To evaluate (1) the feasibility of an audit-feedback intervention to facilitate sports science journal policy change, (2) the reliability of the Transparency of Research Underpinning Social Intervention Tiers (TRUST) policy evaluation form, and (3) the extent to which policies of sports science journals support transparent and open research practices.We conducted a cross-sectional, audit-feedback, feasibility study of transparency and openness standards of the top 38 sports science journals by impact factor. The TRUST form was used to evaluate journal policies support for transparent and open research practices. Feedback was provided to journal editors in the format of a tailored letter. Inter-rater reliability and agreement of the TRUST form was assessed using intraclass correlation coefficients and the standard error of measurement, respectively. Time-based criteria, fidelity of intervention delivery and qualitative feedback were used to determine feasibility.The audit-feedback intervention was feasible based on the time taken to rate journals and provide tailored feedback. The mean (SD) score on the TRUST form (range 0–27) was 2.05 (1.99), reflecting low engagement with transparent and open practices. Inter-rater reliability of the overall score of the TRUST form was moderate [ICC  = 0.68 (95% CI 0.55–0.79)], with standard error of measurement of 1.17. However, some individual items had poor reliability.Policies of the top 38 sports science journals have potential for improved support for transparent and open research practices. The feasible audit-feedback intervention developed here warrants large-scale evaluation as a means to facilitate change in journal policies.Registration: OSF (https://osf.io/d2t4s/).The online version contains supplementary material available at 10.1186/s40798-022-00496-x. An audit-feedback intervention to facilitate policy change in sports science journals appears feasible to conduct on a larger scale.The TRUST form used in our audit-feedback intervention, based upon the TOP guidelines, has moderate reliability.The top 38 sports science journals have potential for improved support for transparent and open research practices.Transparent and open research practices are fundamental for research findings to be critiqued and evaluated, reproduced or replicated, and to inform clinical or policy decisions . HoweverScientific journals disseminate the vast majority of scientific literature . There aThe Transparency and Openness Promotion (TOP) guidelines  Box 1)  1) were The primary aim of this study was to evaluate the feasibility of an audit-feedback intervention designed to facilitate sports science journal policy change towards greater promotion of transparency and openness. We also aimed to evaluate the reliability of a tool that assesses journal support for open science practices and to evaluate the degree to which the policies of leading sports science journals currently support transparent and open research practices. The effectiveness of our audit-feedback intervention on changing journal policies was not an aim of this feasibility study.Open Science Framework (OSF) (https://osf.io/ceb8u/). All data, code and materials supporting the findings are available on the OSF repository (https://osf.io/d2t4s/). Journal TOP Factor scores are available at topfactor.org  to enable comparison of Sports Science to other disciplines.This study was prospectively registered on the This study comprised a feasibility assessment of an audit-feedback intervention targeted at journals’ editorial policies, an evaluation of the reliability of a tool for this purpose, and a cross-sectional audit of transparency and openness standards in sports science journals’ editorial policies , and fidelity of the intervention delivery . Outcomes for reliability were inter-rater reliability and absolute agreement of the Transparency of Research Underpinning Social Intervention Tiers (TRUST) policy evaluation form (hereafter TRUST form). Outcomes related to journal support for transparent and open research practices were each journal’s TRUST form score , as well as requirements for disclosures of conflicts of interest. The effectiveness of our audit-feedback intervention on changing journal policies was not an outcome of interest for this feasibility study.Our predefined criteria for feasibility of the audit-feedback intervention were the time taken to (1) rate each journal’s policies, and (2) format and submit individualised letters to the editor. The audit-feedback intervention was regarded as feasible if, on average, it took less than 30 min to rate the journal’s policies and less than 45 min to create and submit the tailored letter to the editor. We established additional feasibility outcomes post hochttps://osf.io/d2t4s/ for REDCap Codebook). We determined relative inter-rater reliability using the intraclass correlation coefficient for agreement ) and absolute reliability using the standard error of measurement; for individual TOP Factor items and the total TOP Factor score using the TRUST form. The reliability strata were < 0.5 = poor, 0.5–0.75 = moderate, 0.75–0.9 = good, > 0.9 = excellent [The TRUST form , based uxcellent . We did xcellent .The sample size calculation was based on the reliability for the overall score of the TRUST form between raters. We required 38 journals to detect good reliability (ICC = 0.8) between the three raters with a 95% confidence interval of 0.7–0.9 . We consWe considered the journals’ policies regarding transparent and open practices and their requirements for disclosing conflicts of interest to be reflected in the ‘guidance’ or ‘instructions to authors.’ We employed a 2-click rule for locating author guidelines on the journal’s home or linked web-pages. If the instructions provided a link to the broader policies of the journals publishing house , these were also assessed. One author (HJH) sourced the online journal ‘guidance/instructions to authors’ or the equivalent section of the respective journal websites on 24 May 2021. The same author saved the relevant web page(s) in HTML format and used Apple Preview (OSX 11.5.2) to create time-stamped, PDF files. Journal policies were rated independently by at least three authors (i.e. in triplicate) from a pool of five authors . Disputes were resolved with recourse to an author not involved in the triplicate rating. These authors were PhD Candidates, early-mid career researchers and an honours student, some having experience in conducting a similar audit.The behaviour our audit-feedback intervention sought to change was adherence to transparency and openness standards within journal editorial policies. We intervened at the level of the journal editor-in-chief. We used the data describing the journal’s support for transparent and open research practices and requirements for disclosing conflicts of interest to construct a tailored letter for each editor-in-chief. This letter informed the editor-in-chief of their journal’s scoring and comparison with the other 37 journals. Each letter also contained individualised information describing the importance of improving adherence to the recommended transparency standards  –43 and S2r = variance of subjects, S2c = variance of bias from raters, s2residual = random error variance.ICC formula, SWe calculated the standard error of measurement using an agreement formula that was analogous to the ICC model and included systematic differences between raters in the calculation.t2 = variance due to systematic differences between raters, s2residual = random error variance.Equation psych R package [Inter-rater reliability was reported with 95% confidence intervals (CI). The 95% CI’s were calculated from the  package  in accor package . We calc package . We summIn order to improve the interpretability of our findings we calculated the smallest detectable change of the TRUST form in addition to the standard error of measurement and intraclass correlation coefficient. We planned to include 36 journals in our audit-feedback intervention. However, during the course of our study we became aware that two journals on our list were already being evaluated in a separate but related study . To avoiIt took 2 h total to locate and download the ‘guidance’ forms for all 38 journals. It took 17.4 h to rate all journals in triplicate, an average of 9 (5) minutes for each rater per journal. It took 18.4 h total to prepare and submit the letters; an average of 29 (10) minutes per letter.From the letters submitted through formal publication pathways (n = 15), all were confirmed as received by editors. In contrast, of those emailed (n = 16), only two were confirmed to be received. We were unable to submit six letters due to those journals not accepting letters to the editor and being unable to locate the email of the journal editor/s (e.g. the editor was a practicing clinician and had no publicly available email address). We did not submit a letter to one journal as they had been included in a previous assessment using the TRUST form . RegardiThe raters highlighted differences in formatting ‘author guidelines’ between journals as the primary challenge when rating journals. These between-journal differences increased the time taken to find and score each journal policy. Nine editors who rejected the letter for publication responded by email stating they would discuss the findings with their editorial board. One editor suggested immediate changes to their policies whereas another editor was unaware of the TOP guidelines. One editor reported the open science practices supported by the journal were decided by the publisher and two editors expressed that time to change policies was a barrier for editorial staff.The overall relative inter-rater reliability was moderate  [ICC 2,,2. Data data citation, code citation, and analysis transparency standards. The data transparency, code transparency, materials transparency and replication standards all had a median score of 0 (range 0–1). The study preregistration standard had a median score of 0 (range 0–3), and the median score of the design and analysis transparency standard was 1 (range 0–2)  range 0–, and theWe evaluated the feasibility of an audit-feedback intervention designed to facilitate policy change in the leading sports science journals towards greater adherence to transparency and openness standards. We found our intervention was feasible and that the TRUST form had moderate reliability, implying suitability of our approach for use in a future randomised controlled trial aiming to change journal policy. Our evaluation of the sports science journal’s engagement with transparency and openness standards indicated substantial room for improvement. In contrast, the journals demonstrated high engagement with standards for disclosure of conflicts of interest.It has been suggested that feasibility studies should not evaluate the effectiveness of interventions, but aid in the decision to conduct a larger study, and guide its development . Based oProper assessment of how journal policies promote transparency and openness is an important first step in changing such policies. Proper assessment relies on tools that are valid and reliable. Determination of validity requires comparison to a gold standard  or to a similar tool that assesses the same construct . While tools have been developed to assess some transparency and openness indicators , the TOPThe utility of a measurement instrument extends beyond simply its relative reliability. For example, the standard error of measurement and the smallest detectable change  are two important measures that should be considered when determining the potential utility of the TRUST form. While there is no clear guidance on interpreting the standard error of measurement, the value found here for the TRUST form of 1.17  can be considered small measurement error, indicating good absolute reliability. The smallest detectable change of the overall TRUST form was 3.2, indicating that changes in scores greater than this could be distinguished from measurement error and considered ‘true’ change. Therefore, if journals made changes to their policies relating to the TOP Guidelines, even if only to improve their scores by one level on four items, the tool would be able to detect this change. We believe the low values for standard error of measurement and smallest detectable change indicate the TRUST form is appropriate to assess change in journal policy over time. For example, in a randomised controlled trial of an intervention targeted at improving expression of the TOP guidelines in journal editorial policies.design and analysis transparency having a median score of 1 (disclosed) , with only d) Table . This poQualitative feedback provided by some editors highlighted a willingness to improve their journal’s policies but identified time and other logistical concerns as barriers to this. Adoption of the level 1 TOP guidelines may be a suitable starting point to address these concerns because this level was designed to have minimal impact on editorial workload while making measurable inroads to improving transparency and openness . For exaConflicts of interest can unintentionally influence research design, conduct and reporting. Thus, disclosure of conflicts of interest are important to reduce bias and increase confidence in science . Most spExercise Immunology Review was undergoing maintenance, so a cached version of the website from 2020 was sourced. Furthermore, we were unable to completely assess fidelity of the intervention delivery because we were unable to confirm receipt of the letter to 14 (39%) journal editors. This may have limited the ability for feedback to be received by editors, a consideration for audit-feedback approaches in future studies. Finally, due to the low number of journals that scored > 1 on any item, the ability of the TRUST form to reliably distinguish between higher levels remains unknown. That is, we can currently distinguish with moderate reliability between journals that have a policy compared to those that do not. However, we are unsure whether we can reliably distinguish between journals that have a “lenient” policy compared to those that have a more “stringent” policy. Limited inter-rater reliability may also reflect ambiguities in journal policies whereby we expect these instruments would be more reliable if instructions to authors were clearer. Assessment of the TRUST form reliability in disciplines which have a wider range of TOP Factor scores  is needmedicine  and its Transparency and openness in science promotes reproducibility, replicability and ultimately trust in research findings. The TRUST form is reliable and can feasibly be used as part of an audit-feedback intervention to rate journal policies on a larger scale. Our audit of the top 38 sports science journals’ policies shows significant room for improvement in the requirement of open science practices. Journals can improve the transparency and openness of research in the field by adopting policies that facilitate greater transparency and openness. Minimally resource-intensive audit-feedback interventions may provide one potential avenue towards helping facilitate these practices.Additional file 1. Supplementary Material 1. Letter template. Supplementary Material 2. ICMJE disclosure of conflict of interest form and levels. Supplementary Material 3. Email template to journal editors.


