Protective Measures Research Articles

Ethical Considerations for Companies Implementing LLMs in Education Software

Large Language Models (LLMs) have revolutionized natural language processing, offering significant advancements in educational software through applications like personalized learning and virtual tutoring. This position paper investigates the ethical considerations for companies integrating LLMs into educational tools. Key issues include data privacy, with a focus on safeguarding sensitive student information against breaches while ensuring transparency and consent. The paper highlights the risk of misinformation, as LLMs might generate incorrect or misleading content that could affect students’ learning. It also addresses concerns about algorithmic bias, which can lead to unfair treatment of students from diverse backgrounds, and the potential over-reliance on AI, which may undermine critical thinking and human oversight. Additionally, the paper explores the challenge of equitable access to LLM- based technologies, particularly in underserved communities. The analysis concludes with practical recommendations for companies, including robust data protection measures, balanced AI integration with human oversight, and strategies to enhance access for all students. By emphasizing these ethical challenges, the paper aims to guide responsible AI implementation in education, ensuring that technological advancements benefit all learners fairly and effectively.

A Narrative Review of Burnout Syndrome in Medical Personnel.

A review of the literature, including PubMed searches and analyses of risk factors and protective measures, was conducted to assess the prevalence, impacts, and biomarkers associated with burnout among healthcare workers. Various instruments for evaluating burnout were examined, including the widely used Maslach Burnout Inventory, alongside specific tools tailored to different occupational populations. Healthcare workers, particularly physicians, exhibit significantly higher rates of burnout compared to the general population. Factors such as night shifts, workload, and exposure to biohazards contribute to elevated burnout risk. Biomarkers like cortisol, melatonin, and thyroid hormones have been linked to burnout, highlighting physiological implications. Burnout poses significant challenges to healthcare systems globally, impacting patient care, worker retention, and overall well-being. Identifying and addressing risk factors while promoting protective factors such as resilience and social support are crucial in mitigating burnout. Further research into prevention strategies and biomarker monitoring is warranted to support the mental and physical health of healthcare workers.

Association of ambient air pollutant mixtures with IVF/ICSI-ET clinical pregnancy rates during critical exposure periods

