Facility Size Research Articles

P-2010. Association between Urbanicity and Up-to-date COVID-19 Vaccination Coverage among Healthcare Personnel and Residents of Nursing Homes - National Healthcare Safety Network, United States, March 3, 2024

Abstract Background CDC recommends that residents and healthcare personnel (HCP) in nursing homes be up to date with COVID-19 vaccinations to protect residents, who are at increased risk for severe COVID-19. COVID-19 vaccination coverage is often lower in rural versus urban populations; it is unclear if this applies to residents and HCPs in nursing homes. We assessed the association of urbanicity with up-to-date COVID-19 vaccination of residents and HCP in U.S. nursing homes. Methods We conducted a cross-sectional study of 14,304 nursing homes reporting to the CDC’s National Healthcare Safety Network (NHSN) for the week ending March 3, 2024. Up-to-date COVID-19 vaccination was receipt of an updated 2023-2024 COVID-19 vaccine. We used the 2006 NCHS urban-rural classification scheme for counties to group nursing homes as urban, suburban, and rural. We used logistic regression models to assess the association between urbanicity and up-to-date vaccination among residents and HCP. Facility size, social vulnerability index, and region were tested as potential confounders; facility size met the criteria for confounding (≥10% change in parameter estimates) and was included in the model. Results Among residents, vaccination was similar in rural (43.2%), suburban (41.3%), and urban (41.7%) nursing homes. Controlling for facility size, there was no association between urbanicity and odds of vaccination for residents (rural vs. urban: OR=1.0 [95% CI 1.0-1.1]; suburban vs. urban: OR = 1.0 [96% CI 0.9-1.0]); Table 1). Among HCP, urban nursing homes had the highest coverage at 9.1%; coverage at suburban and rural nursing homes was 6.9% and 5.7%, respectively. Controlling for facility size, compared to HCP in urban nursing homes, HCP in rural (OR= 0.7 [95% CI 0.5-0.6]) and suburban (OR= 0.7 [95% CI 0.7-0.8]) nursing homes had lower odds of vaccination (Table 2). Conclusion Up-to-date vaccination coverage among HCP and residents was low. HCP working in suburban and rural nursing homes were less likely to be up to date with COVID-19 vaccination than their urban counterparts. Coverage among residents did not vary by urbanicity. There is room to improve vaccination coverage among nursing home residents and HCP, especially among HCP working outside of urban areas. Disclosures All Authors: No reported disclosures

Assessment of Antimicrobial Use for Companion Animals in South Korea: Developing Defined Daily Doses and Investigating Veterinarians' Perception of AMR.

There are global concerns regarding the transmission of antimicrobial-resistant pathogens from animals to humans. Especially, companion animals are increasingly recognized as a potential source due to their close interactions with people, despite a limited number of reported cases. Although, social demands regarding comprehensive surveillance for antimicrobial resistance (AMR) among companion animals are highlighted, there is a lack of a relevant system in South Korea. In this regard, we conducted preliminary investigation on antimicrobial use (AMU) among small animal clinics, along with veterinary practitioner's knowledge and attitude regarding this issue in South Korea. We collected data on 684,153 antimicrobial prescription visits for canine and feline patients from 2019 to 2022 at 100 veterinary facilities in South Korea, using electronic medical records. To evaluate antimicrobial use (AMU) and facilitate comparisons across institutions and time periods, we developed the Defined Daily Dose for Animals (DDDA) and the Defined Animal Daily Dosages per 1000 Animal-Days (DAPD). In addition, we conducted an online survey of 362 veterinary practitioners, which included questions on their perceptions, attitudes, and practices regarding antimicrobial prescriptions. Simple frequency analyses were performed to examine temporal trends, regional differences and variations by facility size in AMU, and to summarize survey responses. Descriptive analysis using data from 100 veterinary clinics revealed a rising trend in AMU between 2019 and 2022, with higher usage observed in larger clinics and non-capital regions. DDDA values for dogs were generally higher than for cats. Survey results highlighted that, while veterinarians exhibited high awareness of AMR, prescribing practices were significantly influenced by clinical judgments and owner demands, often deviating from established guidelines. The adoption of an electronic veterinary prescription management system (e-Vet) was proposed to enhance antimicrobial stewardship. However, concerns regarding the system's efficiency and administrative burden were prominent. To our best knowledge, this study provided DDDA for companion animals for the first time in South Korea. Although the indicator should be improved with more comprehensive data and expert opinion, our study showed that it enables reasonable situation analysis regarding AMU in companion animals. The identified factors that affect veterinarians' prescription practices can also be used to design an effective strategy for promoting appropriate antimicrobial usage.

