Chart Analysis Research Articles

The Unhoused Burn Population: An Alarming Increase of Leaving Against Medical Advice.

Unhoused burn patients (UBP) have historically been more likely to leave against medical advice (AMA) and suffer worse health outcomes than the general population. The coronavirus disease 2019 (COVID-19) pandemic created a major strain on the healthcare system, resulting in worse overall health outcomes for burn patients. We sought to investigate how COVID-19 impacted treatment for UBP, specifically the rate of leaving AMA. We conducted a retrospective chart analysis of patients admitted to a regional burn center between June 2015 and January 2023. March 1, 2020, was used as a cut point to separate the cohorts into patients seen pre-COVID-19 (p-CV) and during COVID-19 (CV). Outcomes included leaving treatment AMA and readmission within 30 days. 385 patients met criteria for being unhoused and were included in our analytic sample, of which 199 were in the p-CV cohort and 186 in the CV cohort. UBP were significantly more likely to leave AMA during CV compared to p-CV (22.6% vs. 7.5%, p<0.001). Housed burn patients did not experience an increase in discharges AMA during this time period. The COVID-19 pandemic resulted in an increase in discharges AMA among unhoused patients only. While the etiology is unclear, our findings suggest that this vulnerable patient population is receiving inadequate care post-COVID. Future research should determine the driving force behind these increases and identify early interventions to mitigate them.

The Relationship between Socket Comfort, Pain, and Mobility Over Treatment Milestones for Individuals with Lower-Limb Loss

Introduction This study investigates the relationships among mobility, pain, and socket comfort for people with lower-limb amputations who use prostheses over specific treatment milestones. Methods This is a retrospective chart analysis from January 1, 2015, to July 15, 2021. Outcome measures included are the Socket Comfort Score, Pain Scale, 2-Minute Walk Test, and PLUS-M (Prosthetic Limb Users Survey of Mobility). Data were collected at 4 milestones: Baseline and Discharge from Rehabilitation for those receiving their first prosthesis in rehabilitation and Initial Evaluation and Definitive Fitting for experienced prosthesis users receiving a replacement socket. Demographic data were analyzed using descriptive statistics, and the strength of the correlations was determined using Pearson’s correlations. Results Measures were included from 59 individuals in rehabilitation and 165 individuals receiving a replacement socket. The sample was in general older males with transtibial amputations due to a variety of etiologies. The Pain Scale was negatively correlated with the Socket Comfort Score (−0.49 &lt; r &lt; −0.60), and the PLUS-M was correlated with the 2-minute walk test (0.41 &lt; r &lt; 0.61) at all milestones. Additionally, there were positive correlations between the PLUS-M and Socket Comfort Score (0.30 &lt; r &lt; 0.32), and negative correlations between the PLUS-M and Pain Scale (−0.46 &lt; r &lt; −0.32) for those receiving a replacement socket. Conclusions The relationship among comfort, pain, and mobility changes over the treatment timeline. There is evidence that, by addressing comfort and pain for those with experience using a prosthesis, clinicians can support the goal of increasing self-reported functional mobility. Clinical Relevance This study provides novel information about the relationships among pain, comfort, and mobility and the importance of considering the impact of treatment milestones when taking outcome measures and providing interpretative values as scores and relationships differ over the course of treatment.

Racial and Socioeconomic Differences Correlate with Healthcare Disparities in Patients with Diabetic Retinopathy

Diabetic retinopathy (DR), an ocular complication of diabetes mellitus, is the leading cause of permanent blindness in the United States for young adults. Due to biological and environmental factors, diabetes mellitus is well known to disproportionally affect people of color and those of lower socioeconomic status; however, the racial and socioeconomic disparities of DR are less researched. The purpose of this research is to elucidate any differences in DR presentation that arise across racial and socioeconomic lines and to determine if diabetic control can be a predicting factor for DR severity. For this study, a retrospective patient chart analysis was performed on 511 consecutive newly referred patients with diabetes at New England Retina Associates, a vitreo-retinal ophthalmology practice with four locations throughout Connecticut. Our analysis shows that, when compared to their White and Asian counterparts, Black/African American and Hispanic patients present with DR at younger ages, had the higher HbA1c, were uninsured at higher rates, and presented with severe forms of DR in higher rates when compared to their counterparts. Many of these patterns are mirrored in patients that are uninsured or on Medicaid, indicators of lower socioeconomic status. Additionally, regardless of race or socioeconomic status, patients with higher HbA1c tended to present with more severe forms of DR. These findings indicate that DR disproportionately affects racial minority populations and those in socioeconomically disadvantageous positions, but effective glycemic control and routine eye exam screening can improve the outcomes of these patients. It is important for medical providers to recognize the disparities in these vulnerable populations in order to facilitate the timely referrals and the proper care for their long-term ocular health.

