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Emergency Management in Japan: Human Decision‐Making Strategy Analysis During Large‐Scale Earthquake

ABSTRACTIn the context of unexpected disasters, comprehending individual decision‐making strategy is essential for governmental policy formulation and evacuation planning. The main challenges stem from the absence of large‐scale mobility data and the complex influences of multiple factors on personal strategies. To address this, this study focuses on the 2011 Tohoku earthquake in Japan as a case, which struck at 14:46 on March 11, a typical working day. Decision‐making strategies regarding how people return home from their workplaces have emerged as a primary concern. Therefore, we construct a large human mobility database for the Greater Tokyo area, and develop an empirical prediction for decision‐making strategies following earthquakes with the consideration of multiple factors. Except for users' location‐based information, we extract the grid‐based stay areas from historical stay records (normal days before disasters) and discover the functions of these areas combined with points of interest located within them. Experimental results indicate the effectiveness of our proposed framework in strategy prediction. Besides, we conduct an explainable feature importance analysis of key factors, which also provides insights for understanding human decisions during disasters.

Non-returning factors from an interview survey of 16 residents of Katsurao village 12years after the Fukushima nuclear power plant accident.

People generally wish to return home after being evacuated due to disaster situations. Evacuation orders have now been lifted in the Fukushima region following the nuclear accident in 2011, and the Japanese government is promoting a return policy. However, many residents who wish to return home remain unable to and continue living in evacuation sites or other areas. Sixteen residents of Katsurao village were interviewed after evacuation orders were lifted in 2016 who have not yet returned. Concerns were cited regarding radiation, prolonged evacuation, health problems, buying a house in the evacuation area and schooling. The problems identified were primarily due to the rapid ageing and decline of the regional population, reflecting similar issues throughout Japan. In particular, health problems and intention to return were thought to be closely related. Over 10 y have passed since the evacuation, and many residents have experienced familial separation and divided living situations.

QLTI-18. TREATMENT AND OUTCOMES OF FRAIL PATIENTS WITH NEWLY DIAGNOSED HIGH-GRADE GLIOMAS: SHOULD WE CONSIDER CHANGING OUR TREATMENT APPROACH?

Abstract BACKGROUND Patients with newly diagnosed high-grade glioma (HGG) and low Karnofsky Performance Status (KPS) often face challenges in receiving cancer-directed therapy. They are excluded from prospective trials, limiting the chance of developing novel therapeutic approaches. METHODS We retrospectively reviewed charts of patients with functional debility and newly diagnosed HGG who received radiotherapy (RT) while admitted to the inpatient service at Memorial Sloan Kettering between 2013 and 2023. Multivariable analyses were performed which associated patient demographics, KPS, histology, genetic and molecular pathology, RT duration and dose, chemotherapy, palliative/supportive care consultation, and advanced care planning documentation with overall survival (OS) and discharge location, separately. RESULTS Fifty-four patients were identified; median age was 68 years (range:21-86) and 28 (52%) were women. Median KPS was 50 (range:30-70). Per WHO 2021 criteria, 47 (87%) were glioblastoma, IDH wild-type and 7 (13%) were HGG not otherwise specified, diagnosed by biopsy in 30 (56%), subtotal resection in 23 (43%), and gross total resection in one. MGMT promoter methylation was performed in 39/54 and was hypermethylated in 15 (38%). All patients received RT and 52 (96%) with concurrent temozolomide; 47/54 (87%) completed planned RT, with the median dose of 4,005 cGy in 15 fractions. 13 (24%) received bevacizumab. The median length of stay (LOS) was 29 days (range:20-65). Only 17 (31%) had palliative care consultation prior to discharge. The median OS (mOS) from the last radiation treatment was 4.21 months (95% CI: 2.73, 6.63). In multivariable Cox and logistic regression, respectively, lower KPS remained the sole factor significantly associated with increased risk of death (p=0.004) and decreased chance of return home (p=0.040). CONCLUSION In our patient cohort, treatment was associated with prolonged LOS and poor outcomes. A clinical trial should be considered to evaluate shorter RT courses and early palliative care consultation in this patient population.

