Primary Facilities Research Articles

Budget Impact Analysis of Implementing Antenatal Care Recommendations for Positive Pregnancy Outcomes at Public Primary Facilities in Tanzania.

Tanzania recently changed its antenatal care (ANC) guidelines to reduce perinatal mortality and improve the experience of pregnancy care. The new guideline recommends increasing the number of ANC visits from four to eight and introducing one routine ultrasound scan, among other recommendations. We estimated the budget impact of implementing the new guideline compared to the previous focused ANC guideline at public dispensaries and health centers. In a dynamic Markov model, we prospectively followed annual cohorts of between 2.3 and 2.6 million pregnant women who will be attending ANC at dispensaries and health centers for 5years. We allowed a population of pregnant women into the model every year and women exit the model at delivery. We calculated the cost of medicines, medical supplies, and laboratory supplies required to produce services from a public health system perspective. Our model neither estimated condition-related costs nor health effects. The budget impact was calculated as the difference in the estimated costs between the two guidelines. We conducted scenario analyses to explore attending more visits and different assumptions to calculate the target population. We estimated that implementing the new ANC guideline would have a cumulative budget impact of around US$154 million over 5years. The budget required will increase from US$137 million under the focused ANC guideline to US$291 million under the new guideline. Laboratory supplies will consume 47% of the estimated budget under the new guideline. We expect the annual budget impact to be US$38 million in the first year of implementation and US$32 million in the fifth year. We assumed that by the fifth year, 82% of all pregnant women would have had four or more visits. The budget impact would increase to US$214 million, with the proportion of pregnant women attending four or more ANC visits reaching 90% within 5years. Scaling up the implementation of the new ANC guideline at public dispensaries and health centers may substantially increase the supplies required to produce ANC services, particularly laboratory supplies. Studies on the health impact of the new guideline are warranted to estimate the value for money.

Patient-, Provider-, and Facility-Level Contributors to the Use of Cardiology Telehealth Care in the Veterans Health Administration: Retrospective Cohort Study.

Telehealth (care delivered by phone or video) comprises a substantial proportion of cardiology care delivered in the Veterans Health Administration (VHA). Little is known about how factors specific to patients, clinicians, and facilities contribute to variation in cardiology telehealth use. The aim of this study is to estimate the relative extent to which patient-, clinician-, and facility-level factors affect cardiology telehealth use in VHA. This was a retrospective, nation-wide cohort study of veterans' use of VHA cardiology telehealth care during the first 2 years of the COVID-19 pandemic (March 11, 2020, to March 10, 2022). We constructed multilevel, multivariable, logistic regression models of patient-level cardiology telehealth use (telephone or video-based care). Models included random effects for the patient, the patient's main cardiology provider, and the patient's primary facility (ie, VHA medical center) for specialty care and fixed effects for patient sociodemographic and clinical characteristics. Our analytic cohort comprised 223,809 veterans with 989,271 encounters among 2235 unique clinicians. The veterans' average age was 70.2 years, and 3.4% (n=7616) were women. Of the 989,271 encounters, 4.2% (n=41,480) were video based and 34.3% (n=338,834) were phone based. Adjusted odds of telehealth use were slightly higher for women versus men (adjusted odds ratio [AOR] 1.08, 95% CI 1.05-1.10), individuals identifying as Hispanic or Latino versus not Hispanic or Latino (AOR 1.46, 95% CI 1.43-1.49), and those with medium and long drive times versus short drive time (AOR 1.11, 95% CI 1.10-1.12 and AOR 1.09, 95% CI 1.07-1.10, respectively). Further, 40.5% of the variation in a veteran's likelihood of using cardiology telehealth care was found at the patient level, 30.8% at the clinician level, and 7% at the facility level. The largest share of the attributable variability in VHA cardiology telehealth use in this cohort was explained by the patient, followed closely by the clinician. Little variability was attributed to the primary facility through which the veteran received their cardiology care. These results suggest that policy solutions intended to improve equity of cardiology telehealth care use in VHA may be most impactful when directed at patients and clinicians.

Handling client financial insolvency in maternity services: An occurrence, experience and policy gap qualitative analysis among healthcare stakeholders in North-Central Nigeria.

