Program Guidelines Research Articles

POVERTY AND ETHNIC MINORITY IN BANGLADESH: A SOCIOLOGICAL INVESTIGATION ON CHAKMA COMMUNITY

This paper attempts to depict the deteriorating socio-economic status of the indigenous community as an ethnic minority in Bangladesh. The study focuses on the poverty of the community, which is deprived by the majority of Bengalis. This is explained through a broad spectrum of issues that constructed the structure of the discrimination occurring against the community in Bangladesh. The article is based on an empirical study in Rangamati through a survey method using a structured questionnaire. The structure of poverty and its correlates thereof were explained following a systematic poverty measurement technique. The study includes measuring the Headcount ratio, Poverty gap, Squared poverty gap, and Gini- coefficient that made poverty rate and extent of poverty. The major findings reveal that the Chakma community is not only suffering from severe poverty but also faces discrimination and deprivation to a great extent. Results reveal that the Chakma community’s large extent of poverty is caused by belongingness to the minority group while the group has lower inequality or Gini-coefficient among the group. Based on the findings, the study suggests specific policy guidelines for comprehensive poverty alleviation programs in order to improve the socioeconomic conditions of the indigenous community in Bangladesh.

Implementing sanitation marketing as a form of social marketing: A case scheduled desludging service, Malang City

To reach sustainable development goal 6, “clean water and sanitation,” the government has made it mandatory to implement the Scheduled Desludging Service program (in the Indonesian language as layanan lumpur tinja terjadwal / L2T2). The L2T2 program is a septic tank desludging service in a given desludging period following a set desludging schedule. Malang City has successfully implemented the program within a short period despite starting the program only recently, in 2019. The researchers employed a qualitative research design with the case study method to derive a meaning behind a phenomenon, given that the program is actual, specific, and detailed. The research results indicated that the L2T2 program implementation in Malang City had met 7 of 8 criteria under the L2T2 program guideline set by the Ministry of Public Works and Housing. The one criterion that needed to be fulfilled concerning service pricing. Instead, the sanitation marketing implementation in the L2T2 program has met 7 of 10 standards in the sanitation marketing aspect—the three criteria needed to be fulfilled service pricing, CSR strategy, and loyalty program.

Curriculum Guidelines for Mathematics degree and Gender and Sexuality issues in Brazil

The objective of this article was to analyze the speech acts present in a curricular document currently in force as a guideline for (re)formulations of undergraduate programs in Mathematics in Brazil. The theoretical and methodological framework adopted is based on the Habermasian perspective of Discursive Ethics. In structural terms, we present discussions on the importance of Gender and Sexuality issues amid the contemporary debate on Mathematics Education. In terms of results, we affirm that the rationality by which the guidelines for undergraduate programs in Mathematics are oriented is characterized as instrumental when considering experiences, reflections, and formative practices that permeate the issues of Gender and Sexuality.

Reference centers for tissue and body donations: Compulsory requirements in Italy.

Recent Italian legislation (Law No. 10/2020) establishes the legal, ethical and technical requirements governing how individuals can donate their bodies or tissues post-mortem for study, training, and scientific research purposes. A ministerial working group has recently approved some of the law's implementing rules relating to technical issues. The rules for implementing the new legislation, retrieved from the legal databases and translated into English, are discussed. For the first time in Italy, the law establishes compulsory requirements and minimum characteristics-in terms of logistics, safety, availability of staff, space, and equipment-for institutions to be recognized as reference centers for the conservation and use of bodies and tissues donated post-mortem for study, training and scientific research purposes. This makes it possible to standardize the features of such reference centers nationwide, and to coordinate their activities and potential future development, while ensuring basic operational efficiency and workplace safety, the provision of adequate facilities, buildings and equipment, and staff training. The law and its implementing rules discussed here are the first to establish criteria and compulsory requirements for centers receiving body and tissue donations in Italy. This is a step forward for the whole anatomy community, providing practical guidelines for body donation programs and related facilities in other countries too.

