United States Counterparts Research Articles

Regional Disparities in Growth Patterns of Children with Cerebral Palsy: A Comparative Analysis of Saudi Arabian, UK, and US Data.

In order to understand the global variations in the growth trajectories of cerebral palsy patients, this study aimed to compare the growth patterns of cerebral palsy patients in Saudi Arabi with United States and United Kingdom counterparts. Anthropometric data from 107 participants with cerebral palsy in Saudi Arabia were collected, including age, gender, cerebral palsy type, Gross Motor Function Classification System level, birth weight, weight at assessment, height at assessment, body mass index, and head circumference at assessment. This study found discrepancies between the growth patterns of Saudi Arabian children with cerebral palsy and United Kingdom and the United States growth charts, particularly among those with severe cerebral palsy. Significant differences were observed in weight, height, and body mass index z-scores when comparing Saudi Arabian data with the United kingdom and United States reference data. These findings emphasize the importance of validating growth charts across different populations to ensure accurate monitoring and clinical management of children with cerebral palsy. Additionally, this study highlights the need for region-specific growth references to better address the diverse needs of individuals with cerebral palsy worldwide.

Emotion regulation as a complex system: A multi-contextual and multi- level approach to understanding emotion expression and cortisol reactivity among Chinese and US preschoolers.

Are children from "Eastern" cultures less emotionally expressive and reactive than children from "Western" cultures? To answer this, we used a multi-level and multi-contextual approach to understand variations in emotion displays and cortisol reactivity among preschoolers living in China and the United States. One hundred two preschoolers from China (N=58; 55% males) and the United States (N=44, 48% males) completed three (i.e., control, interpersonal-related, and achievement-related) emotion-challenging paradigms over 3 days. Behavioral emotion expressions were coded, and salivary cortisol was sampled 30minutes before and across 90minutes post-task. Without considering context, Chinese preschoolers displayed fewer levels of positive and negative emotion expressions relative to their United States counterparts. However, Chinese preschoolers displayed similar levels of expressions as their United States counterparts during an achievement-related challenge that is more salient to their sociocultural emphases and showed higher negative emotion expressions in this challenge, relative to other contexts. Moreover, only the achievement-related challenge elicited increased cortisol levels among Chinese preschoolers, and this was correlated with higher levels of negative expressions. For US preschoolers, no cortisol increase was observed in any challenging paradigms, nor was cortisol associated with emotional expressions. Findings counter prior notions that East Asian children are generally less emotionally expressive. Instead, an achievement-related challenge elicited higher emotion expression and cortisol reactivity among Chinese preschoolers, suggesting that children's emotion expression and biological reactivity may be most responsive to contexts salient to their socio-cultural environments. We discuss the importance of considering cultural contexts when studying emotion regulation. RESEARCH HIGHLIGHTS: Chinese preschoolers displayed lower overall positive and negative expressions relative to their US counterparts without considering situational contexts. Chinese preschoolers displayed similar levels of emotion expressions as their US counterparts during an achievement-related challenge salient to their social-cultural environment. Chinese preschoolers are particularly responsive to achievement-related challenges, relative to other emotion-challenging situations that are less culturally salient. No cortisol increase was observed in any of the emotion-challenging paradigms among US preschoolers. Children's emotion expression and biological reactivity may be most responsive to challenges relevant to their socio-cultural environments.

