Permanent Suspension Research Articles

Rocking Under Orion’s Belt: The Rise and Fall of Seibu Kōdō as International Concert Venue

ABSTRACT An edifice resembling a temple hall and located on the outskirts of the Kyoto University campus, Seibu Kōdō, rose to national prominence in the early 1970s as a hub for the city’s burgeoning performing arts and rock music scene. Its reputation and legend quickly grew after hosting the MOJO WEST series, inaugurated in 1971, that included concerts by iconic Japanese bands such as Flower Travellin’ Band, Murahachibu, and Zunō keisatsu. Towards the end of the decade, Seibu Kōdō began attracting international performers, spearheaded by Frank Zappa and the Mothers of Invention in 1976. However, an incident during a concert by The Police in 1980 led to a permanent suspension of welcoming foreign acts. This article explores Seibu Kōdō’s formative years as a concert venue and the way its connections to the radical student movement, symbolised by the constellation of three red stars painted on its roof, informed its peculiar self-management model. This facilitated the venue’s use as a space for unrestricted artistic expression, but at the same time hindered its development beyond local significance.

Investigating Influential Users' Responses to Permanent Suspension on Social Media

Social media platforms use permanent suspension as a measure of last resort to intervene with users who spread harmful or misleading content. However, permanent suspension does not signify the end of a user's online presence, but rather on that specific platform. This issue is particularly salient for influential users with large audiences, as they have the potential to cause substantial shifts in the overall social media information landscape when suspended. Our work employs a mixed methods approach to study the context around, and behavioral patterns after, permanent suspension. We find that migration is a common step after suspension, and characterize a number of behavioral strategies and patterns that occur after influential users are suspended. By focusing on consequences of suspension across more holistically, we have identified numerous opportunities for design and future research to mitigate the potential negative effects of permanent suspensions on the broader social media information landscape.

Kelayakan Konstruksi Bangunan Trotoar di Kota Ambon

Introduction: Sidewalks are road support facilities as stipulated in Law no. 22 of 2009 concerning Road Traffic and Transportation. The availability of sidewalks must provide safety and comfort for pedestrians passing through.Purposes of the Research: The purpose of writing this thesis is to find out and analyze (1) Does the sidewalk building in Ambon City meet the construction feasibility requirements in the provisions of laws and regulations.? and (2) What are the legal consequences if the sidewalk building does not meet the construction feasibility standards in the ptovisions of the legislations.? Methods of the Research: The type of research used in this study is normative juridical legal research, namely legal research conducted by examining library materials or secondary materials which consist of primary legal materials and secondary legal materials. These materials are arranged systematically, studied, then a conclusion is drawn in relation to the problem under study.Results of the Research: The results and discussion show that the construction of sidewalks in the city of Ambon does not meet the feasibility standards for the construction of sidewalks as stipulated in the Regulation of the Minister of Public Works Number 03/PRT/M/2014 concerning Guidelines for Planning, Provision and Utilization of Infrastructure and Facilities for Pedestrian Networks and Urban Areas, and Decree of the Director General of Highways No. 74/KPTS/Db/1999, Date, 7 December 1999 Concerning Ratification of One Technical Guideline of the Directorate General of Highways. Of course, this condition has legal consequences as stipulated in Article 44UU No. 28 of 2002 concerning Buildings in which there are administrative sanctions in the form of a) Written warning; b) Restrictions on development activities; c) Temporary or permanent suspension of construction implementation work; d) Temporary or permanent suspension of building use; e) Freezing of building construction permits; f) Revocation of building construction permit; g) Freezing of the certificate of proper function of the building h) revocation of the certificate of proper function of the building; or i) an order for the demolition of a building.

