The burden of wildland fires to human health is well established, but less is known about how these impacts are distributed among vulnerable population groups and whether and to what extent wildland fire smoke affects certain parts of the country repeatedly. Moreover, much of the literature has focused on impacts from fine particles, but very few researchers have investigated deaths and illnesses attributable to ozone associated with wildland fires. This paper uses a 12-year time series of CMAQ model-predicted PM2.5 and ozone concentrations between 2007 and 2018 and the BenMAP-CE tool to quantify the number, distribution, and economic value of these impacts. We calculate measures of inequality, including the Gini coefficient, to determine how these impacts are distributed among populations and locations. We estimate cumulatively tens of thousands of wildland fire PM2.5- and ozone-attributable deaths, valued at $130B. Impacts occur disproportionately among those most vulnerable, as characterized by socioeconomic status in the Social Vulnerability Index, who experience a greater air pollution mortality burden as compared to those less vulnerable. A relatively small number of counties in northern California and Idaho experience a disproportionately high number of days of wildland fire PM2.5 exposure. The Gini coefficient and Atkinson index indicate that counties with vulnerable populations are inequitably impacted, suggesting an opportunity for policies that could promote a more equitable burden of smoke to human health.

• Firms’ experiences with corruption outside tax authority have significant adverse spillovers on tax evasion. • Bribes for operating licenses raise firm tax evasion by up to 24.2 percentage points. • Bribes for government contracts increase tax evasion by 2.1 percentage points per contract value percent. • Working capital depletion mediates the corruption–tax evasion link in firms. • Anti-corruption in tax only is insufficient; multisectoral action is needed to curb tax evasion. This study examines the direct and spillover effects of corruption on firms’ tax evasion in sub-Saharan Africa (SSA), a region plagued by both phenomena. Firm-level data on 17 SSA economies spanning 2008–2014 were sourced from the World Bank’s Enterprise Survey. I instrument for endogeneity of corruption using five variables, namely the number of days it takes to (i) clear exports, (ii) clear imports, (iii) obtain an operating license, (iv) time spent by senior management on regulatory compliance, and (v) the extent to which business licenses and permits are an obstacle the firm’s operation. I implemented a battery of endogeneity-correcting estimators: traditional instrumental-variable two-stage least squares (2SLS), Lewbel’s 2SLS, Oster’s bounding analysis, propensity score matching, and Kinky Least Squares. I find that corruption of tax officials (i.e., bribe expected/requested in exchange for a favourable tax inspection) significantly increases tax evasion. More critically, this study challenges prevailing assumptions from European and Central Asian contexts by demonstrating that corruption outside tax authorities—specifically bribes expected/requested in exchange for operating licenses and government contracts—also exerts substantial adverse spillover effect on tax compliance. Firms that perceived/experienced bribe requests in exchange for obtaining operating licenses evaded taxes at rates 24.2 percentage points higher than their counterparts who did not perceive/experience bribe requests in exchange for obtaining operating licenses. In contrast, a percent increase in perceived bribe rates for government contracts corresponded to a 2.1 percentage-point increase in tax evasion. Mediation analysis identifies working capital depletion as a key transmission channel. These findings underscore the need for multisectoral anti-corruption strategies to effectively combat tax evasion and enhance domestic revenue mobilisation in SSA.

Pre-anaesthetic assessment is essential for identifying perioperative risk and optimising patient safety. Digital alternatives, including video consultation and structured electronic health record (EHR) review, may improve efficiency, but comparative evidence regarding postoperative safety remains limited. We hypothesise that digital pre-anaesthetic assessment modalities will be associated with low rates of major postoperative complications in selected low-risk patients. This protocol describes a single-centre study with retrospective data collection including adult patients scheduled for elective otorhinolaryngologic, oral or maxillofacial surgery at Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark. Patients underwent preoperative assessment using one of three modalities: in-person consultation (2019-2020), EHR review (2021-2022) or video consultation (2024-2025). The primary outcome is a composite of major postoperative complications within 30 days, including all-cause mortality, admission to the intensive care unit, bleeding requiring transfusion, infection requiring antibiotics, or hospital readmission. Secondary outcomes include number of days spent hospitalised within 30 days after surgery, changes in anaesthesia plan, airway management modifications, delay in surgical start time, intubation attempts and same-day cancellations. Associations between assessment modality and dichotomous outcomes will be examined using multivariable generalised linear models with a log-link function, adjusted for prespecified covariates. Sensitivity analyses will include inverse probability weighting and win ratio analysis. This single-centre cohort study will examine whether digital pre-anaesthetic assessment strategies, such as video consultation and EHR review, are associated with differences in major postoperative complications compared with in-person assessment. The findings may inform the implementation of patient-centred, resource-efficient preoperative assessment strategies within the Danish healthcare system and similar international settings.

