Large Institutions Research Articles

Validating an instrument for measuring community cultural wealth with biology majors at a Hispanic-serving institution.

Boosting underrepresented student persistence in STEM majors has been of interest for several years. Prior research has explored various factors that may influence student success and persistence in STEM majors. Specifically, some of these studies have employed Yosso's community cultural wealth framework to explore how a student's cultural wealth may link to certain outcomes. Most of these studies have taken a qualitative approach when exploring cultural wealth and less adopt a quantitative approach. Using biology students in an introductory biology class during the fall (n = 303) and spring semesters (n = 215) at a large Hispanic-serving institution in the southeastern United States, this study seeks to contribute to the literature by validating a previously constructed instrument with a new population. An exploratory factor analysis (EFA) was conducted using principal axis factoring and an oblique rotation. EFA results revealed 10 dimensions of cultural wealth. Additionally, confirmatory factor analysis confirmed that the model produced properly measures the constructs as intended. Overall, the final 56-item instrument used in this study was validated and can be used for measuring cultural wealth in similar populations.

Meet and Greet Sessions: A Unique Virtual Opt-Out Approach to Support Trainee Well-Being.

Background Interventions to support graduate medical education (GME) trainee well-being at the institutional level continue to be an area for continuous improvement. Objective To assess participation, feasibility, and acceptability of a virtual, individual, brief, nonevaluative opt-out approach to accessing mental health support for residents and fellows. Methods From 2021 to 2023, all GME programs at one large institution were invited to participate. During orientation, incoming trainees from programs that had communicated interest were prescheduled for optional 20-minute, virtual "meet and greet" sessions with a counselor from the hospital's Employee Assistance Program. Nonformal feedback was gathered using an anonymous 6-question survey. Results Three hundred thirty-four residents and fellows from 12 of 74 (16%) participating GME programs were prescheduled for opt-out sessions over 3 academic years. Of the 334, 182 (54%) attended the sessions, 116 (35%) subsequently reached out to start counseling, and 108 (32%) responded to the survey. Each year, approximately 7 counselor hours were needed for the opt-out sessions per week over an 8-week period, which was feasible and added no extra cost. In the follow-up survey shared with all participants, 59 of 81 (73%) respondents reported that the sessions helped to reduce barriers to seeking mental health care. Conclusions During orientation, one-half of invited GME trainees participated in a virtual, individual, brief, nonevaluative meet and greet session with a counselor using an opt-out approach, and one-third subsequently requested counseling. Survey feedback was encouraging, and this approach can serve to help normalize culture surrounding accessing mental health services.

Ocular Imaging Challenges, Current State, and a Path to Interoperability: A HIMSS-SIIM Enterprise Imaging Community Whitepaper.

Office-based testing, enhanced by advances in imaging technology, is routinely used in eye care to non-invasively assess ocular structure and function. This type of imaging coupled with autonomous artificial intelligence holds immense opportunity to diagnose eye diseases quickly. Despite the wide availability and use of ocular imaging, there are several factors that hinder optimization of clinical practice and patient care. While some large institutions have developed end-to-end digital workflows that utilize electronic health records, enterprise imaging archives, and dedicated diagnostic viewers, this experience has not yet made its way to smaller and independent eye clinics. Fractured interoperability practices impact patient care in all healthcare domains, including eye care where there is a scarcity of care centers, making collaboration essential among providers, specialists, and primary care who might be treating systemic conditions with profound impact on vision. The purpose of this white paper is to describe the current state of ocular imaging by focusing on the challenges related to interoperability, reporting, and clinical workflow.

