Period October Research Articles

Investigation of polychlorinated biphenyls in breast milk from two regions in Bulgaria.

Human breast milk is an optimally balanced infant food and a suitable tool for assessing the burden of humans with lipophilic persistent organic pollutants. The aim of this study was to investigate the accumulation profile of polychlorinated biphenyls in breast milk of women living in Bulgaria and to assess the health risk to infants. Breast milk samples were obtained from 72 healthy primiparae and multiparae mothers, living in two regions in northeastern Bulgaria - Varna region and Dobrich region, in the period October 2019-July 2021. Important information for the study, such as age, body mass, smoking and dietary habits, was collected through a questionnaire. Fifteen congeners of PCBs, including six indicator congeners, were determined by capillary gas chromatography system with mass spectrometry detection. The lipid content of the tested samples was in the range from 0.5% to 6.7%, with average value 3.25%. The six indicator PCBs in human milk samples formed up to 89% of the total PCBs levels. The most abundant congener was PCB 153, followed by PCB 138 and PCB 180. Five of the 15 PCB congeners (77, 126, 128, 156, 169) were not detected in any of the milk samples. The arithmetic mean PCB levels in milk samples from Varna (32.7ng/g lw) were found higher than PCB levels in breast milk of mothers from Dobrich (22.5ng/g lw). The highest PCB levels were found in milk samples from primiparae mothers in 36-40 age group (for both regions). Infant exposure to PCBs present in human milk was estimated using toxic equivalents (TEQ). The health risk to infants was assessed and was compared to the tolerable daily intake (TDI). Positive correlation was found between the arithmetic mean PCBs levels and two important factors - the age and body mass index of the primiparae group. The mean values of the analyzed PCB congeners in breast milk samples from multiparae were lower than in those from primiparae mothers. The regional differences in PCB concentrations were small, suggesting similar exposures in the studied regions. The levels of PCBs in breast milk were found lower than levels from studies in other European countries. Statistical data does not show any association between PCB levels in milk and dietary habits. The results showed that infants are not at risk of any adverse effects caused by PCBs through breast milk.

Assessment of risk factor profile of the non-communicable diseases among bank employees in the Gadag district

Background: Non-communicable disease (NCD) burden is rapidly overtaking communicable disease burden in India, including TB, HIV, water-borne or vector-borne diseases. Bank employees' jobs are physically sedentary and also involve a lot of mental stress. So that the current study was carried out to determine the prevalence of NCD risk factors among Gadag district bank employees. Methods: A cross sectional study was carried in the Bank employees of Gadag district from both private and Govt. bank, during the period of October 2022 to February 2023, for which ethical clearance was taken from the institutional ethical committee. We have included total study subject 100, subjects was selected by using convenient sampling technique and The study subjects included in the study are who willing to participate and given consent for the study. Results: In our study it was observed that the prevalence of hypertension, diabetes and other cardiac problems were 21%, 12% and 2% respectively and the prevalence of obesity (BMI) (35%), High waist - hip ratio (24% in females and 47% in males), mixed diet (83%) preferably red meat (47%), tobacco use (24%), alcohol consumption (34%) and physical inactivity (61%). There is significant association between NCD in the study participants and the risk factors like long daily working hours, increased waist - hip ratio, high BMI, alcohol consumption, physical activity (MET) and mixed diet. Conclusions: There is a high burden of major risk factors for non-communicable diseases among Bank employee. We recommend routine screening for NCD among bank employees and include appropriate preventive interventions like health education on life-style modification.

Comparative analysis of discharge and sediment flux from two contiguous glacierized basins of Central Himalaya, India

