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In this article, the authors examine employer perceptions of local and foreign MBA graduates along with the problems encountered and factors considered important in hiring them. Based on a sample of 91 respondents, the findings show significant differences in perceptions of local and foreign MBA graduates, as well as significant differences in employers' perceptions regarding the problems encountered with local and foreign MBAs. The key factors considered important in hiring MBA graduates included decision-making ability, written communication, oral communication, analytical skills, and interpersonal skills. The authors discuss the implications of their findings. (Contains 4 tables.)

Presents information on a study that examined the prevalence and predictors of highly active antiretroviral therapy use among persons with AIDS in San Francisco, California. Methodology of the study; Results and discussion on the study.

Background: Pneumonia, the most common infection following cardiac surgery, is associated with major morbidity and mortality. Although prior work has identified preoperative risk factors for pneumonia, the present study evaluated the role and associated impact of intraoperative and postoperative risk factors on pneumonia after cardiac surgery., Methods: This observational cohort study evaluated 71,165 patients undergoing coronary and/or aortic valve surgery across 33 institutions between 2011 and 2021. Terciles of estimated pneumonia risk were compared between a validated preoperative model (Model One) and a model additionally accounting for significant intraoperative (eg, bypass duration) and postoperative (eg, extubation time) factors (Model Two). Logistic regression was used to develop and validate Model Two., Results: Postoperative pneumonia occurred in 2.62% of the patients. A total of 9 significant intraoperative and early postoperative risk factors were identified. The absolute risk of pneumonia increased across Model One terciles: low (≤1.04%), medium (1.04%-2.40%), and high (>2.40%). Model two performed well (c-statistic = 0.771). Most patients (60.1%) had no change in their preoperative versus intraoperative/postoperative risk tercile. The 19.6% of patients who increased their risk tercile with Model Two accounted for 18.6% of all pneumonia events., Conclusions: This study identified 9 significant perioperative risk factors for pneumonia. Nearly 1 of every 5 patients moved into a higher pneumonia risk category based on their intraoperative and postoperative course. These findings may serve as the focus of future quality improvement efforts to reduce a patient's risk of postoperative pneumonia., Competing Interests: Conflict of Interest Statement Dr Pagani is an ad hoc, uncompensated scientific advisor for Medtronic, Abbott, FineHeart, and CH Biomedical; an uncompensated medical monitor for Abiomed; and a member of the data safety monitoring board for Carmat and the National Heart, Lung, and Blood Institute PumpKIN Study. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest., (Copyright © 2023 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Information on lentigo maligna (LM) and lentigo maligna melanoma (LMM) in the 21st century is scarce. We aimed to elucidate the incidence of LM and LMM using the Surveillance, Epidemiology, and End Results (SEER) 17 Registries., Methods: The data of patients diagnosed between 2000 and 2019 were extracted from the SEER database. The percentage of LM/LMM cases among all melanoma patients, age-standardized incidence rates, estimated annual percentage changes, and the cumulative incidence of LMM after LM were calculated., Results: The SEER data yielded 95,175 patients with LM/LMM between 2000 and 2019. Cases of LM/LMM accounted for 15.7% of all melanomas. The age-standardized incidence per 100,000 person-years for LM increased from 4.16 to 5.61 and for LMM from 1.33 to 2.35 between 2000 and 2019. The annual increase in incidence of LM was 2.42%, and that of LMM was 3.32%. The cumulative incidence of LMM after a primary LM after 10-year follow-up was 0.94%., Conclusions: This study provides the first comprehensive analysis of the epidemiological status of LM/LMM in the United States in the 21st century using the population-based SEER data., (© 2024 the International Society of Dermatology.)

Providers who are not in proximity to military bases or posts cannot assume that they do not have military-connected families in their practices. Military families face many unique challenges and risks. It is important that civilian providers support the physical and psychological well-being of this population., Competing Interests: Disclosure of interests: Drs Ling and Rossiter have no funding or conflict of interests to report. The ideas and content put forth here do not reflect the positions or policy of the US Department of Defense or the US Government., (Copyright ©2023 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.)

