Types Of Facilities Research Articles

Association between sick child facility readiness and quality of care at the individual and facility level in five low- and middle-income countries.

Raising the quality of health services is key to continued progress in improving child health, however, data on service quality are limited and difficult to interpret. The relationship between facility readiness and the quality of care is complex. Using publicly available data sets from five low- and middle-income countries (LMICs), we assessed the relationship between structural factors and the clinical quality of care for managing sick children. We developed indices for readiness and quality accounting for available indicators, expert opinion, and alignment with integrated management of childhood illness (IMCI) guidelines. In each country, we assessed the association between readiness and quality, with and without adjusting for other factors. We considered associations overall, by domain, and by provider type, explored non-linear associations, and compared associations at the individual and facility-level. The analysis included data from 3,149 health facilities and 11,159 sick child observations. In four of the five countries included in the analysis, we observed for every 10%-point increase in readiness, quality increased by about 1% point after adjusting for facility type and managing authority. There was little evidence of a non-linear relationship or a threshold effect altering the relationship between readiness and quality of care. Beyond readiness, younger child age, higher cost of care, and having a respiratory, digestive, or febrile diagnosis were most often associated with a higher quality of care. Higher "human resources" readiness domain scores were most consistently associated with better quality of care, while the quality of care domain of "treatment" was the least influenced by readiness. Facility-level associations did not vary greatly from individual-level associations. The weak correlation observed suggests readiness plays an important role in quality but as currently measured cannot be used to characterize clinical quality of care. Data for assessing quality of health services are limited, presenting challenges for understanding impediments, assessing interventions, and gauging changes in the quality of care over time. We need better data to assess the quality of care being delivered in LMICs to understand what factors drive quality, with the goal of improving the management of sick children.

Cost analysis of adding hypertension and diabetes management into routine HIV care in Mbarara and Ibanda districts, Uganda.

In 2016, Uganda introduced services for hypertension and diabetes in selected HIV clinics. We evaluated the costs associated with scaling up these services in HIV clinics in Mbarara and Ibanda districts, Uganda. We estimated the annual costs of providing hypertension and diabetes services using an activity-based costing approach from the health system perspective in ten randomly selected HIV clinics in Mbarara and Ibanda districts. Cost inputs included 2023 data on costs of medications, health provider time, salaries, training costs, and monitoring costs. We determined the average annual cost and medication costs for hypertension and diabetes treatment per enrolled adult patient, stratified by type of health facility. The total annual cost of hypertension and diabetes management services in ten selected HIV clinics was estimated to be $413,850 (range: $8,386 - 186,973). The annual average clinic-level cost per enrolled patient was estimated at $14 (range: $7 - 31). Of the total annual cost, the cost of provider time for initial and follow-up visits represented the largest cost component in 5/10 clinics (mean: 37%, range [13-58%]). In 4/10 clinics, the major cost components were the costs of medication, diagnostic tests, and related supplies (mean: 37%, range [10-75%]). The average cost per enrolled adult patient was $11 at public facilities and $21 in private not-for-profit facilities. The average medication cost per patient for hypertension was $24 (range: $7 - 97) annually; $13 at public facilities and $50 at private not-for-profit facilities. For diabetes treatment, the average annual medication cost per patient was estimated at $14 (range: $6 - 35); $11 at public facilities and $22 at private not-for-profit facilities. Adding hypertension and diabetes management to routine HIV care might be feasible based on the estimated annual cost per patient. Hypertension and diabetes treatment was more costly in private not-for-profit facility-based clinics than at public facilities. This variation was primarily driven by higher medication procurement prices at private facilities, revealing a potential area for optimizing costs through improved procurement practices.

Exploring the Impact of Regional Environment and Institutional Factors on Operation Period of Nursing Facilities in Taiwan.

This study examines factors influencing the operational durations of nursing facilities in Taiwan. It departs from previous closure-focused research by analyzing the duration of facility operation. A Cox regression model was employed to assess the impact of regional, governmental, and individual institutional factors on 199 facilities across diverse areas in Taiwan from 2011 to 2019. Results demonstrate closure hazards associated with rising property prices, particularly for rented facilities, with metropolitan locations exhibiting superior survival rates and lower institutional appraisal grades significantly increasing closure. Additionally, operator background, facility type, and bed occupancy emerged as influential factors. These findings underscore the financial vulnerability of rented facilities to market fluctuations and the challenges associated with adjusting resident fees. Furthermore, the study highlights the unique challenges faced by facilities in low-density areas regarding resident access to resources. Policymakers should closely monitor regional factors and consider proactively implementing early warning systems to address these challenges.

