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The literature supports interval simulation training as a means of improving nurses' cardiopulmonary resuscitation (CPR) skills. The aim of this project was to improve the time-to-task skills in single-rescuer basic life support (BLS) in an outpatient surgery center through interval simulation training.Quality Improvement project.Twenty-nine nursing staff were included in this pretest/post-test within subjects interventional design quality improvement project. A 2-minute pretest cardiac arrest simulation was performed in the outpatient surgery center where time-to-task and quality of CPR data were collected. The pretest was followed by a lecture and CPR training. Three months later, the simulation was post-tested in an identical scenario with measures of time-to-task and quality of CPR.T4he mean times for code bell activation and initiation of CPR decreased significantly following the interval simulation training (P.05). A clinically significant decrease was seen in the mean time-to-task placement of a backboard on code team arrival.Interval simulation training is an effective means of maintaining CPR skills in the outpatient surgery center setting.

Annual surveillance mammography is recommended for breast cancer survivors on the basis of observational studies and meta-analyses showing reduced breast cancer mortality and improved quality of life. However, breast cancer survivors are at higher risk of subsequent breast cancer and have a fourfold increased risk of interval breast cancers compared with individuals without a personal history of breast cancer. Supplemental surveillance modalities offer increased cancer detection compared with mammography alone, but utilization is variable, and benefits must be balanced with possible harms of false-positive findings. In this review, we describe the current state of mammographic surveillance, summarize evidence for supplemental surveillance in breast cancer survivors, and explore a risk-based approach to selecting surveillance imaging strategies. Further research identifying predictors associated with increased risk of interval second breast cancers and development of validated risk prediction tools may help physicians and patients weigh the benefits and harms of surveillance breast imaging and decide on a personalized approach to surveillance for improved breast cancer outcomes.

Air pollution affects Thai people's health and social life nowadays as it exceeds the standards levels of both Thailand and the World Health Organization. Estimating air pollution data can benefit understanding and determining policies to help deal with this issue. Prior knowledge from past surveys or censuses could be useful for increasing the effect of the estimation. Improved ratio estimators utilizing prior knowledge in simple random sampling without replacement have been advocated. The property of the mean square error of the proposed class of estimators is obtained. We applied the proposed estimators to the fine particulate matter data in Dindang in 2019. The results from the air pollution data illustrate the improved ratio type estimators work better with respect to the existing estimator using some prior information. Existing knowledge of the quartile average and the median of the auxiliary variable gives rise to the best estimators with the lowest mean square errors for estimating fine particulate matter. Nevertheless, the proposed estimators are useful for small sampling fractions which can help in financial and time-consuming.

Abattoir operation could be very beneficial to man; in that it provides meat for human consumption and other by-products. The study was aimed at isolation of Staphylococcus species from various equipment used in abattoir. A total of 100 samples were collected from five different surfaces; bucket swab, butchers hand swab, table swab, knife swab and meat swab from four abattoirs; two from Obio/Akpor and two from Eleme Local Government of Rivers State. The samples were transported aseptically to laboratory for immediate analysis. The samples were cultured using standard microbial method on Mannitol salt agar. The isolates of Staphylococcus species were identified using biochemical tests. The Staphylococcal counts ranged from 10.64±0.07 to 25.50±0.71×105 CFU/g for bucket. The least count for the bucket sample was observed in Akpajo while the highest count was observed in Rumuokurushi. For the meat samples the counts ranged between 8.40±0.14 to 12.85±0.07 ×105 CFU/g, the least count was observed in Rumuokoro, while the highest was observed in Aleto. For the hand, knife and table samples the least counts of 10.35±0.35 ×105 CFU/g, 12.50±0.14 ×105 CFU/g and 14.80±0.14 ×105CFU/g were observed from Akpajo, and Rumuokoro, respectively, while the highest count was obtained from hand (26.75±0.07 ×105CFU/g), knife (15.30±0.14x105CFU/g) and table (22.50 ± 0.71x105 CFU/g) in Aleto, Rumuokrushi and Akpajo, respectively. A total of 43 isolates of Staphylococcus species was obtained in the study of which least percentage occurrence of 2.33% was record from table in Akpajo while the highest percentage occurrence of 9.3% was recorded from bucket in Akpajor. The results shows that cross-contamination of meat sold in the abattoir could come from the equipment used in the abattoir hence, their hygienic condition should be ensured.

