Program Guidelines Research Articles

Impact of empirical treatment in patients with extrapulmonary tuberculosis and their outcome

Abstract Background Tuberculosis (TB), primarily caused by mycobacterium tuberculosis (Mtb), remains a significant public health concern globally, particularly in low-resource settings. Extrapulmonary tuberculosis (EPTB), which affects organs beyond the lungs, presents diagnostic and treatment challenges, necessitating improved clinical management strategies. This work was aimed to assess the impact of empirical anti-TB treatment on the outcomes of patients with extrapulmonary tuberculosis and to analyze the demographic and risk factors associated with EPTB. Methods A retrospective cohort study was conducted over three years (2020–2023) at PSG Hospitals, Coimbatore. Ninety-two subjects, all with negative microbiological results but symptoms indicative of EPTB, were carefully selected. Results A total of 92 patients were included in the study, all of whom had negative microbiological diagnosis with symptoms suggestive of EPTB. The mean age of patients was 58.14 years, with a male predominance (59.78%). Pleural effusion was the most common EPTB site, with many patients having no co-morbidities. Occupational factors, such as cotton millwork, and lifestyle factors, including alcohol use and malnutrition, were prominent risk factors. Clinical manifestations varied, with fever being the most common symptom. Treatment completion was 65.22%, falling below National Tuberculosis Elimination Program (NTEP) guidelines, with notable loss to follow-up and mortality rates. Conclusion Empirical treatment for EPTB showed notable improvement in the patient's symptoms and overall health. However, challenges persist in treatment completion, especially among socioeconomically disadvantaged populations. Early detection, prompt treatment initiation, and comprehensive management are essential to address the multifaceted challenges posed by EPTB effectively.

Effects of Responsiveness and Responsibility Parenting Factors on Family Mealtime Outcomes in Overweight African American Adolescents

Background/Objectives: Family meals have been shown to be an important protective factor for positive health outcomes. This study assessed the associations of parenting factors with family mealtime among overweight African American adolescents over a period of 4 months. It was hypothesized that increases in warm and responsive parenting (parental responsiveness, parental responsibility) would be associated with increased frequency and quality of family mealtimes, while more demanding and controlling parenting (parental demandingness, parental monitoring) would be associated with a reduced frequency and quality of family mealtimes over time. Methods: Data from baseline to 16 weeks were collected from 241 African American adolescent–parent dyads (adolescent: Mage = 12.8 ± 1.7 years; 64% female; MBMI%= 96.6 ± 4.2) that participated in the Families Improving Together (FIT) for Weight Loss randomized controlled trial. Results: Multilevel models revealed significant positive main effects of parental responsiveness and parental responsibility (p < 0.05) on the increased frequency of family meals (p < 0.01). Significant two-way interactions also showed that parental responsiveness (p < 0.05) predicted improved quality of family mealtimes, whereas parental demandingness (p < 0.01) predicted reduced quality of family mealtimes from baseline to 16 weeks. Conclusions: Results from this study have important implications for African American adolescent obesity prevention and future family-based intervention program guidelines.

Abstract 4138420: Impact of the American Heart Association Get-With-The-Guidelines Heart Failure A.S.I.A. Program in Taiwanese hospitals

