Four-year Study Research Articles

Measurement of DDD and DOT metrics for optimizing antimicrobial surveillance in two tertiary hospitals in Viet Nam: A four-year retrospective study

Measurement of DDD and DOT metrics for optimizing antimicrobial surveillance in two tertiary hospitals in Viet Nam: A four-year retrospective study

Resistance of sugarcane hybrids to internode borer Chilo sacchariphagus indicus (Lepidoptera: Crambidae)

ABSTRACT A four-year field study (2013–2016) was conducted to screen Indian sugarcane hybrids together with two susceptible checks against internode borer Chilo sacchariphagus indicus (Kapur) (Lepidoptera: Crambidae) in endemic locations of Tamil Nadu State, India. Each year, borer incidence on cane basis and intensity on internode basis were assessed at harvest to eliminate susceptible entries. Of the total 535 hybrids screened, only Co 293 emerged as resistant at the end of fourth year trial which was confirmed in tests under controlled conditions with artificial infestation. A modified relative resistance ratio computed using incidence and intensity also confirmed its resistance to the borer. In laboratory oviposition choice tests with excised leaves of the resistant Co 293 and susceptible hybrids Co 86032 and Co 1060, percent of leaf bits oviposited, egg masses laid, and egg numbers deposited were significantly lowest in Co 293. Also, an oviposition preference index computed for both egg mass number and egg number was significantly lowest for Co 293 which suggested antixenosis. Larval survival was significantly lowest in Co 293 with 5 to 10-fold higher neonate mortality than in the two susceptible hybrids. Prolonged larval development period and lower fecundity were observed when the borer was reared on Co 293 which indicated antibiosis. A relative suitability ratio developed from larval and pupal durations also indicated lower suitability of Co 293. Among the plant morphological characters examined, leaf length and cane thickness positively influenced borer incidence; loose sheath-clasp was associated with higher borer incidence. Among 12 shoot phenolics quantified, eight were present in higher quantities in Co 293 suggesting their role in antibiosis. Co 293 identified as resistant hybrid in the present study has the potential to be used as a parent in breeding programs for C. sacchariphagus indicus resistance.

Analysing lapsing rates among first-time blood donors at a blood centre in Zimbabwe using survival analysis.

blood centres are often faced with the problem of donor lapsing resulting in loss of donors from the already strained donor pool. In Zimbabwe, 70% of the donated blood comes from younger donors aged 40 years and below, who at the same time, have high attrition rates. This study seeks to apply the concept of survival analysis in analysing blood donor lapsing rates. in analysing the donor lapsing and retention rates, data on 450 first-time blood donors at the National Blood Service Zimbabwe, in Harare´s blood bank for the period 2014 to 2017 was extracted from the donors´ database. The Cox proportional hazards (Cox PH) and Kaplan-Meier methods were applied in the analysis. Donor demographic characteristics suspected of having effect on donor lapsing and retention were identified and analysed. the study findings show that 56.9% of the donors had lapsed by the end of the four-year study period. Results from the multiple Cox PH model indicate that donor age had a significant effect on blood donor retention time (p = 0.000918 < 0.05). The hazard ratio (HR) = 0.615 with 95% CI: (0.461; 0.820) shows that the relatively older donors had a lower hazard (38.5% lower) of lapsing compared to the hazard for younger donors. The effect of gender, blood donor group and donation time interval on donor retention and attrition were not statistically significant. Male donors had HR = 1.03; 95% CI (0.537; 1.99) with (p = 0.922 > 0.05) and donors with a 4-month interval between donations had HR = 1.31; 95% CI (0.667; 2.59) with (p = 0.430 > 0.05). the study confirmed the problem of donor attrition faced by blood centres. The age of the donor had a significant effect on the retention time of blood donors before lapsing. The older the blood donor, the lower the risk of lapsing. The Zimbabwe National Blood Service (NBSZ) Blood Centre authorities should have a critical mass of individuals above 40 years as potential blood donors because of their reliability in blood donation according to the study findings.

