Individual Residents Research Articles

Exposure to concentrated animal feeding operations (CAFOs) and risk of mortality in North Carolina, USA

BACKGROUND AND AIM: Concentrated animal feeding operations (CAFOs) have emerged as an environmental justice issue due to disproportionate siting in low-income and minority communities. However, CAFOs’ impact on health is not fully understood. We examined risk of cause-specific mortality associated with CAFOs in North Carolina (NC) for 2000-2017 and health disparities. METHODS: We obtained data on individual-level cause-specific mortality and on permitted animal facilities. We estimated associations between exposure to CAFOs and cause-specific mortality using logistic regression, controlling for demographics (e.g., age) and area-level covariates. To estimate exposure to CAFOs, we considered (1) a binary indicator (presence or absence) of CAFOs within a buffer around individual residence based on several buffer sizes, and (2) four levels of exposure (no, low, medium, and high) based on the number of CAFOs within 15km around each residence. We considered individual-level (sex, race/ethnicity, age, education) and community-level (median household income, urbanicity, and region) factors. RESULTS:Under all buffer sizes used to estimate CAFO exposure, people living near CAFOs had significantly higher risk of cardiovascular mortality than other persons. Comparing those living near CAFOs to the no exposure group, odds ratios (ORs) for cardiovascular mortality were 1.01 (95% confidence interval (CI) 1.00, 1.03), 1.04 (1.03, 1.06), and 1.06 (1.05, 1.07) for low, medium, and high CAFOs exposure, respectively, indicating a trend of higher risk with higher exposure. Those in the high CAFOs exposure group had significantly higher risk of anemia and kidney disease mortality than those with no exposure. Results suggest higher mortality risk from CAFOs for some subpopulations, however differences were not statistically significant. CONCLUSIONS:Findings provide evidence of excess mortality risk from CAFOs in NC. These results have implications for future studies of environmental justice and CAFOs. KEYWORDS: CAFOs, Environmental justice, Health disparities, Mortality, Vulnerable population

Engaging in Health Activism through Neighbor-to-Neighbor Communication

ABSTRACT Given the importance of local organizing to environmental health advocacy and activism, we need more understanding of how neighbors communicate about health risks. Individual residents in a neighborhood can be agents of social change, communicating about common health concerns and ways to cope with them, potentially leading to health activism. In this study, we used a grounded theory approach to analyze Pennsylvania residents’ (N = 407) responses to open-ended questions that asked their thoughts on engaging in conversations with neighbors about the risk of lead exposure. Our findings describe (a) what respondents would want to share with neighbors about health risks and how they would communicate with their neighbors, (b) what actions they would like to promote to neighbors, and (c) what additional factors would facilitate conversations with neighbors. Based on the critical examination of the findings, we discuss communication strategies that can motivate health activism to bring about social structural changes.

Consciousness on property rights, homeowner associations and neighbourhood governance: Evidence from Shanghai

Previous studies have scrutinised the proliferation of privately governed neighbourhoods and the role of homeowner associations (HOAs) in governing the neighbourhood and residents' conducts in different contexts, while little attention has been paid to individual residents' agency. This research introduces a novel perspective to examine the role of neighbourhood residents and their perception of property rights, which carry significant weight in governing the private neighbourhoods in transitional urban China. Based on a large-scale neighbourhood-based survey in Shanghai, this study employs multilevel regression models to understand the determinants of individual-level consciousness on property rights and its correlations with the outcomes of HOA governance efficacy at neighbourhood level. Empirical results suggest that housing tenure, community participation, sense of collectivism, gatedness, size and age of neighbourhoods are significantly correlated with residents' consciousness on property rights, and that the rise of consciousness among individual residents is positively associated with the governance efficacy of HOAs. Through presenting a contextualised examination of the emerging “private” governance in China and addressing a missing account of consciousness on property rights in the literature, this study makes theoretical and empirical contributions to understanding the complex social processes of neighbourhood governance in China and beyond.

Modeling spatially resolved characterization factors for eutrophication potential in life cycle assessment.

