State Level Research Articles

Improving health system responses when patients are harmed: a protocol for a multistage mixed-methods study

IntroductionAt least 10% of hospital admissions in high-income countries, including Australia, are associated with patient safety incidents, which contribute to patient harm (‘adverse events’). When a patient is seriously harmed,...

Measures of Economic Disadvantage Explain Outcomes Differently Across Geographies

Alternative poverty measures have been proposed in response to the emerging insufficiencies of the National School Lunch Program (NSLP) eligibility data. The analysis presented here involves seven poverty measures. Using outcome measures as a yardstick, we can assess how poverty measures explain these outcomes and note variations between geographical locales (assessing predictive validity). An analysis of 2019 data from Montana revealed that no poverty measure emerges as consistently meeting or exceeding the results found with the NSLP on the state level. Results are mixed based on locale (size) and distance from an urban centre, and within school communities.

Inadequate Glucagon Suppression During OGTT in prediabetes: A Systematic Review and Meta-Analysis.

Glucagon plays a role in the development of type 2 diabetes, yet its role in prediabetes (preDM) remains uncertain. To evaluate glucagon levels in fasting state and its response to glucose inhibition in preDM through meta-analysis. A systematic search across Pubmed, Embase, Web of Science, and Cochrane Library identified studies assessing glucagon levels during 75g oral glucose tolerance test (OGTT) in both preDM and normal glucose tolerance (NGT) cohorts. Data on glucagon, glucose and insulin were pooled using random-effect model. Although glucagon levels decreased in both preDM and NGT groups upon glucose challenge, glucagon levels at 0h, 0.5h, 1h and 1.5h in preDM were significantly higher compared to NGT, despite higher glucose levels at all time points and higher insulin levels at 0h, 1h, 1.5h and 2h during OGTT. Subgroup analysis revealed that in studies using the radioimmunoassay (RIA) method, glucagon levels in preDM were higher at 0.5h and 1h than NGT, while in studies using the Enzyme linked immunosorbent assay (ELISA) method, glucagon levels were similar to those of the NGT group despite higher glucose in preDM compared to NGT. Fasting glucagon level was inadequately suppressed in both impaired glucose tolerance (IGT) and impaired fasting glucose (IFG). Responsiveness to glucose inhibition was preserved in IFG, while glucagon level in IGT group at 0.5h after glucose intake was not suppressed and was higher than NGT. Glucagon was not adequately suppressed during OGTT in preDM. Glucagon dysregulation is a contributing mechanism underlying both IFG and IGT.

Bee monitoring by community scientists: comparing a collections-based program with iNaturalist.

Bee monitoring, or widespread efforts to document bee community biodiversity, can involve data collection using lethal (specimen collections) or non-lethal methods (observations, photographs). Additionally, data can be collected by professional scientists or by volunteer participants from the general public. Collection-based methods presumably produce more reliable data with fewer biases against certain taxa, while photography-based approaches, such as data collected from public natural history platforms like iNaturalist, can involve more people and cover a broader geographic area. Few efforts have been made to quantify the pros and cons of these different approaches. We established a community science monitoring program to assess bee biodiversity across the state of Pennsylvania (USA) using specimen collections with nets, blue vane traps, and bowl traps. We recruited 26 participants, mostly Master Gardeners, from across the state to sample bees after receiving extensive training on bee monitoring topics and methods. The specimens they collected were identified to species, stored in museum collections, and the data added to public databases. Then, we compared the results from our collections to research-grade observations from iNaturalist during the same time period (2021 and 2022). At state and county levels, we found collections data documented over twice as much biodiversity and novel baseline natural history data (state and county records) than data from iNaturalist. iNaturalist data showed strong biases toward large-bodied and non-native species. This study demonstrates the value of highly trained community scientists for collections-based research that aims to document patterns of bee biodiversity over space and time.

State-level structural racism and adolescent mental health in the United States.

We explored state-level indicators of structural racism on internalizing symptoms of depressive affect among US adolescents. We merged 16 indicators of state-level structural racism with 2015-19 Monitoring the Future surveys (N=41,258) examining associations with loneliness, self-esteem, self-derogation, and depressive symptoms using regression analyses. Students racialized as Black in states with bans on food stamp eligibility and temporary assistance for drug felony conviction had 1.37 times the odds of high depressive symptoms (95% C.I. 1.01-1.89) compared to students in states without bans. In contrast, students racialized as White living in states with more severe disenfranchisement of people convicted of felonies had lower odds of high self-derogation (OR=0.89, 95% C.I. 0.78-1.02) and high depressive symptoms (OR=0.83, 95% C.I. 0.70-0.99) compared to states with less severe disenfranchisement. These findings demonstrate the need to address the legacy of structural racism at the state level to reduce mental distress for US youth.

