The ABCD2 score is a validated risk stratification tool used to quantify the risk of stroke within 48 hours among patients presenting with suspected transient ischemic attack (TIA). Limited data exist regarding its performance among patients in an emergency department observation unit (EDOU). The objective of this study was to determine the safety and efficacy of the ABCD2 score in a US EDOU cohort. We conducted an observational cohort study using the Wake Forest Emergency Medicine TIA Registry. Patients ≥18 years old who were evaluated for possible TIA in the EDOU of Atrium Health Wake Forest Baptist from July 1, 2021 to December 1, 2023 were accrued. This analysis included patients without a persistent neurologic deficit, except for amaurosis fugax, vertigo, or paresthesias, as determined by the consulting neurologist and attending emergency physician. Patients were risk-stratified using the ABCD2 score as low- (0-3), moderate- (4-5), and high- (≥6) risk for short-term stroke. The primary safety outcome was index encounter stroke, as determined by the consulting neurologist and imaging. Efficacy was defined as the proportion of patients classified to the low-risk group. Negative predictive values and positive predictive values, and negative likelihood ratios and positive likelihood ratios for the ABCD2 score were calculated for index stroke and reported with 95% confidence intervals (CI). Of the 340 EDOU TIA patients, 55.9% (190/340) were female, 27.9% (95/340) were nonwhite, and the mean age was 67.1 ± 13.6 years. During the index visit, 21.8% (74/340) were diagnosed with acute stroke. The ABCD2 score classified 45.0% (153/340) as low-, 45.6% (155/340) as moderate-, and 9.4% (32/340) as high-risk. Of those identified as low-risk, 17.7% (27/153) had an index acute stroke. Negative predictive values and negative likelihood ratios of the ABCD2 score for index stroke were 63.5% (95% CI, 53.3-72.6) and 0.7 (95% CI, 0.5-1.1). Among patients classified as high-risk, 34.4% (11/32) had an index stroke, corresponding to a positive predictive value of 34.4% (95% CI, 20.9-50.9) and a positive likelihood ratio of 1.9 (95% CI, 1.0-3.7). Although the ABCD2 score classified approximately half of patients as low-risk, nearly 20% of this group were diagnosed with an acute stroke during EDOU evaluation. These findings suggest that the ABCD2 score is not appropriate for ruling-out acute stroke among EDOU patients as it would lead to a high rate of missed strokes.

Within classical sociological accounts of capitalism, families are curious remnantsof the past. Contemporary elite sociology dismisses the family in a different way: by primarily focusing on individual men. When the family does appear within elite studies, scholars frequently follow a stratification framework, which focuses on the transmission of social position from parents to children. This paper breaks with these dominant tendencies to understand the elite family as a shared site of work. Families are social phenomenon in their own right: they are the makers of capitalist enterprises, and they endure and thrive within capitalism. Children do not simply receive potential positions from their parents; their actions can augment or diminish family social positions. Families are impacted by previous generations' material, socio-cultural and narrative work, and by the work done by various members within a generation. The approach we offer is part of a recent development within the sociology of elites to understand the family as the central unit of analysis, with multiple members (children, siblings, spouses, parents, etc.) serving as units of observation. Our approach foregrounds how gender and sexuality structures he work that families do. We develop our approach by tracing multiple generations of the Astor family.