Prior versions of the Tool for Reduction and Assessment of Chemical and other environmental Impacts (TRACI) have recognized the need for spatial variability when characterizing eutrophication. However, the method's underlying environmental models had not been updated to reflect the latest science. This new research provides the ability to differentiate locations with a high level of detail within the USA and provides global values at the country level. In previous research (Morelli et al. 2018), the authors reviewed a broad range of domain-specific models and life cycle assessment methods for characterization of eutrophication and ranked these by levels of importance to the field and readiness for further development. The current research is rooted in the decision outcome of Morelli et al. (2018) to separate freshwater and marine eutrophication to allow for the most tailored characterization of each category individually. The current research also assumes that freshwater systems are limited by phosphorus and marine systems are limited by nitrogen. Using a combination of spatial modeling methods for soil, air, and water, we calculate midpoint characterization factors for freshwater and marine eutrophication categories and evaluate the results through a US-based case application. Maps of the nutrient inventories, characterization factors, and overall impacts of the case application illustrate the spatial variation and patterns in the results. The importance of variation in geographic location is demonstrated using nutrient-based activity likelihood categories of agricultural (rural fertilizer), non-agricultural (urban fertilizer), and general (human waste processing). Proximity to large bodies of water, as well as individual hydraulic residence times, was shown to affect the comparative values of characterization factors across the USA. In this paper, we have calculated and applied finely resolved freshwater and marine eutrophication characterization factors for the USA and country-level factors for the rest of the globe. Additional research is needed to provide similarly resolved characterization factors for the entire globe, which would require expansion of publicly available data and further development of applicable fate and transport models. Further scientific advances may also be considered as computing capabilities become more sophisticated and widely accessible.

Urban-Rural Differences in Clinical Characteristics of Prostate Cancer at Initial Diagnosis: A Single-Center Observational Study in Anhui Province, China.

BackgroundPeople residing in rural areas have higher prostate cancer (PCa) mortality to incidence ratio (M/I) and worse prognosis than those in urban areas of China. Clinical characteristics at initial diagnosis are significantly associated with biochemical recurrence, overall survival, and PCa disease-free survival.ObjectiveThis study aimed at investigating the clinical characteristics at initial diagnosis of urban and rural PCa patients and to establish a logistic regression model for identifying independent predictors for high-grade PCa.Materials and MethodsClinical characteristics for PCa patients were collected from the largest prostate biopsy center in Anhui province, China, from December 2015 to March 2019. First, urban–rural disparities in clinical characteristics were evaluated at initial diagnosis. Second, based on pathological findings, we classified all participants into the benign+ low/intermediate-grade PCa or high-grade PCa groups. Univariate and multivariate logistic regression analyses were performed to identify independent factors for predicting high-grade PCa, while a nomogram for predicting high-grade PCa was generated based on all independent factors. The model was evaluated using area under receiver-operating characteristic (ROC) curve as well as calibration curve analyses and compared to a model without the place of residence factor of individuals.ResultsStatistically significant differences were observed between urban and rural PCa patients with regard to tPSA, PSA density (PSAD), and Gleason score (GS) (p < 0.05). Logistic regression analysis revealed that tPSA [OR = 1.060, 95% confidence interval (CI): 1.024, 1.098], PSAD (OR = 14.678, 95%CI: 4.137, 52.071), place of residence of individuals (OR = 5.900, 95%CI: 1.068, 32.601), and prostate imaging reporting and data system version 2 (PI-RADS v2) (OR = 4.360, 95%CI: 1.953, 9.733) were independent predictive factors for high-grade PCa. The area under the curve (AUC) of the nomogram was greater than that of the model without the place of residence of individuals. The calibration curve of the nomogram indicated that the prediction curve was basically fitted to the standard curve, suggesting that the prediction model had a better calibration ability.ConclusionsCompared to urban PCa patients, rural PCa patients presented elevated tPSA, PSAD levels, and higher pathological grades. The place of residence of the individuals was an independent predictor for high-grade PCa in Anhui Province, China. Therefore, appropriate strategies, such as narrowing urban-rural gaps in access to health care and increasing awareness on the importance of early detection should be implemented to reduce PCa mortality rates.