To assess the occurrence of client financial insolvency, experiences of key healthcare stakeholders, and policy gaps on handling the situation during maternity services. A qualitative study was conducted in North-Central Nigeria. Participants were key healthcare stakeholders including healthcare workers from private, primary, secondary, and tertiary facilities, healthcare administrators/facility-heads, program managers and policy makers at local and state government levels through In-depth and Key Informant interviews. Identified themes were occurrence, experiences of stakeholders, and prevention of client financial insolvency. Data were analyzed with the Nvivo statistical package. Participants confirmed the occurrence of client financial insolvency. Clients' inability to pay hospital bills was due to being indigent, awaiting support from relations, or clients who were uncommitted to the payment. Health facilities lack guiding policy documents; potential cases are referred from private to public or from primary to secondary/tertiary facilities. Methods of handling financial insolvency included healthcare worker-related (staff scavenging for needed consumables, fund-raising among facility staff), facility-related (revolving fund, medical social welfare, welfare committee, discharge with re-payment plan, fee-waiver), community-related (ward development committee, religious organizations/philanthropists) interventions, or hospital detention of insolvent clients. Although clients' bills did not increase during detention, many clients did not honor post-discharge re-payment agreements. Participants suggested a client-friendly billing system, early initiation of birth preparedness, partner involvement, and a rapid scale-up of health insurance for pregnant women to curb financial insolvency. Tackling client financial insolvency requires policy documents, support to private facilities, effective debt-recovery mechanisms, and scale up of health insurance for pregnant women.

Thirty-day outcome of patients who present with chest pain to the emergency department of a tertiary care hospital of Sri Lanka

Background: Patients present with chest pain causes significant burden to the workload in an emergency department (ED). Quick but thorough attention is needed for life threatening emergencies and to minimize unnecessary admissions. We assess the burden of chest pain and 30-day outcome of patients who present with chest pain to the ED. Methodology: Prospective observational study of all adult patients presented to ED over one month with the primary complain of chest pain were evaluated and followed for 30 days. Results: A total of 661 (20.3% of total admissions) patients (mean age 56.7±1 4.9 years, 51% males) were studied. Common causes for the chest pain included gastroesophageal reflux disease (GORD) (29%) and acute coronary syndrome (ACS) (25%). ACS patients included ST-elevation myocardial infarction (STEMI) (10%), Non-ST-elevation myocardial infarction (6.7%) and unstable angina (8.3%). Fifty patients (75% of the STEMI patients) were thrombolysed. Primary angioplasty facility was not available in the hospital during the study period. Five patients (3% of the ACS patients) had coronary revascularization during the follow-up period – 2 patients had angioplasty and 3 patients had coronary bypass surgery. In-hospital mortality was 2.7%. Thirty-day mortality was 3.2%. Thirty three percent of them continued to have recurrent chest pain despite thorough investigation and treatment. Conclusions: Chest pain carries a significant burden to the workload of a busy ED. The commonest causes for chest pain were ACS and GORD. A considerable number of patients continued to experienced chest pain despite investigations and treatment.

Health System Structural Factors Associated with Use of Scorecard to Improve RMNCAH Performance Indicators in Public Primary Health Facilities in Kenya

Purpose: Researchers looked into how the structure of the health system affects the use of scorecards to boost reproductive, maternal, newborn, child, and adolescent health (RMNCAH) in Kenya's Kwale and Kilifi Counties' public primary health facilities. Specifically, this includes use of the RMNCAH indicators, trainings received on RMNCAH indicators, and factors associated with the utilization of the RMNCAH indicators. Materials and Methods: We conducted a cross-sectional study to gather quantitative data from 119 primary healthcare workers in chosen public primary facilities via one-on-one interviews. We collected data using tablets and the Kobo Collect app. Findings: The findings revealed that 89% of the selected facilities analyzed RMNCAH variables, whereas only 13% used scorecards at the time of the study. The study found that 75% of the facilities that used scorecards did not indicate the specific type of scorecard they received training on. Further research revealed a relationship between scorecard type and utilization (p<0.001, χ2= 2.365), with 84% of facilities analyzing RMNCAH indicators on a monthly basis, focusing on immunization and family planning. However, 63% of healthcare workers rated the health system's structures as either low or poor. Only 11% of facilities had monitoring and evaluation budgets, yet 78% had RMNCAH indicator targets. While most public primary facilities analyze RMNCAH indicators, only a small percentage of these facilities use scorecards due to barriers such as limited training on different types of scorecards, a lack of monitoring and evaluation budget commitments, and poor structural components of the health system Implications to Theory, Practice and Policy: While facilities appreciate the availability of RMNCAH indicators, still the main focus is on immunization and family planning, hence the need for a more comprehensive monitoring of all RMNCAH indicators.

