The unmet demand for point-of-care ultrasound among general pediatricians: a cross-sectional survey

Background Point-of-care ultrasound (POCUS) is a noninvasive bedside tool with many pediatric applications but is not currently a formal part of pediatric training and practice. Formal surveys of general pediatricians regarding POCUS training are lacking. We aimed to quantify the baseline ultrasound experience and training needs of general pediatricians and pediatric residents across different practice settings. Methods In 2020, we sent an online survey to 485 current faculty, residents, and graduates from an urban pediatric academic medical center in Northern California. Pediatric subspecialists were excluded. Survey questions about baseline experience, comfort, and perceived usefulness of 20 common POCUS applications were developed by two POCUS experts using existing literature. Chi-squared analysis was used to compare residents versus attendings and to compare attendings practicing in inpatient versus outpatient versus mixed settings. Results Response rate was 20% (98/485). Compared to attendings (n = 73), residents (n = 25) endorsed more exposure to POCUS in medical school (32% vs 5%, p = 0.003) and residency (12% vs 5%, p = 0.003). Respondents endorsed low comfort with POCUS (mean 1.3 out of 5 on Likert scale). Of 20 procedural and diagnostic applications, respondents identified abscess drainage, bladder catheterization, soft tissue, neck, advanced abdominal, and constipation as most useful. Overall, 50% of pediatricians (and 70% of pediatric residents) responded that there were opportunities to use POCUS multiple times a week or more in their clinical practice. Conclusions There is an unmet demand for POCUS training among general pediatricians and trainees in our study. Although the majority of respondents were not POCUS users, our results could guide future efforts to study the role of POCUS in general pediatrics and develop pediatric curricula.

Avaliação de contribuição do reservatório de Movene na bacia hidrográfica do rio Umbeluzi em Moçambique

A gestão dos recursos hídricos na bacia hidrográfica do rio Umbeluzi é uma questão fundamental devido ao agravamento de escassez de água nos centros urbanos e na agricultura que pode pôr em causa os valores socioculturais, ecológicos e econômicos. Torna-se ainda mais importante o fato de ser uma bacia internacional, cuja demanda por água tem aumentando em função de expansão agrícola e crescimento populacional. O estudo avaliou a contribuição do novo reservatório de Movene e novas regras de prioridade na alocação de água superficial para atender às diferentes necessidades usando o modelo WaterEvaluation and Planning System – WEAP. O modelo foi validado no período 2005-2011 apresentando o NSE de 0,69 e Bias de 5,2% no volume do reservatório e 2005 com NSE de 6,7 e Bias de 6,0% na vazão. Os resultados mostram menor contribuição do reservatório de Movene, a demanda não atendida no abastecimento doméstico passou de 33,6 hm3 para 10,1 hm3 no cenário de Referência e de 57,3 hm3 para 19,9 hm3 no cenário Maior Crescimento em 2040. Considerando o mesmo ano, a demanda não atendida na agricultura caiu de 12,9 hm3 para 4,1 hm3 e de 22 hm3 para 10,3 hm3 nos cenários de Referência e de Maior Crescimento. No sector industrial apenas o cenário Maior Crescimento apresenta demanda não atendida, tendo saído de 7,4 hm3 para 0,3 hm3 em 2040. Esses resultados enfatizam a necessidade de implementação de estratégias de gestão de lado de demanda para minimizar os impactos de escassez de água. Contribution assessment of the Movene reservoir in the Umbeluzi river basin in Mozambique A B S T R A C TThe management of water resources in the Umbeluzi River basin is an important issue due to the worsening of water scarcity in urban centres and in agriculture, which can jeopardize socio-cultural, ecological and economic values. Even more important is the fact that it is an international basin, whose demand for water has been increasing due to agricultural expansion and population growth. The study evaluated the contribution of the new Movene reservoir and new rules of priority in the allocation of surface water to meet different needs usingWater Evaluation And Planning (WEAP) model. WEAP modelwas validated from 2005 to 2011 with NSE of 0.69 and Bias of 5.2% in the volume of the reservoir and 2005 with an NSE of 6.7 and Bias of 6.0% in the flow. The results demonstrate a lower contribution of the Movene reservoir, the unmet demand in domestic supply went from 33.6 hm3to 10.1 hm3 in the Reference scenario and from 57.3 hm3to 19.9 hm3 in the Reference scenario Higher Growth scenario in 2040. Considering the same year, unmet demand in agriculture fell from 12.9 hm3to 4.1 hm3 and from 22 hm3to 10.3 hm3 in the Reference and Higher Growth scenarios. In the industrial sector, only the Highest Growth scenario has unmet demand, having gone from 7.4 hm3to 0.3 hm3 in 2040. These results emphasize the need to implement demand-side management strategies to minimize the impacts of water scarcity.Keywords: water resources, water demand, Umbeluziriver, WEAP model.

