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Abstract The deleterious impact of antibiotics (ATB) on the microbiome negatively influences immune checkpoint inhibitors (ICI) response in patients with cancer. We conducted a randomized phase I study (EudraCT:2019-A00240-57) with 148 healthy volunteers (HV) to test two doses of DAV132, a colon-targeted adsorbent, alongside intravenous ceftazidime-avibactam (CZA), piperacillin-tazobactam (PTZ) or ceftriaxone (CRO) and a group without ATB. The primary objective of the study was to assess the effect of DAV132 on ATB plasma concentrations and both doses of DAV132 did not alter ATB levels. Secondary objectives included safety, darkening of the feces, and fecal ATB concentrations. DAV132 was well tolerated, with no severe toxicity and similar darkening at both DAV132 doses. DAV132 led to significant decrease in CZA or PTZ feces concentration. When co-administered with CZA or PTZ, DAV132 preserved microbiome diversity, accelerated recovery to baseline composition and protected key commensals. Fecal microbiota transplantation (FMT) in preclinical cancer models in female mice from HV treated with CZA or PTZ alone inhibited anti–PD-1 response, while transplanted samples from HV treated with ATB + DAV132 circumvented resistance to anti–PD-1. This effect was linked to activated CD8+ T cell populations in the tumor microenvironment. DAV132 represents a promising strategy for overcoming ATB-related dysbiosis and further studies are warranted to evaluate its efficacy in cancer patients.

Given the significance of the Arbaeen event as one of the most important religious tourism events for Shiites, the present study aims to explore the contexts and reasons for the enthusiastic participation of Iranian Shiites, as well as their experiences and perceptions of this activity, using a social interpretive approach. The research methodology is qualitative. Data was collected using conventional methods in ethnography and analyzed through grounded theory. The research results indicate that factors such as the inefficiency of the internal decision-making system, due to the government’s and administrative system’s encounters with various crises in political, economic, social, and cultural domains, and social inequality, play roles in the participation in this event. This inequality is interpreted by participants as a sense of religious discrimination and a lack of rights. The semantic reconstruction of the pilgrims’ experience and understanding of participating in this event serves as a channel for social participation and solidarity, cultural change, and a communication bridge between stakeholders and executive officials. The core category suggests that the Arbaeen pilgrimage event acts as an alternative to existing constraints.