Understanding the impact of orthopaedic scientific research is vital in identifying facilitators and barriers to its implementation in clinical practice. A meta‐analysis was carried out which showed that presoaking hamstring (HT) autografts in vancomycin was associated with a 10‐fold reduction in infection rate in anterior cruciate ligament (ACL) reconstruction. Our aim was to determine the practice of orthopaedic surgeons with regards to vancomycin presoaking and explore whether they would adopt the findings of this meta‐analysis.A paper questionnaire survey was administered to attendees of an annual EFORT podium presentation of the meta‐analysis findings. Descriptive statistics were used to summarize the characteristics of respondents and their responses.A total of 29 senior surgeons/subspecialists performing a median of 40 ACL reconstructions per year completed the survey of whom 7 (24.1%) had encountered an ACL graft infection in the previous 2 years and 14 (48.3%) in the previous 5 years. Only 3 (10.3%) presoaked the ACL graft with an antibiotic. About 1/4 of those who up to then did not pre‐soak the graft  would consider changing their practice to pre‐soaking with vancomycin, with similar findings  in those that used a HT autograft as their first choice.Orthopaedic surgeons are receptive to the findings of a meta‐analysis reporting on the effectiveness of vancomycin graft presoaking in ACL reconstruction, which can thus have a substantial impact upon clinical care. Addressing concerns about vancomycin induced graft toxicity and comparing the pre‐soaking effect to that of specific intravenous antibiotic regimens may further enhance the uptake of this practice. Facilitators and barriers to acceptance of new research findings are thus identified and explored.Our aim was to determine the practice of orthopaedic surgeons who carry out ACL reconstructions with regards to vancomycin presoaking and explore whether they would adopt the findings of this meta‐analysis.2A questionnaire was constructed for the purposes of this study, consisting of 10 questions. This was administered to participants of the 18th EFORT annual congress attending a podium presentation by the first author of the results of a meta‐analysis evaluating the role of vancomycin graft presoaking upon infection rates of ACL reconstruction surgery.3Of the respondents, 29 senior surgeons/subspecialists performing a median of 40 ACLs per year completed the survey of whom 7 24.1%) had encountered an ACL graft infection in the previous 2 years and 14 (48.3%) in the previous 5 years  have been explained.


This study aimed to investigate the fracture resistance of one-piece screw-retained hybrid monolithic zirconia ceramic restorations in different implant angulations.Three implant fixtures were embedded in acrylic resin blocks with 0°, 15°, and 25° angulations. For each group of implant angulations, 11 screw-retained one-piece monolithic zirconia restorations were made and bonded to the titanium inserts with a dual-cure self-adhesive resin. The complexes were screwed to the implant fixtures with titanium screws. The samples were thermocycled, subjected to compressive load, and fracture modes were recorded. One-way ANOVA and post hoc Tukey’s test were used for statistical analyses (α = 0.05).P = 0.036). The 15° group was significantly more resistant than 0° (P = 0.031). However, the 25° group was not significantly different from the 15° (P = 0.203) and 0° groups (P = 0.624). Fractures occurred only on the restorations, not at the screw levels.One-way ANOVA showed the fracture resistance to be significanltly different among the study groups (Tilting the implant up to 15° improves the fracture resistance of one-piece screw-retained hybrid monolithic zirconia restorations; however, increasing the tilt to 25° would not yield restorations with significantly better fracture strength than the straight implants. Accordingly, when angulated implants are indicated in the esthetic zones, one-piece screw-retained hybrid monolithic zirconia ceramic restorations can be used with acceptable fracture strength. Tooth replacement with implants has become part of clinical practice because of its predictable outcomes –3. A suiTitanium abutments are considered the gold standard for durable implant-supported restorations –9. HowevCeramic materials are preferred to metals since they cover the esthetic problems of porcelain-fused-to-metal restorations and titanium abutments; thus, fulfilling the esthetic demands of the patients , 15. ZirTo address the esthetic concerns, zirconia frames are layered with esthetic ceramic veneer, whose chipping is the most frequent flaw of zirconia-ceramic restorations . TherefoConcerning implant inclination, straight implants are usually preferred to facilitate simple and aesthetic rehabilitation . NonetheTo manufacture a monolithic restoration that can be finally screwed to the implant, zirconia abutment and zirconia restoration can be combined as a one-piece monolithic zirconia construction . Hybrid A systematic review showed favorable outcome of zirconium abutments in the incisive region, even in the canine-premolar region, in instances of unitary implant-supported rehabilitations . AnotherThe inclination of implants particularly in the esthetic zone can restrict the restoration of esthetical, functional, and mechanical necessities . Due to The study was designed to simulate implant rehabilitation of a maxillary first premolar. Auto-polymerizing acrylic resin blocks  were prepared and implant fixtures  were inserted in them up to the height of implant platforms to simulate the bone level placement of implants. Three implants (10×4 mm [length×diameter]) were used for 3 different angulations. A dental surveyor  was used to assure the exact inclination of the implant fixture to the long axis, which represented the occlusal force direction. The samples were divided into 3 groups based on the implant angulation with the original root configuration: 0° , 15° to the facial with respect to the implant crown (moderately deviated), and 25° to the facial with respect to the implant crown (more severely deviated) . In the Each of the three implant samples was scanned  using Scan Abutments . Based on the 3 main implant angulations, 3 maxillary first premolar screw-retained one-piece monolithic zirconia restorations and their screw access hole were virtually designed in the CAD software program . A typodont maxillary first premolar  was scanned to facilitate CAD for the zirconia restorations. Crown dimensions were kept as a constant factor simulating clinical conditions. Eleven samples per group were fabricated by milling partially-sintered monolithic zirconia blanks  with a lab milling machine  .The sample size was calculated according to a previous study , and 11 To achieve fully-sintered zirconia restorations, all samples were sintered according to the manufacturer’s instructions in a high-temperature sintering furnace . Then, the fully-sintered one-piece monolithic zirconia restorations were bonded to the titanium implant inserts . Therefore, the bonding surfaces of the titanium implant inserts were air-borne abraded with 50-μm aluminum oxide at a 10-mm distance for 10 seconds (0.4 MPa) . The oneThe screw holes of titanium inserts were sealed with heavy body impression material  so that the excessive cement could not blockade access to the screw head. Then, the one-piece construction and titanium inserts were assembled and bonded by using a dual-cure self-adhesive resin cement  following the manufacturer’s instructions. The whole complex of one-piece restorations and titanium inserts were screwed to all implant fixtures with titanium screws. A manual torque wrench was used to torque the screws of one-piece monolithic zirconia restorations to the implant bodies and tightened at the manufacturer’s recommended torque force of 35 N-cm torque. The constructions were re-torqued after 10 minutes to prevent screw loosening .All the access holes were filled with polytetrafluoroethylene film (Teflon tape) up to 2 mm apical to the occlusal plane as measured with a periodontal probe. After that, a bulk of composite resin  was placed, shaped, and light-cured for 40 seconds on the orifice to fill the screw access hole to the level of the occlusal plan  32]. Th. Th32]. To mimic the oral condition, the samples underwent 5000 thermal cycles between 5 and 50°C, with a dwell time of 30 seconds and a transfer time of 10 seconds. These 5000 cycles of cyclic thermal stressing corresponded to half a year of intraoral conditions . All samFor mechanical testing, all samples were oriented to create a perpendicular relationship between the long axis of the simulated maxillary first premolar crown and the occlusal plane. Attempts were made to meticulously direct the compressive force centrally utilizing a force applicator 3 mm in diameter placed along the central fossae of restorations. Perpendicular compressive force to the central fossa of crowns was chosen for the fracture test as it simulated the most common force clinically applied to these teeth . A comprThe loading went on until fracture was visibly detected with a sudden drop in the force as seen in the graph. The force required (N) to cause fracture of each sample was recorded. The samples were optically monitored and apparent failures were documented. The fracture mode was classified based on scanning electron micrographs  at ×30, ×500, and ×1000 magnifications.Statistical analyses of data were done through the SPSS software program . The mean values and standard deviations were calculated in each group. Shapiro-Wilk and Levene’s tests were used to check the normality and equalization of variances. One-way ANOVA and Tukey’s post hoc pairwise multiple comparisons were used to analyze and determine statistically significant differences among the angulation groups (α = 0.05).P = 0.036). The mean and standard deviation of fracture resistance are presented in P = 0.031). The fracture resistance of the restorations with 25° angulation was higher than the straight restorations, although the difference was not statistically significant (P = 0.624). Nor was the difference between the 15° and 25° groups statistically significant (P = 0.203).As displayed in The titanium inserts of all restorations remained attached to their corresponding implant fixtures after testing the load-to-fracture and all monolithic restorations were split into two pieces. The SEM analysis showed that the fractures began at the occlusal surface of one-piece monolithic zirconia restorations across their screw channel hole for all the samples .The null hypothesis was rejected since implant angulation significantly affected fracture resistance. Restorations with a 15° long axis deviation from the implant axis had the highest fracture resistance among all other angulation groups and were significantly more fracture resistant than 0°. But the fracture resistance was not significantly different between the 15° and 25° groups and 0° and 25° deviations groups.Clinically, to correct the non-axial implants, abutments are more often angulated between 5° and 30°. Angulated abutments are reported to have a high survival rate . In the Like most brittle materials, zirconia ceramic has a high compressive and low tensile strength , approprKatsavochristou et al.  investigIn line with the current study, Nothdurft et al.  found thOn the contrary, in Albosefi et al.’s study , a comprUp to now, almost all similar studies concluded that wider angulation decreases the fracture resistance of restorations , 39, 40.The fracture resistance of implant abutments is highly related to the material of samples, whether they are zirconium dioxide abutments with a titanium alloy carry base  or real Ellakwa et al.  detectedIn the meantime, some studies reported that all zirconia abutments (with zirconia connections) typically fractured at the cervical part of the abutment near the screw and platform of the implant . It suggAmong the limitations was the in-vitro nature of the study. Moreover, this study did not evaluate the effect of mechanical cycling on fracture resistance. Studies are suggested to compare the fracture resistance of one-piece and two-piece zirconia restorations in different angulations.Within the limitations of this study, the following conclusions can be drawn:One-piece screw-retained hybrid monolithic zirconia restorations with 15° implant-restoration angulation are significantly more fracture-resistant than 0°.Increasing implant-to-restoration angulation from 0° up to 25° insignificantly improves the fracture-resistances of one-piece hybrid monolithic zirconia restorations.All samples were cohesively fractured starting from the occlusal surface near the force entry point.When the use of angulated implants is indicated in the esthetic zones, one-piece screw-retained hybrid monolithic zirconia restorations would not negatively affect the fracture strength of restoration, it rather increases it.S1 Table(XLSX)Click here for additional data file.