Reasons for Temporary or Permanent Suspension of Using Electronic Accounts on Social Media Platforms

Objectives: The study aims to achieve a better understanding of the reasons for the temporary or permanent suspension of using the electronic account on a platform or more of social media among Egyptian youth.
 Methods: This research is a descriptive research ; the researcher depends on a questionnaire to collect data that was applied to a sample of Egyptian youth between the age of 18 to 35 years old (225 individuals). They represent 3 different regions which are (Cairo,Giza, and Assuit).
 Results: The research has reached many results, including the decision to temporarily or permanently suspension using a social media platform was not a difficult decision it was previously taken by 86.7% of youth from the sample of the study. The study also found the most important reasons for the temporary or permanent suspension from using the electronic account, including social problems, privacy, disconnection from others, or the desire to escape from threats or prosecutions, etc.
 Conclusions: The study concluded the importance of providing enough awareness and protection for young people that use social media platforms, and preparing future comparative studies between various societies that explain the different reasons for stopping the use of these platforms.

#4680 PATIENT OUTCOMES AND DYNAMICS OF THE AUSTRALIAN KIDNEY TRANSPLANT WAITLIST: SUSPENSIONS, RETURNING TO WAITLIST, TRANSPLANTATION AND DEATHS

Abstract Background and Aims People on the kidney waitlist are less informed about potential temporary or permanent suspensions. Disparities may exist among those who are suspended and who return to the waitlist. In Australia, average wait times vary be state/territory and blood group, but overall is X years. We aimed to describe and evaluate factors associated with waitlist transitions and subsequent outcomes after entering the waitlist for deceased donor kidney transplant. Method We included all incident patients waitlisted for their first transplant from deceased donors in Australia during 2006-2019. We described all clinical transitions after entering the kidney waitlist including: active on waitlist; suspended; kidney transplant; graft failure; and death. We predicted the restricted mean survival time from waitlist entry until first transplant with 5 year time horizon and summarized the annual percentages in each clinical state until 5 years. We used flexible parametric multi-state survival models to evaluate factors associated with transitions after entering the waitlist until first transplant, reporting the hazard ratio (HR) for each transition. We used Cox proportional hazards models to evaluate factors associated with death while waiting and first transplant, reporting HR for these outcomes. Results Of 8,466 people who entered the kidney waitlist, 6,741 people received their first transplant (6,163 deceased donor; 506 living donor; 99 paired kidney exchange donors), 381 people died while waiting (31 active on waitlist; 350 suspended) and 1,344 were still waiting for a transplant (844 active on waitlist; 500 suspended). Nearly two-thirds (63%) were not suspended while waiting, but 2,111(25%) were suspended once and 1,016(12%) were suspended ≥2 times. Of those suspended, 47% spent a total of <6 months off-waitlist. Predicted mean time from waitlist entry to transplant increased with number of suspensions, from 1.9 years (95% CI:1.8-1.9 years) in patients not suspended to 3.0 years (95% CI:2.8-3.2 years) in patients suspended once or more. For the entire cohort, the 1-year probability of transplant was 41%(95%CI:40-42%), active on waitlist was 42%(95%CI:41-43%), suspended was 11%(95%CI:10-12%) and death was 1.4% (95%CI:1.2-1.7%) (Fig. 1). At 5-years, this increased to 63% (95%CI:62-64%) transplanted, 5% (95%CI:4-5%) active on waitlist, 10% (95%CI:9-11%) suspended and 13% (95%CI:12-14%) died. Several patient factors were associated being suspended and returning to the waitlist, as well as with receiving transplant and death while waiting (Fig. 2). Having been suspended from the waitlist, increased the likeliness of further suspensions by 4.2 times (95%CI: 3.8-4.6; p < 0.001) and returning to the waitlist by 50% (95%CI: 36-65%; p < 0.001) but decreased the likeliness of receiving a transplant by 29% (95%CI: 62-82%; p < 0.001). Being previously suspended once reduced the risk of death while waiting by 31% (HR: 0.69, 95%CI: 0.52-0.91; p < 0.01), likely a paradox of being well enough to return to waitlist at least once. Socio-demographic factors were modifiers of returning to the waitlist after suspension. Males of Australian or New Zealand ethnicity (non-Indigenous) were 13% (95%CI: 4-23%) more likely to return to the waitlist compared to females of the same ethnicity (p < 0.01). However, males of Aboriginal, Torres Strait Islander, Māori or Pacific Islander ethnicity had the same likeliness of returning to the waitlist as their female counterparts (p = 0.08). Conclusion The dynamics of the transplant waiting list were not straightforward. About one-third of patients were suspended at least once and wait 1 year longer for a transplant compared with those not suspended. Our findings will provide evidence to support more informed discussions about the patient journey from waitlist to transplantation, and aid in shared decision making.

