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While discussing obesity with pediatric patients and their families can be difficult, it is an essential step toward appropriate weight management. There is paucity of data regarding language preferences when discussing obesity in this population. In this pilot qualitative study, we interviewed 8 parents of patients diagnosed with obesity to identify language and communication preferences for discussing their child’s weight. Interviews were analyzed for emerging themes. Important trends appeared revealing that parents prefer neutral, medical terms discussed at well-child checks or obesity-specific visits. Providers should frame lifestyle changes as positive for all patients and set achievable goals with the help of visual aids. Our analysis uncovered several important communication strategies that can better equip providers to discuss obesity with their pediatric patients. This research may serve as a foundation for larger studies into the topic.

We report a case of recurrent pericarditis as an immune-related adverse event in a 47-year-old man with de novo metastatic renal cell carcinoma. After first-line treatment with sunitinib failed, he received three cycles of nivolumab and developed pericarditis following each cycle. The third cycle was accompanied by colchicine as a secondary prophylaxis. Pericarditis is an uncommon and potentially life-threatening immune-related adverse event, if not managed promptly.

Introduction The popularity of cycling in the United Kingdom is increasing, with a further rise likely due to recent government cycling promotion schemes. This study aims to characterise fractures sustained due to cycling-related collisions in patients presenting to a Major Trauma Centre, in the region with the highest cycling rates in the United Kingdom. Methods A retrospective analysis of cycling injuries presenting to our centre between January 2012 and December 2020 was performed using a prospectively collected electronic database. Comparison of fracture characteristics was made according to patient age and mechanism of injury (collision with a motorised vehicle versus collision with a non-motorised object.). Results Of the 737 patients who suffered a cycling-related injury, 292 (39.6%) suffered at least 1 fracture to the appendicular skeleton. Overall, fractures were most commonly seen in those over 50 years of age. Upper limb fractures were more common than lower limb fractures. Fractures sustained during motorised injuries were more likely to require surgical intervention than those sustained during non-motorised collisions. Conclusion This study provides valuable information regarding the nature, epidemiology and treatment of fractures sustained following cycling-related accidents, adding to the paucity of similar literature in the field. Given the likely increase in future cycling uptake, our results are important to clinicians treating patients with cycling-related injuries and policymakers designing safety interventions.

PrEP adoption among African-American men-who-have-sex-with-men (AAMSM) remains low. We applied Diffusion-of-Innovations (DOI) theory to understand PrEP adoption processes among young HIV-negative/status unknown AAMSM (AAYMSM; N = 181; 17–24 years). Quantitative and qualitative analyses were used to examine predictors of PrEP diffusion stages. Most AAYMSM were in the persuasion stage (PrEP-aware, hadn’t adopted; 72.4%). Our results suggest that model antecedents are DOI stage-specific. PrEP awareness (knowledge stage) was associated with lower levels of social stigma (p

The main purpose of this study is to measure up to what extent the independent factors defined by capital adequacy ratio, non-performing loans ratio, cost-income ratio, liquidity ratio, and loans-to-deposits ratio impact the financial performance of sixteen commercial banks operating in the United Arab Emirates using panel data for the period of 2013-2019. The secondary data was collected from banks and examined by applying standard descriptive statistics and the random effect model for hypothesis testing. It is concluded from the regression outcomes that non-performing loans ratio and cost-income ratio have a significant negative impact on commercial banks profitability in the United Arab Emirates, while capital adequacy ratio, liquidity ratio, and loans -to-deposits ratio all have a very weak positive relationship on the return on assets but they are not determinants of bank’s profitability due to the insignificant statistical impact on it. It is therefore suggested that to enhance financial performance and minimize the risk of non-performing loans in the future, banks must watch very carefully the loans’ performance and analyze thoroughly the clients’ credit history and ability to pay back their debts prior to any approval of loan applications. Furthermore, banks should continuously improve their assets utilization, liquidity, and techniques of managing operating costs, improve the impact of capital adequacy, and the use of deposits for lending activities from a weak positive impact to a significant positive impact on their profitability. The researchers recommend that future studies on credit risk management influence on banks’ financial performance should consider more independent variables and longer periods of study such as twenty or thirty years to have more accuracy and generalized results.