In the present study, suspended sediment load (SSL), sediment yield and erosion rates in Pindari Glacier basin (PGB) and Kafni Glacier basin (KGB) have been estimated using daily discharge and suspended sediment concentration (SSC) data for three ablation seasons (2017-2019). For this, one meteorological observatory and two gauging sites have been established at Dwali (confluence point), and water samples have been collected twice in a day for high flow period (July to September) and daily for lean period (May, June and October). An area-velocity method and stage-discharge relationship has been established to convert water level into discharge (m3 s-1). For estimating SSC (mg/l), collected water samples have been filtered, dried, analysed and confirmed with an automatic suspended solid indicator. Further, SSL, sediment yield and erosion rates have been computed using SSC data. The results reveal that mean annual discharge in PGB (35.06 m3s-1) has been found approximately 1.7 times higher than KGB (20.47 m3s-1). The average SSC and SSL in PGB have been observed about 396.07mg/l and 1928.34 tonnes, and in KGB, it is about 359.67mg/l and 1040.26 tonnes, respectively. The SSC and SSL have followed the pattern of discharge. A significant correlation of SSC and SSL has been found with discharge in both the glacierized basins (p < 0.01). Interestingly, average annual sediment yield in PGB (3196.53 t/km2/yr) and KGB (3087.23 t/km2/yr) have been found almost identical. Likewise, the erosion rates in PGB and KGB have been witnessed about 1.18 and 1.14mm/yr, respectively. Sediment yield and erosion rates in PGB and KGB have been found in correspondence with other basins of Central Himalaya. These findings will be beneficial for engineers and water resource managers in the management of water resources and hydropower projects in high-altitude areas and in the planning and designing of water structures (dams, reservoirs etc.) in downstream areas.

RESULTS OF INTRAVENOUS ALINAMIN AND ALCOHOL EXAMINATION RESULTS IN PATIENTS COMPLAINTS OF SNACTING DISORDERS AT RSMH PALEMBANG

Smell is a chemical substance mixed in the air that humans perceive with their sense of smell. Loss of smell or loss of smell has become very important in recent years. Currently, research on odor is very interesting because it can determine the type of odor, as well as the function of smell. Examination of the intravenous smell test and alcohol smell test is one of the gold standard examinations that can be done to determine the type of smell disorder. To determine the concordance between the results of the intravenous alinamin smell test and the alcohol smell test in patients with olfactory disorders at RSMH Palembang. Observational and analytic research using cross sectional. Data collection was carried out using the medical records of RSUP Dr. Mohammad Hoesin Palembang for the period October 2022 to January 2023. Data were analyzed with IBM SPSS 25. In this study, there were 49 patients with complaints of smell disturbances to the THTBKL department of RSUP Dr. Mohammad Hoesin Palembang. The mean age in the study was 33 years old with the most vulnerable population aged &lt;20 years (26.5%). With the majority of the female sex (57.1%). While the majority of the work is mostly students (26.5%) and complains of gradual disturbance smells (91.8%). Most of the patients who came with complaints of smell disturbances were patients with sinonasal masses (53.1%). The correlation between intravenous alinamin and alcohol smell tests using the Spearman correlation test showed a very strong correlation (r=0.908) and in the conformity test using Cohen's kappa value obtained was 1.000 which means that perfect agreement was reached between the two tests. There is a concordance in the examination results between the alinamin smell test and the alcohol smell test in patients with complaints of smell disorders.

Assessing the Correlation Between Patient-Specific Characteristics and Braden Pressure Injury Risk Score at a Suburban Tertiary Hospital in Nigeria.

Background and objective Pressure injury (PI) is a frequent complication of hospital admissions, and it increases healthcare costs, morbidity, and mortality. This study aimed to use the Braden scale to assess the PI risk among hospitalized patients without PI and determine its association with patient-specific factors. Methods A cross-sectional study was conducted at a suburban tertiary hospital involving a total of 211 hospitalized patients recruited during the study period (October 2022). Patients were assessed using the Braden scale and their sociodemographic data were also recorded. Data analysis was performed using IBM SPSS Statistics version 26.0 (IBM Corp., Armonk, NY). Results The mean ageof the patients was 41.8 ±23.0 years and 54.0% of the patients were females. The average Braden score of the patients was 19.01 ±3.42, and more than half (58.3%) of the patients showed no risk while only 0.9% of the patients had a severe risk of PI. There was a statistically significant association between PI risk and patients' age (r=-0.353, R=12.5%, p<0.001), pre-admission occupation (F=10.290, p<0.001) as well as the ward of admission (F=11.915, p<0.001). However, gender and social support were not significantly associated. Conclusion The age, pre-admission occupation, and ward of admission of patients werefound to be significantly associated with the risk of developing PI.It is recommended that more resourcesbe channeled toward preventing PI among high-risk patients in resource-limited settings.