Parental expectations of residential immersive life skills programs for youth with disabilities and their perception of youth changes

Purpose This study explored parents’ expectations before their youth with a disability attended a Residential Immersive Life Skills (RILS) program, and perceptions of youth change over the following 12 months. Understanding expectations is important because parents play a key role in shaping their youth’s ongoing development and future hopes when they return home. Methods A secondary analysis of qualitative interviews with 13 parents was conducted using a recurrent cross-sectional analysis approach at three time-points: before youth attended a RILS program, and three and 12 months post-program. Results Before the RILS program, most parents focused on “concrete” life skills (e.g., self-care, budgeting), with some hoping for more youth self-awareness. After three months, many expectations were exceeded, leading some parents to re-evaluate their youth’s future. By 12 months, expectations had evolved further, although some parents expressed disappointment in perceived lack of change. Many parental expectations had been initially implicit and unstated. Conclusions Exploring parental expectations of RILS programs is critical, as parents can both enhance and diminish their youth’s personal growth and future aspirations. Parents should understand how RILS programs may (or may not) change both the youth and the family dynamic upon return home.

Life after exile: Introducing a new dataset on post-exile fate

Recent research in international relations and comparative politics has highlighted the post-tenure fate of leaders, particularly exile. Scholars view exile either as a punishment or a “golden parachute” offering a safe exit with potential future power. To assess which perspective aligns with reality, we developed a dataset tracking exiled leaders’ fates across three periods: during exile, upon returning home, and beyond. Our findings reveal significant variations, but the majority of exiled leaders eventually return home and resume power. This suggests a need to reconsider research that groups exile with punishments like imprisonment or execution.

Deltopectoral approach without subscapularis detachment for reverse shoulder arthroplasty. Technique and results of a safe and reproducible subscapularis-sparing approach

AimsThe importance of the subscapularis for reverse total shoulder arthroplasty (rTSA) has been demonstrated, especially for internal rotation and stability. In a deltopectoral approach, a detachment of the subscapularis is performed (tenotomy, tuberosity peeling or osteotomy) but the tendon is not always repairable at the end. When it is repaired, healing is obtained in only 40% to 76% of the cases, with potential consequences for the outcomes. The Anterior Muscle-Sparing (AMS) approach is a deltopectoral approach with preservation of the subscapularis, providing a solution to these problems. We present the surgical technique and results. MethodsIn a retrospective study, we included our first 45 cases of rTSA performed with the AMS approach for a degenerative affection of the shoulder (massive rotator cuff tear, cuff tear arthropathy, primary glenohumeral arthritis, rheumatoid arthritis), excluding traumatic and revision cases. The subscapularis was intact in all the cases. The mean age at inclusion was 74.1 years. No patients were lost at the minimum 24-month follow-up. All the patients underwent a clinical evaluation preoperatively and at the last follow-up, including Constant score, simple shoulder value (SSV), pain scale, and range of motion. An X-ray evaluation was conducted postoperatively and at the last follow-up to assess implant positioning and evolution. ResultsThere was no intraoperative complication, and the mean operative time was 62 minutes. We observed a significant improvement in Constant score (from 36 to 70, p <.001), SSV (from 33 to 81, p <.001), pain (from 6.3 to 0.7, p <.001), strength (from 0.5 to 3.5, p <.001), and most of the active mobilities. Regarding internal rotation, 95% of the patients reached level L3 or higher. Glenoid positioning was considered optimal in more than 90% of the cases (inferior tilt and low position) without any occurrence of superior tilt or high position. The osteophytes could be totally removed in 8 out of 9 cases (88.9%). Six postoperative complications (13.3%) were reported: 1 infection (2.2%), 2 cases of traumatic glenoid loosening (4.4%), 2 acromion fractures (4.4%), and 1 hematoma (2.2%). There was no instability. Eighty percent of the patients could return home, with a mean hospital stay of 1.8 days. ConclusionThe AMS approach is a safe and reproducible technique. The preservation of the subscapularis has potential benefits regarding internal rotation and stability. In the absence of tendon suture, rehabilitation can be started immediately without motion restriction, allowing for a fast recovery and return to autonomy.