Introduction: The American Heart Association (AHA) Get With the Guidelines – Heart Failure program has been implemented for years in the United States with extensive literature supporting its benefits. In 2022, the AHA Heart Failure Adherence to Science Implementation in Asia (HF A.S.I.A.) powered by Get With The Guidelines program was first introduced in five Asian countries. Research Question: This study aims to explore the impact of this program's implementation in Taiwanese hospitals. Methods: Data were sourced from the Taiwan Society of Cardiology-HF-Registry 2020, a prospective registry that tracks HF cases from 27 hospitals in Taiwan between 2020 and 2024. Among these, four hospitals began participating in the HF A.S.I.A. program in January 2022. This study compared patients from hospitals that participated and did not participate in the HF A.S.I.A. program. Results: A total of 1,933 HF patients with a left ventricular ejection fraction ≤ 40% were included, comprising 460 participants from the HF A.S.I.A. program and 1,473 non-participants. The HF A.S.I.A. group was younger, had significantly lower systolic blood pressure, larger left ventricular diameter, and experienced more frequent prior hospitalizations for HF. However, there were no significant differences between the two groups in terms of baseline heart rate, estimated glomerular filtration rate, blood potassium levels, and most comorbidities. During the study period, due to changes in payment policies, the use of angiotensin receptor neprilysin inhibitor (ARNI) decreased in the non-participant group, while the use of sodium glucose co-transporter 2 inhibitor (SGLT2i) increased. Conversely, the use of ARNI in the HF A.S.I.A. group continued to rise in line with guideline recommendations and the usage of SGLT2i was higher than in the non-participant group. After adjustment, one-year lost to follow-up rate was significantly lower (3.0% vs. 5.6%, p =0.032) and all-cause mortality rate trended non-significantly lower (7.6% vs. 11.4%, p =0.096) among the HF A.S.I.A. group. Conclusion: Despite enrolling sicker patients, participation in HF A.S.I.A. program was associated with higher quality of HF care.

Institutional Examples of Applying the SHAPE Appropriate Instructional Practice Guidelines for Higher Education Physical Activity Programs

This educational brief provides examples of applications of the recently updated Society of Health and Physical Educators (SHAPE) Appropriate Instructional Practice Guidelines for Higher Education Physical Activity Programs across several institutions (SHAPE America, 2022). Research has shown that movement and physical activity are essential for managing physical and mental health; therefore, the current low level of physical activity among college students is concerning (American College Health Association, 2024; Rodríguez-Romo et al., 2022). Academic instructional physical activity programs (IPAPs) provide students with quality learning environments that promote and support opportunities for lifelong physical activity and movement. Empowering physical activity instructors with appropriate instructional practices increases the likelihood of positive experiences for both students and instructors. The intent of this brief is to demonstrate how SHAPE IPAP Guidelines are incorporated in universities today. The institutional examples can serve as models to facilitate discussions within other colleges and universities. The information provided will assist program administrators and faculty in developing, better aligning, and supporting their respective IPAP with teaching, administrative, and instructional practices as identified in the SHAPE IPAP Guidelines document.

Development and Evaluation of a Rural Longitudinal Neonatal Resuscitation Program Telesimulation Program (MOOSE: Maine Ongoing Outreach Simulation Education).

Neonatal resuscitation is a high-acuity, low-occurrence event and many rural pediatricians report feeling underprepared for these events. We piloted a longitudinal telesimulation (TS) program with a rural hospital's interprofessional delivery room teams aimed at improving adherence to Neonatal Resuscitation Program (NRP) guidelines and teamwork. A TS study was conducted monthly in one rural hospital over a 10-month period from November 2020 to August 2021. TS sessions were remotely viewed and debriefed by experts, a neonatologist and a simulation educator. Sessions were video recorded and assessed using a scoring tool with validity evidence for NRP adherence. Teamwork was assessed using both TeamSTEPPS 2.0 Team Performance Observation Tool and Mayo High-Performance Teamwork Scale. We conducted 10 TS sessions in one rural hospital. There were 24 total participants, who rotated through monthly sessions, ensuring interdisciplinary team composition was reflective of realistic staffing. NRP adherence rate for full code scenarios improved from a baseline of 39 to 95%. Compared with baseline data for efficiency, multiple NRP skills improved (e.g., cardiac lead placement occurred 12× faster, 0:31 seconds vs. 6:21 minutes). Teamwork scores showed improvement in all domains. Our results demonstrate that a TS program aimed at improving NRP and team performance is possible to implement in a rural setting. Our pilot study showed a trend toward improved NRP adherence, increased skill efficiency, and higher-quality teamwork and communication in one rural hospital. Additional research is needed to analyze program efficacy on a larger scale and to understand the impact of training on patient outcomes. · Optimal newborn outcomes depend on skillful implementation of NRP.. · Telesimulation can deliver medical education that circumvents challenges in rural areas.. · A longitudinal NRP TS program is possible to implement in a rural setting.. · A rural NRP telesimulation program may improve interprofessional resuscitation performance.. · A rural NRP telesimulation program may improve interprofessional resuscitation teamwork..