Temporary Incapacitation Rates and Permanent Loss of Medical License in Commercial Airline Pilots.

INTRODUCTION: The purpose of this study was to report the temporary loss of medical license and pilot incapacitations in the United Arab Emirates from 2018-2021.METHOD: The General Civil Aviation Authority database was searched for all reported temporary suspensions of license between 2018-2021 and the ICD-10 codes were extracted.RESULTS: A total of 1233 incapacitations was reported with a mean license suspension of 148.4 ± 276.8 d. The mean days of suspension for the various medical specialties were 115.2 ± 188.4 for musculoskeletal conditions (N = 392), 189.3 ± 324.8 for medicine (N = 335), 101.6 ± 231.4 for surgery, 109.4 ± 223.5 for urology (N = 93), 90.3 ± 128.7 for ophthalmology (N = 68), 385.6 ± 594.3 for psychiatry (N = 61), 150.4+285.9 for ENT (N = 59), 419.4 ± 382.6 for obstetrics and gynecology (N = 30), and 44.9+39 for dermatology (N = 21). Permanent suspensions were as follows: total N = 100 (8.1%), musculoskeletal N = 13 (3.3%), medicine N = 37 (11%), surgery N = 10 (5.7%), urology N = 10 (10.7%), ophthalmology N = 2 (2.9%), psychiatry N = 20 (32.8%), ENT N = 1 (1.7%), obstetrics and gynecology N = 4 (13.1%), and dermatology N = 3 (14.3%).DISCUSSION: Musculoskeletal conditions are the most common reason for temporary loss of medical license followed by medical and surgical conditions. The least common reason was dermatological conditions. The longest period of incapacitation was associated with psychiatric conditions followed by medical and ENT conditions. The annual calculated temporary incapacitation rate was 2.8% and the permanent suspension rate was 0.25%.Hohmann E, Pieterse R. Temporary incapacitation rates and permanent loss of medical license in commercial airline pilots. Aerosp Med Hum Perform. 2023; 94(3):113-121.

Prevalence of Low Back Pain Among athletes in Riyadh, Saudi Arabia

Background: Lower back pain is a major complaint presented globally with its manifestation attributed to ligament strain or muscle strain and bulging or ruptured disks. 7.5% of the world population suffers from lower back pain with more than 70% of people in developed countries experiencing low back pain at some time. Lower back pain causes posturing problems and decreased motion ranges limiting people's ability to do work. The defect also causes numerous issues like debility, affects the quality of life, and impairs the ability to function and work, generating a socioeconomic burden on patients and society, which may challenge the health care system's cost-effectiveness. The complaint is enormously common in athletes and sportsmen. However, there remains a gap in understanding its prevalence across various sports and time frames. Lower back pain anatomic changes affect athletes' levels of exercising and competing which can result in permanent suspension from sporting activities. The issue of low back pain (LBP) is a persisting challenge, therefore, we are conducting this study to determine the ubiquity of low back pain among athletes in Riyadh, Saudi Arabia. Aim: The purpose of this qualitative research was to understand the ubiquity and prevalence of low back pain among athletes in Riyadh, Saudi Arabia. Materials and methods: The study involved 371 participants enrolled from three units; gyms, sports centers, and public places. The study took place between May 2022 and August 2022. Self-administered questionnaires with questions on demographics and a standardized scale (Standardized Nordic questionnaires for the analysis of musculoskeletal symptoms) were used. Data collection was exercised by trained research assistants pre-trained by the research team. All the questions administered were standardized to enable respondents to receive duplicate questions with identical wording. Results: The participants had a mean age of 26.9 years ± 7.69. Demographic: Gender (M, 193; 52%. F, 178; 48%). BMI (Under, 15; 4.1%, Normal, 184; 184; 49.69%, Overweight, 128; 34.7% and Obese 42; 11.4%). smoking, (yes 114; 30.71%, No 234; 63.1%, ex 23; 6.2%). Nationality, (Saudi, 288; 77.6%, Non-Saudi; 88; 22.4%). Prevalence of back pain: Once in a lifetime, (305; 82.2%, never, 66; 17.8 %,) last twelve months (158; 42.6%, no pain, 213; 57.4%) past seven days (yes 106; 28.6%, no pain in 265; 71.4 %.) p = 0.028), Associated factors: feeling sad (0.002) uncomfortable furniture (p = 0.005), and gender (p < 0.001). Exercise duration and frequency exercising (p < 0.017) (p < 0.052) and Weightlifting (p < 0.065). Conclusion: Back pain is a relatively common complaint experienced by people and is more common among athletes. Besides exercising, it is evident that uncomfortable sleeping conditions, mental well-being, and gender play a big role in spawning back pain.