Mudik Assistance Application Using Android-Based Scrum Method

Homecoming is an activity undertaken by nomads and migrant workers to return to their hometowns. In Indonesia, going home is synonymous with annual traditions starting from religious and national holidays such as Eid al-Fitr, Eid al-Adha, Christmas and New Year. However, going home is often accompanied by traffic jams and confusion, which can be a nuisance for travelers. Therefore, a possible solution to overcome this problem is to develop a mobile application to support homecoming. This research focuses on developing an Android-based homecoming assistance application using the Scrum methodology. The aim is to create technological solutions that make it easier for Indonesian people to return home every year. The development process is divided into sprints, and each sprint lasts two weeks. Each sprint includes planning, developing, and evaluating features such as real-time maps, traffic information, stop locations, and emergency response systems. The development team works closely with stakeholders to ensure that the application meets user needs. The research results show that the use of the Scrum methodology increases development efficiency and improves the quality of the final product. The resulting application prototype received a positive response in user testing. 90% of participants found the app useful when returning home. In conclusion, the development of homecoming assistance applications using the Scrum methodology has produced an effective and user-friendly solution to help travelers. This research opens up opportunities for further development and large-scale implementation in the future.

Factors that Hinder the Return of the IDPs to their Homes at Marawi’s Most Affected Areas

ABSTRACT This study is designed to investigate the factors hindering the return of the internally displaced persons (IDPs) in Marawi City resulting from the May 2017 Marawi Siege to the most affected area (MAA), revealing the urgent need for holistic solutions that address property ownership, socio-economic challenges, security concerns, administrative hurdles, and psychological trauma. The primary data required in the study were scientifically obtained through the use of the FGD and key informant interview (KII) methods. More specifically, the study findings disclosed that despite the fact that over 86% of Marawi's displaced longing to return home, a multitude of obstacles stand in their way such as inadequate housing, insecure land ownership, limited livelihoods, lingering trauma, and bureaucratic hurdles create a tangled web of challenges. Moreover, the aforementioned findings were further exacerbated by the exclusion of undocumented residents from reconstruction efforts, widening inequalities and stalling progress. To facilitate a smooth return, comprehensive solutions addressing financial constraints, trauma, community rebuilding, and streamlined administrative processes are critical. Only then can Marawi's displaced rebuild their lives and restore their shattered sense of home. Hence, a comprehensive housing plan offering reconstruction support, flexible payment options, and diverse shelter models for non-owners is crucial; exigent empowerment through financial assistance, skills training, and infrastructure development; addressing psychological well-being through culturally sensitive mental health programs; building trust and accountability requires transparency in resource allocation and addressing concerns about bogus beneficiaries and unauthorized demolitions; and collaboration between government agencies, NGOs, and communities empowers IDPs and ensures their voices are heard.

Finding the “way back”: Displacement and the imaginings of home in Niq Mhlongo’s Way Back Home

ABSTRACT This article explores the polysemy and ambivalence of “home” in Niq Mhlongo’s Way Back Home, identifying “home” as a place of belonging and origin, as well as a repository of history. It begins by situating the novel in a post-apartheid context, identifying the allegorical potential of its main characters. The article primarily focusses on the material and spiritual journeys of Kimathi, the novel’s protagonist, while also giving consideration to the journey of his victim, Senami (alias Lady Comrade Mkabayi). Informed by Homi Bhabha’s conception of the unhomely, this article argues that the loss of home constitutes a trauma of displacement for Kimathi and considers whether his return home suggests the possibility of closure for both him and South Africa as a nation. Finally, it observes how Way Back Home invokes Njabulo Ndebele’s assertion that South Africans are “yet to return home” to justice and the ideals of democracy.