The effect of conflict on damage to medical facilities in Mariupol, Ukraine: A quasi-experimental study.

Medical facilities are civilian objects specially protected by international humanitarian law. Despite the need for systematic documentation of the effects of war on medical facilities for judiciary accountability, current methods for surveilling damage to protected civilian objects during ongoing armed conflict are insufficient. Satellite imagery damage assessment confers significant possibilities for investigating patterns of war. We leveraged commercially and publicly available satellite imagery and cross-referenced geolocated facility data to conduct a pre-post quasi-experimental study of damage to medical facilities in Mariupol, Ukraine as a result of Russia's invasion. We found that 77% of medical facilities in Mariupol sustained damage during Russia's siege lasting from February 24-May 20, 2022. Facility size was not associated with damage, suggesting that attacks on medical facilities are not random but instead may have been the result of intentional targeting. This is the first cross-referenced pre-post census study of the effects of an ongoing conflict on specially protected medical infrastructure.

High organofluorine concentrations in municipal wastewater affect downstream drinking water supplies for millions of Americans

Wastewater receives per- and polyfluoroalkyl substances (PFAS) from diverse consumer and industrial sources, and discharges are known to be a concern for drinking water quality. The PFAS family includes thousands of potential chemical structures containing organofluorine moieties. Exposures to a few well-studied PFAS, mainly perfluoroalkyl acids (PFAA), have been associated with increased risk of many adverse health outcomes, prompting federal drinking water regulations for six compounds in 2024. Here, we find that the six regulated PFAS (mean = 7 to 8%) and 18 measured PFAA (mean = 11 to 21%) make up only a small fraction of the extractable organofluorine (EOF) in influent and effluent from eight large municipal wastewater treatment facilities. Most of the EOF in influent (75%) and effluent (62%) consists of mono- and polyfluorinated pharmaceuticals. The treatment technology and sizes of the treatment facilities in this study are similar to those serving 70% of the US population. Despite advanced treatment technologies, the maximum EOF removal efficiency among facilities in this work was <25%. Extrapolating our measurements to other large facilities across the United States results in a nationwide EOF discharge estimate of 1.0 to 2.8 million moles F y-1. Using a national model that simulates connections between wastewater discharges and downstream drinking water intakes, we estimate that the sources of drinking water for up to 23 million Americans could be contaminated above regulatory thresholds by wastewater-derived PFAS alone. These results emphasize the importance of further curbing ongoing PFAS sources and additional evaluations of the fate and toxicity of fluorinated pharmaceuticals.

McDonald’s China Adopts Operations Research for Network Design

The supply chain network design (SCND) problem is a typical optimization problem that determines the structure of a supply chain and affects its costs and operational performance. SCND deals with various decisions, such as determining the number, size, and location of facilities and the optimal material and product flows of the entire supply chain network. Therefore, SCND is one of the most crucial planning problems in supply chain management. In this paper, we present a practical approach in which we adopt a mixed-integer programming (MIP) mathematical model to solve a real industry SCND problem for McDonald’s China. As a result of this project, McDonald’s China has saved millions of dollars in logistics costs and reduced CO2 emissions by more than 10%. In our approach, size-reduction techniques were successfully applied to deal with a large-scale model, making it possible to analyze hundreds of scenarios before coming to a consensus.

Enhancing Perinatal Safety with the Advancement of Obstetric Anesthesia in Japan.