Self-interest, positional concerns and distributional considerations in healthcare preferences

Efficiently allocating scarce healthcare resources requires nuanced understanding of individual and collective interests as well as relative concerns, which may overlap or conflict. This paper is the first to empirically investigate whether and to what extent self-interest (SI), positional concerns (PC) and distributional considerations (DC) simultaneously explain individual decision making related to access to healthcare services. Our investigation is based on a stated choice experiment conducted in two countries with different healthcare systems, the United States (US) and the United Kingdom (UK). The choice experiment is on allocation of medical treatment waiting times for a hypothetical disease. We carry out the investigation under two different perspectives: (i) in a socially inclusive personal perspective decision makers were asked to choose between waiting time distributions for themselves and (ii) in a social perspective decision makers were asked to make similar choices for a close relative or friend of opposite gender. The results obtained by estimating a variety of advanced choice models indicate that DC, SI and PC, in this order of importance, are significant drivers of choice behaviour in our empirical context. These findings are consistent regardless of the choice perspective and the country where decision makers live. Comparing the results from different choice perspectives, we find that US respondents who chose for their close relative or friend attach significantly larger weight to their close relative’s or friend’s waiting times as well as to the overall distribution of waiting times than US respondents who chose for themselves. Looking at differences between countries, our results show that UK respondents who made choices for themselves placed significantly larger weight on SI and DC than US respondents, while US respondents, in turn, displayed relatively stronger but not significantly different positional concerns than UK respondents. In addition, we observe that UK respondents who chose for their close relative or friend put a larger weight on DC than their US counterparts. We conclude that the methodological (data collection and analysis) approach allows for disentangling the relative importance of the three motivations and discusses the potential implications of these findings for healthcare decision making.

Kinematic and kinetic comparison between preprofessional pitchers from the Dominican Republic and the United States.

Pitching biomechanical efficiency is defined as the association between pitch velocity and arm kinetics. Pitching mechanics inefficiency, an increase in arm kinetics without the resultant increase in pitch velocity, can lead to increased arm strain, increasing arm injury risk. The purpose of this study was to compare arm kinetics, elbow varus torque and shoulder force, in preprofessional United States (US) and Dominican Republic (DR) pitchers. Kinematics that are known to influence elbow varus torque and shoulder force as well as a representative of pitch velocity (hand velocity) were also compared. A retrospective review was performed on baseball pitchers from the DR and US who participated in biomechanical evaluations conducted by the University biomechanics laboratory personnel. Three-dimensional biomechanical analyses were performed on US (n = 37) and DR (n = 37) baseball pitchers. Potential differences between US and DR pitchers were assessed through analysis of covariance with 95% confidence intervals [95% confidence Interval (CI)]. Preprofessional DR pitchers experienced increased elbow varus torque compared with their US counterparts [DR: 7.5 (1.1); US: 5.9 (1.1) %BWxH; Beta: -2.0 (95% CI: -2.7, -1.2) %BWxH], despite throwing fastballs with slower hand velocity [DR: 3,967.1 (939.4); US: 5,109.1 (613.8) °/s; Beta: 1,129.5 (95% CI: 677.5, 1,581.4) °/s]. DR and US pitchers demonstrated similar shoulder force [DR: 136.8 (23.8); US: 155.0 (25.7); Beta: 0.4 (95% CI: -1.2, 19.7) %BW]. Increased elbow varus torque although decreased hand velocity suggests inefficient pitching mechanics among DR pitchers. Inefficient pitching mechanics and increased elbow torque should be considered when developing training programs and pitching plans for professional pitchers from the Dominican Republic.

Epidemiology of Breast Cancer Presentation in Botswana, South Africa, and the United States

IntroductionThis study sought to compare the clinicopathologic features of women with breast cancer presenting in South Africa, Botswana, and the United States (US). MethodsBreast cancer samples from Botswana (n = 384, 2011-2015), South Africa (n = 475, 2016-2017), and the US (n = 361,353, 2011-2012) were retrospectively reviewed. ResultsThe median age of sub-Saharan African women presenting with breast cancer (age 54 in Botswana and South Africa) was younger than that of those in the US (age 61) (P < 0.001). Sub-Saharan women were more likely to present with advanced stage disease than US counterparts (64.7% in Botswana, 63.3% in South Africa, 13% in the US, P < 0.001). Triple negative disease was highest in Botswana (21.3%) compared to South Africa (11.4%) and the US (12.94%) (P < 0.001). Differences in receptor status at presentation among the three cohorts (P < 0.001) were not observed when the cohorts were stratified by ethnicity. Black/multiracial patients in Botswana and the US were the most likely subsets to present with the adverse characteristic of triple negative disease (21.3% and 23.2%, respectively). No correlation was found between HIV and receptor status in the Botswana (P = 0.513) or South African (P = 0.352) cohorts. ConclusionsHere we report receptor status patterns at presentation in Botswana and South Africa. This study reveals important similarities and differences which may inform policy and provide context for future epidemiologic trends of breast cancer in low- and-middle-income countries particularly in sub-Saharan Africa.

