The Role of Medical Training Background in Patient Satisfaction

The number of international medical graduates (IMG) is increasing and their ability to satisfy patients has never been studied. The purpose of this study is to examine if there is a difference between the patient satisfaction scores of US medical graduates (USMGs) and IMGs. This is a retrospective study in which 2627 returned patient experience surveys of 55 physicians working in Medical Practice in South Western Mayo Health System were evaluated. These surveys were returned from August 2009 to August 2010. An independent t-test and t-inverse test was conducted with significance level of 0.05. The results of t-test lead to conclude with 95% confidence that there is no difference between the patient satisfaction scores of the two groups of physicians. T-inverse test confirms the results of t-test and lead to conclude with 95% confidence that the scores of the two groups of physicians are similar. It is concluded that USMGs and IMGs have similar capability to satisfy their patients and also that patients did not rate USMGs and IMGs differently

The Good Teacher: A Qualitative Analysis of Perceptions of Asian American Parents

This research study examined the general question What do Asian American parents believe to be important characteristics of an effective elementary teacher? In order to investigate this question, the researcher used a qualitative research design employing a semi-structured interview which probed into the personal perceptions voiced by a sample of twelve Asian American parents on the characteristics of good teachers. The twelve Asian American parents who participated in this study were from nine different Asian countries covering the three main regions defined as Asian according to the U.S. Census Bureau, Far East Asia, Southeast Asia, and the Indian sub-continent. Also, the study was focused on the Asian American families living in the Southern region of Minnesota. It was discovered that there was a general agreement among the parents regarding the characteristics of good teachers. The findings were arranged into two main sections, vision of education and characteristics of effective teachers. In the first section, vision of education, five aspects were revealed: 1) opportunity, 2) independence, 3) personal growth, 4) respect, and 5) negative consequences of not getting sufficient education. Parents revealed that the main purpose of education is to have opportunities to be independent and have high social status (financially and socially). Education, according to the Asian American parents, is immensely important for the growth of the individuals to live their daily lives because without education, life would be a struggle. The second section, the characteristics of effective teachers, included fifteen themes. Out of fifteen themes, ten were found to be important features in effective teaching. Those features were 1) teachers\u27 expectations, 2) individualized instruction, 3) teacher as a person, 4) teachers\u27 enthusiasm, 5) discipline, 6) relationship between students, teachers, and parents 7) interactional dynamics, 8) life skills, 9) school uniforms, and 10) classroom climate. The other five themes that emerged were of lesser importance to the parents for effective teaching. Those themes were 1) classroom management, 2) physical layout, 3) teachers\u27 knowledge, 4) teacher\u27s gender, and 5) racial/ethnic background of the teacher

Adopting Architectural Event Modules for Modular Coordination of Multiple Applications

Nowadays, large-scale software systems consist of multiple applications, which interact with each other to fulfill desired system-level requirements. It is usually required to coordinate the interactions of the constituent applications to ensure that the system-level requirements are fulfilled. In this paper, we outline a set of requirements that must be fulfilled to facilitate the modular composition of multiple applications. We introduce the concept of architectural event modules, which are abstractions to represent constituent applications and their coordination logic in a modular and uniform way. We explain the implementation of this concept in the EventReactor language, and define their formal semantics in processing events using the UPPAAL toolset. We illustrate the suitability of architectural event modules in achieving modularity and loose coupling in the composition of multiple applications by means of a case study in the domain of energy-efficient computing

N-(4-Hydroxy­phen­yl)benzene­sulfon­amide

The title compound, C12H11NO3S, synthesized by the reaction of benzene sulfonyl chloride with para-amino­phenol, is of inter­est as a precursor to biologically active sulfur-containing heterocyclic compounds. The structure is stabilized by N—H⋯O and O—H⋯O hydrogen bonds

