Urban Centers Research Articles

Validating a simplified financial toxicity screening tool for patients with cancer.

318 Background: Medical-related financial hardship (called financial toxicity) can negatively impact patient clinical outcomes and overall well-being. Routine financial toxicity screening is recommended to facilitate referrals to resources for patients experiencing, or at risk for, financial toxicity. The validated Comprehensive Score for Financial Toxicity (COST) tool is widely used in research to measure financial toxicity; however, its 11-question length and lack of standardized screening threshold make it challenging to implement in clinical practice. This analysis sought to develop and validate an abbreviated version of the tool, suitable for routine screening in clinical practice. Methods: The full COST was administered as part of clinical care from June 2022-August 2023. Patients receiving treatment for breast, gynecologic, thoracic, or gastrointestinal cancer at an urban comprehensive cancer center were queried via patient portal or in clinic. Using 38,330 observations, we calculated the correlation of abbreviated tools of varying length with the full COST score (0-44, lower scores=higher FT). We then used a validation dataset of 19,196 observations to assess the positive and negative predictive values (PPV, NPV) of an abbreviated tool against the full COST score, when compared to thresholds for risk previously used in the literature (score ≤15, ≤20). Results: Including two questions (Q3: “I worry about the financial problems I will have in the future as a result of my illness or treatment”; Q6: “I am satisfied with my current financial situation”) yielded r=0.922 correlation with the full COST. For this 2-item tool, PPV ranged from 74-91%, and NPV ranged from 91-98% when compared to the full COST tool. Table 1 shows the PPV and NPV of varying score thresholds for the abbreviated COST against full scores ≤15 and ≤20. Conclusions: Using a large and clinically diverse sample of patients with cancer,we demonstrate the predictive value of an abbreviated COST tool and show its approximate accuracy when compared to the full tool. Simplified, clinically integratedscreening for financial hardship can efficiently ensure appropriate intervention for patients experiencing medical-related financial hardship and can also be a first step toward mitigating hardship among those at risk for developing it. Predictive value of 2-item COST vs. full COST score in the validation set. Full COST score ≤ 15 Yes No 2-question, COST score ≤ 1 Yes 2337 (14%) 253 (1.5%) PPV = 90% No 822 (4.8%) 13844 (80%) 1-NPV = 5.6% Full COST score ≤ 15 Yes No 2-question, COST score ≤ 2 Yes 2924 (17%) 1045 (6.1%) PPV = 74% No 235 (1.4%) 13052 (76%) 1-NPV = 1.8% Full COST score ≤ 20 Yes No 2-question, COST score ≤ 2 Yes 3626 (21%) 343 (2.0%) PPV = 91% No 1199 (6.9%) 12088 (70%) 1-NPV = 9.0% Full COST score ≤ 20 Yes No 2-question, COST score ≤ 3 Yes 4359 (25%) 1272 (7.4%) PPV = 77% No 466 (2.7%) 11159 (65%) 1-NPV = 4.0%

A Study of Respiratory Hygiene Among Patients With Respiratory Manifestations in a Selected Primary Healthcare Setting in India.

Tuberculosis is the second leading infectious killer disease, mainly transmitted through undiagnosed presumptive and inadequately treated pulmonary tuberculosis (PTB) cases in the community. This study was conducted to assess the knowledge, attitude, and practices (KAP) related to respiratory hygiene and sputum disposal methods and to estimate the proportion of presumptive PTB cases among patients with clinical features of respiratory manifestations. A hospital-based cross-sectional study was conducted among 80 adult patients with respiratory manifestations at an urban health centre in Goa using a validated, pre-tested, semi-structured questionnaire by interview method. Among 80 study participants, 10 (12.5%) presumptive PTB cases were found. The knowledge regarding the exact cause and transmission of tuberculosis was 55% (44) and 72.4% (58), respectively. Around 32.5% (26) of participants were not following cough etiquette and they studied only up to middle school. Regarding the attitude towards ideal sputum disposal methods, more than three-fourths (81.3%, 65) of the responses were towards unsafe sputum disposal methods. There is a need for health education regarding proper respiratory hygiene and sputum disposal methods, especially among patients with low educational and socio-economic groups.