The impact of exposure to fine particulate matter (PM2.5) on post-discharge recovery in older adults already hospitalized for heart failure remains unclear. We evaluated associations between exposure to PM2.5 and days spent at home (DAH) as well as mortality in a nationwide representative sample of U.S. adults aged 65 years and older. Data from 66 854 Medicare Fee-for-service beneficiaries with heart failure hospitalization (2017-2019) were linked with validated, model-derived mean PM2.5 concentrations at Zip Code Tabulation Areas level during the month of hospital admission. Post-discharge 180-day DAH was defined as days alive minus days spent in inpatient hospitals, hospital observation units, nursing facilities, or emergency departments. All-cause mortality was assessed as time from hospital discharge to death within 180 days. Quantile regression and Cox proportional regression models, adjusted for covariates, were used to quantify associations. Exposure to the highest quartile PM2.5 level (>8.61 µg/m3) was associated with 5.05 fewer DAH (95% CI: -8.61, -1.48; P = 0.006) after discharge at the 20th percentile of DAH, compared with those exposed to the lowest PM2.5 quartile ( < =5.90 µg/m3). Exposure to the highest quartile PM2.5 levels was also associated with higher risk of all-cause mortality within 180 days after hospitalization as compared to the lowest PM2.5 quartile (hazard ratio = 1.05 (95%CI: 1.004-1.10, P = 0.033). Particulate air pollution may negatively impact recovery more strongly at the lower tail of recovery than at the median or higher tail, highlighting the need for targeted intervention strategies to protect the most vulnerable patients.

By examining key milestones, challenges and future directions, this review chronicles the evolution of clinical toxicology in Singapore into a recognised subspeciality and thriving community of practice. Poisoning trends have transitioned alongside socioeconomic changes from agricultural toxins to pharmaceuticals, substance misuse and prescription drugs. Currently, toxicology services have expanded across public hospitals, offering 24/7 consultations and managing selected cases in short-stay observation units to optimise resources. Singapore's hazardous material (HazMat) preparedness includes specialised HazMat Medical Life Support training, antidote and personal protective equipment (PPE) stockpiling, and deployment of semi-automated decontamination facilities. Research has focused on case reports and description of local poisoning epidemiology. Toxicology has also been integrated into nursing, undergraduate medical and residency curricula, with a national fellowship programme in the pipeline. Challenges include the latent HazMat threat, rising burden of poisoning cases, continual evolution of synthetic drugs and occupational hazards from emerging industries. Future directions should emphasise interdisciplinary collaboration, regional partnerships and leveraging artificial intelligence and toxicogenomics to enhance care.

The study examined how effectively major public entities (MPEs) implement compliance measures to reduce irregular expenditure (IE) reported in their annual reports, by comparing IE over two-years period. MPEs are governed and held accountable through corporate governance frameworks and stipulations derived from PFMA and government regulations. Therefore, to avoid incurring IE, MPEs must comply with supply chain management (SCM) frameworks. Qualitative research approach was adopted using content analysis to assess compliance implementation in reducing IE. MPEs annual reports (AR) served as the unit of observation and IE closing balances were used to calculate change in IE percentage. The findings show that regardless of SCM frameworks being in place, most of the MPEs still struggle to implement effective controls to ensure compliance with relevant SCM legislation, leading to continuous IE being reported. Results contribute to agency, institutional and accountability theories and suggest that managers should prioritise practices that benefit the entity over their own financial benefits by implementing a sound compliance system to reduce IE. MPE's management should enforce accountability and apply consequence management to enhance organisational compliance culture. Furthermore, analysis of results provides managerial implications for MPEs' management and policymakers to strengthen their SCM internal control systems and provide continuous training for employees involved in the procurement process to equip their procurement skills. Moreover, management must ensure that all AGSA recommendations regarding IE are implemented to prevent future incurrence of IE.

Feasibility of rapid low dose buprenorphine initiation in an emergency department observation unit.

Functional Decline Prior to Emergency Department Presentation in Older Adults: A Prospective Observational Study.