Facilitating Preschool Children’s Mathematics Development in China, Japan, and the United States: Is the Classroom Library Considered?

The two studies examined in this paper compare the different mathematical opportunities provided in preschool classrooms in China, Japan, and the United States, with an emphasis on mathematical-themed books in classroom libraries. Study one presents the results of an online survey to examining the content of preschool classroom libraries in China (N = 134), Japan (N = 168), and the United States (N = 291). Study two presents data obtained from semi-structured interviews of teachers in China (N = 8), Japan (N = 8), and the United States (N = 8). The interviews examined teacher perceptions of how they teach mathematics, the importance of teaching mathematics, and the use of the classroom library as a venue for mathematics. Study one results indicated that teachers from all three countries encourage classroom library use; however, teachers from China reported more mathematics storybooks than their Japanese or United States counterparts. Study two results indicated that teachers from all three countries viewed mathematics as important and provided various mathematics learning opportunities to children throughout the school day. Chinese teachers reported providing the most mathematics learning opportunities using whole group instruction, mathematics centers, and free play. Japanese teachers reported few whole group forms of instruction other than circle time but reported providing opportunities for using mathematics during free play and other embedded activities. United States teachers indicated that mathematics learning occurred using whole group instruction and mathematics centers.

Performance of Diabetes and Kidney Disease Screening Scores in Contemporary United States and Korean Populations.

BackgroundRisk assessment tools have been actively studied, and they summarize key predictors with relative weights/importance for a disease. Currently, standardized screening scores for type 2 diabetes mellitus (DM) and chronic kidney disease (CKD)—two key global health problems—are available in United States and Korea. We aimed to compare and evaluate screening scores for DM (or combined with prediabetes) and CKD, and assess the risk in contemporary United States and Korean populations.MethodsFour (2×2) models were evaluated in the United States-National Health and Nutrition Examination Survey (NHANES 2015–2018) and Korea-NHANES (2016–2018)—8,928 and 16,209 adults. Weighted statistics were used to describe population characteristics. We used logistic regression for predictors in the models to assess associations with study outcomes (undiagnosed DM and CKD) and diagnostic measures for temporal and cross-validation.ResultsKorean adult population (mean age 47.5 years) appeared to be healthier than United States counterpart, in terms of DM and CKD risks and associated factors, with exceptions of undiagnosed DM, prediabetes and prehypertension. Models performed well in own country and external populations regarding predictor-outcome association and discrimination. Risk tests (high vs. low) showed area under the curve >0.75, sensitivity >84%, specificity >45%, positive predictive value >8%, and negative predictive value >99%. Discrimination was better for DM, compared to the combined outcome of DM and prediabetes, and excellent for CKD due to age.ConclusionFour easy-to-use screening scores for DM and CKD are well-validated in contemporary United States and Korean populations. Prevention of DM and CKD may serve as first-step in public health, with these self-assessment tools as basic tools to help health education and disparity.