Association between food insecurity and healthcare utilization among patients at a breast oncology center.

143 Background: A breast cancer (BC) diagnosis often creates or exacerbates financial stress. As a result, many patients with BC struggle with a lack of consistent access to nutritious food due to limited resources, a condition termed “food insecurity” (FI). We investigated the association between FI and healthcare utilization among breast oncology patients at our urban academic medical center. Methods: Screening for health-related social needs (HRSN) was conducted primarily through the electronic patient portal, at appointment registration for a breast oncology clinic visit. The 8-item HRSN survey included 2 questions on access to food resources and 1 question quantifying emergency department (ED) visits over the past year. Any level of food hardship or concern constituted a positive FI screen. We conducted a retrospective analysis among patients evaluated between 11/2/22 and 4/20/24. Clinical and demographic data were obtained from the electronic health record (EHR). We evaluated the association between FI and health care utilization measures (ED visits, inpatient admissions) with a Pearson's Chi-squared test and univariate logistic regression. Results: A total of 2820 patients were screened for HRSN and provided responses to at least 1 FI question, of which 19.7% (555) reported some level of FI. Food-insecure patients self-reported significantly higher rates of ED visits in the past 12 months compared to food-secure patients: 43.2% vs 22.6% reported at least 1 ED visit, respectively (p<0.001), and 25.0% vs 8.45% reported multiple ED visits, respectively (p<0.001). Overall, FI was associated with 2.5 times the odds of self-reporting at least 1 ED visit (univariate OR 2.47, p<0.001). Similarly, on review of EHR data, 33.3% of food-insecure patients had at least 1 ED visit (vs 20.0% of food-secure patients, p<0.001), and 6.13% had 3 or more ED visits (vs 2.83%, p<0.001) during the study period. On univariate analysis, food-insecure patients had double the odds of having at least 1 ED visit documented in the EHR (univariate OR 2.00, p<0.001). We examined reasons for ED presentations among 186 food-insecure patients with ED visits during the study period, and found that 23.8% had at least 1 cancer-related complaint (oncological treatment-related (16.8%) and/or BC symptom-related (8.6%)). The incidence of inpatient admissions during the study period was similar among food-insecure vs food-secure patients (19.8% vs 18.4%, p=0.467). Conclusions: In this analysis of FI and health care delivery measures, ED utilization was significantly higher among food-insecure patients. A quarter of food-insecure patients who presented to the ED had oncological complaints. FI may be a marker of unmet healthcare needs in patient with cancer, and targeted interventions focused on symptom monitoring and management are warranted to optimize healthcare utilization.

Клинические популяционно-генетические исследования наследственных болезней среди детского населения Северной Осетии – Алании

Currently, there is limited understanding about the cumulative prevalence, diversity, and frequency of distinct orphan hereditary diseases (OHDs) in the pediatric population, both within the Russian Federation and in the global literature. This gap exists despite a significant demand for such knowledge in healthcare and society. Variability and heterogeneity of the above indicators are common across different populations, reflecting significant genetic heterogeneity of OHDs. The study aimed to assess OHDs in the pediatric population of the Republic of North Ossetia – Alania (RNO-A). A total of 543,817 people were evaluated, including 145,560 children aged 0–18 years. The cumulative prevalence of autosomal recessive (AR), autosomal dominant (AD), and X-linked (XL) OHDs was determined. The findings indicate an overall prevalence of OHDs among children of the RNO-A of 1 : 119, meaning that approximately 1% of children are diagnosed with these conditions. Notably, the total burden in children of all types of OHDs in rural areas exceeds that in urban areas and district centers by more than twofold. We identified 1,241 patients from 1,037 families with 241 distinct OHDs (109 with AD inheritance, 102 with AR inheritance, and 30 with XL inheritance). Three diseases were particularly prevalent in this population and have not been documented in similar studies: congenital myasthenia type 12, a rare form of congenital adrenal cortex dysfunction (3-beta-hydroxysteroid dehydrogenase deficiency), and brachydactyly E — amelogenesis — mental retardation — nanism syndrome. Thus, the population of the RNO-A exhibits a unique spectrum of OHDs caused by rare mutations, some of which are infrequent in other populations of the world and the Russian Federation. The significantly higher prevalence of these disorders in rural populations is noteworthy, underscoring the need for tailored, region-specific programs aimed at preventing childhood disability and/or mortality.

