ARCH Development Corporation

To evaluate the feasibility of a breast stimulation program using a breast pump shortly after cesarean section (CS) to enhance the onset of lactogenesis II. We used a convergent mixed-methods design. It provided an overall picture through quantitative results, which were complemented by qualitative findings. The results were presented using a joint display. Participants were full-term women who underwent CS at a regional perinatal hospital and nurse-midwives from January to March 2025. The program included: (1) providing information about breastfeeding after CS; and (2) providing breast pump-mediated nipple stimulation, starting within 6 h postpartum and continuing until day 2, at least four times daily under researcher supervision. Main outcomes focused on the feasibility of the program, including acceptability, practicality, and implementation. An eight-item questionnaire and open-ended questions were administered. Quantitative data were analyzed using descriptive statistics; qualitative data were analyzed using content analysis. Seven full-term women with planned CS and 29 nurse-midwives. Most used a breast pump four times within the first 24 h after CS. Women were satisfied with painless nipple stimulation and early milk expression. Both designs complemented each other, and the program was deemed acceptable based on early postpartum breast milk volume data. Identified challenges included pump operability, individual adaptation, and preparation time. The breast stimulation program initiated shortly after CS was feasible, well accepted, and aspects of breast milk volume. A future randomized controlled trial should consider individual differences and adjustments in the frequency of breast pump usage.

Adrenoleukodystrophy (ALD) encompasses a spectrum of X-linked genetic disorders, including the adult-onset adrenomyeloneuropathy (AMN) phenotype. We report the case of a 32-year-old male with AMN and examine the impact of a tailored home-based rehabilitation regimen, specifically employing Frenkel’s exercises. The patient displayed classic AMN symptoms, including spastic paraparesis, peripheral neuropathy, and urinary disturbances. Initial assessments revealed significant ataxia-related impairments, particularly in gait, stance, and heel-shin slide. A home-visit nurse collaborated with the patient to develop and implement a personalized regimen utilizing Frenkel’s exercises. Over one month, the patient demonstrated remarkable improvement, reducing his Scale for the Assessment and Rating of Ataxia score from 10 to 5. Detailed analysis revealed specific enhancements in gait, stance, and fine motor control, aligning with the goals of Frenkel’s exercises. These findings suggest that Frenkel’s exercises can be a valuable addition to AMN rehabilitation, addressing ataxia-related motor deficits. While recognizing AMN’s complexity and individual variability, further research is essential to refine rehabilitation strategies. Long-term follow-up studies are needed to assess intervention sustainability and its impact on the ALD spectrum’s overall disease progression and quality of life.

Abstract In this study, we synthesized a novel oxaprozin and SB-431542 hybrid molecule, AF-3, exhibiting antifibrotic and anti-cell-migration activities. Although oxaprozin was expected to exhibit antifibrotic activity, this was not observed in this study. Therefore, we designed AF-3 as an oxaprozin derivative and obtained its synthetic precursor, AF-2. Carboxylic acid AF-2 and carboxamide AF-3 showed similar inhibitory activities against AKT phosphorylation and expression of the mesenchymal cell marker, vimentin. Notably, AF-2 exerted weaker effects on cell migration and fibrosis than AF-3. Although the underlying mechanisms remain elusive, this study provides valuable insights for the development of new drugs against fibrosis and cancer metastasis related to cell migration.

This article describes the current interventions and experiences of grassroots members of community-based organisations across South Africa that were presented during the Training Art Therapists for Social Justice conference. The theme of the panel was art therapy and social action in community-based projects. The panel was positioned as a conversation contextualised by the moderator within the South African landscape. After the introductions to the work of Butterfly Art Project, Lefika La Phodiso, Intlantsi Creative Development Project, Creative Mentorship Hub, and Angela Rackstraw, three main questions were discussed by the panellists: How can therapeutic art training programmes incorporate social justice principles to better prepare community workers such as community art counsellors and community art facilitators to address systemic inequalities and remind inclusivity in their practice; What is the role of supervision and mentoring in your specific organisation and how it helped you to sustain the work between the advocacy, the mental health and facilitation; and What examples do we have of community programmes that effectively address any social action or social justice issues and would you measure success in advocating for or achieving a social justice aim?

Exploring a new-family of carbon-based desalinators to optimize their performances beyond the current commercial benchmark is of significance for the development of practically useful capacitive deionization (CDI) materials. Here, we have fabricated a hierarchically porous N,P-doped carbon–graphene 2D heterostructure (denoted NPC/rGO) by using metal–organic framework (MOF)-nanoparticle-driven assembly on graphene oxide (GO) nanosheets followed by stepwise pyrolysis and phosphorization procedures. The resulting NPC/rGO-based CDI desalinator exhibits ultrahigh deionization performance with a salt adsorption capacity of 39.34 mg g−1 in a 1000 mg L−1 NaCl solution at 1.2 V over 30 min with good cycling stability over 50 cycles. The excellent performance is attributed to the high specific surface area, high conductivity, favorable meso-/microporous structure together with nitrogen and phosphorus heteroatom co-doping, all of which are beneficial for the accommodation of ions and charge transport during the CDI process. More importantly, NPC/rGO exhibits a state-of-the-art CDI performance compared to the commercial benchmark and most of the previously reported carbon materials, highlighting the significance of the MOF nanoparticle-driven assembly strategy and graphene–carbon 2D heterostructures for CDI applications.

