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Background: Patients who require emergency general surgery (EGS) are at a substantially higher risk for perioperative morbidity and mortality than patients undergoing elective general surgery. The acute care surgery (ACS) model has been shown to improve EGS patient outcomes and cost-effectiveness. A recent systematic review has shown extensive heterogeneity in the structure of ACS models worldwide. The objective of this study was to describe the current landscape of ACS models in academic centres across Canada. Methods: We sent an online questionnaire to the 18 academic centres in Canada. The lead ACS physicians from each institution completed the questionnaire, describing the structure of their ACS models. Results: In total, 16 institutions responded, all of which reported having ACS models, with a total of 29 ACS services described. All services had resident coverage. Of the 29, 18 (62%) had dedicated allied health care staff. The staff surgeon was free from elective duties while covering ACS in 17/29 (59%) services. More than half (15/29; 52%) of the services described protected ACS operating room time, but only 7/15 (47%) had a dedicated ACS room all 5 weekdays. Four of 29 services (14%) had no protected ACS operating room time. Only 1/16 (6%) institutions reported a mandate to conduct ACS research, while 12/16 (75%) found ACS research difficult, owing to lack of resources. Conclusion: We saw large variations in the structure of ACS models in academic centres in Canada. The components of ACS models that are most important to patient outcomes remain poorly defined. Future research will focus on defining the necessary cornerstones of ACS models. Contexte: Les personnes qui ont besoin d'une chirurgie g n rale d'urgence (CGU) sont expos es un risque nettement plus lev de morbidit et de mortalit p riop ratoires comparativement aux personnes soumises une chirurgie g n rale non urgente. Il a t d montr que le mod le de chirurgie en soins actifs (CSA) am liore le rapport co t-efficacit et les r sultats pour les personnes soumises une CGU. Selon une r cente revue syst matique, la structure des mod les de CSA est tr s h t rog ne dans le monde. L'objectif de cette tude tait de d crire le paysage actuel des mod les de CSA dans les centres hospitaliers universitaires au Canada. M thodes: Nous avons fait parvenir un questionnaire en ligne aux 18 centres hospitaliers universitaires canadiens. Les m decins responsables des services de CSA de chaque tablissement ont r pondu au questionnaire et ont d crit la structure de leurs mod les de CSA. R sultats: En tout, 16 tablissements ont r pondu et tous ont indiqu qu'ils disposent de mod les de CSA; 29 services de CSA ont ainsi t d crits. Des m decins r sidents assuraient la couverture de tous ces services. Sur les 29 services de CSA, 18 (62%) disposaient d'une quipe soignante d di e. La chirurgienne ou le chirurgien en poste tait relev de ses fonctions non urgentes pendant sa couverture des services de CSA dans 17 services sur 29 (59%). Plus de la moiti (52%) des services ont d clar r server du temps pour la CSA au bloc op ratoire, mais seulement 7 sur 15 (47%) disposaient d'un bloc op ratoire r serv la CSA du lundi au vendredi. Quatre services sur 29 (14%) ne disposaient pas de temps r serv au bloc op ratoire pour la CSA. Un seul tablissement sur 16 (6%) s'est fait confier le mandat de faire de la recherche sur la CSA, tandis que 12 sur 16 (75%) ont d plor un manque de ressources, ce qui rend la recherche sur la CSA difficile. Conclusion: Nous avons observ une grande h t rog n it structurale entre les diff rents mod les de CSA appliqu s dans les centres hospitaliers universitaires canadiens et leurs l ments les plus importants pour les r sultats chez les patients demeurent mal d finis. La recherche devra se poursuivre sur les aspects incontournables des mod les de CSA., Patients who require emergency general surgery (EGS) represent a high-risk population, often with severe physiologic derangements, and require urgent timely intervention to prevent deterioration of their condition, including death. (1-3) [...]

Putu Ayu Indrayathi,1– 3 Luh Putu Sinthya Ulandari,2 Putu Erma Pradnyani,4 Inge Dhamanti,5,6 Marilynne N Kirshbaum,7 Csongor Istvan Szepesi,1,3 Nora Horvath,1,3 Laszlo Robert Kolozsvari1,3 1Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary; 2Department of Public Health and Preventive Medicine, Udayana University, Denpasar, Bali, Indonesia; 3Department of Family and Occupational Medicine, University of Debrecen, Debrecen, Hungary; 4Health Polytechnic Kartini Bali, Denpasar, Bali, Indonesia; 5Center of Excellence for Patient Safety Research and Quality, Universitas Airlangga, Surabaya, Indonesia; 6School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia; 7Charles Darwin University, Darwin, Northern Territory, AustraliaCorrespondence: Putu Ayu Indrayathi, Department of Family and Occupational Medicine, University of Debrecen, Móricz Zsigmond körút 22, Debrecen, 4032, Hungary, Email indrayathi.ayu@med.unideb.huPurpose: Understanding patient’s preferences is important to delivering good quality services. Patients’ feedback provides healthcare providers with valuable information about the services provided. The increasing number of international students enrolling in Hungarian Universities raises the need to ensure the quality of services meets international students’ requirements, which includes healthcare. This study aimed to assess service quality in the University Health Center (UHC) from the international student’s point of view to be used to improve the quality of services.Methods: This cross-sectional study was conducted at the university health center. We used a mixed methods approach to collect both quantitative and qualitative data. We used the importance-performance analysis (IPA) for quantitative analysis to understand expectations and perceptions in service research. The qualitative analysis was conducted from responses to reflection questions. The qualitative data were then analyzed using thematic analysis.Results: 437 international students participated in the study, but only 402 (91.99%) were analysed. The gaps between the importance and performance of service quality were negative in all dimensions (P-value < 0.001). This suggests that there is an unmet need for student expectations and university health center performance. From the Importance factor, the highest and lowest were related to safety (4.54 ± 0.56) and efficiency (4.31 ± 0.66) dimensions. The Performance factor’s highest and lowest mean scores were also related to safety (4.22 ± 0.72) and efficiency (3.91 ± 0.87), respectively. From qualitative analysis, there are two major themes several secondary themes from the thematic analysis of free-text responses were identified.Conclusion: The importance and performance analysis could provide useful information to university policymakers about university health center service quality. There is a need for improvement and obviating the importance-performance gaps, especially in the efficiency dimension. Decision-makers can use the IPA analysis results to allocate limited resources more effectively, giving special attention to possible organizational weaknesses for further direction.Keywords: healthcare, service quality, international students