Exposure to concentrated animal feeding operations (CAFOs) and risk of mortality in North Carolina, USA

Concentrated animal feeding operations (CAFOs) have emerged as an environmental justice issue due to disproportionate siting in low-income and minority communities. However, CAFOs’ impact on health is not fully understood. We examined risk of cause-specific mortality associated with CAFOs in North Carolina (NC) for 2000-2017 and health disparities. We obtained data on individual-level cause-specific mortality and on permitted animal facilities. We estimated associations between exposure to CAFOs and cause-specific mortality using logistic regression, controlling for demographics (e.g., age) and area-level covariates. To estimate exposure to CAFOs, we considered (1) a binary indicator (presence or absence) of CAFOs within a buffer around individual residence based on several buffer sizes, and (2) four levels of exposure (no, low, medium, and high) based on the number of CAFOs within 15 km around each residence. We considered individual-level (sex, race/ethnicity, age, education) and community-level (median household income, urbanicity, and region) factors. Under all buffer sizes used to estimate CAFOs exposure, people living near CAFOs had significantly higher risk of cardiovascular mortality than other persons. Comparing those living near CAFOs to the no exposure group, odds ratios (ORs) for cardiovascular mortality were 1.01 (95% confidence interval (CI) 1.00, 1.03), 1.04 (1.03, 1.06), and 1.06 (1.05, 1.07) for low, medium, and high CAFOs exposure, respectively, indicating a trend of higher risk with higher exposure. Those in the high CAFOs exposure group had significantly higher risk of anemia and kidney disease mortality than those with no exposure. Results suggest higher mortality risk from CAFOs for some subpopulations, however differences were not statistically significant. Findings provide evidence of excess mortality risk from CAFOs in NC. These results have implications for future studies of environmental justice and CAFOs.

Do Socially Responsible Firms Foster Socially Responsible Citizens? Social Distancing under Covid-19

The literature on the interplay between geographic communities and organizations has largely ignored the role of individual residents. In adopting a meso-perspective, we examine a potentially vital relationship between corporate conduct and pro-social behavior demanding sacrifice from individuals. Drawing on Weber (1922), we theorize that organizations in a community legitimize personal social conduct in three ways – by serving as role models, imparting norms and values, and routinizing forms of interaction. We study the relationship between corporate social responsibility (CSR) behavior by local firms and the social distancing (SD) of citizens in US counties during the Covid-19 pandemic, a core ethical outcome. We argue and find that the residents of communities in which firms exhibit higher levels of CSR engaged in more SD during the Covid-19 pandemic. This was true when firms were a) long-established, b) isomorphic in their CSR, and c) major employers and vendors. Moreover, CSR relating to the treatment of employees and positive and negative extremes in CSR had an especially strong effect on SD. Implications are drawn for the study of business ethics, as modeled by CSR, as a force for ethical personal behavior and public health in communities.

Bryde's whales in the North‐East Atlantic: New insights on site fidelity and connectivity between oceanic archipelagos

Abstract The conservation of marine megafauna presents numerous difficulties owing to their high mobility over difficult‐to‐access oceanic areas that impairs the collection of basic, but essential, biological information. The Bryde's whale (Balaenoptera edeni) is one of the most elusive species of baleen whales, and although it is known to be a seasonal visitor to several archipelagos in Macaronesia (the Azores, Madeira, and Canaries), there are no studies regarding its occurrence or geographical connectivity in this area of the Atlantic. A 14‐year photographic database was used to determine short‐term (intra‐seasonal) and long‐term (inter‐annual) Bryde's whale site fidelity and to estimate individual residency times in Madeira, whereas photographic catalogues from Madeira and the Canaries were compared in order to assess large‐scale movements (i.e. on the scale of hundreds of kilometres). In Madeira, 59 individuals were identified, 27 (45.8%) of which were recaptured. Of these, 10 individuals (37.0%) presented short‐term site fidelity and 17 individuals (63.0%) presented long‐term site fidelity, with a maximum recapture interval of 12 years. Lagged identification rates showed that five individuals (SE = 2) remained in the area for 32 days (SE = 108 days) before leaving and not returning during the same year. Seven individuals were seen both in Madeira and the Canaries (catalogue comprising 51 individuals), three of which were identified multiple times in both archipelagos, with a minimum of 43 days between consecutive sightings. This information combined with the fact that this species is commonly sighted accompanied by calves and feeding in both archipelagos highlights the ecological importance of this area for Bryde's whales. This should be taken into consideration by policymakers when implementing conservation measures, where coordination of effort among countries is needed. This study also reinforces the value of using data from platforms of opportunity and of making photographic data open access.