Public health and social measures (PHSMs) are key interventions during pandemics. This study quantifies temporal changes in daily interpersonal contacts associated with PHSM implementation and their potential impact on disease transmission across different phases of the COVID-19 pandemic in Hong Kong from 2021 to 2023. We recruited 7,053 individuals from the general population and 3,462 participants from selected high-contact groups between September 2021 and December 2023. The study period spanned the infection-naïve phase before 2022 through the city's fifth wave of COVID-19 (January-April 2022) driven by the Omicron BA.2 variant. Reported cumulative incidence was < 0.2% of the population before the fifth wave and rose to 16% afterward. The onset of the fifth wave prompted the government to impose unprecedentedly stringent PHSMs. Participants reported their daily number of contacts via contact surveys, from which we constructed social contact matrices. We then compared the dominant eigenvalues of these contact matrices to estimate the potential association of PHSMs with changes in the basic reproduction number ([Formula: see text]). Among the general population, the average number of daily contacts dropped significantly from 6.2 (mean; 95% confidence interval [CI]: 5.9-6.5) during pre-fifth wave to 5.1 (5.0-5.3) during the fifth wave. After the fifth wave, the average number of contacts remained low at 5.1 (5.0-5.3) when some PHSMs such as mask-wearing policies were still in place. Once all PHSMs were lifted after March 2023, the average number of contacts increased to 8.4 (8.3-8.5). Compared to the general population, participants from the selected high-contact groups reported more contacts by 23% (95% CI: 21%-26%) on average. Compared to pre-fifth wave levels, PHSMs imposed during the fifth wave were associated with a 20% reduction (median; 95% percentile interval: 1%-40%) in [Formula: see text]. Relaxation of PHSMs in the post-pandemic period suggested an increase in [Formula: see text] by 109% (61%-151%) relative to pre-fifth wave levels. During the COVID-19 pandemic in Hong Kong, PHSMs were temporally associated with reduced social contacts and, potentially, disease transmission. These quantitative estimates may indicate the potential value of PHSMs for informing future pandemic preparedness and response.

Immune checkpoint inhibitors (ICIs) have revolutionized cancer therapy, yet their uptake in low- and middle-income areas is hindered by high prices and uneven distribution. Anhui Province, China-characterized by marked urban-rural economic contrasts-offers a critical setting to examine real-world access to these agents. The objective of this study was to assess the availability, price levels, and affordability of ICIs across Anhui Province and to identify policy levers that could narrow observed access gaps. We applied the World Health Organization/Health Action International (WHO/HAI) standardized survey methodology to evaluate the availability, price differentials, and economic burden of immune checkpoint inhibitors (ICIs) marketed in Anhui Province, China. The survey was conducted in 2025 across 199 public hospitals. Affordability was further assessed using a four-tier framework comprising the WHO/HAI standard indicator (defined as the number of days' wages required to afford 30 days of treatment), adjusted using local urban and rural per capita disposable income to account for China's socioeconomic heterogeneity, and incorporating insurance reimbursement scenarios on the basis of Anhui provincial policy (85% for urban employee insurance and 70% for urban-rural resident insurance) to estimate out-of-pocket expenditure. In addition, catastrophic health expenditure (CHE), defined as household out-of-pocket health spending exceeding 40% of non-food expenditure, was used to capture household-level financial risk beyond individual income-based measures. Availability was defined as the proportion of facilities stocking a medicine on the survey day. Prices were collected at unit level and summarized as medians across facilities, with affordability assessed using the median price ratio (MPR), calculated as median local unit price relative to the international reference price (IRP) from the MSH International Drug Price Indicator Guide, in line with WHO/HAI methodology. Surveying 199 hospitals, we found that domestic PD-1 inhibitors-sintilimab, camrelizumab, and tislelizumab-were stocked in roughly 4 out of 5 facilities, whereas 11 of the 15 mainly imported ICIs appeared in fewer than 16% of hospitals; although some imported agents had acceptable median-price ratios (0-2), their absolute prices remained several-fold higher than domestic alternatives; thus even after insurance (85% urban, 70% rural), a year's treatment with cadonilimab or durvalumab still exceeded the catastrophic-expenditure threshold by up to 40 times for rural households, while domestic sintilimab or camrelizumab stayed well below that line. Domestic ICIs are broadly available and relatively affordable, whereas imported brands remain scarce and financially out of reach; boosting reimbursement limits, expanding centralized procurement, and favoring cost-effective domestic options may help reduce Anhui's access gap, although their implementation should take budget constraints and opportunity costs into account.