Japan is one of the most developed countries in the world, and perinatal care is safe, with low maternal and neonatal mortality rates. However, as birthrate declines, advanced maternal age and the number of cesarean deliveries increases, efforts must be made to maintain safety in the future. The characteristic of the delivery facilities is "many small clinics," and half of all facilities have fewer than 500 deliveries per year. Such clinics rarely have full-time anesthesiologists; therefore, anesthetic management, including cesarean deliveries and labor analgesia, is left to obstetricians' efforts. Furthermore, the prevalence of labor analgesia is very low compared with that in developed countries. In 2017, maternal deaths during labor analgesia were reported and became a social problem. The Ministry of Health, Labor, and Welfare (MHLW) appointed a research group to conduct a study on labor analgesia and issued recommendations for a safe delivery system in 2018. Even when recommendations are understood, changing the size and staffing of medical facilities is challenging, and the field needs specific interventions such as education and information sharing. Most maternal deaths related to anesthesia are preventable. Within the existing medical environment, a distinctive anesthetic management system is crucial to improve the safety of perinatal care, and cooperation among obstetricians, anesthesiologists, nurses, and midwives involved in perinatal care through education and management is essential. We review past perinatal safety initiatives in Japan and discuss the need to make obstetric anesthesia safer as future risks increase.

Determination of car park locations to accommodate maximum dynamic demand

Cruising for parking is one of the most important issues affecting the air quality and traffic congestion in large- and medium-sized cities. This may emanate from insufficient parking spaces, which can itself cause illegal parking. This paper proposes a bi-level model to optimise parking facility location and size, as its upper-level problem, considering drivers’ parking search behaviour to determine demand allocation, as its lower-level problem. The model determines parking capacities such that the dynamic demand is met legally at a pre-specified satisfaction level. Results show that, for the entire study area, the legal satisfaction ratio is 92% for 20-year planning horizon, while an optimal addition of 2100 parking spaces can increase it to 98.7%. Also, the ratio has a significant increase from 62% to 92% for the most critical zone. Moreover, the establishment cost incurred by the proposed model is 28% less than the commonly used parking accumulation method.

Factors associated with unplanned readmissions for patients with mental and behavioural disorders in China: a quantitative analysis

ABSTRACT Background Unplanned readmissions among patients with mental and behavioural disorders (MBDs) disrupt inpatient recovery and impose financial burdens on families and healthcare systems. Objectives To estimate the 31-day unplanned inpatient readmission rates for MBDs in China and identify determinant profiles from the perspective of individual, hospital, and contextual levels. Methods Data from patients with MBDs were collected from the medical records of 99 public hospitals across 10 cities. A total of 49,352 inpatient admissions were analysed based on the proposed conceptual model using multilevel logistic regressions. Results The 31-day unplanned readmission rate (excluding 0–1-day returns) was 8.6% (95% CI: 8.4–8.9%). Determinant profiles differed across the overall group and subgroups. The number of general practitioners within cities was associated with reduced risk of unplanned readmissions. Hospital factors such as facility type and size, human resources, and revenue size were associated with unplanned readmissions only in specific subgroups. Additionally, individual-level factors, including demographic information (e.g. gender, age, marital status, and occupational status), disease-related factors (e.g. primary diagnostic group, condition at admission, and other diagnoses), and clinical characteristics (e.g. length of stay and medical costs), were associated with unplanned readmissions across all subgroups. Conclusion The study emphasises collaborative efforts from health systems, hospitals, and patients to reduce unplanned readmissions for MDBs. Health systems should focus on improving access to care, enhancing quality, and ensuring continuity while providing incentives for hospitals. Additionally, hospitals should prioritise the identification and effective management of their high-risk patients.

Framework Nucleic Acid-Nanobody Fusion Probe-Based Pharmacokinetics Modulation and Analysis for Efficient Positron Emission Tomography Imaging.