Discrete trapping levels of localized states in amorphous silicon nitride

The spectrum of localized hole states (traps) in amorphous silicon nitride, a-Si3N4, is experimentally studied using the method of thermally stimulated depolarization. The experiment is compared with theoretical calculations using three models of the energy spectrum of traps: discrete spectrum (monoenergetic trap), continuous spectrum, and Gaussian trap distribution. The experiment is quantitatively described by a model of a discrete spectrum of traps with an energy of 1.15 eV and a width of no more than 0.01 eV. In the case of a continuous and Gaussian spectrum of traps, the contribution to depolarization is made by the deepest traps. The blurring of the trap energy level in a-Si3N4 due to the absence of long-range order (fluctuations in the Si–N bond length and fluctuations in the N–Si–N and Si–N–Si angles) does not exceed 0.01 eV.

National and State Estimates of SELECT Trial Eligibility and Its Public Health Impact in the US

This cross-sectional study of US adults examines the geographical distribution of individuals eligible to participate in the Semaglutide Effects on Heart Disease and Stroke in Patients With Overweight or Obesity (SELECT) trial to estimate potential cardiovascular health impacts of implementing the trial findings at state and national levels.

Barriers and opportunities to agrihood development in growing cities of the Rocky Mountain region: A comparative case study

Rapid urbanization and peri-urban development are driving land use change across the globe, result­ing in lands being converted from agricultural uses to housing development. Sustainable, multifunc­tional land use in urban and peri-urban areas is needed to balance the requirements of producing food in a way that protects environmental resources and of providing housing to a growing population. An agrihood is a planned development model that incorporates food production within a community to help address goals of nutritious food security while providing social, economic, and environmental benefits. Agrihoods may offer an alternative land use for integrating food production in new housing developments for the sustainable development of rapidly urbanizing cities. A com­parative case study, using semi-structured, qualita­tive interviews with key informants from two cities (Bozeman, Montana, and Longmont, Colorado), highlighted four key barriers to agrihood develop­ment in two cities in the Rocky Mountain region of the U.S: labor; ownership and governance struc­tures; resource availability; and land use regulation. Concerns for water and land resource availability reflect general barriers to agricultural expansion in the Rocky Mountain region, while the other identi­fied barriers reflect the structural and legal limita­tions preventing agrihood development and expan­sion. To reduce these barriers, policy interventions and incentives provided at municipal, state, and federal levels, informed by community advocates in support of local food production, will be essential.

Challenges to the Contemporary Death Penalty in the United States

This review focuses on empirical research about contemporary challenges to the death penalty in the United States. Challenges are factors that obstruct capital punishment, including legal or political restrictions; elimination at the federal or state level; or the hindrance of the process at its operational stages of charging, adjudicating, appeals, clemency, or executions. By the best-known measures, the death penalty has been in decline in the United States since the turn of the century. Lethal injection errors—“botches”—are arguably the most important current challenge to the institution. Wrongful capital conviction has made capital punishment less tolerable to the general public. Mitigation remains an important challenge to the death penalty. This review emphasizes botches, innocence, and mitigation but also touches on disparate impact, failure-to-deliver a social benefit, and cost. Along the way, this review proposes a framework for considering challenges as they occur on two continua of impact, a micro/meso/macro axis and a narrow/wide axis.

Identifying enablers and barriers to the control of multidrug-resistant tuberculosis in Abia State, Nigeria: A qualitative study

ObjectiveDrug-resistant tuberculosis (TB) is a significant public health threat in high-burden TB countries, including Nigeria, constraining the achievement of End TB targets. Nonetheless, Nigeria's health system factors shaping the care of patients with multidrug-resistant tuberculosis (MDR-TB) are understudied. The study assessed the enablers and barriers to implementing MDR-TB care and treatment in Abia State, Nigeria. MethodsThis is a qualitative interview study adopting a phenomenological approach. We interviewed twelve participants comprising health workers and TB policymakers with roles in MDR-TB patient management at the national (n = 2) and state (n = 10) levels in May 2022. We used maximum variation sampling to purposively select participants based on their roles, availability, and consent. The data were analysed thematically. ResultsThe factors enhancing care for patients with MDR-TB include using a certificate of readiness, community involvement, donor financing, availability of treatment centre, effective facility-community linkage, treatment support, multidisciplinary care team, training service providers, availability of oral drugs, expansion of diagnostic facilities, data tool availability, review meetings, and data-focused supervision. In contrast, the factors constraining MDR-TB management are poor implementation of infection control policy, donor dependence, delayed initiation of treatment, poorly motivated health workers, health worker stigma, shortage of personal protective equipment, and role conflict in data management. ConclusionThe findings highlight critical health systems strengths and weaknesses in MDR-TB control. MDR-TB care policies must build on the enablers and address the barriers to strengthen the care for patients with MDR-TB.

