Small Facilities Research Articles

158. Hepatitis B Screening Among Persons With HIV Receiving Care from the U.S. Department of Veterans Affairs

Abstract Background In the United States, around 8% of persons with HIV (PWH) are coinfected with Hepatitis B (HBV), influencing antiretroviral choice and conferring higher mortality. Despite recommendations for universal HBV screening in PWH, small US and international studies found 52-68% were ever screened. National US data on HBV screening in PWH that could inform quality improvement efforts is lacking. Hepatitis B Screening in Persons with HIV Receiving Care in the US Veterans Health Administration Methods We used the Veterans Health Administration (VHA) Corporate Data Warehouse to conduct a service evaluation of longitudinal operational data collected during routine care in the integrated electronic health record. We assessed the proportion of PWH receiving HIV care through VHA (at least one encounter in the current or previous year) who have complete HBV serologic screening, defined as at least one result for each of hepatitis B surface antigen (sAg), core antibody (cAb) and surface antibody (sAb). We conducted two multivariate logistic regressions on complete HBV serologic screening using (1) demographic and comorbidity variables, and (2) geographic and facility variables. Hepatitis B Screening Amongst Persons with HIV by Geographic and Facility Factors Results Of 30,412 PWH receiving VHA care, 24,913 (81.9%) had complete HBV serologic screening. Adjusted odds ratios (AOR) for complete HBV screening were significantly higher in PWH who were black or Hispanic, born from 1961 onwards, were homeless, or had comorbidities such as hepatitis C, mental health and substance use disorders, as shown in Table 1, but did not differ significantly by sex. AOR for complete HBV screening were significantly lower for PWH seen at rural and lower complexity (smaller) facilities as shown in Table 2. Among non-immune PWH without hepatitis B (sAg negative, no prior reactive sAg), 55% subsequently received at least 1 dose of hepatitis B vaccine after a median 370-day interval (IQR 75-1512) as shown in Figure 1. Time to Administration of At Least One Dose Of Hepatitis B Vaccine in Persons with HIV with Negative Hepatitis B Surface Antigen Lacking Prior Positive Surface Antibody Results. Conclusion Our data provide insight into current HBV screening practices for PWH in a nationwide US health system. Overall HBV screening rates were high, but 18.1% of PWH had incomplete HBV screening with cAb most frequently missing. Lower odds of HBV screening in smaller facilities and rural populations underscore the need for tailored strategies to ensure equitable access. Our data will inform quality improvement efforts to enhance screening practices for HBV among Veterans living with HIV. Disclosures All Authors: No reported disclosures

Three-dimensional structure of entire hydrated murine hearts at histological resolution

Imaging the entire cardiomyocyte network in entire small animal hearts at single cell resolution is a formidable challenge. Optical microscopy provides sufficient contrast and resolution in 2d, however fails to deliver non-destructive 3d reconstructions with isotropic resolution. It requires several invasive preparation steps, which introduce structural artefacts, namely dehydration, physical slicing and staining, or for the case of light sheet microscopy also clearing of the tissue. Our goal is to provide 3d reconstructions of the cardiomyocyte network in entire hydrated murine hearts, and to develop a methodology for quantitative analysis of heart pathologies based on X-ray phase contrast computed tomography (XPCT). We have used XPCT at two beamlines of the extremely brilliant source (EBS) at the European Synchrotron Radiation Facility (ESRF) to scan wild-type murine hearts at high resolution, as well as a series of murine hearts of different pathological models, at reduced resolution and higher throughput. All hearts were obtained from the small animal facility of the university medical center in Göttingen. The hearts were fixed in formalin, stored and measured non-destructively in phosphate buffer solution. The high resolution dataset allows to discern individual cardiomyocytes in the tissue. All datasets have been analyzed using semi-automated image segmentation of the ventricles, rotation into a common coordinate system, classification into different anatomical compartments, and finally the structure tensor approach. A 3d streamline representation of the cardiomyocyte orientation vector field is provided. The different cardiovascular disease models are analysed based on metrics derived from the 3d structure tensor. An entire hydrated murine heart has been covered at an isotropic voxel size of 1.6μm (distributed over several volumes). A binned and fused dataset of this heart is available at 3.2μm, and has been analyzed by the structure tensor approach to yield the ventricular cardiomyocyte network or mesh, i.e. the aggregation of the cardiomyocyte chains in particular in the ventricular wall. Semi-automatic determination of structural metrics is already achieved and the corresponding tools and resulting data are made publically available. XPCT using extremely brilliant undulator radiation is close to achieve single cell reconstruction in an entire small animal organ.

