Using traditional rituals in hospitality to gain value: A study on the impact of Feng Shui

Superstition and the rituals used to support such beliefs remain an important part of Chinese business society. With the advance of globalisation and the normalisation of many business practices this study explores the importance these rituals continue to play in the contemporary hospitality setting. The paper examines the prominence of Feng Shui in business today in a qualitative study using Chinese restaurants to explore associated business behaviours and perceived value of use. Findings from 20 phenomenological interviews from across four different Asian communities are discussed highlighting the core elements of this ritualistic practice. Results indicate that these practices continue to be used widely, have significant impact in managing the servicescape, and, influence the decisions and behaviours of proprietors. Feng Shui ritual plays an important role in the creation of value for business proprietors who practice it and a conceptual framework on how these rituals provide value is proposed

Doppler Parameters in Renal Transplant Dysfunction

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135678/1/jum2011302169.pd

Combined novice, near-peer, e-mentoring palliative medicine program: A mixed method study in Singapore

INTRODUCTION:An acute shortage of senior mentors saw the Palliative Medicine Initiative (PMI) combine its novice mentoring program with electronic and peer mentoring to overcome insufficient mentoring support of medical students and junior doctors by senior clinicians. A three-phased evaluation was carried out to evaluate mentees' experiences within the new CNEP mentoring program. METHODS:Phase 1 saw use of a Delphi process to create a content-valid questionnaire from data drawn from 9 systematic reviews of key aspects of novice mentoring. In Phase 2 Cognitive Interviews were used to evaluate the tool. The tool was then piloted amongst mentees in the CNEP program. Phase 3 compared mentee's experiences in the CNEP program with those from the PMI's novice mentoring program. RESULTS:Thematic analysis of open-ended responses revealed three themes-the CNEP mentoring process, its benefits and challenges that expound on the descriptive statistical analysis of specific close-ended and Likert scale responses of the survey. The results show mentee experiences in the PMI's novice mentoring program and the CNEP program to be similar and that the addition of near peer and e-mentoring processes enhance communications and support of mentees. CONCLUSION:CNEP mentoring is an evolved form of novice mentoring built on a consistent mentoring approach supported by an effective host organization. The host organization marshals assessment, support and oversight of the program and allows flexibility within the approach to meet the particular needs of mentees, mentors and senior mentors. Whilst near-peer mentors and e-mentoring can make up for the lack of senior mentor availability, their effectiveness hinges upon a common mentoring approach. To better support the CNEP program deeper understanding of the mentoring dynamics, policing and mentor and mentee training processes are required. The CNEP mentoring tool too needs to be validated

Viral load and sequence analysis reveal the symptom severity, diversity, and transmission clusters of Rhinovirus infections

Background:Rhinovirus (RV) is one of the main viral etiologic agents of acute respiratory illnesses. Despite the heightened disease burden caused by RV, the viral factors that increase the severity of RV infection, the transmission pattern, and seasonality of RV infections remain unclear. Methods: An observational study was conducted among 3935 patients presenting with acute upper respiratory illnesses in the ambulatory settings between 2012 and 2014. Results: The VP4/VP2 gene was genotyped from all 976 RV-positive specimens, where the predominance of RV-A (49%) was observed, followed by RV-C (38%) and RV-B (13%). A significant regression in median nasopharyngeal viral load (VL) (P < .001) was observed, from 883 viral copies/µL at 1-2 days after symptom onset to 312 viral copies/µL at 3-4 days and 158 viral copies/µL at 5-7 days, before declining to 35 viral copies/µL at ≥8 days. In comparison with RV-A (median VL, 217 copies/µL) and RV-B (median VL, 275 copies/µL), RV-C-infected subjects produced higher VL (505 copies/µL; P < .001). Importantly, higher RV VL (median, 348 copies/µL) was associated with more severe respiratory symptoms (Total Symptom Severity Score ≥17, P = .017). A total of 83 phylogenetic-based transmission clusters were identified in the population. It was observed that the relative humidity was the strongest environmental predictor of RV seasonality in the tropical climate. Conclusions: Our findings underline the role of VL in increasing disease severity attributed to RV-C infection, and unravel the factors that fuel the population transmission dynamics of R

