National Center Research Articles

Evaluation of Two Different Approaches for Selecting Patients for Postoperative Radiotherapy in Deep-Seated High-Grade Soft Tissue Sarcomas in the Extremities and Trunk Wall

Two national sarcoma centers have had different approaches for selecting patients with grade 2–3 deep-seated soft tissue sarcomas (STS) for postoperative radiotherapy (RT). We evaluated potential differences in local recurrence in patients treated at the two centers. At Sarcoma Center 1 (SC1), RT was the standard treatment for all tumors except certain small tumors excised with a margin wider than 1 cm. Sarcoma Center 2 (SC2) avoided RT for tumors regardless of tumor size if removed with a margin wider than 1 cm and/or a solid barrier. We included 386 patients (SC1/SC2 = 196/190) over 18 years of age diagnosed with a non-metastatic grade 2–3, deep-seated STS of the extremities or trunk wall, who underwent primary surgical treatment (only tumors excised with a negative margin) from 1 January 2000, to 31 December 2016. Kaplan–Meier survival analysis, competing risk analysis, and cause-specific Cox regression were applied. A total of 284 patients received primary RT, 163 (83%) at SC1 and 121 (64%) at SC2 (p < 0.001). The cumulative incidence of local recurrence at five years was 15% (95% CI: 10–19%) at SC1 and 14% (95% CI: 9–19%) at SC2. Multivariate analysis showed no significant differences in local recurrence between the centers. We concluded that when entering all available patients into the analysis using an intention-to-treat principle, a more selective approach to postoperative RT in patients with grade 2–3 deep-seated STS did not lead to a higher local recurrence rate. However, with this study design, we cannot rule out if the local recurrence rate could have been lower if RT was administered to all tumors removed with a margin wider than 1 cm and/or a solid barrier.

Pharmacokinetic Variability of Rufinamide and Stiripentol in Children With Refractory Epilepsy: A Retrospective Study of Therapeutic Drug Monitoring From the National Epilepsy Centers in Denmark and Norway.

Rufinamide and stiripentol, orphan drugs used in Lennox-Gastaut and Dravet syndromes, respectively, are antiseizure medications (ASMs), often administered to children; however, pharmacokinetic studies are lacking. The authors compared the pharmacokinetic variability of these drugs with respect to the dose, serum concentrations, comedication, age, and duration of treatment. Children and adolescents (<18 years) whose serum concentrations were measured were retrospectively identified from the therapeutic drug monitoring (TDM) databases at 2 national epilepsy centers in Norway and Denmark (2012-2021). Data from 165 patients (56% boys/44% girls) treated with rufinamide and 52 patients (50% boys/50% girls) treated with stiripentol were included. For rufinamide, the median age was 10 (range 2-17) years, dose 23 (3-73) mg/d, and serum concentration 34 (3-227) µmol/L [8.1 mg/L (0.71-54.0 mg/L)]. For stiripentol, the median age was 8.5 (range 1-17) years, dose 37 (18-76) mg/d, and serum concentration 33 (4-113) µmol/L [7.7 mg/L (0.93-26.3 mg/L)]. The concomitant use of 1-9 other ASMs during the data collection was noted. Pharmacokinetic variability, calculated as the concentration/(dose/kg) ratio, ranged from 0.26 to 11.31 (µmol/L)/(mg/kg) for rufinamide and 0.17-1.52 (µmol/L)/(mg/kg) for stiripentol. The intraindividual coefficients of variation ranged widely, from 5% to 110% for rufinamide and 11%-117% for stiripentol. The treatment period was at least 5 years in 50% of patients. No statistically significant effects of age, sex, or ASM comedication were observed, possibly due to the small sample size and heterogeneous groups with variable seizure situations, comorbidities, and changes in comedication and physiology. This study demonstrates considerable pharmacokinetic variability in and between patients for both drugs and similar use in terms of age, burden of comedication and retention rates. TDM may be useful in the clinical setting to monitor and optimize treatment in this vulnerable patient group.

Research on the Regulatory Mechanism of Ginseng on the Tumor Microenvironment of Colorectal Cancer based on Network Pharmacology and Bioinformatics Validation.

