. Ultimately, this risk was understood to be due to detection bias inherent in the use of finasteride, but the stigma remained [3]. Perhaps more importantly, the reduction in prostate cancer was only seen in low risk, clinically insignificant prostate cancer. A second 5-ARI trial with dutasteride, a more potent blocker, also reported similar results, for low risk prostate cancer prevention [4]. Due to the lack of benefit in clinically significant disease, and controversy surrounding potential harms, this class of medication was never adopted for prevention and remained a footnote in prostate cancer history. A new study from Sarkar et al [5] suggests the 5-ARI story in prostate cancer is not over yet, however. Finasteride and dutasteride are commonly used to improve bladder outlet obstructive urinary symptoms in men with benign prostatic hyperplasia. In addition to a reduction in the size of the prostate, one of the most prominent effects of these medications is an approximate 50% reduction in the serum prostate specific antigen (PSA) concentration [6]. The appropriate PSA based screening for prostate cancer practice in men on 5-ARIs is to therefore normalize the PSA by doubling it in these men, for appropriate population based comparisons [7]. There has been speculation that this normalization is seldom done in primary care practices that pursue PSA screening in general, which may lead to delays in detection and worse outcomes for some men. Sarkar and colleagues [5] performed a retrospective cohort comparison of men in the Veterans Affairs database who were diagnosed with prostate cancer from 2001 to 2015. The cohort consisted of 80,875 men, of whom 8,587 (10.6%) had been prescribed a 5-ARI at least 1 year prior to diagnosis. The study found that men taking 5-ARIs had significantly higher rates of prostate cancer-specific (39% greater) and overall (10% greater) mortality. Interestingly, there was no difference in non-cancer related mortality. Secondary outcomes were also worse across all measures in the 5-ARI group, showing a significant delay in time to diagnosis of cancer (3.6 vs. 1.2 years), higher adjusted PSA value (13.5 vs. 6.4 ng/mL), higher grade (25.2% vs. 17% Gleason 8–10), stage (4.7% vs. 2.9% T3–4), presence of lymph nodal (3.0% vs. 1.7%), and metastatic disease (6.7% vs. 2.9%) at diagnosis. In the absence of randomized controlled trials, these findings would raise greater concerns over the effects of 5-ARIs to directly influence the genomic behavior of prostate cancer, leading to aggressive and more lethal disease. But prior randomized controlled trials show at most a small increase in the incidence of more aggressive disease, a finding which is likely due to detection bias [3]. While this explanation is still possible based on the study's observational design, a more likely explanation is the delay in diagnosis in men taking 5-ARIs, related to the misinterpretation of their artificially lower PSA values. Although the absolute median del...

Utility of a modified components separation for abdominal wall reconstruction in the liver and kidney transplant population

Cara K Black,Elizabeth G Zolper,Elliot T Walters,Jessica Wang,Jesus Martinez,Andrew Tran,Iram Naz,Vikas Kotha,Paul J Kim,Sarah R Sher,Karen K. Evans 대한성형외과학회 2019 Archives of Plastic Surgery Vol.46 No.5

Background Incisional hernia is a common complication following visceral organ transplantation. Transplant patients are at increased risk of primary and recurrent hernias due to chronic immune suppression and large incisions. We conducted a retrospective review of patients with a history of liver or kidney transplantation who underwent hernia repair to analyze outcomes and hernia recurrence. Methods This is a single center, retrospective review of 19 patients who received kidney and/or liver transplantation prior to presenting with an incisional hernia from 2011 to 2017. All hernias were repaired with open component separation technique (CST) with biologic mesh underlay. Results The mean age of patients was 61.0±8.3 years old, with a mean body mass index of 28.4±4.8 kg/m2, 15 males (78.9%), and four females (21.1%). There were seven kidney, 11 liver, and one combined liver and kidney transplant patients. The most common comorbidities were hypertension (16 patients, 84.2%), diabetes (9 patients, 47.4%), and tobacco use (8 patients, 42.1%). Complications occurred in six patients (31.6%) including hematoma (1/19), abscess (1/19), seroma (2/19), and hernia recurrence (3/19) at mean follow-up of 28.7±22.8 months. With the exception of two patients with incomplete follow-up, all patients healed at a median time of 27 days. Conclusions This small, retrospective series of complex open CST in transplant patients shows acceptable rates of long-term hernia recurrence and healing. By using a multidisciplinary approach for abdominal wall reconstruction, we believe that modified open CST with biologic mesh is a safe and effective technique in the transplant population with complex abdominal hernias.

