Shortage Of Equipment Research Articles

The Effect of Virtual Laboratories on the Academic Achievement of Undergraduate Chemistry Students: Quasi-Experimental Study.

Experimentation is crucial in chemistry education as it links practical experience with theoretical concepts. However, practical chemistry courses typically rely on real laboratory experiments and often face challenges such as limited resources, equipment shortages, and logistical constraints in university settings. To address these challenges, computer-based laboratories have been introduced as a potential solution, offering electronic simulations that replicate real laboratory experiences. This study examines the effect of virtual laboratories on the academic achievement of undergraduate chemistry students and evaluates their potential as a viable alternative or complement to traditional laboratory-based instruction. A quasi-experimental design was implemented to examine the cause-and-effect relationship between instructional methods and student outcomes. The study involved 60 fourth-year BSc chemistry students from Dilla University, divided into 3 groups: a real laboratory group (n=20), which performed real laboratory experiments; a virtual group (n=20), which used virtual laboratory simulations; and a lecture group (n=20), which received lecture-based instruction. Quantitative data were collected through tests administered before and after the intervention to assess academic performance. The data analysis used descriptive and inferential statistics, such as means and SDs, 1-way ANOVA, the Tukey honestly significant difference test, and independent-sample t tests (2-tailed), with a P value of .05 set for determining statistical significance. Before the intervention, the results indicated no significant differences in academic achievement among the 3 groups (P=.99). However, after the intervention, notable differences were observed in student performance across the methods. The real laboratory group had the highest mean posttest score (mean 62.6, SD 10.7), followed by the virtual laboratory group (mean 55.5, SD 6.8) and the lecture-only group, which had the lowest mean score (mean 43.7, SD 11.5). ANOVA results confirmed significant differences between the groups (F2,57=18.429; P<.001). The Tukey post hoc test further revealed that the real laboratory group significantly outperformed the lecture-only group (mean difference 18.88; P<.001), while the virtual laboratory group also performed significantly better than the lecture-only group (mean difference 11.7; P=.001). However, no statistically significant difference was found between the real laboratory and virtual laboratory groups (mean difference 7.12; P=.07). In addition, gender did not significantly influence performance in the virtual laboratory group (P=.21), with no substantial difference in posttest scores between male and female students. These findings suggest that computer-based laboratories are a viable and effective alternative when real laboratories are unavailable, enhancing learning outcomes when compared with traditional lecture-based methods. Therefore, universities should consider integrating computer-based laboratories into their practical chemistry curricula to provide students with interactive and engaging learning experiences, especially when physical laboratories are inaccessible.

Disposal of SARS-CoV-2 corpses: experiences of environmental health officers

BackgroundThough the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is no more of a public health emergency, the experiences from burying SARS-CoV-2 infectious dead bodies may remain with the workers. For Environmental Health Officers (EHOs), dealing with decedents during the SARS-CoV-2 outbreak may arouse strong feelings of pity, horror, repulsion, disgust, and anger at the tragedy. Therefore, this study aims to explore the experiences of EHOs in disposing off of confirmed or suspected SARS-CoV-2 fatalities in Ghana.MethodsUsing an 18-item interview guide, we gathered data from 27 EHOs from three regions of Ghana. We followed the steps in Descriptive Phenomenology in conducting the data analysis.Resultsi. EHOs were confronted with several occupational health and safety (OHS) hazards like physical and chemical injuries, threat of harm, and psychological harm, ii. The officers also faced severe shortage of personal protective equipment (PPE). Unfortunately, they were not provided with any form of psychological support during the period.ConclusionThe SARS-CoV-2 outbreak in Ghana exposed major fault lines in the health and safety/disaster and emergency preparedness of EHOs towards the burial of infectious disease dead bodies. Clearly, the disposal exercise failed to uphold the Sustainable Development Goals (SDGs) 4.4, 8.3, and 8.5, which advocate for the promotion of decent jobs for all.RecommendationGhana’s Ministries of Health, Local Government, and Sanitation and Water Resources need to attach Clinical Psychologists and security personnel to the disposal teams in future exercises to provide psychological support and security to the team. Though studies on the disposal of infectious bodies in Africa exist, very little is known about the experiences of EHOs in the disposal of SARS-CoV-2 dead bodies during the outbreak.