ContextParkinson’s disease (PD) is the second most common neurodegenerative disorder and causes many clinical manifestations including bradykinesia, tremor, postural instability, and musculoskeletal stiffness. Neurodegeneration is commonly associated with oxidative stress. Oxidative stress has not been measured in PD in relation to the manual techniques used in Osteopathic Manipulative Treatment (OMT).ObjectiveTo investigate the effect of OMT on oxidative stress biomarkers in PD.MethodsIn this randomized non-blinded study, 32 PD subjects were separated by block randomization into counseling and OMT groups, receiving respective interventions twice a week for six weeks. The counseling arm received informative sessions while the OMT arm received a set treatment protocol. Biomarkers of oxidative stress, malondialdehyde (MDA), dityrosine (DT), 3-nitrotyrosine (3-NT), 8-hydroxy-2-deoxyguanosine (8-OHdG), and 8-isoprostane were measured before and after the first session and at weeks three, six, and 10 (four weeks after conclusion of intervention).ResultsNo significant changes were found in blood plasma levels of MDA, DT, 3-NT, or 8-OHdG during or after intervention compared to controls (p > 0.05). No significant changes were found in urine 8-OHdG or 8-isoprostane during or after intervention compared to controls (p > 0.05).ConclusionOMT used in this study did not significantly affect the chosen oxidative stress biomarkers, however many limitations of the study may have impeded possible findings. Parkinson’s disease (PD) is the most common progressive neurodegenerative movement disorder in humans. Globally, the prevalence of PD is seven to 10 million. The incidence of PD increases with age. In those diagnosed before age 50, it is at an estimated 4% in North America. Annually, 60,000 people in the United States are diagnosed with PD and the expected prevalence for 2030 is 1,238,000 [PD is a complex disease with variable signs and symptoms commonly including resting tremor, rigidity, bradykinesia and postural instability, which directly leads to diminished control of balance and a high rate of falling -6. DespiNeuroinflammation and oxidative stress are commonly linked with brain injury and neurodegeneration such as in PD ,18,19. HBiomarkers are now frequently used to monitor disease states linked to elevated oxidative stress ,43. MDA,The aim of the study was to determine if OMT was effective in changing oxidative stress levels as measured via established biomarkers. We hypothesize that MDA, DT, 8-OHdG, 3-NT, and 8-Isoprostane will significantly change with the application of 12 treatments of an established OMT sequence. Our scientific hypothesis is based on the observation that nigrostriatal circuits and DA neurons of the SNc are at heightened susceptibility to mitochondrial dysfunction and subsequent cell death. This is due to a naturally elevated baseline of ROS in DA neurons (catecholamine-driven Fenton reaction) and exacerbated by a local increase of iron, decrease of neuromelanin and enhanced Lewy body formation ,53. The clinicaltrials.gov: NCT02107638). We recruited subjects from March 2015 through June 2019. Recruitment took place through an internet search , referrals by the in-house neurologist, personal advertisements at local PD support groups, and recruiting tables at local fundraising events for PD-associated charities and organizations.This non-blinded, randomized, controlled trial of a pre-defined OMT sequence targeting mobility and balance in PD was conducted at the clinic of New York Institute of Technology, a private, not-for-profit institution  . AdditioStudy designEligible and consenting individuals were randomly assigned by blocks of two (determined by date of study consent signing) into OMT or PD patient counseling groups. This was determined by a research coordinator who was not personally involved with the interventions. Each OMT treatment consisted of a 30-minute treatment sequence previously established and validated for use in motor dysfunction . TreatmeBlood extraction, urine collection, and quantificationAll subjects consented to blood draws after a 12-hour washout period from their PD medication on day one immediately before and after intervention (Pre and Post), week three (visit seven), week six (visit 12), and week 10 (four-week-washout). Phlebotomy tourniquets were applied for less than one minute and removed immediately upon establishing blood flow. All specimens were centrifuged at 1200 g for 15 minutes, and serum was portioned into multiple aliquots containing sufficient volume to provide for duplicate analysis for each assay and immediately frozen at -80° C. Urine samples were collected into standard urine collection vessels and frozen at -80° C. Serum samples were analyzed in duplicate on an enzyme-linked immunosorbent assay (ELISA) platform using the following assay kits from Abcam  and according to the manufacturer’s instructions: MDA (ab238537), 3-NT (ab113848), and 8-OHdG (ab201734) for oxidative damage. Dityrosine was analyzed using the Japan Institute for the Control of Aging (JaICA) kit KDT010/E. Urine samples were analyzed in duplicate on an ELISA platform using the following Abcam assay kits: 8-OHdG (ab201734) and 8-isoprostane (ab175819); 8-OHdG and 8-isprostane. These values were then normalized against creatinine (ab65340).Statistical analysisPower analysis has been performed using G*Power 3.1.9.2 to estimate a reasonable sample size for the study. From the results in the preliminary studies , effect sizes were estimated to be medium or large . To achieve 80% of statistical power, a total sample size of 126 (64 in each group) was required to detect a medium effect size (Cohen’s d=0.5), and a total sample size of 24 (12 in each group) was required to detect a large effect size (Cohen’s d=1.2), α=0.05. Based on these determinants of power analysis and anticipated attrition of PD patients over 24 months, we recruited 32 PD subjects .A repeated measures analysis of variance  using SPSS software version 25 , was conducted to determine whether biomarker levels had significantly responded to OMT.The hypothesis that the mean levels of each biomarker were significantly different between the two groups was tested by a repeated measures ANOVA using SPSS software version 25, α=0.05.Subject recruitmentThis study includes a total of 32 subjects in alignment with the inclusion criteria Figure . FourteeBiomarkersOMT on systemic MDA levels throughout and after 12 OMT sessions over six weeks were investigated Figure . No inteOMT has been shown to benefit individuals with PD as well as other older individuals suffering from postural and balance issues as well as subjects with dizziness and prone to falling -11. In aHere we show that OMT did not affect the measured biomarkers either acutely or chronically post-intervention. This may suggest that benefits seen after OMT treatments are not necessarily due to changes in oxidative stress mechanisms. Further research is required to elucidate the molecular effects of OMT in PD, perhaps investigating biomarkers specific for muscle activity, such as the PI-3K/Akt/mTOR pathway .There are limited studies examining OMT and molecular biomarkers. The OMT protocol used for this study was focused on improving biomechanics, such as balance and gait as shown in previous studies, including stride length, cadence, upper and lower limb velocities, however biomarkers were not established for these studies ,15. It iWhile it is still unclear whether this treatment regimen affects production or clearance of ROS in any way, osteopathic lymphatic techniques have moved into focus and need to be investigated. Additionally, it must be considered that ROS vary greatly depending on many factors. Studies have shown that long-term diet, time of day, sleep, exercise, disease comorbidities, among others, all create variability in intra-subject ROS biomarkers, including MDA and DT -74.For this study cohort, we did not account for or control these dynamics as this would have required unreasonable efforts by the study subjects. Subjects with PD also fluctuate greatly on a day-to-day basis as far as severity of symptoms, especially when skipping doses of their medication, which we asked to avoid due to their confounding nature . The avaForemost, the largest limitation we see is sample size. Unfortunately, recruitment was difficult (32 subjects over four years). We regularly attempted recruiting at local PD support groups, PD fundraisers, and through neurologists. Despite reaching our sample goal, many blood draws were unfortunately insufficient to run sufficient assays, further reducing the sample size.When designing biomarker studies, one must consider the above confounding factors and attempt to control them. One of the seemingly easier factors to control is fasting state upon arrival. Subjects should be fasting when blood samples are extracted, however this does not account for longer-term/lifestyle diets. Additionally, due to longer measurement times (three to four hours), asking subject to fast for the morning and continue to not consume calories may be unreasonable. While the creation of a manageable testing environment is paramount, drawbacks in the form of variable outcomes need to be considered.Time of day for treatment or measurement is another element that needs to be standardized. To overcome the above limitations, one could offer chaperoned transportation independent of the schedule of caregivers or the weather situation.Sleep time and quality are, for the most part, beyond the control of the investigator, especially in subjects that are active and mobile. Sleep habits vary greatly on an individual basis and any attempted control would pose an unreasonable request interfering with the subject’s quality of life.Accounting for disease comorbidities that might influence biomarker behavior is easily controllable through appropriate inclusion and exclusion criteria. However, in studies with focus on geriatric populations, limiting comorbidities to ensure similar overall health between subjects, could drastically impact recruiting efforts, diminish a study’s power, and render it impossible at a certain site altogether.Despite significant research efforts, the diagnosis, management, and prognosis of PD have not fundamentally changed over the past few decades. The development of reliable predictive and outcome markers could revolutionize the field and point the way toward personal risk assessment and novel therapeutic strategies . The rolIn summary, we were unable to provide conclusive support to our hypothesis that application of OMT may reduce the ROS burden seen in advanced-stage PD. The biomarkers we utilized are state-of-the-art for a variety of inflammatory and degenerative conditions tied to elevated systemic oxidative stress. However, it must be mentioned that the field of biomarker discovery is fast advancing with new combinatorial approaches  on the horizon. Specific to PD via established biomarkers of oxidative stress. There were several limitations of this study, most importantly those potentially affecting highly reactive biomarkers. To better account for and offset the effects of controllable and non-controllable confounders, future OMT studies will require a more tightly controlled study environment and a larger sample size.