Tourism events, in addition to aiding destination marketing, can bring about numerous positive economic implications for destinations and tourism businesses. Consequently, event tourism attracts the attention of stakeholders and destination managers, as well as captivates researchers, leading to the advancement of research in this domain. The objective of this research is to conduct a quantitative review of event tourism studies to better understand the conceptual and social structures of this field, as well as its current and future research trends. Accordingly, a bibliometric analysis was adopted in this research. To achieve this aim, 2014 event tourism articles were retrieved from the Web of Science database and visualized using VOS viewer software. The research findings indicate that the number of article publications peaked in 2019 with 206 articles, while citations peaked in 2021 with 6783 citations. Moreover, the findings identify the top articles, researchers, journals, universities, and countries based on citation volume. By employing co-authorship analysis, the study illustrates international collaboration networks in this field, with the United States exhibiting the highest level of collaboration with other countries. Additionally, co-occurrence analysis of keywords identifies the most prominent research topics and delineates new trends in this area. Increased attention to small-scale and cultural events compared to large-scale sporting events, a focus on marketing, consumer behavior, tourist experience, and the role of technology represent significant emerging trends in event tourism that could attract researchers' attention. 1. Introduction The world has been moving towards utilizing events to attract tourists in the past three decades (Kelly and Fairley, 2008). Recently, various cities and towns have added events such as exhibitions, performances, thematic markets, festivals, and events to their offerings as tourist attractions in order to both attract tourists more successfully and prolong their stays (McKercher and Du Cros, 2003). Destination managers have realized the necessity of augmenting their tourism offerings with novel, exciting, pristine, and unparalleled attractions (Connell, Page, and Mair, 2015). Tourism events can serve as powerful tools for attracting tourists and creating an image and awareness of the region in the minds of tourists (Kovalenko, Dias et al., 2023). Events breathe life into attractions and invigorate them; otherwise, tourists' experiences become repetitive and tedious, gradually reducing visitor numbers (Getz and Page, 2016; Kruger and Saayman, 2017), to the extent that they have become a key component of tourism products in many destinations (Getz, 2016). In recent years, there has been a noticeable increase in the academic community's attention to research related to event tourism. With the expansion of event tourism research, the literature in this field requires more comprehensive review studies than ever before. Despite qualitative review studies conducted in the field of event tourism (Getz, 2005; 2008; 2012; 2016), there is still a gap in the literature for a quantitative study that examines the structures of event tourism and can provide an overview of this research field. Since bibliometrics is a quantitative method that evaluates and reviews the existing body of research in a field or research topic and can identify research trends and highlight knowledge gaps (Kryszak et al., 2023; Thukral & Jain, 2021), the present study aims to conduct a bibliometric review of event tourism research to not only demonstrate conceptual and social structures but also introduce the overall status of research conducted in this field to date, as well as gaps and future research trends. Consequently, the present study seeks to address the following questions: 1) What trend has quantitative publication and citation of event tourism research followed in recent years? 2) Which articles, journals, researchers, countries, and universities have been the most cited in the field of event tourism? 3) What has been the status of international collaboration in this field? 4) Which keywords have been the most frequent in this field, and what has been the conceptual structure of event tourism? 2. Literature Review There is no clear consensus on the classification and determination of key terms in these definitions. Since an event can gather people for a specific purpose, some researchers in this field define events based on their objectives. Another group of scholars emphasizes the unique aspects and characteristics of each event in their definition. In a comprehensive definition by Zhu (2007), events are phenomena that signify and delineate individual and collective realities. According to Jacqueline (2019), events are categorized based on their content, such as historical, geographical, and cultural events. Such contents can include music, film, performances, being in a specific location, or occurring at a specific time. The purpose of events should be clear and should not contradict existing institutional objectives. Getz (2008) refers to event tourism as a form of travel with special interests, where individuals travel to see an event or attend one during their journey. Examples include religious ceremonies, art exhibitions, music concerts, and other cultural festivals, which are significant attractions for residents and tourists and play a fundamental role in reviving other arts and cultural elements. According to Mair (2015), events are special occasions that rarely occur and have a specific duration, offering participants opportunities beyond their everyday lives. Pross (2005) also defines event tourism as short-term periods filled with engaging and exciting activities, usually held in a geographical or historical area. Therefore, events are unique celebrations that occur in a specific place and at a particular moment to fulfill specific needs. The most comprehensive definition of events in the tourism literature was proposed by Getz in 1991. He defines events from the perspectives of organizations and consumers: from the organization's perspective, events are phenomena that occur once or repeatedly outside of sponsorship programs and organizer activities, and from the consumer's perspective, events are opportunities for social, cultural, and recreational experiences that typically differ from the conventional and ongoing life of the local community (Abbas et al., 2021). According to Getz (2008), planned events are spatial and temporal phenomena, each uniquely designed and programmed due to the interaction between the environment, individuals, and management systems. One of the significant attractions of events is that they are never the same, and you have to be there to fully enjoy the unique experience that an event offers. Therefore, if you miss it, it's a missed opportunity. Virtual events, or events that communicate with people through media, also provide different interests and values for the tourism industry and offer a different type of event experience (Zhou, 2007). Similarly, regarding the types of events, there are many disagreements. Bridge (2007) enumerates the typology of event types as follows: local events, major events, prominent events, and mega-events. As the dimensions and size of events increase, so do their effects. Connell, Page, and Mair (2015) provide the following classification of events: Cultural events: festivals, carnivals, memorials, and religious events; Political events: summits, royal occasions, and political events; Business and trade events: conferences, exhibitions, trade shows, and markets; Educational and scientific events: conferences; Sports events: non-professional, professional, spectators, participants, and recreational; Private events: weddings, parties, gatherings, and celebrations. Eckulica et al. (2012) categorize events into various types, including tourism events, urban events, competitions, weddings, mega-events, and prominent events. Another typology proposed by Barker (2003) divides events into three categories: business events, cultural programs, and sports programs. Boudin et al. (2006) present another taxonomy consisting of ten parts: 1) business, 2) festivals, exhibitions, cultural events, 3) social events (community-based), 4) outdoor events, 5) entertainment, festivals, live music, 6) concerts, theater, and shows, 7) sports events or sports spectators, 8) charity events, fundraising, voluntary activities, 9) party and wedding planning, and life cycle-related events, and 10) special events. Servetti and Piva (2015) argue that events can vary significantly in scale, complexity, and the number of stakeholders involved. Larger events tend to have broader and more numerous objectives and stakeholders. Additionally, events are classified based on their social construction, performance, and their roles in governmental policies and corporate strategies. Sometimes events are classified based on their form and program, a concept referred to as social construction. By anticipating the economic benefits derived from the spending of tourists and visitors at festivals, various private and governmental agencies can utilize these events as a new source of income for local businesses and taxation. Moreover, besides the economic advantages, festivals, by offering diverse cultural events, are perceived to enhance infrastructural facilities, transportation, etc., as part of the destination's quality and residents' quality of life, contributing to their improvement. However, stringent and effective mechanisms are required by policymakers to minimize the negative social impacts of events, paving the way for reputation building and destination and event enhancement (Campón et al., 2019). 3. Methodology This research is of a descriptive-analytical nature and has utilized bibliometric methodology. Bibliometric analysis is a quantitative analytical method used to examine the progress of a research field (León-Gómez et al., 2021), employing quantitative and statistical techniques such as descriptive analysis and visualization of conceptual, intellectual, and social structures (Mukherjee, Lim et al., 2022). In this study, descriptive, co-authorship, and co-citation analyses have been employed. For data analysis and visualization, as well as illustrating existing scientific patterns, the VOS viewer software has been utilized (Van Eck & Waltman, 2010). To retrieve data in this research, the Web of Science database and its subsets, which include high-quality journals, have been utilized (Rai et al., 2021; Hassan Shah et al., 2022). Initially, to determine the scope of the search, appropriate titles, abstracts, and keywords based on the literature review of the research under consideration were selected. Then, no starting point was determined for the search in terms of time, and all articles in the field of event tourism up to December 31, 2023, were utilized. The keywords used for the search were "Event tourism," "Event," and "Tourism." In the first stage of data analysis, information from 3349 articles was extracted and retrieved from the database. In the second stage, criteria for the desired output were applied to discard irrelevant research. The first output criterion in this research was to classify articles into review and research categories. In the second stage, considering that the aim of the research is to examine the international trend of articles in the field of event tourism, articles' language was restricted to English, and articles before 2014 were retained for analysis. 4. Results The findings of the research indicate that although the number of publications increased quantitatively until 2019, it has decreased in recent years, possibly due to the COVID-19 pandemic and the cancellation of many major events, especially sporting events. Descriptive analysis findings show that the article by Getz (2008), titled "Event Tourism: Definition, Evolution, and Research," with 1081 citations, has been the most cited article in the field of event tourism. This is due to the conceptualization of event tourism in this research, which has been cited by many other researchers. With 1990 citations resulting from ten research studies in the field of event tourism, Getz can be considered the most cited and perhaps the most significant researcher in the field of event tourism. The Journal of Tourism Management, with 9677 citations, has been the most influential journal in this field. The most cited country among the active countries in event tourism is the United States of America, with 12462 citations. However, Griffith University, Australia, with 3587 citations, has ranked first among the most cited universities in event tourism. This indicates the concentration of several top researchers in this field at this university, as well as the university's significant activity in event tourism, as Florida and Washington State Universities rank fourth and fifth, respectively, among the most cited universities. Co-authorship analysis also showed that the United States had the most connections and collaborations with other countries in research, with 46 more links. Co-citation analysis displayed the most frequent keywords and, based on the temporal trend, illustrated the conceptual structure of event tourism research. 5. Conclusion The research shows a diversification of topics explored, with an emphasis on sports events, including major ones like the Olympics, alongside a growing interest in smaller-scale events. Commercial and festival tourism, as well as cultural events, have garnered significant attention thematically, with festival attendance being a key motivator for tourists. Recent studies have shifted focus towards marketing aspects within event tourism, aligning with previous research emphasizing the role of events in destination promotion and branding. Consumer behavior and marketing strategies in event tourism are highlighted, underscoring the need for a comprehensive understanding of both supply and demand dynamics. Furthermore, the study emphasizes the importance of human resources in event management, an aspect that has received less attention in research. Emerging concepts like tourist experiences and value co-creation are identified as crucial areas requiring further investigation, given their potential to enhance event experiences and destination development. A shift towards active tourist participation in events signifies a broader transformation in tourism paradigms, emphasizing value co-creation and active engagement over passive observation. This shift has implications for the definition of cultural tourism and its intersection with event tourism, as tourists increasingly seek immersive and participatory experiences in cultural events and festivals.