To examine whether higher national list prices for new medicines are associated with faster patient access across 18 European countries. Data were drawn from the 2023 European Federation of Pharmaceutical Industries & Associations (EFPIA) Patients Waiting to Access Innovative Therapies (WAIT) Indicator Survey and the Swedish TLV's 2023 international price index. Time to availability was defined as the number of days between marketing authorisation and national reimbursement access. A multivariable linear regression model was applied, controlling for gross domestic product (GDP) per capita, population size, health technology assessment (HTA) duration, and the use of Managed Entry Agreements (MEAs). To address endogeneity, a two-stage least squares (2SLS) regression was conducted using a composite headquarters (HQ) Index as an instrumental variable for national list prices. In the multivariable model, each one-point increase in the list price index (European average = 100) was associated with a 7.9-day reduction in time to availability (p = 0.091). A slow HTA/reimbursement process was significantly associated with longer delays (p = 0.022). Managed entry agreement intensity was positively associated with longer delays but did not reach statistical significance (p = 0.103). In the 2SLS model, a one-point increase in the instrumented list price was associated with a 14.1-day reduction in access delays in the preferred parsimonious specification (p = 0.011). Sensitivity analyses showed that the negative association was generally preserved across alternative instrumental variable specifications and after exclusion of Poland, although effect sizes and first-stage strength varied. Higher national list prices may be associated with faster patient access to new medicines in European markets. Although the findings are consistent with a possible causal effect, they should be interpreted with caution given the sensitivity of the estimates to specification and sample composition, as well as concerns about instrument validity and strength. The results highlight a potential policy trade-off between affordability and timely availability in pharmaceutical pricing and access frameworks.

The number of deaths in Germany attributed to heat has risen in recent years. At the same time, winters have become milder, which implies that there may be fewer deaths due to extreme cold. In this study, we estimated the mortality associated with both heat and cold in Germany for the years 2000-2023. We used daily death counts and mean temperature records to estimate the percentage of heat- and cold-associated deaths for the years 2000-2023 by means of a generalized additive model (GAM). We also carried out a meta-analysis to estimate the effect of temperature on the relative mortality risk (exposure-response curve). We confirmed the recent increase in heat-associated mortality already reported elsewhere, while also documenting a decline in cold-associated mortality from approximately 2015 onward. As a result, overall temperature-associated mortality has fallen slightly over the past 10 years. We estimate that 4-5% of deaths are temperature-associated; typically, 3-4% are linked to cold, and just under 1% to heat. The slight decline in temperature-associated mortality does not imply that there is no cause for concern in the future, nor can it be simply extrapolated to future developments. Temperature-associated mortality reflects both the relative mortality risk at a given temperature and the number of days with that temperature. If the number of days with high temperatures continues to rise, adaptation strategies will have to be developed rapidly to prevent a marked rise in heat-related deaths.

Standardizing outcome measures in preterm infant nutrition research: Use of anthropometry and body composition in the neonatal intensive care unit.