To explore the impact of gender mismatch on corneal allograft rejection and rejection-related graft failure in patients with repeat penetrating keratoplasty (PK).A retrospective cohort was conducted at Ramathibodi Hospital, Bangkok, Thailand. Patients with repeat PK and follow-up period of at least 6 months were recruited. Demographic data, pre-operative ocular findings and donor information were collected. Patients were divided into 2 groups according to gender mismatch between donor and recipient . Survival analysis was performed using the Kaplan-Meier method. The association between risk factors and the outcomes of graft rejection and rejection-related graft failure were analyzed using Cox proportional hazards regression.Of 68 patients with repeat PK, 26 patients (38.2%) were gender mismatched. There was no difference in 3-year rejection-free survival and graft survival between patients with gender mismatch and others . Younger recipients (< 40 years) showed a significantly higher rejection rate compared to older recipients , while patients with multiple PK (> 2 times) were found to be significantly associated with higher rejection-related graft failure compared to patients with 2 times or less PK . After multivariate analysis, only younger recipients demonstrated a statistical significance on graft rejection .Gender mismatch might not impact corneal graft rejection or rejection-related graft failure in patients with repeat PK. Younger age was found to be a strong factor associated with graft rejection. Gender matching might not be compulsory for repeat PK. Corneal transplantation is the most common and successful procedure among all tissue and organ transplantation . The maiSeveral measures for donor and recipient matching to reduce the occurrence of graft rejection in high-risk eyes have been proposed . CurrentThis study aimed to investigate the role of gender mismatch between corneal donors and recipients on corneal allograft rejection and rejection-related graft failure in patients with repeat PK. Our results can assist in the allocation of donor corneal grafts to recipient eyes with history of previous PK to reduce corneal graft rejection, increase corneal graft survival and improve overall clinical outcomes.A retrospective chart review of patients with repeat PK was conducted according to the tenets of the Declaration of Helsinki and was approved by the Ethics Committee of Ramathibodi Hospital (MURA2018/350). Consecutive patients who underwent repeat PK at our hospital from January 2010 to December 2017 and were followed up for at least 6 months were included. Patients’ characteristics including gender, age, both underlying systemic and ocular diseases, primary diagnosis, number of PK, ocular findings  were collected from electronic medical records. Donors’ information  and source (domestic or US eye banks) were also obtained. The information of the first graft was also collected whenever available. Patients with incomplete information of both donors and recipients of repeat graft were excluded.Experienced cornea surgeons performed PK using the same technique with 16 interrupted sutures. The standard postoperative regimen in our center included prednisolone acetate 1% every 2 hours and levofloxacin 4 times a day for 2–4 weeks, followed by prednisolone acetate 1% only, slowly tapered until 1 drop daily at 6 months after surgery. Immunosuppressive medication, apart from topical steroid, was individually prescribed according to patient health and socioeconomic status. Patients were admitted and followed-up daily until corneal epithelial defect was closed, generally within 10 days. Then, patients were evaluated at 2 weeks, 1 month, 3 months, and every 3 months up to 1 year after surgery, and then examined every 3–6 months for patient lifetime. Corneal graft rejection was defined as new onset of anterior chamber inflammation and corneal edema with or without endothelial rejection line . CornealOnly one eye of each patient was analyzed and only the latest graft received by an individual patient during the study period was considered in the analysis. Mean and standard deviation (SD) or median and range; and counts with percentage were used to describe continuous and categorical data, respectively. Patients were divided into 2 groups according to gender mismatch  and others . The associations between factors of interest  and the presence of corneal graft rejection and rejection-related graft failure were analyzed using Kaplan-Meier curves with Cox proportional hazards regression. Significant factors from univariate analysis with a p-value < 0.2 were included and selected into the final model using the backward selection method. The effects of gender mismatch of the first graft on rejection and rejection-related graft failure were also evaluated in 43 patients with available information. Survival rate and hazard ratio (HR) were estimated and presented with 95% confidence interval (CI). P-values of less than 0.05 were considered statistically significant. Analyses were conducted using STATA version 16.0 .Sixty-eight patients with repeat PK were included in the analysis. Half of the patients  were female with the mean age of 63.7 (SD 15.2) years. Glaucoma was found in 46 patients (67.7%). Of these patients, most underwent PK twice  and one patient underwent PK 6 times. Most corneal donors  were from a domestic eye bank (Thai Red Cross Society) and the rest were imported from the US. Twenty-six patients (38.2%) were gender mismatched. Recipient and donor information between gender mismatch and others were compared and are presented in Of 68 patients with repeat PK, 29 (42.6%) patients developed corneal graft rejection and 21 (30.9%) patients consequently turned to graft failure. The median follow-up time in our study was 3 years (ranged 7 months to 9 years). The overall rejection free survival rates estimated at 1, 3 and 5 years were 85.2% , 64.3% , and 47.9% , respectively. The overall rejection-related graft survival rates at 1, 3, and 5 years were 95.4% , 79.6% , and 52.3% , respectively.Gender mismatch did not have a statistically significant association with graft rejection . Only young recipients (< 40 years) had a significantly increased risk of graft rejection. The Kaplan-Meier rejection-free survival estimated at 3 years was lower in young patients  compared to patients aged ≥ 40 years  as shown in After multivariate analysis using Cox proportional hazards regression model, the effect of gender mismatch was still unchanged after adjusted with age group and number of PK. Young recipients remained the only significant factor associated with higher rate of graft rejection , see Gender mismatch had no statistically significant association with rejection-related graft failure . Only number of PK was significantly associated with higher risk of rejection-related graft failure . The Kaplan-Meier graft survival estimated at 3 years was lower in patients with multiple PK  compared to patients who underwent PK twice  as shown in There were 43 patients with available gender information of the first graft. Gender mismatch was found in 5 patients (11.6%). Of 43 patients, graft rejection and rejection-related graft failure developed in 20 patients (2 patients with gender mismatch) and 13 patients (1 patient with gender mismatch), respectively. Gender mismatch of the first graft was found to have no statistically significant association with graft rejection  and rejection-related graft failure  in patients with repeat PK.Results of the effect of gender mismatch on corneal allograft rejection remains controversial. Our study found that gender mismatch was not significantly associated with the risk of graft rejection in patients with repeat PK. Previous evidence from Bohringer et al. showed that HLA-A1-restricted Y-antigen on chromosome Y in male donors may have a role in inducing graft rejection when they are transplanted in female recipients . HoweverWe found a significant increase in graft rejection rate in young patients. Recipients aged below 40 years were approximately 3 times more likely to develop graft rejection after repeat PK compared to recipients aged 40 years or older. Our finding was similar to results from previous studies that demonstrated a higher risk of corneal graft rejection in young recipients ,14,23–25Regraft is considered as one risk factor for graft rejection and failure . This miThis study did have some limitations due to the nature of the retrospective study design. The effect of HLA matching or ABO compatibility between donor and recipient on graft rejection in patients with repeat PK could not be evaluated and adjusted in the analysis because corneal tissue matching was not included in the criteria for donor allocation of the national eye bank in our country. Our study has a small sample size due to the strict inclusion criteria of regraft. However, to the best of our knowledge, this is the only study focusing on the effect of gender mismatch in patients with repeat PK and demonstrated no significant association between gender mismatch and poor survival outcome of repeat PK. We also performed a subgroup analysis in patients with available data of the first graft and found no significant association between gender mismatch of the first graft and graft rejection or rejection-related graft failure in repeat grafts. Therefore, the effect of gender mismatch of the first graft is unlikely to be masked by other risks associated with repeat PK.In summary, we did not observe the effect of gender mismatch on corneal graft rejection and rejection-related graft failure in patients with repeat PK. Young recipients and multiple PK were significantly associated with higher risk of graft rejection and rejection-related graft failure, respectively. Our results support previous evidence ,18 that S1 File(XLS)Click here for additional data file.