Influence of COVID-19 pandemic on the tourism sector: evidence from China and United States stocks

ABSTRACT The coronavirus disease (COVID-19) has adversely impacted the globally interconnected economy and brought the tourism sector to a temporary standstill. As such, this study aimed to investigate the spillover effect of industrial sectors by emphasizing the tourism sector. The study data was gathered from China and The United States (US) between 2019 and 2020 (pandemic period) using the Multivariate Generalised Autoregressive Conditional Heteroscedastic-Dynamic Conditional Correlation (MGARCH-DCC) and Wavelet Coherence Transform (CWT) techniques to analyse the investment holding period. Country-wise, the sectoral return volatility in China was significantly higher than the US counterpart. Additionally, the intra-sector correlation analyses demonstrated that Chinese sectors successfully mitigated the intra-sector correction in the last quarter of 2019. A short-term holding period was also suggested for investors in China while a long-term counterpart was recommended for investors in the US. Regarding the Chinese and US industrial sectors in the first quarter of 2020, it was mutually concluded that both country stocks reflected high volatility. The tourism sector was also negatively affected throughout the pandemic period (between 2019 and 2020). Essentially, this study offered practical contributions to investors, mutual fund holders, and brokers.

Cross-cultural differences in Parkinson's disease caregiving and burden between the United States and Mexico.

IntroductionGiven the rapidly aging population in both the United States and Mexico, rates of Parkinson's disease (PD) are likely to rise in both countries, suggesting that the number of individuals providing informal care will also increase, and the healthcare system will have to consider the burden this places upon caregivers. Therefore, the purpose of the current study was to examine differences in PD caregiving and burden between the United States and Mexico.MethodsData were collected from PD caregivers in the Parkinson's Clinic at the Hospital Civil Fray Antonio Alcalde in Guadalajara, Mexico (N = 148) and the Parkinson's and Movement Disorders Center at Virginia Commonwealth University in Richmond, Virginia (N = 105) regarding caregiver demographics and self‐reported burden.ResultsDespite considerably more time spent in caregiving duties, higher rates in unemployment or underemployment, and lower education levels, Mexican PD caregivers reported significantly less personal strain and role strain than did their United States counterparts. Even after controlling for these and other demographic differences between the two sites, the differences in caregiver burden remained.ConclusionsLatino cultural values in Mexico encouraging the importance of caring for family members with PD and respecting elders may promote caregiving and even make it a point of cultural pride, helping to overcome potential negative effects on caregivers seen in the United States. The scientific and medical communities should view caregiving as a culturally embedded and potentially positive role, rather than predominantly as burdensome as frequently conceptualized in Western or Eurocentric cultures.

Time to Treatment Intensification in Newly Treated Adult Type 2 Diabetes Patients: Comparison of Canada and the United States

ObjectivesOur aim in this study was to determine whether differences exist in time to treatment intensification in newly treated type 2 diabetes patients in Canada and the United States (US). MethodsTwo separate retrospective cohorts of diabetes patients were used from Canada and the US. Time to treatment intensification (i.e. addition of a second antihyperglycemic agent after initial metformin use) was determined using multivariate Cox proportional hazard models. ResultsAmong new metformin users in 2004‒2007 (2,116 Canadians and 2,631 Americans) >65 years of age, the median time to treatment intensification was 362 days for Canadians and 170 days for Americans (adjusted hazard ratio, 1.99; 95% confidence interval, 1.69 to 2.36). In a second cohort of all adult ages with clinical data between 2008 and 2010 (23,022 Canadians and 19,318 Americans), the median time to treatment intensification was 197 days for Canadians and 119 days for Americans (adjusted hazard ratio, 5.62; 95% confidence interval, 5.246 to 6.029). At treatment intensification, the mean glycated hemoglobin was 9.0% (standard deviation, 2.0) in Canada and 8.6% (standard deviation, 2.2) in the US (p<0.01). ConclusionsAlthough clinical practice guidelines are similar between Canada and the US, Canadian clinicians have historically demonstrated more clinical inertia compared with their US counterparts with respect to intensifying antihyperglycemic therapy. It is relatively unknown whether these differences currently exist or whether Canadian clinicians have closed the gap.