Optimizing Comprehensive Care for the Hospitalized Hip Fracture Patients: Time to Surgery and Bone Health at Discharge

Background: Approximately 300,000 older people ( 65 years and older) are hospitalized yearly for hip fractures, according to the CDC. Hip fracture is considered a life-altering event with increased morbidity and up to 30% mortality. The Clinical Practice Guidelines by the American Academy of Orthopedic Surgeons highlight the importance of an interdisciplinary team approach while caring for these patients and recommend surgery within 24 hours for improved outcomes. Most of these fractures are considered fragility fractures occurring from a simple ground-level fall and, thus, a manifestation of osteoporosis. Yet, only a few patients, 26%, receive osteoporosis treatment within 30 days of surgery, as per a recent study. ACP recommends replenishing Vitamin D and Calcium in all fragility fracture patients, followed by the initiation of bisphosphonates. At our institution, hip fracture patients used to be admitted to internal medicine or orthopedic services based on their complexity. There was a perceived feeling that those admitted to primarily internal medicine service received less comprehensive care and were likely delayed in getting to the OR given the competing priorities of a sick internal medicine service load. Vitamin D levels were not being checked or replaced despite having it be part of the admission order set used for hip fracture patients. Our project aimed at improving overall care for hospitalized hip fracture patients. Our goal was to increase the percentage of hospitalized hip fracture patients going to the operating room within 24 hours to 85% by the end of 2023. Additional goals were to improve the percentage of checking vitamin D levels and supplementing them at discharge by 25% by the end of 2023. Methods: Our intervention was to build a fragility fracture orthopedic and internal medicine co-management service where hip fracture patients were admitted. We collected outcome, process, and balancing measures, including time to surgery, unnecessary cardiac testing and consultation before surgery, percentage of ordering vitamin-D levels, and vitamin-D supplementation at discharge. Qualitative satisfaction with the process was also included. Data was collected biweekly from Jan 2023 to Dec 2023. Run chart analysis was utilized for statistical analysis. Results: Our results showed that the percentage of patients going to surgery within 24 hours did not differ (median of approximately 80%). Patients rarely got unnecessary cardiac testing or consultations, so we stopped following this measure. The median of vitamin-D level checking and supplementation at discharge had improved from 45% to 77% and 35% to 50%, respectively, sustaining a shift using run chart analysis rules. Conclusions: Our project shows that establishing a dedicated service for hospitalized fragility hip fractures has improved care for our patients. While time to surgery had not improved, it had been within the reported national average. Time to surgery is being delayed mostly when further medical optimization is required. However, having this service improved bone-focused care with vitamin-D testing and supplementation. The future PDSA cycle will focus on post-discharge osteoporosis management and treatment when appropriate.

Soil Microbial Community Structure and Its Contribution to Carbon Cycling in the Yalu River Estuary Wetland