This article reflects on how autism interacts with the Christian faith and the Church. From considerations of the lived experience of the author’s son, who has autism, tensions are noted between the two main theoretical stances which are commonly applied to autism and how this has a bearing on a ‘theology of autism’. Of these two stances, it is suggested that ‘Intense World’ theory is more useful because it treats autistic people with greater empathy; ironically, an aspect that an ‘impaired’ Theory of Mind suggests they lack. This has implications for how the Church can learn from and be enriched by neurodiverse people.

Background: The relationship between dyslipidemia and the severity of coronavirus disease 2019 (COVID-19) has extensively been characterized in the Western population with a dearth of data among Nigerians. Hence, the current study evaluated the lipid/lipoprotein disorders inherent in COVID-19 and its relationship with disease severity among Nigerians. Methods: This was a retrospective study conducted among 600 patients with RT-PCR-confirmed COVID-19 at the Eleme COVID-19 treatment facility in Port Harcourt, Southern Nigeria. Data were obtained from medical records using validated acquisition templates and analyzed based on lipid/lipoprotein abnormalities and disease severity status. Results: Among those studied, 54.7% had dyslipidemia while others were normolipidemic. HDL-C dyslipidemia was the most common with a preponderance of hypoalphalipoproteinemia (84.4%). Dyslipidemia afflicted mostly middle-aged, males, urban dwellers, the overweight, and those with classic COVID-19-induced respiratory symptoms. Dyslipidemic cohorts had higher pro-calcitonin, C-reactive protein, D-dimer, total white cell count, and neutrophils, but lower albumin, lymphocyte, and platelet counts compared to the normolipidemic cohorts. Dyslipidemic cohorts with concurrent severe COVID-19 had lower levels of TChol, Tg, HDL-C, and LDL-C levels compared to patients with the less-severe disease. HDL-C was the only lipid/lipoprotein parameter that was associated with severe COVID-19 on crude (OR:8.65; CI:5.96-11.44; p

PurposeThis paper examines the discourse of consumers as they attempt to define and create consensus on the meaning and significance of cultural appropriation within a fashion context.Design/methodology/approachData were collected via consumer comments posted to an article from The Guardian about the banning of headdresses from a large-scale music festival in Canada. Data were analyzed according to protocols for grounded theory.FindingsFour themes emerged from the data: values consensus, ideological control, social and symbolic boundaries and social impact and change. These themes captured consumers' perspectives on the debate of cultural appropriation in fashion.Social ImplicationsCultural appropriation has become an increasingly important topic of interest as consumers share their voices online and demand companies increase their cultural competence.Originality/valueFew researchers have examined cultural appropriation in fashion and captured the various perspectives of consumers on this phenomenon.

The main environmental problem in Kumasi is water pollution, but little is done about this. Neither water quality nor the degree of heavy metal contamination in Kumasi has been assessed. The degree of mercury and lead pollution in Kumasi was investigated in this study by determining the geo-accumulation index, the contamination factor, and the water quality index (WQI) of mercury and lead in selected rivers in Kumasi. Mercury and lead concentrations were the highest in the Aboabo River, particularly in the Anloga area. This was attributed largely to electronic waste dumping, collection, and processing in the area. The WQI of the rivers indicated that the water was unsuitable for drinking. It is also shown that the water should not be used for crop cultivation or animal rearing, which are among the anthropogenic activities that are both carried out along the rivers, to limit risk to human health.

Type 2 diabetes (T2D) is a growing problem in children. Children with NAFLD are at potentially high risk for developing T2D; however, the incidence of T2D in this population is unknown. This study aimed to determine the incidence of T2D in children with NAFLD and identify associated risk factors.Children with NAFLD enrolled in the Nonalcoholic Steatohepatitis Clinical Research Network were followed longitudinally. Incidence of T2D was determined by using clinical history and fasting laboratory values. Cumulative incidence curves were developed for time to T2D. A Cox regression multivariable model was constructed using best subsets Akaike's Information Criteria selection.This study included 892 children with NAFLD and with a mean age of 12.8 years (2.7) followed for 3.8 years (2.3) with a total 3234 person-years at risk. The incidence rate of T2D was 3000 new cases per 100,000 person-years at risk. At baseline, 63 children had T2D, and during follow-up, an additional 97 children developed incident T2D, resulting in a period prevalence of 16.8%. Incident T2D was significantly higher in females versus males (hazard ratio [HR], 1.8 [1.0-2.8]), associated with BMI z-score (HR, 1.8 [1.0-3.0]), and more severe liver histology including steatosis grade (HR, 1.3 [1.0-1.7]), and fibrosis stage (HR, 1.3 [1.0-1.5]).Children with NAFLD are at high risk for existing and incident T2D. In addition to known risk factors for T2D (female and BMI z-score), severity of liver histology at the time of NAFLD diagnosis was independently associated with T2D development. Targeted strategies to prevent T2D in children with NAFLD are needed.

