Variation In Practice Research Articles

69 The Holos model for estimating greenhouse gases and soil carbon: Characterizing regionalized beef farm model systems

Abstract The objective of this work is to characterize regionally representative beef farm systems that represent dominant or typical surveyed management practices for 11 beef-producing regions across Canada. This work fulfills two further purposes 1) to improve and expand the Holos model interface; and 2) to facilitate the estimation of greenhouse gas (GHG) emissions and soil carbon (C) changes on beef farms in different regions of Canada. Holos version 4 is the whole-farm model of Agriculture and Agri-Food Canada’s to estimate GHG emissions and changes in soil C on Canadian farms in response to shifts in management practices. Holos can be implemented in all 10 Canadian provinces and accounts for GHG emissions from crop and livestock production [enteric and manure methane (CH4), manure and soil N2O emissions], farm machines and infrastructure [on-farm energy carbon dioxide (CO2) emissions], as well as from the upstream production of some farm inputs (synthetic fertilizer and pesticides). The model is designed to utilize data readily available on the farm to answer, ‘What if?’ scenarios, whereby the user can test the effect of changing management practices on their whole-farm GHG budget. To reduce the data input burden on the user, Holos V4 has built-in model livestock systems for beef, dairy, swine and poultry production that characterize the dominant features of these operations in Canada at the national scale based on relevant literature/data and expert opinion. Regarding beef production, we have characterized regionally specific model beef farms for incorporation into Holos, one for each of 11 Canadian beef-producing regions. General characteristics and management practices for each farm were based on the 2011 Beef Farm Survey (Sheppard et al., 2015), which summarizes management information from 1,009 Canadian beef farms, combined with data from the Canadian Cow-Calf Cost of Production Network (Canfax 2023). Each regional farm includes cow-calf, backgrounding in confinement, backgrounding on pasture and finishing components, and considers all the specific feed (e.g., forage, grains, by-products) required for each stage of the beef cycle. These 11 model farms are simulated within the current Holos V4 model to explore the impacts of variation in beef management practices on farm GHG emissions across Canada and on soil C stocks on lands used to produce feed and graze cattle. An overview of the national-level dairy, swine and poultry components in Holos will be presented along with a more detailed perspective of whole-farm GHG budget and multi-decadal soil C dynamics in regionalized beef farms. The impact of management and environmental factors that lead to differences in GHG emissions and soil C stocks in beef farms will also be explored.

Deferred Cord Clamping in Twin Pregnancies Across Canada: A National Survey of Practices

ObjectiveGuidelines recommending deferred cord clamping (DCC), delaying cord clamping for at least 30 seconds post-birth, have shown significant benefits in preterm singleton births. However, evidence supporting DCC in twins is scarce due to limited trial data, leading to practice variations. This study aims to assess current reported DCC practices for twin pregnancies in tertiary hospitals across Canada. MethodsA web-based survey was distributed to neonatologists and obstetrician investigators associated with the Canadian Neonatal and Preterm Birth Networks operating maternity and neonatal units. ResultsThe site response rate was 93% (28/30 sites), with 83% (25/30) for neonatologists and 56% (17/30) for obstetricians. The majority had a local protocol for twin pregnancies (obstetricians 13/17, neonatologists 21/25). While all centres practised DCC in dichorionic-diamniotic twins, a difference was noted for monochorionic-diamniotic twins, with 56% of neonatologists and 65% of obstetricians performing DCC. During cesarean delivery, most obstetricians (76.5%) placed the firstborn on the mother’s thighs. Neonatologists varied in their practices, with 32% placing the baby on the mother’s abdomen, 32% on the mother’s thighs, and 28% holding the baby at the height of the perineum. Divergent opinions were observed regarding contraindications, including risks of postpartum hemorrhage and velamentous cord insertion. ConclusionsDCC is reported to be practised in most twin deliveries among Canadian Neonatal and Preterm Birth Network centres. However, there are wide variations in practice, especially concerning the characteristics of the twins in which DCC is performed. Future research should investigate optimal cord clamping management in twins to standardize practices and maximize benefits.

Practice variation in the management of pediatric intussusception: a narrative review.

