Group Of Residents Research Articles

Group text messaging as a residency teaching tool in outpatient neurology and headache: A mixed-methods observational study.

To assess the feasibility and efficacy of group text messaging as a teaching tool to improve neurology resident knowledge and clinical pearl dissemination in an outpatient setting enriched with headache encounters, and to evaluate if learning points from this teaching method would influence resident care of subsequent patients. Inpatient neurology teaching during training is most often accomplished in team settings during rounds or conferences such as morning report, but outpatient teaching where headache is more likely encountered may be less consistently performed in such a setting where learning points may be shared. Few studies have evaluated whether group text messaging can be an innovative tool for teaching in residency training. Neurology residents in a continuity clinic pod at New York Presbyterian-Weill Cornell were included in this cohort from December 2020 through March 2024. Group text messages deidentified of any patient information were sent to the resident pod by their preceptor after each clinic session featuring one text message regarding a takeaway learning point pertaining to each patient encounter. Residents were surveyed on their satisfaction with this teaching method and whether these text messages improved their outpatient neurology knowledge. A total of 230 text messages were sent to a cohort of 21 residents across 4 academic years. Text message topics covered a variety of neurological subspecialties, most commonly headache and facial pain (44.8%), general neurology (15.7%), and neuromuscular (14.3%). In our survey, 93% of resident respondents reported that receiving clinical pearls improved their outpatient neurology knowledge and changed how they cared for subsequent patients. Reinforcement of traditionally one-on-one learning points in a teaching outpatient setting to engage a group of residents was feasible across visit types. There was an overall very positive response to this teaching method, and residents reported improved knowledge, which influenced their care of subsequent patients.

Statewide Trends in Medications for Opioid Use Disorder Utilization in Rhode Island, United States, 2017-2023.

Buprenorphine and methadone are US Food and Drug Administration-approved medications for opioid use disorder (MOUD). Although utilization of MOUD was increasing pre-COVID-19, it is not well understood how this trend shifted during and "after" the COVID-19 pandemic in Rhode Island. This analysis will consider the differential utilization of MOUD over time and by key demographic factors. We utilized two of Rhode Island's statewide databases to examine aggregate counts of dispensed buprenorphine and methadone from January 1, 2017, to December 31, 2023. Data were stratified by age group, sex assigned at birth, and race/ethnicity (where available). Counts were stratified into pre-COVID-19 (Q1 2017-Q1 2020), COVID-19 (Q2 2020-Q4 2022), and endemic COVID-19 (2023) eras. Averages and annualized percent change for each period were calculated to understand how utilization changed over time. Before COVID-19, buprenorphine and methadone utilization were increasing annually. During COVID-19, utilization declined annually by 0.40% and 0.43%, respectively. In the endemic COVID-19 time period, buprenorphine and methadone utilization declined more rapidly at 2.59% and 1.77%, respectively. Declines were more dramatic for adults aged 18-34. We observed a decline in MOUD utilization during and after COVID-19 in Rhode Island, primarily driven by substantial decreases in MOUD use among the youngest group of adult residents. Interventions specifically tailored to youth, such as school-based or primary healthcare-based programs, may be particularly effective in engaging with youth in substance use disorder treatment.

Participation at the margins – participation practices from the viewpoint of young people in residential care

ABSTRACT This article critically discusses young service users’ participation rights and participation processes in residential group care concerning the challenges, requirements, and opportunities that such a form of organised participation entails for them. A comparative analysis of findings from two qualitative studies from Germany and Switzerland is an empirical basis. Experiences of lived, negotiated, or subtle struggles for the participation of children and youth in everyday institutional life are presented. Identified resistant practices of children and youth, which are of great importance to them, deviate from the usual organisational and normative requirements for participation. The article closes a vital research gap: It presents young people's strategies for dealing with organised and sometimes tokenistic participation. The focus on the self-will of the young actors offers the possibility of supplementing a frequently normative discourse about securing children´s rights in alternative care without making the lifeworld of the young service users and their views a starting point for interventions and legal interpretations. Moreover, the results of both research projects indicate that participation in the everyday life of young people in residential care organisations entails special requirements and challenges, which will be presented here in more detail.