The COVID-19 pandemic has altered the way small and medium-sized businesses (SMEs) function. To maintain business efficiency and reduce operating costs in the context of the constraints imposed by the pandemic, SMEs have been forced to embrace new digital technologies. Cloud accounting is becoming an increasingly important business operating tool for SMEs. By adopting cloud-based accounting, SMEs can become more efficient, financially organized, and flexible. This study aims to investigate the factors that have a pervasive influence on cloud accounting adoption among SMEs in Thailand, following the pandemic's effects. This study integrates three technology adoption theories—the Technology–Organization–Environment framework, Diffusion of Innovation theory, and Institutional Theory—and studies them alongside SMEs' unique characteristics. The research employs a qualitative case study method and triangulated sources of evidence. The findings provide important implications for the research community, policymakers, cloud accounting vendors, and SME owners aiming to formulate better approaches to cloud accounting adoption after the pandemic. The results suggest that vendors should focus on SMEs' particular characteristics and needs. By contrast, SMEs should determine the organizational fit of the cloud accounting platform and integrate cloud accounting with other aspects of their operations. Small- and medium-sized enterprises (SMEs) are commonly considered able to drive a country's economic growth, competitiveness, and innovation  adoption rate of SMEs was traditionally low, and the failure rate high  framework, formulated by Tornatzky et al.  identifiThe Diffusion of Innovation (DOI) framework, presented by Rogers , serves Institutional theory (INT), proposed by Dimaggio and Powell , argues According to Parker and Castleman  and AlkhThe data in Tables This study protocol has been approved by the Research Ethics Review Committee for Research Involving Human Subjects on August 7, 2020.In this study, we followed an exploratory, qualitative, multiple-case study approach to investigate how technology‐organization‐environment‐vendor‐owner (TOEVO) factors influence cloud accounting adoption in Thai SMEs. We prefer a qualitative over a quantitative method for three main reasons. First, cloud accounting is relatively new in the field of business practices and accounting Rindasu, . TherefoWith the case study method, we intended to determine why the adoption rate of cloud accounting in Thailand is relatively low, and whether and how TOEVO variables influence the adoption decision, especially following the COVID-19 pandemic. We conducted semi-structured interviews with SME owners, cloud accounting vendors, and a group of experts  to gain a business perspective, which is vital but less explored by researchers  to increase the richness and validity of its findings. Data were gathered from 17 informants who were involved in various SMEs' decision-making stages, such as research, selection, and adoption of cloud accounting. The informants include six experts, five cloud accounting vendors, and six SME owners. According to Felix and Hunter , a samplThe semi-structured interviews were conducted in Thailand from August to September 2020, 3 months after the first nationwide lockdown in response to COVID-19 in Thailand. We conducted in-depth interviews with the informants, each of which lasted 45–75 min. The interviews where held either via Zoom video conference or face-to-face while wearing a face mask, depending on the informant's preference. During the data collection process, we began by asking “What is cloud accounting/cloud computing?” to ensure that all informants were familiar with the concepts of cloud accounting/cloud computing. Based on the literature review, the informants were broadly asked questions about (a) their background/institutions and views on cloud accounting in Thailand; (b) SMEs' reasons and processes for deciding to select/not select cloud accounting; and (c) factors that led to cloud accounting adoption. With the permission of the informants, the interviews were tape-recorded, fully transcribed, and analyzed based on the qualitative content analysis approach. Content analysis was chosen due to its suitability for exploratory research SaaS is perceived as very new by Thai SMEs. Current adoption should be around 10% of juristic SMEs or 50,000 firms, so the untapped potential is very large, approximately 90%. (VE2)Cloud accounting in Thailand is in the early stages of adoption, as confirmed by 10 out of 11 expert and vendor informants. The existing adoption rate is estimated at 50,000–70,000 companies, or 5–10% of juristic-entity SMEs, as per the following interview extracts:n = 14). However, the reasons for adoption varied; the most frequently cited were as follows: to improve efficiency (n = 7), to obtain real-time data (n = 4), and to increase mobility (n = 3), as illustrated by the following excerpts:We aim to reduce the number of workers, manual work, and paperwork in all processes. (OW1)The main reason is real-time financial data, which is normally missing. With traditional accounting software, sometimes, SMEs do not even know who owe them money. With cloud accounting, they can better track accounts payable, accounts receivable, expenses, revenue, and margins in detail. (VE4)Mobility is the reason why SMEs decide to adopt cloud accounting. After sales meetings, SMEs can immediately issue a purchase order from their mobile or tablets and send it to the customer via the LINE application. They have no need to return to their offices. (EX5)Respondents in our study reported that SMEs' decision to adopt cloud accounting was triggered by perceived internal needs and problems rather than external information about cloud accounting One of my friends recommended cloud accounting, and I signed up for the free trial and found it easy to use. I later persuaded my husband to adopt it for our company. (OW5.2)To facilitate the successful adoption of cloud accounting, the involvement of the SME's owner would be critical. In Thailand, SME owners are decision makers who are proactively involved in the end-to-end adoption process—initiation, evaluation, trial, selection, and acquisition—although this practice is quite unusual in other countries. Owners' decision-making is a nonlinear, ongoing process with several feedback loops. Before adopting new technology, they also actively seek strategic advice from external influencers, such as peers, friends, family, professional accountants, government units, and IT consultants, as well as internal influencers, such as internal accountants and co-owners.Adopters can be categorized into two groups. First, Microsoft Excel users who decide to move to proper online accounting software. Second, on-premise accounting software users whose scope of accounting has become more complex and are looking for a new solution that better serves their needs. Both groups do some research to compare the pros and cons of the available options fit for them. (VE2)If SMEs preferred mobility, they would choose the cloud, but if they are uncomfortable with the monthly fee model and worry about security, they would choose on-premise software. (EX3)When SMEs make adoption decisions, they assess the perceived advantages of cloud accounting and the adoption costs by comparing cloud accounting with the current arrangement or available tools, such as Microsoft Excel and on-premise accounting software.We evaluate the driving factors most frequently mentioned by informants (at least nine informants). Each factor has a varying influence on cloud accounting adoption, as follows:( +) Relative advantage. In our case study, relative advantage has a positive impact on cloud accounting adoption. Most informants indicated that relative advantage is a crucial factor in every IT initiative that SMEs decide to pursue, including cloud accounting. Some of these relative advantages include efficiency, accessibility, speed, accuracy, and professionalism, which ultimately lead to cost savings and improved profitability for SMEs. Below is a selection of the informants' responses:Previously, SMEs lost important documents and wasted time searching for missing documents for the accounting service company. If SMEs store all documents on the cloud, the process of preparing financial reports and tax submissions by the accounting service company would be quicker, easier, and less time-consuming. (EX5)I can use my smartphone to send sales quotations prepared in a professional format from wherever I am. Customers often shop around, so sending a sales quotation quickly will help us get ahead of our competitors. (OW5.1)Sometimes, business owners are not aware of their current business performance and do not have a holistic view of individual customers. With cloud accounting, SME owners will have a better understanding of their current accounts receivable, accounts payable, and profitability in real time. (VE4)Compared to other accounting methods, the benefits of cloud accounting include the ability to (1) improve collaboration and information visibility between SMEs and the accounting service company, (2) issue purchasing orders and invoices to customers, record business expenses, and receive payments anywhere and at any time, and (3) access up-to-date information on financial performance and the customer.(-) Complexity. Although the adoption of digital technologies by SMEs is considered complex in many countries, the situation in Thailand is much more difficult, as many of our informants noted. This is because Thai SMEs are in the early stages of IT-enabled business transformation. The informants stated that the vast majority of Thai SMEs preferred traditional methods of recording accounting transactions, prepared by their outsourced or internal accountants. Early adopter SMEs typically relied on external consultants, such as accounting service companies, peers, and vendors when adopting cloud accounting. They perceived cloud accounting as involving a “user-friendly interface,” “easy deployment and maintenance,” and “less work of preparing budgets, financial statements, and cash flow statements,” as illustrated by the following excerpts:A simple usable UX/UI is one of my top selection criteria. (OW2)Cloud accounting makes accounting easy for the company without a dedicated accountant or accounting experience. (OW3)In particular, informants noted that the perception of complexity was inversely related to SMEs' extent of experiences with other cloud-based solutions and digital technologies in general.( +) Compatibility. Herein, compatibility refers to the degree to which cloud accounting, as an innovation, is seen as consistent with the existing values, needs, and past experiences of SMEs. Several informants confirmed the importance of introducing digital-enabled business practices that are compatible with current organizational practices. There are different needs within the SME segment; therefore, cloud accounting has been adapted in different ways based on the size and scope of operations, as illustrated in the following excerpt:Cloud accounting is typically for SMEs with a non-complex business model, such as a trading company, general service company, or small agency. It is not suitable for companies with many subsidiaries that need to comply with advanced accounting rules. Therefore, in my case, I use cloud accounting for quotations and invoice processing only. My accountancy team handles accounting separately to ensure accuracy in financial statements. (OW4)Based on the interviews, the following three conditions within firms are identified as particularly well-suited to embracing cloud accounting: (1) having a simple business structure and operations, (2) being equipped with computer and Internet access, (3) and engaging with accounting service companies that have adopted automation and cloud accounting software.( ±) Firm characteristics. In this study, the term “firm characteristics” refers to firm size and nature of business. Firm size is defined by the number of employees and annual revenue, whereas nature of business refers to industry type, the business model, geographical scope, and taxation requirements. Below is a selection of the informants' responses on the firm characteristics that influence adoption:In case of mom-and-pop stores, they do not benefit from cloud accounting. However, if they want to grow the business or set a company standard, cloud accounting is the best fit for their businesses. (EX2)Most adopters are juristic-entity SMEs, because they are required by Thai law to file and pay monthly taxes. If they are late or fail to meet a required legal obligation, penalties will apply immediately. (VE1)Most adopters are business-to-business (B2B) SMEs that operate nationwide. SME owners use cloud accounting for tracking salesperson records and available stock with greater ease. (EX1)In general, the informants concluded that cloud accounting is relatively important for the trading and service-type industries. Registered SMEs, B2B SMEs, and SMEs with a wider geographic presence were more willing to adopt cloud accounting.