Integrating Heat-Stable Carbetocin and Tranexamic Acid for Prevention and Management of Postpartum Hemorrhage in Sub-Saharan Africa: A Five-Country Pilot Implementation Study

Background and Objective Globally, postpartum hemorrhage (PPH) remains the most common direct cause of maternal mortality. This study evaluated the feasibility and acceptability of introducing heat-stable carbetocin (HSC) for PPH prevention and tranexamic acid (TXA) for PPH treatment in five Sub-Saharan African countries following recent World Health Organization (WHO) recommendations. This study also assessed healthcare providers’ (HCPs’) favorability toward using these medicines. Methods We conducted a mixed methods pilot implementation study in selected facilities across Burkina Faso, Ethiopia, Ghana, Sierra Leone, and Uganda between May and December 2022. We compared baseline data obtained from patient registers with data collected during implementation on the safe and appropriate use of HSC and TXA using descriptive statistics. HCP responses were analyzed qualitatively using a thematic analysis. Results Following training, HSC was administered prophylactically in 11,329 (92.4%) of 12,262 deliveries in all study facilities which received a uteorotonic for PPH prevention during implementation and was used safely and appropriately. TXA administration for PPH treatment was done safely, appropriately, and within the WHO-recommended time. No adverse events were reported throughout the study. HCPs overall showed high confidence in, and favorability toward, using both medicines. Conclusion and Global Health Implications Our study demonstrated that HSC and TXA can be safely and appropriately implemented in primary and tertiary facilities, and their introduction is feasible and acceptable from the perspective of HCPs. A holistic approach to training and regular supportive supervision is needed to ensure the continued safe use of these new and lesser-utilized PPH medicines. Dedicated training is required to improve the documentation of patient charts on PPH care. Introducing these medicines holds promise for improving PPH care in low- and middle-income countries, including by addressing suboptimal efficacy due to cold chain system challenges.

Monitoring airborne pathogen transmission for enhanced safety at food processing facilities

AbstractFood manufacturing and processing are part of the nation's critical infrastructure. Due to the recent global spread of the SARS-CoV-2 virus, the potential contamination of the food chain and the resulting public health implications are of high consequence to society. The current primary food manufacturing and processing facilities already have various mechanisms such as hazard analysis and critical control point (HACCP) system in place. However, the widespread microbial infections in these facilities raise concerns that they will not only threaten the welfare of food processing workers, but also have a potentially greater consequence on the public if the food is contaminated with an infectious agent.Despite the increasingly recognised role of the environment in the spread of microbes, the effect of air properties remains poorly understood. Heating, ventilation, and air conditioning (HVAC) systems in meat processing facilities not only provide a means of transport for viruses and bacteria but may also deposit them on surfaces where they can survive for days. To maintain a stable and safe food chain supply during the pandemic, the challenges to ensure safe food supply and protect the workers' health must be quickly addressed through sustainable, safe and economic approaches. With these two imminent challenges in mind, the overall goal of this review article is to provide a comprehensive overview of the role of the environment in the impaction and resuspension of bioaerosols, focusing on airborne bacteria and viruses. The review includes the latest results of modeling the spread of microbial aerosols in the airflow and the development of preventive measures to mitigate virus contamination in the unique environment of meat processing operations. By understanding how the environmental factors and seasonality affect the infectivity and spread of airborne pathogens, mitigation measures can be designed to minimise future infections within and beyond these facilities.

