Large-scale Programs Research Articles

Long-acting injectable cabotegravir for PrEP: A game-changer in HIV prevention?

Long-acting injectable cabotegravir (CAB-LA) represents a new additional option for HIV prevention in people at substantial risk of HIV infection that may fill the gaps in pre-exposure prophylaxis (PrEP) uptake, adherence, and retention in users having difficulty with oral PrEP. Data from clinical trials demonstrated that CAB-LA was safe, highly effective, and well-accepted for HIV prevention. However, the occurrence of breakthrough HIV infections despite timely injections, HIV seroconversion timing and patterns, risk of selection and dissemination of resistance-associated mutations to integrase inhibitors, complexity of follow-up, logistical considerations, and its cost effectiveness compared with oral PrEP constitute significant issues for the integration of CAB-LA into clinical routine. These concerns need to be addressed before moving forward with large-scale implementation programmes. Pilot and implementation projects are required in the following areas: HIV testing algorithms, patient education, clinic procedures, protocols for switching and discontinuation, efficacy and safety in populations not included in clinical trials, and demedicalization processes. The development of models to increase the uptake of, adherence to, and persistence with and after CAB-LA injections will also be of paramount importance for success. Lessons learned from these projects will increase experience, staff expertise, and organizational and training capacities to support the roll-out of this new agent as part of HIV prevention programmes. CAB-LA has not yet achieved its full potential in HIV prevention, and strong commitment from all stakeholders is required to push CAB-LA as a game-changer in HIV response.

Hepatitis B vaccination in Iran: Historical policies and programs.

Hepatitis B virus (HBV) infection is a main challenge of the health system worldwide. Health policymakers in most countries attempt to help HBV patients by implementing support programs in addition to controlling HBV in their community so that the economic burden caused by HBV do not deprive the patients of accessing health services and reducing their quality of life. There are several health interventions for the prevention and control of HBV. Providing the first dose of the HBV vaccine within 24 hours after the infant is born is the most cost-effective way to prevent and control HBV. The purpose of this study is to review the nature of HBV, its epidemiology in Iran and worldwide, and to review the various policies and programs in Iran regarding the prevention and control of HBV, especially the use of vaccination. One of the goals of Sustainable Development Goals (SDGs) is to consider hepatitis as a threat to human health. In this regard, one of the top priorities of WHO is the prevention and control of HBV. In connection with the prevention of HBV, it is claimed that vaccination is the most effective and best intervention. Thus, vaccination in the safe's program of countries is highly recommended. According to the Ministry of Health and Medical Education (MOHME) reports, Iran has the lowest prevalence of HBV among the countries in Eastern Mediterranean Region Organization (EMRO). There is a hepatitis unit in MOHME whose responsibility is to coordinate and implement the hepatitis prevention and control programs. The HBV vaccine has been officially included in the vaccination program for children in Iran since 1993, and three doses of the vaccine are given to all infants. In 2007, during a large-scale program in Iran, 17-year-olds received the HBV vaccine, followed by adolescents born in 1990 and 1991. In recent years, the health system in Iran has made significant progress in preventing and controlling HBV. Over 95% coverage of the HBV vaccination is one of the achievements that have had a great impact on reducing the trend of HBV infection. In order to achieve the 2030 goals, the Iranian government, in addition to paying more attention to HBV elimination programs, should encourage other organizations to cooperate more effectively with MOHME.

EE57 Recombinant Zoster Vaccine for High-Risk Ageing Adults in the Netherlands: Cost-Effectiveness and Value of Information Analyses

Ageing adults, especially with comorbidities are at risk of Herpes zoster (HZ) and its chronically painful complication, postherpetic neuralgia (PHN). The disease can be prevented by the Recombinant Zoster Vaccine (RZV), but a large-scale RZV program is not advisable in the Netherlands mainly due to its unfavorable cost-effectiveness. This work aims to estimate the incremental cost-effectiveness ratio (ICER) of high-risk and overall-cohort vaccination strategies compared with non-vaccination in 70-year-old Dutch people, and to prioritize future research addressing the uncertainty of the decision model.