Clinical significance of vasculogenic mimicry in human gliomas

Vasculogenic mimicry (VM) is known as non-endothelial tumor cell-lined microvascular channels in aggressive tumors. We have previously found the presence of VM in high-grade gliomas. In this study, we aimed to identify VM patterns in gliomas and to explore their clinical significance. Tumor samples as well as their detailed clinical/prognostic data were collected from 101 patients. Vasculogenic mimicry in the glioma samples was determined by dual staining for endothelial marker CD34 and periodic acid–Schiff (PAS). Tumor samples were also immunohistochemically stained for Ki-67, VEGF, COX-2 and MMP-9. The association between VM and the clinical characteristics of the patients were analyzed. A Kaplan–Meier survival analysis and log-rank tests were performed to compare survival times of the patients. Vasculogenic mimicry was present in 13 out of 101 samples. The higher grade gliomas had a higher incidence of VM than that of lower grade gliomas (P = 0.006). Vasculogenic mimicry channels were associated with the expression of COX-2 and MMP-9 (P < 0.05). While there was no association between the existence of VM and the sex, age and preoperative epilepsy of the patients, or expression of Ki-67 and VEGF. However, patients with VM-positive gliomas survived a shorter period of time than those with VM negative gliomas (P = 0.027). Interestingly, in high-grade gliomas, the level of microvascular density was lower in VM positive tumors than those VM negative tumors (P = 0.039). Our results suggest that VM channels in gliomas correlate with increasing malignancy and higher aggressiveness, and may provide a complementation to the tumor’s blood supply, especially in less vascularized regions, which may aid in the identification of glioma patients with a poorer prognosis

Experiences of environmental services workers in a tertiary hospital in Asia during the COVID-19 pandemic: a qualitative study

BackgroundThe Coronavirus Disease 2019 (COVID-19) pandemic has had a significant impact on all walks of life, in particular, environmental services workers in healthcare settings had higher workload, increased stress and greater susceptibility to COVID-19 infections during the pandemic. Despite extensive literature describing the impact of the pandemic on healthcare workers such as doctors and nurses, studies on the lived experiences of environmental services workers in healthcare settings are sparse and none has been conducted in the Asian context. This qualitative study thus aimed to examine the experiences of those who worked for a year of the COVID-19 pandemic.MethodsA purposive sample of environmental services workers was recruited from a major tertiary hospital in Singapore. Semi-structured interviews were conducted in-person, lasting around 30min, and included open-ended questions pertaining to five main domains: work experiences during COVID-19, training and education needs, resource and supplies availability, communication with management and other healthcare staff, and perceived stressors and support. These domains were identified based on team discussions and literature review. The interviews were recorded and transcribed for thematic analysis, as guided by Braun and Clarke.ResultsA total of 12 environmental services workers were interviewed. After the first seven interviews, no new themes emerged but an additional five interviews were done to ensure data saturation. The analysis yielded three main themes and nine subthemes, including (1) practical and health concerns, (2) coping and resilience, and (3) occupational adaptations during the pandemic. Many expressed confidence in the preventive efficacy of proper PPE, infection control practice and COVID-19 vaccination in protecting them against COVID-19 and severe illness. Having prior experience with infectious disease outbreaks and previous training in infection control and prevention appeared to be useful as well for these workers. Despite the various challenges presented by the pandemic, they could still find meaning in their everyday work by positively impacting the wellbeing of patients and other healthcare workers in the hospital.ConclusionBesides uncovering the concerns shared by these workers, we identified helpful coping strategies, resilience factors and certain occupational adaptations, which have implications for future pandemic planning and readiness

Influência do regime alimentar sobre os parâmetros de crescimento de borregas merinas.