Can early treatment of lisfranc injuries without planned re-intervention be safely performed

The Lisfranc complex is a unique combination of ligamentous and osseous relationships between the medial cuneiform and second metatarsal base that is often injured by high energy mechanisms. Fixation for these injuries is often operative; however, the optimal timing of surgical treatment has been debated. All patients who underwent operative fixation of a Lisfranc injury at a single urban tertiary care center were reviewed. Patient were split into two groups based on timing to fixation with one group being less than 24 h from presentation and a second group being greater than 24 h. There were 58 patients who underwent what was planned as final operative stabilization of their Lisfranc injury in less than 24 h and 41 patients who underwent fixation after more than 24 h. The early treatment of Lisfranc injuries did not lead to significant increases in follow up time, infections, time to weight bearing, union rates, or time to union compared patients treated with delayed fixation. There was a higher rate of superficial infection in the early intervention group, but it did not reach statistical significance. We believe our findings demonstrate that delayed fixation is not superior to early treatment of Lisfranc injuries. Level of evidenceLevel 3 Therapeutic retrospective comparative study.

Financial toxicity screening in an urban underserved patient population with cancer.

169 Background: Cancer-related financial hardship is associated with treatment delays, non-adherence and adverse survival outcomes. Racial/ethnic minorities and low-income households are disproportionately impacted by financial toxicity. The Comprehensive Score for Financial Toxicity (COST) measure is used to measure financial toxicity in research but has not been validated in low-income, racially diverse cancer patient populations. Methods: We conducted this study at a large urban medical center from January-August 2023. We included cancer patients on systemic therapy for at least 2 months with ECOG performance status 0-2. Participants completed the COST measure, the Functional Assessment of Cancer Therapy: General (FACT-G) and the European Organization for Research and Treatment of Cancer (EORTC) QOL to assess health-related quality of life (HRQOL). Cancer diagnosis/stage, demographic data, and social work/financial counseling interventions were abstracted. Factor analyses were conducted to determine the underlying factor structure of the COST measure responses and bivariate analyses were conducted to identify relationships between COST scores and other data. Results: 100 patients participated in the study; the average age was 65 and both sexes were equally represented. Most patients reported African American (67%) race/ethnicity. 72% of patients held less than a 4-year college degree, 22 % were unemployed and 55% reported a yearly household income of less than $35,000. Lung (46%) and gastrointestinal (38%) cancers were the most represented. 73% were enrolled in a government sponsored insurance program (Medicare, Medicaid). The average COST score among participants was 22 [range 0-44] and mean FACT-G and EORTC scores were 16.5 [range 0-28] and 59.6 [ range 0 – 100] respectively. Fifty-eight patients were referred to social work or financial counseling for financial interventions. Factor analysis revealed three predominant factors among the COST responses (Eigenvalues > 1) including Factor 1: items 3, 7, 8, 9, 10, 11; Factor 2: item 4; Factor 3: item 5. COST was weakly associated with FACT-G and EORTC (Pearson range 0.27 – 0.37). The most highly correlated value was between the COST and EORTC physical wellbeing subscale (Pearson 0.38). The COST score was significantly associated with income, with higher incomes reporting less financial toxicity (p = 0.004). No significant differences in COST scores were noted across gender, race, or level of education. Conclusions: Low levels of financial toxicity were detected using the COST measure in a diverse, low-income cancer patient population despite many patients being referred to social work/financial counseling. Compared to similar studies, we found a weaker correlation between the COST measure and HRQOL. These findings suggest that the COST measure may need to be further adapted for use in underserved populations and patients with government sponsored insurance.

Characterizing health-related social needs and their association with medication adherence in a diverse cohort of patients with breast cancer.