Purpose: COVID-19 and other recent infectious disease outbreaks have highlighted the urgency of robust, resilient health systems. We may now have the opportunity to reform the flawed health care system that made COVID-19 far more damaging in the United States (U.S.) than necessary., Design and Methods: Guided by the World Health Organization (WHO) Health System Building Blocks framework (WHO, 2007) and the socio-ecological model (e.g., McLeroy et al., 1988), we identified challenges in and strengths of the U.S.' handling of the pandemic, lessons learned, and policy implications for more resilient future health care delivery in the U.S. Using the aforementioned frameworks, we identified crucial, intertwined domains that have influenced and been influenced by health care delivery in the U.S. during the COVID-19 pandemic through a review and analysis of the COVID-19 literature and the collective expertise of a panel of research and clinical experts. An iterative process using a modified Delphi technique was used to reach consensus., Findings: Four critically important, inter-related domains needing improvement individually, interpersonally, within communities, and for critical public policy reform were identified: Social determinants of health, mental health, communication, and the nursing workforce., Conclusions: The four domains identified in this analysis demonstrate the challenges generated or intensified by the COVID-19 pandemic, their dynamic interconnectedness, and the critical importance of health equity to resilient health systems, an effective pandemic response, and better health for all., Clinical Relevance: The novel coronavirus is unlikely to be the last pandemic in the U.S. and globally. To control COVID-19 and prevent unnecessary suffering and social and economic damage from future pandemics, the U.S. will need to improve its capacity to protect the public's health. Complex problems require multi-level solutions across critical domains. The COVID-19 pandemic has underscored four interrelated domains that reveal and compound deep underlying problems in the socioeconomic structure and health care system of the U.S. In so doing, however, the pandemic illuminates the way toward reforms that could improve our ability not only to cope with likely future epidemics but also to better serve the health care needs of the entire population. This article highlights the pressing need for multi-level individual, interpersonal, community, and public policy reforms to improve clinical care and public health outcomes in the current COVID-19 pandemic and future pandemics, and offers recommendations to achieve these aims., (© 2022 Sigma Theta Tau International.)

Service members and their families have endured significant stressors over the past 19 years in support of the nation's engagement in the wars in Iraq and Afghanistan. 'Resilience' is the term most commonly used to describe the military spouse and military-connected child. However, due to a paucity of research on military families, little is known about the impact of spousal/parental military service on the military family. The ability of the healthcare provider is critical to ensuring the success of the military spouse and military-connected child. Providers can support the physical and psychological health needs of military families through (1) identification of military family members in clinical practice and (2) providing culturally competent care that correlates the unique lifestyle and physical and psychological health exposures associated with spousal/parental military service. Historically, in the United States, there has been a proud legacy of generational military service in families-upwards of 80% of new recruits have a family member who has served in the military. The leading factor associated with retention of the service member on Active Duty or in the Reserve or National Guard is the satisfaction of the at-home spouse. Disenfranchising the military spouse and lack of services and support for military-connected children could create a gap in meeting recruitment goals creating a threat to national security in the United States., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Currently, a binary alarm system is used in the United States to issue deterministic warning polygons in case of tornado events. To enhance the effectiveness of the weather information, a likelihood alarm system, which uses a tool called probabilistic hazard information (PHI), is being developed at National Severe Storms Laboratory to issue probabilistic information about the threat. This study aims to investigate the effects of providing the uncertainty information about a tornado occurrence through the PHI's graphical swath on laypeople's concern, fear, and protective action, as compared with providing the warning information with the deterministic polygon. The displays of color-coded swaths and deterministic polygons were shown to subjects. Some displays had a blue background denoting the probability of any tornado formation in the general area. Participants were asked to report their levels of concern, fear, and protective action at randomly chosen locations within each of seven designated levels on each display. Analysis of a three-stage nested design showed that providing the uncertainty information via the PHI would appropriately increase recipients' levels of concern, fear, and protective action in highly dangerous scenarios, with a more than 60% chance of being affected by the threat, as compared with deterministic polygons. The blue background and the color-coding type did not have a significant effect on the people's cognition of the threat and reaction to it. This study shows that using a likelihood alarm system leads to more conscious decision making by the weather information recipients and enhances the system safety., (© 2019 Society for Risk Analysis.)

Background: Residents of urban areas have accounted for the majority of persons diagnosed with HIV disease in the United States. Linking persons recently diagnosed with HIV to primary medical care is an important indicator in the National HIV/AIDS Strategy., Methods: We analyzed data reported to the HIV Surveillance System in 18 urban areas in the United States. Standardized executable SAS programs were distributed to determine the number of HIV cases living through 2008, number of HIV cases diagnosed in 2009, and the percentage of those diagnosed in 2009 who had reported CD4 lymphocyte or HIV viral load test results within 3 months of HIV diagnosis. Data were presented by jurisdiction, age group at diagnosis, race/ethnicity, sex at birth, birth country, disease stage, and transmission category., Results: By jurisdiction, the percentage of persons diagnosed in 2009 with at least 1 CD4 or HIV viral load test within 3 months of diagnosis ranged from 48.5% to 92.5% (median: 70.9). The percentage of persons linked to care varied by age group and by racial/ethnic groups. Fourteen of the 18 areas reported that the percentage of persons linked to care was greater than 65%, the baseline measure indicated in the National HIV/AIDS Strategy., Conclusions: A wide range in percent linked to HIV medical care was observed between residents of 18 urban areas in the United States with noted age and racial disparities. Routine testing and linkage efforts and intensified prevention efforts should be considered to increase access to primary HIV-related medical care.