( ±) Technology competence. Technology competence refers to three aspects: (1) digital technology knowledge—the degree to which SMEs realize the ability of existing and emerging digital technology, (2) digital technology utilization—the extent to which SMEs employ digital technology to enhance their effectiveness and decision-making, and (3) digital technology facility—a set of tools that contribute to SMEs' digital technology utilization. We find that prior experiences and success in digital technology adoption are a source of digital technology knowledge and increase its utilization. At present, cloud accounting relies mainly on having an Internet connection and Internet-enabled devices. Poor and slow Internet connections can affect the work methods of rural SMEs.SMEs that rarely use technology are reluctant to adopt cloud accounting. (VE3)They selected SaaS, because they have limited technology competence. (VE4)n = 9). On the other hand, some informants argue that if the level of technology competence in SMEs is too low—if they have no computer or Internet access—cloud accounting adoption is simply not possible (n = 8).This study portrays two different views on technology competence. On the one hand, it is believed that cloud accounting fits SMEs particularly well as they usually have limited technology competence and resources (( +) Coercive pressure. At present, Thai government agencies, such as the Digital Economy Promotion Agency, Department of Industrial Promotion, and Department of Business Development are consistently promoting and enforcing digital technology adoption among SMEs. This is done through government policies, such as a 200% tax deduction scheme up to 100,000 THB for the purchase of digital technology (including cloud accounting), a grant of up to 10,000 THB to support SMEs' software purchasing needs—including fees for cloud accounting, software training, and consultation—and a free e-accounting program for SMEs and electronic tax return filing platforms, as confirmed by the following quotes:Right now, we use webinars to connect with SMEs. Before the COVID-19 pandemic, we arranged face-to-face consultations with SMEs seeking software-related advice and government grant information. This year, we have 3,500 grants available, valued up to 10,000 THB each. (EX2)Government policy increasingly favors SaaS adoption in SMEs; for instance, the DBD e-filing system—submitting financial statements of a company established under Thai law online. (VE3)According to expert groups, coercive forces are mainly triggered by regulations associated with tax-related benefits and government sponsorship. However, vendor and owner groups perceived current government support as being less attractive and rather proposed promotion of long-term cloud accounting usage, such as speedy and streamlined loan scheme applications for SMEs that periodically synchronize their financial information with the cloud accounting platform.( +) Normative pressure. In this research, sources of normative pressure include industry norms and customer expectations. These norms were created through training, social networks, and professional processes. Some informants mentioned that normative pressure could also be traced to other bodies that have successfully employed cloud accounting.People in the digital startup industry have a sense of getting it done fast and online only. That's why I chose cloud accounting since Day 1. (OW3)First, the owners attended SME trainings and seminars. Then, they realized the importance of digital tools and finally asked us for an adoption consultation. (EX4.1)( +) Mimetic pressure. Some SMEs felt pressure to adopt cloud accounting, typically because of its adoption by their competitors or other similar organizations. Our informants determined that mega trends and competitive intensity also encourage SMEs to adopt cloud accounting. As increasing numbers of SMEs adopt cloud accounting during the COVID-19 pandemic, mimetic pressure to change will increase rapidly for those who do not.SMEs were forced to adopt cloud accounting due to mega trends, such as globalization and competitive rivalry among the firms in an industry. (VE4).After reviewing the vendor's website, I felt its targets SMEs similar to mine. If others can use it, I should use it, too. (OW2)This finding further indicates that pressure from competitors is more impactful than that from other stakeholders.( +) COVID-19 pressure. All informants perceived that the COVID-19 pandemic has accelerated the digital transformation of SMEs. Cloud accounting awareness and adoption has been consistently increasing post-COVID-19. Interviewee comments often highlighted that SMEs with cloud accounting have been able to adapt readily to the lockdown, while others are unable to operate effectively. As mentioned by informants, cloud accounting can help in avoiding physical contact, accessing up-to-date financial information remotely, and integrating with other systems, such as e-commerce platforms, payroll, and warehouse management.The adoption is rising. SMEs want to use cloud accounting as soon as possible, because they saw that their competitors who already adopted cloud accounting could run their business more smoothly during the COVID-19 lockdown. (EX2)COVID-19 and work-from-home policies are raising the awareness of SMEs who are using on-premise software. (VE4)The informants concluded that the ongoing COVID-19 pandemic has pushed SMEs to opt for remote working, and cloud accounting has contributed to maintaining business continuity in this period.( +) Vendor support and service quality. Cloud accounting vendors provide more than software and hardware; they also deliver expertise in a specific accounting area that SMEs feel can augment their accounting knowledge, process, and system. Vendor support and service quality refer to vendor promotion, training workshops, and technical support. In Thailand, online and offline training is regularly provided by local vendors:I think SMEs decide based on vendor support and functionality. Old SMEs in particular prefer a vendor that can answer their questions and resolve their issues quickly. (EX2)I first chose this vendor because of special promotion—50% discount, equal to just 3,000 THB per year. It is not expensive for an initial-stage business-like mine. (OW1)Vendor support and service quality are key considerations, since adopting cloud accounting requires strong commitment between the vendor and SMEs. (VE5)The interview outcomes indicate that cloud accounting vendors play an important role in helping SMEs to implement cloud accounting and facilitating their use of this technology while aiding resolution of both technical and accounting issues.( +) Owner's support. In our study, the decision to adopt cloud accounting made entirely by SME owners, who usually make all business decisions, from daily operations to future investments. To facilitate successful implementation, SME owners are proactively involved in the adoption process, including the initiation, evaluation, trial, selection, and acquisition of software. Proactive owners are convinced of the benefits of cloud accounting, and likely to support it.Owner's participation and strong desire to use are key contributors to the digital technology adoption success within SMEs. (EX4.2)The owner is the key decision maker to adopt or not adopt cloud accounting. (OW1)All six SME owners who were involved in the entire adoption process perceived cloud accounting adoption and usage positively.( +) Owner's attitude. Attitude toward change is related to owners' change competency, such as taking risks, emphasizing goal achievement, and being socially active. SME owners that have a greater tolerance for risk and change are more likely to accept cloud accounting. For instance, OW3 was a visionary and passionate about the future direction of her business. She was a risk taker, judging by her decision to adopt Xero, a New Zealand-based cloud accounting provider not commonly used in Thailand.Six years ago, we decided to use cloud accounting though there was only Xero available. We are possibly the first Thai user of Xero. (OW3)The owner's positive attitude toward change is critical. If the owner prefers not to change, new technology adoption is not possible. (OW4)Ten out of seventeen informants believed that the SME owner's attitude was critical for any IT/IS adoption success, including cloud accounting.( +) Owner's innovativeness. Owner's innovativeness appears to be another determinant of cloud accounting adoption. Innovative owners prefer to apply distinctive and risky solutions, such as cloud accounting that modify the traditional structure. As all owner informants mentioned, they always seek, support, and contribute to innovative activities, which results in enhancing the firm's efficiency and competitiveness. New technology and research and development (R&D) are common in these firms.To support operation, we develop our own task-tracking software on the cloud for internal and customer use. We never use the local server in any areas. (OW4)Owners' innovativeness is very important. If they are tech-savvy, they normally choose online, rather than offline solutions. (VE2)These results suggest that the innovativeness of the owner influences the cloud accounting adoption decision in SMEs.In this section, we first discuss why and how SMEs adopt cloud accounting in Thailand and then elaborate on the influence of the TOEVO factors on cloud accounting adoption.Before examining why SMEs adopt cloud accounting, it is worthwhile understanding the state of cloud accounting in developing countries, particularly in Thailand. Our study indicates that most Thai SMEs did not use cloud accounting before the COVID-19 pandemic. They were reluctant to adopt cloud accounting due to their reliance on traditional processes centered around paperwork and desktop-based software. This is in line with Nyathi et al. , who fouOur cross-case analysis indicates that the intention to adopt cloud accounting was initially triggered by internal needs to improve business activities, rather than by external factors. The key rationales are to improve efficiency through lower operating costs and reduced error, stay competitive in a data-driven world, and increase mobility in response to the pandemic. As a top priority, SMEs' higher efficiency is derived from lower manual workload, no upfront IT investment, fewer workers, and minimized paperwork, as well as online collaboration between co-owners, SMEs and customers, and SMEs and accounting service companies. This is a key rationale in developing countries and has also been reported in other IT/IS adoption studies , and then compare costs with other available tools. For micro and small businesses, low price and ease of use are more important than complete functionality. These results are in line with the findings of Levenburg . AlthougThis study shows that SME owners are not only decision makers but also initiators, trial users, evaluators, and executors during the adoption process, confirming that owner commitment is essential in the implementation of accounting-related information systems Rahayu, . FurtherThe study's findings reveal that vendor, owner, technological, organizational, and environmental factors have a positive effect on cloud accounting adoption in SMEs.An integrated conceptual model through the lens of extended TOE–DOI–INT, depicting the relationship between relevant factors and SMEs' decision to adopt cloud accounting, is presented in Fig. With regard to the environment, all determinants confirmed the findings of previous IT/IS adoption studies . Moreover, vendors should focus on SMEs' particular characteristics and needs. By contrast, SMEs should determine the organizational fit of the cloud accounting platform and utilize cloud accounting to its full potential, for instance, in cashflow management and integration with other cloud-based open platforms for inventory management, e-commerce platforms, and point-of-sale software.As cloud accounting is relatively new in Thailand, this study focuses on its adoption and initial usage by SMEs. For future research, these findings are potentially transferable to other types of organizations and beyond the geographic restrictions explored initially. That is, to address this study's limitations, the TOEVO framework developed here requires further investigation and testing using larger sample sizes, a broader range of SME characteristics , and more locations. Future studies might also examine the diffusion of cloud accounting across time, given that factors influencing initial adoption could possibly change during the routinization and infusion stages.