Willpower as Cultural Construct: Do Chinese Students Believe Less in Its Depletion?

The idea of ego-depletion has been examined extensively in western cultures, but cultural background might substantially influence the understanding and effect of the concept. In the present study we used Job et al. (2010) Implicit Theories on Willpower Questionnaire to examine whether Chinese college students, compared to United States students, are less inclined to believe that willpower depletes. Applying two-group confirmatory structural equation modeling, the questionnaire with its two subscales – depletion of mental resources (DMR) and depletion of resistance to temptation – showed consistent psychometrical qualities across both samples. As predicted, Chinese student believed less in the concept of DMR than United States students. However, Chinese students showed a stronger belief in the depletion of resisting temptation (DRT) compared to their United States counterparts, suggesting different normative contexts for the response to the two subscales across cultures.

Syrian Refugee Children: A Study of Strengths and Difficulties

This research examined the psychological status of Syrian refugee children residing in Antalya, Turkey using the Strengths and Difficulties Questionnaire (SDQ). The psychological aspects explored in the SDQ are emotional symptoms, hyperactivity, conduct disorder, peer relationship problems, and prosocial behavior. We analyzed scores for Syrian refugee children between the ages of 9 and 15 years living in the city center of Antalya, Turkey. For comparison, a similar group of Turkish students completed the same questionnaire. Significant effects of psychological deficit were found for the Syrian refugee children. We conclude that Syrian refugee children in Antalya suffer from severe emotional and conduct problems compared to the Turkish children (who have heightened hyperactivity). Most startling is that both Syrian and Turkish youth in this study have the highest averages for Total Difficulties worldwide, with Syrian refugee children scoring twice as high as their United States counterparts. The results of this study strongly support the need for psychological counseling for refugee children. Additionally, access to counseling should be understood to be critical to refugees’ human right to rehabilitation.

U.K. Counterterrorism Law, Pre-Emption, and Politics

Since the turn of the century, across North Atlantic countries, counterterrorism law has been an area of relentless, highly prioritized, legal production that often challenges rule of law principles. This article provides a general overview of United Kingdom counterterrorism legislation and, drawing from jurisprudence, state theory, and political philosophy, constructs an analytical framework to assess its implications for the broader shape, function, and logic of law. It starts by assessing the dynamic tension between authoritarian and democratic elements that constitutes modern law, thus setting the overall conceptual framework in which counterterrorism law pertains. It proceeds to analyze U.K. counterterrorism law, by juxtaposing it to its United States counterpart and by deciphering the key trends into which its provisions combine. Based on this account, the article considers the implications of counterterrorism law for the law-form, that is, for the articulation between legal content, logic, and institutionality. It finds that, although the content and logic of counterterrorism law are incompatible with rule of law principles, they are developed in an institutional framework adherent to the rule of law. To account for this paradox, the article concludes that counterterrorism law signals the advent of authoritarian legality, a reconfiguration of the rule of law where the latter holds its institutional shape, but comes to consist of, and be driven by, authoritarian content and purposes. The article outlines the main characteristics of authoritarian legality, compares it to existing approaches to counterterrorism law, and indicates its plausibility for U.S. counterterrorism jurisprudence.

A Comparative Study of Firm-Level Climate Change Mitigation Targets in the European Union and the United States

While the debate on global and national carbon emission targets has dominated every major climate change conference, setting firm-level climate change mitigation targets has become an increasingly important issue. In this paper we present illustrative evidence on cross-country and cross-industry differences of the firm-level mitigation targets among some of the largest corporations in the European Union (EU) and the United States (US) with regard to five aspects, i.e., target adoption, target metric, target scope, target stringency, and target completion. We find that overall 25% of the firms have not set up emission targets. The EU firms are significantly more likely to use intensity targets than the US firms. The EU firms are twice as likely as the US firms to incorporate indirect emissions from the supply chain into the scope of their targets. The Energy and Materials sectors in the EU set significantly more stringent targets than their US counterparts. The energy sectors of the EU and the US in general have not made satisfactory progress toward accomplishment of the targets. Based on these findings, we discuss the most pressing issues that should be addressed by policymakers and firm managers in different regions and sectors with regard to target-setting.