Enhancing team development in an internal medicine resident continuity clinic

ABSTRACT Interprofessional teamwork is important for the provision of safe, high value patient care and is recognized as essential by the ACGME. We aimed to assess the impact of an interprofessional continuity clinic teamwork curriculum on perceptions of team development and patient safety. This project was conducted in an IM Resident Continuity Clinic where 96 residents, supported by 28 faculty and 48 interprofessional team members, attended continuity clinic two afternoons per week during alternating months of a 50/50 outpatient-inpatient training model. Teams were configured into two groups of residents, faculty and interprofessional team members. The randomly selected intervention group participated in strategically-timed TeamSTEPPS training. The control group received usual clinic education. Teamwork and safety climate were measured using the Team Development Measure (TDM) and Safety Attitudes Questionnaire (SAQ) collected before and after the intervention. Following the teamwork curriculum, team development improved in the intervention group as compared to control [mean change (95% CI) +13.9 (+9.3, +18.6) versus + 4.8 (+0.4, +9.1), p = 0.007]. Though 30% of the individual items on the SAQ improved significantly in the faculty intervention group as compared to control, the overall improvement in SAQ [intervention mean change + 0.4 (+0.2, +0.5), control mean change + 0.2 (−0.1, +0.5)] was not statistically significant (p = 0.36). It is feasible to implement a TeamSTEPPs-based interprofessional teamwork curriculum among IM residents in a block clinic model and achieve enhanced teamwork and safety attitudes. Additional assessment of clinical and educational outcomes is ongoing.

Performance of ChatGPT in emergency medicine residency exams in Qatar: A comparative analysis with resident physicians.

The inclusion of artificial intelligence (AI) in the healthcare sector has transformed medical practices by introducing innovative techniques for medical education, diagnosis, and treatment strategies. In medical education, the potential of AI to enhance learning and assessment methods is being increasingly recognized. This study aims to evaluate the performance of OpenAI's Chat Generative Pre-Trained Transformer (ChatGPT) in emergency medicine (EM) residency examinations in Qatar and compare it with the performance of resident physicians. A retrospective descriptive study with a mixed-methods design was conducted in August 2023. EM residents' examination scores were collected and compared with the performance of ChatGPT on the same examinations. The examinations consisted of multiple-choice questions (MCQs) from the same faculty responsible for Qatari Board EM examinations. ChatGPT's performance on these examinations was analyzed and compared with residents across various postgraduate years (PGY). The study included 238 emergency department residents from PGY1 to PGY4 and compared their performances with ChatGPT. ChatGPT scored consistently higher than resident groups in all examination categories. However, a notable decline in passing rates was observed among senior residents, indicating a potential misalignment between examination performance and practical competencies. Another likely reason can be the impact of the COVID-19 pandemic on their learning experience, knowledge acquisition, and consolidation. ChatGPT demonstrated significant proficiency in the theoretical knowledge of EM, outperforming resident physicians in examination settings. This finding suggests the potential of AI as a supplementary tool in medical education.

Can Ileostomy Reversal Be Safely Performed by Surgical Residents?

Background and Objectives: The growing number of colorectal cancer patients has highlighted the importance of surgical education in colorectal surgery. Despite the negative impact of the COVID-19 pandemic on surgical training, recent changes in the Polish surgical training program have increased the number of intestinal procedures required to be completed by residents. This study aims to assess the safety of ileostomy reversal procedures performed by surgical residents. Materials and Methods: A multicenter prospective cohort study, the LILEO study, was conducted from October 2022 until December 2023 across 20 Polish surgical departments. The study included 199 patients who underwent ileostomy reversal and were divided into two groups: 139 patients operated by specialist surgeons and 60 patients operated by surgical residents. The primary outcomes measured were postoperative complications, length of hospital stay (LOS), and 30-day reoperation rate. Secondary outcomes included the severity of perioperative complications assessed using the Clavien-Dindo classification and a focused analysis of loop ileostomy reversal outcomes. Results: The median LOS was significantly shorter in the resident group (5.5 days vs. 6 days, p < 0.05). Although the overall complication rate was lower in the resident group (21.7% vs. 33.1% in the specialist surgeon group), this difference was not statistically significant (p = 0.105). The 30-day reoperation rate was 3.3% in the resident group and 8.6% in the specialist surgeon group (p = 0.179). In terms of severity, minor complications (Clavien-Dindo grades 1 and 2) were more common in the specialist group (p < 0.05). The analysis of loop ileostomy reversals revealed no significant differences in postoperative outcomes between the two groups. Conclusions: Ileostomy reversal procedures performed by surgical residents under supervision are safe and feasible, with outcomes comparable to those performed only by specialist surgeons. These findings support ileostomy reversal as a valuable procedure for developing surgical residents' skills and do not negatively affect postoperative outcomes.