DISP-18. RACIAL DISPARITY IN THE UTILIZATION OF MOLECULAR DIAGNOSTIC AS A PROXY FOR SUB-OPTIMAL CLINICAL CARE IN GLIOBLASTOMA PATIENTS

Abstract BACKGROUND Molecular characterization of IDH mutation and MGMT-promoter methylation (MGMTm) are standard-of-care (SOC) diagnostics and essential to diagnosis, treatment, and prognosis of glioblastomas. Here, we determined the extent to which racial disparity occurs in this dimension of oncologic care. METHODS 31,439 glioblastoma patients were derived from the National Cancer Database (NCDB,2018-2021), with 20,736 IDH-wildtype patients with defined MGMT-status. Accessibility to SOC diagnostics was defined as whether patients got IDH/MGMT testing or not. Race/Ethnicity was grouped into Non-Hispanic White (NHW), Non-Hispanic Black, Asian/Pacific Islander, Hispanic, and Others. Receipt of SOC diagnostics and treatments, post-operative outcomes, and overall survival (OS) were explored using multivariable logistic regression, Kaplan-Meier method, and Cox proportional hazards models. RESULTS Relative to NHWs, all racial minority groups were less likely to have undergone IDH or MGMT-testing. These effects remain robust after adjusting for economic status, insurance, and facility type. Patients who received neither IDH nor MGMT-testing were 38% less likely to undergo SOC concurrent chemo-/radiation therapy (cCRT) relative to those having both testing. Further, patients having neither IDH nor MGMT-testing showed significantly higher risk of 30-day mortality (aOR:2.20), 90-day mortality (aOR:1.60), and hazard of death (median OS:8.9-mon,aHR:1.09,p=0.002) than those having both testing (median OS:12.9-mon). Of those tested for both IDH/MGMT, the odds of bearing a methylated MGMT-promoter remained relatively constant across five racial groups. Non-NHW glioblastomas patients were significantly less likely to receive SOC-modality. Of the patients who underwent IDH/MGMT-testing and cCRT, median OSs were 23.7 and 14.4-mon for MGMT-methylated and unmethylated glioblastoma, respectively. No significant difference in hazards of death for racial/ethnic minorities compared to NHWs was detected, regardless of MGMT-methylation status. CONCLUSIONS Our findings suggest that non-NHW glioblastoma patients are less likely to undergo SOC diagnostic (IDH/MGMT) testing, which serves as a proxy for receipt of sub-optimal clinical care. For glioblastoma patients who underwent SOC molecular testing and treatment, survival is similar across racial groups.

Analyzing spatiotemporal features of Suzhou's old canal city: an optimized composite space syntax model based on multifaceted historical-modern data

AbstractRivers and road systems play crucial roles in urban development and in shaping the vitality of cities. The present study focuses on the spatiotemporal development patterns of canal cities. Taking Suzhou as an example, employing various spatial measurement methods combined with multidimensional spatiotemporal data, it clearly demonstrates the urban morphological patterns and societal characteristics related to the road and river network systems at different stages of urban development. Utilizing data extracted from historical and modern maps of Suzhou and employing the YOLO (You Only Look Once) algorithm, this study establishes a spatiotemporal dataset for Suzhou's ancient city, a representative Chinese canal city. An optimized space syntax algorithm for public service facilities, utilizing Python library like Geopandas, Numpy, is proposed to analyze the river and road system's impact on historical development and urban morphology. With multiple spatial econometric models applied to maps from various periods, this research explores the following findings: (1) By controlling rivers as a variable, it quantitatively confirms that rivers were crucial components of urban systems in ancient cities, playing a significant role in urban development and activities, though gradually overlooked in modern times. (2) Public service facilities of different types demonstrate patterns of Accessibility and Integration within the river-road system across various periods. (3) Changes in the distribution of public service facilities correspond to phased shifts in the center of Suzhou’s ancient city, mutually validating the authenticity of realistic paintings, historical maps, and the methodologies used in this study. This study emphasizes a broader historical and spatiotemporal perspective, augmented by quantitative research methods. It investigates the distribution and developmental characteristics of various types of public service facilities across different periods. The research aim is to understand the impact of river and road systems on urban development, as well as the morphological and social changes in historical cities that arise from urban activities.