Perceptions of government-assisted payors: a survey and analysis of American Shoulder and Elbow Surgeons current Medicare, Medicare Advantage, and Medicaid practice allocation

Significant discrepancy and variance exist in the United States health care system with regard to patient access to medical care based on a patient's insurance type, whether that be government-assisted or a private insurer. There are currently 3 major government-assisted insurance programs, Medicare, Medicare Advantage, and Medicaid, each of which has its own patient mix and regulatory processes that govern care delivery. The purpose of this study was to evaluate the current perceptions of shoulder and elbow surgeons surrounding practice patterns and barriers to access for patients whose primary insurance is a government-assisted payor. This was a national, observational study that surveyed the American Shoulder and Elbow Surgeons (ASES) society membership. This 15-question survey assessed surgeon demographics, practice types, reimbursement models, as well as rates and trends of their access to patients with government-assisted insurance. Subgroup analysis between practice type and barriers to access for patients with one of these 3 government-assisted insurance were also analyzed and compared. Pearson χ2 test or Fisher exact test was used to test association between categorical responses and categorical/binary respondent characteristics. A P value<.05 was deemed statistically significant. A total of 257 ASES members completed the survey. Mean years in practice for respondents was 14. For Medicare patients, the most common perceived barriers were reimbursement (49%) followed by administrative burden (33%) and then implant reimbursement at the surgeon's primary surgical facility (32%). For Medicare Advantage patients, the most common barrier to access was administrative burden (52%), reimbursement (50%), and the patient's ability to access perioperative services such as physical therapy and home health (40%). The most common barriers for Medicaid patients were relatively evenly distributed between reimbursement (62%), low patient engagement in their care (61%), and patient's ability to access perioperative services (60%). Among members of the ASES, barriers to patient access varied by government-assisted payor. For Medicare advantage, administrative burden was the largest barrier to access. Whereas for Medicare and Medicaid, reimbursement was the most significant barrier. Further investigation and understanding of these barriers to patient access are necessary to improve availability of shoulder and elbow subspecialized care to a broader population of patients insured by government-assisted payors.

Public perceptions of reportable safety events and risks in United States primary care

Introduction: Patients may not feel responsible for reporting safety events, and social norms may prevent patients from questioning health care providers’ judgment. There is a paucity of research regarding public awareness of reportable safety events/risks. Educating the public about reporting is paramount in error prevention. Because more than 70% of errors (e.g., errors in diagnosis, communication errors, unsafe medication practices, and care fragmentation) occur in primary care settings, the purpose of this study was to explore public perceptions of when to report safety events/risks in these settings. Method: System-level primary and outpatient facility safety incident scenarios conducive to safety events/risk reporting were developed and administered via online survey methodology. Following completion of the scenario questions, participants were asked a single open-text item: “As you were reading the scenarios above, what did you think makes an event/risk ‘reportable’?” Results: At least one-third of participants responded incorrectly in 70% of the scenarios. The percentage of incorrect responses ranged from 5.2% to 62.3% with “unwitnessed falls” and “nursing scope of practice” queries incorrectly reported at 44.5% and 53.9%, respectively. Rationales for inappropriate events/risk reporting included “risk prediction at the management/system level,” “legal repercussions/protection (e.g., negligence, legal responsibility to patient),” “violations of scope of practice/professional expectations,” “degree of potential/actual lethality,” and “personnel errors.” Conclusion: This study revealed a gap between understanding why to report an event/risk and when to correctly report (or not report) an actual healthcare issue. Practical applications: Awareness of reasons for correctly reporting incidents and how correct reporting builds a culture of safety needs to be strengthened.

Survival Following Diagnosis of HIV-Associated Kaposi Sarcoma Among Adults in East Africa in the "Treat-All" Era.

Despite widespread access to antiretroviral therapy (ART) in the "Treat All" era, HIV-associated Kaposi sarcoma (KS) remains among the most common malignancies in sub-Saharan Africa. Survival after KS diagnosis has historically been poor in Africa, but knowledge whether survival has changed at the population level in the contemporary era has been limited by lack of community-representative surveillance and monitoring systems. We identified all adult persons living with HIV (PLWH) with a new diagnosis of KS made between 2016 and 2019 during outpatient or inpatient care at prototypical primary care-providing medical facilities in Kenya and Uganda using rapid case ascertainment. Participants were subsequently followed for vital status, including community tracking for those who became lost to follow-up. Among 411 participants with newly diagnosed KS, 71% were men, median age was 34 (IQR: 30 to 41) years, and 91% had ACTG T1 tumor extent. Over a median follow-up of 7.8 (IQR: 2.4 to 17.9) months, cumulative incidence of death (95% CI) at months 6, 12 and 18 were 34% (30% to 39%), 41% (36% to 46%) and 45% (40% to 51%), respectively. Having the highest number of anatomic sites (11 to 16) harboring KS lesions (hazard ratio 2.2 (95% CI: 1.3-3.8) compared to 1 to 3 sites) and presence of oral KS lesions (hazard ratio 2.2 (95% CI: 1.4-3.3)) were independently associated with higher mortality. Lower hemoglobin and CD4 count as well as higher plasma HIV RNA were also associated with higher mortality. Among PLWH with newly diagnosed KS in East Africa in the "Treat All" era, survival was poor and related to mucocutaneous extent of KS. The findings emphasize the need for better control of KS in Africa, including novel approaches for earlier detection, better linkage to oncologic care, and more potent therapy.

