Admission Criteria Research Articles

An Evaluation of the Attainment Gaps in State Schools in England: Evidence from Next Steps’ Age 25 Sweep Dataset

This paper evaluates the higher education (HE) admissions policy by examining the educational attainment gaps in state schools of young people from different socio-economic backgrounds in England. We analysed data for a cohort of 5192 state-educated young people from the large-scale nationally representative longitudinal Next Steps dataset from 2004 to 2015, linked to the robust administrative National Pupil Database (NPD) for England. The analytical methods used include effect sizes and correlations. The results show a clear pattern of the socio-economic stratification of young people’s educational attainment. Pupil deprivation is a key indicator which is consistently associated with lower educational attainment. While this is not surprising, our study also suggests that there are other factors besides the family backgrounds which are associated with young people’s educational outcomes. Pupils’ enjoyment of school, their educational aspirations, and their parent’s aspirations for their children are found to have a positive correlation with attainment at school, suggesting that educational aspirations and positive school experiences might contribute to a narrowing of deprivation-related gaps. As the analyses also suggest that young people who went to university and those in professional occupations consistently achieved higher academic performance than their peers, the findings have policy implications for improving social mobility. While it is not possible to alter parents’ socioeconomic backgrounds, raising children’s aspirations and making school enjoyable are amenable to policies and interventions. The common practice of using academic attainment as a selection criterion for admission to HE is likely to disadvantage children from low socioeconomic families, with implications for social mobility. The contextualised admission (CA) policy should lead to fairer approaches, which could be used for admissions to HE.

P-2348. Predictors of Dengue Outcome after Adoption of a Management Protocol

Abstract Background Dengue caused a large outbreak in Nepal with over 54,000 reported cases in 2022. Once considered a disease of tropics, dengue has expanded to subtropical and temperate regions of Nepal including Kathmandu valley. A standard protocol, which included screening criteria for admission and treatment based on severity, was adopted at our hospital which is located at the epicenter of 2022 outbreak. Methods We enrolled 261 patients admitted to Patan Academy of Health Sciences between August and October, 2022. We analyzed patients’ baseline clinical and laboratory characteristics as predictors of outcomes including duration of stay and mortality. Results The mean age of the patients was 40.9 (±19.1) years with female predominance (54.4%). Most patients were from Lalitpur district followed by Kathmandu, which are the main catchment areas of the hospital and epicenter of 2022 outbreak. Most common clinical presentations included fever (93.5%),followed by vomiting (65.5%), myalgia (52.1%), headache (45.6%), mucosal bleeding (18.4%), eye pain (16%), anorexia (13.8%), loose stools (13.8%), and rash (10%). The patient’s age correlated directly with both systolic and diastolic blood pressures (p=0.002 and 0.01, respectively), and inversely with platelet counts (p=0.002). Duration of hospital stay (median 3, IQR 2 days) correlated with aspartate aminotransferase (median 141 U/L) and alanine aminotransferase (median 90.5 U/L) levels at presentation (p< 0.001 and p=0.03, respectively). Hemorrhagic rash occurred in 10 patients and was associated with low platelets at day 1 of admission (p=0.01). There were no deaths. Conclusion Elevated aminotransferases as a marker of hepatocellular injury was the main predictor of longer duration of hospital admission. With adoption of a standard screening and treatment protocol, despite varied clinical presentations and complications, no fatalities occurred among the 261 adult patients in our hospital. This underscores the importance of early detection and proper management in effectively combating the disease and preventing mortality. Disclosures All Authors: No reported disclosures

Development and validation of a prognostic nomogram for predicting of patients with acute sedative-hypnotic overdose admitted to the intensive care unit