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.

Bicycle Simulator Use to Evaluate Safety Risks and Perceptions for Enhanced Sustainable Urban Mobility

(1) Background: As cycling gains popularity as a mode of transportation, the frequency of accidents involving cyclists also rises. This has become a major concern for traffic safety, sustainability, and city planning. Identifying the risk factors that contribute to bicycle road accidents remains a significant challenge. This study aims to figure out which risk factors make some road segments more dangerous for cyclists than others. (2) Methods: This study introduces the use of a bicycle simulator to test different road segments involving thirty-nine participants. The impact of demographics and some risk factors related to infrastructure were analyzed in terms of their influence on the perceived level of risk through pre- and post-surveys. (3) Results: The findings showed that the bicycle facility type affects the perceived level of risk. Shared-use roads were ranked as riskiest, while separated bike lanes were least risky. Bicycle roads with no separated safety barriers had higher risks. Heavy traffic jams increased danger among cyclists. Women gave higher risk ratings than men. The perceived levels of risk were then compared with the previously developed risk index and they correlated well. (4) Conclusions: This confirms that the risk index can reliably evaluate the degree of risk of each road segment.

Rural Residence Associated with Receipt of Recommended Post-Discharge COPD Care among a Cohort of U.S. Veterans.

Individuals with chronic obstructive pulmonary disease (COPD) in rural areas experience inequitable access to care. To assess whether rural residence is associated with receipt of recommended post-discharge COPD care. We conducted a cohort study of all U.S. Veterans discharged from a VA Medical Center following COPD hospitalization from 2010 to 2019. Rural residence was defined by Rural Urban Commuting Area classification. Our primary outcome was the proportion of recommended care received within 90 days of hospital discharge, including: smoking cessation therapy; appropriate management of supplemental oxygen; appropriate prescription of inhaled therapy; and pulmonary rehabilitation. We conducted multi-variable linear regression between rural residence and the proportion of recommended care received, adjusting for age, sex, race, ethnicity, comorbidities, and primary care facility type. We tested multi-variable linear probability models for each of the recommended therapies. Of 67,649 patients, 7,370 (10.8%) resided in rural areas, and 2,000 (3.0%) in highly rural areas. Overall, the proportion of recommended COPD treatments received was low (mean 15.0%, standard deviation 21.0%). Compared with urban residence, patients with rural and highly rural residence received fewer recommended COPD care treatments (rural estimate [adjusted % difference (95% CI)]: -1.1 (-1.6, -0.6); highly rural estimate: -1.2 (-2.1, -0.3)). Rural and highly rural residence were associated with lower likelihood of receiving appropriate inhaled therapy escalation (rural estimate: -4.0 (-5.1, -3.0); highly rural estimate: -3.0 (-5.0, -1.1)) and pulmonary rehabilitation referral (rural estimate: -1.2 (-1.6, -0.9); highly rural estimate: -2.1 (-2.7, -1.4)), but a higher likelihood of receiving smoking cessation therapy (rural estimate: 5.4 (3.3, 7.5); highly rural estimate: 7.2 (3.3, 11.2)). There was no significant difference in appropriate oxygen management (rural estimate: -1.0 (-2.8, 0.9); highly rural estimate: 3.1 (-0.7, 6.9)). Patients across the rural-urban spectrum received few recommended post-discharge COPD treatments. Health systems approaches are needed to address widespread underutilization of evidence-based COPD care.