Background Medical educational societies have emphasized the inclusion of marginalized populations, including the lesbian, gay, bisexual, transgender and queer (LGBTQ+) population, in educational curricula. Lack of inclusion can contribute to health inequality and mistreatment due to unconscious bias. Little didactic time is spent on the care of LGBTQ+ individuals in emergency medicine (EM) curricula. Simulation based medical education can be a helpful pedagogy in teaching cross-cultural care and communication skills. In this study, we sought to determine the representation of the LGBTQ+ population in EM simulation curricula. We also sought to determine if representations of the LGBTQ+ population depicted stigmatized behavior. Methods We reviewed 971 scenarios from six simulation case banks for LGBTQ+ representation. Frequency distributions were determined for major demographic variables. Chi-Squared or Fisher’s Exact Test, depending on the cell counts, were used to determine if relationships existed between LGBTQ+ representation and bank type, author type, and stigmatized behavior. Results Of the 971 scenarios reviewed, eight (0.82%) scenarios explicitly represented LGBTQ+ patients, 319 (32.85%) represented heterosexual patients, and the remaining 644 (66.32%) did not specify these patient characteristics. All cases representing LGBTQ+ patients were found in institutional case banks. Three of the eight cases depicted stigmatized behavior. Conclusions LGBTQ+ individuals are not typically explicitly represented in EM simulation curricula. LGBTQ+ individuals should be more explicitly represented to reduce stigma, allow EM trainees to practice using gender affirming language, address health conditions affecting the LGBTQ+ population, and address possible bias when treating LGBTQ+ patients.