139 Background: Food insecurity, housing instability, and transportation challenges are modifiable health-related social needs (HRSN) that have been associated with worse health outcomes in patients with cancer. Nonadherence to medications is also associated with decreased survival and other poor outcomes. Less is known about the association between HRSN and medication adherence in this patient population. Methods: We implemented screening for HRSN among breast oncology patients at our urban academic medical center, primarily through the electronic patient portal. Patients were offered an 8-item HRSN survey with questions covering food insecurity, housing, transportation needs, and emergency department visits. Any level of food hardship, housing instability, or transportation challenges reported during the study period (11/2/22-4/20/24) constituted a positive screen for that HRSN. We also screened patients for nonadherence to medications (any medication) using the 3-item DOSE-Nonadherence questionnaire. Pearson's Chi-squared tests and univariate logistic regressions were used to compare differences between subsets. Results: During the 18-month study period, 2945 patients completed at least 1 item on the HRSN questionnaire, of which 765 (26.0%) screened positive for at least 1 HRSN. Among patients who responded to each HRSN domain, 555/2820 (19.7%) screened positive for food insecurity, 374/2650 (14.1%) for housing instability, and 255/2656 (9.6%) for transportation needs. Food-insecure patients also reported more housing (43.1% v 5.6%, p<0.001) and transportation needs (27.7% v 4.0%, p<0.001) compared to food-secure patients. When comparing the cohort of patients who screened positive for at least 1 HRSN vs those who screened negative, there was a higher proportion of Hispanics (55.3% vs 25.1%, p<0.001), non-Hispanic Blacks (15.3% v 10.0%, p<0.001), and Spanish speakers (41.2% v 17.2%, p<0.001). Patients with any HRSN were more likely to self-report medication nonadherence compared to those with a negative HRSN screen (44.2% v 35.3%, OR 1.45, 95% CI 1.18-1.79). When looking at each individual HRSN domain, food-insecure patients were more likely to self-report medication nonadherence than food-secure patients (45.9% v 35.9%, OR 1.51, CI 1.19-1.92); this was also true for patients with housing instability (45.7% v 36.4%, OR 1.47, CI 1.12-1.92) and transportation needs (49.1% v 36.5%, OR 1.68, CI 1.23-2.31). Conclusions: More than a quarter of breast cancer patients self-reported at least 1 HRSN, with food insecurity being most frequently reported. Patients with at least 1 HRSN had 45% increased odds of medication nonadherence. Further research is warranted to understand the financial, social, psychological, and healthcare-related factors that may underlie this association, and to design interventions targeting at-risk cancer populations.

Patient interest in clinical trials and remote technology among a diverse oncology patient population.

389 Background: Existing research describes a number of barriers limiting cancer clinical trial enrollment, including time constraints and financial burden, particularly among under-represented populations. In this study, we sought to assess the relationship between the use of remote technology in clinical trials and patient interest in trial participation amongst oncology patients at an urban academic medical center. Methods: We administered a 60-question, cross-sectional, in-person survey to adult patients with a solid tumor or hematological malignancy diagnosis on active treatment at Columbia University Irving Medical Center between 1/2023 and 2/2024. The survey assessed patient demographics, telehealth access, and interest in using telehealth as part of routine care and clinical trials. Demographics including age, gender, race/ethnicity, marital status, income, insurance type, education level, and cancer type were self-reported. Results: The survey was administered to 100 oncology patients. The mean age was 61 years; 51% were female; 45% non-White and 23% identified as Hispanic. The majority (87%) reported having access to a computer or electronic device; 99% of those having internet access and 81% being somewhat or very comfortable using the internet. Forty seven percent of patients had been offered a cancer clinical trial by their oncology provider, and 19% had participated or were currently participating in a clinical trial. Of the 53% of patients who had not been offered a clinical trial or did not know, 64% reported they would consider participating in a trial recommended by their oncologist. Among all respondents, 52% of patients reported it would make no difference in their decision to participate in a trial if they learned about the risks and benefits remotely (phone or video), 28% were somewhat more or much more likely to participate learning about the risks and benefits remotely, and 20% were somewhat less or much less likely to participate under these conditions. Seventy five percent of respondents would be willing to sign consent for a trial remotely. Sixty four percent of respondents were not willing to spend over an hour traveling to a trial site, citing time, cost, family, and work obligations as reasons for limiting travel. The majority of respondents (>50%) indicated that they would be more likely to participate if the trial used remote technology to decrease the need to travel to a trial site. Conclusions: In this cross-sectional study amongst a diverse patient population, we found that the majority of oncology patients on active treatment have access to telehealth, express interest in clinical trials despite barriers to participation, and would be more likely to enroll in trials if remote communication reduced the amount of travel time for trial participation. Decreasing the logistical burden of cancer clinical trials may increase patient access and diversity in trial participation.