A Monge Sequence-Based Approach to Characterize the Competitive Newsvendor Problem

Replicating cash flows of multiple agents in game-theoretic settings tends to be a challenging task. In this paper, we consider the competitive newsvendor game where multiple newsvendors choose inventory levels before demand arrival and the unmet demand of each newsvendor spills over to multiple other newsvendors. We show that this spillover behavior and the resulting cash flows of each newsvendor can be replicated within a transportation problem after assigning artificial costs on spillover behavior. This replication provides an opportunity to study structural properties of the problem, as well as determine the equilibrium of the game. This paradigm of using artificial costs within an optimization framework to replicate agents’ cash flows can be used in many other games as well.

Evaluating the Impact of the Accounting Doctoral Scholars Program on Academic Accounting in the US

The accounting establishment and AICPA Foundation responded to an inadequate supply of new accounting faculty by creating the Accounting Doctoral Scholars (ADS) program. Between 2009–2018, the $17 million program enabled 105 practitioners to become audit and tax faculty. Based on market data and an ADS participant survey, we find an increase in doctoral graduates at ADS and non-ADS schools relative to pre-ADS years, and unmet demand for audit has decreased after ADS, whereas tax remains in need. Compared to the market, ADS graduates experienced somewhat better placements by moving up to more prestigious strata and were more likely to place at schools with a doctoral program. Additionally, we present results for ADS students’ motivations, degree completion time, and differences between audit and tax participants. Our findings have important implications for academic accounting, business schools, regulators, and policymakers. We also provide important context for changes in market trends preceding COVID 19.

A Quarter Acre Pavlova Paradise Lost? The Role of Preferences and Planning in Achieving Urban Sustainability in Wellington, New Zealand

<p>This thesis investigates the scope for compact development to accommodate population growth in Wellington, New Zealand. The topic is particularly significant for New Zealand as the great majority of the population lives in urban areas, historical development has been dominated by low density urban form, and transport and urban form are two of the main domains in which the country can reduce its carbon emissions. The influence of urban planning and residents’ preferences on achieving sustainable outcomes is investigated. Historical and current planning rules and transport policies in the City are analysed to determine their influence on the provision of compact development. Wellington’s transport policy shows a pattern of path dependency: historical decisions to favour car oriented investment have driven subsequent transport investments and influenced the ease of using different transport modes. Planning policies show a similar pattern of path dependency: planning rules enacted in the 1960s endure in present planning despite being packaged with different justifications and regulatory regime. Current planning rules severely restrict infill development in most existing neighbourhoods, which reduces the availability of housing in accessible medium density neighbourhoods and likely increases the cost of this type of housing. A stated choice survey was conducted of 454 residents of Wellington City to investigate the extent to which there is an unmet demand for compact development and alternatives to car travel. The survey held presentation mode constant across two completion modes (internet and door to door with tablet completion), allowing the impacts of recruitment and completion mode to be examined. Survey recruitment mode appeared to influence both response rates and the representativeness of the survey, while completion mode appeared to have little or no impact on survey responses. Using the stated choice survey results, a latent class model was developed to examine the preferences of residents and the trade-offs they are willing to make when choosing where to live. This type of model allows for the identification of preference groups as a means of understanding the diversity of preferences across the population. The study found that there is an unmet demand for medium density, accessible housing, but that affordability is a barrier for households to choose this type of housing. There was also an unmet demand for walking and cycling, with more residents currently driving than would prefer to use this mode, and more residents preferring to walk and cycle to work than currently use these modes. The ability to use a desired travel mode appears to be related to the neighbourhood in which a person lives, with residents of medium and high density neighbourhoods being more likely to use their preferred travel mode. This study also modelled future development trajectories for Wellington based on demand for housing, neighbourhood and transport attributes. This preference based growth model was contrasted with the City’s plan for development over the next 30 years. Comparing the two scenarios, the planning based trajectory performed better than the demand based scenario in terms of both carbon emissions and achieving compact development.</p>