O presente trabalho teve por objetivo avaliar o efeito que três suplementos alimentares (alimento composto comercial (CP), farinha forrageira de milho (FM) e cladódios de Opuntia ficus-indica (OFI)) tiveram sobre os indicadores de crescimento de borregas de substituição de raça Merino Branco alimentadas com feno de consociação (F), como alimento forrageiro base em regime ad libitum controlado, assim como a ingestão de água. Os 24 animais selecionados foram organizados em grupos de 8 borregas cada um, homogéneos em relação ao peso vivo, à idade e ao ganho de peso médio diário do nascimento até ao início do ensaio. Cada grupo de 8 borregas foi organizado em quatro subgrupos de 2 borregas cada um e o controlo da ingestão alimentar foi feito para cada um destes subgrupos. Para cada tratamento avaliou-se os seguintes parâmetros de crescimento e de consumo de alimentos: peso vivo; ganho de peso diário; consumo de feno (MS); consumo de cada um dos suplementos alimentares (MS); consumo de MS/kg0,75; consumo de PB/kg0,75; consumo de EM/kg0,75; consumo de NDF/kg0,75; consumo de NFC/kg0,75; índice de conversão alimentar (kg MS/kg PVG); consumo de água; ingestão total de água. Durante os 63 dias de ensaio, verificou-se que as borregas submetidas ao regime alimentar CP+F (T1) apresentaram maior ingestão (p≤0,05) de MS, MS/kg PV0,75, C, NDF, ADF, PB, PB/kg PV0,75, GB, EM e H2O e menor ingestão (p≤0,05) de NFC e de NFC/kg PV0,75. No regime alimentar FM+F (T2), verificou-se maior ingestão (p≤0,05) de NFC/kg PV0,75 e menor ingestão (p≤0,05) de C. No regime alimentar OFI+FM+F (T3) as borregas ingeriram menos (p≤0,05) NDF, PB/kg PV0,75 e H2O. Não se encontraram diferenças estatísticas significativas entre os tratamentos T2 e T3 relativamente à ingestão média diária de MS, de EM, de PB, de NDF e de ADF (p≤0,05). O maior consumo de H2O foi apresentado no T1 (2,037 kg/dia) (p≤0,05), seguido das borregas do T2 (1,459 kg/dia). O menor consumo médio diário de H2O de bebida ocorreu nas borregas do T3 (0,277 kg/dia ±0,038) (p≤0,05), no entanto as borregas do T3 apresentaram o maior CTH2O (3,900 kg/dia) (p≤0,05). As borregas do T1 apresentaram GPD significativamente mais elevado (0,180 kg/dia ±0,009) (p≤0,05) do que as borregas do T2 e T3 (0,110 kg/dia ±0,020 e 0,131 kg/dia 0,006 respetivamente). No final do ensaio, as borregas do T3 alimentadas com OFI+FM+F apresentaram PV semelhante (29,5 kg; p≤0,05) às borregas do T2 alimentadas com FM+F (27,94 kg), porém inferiores (p≤0,05) às borregas do T1 alimentadas com CP+F (33,01 kg). Considera-se que a baixa concentração proteica dos 2 regimes alimentares OFI+FM+F (85,54 g PB/kg MS ±0,560) e FM+F (84,76 g PB/kg MS ±0,367) terá afetado o crescimento dos animais relativamente aos animais alimentados com CP+F (148,62 g PB/kg MS ±2,914).The objective of this study was to evaluate the effect of three feed supplements (commercial compound (CC), corn flour (CF) and Opuntia ficus-indica (OFI) cladodes) on the growth indicators of Merino Branco female lambs, fed as forage with hay (H) of association based on controlled ad libitum regime, as well water intake. The 24 animals selected were organized in groups of 8 lambs each, homogeneous in relation to live weight, age and average daily weight gain from birth until the beginning of the test. Each group of 8 lambs was organized in four subgroups of 2 lambs each and the food intake control was done for each of these subgroups. For each treatment the following growth and food consumption parameters were evaluated: live weight; daily weight gain; hay consumption (DM); consumption of each dietary supplements (DM); consumption of DM/kg0,75; consumption of CP/kg0,75; consumption of ME/kg0,75; consumption of NDF/kg0,75; consumption of NFC/kg0,75; feed conversion index (kg DM/kg DWG); water consumption; total water intake. During the 63 test days, it has been found that lambs submitted on the diet CC+H (T1) presented the highest intake (p≤0.05) of DM, DM/kg LW0,75, A, NDF, ADF, CP, CP/kg LW0,75, CF, ME and H2O, and the lowest intake (p≤0.05) of NFC and NFC/kg LW0,75. In the CF+H diet (T2), it was verified the highest intake (p≤0.05) of NFC/kg LW0,75 and the lowest intake (p≤0.05) of A. In the OFI+CF+H diet (T3) the lambs ingested less (p≤0.05) NDF, CP/kg LW0,75 and H2O. No statistically significant differences were found between treatments T2 and T3 in relation to the mean daily intake of DM, ME, CP, NDF and ADF (p≤0.05). The T1 showed the highest H2O intake (2.037 kg/day) (p≤0.05), followed by the lambs of T2 (1.459 kg/day). The lowest daily H2O intake occurred in the lambs of T3 (0.277 kg/day ±0.038) (p≤0.05), however the lambs of T3 showed the highest TH2OI (3.900 kg/day) (p≤0.05). The lambs of T1 presented significantly higher DWG (0.180 kg/day ±0.009) (p≤0.05) than lambs of T2 and T3 (0.110 kg/day ±0.020 and 0.131 kg/day 0.006 respectively). At the end of the test, the lambs fed with OFI+CF+H (T3) showed a LW similar (29.5 kg; p≤0.05) to the lambs fed with CF+H (T2) (27.94 kg) but lower (p≤0.05) than the animals fed with CC+H (T1) (33.01 kg). It was considered that the low protein concentration of the 2 feed treatments OFI+CF+H (85.54 g CP/kg DM ±0,560) and CF+H (84.76 g CP/kg DM ±0,367) will have affected the growth of the animals compared to animals feed with CC+H (148.62 g CP/kg DM ±2.914)