Nanobodies are promising for immunoPET imaging due to their excellent antigen recognition and tumor targeting, yet rapid clearance limits their tumor accumulation. Although multimerization and albumin binding can extend their circulation time and improve tumor targeting, a simple and universal method for creating protein multimers is still needed. Here, we leveraged the facile synthesis, controllable size, and precise assembly of DNA nanotechnology to construct CD47-targeted framework nucleic acid-nanobody fusion probes with multiple valences and sizes. Following comprehensive structural characterization, in vitro specificity assessment and in vivo PET/CT imaging analysis were conducted on a colorectal cancer LS174T mouse model. Furthermore, a pharmacokinetic model was developed and fitted with considerable in vivo data to prove its rationality, followed by testing the effects on tumor uptake prediction by changing different pharmacokinetic parameters. Indeed, by manipulating the size of the nucleic acid scaffolding and the number of attached nanobodies, we could precisely modulate the accumulation of probes at the tumor site. Overall, this study not only developed an efficient strategy for constructing nanobody multimers but also provided a pharmacokinetic model, allowing profound insight into the multidimensional data obtained experimentally and informing the design of future imaging probes with predictable delivery efficacies.

Effects of a nutrition education intervention on food-provision managerial decisions in Catalan old age nursing homes.

Existing research does not provide definitive conclusions on the most effective initiatives for preventing malnutrition among older adult residents in nursing homes. We aimed to assess whether a nutrition education intervention provided to nursing home managers can improve dietary managerial decisions within nursing homes. We performed a multicenter study, where each center was randomized to an intervention or a control group. To ensure homogeneous group representation, we stratified the sample based on the facility size and the availability of kitchen equipment. The baseline survey contained questions related to center characteristics, kitchen size and availability of cooking tools, availability of different daily menu options and the staff working in the kitchen. The follow-up survey included questions about the staff responsible for making nutritional decisions, the degree of food handling, the availability of texture-modification tools, and the residents' satisfaction. We use ordered probit regression models to estimate the effect of the educational intervention on decisions around food management. From the 238 nursing homes that responded to the initial survey, 176 were followed-up; 56 were allocated to the intervention group and 120 to the control group. There were 53.32 residents per center among the treated group and 40.82 residents in the non-treated institutions. The intervention increased by 24% the nursing homes' probability of increasing their stock of texture-modification tools, which rose to 26% after controlling for the effect of receiving specific training on textures or presentation, compared to the control group. The intervention improved managerial decisions in nursing homes concerning meal presentation through an increase in the number of cooking tools. Incorporating structured and comprehensive sessions to improve food texture and presentation could help fight the risk of residents' malnutrition.

Provision of hospice and palliative care and implementation of advance care planning for residents in German nursing homes – a cross-sectional study

BackgroundDemographic changes are leading to a rise in the demand for care services, with nursing homes (NHs) playing an increasingly important role in end-of-life care. Evidence suggests that NH residents at the end of life significantly benefit from hospice and palliative care and the implementation of advance care planning (ACP). In 2018, Germany passed a law to promote the implementation of ACP in NHs and to enable the refinancing of ACP services by the statutory health insurance funds. The present study aimed at assessing current hospice and palliative care structures, examining the implementation of ACP and identifying barriers to obtain approval for billing for ACP services under this specific legislative (§ 132 g SGB V).MethodsAs a part of the "Gut-Leben" project, the present study administered a cross-sectional quantitative survey in 2023 to evaluate hospice and palliative care structures, the implementation of ACP, and barriers to ACP approval in German NHs. A questionnaire was distributed to a random sample of N = 1,369 NH managers. Responses were analyzed using descriptive statistical methods.ResultsN = 330 NH managers responded to the questionnaire (24.1% response). The majority described the end-of-life care structures in their region as rather good (77.7; n = 256), and very strong collaboration was reported with general practitioners (54.7%), physiotherapists (42.9%), and palliative care physicians (38.6%). Awareness of the legislative for ACP was reported by n = 201 NHs (64.4%), and 100 (50.3%) of these NHs had already obtained approval. The primary barriers to approval identified by 68 NHs included a lack of available staff (48.5%; n = 33) and a small facility size (27.9%; n = 19).ConclusionsAlthough half of the NHs have implemented ACP, there is still a need to enhance awareness of the ACP legislative. These efforts should aim to reduce the existing barriers to approval, which could be achieved, for instance, by fostering collaboration between NHs or by cooperating with external ACP service providers.

