Search

In its classical form, ballroom dancing constitutes heterosexual dance couples enacting conservative forms of masculinity and femininity. A normative focus, both in scholarship and in practice, on the classical form in competitive ballroom dancing (also known as Dancesport) excludes the lived narratives of LGBT + dancers practicing the sport outside of the mainstream. Equality Dancesport is one such example, with dancers performing in diverse partnership typologies and adopting less gender-segregated dance roles and movements. Drawing on the photo-elicitation exercise, embedded within in-depth interviews, conducted as part of a broader ethnographic study on the equality Dancesport scene in the United Kingdom, I demonstrate how the strategy informed a ground-up emergence of a queer theoretical framework for understanding masculinities and femininities across the sex, gender and sexuality categorical divides. Four key opportunities afforded by photo elicitation are identified, namely (1) invoking new queer knowledge which blurs the binary divide in how concepts of masculinities and femininities are investigated in existing dance scholarship, (2) facilitating the development of more egalitarian researcher/participant relationships, (3) enabling affective, detailed and fluid narrations of lived experiences of dancing, and (4) positioning interviewees as dance spectators and inspiring reflections on the community. The paper concludes with three recommendations for negotiating the pitfalls of using a photo elicitation technique in dance studies. First, researchers need to recognise the limits of inclusivity offered by photo elicitation and practice sensitivity towards participants. Second, integrating photographs with other visual methods such as videos can enable researchers to leverage the strengths of different visual tools to inspire talk about broader topics. Third, before using the method, researchers need to develop mental strength for coping with negative talk, to achieve more holistic understanding of participants’ sentiments and motivations and as a duty of accountability towards them.

The demand for highly efficient and dynamic electric vehicles (EVs) has increased dramatically. The traction inverter, a pivotal component in an EV powertrain, plays a crucial role. This study is dedicated to designing a traction inverter with focus on achieving high efficiency and elevated power density and mitigating electromagnetic interference (EMI) issues. To realize these objectives, autonomous gate drivers (AGDs) are proposed and designed using LTspice simulation software. The aim is to achieve zero voltage switching (ZVS) at both turn-on and turn-off through the utilization of triangular current mode (TCM) control on the gate driver. The AGDs implement a current modulation scheme by sensing the current and voltage and generating gate-source voltage signals with minimal delays. The implemented current modulation scheme by the AGDs results in an efficiency exceeding 99% for a 10 kW power rating. The sinusoidal output waveforms not only contribute to extending the motor lifespan by mitigating sharp-edge voltages but also bring advantages such as reduced switch stress, decreased EMI, and simplified thermal management.

Since ancient times, essential oils (EOs) derived from aromatic plants have played a significant role in promoting human health. EOs are widely used in biomedical applications due to their medicinal properties. EOs and their constituents have been extensively studied for treating various health-related disorders, including cancer. Nonetheless, their biomedical applications are limited due to several drawbacks. Recent advances in nanotechnology offer the potential for utilising EO-loaded nanoparticles in the treatment of various diseases. In this aspect, chitosan (CS) appears as an exceptional encapsulating agent owing to its beneficial attributes. This review highlights the use of bioactive EOs and their constituents against breast cancer cells. Challenges associated with the use of EOs in biomedical applications are addressed. Essential information on the benefits of CS as an encapsulant, the advantages of nanoencapsulated EOs, and the cytotoxic actions of CS-based nanoencapsulated EOs against breast cancer cells is emphasised. Overall, the nanodelivery of bioactive EOs employing polymeric CS represents a promising avenue against breast cancer cells in preclinical studies.