Unique local bone tissue characteristics in iliac crest bone biopsy from adolescent idiopathic scoliosis with severe spinal deformity

Adolescent idiopathic scoliosis is a complex disease with unclear etiopathogenesis. Systemic and persistent low bone mineral density is an independent prognostic factor for curve progression. The fundamental question of how bone quality is affected in AIS remains controversy because there is lack of site-matched control for detailed analysis on bone-related parameters. In this case-control study, trabecular bone biopsies from iliac crest were collected intra-operatively from 28 severe AIS patients and 10 matched controls with similar skeletal and sexual maturity, anthropometry and femoral neck BMD Z-score to control confounding effects. In addition to static histomorphometry, micro-computed tomography (μCT) and real time-PCR (qPCR) analyses, individual trabecula segmentation (ITS)-based analysis, finite element analysis (FEA), energy dispersive X-ray spectroscopy (EDX) were conducted to provide advanced analysis of structural, mechanical and mineralization features. μCT and histomorphometry showed consistently reduced trabecular number and connectivity. ITS revealed predominant change in trabecular rods, and EDX confirmed less mineralization. The structural and mineralization abnormality led to slight reduction in apparent modulus, which could be attributed to differential down-regulation of Runx2, and up-regulation of Spp1 and TRAP. In conclusion, this is the first comprehensive study providing direct evidence of undefined unique pathological changes at different bone hierarchical levels in AIS

International Guideline on Dose Prioritization and Acceptance Criteria in Radiation Therapy Planning for Nasopharyngeal Carcinoma

Purpose: The treatment of nasopharyngeal carcinoma requires high radiation doses. The balance of the risks of local recurrence owing to inadequate tumor coverage versus the potential damage to the adjacent organs at risk (OARs) is of critical importance. With advancements in technology, high target conformality is possible. Nonetheless, to achieve the best possible dose distribution, optimal setting of dose targets and dose prioritization for tumor volumes and various OARs is fundamental. Radiation doses should always be guided by the As Low As Reasonably Practicable principle. There are marked variations in practice. This study aimed to develop a guideline to serve as a global practical reference. Methods and Materials: A literature search on dose tolerances and normal-tissue complications after treatment for nasopharyngeal carcinoma was conducted. In addition, published guidelines and protocols on dose prioritization and constraints were reviewed. A text document and preliminary set of variants was circulated to a panel of international experts with publications or extensive experience in the field. An anonymized voting process was conducted to rank the proposed variants. A summary of the initial voting and different opinions expressed by members were then recirculated to the whole panel for review and reconsideration. Based on the comments of the panel, a refined second proposal was recirculated to the same panel. The current guideline was based on majority voting after repeated iteration for final agreement. Results: Variation in opinion among international experts was repeatedly iterated to develop a guideline describing appropriate dose prioritization and constraints. The percentage of final agreement on the recommended parameters and alternative views is shown. The rationale for the recommendations and the limitations of current evidence are discussed. Conclusions: Through this comprehensive review of available evidence and interactive exchange of vast experience by international experts, a guideline was developed to provide a practical reference for setting dose prioritization and acceptance criteria for tumor volumes and OARs. The final decision on the treatment prescription should be based on the individual clinical situation and the patient's acceptance of optimal balance of risk. (C) 2019 Elsevier Inc. All rights reserved