OMAD-6: Advancing Offshore Mariculture Monitoring with a Comprehensive Six-Type Dataset and Performance Benchmark

Offshore mariculture is critical for global food security and economic development. Advances in deep learning and data-driven approaches, enable the rapid and effective monitoring of offshore mariculture distribution and changes. However, detector performance depends heavily on training data quality. The lack of standardized classifications and public datasets for offshore mariculture facilities currently hampers effective monitoring. Here, we propose to categorize offshore mariculture facilities into six types: TCC, DWCC, FRC, LC, RC, and BC. Based on these categories, we introduce a benchmark dataset called OMAD-6. This dataset includes over 130,000 instances and more than 16,000 high-resolution remote sensing images. The images with a spatial resolution of 0.6 m were sourced from key regions in China, Chile, Norway, and Egypt, from the Google Earth platform. All instances in OMAD-6 were meticulously annotated manually with horizontal bounding boxes and polygons. Compared to existing remote sensing datasets, OMAD-6 has three notable characteristics: (1) it is comparable to large, published datasets in instances per category, image quantity, and sample coverage; (2) it exhibits high inter-class similarity; (3) it shows significant intra-class diversity in facility sizes and arrangements. Based on the OMAD-6 dataset, we evaluated eight state-of-the-art methods to establish baselines for future research. The experimental results demonstrate that the OMAD-6 dataset effectively represents various real-world scenarios, which have posed considerable challenges for current instance segmentation algorithms. Our evaluation confirms that the OMAD-6 dataset has the potential to improve offshore mariculture identification. Notably, the QueryInst and PointRend algorithms have distinguished themselves as top performers on the OMAD-6 dataset, robustly identifying offshore mariculture facilities even with complex environmental backgrounds. Its ongoing development and application will play a pivotal role in future offshore mariculture identification and management.

A Hybrid Framework for Multi-Objective Construction Site Layout Optimization

Effective Construction Site Layout Planning (CSLP) ensures the organized placement and sizing of temporary facilities, enhancing workflow and logistical efficiency. Poorly planned layouts, however, can increase material handling times, create bottlenecks, and reduce productivity, ultimately leading to higher costs. The main objective of this study is to introduce a BIM-based hybrid framework for CSLP that integrates Systematic Layout Planning (SLP) with a Genetic Algorithm (GA), developed through a Design Science Research approach. This Construction Site Optimization Framework (CSOF) addresses CSLP as a multi-objective optimization problem, prioritizing efficient positioning of facilities while accounting for workflow intensity, safety, and manager preferences. The framework’s continuous-space modeling supports a realistic approach, moving beyond fixed-location models. Exploratory case studies demonstrated CSOF’s effectiveness, achieving 30.79% to 40.98% reductions in non-value-adding travel distances and adaptability across varied site conditions. In this way, this research provides a decision-support tool that balances automation with decision-maker input, enhancing layout efficiency and operational flexibility in construction site management.

Documenting Trends in Malaria Data Reporting Accuracy Using Routine Data Quality Audits in Zambia, 2015-2022.