Abstract STUDY QUESTION Does exposure to a mixture of ambient air pollutants during specific exposure periods influence clinical pregnancy rates in women undergoing in vitro fertilization/intracytoplasmic sperm injection—embryo transfer (IVF/ICSI-ET) cycle? SUMMARY ANSWER The specific exposure period from embryo transfer to the serum human chorionic gonadotropin (hCG) test was identified as a critical exposure window as exposure to sulfur dioxide (SO2) or a combination of air pollutants was associated with a decreased likelihood of clinical pregnancy. WHAT IS KNOWN ALREADY Exposure to a single pollutant may impact pregnancy outcomes in women undergoing assisted reproductive technology (ART). However, in daily life, individuals often encounter mixed pollution, and limited research exists on the effects of mixed air pollutants and the specific exposure periods. STUDY DESIGN, SIZE, DURATION This retrospective cohort study involved infertile patients who underwent their initial IVF/ICSI-ET cycle at an assisted reproduction centre between January 2020 and January 2023. Exclusions were applied for patients meeting specific criteria, such as no fresh embryo transfer, incomplete clinical and address information, residency outside the 17 cities in the Sichuan Basin, age over 45 years, use of donor semen, thin endometrium (< 8 mm), and infertility factors unrelated to tubal or ovulation issues. In total, 5208 individuals were included in the study. PARTICIPANTS/MATERIALS, SETTING, METHODS Daily average levels of six air pollutants (fine particulate matter (PM2.5), inhalable particulate matter (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), and ozone (O3)) were acquired from air quality monitoring stations. The cumulative average levels of various pollutants were determined using the inverse distance weighting (IDW) method across four distinct exposure periods (Period 1: 90 days before oocyte retrieval; Period 2: oocyte retrieval to embryo transfer; Period 3: embryo transfer to serum hCG test; Period 4: 90 days before oocyte retrieval to serum hCG test). Single-pollutant logistic regression, two-pollutant logistic regression, Quantile g-computation (QG-C) regression, and Bayesian kernel machine regression (BKMR) were employed to evaluate the influence of pollutants on clinical pregnancy rates. Stratified analyses were executed to discern potentially vulnerable populations. MAIN RESULTS AND THE ROLE OF CHANCE The clinical pregnancy rate for participants during the study period was 54.53%. Single-pollutant logistic models indicated that for PM2.5 during specific exposure Period 1 (adjusted odds ratio [aOR]= 0.83, 95% CI : 0.70–0.99) and specific exposure Period 4 (aOR = 0.83, 95% CI : 0.69–0.98) and SO2 in specific exposure Period 3 (aOR = 0.92, 95% CI: 0.86–0.99), each interquartile range (IQR) increment exhibited an association with a decreased probability of clinical pregnancy. Consistent results were observed with dual air pollution models. In the multi-pollution analysis, QG-C indicated a 12% reduction in clinical pregnancy rates per IQR increment of mixed pollutants during specific exposure Period 3 (aOR = 0.89, 95% CI: 0.79–0.99). Among these pollutants, SO2 (33.40%) and NO2 (33.40%) contributed the most to the negative effects. The results from BKMR and QG-C were consistent. Stratified analysis revealed increased susceptibility to ambient air pollution among individuals who underwent transfer of two embryos, those with BMI ≥ 24 kg/m2, and those under 35 years old. LIMITATIONS, REASONS FOR CAUTION Caution was advised in interpreting the results due to the retrospective nature of the study, which was prone to selection bias from non-random sampling. Smoking and alcohol, known confounding factors in IVF/ICSI-ET, were not accounted for. Only successful cycles that reached the hCG test were included, excluding a few patients who did not reach the ET stage. While IDW was used to estimate pollutant concentrations at residential addresses, data on participants' work locations and activity patterns were not collected, potentially affecting the accuracy of exposure prediction. WIDER IMPLICATIONS OF THE FINDINGS Exposure to a mixture of pollutants, spanning from embryo transfer to the serum hCG test (Period 3), appeared to be correlated with a diminished probability of achieving clinical pregnancy. This association suggested a potential impact of mixed pollutants on the interaction between embryos and the endometrium, as well as embryo implantation during this critical stage, potentially contributing to clinical pregnancy failure. This underscored the importance of providing women undergoing ART with comprehensive information to comprehend the potential environmental influences and motivating them to adopt suitable protective measures when feasible, thereby mitigating potential adverse effects of contaminants on reproductive health. STUDY FUNDING/COMPETING INTEREST(S ): This work received support from the National Key Research and Development Program of China (No. 2023YFC2705900), the National Natural Science Foundation of China (Nos. 82171664, 81971391, 82171668), and the Natural Science Foundation of Chongqing Municipality of China (Nos. CSTB2022NSCQ-LZX0062, CSTB2023TIAD-KPX0052). The authors report no conflicts of interest. TRIAL REGISTRATION NUMBER N/A.

Investigating the explosive characteristics of hydrogen/ n-butane blended fuel: Experimental and kinetic insights

Investigating the explosive characteristics of H2/n-C4H10 mixtures is crucial for the safe utilization of this blended fuel. Our study focused on varying equivalent ratios and hydrogen blending ratios within a closed 20-L spherical explosion vessel. Additionally, the microscopic kinetics of the reactions were analyzed through chemical reaction simulation. Our findings indicate that the most violent explosion occurred at an equivalent ratio of 1.2. Increasing hydrogen content intensified combustion reactions, reducing flame thickness and inducing cellular structures along the flame front. This escalation also increased explosion pressure, flame temperature, and flame propagation speed, elevating explosion risk. Moreover, the equilibrium molar fraction of O2 and CO2 decreased while that of H2O increased with higher hydrogen blending ratios. Correspondingly, the heat release rate and generation rates of H•, O•, and OH• radicals increased. Notably, the peak time of C2H4 and CH4 consumption rates preceded. Additionally, R5: O2 + H• = O• + OH• and R978: C4H10 + H• = SC4H9 + H2 represented crucial promoting and inhibiting steps, respectively. These insights deepen our understanding of the explosion mechanism of H2/n-C4H10 mixtures, providing a theoretical basis for designing safer protective measures and evaluating explosion risks in industrial production.