PELAKSANAAN PEMBERDAYAAN MASYARAKAT DALAM PROGRAM MASYARAKAT BERDAYA MENUJU KOTA PARIWISATA DI KOTA BLITAR

This research is motivated by the importance of optimizing the implementation of community empowerment in a program so that it runs in accordance with the policy implementation plans that have been written and compiled. The implementation of the MAYAJUWITA program is regulated by Perwali No. 2 of 2016 concerning the implementing guidelines for community programs towards a tourism city (MAYAJUWITA). This implementation is proven to run with the attention and detailed implementation of the Government as a whole. This study uses a qualitative descriptive method with data collection techniques using observation, interviews, and documentation studies. The data processing technique uses data reduction, data presentation, drawing conclusions/verification. Research Results The implementation of community empowerment in the MAYAJUWITA program in Blitar City was able to run well because the sub-districts and villages of each Blitar City were able to optimize implementing regulations with the budget provided by the APBD PRO RAKYAT

Echocardiographic Evaluation in Paediatric Sickle Cell Disease Patients: A Pilot Study

Cardiovascular involvement has a great impact on morbidity and mortality in sickle cell disease (SCD). Currently, few studies are available regarding the paediatric setting and, moreover, current guidelines for the echocardiogram screening program in the asymptomatic paediatric population are controversial. We performed a retrospective observational monocentric study on 64 SCD patients (37 male and 27 female, median age 10) at the Bambino Gesù Childrens' Hospital, who had undergone a routine transthoracic echocardiogram. In total, 46 (72%) patients had at least one cardiac abnormality. Left atrial dilatation (LAD) was present in 41 (65%) patients and left ventricular hypertrophy (LVH) was found in 29 (45%) patients. Patients with LAD showed lower median haemoglobin levels (p = 0.009), and a higher absolute reticulocyte count (p = 0.04). LVH was negatively correlated with the median haemoglobin value (p = 0.006) and positively with the reticulocyte count (p = 0.03). Moreover, we found that patients with cardiac anomalies had higher transfusion needs and a lower frequency of pain crises. In our setting, cardiac involvement has a high prevalence in the paediatric cohort and seems to be associated with specific laboratory findings, and with a specific clinical phenotype characterized by complications related to high haemodynamic load.

Evaluating Pedestrian Service of the New Super Diverging Diamond Interchange on Three Case Study Sites in Denver, Colorado

Ensuring safe and comfortable conditions for pedestrians necessitates specific strategies at intersections and service interchanges where traffic and pedestrians interact in complex ways with other modes of transportation. This study aims to investigate pedestrian performance at the new Super Diverging Diamond Interchange (Super DDI) using real-world locations (i.e., I-225 and Mississippi Ave, I-25 and 120th Ave, and I-25 and Hampden Ave in Denver, Colorado). Three alternative designs, typical DDI, and two versions of Super DDI were considered to make a reasonable comparison with the existing Conventional Diamond Interchange (CDI). A comprehensive series of simulation models (192 scenarios with 960 runs) were tested using VISSIM and Synchro to analyze pedestrian operation (travel time, number of stops, and waiting time) in various traffic and pedestrian distributions. As one of the primary contributions in this paper, pedestrian safety was evaluated based on a surrogate performance measure called design flag, introduced by the new National Cooperative Highway Research Program (NCHRP-948) guideline. The results indicated that the proposed new Super DDI designs are relatively safe when compared with CDI and DDI. For example, a pedestrian analysis of one of the most popular alternative interchanges, DDI, showed potential for unsafe pedestrian conditions in all aspects.