Estimation of temporospatial clinical features of gait (CFs), such as step count and length, step duration, step frequency, gait speed, and distance traveled, is an important component of community-based mobility evaluation using wearable accelerometers. However, accurate unsupervised computerized measurement of CFs of individuals with Duchenne muscular dystrophy (DMD) who have progressive loss of ambulatory mobility is difficult due to differences in patterns and magnitudes of acceleration across their range of attainable gait velocities. This paper proposes a novel calibration method. It aims to detect steps, estimate stride lengths, and determine travel distance. The approach involves a combination of clinical observation, machine-learning-based step detection, and regression-based stride length prediction. The method demonstrates high accuracy in children with DMD and typically developing controls (TDs) regardless of the participant’s level of ability. Fifteen children with DMD and fifteen TDs underwent supervised clinical testing across a range of gait speeds using 10 m or 25 m run/walk (10 MRW, 25 MRW), 100 m run/walk (100 MRW), 6-min walk (6 MWT), and free-walk (FW) evaluations while wearing a mobile-phone-based accelerometer at the waist near the body’s center of mass. Following calibration by a trained clinical evaluator, CFs were extracted from the accelerometer data using a multi-step machine-learning-based process and the results were compared to ground-truth observation data. Model predictions vs. observed values for step counts, distance traveled, and step length showed a strong correlation (Pearson’s r = −0.9929 to 0.9986, p < 0.0001). The estimates demonstrated a mean (SD) percentage error of 1.49% (7.04%) for step counts, 1.18% (9.91%) for distance traveled, and 0.37% (7.52%) for step length compared to ground-truth observations for the combined 6 MWT, 100 MRW, and FW tasks. Our study findings indicate that a single waist-worn accelerometer calibrated to an individual’s stride characteristics using our methods accurately measures CFs and estimates travel distances across a common range of gait speeds in both DMD and TD peers.

Truncating mutations in filamin C (FLNC) are associated with dilated cardiomyopathy and arrhythmogenic cardiomyopathy. FLNC is an actin-binding protein and is known to interact with transmembrane and structural proteins; hence, the ablation of FLNC in cardiomyocytes is expected to dysregulate cell adhesion, cytoskeletal organization, sarcomere structural integrity, and likely nuclear function. Our previous study showed that the transcriptional profiles of FLNC homozygous deletions in human pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) are highly comparable to the transcriptome profiles of hiPSC-CMs from patients with FLNC truncating mutations. Therefore, in this study, we used CRISPR-Cas-engineered hiPSC-derived FLNC knockout cardiac myocytes as a model of FLNC cardiomyopathy to determine pathogenic mechanisms and to examine structural changes caused by FLNC deficiency. RNA sequencing data indicated the significant upregulation of focal adhesion signaling and the dysregulation of thin filament genes in FLNC-knockout (FLNCKO) hiPSC-CMs compared to isogenic hiPSC-CMs. Furthermore, our findings suggest that the complete loss of FLNC in cardiomyocytes led to cytoskeletal defects and the activation of focal adhesion kinase. Pharmacological inhibition of PDGFRA signaling using crenolanib (an FDA-approved drug) reduced focal adhesion kinase activation and partially normalized the focal adhesion signaling pathway. The findings from this study suggest the opportunity in repurposing FDA-approved drug as a therapeutic strategy to treat FLNC cardiomyopathy.

A series of 20 wt.% MO2/S catalysts (where M = Ce, Mn or Zr and S = SiO2 or Al2O3) were prepared using various precursors of the active phases. The resulting catalysts were characterized using different methods (XRD, TPR and SBET). For the first time, anhydrides were used as potential starting materials for ketone synthesis. This novel reaction was performed on various aliphatic anhydrides in the presence of catalysts within a temperature range of 523–723 K. For all anhydrides, except for pivalic anhydride, the appropriate ketones were obtained with good or very good yields. The vapor-phase catalytic ketonization of esters of benzene-1,x-dicarboxylic acids (x = 2, 3 or 4) with acetic acid were studied in the range of 673–723 K in order to obtain 1,x-diacetylbenzenes. Their yields strongly increased with an increase in the x value (0, 8 and 43% for x = 2, 3 and 4, respectively). The presence of acetophenone as a side product was always noted. In the case of ω-phenylalkanoic acids, their vapor-phase ketonization with acetic acid led to the formation of appropriate ketones with 47–49% yields. Much lower yields of ketones (3–19%) were obtained for acids and ethyl esters containing heterocycle substituents (with O or S atoms) and/or vinyl groups. In the reaction between ethyl 4-nitrophenylacetate and acetic acid, only the products of ester decomposition (p-toluidine and p-nitrotoluene) were determined.