The use of audio-biographical cues in dementia care: a four-year evaluation in Swiss hospitals, care, and domestic homes.

In dementia care, the integration of innovative interventions is essential to enhancing the wellbeing and quality of life of people with dementia. Among these interventions, the Music Mirror intervention has emerged as a promising tool to provide personalized audio-biographical cues aimed at soothing, motivating, and engaging people with dementia. This study examined the effects of a Music Mirror intervention on the (a) wellbeing, emotions, and behavioral and psychological symptoms of 155 individuals with dementia, (b) perceived burden, relationship quality, and gains of their informal/formal caregivers, and (c) momentary closeness, wellbeing and stress of caregivers. This four-year study employed a quasi-experimental waiting-control group design, utilizing before-after measurements in Swiss hospitals, care homes, and domestic homes. For four 6-week intervention phases, Music Mirrors, i.e., brief written resources of acoustic material, associated with practical activities of daily life, were applied at least twice a week by the caregivers during critical moments such as staff handover. Repeated measures' analysis of variance and other tests were used to analyze the data. Individuals with dementia had a higher wellbeing after the Music Mirror use across different care situations. While the Music Mirrors were played, individuals with dementia showed more positive than negative emotions at each measurement occasion, but emotion scores did not significantly change over time. After the MM use, caregivers felt better, closer to the person with dementia, and less stressed. Caregivers also reported significant gains at the end of the intervention. However, there were no significant changes in the frequency of the behavioral and psychological symptoms of dementia, care-related burden and relationship quality over time, regardless of the treatment condition. By incorporating personalized audio-biographical cues into their care routines, the wellbeing of people with dementia was improved as well as it had positive momentary effects on their caregivers. The Music Mirror intervention addresses the preferences and needs of people with dementia and helps build bonds between care-recipients and caregivers. Therefore, Music Mirrors can be seen as a highly adaptive and individualized instrument to improve momentary wellbeing of people with dementia in various care situations during daily life.

Evolutionary Profil of Triple-Negative Breast Cancer and Influence of Histopronostic Factors: Experience of Oncology Department Chu Ibn Rochd Casablanca

Triple-negative breast cancer (TNBC) is a subgroup of breast cancer with hormone receptor and Her2 overexpression absence, accounting for 15%–20% of all breast cancers. Its unpredictable evolution, poor treatment response, and highly invasive nature warrant research interest. The main objective of this study is to assess the evolution of triple-negative breast cancer as a role for histopronostic factors. We present the evolutionary profile of triple-negative breast cancer in the role of histopronostic factors using data from a four-year retrospective study of cases of triple-negative breast cancer collected in the oncology-radiotherapy department at Chu Ibn Rochd Casablanca between January 2015 and December 2019. 232 patients were included, regardless of disease stage. The mean age was 49.54 ± 11.21 years. In 68% of cases, the disease was localized. All metastatic patients (32%) died, with a median survival of 15 months. We analyzed the evolution of triple-negative breast cancer in localized disease as a role for age, tumor size, histological type, SBR grade, lymph node invasion, and vascular invasion, with a median follow-up of 24 months (2 years). In 158 patients in our series with localized disease, local or locoregional recurrence was noted in 16% of cases, metastatic relapse in 10%, and 30% of cases were still in complete remission. Patients aged between 40 and 50 had a higher rate of local and locoregional recurrence. Patients with tumors between 2 and 6 cm in size had a high rate of metastasis and death. Grade SBR III is generally marked by a poor prognosis, with 39 patients having local or locoregional recurrence, 41 patients having metastases, and 15 patients having died. In our series, the greater the lymph node and vascular invasion, the poorer the prognosis, with a higher risk of recurrence and metastasis. These results support the role of early screening, especially for at-risk patients, adequate therapeutic management, and active surveillance of patients with triple-negative breast cancer. New research has shown the effectiveness of immune checkpoint inhibitors and anti-parp in treating advanced triple-negative breast cancer (TNBC), with encouraging findings indicating their potential benefit. Clinical studies including anatomical pathologists, oncologists, and fundamental researchers must be conducted globally to achieve this. Clinical studies involving pathologists, oncologists, and basic researchers are needed worldwide to define new therapeutic strategies for the management of this type of aggressive breast cancer.