Politicizing belonging: Community formation at the Late Preclassic Maya hamlet of Dos Ceibas

Abstract People are often assumed to expand existing mechanisms—kinship in particular—to include others when they form communities. These models (con)fuse similarity with sameness, as we argue based on Husserl's concept of empathy. People recognize others without overlooking differences. They form community by negotiating belonging. We ask how individuals materialize community, how they create unity in a political process, and how they employ bordering and bonding social interactions. Our case study is Dos Ceibas, a Late Preclassic (350 b.c. to a.d. 250) Maya hamlet in the Petexbatun region. The North Plaza originated as a residential group—possibly of the hamlet's founder—and was transformed over multiple construction episodes into a public and ceremonial place. By a.d. 250, Dos Ceibas consisted of a small pyramid overlooking a plaza and two likely residential buildings. Its growth pattern sets the North Plaza apart from nearby Group MP16 and magnified internal differences. At the same time, Dos Ceibas's pyramid and plaza were likely communal constructions that project a shared community identity. The comparison with contemporary settlements nearby identifies distinct settlement layouts and suggests localized community identities.

Game-Based Learning and Gamification, Effective Innovation in Emergency Medicine Training Program

Background: Game-based learning (GBL) and gamification have recently been applied in medical education. Both approaches utilize methods to teach specific skills or knowledge in a more motivating manner than traditional teaching. Objectives: This study aimed to evaluate the impact of GBL and gamification in an emergency medicine (EM) residency training program by comparing education through e-learning with GBL and gamification. Methods: We randomly enrolled EM residents into two groups. Over the course of one educational year, one group of residents participated in a GBL and gamification course (10 designed GBL and gamification sessions), while the other group received e-learning materials (10 designed podcasts and videos). Traditional training programs continued as routine in both groups. After the intervention, we assessed learners' educational achievements (exam scores) in both groups. Additionally, EM residents' viewpoints (in the first group) on the innovative program were collected using the model for the evaluation of educational games (MEEGA). Finally, the short version of the postgraduate hospital educational environment measure (PHEEM) was administered to evaluate learners' general feedback (in the first group) about the new educational environment after the intervention. Results: Game-based learning and gamification significantly improved scores in written, oral, and electronic exams assessing knowledge, skills, clinical reasoning, and judgment among EM residents (P-value &lt; 0.05). All MEEGA items under “Usability” and “Player Experience” had mean scores &gt; 3 (indicating agree and totally agree) (median score = 3 - 4). All PHEEM items under “Teacher Support and Skills” and “Work Conditions and Allocated Time for Learning” also had mean scores &gt; 3 (indicating agree and totally agree) (median score = 4). Conclusions: Game-based learning and gamification enhanced EM residents’ knowledge, skills, clinical reasoning, and judgment. Learners largely agreed on the positive impact of the intervention on their residency training program.