Background: Postarrest acute kidney injury (AKI) is a major health burden because it is associated with prolonged hospitalization, increased dialysis requirement, high mortality, and unfavorable neurological outcomes. Managing hemodynamic instability during the early postarrest period is critical; however, the role of quantified vasopressor dependence in AKI development in relation to illness severity remains unclear. Methods: A retrospective, observational cohort study that enrolled 411 non-traumatic adult cardiac arrest survivors without pre-arrest end-stage kidney disease between January 2017 and December 2019, grouped according to their baseline kidney function. The criteria for kidney injury were based on the Kidney Disease: Improving Global Outcomes definition and AKI staging system. The degree of vasopressor dependence within the first 24 h following return of spontaneous circulation (ROSC) was presented using the maximum vasoactive-inotropic score (VISmax). Results: Of the 411 patients, 181 (44%) had early AKI after ROSC. Patients with AKI showed an increased risk of in-hospital mortality (adjusted OR [aOR] 5.40, 95% CI 3.36–8.69, p < 0.001) and unfavorable neurological outcome (aOR 5.70, 95% CI 3.45–9.43, p < 0.001) compared to patients without AKI. The risk of adverse outcomes increased with illness severity. Patients with vasopressor support had an increased risk of early AKI. A low VISmax was associated with AKI stage 1–2 (aOR 2.51, 95% CI 1.20–5.24), whereas a high VISmax was associated with an increased risk for AKI stage 3 (aOR 2.46, 95% CI 1.28–4.75). Conclusions: Early AKI is associated with an increased risk of in-hospital mortality and unfavorable neurologic recovery in cardiac arrest survivors. Postarrest VISmax is an independent predictor of the development and severity of AKI following ROSC, regardless of baseline kidney function.

An increasing share of fluctuating and intermittent renewable energy sources can cause over-currents (OCs) in the power system. The heat generated during OCs increases the junction temperature of semiconductor devices and could even lead to thermal runaway if thermal limits are reached. In order to keep the junction temperature within the thermal limit of the semiconductor, the power module structure with heat-absorbing material below the chip is investigated through COMSOL Multiphysics simulations. The upper limits of the junction temperature for Silicon (Si) and Silicon Carbide (SiC) are assumed to be 175 and 250 ∘C, respectively. The heat-absorbing materials considered for analysis are a copper block and a copper block with phase change materials (PCMs). Two times, three times, and four times of OCs would be discussed for durations of a few hundred milliseconds and seconds. This article also discusses the thermal performance of a copper block and a copper block with PCMs. PCMs used for Si and SiC are LM108 and Lithium, respectively. It is concluded that the copper block just below the semiconductor chip would enable OC capability in Si and SiC devices and would be more convenient to manufacture as compared to the copper block with PCM.

The application of biomass as a co-feed in coal power plants and in standalone biomass power plants, as well as in char production for soil remediation, is a currently important issue. This paper reports on the investigation of biochar formation from agricultural waste crops that are used for soil upgrading, but which do not meet the standards of EU crops, as well as largescale food processing waste. These were compared to test results from basket willow, which is commonly used for energy generation. Food industry waste is often produced in cities on a large scale and is generally easier to process due to lack of other stream components. The key parameters, namely, the content of volatiles, energy content of the formed biochar and the composition of the ash, were determined for a number of herbaceous materials locally available in the European Union. All of them can be used as a cheap source of biochar. A novel procedure of capturing volatiles and hence minimizing the PAH content in the biochar, as well as enabling the recovery of energy from the volatiles is presented. Knowledge of the composition and form of elements in ash is very important for designing ash management systems if co-combustion is implemented. The aim of this study was to determine if the types of biomass are better suited for biochar production or energy generation.