Salvage interstitial brachytherapy for treatment of recurrent endometrial cancers in the vagina: Seven-year single institution experience and review of second recurrence patterns

IntroductionInterstitial brachytherapy (ISBT) is a known treatment for vaginal recurrence of endometrial cancer. This study reviews a large tertiary institution's ISBT experience and outcomes for vaginal recurrences. Material and MethodsPatients who underwent salvage ISBT for vaginal recurrence of endometrial cancer from January 1, 2014 - August 31, 2021, were identified. Initial and salvage disease factors and treatments were recorded. Outcomes were calculated including overall survival, local, and distant failure. ResultsThirty-nine patients were included; thirty received external beam radiotherapy and interstitial brachytherapy (EBRT + ISBT) while nine received ISBT alone. At initial diagnosis, the ISBT alone group had an older median age, with stage IA-IV disease, frequently receiving adjuvant treatment, compared to the EBRT with ISBT group with mainly stage IA disease who did not. Median follow up was 22 months and median time to recurrence 14 months (16.5 months in EBRT + ISBT group and 14 in the ISBT alone group). Two-year overall survival was 85% for all patients, 85.6% and 83.3%in the EBRT + ISBT and ISBT alone groups, respectively. Local failure was 22.7% for all patients,16.7% in the EBRT + ISBT group and 11.1% in the ISBT alone group. Median HRCTV D90 (EQD2) was 76.8 Gy in the EBRT + ISBT group, and 57.9 Gy in the ISBT alone group. Late grade 3 or higher toxicity occurred in only three patients. ConclusionsEBRT + ISBT is an effective treatment for endometrial cancer vaginal recurrence, with acceptable toxicity. ISBT alone is an option for patients with contraindications to or with previous treatment of pelvic radiation.

Neonatal outcomes after intervention for suspected renal colic in pregnancy

ObjectiveTo compare neonatal outcomes following URS, stent, or PCN in pregnant women presenting with suspected renal colic. MethodsWomen undergoing a procedure for suspected renal colic during pregnancy at a large multi-center institution between 2008–2022 were retrospectively reviewed and categorized by initial intervention. Neonatal outcomes were recorded and linked to maternal and obstetric data. Groups were compared by a Kruskal-Wallis, ANOVA, or Fisher’s Exact test, followed by pairwise post-hoc testing as appropriate (α = 0.05). Multivariate analyses were also conducted. Results95 patients were analyzed, of whom 32 were managed with PCN, 47 with stent, and 16 with URS. Maternal baseline characteristics were similar between groups, except for lower gravidity and parity in the stent group. Rates of premature delivery did not differ, but gestational age at delivery was lower in the PCN group versus the stent and URS groups (p = 0.006 and p = 0.025, respectively). Neonatal Intensive Care Unit (NICU) admission rates were higher in the PCN group versus the stent and URS groups (p = 0.006 and 0.036, respectively). Respiratory distress syndrome significantly differed between groups (p = 0.041). Neonatal birth weight, Apgar scores, and other complications did not significantly differ. ConclusionThis study demonstrated higher rates of NICU admissions and lower gestational age at delivery for neonates born to mothers managed with PCN compared to stent and URS. Larger multi-institutional studies are warranted to further explore these associations.

State opioid prescribing laws and associations with radiotherapy delays and radiotherapy completion.

122 Background: In July 2018, Missouri introduced a 7-day limit for initial opioid prescriptions, though there was an exemption for cancer-related pain. However, some worry that the exemptions may be inadequate for patients with cancer who experience cancer-related pain. Since some courses of radiotherapy can cause pain (eg, mucositis, esophagitis), appropriate opioid access is important for helping patients complete radiotherapy in a timely manner, which is associated with oncologic outcomes. Methods: Patients with cancer of all ages treated with radiotherapy from 2018-2019 at a large academic institution in Missouri were identified. More recent data were excluded due to the COVID-19 pandemic and Missouri Medicaid expansion. Trends over time in the proportion of missed/delayed radiotherapy fractions, incomplete radiotherapy courses, and a composite measure of excessive delays (≥5 days) or incomplete course were evaluated in linear and linear probability models. Additional analyses included patients from Illinois, an adjacent state without opioid prescribing legislation, and we subsequently performed difference-in-differences analyses comparing the outcomes from pre- to post- Missouri opioid legislation between the states. We conducted unadjusted analyses as well as analyses adjusted for age, sex, site, radiotherapy modality and fractions, as well as other covariates that could impact access to radiotherapy (ZIP code deprivation, distance from the facility, insurance status, and social work referral for unmet needs). Subgroup analyses focused on patients with head and neck cancer and lung cancer receiving definitive radiotherapy, who are at high risk of radiotherapy-related pain. Results: A total of 2613 and 1518 patients from Missouri and Illinois were identified, respectively. 4.7% of fractions were missed/delayed, 3.7% of patients did not complete treatment, and 8.1% of patients had either an incomplete course or excessive delays. There were no statistically significant increases (ie, worsening) in any outcome in any quarter after opioid policy implementation, and there were significant decreases in the composite outcome in multiple post-policy quarters in both unadjusted and adjusted analyses. In difference-in-differences analyses comparing trends over time with patients from Illinois, there were no significant associations of policy implementation with any of the outcomes. Results were similar in subgroup analyses for patients with head and neck and lung cancers. Conclusions: Missouri legislation limiting opioid prescribing for non-cancer-related pain was not associated with significant changes in a patient’s ability to undergo radiotherapy. Limitations of the study include evaluation of a single center in a single state and the lack of other intermediate outcomes important to patients including access to opioid medication itself, which we will examine in future work.