Taita Taveta is in Kenya’s Coastal area and has four sub-counties: Mwatate, Taveta, Voi and Wundanyi. The district borders Kwale, Makueni and the Republic of Tanzania. It is home to the Tsavo East and Tsavo West National Parks, the Lumo Community Nature Reserve, and many ranches. Good roads in the region are therefore essential for tourism, trade with neighboring countries, and connecting Nairobi and the Mombasa region. The research was meant to evaluate training and efficacy of employees in the public works, transportation, and infrastructure sector of Taita Taveta County. The researcher investigated how training employees affect the performance of public works, transportation, and infrastructure in Taita Taveta County Government, specifically Training needs analysis. The study was guided by Instructional Systems Design (ISD). It also took interest on Human Performance Technology (HPT). Using a descriptive research design with a target population of fifty-five, selected through a simple random sampling method. Primary data was gathered using a questionnaire, which was validated through a pilot study. The reliability of the questionnaires was established, ensuring a thorough approach to validity. A correlation test and regression analysis were run and presented results in a statistical format, supported by graphics and diagrams. The unit of observation was individuals selected using a simple random sampling method. The researcher found that training needs had immense positive influence on employee performance in department of public works. They also determined that a strong correlation existed between training design and the performance of employees in this department. It was noted that implementing training policies caused significant positive changes in performance of employees in the public works department in Taita Taveta County. Recommendations arose from these findings. First, there was a need to encourage the implementation of suitable policies during employee training. Secondly, it was crucial to emphasize the importance of addressing the underlying training needs of employees

Numerous medications have been approved to treat heart failure (HF). Given the risk of irreversible morbidity and mortality in chronic HF, medication approval was traditionally based upon reductions in cardiovascular death or HF hospitalization. However, expanding use of effective medicines has reduced hospitalization and mortality rates. This incremental reduction in 'hard' outcomes has made endpoints that capture how patients feel or function attractive for new medicine development as efficacy can potentially be demonstrated in smaller trials of shorter duration than cardiovascular outcome trials. Moreover, while inpatient hospitalization is the traditional vehicle for managing acute HF, dedicated infusion centers, observation units, and emergency departments now provide alternative outpatient venues. This changing clinical practice landscape prompts consideration of certain outpatient HF events as reasonable for inclusion in a primary composite endpoint, though these events span a broad spectrum of severity of worsening HF. At the high severity margin, outpatient events approximate a hospitalization-equivalent, i.e., but for the existence of alternative venues, patients would have been hospitalized. At the opposite end of the continuum are changes in care without direct contact, e.g., increasing oral diuretics after a brief telephone call. Both events ostensibly represent clinical worsening yet differ markedly in patient relevance. Building upon previous guidance documents, a contemporary regulatory perspective is presented on innovating, standardizing, and streamlining HF trials. Adoption of these principles may improve trial efficiency while ensuring new therapies possess unambiguous public health benefits.

This study aims to analyze the effect of Regional Taxes, Regional Retributions, Separated Regional Wealth Management Results, and Other Legitimate Regional Original Revenues on the Regional Original Revenue (PAD) of Lembata Regency for the 2020–2024 period. The research employs a quantitative approach with an associative and causal-comparative design, using secondary data obtained from the Regional Budget Realization Reports (APBD), official government documents, and publications from the BPS. The sampling technique used is the census (saturated sampling) method with a total of 60 observational units, and data analysis was conducted using multiple linear regression. The results show that partially, Regional Retributions and Other Legitimate PAD have a positive and significant effect on the PAD of Lembata Regency. Meanwhile, Regional Taxes and Separated Regional Wealth Management Results (HPKDD) have a positive but insignificant effect. Simultaneously, the four independent variables have a significant effect on PAD. These findings indicate that the management of retributions and other legitimate revenues plays a dominant role in enhancing regional fiscal independence, while the contribution of regional taxes and HPKDD still needs to be optimized through improved governance, tax policy effectiveness, and the performance of regional-owned enterprises (BUMD) to strengthen the regional financial structure sustainably.

