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was detected only in the ward closest to the demolition site. However, no case of aspergillosis was reported. The difference-in-difference analysis revealed that the interaction between the demolition activity, height of the ward, and distance of the air intake to the demolition activities resulted in a significant increase in the numbers of

spp.

When large-scale demolition work occurs in hospital premises,

spp. may increase in the ward where the vertical and horizontal distance of air intake from the demolition site is close, even though infection control measures based on the ICRA are implemented.

When large-scale demolition work occurs in hospital premises, Aspergillus spp. may increase in the ward where the vertical and horizontal distance of air intake from the demolition site is close, even though infection control measures based on the ICRA are implemented.The patient decision aid (PDA) is a promising patient engagement tool for use in shared decision making (SDM). selleck kinase inhibitor Selecting a PDA is an essential precursor to successful SDM implementation. Little is known regarding the organizational stakeholder process for assessing and selecting a PDA. We conducted a qualitative, multicase study within the context of a maternal health decision to identify the criteria used by stakeholders to select a PDA. We further explored the perceived value of PDA certification on PDA selection. We reported the PDA selection criteria within the domains of (1) Design and Functionality, (2) User Fit, (3) Context and Climate, (4) Support, and (5) Strategic Vision and found that certification was perceived to be a valuable screening mechanism for smaller health organizations. Health organizations and researchers may use our PDA selection criteria and conceptual model to plan future deployments of PDAs and patient engagement tools.

Diabetes mellitus technology (DMT) is increasingly used for routine management in developed countries, yet its uptake in developing countries is not as consistent. Multiple factors may influence this, including country specific patient perception regarding DMT. We conducted a pilot study in Pakistan to understand this important question which has not been studied yet.

A cross-sectional pilot study was conducted in Pakistan. An anonymous survey exploring perceptions of diabetes technology was circulated on social media platforms, collecting responses over 2 weeks. Target population included adults (≥18 years) living in Pakistan, with DM1 or 2.

A total of 40 responses were received. The majority (36/40) reported using conventional glucometers. Nine used continuous glucose monitoring (CGM). Thirty-two of 40 patients believed DMT improved diabetes care, 22 felt it helped decreased risk of Diabetes-related complications. 15/40 stated that DMT results in increased cost of care. Sixteen reported their diabetesey) and small sample size, but this data can help inform larger studies, to look at this important topic in greater detail.While forensic psychologists have some access to their patients' thoughts when deciding on a diagnosis or appraising risk, others, such as police investigators, must rely on physical evidence and behavioral markers to make sense of a crime. Studies showing that offense-supportive cognitions constitute a risk factor for sexual offending, including offenses that take place on the internet, highlight the need for some access to offenders' thoughts. This exploratory study examines the associations between offense-supportive statements about the sexual exploitation of children and adolescents and proxy behaviors. As part of PRESEL, a collaborative research project between Québec provincial police and academic researchers, the case files of 137 men convicted of using child sexual exploitation material or committing child-luring offenses were analyzed. Results showed that many meaningful risk factors and sexual offending behavioral markers were associated with the cognitive themes Sexualization of children, Child as partner, Dangerous world, Entitlement, and Uncontrollability. The use of encryption was negatively associated with the cognition Virtual is not real while Internet is uncontrollable was associated with fewer contacts with minors over the internet. Findings are useful for understanding the psychological needs that should be targeted in treatment, as well as helping prioritize police workloads.

Healthcare workers must be protected during extubation of patients with coronavirus disease 2019 (COVID-19) owing to the presence of aerosolized droplets. Herein, we report a technique for extubating a patient with COVID-19 while minimizing aerosol dispersion.

We retrospectively identified a total of 79 patients admitted to our hospital from February 2020 to January 2021. Six of these patients were intubated for mechanical ventilation, 2 of whom had to be extubated. We prepared a clear vinyl sheet in the shape of a tent to place over the patient, and 2 staff members, both well experienced in airway management, stood outside the tent on either side of the patient. Before extubation, we confirmed that the patient's consciousness level was good and the patient had no distress by adjusting the dose of sedative drugs. After extubation, a surgical mask was placed on the patient's face.

Our experience indicates that this method of extubation in a patient with COVID-19 could be safely implemented to protect healthcare workers.

Our experience indicates that this method of extubation in a patient with COVID-19 could be safely implemented to protect healthcare workers.

To compare the educational value of endoscopic ear surgery versus microscopic ear surgery among medical students.

Medical students anonymously completed a cross-sectional survey immediately after observing endoscopic or microscopic ear surgery. A Likert scale (1 = worst, 5 = best) was used to analyze variables across 3 domains including (1) area of interest visibility, (2) optical quality, (3) education and understanding. The Mann-Whitney

-test and multivariable linear regression were used to compare mean scores of individual items and domain means between endoscopic and microscopic groups.

