A Descriptive Analysis of the Youth Study Center of Yakima, Washington, from 1957 to 1964

It is the purpose of this paper to record the history of the Youth Study Center, showing how and why it came about, and how it now fits into the total school picture in Yakima

When Tradition Meets Modernity in Land Registration: Evidence from Dagbon, Ghana

Development practice over recent years in much of Africa prioritized formalization of land policies deemed to enhance better handling and use of land as an asset for social development. Following this trend, land reform policy in Ghana was based on a pluralistic legal system in which both the customary land tenure system and the statutory system of land ownership and control co-exist by law. The primary research question for this study was the following: What implications emerge when customary land tenure system and the statutory system of land ownership and control co-exist in law? The study discussed the prospects and challenges of land title registration and the meaning of the new organizing concept in land ownership and administration among the people of Dagbon in the northern region of Ghana. The principal aim of the study was to assess the challenges of the implementation of a modern land registration system over a deeply traditional one. A qualitative research methodology was used and included qualitative descriptive analysis. This descriptive-analytical study was carried out to investigate opinions on the implications of the merger and preferred options for redress of any systemic challenges. It employed Focused Group Discussions (FGDs) to supplement in-depth interviews. Interviews were conducted among 40 key participants within formal and informal institutions including officials from both the Land Commission and Town and Country Planning Departments. Purposeful sampling was employed, and an interview guide was developed and used for collecting the data. Data were analyzed using a thematic approach. The results showed that in this structural reform, the ‘allodial title’ holder was much more trusted for tenure security because of the traditional legitimacy of the King as the sole owner and controller of land. The title registration system therefore principally served the secondary purpose as additional security. The findings indicate that in the circumstance where the law was seen as pliable, the policy engendered blurred and confusing effects that deepened the sense of ambiguity and outcomes were sometimes contradictory. We argued that the crossroads presented challenges that were novel and engendered innovative thinking for more appropriate solutions. The study revealed that policy reforms must be tailor-made to the physical, social, cultural and economic settings

When Tradition Meets Modernity in Land Registration: Evidence from Dagbon, Ghana

Development practice over recent years in much of Africa prioritized formalization of land policies deemed to enhance better handling and use of land as an asset for social development. Following this trend, land reform policy in Ghana was based on a pluralistic legal system in which both the customary land tenure system and the statutory system of land ownership and control co-exist by law. The primary research question for this study was the following: What implications emerge when customary land tenure system and the statutory system of land ownership and control co-exist in law? The study discussed the prospects and challenges of land title registration and the meaning of the new organizing concept in land ownership and administration among the people of Dagbon in the northern region of Ghana. The principal aim of the study was to assess the challenges of the implementation of a modern land registration system over a deeply traditional one. A qualitative research methodology was used and included qualitative descriptive analysis. This descriptive-analytical study was carried out to investigate opinions on the implications of the merger and preferred options for redress of any systemic challenges. It employed Focused Group Discussions (FGDs) to supplement in-depth interviews. Interviews were conducted among 40 key participants within formal and informal institutions including officials from both the Land Commission and Town and Country Planning Departments. Purposeful sampling was employed, and an interview guide was developed and used for collecting the data. Data were analyzed using a thematic approach. The results showed that in this structural reform, the ‘allodial title’ holder was much more trusted for tenure security because of the traditional legitimacy of the King as the sole owner and controller of land. The title registration system therefore principally served the secondary purpose as additional security. The findings indicate that in the circumstance where the law was seen as pliable, the policy engendered blurred and confusing effects that deepened the sense of ambiguity and outcomes were sometimes contradictory. We argued that the crossroads presented challenges that were novel and engendered innovative thinking for more appropriate solutions. The study revealed that policy reforms must be tailor-made to the physical, social, cultural and economic settings

Coronary CT Angiography and 5-Year Risk of Myocardial Infarction.