Analysis of the Impact of China's Carbon Neutrality Policy on the Environment and Economy at Home and Abroad

China has made remarkable achievements in reducing greenhouse gas emissions, especially in achieving the emission reduction targets set for 2020. This progress is mainly due to China's reduced dependence on coal and other fossil fuels, which not only promotes significant improvements in air quality but also lays the foundation for the transformation of China's economic structure. Especially in the energy and industrial fields, carbon neutrality policies are driving companies to transform into greener and more sustainable operating models. Facing the economic challenges brought about by the COVID-19 epidemic, China is actively seeking a path to low-carbon economic recovery by increasing public investment in renewable energy and other fields. From an international perspective, China's carbon neutrality commitment has the potential to inspire other large carbon-emitting countries, especially countries along the Belt and Road and neighboring countries, to strengthen their emission reduction efforts. At the same time, Southeast Asian countries face shortages of technology, equipment, and raw materials, as well as insufficient investment when developing renewable energy. In this regard, Chinas experience and investment have a significant impact on Southeast Asian countries carbon neutrality policies and renewable energy development. China can use its technological and manufacturing advantages to share resources with neighboring countries in renewable energy technology and equipment manufacturing, and provide support for ASEAN countries to achieve their renewable energy goals.

Monte-Carlo Simulation of Reliability of System with Complex Interconnections

Modern automotive systems must satisfy strict reliability requirements. Most real vehicle systems and safety-critical networks have complex interconnections. The sensitivities and probabilistic uncertainties of the reliability of systems with complex interconnections (SwCIs) can be investigated by Monte-Carlo Simulation (MCS). This paper focuses on the sensitivities and parametrical uncertainties of SwCIs’ reliability. The proposed method can be implemented in the investigation of the uncertainties of SwCI reliability, i.e., in the determination of critical system elements and the estimation of the required number of spare parts (RNSP) of the system, which depends on the probability of allowable spare equipment shortage.

Exploring barriers to and facilitators of infection prevention and control practices in the Pediatrics and Child Health Department of Tikur Anbessa Specialized Hospital, Ethiopia

BackgroundAdherence to infection prevention and control (IPC) standards and guidelines by healthcare workers is essential for reducing the spread of healthcare-associated infections (HAIs). However, IPC practices among healthcare workers in low- and middle-income countries (LMICs), including Ethiopia, are generally inadequate. This research aims to identify the barriers to and facilitators of IPC practices in the Pediatrics and Child Health Department of Tikur Anbessa Specialized Hospital (TASH) in Ethiopia.MethodsWe employed a rapid ethnographic assessment (REA) approach for this study, using focus group discussions (FGDs), in-depth interviews (IDIs), and observations to collect data. Participants were selected from the Pediatrics and Child Health Department of TASH, and data collection took place in March and April 2022. Two FGDs and eight IDIs were conducted in the participants’ workplace within the department. Unstructured guides were used to facilitate the FGDs and IDIs. Nvivo version 10 software was used for data organization and analysis. The data were coded deductively through thematic analysis to identify similar ideas and concepts, based on the Systems Engineering Initiative for Patient Safety (SEIPS) model.ResultA total of 23 healthcare workers participated, with 15 in FGDs and 8 in IDIs. The study identified several barriers to IPC practices, including nonadherence to IPC practice protocols, lack of pre-employment training, space constraints, insufficient maintenance and repair of equipment, limited management engagement and support, shortage of resources and budget, incidents of needle stick injuries and infections, high workloads for healthcare workers, shortages of personal protective equipment and water supply, and inadequate waste management. We also identified some facilitators, including the existence of an IPC team and committee, a health education schedule for patients and visitors, morning sessions for healthcare providers, and the presence of television screens in waiting areas. By addressing the identified barriers and leveraging the facilitators, department heads, IPC team leaders, and decision-makers can develop targeted strategies and interventions to improve infection control, reduce the spread of HAIs, and ultimately enhance the quality of healthcare services.ConclusionThis study explored several barriers that contribute to inappropriate and suboptimal IPC practices in the study area. These barriers create significant challenges for healthcare workers and hindering their ability to effectively implement IPC practices. The findings highlight the complex and multifaceted nature of the problems, which not only affect the current working environment but also compromise the overall quality of care. The hospital administrator should address these critical issues to improving IPC practices and ensuring a safer healthcare environment.