Polymerase Epsilon (POLE)-mutant endometrial cancer accounts for 7%-12% of endometrial cancer molecular types, and most of these patients are early-stage endometrioid carcinoma. Although POLE-mutant endometrial cancer has some unfavorable pathological features such as being poorly differentiated, the overall prognosis is good, and postoperative adjuvant treatment may be considered for de-escalation. POLE-mutant endometrial cancer is relatively less sensitive to postoperative adjuvant chemotherapy or radiotherapy, but because of its ultra-high tumor mutation load, recurrent or advanced patients are expected to benefit from programmed cell death receptor 1 (PCDR1) blockade therapy. This review will discuss the clinical features of POLE-mutated endometrial carcinoma and the progress made in the detection of POLE gene mutations.

SYNOPSIS Audit market concentration remains a concern due to its potential impact on audit quality. We examine whether audit market concentration influences properties of analysts’ forecasts. We find that analyst forecasts are more accurate and less dispersed when audit markets are more concentrated. Consistent with regulators’ concerns, we find evidence of decreased auditor independence in concentrated markets but also increased auditor effort and a higher likelihood of a Big N auditor. This results in an overall net positive effect between audit market concentration, audit quality, and ultimately, analysts’ forecasts. These results are concentrated in settings where analysts rely more on audited financial statements. Our findings support regulators’ concerns regarding concentration in the U.S. audit market but also help to explain why audit market concentration leads to improved audit quality.

Background: COVID-19-induced hyponatremia is reportedly associated with pulmonary dysfunction, but mostly among Caucasians. Hence, the current study evaluated sodium status and its correlation with indices of pulmonary dysfunctions among Nigerians of Negroid race. Methods: This was a retrospectively-designed observational study. Data, all obtained at presentation, were acquired from medical records of 480 RT-PCR-confirmed COVID-19 patients managed at a COVID-19-designated treatment facility in Port Harcourt, Southern Nigeria. Analysis of acquired data was done by COVID-19 clinical grades and sodium status using descriptive and inferential statistics. Results: At presentation, hyponatremia and hypernatremia were observed in 47.7% and 1.0% of the entire studied cohorts (n=480), respectively. Both disorders (hyponatremia/hypernatremia) were mostly observed among the moderate, severe, and critical cases. Most hyponatremic cases (n=154;67.2%) and the entire hypernatremic cases (n=5;100%) were of mild grades. Hyponatremics had higher proportions of fever, breathlessness, confusion, and a higher burden of inflammatory markers which increased with worsening hyponatremic grade. Etiologically, hyponatremia was mostly associated with the syndrome of inappropriate anti-diuretic hormone secretion (SIADH) (n=132;56.7%). Among the hyponatremics, an inverse correlation existed between sodium and respiratory rate (RR), while a correlation existed between sodium and oxygen saturation (SpO2). Compared to mild hyponatremics, the moderate/severe hyponatremics had a greater risk of having RR>30 and SpO2

Multiprincipal-element alloys are an enabling class of materials owing to their impressive mechanical and oxidation-resistant properties, especially in extreme environments1,2. Here we develop a new oxide-dispersion-strengthened NiCoCr-based alloy using a model-driven alloy design approach and laser-based additive manufacturing. This oxide-dispersion-strengthened alloy, called GRX-810, uses laser powder bed fusion to disperse nanoscale Y2O3 particles throughout the microstructure without the use of resource-intensive processing steps such as mechanical or in situ alloying3,4. We show the successful incorporation and dispersion of nanoscale oxides throughout the GRX-810 build volume via high-resolution characterization of its microstructure. The mechanical results of GRX-810 show a twofold improvement in strength, over 1,000-fold better creep performance and twofold improvement in oxidation resistance compared with the traditional polycrystalline wrought Ni-based alloys used extensively in additive manufacturing at 1,093 °C5,6. The success of this alloy highlights how model-driven alloy designs can provide superior compositions using far fewer resources compared with the ‘trial-and-error’ methods of the past. These results showcase how future alloy development that leverages dispersion strengthening combined with additive manufacturing processing can accelerate the discovery of revolutionary materials.