Valuable Characteristics of Historical Gardens in Tomsk

The article defines valuable characteristics of historical gardens and parks in Tomsk, formed in the late 18 and early 20th centuries as recreational areas and urban planning elements in is planning structure.Purpose: To identify valuable characteristics of further development of protective measures for historical territories.Methodology: Comprehensive historical and architectural analyses and generalization of archival materials, field data. This analysis of existing methods for determining valuable characteristics of cultural heritage objects and their application, taking into account garden and park territories in Tomsk. The analysis is based on the methods used in various regions of the Russian Federation.Research findings: An attempt is made to develop a scientifically based method for assessing valuable characteristics of landscape architecture and art of the city of Tomsk, which allow for physical preservation and targeted functional use of gardens and parks and continuous development of the urban and natural environment of the city.Practical implications: The results can be used in the preparation of protective documents regulating the preservation procedure, development and further use of historical gardens and parks as objects of cultural and natural heritage.Originality: Valuable characteristics of historical gardens and parks in Tomsk are determined for the first time and a methodology is developed for establishing the historical and cultural value of the Tomsk gardens and parks, including a set of criteria and assessment tools with calculated indicators of historical and cultural objects.

Global estimates of 100-year return values of daily precipitation from ensemble weather prediction data

Abstract. High-impact river floods are often caused by very extreme precipitation events with return periods of several decades or centuries, and the design of flood protection measures thus relies on reliable estimates of the corresponding return values. However, calculating such return values from observations is associated with large statistical uncertainties due to the limited length of observational time series, uneven spatial distributions of rain gauges and trends associated with anthropogenic climate change. Here, 100-year return values of daily precipitation are estimated on a global grid based on a large data set of model-generated precipitation events from ensemble weather prediction. In this way, the statistical uncertainties in the return values can be substantially reduced compared to observational estimates due to the substantially longer time series. In spite of a general agreement in spatial patterns, the model-generated data set leads to systematically higher return values than the observations in many regions, with statistically significant differences, for instance, over the Amazon, western Africa, the Arabian Peninsula and India. This might be linked to an overestimation of tropical extreme precipitation in the model or an underestimation of extreme precipitation events in observations, which, if true, would have important consequences for practical water management.

Geospatial modeling of wildfire susceptibility on a national scale in Montenegro: A comparative evaluation of F-AHP and FR methodologies

Abstract Wildfires pose a significant ecological, environmental, and socioeconomic challenge in southeastern Europe. The preservation of wildlands is not only essential but also a foremost priority for Montenegro, a country recognized as the world’s first ecological state. Consequently, the development of optimal methodologies and models is of paramount importance to enhance fire protection measures. With this objective in mind, this study strives to create a wildfire susceptibility model on a national scale for Montenegro. The study employed seven natural and anthropogenic causative criteria: vegetation type; aspect; slope; elevation; climate classification; distance from road; and population. The modeling process integrates both natural and anthropogenic causal criteria, employing the Fuzzy Analytic Hierarchy Process (F-AHP) and Frequency Ratio (FR) within geoinformatics environment. The outcomes of the F-AHP model reveal that 72.84% of the total area is categorized as having high to very high susceptibility. Conversely, based on the FR model, only 29.07% of the area falls within these susceptibility levels. In terms of validation, the area under curvature values indicates good performance of the F-AHP model. In contrast, the FR model demonstrates poor performance. These novel findings, pertaining to Montenegro at a national scale, offer valuable insights for preemptive wildfire safeguarding efforts. Moreover, the methodologies employed, with necessary modifications, hold potential for application in geographically diverse regions.

GIS-based spatial modeling of landslide susceptibility using BWM-LSI: A case study – city of Smederevo (Serbia)