Abstract There are several overlapping clinical practice guidelines in acute pancreatitis (AP), however, none of them contains suggestions on patient discharge. The Hungarian Pancreatic Study Group (HPSG) has recently developed a laboratory data and symptom-based discharge protocol which needs to be validated. (1) A survey was conducted involving all members of the International Association of Pancreatology (IAP) to understand the characteristics of international discharge protocols. (2) We investigated the safety and effectiveness of the HPSG-discharge protocol. According to our international survey, 87.5% (49/56) of the centres had no discharge protocol. Patients discharged based on protocols have a significantly shorter median length of hospitalization (LOH) (7 (5;10) days vs. 8 (5;12) days) p

The national information network is being implemented with the aim of providing the services needed by the people through internal infrastructure and independent of international internet platforms. Considering the geographical diversity of the country and in order to increase the reliability coefficient and access penetration coefficient in the national information network and also due to the needs of future services, it is not possible to rely solely on fiber and the use of satellite communications will be unavoidable. At present, satellite communication has not reached a worthy position in the country's communication network and is limited to some applications such as banking, oil and gas etc. However, due to the development of broadband networks and the increasing need for high-speed data transmission and the increase in data volume, as well as creating social justice and increasing the speed of access, as well as the Internet penetration rate in the country in order to access various services, it is necessary to develop satellite communications to should be taken seriously. In this regard, an analysis of the market of several categories of services in Iran has been done so that the amount of gap in the amount of service provision and the amount of need to receive services can be seen.

Introduction: Following resident requests, we created a public metrics dashboard to inform residents of their daily productivity. Our goal was to iteratively improve the dashboard based on resident feedback and to measure the impact of reviewing aggregate data on self-perceived productivity.  Methods: A 10-question anonymous survey was completed by our postgraduate year 1-3 residents. Residents answered questions on the dashboard and rated their own productivity before and after reviewing aggregate peer-comparison data. Using the Wilcoxon signed-rank test we calculated summary statistics for survey questions and compared distributions of pre- and post-test, self-rated productivity scores.  Results: All 43 eligible residents completed the survey (response rate 100%). Thirteen (30%) residents “rarely” or “never” reviewed the dashboard. No respondents felt the dashboard measured their productivity or quality of care “extremely accurately” or “very accurately.” Seven (16%) residents felt “very” or “extremely pressured” to change their practice patterns based on the metrics provided, and 28 (65%) would have preferred private over public feedback. Fifteen residents (35%) changed their self-perceived rank after viewing peer-comparison data, although not significantly in a particular direction (z = 0.71, P = 0.48).  Conclusion: Residents did not view the presented metrics as reflective of their productivity or quality of care. Viewing the dashboard did not lead to statistically significant changes in resident self-perception of productivity. This finding highlights the need for expanding the resident conversation and education on metrics, given their frequent inclusion in attending physician workforce payment and incentive models.