Oral Immune-Related Adverse Events Associated with PD-1 Inhibitor Treatment: A Case Series

Introduction: Immune Checkpoint Inhibitor (ICI) drugs have led to a revolution in the treatment of different forms of cancer, shifting the target of action from cancer cells to the patient’s immune system, enhancing their responses against the tumor itself. On the other hand, this mechanism can lead to responses against oneself, with the appearance of immune-related adverse events. The aim of the present study was to examine the immune-related adverse events (irAEs) affecting the mucous membranes of the oral cavity and the possible correlation between these and skin toxicities, which are reported in the literature as the most common adverse events. Materials and methods: Thirteen patients treated with anti-Programmed Death (PD-1) drugs (pembrolizumab, nivolumab, and cemiplimab) were selected. The data collected include the general history of the patient and the type of anticancer treatment. The sample was then analyzed by recording the alterations found on the mucous membranes of the oral cavity and on the skin. Finally, the average time that elapsed between the start of immunotherapy and the onset of lesions was analyzed. Results: Patients often had multiple lesions at the same time. Hyperkeratosis was found in three patients, candidiasis (pseudomembranous and median rhomboid glossitis) in two patients, epithelial atrophy in four patients, and ulcerative areas in two patients. One patient reported xerostomia with dysphagia. The anatomical areas most involved were the dorsal tongue and palate. Skin irAEs included skin rash erythema (n = 7) with diffuse redness, the presence of small bubbles with a crusty outcome, and dryness of the skin in the affected areas. Discussion: In the literature, there are few studies that analyze how irAEs affect the mucous membranes of the oral cavity in patients treated with ICI drugs. The most frequently described lesions are lichenoid reactions and xerostomia. Moreover, the development of mucositis, generally of low grade, has been reported. The present study has confirmed the data from the literature and, in addition, reports two cases of candidiasis, an adverse event that has never been shown in the literature. Conclusions: irAEs have the potential to affect any organ. The only way to avoid the occurrence of serious events that is currently available is early interception, which is only possible through the knowledge of these manifestations. It is therefore considered necessary to deepen our knowledge of oral irAEs and their correlation with dermatological toxicities, allowing for a multidisciplinary classification of the patient and a timely diagnosis of any adverse event and avoiding progression to more advanced stages, which could lead to the temporary or permanent suspension of anticancer drugs.