To develop and evaluate a predictive model for intensive care unit (ICU) admission among patients with acute sedative-hypnotic overdose. We conducted a retrospective analysis of patients admitted to the emergency department of West China Hospital, Sichuan University, between October 11, 2009, and December 31, 2023. Patients were divided into ICU and non-ICU groups based on admission criteria including the need for blood purification therapy, organ support therapy (ventilatory support, vasoactive drugs, renal replacement therapy, artificial liver), or post-cardiopulmonary resuscitation. Patients were randomly split into a training set and a validation set in a 7:3 ratio. Least Absolute Shrinkage and Selection Operator (LASSO) regression was used to optimize variables, followed by a multivariate logistic regression analysis to identify independent risk factors for ICU admission. A nomogram model was constructed and assessed using receiver operating characteristic (ROC) curves, calibration curves, Decision Curve Analysis (DCA), and Clinical Impact Curve (CIC). Predictors in the nomogram included barbiturate overdose, Glasgow Coma Scale (GCS) score, and anion gap at admission. The nomogram demonstrated strong predictive performance with an area under the curve (AUC) of 0.858 (95% CI: 0.788–0.927) in the training set and 0.845 (95% CI: 0.757–0.933) in the validation set. Calibration curves showed the model closely matched the ideal curve, and DCA and CIC indicated high clinical applicability and utility. Barbiturate overdose, initial decreased GCS score and decreased anion gap were identified as independent risk factors for ICU admission in acute sedative-hypnotic overdose. The nomogram model based on these indicators demonstrates good predictive accuracy, discrimination, and clinical utility.

Promoting Accessibility and Equity in Social Work Education : Measures to Develop Forms of Outreach, Access and Support During Studies for Migrants

The education and labour markets have become segregated. Migrants find it difficult to find employment in specialist jobs in the healthcare and social welfare sector that require a university degree and are linguistically demanding. Particularly in social work, the need for a diverse workforce has been recognised: workers should be more representative of the population and respond to the needs of an increasingly diverse client base. The Faculty of Humanities and Social Sciences at the University of Jyväskylä seeks to promote educational equity and to find ways to increase the representation of migrants in Finnish-medium social work degree programmes. This survey examines (a) how to better reach migrants to engage them in social work degree programmes, (b) how to improve access to degree programmes and (c) what kind of support should be offered to migrants during their studies. The survey proposes measures to promote accessibility and equity in social work degree programmes. While this survey focuses on a specific area of education, accessibility and equity issues concern the whole university field, which must be able to serve increasingly diverse groups of applicants and students. The results indicate that the marketing of social work degree programmes needs to be more clearly targeted at migrants: the recognition of social work needs to be increased, and the narratives of migrants’ careers and studies need to be shared across multiple channels and languages to make the pathways to university studies appear more accessible. New solutions are also needed to enable equitable access to degree programmes. When communicating about application and admission practices, linguistic accessibility should be considered. Similarly, the ongoing entrance examination reform should ensure cooperation with language, assessment and testing experts. Migrants should be offered the opportunity to be granted extra time in entrance examinations, so that they can compete with native speakers in student admissions. To improve conditions for equitable access, a dedicated admission path to a bachelor’s and master’s degree programme or a master’s degree programme must be established for migrants. As part of this, the linguistic accessibility of admission criteria and methods should be developed. The needs for linguistic support should be identified at the beginning of studies and appropriate language learning paths should be planned. Improving the accessibility of content studies requires a language-aware approach that integrates language and content, which, in turn, calls for the development of staff competence and resources for training and the consolidation of practices. A prerequisite for the targeting of these measures is the identifiability of migrants at universities. Overall, the promotion of educational accessibility requires addressing the issues of outreach, access and support during studies in parallel.

Tolerance for uncertainty and medical students' specialty choices: A myth revisited.