生活方式與可購買時尙産品展示對消費者趨向行爲與回避行爲的影響

( Cara Damminga ),( Juan Juan Wu ),( Kim K. P. Johnson ) 한국마케팅과학회 2012 Journal of Global Fashion Marketing Vol.3 No.3

時尙産品展示是視覺營銷的一個元素(Kerfoot, Davies, and Ward, 2003)。視覺營銷與零수業的興起息息相關。零수業主們通過타向銷수者傳遞視覺信息幷收集消費者對這些信息的看法(Kerfoot et al., 2003)。當信息反饋意向是正面的證明消費者有積極的回應, 最終會促使消費者購買(Kerfoot et al., 2003)。産品展示是零銷商激發消費者計劃外購買的一種方式(Abratt and Goodey, 1990; Chevalier, 1975; Curhan, 1974; Stern, 1962; Wilkinson, Mason, and Paksoy, 1982; Wood, 1998)。有效的商場産品展示可以吸引消費者對某種特定産品的注意力(Stern, 1962), 通過有吸引力的視覺刺激觸動消費者(Kalla and Arora, 2011; Miao, 2010), 或者使消費者忽略對購買決策的理性分析(Kalla and Arora, 2011)。消費者的計劃外購買是零수商利潤的重要組成部分, 因此商場會通過有效的産品展示促進消費(Wood, 1998)。本硏究運用Fiore (2000, p.29)對于産品展示的定義(“在特定地点精心設計對特定産品的展示能구更加突出産品特性, 幷且爲積極影響消費者的趨向反應而調動消費者情緖幷傳遞産品信息。Blackwell and Talarzyk 對生活方式零수的定義(“制定特定目標市場劃分的生活方式零수的方針”), 提出兩種新産品展示類型: (1) 生活方式産品展示, (2) 可購買産品展示。生活方式産品展示是交叉産品化支柱特定商品的展示, 目的是打造出令消費者彷佛置身其中的, 帶有藝術色彩的、賞心悅目的、全面的幷有主題性的展示。本硏究同時運用Burke and Payton 對購買能力的定義(“購物環境的承受力能구改變消費者的需求和購買欲望”), 可購買産品展示是展示本身就可以對特定商品貨存的産品展示。硏究目的文旨在硏究消費者通過生活方式和可購買時尙産品展示表現出的情感狀態(愉悅, 激勵, 認知愉悅), 進而對消費者趨向行爲與回避行爲進行分析。同時, 本文討論了消費者便利導向與享樂主義購物价値觀對産品展示與情感狀態, 産品展示與趨向行爲和回避行爲兩者之間聯系的調節效果。硏究假設如下: H1: 産品展示類型對消費者的(a) 愉悅, (b) 激勵, (c) 認知愉悅與(d) 趨向行爲與回避行爲影響顯著。H2: 消費者的(a) 愉悅, (b) 激勵, (c) 認知愉悅對産品展示類型及其趨向行爲與回避行爲起調節作用。H3: 消費者的(i) 便利導向或者(ii) 享樂主義購物价値觀對産品展示類型與(a) 愉悅, (b) 激勵, (c) 認知愉悅與(d) 趨向行爲與回避行爲之間的關系起到調節作用。本文通過對兩種時尙産品展示的兩種方法分析了視覺營銷理論(生活方式産品展示與可購買産品展示)。同時, 本文爲産品展示與零수業情況對消費者行爲的影響提供了廣闊思路。硏究思路本文采用了在學科試驗中生活方式産品展示與可購買産品展示隨机排列的方法。在視覺環境中對此兩種變量進行分析。硏究選取了三種服飾産品進行模特實體展示: 친衫, 運動衫與女裝。可購買産品展示中, 女裝同時也在相隣的T型台上展示, 上衣則折疊放在臨近的展示탁上(如圖3與圖5)。生活方式展示中同時利用到了便于生活方式交流的工具(如圖4與圖5)。展示中包括了廚具與家居(攪拌机, 盤子與窓렴)與一個野餐場景(餐籃, 熱狗, 담子與一甁酒)。