Health Care Facility Characteristics Associated With Providing Telehealth HIV Care Services During the COVID-19 Pandemic.

Objectives. To describe provision of HIV telehealth services during the COVID-19 pandemic using data from the Centers for Disease Control and Prevention (CDC) Medical Monitoring Project Facility Survey for the Ending the HIV Epidemic in the United States initiative, which aims to achieve an at least 90% reduction in new HIV infections by 2030 and highlights telehealth as an important strategy. Methods. During 2021, we surveyed 1023 facilities providing HIV care to a nationally representative sample of US adults with diagnosed HIV, of which 45% responded. We calculated weighted percentages with 95% confidence intervals comparing the characteristics of facilities providing telehealth services. Results. Overall, 83.4% of facilities provided HIV care telehealth services by the facility's own providers (82.0%) or by outside providers through remote conferencing (27.0%). Gaps in coverage were identified in smaller facilities and in facilities in rural and primary care health professional shortage areas. Conclusions. Although most HIV care facilities provided telehealth services during the COVID-19 pandemic, gaps were identified, which must be addressed to meet Ending the HIV Epidemic in the United States goals and better prepare for future health emergencies. (Am J Public Health. Published online ahead of print January 16, 2025:e1-e5. https://doi.org/10.2105/AJPH.2024.307908).

Boosting circular economy solutions in the construction sector using a life cycle assessment

AbstractConstruction and demolition waste (CDW) management activities have had wide‐ranging adverse impacts on the Earth's climate. Addressing the problems of construction and demolition waste production requires a comprehensive and multifaceted approach and specific attention to the development of sustainable circular on‐site practices. This study compares recycled products against conventional products already available on the market. This study applied a life cycle assessment (LCA) to evaluate the benefits of secondary raw material (SRM)‐based products compared to conventional virgin raw materials. Focusing on a Spanish case study that had foreseen the revitalization of a degraded area, the construction of a small utility building, and road construction, this analysis also assessed the overall environmental footprint of the overall construction work. The results showed that, despite the impact savings achieved by opting for SRM‐based products rather than conventional solutions, the production stages still have the greatest impact on the scale of construction, with the sole exception of the construction of small facilities where the construction itself was the largest contributor. Climate change; water scarcity; freshwater eutrophication; resource use, energy carriers; and resource use, minerals and metals were the most significant impact categories both in the analysis of the construction products and the overall construction work. An LCA is vital in the construction and demolition sector because it provides a holistic understanding of the environmental impacts associated with the different stages of a project's life cycle fostering the implementation of circular on‐site practices.

Wastewater monitoring - passive sampling for the detection of SARS-CoV-2 and antibiotic resistance genes in wastewater.

As a lesson learned from the COVID-19 pandemic, wastewater-based epidemiology was recognised and used as an important method for surveillance and early detection of SARS-CoV-2. As a result, consideration of wastewater as a source of public health information has gained new prominence, and there is consensus that similar approaches can be used to detect the spread of other viral pathogens or antimicrobial resistance (AMR) in populations. However, the implementation of wastewater monitoring poses challenges in terms of obtaining representative and meaningful samples. In particular, it is difficult to sample small catchments, critical facilities (e.g. hospitals) or low-income countries where the use of automatic water samplers is not possible or the samplers are not available. To overcome these problems, this study developed a low-cost and easy-to-use passive sampler based on activated carbon as an adsorbent with a corresponding elution/extraction protocol that allows the detection of viruses and antibiotic resistance genes in wastewater. Monitoring of SARS-CoV-2 with these passive samplers at the influent of a wastewater treatment plant over a period of 1.5months showed a positive correlation with monitoring with 24-h composite samples in the catchment area. Analysis of the nucleic acid extracts for antibiotic resistance genes showed the presence of clinically relevant carbapenemase genes such as blaKPC-3 and blaNDM-1 in the wastewater samples, with these genes being detected more reliably by the passive samplers than in the 24-h composite samples. This study therefore demonstrated that passive samplers provide reproducible SARS-CoV-2 RNA and antibiotic resistance gene signals from wastewater and a time-integrated measurement of the sampled matrix with high sensitivity.