570. What’s the Harm? Development and Implementation of an Antimicrobial Stewardship Intervention Impact Score

Abstract Background Various metrics evaluate antimicrobial stewardship program (ASP) success, including utilization, cost savings, and guideline adherence. Patient safety initiatives are at the forefront of hospital metrics. No commonly applied ASP measures evaluate patient harm. Our objective was to develop and implement a novel scoring tool quantifying the impact of ASP interventions on prevention of patient harm. Methods This initiative was conducted at a 386-bed pediatric hospital with an ASP conducting prospective audit with feedback (PAF) rounds since 2008. ASP created a multidisciplinary subgroup to develop a scoring tool classifying interventions as low, moderate, and high impact. With low impact interventions, patient harm was unlikely, but opportunities existed for minor antimicrobial optimization. Moderate interventions had substantial room for optimization but still had low risk for patient harm. High impact interventions carried a substantial risk of patient harm due to high probability of an adverse drug event or due to poor outcomes from an inappropriate regimen. Using these principles, definitions for each level of impact were created for all ASP intervention categories (Table 1). ASP providers were trained on the tool and scored each intervention on daily PAF rounds. To improve objectivity, 2 ASP providers independently scored each intervention and discrepancies identified. Discrepancies were evaluated monthly, and the tool was modified. Results Between 11/9/21-3/31/22, ASP reviewed 2010 antimicrobial orders with 238 interventions made and scored for impact. Of these, 124 (52.1%) were low, 99 (41.6%) moderate, and 15 (6.3%) high impact. There were 26 scoring discrepancies identified which were discussed by the ASP subgroup. To further clarify definitions, there were 5 substantive definition changes and 4 minor modifications; most changes were made in 12/2021. Conclusion We describe here the successful implementation of a novel tool to score ASP interventions on stewardship impact and prevention of patient harm. Future directions include utilizing this tool to direct systematic ASP interventions, partnering with organizational patient safety, and engaging in a multi-institutional working group for further development. Disclosures All Authors: No reported disclosures.

1279: EARLY GOALS-OF-CARE DISCUSSION IN GERIATRIC TRAUMA IS ASSOCIATED WITH INCREASED CODE STATUS CHANGES

Introduction: The Trauma Quality Improvement Program guidelines recommend early goals of care (GOC) discussions within 72 hours of admission for geriatric trauma patients. Despite this recommendation family meetings and GOC conversations are often performed in a delayed fashion. We hypothesized that early GOC discussions are associated with higher incidence of goal concordant care manifested as code status changes and implementation of comfort measures only (CMO), as well as shorter hospital length of stay (LOS). Methods: A retrospective chart review was performed on patients aged ≥65 years admitted to Hartford Hospital intensive care units (ICU) with a trauma diagnosis between January 2020 and December 2021. Demographics, timing of GOC discussion, and clinical outcomes were collected. Results: Of 273 identified patients, 78% were male, and median age was 79 years (interquartile range, IQR 71 – 86). Median injury severity scale (ISS) was 13 (IQR 9 – 21), and the most common mechanism of injury was falls (77%). Only 51 (19%) had a GOC discussion documented in the chart within 72 hours of admission. In a logistic regression model adjusting for significant variables, early GOC discussion was associated with higher likelihood for changing code status (adjusted odds ratio, OR 6.0; p< 0.001) and transitioning to CMO (OR 3.4; p=0.008), compared to having GOC discussion after 72 hours or not at all. Among those who had GOC discussion during hospitalization, early GOC discussion was associated with shorter ICU LOS (β=-7.4; p=0.014) and hospital LOS (β=-10.9; p=0.008), adjusting for significant variables identified on the univariable analysis. Patients who had GOC discussion within 72 hours were at significantly lower odds of undergoing invasive procedures (OR 0.41; p=0.02). Conclusions: Early GOC discussion within 72 hours of admission is associated with higher likelihood of code status change and election of CMO in geriatric trauma patients. Interventions to increase adherence to the early GOC meeting recommendation should be emphasized at an institutional level.