整個展示過程中始終貫穿着固定架、地板、壁紙、정光、尺寸以及商場中的商品這些元素。調査問卷中添加了産品展示的屛幕快照。調査問卷中指出購買物品中只包含服飾。在此一條件限制下, 問卷參與者在愉悅程度、激勵、認知愉悅、趨向行爲與回避行爲等方面做出反饋。結論參與者(n=157)年齡在18至30歲之間。一個MANOVA 運用于産品展示激勵操作檢査測評。Pillai曲線顯示産品展示類型對操作檢査物品影響顯著(V=.273, F (6, 306)=8.053, p<.001)。參與者强調了産品展示激勵中的生活方式(F (3, 153)=10.648, p 4<.001)與可購買性(F (3, 153)=2.853, p<.05)。Levene 的試驗證明方差齊性的假設成立(p>.05), 4個2×2 ANOVA 運用于生活方式與可購買産品展示對愉悅、激勵、認知愉悅、趨向行爲與回避行爲的獨立和綜合影響。生活方式産品展示對認知愉悅的影響顯著(F (1, 153)=5.543, p<.01), 可購買産品展示對愉悅影響顯著(F (1, 153)=5.344, p<.05), 激勵(F (1, 153) =6.754, p<.05), 認知愉悅(F (1, 153)=8.287, p<.01)。認爲生活方式-可購買産品展示對提高消費激勵, 愉悅以及認知愉悅程度흔重要的參與者比相反觀点的參與者數量多。但是, 幷未得到調節作用的相關理論。硏究局限本硏究運用産品展示視覺刺激來論述, 但可能幷不能准確反映出消費者對于實際零수業的看法。結果也只是針對廣泛産品分類中的服飾類或者부限于通過産品展示來觀察消費者情緖變化的零수商。 This research conducted in the US investigated the effect of lifestyle and shoppable fashion product displays on consumers` emotional states (pleasure, arousal, cognitive pleasure) and further on approach and avoidance behaviors. It also tested the moderating effect of consumers` convenience orientation and hedonic shopping value on the relationship between product displays and consumers` emotional states, as well as between product displays and their approach and avoidance behavior. A 2 (lifestyle vs. non-lifestyle) by 2 (shoppable vs. non-shoppable) experimental research revealed that participants who viewed the lifestyle-shoppable product display experienced significantly more arousal, pleasure, and cognitive pleasure than those who viewed the non-lifestyle-non-shoppable product display.

Hedonic and utilitarian message characteristics in social networking sites. A qualitative approach

Corina Cara(코리나 카라),Tudor Tocila(투도르 토칠라) 한국외국어대학교 동유럽발칸연구소 2017 동유럽발칸연구 Vol.41 No.2