Weakly-supervised detection of AMD-related lesions in color fundus images using explainable deep learning

Background and ObjectivesAge-related macular degeneration (AMD) is a degenerative disorder affecting the macula, a key area of the retina for visual acuity. Nowadays, AMD is the most frequent cause of blindness in developed countries. Although some promising treatments have been proposed that effectively slow down its development, their effectiveness significantly diminishes in the advanced stages. This emphasizes the importance of large-scale screening programs for early detection. Nevertheless, implementing such programs for a disease like AMD is usually unfeasible, since the population at risk is large and the diagnosis is challenging. For the characterization of the disease, clinicians have to identify and localize certain retinal lesions. All this motivates the development of automatic diagnostic methods. In this sense, several works have achieved highly positive results for AMD detection using convolutional neural networks (CNNs). However, none of them incorporates explainability mechanisms linking the diagnosis to its related lesions to help clinicians to better understand the decisions of the models. This is specially relevant, since the absence of such mechanisms limits the application of automatic methods in the clinical practice. In that regard, we propose an explainable deep learning approach for the diagnosis of AMD via the joint identification of its associated retinal lesions. MethodsIn our proposal, a CNN with a custom architectural setting is trained end-to-end for the joint identification of AMD and its associated retinal lesions. With the proposed setting, the lesion identification is directly derived from independent lesion activation maps; then, the diagnosis is obtained from the identified lesions. The training is performed end-to-end using image-level labels. Thus, lesion-specific activation maps are learned in a weakly-supervised manner. The provided lesion information is of high clinical interest, as it allows clinicians to assess the developmental stage of the disease. Additionally, the proposed approach allows to explain the diagnosis obtained by the models directly from the identified lesions and their corresponding activation maps. The training data necessary for the approach can be obtained without much extra work on the part of clinicians, since the lesion information is habitually present in medical records. This is an important advantage over other methods, including fully-supervised lesion segmentation methods, which require pixel-level labels whose acquisition is arduous. ResultsThe experiments conducted in 4 different datasets demonstrate that the proposed approach is able to identify AMD and its associated lesions with satisfactory performance. Moreover, the evaluation of the lesion activation maps shows that the models trained using the proposed approach are able to identify the pathological areas within the image and, in most cases, to correctly determine to which lesion they correspond. ConclusionsThe proposed approach provides meaningful information—lesion identification and lesion activation maps—that conveniently explains and complements the diagnosis, and is of particular interest to clinicians for the diagnostic process. Moreover, the data needed to train the networks using the proposed approach is commonly easy to obtain, what represents an important advantage in fields with particularly scarce data, such as medical imaging.

Impacts of different fencing periods and grazing intensities on insect diversity in the desert steppe in Inner Mongolia

For the past several decades, both species biodiversity and productivity of desert steppe have been reduced due to excessive use and climate factors. To counteract this, Chinese government has supported large-scale grassland ecological restoration programs since the year 2000. The policy needs a standard for the evaluation of the effects of such restorative measures on the grasslands after decades. Grassland insect diversity plays an important role in the maintenance of plant species and functional diversity. To understand the relation of grazing management and insect diversity, we use a complete two factor design, two fencing periods (3 or 7 years) and three grazing intensities (0, 6, or 12 sheep per ha), to examine the response of the insect diversity to fencing and grazing in desert steppe. We found almost no significant differences in either plant or insect species diversity between the sites fenced for 3 and 7 years, as the pressure of grazing increased, insect diversity decreased to a greater extent at 7-year enclosure sites than at 3-year sites. We recommend the most suitable grazing intensity for the sustainability of biodiversity of the desert steppe in Inner Mongolia is light grazing (8 sheep/ha 0.5 yr−1), and the most suitable fencing period is three years, which suggest that policies that remove livestock from the desert grassland for long periods (7 + years) are not beneficial for maintaining insect diversity, and heavy grazing lead ecological environment weaker and insect diversity decreasing. Thus, periodic livestock grazing is important in the design of management actions to preserve biodiversity.