A network pharmacology study on the biological action of ginseng in the treatment of colorectal cancer (CRC) by regulating the tumor microenvironment (TME). To investigate the potential mechanism of action of ginseng in the treatment of CRC by regulating TME. This research employed network pharmacology, molecular docking techniques, and bioinformatics validation. Firstly, the active ingredients and the corresponding targets of ginseng were retrieved using the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform (TCMSP), the Traditional Chinese Medicine Integrated Database (TCMID), and the Traditional Chinese Medicine Database@Taiwan (TCM Database@Taiwan). Secondly, the targets related to CRC were retrieved using Genecards, Therapeutic Target Database (TTD), and Online Mendelian Inheritance in Man (OMIM). Tertiary, the targets related to TME were derived from screening the GeneCards and National Center for Biotechnology Information (NCBI)-Gene. Then the common targets of ginseng, CRC, and TME were obtained by Venn diagram. Afterward, the Protein-protein interaction (PPI) network was constructed in the STRING 11.5 database, intersecting targets identified by PPI analysis were introduced into Cytoscape 3.8.2 software cytoHubba plugin, and the final determination of core targets was based on degree value. The OmicShare Tools platform was used to analyze the Gene Ontology (GO) enrichment analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis of the core targets. Autodock and PyMOL were used for molecular docking verification and visual data analysis of docking results. Finally, we verified the core targets by Gene Expression Profiling Interactive Analysis (GEPIA) and Human Protein Atlas (HPA) databases in bioinformatics. A total of 22 active ingredients and 202 targets were identified to be closely related to the TME of CRC. PPI network mapping identified SRC, STAT3, PIK3R1, HSP90AA1, and AKT1 as possible core targets. Go enrichment analysis showed that it was mainly involved in T cell co-stimulation, lymphocyte co-stimulation, growth hormone response, protein input, and other biological processes; KEGG pathway analysis found 123 related signal pathways, including EGFR tyrosine kinase inhibitor resistance, chemokine signaling pathway, VEGF signaling pathway, ErbB signaling pathway, PD-L1 expression and PD-1 checkpoint pathway in cancer, etc. The molecular docking results showed that the main chemical components of ginseng have a stable binding activity to the core targets. The results of the GEPIA database showed that the mRNA levels of PIK3R1 were significantly lowly expressed and HSP90AA1 was significantly highly expressed in CRC tissues. Analysis of the relationship between core target mRNA levels and the pathological stage of CRC showed that the levels of SRC changed significantly with the pathological stage. The HPA database results showed that the expression levels of SRC were increased in CRC tissues, while the expression of STAT3, PIK3R1, HSP90AA1, and AKT1 were decreased in CRC tissues. Ginseng may act on SRC, STAT3, PIK3R1, HSP90AA1, and AKT1 to regulate T cell costimulation, lymphocyte costimulation, growth hormone response, protein input as a molecular mechanism regulating TME for CRC. It reflects the multi-target and multi-pathway role of ginseng in modulating TME for CRC, which provides new ideas to further reveal its pharmacological basis, mechanism of action and new drug design and development.

Miotomía endoscópica por vía oral (POEM) como tratamiento para la acalasia pediátrica: estudio multicéntrico y primeros resultados

Introduction: Laparoscopic Heller miotomy of achalasia has been classically recognized as the gold standard management in children. There is increasing experience with the peroral endoscopic miotomy (POEM) approach in pediatrics, although the series published are scarce. The objective of this study was to present our experience in primary or secondary treatment of pediatric achalasia by POEM and its clinical success rate.Methods: We performed a retrospective review of pediatric patients with achalasia who underwent POEM in some national centers from October 2016 to January 2023. We evaluated clinical efficacy (Eckardt score ≤3), demographic characteristics, intraoperative, preoperative and postoperative, complications, and follow-up.Results: Fifteen POEM were performed in fourteen pediatric patients (aged 12 to 18 years) with achalasia. POEM was the first line treatment in 11 patients, but 4 (21.3%) had previous treatment: 1 (7,1%) pneumatic balloon dilation and 2 (14,2%) laparoscopic Heller myotomy and 1 (7,1%) previous POEM. The average age was 15 years (SD ± 1,9). The baseline Eckardt score was 7,5 (SD:± 1,8), with the baseline GERD score being 6 (SD:± 2,9). There was a Clavien Dindo grade 2 postoperative adverse event corresponding to mild pneumonia (7,1%). The postoperative Eckardt and GERD score after 12 months of follow-up were 0.7 (SD±1,2) and 0,5 (SD±0,7). The study has a success rate greater than 93%.Conclusions: POEM seems a safe and effective procedure, with a short postoperative period for treatment of pediatric achalasia.