Spatiotemporal characteristics and driving mechanisms of land-use transitions and landscape patterns in response to ecological restoration projects: A case study of mountainous areas in Guizhou, Southwest China

With the acceleration of urbanization and industrialization, the land-use mode in mountainous areas has changed significantly, causing serious ecological destruction. Therefore, improving the efficiency of land-resource use in mountainous areas and enhancing ecological protection are important issues. This study focuses on typical mountainous areas in Guizhou Province to explore their significance not only for ecological restoration but also for sustainable socioeconomic development. In this study, we integrated the framework of the interaction between land-use transitions and landscape patterns and employed Spearman's rank correlation coefficient and a spatial bivariate model to reveal the spatiotemporal heterogeneity of landscape patterns and land-use transitions. The results showed that for 1990–2020, the cultivated, forest, and grassland areas decreased by −1353.66, −749.98 and − 541.72 km2 respectively, whereas the water area, urban, and other construction land increased by 799.69, 542.62, and 1230.90 km2, respectively. Moreover, the cultivated land areas converted into urban and other construction land were 358.03 and 661.77 km2 respectively, and the grassland areas converted into forest and other construction land were 3550.08 and 277.32 km2, respectively. Different land-use transitions presented rapid expansion and contraction characteristics, resulting in an increase in overall patch fragmentation, a decrease in uniformity, and an increase in irregular patches, which enhanced the spatial heterogeneity of diversity and complexity. Finally, the land-use transition effects on landscape patterns were primarily elevation, slope, and primary road facility factors. In-depth research on land-use transitional evolution and its impact on landscape patterns has important theoretical and practical value for formulating land-management policies and promoting sustainable development in mountainous areas.

Treating wartime injuries amidst attack: insights from a medical facility on the edge of combat

BackgroundProviding emergency care during conflict poses unique challenges for frontline hospitals. Barzilai Medical Center (BUMCA) in Ashkelon, Israel is a Level I trauma center located close to the Gaza border. During the November 2023 escalation of conflict, BUMCA experienced surging numbers of civilian and military trauma patients while also coming under rocket fire.MethodsWe conducted a retrospective review of BUMCA operational records and 827 de-identified patient records from October 7–14, 2023. Records provided data on daily patient volumes, injury patterns, resource constraints, and impacts of rocket attacks on hospital function. Basic demographic data was obtained including age, gender, injury severity scores, and disposition.ResultsOf the 827 patients brought to BUMCA, most (n = 812, 98.2%) presented through the emergency department. Tragically, 99 individuals were pronounced dead on arrival. Injury severity assessments found nearly half (47%) had minor injuries such as lacerations, contusions and sprains, while 25% exhibited moderate injuries like deep lacerations and fractures. 15% sustained severe or critical injuries including severe head injuries. The largest age group consisted of adults aged 19–60 years. No pediatric patients were admitted despite proximity to residential neighborhoods. The majority of cases (61%) involved complex polytrauma affecting multiple body regions. BUMCA served as both the primary treatment facility and a triage hub, coordinating secondary transports to other trauma centers as needed. Patient volumes fluctuated unpredictably from 30 to an overwhelming 125 daily, straining emergency services. Resources faced shortages of beds, medical staff, supplies and disruptions to power from nearby missile impacts further challenging care delivery.ConclusionDespite facing surging demand, unpredictable conditions and external threats, BUMCA demonstrated resilience in maintaining emergency trauma services through an adaptive triage approach and rapid surges in capacity. Their experience provides insights for improving frontline hospital preparedness and continuity of care during conflict through advance contingency planning and surge protocols. Analysis of patient outcomes found a mortality rate of 15% given the complex, multi-region injuries sustained by many patients. This study highlights the challenges faced and strengths exhibited by medical professionals operating under hazardous conditions in minimizing loss of life.Patient and public involvement in researchGiven that the study analyzed patient data from a hospital treating casualties of an ongoing armed conflict, directly engaging patients or the public during the sensitive research process could have posed risks. The volatile security situation and restrictions and protections in place amidst the crisis made it not feasible or appropriate to involve them in the study’s design, methods, reporting of results, or dissemination plans. Our aim was to conduct this retrospective analysis in a way that did not endanger those affected or compromise the hospital’s emergency response operations.