Performance Evaluation of Khari and Boer Crossbred Goats in Mid Hills Under Optimum Management Regime.

Goats are recognized as a vital and versatile livestock commodity with significant importance in rural farmers’ communities of developing countries, including Nepal. Growth, reproductive and litter performances are considered as the major economic traits of goats. This study was designed to compare the growth, reproduction and litter traits of goat kids and does at mid hill region for different non-genetic factors such as genetic groups (Khari, Boer 75% and 50%), parity (early, mid and late), season of conception and kidding (summer, autumn, winter, spring), sex (male and female) and type of birth (single, twins and triplet) under optimum management regime. Data for the four-year study period (2017 to 2021) on production performance were entered into MS-Excel sheet from the data record book of the National Goat Research Program, Bandipur and analyzed by using Mixed Model Least-square and Maximum Likelihood Computer Program PC-2 statistical package. The means were compared using Duncans' Multiple Range Test (DMRT). Results revealed that the effect of genetic group, parity, type of birth and sex were significant (p&lt;0.05) with respect to growth at different stages along with genetic group and parity that were significant with major non-genetic factors affecting reproduction and litter traits. Better reproduction parameters were recorded for the Khari goat breed than Boer crossbred. Similarly, litter traits at both birth and weaning were found better in later parities with better performance in Khari. Males were born heavier and consistent throughout the study period up to eighteen months. Hence, based on the findings of this study, it can be concluded that Khari goat breed has high potential for its reproduction and litter traits with a massive scope of improvement through selection within the population. Likewise, it is also important to consider the growth of inferior Khari goats can also be genetically improved through upgrading up to 75% blood level using an appropriate breed, such as Boer.

Steel Structures Research Update: Adhesive Steel-to-Steel Connections

Ongoing research on adhesive steel-to-steel connections is highlighted. This study, currently underway at the University of Massachusetts–Amherst, is led by Dr. Kara Peterman, Associate Professor in the Department of Civil and Environmental Engineering. Dr. Peterman’s research interests include behavior of cold-formed and hot-rolled steel structures under service loads and extreme loads due to natural hazards. Among Dr. Peterman’s accolades for her teaching and research are the University of Massachusetts–Amherst College of Engineering Outstanding Teacher Award, the McGuire Award for Junior Researchers from the Structural Stability Research Council (SSRC), the AISC Terry Peshia Early Career Faculty Award, and the AISC Milek Fellowship. The four-year Milek Fellowship is supporting this research on the holistic design and behavior of adhesive steel-to-steel connections. The research team is partway through year two of the four-year study. Selected highlights from the work to date are presented, along with a preview of future research tasks.

Cadre Knowledge And Self-Efficacy Following Care For Child Development Post Intervention: A Four-Year Prospective Follow-Up Study

Background: Stunting is a significant malnutrition problem in Indonesia, and community health cadres play a vital role in addressing it through programs like Care for Child Development (CCD) training. This study aimed to delineate the knowledge and self-efficacy of cadres who participated in CCD training in Yogyakarta in 2018, comparing their status in 2022. Methods: In October 2022, a quantitative cross-sectional approach was utilized to examine the knowledge and self-efficacy of 56 cadres who had undergone CCD training in 2018, organized by the same authors and documented in a prior publication, with participants selected through total sampling. Three instruments were utilized, including a participant demographic survey, the CKCDI, and the GSES. The paired t-test was employed to analyzed the data. Results: The study's results reveal a significant difference (p=0.002) in the mean knowledge scores of cadres following their participation in the Care For Child Development (CCD) training program in 2018 and four years later. The mean score was 13.39 in 2018, decreased to 11.9 in 2022. Likewise, the self-efficacy component among cadres exhibited a reduction, with mean scores of 30.93 in 2018 and 29.4 in 2022. However, it is important to note that there is no statistically significant difference in self-efficacy (p=0.106). The decline in average knowledge scores over the four-year period may be attributed to potential knowledge decay. Conclusion: This study underscores the significance of sustained training and support for community health workers, emphasizing the need for flexible approaches to maintain their knowledge and self-efficacy over time.

