This article explores pre-service teachers’ personal experiences as they implemented immersive virtual reality using Google Expedition during a summer STEM camp for primary students. The research is situated around semi-structured interviews conducted to determine how pre-service teachers view their experiences using Google Expedition in primary classrooms, and the pedagogical challenges they encountered during this process. The semi-structured interviews provided insight into the planning, the pedagogical applications, and the obstacles or challenges they encountered during the planning stage and execution of their lesson using a highly interactive, three-dimensional tool such as Google Expedition. The data indicated that pre-service teachers had confidence in implementing virtual reality lessons in the class and considered it a new horizon for teaching. Yet, it also identified pedagogical challenges associated with implementing virtual reality in a primary classroom.Utilizing national migration data regarding the outbreak of the novel coronavirus (2019-nCoV), this paper employs a difference-in-differences approach to empirically analyze the relationship between human mobility and the transmission of infectious diseases in China. We show that national human mobility restrictions ascribed to the first-level public health emergency response policy effectively reduce both intercity and intracity migration intensities, thus leading to a declining scale of human mobility, which improves the effectiveness in controlling the epidemic. Human mobility restrictions have greater influences on cities with better economic development, denser populations, or larger passenger volumes. Moreover, mobility restriction measures are found to be better implemented in regions with increased public awareness, or with provincial leaders who have healthcare crisis management experience, local administrative experience, or the opportunity to serve a consecutive term.Australia-China relations have been relatively stable over the last decade. However, soon after the outbreak of COVID-19, Australia took an increasingly assertive stance toward China, one that is arguably even more assertive than those of its Western allies. What prompted Australia to adopt a tougher policy against China? This article argues that COVID-19 has brought significant uncertainty to the international system and, hence, to Australia’s external environment, which has affected the country’s decision-making, accelerating the formation of a hardline policy toward China. A contributing factor behind this policy is Australia’s quest for ontological security, which, in the context of COVID-19, has triggered a rise in anti-China sentiment. Meanwhile, this strategy backfired when it encountered China’s own nationalism, which exacerbated the widening political chasm, dragging the two countries into an unprecedented diplomatic confrontation. The core of ontological security lies in maintaining the stability of the identity needed for the formation of consistent policy. The uncertainties created by the COVID-19 pandemic have changed the familiar external environment and challenged Australia’s ability to interpret this new environment and adjust to it, which has triggered ontological insecurity. By analyzing Australia’s identity as a middle power in the context of changing regional security and its commitment to certain values, the article shows how COVID-19 has accelerated Australia’s quest for ontological security, which has changed the country’s China policy.In patients with T2DM and ESRD, insulin is the antidiabetic medication of choice with a hemoglobin A1c target of 6 to 8%, using fructosamine levels or other measures for better assessment of glycemic control.In areas where the zoonotic disease leptospirosis is endemic, reduced morbidity and mortality is strongly linked to quick initiation of renal replacement therapy.

Radium-223 (Ra-223) radioisotope has been reported to increase median survival in bone metastatic prostate carcinoma. The addition of Ra-223 to abiraterone was associated with an increased risk of bone fractures. There has been no comprehensive data for using Ra-223 in veterans who were exposed to Agent Orange (AO+).

We present a retrospective study of veterans with bone metastatic castration-resistant prostate cancer (CRPC) who received standard doses of Ra-223 and other sequential therapies at US Department of Veterans Affairs Pittsburgh Healthcare System in Pennsylvania from January 2014 to January 2019. Veterans were divided into 2 groups those who were exposed to Agent Orange (AO+) and those who had no exposure (AO-). Time to study was calculated from the initiation of Ra-223. Time to skeletal-related events (SRE), progression of prostate specific antigen (PSA), bone metastasis, and alkaline phosphatase (ALP) were calculated in months using unpaired t test with 2-tailed

values. Median survival was15 months (

= .14; hazard ratio [HR] 0.48; 95% CI, 0.17-1.3). Median survival for AO+ and AO- veterans was 12 months and 18 months, respectively (

= .15; HR, 2.0; 95% CI, 0.77-5.0).

There was no statistical difference between AO+ and AO- veterans in terms of time to SRE, PSA, bone and ALP progression, even though there was a trend of shorter duration in AO+ veterans. There was no median survival difference between Ra-223 first vs Ra-223 later as well as between AO+ and AO- but there is a trend of worse survival in AO+ veterans.

There was no statistical difference between AO+ and AO- veterans in terms of time to SRE, PSA, bone and ALP progression, even though there was a trend of shorter duration in AO+ veterans. There was no median survival difference between Ra-223 first vs Ra-223 later as well as between AO+ and AO- but there is a trend of worse survival in AO+ veterans.Acute colonic pseudo-obstruction is a postsurgical dilatation of the colon that presents with abdominal distension, pain, nausea, vomiting, constipation, or diarrhea and may lead to colonic ischemia and bowel perforation.