Heat Stress Metrics, Trends, and Extremes in the Southeastern United States

Abstract Humid heat and associated heat stress have increased in frequency, intensity, and duration across the globe, particularly at lower latitudes. One of the more robust metrics for heat stress impacts on the human body is wet-bulb globe temperature (WBGT), because it incorporates temperature, humidity, wind speed, and solar radiation. WBGT can typically only be measured using nonstandard instrumentation (e.g., black globe thermometers). However, estimation formulas have been developed to calculate WBGT using standard surface meteorological variables. This study evaluates several WBGT estimation formulas for the southeastern United States using North Carolina Environment and Climate Observing Network (ECONet) and U.S. Military measurement campaign data as verification. The estimation algorithm with the smallest mean absolute error was subsequently chosen to evaluate summer WBGT trends and extremes at 39 ASOS stations with long continuous (1950–2023) data records. Trend results showed that summer WBGT has increased throughout much of the southeastern United States, with larger increases at night than during the day. Although there were some surprisingly large WBGT trends at higher elevation locations far from coastlines, the greatest increases were predominantly located in the Florida Peninsula and Louisiana. Increases in the intensity and frequency of extreme (90th percentile) WBGTs were particularly stark in large coastal urban centers (e.g., New Orleans, Tampa, and Miami). Some locations like New Orleans and Tampa have experienced more than two additional extreme heat stress days and nights per decade since 1950, with an exponential escalation in the number of extreme summer nights during the most recent decade. Significance Statement Humid heat and associated heat stress pose threats to health in the moist subtropical climate of the southeastern United States. Wet-bulb globe temperature (WBGT) is a robust metric for heat stress but must be estimated using complex algorithms. We first evaluated the accuracy of three WBGT algorithms in the southeastern United States, using measured verification data. Subsequently, we used the most accurate algorithm to investigate WBGT trends and extremes since 1950 in 39 cities. Results showed that summer heat stress has increased throughout the region, especially at night. Increases in the intensity and frequency of extreme heat stress were most prevalent at urban coastal locations in Florida and Louisiana, emphasizing the impacts of increased urbanization and evaporation on heat stress.

The Impact of Administrative Division and Reorganization on the Urban Network in Hodna Region (M'sila, Algeria), Spatial-Temporal Approach

Objectives: This study aims to achieve two main objectives. The first one is determining the characteristics of the municipal network in the Hodna region and describing the most prominent spatial imbalances. The second is the impact of administrative divisions and regional reorganization processes on the spatial distribution and evolution of the population. Methods: The approach adopted in determining the characteristics of the municipal network and evaluating the degree of spatial efficiency is the descriptive, analytical and measurement approach through the application of the shape index and the polygons of Thiessen. The analysis of variation in the spatial distribution of population and spatio-temporal dynamics according to administrative divisions was through the spatio-temporal approach. Results: The results show that the municipalities shapes do not correspond to any spatial logic, as their forms are old and depend on the terrain or social factors. The reorganization of 1974 and 1984 contributed to the reinforcement of the capacities of province and the municipalities by equipping them with new urban functions and many agglomerations have been promoted to extended functions, where the capitals of districts and municipalities were turned from small urban centers to real cities. Conclusions: The administrative division and reorganization of the territory has a significant impact on the urban network and the stability of the population.Therefore, the reorganization has given more finesse and flexibility to the management of the territories by providing them with various public services and administrations inherent to their respective ranks.

Global San Francisco and the Irish of the New Pacific

Abstract Following the discovery of gold in the Sierra Nevada Mountains in January 1848, San Francisco established itself as the premier city of the western Americas. From the outset, its substantial Irish immigrant population enjoyed the standing of a charter group and exhibited high levels of political power and cultural influence, characteristics that were frequently noted by contemporaries and continued well into the twentieth century. While San Francisco's Irish population shared much in common with their compatriots in other American cities, the Golden City developed its own unique identity and quickly emerged as a truly global Irish city. Key features that account for its experience include the city's distinctive nineteenth-century population composition, which included a large Chinese component; the notable confidence of its Irish-born population compared with that in other American urban centers; and the unique westward orientation of the city and its people that contributed to San Francisco's pivotal role in emerging transnational Pacific networks.