Ethnic and Racial Disparities in Self-Reported Personal Protective Equipment Shortages Among New York Healthcare Workers During the COVID-19 Pandemic

Ethnic and Racial Disparities in Self-Reported Personal Protective Equipment Shortages Among New York Healthcare Workers During the COVID-19 Pandemic

Digital transformation and religious entrepreneurship in Nigeria: integrating artificial intelligence toward competitive advantage

PurposeBased on the technology acceptance model (TAM), this study contextually examines the level of willingness of religious entrepreneurs to accept and implement artificial intelligence (AI) tools. Furthermore, it aims to explore the challenges and prospects of AI adoption among entrepreneurs.Design/methodology/approachFollowing a qualitative approach, the data were collected from 12 informants from different segments of religious entrepreneurship in Nigeria. Semi-structured interviews and deductive thematic analysis were used to collect data.FindingsThe findings show that religious entrepreneurs demonstrate commendable level of awareness of the availability and usefulness of AI tools that support secular and sacred entrepreneurial pursuits. Furthermore, findings indicate that they have fully integrated AI in their secular entrepreneurial affairs but still demonstrate restraints in implementing it in certain sacred functions. Several challenges including shortage of finance, trained manpower and equipment are faced by the entrepreneurs.Originality/valueTheoretically, the findings demonstrate that AI awareness and perceived usefulness influence the intention of religious entrepreneurs to integrate AI into religious entrepreneurship, while perceived ease of use does not.

Infection Prevention and Control in Long-term Care Facilities in Florida: A Needs Assessment Survey

Although several surveys of infection prevention and control (IPC) practices have been conducted in the United States, none have focused on the state of Florida, which has the fourth largest number of certified nursing facilities in the country. A needs assessment survey was conducted to better understand the specific needs and practices of individuals responsible for IPC in long-term care facilities (LTCFs) in Florida. In November and December of 2022, a 90-question online survey was distributed to individuals responsible for IPC activities at 3,690 LTCFs in Florida. After omitting incomplete responses, 304 survey responses were analyzed using descriptive statistics. Survey responses regarding hand hygiene, sharps safety, and staff training reflect compliance with recommended IPC practices. Staffing shortages for Registered Nurses, Licensed Practical Nurses, and Certified Nursing Assistants were high among respondents (30%), while few reported shortages of Personal Protective Equipment (5%). Only 11% of respondents state their facility requires flu vaccines despite the high-risk environment of LTCFs. Concerning the built environment, the results suggest Infection Preventionists have limited awareness of the scope of heating, ventilation, and air conditioning systems in their facilities. Some areas of compliance with IPC best practices were noted, but multiple opportunities for education and training on IPC best practices were identified.