In 1962, the idea emerged that medical students' tolerance of uncertainty could determine their specialty choice. While some studies supported this claim, others refuted it, often using independently developed instruments. We explored whether the reported link between specialty choice and uncertainty tolerance is more myth than evidence by employing established instruments to investigate whether specialty choice could be explained by variance in uncertainty tolerance. We conducted a cross-sectional online survey at two periods of time. From February to June 2023, we queried 563 final-year medical students from 34 German medical universities (1) on their uncertainty tolerance using three validated tools (the modified tolerance for ambiguity scale, the physicians' reaction to uncertainty scale and the uncertainty intolerance scenario method) and (2) on their intended specialty choice. In a follow-up 1 year later (May to June 2024), 263 of those medical students responded to our query on their final specialty choice and again on their uncertainty tolerance. Participants' (N= 563) median age was 26.0 years (mean: 27.2; SD = 3.8), and 70% (n= 396) were female. Originally reported differences and rank orders in uncertainty tolerance among medical students with different intended specialty choices could not be replicated for any of the three scales. Instead, our results suggest different rank orders of uncertainty tolerance by different tools, as well as nonsignificant differences between intended medical specialties. Intercorrelation coefficient analyses demonstrated that, depending on the scale, only 0.3% to 1.5% of the variance in uncertainty tolerance could be attributed to specialty choice. Follow-up data using actual instead of intended medical choices left findings unchanged. Our findings suggest that the presumed link between uncertainty tolerance and specialty choice is more myth than evidence. Instead of teaching this link or using it as an admissions criterion, medical schools should equip students with the skills needed to navigate uncertainty across their careers.

The opportunities and effectiveness of the use of autologous platelet-rich plasma in plastic surgery, anti-age medicine and dermatology

Today, the use of autologous platelet-rich plasma expands the horizons of its use in medicine. However, to uncover the key factors of plasma effectiveness, more data is required, describing in detail the method of plasma preparation, the amount of material introduced, as well as data on a comparative analysis of various methods of its administration. The purpose of this review was to search for data on the use of autologous plasma in the fields of Anti-Age medicine, plastic surgery and dermatology with a description of the methodology, as well as local and general effects. Publications of foreign and domestic authors in the Scopus and Pubmed databases were analyzed. When searching using the keywords: platelet rich plasma, safety, effects, dermatology, cosmetology, surgery, melasma, acne, 570 publications were found. Taking into account the depth of the search (the last 5 years), the language of publications (Russian, English), 32 full-text articles were included in the analysis. The presence of a large number of studies demonstrates the high interest of scientists from all over the world in studying the properties and effectiveness of plasma. Positive results of using plasma were presented in the field of plastic surgery, cosmetology, and dermatology. However, the lack of a detailed description of the methodology of the procedure, and moreover, a unified standard algorithm for the procedure and criteria for admission to receiving plasma, creates difficulty in comparability of results, both positive and negative. Therefore, additional larger studies are required to help answer these unresolved questions.

The development of the profession and education of Prosthetics and Orthotics in South Africa.

The history of a profession is valuable literature as it recognizes the noteworthy contributions of its forerunners and the scientific evolution from its earliest state. The purpose of this paper is to recount the historical developments in the profession of Prosthetics and Orthotics (P & O) in South Africa. An electronic literature search identified 54 Sabinet and 17,400 Google Scholar records. Key search words were "medical orthotics and prosthetics," "South Africa," and "history." The selection criteria of literature were accomplished in the subsequent 3 phases: (1) the title review, (2) the abstract review, and (3) the full-text review. The records were screened by all 3 authors. Records were excluded if they were unrelated to the history and/or development of P & O in South Africa, the history and development of other medical professions in South Africa, the historical development of P & O in other countries, the historical development of other medical professions of other countries, and records that were non-English. No peer-reviewed record was found describing the history of P & O in South Africa. Faced with the paucity of peer-reviewed evidence, the authors browsed Tshwane University of Technology, Durban University of Technology, and Walter Sisulu University websites to secure historical context. The analyses of these P & O training institutions websites provide a glimpse of the history of P & O in South Africa. The authors had identified the following areas noteworthy to be reported on (1) the historical account of the profession in South Africa, (2) the recognized tertiary training institutions, (3) the minimum admission criteria to South Africa P & O training institutions, and (4) regulatory and statutory bodies of the profession of P & O in South Africa.