Adult-type granulosa cell tumors (aGCT) are rare ovarian sex cord tumors with few effective treatments for recurrent disease. The objective of this study was to characterize the tumor microenvironment (TME) of primary and recurrent aGCTs and to identify correlates of disease recurrence. Total RNA sequencing (RNA-seq) was performed on 24 pathologically confirmed, cryopreserved aGCT samples, including 8 primary and 16 recurrent tumors. After read alignment and quality-control filtering, DESeq2 was used to identify differentially expressed genes (DEG) between primary and recurrent tumors. Functional enrichment pathway analysis and gene set enrichment analysis was performed using “clusterProfiler” and “GSVA” R packages. TME composition was investigated through the analysis and integration of multiple published RNA-seq deconvolution algorithms. TME analysis results were externally validated using data from independent previously published RNA-seq datasets. A total of 31 DEGs were identified between primary and recurrent aGCTs. These included genes with known function in hormone signaling such as LHCGR and INSL3 (more abundant in primary tumors) and CYP19A1 (more abundant in recurrent tumors). Gene set enrichment analysis revealed that primarily immune-related and hormone-regulated gene sets expression was increased in recurrent tumors. Integrative TME analysis demonstrated statistically significant depletion of cancer-associated fibroblasts in recurrent tumors. This finding was confirmed in multiple independent datasets. Implications: Recurrent aGCTs exhibit alterations in hormone pathway gene expression as well as decreased infiltration of cancer-associated fibroblasts, suggesting dual roles for hormonal signaling and TME remodeling underpinning disease relapse.

The COVID-19 pandemic has caused widespread illness, death, and economic disruption around the world. At the same time, malaria continues to be a leading cause of death in many countries. This study aims to examine the relationship between COVID-19, malaria, and occupation. It was a cross sectional study of 400 COVID-19 positive patients. Data were collected through questionnaires and blood samples collected and examined for malaria parasite. The data gotten was analyzed using graph pad prism Version 8.0.2.263. Results gotten reveals that risk factors are not significantly associated with occupation, Prevalence of malaria is not significantly associated with occupation, the level of Parasitaemia is not significantly associated with occupation and Symptoms are also not significantly associated with occupation at p>0.05. The study has confirmed that risk factors, prevalence of malaria, severity of parasitaemia and symptoms have no association with occupation. These findings highlight the need for targeted interventions to protect other populations, including measures to improve access to personal protective equipment and treatment for COVID-19 and malaria.

International audience; Nirmatrelvir/ritonavir (Paxlovid®) consists of a peptidomimetic inhibitor (Nirmatrelvir) of the SARS-CoV-2 main protease and a pharmacokinetic enhancer (Ritonavir). It is approved for the treatment of mild-to-moderate COVID-19. This combination of nirmatrelvir and ritonavir can mediate significant and complex drug-drug interactions (DDIs), primarily due to the ritonavir component. Indeed, ritonavir inhibits the metabolism of nirmatrelvir through cytochrome P450 3A (CYP3A) leading to higher plasma concentrations and a longer half-life of nirmatrelvir. Co-administration of nirmatrelvir/ritonavir with immunosuppressant drugs (ISDs) is particularly challenging given the major involvement of CYP3A in the metabolism of most of these drugs and their narrow therapeutic ranges. Exposure of ISDs will be drastically increased through the potent ritonavir-mediated inhibition of CYP3A, resulting in an increased risk of adverse drug reactions. While a decrease in the dosage of ISDs can prevent toxicity, an inappropriate dosage regimen may also result in insufficient exposure and a risk of rejection. Here we provide some general recommendations for therapeutic drug monitoring (TDM) of ISDs and dosing recommendations when co-administered with nirmatrelvir/ritonavir. Particularly, tacrolimus should be discontinued, or patients should be given a microdose on day-1, while cyclosporine dosage should be reduced to 20% of the initial dosage during the antiviral treatment. Dosages of mammalian target of rapamycin inhibitors (m-TORis) should also be adjusted while dosages of mycophenolic acid and corticosteroids are expected to be less impacted.