Since 2015, the Zambia National Malaria Elimination Centre has conducted routine data quality audits in Central, Southern, and Western provinces, but trends in data reporting accuracy have not been examined. Routine data quality audit data collected at health facilities reporting into the monthly health management information system (HMIS) and weekly malaria rapid reporting system (MRRS) were used to measure data reporting accuracy trends from 2015 to 2022 and potential influencing factors using three data elements: outpatient department attendance and rapid diagnostic test (RDT)-tested cases for HMIS and MRRS, total confirmed cases for HMIS only, and RDT-positive cases for MRRS only. Reporting accuracies for HMIS and MRRS data elements and the percentage of facilities reporting with high accuracy (≥85%) improved over this period. Low-accuracy (<70%) health facilities were uncommon, accounting for less than 15% of facilities for HMIS and MRRS. With each successive DQA visit, the proportion of facilities with high accuracy increased from visits 1 to 8: 23% to 56% (HMIS) and 42% to 85% (MRRS). No correlation was observed between facility size or incidence and overall accuracy for HMIS and MRRS. Starting in 2017, about 40-50% of health facilities appeared to be overreporting incidence in comparison with their register-based incidence. The risk stratification determined by register-based and reported incidences matched in more than 70% of facilities. Routine data quality audits conducted between 2015 and 2022 in Central, Southern, and Western provinces showed an improvement in malaria data reporting accuracy.

Machine Learning-Assisted High-Throughput Experiments for Selective Seawater Electrolysis

Global warming is an urgent issue for our planet thereby many countries has declared to achieve zero emission of carbon dioxide in 2050s. In the next generation industry, electricity produced from renewable energy becomes major energy while heat is a major in the current industry. Therefore, electrochemical process should play a critical role. For example, water electrolysis and seawater electrolysis combined with solar energy or wind energy to produce hydrogen must be developed. However, developing non-precious electrocatalysts with high catalytic activity is still a big challenge in material science.Among various electrochemical processes, seawater electrolysis is recently paid much attention as an attractive process for cost effective hydrogen production. In sea water electrolysis, oxygen, chlorine, or hypochlorous acid (HClO) is evolved at anodic side as well as hydrogen in cathodic reaction. In this reaction, HClO is usually regarded as undesired byproduct in mass production. On the other hand, HClO can be high-value-added oxidative material than oxygen, contributing to a cost-effective system, especially in the case of rather small distributed system. Therefore, it is important to selectively generate both oxidative products.Recently, many papers investigated the potential research scheme which is supported by machine learning and/or robots. Here, the authors developed the high-throughput automatic robot for electrochemistry (namely HARfE) as shown in Fig. 1. High-throughput screening of 4-element system was performed for salted water (NaCl solution) electrolysis that is a model reaction for sea water electrolysis.This robot is able to perform fully automatically from preparing samples to measuring electrochemistry. Mainly, this robot is consisted of two parts; sample preparation part, and sample measuring part. HARfE can prepare 88 separated samples in a single run and subsequently measure electrochemistry. One notable advantage of this robot is that the robot can perform almost the same procedure as human researchers do using almost the same sizes of facilities as human researchers use, intending that this robot system can replace human labor force. The size of electrodes (≈0.5 cm2), an electrochemical cell (21 mL of solution), and measurement conditions are very similar to those of human researchers. In addition, a relatively long-term measurement such as stability test which requires a certain amount of solution is also able to be done. Hence, the robot can cover a wide range of electrochemical measurements.The typical procedures are the following. First, the pipetting arm dispenses and mixes up to ten kinds of solution that include metal ion. Second, the robot drops the mixed solution onto the substrates such as F-doped tin oxide (FTO) with a size of 5 mm by 30 mm and dry them on a hotplate. Third, the transfer arm transports the sample holders to an electrical furnace to calcine. Then, the picking-up arm transfers each obtained electrode to a H-type cell to perform electrochemical measurements. Finally, the pipetting arm dispenses a small amount of solution from the cell, mixes with color reagent, subsequently measures absorption to quantitate the products. After each measurement, solution was changed automatically from a tank behind the robot.In this study, the composition effect of Co-Mn-Fe-Ni-Cr electrocatalysts was investigated. Current density at 2.0 V vs. Ag|AgCl reference electrode, Faraday efficiency for hypochlorous acid/oxygen when 1 mA of current flew for 200 s (0.2 C), and the ratio of current density at 2.0 V vs. Ag|AgCl after 1000 s and 100 s were calculated. It was revealed that the obtained color maps clearly showed the composition dependence, and that The optimal composition varied depending on each evaluation criterion. For example, Co-rich composition provides high current densities and Mn-rich electrodes produced little HClO. It is notable that NiO x exhibited poor stability while stability was drastically improved by combining with FeO x .In addition, we demonstrated the composition optimization using Bayesian optimization (BO) algorithm. In this case, we used the dataset of Co-Mn-Fe-Ni four elements system with 286 data points. Composition is explanatory variables and current density at 2.0 V vs. Ag|AgCl is the target variable. Usually, BO-assisted experiment was performed one sample by one sample. Contrary, HARfE can deal with multiple samples in a single run. Therefore, multi-sample Gaussian process regression was performed to effectively search superior compositions. The detailed results will be shown in the presentation. Figure 1