Influence of setting-dependent contacts and protective behaviours on asymptomatic SARS-CoV-2 infection amongst members of a UK university

We survey 62 users of a university asymptomatic SARS-CoV-2 testing service on details of their activities, protective behaviours and contacts in the 7 days prior to receiving a positive or negative SARS-CoV-2 PCR test result in the period October 2020–March 2021. The resulting data set is novel in capturing very detailed social contact history linked to asymptomatic disease status during a period of significant restriction on social activities. We use this data to explore 3 questions: (i) Did participation in university activities enhance infection risk? (ii) How do contact definitions rank in their ability to explain test outcome during periods of social restrictions? (iii) Do patterns in the protective behaviours help explain discrepancies between the explanatory performance of different contact measures? We classify activities into settings and use Bayesian logistic regression to model test outcome, computing posterior model probabilities to compare the performance of models adopting different contact definitions. Associations between protective behaviours, participant characteristics and setting are explored at the level of individual activities using multiple correspondence analysis (MCA). We find that participation in air travel or non-university work activities was associated with a positive asymptomatic SARS-CoV-2 PCR test, in contrast to participation in research and teaching settings. Intriguingly, logistic regression models with binary measures of contact in a setting performed better than more traditional contact numbers or person contact hours (PCH). The MCA indicates that patterns of protective behaviours vary between setting, in a manner which may help explain the preference for any participation as a contact measure. We conclude that linked PCR testing and social contact data can in principle be used to test the utility of contact definitions, and the investigation of contact definitions in larger linked studies is warranted to ensure contact data can capture environmental and social factors influencing transmission risk.

Analysis of All-Cause Hospitalization and Death Among Nonhospitalized Patients With Type 2 Diabetes and SARS-CoV-2 Infection Treated With Molnupiravir or Nirmatrelvir-Ritonavir During the Omicron Wave in Hong Kong

Diabetes and COVID-19 are both global pandemics, and type 2 diabetes is a common comorbidity in patients with acute COVID-19 and is proven to be a key determinant of COVID-19 prognosis. Molnupiravir and nirmatrelvir-ritonavir are oral antiviral medications recently approved for nonhospitalized patients with mild to moderate COVID-19, following demonstration of their efficacies in reducing adverse outcomes of the disease; it is crucial to clarify whether both oral antiviral medications are efficacious in a population consisting exclusively of patients with type 2 diabetes. To evaluate the effectiveness of molnupiravir and nirmatrelvir-ritonavir in a contemporary population-based cohort comprising exclusively nonhospitalized patients with type 2 diabetes and SARS-CoV-2 infection. This retrospective cohort study was performed using population-based electronic medical record data for patients in Hong Kong with type 2 diabetes and confirmed SARS-CoV-2 infection between February 26 and October 23, 2022. Each patient was followed up until death, outcome event, crossover of oral antiviral treatment, or end of the observational period (October 30, 2022), whichever came first. Outpatient oral antiviral users were divided into molnupiravir and nirmatrelvir-ritonavir treatment groups, respectively, and nontreated control participants were matched through 1:1 propensity score matching. Data analysis was performed on March 22, 2023. Molnupiravir (800 mg twice daily for 5 days) or nirmatrelvir-ritonavir (300 mg nirmatrelvir and 100 mg ritonavir twice daily for 5 days, or 150 mg nirmatrelvir and 100 mg ritonavir for patients with an estimated glomerular filtration rate of 30-59 mL/min per 1.73 m2). The primary outcome was a composite of all-cause mortality and/or hospitalization. The secondary outcome was in-hospital disease progression. Hazard ratios (HRs) were estimated with Cox regression. This study identified 22 098 patients with type 2 diabetes and COVID-19. A total of 3390 patients received molnupiravir and 2877 received nirmatrelvir-ritonavir in the community setting. After application of exclusion criteria followed by 1:1 propensity score matching, this study comprised 2 groups. One group included 921 molnupiravir users (487 men [52.9%]), with a mean (SD) age of 76.7 (10.8) years, and 921 control participants (482 men [52.3%]), with a mean (SD) age of 76.6 (11.7) years. The other group included 793 nirmatrelvir-ritonavir users (401 men [50.6%]), with a mean (SD) age of 71.7 (11.5) years, and 793 control participants (395 men [49.8%]), with a mean (SD) age of 71.9 (11.6) years. At a median follow-up of 102 days (IQR, 56-225 days), molnupiravir use was associated with a lower risk of all-cause mortality and/or hospitalization (HR, 0.71 [95% CI, 0.64-0.79]; P < .001) and in-hospital disease progression (HR, 0.49 [95% CI, 0.35-0.69]; P < .001) compared with nonuse. At a median follow-up of 85 days (IQR, 56-216 days), nirmatrelvir-ritonavir use was associated with a lower risk of all-cause mortality and/or hospitalization (HR, 0.71 [95% CI, 0.63-0.80]; P < .001) and a nonsignificantly lower risk of in-hospital disease progression (HR, 0.92 [95% CI, 0.59-1.44]; P = .73) compared with nonuse. These findings suggest that both molnupiravir and nirmatrelvir-ritonavir oral antiviral medications were associated with a lower risk of all-cause mortality and hospitalization among patients with COVID-19 and type 2 diabetes. Further studies in specific populations, such as individuals in residential care homes and individuals with chronic kidney disease, are suggested.