Research of Options for Constructing Information Management Systems Based on Network Models of Queuing Systems

The use of information management systems (IMSs) for the management of technical facilities is currently one of the directions for further improvement and increase in the effectiveness of the use of technical facilities in solving their target tasks. The existing modern IMSs are a set of hardware and software tools designed for collecting, processing and storing information and management. In the presence of a large amount of information and contradictory factors affecting the quality of management, making informed and timely decisions in the management process is impossible without the use of IMSs. The IMSs currently being developed are, for the most part, specialized systems and are designed to solve specific tasks. In this regard, the development and design of IMSs should be carried out taking into account the relationship with the target indicators and features of the management facilities, the results of a comprehensive analysis of information about the IMS elements in the process of functioning, and structural and algorithmic parameters that affect performance indicators. The use of mathematical models for the study of options for the construction of an IMS is the basis for the design and development of devices and subsystems of an IMS. The IMS models currently being developed make it possible to conduct research for single-stage management processes with the presence of similar service facilities in the system. At the same time, modern technical facilities and control systems are complex complexes with cyclically repeating control processes of various types of means. As a rule, such complexes have a set of parallel operating devices (control channels) that provide control of different types of objects at various stages of information processing. In this case, the structure of the IMS must be represented as a multiphase multichannel technical system in which the process of simultaneous management of several objects of various types takes place. In this regard, the purpose of the article is to develop a mathematical model of an IMS with two phases of management and the presence of an arbitrary number of serviced different types of management facilities. The basis of the model is a multiphase CFR network model with a limited waiting time for an application in the service queue. The study on the model allows choosing an option for building an IMS, in particular, choosing the optimal number of control channels for various types of objects according to the criterion of optimality and restrictions on the cost and time of management. An algorithm for selecting an option for building an IMS has been developed, and an example of calculating the number of control channels for managing three types of objects is given.

Disparities in Receipt of Adjuvant Immunotherapy among Stage III Melanoma Patients.

Melanoma survival has greatly improved with the advent of immunotherapy, but unequal access to these medications may exist due to nonmedical patient factors such as insurance status, educational background, and geographic proximity to treatment. We used the National Cancer Database to assess patients with nonmetastatic cutaneous melanoma who underwent surgical resection and sentinel lymph node biopsy (SLNB) with tumor involvement from 2015 to 2020. We evaluated rates of adjuvant immunotherapy among this patient population based on patient, tumor, and facility variables, including insurance status, socioeconomic status, pathologic stage (IIIA-IIID), and treatment facility type and volume. Adjuvant immunotherapy was associated with improved survival for stage III melanoma, with a slight increase in 5-year OS for stage IIIA (87.9% vs. 85.9%, P=0.044) and a higher increase in stages IIIB-D disease (70.3% vs. 59.6%, P<0.001). Receipt of adjuvant immunotherapy was less likely for patients who were older, low socioeconomic status, or uninsured. Low-volume and community cancer centers had higher rates of adjuvant immunotherapy overall for all stage III patients, whereas high-volume and academic centers used adjuvant immunotherapy much less often for stage IIIA patients compared with those in stages IIIB-D. Our results demonstrate inconsistent use of adjuvant immunotherapy among patients with stage III melanoma despite a significant association with improved survival. Notably, there was a lower use of adjuvant immunotherapy in patients of lower SES and those treated at high-volume centers. Equity in access to novel standards of care represents an opportunity to improve outcomes for patients with melanoma.

Analysis of the Implementation of Standard Precautions in Preventing Healthcare Associated Infections (HAI's) at Wampu Norita General Hospital

Standard precautions are needed to implement the IPC program in hospitals. Implementation of Standard Precautions can be carried out because it is driven by the PPI Committee or Team. The PPI Committee or Team is formed based on needs, workload, and type of health service facilities. The eleven components of standard precautions can be implemented in every health service, especially in Indonesia which is trying to reduce HAIs. HAIs are known as nosocomial infections that occur in hospital patients, where infection has not occurred while the patient has been hospitalized for more than 48 hours. The large risk of infection in hospitals encourages the need to reduce the risk of infection through the PPI Program. A descriptive qualitative research method was chosen to obtain meaning from a number of individuals and social groups. The qualitative research process includes asking questions, collecting data, analyzing data, and interpreting the meaning of the data. The sample in this study was 8 informants, including Hospital Leaders, heads of Hospital Quality, Nurses in charge of the field, Daily Executive Officers, and Executive Nurses in service units. The results show that the PPI policy has been implemented well which includes the PPI Structure and Team, Infection Surveillance Manual, Standard Precautions and implementation of Hand Hygiene and PPE, as well as the budget. Meanwhile, the condition of facilities and infrastructure is not optimal, such as hand hygiene facilities and use of PPE, collection of HAI infection surveillance data, and training. Conclusion: The Standard Precautions Implementation Policy already exists and is based on Minister of Health Regulation No. 27 of 2017. The results of the Hand Hygiene and PPE compliance audit do not match the Quality Profile, facilities, and infrastructure are not optimal, namely below 100%, and stock in the premises is still limited

Are there differences in overall survival among older breast cancer patients by race and ethnicity?