Integrating HEC-RAS, GIS, and LISREL for assessing and enhancing urban building resilience against flood threats: Comprehensive model and analysis

Floods pose significant threats to urban areas, resulting in substantial human and financial losses annually. The vulnerability of key urban centers to these risks diminishes their efficiency, leading to public dissatisfaction and service deficiencies. Recognizing and enhancing the resilience of essential buildings becomes crucial in mitigating these challenges. This study employs a comprehensive approach to achieve a resilience model for critical buildings facing floods. The research process involves the identification of city assets based on leveling criteria, utilizing GIS technology for spatial mapping. HECRAS software aids in river flow modeling, identifying areas lacking flood-carrying capacity. By overlaying vulnerable gravity centers with flood-prone regions, building resilience components are computed through structural factor analysis and LISREL modeling. The study identifies ten key criteria. Further analysis includes resilience modeling using TOPSIS and AHP methods. The positive ideal and negative ideal solutions are determined, resulting in the grading of building resilience. Notably, the balance redundancy index with cascading potential effects attains the highest positive ideal value at 0.257, while the resistance to a level of stress index achieves the lowest negative ideal value at 0.02. This comprehensive approach and modeling contribute to the understanding and enhancement of urban building resilience in the face of flood threats.

Indications for Transfer and Care Pathways of Inuit Transferred to a Tertiary Centre for Childbirth in Québec, Canada: A Chart Review 2015–2019

ObjectivesChildbirth evacuation, the transfer of patients from rural and remote communities to urban centres for pregnancy care or childbirth, can be associated with numerous adverse health outcomes and contributes to widening health disparities between Inuit and non-Indigenous populations in Québec. We examined the indications and outcomes of childbirth evacuations among Inuit from Nunavik, Northern Québec transferred to a southern tertiary care centre. MethodsA 5-year retrospective chart review included 677 pregnancies of 597 Inuit with obstetric indications transferred to a tertiary care centre between 2015 and 2019. ResultsThe most common reasons for transfer were diabetes (70/677, 10.3%), hypertension (69/677, 10.2%), abnormal prenatal screen/soft markers (57/677, 8.4%), and threatened preterm labour (55/677, 8.1%). Of the 534 (78.9%) Inuit who gave birth at the tertiary centre, 84.1% (449/534) were vaginal births. Overall, 27.0% (144/534) had obstetric complications, with postpartum hemorrhage (58/534, 10.9%) and retained placenta (34, 6.37%) being the most common. Of the 549 neonates, 9 were stillbirths (1.6%), and 69 neonates (12.6%) required admission to the neonatal intensive care unit. Approximately 3.4% (18/534) had complications within the postpartum period, with the most common being retained products of conception (4/18, 22.2%) and postpartum preeclampsia (4/18, 22.2%). ConclusionsA relatively young and multiparous population, Inuit from Nunavik have unique health profiles and care needs. Further investment in health care capacity in Nunavik, alongside locally adapted, prevention-focused perinatal health programming, might improve perinatal health profiles and reduce the rates of childbirth evacuation.

Time to Make Early Pregnancy Care a Priority in Canada

Early pregnancy is a critical period often accompanied by complications like early pregnancy loss. Early Pregnancy Assessment Clinics (EPACs) provide specialized and compassionate care to those experiencing these complications. First introduced in the United Kingdom, EPACs have been found to improve quality of care, reduce wait times, and cut costs. In Canada, EPACs are primarily limited to large urban centres at hospital sites. Access in other parts of the country, especially in rural areas, remains limited. Low-volume units managed by specialist nurses and family doctors, with support from specialists, are the best way to bring EPACs to more Canadians in need.

Physiological deterioration prior to in-hospital cardiac arrest: What does the National Early Warning Score-2 miss?