CO2 and CH4 fluxes from forest soil in the northern Da Xing’anling Mountains in Northeast China during the freezing and thawing periods of near-surface soil in 2018–2019

ABSTRACT Under a warming climate, the studies on effects of seasonal freeze–thaw cycles on soil respiration are key to understanding the soil carbon cycles and ecosystem responses and resilience at mid- and high latitudes. In this study, the effluxes of soil surface CO2 and absorption rates of CH4 were measured in the Xing'an larch (Larix gmelinii) forest in the northern Da Xing’anling Mountains, Northeast China using an automatic multichannel soil greenhouse gas measurement system (dynamic gas chamber method) during the periods of October–November 2018 and April–May 2019. The results showed that during the freezing period of near-surface soil, CO2 and CH4 fluxes significantly declined, approaching zero, at the end of November. During the thawing period of near-surface soil, CO2 and CH4 fluxes from surface soil fluctuated markedly at first and then rose rapidly. The respective Q10 values of 3.86 and 4.89 during the freezing and thawing periods of near-surface soil, respectively, indicate the important role of ground freeze–thaw cycles in the modifications of CO2 and CH4 fluxes. The results of this study could help assess the stability of the soil carbon pool and carbon flux strength in taiga-forested permafrost regions in the northern Da Xing’anling Mountains, Northeast China.

Improving and Sustaining Interpreter Use Over 5 Years in a Pediatric Emergency Department.

Patients with a language for care other than English (LOE) face communication barriers and inequitable outcomes in health care. Professional interpretation can improve outcomes but is underutilized. Our pediatric emergency department (ED) implemented quality improvement (QI) interventions over a 5-year period with an aim to increase interpreter use to 80% of patient encounters with LOE. Overall interpreter use for ED encounters was measured over time, with a baseline period of October 2015 to December 2016 and during 5 years of QI interventions from January 2017 to August 2021. Interventions included staff education, data feedback, reducing barriers to interpreter use, and improving identification of language for care with plan-do-study-act cycles. Outcomes were analyzed by using statistical process control charts and standard rules for special cause variation. We analyzed a total of 277 309 ED encounters during the study period, 12.2% with LOE. The overall use of interpretation increased from a baseline of 53% to 82% of encounters. Interpretation throughout the ED visit and the number of interpreted interactions per hour also increased. There was improvement across language types, patient age groups, acuity levels, and during different times of day. Special cause variation was associated with multiple QI interventions. We reached our primary aim of providing professional interpretation for 80% of patient encounters with LOE. There were several QI interventions associated with improvements, including staff education, data feedback, improved access to interpretation, and improved identification and visualization of language for care. Efforts to improve interpreter use may benefit from a similar multifaceted approach.

A Useful (But Painful) Risk-Management Lesson from the Chilean Pension System

This article demonstrates the dangers of attempting to create investment funds with different risk-return profiles by relying only on investment policies based on asset class-limits, but without incorporating portfolio-level risk constraints. The analysis is based on a natural experiment: the Chilean pension system. The study considers monthly returns data from the five investment funds that constitute the bedrock of the Chilean system and covers the period October 1, 2002 to June 1, 2020. The analysis, which relies on the use of different rank-order metrics, shows that the five funds delivered returns incompatible with their intended risk-return profile. In short, rank-ordering the five funds based on their cumulative returns resulted in a sequence at odds with the original intention; that is, contrary to the regulator’s aim, riskier funds frequently delivered lower returns. These findings are relevant for policy makers and the private sector, as many institutional investors (not only pension funds) based their investment policies on such limits alone.