BACKGROUND: Although coronary computed tomographic angiography (CTA) improves diagnostic certainty in the assessment of patients with stable chest pain, its effect on 5-year clinical outcomes is unknown. METHODS: In an open-label, multicenter, parallel-group trial, we randomly assigned 4146 patients with stable chest pain who had been referred to a cardiology clinic for evaluation to standard care plus CTA (2073 patients) or to standard care alone (2073 patients). Investigations, treatments, and clinical outcomes were assessed over 3 to 7 years of follow-up. The primary end point was death from coronary heart disease or nonfatal myocardial infarction at 5 years. RESULTS: The median duration of follow-up was 4.8 years, which yielded 20,254 patient-years of follow-up. The 5-year rate of the primary end point was lower in the CTA group than in the standard-care group (2.3% [48 patients] vs. 3.9% [81 patients]; hazard ratio, 0.59; 95% confidence interval [CI], 0.41 to 0.84; P=0.004). Although the rates of invasive coronary angiography and coronary revascularization were higher in the CTA group than in the standard-care group in the first few months of follow-up, overall rates were similar at 5 years: invasive coronary angiography was performed in 491 patients in the CTA group and in 502 patients in the standard-care group (hazard ratio, 1.00; 95% CI, 0.88 to 1.13), and coronary revascularization was performed in 279 patients in the CTA group and in 267 in the standard-care group (hazard ratio, 1.07; 95% CI, 0.91 to 1.27). However, more preventive therapies were initiated in patients in the CTA group (odds ratio, 1.40; 95% CI, 1.19 to 1.65), as were more antianginal therapies (odds ratio, 1.27; 95% CI, 1.05 to 1.54). There were no significant between-group differences in the rates of cardiovascular or noncardiovascular deaths or deaths from any cause. CONCLUSIONS: In this trial, the use of CTA in addition to standard care in patients with stable chest pain resulted in a significantly lower rate of death from coronary heart disease or nonfatal myocardial infarction at 5 years than standard care alone, without resulting in a significantly higher rate of coronary angiography or coronary revascularization. (Funded by the Scottish Government Chief Scientist Office and others; SCOT-HEART ClinicalTrials.gov number, NCT01149590 .)

Action Without Awareness: Reaching to an Object You Do Not Remember Seeing

BACKGROUND: Previous work by our group has shown that the scaling of reach trajectories to target size is independent of obligatory awareness of that target property and that "action without awareness" can persist for up to 2000 ms of visual delay. In the present investigation we sought to determine if the ability to scale reaching trajectories to target size following a delay is related to the pre-computing of movement parameters during initial stimulus presentation or the maintenance of a sensory (i.e., visual) representation for on-demand response parameterization. METHODOLOGY/PRINCIPAL FINDINGS: Participants completed immediate or delayed (i.e., 2000 ms) perceptual reports and reaching responses to different sized targets under non-masked and masked target conditions. For the reaching task, the limb associated with a trial (i.e., left or right) was not specified until the time of response cuing: a manipulation that prevented participants from pre-computing the effector-related parameters of their response. In terms of the immediate and delayed perceptual tasks, target size was accurately reported during non-masked trials; however, for masked trials only a chance level of accuracy was observed. For the immediate and delayed reaching tasks, movement time as well as other temporal kinematic measures (e.g., times to peak acceleration, velocity and deceleration) increased in relation to decreasing target size across non-masked and masked trials. CONCLUSIONS/SIGNIFICANCE: Our results demonstrate that speed-accuracy relations were observed regardless of whether participants were aware (i.e., non-masked trials) or unaware (i.e., masked trials) of target size. Moreover, the equivalent scaling of immediate and delayed reaches during masked trials indicates that a persistent sensory-based representation supports the unconscious and metrical scaling of memory-guided reaching

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study

Introduction: The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures. Methods: In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025. Findings: Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2–6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p&lt;0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5–5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p&lt;0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4–10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p&lt;0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32–4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP &gt;5mg/L, OR 3·55 [1·23–11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation. Interpretation: After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification

Factors Responsible for Youth Migration to the City : The Case of Ghana

One of the major concerns in Ghana, like in most developing countries today, is how to manage the influx of youth migration from rural north to cities in urban south; in search of opportunities and a better life. The present study was undertaken generally for the purpose of investigating the causes of rural-urban migration of youth from northern Ghana to southern Ghana, with a view of providing insights into the growth, direction, and continuation of internal migration flows in Ghana. More specifically, the aim of the study was to investigate the pull factors influencing in-migration; to investigate the push factors influencing out-migration and to recommend policy and programme interventions for strengthening support programme activities for migrants. The study, therefore, attempts to answer the following questions: What are the push factors affecting out-migration? What are the pull factors affecting in-migration? What policy and programme interventions can help strengthen support programme activities for migrants? The study involved a cross-sectional survey conducted with a total of 89 respondents randomly selected from the list of beneficiaries of a NGO programme in Tamale in Ghana, through questionnaire-based interviews, focus group discussions and participant observation. Results show that major factors triggering migration in the northern sector comprise a complex mix of pull and push factors which include learning vocation, social amenities, freedom, general poverty, inability of parents to play their roles, poor job availability in the rural areas. The study suggests that the Government should find more innovative strategies to empower rural communities in other forms of income generating activities such as providing access to skill training and micro-credit facilities that could give better livelihoods to parents and support for families in especially rural areas in Ghana.Peer reviewe