CAREGIVING CRISIS: NURSING ASSISTANT TRAINING REQUIREMENTS AND QUALITY OF LIFE IN SKILLED NURSING FACILITIES

Abstract Nursing Assistants (NAs) provide the majority of hands-on care for older adults in skilled nursing facilities (SNFs) while also providing companionship and psychological support. NAs receive a minimum of 75 hours of training in every state with 12 states requiring 120 or more (M=95.2). However, many NAs feel unprepared for the complexities of caring for older adults (Trinkoff et al., 2017). This lack of preparedness likely contributes to high staff turnover in SNFs (Gaivin, 2022) and directly impacts the quality of care (Castle & Endberg, 2006). This research explored the relationship between NA training hours and SNF quality of care citations in the United States. Data from the Centers for Medicare and Medicaid Services (CMS) SNF Quality Reporting Program (QRP) were used to determine the number of quality of life (QOL) citations for 5408 facilities in all 50 states and cross-referenced with the number of training hours required in each state. To control for the influence of a social worker, not required in smaller facilities, only facilities with 100 or more beds were examined. Regression analysis found for every hour increase in training hours, there will be an approximate 4% decrease in the predicted percentage of facilities with less than satisfactory QOL deficiencies. This research provides additional evidence that providing NAs with more training can improve QOL outcomes for residents of SNFs. This has implications for SNFs, assisted living, home health care, adult foster care, and other settings where NAs are employed.

Technologies for capturing and storing carbon dioxide during conversion, use of fuel and gaseous waste from energy production

Relevance. The continued dependence on the combustion of carbon-based fuels for energy and industry leads to the need to develop various categories of technologies to reduce carbon dioxide emissions. Aim. Development of carbon capture and storage technologies for all stages of fuel conversion and processing, ensuring a low-carbon cycle for the production of electrical and thermal energy, as well as industrial and social facilities. Methods. Chemical, physical adsorption and absorption. Results and conclusions. For large industrial and energy producers, for small energy consumers, it is necessary to be guided by the principles of environmental friendliness and efficiency when implementing the production process, and to increase the percentage of carbon dioxide removal, implement decarbonization technologies at all stages of producing electricity and thermal energy. For the category of CO2 removal at the stage of preliminary fuel conversion, adsorbent compositions using predominantly environmentally friendly and inexpensive natural materials based on bentonite have been developed and tested. The collection capacity of the developed adsorbents is 85–98%. For the category of CO2 removal at the stage of fuel use, a hybrid energy system is presented, including a microgas turbine with heat recovery, a high-temperature fuel cell and other devices and material flows connecting them. A pilot industrial prototype of a 30 kW hybrid energy system will produce heat, electricity, steam, and hot water. In this embodiment, the hybrid system can work as an autonomous energy source for small social and commercial facilities, representing a pilot stage of the engineering and design implementation of the results of an industrial-level hybrid system. For the category of carbon dioxide removal at the stage of CO2 separation from the flue gas mixture after fuel conversion, a block for removing CO2 from flue gases using the absorption method was proposed. Solutions of 15% monoethanolamine, 15% ammonia solution, and 6% sodium hydroxide solution showed the best absorption capacity. It is proposed to equip the hybrid energy system with a CO2 capture unit for complete decarbonization of gas emissions based on closed-cycle technology. The proposed technology for capturing and storing carbon dioxide at the post-fuel conversion stage is characterized by ease of implementation and economic accessibility.