Model Pengukuran Working Out Loud (WOL) Terhadap Adopsi Enterprise Social Networks (ESNs)

This study aims to examine the concept of Working Out Loud (WOL) in measuring the success rate of implementing Enterprise Social Networks (ESNs) in companies. The adoption of this technology has not been widely implemented by companies in Indonesia. Implementing ESNs in companies as a tool to drive increased employee collaboration requires integration of social media and enterprise technology infrastructure. This platform does provide benefits for companies in the areas of innovation, increased productivity, and also employee engagement; but on the other hand there are several failures caused by employee factors that only focus on implementing technology without changing employee behavior patterns and also how to measure this behavior. The concept of Working Out Load (WOL) is an indicator tool that can be used to measure the success of ESNs implementation. Although the concept of WOL is still unclear, it provides many benefits. Not much research has discussed the benefits that exist in this relationship. The initial hypothesis of this study is that the two behavioral factors above exist and influence each other but are different, so measurements can be made with the developed scale. This study uses a survey distributed to employees of PT. Djarum (one of the large companies in Indonesia) which has implemented ESNs technology in the period October - November 2022. Processing exploratory analysis and data confirmation using SPSS 22 and AMOS 22 with a total of 313 respondents; which was divided randomly with 200 respondents for confirmation analysis and the rest as data for exploratory analysis. Departing from the abnormal nature and ordinal nature of the item scale used, this study uses the Spearman method (not Pearson). This aims to confirm the hypothesis so as to produce a rating scale for individuals and groups of WOL, so that researchers and practitioners can find WOL behavior in a company as a continuous process. The results of this study can be used as a reference for companies in Indonesia to develop ESN technology and measure the success rate of their operations.

Three-Dimensional Disease Outbreak Surveillance System in a Tertiary Hospital in Singapore: A Proof of Concept

ObjectiveTo develop an electronic surveillance system that provides prompt in-depth situational infectious disease risk and linkage analysis for inpatients in a tertiary hospital. Patients and MethodsAll patients admitted to Singapore General Hospital (SGH), a 1900-bedded tertiary care hospital, are included in routine surveillance. The 3-Dimensional Disease Outbreak Surveillance System (3D-DOSS) was developed to spatiotemporally represent inpatient surveillance data on a “digital twin” of SGH and evaluated for performance in surveillance, contact tracing, and outbreak investigations. This study was conducted over a 12 month period (October 1, 2020 to September 30, 2021). ResultsThe 3D-DOSS surveillance module identified an influenza cluster of 10 inpatients in November 2018, mapping retrospective data between September 2018 and December 2018. Seventy-six clusters of 2 or more linked patients with health care–associated Klebsiella pneumoniae carbapenemase–type carbapenemase-producing Enterobacteriaceae were detected in SGH in 2 years (2018 and 2019). The 3D-DOSS contact tracing module promptly identified 44 primary and 162 secondary inpatient contacts, after exposure to a health care worker with coronavirus disease 2019 in April 2021. For outbreak mapping, 24 patients with OXA-48 were mapped on October 22, 2020, using 3D-DOSS to determine their spatiotemporal distribution. ConclusionThe integration of health care data and representation on a virtual hospital digital twin is a useful tool in an outbreak alert and response framework. Infectious disease surveillance systems, which are syndrome-based, that can access real-time data, and can incorporate movement networks, can potentially enhance health care–associated infection prevention and preparedness for disease X.