Wetland microbial communities play a vital role in ecosystem functioning, particularly in the intricate processes of carbon cycling. This study employed metagenomic sequencing to investigate the diversity, composition, structural differences, carbon cycling functional gene, and microbial species of soil microbial communities in five distinct soil types of the Yalu River estuary wetland, including shoal soil, bog soil, paddy soil, meadow soil, and brown forest soil. We further explored the influence of environmental factors on both the microbial community structure and carbon cycling functional genes. Our results revealed a bacterial-dominated soil microbial community, constituting about 97.6%. Archaea and fungi represented relatively minor fractions, at 1.9% and 0.4%, respectively. While no significant differences were observed in Chao1 indices between bacterial and fungal communities, the Shannon index revealed notable differences. Both Chao1 and Shannon indices exhibited significant variations within the archaeal communities. The dominant bacterial phyla were Proteobacteria, Actinobacteria, Acidobacteria, Bacteroidetes, and Nitrospirae. Thaumarchaeota, Crenarchaeota, and Euryarchaeota formed the major archaeal phyla, while Ascomycota, Mucoromycota, and Basidiomycota were the dominant fungal phyla. Non-metric multidimensional scaling (NMDS) analysis based on Bray-Curtis distance revealed notable differences in the bacterial, archaeal, and fungal community structures across the samples. Redundancy analysis (RDA) identified key environmental factors for the major phyla. Soil pH, soil organic carbon (SOC), electrical conductivity (EC), and total phosphorus (TP) were the main influencing factors for bacteria, while soil TP, EC, total sulfur (TS), and SOC were the primary drivers for archaeal phyla. Soil total nitrogen (TN) and EC were the main influencing factors for fungal phyla. Analysis of key carbon cycling pathway genes utilizing the Kyoto Encyclopedia of Genes and Genomes (KEGG) database and clustering heatmap revealed some variations in functional gene composition across different soil types. Mantel test indicated that pH, TN, and SOC were the primary environmental factors influencing microbial functional genes associated with soil carbon cycling. Stratified bar chart analysis further demonstrated that the major contributors to carbon cycling originated from corresponding dominatnt phyla and genera of Proteobacteria, Thaumarchaeota, Actinomycetota, Euryarchaeota, and Bacteroidota. The species and relative abundance of microorganisms associated with carbon cycling pathways varied among the samples. These findings provide a crucial reference for informing the conservation and sustainable management of wetland ecosystems in the Yalu River estuary.

A Quality Initiative to Improve Breastfeeding Initiation Rates in a Resident Continuity Clinic Using Physician Directed Education

Introduction: Known disparities exist in breastfeeding rates among marginalized populations. Direct patient counseling improves these rates. Non breastfed infants have increased risk of infections, obesity, and chronic disease. Mothers who do not breastfeed have increased incidence of breast and ovarian cancer. The aim of this quality initiative is to improve breastfeeding initiation rates in our resident OBGYN continuity clinic from the baseline rate of 74.9 % to 81.9%. Methods: This project was a pragmatic quasi-experimental time series, utilizing PDSA cycles for an implementation framework. The outcome measure was monthly breastfeeding initiations rates of the Academic OB/GYN Center’s patients. This was determined by reviewing charts after birth from September 2021 through February 2022. This outcome was tracked and analyzed using a statistical control chart. We then designed three intervention cycles to improve breastfeeding rates. In September 2022, intervention one was implementation of an informational handout to guide residents on breastfeeding counseling. This was evaluated by tracking completion rates of documented counseling. In January 2023, intervention two was completed and consisted of a three-hour resident didactic on breastfeeding. The process measure for this intervention was recording attendance. May 2023, intervention three was the implementation of an informational handout directed to patients of color. Results: A total of 496 patients were trended over 24 months. Statistical analysis on average initiation rates were completed with Welch’s t-tests. Average breastfeeding initiation rate increased from 74.9% to 76% (p-value 0.86) after intervention. After intervention two, breastfeeding initiation rates again increased to 82.8% (p value 0.22). There was a lower average breastfeeding initiation rate noted in non-Hispanic black patients compared to non-Hispanic white patients (70.8% vs 78%), prompting intervention three. After intervention three, overall breastfeeding initiation rates decreased to 72.8% (p-value 0.73), however, rates in non-Hispanic black patients increased to 72% (p-value 0.91). Conclusion: Although physician directed patient education, resident didactics on breastfeeding, and directed breastfeeding resources appeared to positively impact breastfeeding initiation rates, control chart analysis shows no special cause variation indicating changes were associated with common causes. While the goal of increasing breastfeeding initiation rate to 81.9% was achieved, it was not sustained indicating additional interventions are needed.