淸末 捐納廢止論의 形成과 그 意味

The office purchase system (Juanna; 捐納) is a system that sells the titles of university student (jiansheng 監生), tribute student (gongsheng 貢生) and clerk or archivist (典簿), Rank, the title of an office (guanxian 官銜) - mostly just a brevet title (xuxian 虛銜) - or a real office (shizhi 實職) etc., and was also called ‘maiguan(賣官)’ (Selling Offices). It is a system in which the government sells according to certain regulations to cover insufficient financial resources as a financial means other than fixed-rate, and civilians and bureaucrats purchase it. From a social point of view, the office purchase system not only functioned as a tool to prevent the rise or fall of status along with the past system, but also provided a means of guaranteeing faster promotion and commissioning for incumbent or candidate bureaucrats. After the Xianfeng reings (1851~1861), the frequent implementation of the office purchase system was to prove the state''s financial difficulties, but above all, it was causing the collapse of the official administration. In this respect, after the Xianfeng reings, public opinion on the suspension of the payment of arrears began to boil, but from a financial point of view, it did not lead to the abolition due to ''unavoidable''(不得已). From the time after Xianfeng reings until Shiguanjuan (Purchasing for real Offices;實官捐) implemented the ‘permanent suspension’(永遠停止) in 1901, public opinions on the suspension of the donation System was mainly focused on the collapse of reason from the traditional perspective. However, during the Guangxu reigns (1875~1908), the utility of annual payments as a non-fixed financial means was lost, and only the negative effects were exacerbated. In the end, the ‘permanent suspension’ measures were taken in 1901, but nevertheless, the actual relationship was not stopped and continued until the moment of the collapse of the Qing Dynasty. The public opinion at the time regarding the abolition of the abolition of the pension after 1901 never trusted the ''permanent suspension'' because of the precedent that had already been repeated over and over again. Shiguanjuan (Purchasing for real Offices) after 1901 was an important ground that it mainly hindered the promotion of the theocracy, but paradoxically, Shiguanjuan (Purchasing for real Offices) had to be implemented in order to raise expenses for the promotion of various new policy(光緖新政). In fact, from 1900 to 1911, the practice was conducted in various parts of the Porvinces. By 1910, annual donation income was incorporated into the official fiscal income of the Porvinces. Although the proportion of total fiscal revenue is significantly lower than in the previous period, the reason why the Selling Offices System could never be given up was because the annual payment was ultimately a financial means.

Ah Bartleby! Study, learning, and pedagogy in Occupy Wall Street

On October 26, 2011, a post appeared on the Occupy Wall Street Library blog titled “I would prefer not to.” The constant refrain of Herman Melville’s Bartleby, the Scrivener became one of Occupy’s defining mottos, appearing on placards, T-shirts, and tote bags. The phrase became so symbolic that it was used on the posters promoting the general strike called for May 2012. Bartleby’s mode of passive resistance has been theorized extensively. His appropriation by OWS has been the source of much theorizing too. What I want to do in this paper is use Bartleby as a useful analogy for exploring the educational logic of Occupy Wall Street. While some read a dangerous and threatening “Bartlebyan inscrutability” into OWS’s various refusals (the refusal to issue demands, to address questions of political ontology, to specify conditions of success), I argue instead that the performativity of Bartleby’s refusal helps cast light on the need for pedagogical intervention in moments and movements of utopian rupture. The very indeterminacy of study as a mode of educational being within OWS—of “preferring not to” actualize potential, adopt a political subjectivity, elucidate any determinate ends—created a vacuum that precluded the movement from learning from itself. The oscillating state of permanent suspension, in which the utopian possibilities contained within the movement were held im-potential, led to paralysis and neglect. In contrast to the “weak” utopianism ascribed to OWS by Tyson Lewis, I conclude the paper by calling for a “strong” utopianism conceived as a collective endeavor and iterative process but one within which pedagogical organization plays a crucial facilitating role.