Beyond diagnosis: using a futurist approach to improve access to radiation oncology services in South Africa

Aim Radiation oncology is an integral aspect of comprehensive cancer treatment, with approximately 50% of patients requiring curative or palliative radiotherapy intervention. In the South African public sector, radiation oncology services are constrained by various factors including service coverage, equipment and staff shortages, causing consequent delays in access to care. The National Cancer Strategic Framework for South Africa (NCSF) (2017-2022) offers strategic direction for cancer services in the country. Methods Futurist causal layered analysis (CLA) provides a comprehensive approach to exploring the multifaceted factors that influence access to radiation oncology services. Using the established layers of CLA, namely, the litany, systemic, worldview and mythical layers, the NCSF, relevant literature, and expert perspectives, were used to explore the multiple levels of influence related to radiation oncology services in South Africa. Findings Considering litany, review of process flows and radiation oncology care models could offer strategic pathways for reducing waiting times and improving access to care. From the systemic layer analysis, health system strengthening should include improving clinical governance and access to available services within both the public and private sectors. This could simultaneously address the worldview of an unconstitutional lack of access to radiation oncology care within the public health sector. The final level considered myths related to radiation oncology in South Africa, including its perceived efficacy only in advanced cancer stages, and highlighted the importance of a business case for radiation oncology services to support enhanced planning and outcomes. Conclusions CLA methodology offers new insights into the challenges and opportunities facing radiation oncology services in South Africa. By comprehensively addressing the complex causal layers impacting radiation oncology services, policymakers and stakeholders can make more informed decisions to improve access to radiation oncology care in the country. The study recommends that the entire cascade of cancer care, including treatment pathways and multi-stakeholder perspectives, should be reviewed. Internal and external factors that delay the initiation of radiotherapy should be mapped and mitigated.

Barriers and facilitators to implementation of intravenous cardiovascular treatments in ambulatory settings.

Intravenous (IV) therapies have transformed the management of various cardiovascular conditions in ambulatory patients. However, uptakeof these therapies in ambulatory care settings has several barriers. In this systematic scoping review, we aimed to identify the barriers and facilitators that influence the implementation of current IV therapies in ambulatory settings. We searched MEDLINE, Embase and CINAHL databases from inception to September 2023 for studies on barriers and facilitators of IV therapy uptake in ambulatory patients. We classified the identified factors and performed a thematic analysis. Fifteen studies, primarily conducted in North America and Europe, were included. Methodologies varied, precluding quantitative synthesis. Key barriers were identified across several levels. At the medication level, barriers included the need for multiple vials and lengthy preparation. Patient-level barriers included adverse effects, infections, painful venous access and non-adherence. Clinician-level barriers included understaffing, time constraints and safety concerns. Institutional barriers ranged from staff or equipment shortages to liability concerns and complex logistics. Healthcare system barriers included financial constraints and limited care delivery services. Facilitators included evidence-based indications, patient education and comfort, staff experience, guidance documents, safe settings, favourable insurance policies and supportive guidelines. As novel IV treatments emerge, addressing barriers and leveraging facilitators preemptively can enhance the successful implementation of IV therapies and improve clinical outcomes in ambulatory settings.

A Cross-Border Biorisk Toolkit for Healthcare Professionals.

The COVID-19 pandemic posed significant challenges to public health, exposing first responders to high biosafety risks during medical assistance and containment efforts. The PANDEM-2 study aimed to address these critical biosafety issues by emphasising the importance of frequently updated, harmonised guidelines. This study reviewed scientific publications, lessons learned, and real-world experiences from the COVID-19 pandemic to identify biorisk gaps in three critical areas: (i) patient transportation and management, (ii) sample handling and testing, and (iii) data management and communication by laboratory staff. At the onset of the pandemic, first responders faced several challenges, including the rapid expansion of emergency medical services, conversion of non-medical structures, increased internal and cross-border transport of infected patients, frequent changes in biosafety protocols, and a shortage of personal protective equipment. In response, this study developed a versatile and easily adaptable toolkit, including biosafety guidance and recommendations linked to updated national and international online repositories. It establishes the groundwork for a minimum standard that can be tailored to various pandemic response scenarios, using monkeypox as a fictive test case. The toolkit enables rapid access to updated information via QR codes and mobile devices, improving biorisk response by providing an adaptable and standardised approach for caregivers involved in national and cross-border responses.

Fear of COVID-19 among Frontline Nurses in a National University Hospital in the Philippines: A Mixed-Methods Study.