Influence of operator's experience on the quality and success rate of root canal treatment with new nickel-titanium instruments

Objective: To analyze the influence of operator's experience on the quality and success rate of root canal treatment with new nickel-titanium instruments, providing support for improving the success rate of root canal treatment with new nickel-titanium instruments in clinic. Methods: Cases of root canal treatment and non-surgical root canal retreatment with 6-12 months recall performed by residents (resident group) with experience of 1-3 years and endodontic specialists (specialist group) with experience of 5-7 years were collected from the electronic medical system of the Department of Endodontics, School of Stomatology, Capital Medical University, from September 2020 to August 2021. All cases were prepared by engine-driven glide path files and controlled memory nickel-titanium finishing files. Chi-square test and logistic regression were used to analyze the differences and influencing factors of complications, filling quality and success rate of root canal treatment between the two groups. Results: A total of 277 cases performed by 24 residents and 3 specialists were included, 169 in the resident group and 108 in the specialist group. The clinical incidence of flare-ups was significantly higher in the resident group [3.6% (6/169)] than in the specialist group [0(0/108)] (P=0.048). There were no significant differences in ledges, root canal transportations, perforations, or instrument separations between the two groups (P>0.05). The prevalence of satisfactory fillings was 62.7% (106/169) in the resident group, which was significantly lower than that in the specialist group [86.1% (93/108)] (P<0.05). The success rate of root canal treatment was 91.7% (155/169) and 94.4% (102/108) in the resident group and the specialist group, respectively, with no significant differences (χ2=0.73,P=0.392). Multivariate analysis showed that the success rate of root canal treatment was related to complications and quality of root fillings (P<0.05). Conclusions: Higher success rate of root canal treatment could be achieved by residents and endodontic specialists with engine-driven glide path files and controlled memory nickel-titanium files.

Multi-level social capital effects on residents: Residents’ cooperative behavior in neighborhood renewal in China

China has recently shown great enthusiasm for developing neighborhood renewal, and good cooperation within resident groups is the key to successful implementation. Residents’ cooperative behavior is easily influenced by social relationships among residents, which are referred to as resident-level social capital. Further, resident-level social capital is influenced by the neighborhood effects, known as neighborhood-level social capital. However, few studies examined the impact of social capital on residents’ behavior from the perspective of both resident-level and neighborhood-level. This paper aims to examine the multilevel social capital that influence residents’ cooperative behavior in China. Using social capital theory and the theory of planned behavior, this study collects questionnaire survey data from 1039 residents in 98 neighborhood renewal projects in China. The results from multilevel structural equation modeling suggest that residents’ social capital can directly influence residents’ cooperative behavioral intention. The variability of neighborhood-level social capital and the impact of multidimensional social capital were examined. The findings of this study have strengthened the explanatory power of the theory of planned behavior and expanded the application scope of social capital theory. The results provide a more cultural and historical perspective, that is, resident relationships, for promoting cooperation among residents in neighborhood renewal.

Salt-related knowledge, attitudes and practices and their relationship with 24-h urinary sodium and potassium excretions among a group of healthy residents in the UAE: a cross-sectional study.

This study aimed to measure urinary sodium and potassium as a measure of sodium and potassium intake concerning the knowledge, attitude and practice towards sodium intake among a group of healthy residents in the UAE. A cross-sectional study on a sample of healthy adults in the UAE. In addition to the knowledge, attitude and practice questionnaire, sodium and potassium excretions and food records were taken. The UAE. A sample of 190 healthy individuals aged between 20 and 60 years. The mean (± sd) age of the sample was 38·6 (± 12·5) years, and 50·5 % were females. The mean urinary sodium and potassium intake were 2816·2 ± 675·7 mg/d and 2533·3 ± 615 mg/d, respectively. The means were significantly different compared with the WHO recommendation of sodium and potassium (P < 0·001). About 65 % of the participants exceeded the WHO recommendations for salt intake, and participants' knowledge classification for health-related issues was fair, while food-related knowledge was poor (P = 0·001). A two-stage stepwise multiple regression analysis revealed that knowledge, attitude and practice scores were negatively associated with urinary sodium excretion (r = -0·174; P = 0·017) and those older participants and females had lower urinary sodium excretion (P < 0·001). These findings may suggest an increase in the risk of hypertension in the UAE population. Moreover, these findings emphasise the need to establish education and public awareness programmes focusing on identifying the sodium contents of foods and establishing national regulations regarding food reformulation, particularly for staple foods such as bread.