Constructing a Competency Training Index System in Public Health Emergencies for Community Nurses.

A competency training index system was designed in public health emergencies for community nurses. The purpose of this approach is to provide community nurses with guidelines for standardized training programs on how to respond to public health emergencies. Through semi-structured interviews, a literature review, and team discussion, the first draft of competency training index system in public health emergencies for community nurses was formed. The Delphi method was used for two rounds of expert consultation to screen, modify and determine indicators. Finally, the analytic hierarchy process was utilized to calculate the weights of indicators at all levels. A total of 15 expert consultants were included. The effective recovery rate of the two rounds of expert consultation questionnaire was 100%, the expert authority coefficient was 0.880, 0.887, and the Kendall coordination coefficient was 0.172 and 0.171 (p < 0.001). Expert opinions have determined that the final revised competency index system in public health emergencies for community nurses training consists of 2 primary indicators, 10 secondary indicators, and 46 tertiary indicators. The study has developed a competency training index system in public health emergencies for community nurses. This system can serve as a foundation for standardized training in community health service institutions. It is characterized by its high demand, scientific approach, reliability, and rationality.

The association between dietary carbohydrate intake and the risk of hyperlipidemia among reproductive-aged women in the US: A cross-sectional study.

The association between dietary carbohydrate intake and hyperlipidemia remained incompletely understood. This study aimed to explore the association between dietary carbohydrate intake and the risk of hyperlipidemia among reproductive-aged women in the US. The study utilized data from the National Health and Nutrition Examination Survey (NHANES) conducted from 2005 to 2020. Dietary intake information was assessed via interviews using 24-hour dietary recall interviews, and hyperlipidemia diagnosis adhered to the National Cholesterol Education Program guidelines. Univariate and multivariate logistic regression analyses, along with restricted cubic splines (RCS) and stratified analyses, were conducted to investigate the association between dietary carbohydrate intake and the risk of hyperlipidemia. A total of 6,791 women of reproductive age, with a mean age of 34.87 (±8.57) years, were included in the final analysis. In the multivariate logistic regression model adjusting for covariates, a higher percentage of energy from carbohydrate was positively correlated with the risk of hyperlipidemia (adjusted odds ratio (AOR): 1.014, 95% CI: 1.004-1.024). Analyzing the percentage of energy from carbohydrate as a categorical variable, compared to the lowest quartile, the third quartile (AOR: 1.263, 95% CI: 1.031-1.546) and the highest quartile (AOR: 1.411, 95% CI: 1.083-1.839) were associated with increased hyperlipidemia risk. Additionally, a linear relationship (P for nonlinearity = 0.088) existed between the percentage of energy from carbohydrate and the risk of hyperlipidemia, with an inflection point identified at 49.64. This study found that elevated dietary carbohydrate intake was associated with an increased the risk of hyperlipidemia in reproductive-aged women. These findings implied that reproductive-aged women should pay closer attention to reducing their carbohydrate intake.