A model to access the productivity of an agricultural implements consortium: a case study

Purpose This work presents the results of a case study aimed at revitalizing an agricultural equipment manufacturing consortium facing prolonged losses. The purpose of this paper is to enhance productivity and profitability by identifying and eliminating waste within the manufacturing processes. The study uses lean principles and tools to achieve this objective. Design/methodology/approach The study begins with the creation of a questionnaire, administered to the consortium to gather insights. The questionnaire responses serve as a foundation for pinpointing critical areas in need of immediate attention. To tackle the challenge of demand forecasting without customer data, a demand forecasting model is introduced. Value stream mapping (VSM) is used to identify and highlight process inefficiencies and waste. The findings are further analyzed using a Pareto chart to prioritize waste reduction efforts. Based on these insights, the study proposes alternative manufacturing methods and waste elimination strategies. A multiphase lean framework is developed as a step-by-step roadmap for implementing lean manufacturing. Findings The study identifies a broken process flow within the consortium’s manufacturing processes and highlights areas of waste through VSM. The Pareto chart analysis reveals the most significant waste areas requiring immediate intervention. Recommendations for process improvements and waste reduction strategies are provided to the consortium. Originality/value This study contributes to the field by applying lean principles and tools to address the unique challenges faced by an agricultural equipment manufacturing consortium. The integration of a demand forecasting model and the development of a multiphase lean framework offer innovative approaches to enhancing productivity and profitability in this context.

A practical stability/instability chart analysis for slope large deformations using the material point method

Slope instability and failure may lead to severe geological disasters, which are a primary concern of geotechnical engineering. To estimate the safety of a slope, Taylor (1937) proposed a stability chart that evaluates the factor of safety (FOS) of a homogeneous slope using several simple geometric and material parameters. This study extends the stability chart further into the field of failure, summarising and discussing the failure mode and affected area. A few hundred slope failure simulations have been conducted using the material point method (MPM), which reproduces similar FOSs to traditional stability charts. Three major failure modes, i.e., face failure, toe failure, and base failure, are categorized according to the different positions of the failure bands, and a failure mode distribution spectrum chart is established according to the material parameters of the slope. The affected area of slope failure is characterized by four indicators: the influence distance, run-out distance, sliding depth, and sliding volume. An instability chart is proposed to describe the affected area of slope failure based on simple geometry and material parameters. Further analysis indicates that the internal friction angle plays the most prominent role in the failure modes and slope failure volumes.

HGG-08. DIFFUSE HEMISPHERIC GLIOMA, H3 G34-MUTANT: A MULTI-INSTITUTIONAL EXPERIENCE

Abstract BACKGROUND Diffuse hemispheric glioma (DHG), H3 G34-mutant, is a rare, aggressive brain tumor molecularly defined by mutations in the H3-3A gene. Our study explored the association between patient outcomes and key molecular findings, resection extent, and temozolomide (TMZ) use. METHODS Multi-institutional chart and molecular analysis of 32 patients with H3 G34-mutant DHG. RESULTS The median patient age was 14 (10-28 years), with a M/F ratio of 1.4. The 1-year, 2-year, and 5-year PFS were 40.4% (23.7%, 57.1%), 22.1% (9.0%, 38.7%), and 11.0% (1.9%, 33.7%), respectively. The 1-year, 2-year, and 5-year OS were 82.5% (63.2%, 92.3%), 49.3% (28.7%, 66.3%), and 29.6% (9.1%, 50.6%), respectively. Patients who underwent a gross total resection (GTR) had improved PFS (p=0.0105) and OS (p=0.0184) compared to non-GTR patients. 22 patients (68.8%) received concurrent and/or adjuvant TMZ and had improved PFS (p=0.0278) compared to patients who did not receive front-line TMZ. Disease recurrence in relation to the radiation therapy (RT) field was analyzed in 17 patients; 5 recurred locally within the high-dose RT field, 5 recurred distantly, and 7 had both local and distant recurrences. There was no significant association between MGMT promoter methylation status (18 evaluable cases), PDGFRA amplification (N=6), and CDKN2A homozygous deletion (N=10) and survival outcomes. MGMT promoter methylation was not associated with increased TMZ efficacy (N=8 with MGMT silencing, N=4 without). CONCLUSIONS In our cohort, MGMT promoter methylation was not a favorable prognostic factor, in distinction from prior reports in adult and pediatric high-grade gliomas. Resection extent and the use of TMZ were associated with improved survival outcomes. As most treatment failures occurred within the high-dose RT field, extended fields do not appear warranted. Our findings may guide prognostic and therapeutic decisions in patients with H3 G34-mutant DHG and support the need for prospective efforts to improve outcomes in this patient population.