A survey of essential anatomy from the perspective of anesthesiology, emergency medicine, obstetrics and gynecology, and orthopedics resident physicians

BackgroundRecent changes in anatomy curricula in undergraduate medical education (UME), including pedagogical changes and reduced time, pose challenges for foundational learning. Consequently, it is important to ask clinicians what anatomical content is important for their clinical specialty, which when taken collectively, can inform curricular development.MethodsThis study surveyed 55 non-primary care residents in anesthesiology (AN; N = 6), emergency medicine (EM; N = 15), obstetrics and gynecology (OB; N = 13), and orthopedics (OR; N = 21) to assess the importance of 907 anatomical structures across all anatomical regions. Survey ratings by participants were converted into a post-hoc classification system to provide end-users of this data with an intuitive and useful classification system for categorizing individual anatomical structures (i.e., essential, more important, less important, not important).ResultsSignificant variability was observed in the classifications of essential anatomy: 29.1% of all structures were considered essential by OB residents, 37.6% for AN residents, 41.6% for EM residents, and 72.0% for OR residents. Significant differences (with large effect sizes) were also observed between residency groups: OR residents rated anatomy of the back, limbs, and pelvis and perineum anatomy common to both sexes significantly higher, whereas OB residents rated the pelvis and perineum anatomy common to both sexes and anatomy for individuals assigned female at birth highest. Agreement in classifications of importance among residents was observed for selected anatomical structures in the thorax, abdomen, pelvis and perineum (assigned male at birth-specific anatomy), and head and neck. As with the ratings of anatomical structures, OR residents had the highest classification across all nine tissue types (p < 0.01).ConclusionsThe present study created a database of anatomical structures assessed from a clinical perspective that may be considered when determining foundational anatomy for UME curriculum, as well as for graduate medical education.

57 Resident education in the NICU: A curriculum innovation project

Abstract Background For paediatrics residents, much of newborn care is learned during Neonatal Intensive Care Unit (NICU) rotations. However, the NICU is a high-stress and specialized learning environment. Today’s residents often have less NICU exposure during their training than in the past, leading to concerns from trainees that they are inadequately prepared for neonatal care and resuscitation upon graduation. Objectives We aimed to develop, implement and evaluate a paediatric residency NICU curriculum aimed to augment and improve learning on rotation. Design/Methods We utilized Kern’s Six Step Approach for Curriculum Development. Step 1: We identified that our paediatric residents consistently expressed dissatisfaction with the quality and quantity of learning opportunities on their NICU rotations. Step 2: A collaborative working group of residents, paediatricians, and neonatologists identified learning needs. Step 3: Needs were mapped to specific general paediatrics educational objectives within the Royal College Competency Based Medical Education (CBME) curriculum. Step 4: Suitable learning strategies were selected including simulation, procedural skill training, embedded time with the neonatal resuscitation team, and lunch and learn seminars. Steps 5 and 6: The curriculum was piloted during the 2021-2022 academic year and resident reactions evaluated. Results The detailed curriculum is shown in Table 1. At the start of each NICU rotation, all paediatrics residents on rotation attended a half-day simulation based “boot-camp” consisting of a didactic Neonatal Resuscitation Program (NRP) refresher course, relevant procedural skills stations (intubation, UVC placement, needle thoracocentesis), and simulated neonatal resuscitation scenarios. Junior residents were scheduled for protected time to attend deliveries with a dedicated multidisciplinary resuscitation team to ensure familiarity and begin to solidify skills. Learning was further augmented by weekly, resident-led lunch and learn sessions on topics mapped to level of training. To evaluate this curriculum, resident satisfaction was assessed using surveys post bootcamp and at the end of their rotation. Overall, the curriculum was well received. Bootcamp was the highest rated element; 96% of residents agreed or strongly agreed that the session was useful for their education (Figure 1). Post curriculum implementation, there was significant improvement in resident NICU rotation feedback; residents expressed that the NICU learning environment and resident experience has improved. Conclusion We successfully implemented a NICU curriculum for paediatrics residents, with high satisfaction ratings and improved overall rotation feedback. This program shows promise in addressing a long standing educational gap. More research is needed to investigate whether it leads to improved competency in practice.