Abstract Background Anatomical characteristics of the left atrium and the pulmonary veins (PVs) may be relevant to the success rate of cryoballoon (CB)-ablation for atrial fibrillation (AF). Cardiac computed tomography (CCT) is considered as the gold standard for preablation imaging. Recently, three-dimensional transesophageal echocardiography (3DTOE) has been proposed for preprocedural assessment of cardiac structures relevant to CB-ablation. The accuracy of 3DTOE has not been validated by other imaging modalities. Objective We prospectively evaluated the feasibility and the accuracy of 3DTOE imaging for the assessment of left atrial and PV structures prior to pulmonary vein isolation (PVI). In addition, CCT was used to validate the measurements obtained with 3DTOE. Methods PV anatomy of 67 patients (59.7% men, mean age 58.5 ± 10.5 years) was assessed using both 3DTOE and CCT scan prior to PVI with the Arctic Front CB. The following parameters were measured bilaterally: PV ostium area (OA), the major and minor axis diameters of the ostium (a > b) and the width of the carina between the superior and the inferior PVs. In addition, the width of the left lateral ridge (LLR) between the left atrial appendage and the left superior PV. Evaluation of inter-technique agreement was based on linear regression with Pearson correlation coefficient (PCC) and Bland–Altman analysis of biases and limits of agreement. Results Moderate positive correlation (PCC 0.5–0.7) was demonstrated between the two imaging methods for the right superior PV’s OA and both axis diameters, the width of the LLR and left superior PV (LSPV) minor axis diameter (b) with limits of agreement ˂50% and no significant biases. Low positive or negligible correlation (PCC

Csenge Kolozsvari, "Bodylandscapes I." (10:58). A proposition for remembering the ecological ways of belonging, a feeling into other ways of knowing, connecting into the vastness that surrounds us and moves across us, becoming-environment once again. // Anja Plonka, Marko Stefanovic, and Rasmus Nordholt-Frieling, "Breathing Gaia: Searching for Kinship Around Walensee" (8:28). The video essay creates a speculative-utopian body and existence of human and non-human. The body as an archive of traumatic inscriptions practices transformation as a being in resonance with Gaia. // Jessica Marion Barr, Jenn Cole, and LA Alfonso, "Our Bodies, These Lands: Practising Reciprocity" (6:03). As artist-researchers with embodied practices and relationships with lands and waters, we explore a unique part of Michi Saagig Nishnaabeg territory wherein “rockmills” or “kettles” offer spaces for our human selves to be held and surrounded by massive ancient rock beings. // Alessandro Guglielmo, "Wisdom and Trouble: Notes on Blood, Care, and Death in Multispecies Settings" (9:30). In this video essay, I employ my emplacement as a vegetarian anthropologist witnessing the killing of a non-human being to produce an understanding of more-than-human ecologies. I reflect on narratives of death, and the trouble of care and killing in multispecies settings.

Background: Different methods are established for the changes in aortic valve stenosis with cardiac computed tomography angiography (CCTA), but the effect of the grade of stenosis on contrast densities around the valve has not been investigated. Aims/methods: Using the information from flow dynamics in cases of increased velocity through narrowed lumen, the hypothesis was formed that flow changes can alter the contrast densities in stenotic post-valvular regions, and the density changes might correlate with the grade of stenosis. Forty patients with severe aortic stenosis and fifteen with a normal aortic valve were enrolled. With echocardiography, the peak/mean transvalvular gradients, peak transvalvular velocity, and aortic valve opening area were obtained. With CCTA, densities 4–5 mm above the aortic valve; at the junction of the left, right, and noncoronary cusp to the annulus; at the middle level of the left, right, and noncoronary sinuses of Valsalva in the center and the lateral points; at the sinotubular junction; and 4 cm from the sinotubular junction at the midline were measured. First, a comparison of the densities between the normal and stenotic valve was performed, and then possible correlations between echocardiography and CCTA values were investigated in the stenotic group. Results: In all CCTA regions, significantly lower-density values were detected among stenotic valve patients compared to the normal aortic valve population. Additionally, in both groups, higher densities were measured in the peri-jet regions than in the lateral ones. Furthermore, a good correlation was found between the aortic valve opening area and the densities in almost all perivalvular areas. With regard to the densities at the junction of the non-coronary leaflet to the fibrotic annulus and at the most lateral point of the right sinus of Valsalva, a high level of correlation was found between all echocardiography and CCTA parameters. Lastly, with receiver operating characteristic curve measurements, area under the curve values were between 0.857 and 0.930. Conclusion: Certain CCTA density values, especially 4–5mm above the valve opening, can serve as auxiliary information to echocardiography when the severity of aortic valve stenosis is unclear.