ENGLISH TEACHERS’ SATISFACTION WITH THE QUALITY OF GENERAL ENGLISH PROFICIENCY TRAINING PROGRAM: THE CASE OF THE MEKONG DELTA, VIETNAM

Many policy changes in teaching and learning English in Vietnam have been implemented. To make those changes successful, the quality of English teachers is paid remarkable attention to by stakeholders. In particular, the quality of their teaching is said to be the determining factor in the success or failure of the changes. Since then, many professional development programs for English teachers have been implemented in Vietnam. This research explores Vietnamese teachers’ satisfaction with the effectiveness of a large-scale general English proficiency training program provided by MOET’s National Foreign Languages Project for school teachers in the Mekong Delta. Employing questionnaires with 174 school teachers in the Mekong Delta, the study sheds light on the main factors that these teachers perceive as crucial factors that influence the quality of the training program and their satisfaction. Findings from the survey reveal that the teachers were highly satisfied with the training program, and the critical factors impacting the training effectiveness included training materials, training duration, teaching and learning facilities, qualified trainers, and support from management. These findings provide a solid foundation for proposing an efficient model training program to effectively support English language teachers in the Mekong Delta to accomplish the required English proficiency level.<p> </p><p><strong> Article visualizations:</strong></p><p><img src="/-counters-/edu_01/0261/a.php" alt="Hit counter" /></p>

Teacher professional development for disability inclusion in low- and middle-income Asia-Pacific countries: An evidence and gap map.

In the Asia-Pacific region, around one-third of the children who are out-of-school have a disability and given that teacher readiness and capability are key contributors for inclusive education, it is high time for a mapping of disability inclusive teacher professional development (TPD) interventions in this region. The key objective of this evidence and gap map (EGM) is to locate evidence on interventions for in-service TPD focussing on education for the inclusion of students with a disability in low- and middle-income countries (LMICs) in the Asia-Pacific region. A broad range of bibliographic databases and repositories were searched electronically to identify the evidence published between January 2000 and December 2021. Key search platforms included the British Education Index (BEI), Education Research Complete (ERC), Education Resources Information Center (ERIC), SCOPUS, 3ie Development Evidence Portal (Evidence Hub) and the Campbell Collaborations Systematic Reviews and EGMs portal (Better evidence for a better world). In addition, potential program evaluations/impact reports, reviews, case studies, and program descriptions/summaries were sought through 'snowballing' based on searching bibliographies and reference lists of papers located during the search process, as well as specific searches of relevant grey literature. To be eligible for inclusion, studies had to contain sufficient details about TPD interventions that support early childhood educators and kindergarten to Year 12 teachers to understand the needs of students with disabilities and aid them to create inclusive mainstream classrooms and/or provide improved support for students with disabilities in special education settings. A total of 820 records were entered into the MS Excel file in which the entire data extraction process was managed. All records were screened against the predefined inclusion and exclusion criteria. Data were extracted independently by two reviewers and any differences were resolved through consultations. All included studies and their characteristics were extracted from the MS Excel file and uploaded to the ACER server in.csv file format. The interactive, online EGM is available here: https://datavis.acer.org/gem/disability-inclusion-TPD/. Fifty studies from 16 countries out of the 41 LMICs in the Asia-Pacific region were identified, whereby Thailand had the largest number of studies with evidence (7) followed by China, Vietnam, and India (5 each). Two main gaps in research about professional learning were identified. First, only three studies reported interventions aimed at supporting mental health among students with a disability. Second, no studies were found that reported on how teachers could support positive student behaviour. These gaps are important because research has persistently suggested that experiencing disability is an important risk factor for young people developing mental health conditions. This report illustrates the critical value of evaluating and publishing evidence from disability inclusive TPD interventions in LMICs, including any that are ongoing, or are components of highly resource intensive large-scale education sector programs.