Barriers and facilitators to the formation of professional identity among nursing students: A four-year longitudinal qualitative study

BackgroundNursing professional identity (NPI) is essential for nurses to develop their nursing profession. It reflects the competencies consistent with the professional practices of nurses and contributes to them providing better healthcare and public health. The formation process of NPI started with undergraduate nursing education and continued throughout the nursing career. ObjectiveTo explore nursing students' perceptions of facilitators and barriers to the formation of NPI during their study. MethodsA 4-year longitudinal, qualitative research design with yearly semi-structured interviews undertaken from 2019 to 2022. The reflexive thematic analysis methodology was applied for the data analysis. ResultsNinety-three nursing students were recruited, joining a group or individual interview. The four-year nursing baccalaureate program revealed a dynamic formation process of NPI: “Outsider of nursing”, “Entering the nursing courses”, “Building nursing competence”, and “Thinking and acting like a nurse”. A total of 12 themes were identified to present the barriers and facilitators to the NPI formation at different stages. Specifically, the six barriers include conflict between their ideals and reality, sociocultural stereotypes about nursing, the negative impact of COVID-19, the pre-internship concerns, struggling to meet expectations, and potential danger and discrimination in the healthcare settings. The enablers were: self-motivation and inner belief towards the nursing profession, the power of role models, the improvement of nursing capacity, well integration into the healthcare professional teams, understanding of the clinical environment, and recognition and encouragement from others. ConclusionsThe formation of nursing students' NPI is an ever-changing process, with various intrinsic and extrinsic influences during their four-year study. Nursing educators are suggested to prepare and develop students' professional comportment in their theoretical and clinical practice to develop their professional identity as a nurse.

Healing Hanuman's Army: Veterinary Care as a Core Component of One Health Principles in a Southeast Asian Monkey Forest.

Wildlife that inhabit urban landscapes face the dual challenge of negotiating their positions in their group while navigating obstacles of anthropogenically modified landscapes. The dynamics of urban environments can result in novel injuries and mortalities for these animals. However, these negative impacts can be mitigated through planning, and onsite veterinary care like that provided by the Ubud Monkey Forest in Bali, Indonesia. We examined 275 recorded injuries and mortalities among six social groups of long-tailed macaques (Macaca fascicularis) brought to the veterinary clinic from 2015-2018. We fit the probabilities of injury vs. death among macaques brought to the clinic using a multilevel logistic regression model to infer the relationship between injury vs. death and associated demographic parameters. Males were more likely to sustain injuries and females were more likely to die. The frequency of injuries and mortalities changed over the four-year study period, which was reflected in our model. The odds of mortality were highest among young macaques and the odds of injury vs. mortality varied across the six social groups. We categorized injuries and mortalities as "natural" or "anthropogenic". Most injuries and mortalities were naturally occurring, but powerlines, motorized vehicles, and plastic present ongoing anthropogenic threats to macaque health. Most wounds and injuries were successfully treated, with healthy animals released back to their group. We suggest other sites with high levels of human-alloprimate interplays consider the Ubud Monkey Forest veterinary office as a model of care and potentially adopt their approaches.