Accurate characterisation of optical diffuse transmission—primary facility and extension to translucent samples

To perform accurate, high-quality and traceable measurement of optical diffuse transmission, which is quantified using the bidirectional transmittance distribution function (BTDF), a new primary facility has been developed at the Physikalisch–Technische Bundesanstalt (PTB), the German metrology institute. This newly developed reference facility will complement the available calibration services and research facilities at PTB for regular reflectance and transmittance and diffuse reflectance. The performance of the new BTDF setup has been investigated in an internal comparison, where consistency of the results was achieved. A thorough uncertainty analysis results in a minimum combined standard (k = 1) uncertainty of about 0.8 %. Research on the accurate characterisation of the BTDF of samples with non-negligible lateral scattering is being carried out on this new setup. Some first results have shown that the measured BTDF value depends on the applied irradiation area size. An empirical model has been found to describe the diffuse transmission of such translucent samples with different scattering parameters.

Optimization of spatial layouts for underground facilities to achieve carbon neutrality in cities: A multi-agent system model

Subways, underground logistics systems and underground parking, as the primary facilities types of underground, contribute significantly to the achievement of carbon–neutral cities by moving surface transportation to underground, thereby releasing surface space for the creation of more urban blue-green space for carbon sink. Therefore, in-depth studies on carbon neutrality strategies as well as reliable layout optimization solutions of these three types of underground facilities are required. This study proposes a spatial layout optimization strategy for carbon neutrality using underground hydrogen storage and geothermal energy for these three types of underground facilities employing a multi-agent system model. First, three spatial layout relationships, competition, coordination, and followership, between five underground facilities that contribute to emission reduction were investigated. Second, the implementation steps for optimizing the spatial layout of underground facilities were determined by defining the behavioral guidelines for spatial environment, underground facility, and synergistic agent. Finally, using the Tianfu New District in Chengdu City, China, as a case study, layouts of underground facilities under three different underground space development scenarios were simulated to verify the model. The findings of this study address the gap in the research on underground spatial facilities and their layout optimization in response to emission reduction. This study provided a significant reference for the study of underground space and underground resources at the planning level to aid in achieving carbon–neutral cities.

Mixed influence of COVID-19 on primary maternal and child health services in sub-Saharan Africa: a scoping review.

The COVID-19 pandemic profoundly affected the provision of and demand for routine health services in the world. The objective of this scoping review was to synthesize the influence of the COVID-19 pandemic on primary maternal and child health (MCH) services in sub-Saharan Africa. The studies searched original studies reporting on the influence of the COVID-19 pandemic on primary MCH services. Four scientific databases (Pubmed, AJOL, CAIRN, CINAHL) and one gray literature database (Google Scholar) were used for this search. We also searched through the snowball citation approach and study reference lists. The influence of the COVID-19 pandemic on primary MCH services has been mixed in sub-Saharan Africa. Attendance at some health centers declined for antenatal care, deliveries, immunization, and pneumonia cases. Other health centers did not experience a significant influence of the pandemic on some of these services. In fact, antenatal care increased in a number of health centers. MCH service indicators which declined during COVID-19 were linked on the demand side to regulatory measures against COVID-19, the perceived unavailability of resources for routine services, the perceived negative attitude of staff in these facilities, the perceived transmission risk in primary health care facilities and the perceived anticipated stigma. On the supply side, factors included the lack of equipment in primary facilities, the lack of guidelines for providing care in the pandemic context, the regulatory measures against COVID-19 taken in these facilities, and the lack of motivation of providers working in these facilities. This study recommends prioritizing the improvement of infection prevention measures in primary health care facilities for resilience of MCH indicators to epidemic crises. Improvement efforts should be tailored to the disparities in preventive measures between health centers. The identification of best practices from more resilient health centers could better guide these efforts.