Assessment of the usefulness of Neurodevelopmental Centered Care (NCC) in relation to the knowledge and professional experience in Neonatal Intensive Care (NICU) of nurses in a public hospital in the city of Rosario

Prematurity is a well-known problem and a leading cause of newborn deaths. Premature newborns (PTNB) have criteria for admission to Neonatal Intensive Care Units (NICU) for care and survival with a series of neurodevelopmental risks. The aim of this study was to determine the assessment of the usefulness of Neurodevelopmental Centered Care (NCC) in relation to professional knowledge and experience in Neonatal Intensive Care Units (NICU) of nurses in a public hospital in the city of Rosario. A non-experimental, descriptive, qualitative-quantitative, cross-sectional study was carried out on the total population of nurses (25) working in the NICU. The data collection technique was the survey and a self-administered questionnaire was used with 12 items that accounted for the different indicators of the variables. The degree of the respondents showed some parity between undergraduate and undergraduate academic degree; and specific training in NCC -updated to the last year- represented a little more than a third of the population. The nurses' self-perception of their knowledge and experience to perform in the NICU was predominantly intermediate - 84% and 72% respectively. The mean usefulness assessment of 7 activities of the NCC in relation to the evolution and prognosis of the PTNB in the NICU had levels compatible with the range of maximum possible assessment (between value=5 and value=6): impact of stress prevention 5.80; family participation, noise control and pain prevention 5.76; care of the PTNB's posture 5.60; care of maneuvers and contact 5.52; and mother/parent kangaroo method 5.44. It is concluded that the valuation of usefulness of CCN in this population has been very high and no correlation is seen with the academic degree, the training present in CNN and the different levels of self-perceived knowledge and experience in the NICU

Asynchronous Resilient Filtering for Singular Perturbation Stochastic Semi‐Markov CPSs Against Stochastic Cyber Attacks

ABSTRACTThe article investigates the problem of asynchronous resilient filter design for cyber‐physical systems (CPSs) under multiple cyber‐attacks, which are characterized by singular perturbation and stochastic semi‐Markov jump systems (SPSS‐MJSs) with a dynamic‐memory event‐triggered (DMET) scheme. Firstly, we consider the vulnerability of communication network and establish a unified cyber‐attack framework to address the occurrences of deception attacks and denial‐of‐service (DoS) attacks, simultaneously. Then, we introduce the function of the memorizer and propose the DMET scheme, which can effectively save network resources in bandwidth‐limited environments. Since the mode information of the resilient filter is often unavailable, we employ a hidden Markov model (HMM) to describe the asynchronous relationship between the modes of the original system and the constructed filter. Furthermore, we judiciously select a stochastic Lyapunov functional concerning the internal dynamic variable, which results in the stochastically admissible criterion for filtering error systems under complex cyber‐attacks. The co‐design approach is adopted to obtain the gains of the asynchronous resilient filter and the DMET scheme. Finally, a continuous stirred‐tank reactor (CSTR) system is offered to validate the effectiveness of the developed method.

Identifying factors that underpin student decisions to pursue the Doctor of Pharmacy degree at Atlantic Canadian Universities: Protocol for a mixed methods study.

Several international studies have investigated academic decision-making in higher education, but there is limited research on students' choice to study pharmacy in the Canadian context. While there is some variation across jurisdictions, decisions to enroll in a particular degree program fall into several decision-making domains (e.g., personal, family, institutional, social, and economic). These findings have been theorized in various ways, for example, through social cognitive theory and social reproduction theory. The purpose of this study is to gain a better understanding of the personal, family, institutional, social, and economic factors that underpin student decisions to pursue the Doctor of Pharmacy (PharmD) degree at Atlantic Canadian Universities and to explore barriers to pursuing a pharmacy degree. The proposed study uses an explanatory sequential mixed-methods design consisting of a quantitative survey followed by qualitative interviews. All entry-to-practice PharmD students and graduates in Atlantic Canada are eligible to participate. The survey consists of several Likert scale questions associated with five decision-making domains, as well as several socio-demographic questions. Descriptive statistics and frequency counts will be used to describe the data; differences across decision-making domains, by gender and other demographic groupings, will be analyzed using inferential statistics. Semi-structured interviews with a sample of 12 to 15 participants will be conducted to further understand and explain the quantitative results. We will engage in thematic analysis of qualitative data. The findings of this research will provide insight into the decision-making patterns and socio-demographic characteristics of students who have chosen to pursue a PharmD. Important information will be gathered to inform health professional education and workforce planning, which we believe will contribute to improving healthcare resource capacity and patient outcomes in Atlantic Canada. The results of this project will also inform future recruitment strategies and admission criteria and support educators in the secondary school system in providing evidence-informed career counselling advice for students interested in pursuing a degree in pharmacy. The findings of this study may also be useful to educational leaders and policymakers.