The Resident Voice: Identifying Qualities of Resident Leadership with a Focus Group of Second Year Internal Medicine Residents

Background The Accreditation Council for Graduate Medical Education (ACGME) Internal Medicine Residency Program Guidelines identifies leadership as a core competency. The definition of strong resident leadership is not clearly defined. Prior studies have identified characteristics of resident leadership from the perspective of residency program leaders with little emphasis on the resident point of view. Objective This study aims to identify qualities of effective resident leadership from the perspective of Internal Medicine (IM) residents. Methods Participants were recruited through email invitations. An online focus group with five IM residents was conducted in September 2020. The transcribed discussion was inductively analyzed using thematic data analysis. Results Analysis resulted in four main themes of strong resident leadership: mentorship, team ownership, communication, and emotional intelligence. All four themes were further characterized by subthemes. Being a mentor as a resident leader was described as having the ability to guide, motivate, and empower team members. Team ownership was defined as caring about team image, adaptability, and accountability for team performance. Communication skills included setting expectations, giving feedback, and utilizing closed-loop communication. Emotional intelligence was characterized as practicing empathy, psychological safety, and appreciation. Conclusions Strong resident leadership is crucial to providing effective residency training and the highest level of patient care. This study identifies from the perspective of residents, the principal characteristics of strong resident leadership: mentorship, communication, team ownership, and emotional intelligence. The identification of these characteristics provides an opportunity to create leadership curricula for residents that focus on developing these specific skills.

New Delhi, India: Perceptions & apprehensions: A qualitative studyOral HIV self-testing among men who have sex with men in.

The overall adult prevalence of HIV in India was estimated to be 0.22 per cent in 2019. The HIV prevalence among men who have sex with men (MSM), a high-risk group for HIV, was estimated to be 4.3 per cent, which is 16 times higher than the national average. In Delhi, the estimated prevalence among MSM was 1.8 per cent. Despite free HIV testing services being made available by the National AIDS Control Programme for more than two decades, many MSM were not aware about their HIV status. Therefore, newer testing strategies are needed. Oral HIV self-testing (HIVST) has proved to be one such promising innovation. At present, there are no programme guidelines on HIVST and oral HIVST kit is not available in India. The aim of this study was to understand the perceived advantages and disadvantages of introduction of oral HIVST strategy among MSM. MSM who were registered with the selected non-governmental organizations working as targeted intervention sites in Delhi, India, were recruited for focus group discussions (FGDs) between January and May 2021. For the purpose of this study, MSM were defined as males who had anal/oral sex with male/hijra partner in the past one month. A total of six FGDs were conducted using a prepared FGD guide. The FGD guide included questions on problems faced during conventional HIV testing, participants' awareness, acceptability and perceptions of oral HIVST. The data were manually coded and entered in NVivo release 1.5 and themes were identified. A total of 67 respondents participated in the FGDs. A total of 28.4 per cent MSM were beggars at traffic lights, 12 per cent were sex workers and 11.9 per cent were bar/event dancers. Nearly half (50.7%) of the participants had undergone HIV testing less than twice in the preceding one year. None of the MSM were aware about oral HIVST. Perceived advantages of oral HIVST were ease of use, confidentiality and the non-invasive pain-free procedure. Perceived concerns included lack of post-test counselling, linkage to care, poor mental health outcomes and forced testing. Most MSM had positive perceptions about oral HIVST. Therefore, it is likely that the introduction of oral HIVST may result in higher uptake of HIV testing among MSM.

Determination of Amygdalin in Apricot Kernels and Almonds Using LC-MS/MS.

Cyanogenic glycosides are secondary metabolites in plants. In almonds and apricot kernels, amygdalin is an abundant cyanogenic glycoside. Upon consumption, amygdalin is enzymatically metabolized into hydrogen cyanide. Depending on the number of kernels consumed and the amygdalin concentration, ingestion of amygdalin-containing kernels may result in adverse effects. To better understand the US marketplace, the development and validation of analytical methods to reliably measure amygdalin in apricot kernels and almonds is needed to support the collection of occurrence and consumption data in retail products. The aim of this study was to develop and validate a liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for the quantitation of amygdalin in apricot kernels and almonds following the U.S. Food and Drug Administration (FDA). Foods Program Guidelines for the Validation of Chemical Methods, 3rd Edition. Apricot kernels and almonds were cryogenically homogenized and extracted using methanol containing an internal standard (IS), geniposide, followed by filtration, dilution, and LC-MS/MS analysis. Matrix effects were minimized using dilution. Quantitation was achieved using an external, solvent-based calibration. The amygdalin response was linear (r2 > 0.99) over a range of 0.05-50 µg/mL. The recovery of amygdalin spiked at 10-10 000 µg/g in sweet apricot kernels, raw almond, and dry-roasted almond ranged from 90 to 107% with RSDs ≤6%. The method limit of detection and limit of quantitation was 0.8 and 2.5 ng/g, respectively. Amygdalin concentrations in 18 market samples ranged from 2 to 24 000 µg/g. Corresponding estimates of cyanide concentration ranged from 0.2 to 1420 µg/g. Method performance meets the acceptance criteria defined by FDA guidelines and is fit for purpose for the analysis of amygdalin in apricot kernels and almonds. An LC-MS/MS method is developed for the quantification of amygdalin in apricot kernels and almonds.