Introduction: Rapid laboratory glucose testing assists prompt on-site treatment for abnormal glycaemic episodes. New generation Point-of-Care Testing (POCT) for whole blood glucose analysis have high sensitivity and short processing time, which is competent for on-site rapid glucose testing. Aim: To assess the accuracy and Turn Around Time (TAT) of the POCT (Rightest GM700 Pro) compared with the Central Laboratory Testing (CLT) at a National Level, Urban Hospital. Materials and Methods: A retrospective study of 1,812 patients was conducted for glucose testing at the Laboratory Department of Cathay General Hospital from November 2016 to November 2017. Consistency between GM700 Pro and Beckman Coulter AU680, used as CLT, was analysed. TAT was measured from phlebotomy to result availability in Laboratory information system (LIS). Two widely accepted standards for blood glucose meters ISO 15197:2013 (for self-monitoring) and USFDA Prescription Point-of-Care Use (for hospital use) were adopted to evaluate the accuracy. Pearson’s correlation and Passing-Bablok regression were used for the analysis. BlandAltman analysis was used to determine the agreement between POCT and CLT glucose results. Results: Linear regression analysis of GM700 Pro showed significant agreement (y=0.97×-0.89, r2 =0.99) with CLT. Results of TAT indicated that POCT generated glucose report for clinical decision-making was 7 times faster than CLT (p<0.0001) in general practice. Conclusion: Point-of-Care Testing GM700 Pro is reliable and efficient for on-site glucose analysis.