BackgroundNon-Hispanic Black women have lower breast cancer incidence but twice the mortality of non-Hispanic White women. Recent data suggest that the overall survival difference may not be observed in older women. This study aims to determine overall survival in women aged ≥70 years with operable breast cancer by race and ethnicity and factors contributing to overall survival. MethodsThe National Cancer Database was queried to identify women aged ≥70 years with stage 0–III breast cancer from 2004 to 2018. Patients were separated by race and ethnicity: non-Hispanic White, non-Hispanic Black, Hispanic, and Other. To examine overall survival, a Cox proportional hazards model was created, and overall survival was calculated using the Kaplan-Meier method. ResultsThere were 304,345 eligible patients. The mean age was 76.8 years (standard deviation 5.5 years), and most were non-Hispanic White (85.2%), had Medicare (86.8%), had hormone receptor–positive breast cancer (78.7%), and underwent partial mastectomy (64.5%). Compared with non-Hispanic White women, non-Hispanic Black women had a higher prevalence of stage III disease (10.8% vs 7.5%, P < .001) and triple-negative breast cancer (16.7% vs 8.7% P < .001), and a longer time to treatment initiation (39.2 vs 32.3 days, P < .001). Median follow-up was 5.38 years (interquartile range: 3.83–7.46 years). Non-Hispanic Black women had the lowest median survival time compared with non-Hispanic White women (9.7 vs 10.4 years, P < .001). After adjusting for insurance type, receptor status, stage, comorbidity, time to treatment, and facility type, there was no increased risk of death for non-Hispanic Black patients (hazard ratio: 0.99, 95% confidence interval: 0.96–1.01, P = .29). ConclusionAlthough overall survival was lower in older non-Hispanic Black women, this difference resolved on multivariate modeling, suggesting that other factors likely influence overall survival for this cohort.

Racial and ethnic disparities in the incidence of stroke and mortality in atrial fibrillation: a US nationwide study

Abstract Background Atrial fibrillation (AF) is the most common arrhythmia globally and is associated with increased risks of cardiovascular mortality and ischemic stroke. Prior research has demonstrated racial/ethnic disparities in AF outcomes yet this work has been limited to small cohorts and did not adjust for anticoagulant therapy. Purpose We compared incidence of ischemic stroke and death by race/ethnicity for patients with AF in the Veterans Health Administration (VA), the largest integrated, low-cost, national healthcare system in the US. Methods In this retrospective cohort study we identified those with an outpatient diagnosis of AF and a confirmatory diagnosis ≦ 180 days of their index AF diagnosis enrolled in VA from January 1, 2014 to December 31, 2021, with follow-up for outcomes from the index AF diagnosis date until May 31, 2022. To create a cohort of incident AF cases, we excluded patients with an AF diagnosis or anticoagulant therapy in the 2 years prior to their index AF diagnosis. We also excluded patients with pre-existing valvular heart disease, prior stroke, receiving hospice care or who died within 180 days of index AF diagnosis. We categorized our independent variable as race (i.e., non-Hispanic American Indian / Alaska Native [AI/AN], Asian, Black, or White [reference group]), and ethnicity (i.e., Hispanic). Our primary outcomes were incidence of stroke or death at any point within the study follow-up period. To compare these outcomes by race/ethnicity we conducted a survival analysis, adjusting for anticoagulant use as a time-varying covariate along with sociodemographic factors (age, sex, region, area deprivation index), clinical factors (CHADS2VA2Sc stroke risk and HAS-BLED bleeding risk), and facility type. Results There were 187,080 patients in the final cohort including 0.5% AI/AN, 1% Asian, 9% Black, 4% Hispanic, 85% White; mean age was 73 years. Over a mean study follow-up period of 4.43 years, 65,375 (34.9%) patients died and 24,910 (13.3%) developed stroke. The adjusted hazard ratio [95% CI] for death was lower for Hispanic (0.84 [0.78, 0.91]) and Black (0.94 [0.91, 0.97]) patients than White patients. In contrast, the adjusted hazard ratio for stroke incidence was higher for Black (1.21 [1.16, 1.27]) and Hispanic (1.10 [1.03, 1.17]) patients than White patients. There was no difference observed between AI/AN or Asian and White patients in either outcome. Conclusions In a national cohort of patients with incident AF, we identified significantly higher rates of stroke in Black and Hispanic than White patients even controlling for myriad factors including anticoagulant use. Conversely, racial/ethnic disparities in mortality appear to be eliminated in VA, counter to prior data. Understanding the factors, beyond anticoagulation, driving disparities in stroke outcomes and identifying factors reducing mortality among minority groups is critical to improving overall AF care in the largest integrated US health system.Adjusted Hazard Ratios of Study Outcomes