Caregivers' Mastery in Handling Gastrostomy at Home after Educational Intervention: Qualitative Descriptive Study.

Effective hospital discharge planning is crucial, particularly in educating caregivers on handling medical devices. This education helps manage the patient's signs and symptoms, prevents post-discharge complications, and reduces early readmissions. This study aimed to understand aspects involved in the acquisition of mastery by home caregivers, in handling care of a patient who just underwent gastrostomy, after educational intervention during hospitalization and telemonitoring upon return home. Qualitative descriptive study. It followed 15 caregivers of people with percutaneous endoscopic gastrostomy. The intervention took place between November 2022 and July 2023 in the neuromusculoskeletal unit of a Brazilian university hospital. The educational intervention had four stages. In stage 1, caregivers felt confused and uncertain about managing PEG. By stage 2, they expressed a desire to be capable of handling care, especially in the event of potential complications, and showed increased awareness and engagement. Stage 3 highlighted the effectiveness of hands-on training with feedback from professionals. In stage 4, during monitoring, several complications were noted, including granuloma formation in the stoma, tube obstruction, and accidental tube loss. However, caregivers demonstrated the ability to handle these situations, indicating the effectiveness of the training and telemonitoring interventions. Nursing professionals should consider various factors when training caregivers in a hospital setting, including providing adequate space, allocating sufficient time for educational interventions, offering both theoretical and practical demonstrations, ensuring effective communication, and taking into account the caregivers' context, as they play a direct role in acquiring a safe and effective skill set.

Poisoning with Local Anesthetics Following Circumcision : A Case Report

Introduction: Circumcision or posthectomy is the removal of the foreskin, this act seems commonplace practiced by paramedical personnel or unqualified traditional practitioners who may cause significant complications. Objective: Our work aimed to highlight one of the complications of this act which must remain a supervised medical act. Observation: We report the case of a 2-month-old infant who presented with complications related to anesthesia. the clinic was dominated by convulsions and alteration of the state of consciousness 15 minutes after circumcision in this well infant carrying without any particular history. The evolution was favorable thanks to support rapid and urgent about 20 minutes with the cessation of convulsions and a return to consciousness, the patient was monitored for 48 hours then return home was indicated due to the absence other complications. Conclusion: Circumcision is a widespread act throughout the world either by medical necessity or by religious tradition. its trivialization and its practice by non-experts, explains the multiple complications observed.

Incidence, predictors and outcomes of non-home discharge following transcatheter aortic valve implantation: a multicentre Australian experience. The NHD TAVI study

Abstract Background Patients undergoing transcatheter aortic valve implantation (TAVI) commonly experience non-home discharge (NHD), a phenomenon associated with increased health-care expenditure and possibly poorer outcomes. Despite its relevance to patients, post-TAVI NHD remains poorly explored in the literature. Purpose To characterise the incidence and predictors of NHD following TAVI, understand its impact on quality of life, and identify the proportion of patients that require long-term residential care following initial NHD. Methods Retrospective analysis of prospectively collected data of 2229 patients undergoing TAVI from 2010–2023 included in an Australian TAVI Registry. Results Median age was 82 (IQR: 78-86) years and 41% were female. 257 (11.5%) patients were not discharged home following TAVI, with incidence falling over time (R2=0.636, p&amp;lt;0.001). Multivariable logistic regression modelling for NHD prediction was developed with excellent calibration and discrimination (C-Statistic 0.835). Independent predictors of NHD were post-procedural stroke (adjusted odds ratio [aOR] 11.1), procedure at a private hospital (aOR 3.0), living alone (aOR 2.4), vascular access site complications (aOR 2.1), frailty (aOR 1.9), age&amp;gt;80 (aOR 1.8), hypoalbuminemia (aOR 1.8), NYHA III-IV (aOR 1.7) and hospital length of stay (aOR 1.1) (all p&amp;lt;0.05). NHD was not associated with mortality at 30-days and less than one percent of all patients required longer-term residential care. Conclusion While common following TAVI, NHD does not predict short-term mortality and most patients successfully return home within 30-days. When used appropriately, NHD may serve as a brief and effective method of optimising functional status without compromising long-term independence.Predictors of Non Home Discharge

Same-day discharge after atrial fibrillation ablation: is it equally safe?