Health has become one of the most important concerns in the field of development in various societies, as it is one of the most important factors contributing to achieving sustainable development, because healthy development represents an important element in the process of social and economic development, where real development cannot be achieved without improving health conditions. This study aims to identify the concept of sustainable health development, and the factors that contribute to achieving it, and its future directions, as well as an add value research related to health service facilities and the challenges that prevent achieving sustainability. The two researchers adopted the descriptive approach and deductive analysis of sustainability indicators, by reviewing many scientific sources related to the subject of the study in order to shed light on the sustainable design of health care services

The purpose of this study was to examine preference for radial or femoral access for visceral arterial interventions among nursing staff responsible for postprocedural care at a single institution. In September 2018, 100 surveys were sent to nurses in the Cardiac and Interventional Radiology Recovery Unit, 48 of whom completed the survey. On a 5-point Likert scale, nurses responded to whether they disagree or agree with 10 encouraging statements regarding radial arterial access. An average of these 10 scores was calculated and an average score >4 for a nurse was considered to be favorable for radial access. Surveyed nurses had an average of 16.7 years of experience with a standard deviation of 10.2 years. The mean value for 7 of 10 statements regarding radial access was >4.5; the mean value was a 4.1 for the statement “radial access requires less nursing care.” Nurses responded most favorably to the statements “radial access is less embarrassing” and “radial access lets patients go home sooner," with 93% (43/47) of nurses either strongly agreeing or agreeing. Among the 48 nurses, 40 nurses had a cumulative average score >4. A chi-square test of radial favorability versus level of experience yielded a chi-square statistic of 1.2 and a p-value of .273 (not significant at p

As mobile devices become global, it is essential to check and assess student satisfaction with mobile learning. This review aims to investigate the assessment of student satisfaction with mobile learning and provides an analysis and summary of current research in order to better understand student satisfaction with the use of mobile learning. In order to achieve the objectives of the review, the researcher provides a summary of recent studies published in the most popular research databases. The review found that student satisfaction with mobile learning has been reported as effective in recent studies, and the most common form of mobile learning technology is the smartphone. Smartphones have often been the mobile learning technology of choice for researchers. Analysis of the previous literature also revealed that there are many factors that influence student satisfaction with Mobile Learning (ML) and that the factors used to predict student satisfaction with ML are internet speed, smartphone portability, smartphone skills, screen size, student participation, and Interact with the device used. The role of the teacher, interaction is an important component of the satisfaction and persistence of online learners. The review recommends that consideration should be given to factors that have emerged in the analysis of previous studies that influence student satisfaction with mobile learning to enhance student satisfaction with mobile learning. The researcher also recommended the necessity of benefiting from the experiences of other universities in applying UTAUT-based models and trying to apply them to Malaysian universities, especially at Sultan Zain Al-Abidin University (UniSZA)

The success of deep learning techniques over the last decades has opened up a new avenue of research for weather forecasting. Here, we take the novel approach of using a neural network to predict full probability density functions at each point in space and time rather than a single output value, thus producing a probabilistic weather forecast. This enables the calculation of both uncertainty and skill metrics for the neural network predictions, and overcomes the common difficulty of inferring uncertainty from these predictions. This approach is data-driven and the neural network is trained on the WeatherBench dataset (processed ERA5 data) to forecast geopotential and temperature 3 and 5 days ahead. Data exploration leads to the identification of the most important input variables, which are also found to agree with physical reasoning, thereby validating our approach. In order to increase computational efficiency further, each neural network is trained on a small subset of these variables. The outputs are then combined through a stacked neural network, the first time such a technique has been applied to weather data. Our approach is found to be more accurate than some numerical weather prediction models and as accurate as more complex alternative neural networks, with the added benefit of providing key probabilistic information necessary for making informed weather forecasts., 21 pages, 14 figures, Github repository: https://github.com/mc4117/ResNet_Weather, Submitted to Quarterly Journal of the Royal Meteorological Society

The pre-industrial (PI; Year 1850) to present-day (PD; Year 2014) increase in methane concentration leads to a global mean effective radiative forcing (ERF) of 0.97 ± 0.04 W m-2 in the UK’s Earth System Model, UKESM1. In comparison with the multi-model estimate of 0.75 ± 0.10 W m-2 from the Aerosol and Chemistry Model Intercomparison Project (AerChemMIP), UKESM1 has the highest methane ERF and lies outside the 1-sigma range. This is, in part, due to UKESM1 including interactive chemistry and positive indirect effects, such as methane-driven changes in tropospheric ozone. However, UKESM1 is the only model within AerChemMIP whose contribution to the methane ERF from tropospheric adjustments is positive – this is largely driven by the strong positive cloud adjustment in UKESM1, in contrast to other models. In this work, we apportion the total methane ERF between direct and indirect effects (including adjustments) and provide a process-based understanding of what is driving the positive cloud adjustment in UKESM1.Using additional UKESM1 paired simulations, we apportion the total methane ERF between its direct methane contribution and indirect contributions from ozone, water vapour, and aerosols. This approach offers the advantage that linearity is not assumed and it distinguishes between cloud effects that are dynamically-driven via changes in temperature and those that are aerosol-mediated. By analysing the chemistry-aerosol budgets and the cloud responses, we find that the PI to PD increase in methane leads to an indirect positive aerosol ERF of up to 0.3 ± 0.06 W m-2, with a near-zero contribution from the instantaneous radiative forcing from aerosol-radiation interactions. Methane-driven changes in oxidants alter the relative contributions of the different sulphur dioxide oxidation pathways, causing a change in new particle formation rates and a shift in the aerosol size distribution towards fewer but larger particles. There is a resulting decrease in cloud droplet number concentration, an increase in cloud droplet effective radius, and a decrease in liquid water path in marine stratocumulus regions from aerosol-cloud interactions (mainly through the cloud lifetime effect). There is a subsequent change in the cloud radiative effect, with the positive change in the shortwave dominating over the negative change in the longwave. However, when aerosol-cloud interactions are disabled, the change in the cloud radiative effect is negative and is dominated by the reduction of cirrus clouds in the tropics, thus making UKESM1 more consistent with the other AerChemMIP models.These results can explain some of the diversity in multi-model estimates of methane forcing and highlight the importance of chemistry-aerosol-cloud interactions when quantifying climate forcing by reactive greenhouse gases.