Psychometric development and validation of the Hospital Resilience Index

BackgroundThroughout the past decades, the United States healthcare system has seen increased efforts to promote continuity of operations in response to external or internal stressors. There is no marker to characterize this facet of health system resilience. The two databases which may contain the most relevant data are the American Hospital Association (AHA) annual survey, which gathers over 1000 data points from more than 6000 hospitals, and the RAND corporation, which provides information on the financial health and viability of hospitals and health care systems. In that sense, AHA focuses more on organizational and practice issues, while RAND will cover more economic factors. Our study aimed to develop and psychometrically validate a new Hospital Resilience Index (HRI).MethodsWe took the AHA and RAND databases as primary data sources, and defined hospital closure as the main negative outcome indicating failed resilience. We performed descriptive statistics, and regression analysis of the databases.ResultsOur findings show that a combination of eleven variables is strongly associated with the likelihood of hospital closure. These factors mirror smaller hospital size, lack of ancillary functions, staffing structure of the hospital, size of facilities, number of surgeries performed, Medicare discharges, operating expenses, and medical school affiliation as a teaching hospital. We further classified hospitals with a low HRI (< 25) or high HRI (> 25). In this setup, we found that both hospitals with a low HRI and hospitals that would subsequently close were characterized by smaller patient census, smaller numbers of surgeries, fewer beds, a smaller staff, and a lower operating margin.ConclusionsTogether, these factors would point to a higher resilience to external stressors in larger, more expanded hospitals and healthcare systems, offering a broad range of services, and having a higher operating margin. The higher tiers of the healthcare system therefore seem to have more resilience, but the recent Covid-19 pandemic exhibited how much all tiers in the system are needed to respond to extraordinary crises such as pandemics or large natural disasters. Future research should seek to determine whether tracking the HRI over time may be a tool to identify hospitals at risk of closure.

Coverage with Influenza, Respiratory Syncytial Virus, and COVID-19 Vaccines Among Nursing Home Residents - National Healthcare Safety Network, United States, November 2024.

Nursing home residents are at elevated risk for severe complications from respiratory viruses, including SARS-CoV-2, influenza, and respiratory syncytial virus (RSV). Nursing homes are required to report COVID-19 vaccination coverage and can voluntarily report influenza and RSV vaccination coverage among residents to CDC's National Healthcare Safety Network. The purpose of this study was to assess COVID-19, influenza, and RSV vaccination coverage among nursing home residents early in the 2024-25 respiratory virus season. As of November 10, 2024, 29.7% of nursing home residents had received a 2024-2025 COVID-19 vaccine. Among residents at facilities that elected to report vaccination against influenza (59.4% of facilities) and RSV (51.8% of facilities), 58.4% had received influenza vaccination, and 17.9% had received RSV vaccination. Vaccination coverage varied by U.S. Department of Health and Human Services region, social vulnerability index level, and facility size. Addressing low coverage with COVID-19, influenza, and RSV vaccines is a priority to protect residents who are susceptible to severe outcomes associated with respiratory illnesses.