Heart disease continues to be the leading cause of death in the US, and the number of people with cardiovascular disease (CVD) is rising. CVD is more prevalent among military veterans than nonveterans, and veteran status is associated with higher risk of incident heart disease after controlling for socioeconomic status, other medical diseases, depression, and lifestyle. Many patients seeking care in the Veterans Health Administration, including those who undergo cardiac catheterization, meet the criteria for multimorbidity (defined as ≥ 2 chronic diseases).

The Heart Disease Reversal Program (HDRP) is a novel interdisciplinary, multicomponent lifestyle program at the US Department of Veterans Affairs (VA) Sacramento VA Medical Center. This program is a streamlined adaptation of behavioral/lifestyle interventions aimed at promoting partial reversal (regression) of atherosclerotic heart disease and achievement of comprehensive cardiovascular risk reduction. HDRP was developed and implemented within a VA behavioral medicine clinic and successfully adapted for delivery through videoconferencing during the COVID-19 pandemic. Patient satisfaction survey data indicate a very high level of patient acceptability. We found direct-to-patient clinical outreach an effective method for launching a disease reversal program.

Beyond the clinical benefits to patients, there is significant value and benefit added to the health care system by offering an intervention within the disease reversal paradigm. Efforts of the health care team to reverse a disease can be considered the highest aim of medicine and health care.

Beyond the clinical benefits to patients, there is significant value and benefit added to the health care system by offering an intervention within the disease reversal paradigm. Efforts of the health care team to reverse a disease can be considered the highest aim of medicine and health care.The size of copper precipitates is the main factor affecting the antibacterial performance of antibacterial stainless steel. To study the mechanism of copper precipitate growth in ferritic stainless steel, the shape coefficient η and average specific interfacial energy of copper precipitate σ ¯ were calculated. The growth process of copper precipitate was observed by atomic probe tomography and transmission electron microscope. The results show that the shape coefficient of copper precipitate was 3.053, and the average specific interfacial energy was σ ¯ = 0.4832 – 0.1652 × 10 – 3 T . The increase in the aging time resulted in an increase in the size of copper precipitates and a decrease in the number density. In addition, with the increase in the aspect ratio, the shape of the precipitated phase changed from an initial spherical shape to ellipsoid shape and finally to a rod shape. The increase in the annealing time enhanced the antibacterial activity of the tested steel until almost 100% of the bacteria were killed. Thus, the antibacterial performance is closely related to the size and total surface area per unit area of the precipitate.The use of serious educational games has the potential to increase student learning outcomes in science education by providing students with opportunities to explore phenomena in ways that vary from traditional instruction; yet, empirical research to support this assertion is limited. This study aimed to explore deeply what learning gains were associated with the use of three serious educational games (SEGs) created for use in secondary biology classrooms that partner teachers implemented during a 2-week curriculum unit. This longitudinal, mixed method study includes a control year, in which we examined how six highly qualified teachers taught students (n = 407) a 2-week curriculum unit addressing cellular biology without the SEGs, followed by 2 years in which the teachers integrated the SEGs into the curriculum unit with students (n =871). Data were collected from multiple sources, including a validated content pre- and post-test measure, embedded gameplay data, participant observation, teacher interviews, and focus groups. Quantitative findings showed significant learning gains associated with students who experienced the game condition during year 2, when compared with the control condition. During the replication year (year 3), learning gains increased again, compared with year two. Although the SEGs did not change between years 2 and 3, teachers were provided real-time access to students’ performance during gameplay. Thematic analysis of observation notes, teacher interviews, and student performance in-game identified four affordances teachers identified related to the use of serious educational games in their classrooms and the extended partnership model employed. Implications for researchers and game designers are discussed.

The aim of our study is to evaluate risk factors associated with the development of

infection (CDI) in hematopoietic stem cell transplant (HSCT) patients, determine its incidence and report outcomes of CDI in our patient population.

We performed a retrospective review of medical records of adult HSCT recipients diagnosed between 2013 and 2016 at our center. Logistic regression models were used to determine the relationship between risk factors and the odds of CDI.

The overall incidence of CDI in HSCT patients was 9.4%. The incidence of CDI was higher in allogeneic HSCT (20%) versus autologous HSCT (4.8%). No statistically significant differences in age, gender, cancer type, transplant type were found between those who developed CDI and those who did not. However, patients with CDI had a longer length of stay (25 days) and used more antibiotics (30 days prior to and during admission for HSCT) than non-CDI patients (19 days). Only two of 17 patients (11.8%) with CDI experienced recurrence among 180 patients after HSCT.