Tourism of event or “Event Tourism” is one of the modern and new established types of tourism in the world, which has not received much attention in the country of Iran despite its unique cultural and local capacities. Studying the impacts of event tourism in Iran has been the main goal of the research. To get the research objectives, a qualitative approach has been used, relying on library and field studies. Qualitative data has been collected based on the published sources on event tourism in Iran. Based on the research findings the following were determined, 1. the contributing factors and involving institutions in organizing event tourism in the country, 2. the existing approaches in the organization and 3. the impacts of event tourism in Iran. Finally, a number of corrections were suggested regarding these deficiencies. Considering the potential opportunities in the field of legislation, it is required to consider the possible capacities for event tourism as one of the essential parts of tourism. It has legal capacities to be considered under the responsibilities and mission of the Supreme Council (Ministry) of Cultural Heritage, to introduce the existing capacities following the approvals of the organization and preparing a relevant calendar. Moreover, the public culture council of the states can use their capacities to improve the cultural activities and utilization of local capacities.

Background At the conclusion of residency candidate interview days, faculty interviewers commonly meet as a group to reach conclusions about candidate evaluations based on shared information. These conclusions ultimately translate into rank list position for The Residency Match. The primary objective is to determine if the post-interview discussion influences the final scores assigned by each interviewer, and to investigate whether interviewer characteristics are significantly associated with the likelihood of changing their score. Based on Foucault’s ‘theory of discourse’ and Bourdieu’s ‘social capital theory,’ we hypothesized that interviewer characteristics, and the discourse itself, would contribute to score changes after a post-interview discussion regarding emergency medicine residency candidates. Methods We conducted a cross-sectional observational study of candidate scores for all candidates to a four-year emergency medicine residency program affiliated with Yale University School of Medicine during a single application cycle. The magnitude and direction of score changes, if any, after group discussion were plotted and grouped by interviewer academic rank. We created a logistic regression model to determine the odds that candidate scores changed from pre- and post-discussion ratings related to specific interviewer factors. Results A total of 24 interviewers and 211 candidates created 471 unique interviewer-candidate scoring interactions, with 216 (45.8%) changing post-discussion. All interviewers ranked junior to professor were significantly more likely to change their score compared to professors. Interviewers who were women had significantly lower odds of changing their individual scores following group discussion (p=0.020; OR 0.49, 95% CI 0.26-0.89). Conclusions Interviewers with lower academic rank had higher odds of changing their post-discussion scores of residency candidates compared to professors. Future work is needed to further characterize the influencing factors and could help create more equitable decision processes during the residency candidate ranking process.

Metabolism is a major regulator of immune cell function, but it remains difficult to study the metabolic status of individual cells. Here, we present Compass, an algorithm to characterize cellular metabolic states based on single-cell RNA sequencing and flux balance analysis. We applied Compass to associate metabolic states with T helper 17 (Th17) functional variability (pathogenic potential) and recovered a metabolic switch between glycolysis and fatty acid oxidation, akin to known Th17/regulatory T cell (Treg) differences, which we validated by metabolic assays. Compass also predicted that Th17 pathogenicity was associated with arginine and downstream polyamine metabolism. Indeed, polyamine-related enzyme expression was enhanced in pathogenic Th17 and suppressed in Treg cells. Chemical and genetic perturbation of polyamine metabolism inhibited Th17 cytokines, promoted Foxp3 expression, and remodeled the transcriptome and epigenome of Th17 cells toward a Treg-like state. In vivo perturbations of the polyamine pathway altered the phenotype of encephalitogenic T cells and attenuated tissue inflammation in CNS autoimmunity.

Physician assistants (PA) are an important part of emergency department healthcare delivery and are increasingly seeking specialty-specific postgraduate training. Our goal was to pilot the implementation of a PA postgraduate program within an existing physician residency program and produce emergency medicine-PA (EM-PA) graduates of comparable skill to their physician counterparts who have received the equivalent length of EM residency training to date (evaluated at the end of first year of EM training).The curriculum was based on the Society for Emergency Medicine Physician Assistants (SEMPA) recommendations with a special focus on side-by-side training with EM resident physicians. In reviewing the program, the authors examined faculty evaluations, as well as procedure and ultrasound experience that the trainees received. We found comparable evaluations between first-year EM-PA and physician trainee cohorts. This program serves as a pilot study to demonstrate the feasibility of collocating clinical and didactic programming for physicians and EM-PAs during their postgraduate training. This brief innovation report outlines the logistics of the clinical and didactic curriculum and provides a summary of outcomes evaluated.