Cost-Effective Decontamination of Conventional Laboratory Animal Rooms Using Hydrogen Peroxide Aerosols

Conventional animal facilities lack HVAC systems with HEPA filters and therefore pose great hurdles in maintaining the pathogen-free status of macro-environment of the animal rooms. Even in places where HVAC has no HEPA filters, maintaining clean air in the animal room is a challenge. Production of healthy animals for biomedical research is a key objective of any laboratory animal facility. There are several factors which can contribute to achieve this goal, and macro enviornment is one of them. Decontamination of animal rooms eliminates the pathogens from the room. Chemical liquids and vapours are mainly used as decontaminating agents. Vaporised Hydrogen Peroxide (VHP) technology is being widely used for this purpose. For VHP technology, motorised equimpents are required which are very expensive. Small animal facilities can not afford to buy expensive VHP equipments. Therefore, the present study was planned to find out cost effective alternative for expensive equipments. Fine mist of working solution Huwa-San- TR50 was sprayed over the walls using a domestic Vacuum Cleaner. Effectnivness of decontamination procedure was conducted by microbiological examination of air and surface monitoring with swab methods after 15 mins. of contact time. Our results suggested that after decontamination, there was significant reduction in microbiological load from animal rooms. Hence, alternatively, facilities with tight annual budget can use this technique to limit the microbiological load in animal facilities in cost effective manner.

Provision of hospice and palliative care and implementation of advance care planning for residents in German nursing homes – a cross-sectional study

BackgroundDemographic changes are leading to a rise in the demand for care services, with nursing homes (NHs) playing an increasingly important role in end-of-life care. Evidence suggests that NH residents at the end of life significantly benefit from hospice and palliative care and the implementation of advance care planning (ACP). In 2018, Germany passed a law to promote the implementation of ACP in NHs and to enable the refinancing of ACP services by the statutory health insurance funds. The present study aimed at assessing current hospice and palliative care structures, examining the implementation of ACP and identifying barriers to obtain approval for billing for ACP services under this specific legislative (§ 132 g SGB V).MethodsAs a part of the "Gut-Leben" project, the present study administered a cross-sectional quantitative survey in 2023 to evaluate hospice and palliative care structures, the implementation of ACP, and barriers to ACP approval in German NHs. A questionnaire was distributed to a random sample of N = 1,369 NH managers. Responses were analyzed using descriptive statistical methods.ResultsN = 330 NH managers responded to the questionnaire (24.1% response). The majority described the end-of-life care structures in their region as rather good (77.7; n = 256), and very strong collaboration was reported with general practitioners (54.7%), physiotherapists (42.9%), and palliative care physicians (38.6%). Awareness of the legislative for ACP was reported by n = 201 NHs (64.4%), and 100 (50.3%) of these NHs had already obtained approval. The primary barriers to approval identified by 68 NHs included a lack of available staff (48.5%; n = 33) and a small facility size (27.9%; n = 19).ConclusionsAlthough half of the NHs have implemented ACP, there is still a need to enhance awareness of the ACP legislative. These efforts should aim to reduce the existing barriers to approval, which could be achieved, for instance, by fostering collaboration between NHs or by cooperating with external ACP service providers.

The Capacity of Power of Biogas Plants and Their Technical Efficiency: A Case Study of Poland

The size of a company is a fundamental factor that can influence its efficiency. In larger companies, economies of scale are a key consideration. The objective of this study was to evaluate the technical efficiency of agricultural biogas plants differentiated according to their capacity of power. The study included 43 agricultural biogas plants, which were divided into three groups according to their capacity power: group I, <0.5 MW; group II, 0.5–1 MW; group III, ≥1 MW. In order to assess the technical efficiency of agricultural biogas plants under the research, the Data Envelopment Analysis (DEA) method was applied. It was found that the largest biogas plants were the most efficient. However, the technical efficiency of the smallest biogas plants was not statistically significantly different from that of the largest biogas plants. This indicates that small entities can achieve the technical efficiency at a satisfactory level. For this reason, in the development policy of agricultural biogas plants, the optimal solution is the coexistence of large and small facilities. The smallest biogas plants were more sensitive to changes in the macroeconomic environment than other biogas plants. This may suggest a need to pay more attention to energy policy mechanisms to stabilize their performance in periods of disadvantageous macroeconomic conditions.