Gender stereotypes in Ukrainian healthcare: results of the mixed methods study

Abstract Background A good interpersonal patient-provider relationship is crucial for quality care, still patients frequently perceive interface as discriminatory and marginalizing, reinforcing societal gender roles and hindering healthcare quality. This becomes even more critical for healthcare systems with limited resources and prolonged emergencies, such as Ukraine during the COVID-19 pandemic and full-scale war. We explore gender stereotypes of healthcare workers in Ukraine. Methods This mixed-methods study was conducted in August-September 2022, and included: 1)16 online focus group discussions with 93 healthcare workers; 2)survey conducted face-to-face with 1,529 physicians and 502 nurses; modified Nijmegen Gender Awareness in Medicine Scale questionnaire was used. Qualitative data was transcribed and inductively analyzed. Survey results were analyzed in SPSS using descriptive statistics and correlation analyses. Results Healthcare workers perceived women patients as ‘more demanding’ and ‘less accommodating’ compared to men. Thus, 64% of healthcare workers perceived female patients as overusing health services; 44%-believed women have higher expectations than male patients; 61%-thought they expected excessive empathy; and 58%-noticed women veering off-topic during consultations. Also, respondents who supported the belief that male patients better understand doctors’ recommendations were more likely to also support the statement that female patients, compared to male patients, more often have higher expectations from doctors (rs = 0.4, p &amp;lt; 0.001). With age prevalence of gender stereotypes increased among healthcare workers; there were no significant differences by sex of healthcare workers, healthcare facility type, position, or geographical location. Conclusions It is crucial to develop and implement gender-sensitive approaches in Ukrainian health facilities, rooted in comprehensive training and continuous professional development targeting prevalent gender stereotypes. Key messages • Gender stereotypes are prevalent among healthcare workers in Ukraine. • Gender-sensitive approaches and comprehensive training should target prevalent gender stereotypes.

Artificial subsurface lithoautotrophic microbial ecosystems and gas storage in deep subsurface.

Over the next few years, it is planned to convert all or part of the underground gas storage (UGS) facilities used for natural gas (salt caverns, depleted hydrocarbon reservoirs, and deep aquifers) into underground dihydrogen (H2) storage reservoirs. These deep environments host microbial communities, some of which are hydrogenotrophic (sulfate reducers, acetogens, and methanogens). The current state of microbiological knowledge is thus presented for the three types of UGS facilities. In the mid-1990s, the concept of anaerobic subsurface lithoautotrophic microbial ecosystems, or SLiMEs, emerged. It is expected that the large-scale injection of H2 into subsurface environments will generate new microbial ecosystems called artificial SLiMEs, which could persist over time. These artificial SLiMEs could lead to H2 loss, an intense methanogenic activity, a degradation of gas quality and a risk to installations through sulfide production. However, recent studies on salt caverns and deep aquifers suggest that hydrogenotrophic microbial activity also leads to alkalinization (up to pH 10), which can constrain hydrogenotrophy. Therefore, studying and understanding these artificial SLiMEs is both a necessity for the development of the H2 industry and presents an opportunity for ecologists to monitor the evolution of deep environments in real time.