Background: Transnet moves around 80% of South Africa’s rail-friendly freight tonne-kilometres, which drops to less than 40% if the rail-only coal and iron ore export lines are excluded. Objectives: Calculating the costs, negative externalities, and job losses caused by Transnet’s recent and historical operational issues and using the results to inform future reform possibilities. Method: Aspects contributing to Transnet’s failures are indicated through an assessment of rail freight’s decreasing market share and infrastructure investment, port ownership and inefficiency concerns, Transnet’s deteriorating financial performance, loss of critical skills, and instances of state capture. Resultant costs and their impact on employment are calculated across various freight flow segments, whereafter reform models are suggested through international benchmarking and extracting lessons from relevant global reforms. Results: The cost of Transnet’s failures are estimated as 7.43% of gross domestic product. A healthy relationship between the government and the private sector is a frequent occurrence in successful reforms seen globally. Locally, recent government reforms acknowledge a meaningful role for the private sector, which is in turn offering pragmatic and achievable solutions. Conclusion: Improved private sector participation can contribute to Transnet’s recovery. South Africa depends on this collaboration and the development of port and rail master plans to guide the infrastructure development required to meet its overall transportation needs. Contribution: Actionable implications for policy implementation, the economic regulation and horizontal separation of the freight railway, shifting freight from road to rail, the corporatisation of the port authority, and increasing port efficiency and capacity.

T follicular regulatory (TFR) cells limit Ab responses, but the underlying mechanisms remain largely unknown. In this study, we identify Fgl2 as a soluble TFR cell effector molecule through single-cell gene expression profiling. Highly expressed by TFR cells, Fgl2 directly binds to B cells, especially light-zone germinal center B cells, as well as to T follicular helper (TFH) cells, and directly regulates B cells and TFH in a context-dependent and type 2 Ab isotype-specific manner. In TFH cells, Fgl2 induces the expression of Prdm1 and a panel of checkpoint molecules, including PD1, TIM3, LAG3, and TIGIT, resulting in TFH cell dysfunction. Mice deficient in Fgl2 had dysregulated Ab responses at steady-state and upon immunization. In addition, loss of Fgl2 results in expansion of autoreactive B cells upon immunization. Consistent with this observation, aged Fgl2-/- mice spontaneously developed autoimmunity associated with elevated autoantibodies. Thus, Fgl2 is a TFR cell effector molecule that regulates humoral immunity and limits systemic autoimmunity.

Eveline de Haan,1,2 Veronique AJIM van Rijckevorsel,1 Pepijn Bod,1 Gert R Roukema,1 Louis de Jong1 On behalf of Dutch Hip Fracture Registry Collaboration (DHFR)1Surgery Department, Maasstad Hospital, Rotterdam, the Netherlands; 2Surgery Department, Franciscus Hospital, Rotterdam, the NetherlandsCorrespondence: Eveline de Haan, Tel +31654922535, Email e.eveline.de.haan@gmail.comPurpose: The primary aim of this study was to identify risk factors for delirium after hip fracture surgery. The secondary purpose of this study was to verify peri-operative clinical outcomes, adverse events and mortality rates in delirium patients after hip fracture surgery.Patients and Methods: A prospective hip fracture database was used to obtain data. In total, 2051 patients older than 70 years undergoing a hip fracture surgery between 01– 01-2018 and 01– 01-2021 were included. A delirium was diagnosed by a geriatrician based on the DSM-V criteria.Results: The results showed that 16% developed a delirium during hospital admission. Multivariable analysis showed that male gender (OR: 1.99, p< 0.001), age (OR: 1.06, p< 0.001), dementia (OR: 1.66, p=0.001), Parkinson’s disease (OR: 2.32, p=0.001), Δhaemoglobin loss (OR: 1.19, p=0.022), pneumonia (OR: 3.86, p< 0.001), urinary tract infection (UTI) (OR: 1.97, p=0.001) and wound infection (OR: 3.02, p=0.007) were significant independent prognostic risk factors for the development of a delirium after hip surgery. The median length in-hospital stay was longer in patients with a delirium (9 days) vs patients without a delirium (6 days) (p< 0.001). The 30-day mortality was 7% (with delirium 16% vs with no delirium 6% (p< 0.001)).Conclusion: Significant independent prognostic factors associated with delirium after hip surgery were male gender, age, dementia, Parkinson’s disease, Δhaemoglobin loss, pneumonia, UTI and wound infection.Keywords: geriatric patients, hip fractures, delirium, risk factors, clinical outcomes