Review of neurological complications following treatment with immune check- point inhibitors

ObjectiveImmunotherapy with cytotoxic T lymphocyte-associated protein-4 (CTLA-4), programmed cell death protein-1 and ligand-1 (PD-1 and PD-L1) inhibitors are the most promising development in oncology. Neurological complications are reportedly seen in 2–4 % of patients treated with immune checkpoint inhibitors (CPI).MethodThis was an observational study which included all oncology and haematology patients who received the most common CPI (Ipilimumab, Nivolumab, and Pembrolizumab), either as monotherapy, in combination or sequentially between the periods of January 2017 to April 2019.ResultsTotal of 375 patients received CPI during this period. The most common cancer was malignant melanoma, lung, head and neck and renal cancers. 199 patients had neurological complications, the vast majority due to metastasis or vascular complications related to the cancer. One hundred patients were identified as having neurological symptoms related to Immune therapy. 67 of these patients who were symptomatic received some sort of intervention for the neurological IRAE, which included change in immunotherapy, temporary or permanent suspension of treatment or steroids.ConclusionThis is one of the largest series of cancer patients studied so far for neurological IRAEs following CPI therapy. Early diagnosis of these events is highly vital for effective treatment and cure of symptoms. Steroids hold the mainstay of treatment followed by IVIG/PLEX, possibly in a graded fashion based on severity. Long term studies are needed to establish a clear pathway and identify prognostic indicators.saiju.jacob@uhb.nhs.uk

Amyloid-Related Imaging Abnormalities With Anti-amyloid Antibodies for the Treatment of Dementia Due to Alzheimer's Disease.

Second-generation anti-amyloid monoclonal antibodies are emerging as a viable therapeutic option for individuals with prodromal and mild dementia due to Alzheimer's disease (AD). Passive immunotherapy with aducanumab (Aduhelm), lecanemab, donanemab, and gantenerumab all lower CNS amyloid (Aβ) burden but come with a significant risk of amyloid-related imaging abnormality (ARIA)—the most common side effect of this class of drugs. While usually asymptomatic and detected only on brain MRI, ARIA may lead to new signs and symptoms including headache, worsening confusion, dizziness, visual disturbances, nausea, and seizures. In addition, one fatality related to ARIA-E (edema) with aducanumab and one fatality due to ARIA-H (hemorrhage) with donanemab are reported to date. ARIA-E may be associated with excessive neuroinflammation and saturation of perivascular clearance pathways, while ARIA-H may be related to vascular amyloid clearance with weakening and rupture of small blood vessels. The risk of ARIA-E is higher at treatment initiation, in ApoE4 carriers, with higher dosage, and with >4 of microhemorrhages on a baseline MRI. The risk of ARIA-H increases with age and cerebrovascular disease. Dose titration mitigates the risk of ARIA, and contraindications include individuals with >4 microhemorrhages and those prescribed anti-platelet or anti-coagulant drugs. A brain MRI is required before aducanumab is initiated, before each scheduled dose escalation, and with any new neurologic sign or symptom. Management of ARIA ranges from continued antibody treatment with monthly MRI monitoring for asymptomatic individuals to temporary or permanent suspension for symptomatic individuals or those with moderate to severe ARIA on MRI. Controlled studies regarding prevention and treatment of ARIA are lacking, but anecdotal evidence suggests that a pulse of intravenous corticosteroids may be of benefit, as well as a course of anticonvulsant for seizures.

Cyberbully-in-chief: exploring Donald Trump’s aggressive communication behavior on Twitter

ABSTRACT Before his permanent suspension from Twitter, former President Trump’s use of Twitter to harm, harass, hurt, or embarrass individuals was well documented, with academics and mainstream news outlets referring to him as a cyberbully. The current study reports a quantitative content analysis of Trump’s Tweets between 2016 and 2019 to determine whether his aggressive behavior online could be considered cyberbullying. Additionally, this study also sought to ascertain Trump’s most frequently used cyberbullying tactics. The results highlight that although Trump frequently employed explicit hostility, name-calling, and rumor-mongering, his behavior on Twitter was not repetitive enough to meet the criteria that researchers often use to define cyberbullying.