Effects of Water Deficit Stress on Growth Parameters of Robinia pseudoacacia L. Selected Clones under In Vitro Conditions

Rapid screening methods for drought-resistant genotypes are urgently needed in tree improvement programs in the face of current climate change. We used a plant tissue culture technique to assess the phenotypic response of three highly productive genotypes of Robinia pseudoacacia to water deficit induced by mannitol and sucrose in a range of water potentials from 0 MPa to −1.5 MPa in an eight-week experiment. Our study showed genotype-specific responses to induced drought stress, indicating the potential for tree improvement in productivity and stress tolerance. Considering that all plantlets were constantly supplied with carbon, from the medium during the drought-induced experiment, our results suggest that hydraulic failure rather than carbon starvation may be the main cause of drought-induced mortality. Furthermore, our results showed different metabolic pathways of sucrose depending on the concentration of sucrose in the medium and different responses to osmoticum (mannitol vs. sucrose) and its concentration among the clones tested. We believe, that for large-scale breeding programs wanting to select for drought-tolerant genotypes, the use of culture media containing 90 gL−1 mannitol or 90 gL−1 sucrose at an early selection stage should provide satisfactory screening results. However, lab-based screening should be supported by further field trials, preferably at multiple sites, to assess the long-term impact and phenotypic stability of the early selection strategies.

A parametric study of nose landing gear noise in a large-scale aeroacoustic wind tunnel

The nose landing gear (NLG) of an aircraft considerably contributes to the undercarriage noise. In this paper, a large-scale testing program was conducted within the FL-17 5.5 m×4 m aeroacoustic wind tunnel in CARDC to characterize the effects from various parameters on the acoustic performance of a generic NLG model. Those investigated parameters include incoming flow velocity, wheel size, height, angle of attack and yaw angles. The test was majorly comprised of noise source localization and free-field sound pressure level spectra analysis. Two categories of tonal noise were distinguished depending on variation between frequency and incoming flow speed. Effects of the sideline directivity were analyzed, and it was found that the side distribution of OASPL shows a saddle-like trend with the flow/flight direction and the tonal noise changes significantly with directivity angle. Regarding spectral scaling, U∞7 was found to be more appropriate for a large-scale NLG model, while for a compact small-scale NLG model, the traditional U∞6 is still recommended. As to transitional size, a combination of U∞7 and U∞6 showed to be more suitable for scaling within the high and low frequency ranges respectively. Contributions of different elements to NLG noise to different noise sources were discussed, which were found not to be dependent on their relative sizes. Analysis of the wheel diameter showed it does not cause obvious changes to the overall spectra trend but can induce variation of the amplitude and frequency tones. When the wheel is sufficiently small, the upper head of the sliding piston can be directly exposed to the incoming flow and thus generate sharp tonal noise. In terms of NLG height, the main effects on the acoustic performance was found to be associated not with the change in the height itself, but rather with the accompanying changes from other elements. Finally, the effects of angle of attack (α) and yaw angle (β) were analyzed with results showing that the angle of attack could potentially lead to substantial changes in the acoustic performance, while the yaw angle within 0°-8° has minimal effects.

Developing large-scale offshore wind power programs: A choice experiment analysis in France

Many offshore wind farms are expected to be installed along the European coasts in the next few years. However, developing offshore wind power may affect other maritime activities already established in the sea space (e.g. commercial fishing). We conducted a discrete choice experiment in France on a national sample, where a wide range of the effects that large-scale offshore wind power programs can have on maritime activities were considered. So far, the valuation of preferences for offshore wind power has mainly focused on the visibility of the wind farms and on their impacts on marine biodiversity. In addition to these impacts, our results show that other types of consequences matter to the public. Employment in the maritime economy, the effect on fresh seafood offer, and conditions for the practice of recreational activities are also found to be significant. Moreover, our study introduces a within-sample treatment in which an information script changes the current situation in the opt-out alternative. We find that social acceptance of offshore wind power varies depending on the information given to the public about other sources of electricity generation that could be prioritised. Policy implications of our results are discussed.