Patients with potential transient ischemic attacks (TIA) are often evaluated with transthoracic echocardiography (TTE) to identify cardioembolic sources. The diagnostic yield of TTE among patients in an Emergency Department Observation Unit (EDOU) with suspected TIA is unknown. We aimed to determine the diagnostic yield of TTE in a U.S. EDOU TIA cohort. We conducted an observational cohort study using the Wake Forest Emergency Medicine TIA Registry. We included patients ≥18 years old evaluated in the EDOU TIA Protocol at a large academic tertiary care center between 7/1/2021-12/1/2023. TTE results were reviewed for high-risk cardioembolic features, which we included as patent foramen ovale (PFO), left ventricular ejection fraction (LVEF) ≤ 40%, focal wall motion abnormalities (FWMA), and ventricular thrombus. The diagnostic yield, defined as the proportion of patients who were found to have a high-risk cardioembolic feature on TTE, was calculated and reported with an exact 95% confidence interval (95%CI) and used to determine the number needed to test (NNT). Among 686 patients included our cohort, 67.1% (460/686) underwent TTE. The diagnostic yield of TTE was 19.4% (95%CI 15.7-23.0%), which corresponds to a NNT of 6 (95%CI 5-7). In our cohort, TTE identified 63 PFOs, 26 instances of LVEF ≤ 40%, 6 FWMAs, and 0 ventricular thrombi. Among patients with suspected TIA in the EDOU, TTE was useful in the detection of high-risk cardioembolic features, especially PFOs and reduced LVEF. These findings support the continued use of TTE for those evaluated for TIA in the EDOU.

Management of patients requiring high-flow nasal cannula in a pediatric observation unit: a single-center experience.

This study aimed to evaluate whether a modified pediatric early warning score (MPEWS)-triggered personalized care bundle – designed to facilitate early detection of clinical deterioration and guide timely individualized interventions – improves outcomes in critically ill children in an emergency observation unit. A retrospective cohort study was conducted among 120 critically ill children admitted to the emergency observation unit. Based on the care received, patients were allocated to either the MPEWS-based personalized care group (n = 60) or the routine care group (n = 60). Data were extracted from electronic medical records. Primary outcomes included stabilization of vital signs, length of stay, incidence of complications, and parent-reported satisfaction. Children in the MPEWS group achieved significantly faster stabilization of heart rate, respiratory rate, blood pressure, oxygen saturation, and consciousness level within 24 to 72 hours compared with those receiving routine care (P < .05). The median length of stay was shorter in the MPEWS group (3.0 days [interquartile range: 2.0–4.0] vs 4.0 days [interquartile range: 3.0–5.0], P < .001). Complication rates were lower, including respiratory failure (6.7% vs 20.0%), cardiac arrest (0% vs 6.7%), and hospital-acquired infections (5.0% vs 16.7%; P < .05). Parent satisfaction was also higher in the MPEWS group (median 98 [95–100] vs 90 [85–94], P < .001). MPEWS-triggered personalized care was associated with more rapid physiological stabilization, reduced hospitalization time, fewer complications, and greater family satisfaction in critically ill children in emergency observation settings.

Introduction. A component step in developing a competency-based education (CBE) program is to define a set of consensus-driven learner performance outcomes that will meet the physical therapy (PT) needs of society. Review of Literature. Entrustable professional activities (EPAs) represent observable units of practice that integrate critical competencies that must be demonstrated in the care of patients. EPAs serve as a framework for teaching, learning, and assessment of key skills and responsibilities. The purpose of this manuscript is to describe the iterative, four-phase national consensus-based process, capturing multiple perspectives, on a core set of EPAs that Doctor of Physical Therapy (DPT) students should be entrusted to perform independently upon entering clinical practice for the first time, regardless of setting. Subjects. Fifteen physical therapists served as members of the national EPA drafting group. Purposive selection was used to recruit 190 participants to serve as members of a Reactor Panel. Methods. A modified Delphi was utilized that included 4 iterative phases. Each phase comprised work completed by the EPA drafting group, supported by experts in EPAs, followed by a reactor panel providing broader community feedback via a modified Delphi to facilitate consensus. Consensus was defined a priori as agreement among &gt;80% of respondents. Results. Nineteen core EPAs were identified as essential activities that all graduates of entry-level DPT programs should be able to perform safely and without the need for supervision, regardless of the practice setting. Each EPA has 5–7 critical competencies mapped to it that are aligned to learner characteristics required to be entrusted to that essential task. Discussion. These core entry-level EPAs can serve as the national standard for minimum core performance outcomes required at entrance into clinical practice. Conclusion. This EPA framework can be used for teaching and assessing the critical competencies necessary for safe and efficient entry-level practice.