Awareness, use and perception of patient versions of clinical practice guidelines – a national cross-sectional survey among patients with a cancer diagnosis and healthcare providers

BackgroundTo investigate awareness, use, and perceptions of the patient guidelines (PGs) of the German Guideline Program in Oncology (GGPO) and to explore general preferences regarding cancer information among patients and healthcare providers (HCPs).MethodsTwo cross-sectional surveys among patients with cancer (November 2020—May 2021) and among HCPs (April -June 2021) were set up as anonymised, self-administered, semi-structured online surveys, including open-ended questions. Data were analysed with descriptive statistics and qualitative thematic analysis. Patients were recruited from national self-help organisations and certified cancer centres located all over Germany. HCPs were recruited from cancer centres, scientific medical societies and guideline groups.ResultsOf 816 participating patients, 45% were aware of the GGPO-PGs, while 55% of the 455 participating HCPs were aware of them. Of those aware of the GGPO-PGs, 65% of patients and 86% of HCPs perceived them as helpful, while 95% in both groups saw them as comprehensive. Seventy-five percent of patients and 85% of HCPs were satisfied with the GGPO-PGs, 22%/13% were partially satisfied, and 3%/2% were rather/not at all satisfied. In addition to self-help organisations, physicians and hospitals were perceived as central in distributing the GGPO-PGs. More patients (78%) than HCPs (56%) stated a preference for detailed information, although the wish for concise information – e.g. decision aids – was concurrently expressed by the majority of all participants. Thematic analysis showed that up-to-dateness, trustworthiness, and supportive messaging are important properties for PGs.ConclusionsHCPs found the GGPO-PGs helpful, but awareness was low, which suggests that dissemination should be improved. This is also true for patients; however, further research needs to be done to increase the helpfulness of PGs for patients. Oncological PGs seem to be needed in different formats according to patients’ situational needs. Theory-driven research should investigate how to best frame patient information in a supportive way.

Assessment of Antitachycardia Pacing in Primary Prevention Patients

The emergence of novel programming guidelines that reduce premature and inappropriate therapies along with the availability of new implantable cardioverter-defibrillator (ICD) technologies lacking traditional endocardial antitachycardia pacing (ATP) capabilities requires the reevaluation of ATP as a first strategy in terminating fast ventricular tachycardias (VTs) in primary prevention ICD recipients. To assess the role of ATP in terminating fast VTs in primary prevention ICD recipients with contemporary programming. This global, prospective, double-blind, randomized clinical trial had an equivalence design with a relative margin of 35%. Superiority tests were performed at interim analyses and the final analysis if equivalence was not proven. Patients were enrolled between September 2016 and April 2021 at 134 sites in 8 countries, with the last date of follow-up on July 6, 2023. Patients were required to have an indication for a primary prevention ICD, including left ventricular ejection fraction less than or equal to 35%. Patients were randomized in a 1:1 ratio to receive ATP plus shock vs shock only. The primary end point was time to first all-cause shock. Secondary end points included time to first appropriate shock, time to first inappropriate shock, all-cause mortality, and the composite of time to first all-cause shock plus all-cause mortality. A total of 2595 patients were randomized (mean age, 63.9 years; 22.4% were females). At a mean follow-up of 38 months, first all-cause shock occurred in 129 participants in the ATP plus shock group and 178 participants in the shock only group. The hazard ratio (HR) for the primary end point was 0.72 (95.9% CI, 0.57-0.92), with P = .005 for superiority of the ATP plus shock group over the shock only group. During follow-up in an intention-to-treat analysis, the total shock burden per 100 patient-years was not statistically different, at 12.3 and 14.9, respectively (P = .70). The use of a single burst of ATP prior to shock in primary prevention ICD recipients with modern ICD detection programming prolonged the time to first all-cause ICD shock. ClinicalTrials.gov Identifier: NCT02923726.

Teacher content-language awareness in Canadian immersion teacher education programs

Research demonstrates that content, language, and literacy integration is challenging for teachers working in content-based instructional contexts such as immersion and Content and Language Integrated Learning. Although teacher preparation programs for content-based instruction contexts exist, it is unclear whether and how they help pre-/in-service teachers acquire the knowledge and awareness they need to be effective. In recent years, scholars have lamented that research has ignored immersion teacher education and that teachers and teacher educators do not yet fully understand the knowledge base that immersion teachers require. This article reports on an exploratory study that included an examination of web-based program descriptions, course outlines, focus groups with course instructors (N = 11), and teacher candidates (N = 29) to compare immersion teacher education programs at Canadian universities with the goal of better understanding how they develop learners’ Teacher Content-Language Awareness (TCLA) and what challenges they face. Findings include the urgent need to establish general guidelines for content-based teacher education programs as well as the need to include criticality as a fundamental element to all TCLA domains.