The emerald ash borer (EAB), Agrilus planipennis Fairmaire (Coleoptera: Buprestidae), native to Northeast Asia, is the most destructive invasive pest of ash (Fraxinus spp.) in North America. In this study, we exposed mature fourth-instar diapausing EAB larvae (J-shaped or J-larvae) to nine temperatures ranging from 1.7 to 23.9 °C for 90 days, and then evaluated their diapause termination by measuring both the probability and timing of post-chill development to adults under warm rearing conditions (27 ± 0.5 °C, 16:8 h L: D). We also determined the effect of chill temperature on the mortality of diapausing J-larvae. Results showed that J-larvae successfully completed diapause after exposure to temperatures between 7.2 and 15.6 °C for 90 days and chill treatment significantly affected the duration required for post diapause development to adult emergence, with the mean number of days required for adult emergence increasing as chill temperature increased. In addition, the mortality rate for the EAB larvae that died at the J-larval stage before completing diapause development to adults was lower (0% to 7.1%) for temperatures between 1.7 and 12.8 °C than that (16% to 32.6%) for temperatures between 15.6 and 23.9 °C. These results refine our understanding of the thermal limits for EAB diapause termination and provide insight into how climatic conditions may influence EAB phenology and distribution across its geographic range.

Developing machine learning models for fluid milk spoilage classification.

Objective: To construct and validate a nomogram model for predicting the risk of acute respiratory distress syndrome (ARDS) in severely burned patients. Methods: This study was a retrospective cohort study. From January 2015 to August 2025, 372 severely burned patients who met the inclusion criteria were admitted to the Fourth Medical Center of Chinese PLA General Hospital, including 279 males and 93 females, aged 18 to 78 years. According to whether ARDS occurred within 7 days post-injury, patients were divided into ARDS group and non-ARDS group. Stratified random sampling was used to allocate patients into training set and validation set in a ratio of 7∶3. In training set, there were 35 patients in ARDS group and 227 patients in non-ARDS group; in validation set, there were 14 patients in ARDS group and 96 patients in non-ARDS group. General clinical data of the patients were collected, including total burn area, modified Baux score, burn index, partial-thickness burn area, full-thickness burn area, severity of inhalation injury, whether mechanical ventilation or high-flow oxygen therapy performed upon admission, number of days after tracheostomy, length of hospital stay, duration in critical illness, and mortality rate, as well as data related to post-burn ARDS development within 24 hours of admission, including white blood cell count, neutrophil count, thrombin time, and levels of hemoglobin, creatinine, chloride, procalcitonin, albumin, and fibrinogen (FIB). Variables with statistically significant differences between two groups in training set were screened, and characteristic variables were further selected using least absolute shrinkage and selection operator (LASSO) regression combined with a weight adjustment strategy. Multivariate logistic regression analysis was performed to identify independent predictors, based on which a nomogram model was constructed. The performance of the model was validated in both training set and validation set. Results: In the general clinical data of training set, patients in ARDS group had significantly larger total burn area and full-thickness burn area (P<0.05), significantly higher modified Baux score, burn index, proportion of patients receiving mechanical ventilation or high-flow oxygen therapy upon admission, and mortality rate (P<0.05), significantly more severe degree of inhalation injury (P<0.05), significantly greater number of days after tracheostomy, length of hospital stay, and duration in critical illness (P<0.05), and significantly smaller partial-thickness burn area (P<0.05) than those in non-ARDS group. With the data related to post-burn ARDS development, patients in ARDS group had significantly higher white blood cell count, neutrophil count, and levels of hemoglobin, creatinine, chloride, and procalcitonin (P<0.05), significantly longer thrombin time (P<0.05), and significantly lower levels of albumin and FIB (P<0.05) than those in non-ARDS group within 24 hours of admission. LASSO regression analysis showed that modified Baux score, neutrophil count, albumin level, and FIB level were the characteristic variables for the development of ARDS in 262 severely burned patients in training set. Multivariate logistic regression analysis revealed that modified Baux score, neutrophil count, albumin level, and FIB level were independent predictors of ARDS in 262 severely burned patients in training set (with ORs of 1.058, 1.147, 0.752, and 0.615, respectively, 95%CIs of 1.045-1.072, 1.092-1.206, 0.694-0.814, and 0.500-0.757, respectively, P values all <0.05). A nomogram model for predicting the risk of ARDS in 262 severely burned patients in training set was constructed based on the above four independent predictors. Receiver operating characteristic curve analysis showed that the model had an area under the curve (AUC) of 0.960 (with 95%CI of 0.934-0.986) in training set and an AUC of 0.914 (with 95%CI of 0.837-0.991) in validation set. The calibration curve showed that the risk of ARDS predicted by the model was in high agreement with the actual observed values. Clinical decision curve analysis showed that within the threshold probability range of 17% to 78%, the clinical net benefit obtained by applying this model for clinical decision-making was significantly higher than that of the strategies of intervening in all patients or intervening in none. Conclusions: The constructed nomogram model incorporating the modified Baux score, neutrophil count, albumin level, and FIB level demonstrates good predictive performance for the risk of ARDS in severely burned patients and holds potential value for clinical decision-making.