Effects of suspensions on offences and damage of suspended offenders and their peers on an online chat platform

While suspensions of online chat offenders occur regularly, it is not known whether the suspensions reduce future offences by them and their peers. Our study aims to clarify the effects of suspensions using a simulation network model on Pigg Party, a popular Japanese online chat platform that uses avatars and has private, group, and public chat channels. The participants were 263,491 Pigg Party users. Data were collected over six months and involved 182,227 offences and 12,780 suspensions. We estimated the offence/damage probabilities and latencies of offences/damage after suspension in both the actual and simulation networks. The results showed that all suspensions, including 24-h, 48-h and permanent suspensions, decreased the risk of offence of offenders and their peers after suspension. Furthermore, these suspensions also decreased the damage of offenders and their peers after suspension. In particular, permanent suspension was effective in reducing the offence and damage risks of popular offenders and their peers. Online suspensions were effective in decreasing future offenses and damage by suspended offenders and their peers. Permanent suspensions may be required for popular offender groups.

Wax and bentonite blends for prototyping industrial clay development: preliminary results

Wax and bentonite blends for prototyping industrial clay development: preliminary results

Support characteristics and application of permanent magnet suspension active mass drive system

In this paper, a kind of permanent magnet (PM) suspension active mass drive mechanism is proposed, and its structure is designed. It has the advantages of non-contact, almost zero friction, small volume, and so on. Aiming at the active driving mass mechanism of PM suspension, the unidirectional PM suspension system and bi-directional PM suspension system are designed respectively, and their analytical models are established. By analyzing and calculating the magnetic force of the unidirectional and bi-directional PM suspension system, the support coefficient of the suspension system is deduced. After theoretical analysis, the structure is simulated and verified by ANSYS MAXWELL 3D in order to determine the correctness of the analytical calculation of the model. Finally, a test device is made and experiments are carried out in the constant temperature laboratory. The experimental results show that the Nd-Fe-B PMs used in the unidirectional suspension system can provide a maximum force of 260 N, which verify the feasibility of the PM suspension active mass drive system.

The Past, Present, and Future of the United States Medical Licensing Examination Step 2 Clinical Skills Examination.

In January 2021, the United States Medical Licensing Examination (USMLE) announced the permanent suspension of their Step 2 Clinical Skills (CS) examination. Launched in 2004, the Step 2 CS examination was intended to ensure that physicians entering graduate medical education possess the necessary information gathering, clinical reasoning, and communication skills necessary to provide patient care. Although the requirement that doctors pass a clinical skills examination as a condition of licensure likely improved some elements of medical education and physician practice, the Step 2 CS examination was deeply unpopular among many medical students since its inception. The demise of USMLE Step 2 CS provides an opportunity to re-examine the test’s value and incorporate improvements in future iterations. However, doing so requires a clear understanding of why the test was so vigorously challenged. Here, we review the history of clinical skills examinations used for medical licensure in the United States and highlight the persistent concerns regarding Step 2 CS’s cost, value, validity, and lack of examinee feedback before proposing future improvements to address each concern.

Design and Experimental Validation of a Fuzzy Cascade Controller for a Zero-Power Permanent Magnetic Suspension System with Variable Flux Path Control

Magnetic suspension technology has been a promising method to achieve contactless movement, and its advantages are smooth motion, no wear, no noise and low maintenance. In previous studies, the suspension force was mainly controlled by the current in the coils, which can lead to energy loss. To solve the problem of energy loss, we have proposed a novel zero-power permanent magnetic suspension system with variable flux path control (ZPPMSS-VFPC); moreover, the interference suppression and response of the ZPPMSS-VFPC need to be further investigated. This paper aims to improve the robustness and decrease the response time for the ZPPMSS-VFPC; as a result, a fuzzy cascade controller composed of a fuzzy controller and a cascade controller is designed and applied, in which the investigated fuzzy cascade control methods include the position loop fuzzy cascade control (PLFCC) and angle loop fuzzy cascade control (ALFCC). The structure and the working principle of the proposed ZPPMSS-VFPC are introduced, and the theoretical modeling and the fuzzy cascade controller design of the system are exhibited. An experimental setup is established to validate the simulation results and to investigate the control effect of the designed controller. The experimental results demonstrate that the response times of the fuzzy cascade controller at the displacement disturbance and the force disturbance are 0.5 s and 0.6 s faster than those of the cascade control, respectively. Furthermore, the control effect of the PLFCC is better than that of the ALFCC. Overall, the fuzzy cascade controller not only has the characteristics of strong adaptability but also has the characteristics of easy adjustment parameters, which can be applied to the complex magnetic suspension system.