Outcomes of sciatic neurolysis in chronic hamstring tears: a retrospective case series.

Proximal hamstring tears may present with neurological dysfunction due to compression or stretching of the sciatic nerve. The purpose of this study was to evaluate the effectiveness of hamstring repair with concurrent sciatic nerve neurolysis for clinical outcomes and patient symptoms. A retrospective chart review of patients who were diagnosed with hamstring injury at a large tertiary care institution was conducted. Patients with chronic tears (> 6weeks from injury to surgery) who underwent hamstring repair were reviewed for demographics, clinical variables including symptoms of sciatic neuritis, sciatic nerve abnormalities on MRI, and postoperative outcomes. Chi-square tests were used for categorical variables, t test for continuous variables. Pairwise t tests were used to compare average pre- and postoperative strength for patients with and without symptoms of sciatic neuritis. Thirty-two patients with chronic hamstring tears were included in the analysis. Patients were 59.4% female with an average age of 51.4years (SD 13.1). Preoperatively, 27 patients (84.4%) were noted to have symptoms of sciatic neuritis. These patients did not differ in age (p = .677) or sex (p = .374) from patients without preoperative symptoms. Sciatic nerve abnormalities were noted on MRI report in 7 patients who had sciatic nerve symptoms and 0 patients who did not have sciatic nerve symptoms. Symptomatic improvement was seen in 21/26 (81%) of patients who had preoperative neurological symptoms, and in 6/7 (86%) of patients with MRI findings. All patients had equivalent or improved strength postoperatively. A sciatic nerve neurolysis is a safe and effective procedure to perform on patients with preoperative sciatic nerve symptoms and chronic hamstring tears that leads to improvement in neurological symptoms and strength. In neurologically asymptomatic patients with chronic hamstring injuries and MRI findings indicating possible nerve damage, a discussion should be held about the risks and benefits of performing a sciatic nerve neurolysis.

Mapping World: A Comparative Analysis of Functionality and Usability between QGIS and ArcGIS

The current review conducts a comprehensive comparison of Quantum GIS (QGIS) and ArcGIS in the context of healthcare applications, aiming to assist users in selecting the most appropriate GIS platform for their specific needs. Geographic Information Systems (GIS) are essential tools in healthcare, providing capabilities for spatial analysis, disease mapping, and resource allocation. Driven by the need to improve healthcare delivery and public health strategies, this study compares the functionalities, costs, and support systems of QGIS and ArcGIS. The major objective is to determine which GIS platform offers the best balance of cost-efficiency and performance across various healthcare scenarios. The methodology encompasses a detailed comparative analysis, incorporating quantitative data from user satisfaction surveys, performance evaluations, and real-world case studies. Findings reveal that QGIS, as an open-source GIS software, is highly cost-effective and customizable, making it particularly advantageous for budget-limited projects and smaller organizations requiring flexibility. Its extensibility via plugins and robust user community fosters continuous innovation and improvement. QGIS proves exceptionally effective in healthcare applications such as disease mapping and accessibility analysis, where customization and cost-efficiency are critical. Conversely, ArcGIS is distinguished by its advanced analytical capabilities and strong performance in handling complex, large-scale studies. Its sophisticated tools and comprehensive spatial analysis functionalities are essential for thorough healthcare research and planning. Although ArcGIS incurs higher costs, its extensive feature set, professional support, and exhaustive documentation justify the investment for large organizations and research institutions engaged in detailed GIS projects. In conclusion, both QGIS and ArcGIS exhibit significant strengths in key healthcare applications. QGIS excels in affordability and flexibility, while ArcGIS provides superior analytical power and support for extensive projects. Future research should focus on integrating real-time data and enhancing user experience to further optimize GIS applications in healthcare.