In recent years, mathematical thinking and reasoning have been widely discussed to promote students' abilities to apply mathematical knowledge and ideas in their daily living. However, few studies have investigated the role of self-regulation in relation to reasoning. This study examined the effects of self-regulation processes on student mathematical reasoning and academic achievement. Using a quantitative research design and the PLS-SEM technique, data were collected from 248 private school students in Malaysia. The PLS-SEM results showed that behavioral regulations, including processes of self-observation, self-judgment, and self-reaction, are decisive factors in influencing student academic achievement and student mathematical reasoning ability. The dimensions of motivational regulation, including processes of self-efficacy, task value, and mastery goal orientation, are dominant factors influencing student reasoning ability, followed by cognition regulation, which includes use of elaboration strategy and critical thinking skills. The study also found that cognition regulation is a significant mediator of the relationship between motivational regulation and reasoning ability. Behavioral and cognition regulation processes, as well as students' reasoning ability, are the mediators of motivational regulation on academic achievement. The results of this study suggest that teachers should foster the adoption of self-regulation processes in mathematics learning.

Clinical decision support systems (CDSS) will play increasing role in improving quality of medical care for critically ill patients. However, due to limitations in current informatics infrastructure, CDSS do not always have complete information on state of supporting physiologic monitoring devices, which can limit input data available to CDSS. This is especially true in use case of mechanical ventilation (MV), where current CDSS have no knowledge of critical ventilation settings, such as ventilation mode. To enable MV CDSS make accurate recommendations related to ventilator mode, we developed a highly performant machine learning model that is able to perform per-breath classification of five of most widely used ventilation modes in USA with average F1-score of 97.52%. We also show how our approach makes methodologic improvements over previous work and is highly robust to missing data caused by software/sensor error.

As the majority of Internet traffic today is attributed to content-centric applications, there has been ever-increasing demand for highly scalable and efficient content delivery. An accurate prediction on future content consumption is essential for such demand. To address such an issue, this paper introduces a new computational approach, Content Network (CN) that can capture the relations among contents, and its potential applications. We conduct a measurement study to investigate how contents are inter-related from the viewpoint of content spreading on one of the popular BitTorrent portals: The Pirate Bay. Based on the large-scale dataset that contains 18 K torrents and 9 M users, we construct the CN and investigate its structural properties. Our key finding is that contents in the same community in the CN (i) belong to the same content category with 94% probability, (ii) are uploaded by the same content publisher with 76% probability, and (iii) have the similar titles with 51% probability, which implies that contents in the same community collectively contain common (shared) interests of users. Our trace-driven study demonstrates that the proposed CN model is useful in (i) content recommendation for increasing sales and (ii) content caching for networking efficiency. We believe our work can provide an important insight for content stakeholders, e.g., content providers for efficient publishing strategies, network engineers for networking efficiency, or content marketers for accurate recommendation.

Learning and exploring the connectivity of unknown networks represent an important problem in practical applications of communication networks and social-media networks. Modeling large-scale networks as connected graphs is highly desirable to extract their connectivity information among nodes to visualize network topology, disseminate data, and improve routing efficiency. This paper investigates a simple measurement model in which a small subset of source nodes collect hop distance information from networked nodes in order to generate a virtual coordinate system (VCS) for networks of unknown topology. We establish the VCS to define logical distance among nodes based on principal component analysis and to determine connectivity relationship and effective routing methods. More importantly, we present a robust analytical algorithm to derive the VCS against practical issues of missing and corrupted measurements. We also develop a connectivity inference method which classifies nodes into layers based on the hop distances and derives partial information on network connectivity.