This review has identified practice variations in several key areas of ileocolic intussusception management. The findings underscore the need for further research in these areas and the establishment of uniform standards aimed at improving the care of children with ileocolic intussusception. • Ileocolic intussusception necessitates rapid diagnosis and a collaborative treatment approach involving emergency medicine, radiology, surgery, and often anesthesia. • A previous study reported variations in the practice of pain management and sedation among these patients. • This narrative review identified practice variations in several key areas within the diagnostic and treatment pathways of ileocolic intussusception.

Infrared thermometry for detecting estrus and pregnancy in Holstein cows

Efficient reproductive management is paramount in enhancing the productivity and welfare of dairy cows. This study investigates the effects of pregnancy status, seasonal variations, and diurnal shifts on the body temperature of different body parts in dairy cows. Using a structured approach, cows were categorized based on pregnancy status (pregnant vs. control) or estrous status (estrous vs. control), season (winter, spring, summer), and time of day (morning, noon, evening). The analysis revealed that pregnancy and estrous statuses significantly affect the body temperature, with pregnant and estrous cows displaying higher temperatures (39.0 ± 0.03 and 38.0 ± 0.06 °C, respectively) than controls (37.1 ± 0.06 °C; p < 0.01). Seasonal impacts were also notable, with the highest temperatures observed in summer (38.3 ± 0.07 °C) followed by spring (38.1 ± 0.09 °C) and winter (37.7 ± 0.06 °C; p < 0.01), indicating a strong environmental influence on physiological responses. Furthermore, diurnal analysis indicated temperature fluctuations throughout the day, peaking at noon (38.1 ± 0.09 °C; p < 0.05) compared to morning and evening. High positive correlations were observed between the measured temperatures in different areas and rectal and vaginal temperatures, suggesting the skin surface is ideal for assessing thermal changes. These findings underscore the critical interplay between an animal's physiological state and external environmental factors in managing dairy cow health and reproduction. The study highlights the potential of non-invasive temperature monitoring as a tool for optimizing reproductive management and underscores the necessity of accounting for environmental and physiological variations in dairy management practices.

Maternal outcomes and pre, syn, and post-partum care in the united states and five high-income countries: An exploratory comparative qualitative study

Many studies have documented differences in maternal health outcomes across high-income countries, noting higher and growing maternal mortality in the US. However, few studies have detailed the journeys of care that may underlie or influence differences in outcomes. This study explores how maternity care entitlements and experiences vary among the US and five high-income countries, to study variations in child delivery care practices. Health systems with different organizational structure, insurance coverage and with known differences in maternal care delivery and maternal health outcomes were selected. Data was collected using a structured questionnaire, comparison of secondary data, and literature scan. We find that, while prenatal care approaches were broadly similar across all six countries, there were some important differences in maternity care provision among the comparator countries: (1) the US has more fragmented coverage during pregnancy than comparator countries (2) there were differences with regards to the main provider delivering care, the US relied primarily on physician specialists rather than midwives for prenatal care and delivery which was more common in other countries, (3) the intensity of labor and delivery care varied, particularly with regards to rates of epidural use which were highest in the US and France and lowest in Japan, and (4), there was large variation in the use of postnatal home visits to assess health and wellbeing, notably lacking in the US. The US’ greater use of specialists and more intensive labor and delivery care may partially explain higher costs of care than in comparator countries. Moreover, US maternal mortality is concentrated in the pre- and postnatal periods and thus may be related to poorer access to prenatal care and the lack of an organized, community-based approach to postnatal care. Given the increase in maternal mortality across countries, policy makers should look across countries to identify promising models of care delivery, and should consider investing in more comprehensive coverage in pre- and postnatal care.

Temporal trends and practice variation in early repair of the ruptured aneurysm among patients with aneurysmal subarachnoid hemorrhage in the United States, 2012-2019.