Determinants of China’s technological trade flows with Central Asian countries (CACs): a panel gravity approach

The purpose of this study is to examine the determinants of Chinese technological trade flows with Central Asian countries (CAC) with a revealed comparative advantage and the gravity model using two estimation techniques. The present study employs the Ordinary Least Square (OLS) and the Poisson pseudo-maximum likelihood (PPML) on the data set from 2003 to 2018 panel dataset. Results from the Gravity model demonstrates that low-tech, medium-tech, and high-tech trade flows boost economic development in China and Central Asian nations, adversely affecting all technology trade flows in geographical distance. The research indicated that exchange rates showed a negative indication in bilateral trade, medium-tech trade, and high-tech trade. In contrast, the low technology trade showed a positive flow between China and Central Asia. Furthermore, the results reveal that openness to trade and membership of the WTO show a positive indication. The trade openness policy on both sides thus has a major beneficial effect on trade volumes. It proposed increased liberalization of trade policy and greater involvement in global commerce. In addition, Central Asia and export industries should take additional initiatives to enhance and diversify high-tech exports. A competitive international market provides perfect equality in reciprocal trade interactions.

A Flexible and Sustainable Analysis of Waste Efficiency at the European Level

AbstractThis paper analyses the waste management efficiency of European Union countries using a flexible nonparametric methodology known as directional data envelopment analysis (DEA). The study evaluates performance at the macro (country) level, considering waste generated as input, landfilled and incinerated waste as bad output and recycled waste as output. The analysis incorporates the heterogeneity and specificities of each country, with respect to social and economic sustainability, establishing specific and realistic targets for each country to achieve efficiency. The research introduces a flexible and innovative method for assessing waste management efficiency and provides new empirical evidence on European waste management, considering economic and social sustainability. The results reveal a significant disparity among European countries in both waste generation and waste recycling. Countries are categorised into five groups according to their level of efficiency, and Central European nations are observed to exhibit generally better performance. A pragmatic approach, based on clear collaboration among countries, could optimise the unique waste management characteristics of individual nations to enhance the overall efficiency of the European waste management system, contributing to a circular economy and sustainable development.

Review Based Study of Monkeypox Disease: A Public Health Emergency of International Concern.

Monkeypox, a zoonotic disease, has become the hot topic spreading across the newspaper headlines like a forest fire. The disease is transmitted from one individual to another by close, intimate contact such as cuddling, kissing, or contact with fluids in the dermal lesions. Though it is a self-limiting disease with symptoms akin to Smallpox (but a milder version), some severe cases have been reported as well. WHO has reported the case fatality rate of Monkeypox infection to be around 3–6%, which is slightly higher than that of COVID-19. Incubation period of the disease is 6–13 days on an average (range of 5–21 days). The monkeypox virus, which was previously exclusive to West and Central African nations and caused endemic diseases in monkeys and people, has recently been linked to human infections in non-endemic areas including the United States of America (USA) and more than 30 additional countries. The monkeypox outbreak continues to be a worldwide health emergency, the highest degree of alert recognised by the World Health Organization. The Centers for Disease Control and Prevention (CDC) advises vaccination for those who have been exposed to the disease as well as those who may be at higher risk of contracting it, such as those who have been identified by public health officials as a contact of someone who has the disease.