Effect of Ocular Perfusion Pressure on Incidence of Diabetic Retinopathy in Type 2 Diabetes: A Two-Year Prospective Study.

To investigate the association between mean ocular perfusion pressure (MOPP), estimated cerebrospinal fluid pressure (CSFP), and changes in diabetic retinopathy (DR) in a Southern Chinese population with type 2 diabetes (T2DM). A total of 1224 subjects from the Guangzhou Diabetic Eye Study were enrolled. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and intraocular pressure (IOP) were measured. MOPP was calculated with the formula: MOPP = 2/3 [DBP + 1/3 (SBP - DBP)] - IOP. CSFP was calculated using the formula: CSFP = 0.44 × body mass index (kg/m2) + 0.16 × DBP - 0.18 × age (years) - 1.91. Incidence, progression, and regression of DR were graded based on seven-field 45° conventional fundus photographs at baseline and during two-year follow-up examinations according to the United Kingdom National Diabetic Eye Screening Program guidelines. Higher MOPP was associated with DR incidence in the multivariate model (per 1 mm Hg increase: relative risk, 1.05; 95% confidence interval, 1.01-1.09; P = 0.02) and was not associated with DR development and DR regression in two-year follow-up of T2DM patients. However, CSFP was not associated with DR changes (incidence, progression, or regression). The higher MOPP is an independent risk factor for DR incidence among T2DM patients in a Southern Chinese cohort. Monitoring MOPP and managing blood pressure can be part of a comprehensive approach to prevent or delay the onset of DR in T2DM patients. MOPP might be an indicator for the detection of DR incidence.

Strengthening guideline contextualization in the WHO European Region.

The World Health Organization (WHO) plays an important role in developing evidence-based and ethically sound guidelines to assist health workers, programme managers and policy-makers, particularly in countries with limited capacities to create their own. While the development of these guidelines follows rigorous methods, contextualizing recommendations is often necessary to ensure their applicability, feasibility and acceptability at the country level. The adaptation and adoption of global guidelines should happen in a transparent, systematic and participatory manner to maintain credibility while ensuring the ownership necessary for implementation. Here, we present an example from Estonia that showcases the process, requirements and outcomes of implementing WHO guidelines through effective contextualization. The work in Estonia showed that contextualization can shorten guideline development time and reduce costs. To support countries in contextualizing guidelines, including those developed by WHO, to local contexts while maintaining trustworthiness and relevance, the WHO Regional Office for Europe has developed a handbook based on the GRADE-Adolopment approach to guide this process. Furthermore, a rapid assessment of 21 of the 53 Member States in the WHO European Region revealed that many countries need guidance and support to build capacity for contextualizing guidelines. To address the capacity gaps, we suggest a way forward that encompasses four areas of further work: standardizing methods; institutionalizing guideline programmes and initiatives; promoting continuous and shared learning; and providing support and identifying resources. Strengthening countries' capacities to contextualize global guidelines is crucial and will become especially relevant during future health threats, such as pandemics, climate change and conflict situations.