Abstract Landslides and slope processes constitute one of the most frequent natural hazards in valleys near major rivers and mountainous regions. The surface layer, characterized by its relatively loose composition, is prone to sliding due to a combination of distinct natural and human-related factors. Specific sections along the right bank of the Danube River in Smederevo city exhibit significant susceptibility to landslide activation, often leading to substantial material losses and posing a risk to the local population. The initial step in the provided research involves analyzing existing literature and mapping landslides within the study area. The initial analysis covers both natural conditions and anthropogenic activities. The second step includes establishing a geospatial database in the Geographic Information System and generating eight thematic maps. In the third step, different weight coefficients were assigned to the criteria, which facilitated the creation of the Landslide Susceptibility Index using the Best–Worst Method. Subsequently, in the fourth step, a composite map illustrating landslide susceptibility was produced. According to this research, about 4% of the territory of Smederevo, or 19.3 km2, is highly or very highly susceptible to landslides. These localities are located on the right bank of the Danube River and around the Ralja River. Receiver operating characteristic-area under the curve value indicates very high predictive power (approximately 1), thus suggesting the reliability of the used methodology. This visualization of areas highly prone to such occurrences empowers policymakers to implement more effective environmental protection measures and institute sustainable management practices for agricultural parcels in this region. Also, the provided research represents the inaugural integration of advanced remote sensing techniques and interdisciplinary investigations, offering deeper insights into landslide activity in the study area and yielding more comprehensive results.

The Reality of The State's Responsibility for Victims of Natural Disasters in The Perspective of Human Rights

This study critically examines the state's role in fulfilling its responsibilities towards victims of natural disasters from a human rights perspective. It aims to analyze the nature of these responsibilities, their conceptual framework, and the factors influencing their effective implementation. Using a philosophical approach alongside qualitative research methods like interviews and direct observations, the study seeks to deepen understanding of how state actions intersect with humanitarian principles. Key findings emphasize the importance of grounding state responsibilities in humanitarian values to uphold human rights and preserve the dignity of affected individuals. This perspective is particularly relevant in Indonesia, where Pancasila principles underscore the state's role in disaster response and recovery. Despite these principles, the study identifies persistent challenges such as inadequate disaster mitigation policies, insufficient community protection measures, and complexities in inter-governmental coordination. To enhance the implementation of state responsibilities in disaster management, several recommendations are proposed. Firstly, integrating humanitarian considerations into criteria for determining national disaster status is essential to prioritize human rights in decision-making. Secondly, regional governments should allocate resources in their budget planning for both proactive disaster prevention and effective post-disaster response tailored to local vulnerabilities. Additionally, the study advocates for improved disaster mitigation policies, including comprehensive public education on disaster impacts, strict building regulations, and robust disaster risk zoning frameworks. Addressing these recommendations can align state actions with humanitarian principles, thereby improving the protection and well-being of communities affected by natural disasters.

The specifics оf тhe development оf soil flushing during spring snowmelt in the arable land of the northern zone of the Krasnoyarsk forest-steppe

The results of studies of soil flushing and accumulation in the period 2009–2017 in the northern part of the Krasnoyarsk forest-steppe in areas with high intensity of erosive and accumulative processes are presented. A wide range of erosion values from meltwater has been established – from 0.4 to 25 mm for the spring period. The results of the application of a refined Regional model for calculating potential flushing for the northern part of the Krasnoyarsk forest-steppe are presented. The analysis of meteorological factors and conditions of the underlying surface affecting the distribution of values of melt runoff, flushing and accumulation of soils on arable massifs located on inclined watershed surfaces is carried out: the specificity of the distribution of meltwater flows determines the formation of zones of extreme erosion along the perimeter of arable land in the lower parts of the slope – up to 15–20 mm of soil layer. In conditions of low slope steepness, the effect of relief on erosion is largely determined by the high slope lengths and melt water flow lines. The distribution of flushing values over the area of arable land shows a close correlation with the values of snow accumulation and soil moisture. The spatial and temporal patterns of the influence of the previous autumn soil moisture on the intensity of erosion have been established: the values of flushing increase with increasing soil moisture, the average values of erosion correlate with the values of autumn soil moisture in dynamics over the years of field observations. Special soil protection measures have been proposed for sites with the most intensive flushing in the research area.