Regional Dynamics and Counterterrorism: Pakistan-Russia Collaboration in Central Asia

Pakistan and Russia face threats from terrorist organizations such as the Islamic Movement of Uzbekistan (IMU), the Turkistan Islamic Party (TIP), the East Turkestan Liberation Organization (ETLO), and the Grey Wolves, which have extended their influence into Central Asia. These groups pose serious security challenges for Pakistan, particularly in Khyber Pakhtunkhwa and Balochistan, with Pakistani intelligence often tracing terrorist incidents back to these organizations. This study explores the geostrategic dynamics and security challenges in Central Asia and the potential for a strategic partnership between Pakistan and Russia. To investigate the potential and implications of a strategic partnership between Pakistan and Russia for regional security and stability. The research involves a comprehensive literature review and analysis of efforts by the Counter Terrorism Implementation Task Forces (CTITF) under the United Nations and the United Nations Center for Regional Preventive Diplomacy for Central Asia (UNCRPDCA). It examines their impacts on Russia-Pakistan relations within the context of regional dynamics and strategic interests. The study finds that a Pak-Russia strategic partnership could enhance regional security and stability through improved counterterrorism efforts, including intelligence sharing and joint military exercises. It highlights the mutual challenges and geopolitical tensions that may affect this partnership. The paper provides valuable insights into the potential strategic partnership between Pakistan and Russia to address shared security threats and the role of international organizations in facilitating counterterrorism initiatives in the region.

Manual versus automatic chest compression devices for cardiopulmonary resuscitation under zero gravity (The MACCC - 0G STUDY)

IntroductionCardiopulmonary resuscitation (CPR) in microgravity requires specific methods to counteract weightlessness. Automatic chest compression devices (ACCDs) could improve CPR in microgravity. We aimed to compare ACCDs versus manual CPR in microgravity simulated through parabolic flights. MethodsThis prospective, open, controlled study compared 3 ACCDs (LUCAS 3©, AUTOPULSE©, EASYPULSE©) to manual CPR during the 66th CNES (Centre National d’Etudes Spatiales) parabolic flights campaign onboard the Novespace Air Zero-G A310 aircraft. Chest compression depths and rates were monitored by a Laerdal© Resusci-Ann-QCPR manikin. ResultsThe LUCAS 3© device had a median compression depth of 53.0 [53.0–54.0] mm, significantly higher than the EASYPULSE©, AUTOPULSE©, and Manual CPR (Handstand method), measured at 29.0 [26.0–32.0] mm, 29.0 [27.5–30.7] mm and 34.5 [29.6–43.3] mm, respectively (p value < 0.001). Compression rates were 101 [101–101], 100 [100–100] and 80 [80–80] compressions per minute (cpm) for the LUCAS 3©, EASYPULSE©, and AUTOPULSE©, respectively. Manual CPR provided a significantly higher compression rate with 115 [109–123] cpm (p value < 0.001). ConclusionOnly LUCAS 3© provided effective CPR according to international guidelines. ACCDs should implement microgravity CPR algorithms.

The Dutch Dystrophinopathy Database: A National Registry with Standardized Patient and Clinician Reported Real-World Data.

Duchenne and Becker muscular dystrophy lack curative treatments. Registers can facilitate therapy development, serving as a platform to study epidemiology, assess clinical trial feasibility, identify eligible candidates, collect real-world data, perform post-market surveillance, and collaborate in (inter)national data-driven initiatives. In addressing these facets, it's crucial to gather high-quality, interchangeable, and reusable data from a representative population. We introduce the Dutch Dystrophinopathy Database (DDD), a national registry for patients with DMD or BMD, and females with pathogenic DMD variants, outlining its design, governance, and use. The design of DDD is based on a system-independent information model that ensures interoperable and reusable data adhering to international standards. To maximize enrollment, patients can provide consent online and participation is allowed on different levels with contact details and clinical diagnosis as minimal requirement. Participants can opt-in for yearly online questionnaires on disease milestones and medication and to have clinical data stored from visits to one of the national reference centers. Governance involves a general board, advisory board and database management. On November 1, 2023, 742 participants were enrolled. Self-reported data were provided by 291 Duchenne, 122 Becker and 38 female participants. 96% of the participants visiting reference centers consented to store clinical data. Eligible patients were informed about clinical studies through DDD, and multiple data requests have been approved to use coded clinical data for quality control, epidemiology and natural history studies. The Dutch Dystrophinopathy Database captures long-term patient and high-quality standardized clinician reported healthcare data, supporting trial readiness, post-marketing surveillance, and effective data use using a multicenter design that is scalable to other neuromuscular disorders.