Early repair of the ruptured cerebral aneurysm (RRCA), preferably within 24 h of onset, is endorsed by clinical guideline as the preferred management strategy for patients with aneurysmal subarachnoid hemorrhage (aSAH). However, a comprehensive picture of this guideline-recommended usage in contemporary clinical practice is not available. This study aimed to characterize trends over time and practice variation in the implementation of an early RRCA strategy among patients with aSAH in a large, national representative data. Using data from the 2012-2019 National Inpatient Sample, we measured trends in the proportion of early RRCA, defined as within day 1 of admission, overall, and by demographic and geographical subgroups. In addition, we created multilevel regression models to quantify hospital-level variation in the early RRCA rates. We identified 82,615 aSAH hospitalizations (mean age = 56.1 years; 68.9% women) undergoing RRCA and, among these, 84.0% (95% confidence interval (CI) = 83.4-84.7%) receiving early RRCA. The proportion of early RRCA increased steadily from 82.5% in 2012 to 85.8% in 2019 (p for trend <0.001). The proportion of patients receiving early RRCA across geographic regions ranged from 78.7% to 87.9%, with a median (interquartile range (IQR)) of 84.2% (83.0-86.1%). In contrast, the delivery of early RRCA varied widely among hospitals, with a median (IQR) rate of 86.1% (75.0-100.0%) and a range from 0% to 100.0%. The median odds ratio for the early use of RRCA treatment was 1.24 (95% CI = 1.21-1.27) in 2019, indicating 24% increased odds of implementing early RRCA if moving from a lower-use to a higher-use hospital. Most patients in the United States with aSAH received early RRCA treatment and exhibited an upward trend over the recent 8-year period. However, substantial variation in access to early RRCA was observed across population subgroups, particularly at the hospital level. Future efforts are necessary to identify further sources of this variation and to develop initiatives that could represent an opportunity to optimize guideline-based quality of care in aSAH management. The data are available from the corresponding author upon reasonable request following completion of onboarding and verification procedures as specified by the HCUP.

How Can Newborn Toxicology Testing Be More Equitable? An Interactive Ethics Workshop.

Practice variation in newborn toxicology testing during the birth hospitalization exists across institutions and legal jurisdictions. While testing can provide benefits, indiscriminate testing has been shown to perpetuate health care inequities. In the backdrop of an opioid epidemic and a charged medicolegal landscape, this workshop guides participants to reexamine newborn toxicology testing through a shared ethical lens. We conducted a live, 90-minute workshop in English at an international pediatric conference. Physicians, residents, and fellows participated in large- and small-group breakout sessions to learn relevant clinical and bioethical frameworks, share their own local context and expertise, and explore ethical applications through case-based discussions. We administered two anonymous online follow-up surveys to assess self-perceived impact on participant knowledge, behavior, and clinical practice. Seven facilitators and 45 individuals participated in the workshop. Eighteen participants completed survey 1 immediately following workshop conclusion, and six participants completed survey 2 after 3 months had elapsed. Immediately following the workshop, 94% of respondents reported that they had been introduced to a new idea, and 82% were considering practice change. A low response rate to survey 2 limited interpretation, but some respondents reported self-perceived change following workshop attendance. This workshop facilitated conversation between physician participants on a complex pediatric health care inequity issue using an ethical framework.

Creating a Data Cleaning and Pre-Processing Module for Generalisable Data Linkage

ObjectiveAcute renal replacement therapy (RRT) is an important life saving technology used in critical care. However, variation in clinical practice for initiation and maintenance of RRT can increase healthcare costs and worsen patient outcomes. In Alberta, Canada, a province-wide electronic health record provides a unique opportunity to measure and evaluate clinical practice. The present study aims to improve the quality of RRT delivery in Alberta critical care units by providing feedback on key performance indicators (KPIs) for RRT based on current evidence. ApproachKPIs for RRT included an initiation pathway based on threshold lab values, and measures of RRT quality such as the time from order to treatment initiation, the average life of dialysis filters, and the actual vs. prescribed fluid removal. Clinical KPI definitions were mapped to data available in the electronic health record to evaluate current practice and track changes in KPIs over time. ResultsMapping the clinical guidelines to the electronic health record took significant time and effort in a large team with expertise on both the data and clinical sides. Each KPI data definition went through several cycles of development, validation and refinement before being included in the dashboards and reports given to participating sites. ConclusionsProviding accurate data on RRT ordering and delivery practices is an important step in aligning acute RRT delivery with current best practice, ultimately improving the quality of care and reducing unnecessary costs. ImplicationsElectronic health records provide a powerful tool for evaluating clinical decisions and implementing best practice guidelines.