HGG-33. HIGH GRADE TRANSFORMATION OF CNS TUMOR WITH BCOR:CREBBP FUSION: A CASE REPORT

Abstract BACKGROUND The discovery of unique EP300:BCOR and CREBBP:BCORL1 fusions has extended the spectrum of BCOR altered CNS tumors previously associated with BCOR internal tandem duplication (ITD). Due to the rarity of CNS tumors with BCOR alterations, there is limited information on the clinical outcomes and the effective treatment strategies. METHODS Literature review and retrospective chart analysis RESULTS An 18-year-old male who presented with seizures was found to have a left temporal mass. Histologic diagnosis was low grade glioneural tumor harboring a pathogenic CREBBP:BCOR1 fusion, matching to CNS tumor with EP300:BCOR/BCORL1 fusion by methylation. A re-resection aimed at gross total resection was then performed. Histologic examination revealed residual glioma with focal high-grade transformation, Ki67 up to 35% and CDKN2A loss via FISH analysis. The patient was treated with focal radiation to 54Gy. He remains disease- and seizure-free 1 month post radiation therapy. This case displayed some similarities to previously reported cases, including oligodendroglial- or ependymoma-like features, positivity for Olig2 and/or GFAP, presence of calcifications, and branching capillary networks. However, this case had less frequent mitoses than previously reported cases. In a series of 21 patients with BCOR altered tumors, BCOR-fusion tumor patients had a more favorable PFS compared to BCOR-ITD tumors. In a reported case series of high grade BCOR altered CNS tumors, 5 out of 8 patients remained alive, all of whom received radiation therapy as a primary treatment or at relapse. There is one prior report of an EP300:BCOR tumor undergoing high-grade transformation; increased mitoses, cellularity, and necrosis were observed. This case was lacked necrosis. CONCLUSIONS The optimal treatment for BCOR altered tumors of the CNS is largely unknown given the limited reported cases. Radiation therapy in addition to gross total resection may be an effective treatment leading to more favorable PFS and OS.

Parenteral fish oil lipid emulsion use in adults: a case series and review from an intestinal failure referral center.

Intestinal failure-associated liver disease (IFALD) is a complication of long-term PN use, attributed to the use of ω-6 injectable lipid emulsions (ILE). Fish oil (FO) ILE have been successful in reversing liver injury in neonates. Evidence for pure FO ILE use in adult patients is limited. Case series of the use of FO lipid emulsions in adults with IFALD from the University of Chicago PN registry. Analysis of medical charts and PN formulations was performed. Three cases of IFALD treated with FO ILE were identified. The first case was a 30-year-old man with short bowel syndrome (SBS), hyperbilirubinemia, and biopsy-proven IFALD. Following a change from a soy lipid emulsion to FO lipid emulsion, his liver tests rapidly improved and remained stable over 202 weeks of use. The second case was a 76-year-old woman with intestinal failure (IF) due to a frozen bowel. A change from a soy ILE to a composite lipid and later to a pure FO ILE did not result in improvement in her liver tests. The third case was a 28-year-old man with SBS and biopsy-proven IFALD. Change to a composite ILE and subsequently FO lipid emulsion resulted in a gradual improvement in liver tests. No clinical essential fatty acid (EFA) deficiencies were identified during treatment. FO ILE may be effective in the treatment of adult patients with cholestatic IFALD. Use is safe with no EFA deficiencies detected in up to 4 years of use.