Trends in Workplace Violence for Health Care Occupations and Facilities Over the Last 10 Years

Abstract Issues of workplace violence (WPV) in healthcare has garnered increasing attention, due to the impact on the health care worker well-being and retention. Yet, our understanding of whether and how WPV rates vary between health care facilities and occupations is limited, particularly information on growth over time. This information is needed to develop and target policies and interventions toward health care workers and settings most at risk. We examined trends in WPV among healthcare occupations and facilities over the past decade (2011-2021/2022), utilizing data from the Bureau of Labor Statistics’ Survey of Occupational Injuries and Illness (SOII). Findings reveal a 30% increase across all health care facility types between 2011 and 2021/22; however there was no difference in the average rate of WPV for health care occupations over the same time period. The increase of WPV for health care facilities began long before the pandemic, suggesting larger systemic issues are likely driving WPV. Existing state and organizational efforts aim to mitigate WPV, yet targeted interventions are crucial. Understanding variations across occupations and facilities will inform tailored strategies to safeguard healthcare workers.

Community members’ perspective on social accountability in the health system: a cross- sectional study from Tanzania

Introduction: Social accountability initiatives are considered a way to address inefficiencies and improve overall health system performance. Tanzania has introduced Health Facility Governing Committees (HFGCs) to improve social accountability of the health system. However, information on how communities perceive these committees is lacking. This study aimed to assess the prevalence and social determinants of the HFGCs accountability from the community perspective in Tanzania. Methods: The research employed a cross-sectional survey design in two Tanzanian districts (Handeni and Mbarali) selected for their contrasting health performance. Data collection took place from July to October 2022, involving 1184 households in 31 villages/mitaa. The study measured social accountability through a set of six questions, focusing on community support, sensitization, feedback, trust, engagement, and overall accountability of HFGCs. Socio-demographic data such as sex, age, education, occupation, type of health facility and district were also collected and analyzed using linear regression to identify factors influencing perceptions of accountability. Results: The findings revealed a low prevalence of social accountability as measured by the variables of community awareness and engagement with the HFGCs. Only a small percentage of respondents felt adequately informed or involved in the activities of these committees. Social determinants such as higher education levels and certain occupations, such as business and retirement and those living in Handeni district, correlated positively with a better perception of social accountability. Conclusion: The study highlights significant challenges in the operational effectiveness of HFGCs in Tanzania, with a notable disconnect between these bodies and the communities they serve. Despite the theoretical framework for social accountability, actual community engagement remains low, impacting the overall efficacy of health governance at the local level. Future research should focus on improving community awareness and participation in these committees to improve their functionality and accountability, thereby aligning with national health objectives and local needs.

Factors Associated with Poor Treatment Outcomes in Newly Diagnosed Tuberculosis Patients in Sub-Sahara Africa: A Systematic Review

Introduction: The burden of Tuberculosis (TB) in Africa continues to rise despite numerous interventions to stop the spread. Addressing factors associated requires a robust model that addresses cross-cutting issues in the continuum of TB care and management. The objective of this systematic review is to determine factors associated with poor treatment outcomes in newly diagnosed TB patients in sub-Saharan Africa. Method: The literature search identified 234 studies that were written in English. All the articles were identified via database search and imported into Mendeley for analysis. A total of 95 duplicates were removed and the abstracts of remaining studies were reviewed. A total of 139 abstracts were screened with misleading and non-open access journal articles removed. A full reading of the remaining 104 potentially relevant studies was done, in order to ascertain compliance with the inclusion/exclusion criteria and 24 studies were found to be eligible and were included in this review. Results: HIV co-infection, type of TB infection and gender were observed as most common factors associated with poor treatment outcomes in newly diagnosed patients. Several studies emphasized the impact of male gender on poor treatment outcomes stating a higher likelihood to developing unfavorable outcomes. Other factors identified included social factors namely employment, location, nutrition, failure to gain weight, failure to present at facility, delay to be treated at the facility and the type of facilities where one was treated. Conclusion: The common factors associated with poor treatment outcomes were HIV co-infection, type of TB infection and gender and these were notably underscored by social factors. Addressing these challenges will significantly improve the health outcomes of TB patients in the region.

Adherence to IMCI guidelines for key symptoms in Ethiopian children: A 2021-2022 national service provision survey.