필라테스가 유방암 환자의 상지 기능, 림프부종, 우울증, 삶의 질에 미치는 영향 : 체계적 고찰연구

Background: Breast Cancer is the leading cause of cancer death. Considering the lifestyle of women with breast cancer, Pilates may be beneficial as a complementary intervention to standard therapeutic exercise. However, few recommendations are available with guidelines for Pilates programs for breast cancer survivors. Objective: This study aims to systematically review previous studies to assess the effects of Pilates on upper extremity function, lymphedema, depression, and quality of life compared to those with other forms of exercise and standard treatment for women with breast cancer. Method: We searched the Cochrane Library, Google Scholar, and Medline via Pubmed for relevant publications through March 2022. The keywords “breast cancer” and “Pilates” were used as keywords, and randomized controlled trials and single-subject studies were included. Results: Thirteen studies were reviewed. Our results show that improvements in the Pilates groups were better than those in groups engaging in home-based exercise or no exercise at all. The Pilates groups showed improvements in upper extremity function including muscle strength, flexibility, and range of motion, as well as improvements in the quality of life score, and reductions in the severity of lymphedema that were greater than other groups. Conclusion: Pilates can complement traditional treatment programs as a safe model. This systematic review provides valuable information for further studies.

Comprehensive Fluid Compositional Analysis Program to Support the Interpretation of Chichimene Field In-Situ Combustion Pilot

Summary The evaluation of enhanced oil recovery (EOR) methods in Colombia has been very active during the past decade. One of the most recent and promising pilots is the in-situ combustion (ISC) in Chichimene field, starting in September 2019. Based on international ISC field experiences, this pilot represents a unique case study given the depth (≈8,000 ft) of this heavy crude oil (9 °API) reservoir. The pilot project consists of one injector, seven producers, and two temperature observation wells between the injector and first-line wells. Production response shows encouraging results. Its interpretation is supported by a comprehensive fluid compositional analysis, which is the main objective of this paper. This paper describes the compositional analysis of produced fluids (gas, oil, and water) and the influence of the current flow assurance program. Geochemical simulations support the evaluation of scaling tendencies, and possible corrosion trends are based on iron and manganese concentrations following the National Association of Corrosion Engineers (NACE) standards. Crude oil analysis is based on conventional techniques (i.e., acid number, distillation curves, etc.) and biomarkers to infer possible thermal maturation changes in the produced oil. Results confirm predicted cycles of CO2 and H2S during the planning of the monitoring program. The solubility of both gases in water leads to their acidification and the formation of carbonate and sulfate scales characterized in production wells. The precipitation of solids was also influenced by the N2-based H2S scavenger decomposition downhole due to the water pH increment observed with the dosage increases. The scaling tendencies did not impact the productivity due to the high reservoir permeability. The precipitation of iron species made it difficult to interpret NACE standards to infer corrosion except for wells shut in for more than 2 months showing a higher concentration of Fe and Mn. However, a recent casing inspection job at one of the first-line producers shows no corrosion signs. Heavy metals such as nickel and vanadium were analyzed in water to infer the possible corrosion or thermal cracking of porphyrins in crude oil. Changes in the paraffinic fractions and biomarkers (i.e., methyl phenanthrene index, mono- and tri-aromatic steroids) suggest an increased thermal maturity of the produced oil. The robust monitoring program has provided important insights from the ISC process and flow assurance strategy supporting possible expansion plans. This study provides valuable guidelines for monitoring programs based on compositional analysis of produced fluids, including the influence of production chemistry. Lessons learned through the Chichimene ISC monitoring program can be valuable in interpreting thermal and potentially nonthermal EOR projects.