Assessing the impact of deep-learning assistance on the histopathological diagnosis of serous tubal intraepithelial carcinoma (STIC) in fallopian tubes.

In recent years, it has become clear that artificial intelligence (AI) models can achieve high accuracy in specific pathology-related tasks. An example is our deep-learning model, designed to automatically detect serous tubal intraepithelial carcinoma (STIC), the precursor lesion to high-grade serous ovarian carcinoma, found in the fallopian tube. However, the standalone performance of a model is insufficient to determine its value in the diagnostic setting. To evaluate the impact of the use of this model on pathologists' performance, we set up a fully crossed multireader, multicase study, in which 26 participants, from 11 countries, reviewed 100 digitalized H&E-stained slides of fallopian tubes (30 cases/70 controls) with and without AI assistance, with a washout period between the sessions. We evaluated the effect of the deep-learning model on accuracy, slide review time and (subjectively perceived) diagnostic certainty, using mixed-models analysis. With AI assistance, we found a significant increase in accuracy (p < 0.01) whereby the average sensitivity increased from 82% to 93%. Further, there was a significant 44 s (32%) reduction in slide review time (p < 0.01). The level of certainty that the participants felt versus their own assessment also significantly increased, by 0.24 on a 10-point scale (p < 0.01). In conclusion, we found that, in a diverse group of pathologists and pathology residents, AI support resulted in a significant improvement in the accuracy of STIC diagnosis and was coupled with a substantial reduction in slide review time. This model has the potential to provide meaningful support to pathologists in the diagnosis of STIC, ultimately streamlining and optimizing the overall diagnostic process.

Residents’ perceptions of tourism development in the context of a new governance framework for Portuguese protected areas: The case of a small peripheral natural park

Historically, Portuguese protected areas (PAs) have been operating under top-down governance, often neglecting local communities. In 2019, the Portuguese government established a new governance model for PAs, based on co-management. The new co-management approach emphasises collaborative and participatory governance and positions sustainable tourism as a catalyst for territorial revitalisation and local development. However, local communities' attitudes and perceptions regarding tourism in these areas remain largely uncharted. This study focuses on the Alvão Natural Park (PNAL), a small rural and mountainous Portuguese PA, which is currently in the early stages of co-management implementation. Our goal was to investigate local residents' perceptions of tourism's impacts and identify potential divergence among resident groups and their level of support for tourism development. These insights are crucial because the active engagement of local communities is a key element for sustainable tourism development and the successful implementation of co-management. The study employed a self-administered survey, garnering responses from 250 PNAL residents representing over half of the park's population. Factor analysis identified four primary perceptual dimensions and cluster analysis classified residents into three distinct groups based on their tourism perceptions. While most PNAL residents express support for tourism development, there is a resounding call for new policies to revert the legacy of top-down governance. This research provides essential insights for shaping effective tourism policies, planning and development strategies, and ensuring the active involvement of local communities in co-management and sustainable development efforts within the PNAL. Moreover, this study demonstrates the applicability of this research approach in the context of evolving governance models with the potential for adaptation to other PAs across Portugal and other countries undergoing similar governance transitions.

Improving agreement in assessing subtrochanteric fracture healing among orthopedic surgeons using the Radiographic Union Score for Hip (RUSH)