Perceptions of stakeholders on the use of a simplified, combined protocol for treatment of acute malnutrition in Central African Republic.

Treatment of acute malnutrition requires novel approaches to improve coverage, reduce costs and improve the efficiency of standard protocols that separate the management of moderate acute malnutrition (MAM) and severe acute malnutrition (SAM). The use of simplified, combined protocols to treat both MAM and SAM has drawn research and policy interest among global, regional and national stakeholders. However, the perspectives of local communities and health care workers regarding the use of protocols to treat acute malnutrition in a routine health care system are generally lacking. This was a cross-sectional mixed-methods study aimed at assessing the perceptions of different stakeholders on the use of a simplified, combined protocol in two districts in the Central African Republic. Most of the respondents preferred the simplified, combined protocol over the standard protocol. They generally agreed that the protocol was easy to understand, allowed more children to receive treatment and was effective in treating acute malnutrition. The protocol modifications were well received, including the expanded admission criteria, use of mid-upper arm circumference (MUAC) only for admission and discharge criteria and reduced and simplified ready-to-use therapeutic food quantity to treat MAM and SAM. Some caregivers expressed concern with the use of MUAC only to declare recovery, flagging that underlying illnesses could still be present. The caregivers recommended the provision of other food basket interventions to improve the treatment. The support by caregivers and health care workers on the idea of training community health volunteers to treat acute malnutrition points to the potential of scaling up decentralized treatment to increase coverage in remote areas.

Improved outcome prediction in acute pancreatitis with generated data and advanced machine learning algorithms.

Traditional scoring systems have been widely used to predict acute pancreatitis (AP) severity but have limitations in predictive accuracy. This study investigates the use of machine learning (ML) algorithms to improve predictive accuracy in AP. A retrospective study was conducted using data from 101 AP patients in a tertiary hospital in Türkiye. Data were preprocessed, and synthetic data were generated with Gaussian noise addition and balanced with the ADASYN algorithm, resulting in 250 cases. Supervised ML models, including random forest (RF) and XGBoost (XGB), were trained, tested, and validated against traditional clinical scores (Ranson's, modified Glasgow, and BISAP) using area under the curve (AUC), F1 score, and recall. RF outperformed XGB with an AUC of 0.89, F1 score of 0.82, and recall of 0.82. BISAP showed balanced performance (AUC = 0.70, F1 = 0.44, and recall = 0.85), whereas the Glasgow criteria had the highest recall but lower precision (AUC = 0.70, F1 = 0.38, and recall = 0.95). Ranson's admission criteria were the least effective (AUC = 0.53, F1 = 0.42, and recall = 0.39), probable because it lacked the 48th h features. ML models, especially RF, significantly outperform traditional clinical scores in predicting adverse outcomes in AP, suggesting that integrating ML into clinical practice could improve prognostic assessments.

Determination of the Reference Intervals of Clinical Biochemistry Tests by Direct and Indirect Methods: a Multicentric Study.

The aim of this study was to determine the reference intervals of 14 clinical biochemistry tests in healthy individuals aged 18 - 65 years. The reference intervals determined by using direct and indirect methods were compared with each other and the manufacturer's RI in terms of gender. Blood was collected from 302 reference subjects selected on the basis of admission and exclusion criteria based on the procedures set out in document C28-A3, and 14 clinical chemistry tests were performed using the analytical systems available in our laboratory. The analyses were conducted using the MedCalc and SPSS20 programs in the direct method and the Bellview (1.2.6 Version) program in the indirect method, according to the Bhattacharya procedure. Nine biochemical tests showed statistically significant differences according to gender (p < 0.05). These tests include alkaline phosphatase, lactate dehydrogenase, high-density cholesterol, low-density cholesterol, urea, uric acid, triglycerides, total cholesterol, and inorganic phosphate. The direct method was the first method used to obtain the reference intervals. The indirect method can be used as an alternative to the direct method for AMLY and UA tests for the general population. According to the manufacturer's RI, lower and upper limits of HDL, LDL, Ca, and Mg were compatible with indirect RI in two genders. Lower and upper limits of ALP, LDH, and ALB were compatible with manufacturer's RI in female.