Semen analysis is known to be important in determining male fertility and also in assessing infertility in men. Both primary and secondary infertility in male have various causes. One very important part of altered semen profile is the quantity of semen ejaculated and the quality of sperm cells in the ejaculate. Oligospermia is the most common cause of poor semen profile and bacteriospermia has been observed as one of the major causes of infertility in men. This study aimed at determining the relationship between bacteriospermia and oligospermia. In this cross-sectional study, 200 semen samples were collected for further analysis and cultured according to the standard laboratory methods. Semen samples were collected after 3-4 days of sexual abstinence in aseptic condition in a clean, dry, sterile and leak-proof container. The result gotten showed that out of 200 semen samples analyzed 64(32%) were oligospermic. The most common infective organism causing bacteriospermia in oligospermic semen isolated on culture was Staphylococcus aureus with prevalence of 26.6%. There was a non-significant negative correlation between bacteriospermia and oligospermia. This study has shown that bacteriospermia does not have any relationship with oligospermia as bacteriospermia affected more normospermic semen than oligospermic group. However, the study also showed that the most common bacteria causing bacteriospermia is Staphylococcal aureus followed by Escherichia coli.

Psychological wellbeing during neurorehabilitation can be difficult to measure. This study aimed to develop a novel patient-rated wellbeing measure for patients attending a community neurorehabilitation service, and explore the relationships between scores on the new self-report measure, a mood questionnaire used in the service, and clinician wellbeing ratings. 178 healthy adults completed an initial wellbeing questionnaire comprised of 48 items. Exploratory principal component analysis was completed, and the final 11-item questionnaire was administered to 25 individuals undergoing community neurorehabilitation alongside the Hospital Anxiety and Depression Scale and Therapy Outcome Measures. Results suggested the novel Wellbeing in Neurorehabilitation Scale may be valid and reliable, with questions relating to social, emotional, and cognitive factors of wellbeing. Wellbeing ratings made by the clinicians correlated with patients self-reported wellbeing on the novel measure, although this was not a perfect relationship. The findings have implications for measuring psychological wellbeing during community neurorehabilitation.

In 1995 small-scale excavations undertaken at Cramond, Edinburgh revealed a number of pit and post hole features related to temporary or intermittent Mesolithic occupation. These features and associated deposits produced sizeable assemblages of charred plant remains and lithic material. Cramond appears to be the first of an increasing number of securely dated narrow-blade microlithic sites excavated in recent times along the Forth Littoral. Together with substantial house sites such as Echline Fields, East Barns and Howick, Cramond produced a narrow-blade microlithic industry associated with occupation during the mid-9th millennium BC. As such it remains the earliest narrow-blade type assemblage yet discovered in Britain and provides a jumping off point for the discussion of Mesolithic responses to a rapidly changing environment in terms of population movement and technological change.

Purpose — The study examines the nexus between financial liberalization and the economic growth of ECOWAS member states.Method — The longitudinal and latitudinal survey research design (expo-facto) is used in this study. Data are sourced from the World Bank and IMF Data Set for 2012-2020 and employed panel co-integration and system GMM for analyses.Result — We found that financial liberalization significantly impacts the economic growth of selected ECOWAS member countries. Similarly, the domestic economy's openness significantly impacts economic growth. While financial development exerts a positive impact, exchange rate and inflation negatively impact economic growth, the impact of interest rate is positive but insignificant.Contribution — The study provides cross-country evidence on the empirical nexus between financial liberalization and the economic growth from ECOWAS member states. To the best of authors’ knowledge, the study is one of the few studies on cross-country financial liberalization and the economic growth and used the panel data regression analysis. By this, the study covers a methodological gap, using a technique that can account for endogeneity and omitted variable problem.

Summary Nematodes perform important ecosystem services in soils and are well studied in traditional farming, but their role in newer soil-less food production systems is unstudied. We determined the nematode assemblages from substrates within the hydroponic media beds of a commercial aquaponics system. Three substrates were studied: coir, compost and lightweight expanded clay aggregate (LECA), with the nematode assemblages ascertained via traditional morphological analysis. All substrates were suitable for nematodes but abundance was lower compared with traditional compost. Compost from within the hydroponic media beds had nematode assemblages with similar maturity indices (MI) to compost external to the system, and both composts housed nematodes with a high proportion of bacterivores, a high degree of enrichment and no structure. LECA that were regularly disturbed and had little organic build up resembled compost – highly enriched and lacking structure. LECA that had been left undisturbed for longer and allowed to accumulate more organic matter had highly structured assemblages and showed less enrichment than the other substrates. Nematode assemblages within the coir showed very little enrichment but had higher MI and were more structured than compost. Problematic plant-parasitic nematodes were not found in any of the samples. We present the first glimpse into the role of nematodes in aquaponics systems and encourage future studies to explore how nematodes in these systems affect yield and plant health.