A review on AI-driven environmental-assisted stress corrosion cracking properties of conventional and advanced manufactured alloys

Stress corrosion cracking (SCC) poses a significant challenge to the integrity and longevity of both conventional and advanced manufactured alloys, impacting critical industries such as aerospace, marine, and nuclear energy. This review explores the use of artificial intelligence (AI) to analyse and predict SCC properties. Traditional alloys such as steel, aluminium, and titanium, as well as advanced materials such as additive-manufactured and high-entropy alloys, exhibit unique SCC behaviours influenced by corrosive environments, mechanical stress, and temperature variations. AI techniques, including machine learning models, offer transformative approaches to understanding and mitigating SCC. Leveraging extensive datasets from experiments and field studies, AI can identify patterns and correlations that traditional methods might miss. Predictive modelling through supervised learning forecasts SCC initiation and propagation, aiding in material design and maintenance. Unsupervised and reinforcement learning enhances alloy composition and processing parameter optimisation for better SCC resistance. In conventional alloys, AI identifies specific SCC conditions, leading to improved protective measures. For advanced alloys, AI-driven insights tailor additive manufacturing processes and design high-entropy alloys with superior corrosion resistance. This review includes case studies demonstrating AI's effectiveness in predicting SCC across various alloy–environment combinations, highlighting successes and challenges. Despite hurdles such as data quality and integration, AI holds immense potential to revolutionise SCC research, enhancing understanding of SCC mechanisms and fostering innovations in alloy design and preventative maintenance.

P15-08 Establishing the efficacy of the Rho-kinase inhibitor fasudil as a protective measure against wildfire smoke-induced neuroinflammation

P15-08 Establishing the efficacy of the Rho-kinase inhibitor fasudil as a protective measure against wildfire smoke-induced neuroinflammation

An In-depth Analysis of the Adverse Effects of Ionizing Radiation Exposure on Cardiac Catheterization Staffs.

Diagnostic and interventional angiograms are instrumental in the multidisciplinary approach to CAD management, enabling accurate diagnosis and effective targeted treatments that significantly enhance patient care and cardiovascular outcomes. However, cath lab staff, including interventional cardiologists, is consistently exposed to ionizing radiation, which poses inherent health risks. Radiation exposure in the cath lab primarily results from the use of fluoroscopy and cineangiography during diagnostic and interventional procedures. Understanding these risks and implementing effective radiation protection measurements are imperative to ensure the well-being of healthcare professionals while delivering high-quality cardiac care. Prolonged and repeated exposure can lead to both deterministic and stochastic effects. Deterministic effects, such as skin erythema and tissue damage, are more likely to occur at high radiation doses. Interventional cardiologists and staff may experience these effects when safety measures are not rigorously followed. In fact, while ionizing radiation is essential in the practice of radiation cardiology ward, cath lab staff faces inherent risks from radiation exposure. Stochastic effects, on the other hand, are characterized by a probabilistic relationship between radiation exposure and the likelihood of harm. These effects include the increased risk of cancer, particularly for those with long-term exposure. Interventional cardiologists, due to their frequent presence in the cath lab, face a higher lifetime cumulative radiation dose, potentially elevating their cancer risk. Protective measures, including the use of lead aprons, thyroid shields, and radiation monitoring devices, play a crucial role in reducing radiation exposure for cath lab personnel. Adherence to strict dose optimization protocols, such as minimizing fluoroscopy time and maximizing distance from the radiation source, is also essential in mitigating these risks. Ongoing research and advancements in radiation safety technology are essential in further for minimizing the adverse effects of ionizing radiation in the cath lab.

Shaping Coastal Nature-based Solutions: Perceptions and Policy Priorities of Living Shorelines

Coastal nature-based solutions, such as living shorelines, are promoted as shoreline stabilization alternatives to hard infrastructure in the United States. In the state of Florida, where sea level rise and increasing storms impact coastal areas, living shorelines are a state research priority to support coastal risk reduction and resilience goals. However, while the ecological benefits of living shorelines are well-documented, few studies have examined the social and institutional factors that hinder or support the design and implementation of living shorelines in Florida.Our study applies an integrated framework combining results from expert interviews with a policy analysis to evaluate decision-making contexts and considerations related to living shorelines in Florida. We present barriers and enablers of living shorelines as perceived by practitioners and marine contractors. Key barriers to adoption of living shorelines include rule or permitting-related mismatches, community-level use and access concerns, and environmental design uncertainties. Enablers include community-level education and incentives, increased demonstration projects, and criteria or policy standardization for living shorelines. We then connect these barriers and enablers to policy priority patterns drawn from coastal management plans in select Florida counties. These policy priority patterns involve defining nature-based and hard solutions, addressing public and private access concerns, and resolving restoration and conservation goals when considering living shorelines as an appropriate coastline stabilization and protection measure. By connecting on-the-ground practical experiences with insights from coastal management policies, our study provides a socio-institutional methodology and contextual baseline for the planning and implementation of living shorelines in Florida and similar coastal areas (252 words).