Coordinated bidding of multi-product charging station in electricity markets using rolling planning and sample average approximation

Recently, there has been an urgent tendency to steer the transport system towards zero-emission. Along natural gas vehicles, electric and hydrogen vehicles represent a promising way to a low-carbon system. Since the development of these vehicles relies on advances of refueling stations, their economic and operational aspects need to be considered. Therefore, this paper addresses a multi-product charging station for refilling electric, hydrogen and natural gas vehicles. The station participates in day-ahead and intra-day markets where the market price is subject to the uncertainty. For charging station participating in sequential markets with different prices, it is necessary to consider the coordinated bidding. Taking into account the sequential clearing of these markets and the gradual realization of market prices, the bidding problem is formulated as a two-stage stochastic program. In order to solve this large-scale stochastic program with a huge number of scenarios, the rolling planning method in combination with sample average approximation and SCENRED tool are applied. The study aims to attain the optimal operation of devices and bidding curves of the charging station in order to maximize its profit. The obtained average optimality gap based on Monte Carlo sampling approach, which is less than 1%, proves the effectiveness of our proposed algorithm in solving this large scale stochastic optimization. The submitted bidding curves to the intra-day market are found to be dependent on changes in the day-ahead market prices. Tornado diagrams indicate that the selling price and demand of electricity are ranked as the most effective factors on profit.

Getting them through the door: Social and behavioral determinants of uptake and engagement in an obesity intervention

Using data from a large-scale screening program (N = 19634), we aimed to prospectively identify factors predicting uptake (i.e. acceptance of the invitation) and engagement (i.e. participation in at least two sessions) in a multi-component-intensive-behavioral-intervention for obesity-management (MBIOM) intervention targeting adolescents (n = 2862; 12–14 years; BMI ≥90th percentile). Approximately one third of adolescents most in need of weight management declined the initial invitation to enter the MBIOM. Poor diet, sedentary behavior, and parental education predicted willingness to enter and stay in the intervention, however measured body mass index did not matter. Perceived family support, instead of initial motivation, facilitated engagement. Our results provide new insights on the importance of regional socio-geographical factors including trust in local authorities.

Concept of the digital transformation of an industrial enterprise

Aim. The presented study aims to develop a concept of digital transformation through the example of an industrial enterprise to enable comprehensive and efficient digital transformation of separate processes, their stages, and even entire organizations in the industrial sphere.Tasks. The authors determine a series of preparatory and transformational steps that can be executed with little dependence on the competencies of the head of digital transformation and would facilitate digital transformation in the organization; develop a methodology in the form of an integrated methodological framework that makes it possible to formalize the owner of the organization as the principal and the head of digital transformation as the agent in the process of its implementation.Methods. The methodological basis of the study includes research in the field of digital transformation and the authors’ analysis of digital transformation cases.Results. The concept of digital transformation developed in the study contains the necessary methodological tools for the formation of a digital transformation program and its implementation at an industrial enterprise. The created methodological basis of digital transformation makes it possible to consistently plan and carry it out, regardless of the level of digital maturity of the transformed process and organization or the level of competence of the head of digital transformation.Conclusions. The concept of digital transformation developed by the authors makes it possible to transfer digital transformation events or a large-scale program from the category of managerial search for solutions with a high level of uncertainty to the category of a methodologically sound reproducible and feasible set of actions with a high level of effectiveness. In other words, the proposed concept of digital transformation makes it not an “art” with unpredictable results depending on the competencies of the organizer, but rather a reproducible activity with predictable achievements.