"For their own good". Medical assistance in dying: a right for whom?

The admission criteria to the medical assistance in dying (MAID) procedures (Euthanasia - E; Physician Assisted Suicide - PAS) represent a much debated issue. In most of the jurisdictions where MAID is legal, the unbearable suffering due to a terminal illness constitues the main admission condition. In contrast, those suffering from either a mental disorder or an existential discomfort are excluded. Some consider the exclusion of the former group to be protective towards those deemed vulnerable because they are not able to make free and informed decisions, while the latter is excluded to align the legal approaches to the prevailing moral models. Others consider these stances discrimination. To prove that when someone requests MAID, his suffering should be first and foremost investigated not only and not so much for its causes, but, above all, for its key role played in understanding the MAID request. After reviewing the specific aspects of suffering in relation to his three determinants - existential suffering, mental disorder, terminal illness - the article provides the evidence that: a) such a conditions, although completely different from each other, share the same psychological processes leading to the unbeaerable suffering and then to the request for MAID or to the suicide ideation/completion; b) there is no scientific data supporting a discrimination access to MAID on the basis of the presence/absence of a terminal illness. Using the unbearable suffering due to a terminal illness as the sole criterion for admission to MAID violates the principle of autonomy, and, lacking scientific evidence, it does not clarify where the line is drawn between those who should be entitled to MAID and those who should not.

입학전형 유형에 따른 대학적응경로 다집단분석: D 대학을 중심으로

Objectives This study was conducted to investigate whether there are differences in academic adaptation trajectories among multiple groups based on admission criteria. Methods For analysis, we obtained cooperation from the CS Center on campus and collected data from 17,969 students enrolled in the 2022 academic year. Descriptive statistics and correlation analyses were performed to determine the data normality and the relationship among variables. In addition, the Mplus program was used to analyze a structural equation model that established the relationship among department satisfaction, student support infrastructure, academic commitment, and GPA, and a multigroup analysis was conducted to verify the difference in pathways between groups according to the admission criteria. Results The structural model, which posits that department satisfaction and student support infrastructure influence GPA through departmental immersion, was found to be appropriate. In the multi-group analysis results comparing four groups—comprehensive student record admission, outstanding academic record admission, regular admission, and transfer admission—statistically significant differences in path coefficients were observed when comparing the comprehensive student record admission group with both the regular admission group and the outstanding academic record admission group. Conclusions It was found that there are differences in the relative impact of satisfaction and support infrastructure on departmental immersion depending on the type of admission. This finding suggests that such information could serve as foundational data for shaping student support policies.

A Mixed-Methods Exploration of the Admissions Process and Criteria for Inclusive Postsecondary Education Programs

The exponential growth of inclusive postsecondary education (IPSE) programs in the United States has reshaped transition pathways for many young adults with intellectual and developmental disabilities (IDD). However, limited research pertains to the admissions process and eligibility criteria of IPSE programs, leading to a lack of knowledge of how to best equip students for successful entry into college. We conducted a survey ( n = 89) and interviews ( n = 14) with IPSE staff members to explore the admissions process and eligibility criteria of IPSE programs and the extent to which staff views align with the criteria of their programs. Our sample represented 62 programs across 32 states. Findings indicated that, although admissions criteria vary widely, most IPSE programs evaluate applicants based on their functional skills and social behaviors rather than academic skills. We share implications for research and practice in transition planning, secondary instruction, and college preparation for students with IDD.