Nurses are at the forefront of caring for patients during the height of the COVID-19 pandemic. Nurses themselves are exposed to serious risk and even death while providing care for these patients. Among other healthcare professionals, nurses are mostly exposed to psychologically distressing situations during this time of crisis. Fear of COVID-19 can affect nurses' overall well-being, which in turn may affect their job performance and lead to a decline in the quality of patient care. To determine the level of fear of COVID-19, and to explore the experiences of COVID-19-related fear of frontline nurses in a national university hospital in the Philippines. To achieve the study objectives, the study utilized a convergent mixed methodology approach. In the quantitative phase, a random sample of participants completed the Fear of COVID-19 scale (FCV-19S) in order to assess their level of fear of COVID-19. Semi-structured interviews were conducted in the qualitative strand. Participants in the qualitative phase was selected using maximum variation sampling. Integration of data was done through a narrative contiguous approach. Quantitative data was obtained from 206 frontline registered nurses. The mean age of the participants was 35.5 years (SD =8.17). Overall, the composite score of the fear of COVID-19 scale was 21.76 (SD = 4.92), indicating an elevated level of fear. Having friends and relatives who tested positive predicted fear of COVID-19 (β = -3.658; p = 0.005; CI: -6.213 to -1.104). Three major themes categories emerged from qualitative data analysis: (1) balancing feelings of fear and moral obligation, (2) challenges experienced while providing frontline work, and (3) resilience amidst challenges. For the reporting and integration of our mixed-method results, a narrative contiguous approach was implemented. Frontline nurses reported an elevated level of fear during the height of the COVID-19 pandemic. This study was also able to capture the impact of COVID-19 on the mental health of nurses, specifically on their fear experiences. Understanding the underlying causes of fear, such as uncertainties surrounding guidelines and protocols, shortage of personal protective equipment, and moral distress, offers invaluable insights for shaping proactive strategies and policies aimed at mitigating these concerns in subsequent pandemics.

A. M. von-Wilken – the first director of the Vyatka Teachers' Institute

Introduction. Russian education at all stages of its development has always relied on the dedicated efforts of numerous educators: teachers, organizers of public schools and other educational institutions, as well as textbook authors. One of these workers of enlightenment was a prominent figure in Russian education in the first third of the twentieth century Alexander Modestovich von Wilken (1874-1934). The example of his life and practical pedagogical activity represent an enduring value over the years and a kind of example for modern teachers. Materials and methods. The author uses as research methods: analysis of historical and pedagogical, local history and memoir literature, biographical and historical methods, axiological (value) approach to the study of historical and pedagogical material. Results. The need to open a teachers' institute in the provincial town of Vyatka at the beginning of the XX century was explained by the lack of an educational institution for the training of teachers in this region. The tireless, selfless work of the first director of the Institute von Wilken contributed to the emergence of the first qualified specialists in the field of primary school education, served as an incentive for the development of general and special education in the Vyatka province. Despite the difficulties of wartime and the accompanying shortage of funds and equipment, the Vyatka Teachers' Institute, headed by von Wilken, coped with tasks assigned to it; in addition to the graduation of teachers, the Institute became the center of education in the region. The teaching staff of the Institute included the best teachers of the time. Director was forced to leave it in 1917, and his further fruitful educational and organizational work was carried out in Kazan. His activity has received recognition, which was evidenced by the assignment of the title "Hero of Labor" to him. Conclusion. The activity of von Wilken has left a bright mark in the history of Russian education. He went down in the history of Vyatka province as one of the most outstanding representatives of local education. The history of his life and work, as well as the history of the Vyatka Teachers' Institute deserves further comprehensive study

A novel deterioration prediction system for mild COVID-19 patients in Korea: a retrospective study