Temporal Trends and Determinants of Antibiotic Prescribing in Primary Care: Insights from Northern Ireland

ObjectiveAntimicrobial resistance (AMR) has become one of the most serious global public health threats. Concerns about AMR resulted in increased monitoring and evaluation of antibiotic prescribing, with primary care responsible for over 80% of these prescriptions. Through this study, we aim to analyse temporal trends and variations in antibiotic prescribing at GP practice level and investigate the association between antibiotic prescribing and demographic, clinical, geographic, and socio-economic characteristics in Northern Ireland. MethodThe descriptive analyses are complemented by performing the multilevel modelling analysis to identify practice-level determinants of prescribing. ResultsChanges in standardised antibiotic prescribing rates are evaluated using a linear mixed-effects model with a random intercept for each GP practice. We discuss the changes in antibiotic prescribing rates over time, between-GP practice variations in prescribing, differences in prescribing between urban and urban practices, and the impact of demographic and socio-economic factors on antibiotic prescribing rates Conclusions and ImplicationsThis study contributes to the debate on determinants of antibiotic prescribing in primary care and provides actionable insights to policy makers responsible for antimicrobial stewardship and public health campaigns.

WP1.5 - Outcomes of inguinal hernia repair in adolescents by both paediatric and adult surgeons- a retrospective observational study

Abstract Aims Adolescent inguinal herniae are repaired by both paediatric and adult surgeons, but there is significant variation in operative technique. We aim to report both adult and paediatric practice, and to compare outcomes amongst different repair techniques. Methods Data were collected from records of patients aged 12-18 who underwent inguinal hernia repair in adult or paediatric services within our region between 2000 and 2023. Results 116 inguinal herniae in 106 adolescents were identified. 66% were repaired by paediatric surgeons. 85% were male. Median age was 14.1 years. Median length of follow-up was 15.0 years. 71% herniae were right-sided and 9% bilateral. 98% were indirect. 3% were incarcerated. 72% underwent open repair. Herniotomy with high ligation of the sac was the most common open operation in adult and paediatric practice. 28% herniae were repaired laparoscopically (64% by adult surgeons). Adult surgeons most commonly utilised total extraperitoneal repair, and paediatric surgeons most utilised closure of the deep ring. 4% recurred (all operated on by paediatric surgeons). 4% of patients developed chronic pain (80% from adult services). Only 1 of 5 patients with chronic pain had mesh repair. Logistic regression showed no independent variables predictive for recurrence or chronic pain. Conclusions There is significant variation in practice between adult and paediatric surgeons in adolescents with inguinal herniae. Recurrence was more common after repair by paediatric surgeons whilst post-operative chronic pain was less common. Paediatric and adult surgeons could learn from each other to optimise outcomes. This study also raises the question of who should be doing these procedures.

SP1.4 - PRESS survey: PREvention of surgical site infection—a global pan-specialty survey of prophylactic practices

Abstract Aims This survey aimed to establish current global practice across surgical subspecialties in the prevention of surgical site infection (SSI) using prophylactic measures. Methodology A cross-sectional survey was formulated following a published protocol, aligning with established guidelines for SSI prevention. A panel of experts provided guidance during iterative rounds of internal validation, incorporating consensus-based modifications. Prior to online dissemination via QualtricsXM link and QR code through international surgical societies, the survey underwent external validation. Recruitment strategies were through international societies, snowballing and social media. Results There were 1232 responses from 97 countries, with 698(56.7%) participants completing all inquiries. Responses were primarily provided by consultants or equivalent (766,75.2%), spanning all ten Royal College of Surgeons-recognised subspecialties. Almost all surgeons (734/779,94.2%) give pre-operative antibiotic prophylaxis at or within one hour of incision. Nutritional assessments do not routinely occur, with less than half (314/734,42.8%) performed often or always. Intraoperatively, normothermia is often or always maintained with standard blankets (389/734,53.0%) and forced air warming (435/734,59.3%) and less frequently with warmed fluids (277/734,37.7%) and heated mattresses (176/734,24.0%). Most surgeons (615/734,83.8%) would use non-iodinated drapes, whereas iodinated are used less frequently (472/734,64.3%). Triclosan coated sutures are never used by almost half of all surgeons (365/734,49.7%). Most surgeons (528/734,71.9%) use a simple wound dressing after skin closure. Conclusions Most prophylactic measures for SSI prevention display considerable variation in practice. Surgeons agree upon pre-operative antibiotic timing, in line with strong evidence and guidance. Other measures, such as antimicrobial sutures which have strong NICE recommendations, are used invariably.