MicroGravity Explorer Kit (MGX): An Open-Source Platform for Accessible Space Science Experiments

The study of microgravity, a condition in which an object experiences near-zero weight, is a critical area of research with far-reaching implications for various scientific disciplines. Microgravity allows scientists to investigate fundamental physical phenomena influenced by Earth’s gravitational forces, opening up new possibilities in fields such as materials science, fluid dynamics, and biology. However, the complexity and cost of developing and conducting microgravity missions have historically limited the field to well-funded space agencies, universities with dedicated government funding, and large research institutions, creating a significant barrier to entry. This paper presents the MicroGravity Explorer Kit’s (MGX) design, a multifunctional platform for conducting microgravity experiments aboard suborbital rocket flights. The MGX aims to democratize access to microgravity research, making it accessible to high school students, undergraduates, and researchers. To ensure that the tool is versatile across different scenarios, the authors conducted a comprehensive literature review on microgravity experiments, and specific requirements for the MGX were established. The MGX is designed as an open-source platform that supports various experiments, reducing costs and accelerating development. The multipurpose experiment consists of a Jetson Nano computer with multiple sensors, such as inertial sensors, temperature and pressure, and two cameras with up to 4k resolution. The project also presents examples of codes for data acquisition and compression and the ability to process images and run machine learning algorithms to interpret results. The MGX seeks to promote greater participation and innovation in space sciences by simplifying the process and reducing barriers to entry. The design of a platform that can democratize access to space and research related to space sciences has the potential to lead to groundbreaking discoveries and advancements in materials science, fluid dynamics, and biology, with significant practical applications such as more efficient propulsion systems and novel materials with unique properties.

Responsible urban development policy: criteria, subjects, prospects

This article examines the primary directions of contemporary urban development policy, along with the issues and contradictions associated with its scientific research and practical implementation. The study aims to conceptualize the concept of “responsible urban development” as a complex of approaches and practices that hold promise for integration into practical urban and regional development policies, and to typologize potential approaches to implementing such policies. The authors use an institutional approach, the methodology of identity studies, the structural-functional approach and a case study. The article investigates quantitative and qualitative indicators, the key challenges and tasks of urban development policy, with a particular focus on the resources of modern urban development. The authors note that relying on a limited set of indicators does not provide the capacity for decision-making necessary to update and transform urban development policy to ensure its ability to promptly and flexibly respond to the numerous problems and challenges arising under conditions of socio-political instability. The article addresses and analyses several cases of contemporary urban development and the implementation of corresponding policies. Based on this analysis, the authors conclude that one of the central and most pressing issues in the policy of responsible urban development and the socio-political dynamics of cities is the inefficiency of the communication process between civil actors and stakeholders, on the one hand, and city authorities and the city administration, on the other. This communication deficit can only be partially addressed through digitalization, as the primary obstacles to improved communication are administrative barriers and the dominance of the interests of certain groups, such as large corporations and financial institutions.