Prenatal exposure to prescribed smoke PM2.5 and low birth weight in Georgia, USA.

To explore perceived work ability after sickness absences of varying durations. Questionnaire data from the Healthy Finland survey in 2022-2023, which included self-rated work ability (SRWA), were linked with registry data of the Social Insurance Institution of Finland on sickness allowance for the period 2021-2022. The association between the number of disability days on sickness allowance over a period of 2 years and SRWA were analysed among sickness allowance recipients (N = 2398) by cross-tabulation and multinomial logistic regression taking potential confounding factors into account. The number of days on sickness allowance (p < .001) was associated with subsequent perceived work inability: the probability of perceived work inability increased with more sickness allowance days. Among individuals who received sickness allowance for more than 300 days over 2 years, the relative risk ratio was 174.5 for perceived work inability and 13.6 for perceived partial work inability, compared with those who received sickness allowance for 1-30 days. Nonetheless, only 44% of those with over 300 sickness allowance days perceived themselves to be completely unable to work. Individuals who did not believe they could work until normal retirement age were more likely to perceive themselves as completely or partially unable to work. Perceived partial work inability is common after receiving sickness allowance, but only a minority of recipients perceive themselves to be completely unable to work even after a high number of sickness allowance days. Utilising the remaining work capacity is key to enabling a successful return to the labour market and supporting longer working careers.

Surgical correction of neuromuscular scoliosis (NMS) carries a high risk of perioperative cardiopulmonary complications, including delayed extubation. This study aims to determine preoperative risk factors of delayed extubation after operative correction of neuromuscular scoliosis. A retrospective chart review identified consecutive patients with NMS surgically treated at an urban academic institution. In accordance with institutional protocol, all patients received preoperative cardiac clearance, including echocardiography. Delayed extubation was defined as intubation for >1 day (24h). Preoperative and intraoperative variables were compared between patients intubated for ≤24 hours and those intubated for >24 hours. Because several diagnoses were represented by small numbers, individual diagnoses were not included as separate variables; instead, univariate analyses were stratified by cerebral palsy (CP) and non-CP cohorts. Multivariate linear regression analyses were then performed to determine whether preoperative and intraoperative variables were associated with the number of days intubated (NDI). A receiver operating characteristic (ROC) curve was constructed to assess the ability of left ventricular ejection fraction (LVEF) to predict delayed extubation and identify the optimal cutoff. Forty-three patients met the inclusion criteria. In subgroup univariate analyses, greater blood loss and blood loss per level fused were associated with delayed extubation in both CP and non-CP cohorts. LVEF was negatively associated with the number of days intubated in the CP cohort on univariate analysis (r=-0.442, P=0.035), and the non-CP cohort showed a similar trend (r=-0.529, P=0.063). In the overall cohort, lower LVEF remained independently associated with prolonged intubation on multivariable analysis (β=-0.11, 95% CI: -0.18 to -0.04; P=0.003). In adjusted subgroup models, LVEF was not independently significant in either cohort. ROC analysis demonstrated an area under the curve of 0.78 for CP and 0.57 for non-CP. Lower LVEF appears to be associated with delayed extubation in the overall cohort, and subgroup univariate analyses suggest a similar association in the CP cohort. Preoperative echocardiography may help identify patients at risk for delayed extubation and allow for proper preoperative optimization, preparation, and counseling. level III.