Utilization of pelvic lymph node dissection in patients undergoing robot-assisted radical prostatectomy in India versus the United States - A Vattikuti Collective Quality Initiative database analysis.

The utilization and extent of pelvic lymph node dissection (PLND) varies depending on the disease and practice patterns. This study compares practice patterns in utilization of PLND between Indian and United States (US) practices. We focused on 415 patients (204 India; 211 US) prostate cancer patients treated with robot-assisted radical prostatectomy, between 2015 and 2016, within the Vattikuti Collective Quality Initiative database. Utilization of PLND and number of nodes removed were evaluated for the entire cohort, and after stratifying for Country of treatment and D'Amico risk groups. Logistic regression tested the relationship between PLND and country of treatment, after adjusting for disease risk. Indian patients had a higher risk distribution (D'Amico high-risk 53.4% in India vs. 27% in the US; P< 0.001) compared to their US counterparts. Overall, 193/204 (94.6%) Indian patients underwent PLND versus 181/211 (85.8%) US patients (P = 0.003). When stratified based on disease risk, PLND was performed more frequently in Indian patients with low-risk disease (81.0% vs. 41.4%,P= 0.008), but not in those with intermediate and high-risk disease. On multivariable analysis, Indian patients had a 2.57-fold higher probability of undergoing PLND than their US counterparts (P = 0.02). The analysis of the number of lymph nodes removed showed similar trends. Indian patients are more likely to undergo PLND than US patients. This is, especially true for patients with low-risk disease, who are unlikely to benefit from this procedure. Efforts should focus on optimizing the utilization of PLND, and deliver it only when there is clinical indication.

Tobacco use disparities by racial/ethnic groups: California compared to the United States

Racial/ethnic disparities in cigarette use and cessation persist. This study compared cigarette consumption and former smoking trends in California (CA) with the rest of the United States (US) by racial/ethnic categories of non-Hispanic White, Black, Hispanic/Latino, and Asian/Pacific Islander groups. Data were analyzed from the 1992 to 2011 Tobacco Use Supplement to the Current Population Survey. Consumption levels across decades were examined and adjusted logistic regression models were fit to compare across CA and US.Results indicated steady declines in ever smoking prevalence for all groups with much lower magnitudes of change among US Blacks and Whites compared to their CA counterparts. After controlling for age, gender, and education, CA had significantly fewer heavy smokers (OR=0.45, 95% CI:0.38–0.54), more light and intermittent smokers (LITS; OR=1.68, 95%CI: 1.45–1.93), and a greater proportion of former smokers (OR=1.35, 95%CI: 1.24–1.48) than the rest of US. Data were stratified by race/ethnicity and the patterns shown were mostly consistent with CA performing statistically better than their US counterparts with the exception of Black LITS and Asian/Pacific Islander former smokers. California's success in reducing tobacco use disparities may serve as a prime example of tobacco control policy for the country. CA and the US will need to continue to address tobacco use and cessation in the context of the growing diversity of the population.

The Consumption, Income, and Wealth of the Poorest: Cross-Sectional Facts of Rural and Urban Sub-Saharan Africa for Macroeconomists

This paper provides new empirical insights on the joint distribution of consumption, income, and wealth in three of the poorest countries in the world — Malawi, Tanzania, and Uganda — all located in Sub-Saharan Africa (SSA). The first finding is that while income inequality is similar to that of the United States (US), wealth inequality is barely one-third that of the US. Similarly, while the top of the income distribution (1 and 10 percent) earns a similar share of total income in SSA as in the US, the share of total wealth accumulated by the income-rich in SSA is one-fifth of its US counterpart. The main contributions of the paper are to document: (i) this dwarfed transmission from income to wealth, which suggests that SSA households face a larger inability to save and accumulate wealth compared with US households; and (ii) a lower transmission from income to consumption inequality, which suggests the presence of powerful institutions that favor consumption insurance to the detriment of saving. These features are more relevant for rural areas, which represent roughly four-fifths of the total population. The paper identifies the few successful pockets of the SSA population that are able to accumulate wealth by exploring sources of inequality such as age, education, migration, borrowing ability, and societal systems.