AimTo determine the frequency with which the National Early Warning Score-2 (NEWS-2) fails to detect physiological deterioration preceding in-hospital cardiac arrest (IHCA). MethodsWe conducted a retrospective observational study of all adult patients (age ≥ 18) who had suffered an IHCA between 1st July 2019 and 31st December 2021 in two large acute hospitals located in an urban centre (Nottingham, UK). Clinical observations and case notes were examined for the period leading up to IHCA events to determine if there was evidence of physiological deterioration which warranted an urgent patient assessment, whether NEWS-2 was triggered, and whether an urgent assessment actually took place. ResultsUrgent assessment was indicated in the lead-up to 126/374 (33.7 %) IHCA cases, and NEWS-2 failed to trigger in 20 of these cases (15.9 %). An urgent assessment took place in 89/106 (84.0 %) cases where NEWS-2 was triggered, and 13/20 (65.0 %) cases where NEWS-2 was not triggered, with the difference in proportions being statistically significant (p = 0.048). Half of cases in which NEWS-2 missed a physiological deterioration were related to a new or rising oxygen requirement. ConclusionsA significant proportion of IHCA events are preceded by clinically important abnormalities in vital signs which are not detected by NEWS-2. This may be a causative factor in some failure-to-rescue events.

Original theme: Problem of exclusive breastfeeding in the town of Kélo, province of Tandjile (Chad)

With the aim of evaluating the problem of breastfeeding (AME) exclusive of breast milk during the first 6 months of life, a prospective cross-sectional study was spread over a period of three months from May 10 to August 10. 2023. It involved 550 people, including 500 breastfeeding mothers of children aged 0 to 6 months and 50 health personnel. The study or investigation took place in five neighborhoods of the city of Kélo and in five urban health centers of the said city. The pre-established questionnaire sheets made it possible to collect the necessary data which were entered and analyzed using the SPSS version 25 software. The Pearson Chi-2 test was used at a threshold of 0.05 to investigate the relationship between the dependent variables and independent variables. he results showed that the average age of mothers is 32.50 and that of health personnel is 35.50. Married women number 474 or 94.8%, 49.40% are educated at the secondary level followed by 39.60% at the primary level. Almost all breastfeeding mothers are housewives, i.e. 65.80%. The proportions of mothers who practiced non-exclusive breastfeeding are 96.60% compared to 3.40% who practiced exclusive breastfeeding. Also a good proportion of mothers (26.40%) breastfed immediately after childbirth and the majority of these mothers breastfeed their children on demand (77.20%). Herbal tea and water were the main foods introduced into the infant's diet before the age of 6 months. Finally, our results showed that there is a relationship between exclusive breastfeeding and factors such as the mother's profession, the place of delivery, the sex of the child, advice on AME, knowledge of the advantages of AME and the practice of AME immediately after delivery. Knowledge of the advantages of AME must be made more available to mothers in order to improve the health of newborns and even children.

Perception towards electronic health records & uptake of digital health IDs among the urban residents in northern India: A mixed methods study.

Background & objectives Ayushman Bharat Digital Mission (ABDM) envisages a unique digital health ID for all citizens of India, to create electronic health records (EHR) of individuals. The present study assessed the uptake of Digital Health IDs by the patient and general population, their attitude toward EHR, and explored the barriers to digital ID and utilizing electronic health records services. Methods A concurrent explanatory mixed methods study was undertaken in Chandigarh, India, with an analytical cross-sectional design as a quantitative part and a qualitative descriptive study. The study participants were 419 individuals aged ≥18 yr who attended the urban primary healthcare centre (n=399) and the community-based screening camps (n=20) between July 2021 and January 2022. Latent Class Analysis (LCA) was undertaken to identify hidden sub-population characteristics. In-depth interviews were done to identify the barriers to health ID uptake. Results The digital health ID uptake rate was 78 per cent (n=327). Among the study participants, those who were aware of EHR, those who wanted a national EHR system, those who were confident with the government on EHR security, and those who were willing to make national EHR accessible for research showed significantly higher digital health ID uptake than their counterparts. The themes identified under barriers of uptake from the qualitative interviews were lack of awareness, technology-related (including digital literacy) and utility-related. Interpretation & conclusions Increasing EHR awareness, digital health literacy, and enacting data protection laws may improve the acceptance of the digital health ecosystem in India.