PRESCHOOL TEACHERS PREPARATION FOR WORKING WITH CHILDREN WITH SPECIAL EDUCATIONAL NEEDS IN CALIFORNIA

Following the realization of the importance of early development and the low quality of early childhood education programs in the United States the National Association for the Education of Young Children (NAEYC) and the Council for Exceptional Children (CEC) were established to develop professional standards for special educators. It was found that the most important factor in providing education for children with special needs is well-trained teaching staff. Principles for ensuring the existence of high-quality programs for kindergartens began to be developed. A new concept of “Developmentally Appropriate Practice” was formed by The National Association for Nursery Education (NANE and seven standards for the professional training of early childhood teachers were proposed. The Education for All Handicapped Children Act was passed by the Congress in 1975. IDEA regulates how states and public agencies provide early intervention, special education, and other services. The state has established grants to improve the quality of school education by attracting and retaining effective teachers. It was found that 7 million, or 14% of all public school received special education services. The California Commission on Teacher Credentialing is revising the Special Education Standards for Children with Disabilities. The commission developed draft teaching, administration, and preparation program guidelines in collaboration with a technical advisory group of early childhood education professionals. It was clarified that there are additional internship programs in California, Completion of the internship program leads to a Certificate of Eligibility to Teach, which is identical to completion of a traditional teacher preparation program. It was concluded that the policy of the Department of Education, the educational laws of the United States are aimed at encouraging participation in formal and informal professional learning, but it should be a continuous process, because adults providing care and education are responsible for the progress of children throughout their lives.

Public Libraries Encouraged to Meet the Health Information Needs of Tribal Women in Bangladesh

A Review of: Yesmin, S., Abdul Karim, M., &amp; Atikuzzaman, M. (2023). Community engagement of public libraries for ensuring tribal women’s health literacy in Bangladesh. IFLA Journal, 49(4), 678–693. https://doi.org/10.1177/03400352231198260 Objective – To investigate public libraries’ existing community engagement practices, explore their willingness to provide health information services to tribal communities in Bangladesh, and examine tribal women’s health information-seeking behavior and interest in obtaining health information from public libraries. Design – A cross-sectional study using online interviews and structured questionnaires. Setting – Public libraries and tribal communities in tribal regions of Bangladesh. Subjects – Public librarians (n=11) and tribal women (n=276) from three tribal districts in Bangladesh (Bandarban, Khagrachari, and Mymensingh). Methods – Interviews were conducted with librarians via Zoom in January 2023. Survey questionnaires were distributed to a convenience sample of 300 tribal women from February to March 2023. Data was analyzed in the Statistical Package for the Social Sciences (SPSS), using univariate and bi-variate measures. Main Results – All of the libraries provided print materials (books, newspapers, and periodicals) for reading and lending and offered photocopying and Internet browsing services. Other forms of resources such as microfiches and digital materials, inter-library loan services, and facilities for people with disabilities were not widely available. Most libraries (72.8%) did not provide any specific program (e.g., health-related outreach program) for tribal community engagement, although they all recognized the urgency and value of such programs. Lack of funding and bureaucratic complexities were identified as the top two barriers. Out of the 276 tribal women responding to the survey, close to two-thirds of the respondents indicated they were either moderately or very interested in receiving health information. The top three health topics the respondents sought information on were vaccinations, symptoms of disease, and nutrition. The primary health information sources for the respondents were doctors at nearby community clinics or government hospitals, and none of the respondents sought health information from public libraries. Most respondents acknowledged the importance of being informed about health issues and found it difficult to locate health information on the Internet. High costs and lack of awareness regarding health issues represented the main challenges the respondents encountered when seeking health information. Among the demographic variables, respondents’ religion and age were negatively correlated with their interest in health information, while their education status was positively correlated with it. Conclusion – Public libraries in tribal areas in Bangladesh lacked health information services but recognized the importance of providing them. Tribal women expressed interest in receiving health information, encouraging public libraries to develop and implement related services and programs. Public libraries may consider adding new job titles such as consumer health librarians and partner with other stakeholders for better community engagement. The government of Bangladesh should substantially invest in public libraries as community hubs and minimize bureaucratic hurdles that prevent public libraries from initiating new services. Professional library organizations in Bangladesh may also draw ideas from the study in establishing professional guidelines for health information services and community outreach programs.