Occupational Health Management in Federal Institutions: an Analysis of SIASS at UTFPR in 2023

Objective: The present study aims to map the performance of the Integrated Subsystem of Health Care for Federal Public Servants (SIASS) in a large Federal Higher Education Institution, identifying the occupational health practices implemented in 2023 and the main challenges faced in managing these policies. Theoretical Framework: The theoretical framework adopted is historical, addressing the evolution of SIASS since its creation in 2009. SIASS was established to integrate occupational health actions in the federal public service, focusing on health promotion, disease prevention, and comprehensive assistance to employees. It highlighted its role in health management within federal institutions. Method: A documentary and quantitative approach was used, analyzing data extracted from the 2023 UTFPR Management Report. The analysis focused on the frequencies of benefit approvals and denials, allowing the identification of patterns and challenges in occupational health management. Results and Discussion: In 2023, SIASS at UTFPR conducted 1,539 medical evaluations, covering 42.45% of employees, with an approval rate of 91.62%. Most evaluations (57.96%) were related to health treatment leaves, followed by leaves for family health reasons (11.76%) and health treatment leaves by an official board (11.70%). The predominance of a reactive approach rather than preventive measures was identified as a critical factor. Research Implications: The research suggests strengthening prevention strategies and adjusting policies to ensure effective employee health management and aligning resources and expectations. Originality/Value: This study contributes to the literature by providing a detailed analysis of SIASS’s performance in a large federal institution, highlighting challenges, and proposing recommendations to improve occupational health management in similar contexts.

Implementing B-BBEE: Leader Experiences in the South African Banking Industry

Orientation: Large banking institutions in South Africa remain complex organisations facing a myriad of challenges as they navigate the Fifth Industrial Revolution (5IR) and strive to remain relevant. A significant challenge relates to how these organisations can utilise Broad-Based Black Economic Empowerment (B-BBEE) to create diverse and inclusive teams for organisational success and sustainability.Research purpose: To explore the experiences and sense-making processes of senior leaders tasked with the implementation of affirmative action as part of a B-BBEE strategy as they navigate this responsibility within a South African bank.Motivation for the study: To shine on the complex experiences of senior leaders tasked with implementing affirmative action within a B-BBEE strategy in a large financial institution.Research approach/design and method: A qualitative interpretivist case study was applied to explore senior leaders’ negotiation of their perceptions and experiences of leading the implementation of B-BBEE in a large bank. Ten semi-structured interviews were utilised as the main data generation tool.Main findings: Study reveals how senior leaders hold strong convictions about the value of diversity and inclusion in the workplace. This included the continued necessity for legislation such as B-BBEE given South Africa’s racial history and existing personal biases that impact workplace diversity and inclusion. The study further reveals that senior leaders believe that B-BBEE is poorly implemented and attribute this to the tension leaders experience between diversity and performance, a lack of organisational policies and practices required to hold leaders accountable for B-BBEE implementation and leaders who lack the skills and expertise required to successfully create diverse and inclusive work environments.Practical/managerial implications: Positive contributions to diversity and inclusion policies and practices, leadership development and transformation of the banking organisations in South Africa and the industry at large.Contribution/value-add: Banking institutions as large market players can play a significant role in leading workplace transformation through improved implementation of diversity and inclusion legislation and principles within B-BBEE.

Preparing Future Special Education Faculty for Service in Rural Communities

In this program description, the authors explain how a doctoral-level embedded service-learning opportunity, part of Project PURPLE (Preparing Urban and Rural Personnel as Leaders in Education), a collaborative personnel preparation training program, taught future faculty to meet the needs of urban and rural schools in high-need settings. The collaboration between two large institutions in the same state offered scholars a unique opportunity to engage in teaching, research, and service across institutions. For the service-learning project, teams of cross-institution scholars partnered with consultants from a regional special education cooperative that provides technical assistance to a large rural geographical area. Eleven scholars completed seven diverse service projects, ranging from training education professionals to engaging caregivers. This description discusses these projects, along with the benefits to the scholars and the regional cooperative. It also explores implications for practice for future personnel preparation collaborations and possible avenues for future research.