Living in the 'liveable' city: Housing, Neighbourhood, and Transport Preferences in New Zealand cities

<p>This thesis investigates preferences for housing, neighbourhoods, and transport in Auckland, New Zealand, supplemented by a comparison with similar research in Wellington and Hamilton. The topic is significant for New Zealand as there is an increasingly urban population, and the interconnected areas of urban form and transport can help the country reduce carbon emissions and provide a healthier, more enjoyable lifestyle for its people. The influence of residents’ preferences and their relationship with urban form on achieving compact city development is investigated. Historical and current planning rules and policies provide context for an analysis of how urban planning, preferences, and location and travel choices interact. Auckland’s housing and transport policies show a pattern of path dependency: decisions favouring greenfield development, sprawling low-density suburbs, and car-centred transport have driven subsequent investments and influenced the ease of using alternative transport modes. Such rules have also reduced the availability of housing in accessible, medium- to high-density neighbourhoods and may have contributed to the rising costs of this type of housing. A stated choice survey of 3,285 Auckland households was conducted to investigate the extent to which there is an unmet demand for compact development and alternatives to car travel. Using the survey results, a multinomial latent class model was developed to examine the preferences of households and the trade-offs they may be willing to make when choosing where to live. This type of model allows for identification of preference groups as a means of understanding the heterogeneity of preferences across the population. There was an unmet demand for accessible, medium-density housing, with some households willing to trade off dwelling size and neighbourhood type for higher accessibility or lower prices. The study also found that more people currently drive than would prefer to, with long journey times, safety concerns, unreliable services, and a lack of infrastructure acting as barriers to active and public transport. Households preferring low density are more likely to occupy their preferred dwelling type and be able to use their preferred transport mode. In contrast, those preferring high accessibility or driven by price are more likely to experience a mismatch between their preferred and current dwelling type, and are less likely to be able to use their preferred transport mode.</p>

A Quarter Acre Pavlova Paradise Lost? The Role of Preferences and Planning in Achieving Urban Sustainability in Wellington, New Zealand

<p>This thesis investigates the scope for compact development to accommodate population growth in Wellington, New Zealand. The topic is particularly significant for New Zealand as the great majority of the population lives in urban areas, historical development has been dominated by low density urban form, and transport and urban form are two of the main domains in which the country can reduce its carbon emissions. The influence of urban planning and residents’ preferences on achieving sustainable outcomes is investigated. Historical and current planning rules and transport policies in the City are analysed to determine their influence on the provision of compact development. Wellington’s transport policy shows a pattern of path dependency: historical decisions to favour car oriented investment have driven subsequent transport investments and influenced the ease of using different transport modes. Planning policies show a similar pattern of path dependency: planning rules enacted in the 1960s endure in present planning despite being packaged with different justifications and regulatory regime. Current planning rules severely restrict infill development in most existing neighbourhoods, which reduces the availability of housing in accessible medium density neighbourhoods and likely increases the cost of this type of housing. A stated choice survey was conducted of 454 residents of Wellington City to investigate the extent to which there is an unmet demand for compact development and alternatives to car travel. The survey held presentation mode constant across two completion modes (internet and door to door with tablet completion), allowing the impacts of recruitment and completion mode to be examined. Survey recruitment mode appeared to influence both response rates and the representativeness of the survey, while completion mode appeared to have little or no impact on survey responses. Using the stated choice survey results, a latent class model was developed to examine the preferences of residents and the trade-offs they are willing to make when choosing where to live. This type of model allows for the identification of preference groups as a means of understanding the diversity of preferences across the population. The study found that there is an unmet demand for medium density, accessible housing, but that affordability is a barrier for households to choose this type of housing. There was also an unmet demand for walking and cycling, with more residents currently driving than would prefer to use this mode, and more residents preferring to walk and cycle to work than currently use these modes. The ability to use a desired travel mode appears to be related to the neighbourhood in which a person lives, with residents of medium and high density neighbourhoods being more likely to use their preferred travel mode. This study also modelled future development trajectories for Wellington based on demand for housing, neighbourhood and transport attributes. This preference based growth model was contrasted with the City’s plan for development over the next 30 years. Comparing the two scenarios, the planning based trajectory performed better than the demand based scenario in terms of both carbon emissions and achieving compact development.</p>