Study of ambulatory care supervision mechanisms in health systems: A comparative study.

Background: Supervision in health sector means a system, process, or mechanism by which some aspects or characteristics of a health care organization is evaluated and analyzed by an external body. This study compared the mechanisms of supervision in ambulatory care in selected countries to provide lessons learnt from global experiences. Methods: In this comparative study USA, UK, Germany, Canada, Turkey, and Iran were selected based on inclusion criteria, including development level and type of the health system. Required data were gathered by searching the internet, browsing the websites of related organizations, and searching research databases. Then, the results were summarized and reported using comparative tables. Results: Some regulations and frameworks exist for assuring and improving the quality and safety of the services in all health systems. The supervising bodies of this subject include central and local governments along with nongovernmental organizations. The supervision in studied countries is mostly compulsory and unannounced. Moreover, accreditation of ambulatory care exists voluntarily and compulsorily. Results of the supervision include temporary or permanent suspension of license for care provision, impact on payment to the providers, and change in popularity of the provider by public communication of the result. Conclusion: Improving the supervision on ambulatory care requires an effective structure for separation of provider and supervisor and the involvement of the professional associations. It is suggested to elevate the ambulatory care supervision through better resource allocation, follow up of the supervision results, enforcement of regulations, and application of novel approaches.

Preliminary Outcomes of an Innovative Approach to Transvaginal Graft Augmentation for Pelvic Organ Prolapse in the “Post-Mesh Era”

Study Objective The objective of this study is to report the early outcomes of a novel transvaginal reconstructive repair of pelvic organ prolapse (POP) augmented with a “Y-shaped” biologic graft (Axis Dermis). Design Retrospective Cohort Study Setting Urogynecology academic private practice in central Pennsylvania Patients or Participants 36 women who underwent transvaginal pelvic reconstructive surgery with augmentation using Axisтм Dermis graft combined with SSL fixation using polypropylene suture for symptomatic Stage 2 prolapse or higher between April 2019 and October 2019 Interventions All patients underwent transvaginal pelvic reconstructive surgery employing a “Y-shaped” Axisтм Dermis graft reinforced with bilateral permanent (polypropylene) suture suspension to the sacrospinous ligament (SSL). Measurements and Main Results Primary outcome was success of surgery, defined by both subjective and objective results up to 6 months post-operatively. Subjectively, as the resolution of bothersome pelvic prolapse related symptoms as indicated by either negative answers to post-op Pelvic Organ Prolapse Distress Inventory 6 or on follow-up telephone interview. Objectively, as a POP-Q Stage ≤ 1. Secondary outcomes were complications, retreatment, and reoperation. The average patient age and BMI was 69.8 years and 27.9 kg/m2, respectively. The average parity was 2.5. The proportion of women with the pre-op diagnosis of uterovaginal prolapse versus post-hysterectomy vaginal vault prolapse was 72.3% and 27.7%, respectively. The subjective and objective cure rate at 6 months was 97.3% and 94.5%, respectively. There were no major complications. There was one retreatment (with a pessary) at 6 weeks postoperatively. One patient was taken for reoperation for ureteral stent placement after post-op transient ureteral dysfunction. Conclusion In this small cohort, a unique technique for transvaginal pelvic reconstruction using biologic graft augmentation combined with permanent suture (polypropylene) SSL suspension has good short-term cure rates for pelvic organ prolapse, without safety concerns. A larger, longitudinal study is planned to investigate long-term success, cost, and efficacy.