Predictors of problematic smartphone use among young adult lesbian, gay and bisexual individuals during the COVID-19 pandemic: a four-year follow-up study

BackgroundThis 4-year follow-up study was conducted to evaluate the predictive effects of prepandemic individual and environmental factors on problematic smartphone use (PSU) among young adult lesbian, gay, and bisexual (LGB) individuals during the COVID-19 pandemic.MethodsData on prepandemic PSU, demographics, sexual stigma (e.g., perceived sexual stigma from family members, internalized sexual stigma, and sexual microaggression), self-identity confusion (e.g., disturbed identity, unconsolidated identity, and lack of identity), anxiety, depression, and family support were collected from 1,000 LGB individuals between August 2018 and June 2019. The participants’ PSU was surveyed again after 4 years (between August 2022 and June 2023). The associations of prepandemic individual and environmental factors with PSU at follow-up were analyzed through linear regression.ResultsIn total, 673 (67.3%) participants completed the follow-up assessment. The severity of PSU significantly decreased after 4 years (p = .001). Before the incorporation of PSU at baseline into the analysis model, the results of the model revealed that high levels depressive symptoms (p < .001), disturbed identity (p < .001), and perceived sexual stigma from family members (p = .025) at baseline were significantly associated with PSU at follow-up. After the incorporation of PSU at baseline into the analysis model, the results of the model revealed that high levels PSU (p < .001) and depressive symptoms (p = .002) at baseline were significantly associated with PSU at follow-up.ConclusionInterventions aimed at reducing the severity of PSU among LGB individuals should be designed considering the predictors identified in our study.

Entrepreneurship in care for elderly people with dementias: situated responses to NPM-based healthcare reforms in the Netherlands

BackgroundDespite the great confidence of Western governments in the principles of New Public Management (NPM) and its ability to stimulate “healthcare entrepreneurship”, it is unclear how policies seeking to reform healthcare services provoke such entrepreneurship in individual institutions providing long-term healthcare. This study examines such situated responses in a Dutch nursing home for elderly people suffering from dementias such as Alzheimer’s disease.MethodsA four-year inductive longitudinal single-case study has been conducted. During this time period, the Dutch government imposed various NPM-based healthcare reforms and this study examines how local responses unfolded in the nursing home. Through interviews conducted with managers, administrators and supporting staff, as well as the examination of a large volume of government instructions and internal documents, the paper documents how these reforms resulted in several types of entrepreneurship, which were not all conducive to the healthcare innovations the government aspired to have.ResultsThe study records three subsequent strategies deployed at the local level: elimination of healthcare services; non-healthcare related collaboration with neighboring institutions; and specialization in specific healthcare niches. These strategies were brought about by specific types of entrepreneurship – two of which were oriented towards the administrative organization rather than healthcare innovations. The study discusses the implications of having multiple variations of entrepreneurship at the local level.ConclusionGovernmental policies for healthcare reforms may be more effective, if policymakers change output-based funding systems in recognition of the limited control by providers of long-term healthcare over the progression of clients' mental disease and ultimate passing.

The Outcome of Antibiotic Overuse before and during the COVID-19 Pandemic in a Tertiary Care Hospital in Oman.

Antimicrobial resistance (AMR), a serious global public health challenge, may have accelerated development during the COVID-19 pandemic because antibiotics were prescribed for COVID-19. This study aimed to assess antibiotics use before and during the pandemic and correlate the results with the rate of resistant microorganisms detected in hospitalized patients during the study period. This single-center study looked retrospectively at four years of data (2018-2021) from Royal Hospital, Muscat, which is the biggest hospital in Oman with approximately 60,000 hospital admissions yearly. The consumption rate of ceftriaxone, piperacillin tazobactam, meropenem, and vancomycin was presented as the antibiotic consumption index, the ratio of defined daily dose (DDD) per 100 bed days. Analyses were performed using the nonparametric test for trend across the study period. Correlation between antibiotic consumption indexes and the isolated microorganisms in the four-year study period was performed using Spearman's rank correlation coefficient. We compared data from the pre-COVID-19 to the COVID-19 period. Though more patients were admitted pre-COVID-19 (132,828 versus 119,191 during COVID-19), more antibiotics were consumed during the pandemic (7350 versus 7915); vancomycin and ceftriaxone had higher consumption during than before the pandemic (p-values 0.001 and 0.036, respectively). Vancomycin-resistant Enterococcus (VRE) and Candida auris were detected more during the COVID-19 period with p-values of 0.026 and 0.004, respectively. Carbapenem-resistant Enterobacterales (CRE), vancomycin-resistant Enterococcus spp., and C. auris were detected more often during the pandemic with p-values of 0.011, 0.002, and 0.03, respectively. Significant positive correlations between antibiotic consumption and drug-resistant isolates were noted. This study confirms that the overuse of antibiotics triggers the development of bacterial resistance; our results emphasize the importance of antibiotic control.