Predictors of Rehospitalization in Patients with Chronic Heart Failure a Single Center Study in Moroccan Patients

Chronic heart failure (HF) is a major problem of public health in Morocco with few studies exploring HF particularities in this country where the prevalence of HF is estimated to be around 2.2%.&#x0D; Objective: The aim of this study was to evaluate the correlation between frequency of rehospitalization in our population with age, left ventricular ejection fraction (LVEF), heart rate (HR), and QRS duration, Since the number of rehospitalizations is strongly correlated to mortality as shown by many studies.&#x0D; Materials and Methods: Patients with HF were enrolled in this retrospective case control study regardless of their LVEF, patients with recent (&lt;3months) myocardial infarction were excluded. They were all examined and questioned in the heart failure unit of our hospital between the period of October 2022 and December 2022. The correlations were calculated by PEARSON index using R Statistical Software.&#x0D; Results: 224 patients were included. The mean patient age was 59 years (57.2-63;IC 95%) with a male predominance of 60.1 % (56.8-71; IC 95%). 35.5% and 32.2% of patients were treated for hypertension and diabetes respectively. The mean LVEF was 35.2% (33.96-36.91;IC 95%). A positive correlation was found between rehospitalization frequency and age and high heart rate (+ 0.42 p = 0,04;+0.322, p&lt;0.005) respectively . Conversely a negative correlation was found with LVEF (-0.312, p&lt;0.005) while there was a positive correlation with QRS duration but without significance (+0.162 , p=0.03).&#x0D; Conclusion: This study shows strong correlation between rehospitalization and advanced age, higher HR and lower LVEF.

Results and insights after 413 TAVI procedures performed by cardiac surgeons on their own.

Current evidence on transcatheter aortic valve implantation (TAVI) has been generated exclusively by cardiology studies and no operative data from cardiac surgeons are available. Here, we describe the development of our TAVI programme and report the results of transfemoral (TF) TAVI done by cardiac surgeons on their own. This study included all the TAVI procedures on native valve performed at Cardiac Surgery Unit, Ospedali Riuniti di Ancona, during the period October 2018 to July 2022. Relevant prospectively collected preoperative, intraprocedural and postoperative data were retrieved from the Institutional database. A total of 413 patients were included in the study. Mean patients' age was 82 years and among them 44% (180/413) were male. STS score was 3.1% (2.2-4.4). Eighty patients underwent transapical TAVI and 333 patients had a TF approach. We progressively moved from transapical TAVI towards TF procedures that are now routinely performed on conscious sedation and using a fully percutaneous approach. After TF TAVI, 30-day mortality rate was 1%, cerebral stroke occurred in 2% of the cases, permanent pacemaker implantation was necessary in 23% of the patients and in 6% of the cases there was a moderate/severe degree of aortic regurgitation. There was no association between operators performing TAVI and 30-day mortality. The acquisition of catheter-based skills and an adequate training allowed cardiac surgeons to perform on their own awake and fully percutaneous TF TAVI with similar results when compared with major randomized clinical trials and registries' experiences.

Assessing the Operational Feasibility of Integrating Point-of-Care G6PD Testing into Plasmodium vivax Malaria Management in Vietnam.

Plasmodium vivax cases represent more than 50% of a diminishing malaria case load in Vietnam. Safe and effective radical cure strategies could support malaria elimination by 2030. This study investigated the operational feasibility of introducing point-of-care quantitative glucose-6-phosphate dehydrogenase (G6PD) testing into malaria case management practices. A prospective interventional study was conducted at nine district hospitals and commune health stations in Binh Phuoc and Gia Lai provinces in Vietnam over the period of October 2020 to October 2021. The STANDARD™ G6PD Test (SD Biosensor, Seoul, Republic of Korea) was incorporated to inform P. vivax case management. Case management data and patient and health care provider (HCP) perspectives, as well as detailed cost data were collected. The G6PD test results were interpreted correctly by HCP and the treatment algorithm was adhered to for the majority of patients. One HCP consistently ran the test incorrectly, which was identified during the monitoring and resulted in provision of refresher training and updating of training materials and patient retesting. There was wide acceptability of the intervention among patients and HCP albeit with opportunities to improve the counseling materials. Increasing the number of facilities to which the test was deployed and decreases in the malaria cases resulted in higher per patient cost for incorporating G6PD testing into the system. Commodity costs can be reduced by using the 10-unit kits compared to the 25 unit kits, particularly when the case loads are low. These results demonstrate intervention feasibility while also highlighting specific challenges for a country approaching malaria elimination.

The impact of war on HIV/AIDS service provision: In rural health facilities of Tigray, northern Ethiopia, a cross-sectional study.