Měnící se komoditní trhy - práce na předpisech EU

Commodity markets are substantial for the shape of the world economy and experienced numerous structural changes over the span of last decades. The financial sector of the economy started to play the commanding role. The prices became more volatile as more and more financial investors began to speculate on commodity markets. Such process combined with other crucial factors leads to market abuses, decreasing transparency of trade and excessive speculation. These issues surged and were mostly observed during the subprime mortgage crisis and in the period straight after it. The policymakers around the globe made an effort in order to diminish those effects and introduced a new policy framework towards commodity markets. This paper focuses on current works and actions taken by the European Union policymakers and their United States counterparts.

Assessing data access issues in online platforms

Online platforms have the characteristics of a particular type of market known as ‘multi-sided’. These businesses create value by bringing advertisers and users together. Access to user data is critical to this process. On the basis of economic literature, the features of multi-sided platforms will be discussed. It will be argued that the characteristics of multi-sided platforms increase the likelihood that successful companies become dominant due to the existence of indirect network effects. In these circumstances, dominant platforms may foreclose competition by raising barriers to entry in the large collections of user data. This may give rise to access problems for competitors and new entrants that need access to data gathered by dominant platforms in order to provide competing or complementary services. A comparative legal analysis will be used to assess the standards that are applicable in the United States (US) and the European Union (EU) for finding liability for refusals to deal under antitrust or competition law. The private antitrust cases that have already occurred regarding access to user data in the US show that the scope of applicability of the US essential facilities doctrine is very limited after the judgment of the Supreme Court in Trinko. Although the European Commission and the European Court of Justice seem to be willing to accept liability for a refusal to deal more easily than their US counterparts, high legal hurdles still have to be met under the essential facilities doctrine in the EU. Nevertheless, there are scenarios in which liability for refusals to give access to data will likely be accepted in the EU.

Indian and United States Paramedic Students: Comparison of Examination Performance for the American Heart Association Advanced Cardiovascular Life Support (ACLS) Training

BackgroundThe American Heart Association (AHA) Advanced Cardiovascular Life Support (ACLS) course is taught worldwide. The ACLS course is designed for consistency, regardless of location; to our knowledge, no previous study has compared the cognitive performance of international ACLS students to those in the United States (US). Study ObjectivesAs international health educational initiatives continue to expand, an assessment of their efficacy is essential. This study assesses the AHA ACLS curriculum in an international setting by comparing performance of a cohort of US and Indian paramedic students. MethodsFirst-year paramedic students at the Emergency Management and Research Institute, Hyderabad, India, and a cohort of first-year paramedic students from the United States comprised the study population. All study participants had successfully completed the standard 2-day ACLS course, taught in English. Each student was given a 40-question standardized AHA multiple-choice examination. Examination performance was calculated and compared for statistical significance. ResultsThere were 117 Indian paramedic students and 43 US paramedic students enrolled in the study. The average score was 86% (± 11%) for the Indian students and 87% (± 6%) for the US students. The difference between the average examination scores was not statistically significant in an independent means t-test (p=0.508) and a Wilcoxon test (p=0.242). ConclusionIndian paramedic students demonstrated excellent ACLS cognitive comprehension and performed at a level equivalent to their US counterparts on an AHA ACLS written examination. Based on the study results, the AHA ACLS course proved effective in an international setting despite being taught in a non-native language.