소셜 네트워킹 사이트는 점점 더 많은 기업들이 마케팅 전략을 세울 때 고려함에도 불구하고 연구되지 않은 분야이다. 이 연구의 목적은 두 가지 다른 접근법인 헤도닉 기법과 실용적 기법의 특성을 밝혀내는 것이다. 샘플은 마케팅전공 3학년인, 21세에서 23세 사이의 전형적인 SNS 사용자들 73명으로 이루어져 있다. 이 연구는 루마니아 북동부에 위치한 도시인 이아시 에서 이루어졌다. 연구 결과는 SNS 메시지가 헤도닉 혹은 실용적으로 여겨지기 위해 가지고 있어야 하는 특징들이 무엇인지를 보여준다. 이 논문은 SNS 메시지를 조사하기 위한 실험 설계를 구성하는 데에 가치 있는 시작점을 제공한다. 또한 분할 시험을 통해 여러 가지 커뮤니케이션 전략을 비교하기 위해 SNS 메시지 레이아웃을 설계해야 하는 기업들에게도 이론적 배경을 제공한다. Social Networking Sites (SNS) represents an area that is understudied, even though more and more companies consider this media when are building their marketing strategies. The purpose of this research is to identify the characteristics of two different approaches, hedonic and utilitarian. The sample consists in 73 typical users of SNS, aged between 21 and 23, 3rd year marketing students, chosen based on convenience. The research was conducted in Iași, a city located in the northeast region of Romania. Results show what characteristics a SNS message should have in order to be considered hedonic or utilitarian. This paper provides valuable starting points for configuring experimental designs in order to investigate SNS messages. It also gives some theoretical background for companies that need to build SNS message layouts in order to compare different communication strategies through split tests.

Black Friday: Has the game changed?

Peters Cara,Thomas Jane 한국마케팅과학회 2022 Journal of Global Fashion Marketing Vol.13 No.4

Previous research on Black Friday consumption rituals has focused on planning and shopping for an in-store customer experience. In recent times, however, consumer perceptions and shopping behaviors related to Black Friday have begun to shift. Consumers are shopping earlier, moving online, taking advantage of delivery and curbside pickup, and expecting retailers to provide a safe, socially distanced shopping experience. This study was grounded in theory from social change within the field of sociology. The purpose of this study was to examine how various factors, such as the pandemic, retailer strategies, online shopping, cultural trends are reshaping consumers’ views and shopping behaviors related to Black Friday. Data were collected via 31 phenomenological interviews with consumers who have shopped on Black Friday in the past. Results were analyzed according to the protocol for phenomenology and were presented in the form of themes that emerged from the data. Overall, consumers believed that Black Friday had changed and had become less impactful. Changes were due to store policies and procedures around safety during the pandemic, retailers extending the number of days and weeks for Black Friday shopping, the convenience and breadth of products available among a plethora of online shopping alternatives, the impact of the economy on the ability to shop, and how the name Black Friday has negative associations for some shoppers. Managerial implications for retailers were discussed as the game of Black Friday has changed. Implications included strategies retailers can use to entice consumers as they try to revamp Black Friday and engage shoppers in the future.

Utility of a modified components separation for abdominal wall reconstruction in the liver and kidney transplant population

Black, Cara K,Zolper, Elizabeth G,Walters, Elliot T,Wang, Jessica,Martinez, Jesus,Tran, Andrew,Naz, Iram,Kotha, Vikas,Kim, Paul J,Sher, Sarah R,Evans, Karen K Korean Society of Plastic and Reconstructive Surge 2019 Archives of Plastic Surgery Vol.46 No.5

Background Incisional hernia is a common complication following visceral organ transplantation. Transplant patients are at increased risk of primary and recurrent hernias due to chronic immune suppression and large incisions. We conducted a retrospective review of patients with a history of liver or kidney transplantation who underwent hernia repair to analyze outcomes and hernia recurrence. Methods This is a single center, retrospective review of 19 patients who received kidney and/or liver transplantation prior to presenting with an incisional hernia from 2011 to 2017. All hernias were repaired with open component separation technique (CST) with biologic mesh underlay. Results The mean age of patients was $61.0{\pm}8.3years\;old$, with a mean body mass index of $28.4{\pm}4.8kg/m^2$, 15 males (78.9%), and four females (21.1%). There were seven kidney, 11 liver, and one combined liver and kidney transplant patients. The most common comorbidities were hypertension (16 patients, 84.2%), diabetes (9 patients, 47.4%), and tobacco use (8 patients, 42.1%). Complications occurred in six patients (31.6%) including hematoma (1/19), abscess (1/19), seroma (2/19), and hernia recurrence (3/19) at mean follow-up of $28.7{\pm}22.8months$. With the exception of two patients with incomplete follow-up, all patients healed at a median time of 27 days. Conclusions This small, retrospective series of complex open CST in transplant patients shows acceptable rates of long-term hernia recurrence and healing. By using a multidisciplinary approach for abdominal wall reconstruction, we believe that modified open CST with biologic mesh is a safe and effective technique in the transplant population with complex abdominal hernias.