52670 Effects of Patient Perception of General Health on Sun-Related Behaviors and Sun Protective Measures

52670 Effects of Patient Perception of General Health on Sun-Related Behaviors and Sun Protective Measures

The Effect of Interpersonal Relationships on Epidemic Spreading in Weighted Multilayer Networks

During the epidemic outbreak, people's reactions to social contacts of varying degrees of intimacy exhibited significant differences. Historical data further reveal that interactions between groups play a crucial role in the epidemic's transmission chain. In light of this, it is essential for epidemiological models to account for more complex interaction mechanisms. Based on this understanding, we have developed a weighted dual-layer network model. One layer simulates the spread of information through 2-simplexes, while the other simulates the actual transmission paths of the disease based on physical contact. The weight between two nodes represents individual differences in information acceptance and self-protection among neighbors with different relationships. We conducted a theoretical analysis using the Micro-Markov Chain Approach to examine transmission behaviors, and we also implemented numerical simulations using the Monte Carlo Method. The simulation results aligned with the theoretical analysis, indicating that stronger interpersonal relationships can enhance information dissemination, prompting more individuals to adopt protective measures, which in turn helps curb the spread of the disease.

Public health contributions of entomological surveillance of West Nile virus (WNV) and other mosquito-borne arboviruses in a context of climate change.

Climate change is likely to increase the risk of human transmission of arboviruses endemic to Canada, including West Nile virus (WNV), Eastern equine encephalitis virus (EEEV) and California serogroup virus (CSV), calling for enhanced surveillance, including entomological surveillance targeting mosquito vectors. A scoping review was carried out to document the public health contributions of entomological surveillance of arboviruses of importance in Canada. The Ovid® and EBSCO platforms and the grey literature were searched to identify documents published between 2009 and 2023, in English or French, dealing with entomological surveillance of arboviruses of interest, conducted annually for human health purposes under the aegis of a government authority, with specified public health objectives and actions. The 42 selected publications mainly reported two public health objectives of adult mosquito surveillance: early warning of viral circulation and assessment of the level of risk of human transmission. Recommended actions included clinical preparedness, risk communication, promotion of personal protection measures and vector control. The main objectives of immature mosquito surveillance were to identify sites with high larval densities, in order to reduce/eliminate them and target the application of larvicides. In a context of climate change favouring the spread of arboviruses, this study highlights the potential public health contributions of regular entomological surveillance of endemic arboviruses of importance in Canada. It helps support concrete actions to protect the health of the population from the risks of arboviral transmission.

Universal Snow Avalanche Modeling Index Based on SAFI–Flow-R Approach in Poorly-Gauged Regions

Most high-mountain regions worldwide are susceptible to snow avalanches during the winter or all year round. In this study, a Universal Snow Avalanche Modeling Index is developed, suitable for determining avalanche hazard in mountain regions. The first step in the research is the collection of data in the field and their processing in geographic information systems and remote sensing. In the period 2023–2024, avalanches were mapped in the field, and later, avalanches as points in geographic information systems (GIS) were overlapped with the dominant natural conditions in the study area. The second step involves determining the main criteria (snow cover, terrain slope, and land use) and evaluating the values to obtain the Snow Avalanche Formation Index (SAFI). Thresholds obtained through field research and the formation of avalanche inventory were used to develop the SAFI index. The index is applied with the aim of identifying locations susceptible to avalanche formation (source areas). The values used for the calculation include Normalized Difference Snow Index (NDSI > 0.6), terrain slope (20–60°) and land use (pastures, meadows). The third step presents the analysis of SAFI locations with meteorological conditions (winter precipitation and winter air temperature). The fourth step is the modeling of the propagation (simulation) of other parts of the snow avalanche in the Flow-R software 2.0. The results show that 282.9 km2 of the study area (Šar Mountains, Serbia) is susceptible to snow avalanches, with the thickness of the potentially triggered layer being 50 cm. With a 5 m thick snowpack, 299.9 km2 would be susceptible. The validation using the ROC-AUC method confirms a very high predictive power (0.94). The SAFI–Flow-R approach offers snow avalanche modeling for which no avalanche inventory is available, representing an advance for all mountain areas where historical data do not exist. The results of the study can be used for land use planning, zoning vulnerable areas, and adopting adequate environmental protection measures.