Reduction of long COVID symptoms after stellate ganglion block: A retrospective chart review study

The SARS-CoV-2 pandemic has left millions of individuals with a host of post-viral symptoms that can be debilitating and persist indefinitely. To date there are no definitive tests or treatments for the collection of symptoms known as “Long COVID” or Post-acute sequelae of COVID-19 (PASC). Following our initial case report detailing improvement of Long COVID symptoms after sequential bilateral stellate ganglion blockade (SGB), we performed a retrospective chart analysis study on individuals treated with the same protocol over the course of six months (2021−2022) in our clinic. Patients self-reported symptoms on a 10-point scale as part of optional patient follow-up using an online survey. After one month or more following treatment, patients reported striking reductions in Fatigue, Worsening of Symptoms following Mental and Physical Activity, Memory Problems, Problems Concentrating, Sleep Problems, Anxiety, and Depression. Loss of Taste and Loss of Smell in some individuals did not respond to treatment, likely indicating structural damage following infection. This study suggests that neuromodulation may provide relief of Long COVID symptoms for at least a subset of individuals, and provides support for prospective studies of this potential treatment.

Safety of ultrasound-guided percutaneous suprapubic catheter insertion in spinal cord injury patients.

Retrospective chart audit. To evaluate the safety of ultrasound-guided percutaneous suprapubic catheter (SPC) insertion in patients with spinal cord injury/disease (SCI/D) and to attempt to identify risk factors for complications. Specialized German centre for spinal cord injuries. This retrospective chart analysis evaluated demographic, neurologic, and neuro-urologic data and the incidence and type of complications within the first 30 days after suprapubic bladder catheter insertion in SCI/D patients in the period between January 1st, 2013, and December 31st, 2022. The data of 721 SCI/D patients (244 women and 477 men, 386 tetraplegics and 355 paraplegics) were analysed. There were 44 complications (6.5%), of which 11 (1.5%) were major complications according to Clavien-Dindo ≥ 3. Among these were one small bowel injury and one peritoneal injury each, but no fatal complications. Regarding major complications (according to Clavien-Dindo ≥3), only patient age was identified as a risk factor (p = 0.0145). Gender, SCI/D level, neurological completeness, and severity of SCI/D or type of neurogenic lower urinary tract dysfunction (Odds ratio [95% CI] 1.6423 [0.4961;5.4361], 1.0421 [0.3152;3.4459], 0.3453 [0.0741;1.6101], 2.8379 [0.8567;9.4004] and 2.8095 [0.8097;9.7481] respectively) did not show any association with the frequency of major complications. Mild complications, especially temporary hematuria or infectious complications, are not uncommon after SPC insertion in SCI/D patients. Major complications occur only rarely, and no risk factor other than age could be detected. On this basis, pre-intervention education on informed consent for SCI/D patients can be provided on an evidence-based approach.

МЕТОДОЛОГИЯ КЛИНИЧЕСКИХ АУДИТОВ ОТДЕЛЕНИЙ ЛУЧЕВОЙ ТЕРАПИИ В РФ НА ОСНОВЕ ПРИНЦИПОВ АУДИТА МАГАТЭ QUATRO

Purpose: To describe the essence, tasks and algorithm of comprehensive audit in radiotherapy departments of medical institutions in Rus sian Federation. The methodology of audits conducted by the International Atomic Energy Agency (IAEA) and adapted for its further application, was used as a model. The global goal of the audit project is to standardize and harmonize procedures to ensure safety and quality control of treatment of cancer patients in different institutions, to enable comparison of radiation therapy results among participating institutions, to conduct interclinical studies and, possibly, to create a unified data register. Material and methods: One of the main aspects of clinical audits is the harmonization of standards between different departments. Clinical audits in radiotherapy can be an important tool for interclinical quality assurance (QA) program, effectiveness and safety of radiotherapy, and treatment protocols synchronization. Audits allow an in-depth analysis of the procedures and processes governing patient care in a particular clinic. Such clinical audits cover the whole chain of patients care, the organization of structural units, the infrastructure, clinical, physics and technical aspects underlying the radiotherapy department. This audit is a peer review process conducted by an audit team consisting of a radiation oncologist (RO), medical physicist (MP) and radiation technologist (RTT) and is known as QUATRO and stands for Quality Assurance Team in Radiation Oncology). Possible audit tools include: 1. Saff interviewing. 2. Examination of the structure of the entire department. 3. Review and evaluation of procedures and all relevant documentation, including analysis of patient charts. 4. Conducting independent measurements of absorbed doses and other methods of local procedures monitoring, where relevant and appropriate. 5. Observation of the practical implementation of operating procedures. Results: It was decided to use the IAEA QUATRO methodology for clinical audits and to adapt it to the specifics of radiotherapy in Russian Federation. One of the advantages of such a clinical audit is that the formalism and algorithm of this approach will be identically applied in all departments, which will allow comparing and analyzing the results. In order to obtain structured information, a detailed research protocol, which is a questionnaire, has been developed. The questions in the questionnaire allow to assess key aspects of the radiotherapy process that affect clinical outcomes and treatment efficiency.