Expression of the SST receptor 2 in uveal melanoma is not a prognostic marker

Introduction: Uveal melanoma (UM) cells and neurohormone-producing cells both originate from the neural crest. Somatostatin receptors subtype 2 (SSTR2) are over-expressed in several tumors, often from neuroendocrine origin, and synthetic antagonists like octreotide and octreotate are being used as diagnostic or therapeutic agents. We investigated the SSTR2 expression in UM, and determined whether this expression was related to prognosis of the disease. Materials and methods: UM cell lines and fresh primary UM samples were tested for SSTR2 expression by autoradiography (AR) using 125I-Tyr3-octreotate. Furthermore, UM cell lines were analyzed for SSTR2 mRNA expression with quantitative real-time RT-PCR. Results: Using AR, cell-surface SSTR2 expression was demonstrated in two UM metastatic cell lines, but no expression was detected in three cell lines derived from primary UM. However, all primary and metastatic UM cell lines showed mRNA expression levels for SSTR2 using quantitative real-time RT-PCR. Only three of 14 primary UM demonstrated moderate SSTR2 expression, and this expression was not significantly associated with tumor-free survival or any tested prognostic factor. Conclusions: Based on the rare and low expression of SSTR2 found in primary UM specimens and in UM cell lines, we conclude that SSTR2 is not widely expressed in UM. Furthermore, SSTR2 expression was not associated with tumor-free survival and prognostic factors. Therefore SSTR2 is not suited as prognostic marker or therapeutic target in UM

COVID-19 vaccine acceptance and hesitancy in low- and middle-income countries

Widespread acceptance of COVID-19 vaccines is crucial for achieving sufficient immunization coverage to end the global pandemic, yet few studies have investigated COVID-19 vaccination attitudes in lower-income countries, where large-scale vaccination is just beginning. We analyze COVID-19 vaccine acceptance across 15 survey samples covering 10 low- and middle-income countries (LMICs) in Asia, Africa and South America, Russia (an upper-middle-income country) and the United States, including a total of 44,260 individuals. We find considerably higher willingness to take a COVID-19 vaccine in our LMIC samples (mean 80.3%; median 78%; range 30.1 percentage points) compared with the United States (mean 64.6%) and Russia (mean 30.4%). Vaccine acceptance in LMICs is primarily explained by an interest in personal protection against COVID-19, while concern about side effects is the most common reason for hesitancy. Health workers are the most trusted sources of guidance about COVID-19 vaccines. Evidence from this sample of LMICs suggests that prioritizing vaccine distribution to the Global South should yield high returns in advancing global immunization coverage. Vaccination campaigns should focus on translating the high levels of stated acceptance into actual uptake. Messages highlighting vaccine efficacy and safety, delivered by healthcare workers, could be effective for addressing any remaining hesitancy in the analyzed LMICs.Publisher PDFPeer reviewe

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Religious orientations, storytelling and the uncanny: a reading of The Adventures of Amir Hamza

EMBARGOED - expected end date 19.06.202

Adopting Architectural Event Modules for Modular Coordination of Multiple Applications

Nowadays, large-scale software systems consist of multiple applications, which interact with each other to fulfill desired system-level requirements. It is usually required to coordinate the interactions of the constituent applications to ensure that the system-level requirements are fulfilled. In this paper, we outline a set of requirements that must be fulfilled to facilitate the modular composition of multiple applications. We introduce the concept of architectural event modules, which are abstractions to represent constituent applications and their coordination logic in a modular and uniform way. We explain the implementation of this concept in the EventReactor language, and define their formal semantics in processing events using the UPPAAL toolset. We illustrate the suitability of architectural event modules in achieving modularity and loose coupling in the composition of multiple applications by means of a case study in the domain of energy-efficient computing

Adopting Architectural Event Modules for Modular Coordination of Multiple Applications

Nowadays, large-scale software systems consist of multiple applications, which interact with each other to fulfill desired system-level requirements. It is usually required to coordinate the interactions of the constituent applications to ensure that the system-level requirements are fulfilled. In this paper, we outline a set of requirements that must be fulfilled to facilitate the modular composition of multiple applications. We introduce the concept of architectural event modules, which are abstractions to represent constituent applications and their coordination logic in a modular and uniform way. We explain the implementation of this concept in the EventReactor language, and define their formal semantics in processing events using the UPPAAL toolset. We illustrate the suitability of architectural event modules in achieving modularity and loose coupling in the composition of multiple applications by means of a case study in the domain of energy-efficient computing