Anxiety levels and influencing factors among the relatives of patients presenting to the emergency department

Background and objective: In recent years, the majority of incidents of increasing violence against healthcare workers, especially emergency department (ED) staff, have been perpetrated by family members of patients. Anxiety is one of the predictors of this violence in ED. The aims of this study were to measure anxiety levels among the relatives of ED patients at the time of presentation and to identify the factors that affect them. Materials and methods: In this prospective, cross-sectional study, 687 relatives of patients were included. The State-Trait Anxiety Inventory- State (STAI-S) and State-Trait Anxiety Inventory- Trait (STAI-T) scales were administered to assess state and trait anxiety levels. The data for the study were recorded using the SPSS 16.0 statistics program. Results: STAI-S averages were found to be statistically significantly higher than their STAI-T averages in parents (p = 0.036). A statistically significant difference was found between the state and trait anxieties of the group whose patients had a history of previous hospitalization (p = 0.013), previous surgeries (p = 0.009), presented with trauma (p=0.007), and received intervention in ED (p = 0.003). The state anxiety of the patient relatives who brought their patients to the ED by their own means was found to be statistically significantly higher than the trait anxiety (p=0.028). Conclusion: Our study showed that patient relatives whose patients presented to the ED due to trauma or had a history of surgery/hospitalization, or arrived at the hospital under their own means, experienced elevated anxiety levels. More multi-center studies are needed. July 2024; Vol. 18(2):008. DOI: https://doi.org/10.55010/imcjms.18.020 *Correspondence: Seçkin Bahar Sezgin, Emergency Department,Gaziantep City Hospital, Gaziantep, Turkey. Email: seckinbahar34@gmail.com

The Interplay of Local- and State-Level Alcohol Policies in the United States.

Most research on alcohol control policies in the United States has focused on the state level. In this study, we assessed both local and state policy prevalence and restrictiveness in a nationwide sample of cities. We conducted original legal research to assess prevalence of local-level policies across 374 cities (48 states) in 2019 for the following seven policy areas: (a) drink specials; (b) beverage service training; (c) minimum age for on-premise servers and bartenders; (d) minimum age for off-premise sellers; (e) prohibitions against hosting underage drinking parties (i.e., social host provisions); (f) bans on off-premise Sunday sales; and (g) keg registration. We obtained parallel state-level policies from the Alcohol Policy Information System. We assessed the restrictiveness of existing policies and how these compared across local and state levels. We found that for six of the seven policy areas, the majority of cities (53% to 83%) had only a state-level policy. Few cities (0% to 8% across policy areas) had only a local-level policy. The percentage of cities that had an alcohol policy at both the local and state levels ranged from less than 1% to 19% across policy areas, and the policies were mostly equally restrictive at both levels. The lack of local policies may point to areas where these localities could strengthen their alcohol policy environments. Additional research is needed to understand how the prevalence and restrictiveness of local and state policies are associated with public health harms such as traffic crashes.

District-level Epidemiology and Sociodemographic Determinants of Noncommunicable Diseases (NCDs)- Results the National Family Health Survey -5 (2019-21).

BackgroundNoncommunicable diseases (NCDs) are the leading cause of adult mortality in India. However, the data regarding the prevalence of NCD risk factors at district level is scarce. This study aims to analyse and map NCD risk factors at the state and district levels, exploring sociodemographic influences on these risks in Indian males and females. MethodsWe analysed National Family Health Survey-5 database and used the prevalence estimates to create choropleth maps, enabling us to examine the geographical variations in NCD risk factors at the district level in India. ResultsDistricts in the Satluj-Yamuna plains, western Rajasthan, and the northeastern regions exhibited clusters with a prevalence of high blood pressure exceeding 30.1%. Northeastern districts showed over 40% prevalence of current tobacco use, while high alcohol consumption clusters were observed in the northeastern and Telangana districts. Southern districts showed clusters of both obesity (as measured by BMI) and highest rates of oral, breast, and cervical cancer screening, moreover districts in Tamil Nadu exhibited notable clusters of raised blood glucose prevalence. ConclusionOur analysis revealed variations in the prevalence of NCD risk factors at both the state and district levels. Accordingly, this study ranks districts based on the NCD burden, offering valuable insights to state and district teams to devise targeted measures for the prevention and control of NCDs, particularly in the most heavily affected districts.