A comparative study between first three waves of COVID-19 pandemic with respect to risk factors, initial clinic-demographic profile, severity and outcome

ABSTRACT Introduction: During the 2 years and 9 months from March 2020 to December 2022, the SARS-CoV-2 virus raged across the country. Cases occurred in three particular time clusters recognised by World Health Organisation as coronavirus disease 2019 (COVID-19) waves. In this study, we compare the clinical parameters of adult non-obstetric COVID-19 patients admitted to our rural tertiary care hospital during the three distinct waves of the pandemic. Materials and Methods: Retrospective chart analysis of 272, 853 and 97 patients admitted with SARS-CoV-2 infection to the only rural medical tertiary care centre in the Sunderbans of West Bengal in the first, second and third waves, respectively, was done after obtaining ethical and scientific clearance. Clinical [vital parameters, oxygen requirement, mental status, risk factor assessment, duration of hospital stay, modified-emergency warning score (m-EWS), quick Sequential Organ Failure Assessment (qSOFA), confusion, uraemia, respiratory rate, blood pressure, age ≥ 65 years (CURB65)], epidemiological variables (age, gender, and vaccination status), laboratory parameters and in-hospital outcome were recorded and analysed statistically. Results: Statistically significant (P &lt; 0.05) m-EWS and qSOFA scores were recorded during the second wave of the pandemic. The second wave also recorded the highest mortality (14.89%) compared to the first (12.87%) and third (11.96%) waves, though this was not statistically significant. The highest duration of hospital stay was recorded in the first wave of the pandemic (mean = 9.99 days, P &lt; 0.01). The difference in mortality rates between patients with and without co-morbidity (P &lt; 0.05) was observed during Wave-1, across any pandemic wave, and overall but not in Wave-2 and Wave-3. Conclusion: The second wave of the COVID-19 pandemic was the most severe in comparison with the other two waves, while the outcome was poorer in those with co-morbidities, especially in the first wave.

Quality Analysis of Fresh Milk Based on Specific Gravity Parameters at CV Cita Nasional in Central Java, Indonesia

In maintaining the quality of milk produced, it is necessary to supervise and control quality. One important aspect is controlling the specific gravity value of fresh milk. The specific gravity parameter of fresh milk is one of the determinants of whether the milk can be accepted or rejected as raw material. In addition, it is also a determining factor in determining the selling price of milk. To determine the quality control of the specific gravity of fresh milk, the control chart analysis method is used. The results of the analysis that have been carried out from various KUDs obtained the average specific gravity of fresh milk from Capita Farm KUD which is 1.0295 g / mL; the average specific gravity of fresh milk from KUD Cepogo is 1.0265 g/mL; the average specific gravity of fresh milk from Andini KUD is 1.0266 g/mL; the average specific gravity of fresh milk from Getasan KUD is 1.0268 g/mL, and the average specific gravity of fresh milk from Boyolali Kota KUD is 1.0292 g/mL. The specific gravity value of fresh milk supplied from various KUD can be concluded that the specific gravity value meet the company's quality standards, SNI, and existing literature so it is said that the specific gravity of fresh milk in CV Cita Nasional is in control, and can be accepted as raw material for making pasteurized milk.

Associations between Diabetes-Specific Medication Regimen Complexity and Cardiometabolic Outcomes among Underserved Non-Hispanic Black Adults Living with Type 2 Diabetes Mellitus.