Changes in the concentration of greenhouse gases within the atmosphere lead to changes in radiative fluxes within the atmosphere and at its boundaries. This paper describes an experiment within the...

To review and outline problems and challenges in regard to patient safety along with solutions to overcome them. Errors and discrepancies in radiology practice are disappointingly common. The estimated rate of errors is more than 5% in many targeted studies. This requires a detailed review of different types of errors in radiology and potential strategies to prevent them. An effective health care delivery system relies heavily on high degrees of skill in professionalism and communication. Strategies to prevent errors and improve communication with physicians in the Emergency Department are helpful in providing quality patient care, thus also decreasing the chances of conflicts and litigation.

To review and contrast varying methods of peer assessment driven practice quality improvement programs in radiology with an emphasis on peer review and peer learning. Review of the literature revealed that the current consensus is that a shift away from the original peer review system toward a peer learning process has the most beneficial effects for organizations seeking to maximally improve performance. This requires altering perceptions towards the peer review process itself, and significant time, effort, and resources. The transition to a peer learning process is a necessity to advance the field of radiology into an era of delivering near faultless quality health care.

The aim of this study was to understand how endurance time, a proxy for physical fitness, has changed in healthy inner-city children and adolescents in the past three decades. This was a retrospective cross-sectional study. This study used exercise stress test in a laboratory of an inner-city teaching hospital. We reviewed all consecutive healthy children and adolescents who underwent an exercise Bruce protocol treadmill test from 1983 to 2010. The study population was divided into five groups of 5-year intervals based on the year of testing. Temporal trend in endurance time was analyzed, adjusting for gender, ethnicity, age, and body mass index (BMI). We analyzed the records of 435 healthy children and adolescents (mean age 12.6 ± 3.2 years, 57% males).There was a significant difference in the mean endurance time between children grouped in 5-year intervals (P

During a cardiac cycle, the vectors of cardiac forces change in both direction and magnitude. The mean vector, which is the average of the direction and magnitude of the various vectors that exist in any instant at any point in the cardiac cycle, can be calculated using a 12-lead ECG. Abnormal axis can indicate aberrant heart structure, chamber hypertrophy/hypoplasia, or abnormal electrical conduction. The mean vector demonstrate the general direction of depolarization. The “axis” used to determine the position of the vector is centered at the AV node. The P wave, QRS complex, and T wave are the most commonly calculated mean vectors due to their clinical relevance [1].

We present the results of a ~ 3 year campaign to monitor the low luminosity active galactic nucleus (LLAGN) NGC 7213 in the radio (4.8 and 8.4 GHz) and X-ray bands (2-10 keV). With a reported X-ray Eddington ratio of 7 x 10^-4 L_Edd, NGC 7213 can be considered to be comparable to a hard state black hole X-ray binary. We show that a weak correlation exists between the X-ray and radio light curves. We use the cross-correlation function to calculate a global time lag between events in the X-ray and radio bands to be 24 +/- 12 days lag (8.4 GHz radio lagging X-ray), and 40 +/- 13 days lag (4.8 GHz radio lagging X-ray). The radio-radio light curves are extremely well correlated with a lag of 20.5 +/- 12.9 days (4.8 GHz lagging 8.4 GHz). We explore the previously established scaling relationship between core radio and X-ray luminosities and black hole mass L_{R} \propto M^{0.6-0.8} L_{X}^{0.6}, known as the `fundamental plane of black hole activity', and show that NGC 7213 lies very close to the best-fit `global' correlation for the plane as one of the most luminous LLAGN. With a large number of quasi-simultaneous radio and X-ray observations, we explore for the first time the variations of a single AGN with respect to the fundamental plane. Although the average radio and X-ray luminosities for NGC 7213 are in good agreement with the plane, we show that there is intrinsic scatter with respect to the plane for the individual data points.