Impact of cognitive decline on medical outcomes and nursing workload: A retrospective cohort study.

Few reports have quantitatively investigated the effect of dementia on medical outcomes and nurse workload. Therefore, we aimed to investigate whether cognitive decline can be identified from a nurse assessment and determined its effect on medical outcomes and nurse workload. This retrospective cohort study used electronic medical record data to investigate whether patients judged by nurses to have cognitive decline were as affected as those with a dementia diagnosis. Further, a model formula was created and validated to predict the probability of needing physical restraint, the nursing care workload, and the record volume. The subjects were 43,330 patients aged ≥40 years who were hospitalized at the study hospital during the four-year study period. Data were analyzed using the chi-square test, Welch's t-test, logistic regression analysis and linear regression analysis. The implementation of physical restraint and a discharge support conference was significantly higher in patients deemed by nurses to have cognitive decline. Nurse-deemed patients with cognitive decline were affected by the outcome and workload as much as those with dementia. The false discovery rate for the Probability model formula of physical restraint and discharge support conference were 0.198 and 0.266. The correlation coefficient of the model formula for predicting nursing care and recording volume was 0.5-0.6. Combining nurse assessment and patient attribute information in a model was useful for predicting nurse workload. These findings may serve as a foundational component for the Clinical Decision Support System, aiding in the evaluation of intervention methods from the early stages of hospital admission and improving care delivery.

Comprehensive Analysis of Risk Factors for Bronchopulmonary Dysplasia in Preterm Infants in Taiwan: A Four-Year Study.

Bronchopulmonary dysplasia (BPD) is a major respiratory condition mainly affecting premature infants. Although its occurrence is global, risk factors may differ regionally. This study, involving 3111 infants with birth weight ≤ 1500 gm or gestational age (GA) < 30 weeks, aimed to identify risk factors for BPD and BPD/mortality in Taiwan using data from the Taiwan Neonatal Network. The BPD criteria were based on the National Institute of Child Health and Human Development standards. Average GA was 27.5 weeks, with 23.7% classified as small for GA (SGA). Multivariate analysis highlighted low GA, low birth weight, and other perinatal factors as significant risk indicators for BPD. For moderate-to-severe BPD, additional risk factors included male gender and SGA, endotracheal intubation (ETT) or cardiopulmonary cerebral resuscitation (CPCR) in initial resuscitation. In the moderate-to-severe BPD/death group, SGA and ETT or CPCR in initial resuscitation remained the only additional risk factors. The study pinpoints male gender, SGA and ETT or CPCR as key risk factors for moderate-to-severe BPD/death in low-birth-weight infants in Taiwan, offering a basis for focused interventions and further research.