PurposeCasirivimab and imdevimab (CAS+IMD) has been shown to improve clinical outcomes (death/mechanical ventilation) in seronegative hospitalized patients with COVID-19. The objective of the current analysis was to assess whether time to administration of CAS+IMD, from the start of COVID-19 symptoms, influenced these outcomes.Patients and MethodsThis was a post hoc analysis of Study 2066 (conducted between 10 June 2020 and 9 April 2021), a Phase I/II/III trial investigating the safety and efficacy of CAS+IMD (single intravenous dose) vs placebo in hospitalized adult patients with COVID-19. The primary outcome in this analysis was death or mechanical ventilation. Two populations of patients were assessed: efficacy (n = 738) and exploratory (full analysis set-exploratory data analysis [FAS-EDA]; n = 1115). Time to administration was defined as the number of days of COVID-19 prior to treatment, 4 days being the first quartile, which was considered early treatment administration of CAS+IMD.ResultsOdds of death or mechanical ventilation were higher in those aged 50–70 years (odds ratio [OR]: 2.98; 95% confidence interval [CI], 1.62–5.91; P = 0.0008) and >70 years (OR: 4.50; 95% CI, 2.45–8.96; P = 0.001) than those aged <50 years. Overall, patients who received CAS+IMD <4 days after first COVID-19 symptoms had better outcomes than patients receiving CAS+IMD ≥4 days, on adjusted analyses (efficacy OR: 0.42; 95% CI, 0.20–0.80; P = 0.0122; FAS-EDA OR: 0.63; 95% CI, 0.38–1.01; P = 0.0664). These differences were most notable in those aged 50–70 years (OR: 0.24; 95% CI, 0.05–0.70; P = 0.0219).ConclusionEarly monoclonal antibody treatment is associated with better outcomes in hospitalized patients with severe COVID-19.

The impact of prohibited periods on the seasonality of marriage: denominational differences and cultural continuities among English settlers in nineteenth century Tasmania

Digital health technologies have untapped potential to transform community health systems, and they are underutilized for chronic HIV care and electronic data management in low- and middle-income countries. We describe the design, development, and use of a mobile health application in community-based HIV prevention, care, and treatment programs implemented in Ethiopia since 2017. Initially, these programs utilized aggregate data collection methods, which were fragmented, non-uniform, and largely paper-based, posing challenges to data quality and data use. Local software developers applied user-centered methods to build a Unified Data System (UDS), an innovative digital health solution aimed at standardizing case management and routine data collection procedures. Developers involved end-users, including frontline community health workers (CHWs) and program managers, in the design and development process. They also conducted field visits to understand and assess user activities and needs. Developers and program staff conducted field testing, and they made design changes iteratively to incorporate user feedback. Local implementing partners deployed 950 CHWs to use the UDS for HIV service delivery and client-level data collection offline. Data were stored centrally in the CommCare HQ web service backed by a local analytics server. The UDS was linked to Power BI for advanced data analytics and visualization. Data validation tests were performed prior to indicator computation and reporting to the next level. 1,766 mobile accounts were opened for CHWs, of which 1,628 (92.2%; 95% confidence interval [CI]=90.8%, 93.4%) have submitted data. An additional 368 of 392 web accounts (93.9%; 95% CI=91.0%, 96.0%) have been used by program managers and monitoring and evaluation experts to access the dashboard. The UDS has eliminated the tedious, manual, paper-based work associated with data (dis)aggregation and reporting by frontline CHWs and local implementing partners. Hence, the number of days to access client-level data by the local partners was reduced from 1 month to just 1 day, and the time to report on activity performance was shortened from 5 days to a half-day. Data completeness was nearly 100% and data validation tests demonstrated no invalid data elements or errors. Generally, there was a high degree of digital health technology utilization by frontline CHWs and local implementing partners for standardized HIV care, high-quality data collection, and making data-informed decisions. Lessons learned from the UDS implementation could be adapted not only to support community HIV programming but also to strengthen national electronic community health information systems.