The ongoing coronavirus disease 2019 (COVID-19) pandemic presents serious public health threats. Omicron, the current most prevalent strain of COVID-19, has a low fatality rate and very high transmissibility, so the number of patients with mild symptoms of COVID-19 is rapidly increasing. This change of pandemic challenges medical systems worldwide in many aspects, including sharp increases in demands for hospital infrastructure, critical shortages in medical equipment, and medical staff. Predicting deterioration in mild patients could alleviate these problems. A novel scoring system was proposed for predicting the deterioration of patients whose condition may worsen rapidly and those who all still mild or asymptomatic. Retrospective cohorts of 954 and 2,035 patients that quarantined in the Residential Treatment Center were assembled for derivation and external validation of mild COVID-19, respectively. Deterioration was defined as transfer to a local hospital due to worsening condition of the patients during the 2-week isolation period. A total of 15 variables: sex, age, seven pre-existing conditions (diabetes, hypertension, cardiovascular disease, respiratory disease, liver disease, kidney disease, and organ transplant), and five vital signs (systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), body temperature, and oxygen saturation (SpO2)) were collected. A scoring system was developed using seven variables (age, pulse rate, SpO2, SBP, DBP, temperature, and hypertension) with significant differences between the transfer and not transfer groups in logistic regression. The proposed system was compared with existing scoring systems that assess the severity of patient conditions. The performance of the proposed scoring system to predict deterioration in patients with mild COVID-19 showed an area under the receiver operating characteristic (AUC) of 0.868. This is a statistically significant improvement compared to the performance of the previous patient condition assessment scoring systems. During external validation, the proposed system showed the best and most robust predictive performance (AUC = 0.768; accuracy = 0.899). In conclusion, we proposed a novel scoring system for predicting patients with mild COVID-19 who will experience deterioration which could predict the deterioration of the patient’s condition early with high predictive performance. Furthermore, because the scoring system does not require special calculations, it can be easily measured to predict the deterioration of a patients’ condition. This system can be used as effective tool for early detection of deterioration in mild COVID-19 patients.

A Comprehensive Review of the Factors and Strategies to Mitigate Construction Projects Delays in Saudi Arabia

Background The construction industry in Saudi Arabia faces numerous challenges that hinder its progress due to frequent and prolonged project delays. Objective The specific objectives of this study are (1) (1) To analyze the factors contributing to construction project delays in Saudi Arabia, (2) To identify the risk of factors contributing to construction project delays, and (3) To propose strategies to mitigate construction project delays in Saudi Arabia. Methods The study reviewed 16 articles to identify and suggest solutions for construction project delays in Saudi Arabia. Results There are 140 factors of delay found and seven pose unacceptable risks including delays due to material delivery, delays in approval of submittals, design drawings, shop drawings, and sample materials (making decisions), delays related to subcontractors work, inflation and escalation of material prices (changes in price), lack of coordination with contractors, shortage of construction materials (non-availability of material), and equipment shortages. The risk assessment can be conducted using the Bowtie diagram, scenario analysis, MRM, and MCS separately or collectively to get a new and improved model. Conclusion This review will contribute to the development of strategies to enhance the performance of ongoing and future construction projects in the region. Additionally, decision-makers can utilize the outcomes to strategically allocate resources and improve construction project success.

Impact of State Intervention During the Pandemic Crisis on the Implementation of Nanotechnological Innovations in the Czech Republic

The article deals with the issue of state interventions during the pandemic in the Czech Republic and the role of nanotechnology, which played an important role in increasing the production capacity of personal protective equipment. Nanotechnology has been rarely used in the long term for the filtration of bacteria and viruses due to its relatively high cost compared to conventional technologies that are commonly used to filter bacteria and viruses. Due to the positive demand shock and therefore the increased price, nanofibres became much more widely used in respirators and hoods. However, the global shortage of protective equipment, in addition to the high demand, also caused government intervention. These may have adversely affected the potential for global implementation of nanofibres in respirators. Based on empirical research, the aim of this paper is to identify the innovation environment during the pandemic and the interventions that disrupted the innovation environment in nanotechnology.