مساهمة أستديو الشركات الناشئة في ريادة الأعمال في المملكة العربية السعودية

The study aims to reveal the degree of contribution of the startup studio to entrepreneurship, and to find statistically significant differences at the significance level between the arithmetic means of the study individuals' responses about the startup studio from the perspective of entrepreneurs in the Kingdom of Saudi Arabia and attributed to the variables (age, type of entrepreneur: participant in a studio, independent entrepreneur). The study relied on the descriptive comparative approach, and the questionnaire as a study tool and was applied to (53) members of the study community of entrepreneurs in Riyadh in the Kingdom of Saudi Arabia. The study concluded that the study individuals from entrepreneurs in Riyadh in the Kingdom of Saudi Arabia believe that the contribution of the startup studio to entrepreneurship is high. It also concluded that there are statistically significant differences in the arithmetic means of the study individuals' responses towards the dimensions (infrastructure, business support, access to networks) according to the variable of entrepreneur type, where the significance levels reached (0.01), that these differences are in favor of the study individuals from entrepreneurs participating in the startup studio. In light of the results, a number of recommendations were made, the most important of which is to increase the number of startup studios in different regions and sectors to serve entrepreneurs and startups in various fields to transfer expertise and provide guidance. Among the recommendations is the need for government agencies and large institutions to adopt the idea of the startup studio to be a link with entrepreneurs and startups and to enhance innovation in the institution.

WP6.9 - Essential Surgery Skills Course: A One Week Training Program to Prepare Surgeons for Humanitarian Deployment

Abstract Background Medical students, surgical trainees, and surgical faculty are increasingly interested in incorporating global surgery into their clinical practices and professional careers. However, many concerns remain about the preparation of surgeons for operating in resource-limited settings and their exposure to critical procedures such as cesarean sections, hysterectomies, or fracture reductions. In an attempt to address these concerns, academic institutions have developed advanced professional training programs for the global surgeon. Methods A six-day essential surgery skills conference was created at a large academic institution that provides trainees and surgeons with an overview of common surgical scenarios across orthopedics, urology, obstetrics, gynecology, general surgery, anesthesia and ultrasound in the form of didactics, simulations, and wet labs. Results 11 surgical trainees from four large academic institutions attended the essential surgery skills conference. Trainees attended sessions on point of care ultrasound, regional anesthesia, general anesthesia, hysterectomies, cesarean sections, post-partum hemorrhage, fracture reduction and fixation, ureteral injuries, and humanitarian deployment. A pre and post-test was administered. Improvement was noted in the trainees scores on the post-test in their knowledge of surgical subspecialty care. Trainees also reported feeling better prepared for humanitarian deployment. Conclusion Global surgery conferences can be designed to provide a networking and collaboration forum for improving access to surgical services worldwide. One-week predeparture conferences that discuss essential technical skills and relevant global surgery knowledge may better prepare surgeons to operate in resource-limited settings.

The Experience of Observational Departments’ Functioning for Treatment of Patients with Tuberculosis from COVID-19 Contact and Convalescents after COVID-19

Relevance. To control COVID-19, a net of special infection hospitals and departments was created, a system of medicaments and protective means’ supply was set up, necessary normative and regulatory documentation was developed and overall vaccination of population was performed in Moscow. Within frames of work for prophylaxis of COVID-19 spread in patients with tuberculosis at in-patient units of the State Budgetary Healthcare Institution of Moscow city «The Moscow Research and Clinical Center for Tuberculosis Control of the Moscow Government Department of Health” (hereinafter referred as the Center), observational departments for treatment of patients with tuberculosis from COVID-19 contact and convalescents after COVID-19. Aims. To evaluate specialized observational departments’ work as part of general anti-epidemic control measure system for COVID- 19 at tuberculosis hospitals. Materials and methods. The observational departments’ work within the period of 2020–2022 with 1075 patients treated including 400 patients from COVID-19 contact areas (37.2%) and 675 convalescent patients after COVID-19 (62.8%), was analyzed. The results obtained during the study were statistically treated by means of application program package Microsoft Office 2007. The quantitative parameters with presumably normal distribution were described with mean arithmetic values (M) and standard deviations (SD), and 95% confidence interval (CI 95%). The estimation of significance of differences between outcomes was evaluated with the Pearson χ2 test. The differences were considered to be statistically significant with p < 0,05. Results and discussion. The evaluation data on functioning efficacy of observational departments for patients with tuberculosis from COVID-19 contact and convalescent patients with tuberculosis after COVID-19 within the large medical institution hospital of physiatry profile. Among all patients, 153 of patients who fell ill with COVID-19 (14.2%; 95% CI [12.21–16.38%]) were determined, which lowered the number of COVID-19 areas at in-patient departments of the Center by 11.8%. The mean timeframes of COVID- 19 determination in general were 8.0 days: 5.4 days among contacts from new coronavirus infection areas and 12.4 days among convalescents at the department for the treatment of patients with tuberculosis and new coronavirus infection. The comparative analysis showed that COVID-19 was more frequently determined in tuberculosis patients from the contact with those who fell ill with COVID-19 (p < 0.001) than in convalescents. Conclusions. During medical care for patients of physiatry profile in Moscow city, a wide range of management decisions consisting in the change of routing system in specialized medical care, was taken. Among them, creation and functioning of observational departments for contact persons from COVID-19 areas and convalescents after COVID-19 play a particular role.Creation of such departments within a large medical institution enabled the contemporary isolation of contact persons from COVID- 19 areas and convalescents after COVID-19 and allowed the additional control of nosocomial infection spread