National Evaluation of Surgical Resident Grit and the Association With Wellness Outcomes

Grit, defined as perseverance and passion for long-term goals, is predictive of success and performance even among high-achieving individuals. Previous studies examining the effect of grit on attrition and wellness during surgical residency are limited by low response rates or single-institution analyses. To characterize grit among US general surgery residents and examine the association between resident grit and wellness outcomes. A cross-sectional national survey study of 7464 clinically active general surgery residents in the US was administered in conjunction with the 2018 American Board of Surgery In-Training Examination and assessed grit, burnout, thoughts of attrition, and suicidal thoughts during the previous year. Multivariable logistic regression models were constructed to assess the association of grit with resident burnout, thoughts of attrition, and suicidal thoughts. Statistical analyses were performed from June 1 to August 15, 2019. Grit was measured using the 8-item Short Grit Scale (scores range from 1 [not at all gritty] to 5 [extremely gritty]). The primary outcome was burnout. Secondary outcomes were thoughts of attrition and suicidal thoughts within the past year. Among 7464 residents (7413 [99.3%] responded; 4469 men [60.2%]) from 262 general surgery residency programs, individual grit scores ranged from 1.13 to 5.00 points (mean [SD], 3.69 [0.58] points). Mean (SD) grit scores were significantly higher in women (3.72 [0.56] points), in residents in postgraduate training year 4 or 5 (3.72 [0.58] points), and in residents who were married (3.72 [0.57] points; all P ≤ .001), although the absolute magnitude of the differences was small. In adjusted analyses, residents with higher grit scores were significantly less likely to report duty hour violations (odds ratio [OR], 0.85; 95% CI, 0.77-0.93), dissatisfaction with becoming a surgeon (OR, 0.53; 95% CI, 0.48-0.59), burnout (OR, 0.53; 95% CI, 0.49-0.58), thoughts of attrition (OR, 0.61; 95% CI, 0.55-0.67), and suicidal thoughts (OR, 0.58; 95% CI, 0.47-0.71). Grit scores were not associated with American Board of Surgery In-Training Examination performance. For individual residency programs, mean program-level grit scores ranged from 3.18 to 4.09 points (mean [SD], 3.69 [0.13] points). In this national survey evaluation, higher grit scores were associated with a lower likelihood of burnout, thoughts of attrition, and suicidal thoughts among general surgery residents. Given that surgical resident grit scores are generally high and much remains unknown about how to employ grit measurement, grit is likely not an effective screening instrument to select residents; instead, institutions should ensure an organizational culture that promotes and supports trainees across this elevated range of grit scores.

A Review on Fog and Smog: Impact, Mode of Action and Remedial Measures under COVID-19 Pandemics

On 11 March 2020, the World Health Organization (WHO) declared the coronavirus pandemic: the Sars-Cov-2 virus (COVID-19) is a threat to the population’s health. A positive correlation has been observed between the spread of the virus and air pollution, which is one of the greatest challenges of our millennium. COVID-19 could have an air transmission and atmospheric particulate matter could create a suitable environment for transporting the virus at greater distances than those considered for close contact. Smog is formed when pollutants like nitrogen oxide, carbon monoxide and volatile organic compounds that are released from automobiles, industries and burning of rice crop residues (parali) and fossil fuels interact with sunlight (WHO, 2016). In this context, COVID-19 could also have an airborne transmission and particulate matter (PM 10 and PM 2.5 which is Fine particulates of 2.5 micrometer or 10 micrometer less are also among the pollutants found in smog and haze) could act as a carrier through the aerosol, conveying the virus and increasing its spread. It prove a direct correlation between current high air pollution levels and incidence of COVID-19, high pollution levels might also increase the risk of contracting COVID-19. One of the most pressing and urgent problems is that polluted air can severely endanger human health and life. Individual residents who are affected by smog pollution can often do very little to prevent it, but they can apply adaptive and protective measures to reduce their risk. Elderly and people experiencing any cardiac or respiratory illness are more prone to harmful effects of smog (Sierra Vargas et al., 2012). These measures are minimal exposure to outdoor air but if exposure is inescapable than a facemask should be worn. Those people who are affected with cardio-vascular disease and its allied patients should increase the dosage of medication on their physician’s advice to prevent worsening of disease. Supplements and food containing antioxidants like omega 3 fatty acids when added to diet may help against oxidative stress caused by pollutants (Xing et al., 2016). Therefore, it is crucial to minimize the negative effects of smog by wearing mask and reduced the environmental pollution by adopting eco-friendly products.