Stop the Bleed-Wait for the Ambulance or Get in the Car and Drive? A Post Hoc Analysis of an EAST Multicenter Trial.

Background: The Stop the Bleed campaign gives bystanders an active role in prehospital hemorrhage control. Whether extending bystanders' role to private vehicle transport (PVT) for urban penetrating trauma improves survival is unknown, but past research has found benefit to police and PVT. We hypothesized that for penetrating trauma in an urban environment, where prehospital procedures have been proven harmful, PVT improves outcomes compared to any EMS or advanced life support (ALS) transport.Methods: Post-hoc analysis of an EAST multicenter trial was performed on adult patients with penetrating torso/proximal extremity trauma at 25 urban trauma centers from 5/2019-5/2020. Patients were allocated to PVT and any EMS or ALS transport using nearest neighbor propensity score matching. Univariate analyses included Wilcoxon signed rank or McNemar's Test and logistic regression.Results: Of 1999 penetrating trauma patients in urban settings, 397 (19.9%) had PVT, 1433 (71.7%) ALS transport, and 169 (8.5%) basic life support (BLS) transport. Propensity matching yielded 778 patients, distributed equally into balanced groups. PVT patients were primarily male (90.5%), Black (71.2%), and sustained gunshot wounds (68.9%). ALS transport had significantly higher ED mortality (3.9% vs 1.9%, P = 0.03). There was no difference in in-hospital mortality rate, hospital LOS, or complications for all EMS or ALS only transport patients.Conclusion: Compared to PVT, ALS, which provides more prehospital procedures than BLS, provided no survival benefit for penetrating trauma patients in urban settings. Bystander education incorporating PVT for early arrival of penetrating trauma patients in urban settings to definitive care merits further investigation.

First molecular characterisation of Hydatigera taeniaeformis (Cestoda: Taeniidae) from Rattus rattus in urban market centres from Tamale, Ghana

BackgroundThe common cat tapeworm, Hydatigera taeniaeformis, is widely distributed across many regions of the world but its global genetic diversity, ecology, and other biological features are not fully understood. The predator-prey relationship of felids and rodents sustains the transmission in both sylvatic and synanthropic or urban settings. This study was carried out in three urban market centres in Tamale, Ghana to determine the prevalence of H. taeniaeformis infection in urban rats and characterise the local population genetics using the mitochondrial nad1 gene sequences.MethodsFrom January to May 2023, rats were captured and euthanized to identity and isolate the H. taeniaeformis metacestodes. The full mitochondrial nad1 gene was amplified, sequenced and used to characterise the cestode population.ResultsIn total 64/80 rats from the three market centres were found naturally infected with metacestodes of H. taeniaeformis. Averagely, infected rats harboured two cysts with one exceptional case of 25 cysts in one liver. Each cyst harboured one metacestode. The DNA sequences revealed four haplotypes in a star-like distribution network across the three market centres. All four haplotypes were found to be unique, clustered with H. taeniaeformis sensu stricto (s.s.) global isolates and had only marginal variation among themselves.ConclusionThis is the first account of the genetic variability within H. taeniaeformis in Ghana and would contribute to ongoing and future studies on African regional biogeographic distribution of the common cat tapeworm.

Location patterns and factors of Polish makerspaces

Makerspaces (MS) represent a type of new working space (NWS), a subject addressed by numerous researchers. Nevertheless, among the abundance of publications on NWS, only a limited number discuss the detailed distribution of MS and address the significant issue of their location factors. This article aims to supplement these research gaps based on the example of Polish makerspaces, through a comprehensive database of Polish NWS and spatial analysis conducted through GIS systems. According to the results, there is a predominance of MS in the main metropolitan centers, alongside a rising significance in peripheral areas while a co‑occurrence of MS with other institutions focusing on innovation, creativity and education is recorded. It is also pointed out that location factors related to transportation are mainly found in large urban centers, but not noticeable elsewhere. Through the use of in‑depth interviews, the author points to the significant relevance of social factors in the MS creation phase, together with accessibility and infrastructure‑related factors. In addition, crucial components impacting on MS establishment include the engagement of MS members, municipal support, location and the characteristics of the MS environment. Lastly, the validity of the rules and regulations of organizations supporting the creation of MS are outlined.