Determinants of exclusive breastfeeding among infants under six months in Nepal: multilevel analysis of nationally representative household survey data

BackgroundThe benefits of exclusive breastfeeding (EBF) have been universally documented, with evidence of positive impacts on a child’s optimal growth, development, and survival. However, EBF practices in Nepal have fluctuated and declined over the last 25 years. In addition to the individual factors of mothers and infants, EBF practices are affected by multiple community-level factors. Understanding these factors is essential for designing breastfeeding promotion programs to improve child nutritional status in Nepal. This study investigated the individual- and community-level determinants of EBF practices among young infants aged 0–5 months in Nepal.MethodWe used the dataset from the Nepal Demographic and Health Survey 2022. Information on EBF in the past 24 h was available for 540 infants aged 0–5 months. A multilevel mixed-effect logistic regression was used to identify individual- and community-level factors associated with EBF among infants aged 0–5 months in Nepal.ResultsThe 24-hour prevalence of EBF among infants aged 0–5 months was 57.46% (95% confidence interval (CI): 52.18, 62.57). The infant’s age was inversely associated with EBF prevalence at the individual level. Compared with infants aged < 1 month, infants aged three months (adjusted odds ratio (AOR): 0.14, 95% CI: 0.05, 0.40), four months (AOR: 0.11, 95% CI: 0.04, 0.28), and five months (AOR: 0.07, 95% CI: 0.03, 0.20) were less likely to receive EBF. At the community level, community-level variables such as ≥ 4 ANC visits coverage, maternal employment status, and poverty level were generated by aggregating the individual characteristics in a cluster and were categorized using quartiles into low (“< 25%”), moderate (25–75%), and high (≥ 75%). Mothers from communities with moderate ≥ 4 ANC visits (AOR: 3.30, 95% CI: 1.65, 6.57) and high ≥ 4 ANC visits (AOR: 2.70, 95% CI: 1.40, 5.22) coverage had higher odds of EBF practices than did those from communities with low ≥ 4 ANC visits coverage. Similarly, communities with moderate (AOR: 2.67, 95% CI: 1.34, 5.30) and high (AOR: 2.34, 95% CI: 1.10, 4.99) levels of maternal employment status and moderate levels of poverty (AOR: 2.20, 95% CI: 1.13, 4.28) were associated with a higher likelihood of EBF practices. Subnational level variation was evident, with infants in Lumbini province having lower odds of EBF (AOR: 0.32, 95% CI: 0.13, 0.77) relative to Koshi province. Approximately 9% of the variation in EBF practices was observed among mothers while mapping across clusters in this study.ConclusionVarious individual- and community-level factors influence the uptake of EBF in Nepal, underscoring the need to improve the approaches and strategies of EBF programs. This study highlighted the significant association of community-level factors (≥ 4 ANC visits coverage, poverty level, and maternal employment status) with EBF among infants under 6 months. It revealed approximately 9% variability in EBF across clusters. Future efforts to promote EBF should focus on older infants and communities with low poverty levels and low coverage of recommended ≥ 4 ANC visits. Furthermore, context-specific adaptation of such efforts might be required considering the variation observed between the communities in the present study.

Postoperative education and information-giving for the individual undergoing elective ostomy surgery.

Postoperative stoma education is an essential aspect of care for all types of stoma formation because having a stoma impacts on every aspect of a person's life. This critical review of the literature explores stoma patients' needs and wants; postoperative education care guidelines; the role of ward link nurses; and care pathways. The findings from this review demonstrate that there is no national standard postoperative stoma care pathway, yet such pathways are a cost-effective means to improve patient outcomes and care. The review also identified that structured care pathways are not a new concept, but there is a lack of formal research to determine best practice in postoperative stoma education. In the UK, there is wide variation in practice and outcomes, which means that effectiveness cannot be accurately measured. The author has developed and implemented a multidisciplinary postoperative education pathway in line with a national need to further refine postoperative stoma care services to meet stoma patients' needs.

Discontinuity of psychiatric care among patients with bipolar disorder in the Netherlands.