Managing sample metadata for biodiversity: considerations from the Darwin Tree of Life project

Large-scale reference genome sequencing projects for all of biodiversity are underway and common standards have been in place for some years to enable the understanding and sharing of sequence data. However, the metadata that describes the collection, processing and management of samples, and link to the associated sequencing and genome data, are not yet adequately developed and standardised for these projects. At the time of writing, the Darwin Tree of Life (DToL) Project is over two years into its ten-year ambition to sequence all described eukaryotic species in Britain and Ireland. We have sought consensus from a wide range of scientists across taxonomic domains to determine the minimal set of metadata that we collectively deem as critically important to accompany each sequenced specimen. These metadata are made available throughout the subsequent laboratory processes, and once collected, need to be adequately managed to fulfil the requirements of good data management practice. Due to the size and scale of management required, software tools are needed. These tools need to implement rigorous development pathways and change management procedures to ensure that effective research data management of key project and sample metadata is maintained. Tracking of sample properties through the sequencing process is handled by Lab Information Management Systems (LIMS), so publication of the sequenced data is achieved via technical integration of LIMS and data management tools. Discussions with community members on how metadata standards need to be managed within large-scale programmes is a priority in the planning process. Here we report on the standards we developed with respect to a robust and reusable mechanism of metadata collection, in the hopes that other projects forthcoming or underway will adopt these practices for metadata.

Predatory efficiency of dragonfly nymphs, Crocothemis servilia and Rhyothemis variegata against the mosquito, Culex quinquefasciatus Say

This study compared the predatory potential of nymphs of two dragonfly species viz. Crocothemis servilia (Drury, 1773) and Rhyothemis variegata (Linnaeus, 1763) using the different larval instars and pupae of Cx. quinquefasciatus (Say, 1823) as preys in normal laboratory settings. Field-collected fed and 24 h starved nymphs of C. servilia and R. variegata were offered 1st, 2nd, 3rd and 4th instar larvae and pupae of Cx. quinquefasciatus to monitor the rate of predation. A 24 h starved nymph of C. servilia showed the highest predation on the 2nd instar larvae (92.00±4.06%) followed by the 3rd (83.00±5.61%), 4th (80±6.89%) and 1st (76.00±4.85%) instar larvae and the pupae (26.00±2.91), respectively, whereas, that of R. variegata exhibited the highest consumption of the 1st instar larvae (90.00±3.54 %) followed by the 2nd (88.00±5.61 %), 3rd (82.00±3.74 %), 4th (70.00±7.91 %) larval instar and the pupae (23.00±4.63), respectively within 24 h exposure. In the same period, the fed nymphs of C. servilia showed maximum consumption of the 2nd instar larvae (77.00±3.54%) followed by the 3rd (76.00±4.58%), 4th (64.00±4.00%) and 1st instar (55.00±3.53%) larvae and the pupae (24.00±3.67), respectively, whereas, that of R. variegata exhibited highest consumption of the 1st instar larvae (67.00±5.38 %) followed by the 2nd (65.00±10.12 %), 3rd (58.00±8.46 %) and 4th (53.00±4.06 %) instar larvae and the pupae (21.00±2.92), respectively. The rate of predation was significant on all the larval instars and the pupae compared to their control counterparts (p<0.05) and the starved larvae and nymphs of both the dragonfly species showed higher predation compared to the fed nymphs. The aforementioned findings suggest that nymphs of both of the dragonfly species exhibited considerable predation potential against the immature stages of the Cx. quinquefasciatus mosquito. The present study recommends assessing the feasibility of using these species in large-scale mosquito control programs.

Ecohydrological decoupling of water storage and vegetation attributed to China’s large-scale ecological restoration programs