Microfinance in Nepal: An Overview

This paper aims to explore the current challenges and opportunities of the microfinance sector in Nepal. The secondary data and descriptive research with a critical approach are adopted to explain the study. The data were mainly collected from Nepal Rastra Bank's (NRB) annual Reports, and other available literature. The result shows that the center numbers (numbers of microfinance user group) change ratio was reduced from 17.11% to 1.30%, the total group numbers were 13% to 2.88%, the borrower 7.51% to (-9.66%), staff progress 9.75% to (-3.48%), loan outstanding 41.18% to (-5.06), profit 150.53% to (-7238), active loan 40.26 to (-7.94), and saving 22.87 to 3.91 between 2020/2021 to 2022/2023. Similarly, the Overdue member change ratio increased upto 53.66%, the passive loan from 79.47% to 104.3%, and the NPL increased continuously from 2.56% to 5.52%. So, all microfinance institutions are in a critical situation in Nepal. However, microfinance is an important concept to reduce poverty and unemployment. Further, it enhances easy access to financial institutions in rural where large banking institutions are merely available. However, microfinance in Nepal is facing critical challenges as many fraud cases are emerging. The policy implication is crucial as policymakers should formulate both long-term and short-term policies and implement those policies immediately in microfinance to revive the critical current situation.

Examining trajectories of nonsuicidal self-injury across the first year of university

BackgroundNonsuicidal self-injury (NSSI) is prevalent among emerging adults in post-secondary school, but little is known about change and stability in NSSI during the transition to university. Moreover, there has been limited person-centered work focusing on heterogeneity in NSSI engagement among students over time. The present study aimed to investigate the development and maintenance of NSSI across the first year of university and explore predictors of potential variability in trajectories of NSSI. MethodsThe present sample consisted of 1125 first-year university students at a large post-secondary institution (Mage = 17.96, 71 % female, 28 % male, 1 % gender diverse) who participated in a larger longitudinal study. Participants completed an online survey three times over their first year of university. Latent growth curve modeling (LGCM) in Mplus was utilized to explore different NSSI group trajectories across first year university. ResultsNSSI was prevalent among first year students (35 %). LGCM revealed one developmental trajectory; NSSI engagement decreased across the first year of university. Students who engaged in NSSI had increased difficulties with emotion regulation, lower self-compassion, and lower levels of social support compared to students who did not engage in NSSI. LimitationsThe present study may be subject to recall errors and future studies should include more gender diverse samples to increase generalization of findings. ConclusionsFindings highlight the transition to university as a peak period of vulnerability for NSSI engagement and emphasize the need for proactive university intervention efforts to mitigate risk and improve student well-being.