Approximately a third of Malaysian adult has been diagnosed with hypertension. This study aimed to investigate the prevalence and key risk factors of hypertension in a community living in a rural area of Kudat, Sabah. Methods: The study included participants of at least 18 years old, able to communicate in the local dialect, no mental disability, not pregnant or lactating and no known cause of secondary hypertension. Sociodemographic data were recorded in addition to assessment of depression, anxiety, stress, and dietary salt of the participants using standard DASS-21 questionnaire (Depression Anxiety Stress Scales standard questionnaire) questionnaire. Multiple logistic regression analyses were used to assess the association of hypertension and health-related variables predicted to be a risk factor. Results: Out of 111 participants, 30% were diagnosed with hypertension of which 60.6% were not aware of their health condition. Among the variables analyzed, higher age (at least 40 years old) and excess BMI (≥23.0) highly contributed to the predisposition of hypertension (p0.05). Conclusion: The community in Kudat, as a representation of the rural population in Sabah, has a high prevalence of hypertension, implying that lifestyle changes and regular health checks are effective interventions to minimise the risk of hypertension.

Abstract Background Skeletal dysplasia is a heterogeneous group of disorders. Spondyloepiphyseal dysplasias comprise one subgroup. Deficiency of carbohydrate sulfotransferase 3 has been reported in a small number of patients with recessively inherited spondyloepiphyseal dysplasia with joint dislocation, short stature and scoliosis. We report here molecular and clinical findings of affected individuals in three consanguineous Pakistani families. Affected individuals in all three families had a uniform phenotype including severe short stature, multiple dislocated joints, progressive scoliosis and facial dysmorphism. Methods Clinical evaluation was done for three unrelated families. Radiological survey of bones was completed for patients from two of the families. Whole exome sequencing index patients from each family was performed followed by Sanger sequencing for validation of segregation of identified variants in respective families. In-silico analysis for determining pathogenicity of identified variants and conservation was done. Results Whole-exome sequencing revealed biallelic variants c.590 T > C;p.(Leu197Pro), c.603C > A;p.(Tyr201Ter) and c.661C > T;p.(Arg221Cys) in CHST3 (NM_004273.5) in the three families with eight, five and two affected individuals, respectively. Contrary to previous reports, affected individuals in none of the families exhibited a hearing loss. Conclusion We describe genotypic and phenotypic findings of three unrelated families with spondyloepiphyseal dysplasia. Our study confirms phenotypic variability and adds to the genotypic spectrum of spondyloepiphyseal dysplasia.

Abstract Background Page kidney (PK) is the occurrence of kidney hypoperfusion and ischemia due to pressure on the kidney by a subcapsular hematoma (SH), a mass, or fluid collection. SH after renal transplantation may result in kidney ischemia and graft loss. Case presentation We present a rare case of early spontaneous SH in an allograft kidney that led to a decrease in renal function. A 56-year-old male patient underwent deceased donor kidney transplantation. After declamping, appropriate renal perfusion and immediate diuresis were observed, with no evidence of SH. However, his urinary output abruptly decreased 6 h postoperatively. Abdominal ultrasonography showed 28 mm deep SH on transplant and the resistive index (RI) increased to 0.98–1 and diastolic flow reversal was observed. Surgical interventions were performed 2 days after transplantation, following a further decrease in urinary output. Serum creatinine decreased to 2.2 mg/dL, urinary output increased to an average of 200 cc per hour and the RI value was decreased to 0.7 on POD 7. Conclusion In patients with abrupt decreased renal function after transplantation, SH should be suspected and the presence of PK should be determined using Doppler USG. In these cases, surgical intervention may avoid allograft dysfunction.