Midwife-Led Quality Improvement: Increasing the Use of Evidence-Based Birth Practices in Uganda

BackgroundAddressing the evidence-to-practice gap in midwifery is vital for improving maternal and newborn health outcomes. Despite the potential of involving midwives in quality improvement interventions to address this gap, such interventions are understudied. In a Ugandan urban hospital, midwifery practices with a significant evidence-to-practice gap have been identified as areas for clinical improvement. ObjectivesThe primary objective of the Quality Improvement was to increase the uptake of identified and essential midwifery practices through a quality improvement approach led by midwives. ParticipantsWe enrolled 703 women aged 18 years and older with uncomplicated full-term pregnancies (between 37+0 and 42+0 weeks) who gave birth at the facility. InterventionThe intervention focused on evidence-based practices with an identified evidence-to-practice gap: dynamic birth position, including women's involvement in birth position decision-making, perineal protection and intrapartum support. A team of midwives led a seven-month co-created quality improvement intervention. The intervention used Plan–Do–Study–Act (PDSA) cycles, following the Model for Improvement and included a train-the-trainer approach and weekly online support meetings. Data collectionIn this single-case prospective observational study, we compared pre-, during and post-intervention uptake of evidence-based practices. Trained research assistants collected data through interviews and observations. ResultsWe observed improvements in the uptake of all clinical improvement areas. Dynamic birth positions increased from 0% to 79%, decision-making of birth positions from 0 % to 75%, perineal protection measures from 62% to 92% and intrapartum support from 7% to 67%. ConclusionA multifactorial midwife-led Quality Improvement resulted in significant and sustained improvements in the uptake of evidence-based practices in maternal and newborn healthcare. If given the mandate and time, midwives can successfully lead Quality Improvements, which enhance the quality of care and close the "evidence-to-practice" gaps in maternal and newborn health. The study's results underscore the significance of developing effective strategies to enhance care quality and promote the adoption of evidence-based midwifery practices.

Characteristics of spatial and temporal changes in ecosystem service value and threshold effect in Henan along the Yellow River, China

Ecosystem services (ES), which serve as the link between human activities and natural ecosystems, are crucial for maintaining ecological balance and supporting economic development. The Ecosystem Services Value (ESV) is an indicator used to quantifying ecosystem services. Accurately estimating the dynamics of ESV and the threshold effects of influencing factors is of great importance for the sustainable development of the region. This study constructs an ESV valuation model based on the equivalent factor method, incorporating construction land, and corrects the initial valuation results in three dimensions. By constructing a random forest model and integrating partial dependence analysis, Elevation, Evapotranspiration, Normalized Difference Vegetation Index, and the proportion of built-up land area were identified as significant factors in determining ecologically vulnerable areas within the study region. The results show that: (1) The total ESV in Henan along the Yellow River in 2000, 2005, 2010, 2015, and 2020 was 204.612 billion yuan, 249.775 billion yuan, 239.100 billion yuan, 234.868 billion yuan and 202.767 billion yuan, respectively. The overall trend of change is first growth and then decline, with spatial features remaining relatively stable, and ESV polarization becoming more pronounced. (2) The spatial clustering characteristics of ESV in Henan along the Yellow River are remarkable, and the cold and hot spot areas show a bidirectional expansion trend. The cold spot areas expand substantially around the construction land, whilethe hot spot areas show a small expansion around the western mountain areas and the vegetation areas along the Yellow River, but the overall growth is slower. (3) The main factors affecting ESV include three natural factors and one anthropogenic factor, namely evapotranspiration (ET), the proportion of built-up land area (POB), normalized vegetation index (NDVI) and elevation (ELEV). ESV is at a high level when ELEV>718 m, ET<90 mm, NDVI>0.7, and POB<25.67 % approximately. The study results can provide an important theoretical basis for the development of comprehensive ecological protection measures. Furthermore, they can contribute to the sustainable development of the Yellow River Basin.