Forty-four surveys were analyzed (20 endoscopic and 24 microscopic ear surgeries). Across domains, the endoscope was superior to the microscope (adjusted

 < .05) for visibility of the area of interest (mean ± SD 4.74 ± 0.26 vs 4.28 ± 0.50), optical quality (4.78 ± 0.38 vs 4.28 ± 0.64), and education and understanding (4.70 ± 0.47 vs 4.13 ± 0.61). In multivariable linear regression, the mean domain score for visibility of the area of interest was 1.23 (95% CI = 0.56, 1.90; adjusted

 < .01) points higher for the endoscopic group, compared to the microscopic group, adjusting for surgeon, procedure, and student type. The mean domain score for education and understanding was 1.19 (95% CI = 0.49. 1.90; adjusted

 < 0.01) points higher for the endoscopic group, compared to the microscopic group, adjusting for the same confounders.

Among medical students, endoscopic ear surgery was superior to microscopic ear surgery for several visual quality indicators and perceived educational benefit. These findings have implications for medical student education and surgical training.

Among medical students, endoscopic ear surgery was superior to microscopic ear surgery for several visual quality indicators and perceived educational benefit. These findings have implications for medical student education and surgical training.

We investigated whether preoperative nutritional indicators predicted the prognosis for patients with early-stage non-small cell lung cancer.

Data for stage I or stage IIA non-small cell lung cancer without lymph node metastasis patients who received anatomical lung resection and were followed-up at least five years after surgery (

=286) were analyzed. We calculated geriatric nutritional risk index, prognostic nutritional index, controlling nutritional status score, and modified Glasgow prognostic score. Multivariate Cox proportional hazard model adjusting for age, BMI, complication, pathological stage, histology of squamous cell carcinoma, T factor, diffusing capacity for carbon monoxide, surgery and smoking status was fitted to evaluate the association between these nutritional indicators and mortality and recurrence within five years.

After adjusted for covariates other than type of surgery and diffusing capacity for carbon monoxide, controlling nutritional status of ≥3 was significantly associated with mortality (hazard ratio (HR) = 2.68, 95% confidence interval (CI) = 1.02, 7.01). The association remained marginally significant by adjusting for type of surgery and diffusing capacity for carbon monoxide (HR = 2.44, 95% CI = 0.92, 6.45). controlling nutritional status of ≥3 was significantly associated with recurrence (HR = 2.60; 95% CI 1.20, 5.61) after adjusting for all covariates. Other nutritional indices did not predict the prognosis in multivariate analysis.

Preoperative high controlling nutritional status score was marginally and significantly associated with mortality and recurrence of non-small cell lung cancer patients after lung resection.

Preoperative high controlling nutritional status score was marginally and significantly associated with mortality and recurrence of non-small cell lung cancer patients after lung resection.

Vascular rings are aortic arch anomalies with a spectrum of manifestations ranging from asymptomatic lesions detected incidentally to an acute presentation secondary to tracheo-esophageal compression. Circumflex retro-esophageal aortic arch is an extreme form of true vascular ring. It remains an uncharted territory to many surgeons.

A comprehensive search of peer reviewed journals was completed based on the key words, "Circumflex aorta," "Circumflex retro-esophageal aorta" and "circumflex arch" using Google scholar, Scholars Portal Journals and PubMed. The reference section for each article found was searched to obtain additional articles. Literature on the circumflex aorta was reviewed starting from the embryogenesis to the latest management strategies.

Right circumflex aorta is more prevalent compared to left circumflex aorta. It can occur in isolation or in association with other intracardiac lesions. Mainly presents in children, however reported in adults too. The presentation may vary from asymptomelpful in addressing residual tracheomalacia but this accounts for a high-risk surgery.

Cancer is the second leading cause of death before the age of 70. Improved cancer survival has put increasing demands on cancer care. Palliative care is the specialized multi-disciplinary care providing relief from the pain, symptoms, and stress of serious illness. The study aims to evaluate the adjunctive effect of acupuncture for advanced cancer patients in a collaborative model of palliative care.

This is a single-blinded, randomized, sham-controlled trial. One hundred twenty advanced cancer patients undergoing palliative care will be randomized in a ratio of 211 to manual acupuncture plus standard care group (ASC), sham acupuncture plus standard care group (SSC), and standard care group (SC). Patients in ASC and SSC will receive 9 sessions of acupuncture or sham acupuncture for 3 weeks, and will be followed up for 2 months. The primary measure is the change from baseline score of the Edmonton Symptom Assessment System at 3 weeks. The secondary measures include the Brief Fatigue Inventory, Hospital Anxiety and Depression Scale, Insomnia Severity Index, Numeric Rating Scale, and European Organization for Research and Treatment of Cancer Quality of Life 15 items Questionnaire for Palliative Care.