China has implemented some of the world's most ambitious ecological restoration (ER) programs over the past two decades. These large-scale multi-billion-dollar projects have achieved widespread greening across the country. However, the impacts of different ER-driven land cover modifications on total water resources remain largely unknown, particularly over areas characterized by complex environments of coupled human and natural systems. Here we quantified ecohydrological impacts of multiple ER programs applied over various parts of China’s Yellow River Basin (YRB), with their lumped effects being partitioned into individual ones. ER-related drivers were disentangled, leading in individual attribution of inter-annual climatic variability and agricultural activity with cross-sensor satellite observations and statistical modelling. Our results showed an ecohydrological decoupling of water storage and vegetation greenness attributed to ER programs. Increases in natural land cover types (e.g. forest and grassland) were found at the expense of human intensive land use, such as farmland, with the combined changes resulting in a concurrent dramatic water storage loss of 3.70 billion tons/year from 2002 to 2021. ER was the dominant driver of water loss (>66 %) among all factors considered, commensurate with areal land-cover change and ER program cost. The entire basin was divided into two regions with opposite water trends by the ER activities with different restoration strategies. This study’s framework is applicable to substantial part of the globe like YRB and is encouraged to be applied for more wholistic ER impact evaluations.

Antiviral Potential of Plants against COVID-19 during Outbreaks-An Update.

Several human diseases are caused by viruses, including cancer, Type I diabetes, Alzheimer's disease, and hepatocellular carcinoma. In the past, people have suffered greatly from viral diseases such as polio, mumps, measles, dengue fever, SARS, MERS, AIDS, chikungunya fever, encephalitis, and influenza. Recently, COVID-19 has become a pandemic in most parts of the world. Although vaccines are available to fight the infection, their safety and clinical trial data are still questionable. Social distancing, isolation, the use of sanitizer, and personal productive strategies have been implemented to prevent the spread of the virus. Moreover, the search for a potential therapeutic molecule is ongoing. Based on experiences with outbreaks of SARS and MERS, many research studies reveal the potential of medicinal herbs/plants or chemical compounds extracted from them to counteract the effects of these viral diseases. COVID-19's current status includes a decrease in infection rates as a result of large-scale vaccination program implementation by several countries. But it is still very close and needs to boost people's natural immunity in a cost-effective way through phytomedicines because many underdeveloped countries do not have their own vaccination facilities. In this article, phytomedicines as plant parts or plant-derived metabolites that can affect the entry of a virus or its infectiousness inside hosts are described. Finally, it is concluded that the therapeutic potential of medicinal plants must be analyzed and evaluated entirely in the control of COVID-19 in cases of uncontrollable SARS infection.

Implementation of a COVID-19 Vaccine Emergency Department Education Program for Underserved Communities.

Background The COVID-19 pandemic has provided an opportunity for significant reflection on our public health response as providers. Throughout the past two years, we learned that administration of COVID-19 vaccines, rapidly and widely across all communities, has been key to halting the spread of the virus. One significant challenge in promoting a large-scale immunization program is the threat of vaccine hesitancy. A general mistrust in healthcare providers exists across the country, especially in underrepresented minority (URM) communities. Objective This study aims to determine reasons for vaccine hesitancy in an urban emergency department and to provide targeted education on the safety and efficacy of the COVID-19 vaccines to patients. Methods An interprofessional quality improvement team was assembled to develop an educational intervention addressing COVID-19 vaccine safety for vaccine-eligible patients receiving treatment in the emergency department at an urban community hospital where over 70% of patients identify as URM. A survey was conducted to elucidate patients' concerns surrounding the COVID-19 vaccine. Upon completion of the survey, up-to-date safety information and education targeting their surveyed concerns were provided by trained medical students. A follow-up survey was conducted to assess the impact of education on patients' attitudes toward the vaccine. Surveys were developed using standardized scoring systems from the Oxford coronavirus explanations, attitudes, and narratives survey (OCEANS) II study and the Kaiser Foundation. Hesitancy scores before and after education were tabulated to assessthe effectiveness of targeted education in improving vaccine hesitancy. Results Patients cited a variety of concerns surrounding the COVID-19 vaccine. The three most common reasons for declining vaccines were potential side effects (67.3% were concerned or extremely concerned), the belief that COVID-19 vaccines are neither effective nor safe (64.5% were concerned to extremely concerned), and the risk of developing COVID-19 infection from the vaccine itself (38.8% were concerned to extremely concerned). This information was used to address these concerns directly with patients, answer questions, clarify information, andencourage patients to get vaccinated. Through this education program, vaccine hesitancy scores improved by an average of 29% indicating an increased likelihood of patients who would get vaccinated in the future. Of patients receiving education, 38% agreed to sign up for a vaccine appointment during the intervention. Conclusion The emergency department often serves vulnerable patient populations. As such, its role in public health in these communities cannot be underestimated. This quality improvement project is a novel method that can be used to develop and implement public health education programs to address specific community needs in the emergency department. These results show that a multidisciplinary healthcare team can provide a measurable change in attitudes about vaccine safety with directed education in the emergency department that can help address vaccine hesitancy in the future.