The life of a military child has several challenges that can provide opportunities for resilience or risk for vulnerability. Nurses in emergent/urgent care may encounter military children when they are in a stressful transition such as during a move or deployment. Understanding the unique lifestyle of military children and implementing some key suggestions for practice can improve outcomes for this population. This article highlights the exceptional context of military children, military transitions, and opportunities to recognize families who are at risk and strategies to reach out using the I CARE (identify, correlate, ask, ready resources, and encourage) framework., (Copyright © 2013 Emergency Nurses Association. Published by Mosby, Inc. All rights reserved.)

Purpose: The Patterns of Care Study (PCS) of patients treated in 1988-89 included "patterns of treatment planning" for radiotherapy of carcinoma of the uterine cervix. A Consensus Committee of radiation physicists and oncologists established current guidelines and developed questionnaires to assess the treatment planning process (i.e., the general structure, methodology, and tools) of institutions involved in the Patterns of Care Study. This paper reports the findings of the assessment., Methods and Materials: The PCS surveyed 73 radiotherapy facilities, of which 21 are academic institutions (AC), 26 hospital-based facilities (HB), and 26 free-standing centers (FS). In total, 242 cases were assessed with 39% from academic centers, 33% from hospital-based centers, and 28% from free-standing centers. The survey collected treatment planning information such as the use of computed tomography (CT), simulation procedure, contouring of patient outline, tumor or target delineation, identification of critical structures, method of dose prescription (point or isodose), etc. Data was also obtained concerning implant boosts, e.g., radioisotope used, use of midline block for external beam treatment, availability of remote afterloader, practice of interstitial implants, combination with hyperthermia, etc., Results: There is a high degree of compliance relative to the basic treatment planning standards. For example, 171 cases (out of 173) from AC and HB institutions included simulation and 169 used port film; for cases from FS centers, 61 out of 69 involved simulation and 66 out of 69 included port film. Most institutions used linacs (231 out of 242); in five cases, Co-60 units and in six cases betatron was used. In terms of treatment planning, 53% used skin contours, but only 14% had target volume delineation, with AC and HB being slightly more conscientious in these efforts. Critical organs did not appear to be explicitly considered in external beam treatment planning, with only 3% outlining the bladder, 5% the rectum, and less than 1% the small bowel. Only 11% of the centers used CT in treatment planning, and none reported the use of magnetic resonance imaging (MRI). For patients receiving implants, about 40% had midline blocking during external beam treatment, of which one out of three were shielded by standard blocks and two out of three with customized ones. About 11% of the patients receiving implants were treated with remote afterloading devices, 5% received interstitial implants, and none were treated in combination with hyperthermia., Conclusion: The treatment planning aspects of radiotherapy of carcinoma of the cervix have been established by this Patterns of Care Study Survey. There is a high level of uniformity in the approach. Some variations exist among centers in the different strata.

Rationale and plans are described for a collaborative case-control study of large bowel cancer among Chinese-Americans in Los Angeles and the San Francisco Bay Area and among Chinese in Zhejiang Province, People's Republic of China. A common protocol and questionnaire will be used during personal interviews of approximately 400 Chinese and 300 Chinese-American patients with histologically confirmed adenocarcinoma of the colon or rectum and 2,100 Chinese and Chinese-American controls. Controls will be matched to patients on age, sex, and community of residence. The information requested from subjects will permit testing of hypotheses relating colorectal cancer risk to: dietary factors, including intake of fat (saturated and unsaturated), animal protein, fiber, and vitamins A and E and ascorbic acid; physical activity levels and body mass index; reproductive factors among women; history of bowel disease; and family history of cancer. The information requested of Chinese-American subjects will also permit testing of hypotheses relating cancer risk to such migrant factors as United States versus Chinese nativity, duration of residence in the United States, and Chinese province of ancestry. These factors will be tested for associations with cancers of the colon and rectum separately and with cancers of the large intestine as a whole. We will examine sex and geographic differences in relative risks for etiologic factors, location of tumors within the large bowel, histologic subtype of adenocarcinoma, and frequency of accompanying polyps.