Patients with bipolar disorder benefit from guidelines recommended continuous community-oriented psychiatric and somatic healthcare, but often discontinue psychiatric care. The first objective was to identify predictive factors of discontinuity of psychiatric care among patients who had received psychiatric care. The second objective was to examine if practice variation in discontinuity of psychiatric care existed between providers of psychiatric care. Registry healthcare data were used in a retrospective cohort study design using logistic regression models to examine potential predictive factors of discontinuity of care. Patient-related predictive factors were: age, sex, urbanization, and previous treatment (type and amount of psychiatric care, alcohol, and opioid treatment). Patients already diagnosed with bipolar disorder were selected if they received psychiatric care in December 2014 to January 2015. Discontinuity of psychiatric care was measured over 2016. A total of 2,355 patients with bipolar disorder were included. In 12.1% discontinuity of care occurred in 2016. Discontinuity was associated with younger age and less outpatient care over 2013 to 2014. Discontinuity of patients who received all eight quarters outpatient care including BD medication was very low at 4%. The final model contained: age, type of psychiatric care, and amount of outpatient care in 2013 to 2014. Practice variation among providers appeared negligible. The (mental) health service in the Netherlands has few financial or other barriers toward continuity of care for patients with severe mental disorders, such as bipolar disorder. An active network of providers, aim to standardize care. This seems successful. However, 12% discontinuity per year remains problematic and more detailed data on those most at risk to drop out of treatment are necessary.

Headache diagnosis and treatment: A pilot knowledge and needs assessment among physical therapists.

The objective of this pilot study was to assess physical therapists' (PTs) knowledge and needs regarding headache diagnosis and management. While there is significant research on physical therapy and cervicogenic headache, studies suggest that migraine is often under-recognized, misdiagnosed, and inadequately treated across society despite its high prevalence and burden. Because migraine commonly includes concurrent neck pain and/or vestibular symptoms, patients with migraine may present to PTs for treatment. Very little is known about PTs' headache and migraine education, knowledge, and clinical practices. A team of headache specialists and PTs adapted a previously used headache knowledge and needs assessment survey to help ascertain PTs' knowledge and needs regarding headache treatment. The cross-sectional survey was distributed online via Research Electronic Data Capture (REDCap) to PTs within a large healthcare system in Connecticut. An estimated 50.5% (101/200) of PTs invited to complete the survey did so. Only 37.6% (38/101) of respondents reported receiving any formal headache or migraine education in their professional training, leading to knowledge gaps in differentiating and responding to headache subtypes. Only 45.5% (46/101) were able to identify that migraine is characterized by greater pain intensity than tension-type headache, and 22.8% (23/101) reported not knowing the duration of untreated migraine. When asked about the aspects of care they believe their patients with headache would like to see improved, PTs reported education around prevention and appropriate medication use (61/100 [61.0%]), provider awareness of the degree of disability associated with migraine (51/100 [51.0%]), and diagnostics (47/100 [47.0%]). This sample of PTs from one healthcare system demonstrates knowledge gaps and variations in clinical practice for managing their patients with headache. Future research on integrating additional opportunities for headache education for physical therapists, including evidence-based behavioral therapies, is needed to ascertain whether it is likely to improve patient care.

Venous thromboembolism prophylaxis prescribing patterns for patients with orthopedic trauma: a clinical vignette survey

BackgroundA recent clinical trial suggested aspirin is a viable alternative to enoxaparin for venous thromboembolism (VTE) prophylaxis in patients after orthopedic trauma. The initial impact of these findings on VTE...

Generation and Composition of Medical Waste in Lafia

Background: Effective management of medical waste is a prerequisite for efficient delivery of healthcare services, human health and environmental protection; and the availability of adequate data with regard to medical waste generation and composition is generally considered to be fundamental in the development of efficient medical waste management. However, in Lafia, the state capital of Nasarawa State, Nigeria and a rapidly developing town, there is inadequate information on the medical waste generation and composition. This study thus sets to evaluate the medical waste composition and generation in Lafia by direct observation during both rainy and dry seasons Methodology: The study involved the survey of a cross section of three (3) tertiary health institution. Findings: The study showed that there is significant variation in healthcare waste management practices and sustainability factors (Reduce, Reuse and Recycle) (3Rs). The test showed that there prominent method of healthcare waste management at the studied institution was practice of incineration, pit burning and burying and frequency of waste disposal, leaving out other new and improved technologies for proper waste managements. This study aims to evaluate the medical waste generation and composition in Lafia, Nasarawa State, Nigeria across public and private hospitals. Unique Contribution to Theory, Practice and Policy: It is anticipated that the outcome of this research will avail resourceful data that will be needed for effective hospital waste management and other planning and design works.