Abstract Introduction Same-day discharge after atrial fibrillation (AF) ablation represents a paradigm shift in post-procedure care. This approach allows patients (pts) to return home on the same day after their ablation, promoting comfort and reducing hospitalization duration. Purpose To evaluate safety of same-day discharge in pts submitted to either pulsed field ablation (PFA) or cryoablation (CA). Methods Single-center retrospective study of AF pts submitted to ablation with either PFA or CA from May 2019 to November 2023. Ablation strategy consisted in pulmonary vein isolation complemented with ablation of the cavo-tricuspid isthmus in pts with history of atrial flutter. Pts were considered eligible to same-day discharge if an observation period of at least 6h was assured after the procedure. Safety was defined as 30-day major or minor complications. Chi-square tests were used for the comparison of continuous variables. Results We included 152 pts, 60 were submitted to PFA and 92 to CA, 56.6% males, median age 66±14 years, mean CHA2DS2-VASc score 2.45±1.4. Paroxysmal AF, short and long-standing persistent AF were present in 67%, 16% and 15% of pts respectively. Previous stroke was present in 8.7% of pts and 27 pts had history of heart failure. Acute success rate was 99.3%, concomitant cavo-tricuspid isthmus ablation was performed in 20% of pts, and mean procedure time was 107.5±74 min. Same-day discharge was initially considered in 70% of pts, however of these, 12 pts remained under further observation due to acute complications. No major or minor acute complications were reported in pts with same-day discharge. There were no significant differences in 30 days complications between groups. At 30 days no major complications were reported in pts with same-day discharge. One pts in which same-day discharge was halted died 4 days after ablation from hemorrhagic shock. Regarding minor complications at 30 days, 4 minor femoral hematoma were reported, 2 in each group. Conclusion In our population, same-day discharge proved to be a safe strategy if careful pts selection is assured. This practice enhances overall pt experience, marking a significant paradigm shift in AF management.

Enhancing thriving during COVID-19: The role of spirituality in fostering self-esteem among sojourners

The COVID-19 pandemic was particularly impactful on sojourners, absent from their families and unable to return home. This study explores how spirituality may impact self-esteem and how this may affect thriving during such a challenging time. Specifically, adopting a positive psychology framework, we expected higher/lower levels of spirituality would result in higher/lower levels of daily self-esteem, which in turn would result in higher/lower levels of daily thriving. We measured these daily fluctuations over a 9-day period by using a diary study. Results supported our hypothesized model. These findings extend our understanding of the role of spirituality during COVID-19 pandemic.

Home-Based Digital Exercise Training Program to Improve Physical Function of Older Sepsis Survivors: Protocol of the HEAL Sepsis Randomized Clinical Trial.