Validation of Neck Disability Index Severity among Patients Receiving One or Two-Level Anterior Cervical Surgery

Geoghegan Cara E.,Mohan Shruthi,Lynch Conor P.,Cha Elliot D. K.,Jacob Kevin C.,Patel Madhav R.,Prabhu Michael C.,Vanjani Nisheka N.,Pawlowski Hanna,Singh Kern 대한척추외과학회 2023 Asian Spine Journal Vol.17 No.1

Study Design: Retrospective cohort. Purpose: To evaluate the validity of established severity thresholds for Neck Disability Index (NDI) among patients undergoing anterior cervical discectomy and fusion (ACDF) or cervical disc arthroplasty (CDA). Overview of Literature: Few studies have examined the validity of established NDI threshold values among patients undergoing ACDF or CDA. Methods: A surgical database was reviewed to identify patients undergoing cervical spine procedures. Demographics, operative characteristics, comorbidities, NDI, Visual Analog Scale (VAS), and 12-item Short Form (SF-12) physical and mental composite scores (PCS and MCS) were recorded. NDI severity was categorized using previously established threshold values. Improvement from preoperative scores at each postoperative timepoint and convergent validity of NDI was evaluated. Discriminant validity of NDI was evaluated against VAS neck and arm and SF-12 PCS and MCS. Results: All 290 patients included in the study demonstrated significant improvements from baseline values for all patient-reported outcome measures (PROMs) at all postoperative timepoints (p<0.001) except SF-12 MCS at 2 years (p=0.393). NDI showed a moderate-to-strong correlation (r≥0.419) at most timepoints for VAS neck, VAS arm, SF-12 PCS, and SF-12 MCS (p<0.001, all). NDI severity categories demonstrated significant differences in mean VAS neck, VAS arm, SF-12 PCS, and SF-12 MCS at all timepoints (p<0.001, all). Differences between NDI severity groups were not uniform for all PROMs. VAS neck values demonstrated significant intergroup differences at most timepoints, whereas SF-12 MCS showed significantly different values between most severity groups. Conclusions: Neck disability is strongly correlated with neck and arm pain, physical function, and mental health and demonstrates worse outcomes with increasing severity. Previously established severity categories may be more applicable to pain than physical function or mental health and may be more uniformly applied preoperatively for cervical spine patients.

BRCA1 and Breast Cancer: a Review of the Underlying Mechanisms Resulting in the Tissue-Specific Tumorigenesis in Mutation Carriers

Lukas Semmler,Cara Reiter-Brennan,Andreas Klein 한국유방암학회 2019 Journal of breast cancer Vol.22 No.1

Since the first cloning of BRCA1 in 1994, many of its cellular interactions have been elucidated. However, its highly specific role in tumorigenesis in the breast tissue—carriers of BRCA1 mutations are predisposed to life-time risks of up to 80%—relative to many other tissues that remain unaffected, has not yet been fully enlightened. In this article, we have applied a universal model of tissue-specificity of cancer genes to BRCA1 and present a systematic review of proposed concepts classified into 4 categories. Firstly, tissue-specific differences in levels of BRCA1 expression and secondly differences in expression of proteins with redundant functions are outlined. Thirdly, cell-type specific interactions of BRCA1 are presented: its regulation of aromatase, its interaction with Progesterone- and receptor activator of nuclear factor-κB ligand-signaling that controls proliferation of luminal progenitor cells, and its influence on cell differentiation via modulation of the key regulators jagged 1-NOTCH and snail family transcriptional repressor 2. Fourthly, factors specific to the cell-type as well as the environment of the breast tissue are elucidated: distinct frequency of losses of heterozygosity, interaction with X inactivation specific transcript RNA, estrogen-dependent induction of genotoxic metabolites and nuclear factor (erythroid-derived 2)-like 2, and regulation of sirtuin 1. In conclusion, the impact of these concepts on the formation of hormone-sensitive and -insensitive breast tumors is outlined.