Navigating “Promising Victimhood:” Discretionary Practices of UNHCR Caseworkers in Rwanda’s Refugee Resettlement Process

Executive Summary As the global refugee population continues to expand, resettlement opportunities remain scarce, accessible only to a select few. Scholarly literature has increasingly drawn attention to the opaque bureaucratic processes, often referred to as “black boxes,” that govern resettlement selection, revealing that the decision-making practices determining which refugees are chosen for resettlement are still not well understood. This study addresses a critical gap concerning the implementation of selection criteria within UNHCR’s operations in the Global South, with a specific focus on caseworkers in Rwanda. It examines how these criteria are applied in practice, providing new empirical insights into the concept of “promising victimhood” — the contradictory demands placed on refugees to simultaneously demonstrate both vulnerability and integration potential to qualify for asylum or resettlement. The study explores how caseworkers navigate their roles amidst the complex and often conflicting demands imposed on refugees during the selection process. The analysis is grounded in interviews with sixteen caseworkers involved in resettlement selection, employing street-level bureaucracy theory alongside the concepts of refugee deservingness and promising victimhood. As key actors in the selection process, caseworkers exercise bottom-up power as policy implementers, while simultaneously adhering to the top-down directives established by resettlement states. The findings reveal that caseworkers employ a range of discretionary practices to reconcile the demands of resettlement states’ admission criteria with their advocacy for refugees deemed most vulnerable by the UNHCR. This research enhances our understanding of UNHCR’s operations at the street level, shedding light on how the practices of caseworkers influence perceptions of refugee eligibility and ultimately influence who is granted resettlement.

Management of diabetic keto-acidosis in adult patients admitted to intensive care unit: an ESICM-endorsed international survey

BackgroundGuidelines for diabetic ketoacidosis (DKA) management are limited, resulting in varied practices. This study assessed Intensive Care Unit (ICU) admission criteria, fluid resuscitation, insulin therapy, and metabolic management in adult patients with DKA.MethodsAn international survey of ICU clinicians consisted of 39 items that focused on management of DKA and was endorsed by the European Society of the Intensive Care Medicine. An experienced ICU was defined as a unit admitting > 20 patients with DKA per year.ResultsA total of 522 respondents from 57 different countries participated: 295(57%) worked in Europe, 86(16%) in North America, 25(5%) in South America, 52(10%) in Africa, 52(10%) in Asia and 12(2%) in Oceania. Among respondents, 377(72%) worked in teaching hospitals, 355(68%) in medical-surgical ICUs, and 204(39%) in experienced ICUs. The pH value (< 7.20), arterial or venous bicarbonate concentration (< 15 mmol/L), and the need for continuous intravenous insulin (regardless of the dose) were considered criteria for ICU admission by 362(69%), 240(46%) and 264(51%) respondents, respectively. A protocol for fluid resuscitation was available for 290(63%) respondents, 135(29%) administered isotonic saline only, 173(38%) administered balanced solutions only, and 153(33%) administered both. A protocol for insulin therapy was available for 355(77%) respondents. An initial bolus of intravenous insulin was administered by 228(49%) respondents, 221(48%) used an initial continuous intravenous insulin dose of 0.1 UI/kg/h, 42(9%) used an initial predefined fixed dose, 159(35%) based the initial dose on blood glucose and 39(8%) on blood and/or urine ketones. Fluid choice and modalities of intravenous insulin administration did not differ between experienced and non-experienced ICUs. Intravenous insulin administration was more likely to be initiated upon ICU admission (57%vs.45%, p = 0.04) and less likely after initial fluid resuscitation (27%vs.35%, p = 0.04) in experienced ICUs. Arterial or venous pH was monitored by 408(90%) respondents. Arterial blood gases were favored by 236(52%) respondents and venous blood gases were more likely to be performed in experienced ICUs (30%vs.18%,p < 0.01).ConclusionsThe management of patients with DKA remains heterogeneous worldwide. Future randomized trials are needed, especially regarding fluid resuscitation and insulin therapy.Trial registrationNot applicable.