BackgroundPrompt identification of fracture healing is crucial for medical decision-making and clinical research. This study aims to assess the effectiveness of the Radiographic Union Score for Hip (RUSH) in subtrochanteric fractures and determine the optimal scoring threshold for fracture healing.MethodsWe obtained 94 sets of X-ray films from the postoperative follow-up of 35 patients who underwent intramedullary nail fixation for subtrochanteric fractures. Six orthopedic trauma surgeons evaluated the imaging data and determined fracture healing based on subjective judgment. They then scored the X-ray images using the RUSH form. After four weeks, the same observers re-evaluated 47 randomly selected sets of radiographs. Subsequently, the observers and study designer conducted a consensus meeting where they agreed on whether the fractures had healed. We used Fleiss kappa to evaluate agreement among observers based on subjective impressions, and the intraclass correlation coefficient assessed RUSH score consistency. Regression analysis examined the relationship between scores and fracture healing consensus using a receiver operator characteristic (ROC) curve.ResultsBased on overall impressions, the agreement level among orthopedic trauma surgeons for determining the healing status of subtrochanteric fractures was moderate (Kappa = 0.564, 95% CI: 0.511–0.616). However, utilizing the RUSH scoring system can improve the consistency to a substantial level of agreement (ICC = 0.748, 95% CI: 0.663–0.817). Regarding intraobserver reliability, there were significant differences among orthopedic trauma surgeons in judging fracture healing based on overall impressions. However, using the RUSH scoring form, the attending group achieved better intraobserver consistency than the resident group. Regression analysis and ROC curve analysis revealed a strong correlation between the RUSH total score, cortical bone score, cancellous bone score, and consensus on fracture healing. The AUC values are 0.769 (95% CI: 0.670–0.868), 0.779 (95% CI: 0.681–0.876), and 0.771 (95% CI: 0.674–0.867), respectively.ConclusionsOur study highlights the effectiveness of the RUSH scoring system in enhancing interobserver agreement and intraobserver consistency when evaluating subtrochanteric fracture healing in orthopedic trauma surgeons. We propose setting 21 points as the threshold for the simplified RUSH scoring system to determine fracture healing. This system includes only eight items related to cortical bone, with a total score of 24 points.

Residents’ place attachment and tourist sexual behaviour in a European coastal tourist destination

PurposeDespite extensive research into residents’ attitudes towards tourist behaviour, little has been explored about the extent to which visitors’ practices contribute to the formation of residents’ bonds with their place of residence, which is also a tourist destination. Therefore, this research aims to determine how residents’ perception of tourist sexual behaviour affects their engagement with the urban environment and the image of the city and tourist destination in which they live. To structure and interpret the various attitudes of the residents surveyed, the authors used a conceptual framework based on identity process theory (IPT) in relation to residents’ attitudes and the impact of a particular dimension of tourist behaviour – their sexual practices – on their perceived connection to their place of residence.Design/methodology/approachA questionnaire was administered to a sample of 457 residents in Salou to collect data regarding their assessments of the sexual behaviour of tourists in their community. A cluster analysis was used to classify residents according to their attitudes and stances towards the different sexual practices of visitors and their evaluation of the importance of those practices for current and future tourism at the destination. Finally, an analysis of variance was performed to compare significant differences in attitudes towards tourist behaviour and the attachment to Salou among the different segments of residents identified.FindingsThe study identified four groups of residents classified by their attitudes towards tourist sexual behaviour: permissive bystanders, supportive expectants, ambivalent pragmatics and opposed rejectors. Two attitudinal components explain the differences between the groups: tolerance and personal interest, which are associated with how residents construct their bond with Salou in terms of place attachment (PA). These results align well with IPT, as they highlight processes of assimilation, evaluation and the contribution of symbolic significance to the place of residence, mediated by the perception of tourist sexual behaviour.Practical implicationsSome practical recommendations are offered to tourist destination administrations regarding the differences among residents’ attitudes towards tourist behaviour and PA. The findings can serve as a valuable tool for designing tourism policies aimed at selecting markets, as well as for marketing and promoting tourist destinations.Originality/valueThe originality of this study lies in that it considers the role of tourist sexual behaviour as a compositional element of the identity of the place – a tourist destination – where residents live, providing new empirical data on an under-researched academic issue. This article attempts to contribute to a critical perspective by conceptualising and introducing new elements for understanding the identity, attraction and sexuality of tourist sites. The study also connects with the urban analysis of tourist destinations, incorporating the role of sex into the social construction of the tourist city, the creation of identity and image and the attribution of symbolic meaning to destination settings.

The Challenge of Misleading Information: Does the Interaction between Zinc and Vitamin D Influence the Immune Response against SARS-CoV-2 in the Elderly Population?