Analysis of Natural and Technological Losses of Products in the Collection, Preliminary Preparation and Storage Systems at the Kokdumalok Umid and South Kemachi Mines

This article examines and analyzes the collection and preparation systems in oil fields. It explores the conditions under which various technological schemes are applied during the process. The establishment of large centralized collection points greatly simplifies the collection schemes of oil and liquid hydrocarbons from separate deposits and creates favorable conditions for their integration into large objects. It is more profitable to separate oil and gas in large centralized facilities than in small facilities. Such centralization allows to reduce the loss of light oil fractions, to improve oil production, to provide deeper processing of gas, and to ensure maximum extraction of raw materials for the chemical industry. Today, in the oil and gas regions of many countries, great work is being done on the development of oil and gas gathering systems, and the technical and economic basis of oil and gas gathering and preparation and shipping is being analyzed. In the future, the development of optimized oil collection and preparation systems is planned, with the goal of integrating these systems into national budgets. This article was prepared on the example of a mine as part of the research and includes the application of the results in these mines. The technological losses in the fields during the initial preparation of the extracted oil in the fields were analyzed. In this process, losses of oil with associated gas, together with separated water and by evaporation in the reservoir are considered. The article also calculates the amount of oil that could be recovered by mixing with satellite gas, specifically for the Kokdumaloq and Southern Kemachi fields, and provides recommendations for reducing these losses.

Socioeconomic impact of the war on the hydropower sector of Ukraine

The invasion of Ukraine on February 24, 2022, caused significant military damage to the hydropower sector, critical for energy security and economic development. The article provided an overview of the Ukrainian hydropower sector and the war’s socioeconomic impact on it in 2022-2024. Based on open source data, the research focused on large and small hydropower facilities, examining their roles in electricity generation, stability of the unified energy system of Ukraine, and water supply. The authors’ findings offer insights into the extent of damage for policymakers, scientists, and sector experts.

Radiation protection and personal dosimetry in a core facility for multimodal small animal imaging.

Clinical imaging techniques such as positron emission tomography (PET) in combination with computed tomography (CT) are increasingly being used in biomedical research involving small animal models. The handling of open radioactive substances (radiopharmaceuticals) necessary for PET imaging requires prior official authorization for handling, the application of radiation protection principles, and regular training. The overriding aim of radiation protection is to protect the personnel directly involved, other persons, and the environment from the harmful effects of ionizing radiation.This paper aims to provide an overview of the regulatory requirements of the Radiation Protection Act (StrlSchG), the Radiation Protection Ordinance (StrlSchV), and the associated standards and guidelines. Furthermore, their implementation in practical work in small animal imaging using PET/CT is shown. We will focus on the individual steps of the imaging process, from delivery of the radiopharmaceuticals to waste disposal. This should provide interested researchers with an initial overview of the safe and successful use of the method. In addition, exposure values from the last six years in the literature were analyzed. While personal dosimetric monitoring in clinical PET/CT imaging has been extensively published, there is no published data known to us for personnel for PET/CT research with small animals. The evaluation of the personal dosimetric monitoring of our small animal imaging facility with 7 employees over 4 years revealed an increased personal and finger dose normalized to the injected activity and compared to human PET/CT imaging. Nevertheless, the annual personal dose or annual finger dose in small animal imaging (Hp(10): 1.7 mSv, Hp(0.07): 64 mSv) is lower than for personnel performing human PET/CT imaging at the local University Department of Nuclear Medicine (Hp(10): 3.8 mSv, Hp(0.07): 156 mSv) or published values, and is well below the legally permissible maximum dose of 20 or 500 mSv per year.The increasing use of PET/CT in small animal research can be safely utilized if the radiation protection principles are implemented and continuously trained. · PET/CT imaging in small animals is increasingly used in biomedical research.. · Radiation protection laws and guidelines have to be known and are relevant in animal experiments.. · Compared to published values from human medicine, activity-specific employee doses are increased in the presented imaging facility.. · The legal personal dose in the studied imaging facility is below legal limits.. · Schildt A, Sänger P, Lütgens M et al. Radiation protection and personal dosimetry in a core facility for multimodal small animal imaging. Fortschr Röntgenstr 2024; DOI 10.1055/a-2462-2419.