ATLAS ITk Pixel Detector Overview

In this work an overview of the layout and current status of development of the ITk Pixel detector is given. For the HL-LHC upgrade the current ATLAS Inner Detector is replaced by an all-silicon system. The Pixel Detector will consist of 5 barrel layers and a number of rings, resulting in about 14 m2 of instrumented area. Due to the huge non-ionising fluence (1×1016 neq/cm2) and ionising dose (5 MGy), the two innermost layers, instrumented with 3D pixel sensors (L0) and 100 μm thin planar sensors (L1) will be replaced after about 5 years of operation. All hybrid detector modules will be read out by novel ASICs, implemented in 65 nm CMOS technology, with a bandwidth of up to 5 Gb/s. Data will be transmitted optically to the off-detector readout system. To save material in the servicing cables, the ASICs are serially powered. Large-scale prototyping programs are being carried out by all sub-systems.

Effectiveness of Glaucoma Screening and Factors Associated with Follow-up Adherence among Glaucoma Suspects in a Safety-Net Teleretinal Screening Program

To evaluate rates and risk factors associated with follow-up adherence to in-person glaucoma evaluations and confirmed glaucoma diagnosis in glaucoma suspects identified through teleretinal diabetic retinopathy screening (TDRS). Retrospective cohort study SUBJECTS: Patients with diabetes identified through teleretinal screening to have large or asymmetric cup-to-disc ratios in a Los Angeles County safety-net primary care-based TDRS program. Retrospective chart review was performed to obtain demographic and clinical information for patients with cup-to-disc ratios concerning for glaucoma on TDRS. Patients who completed an in-person follow-up appointment within 1 year of teleretinal screening were adherent. Factors associated with follow-up adherence and diagnosis of glaucoma were analyzed with chi-square and independent t tests along with multivariable logistic regressions. The proportion of patients with suspected glaucoma who adhered with in-person follow-up examination, proportion of patients with confirmed glaucoma diagnosis, and factors associated with follow-up adherence and glaucoma diagnosis. Eight-hundred seventeen patients with optic discs suspicious for glaucoma were included. Five-hundred thirty-four (65.4%) patients successfully completed an in-person glaucoma evaluation. Among these patients, 62.9% and 24.5% received a diagnosis of glaucoma suspect and glaucomatous optic neuropathy, respectively. Compared with patients aged < 50 years, patients aged 50 to 64 years had 1.57 times higher odds of being adherent with in-person visits (P= 0.036), whereas no difference was seen in those aged ≥ 65 years. Forevery $10 000 increase in the zip code median income, patients had 11% lower odds of being adherent (P=0.031). Compared with Latino patients, Black patients had 3.52 times (P < 0.001) higher odds of having confirmed glaucoma. The majority of patients referred as glaucoma suspects on TDRS completed a follow-up examination, and nearly a quarter of those examined received a confirmed glaucoma diagnosis. Patients aged ≥ 50 and < 65 years along with those from lower-income neighborhoods were more likely to follow up for an in-person evaluation. Compared with Latino patients, Black patients had a higher risk for a confirmed glaucoma diagnosis. This demonstrates the effectiveness of glaucoma detection in a large-scale TDRS program for a safety-net patient population. The authors have no proprietary or commercial interest in any materials discussed in this article.