영아반교사의 전문성 증진을 위한 기록작업에 관한 연구 -일상생활을 중심으로-

This study is about ‘documentation’ for promoting professionalism of infant class teachers. This study examined professionalism of teachers connected to documentation by analyzing journals and observation log prepared by teachers that documented daily life of infants. For the foregoing research, this study collected documentation in regards to daily life of infant classes of national and public day care centers from March through December 2023. A method of qualitative research was applied and the result was categorized as record that leads to ‘observe’, record that arouses ‘concern’ and ‘introspection’ and ‘keeping documentation’ through sympathy and support. Infant class teachers solve concerns about support for daily life by y taking another look at from the infants’ point of view and forming a bond of sympathy through documentation. Experience that observes maladjustment of infants to daycare centers with sympathy and wait was indebted to documentation that leads teachers to observe and wait. Teachers who participated in the research were able to discover one’s fixed idea by looking back on the documentation and experienced emotional care that is professionalism of infant class teachers. Examining the documentation, directors acknowledged that support for daily life of infants and qualification of teachers to respect and encourage infants is related to professionalism. This study is considered significant as it proves that documentation is an important educational behavior that leads professionalism of infant class teachers.

Beyond American College of Surgeons Verification: Quality Metrics Associated with High Performance at Level I and II Trauma Centers.

The American College of Surgeons (ACS) Committee on Trauma has established a framework for trauma center quality improvement. Despite efforts, recent studies show persistent variation in patient outcomes across national trauma centers. We aimed to investigate whether risk-adjusted mortality varies at the hospital level and if high-performing centers demonstrate better adherence to ACS Verification, Review, and Consultation (VRC) program quality measures. We analyzed data from the 2018-2021 ACS TQIP Participant Use Files, focusing on adult admissions at ACS-verified Level I or II trauma centers for blunt, penetrating, or isolated traumatic brain injury. We used mixed-effects models to assess center-specific risk-adjusted mortality and identified high-performing centers (HPTC), defined as those with the lowest decile of overall risk-adjusted mortality. We compared patient and hospital characteristics, outcomes, and adherence to ACS-VRC quality measures between HPTC and non-HPTC. Over the study period, 1,498,602 patients across 442 Level I and II trauma centers met inclusion criteria: 65.3% presenting with blunt injury, 9.3% with penetrating injury, and 25.4% with isolated TBI. Management at HPTC was associated with lower odds of major complications, failure-to-rescue and takeback. Furthermore, HPTC status was associated with increased odds of adherence to several ACS-VRC quality measures, including balanced resuscitation (Odds Ratio [OR] 1.40, 95%Confidence Interval [CI] 1.29-1.51), appropriate pediatric admissions (OR 1.88, 95%CI 1.07-3.68), and substance abuse screening (AOR 1.14, 95%CI 1.12-1.16). Significant variation in risk-adjusted mortality persists across trauma centers. Given the association between adherence to quality measures and high-performance, multidisciplinary efforts to refine and implement guidelines are warranted.

An Occupational Dimethylacetamide Poisoning Incident Responded Efficiently in Health Emergency Response Network - Zhuhai City, Guangdong Province, China, August 2023.

Dimethylacetamide (DMA), a colorless liquid with low toxicity, is commonly used as a solvent in the production of synthetic materials, petroleum processing, and pharmaceutical manufacture. In comparison to substances of higher toxicity, occupational exposure to DMA presents a deceptive risk due to its insidious and subacute progression, increasing the likelihood of escalating into major incidents. In August 2023, an incident of occupational DMA poisoning involving six cases was reported at a spandex manufacturing factory in Zhuhai City, Guangdong Province, China, following post-fire management activities. All affected individuals were employees of an equipment maintenance company tasked with cleaning polymerizers. With the coordinated efforts of the health institutions in Guangdong Health Emergency Response Network for Poisoning Emergencies (HERNPE), the situation was promptly identified and addressed. HERNPE serves as an effective framework for enhancing the integration of health institutions across various levels, facilitating a coordinated response that combines clinical services with public health initiatives. By leveraging the leadership of national centers, HERNPE plays a crucial role in the early detection, prevention, and management of large-scale health events.