Epilepsy is a prevalent neurological condition, with underlying neuronal mechanisms involving hyperexcitability and hypersynchrony. Imbalance between excitatory and inhibitory circuits, as well as histological reorganization are relatively well-documented in animal models or even in the human hippocampus, but less is known about human neocortical epileptic activity. Our knowledge about changes in the excitatory signaling is especially scarce, compared to that about the inhibitory cell population. This study investigated the firing properties of single neurons in the human neocortex in vitro, during pharmacological blockade of glutamate receptors, and additionally evaluated anatomical changes in the excitatory circuit in tissue samples from epileptic and non-epileptic patients. Both epileptic and non-epileptic tissues exhibited spontaneous population activity (SPA), NMDA receptor antagonization reduced SPA recurrence only in epileptic tissue, whereas further blockade of AMPA/kainate receptors reversibly abolished SPA emergence regardless of epilepsy. Firing rates did not significantly change in excitatory principal cells and inhibitory interneurons during pharmacological experiments. Granular layer (L4) neurons showed an increased firing rate in epileptic compared to non-epileptic tissue. The burstiness of neurons remained unchanged, except for that of inhibitory cells in epileptic recordings, which decreased during blockade of glutamate receptors. Crosscorrelograms computed from single neuron discharge revealed both mono- and polysynaptic connections, particularly involving intrinsically bursting principal cells. Histological investigations found similar densities of SMI-32-immunopositive long-range projecting pyramidal cells in both groups, and shorter excitatory synaptic active zones with a higher proportion of perforated synapses in the epileptic group. These findings provide insights into epileptic modifications from the perspective of the excitatory system and highlight discrete alterations in firing patterns and synaptic structure. Our data suggest that NMDA-dependent glutamatergic signaling, as well as the excitatory synaptic machinery are perturbed in epilepsy, which might contribute to epileptic activity in the human neocortex.

Background and Objectives: Self-supported rear-radiating feeds have been widely used as reflector antenna feeds for mini terrestrial and satellite links. While in most terrestrial and satellite links a dual-polarized antenna for send and receive applications are required, all of the reported works regarding this topic are presenting a single polarized self-supported reflector antenna. In this paper, a dual-polarized hat feed reflector antenna with a low sidelobe and low cross-polarization level is presented. Methods: The proposed antenna consists of an orthogonal mode transducer (OMT), a 60 cm ring focus reflector, and a rear radiating waveguide feed known as the hat feed. 21 parameters of hat feed structure are selected and optimized with a genetic algorithm (GA). A predefined ring focus curve is used as a reflector in the optimization procedure. Dual polarization for send and receive applications is also obtained by an OMT at the rear side of the reflector antenna.Results: A prototype of the proposed hat feed reflector antenna is fabricated and the measurement results are compared with simulation ones. The proposed antenna has return loss better than 15 dB at both polarizations in the 17.7~19.7 GHz frequency range. The 60cm reflector antenna has 40dBi gain which means that the proposed antenna has about 70% radiation efficiency. About 20dB sidelobe level and more than 40 dB cross-polarization have also been realized in the measurement patterns of the proposed antenna. Conclusion: A dual-polarized hat feed reflector antenna with excellent radiation efficiency, high sidelobe, and low cross-polarization level is proposed. The proposed antenna can be a good candidate for high-frequency terrestrial and satellite communications.

Introduction: To describe structural changes that can be made in an emergency medicine residency program to increase diversity and foster an inclusive environment.Methods: We established a diversity committee to introduce several simultaneous structural changes focusing on resident recruitment, education and engagement. Some of these changes include establishment of a scholarship to recruit visiting students from diverse backgrounds and a second look weekend for minority applicants. Others focused on ensuring residency didactics, were inclusive and addressed topics pertaining to diversity in emergency medicine.Results: We increased the number of minority residents underrepresented in medicine matching in our program from zero to between 2 and 4 annually. We increased the percentage of women matching in our program from 33% to 47%. We worked with residency leadership to increase the number of didactics focusing on diversity and inclusion.Conclusions: Implementation of a Diversity Committee in emergency medicine training programs can be an important tool to improve diversity on a structural level.