Seroprevalence of Epstein-Barr virus and cytomegalovirus infections in Presidente Figueiredo, Amazonas, Brazil

ABSTRACT Epstein-Barr virus (EBV) and cytomegalovirus (CMV) infections affect around 95% of the world’s population. In Brazil, there are few epidemiological reports related to EBV and CMV infection, especially in the western Amazon region. This study aimed to estimate the seroprevalence of EBV and CMV infection in individuals residents in Presidente Figueiredo, Amazonas, Brazil. Blood samples of 443 individuals were tested for the presence of anti-EBV and anti-CMV IgG antibodies through an enzyme-linked immunosorbent assay. EBV (95.9%; 95% CI: 0.94;0.98), CMV (96.8%; 95% CI: 0.95;0.98) and CMV/EBV (93%;95% CI: 0.91–0.95) coinfection were highly prevalent in the study population. Children (1 to 5 years) not attending school were less susceptible to EBV (OR 0.15; 95% CI: 0.05–0.52; p = 0.017) and CMV infections (OR 0.05; 95% CI: 0.02 − 0.17; p < 0.0001). Teenagers at high school showed increased susceptibility to CMV infection (OR 4.65; 95%CI: 1.43–15.08; p = .013) and EBV/CMV co-infection (OR 3.04; 95%CI: 1.44–6.45; p = 0.005). The seroprevalence of CMV and EBV infections were preeminent and tend to increase with age in the study population. Either attendance to a daycare facility or primary school before the age of 5 years may increase the susceptibility to EBV or CMV infection.

Are Socially Responsible Firms Associated with Socially Responsible Citizens? A Study of Social Distancing During the Covid-19 Pandemic.

The literature on the interplay between geographic communities and organizations has largely ignored the role of individual residents. In adopting a meso-perspective, we examine a potentially vital relationship between corporate conduct and pro-social behavior demanding sacrifice from individuals. Drawing on Weber (Economy and society: an outline of interpretive sociology. University of California Press, Berkeley, 1978 (Translation of Wirtschaft und Gesellschaft, Grundriss der verstehenden Soziologie, 1922)), we theorize that organizations in a community legitimize personal social conduct in three ways—by serving as role models, imparting norms and values, and routinizing forms of interaction. We study the relationship between corporate social responsibility (CSR) behavior by local firms and the social distancing (SD) of citizens in US counties during the Covid-19 pandemic, a core ethical outcome. We argue and find that the residents of communities in which firms exhibit higher levels of CSR engaged in more SD during the Covid-19 pandemic. This was true when firms were (a) long-established, (b) isomorphic in their CSR, and (c) major employers and vendors. Moreover, CSR relating to the treatment of employees as well as positive and negative extremes in CSR bore especially strong relationships with SD. Implications are drawn for the study of business ethics, as modeled by CSR, as a force for ethical personal behavior and public health in communities.

Urban-Rural Disparities in Dental Services Utilization Among Adults in China's Megacities.