A Comparative Study on Workplace Morale and Team Work in Public and Private Sector Organizations

This research examines and contrasts the dynamics of cooperation and workplace morale in businesses in the public and private sectors. By examining the variables that affect employee morale and its effect on organizational performance, the study seeks to comprehend the variations in teamwork practices and morale across various industries. The research uses a mixed-methods approach, collecting data from workers in a range of public and private sector firms using surveys, interviews, and qualitative analysis. Results show clear trends in cooperation techniques and workplace morale across the two industries, providing insight into the underlying causes of these variations. The research adds to the body of knowledge already available on organizational behavior and provides managers and legislators with useful advice on how to improve workplace morale and the efficacy of collaboration across industries.

Education level is associated with the occurrence and timing of hysterectomy: A cohort study of Canadian women.

Hysterectomy is a common surgery with discernible practice variations that could be influenced by socioeconomic factors. We examined the association between level of educational attainment and the occurrence and timing of hysterectomy in Canadian women. We conducted a prospective cohort study of 30 496 females in the Alberta's Tomorrow Project (2000-2015) followed approximately every 4 years using self-report questionnaires. Educational attainment was defined as high school diploma or less, college degree, university degree (reference group), and postgraduate degree. We used logistic regression analyzing hysterectomy occurrence at any time and before menopause, separately, and flexible parametric survival models analyzing hysterectomy timing with age as the time scale. Multivariable models controlled for race/ethnicity, rural/urban residence, parity, oral contraceptive use, and smoking. Overall, 39.1% of females reported a high school diploma or less, 28.9% reported a college degree, 23.5% reported a university degree, and 8.5% reported a postgraduate degree. A graded association was observed between lower education and higher odds of hysterectomy (high school or less: adjusted odds ratio [AOR] 1.68, 95% CI 1.55-1.82; college degree: AOR 1.58, 95% CI 1.45-1.72); results were similar for premenopausal hysterectomy. A graded association between lower education and earlier timing of hysterectomy was also observed up to approximately age 60 (e.g., at age 40: high school or less adjusted hazard ratio [AHR] 1.61, 95% CI 1.49-1.75; college degree AHR 1.53, 95% CI 1.40-1.67). Women with lower levels of education were more likely to experience hysterectomy, including hysterectomy before menopause and at younger ages.

The Discover In-Hospital Cardiac Arrest (Discover IHCA) Study: An Investigation of Hospital Practices After In-Hospital Cardiac Arrest.

In-hospital cardiac arrest (IHCA) is a significant public health burden. Rates of return of spontaneous circulation (ROSC) have been improving, but the best way to care for patients after the initial resuscitation remains poorly understood, and improvements in survival to discharge are stagnant. Existing North American cardiac arrest databases lack comprehensive data on the post-resuscitation period, and we do not know current post-IHCA practice patterns. To address this gap, we developed the Discover In-Hospital Cardiac Arrest (Discover IHCA) study, which will thoroughly evaluate current post-IHCA care practices across a diverse cohort. Our study collects granular data on post-IHCA treatment practices, focusing on temperature control and prognostication, with the objective of describing variation in current post-IHCA practice. This is a multicenter, prospectively collected, observational cohort study of patients who have suffered IHCA and have been successfully resuscitated (achieved ROSC). There are 24 enrolling hospital systems (23 in the United States) with 69 individual enrolling hospitals (39 in the United States). We developed a standardized data dictionary, and data collection began in October 2023, with a projected 1000 total enrollments. Discover IHCA is endorsed by the Society of Critical Care Medicine. The study collects data on patient characteristics including pre-arrest frailty, arrest characteristics, and detailed information on post-arrest practices and outcomes. Data collection on post-IHCA practice was structured around current American Heart Association and European Resuscitation Council guidelines. Among other data elements, the study captures post-arrest temperature control interventions and post-arrest prognostication methods. Analysis will evaluate variations in practice and their association with mortality and neurologic function. We expect this study, Discover IHCA, to identify variability in practice and outcomes following IHCA, and be a vital resource for future investigations into best-practice for managing patients after IHCA.