Patient safety and the COVID-19 pandemic: a qualitative study of perspectives of front-line clinicians

IntroductionStudies on the impacts of COVID-19 on patient safety are emerging. However, few studies have elicited the perspectives of front-line clinicians.MethodsWe interviewed clinicians from 16 US hospitals who worked in...

The Impact Of The Blockade And Politics On Health And Social Welfare In Palestine

The political conflict between Israel and Palestine has created a difficult situation for the Palestinian population, with a blockade imposed by Israel and persistent political tensions. The impact of the blockade and politics on the health and social well-being of the Palestinian population requires in-depth research to fully understand its implications. This research aims to analyze the impact of the blockade and politics on physical and mental health, access to health services, and the social welfare of Palestinian society. This research uses the Systematic Literature Review (SLR) method to collect and analyze data from various related literature sources. Data was analyzed comprehensively to understand the impact of the blockade and politics on health and social well-being in Palestine. The results show that the blockade imposed by Israel has caused a severe health crisis, with increased risks of infectious diseases, shortages of medical equipment, and limited access to health services. In addition, political conflict has also caused an increase in mental disorders among the Palestinian population, as well as disturbing social instability.

Health system barriers to hypertension care in Peru: Rapid assessment to inform organizational-level change.

Traditional patient- and provider-level hypertension interventions have proven insufficient to halt hypertension as the leading cause of morbidity and mortality globally. Systems-level interventions are required to address factors challenging hypertension control across a social ecological framework, an under-studied topic particularly salient in low- and middle-income countries (LMICs) such as Peru. To inform such interventions, we sought to identify key health systems barriers to hypertension care in Puno, Peru. A participatory stakeholder workshop (October 2021) and 21 in-depth interviews (October 2021-March 2022) were conducted with 55 healthcare professionals (i.e., doctors, nurses, midwives, dentists, nutritionists), followed by a deductive qualitative analysis of transcripts and notes. Participating healthcare providers indicated that low prioritization and lack of national policies for hypertension care have resulted in limited funding and lack of societal-level prevention efforts. Additionally, limited cultural consideration, both in national guidelines as well as by some providers in Puno, results in inadequate care that may not align with local traditions. Providers highlighted that patient care is also hampered by inadequate distribution and occasional shortages of medications and equipment, as well as a lack of personnel and limited opportunities for training in hypertension. Multiple incompatible health information systems, complicated referral systems, and geographic barriers additionally hinder continuity of care and care seeking. Insights gained from health providers on the healthcare system in Puno provide essential contextual information to inform development of organizational-level strategies necessary to improve provider and patient behaviors to achieve better hypertension care outcomes.

Cost-effectiveness of portable-automated ABR for universal neonatal hearing screening in India.

The World Health Organization considers Universal Neonatal Hearing Screening (UNHS) essential to global public health. Rashtriya Bal Swasthya Karyakram has included newborn hearing screening in India since 2013. The program faces human, infrastructure, and equipment shortages. First-line hearing screening with improved diagnostic accuracy is needed. The Portable Automated Auditory Brainstem Responses (P-AABR) can be used in remote areas for UNHS due to its low infrastructure needs and diagnostic accuracy. This study evaluated the cost-effectiveness of P-AABR in UNHS. We employed an analytical model based on decision trees to assess the cost-effectiveness of Otoacoustic Emission (OAE) and P-AABR. The total cost to the health system for P-AABR, regardless of true positive cases, is INR 10,535,915, while OAE costs INR 7,256,198. P-AABR detects 262 cases, whereas OAE detects 26 cases. Portable Automated ABR costs INR 97 per case detection, while OAE costs INR 67. The final ICER was 97407.69. The P-AABR device is cost-effective, safe and feasible for UNHS Rashtriya Bal Swasthya Karyakram (RBSK) programs. Beyond reducing false referrals and parent indirect costs, it detects more hearing-impaired infants. Even in shortages of skilled workers, existing staff can be trained. Thus, this study suggests integrating this device into community and primary health centers to expand UNHS coverage.