The purpose of this study is to identify the needs and suggest a revitalization plan for School Forest Welfare Services in Korea which is defined as “school-based services that provide forest education, forest healing, and cultural and recreational activities in the forest by creating, managing, and utilizing local or in-school forest environments to help children and adolescents develop and improve their quality of life.” To this end, using a mixed method, in-depth interviews and needs surveys were conducted with School Forest Welfare Service experts and teachers and parents of middle and high school students to understand the current status of School Forest Welfare Services and to identify their needs. As regards the current status, the environment for the services was assessed at the “middle” level while the forest welfare program was assessed at the “low” level. On the other hand, all the needs asked were found to be at a “high” level; especially, the needs for the “forest therapy” program, both for the selected group of and all students, were the strongest. In regard to revitalization, “programs linked to regular school curriculum,” “policies and budgets,” “green zone in school area,” and “expert supports by forest healing instructors and forest interpreters” were found to be demanded mostly. As a conclusion of the in-depth interviews and needs surveys, a plan to revitalize School Forest Welfare Services has been derived, which includes such objectives as; (1) to strengthen awareness of the necessity (assigning experts within the responsible institution to provide expertise, strengthening awareness among principals, teachers, and parents, and building social consensus with active publicity), (2) to prepare policy and legal basis, and (3) to establish a support system. This study was conducted to revitalize School Forest Welfare Services for adolescents in Korea, but it is hoped that School Forest Welfare Services will be developed and widely implemented for many children and adolescents around the world through diverse further studies.

Abstract Background Sudden cardiac arrest with or without sudden cardiac death (SCD) represents a heterogeneous spectrum of underlying etiology but is often a catastrophic event. Despite improvements in pre‐hospital response and post‐resuscitation care, outcomes remain grim. Thus, we aim to evaluate the predictors of survival in out‐of‐hospital cardiac arrests (OHCAs) and describe autopsy findings of those with the uncertain cause of death (COD). Methods This is a subgroup analysis of the Singapore cohort from the Pan Asian Resuscitation Outcome Study which studied 933 OHCAs admitted to two Singapore tertiary hospitals from April 2010 to May 2012. Results Of the patients analysed, 30.2% (n = 282) had an initial return of spontaneous circulation (ROSC) at the emergency department, 18.0% (n = 168) had sustained ROSC with subsequent admission and 3.4% (n = 32) had survival to discharge. On multivariate analysis, an initial shockable rhythm, a witnessed event, prehospital defibrillation, and shorter time to hospital predicted ROSC as well as survival to discharge. A total of 163 (17.5%) autopsies were performed of which a cardiac etiology of SCD was noted in 92.1% (n = 151). Ischemic heart disease accounted for 54.3% (n = 89) of the autopsy cohort, with acute myocardial infarction (26.9%, n = 44) and myocarditis (3.7%, n = 6) rounding out the top three causes of demise. Conclusion OHCA remains a clinical presentation that portends a poor prognosis. Of those with uncertain COD, cardiac etiology appears to predominate from autopsy study. Identification of prognostic factors will play an important role in improving individual‐level and systemic‐level variables to further optimize outcomes.