Associations of anaemia and iron deficiency with health-related quality of life in patients with chronic kidney disease stage G3b-5 in Japan: sub analysis of the Reach-J CKD cohort study

BackgroundIron deficiency is a major contributor to anaemia in chronic kidney diseases. The association of anaemia and iron deficiency with health-related quality of life in Japanese patients with non-dialysis chronic kidney disease has not been examined. In this study, we evaluated anaemia and iron deficiency in patients with chronic kidney disease G3b-5 and examined their associations with health-related quality of life.MethodsThis nationwide cohort study included 2,249 patients with advanced chronic kidney disease receiving nephrologist care from 31 representative facilities throughout Japan; they were randomly selected through stratification by region and facility size and aligned with the Chronic Kidney Disease Outcomes and Practice Patterns Study. Using baseline patient data, we assessed the association of anaemia and iron deficiency with health-related quality of life, employing the 36-item Kidney Disease Quality of Life Questionnaire.ResultsThe mean mental and physical component summary scores for all patients were 49 and 47, respectively. Patients with haemoglobin levels < 10 g/dL had worse three kidney disease subscale, mental component summary, physical component summary, and subdomain scores than those with haemoglobin levels > 12 g/dL. Patients with absolute iron deficiency (TSAT < 20% and ferritin < 100 ng/mL) had worse three kidney disease subscale and mental component summary scores than those with functional iron deficiency (TSAT < 20% and ferritin ≥ 100 ng/mL).ConclusionsJapanese patients with chronic kidney disease G3b-5 with anaemia or absolute iron deficiency had worse health-related quality of life. Our results provide clinical evidence of renal anaemia in Japan and will be useful for international comparisons.

Development of a web-based platform for rainwater retention facility design

ABSTRACT This study develops a web-based operational platform to streamline the integration of GIS technologies, hydrological analyses, and regulation inspections in the design process of rainwater retention facilities. The system incorporates a comprehensive design procedure, which entails: (1) selecting the type and size of the retention facility based on predefined options, (2) conducting hydrological analyses specific to the development site, and (3) verifying the design’s compliance with relevant regulations. Users can visualize flow hydrographs before and after development, estimate the increase in runoff volume resulting from development, and assess the reduction in peak outflow achieved by the retention facility. The system can also validate the adequacy of the retention facility design in alignment with regional flood control objectives. It offers a user-friendly geographical interface for designing retention facilities and drainageways at development sites. Furthermore, design information displayed on the platform can be conveniently shared with regulatory authorities through a web link.

An international comparison of Long-term Care Facility outcomes during the COVID-19 pandemic

Abstract Background The COVID-19 pandemic has had huge repercussions for public health internationally and different countries had different outcomes based on preconceived policy interventions. Lessons influencing future policy have been learned, notably how best to manage vulnerable populations, particularly those living in long-term care facilities (LTCFs). In Ireland LTCF residents accounted for 56% of deaths during the first wave of the pandemic and it is imperative to establish the causes of this. International research has highlighted how factors including county incidence rate, facility size, occupancy, LTCF ownership and compliance with health inspection regulations influenced LTCF COVID-19 outcomes. The aim of this research is to explore the impact of these factors in an Irish context and compare to best international standards. Methods The main outcome considered was deaths per 100 beds. Data on crude mortality were available for 580 Irish LTCFs up to 28 May 2020. Data regarding occupancy, ownership, facility size and compliance with regulations were obtained for these LTCFs from a novel dataset of 1130 available LTCF regulatory inspection reports between 2018- 2022. Regression analysis was carried out to show how LTCF mortality was predicted by examined variables. Results The most significant predictor of deaths from COVID-19 in Irish LTCFs resulting from this research was LTCF occupancy (Odds ratio:1.029, significance &amp;lt;0.001). Regional community incidence, in concordance with international literature was also an important factor. Other stated predictors in this model were either non-significant or only marginally significant. These results are analysed in conversation with international research of the same variables. Conclusions To protect LTCF residents for potential future pandemics, attention should be paid to monitoring and suppressing local incidence rates and moves should be implemented towards designing smaller facilities with individual rooms for vulnerable residents. Key messages • Irish long-term care pandemic mortality was predicted by high occupancy of facilities and high regional COVID-19 incidence. • Comparing International COVID-19 outcomes in long-term care facilities can provide guidelines for the future.