Content Analysis of Online Co-Design Community Interactions: A Case Study of Crowd-Sourced Threadless

Juanjuan Wu,Cara Damminga,Hye-Young Kim,Kim K. P. Johnson 한국마케팅과학회 2010 마케팅과학연구 Vol.20 No.4

The purpose of this research is to understand the nature, size, and lifecycle of online co-design community interactions through a focused case study of a real business with an aim to provide actionable strategies for co-design service innovation and advancement, and help to forecast future trends in crowd-sourced co-design. Crowd-sourced, socially-empowered design environments not only reduce the cost of design sourcing and production, but also address individual user’s needs for experience sharing, entertainment, and relationship building in the virtual world. Although a great body of research has been established in both co-design (Hoftijzer, J., 2009; Piller, 2008; Relph-Knight, L., 2008; Piller et al., 2005, 2004; Ives, and Piccoli, 2003) and social network analysis (Mehler, and Skiena, 2009; Lin et al., 2009; Agichtein, and Liu, 2009; Ko et al., 2006; Wu, and Huberman 2004; Suh, and Kim, 2002; Park, and Choi, 2001), they often appear to be in two separate fields. Our study aims to better understand the nature of interactions in these unique design environments to better maximize the value of co-design communities. Threadless.com is a t-shirt co-design website that holds an ongoing competition for t-shirt artwork submissions. Anyone can create an account on the website and submit a design, as well as critique and vote on others’ designs. Threadless selects final winning designs from the highest rated designs and awards winners a cash prize. The winning designs are also produced and put up for sale on their website. Our study examines the Critiques Forum of Threadless, where users can upload multiple versions of their designs to be rated and commented on by other members within the community. The critiques of the submitted designs are a great arena for understanding co-design community interactions not only because the Critiques Forum is one of the most essential forums of Threadless, but also because they demonstrate the differences between interactions among co-designers on co-design websites and interactions among the general public on other social networking websites. A total of 367 submissions were included in this study over the period from September 29, 2009, to October 08, 2009. We conducted a content analysis of all the critiquing comments left by the Threadless co-design community on these submissions. From analyzing, sorting, and classifying the meaningful units of the comments, two large categories emerged: “design category” comments and “community category” comments. Subcategories in the “design category” comments included: color, shape/line, orientation/placement, text/slogan, general design ideas/concepts, add/remove attributes, production concerns, and prototype t-shirt color. Subcategories in the “community category” included: encouragement, discouragement, building ties, humor, and commercial. Other important aspects such as the community votes (“submit this,” “needs work,” or “don’t submit”), number of co-designers involved in commenting, number of design sub-categories the original user took advice in, lifecycle of submissions, and total number of comments for each submission were also recorded. The 367 submissions resulted in a total of 2,085 comments left by 1890 co-designers. On average, each submission had 1.75 versions of designs uploaded, 5.68 comments left by 5.15 co-designers, and a 30.28-day lifecycle. A content analysis of the 2,085 total comments showed that the number of community category comments slightly exceeded that of the design category, indicating that co-designers’ interactions are geared towards not only designing, but also building a friendly and supportive community. In descending order, the “design categories” that received the most attention were: add/remove attributes, general design ideas/concepts, color, orientation/placement, shape/line, text/slogan, prototype t-shirt color, and production concerns. In descending order, the “com...