Abstract P326: Measuring Health Equity Gaps for a Blood Pressure Control Quality Improvement Program: Results from Cook County Health

Background: High blood pressure (BP) affects nearly half of U.S. adult population and was responsible for 13.0 deaths per 100,000 in 2022, with significant differences in age-adjusted mortality rates by sex, race, and ethnicity. Previous research has also highlighted that lower BP control rates are more prominent in Hispanic and Non-Hispanic Black patients, and well as those 60 years or older. This study assesses the role of the AMA MAP™ Hypertension quality improvement (QI) program to improve potential inequities in blood pressure control at a large public health care institution. Methods: 18,252 patients diagnosed with hypertension were identified at Cook County Health. BP values were obtained for patients in the 2 -years prior to implementation of the QI program (July 2019 to June 2021) compared to BP in the 2-years after implementation (July 2021 to July 2023). A multivariable logistic regression model of BP control status, paired t-tests, and ANCOVA analyses, stratified by race, ethnicity, sex, and age are conducted to assess SBP and measure the gaps by demographic characteristics. Results: Prior to the QI program, BP control (<140/<90) was significantly less for Black as compared to White patients (OR 0.82 [0.74-0.92]). The racial difference remained after the program, although it was slightly diminished (OR 0.86 [0.76 – 0.97]). Patients who were older were less likely to have controlled BP prior to the program, but these differences were no longer evident following the QI program. The QI program led to a decline in SBP in all demographic groups, including between ethnicity as shown in Figure 1 (Hispanic: -5.74 [CI:6.19- -5.29] vs Non-Hispanic -4.92 [-5.21- -4.63]), White (-5.96 [CI: -6.45- -5.47]) and Black (-4.80 [CI: -5.11- -4.49]) patients, and by age as shown in Figure 2 between 45-64 years ( -5.79 [CI: -6.12- -5.46] and 65-85 years (-4.31 [CI: -4.68- -3.94]). Conclusion: The results indicate an overall improvement in BP control and SBP, however, gaps persisted in SBP across ethnicity, race, and certain age groups. Quality improvement coaching and dashboards may support clinical care teams in addressing inequities in patient BP control.

Pericardial tamponade: a new perspective on echocardiographic features and application of a prediction score.

Few clinical decision rules have been used to guide clinical management and predict outcomes in patients with pericardial tamponade. The objectivesof this study are to identify the echocardiographic features associated with adverse outcomes in patients with pericardial effusions requiring pericardiocentesis and to apply a previously described four-point clinical and echocardiographic score to predict clinical outcomes over 24-hr, 30-day, and 1-year intervals. We performed a retrospective cohort review of patients who had transthoracic echocardiogram (TTE) performed and underwent pericardiocentesis within 48h of emergency department presentation at two large tertiary care institutions. We constructed different stepwise logistic regression models and examined the associations of TTE characteristics and clinical features with ICU admission, hospital length of stay (h-LOS), and survival. The data set was then employed against a previously proposed scoring system to predict factors associated with clinical outcomes over 24hr, 30days, and 1year. Two hundred thirty-nine patients were included in the final analysis. Echocardiographic characteristics of patients with pericardial tamponade who underwent pericardiocentesis are as follows: 69.1% right ventricular (RV) diastolic collapse, 62.3% exaggerated mitral valve (MV) inflow velocities, 56.4% inferior vena cava (IVC) plethora, and 53.4% right atrial (RA) systolic collapse. Increase in systolic blood pressure and increased variation in MV inflow velocity were associated with reduced ICU admission [OR: 0.94 (CI 0.90, 0.99), 0.28 (CI 0.09, 0.89), respectively]. In addition, a history of malignancy increased the length of hospital stay by about 3.89days (CI 1.43-6.35, p < 0.01) and prior pericardiocentesis history was associated with 4.82-day increase in hospital stay (CI 1.19-8.45, p = 0.01). In utilizing the previously published prediction score, we found no statistically significant correlation in predicting survival. RV diastolic collapse and exaggerated MV inflow velocity were the most common echocardiographic findings in patients requiring pericardiocentesis. Contrary to prior studies, exaggerated MV inflow velocity was associated with reduced ICU admission. In addition, a previously described prediction score did not correlate with decreased survival in this cohort.