While sepsis, an exaggerated response to infection, can affect people of all age groups, it is more prevalent in middle-aged and older adults. Older adults suffer worse short-term and long-term outcomes than younger patients. Older sepsis survivors are commonly discharged to long-term acute care facilities, where they often die within 1 year. Those who return home from the hospital lose the momentum of physical function improvement after early inpatient rehabilitation, and often face exacerbation of comorbidities and decline in physical function. Additionally, patients who are discharged home often live at distant locations and are not able to commute to rehabilitation centers due to their poor health status. Therefore, remotely delivered exercise interventions tailored to this population hold promise to improve physical function safely and effectively after sepsis. However, this type of intervention has yet to be tested in this population. This study aims to assess the safety, feasibility, and ease of recruitment and retention of participants for a remotely delivered physical activity intervention for improving physical function in middle-aged and older sepsis survivors. The proposed intervention will be delivered through a digital health platform that comprises a patient-facing mobile app and a 12-week physical activity program specifically designed for middle-aged and older sepsis survivors with poor health status who may face challenges participating in traditional out-patient or community-based exercise interventions. This study is ongoing and plans to enroll 40 sepsis survivors aged 55 years and older who will be randomized to either a remotely delivered exercise intervention group or a control group (electronic health diary). Both groups will use a tablet containing the Health in Motion app (Blue Marble Health). The intervention group will receive a clinician-designed personalized avatar-guided home exercise program and reminders while the control group will self-report daily activities using the in-app health diary feature. This study is the first to use a home-based, remotely monitored 12-week exercise program to improve physical function in sepsis survivors. This study will evaluate the safety, feasibility, and efficacy, providing the necessary knowledge to design and calculate power for future larger trials. This study will provide important information for planning a future randomized clinical trial to test the efficacy of a remotely delivered exercise intervention in this high-risk population. ClinicalTrials.gov NCT05568511; https://clinicaltrials.gov/study/NCT05568511. DERR1-10.2196/60270.

High-resolution outdoor videography of insects using Fast Lock-On tracking.

Insects have important roles globally in ecology, economy, and health, yet our understanding of their behavior remains limited. Bees, for example, use vision and a tiny brain to find flowers and return home, but understanding how they perform these impressive tasks has been hampered by limitations in recording technology. Here, we present Fast Lock-On (FLO) tracking. This method moves an image sensor to remain focused on a retroreflective marker affixed to an insect. Using paraxial infrared illumination, simple image processing can localize the sensor location of the insect in a few milliseconds. When coupled with a feedback system to steer a high-magnification optical system to remain focused on the insect, a high-spatiotemporal resolution trajectory can be gathered over a large region. As the basis for several robotic systems, we show that FLO is a versatile idea that can be used in combination with other components. We demonstrate that the optical path can be split and used for recording high-speed video. Furthermore, by flying an FLO system on a quadcopter drone, we track a flying honey bee and anticipate tracking insects in the wild over kilometer scales. Such systems have the capability to provide higher-resolution information about insects behaving in natural environments and as such will be helpful in revealing the biomechanical and neuroethological mechanisms used by insects in natural settings.

Search with stochastic home returns can expedite classical first passage under resetting

Search with stochastic home returns can expedite classical first passage under resetting

Medals awarded to the personnel of the Scottish National Antarctic Expedition, 1902–1904: an inconsistency of recognition

ABSTRACT The 1902–1904 Scottish National Antarctic (Scotia) Expedition led by William Speirs Bruce was overshadowed by the 1901–1904 British National Antarctic (Discovery) Expedition led by Robert Falcon Scott. The establishment of the independent Scottish expedition had been resented by those promoting the ‘official’ British venture and the accolades accorded to each on their return home were very different. The Royal Scottish Geographical Society honoured both leaders with prestigious medals and later, after public pressure, rewarded Scotia’s captain and scientific staff but not her officers or crew. By contrast, the Royal Geographical Society rewarded the leader and personnel of the Discovery expedition and completely ignored Scotia. An even greater demarcation arose when the Polar Medal was hastily created for the benefit of Scott and the Discovery team, and subsequently extended to the crews of their two relief ships. Aggrieved that his men had not received such public recognition, Bruce commissioned his own expedition silver medal, yet did not present it to all eligible personnel. His exclusion of artist William Cuthbertson and taxidermist Alastair Ross is paradoxical given his indignation over the partiality of other awards but may indicate some unacknowledged personal friction during the Scotia expedition. The paper illuminates the politics and personalities involved in recognition of the achievements of early twentieth-century Antarctic exploration after the events themselves.