Justification and motivation of court decisions in the structure of criminal procedural evidence in the court of first instance

The article is devoted to the analysis of theoretical approaches, normative provisions and the practice of their application regarding the justification and motivation of court decisions in the process of criminal procedural proving in the court of first instance. The problem of the ratio of justification and motivation of court decisions in the context of national legislation and practice of the ECtHR is considered. It is emphasized that the justification and motivation of court decisions is a component of the court's use of evidence as an element of criminal procedural proving in the court of first instance. It is suggested that the justification and motivation of court decisions should be considered as a logical-intellectual and practical activity of the court, which is carried out within the scope of the proving process and consists in citing in the motivational part of the court decision references to legal norms, the set of evidence and arguments laid as its basis, proper and sufficient motives and grounds for its adoption, answers to significant arguments of the parties in the criminal proceedings, which collectively confirm the correctness of the adopted decision and ensure its persuasiveness. A proper definition of the category «rejection of prosecution evidence» is proposed as an activity of the court in the process of justifying and motivating an acquittal, which consists in the absolute exclusion of certain evidence provided by the prosecution from the process due to their non-compliance with the criteria of propriety, credibility and admissibility, in particular, obtaining them in violation of rights and human freedoms. In other words, rejection of evidence at the stage of making a court decision is a complete disregard for their informational value (content) and all conclusions of the prosecution based on this evidence. Under the category of «motives for disregarding certain evidence» it is proposed to understand the legal and factual explanations of the court reflected in the court decision (sentence or resolution) as to why exactly this evidence cannot be used as a basis for justifying the court decision. Key words: court decision, court of first instance, proving, use of evidence, rejection of evidence, justification of court decision, motivation of court decision.

Personality and interest in general practice: results from an online survey among medical students

BackgroundThe growing shortage of General Practitioners (GPs) is a Europe-wide challenge, particularly in rural areas. In Germany, the situation is worsened by an ageing workforce of GPs and insufficient training of new doctors. Many newly qualified physicians choose careers outside primary care or prefer to work part-time to balance work and family life. To address this problem, it is essential to understand the factors that influence medical students’ specialty choice, and then to take action to encourage them to specialise in General Practice (GP). In addition to medical school experiences, rural placements, or characteristics of the specialty, personality traits have been shown to influence students’ specialty decisions. A well-researched approach to assessing personality is the Five-Factor Model, which measures personality on the dimensions openness (to experience), conscientiousness, extraversion, agreeableness, and neuroticism. Using the findings about the links between students’ personalities and an increased interest in a career in General Practice may be an approach to raising the number of GPs.ObjectivesWe aimed to examine how students’ personality traits influence their interest in General Practice and their current intention to pursue General Practice as a specialty.MethodsIn March 2021, we started an ongoing online survey among medical students at the University of Würzburg and assessed cross-sectional data about the ‘Big Five’ personality traits and aspects of career choice. Until December 2022, we invited three cohorts of first-year beginners, and one cohort each of third-, fifth- and sixth-year students via email to participate in the survey. For statistical analysis, we performed linear regression and extended it into a path model to examine the relationship between students’ personality traits, their interest in General Practice, and whether they would currently choose General Practice for their future specialty. We controlled for possible confounding effects of age, gender, and current semester by using covariates.ResultsHigher levels of agreeableness and neuroticism predicted greater interest in GPs, whereas higher levels of conscientiousness and openness predicted less interest in GPs. The effects of extraversion were unclear. Age was a significant predictor of interest, with older age associated with greater interest in General Practice. Gender was not a significant predictor of interest in General Practice, and the results for semester were inconclusive. The interest in General Practice is a predictor of the intention to choose GP as a specialty. The personality dimensions show an indirect predictive effect on the intention to choose GP, mediated by interest in GP. In total, R² = 7.7% of the variance of the interest in GP was explained by the combination of personality dimensions and covariates.ConclusionOur study reveals that students’ personality traits predict their interest in General Practice and their intention to choose it as a specialty. Personality assessments can be integrated into counselling services to help students better understand their traits. Our findings highlight the great potential of considering personality in career counselling during medical education or even the extent of admission criteria to medical school by personality-related criteria.