Euryale ferox seeds treated by exogenous ABA. The differentially expressed genes engaged in the “Starch and sucrose” and “TCA cycle” pathway. Furthermore, the key transcription factor EfABI4 in ABA signaling pathway and the key genes of starch biosynthesis  were significantly up-regulated. Further, the Euryale ferox plant was treated with ABA, it was found that the total starch content of Euryale ferox seeds at different development stages was significantly higher than that of the control, and the key genes of starch synthesis in Euryale ferox seeds were also significantly up-regulated. Finally, yeast one-hybrid and dual luciferase assay proved that EfABI4 can promote the expression of EfSS1 by directly binding to its promoter. Subcellular localization results showed that EfABI4 protein was located at the nucleus and EfSS1 protein was located in the cytomembrane. These findings revealed that ABA promotes starch synthesis and accumulation by mediating EfABI4 to directly promote EfSS1 gene expression, which is helpful for understanding starch synthesis in seeds.Starch is the final product of photosynthesis and the main storage form in plants. Studies have shown that there is a close synergistic regulatory relationship between ABA signal transduction and starch biosynthesis. In this study, we employed RNA sequencing (RNA-Seq) to investigate transcriptomic changes of the  ABA (abscisic acid) is one of the five major plant hormones, and plays an important role in regulating plant development . ABA is Starch is the main carbohydrate formed by carbon fixation during photosynthesis and plays an important physiological role in the whole growth and development of plants . Starch ABI4 is mainly involved in regulating glucose metabolism and thus affecting starch synthesis [Arabidopsis, the abi4 mutant has a glucose and fructose insensitive phenotype [ABI4 regulates the expression of starch synthesis-related genes APL3 and SBE2, and starch degradation genes SEX1 and BMY8/BAM3, thus affecting the synthesis and accumulation of starch [NnABI4 can activate and up-regulate the expression of NnSS1, which promotes starch synthesis in Nelumbo nucifera [ZmABI4 can also up-regulate the expression of AGPL2, AGPLS4, Sh2, SS1, GBSS1, SBE2a, SBE2b and PHOL genes encoding AGPase, thus increasing starch content in maize endosperm [Abscisic acid insensitive 4 (ABI4) is a key transcription factor in ABA signaling. ynthesis ,29,30,31henotype . ABI4 hahenotype . ABI4 ref starch . In addinucifera . Moreovendosperm .Euryale ferox Salisb. (Nymphaeaceae) is an important characteristic aquatic vegetable in China, with high economic value and medical value [E. ferox seeds [Euryale ferox, the starch content in seeds increases with the maturation of seeds, but the amylopectin content and the ratio of amylose to amylopectin are significantly different among varieties [Euryale ferox starch are closely related to the quality of E. ferox seeds [EfSBE1 expression has been proven to be related to the difference in amylopectin in different varieties of E. ferox seeds, and EfSBE3 can regulate the synthesis of amylopectin [Euryale ferox are still scarce. Therefore, studying how the starch synthesis of E. ferox seeds forms is important. In this study, the regulation mechanism of ABA on starch biosynthesis of E. ferox seeds was investigated.al value ,37. It iox seeds . In sevearieties ,40. The ox seeds ,42. At plopectin ,43. HoweEuryale ferox. We screened candidates for key differentially expressed genes after ABA treatment of E. ferox seeds by transcriptome. We further proved the effect of ABA on starch of Euryale ferox by treating the growth and development process of Euryale ferox with exogenous ABA. Finally, we demonstrated the molecular regulatory mechanism using Y1H assays, subcellular localization and dual luciferase assay. This study provides a solid theoretical basis for ABA regulation of E. ferox seed starch synthesis.To explore the physiological, biochemical, and molecular mechanisms underlying ABA regulated starch and to clarify the influence of ABA on quality of starch from p < 0.05 and Log2FC ≥ 1) were obtained. Among them, 2745 genes were up-regulated and 2345 genes were down-regulated in the ABA treatment group, indicating that more genes responded positively to ABA treatment . In total, 264,860,112 high-quality reads were obtained by sequencing, and 39.74 Gb of clean data were obtained by further quality screening and detection . By compreatment .E. ferox seed, differentially expressed genes (DEGs) were classified by GO function. “Vitamin binding protein” and “pyruvate kinase activity” were enriched in “cell component”. “Carboxylic acid biosynthesis”, “organic acid biosynthesis” and “fatty acid metabolism” were enriched in “biological process”. “Catalytic activity” and “binding” were enriched in “molecular function” . E. ferox seeds were collected 25 days after flowering, soaked in 100 mg/L ABA  solution, and sampled after soaking for 0 h and 18 h. They were quickly washed and placed in liquid nitrogen and refrigerated at −80 ℃ for use, with three biological replicates for each sample.Euryale ferox plants entered the reproductive growth stage, 50 mL 5 mg/L ABA solution was applied to the leaves once every 7 days for 3 times in total . E. ferox seed samples were collected at 10, 20, 30 and 40 days after flowering. Three replicates were set for each treatment. The seeds were quickly frozen, made into powder, and stored at −80 ℃.In addition, after the E. ferox seeds after ABA treatment using plant RNA extraction kit . The RNA integrity of ABA treated seeds at 0 h and 18 h was analyzed by agarose gel. After passing the quality inspection process, a cDNA library was constructed according to the steps of the cDNA library construction kit. After the library was constructed, the library was checked and sequenced using Illumina Novaseq 6000 system after reaching the standard. The accuracy of subsequent analysis was positively correlated with the quality of reads, so raw reads obtained by sequencing needed to be detected. In order to ensure high data quality, redundant, complex and low-quality reads were screened and cut out, and the high-quality reads obtained were called clean data. The filtered sequenced sequence was compared with the reference genome E. ferox. Trinity software was used for a series of sequence assembly of high-quality sequencing data, and long and high-quality transcripts were obtained for subsequent research and analysis [Total RNA was extracted from analysis .E. ferox Unigene, including differential expression gene analysis and differential gene GO and KEGG enrichment analysis. After differential gene expression analysis, GO enrichment analysis was performed to further annotate the genes and gene products. Finally, Unigene obtained from E. ferox was compared with KEGG, a database with genome deciphering function, for the convenience of subsequent research and analysis.In order to obtain more comprehensive gene function information, we carried out rigorous bioinformatics analysis on the obtained ®IIl RT SuperMixfor qPCR . Quantitative reverse transcription polymerase chain reaction (QRT-PCR) was used to analyze the key genes of the starch synthesis pathway in E. ferox seeds. The qRT-PCR reaction was 20 µL, including 10 µL 2 × ChamQ SYBR qPCR Master Mix , 0.8 µL positive and negative primer mixture, 1.0 µL cDNA template and 8.2 µL ddH2O, respectively. Primer Premier 5.0 was used for Primer design. See EfUBQ5) gene was used as an internal gene expression control: the gene was amplified with forward primer 5′-GTGAAGGCGAAGATCCAGGACAAG-3′ and reverse primer 5′-CCACGAAGGCGAAGCACAAGG-3′. Amplification was performed on the CFX-96 Real-time PCR system  using the following real-time fluorescent quantitative PCR program: 95 ℃ for 30 s, 95 ℃ for 10 s and 60 ℃ for 30 s for a total of 40 cycles. The relative gene expression was calculated by 2−∆∆CT [The extracted RNA was reverse transcribed into cDNA using HiScripty 2−∆∆CT . Three rThe photosynthetic parameters of leaves were measured for six consecutive days on the second day after the first spray of exogenous ABA. The portable photosynthesis measurement system LI-6400XTP can simultaneously measure the leaf photosynthetic rate (Pn), stomatal conductance, and transpiration rate (Ts).E. ferox seeds were ground with a mortar. The total starch content of 3 mg sample, amylopectin content of 0.005 g sample and amylose content of 0.01 g sample were determined by visible spectrophotometry. A Solarbio Detection Kit  was used to determine total starch, amylose and amylopectin contents. Starch content (mg/g) = 1.351X/0.003 × 1.11, X = (ΔAdetermination + 0.0756)/4.9517, ΔA is ΔA determination = (A determination-A blank) − (A’ determination -A’ blank); Amylose content (mg/g) = 2 × ΔA determination/ΔA standard/0.001; Amylopectin content (mg/g) = X × 5/0.005, X = (ΔAdetermination + 0.0006)/0.7564. Each measurement was repeated three times.Fresh EfABI4 was inserted into pGADT7  to generate the AD-EfABI4 structure. The EfSS1 promoter fragment was cloned into pAbAi  vector to generate pAbAi-EfSS1, which was linearized by BstBI  and then transformed into Y1HGold yeast strain . The transformed cells were grown in the SD/-Ura plate for 3 days. After inhibiting the self-activation of the EfSS1 promoter with Aureobasidin A , the prey ABI4 was transferred to the Y1HGold yeast  containing the EfSS1 promoter. Subsequently, the yeast was spread on the SD/−Leu +AbA100 plate and allowed to stand and cultivate for 3–6 days.The full-length CDS of EfABI4 and EfSS1 were cloned into pCAMBIA1300-GFP by SacⅠ and XbaⅠ  digestion sites . The plasmid was transformed into Agrobacterium tumefaciens GV3101 and grown under appropriate antibiotics for subcellular localization analysis. Agrobacterium-mediated transient expression in 4-week-old Nicotiana benthamiana leaves was studied by syringe osmosis. After 72 h of dark growth, the GFP fluorescence of the samples was observed using a confocal laser scanning microscope . The primers are listed in The encoding sequences of EfSS1 promoter, double luciferase assay was performed. Firstly, the recombinant plasmids EfABI4-pGreenII 62-SK and proEfSS1-pGreenII 0800-LUC were transferred into A. tumefaciens GV3101 strain. Secondly, the bacteria were resuspended with the infection solution  and 10 mM MgCl2) until the OD600 value was 1.0, and the bacterial solution containing EfABI4-pGreenII 62-SK and the bacterial solution proEfSS1-pGreenII 0800-LUC were mixed in a ratio of 1:1, and then left to stand for 3 h. Then, the tobacco (Nicotiana benthamiana) was injected. According to the fluorescence value measured by the double reporting system, the fluorescence value of the target gene plasmid/the fluorescence value of the internal reference plasmid  was calculated, and the ratio of the target gene plasmid to the control group and the standard error were calculated and the histogram was made.To further verify the binding activity of EfABI4 protein and EfABI4, EfDBE1, EfGBSS1, EfSBE2, EfSS1, EfSS2, EfSS3 and EfSS4, which were highly correlated with the expression profiles of key starch biosynthesis-related genes. Moreover, we demonstrated that the EfABI4 transcription factor can directly bind to the EfSS1 promoter, up-regulate the expression of EfSS1 in E. ferox seeds, and promote the biosynthesis of starch in E. ferox seeds. This provides a practical basis for understanding the molecular regulatory network between ABA signal transduction and starch biosynthesis.In conclusion, we identified the expression profiles of a number of differentially expressed key genes, including