Static and dynamic analysis of cerebral blood flow in fifty-six large arterial vessel networks

Objective. The cerebral vasculature is formed of an intricate network of blood vessels over many different length scales. Changes in their structure and connection are implicated in multiple cerebrovascular and neurological disorders. In this study, we present a novel approach to the quantitative analysis of the cerebral macrovasculature using computational and mathematical tools in a large dataset. Approach. We analysed a publicly available vessel dataset from a cohort of 56 (32/24F/M) healthy subjects. This dataset includes digital reconstructions of human brain macrovasculatures. We then propose a new mathematical model to compute blood flow dynamics and pressure distributions within these 56-representative cerebral macrovasculatures and quantify the results across this cohort. Main results. Statistical analysis showed that the steady state level of cerebrovascular resistance (CVR) gradually increases with age in both men and women. These age-related changes in CVR are in good agreement with previously reported values. All subjects were found to have only small phase angles (<6°) between blood pressure and blood flow at the cardiac frequency. Significance. These results showed that the dynamic component of blood flow adds very little phase shift at the cardiac frequency, which implies that the cerebral macrocirculation can be regarded as close to steady state in its behaviour, at least in healthy populations, irrespective of age or sex. This implies that the phase shift observed in measurements of blood flow in cerebral vessels is caused by behaviour further down the vascular bed. This behaviour is important for future statistical models of the dynamic maintenance of oxygen and nutrient supply to the brain.

Unemployment and the direction of technical change

I construct and analyze a growth model in which technical change can increase unemployment. I first analyze the forces that deliver a constant steady state unemployment rate in this setting. Labor-saving technical change increases unemployment, which lowers wages and creates incentives for future investment in labor-using technologies. In the long run, this interaction generates a balanced growth path that is observationally equivalent to that of the standard neoclassical growth model, except that it also incorporates a positive steady state level of unemployment and a falling relative price of investment. I also study the effects of a permanent increase in the ability of R&D to improve labor-saving technologies. In the long run, this change leads to faster growth in output per worker and wages, but it also yields higher unemployment and a lower labor share of income. In the short run, this change exacerbates existing inefficiencies and slows economic growth.

Prognostic factors for the development of obstetric and perinatal pathology in pregnant women under conditions of iodine deficiency

According to the World Health Organization (WHO), iodine deficiency is the main cause of mental retardation in children, and at the same time, it significantly affects the pathological course of pregnancy and childbirth. The problem is complicated by the fact that more than 100.000 children with cretinism are born annually in the world. In recent years, there has been a significant increase in endemic thyroid diseases in Ukraine, the main cause of which is insufficient iodine consumption. Iodine deficiency conditions are aggravated by socio‑economic, ecological and radiological factors, while at the same time mass and group iodine prophylaxis is carried out improperly on the state level. Objective. To determine prognostic factors for the development of obstetric and perinatal pathology in pregnant women under conditions of iodine deficiency. Materials and methods. To compile a diagnostic table of prognostic factors of the threat of miscarriage, the analysis has been performed of 185 cases of threatened abortion (111 in the first trimester, 56 in the second, 18 in the third) and 223 control observations (without the threat of miscarriage). A diagnosis was considered as confirmed if it was established using all applicable methods of examination of pregnant women. Results. The risk factors of the occurrence of perinatal pathology include hypothyroxinemia (DC=–2.5) and ioduria in pregnant women less than 100 mg/l (DC=–1.9). In the intranatal period, a negative impact is exerted by the lack of coordination and weakness of labor activity (DC=–8.1). Levels of thyroid‑stimulating hormone (TSH) in umbilical cord blood &gt;10 mIU/ml (DC=–4.6) are the prognostically favorable factors for the postnatal adaptation of the newborn, especially TSH levels &gt;20 mIU/ml (DC=–8.3). Conduction of iodine prophylaxis (DC=7.7) and ioduria in pregnant women 200—400 mg/l (DC=5.1) contribute to the improvement of perinatal outcomes. Conclusions. A retrospective review of the prognostic significance of the diagnostic table in 188 patients with diffuse nontoxic goiter revealed its sensitivity (76%) and specificity (68%). On the basis of the conducted research, we established risk factors for the development of obstetric and perinatal complications, and assessed their informativeness. The developed algorithm is represented by a diagnostic table for the prediction of complications of pregnancy, childbirth and adverse perinatal outcomes in women with endemic thyropathies.