Objective: China's dental care system is bifurcated between urban and rural areas. However, very few studies have examined the dental services utilization inequities in China's megacities, particularly in these urban and rural areas. This study aims to examine the urban-rural disparities in dental services utilization among adults living in China's megacities based on the Andersen dental services utilization model.Methods: This study used data from 4,049 residents aged 18–65 who participated in the “2019 New Era and Living Conditions in Megacities Survey.” Multivariate logistic regressions were employed to examine the associations between place of residence and dental services utilization for individuals from ten megacities in China. Predisposing variables (age, gender, marital status, living arrangement, and education), enabling variables (socioeconomic status, occupational status, income, insurance coverage, health attitude, and health behavior), and need variables (self-rated health, oral health status, gum bleeding) were controlled for.Results: The mean age of the 4,049 adults was 45.2 (standard deviation = 13.0), and 30.4% (n = 1,232) had no dental visits at all. Adults who resided in urban areas were more likely to use dental services [odds ratio (OR) = 1.57, 95% confidence interval (CI) = 1.30 to 1.91] than those residing in rural areas after controlling for key covariates. Factors associated with higher odds of visiting dentists include having a higher income (OR = 1.44, P < 0.001), higher education level (OR = 1.53, P = 0.042), being covered by insurance for urban residents/employees (OR = 1.49, P = 0.031), having a positive attitude toward healthy diets (OR = 1.43, P < 0.001), attending regular physical examination (OR = 1.66, P < 0.001), having more tooth loss (OR = 1.05, P < 0.001), and having frequent gum bleeding (OR = 2.29, P < 0.001).Conclusion: The findings confirm that place of residence is associated with dental services utilization while adjusting for key covariates. Despite rapid economic development in China, many adults had never visited dentists at all. More efforts should be taken to encourage widespread dental care, such as providing more dental coverage and better access to dental care services.

Airbnb and Amenity: Is Short-Term Letting Reshaping How We Live in the City?

The popularity of short-term letting (STL) platforms like Airbnb has created housing and planning challenges for cities worldwide, including the potential impact of STL on the quality of life of nearby residents and communities. Underpinning this concern is an inherent tension in urban living between the rights and interests of individual residents and the collective rights and interests of neighbours. Through interviews with Australian Airbnb hosts, this paper examines how STL hosts navigate this tension, including how they frame their rights, how they seek to minimise impacts on neighbours, and how they perceive the role of regulation in balancing individual and community rights. In doing so, the paper contributes to both theory and policy debates about urban property rights and how ‘compact city’ planning orthodoxies are reshaping the lived experience of urban residents worldwide.

What is Person-Centered Care?

What is Person-Centered Care?

Modelling of hypothetical SARS-CoV-2 point of care tests for routine testing in residential care homes: rapid cost-effectiveness analysis.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the virus that causes coronavirus disease 2019 (COVID-19), which at the time of writing (January 2021) was responsible for more than 2.25 million deaths worldwide and over 100,000 deaths in the UK. SARS-CoV-2 appears to be highly transmissible and could rapidly spread in residential care homes. The work undertaken aimed to estimate the clinical effectiveness and cost-effectiveness of viral detection point-of-care tests for detecting SARS-CoV-2 compared with laboratory-based tests in the setting of a hypothetical care home facility for elderly residents. The perspective was that of the NHS in 2020. The setting was a hypothetical care home facility for elderly residents. Care homes with en suite rooms and with shared facilities were modelled separately. A discrete event simulation model was constructed to model individual residents and simulate the spread of SARS-CoV-2 once it had entered the residential care facility. The numbers of COVID-19-related deaths and critical cases were recorded in addition to the number of days spent in isolation. Thirteen strategies involving different hypothetical SARS-CoV-2 tests were modelled. Recently published desirable and acceptable target product profiles for SARS-CoV-2 point-of-care tests and for hospital-based SARS-CoV-2 tests were modelled. Scenario analyses modelled early release from isolation based on receipt of a negative SARS-CoV-2 test result and the impact of vaccination. Incremental analyses were undertaken using both incremental cost-effectiveness ratios and net monetary benefits. Cost-effectiveness results depended on the proportion of residential care facilities penetrated by SARS-CoV-2. SARS-CoV-2 point-of-care tests with desirable target product profiles appear to have high net monetary benefit values. In contrast, SARS-CoV-2 point-of-care tests with acceptable target product profiles had low net monetary benefit values because of unnecessary isolations. The benefit of allowing early release from isolation depended on whether or not the facility had en suite rooms. The greater the assumed efficacy of vaccination, the lower the net monetary benefit values associated with SARS-CoV-2 point-of-care tests, when assuming that a vaccine lowers the risk of contracting SARS-CoV-2. There is considerable uncertainty in the values for key parameters within the model, although calibration was undertaken in an attempt to mitigate this. Some degree of Monte Carlo sampling error persists because of the timelines of the project. The example care home simulated will also not match those of decision-makers deciding on the clinical effectiveness and cost-effectiveness of introducing SARS-CoV-2 point-of-care tests. Given these limitations, the results should be taken as indicative rather than definitive, particularly the cost-effectiveness results when the relative cost per SARS-CoV-2 point-of-care test is uncertain. SARS-CoV-2 point-of-care tests have considerable potential for benefit for use in residential care facilities, but whether or not this materialises depends on the diagnostic accuracy and costs of forthcoming SARS-CoV-2 point-of-care tests. More accurate results would be obtained when there is more certainty on the diagnostic accuracy of and the reduction in time to test result associated with SARS-CoV-2 point-of-care tests when used in the context of residential care facilities, the proportion of care home penetrated by SARS-CoV-2 and the levels of immunity once vaccination is administered. These parameters are currently uncertain. This report was commissioned by the National Institute for Health Research (NIHR) Evidence Synthesis programme as project number 132154. This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 39. See the NIHR Journals Library website for further project information.