HIV/AIDS remained among the common public health problems in developing country. Despite the extensive delivery of ART and improved coverage of the service access, still, man-made problems like war have negatively influenced the utilization of antiretroviral treatment services. The war in Tigray Region in the northern Ethiopia broke out in November 2020 and thereby has brought about an extreme damage on most of the infrastructure in Tigray, including the health institutions. The purpose of this study is, therefore, to assess and report the trend of HIV service provision across the war affected rural health facilities in Tigray. The study was conducted in 33 rural health facilities during the active war in Tigray. A facility based retrospective cross-sectional study design was conducted among health facilities from July 03 to August 05, 2021. A total of 33 health facilities from 25 rural districts were included in the HIV service delivery assessment. A total of 3274 and 3298 HIV patients were seen during pre-war period in September and October 2020, respectively. The number of follow-up patients during the war period in January remained to be only 847(25%) which is significantly reduced with a P value<0.001. A similar trend was observed during the subsequent months until May. The trend of follow-up patients on ART significantly declined from 1940 in September (pre-war) to 331(16.6%) in May (during the war). This study also revealed a 95.5% reduction of laboratory service provision to HIV/AIDS patients during the war in January and with similar trends thereafter (P<0.001). The war has led to a significant decline of HIV service provision in the rural health facilities and most part of the region during the first eight months of active war in Tigray.

A study on optical properties, classification, and transport of aerosols during the smog period over South Asia using remote sensing.

Over the past few years, South Asian region has experienced frequent and thick smog events because of rapid population growth and enhanced anthropogenic activities, particularly in the Indo-Gangetic Plain (IGP). Therefore, the present study investigates aerosol properties such as aerosol optical depth (AOD) (500nm), Angstrom exponent (AE) (440-870nm), single scattering albedo (SSA), fine-mode fraction (FMF), absorption aerosol optical depth (AAOD), and absorption aerosol exponent (AAE) over selected AERONET sites namely Bhola (2012-2021), Dhaka (2012-2021), Jaipur (2011-2021), Kanpur (2011-2021), Karachi (2011-2021), Lahore (2011-2021), and Pokhara (2011-2021) in the IGP during the smog period (October, November, and December). Additionally, different aerosol types were categorized using AERONET direct sun (AOD, AE) and inversion products (VSD, SSA, RI, FMF, and ASY). The monthly mean AOD, AE, and FMF varied from ⁓0.33 to 1.07, ⁓0.3 to 1.4, and 0.6-0.9µm over all selected AERONET sites during the smog period. Moreover, the outcomes revealed the dominance of biomass-burning and urban/ industrial aerosols over Lahore, Karachi, Dhaka, and Bhola during the smog period. Contrary to this, dust and mixed aerosols were abundant over Jaipur and Karachi, respectively. Furthermore, HYSPLIT cluster analysis is used to trace the transmission paths and potential sources of aerosols over selected sites.

Improved Yet Varied Clinical Outcomes Observed With Comparison of Arthroscopic Superior Capsular Reconstruction Versus Arthroscopy-Assisted Lower Trapezius Transfer for Patients With Irreparable Rotator Cuff Tears

To evaluate the outcomes of arthroscopic superior capsular reconstruction (SCR) and arthroscopy-assisted lower trapezius tendon transfer (LTT) for posterosuperior irreparable rotator cuff tears (IRCTs). Over an almost 6-year period (October 2015 to March 2021), all patients who underwent IRCT surgery with a minimum 12-month follow-up period were identified. For patients with a substantial active external rotation (ER) deficit or lag sign, LTT was preferentially selected. Patient-reported outcome scores included the visual analog scale (VAS) pain score, strength score, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score, Single Assessment Numeric Evaluation (SANE) score, and Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score. We included 32 SCR patients and 72 LTT patients. Preoperatively, LTT patients had more advanced teres minor fatty infiltration (0.3 vs 1.1, P= .009), a higher global fatty infiltration index (1.5 vs 1.9, P= .035), and a higher presence of the ER lag sign (15.6% vs 48.6%, P < .001). At a mean follow-up of 2.9 ± 1.3 years (range, 1.0-6.3 years), no differences in patient-reported outcome scores were observed. Postoperatively, SCR patients had a lower VAS score (0.3 vs 1.1, P= .017), higher forward elevation (FE) (156° vs 143°, P= .004), and higher FE strength (4.8 vs 4.5, P= .005) and showed greater improvements in the VAS score (6.8 vs 5.1, P= .009), FE (56° vs 31°, P= .004), and FE strength (1.0 vs 0.4, P < .001). LTT patients showed greater improvement in ER (17° vs 29°, P= .026). There was no statistically significant between-cohort difference in complication rate (9.4% vs 12.5%, P= .645) or reoperation rate (3.1% vs 10%, P= .231). With adequate selection criteria, both SCR and LTT provided improved clinical outcomes for posterosuperior IRCTs. Additionally, SCR led to better pain relief and restoration of FE whereas LTT provided more reliable improvement in ER. Level III, treatment study with retrospective cohort comparison.