Federalism in the ambulance service - a country comparison of physician-accompanied secondary transport

The consolidation of the hospital market is being driven by economic constraints, as smaller facilities are often no longer able to operate profitably. The trend towards centralisation is being driven politically by the hospital reform and is intended to improve the quality of care through specialisation and concentration of resources. However, by 2022, only 1075 hospitals in Germany will still have the capacity to provide intensive care [1].

The location routing problem with time windows and load-dependent travel times for cargo bikes

The location routing problem with time windows and load-dependent travel times for cargo bikes

Design of a small gas flow calibration facility by piston prover method

Design of a small gas flow calibration facility by piston prover method

Towards sustainable agricultural water management in Poland – How to meet water demand for supplemental irrigation?

Towards sustainable agricultural water management in Poland – How to meet water demand for supplemental irrigation?

Nurses' and Nursing Assistants' Experiences With Teleconsultation in Small Rural Long-Term Care Facilities: Semistructured Interview Pilot Study.

In Quebec, the shortage of nurses during night shifts compromises the safety and quality of resident care, particularly in small residential and long-term care centers ("Centres d'hébergement et de soins de longue durée"; CHSLDs) located in rural areas. The need to ensure the continuous presence of nurses 24 hours a day in CHSLDs has become more pressing, forcing some facilities to implement exceptional measures such as on-call telephone services to ensure access to a nurse. In light of these challenging circumstances, the Direction nationale des soins et des services infirmiers of Quebec's Ministère de la Santé et des Services sociaux has rolled out a teleconsultation pilot project. This study aims to explore nurses' and nursing assistants' experience of integrating teleconsultation during night shifts in rural CHSLDs with ≤50 residents. The 6-month pilot project was rolled out sequentially in 3 rural CHSLDs located in 2 administrative regions of Quebec between July 2022 and March 2023. A total of 18 semistructured interviews were conducted with 9 nurses and nursing assistants between February and July 2023. Participants' experiences revealed that teleconsultation provided significant added value by improving clinical, administrative, and organizational practices. Some practices remained unchanged, indicating stable workflows. Workflow optimization through an expanded scope of practice ensured efficient and safe continuity of care. Enhanced collaboration between nurses and nursing assistants led to improved care coordination and communication. The leadership played a significant role in clarifying professionals' roles and in supporting effective adaptation to teleconsultation. This pilot project represents a significant step forward in improving care for CHSLD residents in Quebec. Teleconsultation not only makes it possible to overcome recruitment challenges and ensure the continuous presence of nurses during night shifts but also optimizes professional practices while ensuring the safety and quality of care provided to residents.

ANALYSIS OF THE SECURITY SITUATION AND THE STATE OF THE UNDERGROUND ENVIRONMENT IN UKRAINE

Statement of the problem. The use of underground space for the protection of civilians, as well as an opportunity to ensure the safe location of small industrial facilities, is an urgent task today, given the martial law in the country. Objective. To investigate the use of the underground environment of Ukraine for the safety of the population, taking into account the consequences in terms of the number of civilian casualties during rocket attacks (according to open data of the United Nations) and to draw attention to the lack of safe places for civilians by analysing the individual risk in Ukraine. A risk map was developed based on the calculated data, indicating risk zones. Conclusions. Theoretically, based on the analysis of the historical development of underground construction in the world and in Ukraine, the article shows the wide attention to underground construction both for security and industrial purposes. The types of modern weapons and the consequences of their use are identified, and data on civilian casualties are analysed depending on the territorial affiliation, taking into account individual risk. Based on the analysis of open UN data (the number of deaths and injuries during the hostilities in Ukraine) and the calculations of the degree of danger risk, a map of danger risk zones by regions of Ukraine was developed, with the distribution of the risk level intensity into zones of extremely high risk, relatively medium, medium and relatively low risk.

The evolving landscape of urban logistics: A study of the Greater Golden Horseshoe

The evolving landscape of urban logistics: A study of the Greater Golden Horseshoe