8157 Hypercalcemia To Hypocalcemia In Three Days: The Importance Of Asking The Questions

Abstract Disclosure: P. Kachhadia: None. K. Patel: None. S. Khan: None. A. Abu Limon: None. S. Aldasouqi: None. F. Akanbi: None. Z. Ul Abideen: None. Introduction: Severe hypercalcemia needing inpatient hospitalization requires very thorough history taking in order to determine etiology and treatment plan. Causes differ drastically, and misdiagnosis or mistreatment can be life threatening. Here, we present a case of symptomatic hypercalcemia secondary to milk-alkali syndrome that was treated promptly after admission with IV zoledronic acid, leading to severe symptomatic hypocalcemia and prolonged hospitalization. Case presentation: Patient is a 68 year old female with a PMH of breast cancer, osteoporosis and hiatal hernia who presented to the emergency department for fatigue, constipation and lightheadedness. On evaluation, she was found to have a creatinine of 1.54 (0.6-1.1 mg/dL), eGFR 36 (&amp;gt;90 mL/min/1.73 m²), Ca 18.48 (8.6-10.2 mg/dL), albumin 4.7 (3.4-5.4 g/dL), Mg1.4 (1.7-2.2 mg/dL), 25-OHD 18 (30-100), 1,25-Dihydroxy Vitamin D 7.4 (18-78 pg/mL), PTH 11.2 (15-65 pg/mL), phosphorus level 2.4 (2.5-4.5mg/dL), TSH 2.01 (0.4-4.0 mIU/L). SPEP and PTHrP were unremarkable. Due to history of prior breast cancer, imaging was done and CT showed new possible RUL pancoast tumor with RUL spiculated opacity. Patient was started on IV fluids and subsequently received IV zoledronic acid due to concern for severe hypercalcemia secondary to malignancy. By day 3 of treatment, patient's calcium decreased severely, down to a corrected calcium level of 6.4 (8.6-10.2 mg/dL). It was upon further investigation and discussion with the patient that we discovered the patient had received subcutaneous denosumab for her osteoporosis three weeks prior to admission. In addition, she was taking six tums daily (total 1 month duration) for symptoms of dyspepsia secondary her hiatal hernia. The patient’s severe hypocalcemia was treated with high dose oral calcium carbonate and vitamin D along with IV calcium gluconate. Magnesium was replaced daily. Through daily replacement, patient was kept in the hospital for a total of 10 days duration before her calcium levels were deemed safe for return home. Discussion: Hypercalcemia is a common cause of hospitalization worldwide. Testing should be comprehensive and history taking should be thorough to help navigate treatment plans. Bisphosphonates are indicated for hypercalcemia of malignancy, and its use otherwise may be the cause of severe hypocalcemia if not used in the right setting. In our case, the patient’s hypocalcemia was multifactorial from prior denosumab use and then subsequent zoledronic acid use. Additional risk factors included low vitamin D counts and disruption of high amounts of over the counter tums after being admitted to the hospital. Anchoring bias also led clinicians to believe that the hypercalcemia was secondary to malignancy. Consequently, this led to a prolonged 10 day hospitalization for persistently low calcium levels. Presentation: 6/1/2024

Navigating New Horizons: Challenges and Opportunities for Eritrean Expatriates in the U.S.

This research employ qualitative research methodology to explores the challenges and opportunities faced by Eritrean expatriates in America. Using a phenomenological approach, semi-structured interviews were conducted with eleven Eritrean expatriates living in different states in the United States. The study sought to answer three research questions: What challenges do Eritrean expatriates face in America? What opportunities do Eritrean expatriates perceive in America? How do Eritrean expatriates experience and perceive the process of adaptation to their local communities in America? The interviews were analysed using thematic analysis, and three major themes emerged that answered the research questions formulated: perceptions of challenges, perceptions of opportunities, and perceptions of adaptation. Eritrean expatriates reported various challenges, including cultural differences, social isolation, lack of resources, and legal challenges. Some expatriates expressed a desire to return home but felt trapped due to the difficulties of reintegration.Despite the challenges, expatriates also reported opportunities, including access to better education, job opportunities, and the space to express oneself. The cultural clash between Arabic and American cultures was highlighted as a barrier to adaptation in America.