Provision of Postpartum Contraception Before and After the Start of the COVID-19 Pandemic in Maine.

Preliminary findings from selected health systems revealed interruptions in reproductive health care services due to the COVID-19 pandemic. We estimated changes in postpartum contraceptive provision associated with the start of the COVID-19 pandemic in Maine. We used the Maine Health Data Organization's All Payer Claims Database for deliveries from October 2015 through March 2021 (n = 45 916). Using an interrupted time-series analysis design, we estimated changes in provision rates of long-acting reversible contraception (LARC), permanent contraception, and moderately effective contraception within 3 and 60 days of delivery after the start of the COVID-19 pandemic. We performed 6- and 12-month analyses (April 2020-September 2020, April 2020-March 2021) as compared with the reference period (October 2015-March 2020). We used Poisson regression models to calculate level-change rate ratios (RRs) and 95% CIs. The 6-month analysis found that provision of LARC (RR = 1.89; 95% CI, 1.76-2.02) and moderately effective contraception (RR = 1.51; 95% CI, 1.33-1.72) within 3 days of delivery increased at the start of the COVID-19 pandemic, while provision of LARC (RR = 0.95; 95% CI, 0.93-0.97) and moderately effective contraception (RR = 1.08; 95% CI, 1.05-1.11) within 60 days of delivery was stable. Rates of provision of permanent contraception within 3 days (RR = 0.70; 95% CI, 0.63-0.78) and 60 days (RR = 0.71; 95% CI, 0.63-0.80) decreased. RRs from the 12-month analysis were generally attenuated. Disruptions in postpartum provision of permanent contraception occurred at the beginning of the COVID-19 pandemic in Maine. Public health policies should include guidance for contraceptive provision during public health emergencies and consider designating permanent contraception as a nonelective procedure.

Perspectives of Youths on the Ethical Use of Artificial Intelligence in Health Care Research and Clinical Care

Understanding the views and values of patients is of substantial importance to developing the ethical parameters of artificial intelligence (AI) use in medicine. Thus far, there is limited study on the views of children and youths. Their perspectives contribute meaningfully to the integration of AI in medicine. To explore the moral attitudes and views of children and youths regarding research and clinical care involving health AI at the point of care. This qualitative study recruited participants younger than 18 years during a 1-year period (October 2021 to March 2022) at a large urban pediatric hospital. A total of 44 individuals who were receiving or had previously received care at a hospital or rehabilitation clinic contacted the research team, but 15 were found to be ineligible. Of the 29 who consented to participate, 1 was lost to follow-up, resulting in 28 participants who completed the interview. Participants were interviewed using vignettes on 3 main themes: (1) health data research, (2) clinical AI trials, and (3) clinical use of AI. Thematic description of values surrounding health data research, interventional AI research, and clinical use of AI. The 28 participants included 6 children (ages, 10-12 years) and 22 youths (ages, 13-17 years) (16 female, 10 male, and 3 trans/nonbinary/gender diverse). Mean (SD) age was 15 (2) years. Participants were highly engaged and quite knowledgeable about AI. They expressed a positive view of research intended to help others and had strong feelings about the uses of their health data for AI. Participants expressed appreciation for the vulnerability of potential participants in interventional AI trials and reinforced the importance of respect for their preferences regardless of their decisional capacity. A strong theme for the prospective use of clinical AI was the desire to maintain bedside interaction between the patient and their physician. In this study, children and youths reported generally positive views of AI, expressing strong interest and advocacy for their involvement in AI research and inclusion of their voices for shared decision-making with AI in clinical care. These findings suggest the need for more engagement of children and youths in health care AI research and integration.