Interconnected trajectories of achievement goals, academic achievement, and well-being: Insights from an expanded goal framework

Research on achievement goals has primarily focused on mastery and performance goals. This four-year study used an expanded goal framework to compare the prevalence, trajectories, and influence of mastery, performance, outcome, and work-avoidance goals across and beyond the middle school transition. Participants were 1072 Finnish students assessed annually from Grades 6 to 9 (ages 13–16). Across all waves, outcome goals were most strongly endorsed, and work-avoidance goals were more strongly endorsed than performance-avoidance goals. Latent growth models revealed that mastery goals declined across the school transition, but outcome goals remained high. Importantly, these five goals demonstrated distinct associations with student achievement, life satisfaction, and burnout. Outcome goals were linked to higher grades, mastery goals to greater well-being, performance-approach and performance-avoidance goals to lower well-being, and work-avoidance goals to lower grades and well-being. Findings underscore the importance of studying salient goals that students distinguish in authentic classrooms. Educational relevance statementThis study investigated a broad array of academic goals pursued by students, including the desire to learn, attain good grades, outperform others, avoid appearing incompetent, and minimize effort. Findings suggest that educators may support “doing well” and “being well” among students by nurturing certain goals and discouraging others. Students who strived for good grades tended to perform better, while those who expressed a strong desire for learning tended to experience greater well-being. In contrast, goals oriented toward outperforming others or avoiding failure were associated with reduced well-being. Interestingly, the goal of minimizing effort was linked to both lower academic achievement and lower well-being.

The Association between the Platelet to White Blood Cell Ratio and Chronic Kidney Disease in an Aging Population: A Four-Year Follow-Up Study.

The platelet to white blood cell ratio (PWR) has been reported to be a prognostic factor for some diseases, such as subarachnoid hemorrhage. However, the association between the PWR and chronic kidney disease (CKD) remains unknown. To investigate the cross-sectional and longitudinal association between the PWR and CKD, this study was performed. This study used datasets from a national prospective cohort in China (China Health and Retirement Longitudinal Study). A retrospective cohort from 2011 to 2015 was constructed. The PWR was stratified as a categorical variable according to tertiles (T1-T3 groups). CKD was defined as an estimated glomerular filtration rate < 60 mL min-1/1.73/m2. Univariate and multivariate logistic regressions and restricted cubic spline regression were adopted to assess the linear and non-linear association between the PWR and CKD. Propensity score matching was used to balance the discrepancies between covariates. Subgroup and interactive analyses were performed to explore potential interactive effects of covariates. Missing values were interpolated using random forest. The PWR was also stratified according to the median and quartiles as sensitivity analyses. A total of 8600 participants were included in this study. In the full model, the odds ratios (ORs) of prevalent CKD were 0.78 (95% CI = 0.62-0.97, p < 0.05) for the T2 group and 0.59 (95% CI = 0.46-0.76, p < 0.001) for the T3 group. There were significant interactive effects of marital status and smoking in the PWR-CKD association (both p for interaction < 0.05). An L-shaped, non-linear association was detected between the PWR and prevalent CKD in the overall population, participants ≥ 60 years, and females subgroups (all p for non-linear < 0.05). All sensitivity analyses supported the negative association between the PWR and prevalent CKD. In the 2011-2015 follow-up cohort, the ORs of incident CKD were 0.73 (95% CI = 0.49-1.08, p > 0.05) and 0.31 (95% CI = 0.18-0.51, p < 0.001) for the T2 and T3 groups, respectively, in the full model. A high PWR is associated with a reduced risk of prevalent and incident CKD. The PWR may serve as a predictor for CKD, facilitating the early identification and intervention of kidney function decline.

Does PM 2.5 and PM 10-associated heavy metals affect short-term and long-term survival after out-of-hospital cardiac arrest? Four-year study based on regional registry.