Mean Micronuclei Score in Fine-Needle Aspiration Cytology of Patients with Malignant Breast Lump in the Department of Pathology in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Micronucleus is used as a biomarker of chromosomal instability, which is one of the hallmarks of neoplastic transformation. As micronuclei score increases with malignancy, it can be an effective and inexpensive adjunct to breast fine needle aspiration cytology, in diagnosing breast lumps, especially detecting grey lesions between benign and malignant tumours. The aim of this study is to find out the mean micronuclei score in fine-needle aspiration cytology of patients with malignant breast lumps in the Department of Pathology in a tertiary care centre. A descriptive cross-sectional study was conducted among patients with malignant breast lumps in the Department of Pathology in a tertiary care centre between 1 May 2020 to 31 May 2021 after receiving ethical approval from the Institutional Review Committee (Reference number: IRC/2139/021). The fine-needle aspiration cytology of breast lumps was diagnosed as per National Health services breast screening program guidelines. The mean micronuclei score was calculated. Convenience sampling was done and data were collected from the hospital records in the Department. Point estimate and 95% Confidence Interval were calculated. Among 20 malignant breast aspirates, the mean micronuclei score was found to be 8.30±3.75 (3-19, 95% Confidence Interval). The mean micronuclei score in fine-needle aspiration cytology of malignant breast lumps was found to be similar when compared to similar studies conducted in similar settings. biomarker; breast neoplasm; chromosomal instability; fine-needle aspiration.

A Specific Criteria-Based Guideline Improves Compliance With General Surgery Ambulatory Care Standards and Reduces Overcrowding in "Hot Clinic": A Quality Improvement Study.

Background A general surgery hot clinic is designed for the assessment and management of acute general surgical patients in ambulatory settings to avoid unnecessary hospital admissions. Overcrowding in the hot clinicis a major issue in many general surgical settings, and it is thought to be due to a lack of specific criteria-based guideline for identifying eligible patients for ambulatory care. We aimed to perform a prospective audit to assess what proportion of hot clinic patients meets the criteria for ambulatory care. Our second objective was to implement a specific criteria-based guideline and monitoring program to improve compliance with the ambulatory care criteria. Methods The audit included three cycles: baseline audit (30 days in September 2018), first re-audit (30 days in January 2019), and second re-audit (30 days in May 2019). During each cycle, all consecutive patients who attended the general surgery hot clinic were included. Compliance with the hot clinic standards was considered as the outcome measure. We considered compliance of 100% as a target for each standard. A specific criteria-based guideline for the hot clinic was implemented after the baseline audit. A monitoring program was designed to monitor and maintain compliance with the hot clinic guideline. Results During the baseline audit, 224 patients were seen in the general surgery hot clinic. After the implementation of the guideline, this was reduced to 40 patients during the first re-audit and 42 patients during the second re-audit. There was a significant difference in the median number of patients seen per day between the baseline audit and the first re-audit [(7 (6-8) vs 1 (1-2), P < 0.0001]and between the baseline audit and the second re-audit [(7 (6-8) vs 1 (1-2), P < 0.0001].During the baseline audit, only 19% of patients were seen by the on-call general surgery team prior to a hot clinic; this improved to 100% in the first re-audit (P < 0.0001) and remained 100% in the second re-audit (P < 0.0001).During the baseline audit, only 19% of patients met the eligibility criteria for review in a hot clinic; this improved to 100% in the first re-audit (P < 0.0001) and remained 100% in the second re-audit (P < 0.0001). Conclusions A criteria-based hot clinic guideline suggested in this study improved compliance with general surgery ambulatory care standards, the efficiency of general surgery hot clinic, and overcrowding in general surgery hot clinic. A continuous monitoring program led by an on-call junior general surgery doctor helped to maintain the aforementioned improvements.