Central European strategies in the new Cold War: between balancing and bandwagoning

This article argues that the security of Central Europe – defined as stretching from the Baltic Sea to the Black See–is based first and foremost on the viability and engagement of the Western alliance, understood as NATO and the European Union. The security and defense policies in the region are designed in relation to NATO and bilateral relations with the United States, with limited attempts to achieve some degree of self-sufficiency. Therefore, to understand the security of Central Europe and its individual nations, it is essential to understand their attitudes and fears related to alliances as well as their perceptions of Russia’s intentions. It is posited here that the concept that can best explain the behavior of the nations of the region, allowing also for forecasting future behavior, is the balance of threat theory, as put forward by Stephen Walt. According to the theory, the nations facing threat chose to either balance the threatening power by joining forces with other actors and forming alliances or joining in with their predator, which constitutes a bandwagoning behavior. Historically, especially during the interwar period, these strategies have been employed by Central European nations. Today, the security environment is arguably very different– we have NATO, EU, and American engagement in the region. However, the international environment has deteriorated recently, especially since the Russian full-scale invasion of Ukraine in February 2022. Arguably, Central European states have responded by falling, to some extent, into patterns of behavior familiar from the past, with some clinging to closer relations with their external patron (the United States) and some hedging their bets and opting for relative neutrality or even closer relations with Russia. The article argues that four factors determine states’ behavior vis-à-vis the Russian threat: geography, history, predator intentions, and the perception of allied reliability.

Economic Order Quantity Method to Enhance Rice Supplies and Food Security in Indonesia

Ensuring adequate food provision to meet human basic needs is of utmost importance. In Indonesia, achieving food security involves meeting the food requirements of all individuals and eliminating the risk of famine. The government's strategy to ensure national food security centers on maintaining a steady supply of rice throughout the year, recognizing its paramount significance. To address this concern, this study aims to enhance rice supplies at Gudang Bulog Baru Tempel Lemahbang 202 Blora by implementing the economic order quantity (EOQ) method. The research findings demonstrate that by utilizing the EOQ method, the optimal rice supply order size would be 15,319.4 tons. This order should be placed 119 times per year, given the 280 business days available. The annual cost of implementing this policy at Gudang Bulog Baru Tempel Lemahbang 202 Blora is estimated to be Rp. 424,484,526. Implementing the EOQ method proves beneficial in minimizing the cost for individual rice orders due to its high frequency throughout the year, which directly affects the total cost. Nevertheless, it is crucial to reassess alternative policies to further reduce the overall cost incurred in both the short and long term if the objective of the EOQ method is cost minimization.Top of Form

Prevalence of red blood cell alloantibodies in pregnant women with sickle cell disease in Bamako.

Pregnancy in women with sickle cell disease (SCD) is associated with severe complications. Red blood cell (RBC) alloimmunisation is a worrying situation in pregnant women with SCD. This could increase the difficulty in finding a pheno-compatible red blood product. Our study aimed to determine the prevalence of RBC alloantibodies in pregnant women with SCD and to determine the risk factors for alloantibodies formation. We conducted a prospective study at the "Centre National de Transfusion Sanguine de Bamako" from August 2022 to January 2023. For each participant, we collected important information, including obstetrical and transfusion histories. We performed ABO group, Rh and Kell phenotyping, and antibody screening in all study participants. We performed statistical analysis. We recruited 95 pregnant women with SCD. In our study, 62% of our participant had a history of blood transfusion. Only 23% of our pregnant women with SCD had a history of miscarriage. The prevalence of RBC alloantibodies was 14%. The main antibodies detected were anti-E (38%) and pan-agglutinins (23%). Miscarriage history, blood transfusion history, and pregnancy number were the main risk factors for RBC alloimmunisation. The care of pregnant women with SCD is complex and requires collaboration between haematologists, clinicians and gynaecologists. National guidelines should be implemented to make ABO and D typing, Rh and Kell phenotyping and antibody screening routine for all pregnant women. This would facilitate early detection of high-risk situations. Particular attention should be paid to SCD pregnant women with miscarriage and blood transfusion histories.