Emergency department observation units (EDOUs) have been shown to improve hospital operations and capacity during normal operations; however, their role in a disaster or surge event remains unclear. This is a retrospective case series of hospitals that leveraged an EDOU in the setting of a disaster or surge event. Cases were solicited from members of the American College of Emergency Physicians Observation Medicine Section and a review of published literature. Cases were organized under the context of CBRNE (Chemical, Biological, Radiological, Nuclear, Explosives) and environmental disasters. Seven cases were identified across chemical (2), biological (3), and environmental (2) disaster types. In all instances, EDOUs supported continued ED operational flow, enhanced patient surge capacity, and preserved inpatient resources. Five potential models for an EDOU involvement are described: no change, combine disaster and usual patients in the EDOU, only disaster patients in the EDOU, alternative use of the EDOU, and virtual observation care. There was a variable impact of each model on the flow of hospital observation patients and disaster patients. In the setting of a disaster or surge event, the EDOU can play a significant role in ED and hospital operations. Their adaptability, efficiency, and existing infrastructure make them uniquely suited to respond quickly. Opportunities exist for the integration of EDOUs into hospital disaster planning.

The hospitality industry is experiencing tremendous growth, leading to fierce competition among players. Good governance has the benefit of building a company's reputation and investor confidence, and ensuring accounting and reporting standards that attract capital inflows. The hospitality industry plays a critical role in a country’s economic development. In Kenya, even though the sector is the second largest foreign exchange earner the industry faces a myriad of challenges. This study sought to determine the effect of ownership concentration on performance pf five-star hotels in Kenya. The study was anchored on agency theory and adopted a descriptive research design. The unit of analysis was five-star rated hotels and hence the study targeted all the fifteen five-star hotels operating in Kenya, while the unit of observation was 198 head of departments, managers, and board members. The respondents were sought through a census. Structured questionnaires were the main tool to collect primary data from the targeted respondents. Cronbach’s alpha was used to test for the internal reliability of each variable used in the study. Data analysis was done using descriptive statistics, correlation, and regression analysis. The study used bivariate regression analysis to analyze the association between ownership concentration and performance of five-star hotel variables. The study findings indicated that ownership concentration had a positive and significant effect on the performance of five-star hotels. The study concluded that ownership concentration contributes significantly to performance of five-star hotels in Kenya. The study recommends that five-star hotels should put in place measures to safeguard accommodate government, foreign managerial and family ownership since these ownership concentration dimensions play a critical role on performance of the hotels. The study further recommends that the management can use the finding of this study to better align or revise the existing ownership concentration framework, to promote performance of the hotels.

Global climate change and the transition toward green energy have created significant challenges for Indonesia’s manufacturing industry. This study aims to explain the causal relationship between the independent variables ESG and Risk Management Disclosure and the dependent variable, financial performance, with green innovation serving as a moderating variable. The research is grounded in stakeholder theory and contingency theory and employs a quantitative research design.The population of this study consists of all manufacturing companies listed on the Indonesia Stock Exchange (IDX). The sample includes manufacturing firms that meet the research criteria; from a total of 232 companies, 24 firms were selected, resulting in 120 observational units over a five-year period.The findings confirm that ESG, Risk Management Disclosure, and green innovation significantly improve financial performance.These results provide new insights into the integration of green innovation as a moderating factor within the manufacturing sector.