Programming of implantable cardioverter defibrillators for primary prevention: outcomes at centers with high vs. low concordance with guidelines.

While ICD therapy reduction programming strategies are recommended in current multi-society guidelines, concerns remain about a possible trade-off between the benefits of ICD therapy reduction and failure to treat episodes of ventricular arrhythmias. The study is to evaluate the outcomes of primary prevention patients followed in centers with high and low concordance with the 2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement and 2019 focused update on optimal ICD programming and testing guidelines. Consecutive patients with primary prevention ICD implantation from two centers between 2014 and 2016 were included. One center was classified as high guideline concordance center (HGC) with 47% (146/310) of patients with initial ICD concordant with the guidelines, and the other center was classified as low guideline concordance center (LGC) with only 1% (2/178) of patients with guideline-concordant initial ICD programming. Cox proportional hazard models were used to assess risk of first ICD therapy (ATP or shock), first ICD shock, and mortality. A total of 488 patients were included (mean age, 66 ± 13years). During a mean follow-up of 1.9 ± 0.9years, patients followed at HGC were 63% less likely to receive any ICD therapy (adjusted HR [aHR] 0.37, 95% CI 0.42-0.99). There were no significant differences in the rate of first ICD shock (aHR 0.72, 95% CI 0.34-1.52) or mortality (aHR 1.19, 95% CI, 0.47-3.05). Compared to primary prevention patients followed at LGC, primary prevention ICD patients followed at HGC received a significantly lower rate of ICD therapy, mainly from ATP reduction, without a difference in mortality during follow-up.

Do Residential Long-Term Care Policies Support Family Involvement in Residents’ Quality of Life in Four Canadian Provinces?

ABSTRACT Family members are essential contributors to the quality of life (QoL) of persons living in residential long-term care (RLTC). This paper analyzes how the system enables or inhibits family involvement with residents in RLTC. Our analysis of 21 policies that regulate long-term care in four Canadian Provinces reveal differences in their portrayal of residents’ families. Family roles are characterized procedurally (task-oriented) or relationally (interactive). Operational standards linked to licensing of RLTC homes employ more formal terminology, while RLTC program guidelines, use facilitative language to engage families and build relationships. Examples of orientation procedures, care protocols, living at risk, and end-of-life care reveal inter-provincial variations. We argue that there are opportunities to further engage families within the current regulatory framework and improve their continued contributions in the post-pandemic era.

Determining Pesticide Residues in Bee produce and their Potential Risk to Consumers in Tanzania

Purpose: The purpose of this study was to examine pesticide contamination in bee products in Singida District Municipality of Tanzania, particularly at Kijiji cha Nyuki. The specific focus of the study was to assess the levels of pesticides residues in bee products harvested from the selected bee farms, identifying the common type of pesticides that contaminate honey and honey products on the quality of selected bee products.&#x0D; Material and Methods: A mixed methods approach was adopted for this study and collected data both primary and secondary data was collected using physical observation and survey, interviews and questionnaires, the purposive and random sampling techniques was used in this study to select total of 104 participants who was taken as a sample from universal populations. Qualitative and quantitative data were analysed using IBM Statistical Package for Social Sciences (SPSS) Computer Programme version 25, where statistics aspect was determined from the results obtained from both questionnaires and laboratory experiment to the four (4) honey sample Bee pollen One Kg, propolis 500gm, and Bee wax One Kg.&#x0D; Findings: The study found 252 pesticides residues ingredients in beeswax with a mean of 0.03 mg/kg. Lambda-cyhalothrin ingredient had 4.20 mg/kg of the total pesticide’s ingredient found in beeswax against 251 which represent the rest of the pesticides ingredient that were concentrated in the beeswax. In regards with the effect of lambda-cyhalothrin identified in beeswax, bee pollen and honey, the results indicate current concentrations of pesticides in beeswax, bee pollen and honey does not pose risk to human health neither to environment, this is an indication that honey produced in the Kijiji cha Nyuki is safe for consumers as there is very low concentrations of lambda-cyhalothrin in each studies area.&#x0D; Unique Contribution to the Theory, Practice and Policy: It was noted most of the pesticides that found in honey was agricultural pesticides therefore Theory of Planned Behaviour was relevancy in explain the relationship of individual to use pesticides to the agricultural. Therefore, study will contribute to the beekeeping programme guidelines for quality control of bee products to provide thoughtful mitigate to the amount of pesticide contamination in bee and honey products, the study could contribute to policy design and implementation to understanding of how the regulations outlining the use of insecticides is being implemented, and the current economic condition of studied farms.&#x0D; &#x0D;