Clinic-based evaluation of point-of-care dual HIV/syphilis rapid diagnostic tests at primary healthcare antenatal facilities in South Africa and Zambia

BackgroundSouthern African countries have the largest global burden of HIV and syphilis, with a high prevalence among women of reproductive age. Although antenatal screening is standard of care, syphilis screening has generally lagged behind HIV screening. We aimed to evaluate the performance and operational characteristics of two commercial dual HIV/syphilis point-of-care tests (POCTs) for simultaneous maternal HIV/syphilis screening.MethodsA clinic-based evaluation of dual HIV/syphilis POCTs (SD Bioline and Chembio) was conducted at five primary healthcare centres (PHCs) in South Africa and Zambia. POCT results using capillary fingerprick blood were compared to reference laboratory syphilis and HIV serological assays.ResultsThree thousand four hundred twelve consenting pregnant women aged ≥ 18 years were enrolled. The prevalence of treponemal antibody seropositivity and HIV infection ranged from 3.7 to 9.9% (n = 253) and 17.8 to 21.3% (n = 643), respectively. Pooled sensitivity for syphilis compared to the reference assay was 66.0% (95%CI 57.7–73.4) with SD Bioline and 67.9% (95%CI 58.2–76.3) with Chembio. Pooled specificity for syphilis was above 98% with both POCTs. The sensitivities of SD Bioline and Chembio assays were 78.0% (95%CI 68.6–85.7) and 81.0% (95%CI 71.9–88.2), respectively compared to an active syphilis case definition of treponemal test positive with a rapid plasma reagin titre of ≥ 8. The negative predictive values (NPVs) based on various prevalence estimates for syphilis with both assays ranged from 97 to 99%. The pooled sensitivity for HIV was 92.1% (95%CI 89.4–94.2) with SD Bioline; and 91.5% (95%CI 88.2–93.9) with Chembio. The pooled specificities for HIV were 97.2% (95%CI 94.8–98.5) with SD Bioline and 96.7% (95%CI 95.1–97.8) with Chembio. The NPV based on various prevalence estimates for HIV with both assays was approximately 98%. Most participating women (91%) preferred dual POCTs over two single POCTs for HIV and syphilis, and healthcare providers gave favourable feedback on the utility of both assays at PHC level.ConclusionsBased on the need to improve antenatal screening coverage for syphilis, dual HIV/syphilis POCTs could be effectively incorporated into antenatal testing algorithms to enhance efforts towards elimination of mother-to-child transmission of these infections.

Exploring the service needs and the common-suited strengthening paths for bicycle-sharing services based on the AIA-NRM technique in consideration of various users

ABSTRACT Near metro stations in urban areas, a public bicycle rental service allows users to rent bicycles for leisure, short-distance connections, and daily commuting. This study aims to explore the driving factors of bicycle-sharing service systems (BSSSs) and different users’ preferences and service needs (leisure & recreation users, short-connection users, and daily commuting users). The four driving forces (primary services, primary facilities, ancillary services, and ancillary facilities) are applied to evaluate the BSSSs. The researcher used the attention and importance analysis (AIA) technique to assess service driving factors’ attention and importance status in the bicycle-sharing service systems (BSSSs). The DEMATEL technique was also employed to establish a network relation map (NRM) approach for different users. The researcher also combines the AIA and NRM techniques to provide the AIA-NRM technique for identifying common applicable paths and enhancement strategies for the BSSS. Furthermore, this study analyzes various institutions and BSSS service providers from multiple users’ perspectives, determines the development direction of BSSSs, evaluates related challenges, and finds sustainable strategies for strengthening BSSSs.

A study of blockchain-based liquidity cross-chain model.