This study aims to investigate the effect of arsenic (As), cadmium (Cd), nickel (Ni) and lead (Pb) suspended on particulate matters (PM) 2.5 and PM 10 taking into account clinical factors on 30-day and one-year survival after out-of-hospital cardiac arrest (OHCA). A retrospective 4-year study that involved patients hospitalized after OHCA. Patients' data were obtained from Emergency Medical Services dispatch cards and the National Health Fund. The concentration of air pollutants was measured by the Environmental Protection Inspectorate in Poland. Among the 948 patients after OHCA, only 225 (23.7%) survived for 30 days, and 153 (16.1%) survived for 1 year. Survivors were more commonly affected by OHCA in urban areas (85 [55.6%] vs. 355 [44.7%]; P=0.013) and had slightly higher one-year mean concentration of As (0.78 vs. 0.77; P=0.01), Cd (0.34 vs. 0.34; P=0.012), and Pb (11.13 vs. 10.20; P=0.015) with no differences in daily mean concentration. Significant differences in mean concentrations of heavy metals and PM 2.5 and PM 10 were observed among different quarters. However, survival analysis revealed no differences in long-term survival between quarters. Heavy metals, PM 2.5, and PM 10 did not affect short-term and long-term survival in multivariable logistic regression. The group of survivors showed slightly higher mean one-year concentrations of As, Cd and Pb, but they also experienced a higher incidence of OHCA in urban areas. There were no differences in long-term survival between patients who suffer OHCA in different quarters. Heavy metals did not independently affect survival.

Persistent response of the bottom free-living bacteria to typhoon events in a subtropical reservoir

Typhoon-induced perturbations can result in long-lasting effects on aquatic communities in subtropical lakes or reservoirs. However, the responses of bacterial communities and their related nutrient cycling to episodic typhoon events throughout the water column in deep waters remain largely unknown. Here, we conducted a four-year field study to reveal the depth-specific responses of both free-living (FL) and particle-attached (PA) bacteria to typhoon events in a subtropical deep reservoir from 2015 to 2018. By comparing the depth-specific responses of FL and PA bacteria, we found that typhoon-induced inputs of organic matter and microorganisms significantly increased FL bacterial diversity and changed FL bacterial community composition in bottom waters perhaps through the density current or undercurrent. Typhoon events had a more persistent effect on FL than PA bacterial communities, especially in bottom waters of the reservoir. Free-living bacteria were more associated with nutrient cycling in bottom waters than particle-attached bacteria. These findings provide deep understanding of how FL and PA bacteria respond to typhoon events at community level in subtropical deep reservoir and thus help us to improve reservoir management in a rapidly changing world.

A theoretical framework for developing a health impact assessment implementation model in Ireland

Abstract Background A Health Research Board (HRB) four-year research study, which commenced in January 2023, seeks to explore the process of carrying out Health Impact Assessments (HIAs) with a view embedding the approach as normal practice in local and national policy development in Ireland. Methods A theoretical framework has been constructed to develop an HIA implementation model. The framework is based on the all-island Institute of Public Health Ireland's HIA guidance. The theoretical framework will examine factors affecting HIA implementation, using both the Consolidated Framework for Implementation Research (CFIR) and Normalisation Process Theory (NPT). An action research methodological approach will be used to gather data on the experiences that participants will reflect on while doing the HIA. Participants included in the study will be the members of the two HIA Steering Groups created for each HIA (12 participants in each HIA) and policy end-users of the HIA evidence from the city council and government ministries (20 participants for each HIA). Results The theoretical framework will be applied to two HIAs, in order to generate data in creating the HIA implementation model. HIA 1, commencing October 2023, will be conducted on the local government Cork City Development Plan. HIA 2, commencing January 2025, will be carried out on the Irish Government's Climate Action Plan. Preliminary results on the application of the theoretical framework to HIA 1 will be presented, as well as reflections for the planned HIA 2. Conclusions For the first time in Ireland and beyond, a theoretical framework has been developed employing innovative methodological approaches to building a contextualised HIA implementation model. Using action research in assessing the implementation of HIA, with a view to analysing the lived experience of Steering Group members as they conduct the HIAs, and policy end-users, will ensure an enhanced HIA implementation model. Key messages • The development of an innovative theoretical framework for the study of HIA. • The building of HIA capacity in Ireland using the newly revised Institute of Public Health guidance.