Growing community-based composting programs in China: Implementation and policy lessons from eight cases

Localised processing of waste into resources is a prime target towards circular economy, yet community-led composting programs have reported significant implementation challenges. There are no implementation process models or guidelines for programs spanning community, waste, governance, legislation domains: each community learns anew. Here we report a multi-case study of community-led composting program implementations in eight urban sites in China. In-depth key-informant interview information was analysed as cycles of activity towards increasingly-complex needs/targets (like simple recycling; complex composting). Cross-community comparisons suggest transferable implementation lessons: delegation of certain roles is more effective than simply involving stakeholders; enthusiasts can significantly mobilize stakeholders but cannot replace them; paperwork burden could negate funding availability benefits; access to specific expertise (technical, legal, operational) at crucial moments was key; stakeholder learning was most effective via personal meetings and introductions. City policies incorporating these implementation lessons could facilitate scaling-up in China. Future studies can investigate generalizability.

How does energy transition improve energy utilization efficiency? A case study of China's coal‐to‐gas program

AbstractImproving energy efficiency by adjusting the structure of energy consumption types is of great significance for reducing carbon emissions in the short term. The present paper constructs new data envelopment analysis models for evaluating energy utilization under different structural conditions and calculating potential emissions reductions. We conducted empirical research on 30 provinces in China from 2003 to 2019—a time frame that coincides with the instituting of China's “coal‐to‐gas” program. Our results show that technological progress is the main way for China to reduce carbon emissions and that it is possible to reduce the total amount of carbon emissions by 35%. Additionally, optimizing the energy consumption structure following the coal‐to‐gas program guidelines could reduce the country's carbon emissions by a further 25%. Finally, this paper provides specific policy recommendations based on the efficiency analysis results to guide each province in reducing carbon emissions under the conditions of energy demand growth.

Performance of small-scale composting in low ambient temperatures: Effects of adding animal by-products and recycling leachates

Decentralized composting is an emerging method for managing biowaste, engaging waste generators as active recyclers in the waste management cycle. Evaluating performance and identifying optimization opportunities within this composting framework is essential to maximize its benefits and address its challenges. In small-scale composters, fresh waste is continuously mixed with previously added materials, shifting the typical composting process. As with larger systems, the composition of the feedstock influences the temperature profile and the quality of the final product. The issue of whether to include animal-source waste remains controversial in the development of standards and program guidelines. On the other hand, evaluating a leachate recycling method could help prevent nutrient loss and mitigate environmental impacts when bulking agents are lacking. In this study, kitchen and garden wastes were composted in 500-L static composters under cold climate conditions. We examined obtained compost stability, maturity, and quality parameters to determine the effects of adding animal by-product waste and/or recycling leachate. Our findings indicate that including animal by-products allows reaching sanitation temperatures under cold weather conditions and that recycling leachates could reduce nutrient losses and alleviate environmental and other user concerns while improving temperature, stability, maturity, and product quality patterns in decentralized composting.

Clinical spectrum of tuberculosis in adolescents (10–19 years) in a tertiary care center of North India

Background\\objectivesThere is limited literature available to characterize tuberculosis (TB) in adolescents despite them sharing a high burden of the disease. Ours is the first prospective study in India and worldwide to study the clinical profile of tuberculosis in adolescents aged 10–19 years.Methods: We enrolled 82 children and adolescents between March 2021 to March 2022. The diagnosis of TB was made on the basis of National Tuberculosis Elimination Program (NTEP) guidelines 2020. Adolescents were divided into 3 age groups: early (10–13 years), middle (14–17 years), and late adolescents (18–19 years)and the results were compared among the three groups. A two-sided p value of <0.05 was considered statistically significant.Results: The middle age adolescents comprised majority of our study population and females were more than males. The common presenting features were fever, chest pain, breathing difficulty with majority belonging to lower socioeconomic status. The pulmonary TB accounted for 56% and extrapulmonary constituted 44% of the cases. The notable extrapulmonary cases were disseminated TB with secondary lymphangiectasia, compressive myelopathy, sacroiliac joint arthropathy among others. Infiltrates/consolidation were the most frequent radiological findings in patients with pulmonary TB. The microbiological confirmation was available in 44% of the cases. The microbiological positivity was higher in histopathological specimens and in late adolescents. Two patients were rifampicin resistant. Conclusion: There was a varied clinical presentation of TB in this population. The extrapulmonary cases as well as the microbiological yield increased with increasing age of the cases.