Full thickness skin grafting is a common technique for reconstructing defects in the head and neck area. We propose the use of an addition-cured silicone as an individually moulded silicone dressing to keep the vulnerable skin graft in place, prevent shearing forces and create a moist environment.The silicone dressing is applied directly on the graft, using a double cartridge system. The silicone is moulded to the skin graft and hardens quickly, integrating thread knots into its material and creating good adherence to the graft. Charts of 24 patients who had undergone reconstruction with full thickness skin graft from the neck after surgery for skin tumors in the head from November 2017 to October 2020, were reviewed retrospectively to quantify the degree of post-operative graft loss and durability of the dressing.Medical silicone based on venylpolysiloxane is a safe and durable dressing which makes postoperative dressing changes expendable.Trial registration The study was approved by the institutional review board of the Brandenburg state medical association (S 4(bB)/2021).The online version contains supplementary material available at 10.1186/s40463-022-00577-7. Full thickness skin grafting (FTSG) is one of the most important techniques for reconstructing defects in head and neck skin. Grafts usually heal with good aesthetic and functional results, but require substantial nourishment .In the first 24 h after placement the grafts are solely nourished by plasmatic imbibition. 48–72 h after grafting, revascularisation begins to develop when vascular anastomoses between the recipient bed and skin graft are being built. inosculation takes place five to seven days postoperative. If a graft’s metabolic demands are too high, or if the fragile connection of capillaries between the wound bed and graft is disrupted by shearing forces, the graft will die [Due to the vulnerability to insufficient vascularization, it is important that the FTSG needs to be immobile during the time period of inosculation. This can be supported by a dressing that ideally keeps the skin graft in contact with the wound bed, increases the surface area contact, and helps prevent shearing .In addition to mechanical protection, semi-occlusive and occlusive dressings prevent desiccation of the skin graft by creating a moist environment, which improves wound healing and prevents sticking of the sore edge.Complex anatomical structures of the head and neck area, such as ears or nose, often make it difficult to place an occlusive dressing that allows monitoring of the graft and lasts a week or more, and therefore frequent dressing changes are necessary.To improve this situation, we propose the use of an addition-cured, transparent and individually moulded silicone based on venylpolysiloxane (Dreve Regofix transparent), as a dressing applied directly on the graft. The silicone is a well-established impression material used in dentistry, and is widely available , 5.A retrospective medical chart review was undertaken to identify patients who had undergone FTSG in the head after surgery for skin tumors and received a semi-occlusive silicone dressing, at two institutions, from November 2017 to October 2020.The study was approved by the institutional review board of the Brandenburg state medical association (S 4(bB)/2021).Charts of twenty four patients were reviewed. To quantify the degree of post-operative graft loss, partial loss was defined as less than 50% of the graft surface being necrotic. Total graft loss was defined as loss of more than 50% of the surface.The patient is informed about the off label use of a medical silicone. The procedure is performed under local anaesthesia. To cover a post-operative defect after histopathological R0-resection of a skin tumor in the head and neck region, a plastic reconstruction with FTSG is performed Fig. .Fig. 1PrFTSG are harvested from the neck in a shape fitting the defect, and the donor site wound is closed primarily with sub-dermal vicryl 4.0. sutures, topical skin adhesive (LiquiBand Optima) and steristrips Fig. .Fig. 2ThSub-dermal fat is then removed from the graft, which is pierced with a no. 11 scalpel. After meticulous hemostasis to prevent hematoma of the recipient site, the prepared graft is sutured tension-free in place with a 4.0 chromic suture Fig. .Fig. 3thThe graft is covered with a dressing of transparent addition-cured silicone (based on venylpolysiloxane) applied directly on the graft, using a double cartridge system with an injector and mixing tips for the right mix of components Fig. .Fig. 4ThApplication of the material takes only a few seconds, as the silicone is moulded to the skin graft and hardens quickly, integrating thread knots into its material and creating good adherence of the wound dressing. Fig. .Fig. 5ThAfter ten days, thread pull and removal of the dressing is a combined process, firstly by cutting the threads at one side and then lifting the dressing slowly by cutting all threads one by one. After complete detachment of the dressing, remaining threads are removed carefully and the wound is cleaned Fig. .Fig. 6ReTwenty four patients were treated with individually moulded silicone dressings after reconstruction of a defect in the head and neck region, with an FTSG from the neck, in the period from November 2017 to October 2020.Three patients had incomplete charts and were excluded from the study, which analysed the medical records of 21 patients.n = 16) of patients and females 23.8% (n = 5).Median age of patients was 80.5, ranging from 58 to 95 years old. Males comprised 76.19%  cases and a complete graft loss occurred in one (4.76%) case, leading to an overall complication rate of wound healing of 14.28%.2 and the shortest duration of applied silicone dressing at 6 days. One of the patients with partial graft loss had a duration of 7 days with a defect size of 2.55 cm2. Whereas the other patient had an application duration of 11 days with a defect size of 6.6 cm2. Hence the median preoperative defect size within the patient group with complications didn’t differ significantly from the overall preoperative defect size among all analyzed cases (4.81 cm2 vs. 4.42 cm2).When analyzing the three patients with complications, the patient with complete graft loss had a preoperative size defect of 5.29 cmn = 13) the recipient site was the ear  and in 38% (n = 8) the recipient site was the mobile region of the face . Mean duration of the dressing related to the localisation was 9.84 days in the ear and 12.22 days in the mobile region of the face which was statistically significant (p < 0.05). Preoperative defect size was 5.71 cm2 in the mobile region of the face and 3.52 cm2 in the ear.Donor site for FTSG in all patients was the neck. In 61.9% of cases  and physicians.By analysing the patients with graft loss, there was no relation between the preoperative defect size and graft loss. In particular the patient with the largest FTSG had no problems with wound healing.Up to now, silicone as a dressing is mostly used as a gel sheet for preventing and treating hypertrophic and keloid scars, and has proved useful and safe, although the exact mechanism is not completely understood yet , 6.In our technique, the silicone is used as a transparent semi occlusive dressing that is moulded on complex wounds and leads to a moist chamber with increased temperature and improved hydration. Furthermore, it holds the FTSG in place and shearing forces are reduced which is especially important in FTSG.Limitations in the method are possible complications from the material, such as intolerance or rashes, which were not seen in our study, possibly due to the small number of patients. Therefore, rare complications didn’t show up. In case of wound infection, bleeding or necrosis which makes removal of the dressing necessary, thread pull also has to be done, since the dressing holds on to the threads.In comparison to traditional dressings with a bolster, such as petroleum or paraffin impregnated gauze with an overlying pressure dressing to secure the graft in place, it is not possible to monitor the graft without a dressing change and the application is rather complicated and time consuming. The application of the addition-cured silicone takes only a few seconds and the cartridge can be used several times with a new mixing tip for each patient.2. Arithmetically 1.25 ml silicone cover 5 cm2 wound surface with a thickness of 2.5 mm, so that a 50 ml cartridge can be used 17.54 times.The costs at our institution for a 50 ml cartridge are 8.01 € and 0.39 € for a mixing tip. The mixing tips are available in different sizes; the tip we use contains 1,6 ml and has to be discarded after use on one patient. The mean defect size in our collective is 4.42 cm2. In relation, bigger silicone dressings are more cost effective because of the high proportion of the mixing tip in the total cost.This results in average cost of 0.85 € per application including the mixing tip for a wound surface of 5 cm2) and overlying compress would cost 0.74 € at our institution. In bigger defects, an additional chromic suture can be necessary for the bolster dressing to hold effectively. This would exceed the costs of the moulded silicone dressing as chromic suture material is expensive .In comparison, a traditional bolster dressing with Paraffin impregnated gauze (Lomatuell, 5 cmThe use of addition-cured silicone as an individually moulded dressing is a safe technique to achieve a very durable, three dimensional dressing, with no need for regular postoperative dressing changes (Additional file Especially in bigger defects, silicone can be cheaper than traditional bolster dressings with potential cost savings for publicly funded health systems.Additional file 1: Supplemental video.