Impact and Implications of Solid Organ Transplant of Undocumented Immigrants versus Transplant Tourists on the Transplant Center and OPTN National Policy Development

Impact and Implications of Solid Organ Transplant of Undocumented Immigrants versus Transplant Tourists on the Transplant Center and OPTN National Policy Development

BUILDING PERFORMANCE ANALYSIS OF CHILDCARE CENTERS IN KOREA FOR RETROFIT DESIGN: TYPOLOGY BASED STUDY ON ENERGY PERFORMANCE

ABSTRACT This study investigates different architectural types of Korean national childcare centers. The goal of this study is to provide a preliminary study of the energy retrofit of childcare centers. Given the growing concern over climate change, renovation and remodeling of current buildings for energy use improvement has become a major movement. Thus, today’s improvement in the building environment inevitably accompanies energy use improvement. An examination of 17 childcare centers in the Dongdaemon-gu district in Korea has been carried out. This includes the history of the buildings, construction information and energy use of the buildings. The cases are classified depending on their architecture type and have been analyzed with their energy use. Korea has embraced the influence of other countries with child care policies and types. The typology has been adapted to the Korean environment. This research is the preliminary study for green renovation of national childcare centers under a Korean context.

Pediatric COVID-19 in Lesotho and Post-pandemic Implications on Lower Respiratory Infections in Children.

Background The United States Agency for International Development (USAID) Reaching Impact, Saturation, and Epidemic Control (RISE) program funded Jhpiego to support the Government of Lesotho's COVID-19 response, including two national COVID-19 treatment centers. To evaluate the status of post-pandemic pediatric respiratory care in Lesotho, we analyzed pediatric treatment center data and healthcare worker (HCW) performance on pediatric COVID-19 training offered to HCWs at COVID-19 treatment centers. Methods We conducted a retrospective cohort study of patients 15 years of age or less hospitalized at two COVID-19 treatment centers in Lesotho from May 1, 2020, to April 30, 2022. Patient data were extracted from hospital files. We used the independent sample t-test, Mann-Whitney U test, or Fisher's exact test to evaluate associations between exposure variables and death. We also assessed differences between pre- and post-training examination scores of three one-day HCW training on pediatric COVID-19 using paired t-tests. Results Overall, <15-year-olds comprised 18/1,448 (1.2%) hospitalizations. Twenty-two percent (4/18) of children were hypoxemic (oxyhemoglobin saturation <94%) within the first 24 hours and 44% (8/18) at any point in the hospitalization. Oxygen utilization increased over the two-year period (p=0.004) and all eight children with hypoxemia received oxygen (p<0.001). Four of 18 (22%) patients died. For HCW training, pre- and post-training examinations were completed by 76/82 (92.7%) participants. The overall mean pretraining score was 44.6% (standard deviation (SD) 15.7%). Mean scores improved by an average of 32.2% (95% confidence interval (CI) 27.7%, 36.6%, p<0.001) on the same day post-training examination. Conclusions National COVID-19 treatment center data indicate a low burden of severe pediatric COVID-19 disease in Lesotho. However, recognized HCW knowledge gaps suggest deficiencies in identifying and referring severely ill children, which may detrimentally impact the ongoing post-pandemic care of children with severe lower respiratory infections.

The Impact of the Communities that Care Approach in Reducing Violence and Crime Within an Urban, High-Burden Community.

Community violence and crime are significant public health problems with serious and lasting effects on young people, families, and communities. This violence and crime have significant ripple effects, affecting not just those who are directly physically injured, but also those who witness violent episodes, those who have friends or loved ones killed or injured, and those who must everyday navigate streets that they know have been frequent sites of serious violence and crime. The current study presents evidence of the impact that a data-driven, collective impact approach - the Communities that Care prevention system - can have on violence and crime outcomes within a large urban, high-burden community. Established as one of the national Youth Violence Prevention Centers (YVPC) funded by the Centers for Disease Control and Prevention, the Chicago Center for Youth Violence Prevention is among the first to implement the CTC approach in a large, urban community. The current study's findings show reductions in violence (i.e., aggravated assaults and robberies) in the Bronzeville community, compared to similar communities in Chicago.