Site Characterization In Champhai Town Area Of Mizoram State In Northeast India: Geological And Geophysical Studies

The Mizoram state of northeast region (NER), India located in close proximity to Indo-Burma subduction zone, recently experienced an earthquake swarm; eight severely felt earthquakes (Mw 5.0–5.9) occurred during April–October, 2020 around Champhai town that caused damages to several buildings and ground cracks with maximum reported MSK intensity VIII. The largest event Mw 5.9, at depth 15 km, occurred on April 16 (ISC catalog). The present study deals with site characterization of the Champhai town area by geological and geophysical investigations. The geological investigation involves detailed mapping of the lithounits, and the geophysical investigation includes shallow (down to 30 m) shear wave velocity (Vs 30) and site amplification (SA) measurements in an about 50 sq km area in the town. Some 23 sites are selected for Vs 30 measurements using the Multichannel Analysis of Surface Wave (MASW) technique. The observed Vs 30 ranges from 200 m/s to 1060 m/s classifying the area into three categories: Class-B (hard rock), class-C (soft rock), and class-D (stiff soil) as per National Earthquake Hazard Reduction Program (NEHRP) guidelines. Geologically, the class B and C sites are represented by arenaceous and argillaceous Tertiary rocks, respectively, whereas the class D is represented by the Quaternary sediments. Site amplification (SA) studies, on the other hand, are carried out by making ambient noise surveys at some 52 selected stations using a digital seismograph. The ambient noise data are analyzed by the Nakamura method of H/V spectral ratio. The overall variation of peak amplification of the sites ranges from 1.26 to 6.65. A good correlation is obtained; the observed Vs 30 and site amplification (SA) maps are fairly comparable with the detailed geological or lithounit map. These maps are much useful for seismic hazard microzonation of the town area to mitigate seismic hazard-risk

Development and Update of Guideline-based Quality Indicators in Lung Cancer

Abstract Background In 2022, an update of the German lung cancer guideline, first published in 2010 and revised in 2018, was released. This article aims to show the process of updating, developing, and implementing guideline-based quality indicators (QI) into the certification system for lung cancer centers (LCC). Methods A multidisciplinary and interprofessional working group revised the guideline QIs from 2018 using the strong recommendations of the guideline update, a systematic review for QIs, and the results of the implemented QIs from LCC. Results For 4 out of 8 indicators from the 2018 guideline, the LCC showed an improved implementation of the requirements in the last 3 years (2018–2020). For 3 indicators, the median of the results was constant at a very high level (≥96% or 100%). Only the “adjuvant cisplatin-based chemotherapy” indicator showed declining values between 2018 and 2020. The target values and plausibility limits were well achieved by LCC. After updating the guideline, one QI from 2018 was not included in the new QI set due to the small denominator population. Based on the new strong recommendations, 8 new QIs were defined. From the QI set of the guideline update, 13 of 15 indicators (7 since 2018 and 6 from 2022 on) were adopted into the certification program. Conclusions The guideline recommendations are implemented by LCC at a high level. The process presented confirms the successful implementation of the so-called quality cycle in oncology. The QIs developed by the German Guideline Program in Oncology (GGPO) are adopted by the certification program. The implementation of the QI is measured in LCC, evaluated by the German Cancer Society (DKG), and reflected back to the GGPO. The “real world” data have led to the deletion of one QI and show a high implementation of most QIs in LCC.