Abstract Background Energy drinks (EDs) are a type of beverage that mostly contains caffeine and other dietary supplements (if present) and does not contain any alcohol in the ingredients. The products in this category include Red Bull, Redline, Monster, Full Throttle, and others. They are claimed to help in boosting energy, stamina, sports performance, and concentration among individuals. This article focused on the review of the benefits and disadvantages of consumption of energy drinks to health and well-being. ED provides health benefits effects such as improved physical performance, mood and attitude, cognition, and weight loss. Some adverse negative health challenges have been linked to consumption of ED. Therefore, this review is a wholistic appraisal of benefits or detriments of consumption of energy drink to our health and suggestions to curtail the excesses of ED consumption. Main body Energy drink has been around since 1950, and it is marketed as energy booster and comes in different types, energy shots, fruit-based, non-fruit-based (regular), sugar-free, and plant-based. These products are marketed as a low-calorie “instant” energy drink that can be consumed in a single sip, or bottle to boost energy or to boost the nutritional value of conventional products. Many of them contain different ingredients such as caffeine, guarana, ginseng, yerba mate, acai berry, ginkgo biloba, methylxanthines, sugar, glucuronolactone, taurine, maltodextrin, B vitamins. Vitamin B2 (riboflavin), B3 (niacin), B6 (pyridoxine, pyridoxal, and pyridoxamine), Inositol B8 and B12, vitamin C and vitamin D; calcium, Iron, chromium, zinc, manganese, molybdenum; artificial sweeteners, aspartame, and sucralose. Health benefits such as improved physical performance, improved mood and attitude, improved concentration, and memory, good source of vitamin B and weight loss have been reported. Negative impact on health such as adverse cardiovascular effect, headaches, epileptic seizures, ischemic stroke, hallucinations, muscular twitching, restlessness, sleeplessness, anxiety, depression, gastrointestinal effect, renal effects, dental effects, obesity and type II diabetes, cancer, and caffeine toxicity has been reported. Conclusions Most of the health detriments caused because of consumption of energy drink is mostly due to the presence of excess quantity of caffeine and sugar. If the quantities of caffeine and sugar content in energy drink are kept at FDA- and WHO-recommended daily consumption amount, then it will not be present any problem to health. Consumption of energy drink that contains natural ingredients such as yerba mate, acai berry, ginkgo biloba, methylxanthines, amino acid, guarana, and ginseng with moderate FDA- and WHO-approved daily consumption of caffeine and sugar is not detrimental to health.

Summary: Background: The causal relevance of polyunsaturated fatty acids (PUFAs) for risk of site-specific cancers remains uncertain. Methods: Using a Mendelian randomization (MR) framework, we assessed the causal relevance of PUFAs for risk of cancer in European and East Asian ancestry individuals. We defined the primary exposure as PUFA desaturase activity, proxied by rs174546 at the FADS locus. Secondary exposures were defined as omega 3 and omega 6 PUFAs that could be proxied by genetic polymorphisms outside the FADS region. Our study used summary genetic data on 10 PUFAs and 67 cancers, corresponding to 562,871 cases and 1,619,465 controls, collected by the Fatty Acids in Cancer Mendelian Randomization Collaboration. We estimated odds ratios (ORs) for cancer per standard deviation increase in genetically proxied PUFA exposures. Findings: Genetically elevated PUFA desaturase activity was associated (P

Rationale & Objective: Adoption of point-of-care ultrasound (POCUS) into nephrology practice has been relatively slow. We surveyed US nephrology program directors, their fellows, and graduates from a single training program regarding current/planned POCUS training, clinical use, and barriers to training and use. Study Design: Anonymous, online survey. Setting & Participants: All US nephrology program directors (n=151), their fellows (academic year 2021-2022), and 89/90 graduates (1980-2021) of the Walter Reed Nephrology Program. Analytical Approach: Descriptive. Results: 46% (69/151) of program directors and 33% (118/361) of their fellows responded. Response rate was 62% (55/89) for Walter Reed graduates. 51% of program directors offered POCUS training, most commonly bedside training in non-POCUS oriented rotations (71%), didactic lectures (68%), and simulation (43%). 46% of fellows reported receiving POCUS training, but of these, many reported not being sufficiently trained/not confident in kidney (56%), bladder (50%), and inferior vena cava assessment (46%). Common barriers to training reported by program directors were not enough trained faculty (78%), themselves not being sufficiently trained (55%), and equipment expense (51%). 64% of program directors and 55% of fellows reported