National Education Policy, 2020 and Appointment of Teachers through UGCNET-the Policy Paradox

In a recent notification in July (UGC, 5th July ) 2023, the University Grants Commission (UGC) has once again acknowledged the vitality of the National Eligibility Test (NET), State Level Eligibility Test (SLET) and State Eligibility Test (SET) as minimum criteria for appointment of teachers in Higher Education Institutions (HEIs) whereas Ph.D. will remain an optional criterion. This notification once again revived the debates of NET or an accredited test (SLET/SET) and/or Ph.D. and embarked scholars to read the underlying causes of such frequently changing policies of UGC and overall ramifications of these on recruitment in the HEIs. In the context of implementation of the National Education Policy (NEP), 2020, role of the HEIs for ensuring quality education has focused [1]. However, how these can be achieved through a dichotomous policy of NET/SLET/SET or PhD in the matters of selection of teachers. When many universities and colleges are run with inadequate teachers, in what ways they can fulfil the goal of NEP, 2020? How NET or an accredited test can be an important criterion for strengthening research programmers in HEIs? This paper critically evaluates these issues and presents the prolong issue of teachers’ recruitment and role of HEIs in India for quality education through teachers in the context of NEP. It brings light to how contradictory policies are embedded and in operational in the form of UGC-NET and other similar tests for limiting HEIs despite implementation of NEP, 2020.

Тенденции и перспективы применения технологий GovTech в процессе цифровизации государственного сектора

These days, governments are actively increasing the introduction of new GovTech solutions in order to improve the efficiency of public authorities work. The digital government, as a key concept of the public sector digitalization, is the next stage in the evolution of public administration, which is aimed at accelerating the decision-making process at the state and municipal levels, improving the interaction with citizens and public organizations, as well as increasing the level of trust in the authorities. The article analyses GovTech technologies and the principles of their introduction, the stages of public sector digital maturity. The COVID-19 pandemic was identified as the driver of the government digitization, but in the long run, the reactive policy should move to a complete reorganization of public administration systems in terms of the introduction of new technologies and ensuring cybersecurity. The article assesses the main challenges of GovTech introduction, as well as the key GovTech trends. Additionally, the authors analyzed the European and Russian practices of public administration digitalization. An analysis of GovTech concept, conducted by the authors, allowed to determine the conditions of growth of the Russian GovTech market and its prospects and to draw conclusions about the significant potential of Russia to successfully achieve the stage of the digital government.

PANDANGAN AL-QUR'AN TENTANG SOLUSI PENGENTASAN KEMISKINAN KELUARGA DAN MASYARAKAT MUSLIM MELALUI PENDEKATAN TAFSIR TEMATIK

This research aims to reveal the Al-Qur'an's views on solutions to poverty alleviation in Muslim families and communities, by identifying and classifying Al-Qur'an verses that discuss poverty and solutions to its alleviation in the contemporary era. The research method used is a literature study with secondary data sourced from verses of the Al-Qur'an and their interpretations, using a descriptive analytical approach. In the discussion it was revealed that the Qur'an offers several concrete and holistic solutions in overcoming poverty, which includes economic, social and spiritual aspects, including: Implementation of the zakat, infaq and alms and waqf systems as a means of economic equality and philanthropy in Islam, In this way, there will be an integration of spiritual and material aspects in alleviating poverty. The application of Al-Qur'an solutions in alleviating poverty starts from the individual, family, community level, up to the state level as a policy regulator.

Access to PrEP and other sexual health services for cisgender women in the United States: a review of state policy and Medicaid expansion.

Pre-exposure prophylaxis (PrEP) has the potential to prevent new HIV infections, but it is unclear how state policies governing sexual and reproductive health services (SRH) impact access for cisgender women. The objective of this review is to identify barriers to PrEP access for cisgender women in the United States. Using the CDC Atlas Program, 20 states with the highest HIV incidence among cisgender women were included in this analysis. Through a search conducted in May-July 2022 of CDC, PrEPWatch.org, and other State Department and Insurance websites, Medicaid expansion status, pharmacist PrEP prescribing laws, financial support programs, and Traditional Medicaid coverage of PrEP, HIV testing, and emergency contraception were reviewed. Of the included states, nearly half did not expand Medicaid at the state level. Emergency contraception and HIV testing was covered under Traditional Medicaid for almost all included states, but insurance stipulations and eligibility requirements remain. Although PrEP is covered under all Traditional Medicaid plans, six states require pre-authorization. Three states have HIV testing mandates, four allow pharmacists to prescribe PrEP and six have financial support programs to cover the cost of PrEP. Medicaid expansion, pre-authorization requirements for PrEP prescriptions and emergency contraception, and limitations on pharmacist prescribing abilities were identified as barriers to SRH access for cisgender women. Medicaid expansion should be prioritized as an approach to expanding access to HIV prevention services at the state level.