This study presented a systematic review of artificial intelligence–based predictive safety models aimed at reducing workplace injuries in manufacturing and construction, with emphasis on quantitative comparability across outcomes, data modalities, validation designs, and performance metrics. A total of 312 observational units and respondent-linked records from manufacturing and construction contexts were synthesized to evaluate injury occurrence, high-severity injury outcomes, and leading-indicator–based risk prediction. Manufacturing accounted for 51.9% of the analyzed records, while construction represented 48.1%. Descriptive results showed moderate-to-high levels of perceived AI usefulness (mean = 3.92, SD = 0.64) and leading-indicator maturity (mean = 3.74, SD = 0.69), with construction exhibiting higher median near-miss activity (median = 2 events per unit window) than manufacturing (median = 1). Logistic regression analyses indicated that data quality readiness was significantly associated with reduced injury occurrence (odds ratio = 0.78, p = 0.002) and reduced high-severity injury occurrence (odds ratio = 0.73, p = 0.006). Safety culture also demonstrated a protective association with injury occurrence (odds ratio = 0.82, p = 0.013). Sector-stratified analyses showed stronger readiness effects in construction (odds ratio = 0.72, p = 0.001) than in manufacturing (odds ratio = 0.83, p = 0.041). Leading-indicator maturity was associated with lower general injury odds (odds ratio = 0.85, p = 0.028) but did not reach significance for high-severity injuries. Validation design and metric selection were found to substantially influence reported performance, with temporal and site-held-out testing yielding more conservative and credible estimates than random splits. Overall, the findings underscored that predictive safety effectiveness depended primarily on data readiness, measurement quality, and validation rigor rather than algorithm complexity alone.

Functional data analysis involves data for which the basic unit of observation is a function or image. The development of robust exploratory tools and inferential methods is very much needed since few assumptions can be made about the generating process. Data depth, a well-known nonparametric tool for analyzing functional data, provides a rigorous method for ranking a sample of curves from the center outwards, allowing for robust inference and outlier detection. Several notions of depth for functional data have been introduced in the last few decades. Here we develop a new family of depths, termed quantile integrated depth (QID), that are based on integrating up to the Kth quantile of the univariate depths. We show that this new family of depths has desirable properties, including a type of invariance, maximality at the center, and monotonicity with respect to the deepest point. In addition, since functional data are commonly observed with noise, we explore the effect of noise on different notions of depth. Compared to alternatives, the proposed QID is shown to be robust and perform well on noisy functional data. We also illustrate the advantages of using QID K to identify potential hard-to-detect shape outliers.

This study aims to analyze the effect of inflation, sales growth, and profitability on stock prices in healthcare sector companies listed on the Indonesia Stock Exchange (IDX) during the 2019–2023 period. A quantitative approach was used with multiple linear regression analysis. The sample was selected using a purposive sampling technique, comprising 17 companies that were consistently listed on the IDX throughout the five-year observation period, resulting in 85 observation units. The data used are secondary data obtained from company financial statements published on the official IDX website (www.idx.co.id). Data analysis was conducted using SPSS version 25, which included descriptive statistics, classical assumption tests, and hypothesis testing through the adjusted coefficient of determination (Adjusted R²), t-test, and F-test. The results show that simultaneously, the variables inflation, sales growth, and profitability (measured by Return on Equity/ROE) significantly affect stock prices, with an adjusted R² value of 34.3%. However, partially, inflation and sales growth do not have a significant effect on stock prices, while ROE has a significant influence. These findings indicate that although inflation and sales growth are not yet the main determinants of stock price increases, ROE remains the key indicator most considered by investors. The implication of these findings suggests that companies should not only focus on increasing profitability but also actively manage inflation risk and optimize sales growth as part of their stock value enhancement strategy. Although the impact of inflation and sales growth is not statistically significant, consistent management of these factors remains essential as it can shape positive investor perceptions, ultimately contributing to long-term stock price stability and growth, especially amid increasing market expectations for sustainable and responsible business practices.