BackgroundAn estimated 5 to 8 million US children live with a parent who uses cannabis, and most cannabis users report smoking cannabis inside their homes, placing children at risk for cannabis secondhand smoke (cSHS) exposure. Indoor air quality (IAQ) monitoring provides real-time feedback on airborne pollutants and has shown promise in reducing in-home tobacco secondhand smoke exposure, suggesting its potential as an effective harm reduction strategy for cSHS.ObjectiveThis pilot study evaluated the feasibility, acceptability, and preliminary effectiveness of using low-cost, off-the-shelf IAQ monitors to increase caregivers’ awareness of children’s cSHS exposure risk and to change smoking behavior. Secondary aims were to assess participant engagement, perceived usefulness, and household communication regarding in-home cannabis smoking.MethodsBetween February 2025 and April 2025, 14 adults who smoked cannabis indoors and lived with at least 1 child aged younger than 16 years were recruited primarily via targeted social media advertisements and completed a 3-week trial. Participants received an Awair Element IAQ monitor, printed health education materials, and text messaging prompts for brief surveys. The IAQ monitor continuously measured PM2.5, VOCs, CO₂, temperature, and humidity. Daily surveys captured self-reported PM2.5 readings and recent cannabis use, while baseline and end-of-study assessments evaluated IAQ perceptions, cSHS risk awareness, and in-home smoking behavior. Survey results were summarized via descriptive statistics, and linear mixed-effects models were used to characterize objective IAQ trends. Six additional adult household members provided parallel end-of-study data.ResultsReported engagement was high, with 85% (11/13) of participants indicating that they reviewed the monitor at least daily. The average number of days in the previous week that a caregiver reported a child being home while cannabis was smoked declined from 4.5 (SD 2.2) at the trial start to 2.8 (SD 2.9) at the end (6/13, 46% had a reduction; 1/13, 8% reported an increase). Furthermore, 62% (8/13) of participants reported that they reduced (4/13, 31%) or thought about changing (4/13, 31%) their smoking habits. Around 62% (8/13) of participants agreed or strongly agreed that IAQ monitoring helped drive conversations about changing indoor smoking rules, while 100% (13/13) reported no IAQ-driven disagreements among household residents regarding in-home smoking rules. A linear mixed-effects model did not indicate a consistent trend in PM2.5 levels across participants over time (β=–0.28; SE 1.13; P=.81), but there was heterogeneity in trends, and those with the largest reductions in PM2.5 over the trial had the largest reduction in reported children’s cSHS exposure.ConclusionsIn-home IAQ monitoring was feasible and perceived as useful among caregivers who smoked cannabis indoors. Real-time IAQ feedback supported risk awareness, promoted family dialogue, and coincided with reductions in in-home smoking around children. These findings suggest that IAQ feedback may represent a scalable tool for reducing children’s cSHS exposure and merits further testing in larger, controlled trials.

Days at Home among Children by Medical Complexity, Public/Private Insurance, and Urban/Rural Residence.

BackgroundEstimated fetal weight (EFW) is a key determinant of obstetrical decision‐making and an independent risk factor of high perinatal morbidity and mortality. However, routine ultrasound during pregnancy test is not universally available in the Malaysia primary care settings.ObjectiveTo compare the accuracy of ultrasonographic EFW to the actual birth weight (ABW). Study DesignThis was a prospective cohort study involving women with singleton pregnancies, at term (37–38 + 6 weeks) and age ≥ 18 years. The accuracy of EFW was evaluated by calculating the percentage error (PE). PE of < 10% was regarded as “accurate.”ResultsA total of 153 participants were recruited. The majority of the participants were Malay (77.8%), followed by Indian (12.4%), Chinese (4.6%), and others. There was no significant association between ethnicity and ultrasound accuracy. The mean maternal weight at booking was 64.10 kg, while the mean body mass index (BMI) was 26.09 kg/m2. The mean EFW was 2992.72 ± 338 g, while the mean ABW was 2960 ± 400 g. For ultrasound accuracy, the mean PE was 8.11%, with 68.63% of accurate EFW. Maternal weight, parity, and gestational diabetes were significantly associated with the accuracy of ultrasound EFW. The mean number of days from ultrasound to birth was 2.64 days. Performing an EFW within 24 h prior to delivery yielded optimal accuracy of EFW. There was a significant association between experiences of examiners with ultrasound accuracy.ConclusionThe accuracy of EFW in our study was comparable to similar studies done in other countries. There was a strong positive correlation between ultrasound EFW using the Hadlock‐4 weight estimation model with ABW in our population. The accuracy of EFW within 24 h prior to delivery warranted a calculated decision on the induction of labor. Adequate training of examiners was crucial. Routine ultrasound EFW services should be made available and accessible in all healthcare settings in Malaysia.