Immunization is a challenge for the elderly population and can leave this group more vulnerable to opportunistic pathogens such as SARS-CoV-2. Due to this situation, while vaccines were in the development phase, hypotheses were raised about the role of vitamins and minerals in immunization. In Brazil, there was a controversy regarding the well-known COVID-19 Kit, a standardized prescription for positive cases that contained zinc, and vitamin D, and anti-parasitic drugs. There was great controversy in scientific circles, since COVID-19 brought a major challenge for health professionals and public authorities: misleading information. In this study, we evaluated the role of vitamin D and zinc in the production of anti-SARS-CoV-2 neutralizing antibodies (NAbs) in a group of elderly residents in a nursing home in northeastern Brazil. Serum levels of COVID-19 NAbs were assessed, along with vitamin D and zinc, in two phases. The first (T1) was in August 2022 with 26 elderly people, and the second (T2) was in March 2023 with 21, due to the death of five participants. Overall, we observed satisfactory levels for vitamin D, with no participants showing a deficiency in either test, and zinc, with only two participants having a negative result at T1 and three at T2. However, a drop in the average number of NAbs was observed, especially in women (T1 = 89 ± 19 vs. T2 = 57 ± 44), highlighting the importance of monitoring this immunological parameter in the population studied. Based on the results, we suggest that there is no synergism between the micronutrients studied and NAbs (p &gt; 0.05). Further studies are needed to consolidate the findings of an absence of synergism between vitamin D and zinc in the maintenance of NAbs.

An epidemiologic blood group-1

Aim Polycythemia, also known as erythrocytosis, is an abnormal accumulation of red blood cells, packed cell volume, and hemoglobin that can lead to debilitating symptoms and significant mortality. Polycythemia is estimated to affect 22 people per 100,000. The epidemiology of polycythemia in Iraq is limited. This study aimed to investigate the prevalence and incidence of polycythemia in Babylon City, Iraq, from 2018 to 2022 and to identify populations at high risk. Materials and Methods Due to the relative scarcity of epidemiological studies on polycythemia in Iraq, this study was conducted to identify some epidemiological features of polycythemia patients in Babylon province. A study conducted at the Babylon Central Blood Bank included 220 polycythemia patients. This data was obtained by reviewing all patient documents and the registration book from 2018 to 2022. Participants completed a questionnaire with information about their Sex, age, place of residence, smoking habits, and blood group. Statistics were analyzed using SPSS version 23.0 and Prism software. Results were presented in numbers and percentages and analyzed using the Chi-square test. Results Results indicated that polycythemia increased between 2018 and 2020, with the highest numbers in 2018 and decreasing in 2022. There was a higher frequency in the age group of (41-50) years, and it was more common in males with polycythemia (92.72%) who were smokers (79.09%). Most polycythemia patients had the B blood group (38.2%), while the AB blood group had the lowest percentage (5.5%), and most cases were Rh-positive (91.8%). Conclusion this study provided an overview of the epidemiology of polycythemia in Babylon, Iraq. The findings indicate that polycythemia was more prevalent in men of middle age and with blood group B+. Therefore, further research is needed to examine the relevance of the ABO blood group to polycythemia severity and susceptibility. Bangladesh Journal of Medical Science Vol. 23 No. 04 October’24 Page : 1068-1074

Municipal solid waste management in Lagos State: Expansion diffusion of awareness

This study examined the role of waste management authorities in promoting public awareness of municipal solid waste management (MSWM) through the lens of the expansion diffusion theory (EDT). EDT emphasizes the spread of new ideas and practices within a society through various communication channels and distinct individuals within each system. We employed a mixed-method approach using 116 survey responses from Lagos residents and five semi-structured in-depth interviews. Our findings reveal the need for a more structured approach to create public awareness of MSWM, considering the distinct groups of residents in Lagos and their responses to innovation and knowledge diffusion. We propose four pillars on which waste management authorities in developing countries can sustain their MSWM awareness campaigns, as well as an awareness campaign strategy flowchart. Our findings add to the expanding body of research on public awareness and participation in MSWM, emphasizing the critical role that waste management authorities can play in fostering sustainable waste management awareness and practices.