International survey on residency programs in radiology: similarities and differences among 17 countries

ObjectiveWith the initiative of the ACR International Economics Committee, a multinational survey was conducted to evaluate radiology residency programs around the world. MethodsA 31-question survey was developed. It included: economic issues, program size and length, resident's activities during daytime and call, academic aspects including syllabus and examinations. Data was tabulated using the forementioned thematic framework and was qualitatively analyzed. ResultsResponses were received from all 17 countries that were invited to participate (France, Netherlands, Israel, UK, Russia, USA, Japan, India, Germany, Canada, Turkey, Croatia, Serbia, Italy, Ireland, Hungary, and Greece). Residency length varied between 2 and 5 years. The certificate of residency completion is provided by a local hospital [4/17 (23%)], University [6/17 (36%)], National Board [6/17 (36%)], and Ministry of Health [1/17 (6%)]. There was variability among the number of residency programs and residents per program ranging from 15 to 300 programs per nation with a 1–700 residents in each one respectively. Salaries varied significantly and ranged from 8000 to 75,000 USD equivalent. Exams are an integral part of training in all surveyed countries. Length of call varied between 5 and 26 h and the number of monthly calls ranged from 3 to 6. The future of radiology was judged as growing in [12/17 (70%)] countries and stagnant in [5/17 (30%)] countries. DiscussionRadiology residency programs worldwide have many similarities. The differences are in the structure of the residency programs. Stagnation and uncertainties need to be addressed to ensure the continued development of the next generation of radiologists. Summary statementThere are many similarities in the academic aims and approach to education and training of radiology residency programs worldwide. The differences are in the structure of the residency programs and payments to individual residents.

Effects of an interprofessional Quality Circle-Deprescribing Module (QC-DeMo) in Swiss nursing homes: a randomised controlled trial