The Health Services Provision Assessment in Ethiopia (SPA-ET) is a survey that generates data on the availability and quality of health services in Ethiopia. Despite the presence of integrated management of childhood illness guidelines in healthcare settings, there has been inadequate exploration or assessment of how effectively and consistently health professionals follow the guidelines. This study aims to identify factors influencing healthcare worker adherence to the integrated management of childhood illness guidelines to identify spatial clusters. The data for this study were gathered from the Service Provision Assessment (SPA) survey in Ethiopia, which was conducted nationwide from August 11, 2021, to February 4, 2022. It included a total of 788 health professionals who assessed sick children experiencing at least one of the three main childhood illness symptoms: fever, cough, or diarrhea. We employed STATA version 16 for data analysis, utilizing cross-tabulations to explore relationships between variables and logistic regression modeling to identify factors influencing adherence. To account for the hierarchical structure of the health survey data, we employed multilevel logistic regression. Model selection was based on comparison parameters including the Bayesian Information Criterion (BIC) and Akaike Information Criterion (AIC). We computed adjusted odds ratios with 95% confidence intervals, and statistical significance was determined at a significance level of p < 0.05. The rate of adherence to the integrated management of childhood illness guideline was 33% (95% CI: 29.70%, 36.26%). The analysis revealed several factors influencing adherence to IMCI protocols. child's age (being ≥24 months) [aOR = 0.66, 95% CI: (0.45, 0.87)], facility type (health center) [aOR = 2.61, 95% CI: (1.84, 3.37)], place of residency (being rural) [aOR = 0.54, 95% CI: (0.38, 0.77)], and care provider's qualification (health officer) [aOR = 1.71, 95% CI: (1.18, 2.48)] were all statistically significant. Moreover, the primary cluster is situated in the west Oromia region, with a central focus at coordinates (7.982108 N, 36.203355 E) and extends to a radius of 78.28 km. This study confirms a low adherence rate (33%) among health professionals in Ethiopia to the IMCI guideline for assessing the three main symptoms of sick children. The study identified child's age, facility type, academic qualification, and place of residence as crucial factors correlated with adherence rate. Furthermore, 5 secondary clusters (hotspot areas) were identified using SaTScan software. To address the higher protocol refusal, interventional plan needs to be based on academic qualification of care provider, facility type, age of child and place of residency. Moreover, interventions to reduce non-adherence to IMCI guidelines should be location-tailored based on identified hotspot areas to restore guidelines adherence equality.

In-depth characterization of food and environmental microbiomes across different meat processing plants

BackgroundProcessing environments can be an important source of pathogenic and spoilage microorganisms that cross contaminate meat and meat products. The aim of this study was to characterize the microbiome of raw materials, processing environments and end products from 19 facilities producing different meat products.ResultsThe taxonomic profiles of the microbial communities evolved along processing, from raw materials to end products, suggesting that food contact (FC) surfaces play an important role in modulating the microbiome of final products. Some species persisted with the highest relative abundance in raw materials, food processing environments and/or in the final product, including species from the genera Pseudomonas, Staphylococcus, Brochothrix, Acinetobacter and Psychrobacter. Processing environments showed a very diverse core microbiota, partially shared with the products. Pseudomonas fragi and Pseudomonas sp. Lz4W (in all sample and facility types) and Brochothrix thermosphacta, Psychrobacter sp. and Psychrobacter sp. P11F6 (in raw materials, FC surfaces and end products) were prominent members of the core microbiota for all facilities, while Latilactobacillus sakei was found as a dominant species exclusively in end products from the facilities producing fermented sausages. Processing environments showed a higher amount of antimicrobial resistance genes and virulence factors than raw materials and end products. One thousand four hundred twenty-one medium/high-quality metagenome-assembled genomes (MAGs) were reconstructed. Of these, 274 high-quality MAGs (completeness > 90%) corresponded to 210 putative new species, mostly found in processing environments. For two relevant taxa in meat curing and fermentation processes (S. equorum and L. sakei, respectively), phylogenetic variation was observed associated with the specific processing facility under study, which suggests that specific strains of these taxa may be selected in different meat processing plants, likely contributing to the peculiar sensorial traits of the end products produced in them.ConclusionsOverall, our findings provide the most detailed metagenomics-based perspective up to now of the microbes that thrive in meat, meat products and associated environments and open avenues for future research activities to better understand the microbiome functionality and potential contribution to meat quality and safety.BW5-yJYgBWXLb4-yN7W47nVideo