Blockchain cross-chaining is about interconnectivity and interoperability between chains and involves both physical to virtual digital aspects and cross-chaining between digital networks. During the process, the liquidity transfer of information or assets can increase the use of items with other chains, so it is worth noting that the enhancement of cross-chain liquidity is of great practical importance to cross-chain technology. In this model, Layerzero is used as the primary secure cross-chain facility to build a full-chain identity by unifying NFT-distributed autonomous cross-chain identity IDs; applying super-contract pairs to enhance cross-chain liquidity; and initiating a dynamic transaction node creditworthiness model to increase the security of the cross-chain model and its risk management. Finally, by verifying three important property metrics timeliness is improved by at least 18%, robustness is increased by at least 50.9%, and radius of convergence is reduced by at least 25%. It is verified that the liquidity cross-chain model can eliminate the authentication transition between hierarchies while saving the cross-chain time cost, as a way to truly realize the liquid interoperability between multiple chains of blockchain.

Musculoskeletal injury and medical discharge prevalence during Army basic training

Musculoskeletal injuries (MSKIs) pose the primary health and operational risk to the military trainee population particularly those within basic training, leading to several issues such as reduced training time, chronic morbidity, and inevitably increased medical discharge. The purpose of the study was to investigate the current incidence, prevalence, and nature of MSKIs across British Army basic training. In addition to identifying the prevalence of MSKI medical discharges concerning the type and nature of the injury. A retrospective analysis of the Army Recruiting and Initial Training Command MSKI and Medical Discharge database was undertaken. Injury data was collected from Primary Care Rehabilitation Facilities at British Army training units, using a standardised procedure. A multiple-choice questionnaire was used within the initial consultation with the clinician to determine the severity and progression of the injury, whilst consenting to a data privacy notice. Prevalence of MSKIs (% recruits) was articulated in relation to the total number of recruits starting each training year. Over the past decade MSKIs have declined from a peak of 47% in men and 58% in women in 2013/14, to 22% in men and 21% in women in the 2022/23 training year, with the prevalence of female MSKIs being lower than male counterparts for the first time in this population. Trauma and overuse injuries correspond for 48% and 52% of these MSKIs respectively in 2022/2023, whereas historically overuse injuries have been responsible for a greater proportion. These overuse and trauma injuries were most common in the early stages of training. Lower limb injuries were more prevalent throughout training, resembling 2021/22 data where lower limb injuries accounted for c.80% of total MSKIs among both sexes. The total number of MSKIs resulting in medical discharges was 70, constituting 1.1% of all recruits. Among these discharges, 54 were observed in men and 16 in women. The prevalence of MSKIs resulting in medical discharges was 4.5% in men and 12.4 % in women. The gap between MSKI prevalence between sexes has decreased with recent data showing prevalence being similar. Despite this, women had an increased risk of medical discharge, suggesting gender differences in the severity of MSKIs. To reduce MSKI prevalence, strategies should focus on lower limb injuries, with an emphasis on the early stages of training.

Mesozooplankton production and respiration across a trophic gradient in a coastal Eastern Mediterranean ecosystem

The Inner Saronikos Gulf has served as an area of continuous environmental monitoring for many decades, primarily due to the operation of primary and secondary sewage treatment facilities of the Psyttalia Waste Water Treatment Plant (WWTP). In this groundbreaking study within the region, we conducted measurements of biochemical indices related to respiration (referred to as spETS) and growth (referred to as spAARS) of mesozooplankton. These measurements were then correlated with both biological and environmental data. The ecological quality of the inner Saronikos Gulf was ameliorated moving away from the sewage outfall and thus mesozooplankton sampling encompassed various sites located across a trophic gradient from the WWTP during different seasons (May, September, November 2017, and January 2018). Our observations revealed seasonal variations in both zooplankton abundance and composition, alongside spatial disparities in environmental data. In terms of biochemical data, we observed significant seasonal fluctuations in spETS and R respiration values. Notably, the lowest respiration R value (0.22 mg C m⁻³ d⁻1) was recorded in May, while the highest (4.74 mg C m⁻³ d⁻1) was observed in September. Nevertheless, the variations in spETS and spAARS values among different sites did not demonstrate statistically significant differences. Furthermore, the values of these indices (spETS and spAARS) exhibit a positive correlation with temperature and mesozooplankton biomass at a significance level of 0.01. Lastly, it is noteworthy that phytoplankton production, measured in terms of carbon content (mg C m⁻2), appeared to adequately meet the carbon requirements of the zooplankton throughout all the examined months.