Living in the 'liveable' city: Housing, Neighbourhood, and Transport Preferences in New Zealand cities

<p>This thesis investigates preferences for housing, neighbourhoods, and transport in Auckland, New Zealand, supplemented by a comparison with similar research in Wellington and Hamilton. The topic is significant for New Zealand as there is an increasingly urban population, and the interconnected areas of urban form and transport can help the country reduce carbon emissions and provide a healthier, more enjoyable lifestyle for its people. The influence of residents’ preferences and their relationship with urban form on achieving compact city development is investigated. Historical and current planning rules and policies provide context for an analysis of how urban planning, preferences, and location and travel choices interact. Auckland’s housing and transport policies show a pattern of path dependency: decisions favouring greenfield development, sprawling low-density suburbs, and car-centred transport have driven subsequent investments and influenced the ease of using alternative transport modes. Such rules have also reduced the availability of housing in accessible, medium- to high-density neighbourhoods and may have contributed to the rising costs of this type of housing. A stated choice survey of 3,285 Auckland households was conducted to investigate the extent to which there is an unmet demand for compact development and alternatives to car travel. Using the survey results, a multinomial latent class model was developed to examine the preferences of households and the trade-offs they may be willing to make when choosing where to live. This type of model allows for identification of preference groups as a means of understanding the heterogeneity of preferences across the population. There was an unmet demand for accessible, medium-density housing, with some households willing to trade off dwelling size and neighbourhood type for higher accessibility or lower prices. The study also found that more people currently drive than would prefer to, with long journey times, safety concerns, unreliable services, and a lack of infrastructure acting as barriers to active and public transport. Households preferring low density are more likely to occupy their preferred dwelling type and be able to use their preferred transport mode. In contrast, those preferring high accessibility or driven by price are more likely to experience a mismatch between their preferred and current dwelling type, and are less likely to be able to use their preferred transport mode.</p>

Effects of institutional capacity, infrastructure governance, and equity on state- and nation-building processes in Ethiopia

This paper analyzed the equitable allocation of infrastructure across regional states in Ethiopia. In general, in the past years, there has been a good start in the infrastructure sector in Ethiopia. However, the governance and equity system of infrastructure in Ethiopia is not flexible, not technology-oriented, not fair, and not easily solved. The results of in-depth interviews and focus group discussions (FGDs) showed that there is a lack of institutional capacity, infrastructure governance, and equity, which has negatively impacted the state- and nation-building processes in Ethiopia. According to the interviewees, so long as the unmet demand for infrastructure exists, it remains a key restrain on doing business in most Ethiopian regional states. This is due to the lack of integrated frameworks, as there are coordination failures (lack of proper government intervention, including a lack of proper understanding and implementation of the constitution and the federal system). In Ethiopia, to reduce these bottlenecks arising from the lack of institutional capacity, infrastructure governance, and equity and their effects on nation-building, first of all, the government has to critically hear the people, deeply assess the problems, and come to the point and then discuss the problems and the way forward with the society at large.

Cell-derived extracellular vesicles and membranes for tissue repair

Humans have a limited postinjury regenerative ability. Therefore, cell-derived biomaterials have long been utilized for tissue repair. Cells with multipotent differentiation potential, such as stem cells, have been administered to patients for the treatment of various diseases. Researchers expected that these cells would mediate tissue repair and regeneration through their multipotency. However, increasing evidence has suggested that in most stem cell therapies, the paracrine effect but not cell differentiation or regeneration is the major driving force of tissue repair. Additionally, ethical and safety problems have limited the application of stem cell therapies. Therefore, nonliving cell-derived techniques such as extracellular vesicle (EV) therapy and cell membrane-based therapy to fulfil the unmet demand for tissue repair are important. Nonliving cell-derived biomaterials are safer and more controllable, and their efficacy is easier to enhance through bioengineering approaches. Here, we described the development and evolution from cell therapy to EV therapy and cell membrane-based therapy for tissue repair. Furthermore, the latest advances in nonliving cell-derived therapies empowered by advanced engineering techniques are emphatically reviewed, and their potential and challenges in the future are discussed. Graphical Abstract