Anakinra for Treatment and Prevention of CAR-T Neurotoxicity: A Systematic Review of Evidence to Inform SIE-GITMO-Sidem Guidelines

Background Patients with aggressive B-cell lymphomas may achieve prolonged survival after treatment with chimeric antigen receptor T-cells (CAR-T). Nevertheless, after CAR-T infusion 22-43% of the patients develop cytokine-mediated neurotoxicity (ICANS) (Meng 2021, Belin 2020). Steroids are commonly used to treat patients who develop ICANS, which, however, is still fatal in 16-27% of overall patients developing neurotoxicity (Dolladille 2021). Moreover, a warning to a higher rate of infections after prolonged exposure to high-dose steroids has been launched. For the above reasons Anakinra, a monoclonal neutralizing antibody against interleukin-1 (IL-1), has been tested in such a clinical scenario. Aims of the study The present study is aimed at revising the available literature regarding Anakinra use for the prevention or treatment of ICANS in order to support the development of evidence-based recommendations for the CAR-T guideline program started by three national scientific societies, namely SIE, GITMO and SIDEM. Methods On 1st April 2022 EMBASE, PubMed and Cohrane Library databases were scanned with standard queries in order to identify overall records (published since Jan 2019) reporting clinical outcomes of CAR-T in adult patients with lymphoma. Out of 730 identified records, those reporting Anakinra use after CAR-T therapy were identified. The search also included studies presented uniquely in abstract form. Case series including less than 5 treated patients were excluded. Response rates were reported in 8 treatments and 3 prophylaxis studies. Results We collected 15 studies reporting the use of Anakinra in 189 recipients of CAR-T for refectory/relapsed aggressive B-cell lymphomas: 132 patients received off-label Anakinra for severe (grade 3-4) or steroid-refractory ICANS, while 57 patients were enrolled into 3 prospective studies aimed at ICANS prevention. The commercial CAR-T products employed included axi-cel (63/120), brexu-cel (30/120), tisa-cel (37/120), and liso-cel (9/120). Grade 5 ICANS were reported in 4/84 (4.7%) patients treated with Anakinra and amelioration of the neurological status was reported in 46-100% of the patients. Higher response rates were reported for doses higher than 200 mg per day and early mortality declined from 84% to 7% in patients receiving high vs low doses in one study. The rate of ICANS in patients receiving prophylaxis with Anakinra was 14% and only transient grade 3 ICANS developed. As a consequence a significant reduction of the hospital stay from 38 to 24 days was reported in one study comparing two paired cohorts. Several limitations were reckoned in the available evidence including small sample size and huge heterogeneity of patient population and CAR-T products. Moreover different ICANS grading systems were used and cumulative steroid doses were provided only by a few studies. Finally, a high rate of infection-related deaths were reported in this patient population, including viral encephalitis, which deserves a better insight, in particular regarding titration of steroids in patients starting Anakinra. Conclusions A growing body of evidence has been reporting the outcomes of Anakinra in lymphoma patients who developed ICANS after CAR-T, higher Anakinra doses proving the most satisfactory results. Preliminary studies also tested an early adoption of Anakinra for the prevention of severe ICANS. The above systematic review confirms the need of randomized clinical trials to assess the effectiveness (grade 5 ICANS, duration of ICANS, steroid cumulative dose) of Anakinra in different patients subgroups, i.e. severe ICANS, steroid-refractory ICANS, ICANS with concurrent CRS, patients at high risk of developing ICANS (Rubin 2020). Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal