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Outcomes for surgical patients with limited English proficiency (LEP) may be worse compared to patients with English proficiency. We sought to evaluate the association of LEP with outcomes for trauma patients.Admitted adult patients on trauma service at two Level One trauma centers from 2015 to 2019 were identified.12,562 patients were included in total; 7.3% had LEP. On multivariable analyses, patients with LEP had lower odds of discharge to post-acute care versus home compared to patients with English proficiency (OR 0.69; 95% CI 0.58-0.83; p 0.001) but had similar length of stay (Beta coefficient 1.16; 95% CI 0.00-2.32; p = 0.05), and 30-day readmission (OR 1.08; 95% CI 0.87-1.35; p = 0.46).Trauma patients with LEP had comparable short-term outcomes to English proficient patients but were less likely to be discharged to post-acute care facilities. The role of structural barriers, family preferences, and other factors merit future investigation.

In this article, we sought to examine the effect of Cameroon's public expenditure, with a focus on governance, on the reduction of unemployment from 1988 to 2020. By implementing a multiple linear regression model and applying the OLS method, we found that only military spending significantly contributed to the decrease in youth unemployment. Nonetheless, the efficacy of all types of public expenditure is heavily contingent upon socio-economic conditions. It is apparent that corruption and economic crises contribute greatly to the unemployment rate, hence why public entities must make greater efforts to form a strict institutional framework governing the labor market and invest in anti-exogenous shock programs. This would ensure that unemployment rates can be decreased systematically and substantially.

Intimate partner violence (IPV) is a serious public health issue. This study aims to characterize IPV-related injuries in trauma patients presenting to emergency departments (ED) who required hospitalization.Trauma registries of two Level 1 trauma centers were searched for assault-related ED visits by adults reporting "abuse" over 3 and 5 years to identify IPV victims. Imaging and electronic medical records were reviewed for demographics, injury type, hospital stay, and previous or subsequent presentations for presumed IPV.Twenty-nine of 18,465 (0.2%) individuals seen on the trauma service had reported IPV. Majority were women (90%, mean age 37) and Caucasian (69%), over 50% had psychiatric or substance use comorbidities, and 45% reported prior IPV. Blunt trauma (22/29) was more common than penetrating trauma. Soft tissue injuries dominated when including both radiologic and non-radiologic findings. Excluding two patients who were not imaged, most frequent injuries identified on imaging were to the head/face (14/27), followed by the chest (9/27; mainly rib fractures), upper extremity and abdomen (7/27 each). All spinal fractures involved the upper lumbar spine. Synchronous injuries to multiple body regions were common, particularly craniofacial and upper extremity. Twenty-eight of 29 patients scored a grade 3-4 on the IPV severity grading scale. Eight (28%) patients required intensive care unit -level care. One patient passed. Four (14%) patients had prior IPV-related ED presentations.While craniofacial and soft tissue injuries dominate, IPV can also result in serious thoracoabdominal, extremity and spinal injuries, even death. Multisystem injuries are common with synchronous craniofacial and upper extremity injuries being the most common combination.

This research article aimed to examine the significance of transaction costs on CO2 emissions intensity in Sub-Saharan Africa (SSA) from 2003-2018. Based on a sample size of 33 countries, we specified models where the level of carbon pollution was directly linked to an increase in transaction rates. We then used the augmented STIRPAT model which accounts for changes in populations, wealths and technologies on environmental conditions. The system Generalized Method of Moments (GMM) framework is used as it accounts for the possible endogeneity arising from the reverse causality between the dependent and independent variables and the potential correlation between the error term and the country fixed-effects. The results based on this system GMM were conclusive; transactions cost has a persistent and strong negative effect on the country's levels of greenhouse gas emissions. Transaction costs are one key reason why there is such variation between different forms of carbon dioxide intensities within SSA nations, specifically because they had been experiencing higher levels than other regions. An additional test reveals the existence of one of the most fundamental assumptions of environmental studies, namely the Environmental Kuznets Curve (EKC). As policy implications, it is recommended that authorities set up property rights as well as an emission permit market to solve environmental externalities.

Malaysian universities’ adoption of English as a medium of instruction provides Libyan international students, who have been reported as the seventh largest ethnic group enrolled in those institutions, with opportunities to pursue various fields of study. However, Libyan students struggle with academic speaking resulting from inadequate prior EFL learning experience characterised by a lack of speaking practice. Consequently, causing communicative incompetency that contributes to language anxiety. Therefore, this study investigates the academic speaking challenges of Libyan students in Malaysian academic settings using an explanatory mixed-mode research design. Data were collected through an online questionnaire, interviews, and a focus group discussion. The research found that Libyan international students faced challenges in academic speaking due to insufficient linguistic knowledge and a lack of prior academic speaking practice. The study further found that the Libyan students’ speaking challenges in the academic setting were affected by cognitive inhibition resulting from communicative incompetency. The qualitative phase of the study revealed that the students were reluctant to engage in academic discourse because of their incompetency in academic speaking skills, which caused anxiety and embarrassment. The study results could inform stakeholders such as the Libyan Ministry of Education about the academic speaking challenges of Libyan students studying abroad. Furthermore, it could lead to improvements in preparatory programs, English teaching practices and materials, and exposure to academic settings in foreign universities to prepare students to further their studies abroad and achieve international academic success.

The impact of disparities at the intersection of multiple marginalized social identities is poorly understood in trauma. We sought to evaluate the joint effect of race, ethnicity, and sex on new functional limitations 6 to 12 months postinjury.Moderately to severely injured patients admitted to one of three Level I trauma centers were asked to complete a phone-based survey assessing functional outcomes 6 to 12 months postinjury. Multivariate adjusted regression analyses were used to compare functional limitations by race and ethnicity alone, sex alone, and the interaction between both race and ethnicity and sex. The joint disparity and its composition were calculated across race and sex strata.Included were 4,020 patients: 1,621 (40.3%) non-Hispanic White male patients, 1,566 (39%) non-Hispanic White female patients, 570 (14.2%) Black or Hispanic/Latinx male patients, and 263 (6.5%) Black or Hispanic/Latinx female patients (BHF). The risk-adjusted incidence of functional limitations was highest among BHF (50.6%) vs non-Hispanic White female patients (39.2%), non-Hispanic White male patients (35.8%), and Black or Hispanic male patients (34.6%; p0.001). In adjusted analysis, women (odds ratio 1.35 [95% CI 1.16 to 1.57]; p0.001) and Blacks or Hispanic patients (odds ratio 1.28 [95% CI 1.03 to 1.58]; p = 0.02) were more likely to have new functional limitations 6 to 12 months postinjury. When sex and race were analyzed together, BHF were more likely to have new functional limitations compared with non-Hispanic White male patients (odds ratio 2.12 [1.55 to 2.90]; p0.001), with 63.5% of this joint disparity being explained by the intersection of race and ethnicity and sex.More than half of the race and sex disparity in functional limitations experienced by BHF is explained by the unique experience of being both minority and a woman. Intermediate modifiable factors contributing to this intersectional disparity must be identified.

Academic listening and interaction in international educational settings are essential for academic success. International students’ language proficiency and prior practice in their home countries either facilitate or impede their academic success. Thus, internationalization has become a desirable trend among learners to further their studies in overseas institutions where English is the medium of instruction. Overseas education allows international students to gain new knowledge and improve their academic skills in various academic fields. However, a lack of English communicative competence and comprehension impedes learners’ academic and communicative success. As a result, international students look for strategies to help them overcome their academic comprehension challenges. This paper explores and better explains EFL international students’ academic listening challenges and strategies to motivate stakeholders to support international students in furthering their studies overseas. Thus, this paper reviews related literature on academic listening strategies through the traditional literature review process. Therefore, this paper explores and better explains EFL international students’ academic listening challenges and strategies to motivate stakeholders to support international students in furthering their studies overseas. The discussion of findings reveals that international students face challenges with understanding others in academic discourse. These challenges are due to their lack of prior English listening practice in their home countries. Thus, international students rely on strategies to overcome communication challenges and improve academic listening comprehension skills (i.e., memory, cognitive, and social strategies). The findings should encourage administrators of international institutions, researchers, and other stakeholders to revamp pre-sessional English language programs and conduct more research on international students’ language learning experiences to help them succeed in their overseas study programs.

Blunt cerebrovascular injury (BCVI) is a significant cause of morbidity and mortality following blunt trauma. Numerous screening strategies exist, although which is used is institution and physician dependent. We sought to identify the most cost-effective screening strategy for BCVI, hypothesizing that universal screening would be optimal among the screening strategies studied.A Markov decision analysis model was used to compare the following screening strategies for identification of BCVI: (1) no screening (NS); (2) Denver criteria (DC); (3) extended Denver criteria (eDC); (4) Memphis criteria (MC); and (5) universal screening. The base-case scenario modeled 50-year-old patients with blunt traumatic injury excluding isolated extremity injures. Patients with BCVI detected on imaging were assumed to be treated with antithrombotic therapy, subsequently decreasing risk of stroke and mortality. One-way sensitivity analyses were performed on key model inputs. A single year horizon was utilized with an incremental cost-effectiveness ratio (ICER) threshold of $100,000 per quality-adjusted life-year (QALY).The most cost-effective screening strategy for patients with blunt trauma among the strategies analyzed was universal screening. This method resulted in the lowest stroke rate, mortality, cost, and highest QALY. An estimated 3,506 strokes would be prevented annually as compared to eDC (ICER of $71,949 for universal screening vs. ICER of $12,736 for eDC per QALY gained) if universal screening were implemented in the United States. In one-way sensitivity analyses, universal screening was the optimal strategy when the incidence of BCVI was6%.This model suggests universal screening may be the cost-effective strategy for BCVI screening in blunt trauma for certain trauma centers. Trauma centers should develop institutional protocols that take into account individual BCVI rates.