Objectives This project seeks to improve providers’ practices and patient outcomes from prehospital (ie, ambulance-based) trauma care in a middle-income country using a novel implementation strategy to introduce a bundled clinical intervention.Design We conduct a two-arm, controlled, mixed-methods, hybrid type II study.Setting This study was conducted in the Western Cape Government Emergency Medical Services (EMS) system of South Africa.Interventions We pragmatically implemented a simplified prehospital bundle of trauma care (with five core elements) using a novel workplace-based, peer-to-peer, rapid training format. We assigned the intervention and control sites.Outcome measures We assessed implementation effectiveness among EMS providers and stakeholders, using the RE-AIM framework. Clinical effectiveness was assessed at the patient level, using changes in Shock Index x Age (SIxAge). Indices and cut-offs were established a priori. We performed a difference-in-differences (D-I-D) analysis with a multivariable mixed effects model.Results 198 of 240 (82.5%) EMS providers participated, 93 (47%) intervention and 105 (53%) control, with similar baseline characteristics. The overall implementation effectiveness was excellent (80.6%): reach was good (65%), effectiveness was excellent (87%), implementation fidelity was good (72%) and adoption was excellent (87%). Participants and stakeholders generally reported very high satisfaction with the implementation strategy citing that it was a strong operational fit and effective educational model for their organisation. A total of 770 patients were included: 329 (42.7%) interventions and 441 (57.3%) controls, with no baseline differences. Intervention arm patients had more improved SIxAge compared with control at 4 months, which was not statistically significant (−1.4 D-I-D; p=0.35). There was no significant difference in change of SIxAge over time between the groups for any of the other time intervals (p=0.99).Conclusions In this quasi-experimental trial of bundled care using the novel workplace rapid training approach, we found overall excellent implementation effectiveness but no overall statistically significant clinical effectiveness.

ObjectiveTo construct a national fetal growth chart using retrospective data and compared its diagnostic accuracy in predicting SGA at birth with existing international growth charts.MethodThis is a retrospective study where datasets from May 2011 to Apr 2020 were extracted to construct the fetal growth chart using the Lambda-Mu-Sigma method. SGA is defined as birth weight

The hospitality and tourist industries depend on homestays and accommodations. Different factors, i.e., promotion strategies, service quality, cleanliness, and perceived health risks, influence tourists’ repeat purchase intention for accommodation. This study highlights different variables influencing domestic tourists’ accommodation repurchase decisions in Malaysia. Around 304 respondents from this quantitative survey are tourists who have already experienced choosing their accommodations during travel. Statistical Packages of Social science software (SPSS-23.0) were used to examine the data through multiple regression and descriptive approaches. The finding suggests that promotion, and services, can positively affect visitors’ purchasing decisions. However, there is a negative but statistically significant link between perceived health risk and repurchase decisions. Furthermore, the result revealed that the predictors of purchase decisions significantly influence selection. This study observed the undervalued quality of services and facilities provided by the hotel industry. The results identified that sustainable practices could enhance the impressive recovery of the tourism industry during and after the pandemic. Furthermore, cleanliness and cost are vital to be considered a primary quality service factor, reducing the perceived health risk, even if there is a pandemic. The study suggested that lodging providers could upgrade on-site facilities and acquire better promotion strategies. The study’s conclusions can increase satisfaction to avoid health risks in any circumstance and promote tourism.

Summary: Background: Understanding the long-term outcomes and disability-adjusted life years (DALY) after out-of-hospital cardiac arrest (OHCA) is important to understand the overall health and disease burden of OHCA respectively, but data in Asia remains limited. We aimed to quantify long-term survival and the annual disease burden of OHCA within a national multi-ethnic Asian cohort. Methods: We conducted an open cohort study linking the Singapore Pan-Asian Resuscitation Outcomes Study (PAROS) and the Singapore Registry of Births and Deaths from 2010 to 2019. We performed Cox regression, constructed Kaplan–Meier curves, and calculated DALYs and standardised mortality ratios (SMR) for each year of follow-up. Results: We analysed 802 cases. The mean age was 56.0 (SD 17.8). Most were male (631 cases, 78,7%) and of Chinese ethnicity (552 cases, 68.8%). At one year, the SMR was 14.9 (95% CI:12.5–17.8), decreasing to 1.2 (95% CI:0.7–1.8) at three years, and 0.4 (95% CI:0.2–0.8) at five years. Age at arrest (HR:1.03, 95% CI:1.02–1.04, p