A key component of the Next Accreditation System are the Educational Milestones for all accredited residency and fellowship programs. Use of the milestones in trainee assessment began in 2013, as a key element of the Accreditation Council for Graduate Medical Education's (ACGME's) Next Accreditation System.1 Milestones are used in resident and fellow outcomes-based assessment based on the 6 general competencies: medical knowledge (MK), patient care (PC), interpersonal and communication skills (ICS), practice-based learning and improvement (PBLI), professionalism (PROF), and systems-based practice (SBP). The 6 competencies were introduced by the ACGME and the American Board of Medical Specialties (ABMS) in 1999.While the competencies were crafted with the intent to provide a shared model of professional development and advance assessment of physicians in training, their implementation faced challenges, as programs, faculty, and trainees lacked an understanding of the meaning of the competencies in the context of their specialty. In response, content experts from each specialty created subcompetencies, using narrative milestones to provide more specific and developmental descriptions of the general competencies. This included representatives from the ACGME Residency Review Committees, ABMS certification boards, program director groups, specialty societies, and residents and fellows. These volunteers collectively gave more than 5000 hours of their time to develop the specialty-specific milestones. These milestones were intended "to create a logical trajectory of professional development in essential elements of competency" and provided a "measurable framework of specialty-specific outcomes."1 When the milestones were first developed, each specialty had the flexibility to identify subcompetencies and write associated developmental milestones. Specialties reviewed program requirements, certification examination outlines and blueprints, curricula, national competency statements, the literature, and results from national consensus-building exercises to guide their process.2The resulting specialty-specific milestones demonstrate substantial variability both with respect to content and how the developmental progression is operationalized across milestone levels.3 In 2013, the ACGME recognized the implementation of the milestones would be an iterative process, and that a periodic review and revision of the milestones would be beneficial, as experience and research evidence accrued. The ACGME made a commitment to begin this task within 3 to 5 years of Phase 1 implementation, as a part of a continuous quality improvement process. Over the course of the first 3 years of implementation, ACGME Milestone staff attended more than 200 program director meetings, focus groups, and visits to accredited programs and sponsoring institutions to gather feedback about the initial experience with milestones. These meetings helped to outline the revision process for Milestones 2.0.Additional concerns were heard through various channels such as focus groups, interviews, and at the 2nd ACGME Milestones Summit in December 2016, where representatives from all ACGME core specialties were present. Stakeholders expressed dissatisfaction with the inconsistencies in the milestones and subcompetencies.4 In fact, these differences were noted to have "complicated efforts to share assessment tools across programs, and provide comprehensive faculty development across specialties."4 These differences may hamper, rather than encourage, collaboration in assessment and faculty development activities across specialties.In 2016, the ACGME Department of Milestone Development and Evaluation formalized the plan for the review and revision process. This work began with a review of data collected from the field, the data submitted for the twice-yearly milestone reporting, and learning from quantitative and qualitative research. To date, 40 national and multi-institutional studies about the milestones have been completed, and a bibliography of milestone research is available on the ACGME website.5The quantitative research demonstrated validity evidence for key components of the milestones in several specialties.5 Qualitative research has focused on program directors' and trainees' experience with the milestones, Clinical Competency Committee processes, the value of milestone-based feedback, and milestone design. A thematic analysis of the milestones for the non-PC and non-MK domains, completed in preparation for the revision process, demonstrated wide variation among specialties. The analysis showed that across the 26 core specialties and the transitional year there were more than 230 different ways of describing PROF, 171 for PBLI, 176 for ICS, and 122 for SBP.4Lessons from early research on the milestones has informed the milestone revision process. However, it is important to recognize that much has remained the same. Changes can be grouped into 4 categories: (1) selecting the milestone development groups; (2) reducing milestone complexity; (3) enhancing community engagement, including participation by public members; and (4) providing additional tools and resources for programs and sponsoring institutions.There were many concerns regarding the differences in the non-PC and non-MK milestone content across specialties, prompting the ACGME to convene 4 groups to develop cross-specialty "harmonized" milestones for ICS, PBLI, PROF, and SBP. The 4 groups consisted of content experts, directors, interprofessional team members, and other faculty. Each group developed 2 to 3 subcompetencies that were applicable to all specialties and subspecialties. Stakeholders across the specialties will be asked to edit the language, as needed. In 2017, the harmonized milestones were made available for public review and comment.The specialty-specific development groups for Milestones 2.0 include representatives from key stakeholder groups involved in initial milestone development. In addition, the groups include representatives from the osteopathic community and public members. The public members serve a vital role in ensuring that the Milestones 2.0 developers consider the quality and safety of patient care, as well as provide essential input into the non-PC, non-MK competencies. Additional volunteers represent 2 other stakeholders. Specialties that have direct-entry from medical school (eg, internal medicine, pediatrics, surgery) now include a representative from the Association of American Medical Colleges and the American Association of Colleges of Osteopathic Medicine to ensure that the link between undergraduate and graduate medical education is considered in milestone development. Finally, each specialty will hold a "Call for Volunteers" that is open to all members of the community, with the plan to select 5 individuals from those who apply. Of the specialties that have used this process to date, most of the volunteers have been junior and midcareer faculty, representing diverse program sizes, types, and locations.Another area in need of change was the language used to describe the milestone developmental levels, with complaints about the length of individual milestones (the number of words or number of subcompetencies) and the complexity of the language. During the revision process, it will be critical to examine the language of each milestone, to ensure it is clear and easy to understand (ie, removal of education jargon).The harmonized subcompetencies for ICS, PBLI, PROF, and SBP are shown in the box. Detailed information on the approaches each group took to develop them, are presented in 4 summaries published as online supplemental material.Engaging with the specialty communities is vital to the refinement of the milestones. The first level of engagement is the Call for Volunteers. We will continue open communication with program directors by surveying them as part of the review and revision process, to examine their opinion of the current PC and MK milestones. Following development of the revised milestones, program directors, faculty, residents, and others will have the opportunity to review and comment on the draft content. We are able to engage with the patient community through the inclusion of public members on the development groups, maximizing the importance of patient perspective in quality, safety, communication, and patient-centeredness. These members have already demonstrated the ability to strongly advocate for the needs of the patient.To ensure that programs have the resources available to aid in implementation of the revised milestones, a Supplemental Guide will be created for each specialty to provide insights into the intent of the subcompetencies, with examples for each level, sample assessment methods, and other available resources. Additionally, an Implementation Guidebook that highlights planning, change management, and continuous quality improvement will be available in the summer of 2018. Review and revision of the milestones have begun, and there are 15 specialties in various stages of development, with more starting soon. All specialties and subspecialties will have initiated the process by the end of 2020.Much has been learned about the milestones over the past 5 years. The framework will remain the same, but version 2.0 will provide critical improvements. As the milestone revision process moves forward, we invite the specialty communities to be active partners, to ensure that the milestones are an effective tool for the assessment of residents and fellows.

We developed a fast‐response LCD. The fabrication process is the same as that of the conventional Fringe‐Field‐Switching mode. A diamond‐shape slit was fabricated for applying the fringe field. The response time is half that of the conventional mode. We applied the developed technology to a 2.89‐inch LCD with a resolution of 706 ppi for Head Mount Display (HMD).

A self-assembled nanogel is constructed from light-sensitive cholesteryl pullulan (Ls-CHP) by using photo-labile ortho-nitrobenzyl (o-NB) units. The nanogel-based film is obtained by evaporation of an Ls-CHP nanogel solution. Exposure of the resulting nanogel-based film to light with a mask resulted in a patterned film that can encapsulate FITC-insulin.