BackgroundPotentially inappropriate medications (PIMs) are common among nursing homes (NH) residents, as is polypharmacy. Deprescribing has emerged in the past decade as a safe and effective way to reduce the use of PIMs and improve patient outcomes. However, effective deprescribing interventions are expensive, as they require specialised staff and a great amount of time for each resident.The Quality Circle Deprescribing Module (QC-DeMo) intervention was designed to be less resource-intensive than medication reviews, the current deprescribing gold standard. It consists of a QC session in which physicians, nurses, and pharmacists define a local deprescribing consensus for specific PIMs classes, which is then implemented in the NH. The intervention was trialled in a RCT, with the NH as unit of analysis.MethodsAfter randomisation, intervention NHs enacted the QC-DeMo at the start of the follow-up year. The primary outcomes were the proportion of PIM galenic units and number of PIM defined daily dose per average resident and per day (DDD/res). PIM status was assessed by a combination of the 2015 Beers list and the Norwegian General Practice-Nursing Home criteria. Secondary outcomes were the number of DDD/res to avoid and to reevaluate; safety outcomes were mortality, hospitalisations, falls, and use of physical restraints. Outcomes were evaluated at follow-up using linear regression models, adjusting for the outcome baseline values.ResultsFifty-eight NHs took part in the trial; no individual residents were recruited. The intervention did not reduce the primary outcomes, but a strong trend towards reduction was seen for the number of PIM DDD/res, which accounts for the doses used. PIM DDD/res to reevaluate were significantly reduced, mostly through a reduction in the use of proton-pump inhibitors. Falls and use of physical restraints were not affected, but a statistical interaction between the mission of the NH (geriatric unit or specialised dementia unit) and the intervention group was seen for mortality and hospitalisations.ConclusionsThe QC-DeMo intervention can reduce the use of some PIM classes, and could usefully complement other deprescribing interventions.Trial registrationClinicalTrials.gov (NCT03688542), registered on 26.09.2018, retrospectively registered.

Clustered embedding using deep learning to analyze urban mobility based on complex transportation data.

Urban mobility is a vital aspect of any city and often influences its physical shape as well as its level of economic and social development. A thorough analysis of mobility patterns in urban areas can provide various benefits, such as the prediction of traffic flow and public transportation usage. In particular, based on its exceptional ability to extract patterns from complex large-scale data, embedding based on deep learning is a promising method for analyzing the mobility patterns of urban residents. However, as urban mobility becomes increasingly complex, it becomes difficult to embed patterns into a single vector because of its limited capacity. In this paper, we propose a novel method for analyzing urban mobility based on deep learning. The proposed method involves clustering mobility patterns and embedding them to capture their implicit meaning. Clustering groups mobility patterns based on their spatiotemporal characteristics, and embedding provides meaningful information regarding both individual residents (i.e., personalized mobility) and all residents as a whole, enabling a more effective analysis of mobility patterns. Experiments were performed to predict the successive points of interest (POIs) based on transportation data collected from 1.5 million citizens in a large metropolitan city; the results demonstrate that the proposed method achieves top-1, 3, and 5 accuracies of 73.64%, 88.65%, and 91.54%, respectively, which are much higher than those of the conventional method (59.48%, 75.85%, and 80.1%, respectively). We also demonstrate that the proposed method facilitates the analysis of urban mobility through arithmetic operations between POI vectors.

Successful discharge from a mental health halfway house: A personalized process with integrated approaches

IntroductionIn Taiwan, residents of mental health halfway houses (MHHH) receive psychiatric rehabilitation services, aiming for independent living and community integration. Research is yet to investigate how MHHH may effectively assist residents’ discharge in this cultural context.ObjectivesTo examine the processes of assessment, preparation, assistance, and appraisal of discharge from MHHH staff’s perspectives.MethodsSemi-structured in-depth interviews were conducted with 11 halfway house staff members. Verbatim transcripts were analyzed with dimensional analysis procedures of the grounded theory methodology.ResultsSuccessful discharge is a personalized process with integrated approaches addressing three essential factors: (a) regular community involvement, (b) the residents’ capacity to work, and (c) the family’s acceptance and support. Staff supported individual residents’ community involvement by attending to residents’ personal interests, resource availability, financial concerns, and transportation. Moreover, staff provided rehabilitation trainings to develop work capacity. However, residents’ motivation and functioning as well as job opportunities might affect their employment. Finally, in Taiwan, residents were rarely discharged without their family members’ consent because residents tended to co-reside with their family after discharge or rely on family support while living separately. Staff worked to engage families, which was influenced by family relationship quality, past traumatic events, financial concerns, capacity to assist the resident, and/or the resident’s ability to assist with family affairs.ConclusionsTo achieve successful discharges, MHHH staff need to assist each resident by developing an integrated plan to enhance conditions of the aforementioned factors, including strategies for different familial situations to garner family support in this cultural context.