Type 2 diabetes mellitus (T2DM) management and glycemic control in underserved non-Hispanic Black adults presents with multifaceted challenges: balancing the optimal complexity of antihyperglycemic medications prescribed, limited medication access due to socioeconomic status, medication nonadherence, and high prevalence of cardiometabolic comorbidities. This single-center, cross-sectional, retrospective chart analysis evaluated the association of Medication Regimen Complexity (MRC) with cardiometabolic outcomes (glycemic, atherogenic cholesterol, and blood pressure control) among non-Hispanic Black adults with type 2 diabetes. Utilizing 470 independent patient electronic health records, MRC and other covariates were examined to determine their associations with cardiometabolic outcomes. Chi-square tests of independence and multiple logistic regression were performed to identify associations between MRC and cardiometabolic outcomes. Our findings indicate significant negative and positive associations between MRC and glycemic control and atherogenic cholesterol control, respectively. However, there were no associations between MRC and blood pressure control. As diabetes MRC was shown to be associated with poor glycemic control and improved atherogenic cholesterol control, there is a critical need to standardize interdisciplinary diabetes care to include pharmacists and to develop more insurance policy interventions that increase access to newer, efficacious diabetes medications for historically marginalized populations.

Numerical simulation of forced ventilation fire suppression for wing leading edge pool fires

In order to meet the requirements of the flammable liquid fire prevention regulations under AC25-863, which stipulates that in the event of ignition, the ignition and its harm of leaked flammable liquids should be minimized, this study investigates the impact on the aircraft structure and the suppression process of wing leading edge pool fires of flammable liquid leakage under forced ventilation fire suppression. Geometric modeling of the wing leading edge in the flammable liquid leakage area is performed, and the burning conditions of the flame under different conditions are simulated. The heat release rate per unit area of the pool fire surface is set to 396.67 kW/m, with ventilation speeds ranging from 0 to 3.1 m/s. Through the analysis of simulation charts and data, it is observed that as the forced ventilation rate increases, the pool fire gradually tends towards a trend of suppression

Risks and Countermeasures of Internet Consumer Financial Asset Securitization: A Case Study of Jingdong Baitiao

Asset securitization is one of the most important innovations in the financial field in recent decades. The introduction of this financial instrument enables commercial banks to have both functions as "fund lenders" and "fund sellers". JD Baitiao is the product of asset securitization and is the first Internet credit consumption product in Chinese industry. Due to the huge demand in the credit market, it has been popular among users since its establishment in 2014. We will give a basic introduction to of JD and JD financial asset securitization: the development process and an introduction to the fundamentals of the whole company, including the background of the development of JD Baitiao in financial aspect, as well as the benefits of its appearance in stimulating consumption by users on JDs platform. We further provide an analysis of the JD Baitiao, including its background, transaction process, asset pool composition, and credit enhancement arrangement. issuance, pricing, to trading, also with its quota application, repayment forms, as well as its risk control system for users. Next, through data and chart analysis, we analyze the various aspects of the securitization risks. Last, based on our analysis, we recommend several ways to improve issuance efficiency and risk management capabilities.

Investigation of the French Terry structure characteristics on sport-veiling using sustainable eco-materials

Purpose This paper aims to produce sustainable sport-hijab or veiling using cotton and bamboo as renewable and eco-material blending with polyester. Due to the unique characteristics of the knitting fabrics, the research focused on constructing the proposed samples using a circular knitting technique with a French terry structure, to achieve comfort, ease of care, good appearance and sustainability in different climatic conditions. Design/methodology/approach The researchers formed three different knitted samples using yarn count 30/1Ne for cotton and bamboo and 70 dens for polyester yarn, using the same blending ratio of 50:50% (cotton/polyester, bamboo/ polyester and cotton/ bamboo). They tested several mechanical and physical properties (weight, thickness, air permeability, water permeability, electrostatic charges, ultraviolet protection factor, stiffness, pilling resistance and bursting strength). Findings Using different tools, the researchers statistically analyzed the influence of variables on sample properties, including a Chart line, ANOVA test at p-value = 0.05 and the least significant differences values to identify the effect significantly as well as demonstrate the interaction among the samples at each tested property. Finally, radar chart areas to clarify the preferable sample performance. Originality/value The findings declared that blending materials used significantly affected most properties of the produced samples, except for the water permeability and an electrostatic charge. Furthermore, the findings pointed out that blending (cotton or bamboo/polyester) is more efficient and desirable than blending (cotton/ bamboo). Additionally, based on radar charts analysis, the cotton/polyester knitted outperforms other blended materials samples in producing sport-hijab or veiling fabric.