Standardized Data Collection Methods Research Articles

Analysis of Soil Differences in Subway Vibration Transmission Paths

Current challenges in collecting and analyzing subway vibration data include the absence of standardized data collection methods, limitations in data analysis techniques, and an unclear understanding of the effects of geological conditions on vibrations. This study investigated vertical vibrations of tunnel walls and the ground above tunnels under different geological conditions of soft soil and rock strata at horizontal distances of 0, 15 m, and 30 m from the tunnel center line during train passages. The collected data underwent Fourier transformation and 1/3 octave processing to extract spectral characteristics and analyze transmission losses across different frequency bands. Our findings revealed two vibration peaks in the transmission process for both soft soil and rock formation geology. Specifically, high-frequency vibrations in soft soil experienced greater attenuation when transmitted from the tunnel wall to the ground at 0 m, while low-frequency vibrations in rock formations showed greater attenuation. We also observed a vibration amplification phenomenon at 15 m under soft soil geology conditions. Although low-frequency vibrations below 12.5 Hz showed slight attenuation within a 30 m test distance under both geological conditions, vibrations above 40 Hz experienced significant attenuation. These results offer valuable insights for reducing vibrations in subway superstructures and planning subway lines under diverse geological conditions. Furthermore, this study serves not only as a basis for mitigating vibrations in metro spans and designing metro lines in various geological contexts but also establishes a scientific foundation for future research.

Lead occurrence in North Carolina well water: importance of sampling representation and collection techniques

Private wells often lack centralized oversight, drinking water quality standards, and consistent testing methodologies. For lead in well water, the lack of standardized data collection methods can impact reported measurements, which can misinform health risks. Here, we conducted a targeted community science testing of 1143 wells across 17 counties in North Carolina (USA) and compared results to state testing data primarily associated with new well construction compiled in the NCWELL database. The goal of our study was to explore the impacts of sampling methodology and household representation on estimated lead exposures and subsequent health risks. At the household scale, we illustrated how sampling and analytical techniques impact lead measurements. The community science testing first draw samples (characterizing drinking water) had a 90th percentile lead value of 12.8 μg l−1 while the NCWELL database flushed samples (characterizing groundwater) had a value below the reporting level of 5 μg l−1. As lead was associated with the corrosion of premise plumbing, flushing prior to collection substantially reduced lead concentrations. At the community scale, we examined how the lack of representation based on household demographics and well construction characteristics impacted the knowledge of lead and blood lead level (BLL) occurrence. When simulating representative demographics of the well populations, we observed that the 90th percentile lead level could differ by up to 6 μg l−1, resulting in communities being above the USEPA action level. This translated to a 1.0–1.3 μg dl−1 difference in predicted geometric mean BLL among infants consuming reconstituted formula. Further, inclusion of less common well construction types also increased lead in water occurrence. Overall, under- and overestimations of lead concentrations associated with differences in sampling techniques and sample representation can misinform conclusions about risks of elevated BLLs associated with drinking water from private wells which may hinder investigations of waterborne lead exposure.

Descriptive analysis of the legal ramifications of medication diversion by pharmacy employees

BackgroundMedication diversion, the act of illegally redirecting prescription drugs from their intended path, is a growing problem in the United States, with significant implications for patient safety and the integrity of the health care system.Objective: The objective of this study was to link reported diversion cases from state boards of pharmacy to state court docket records to describe the legal ramifications of medication diversion. MethodsA retrospective analysis of state board of pharmacy records and state court docket records from six states between 2016 and 2021 was completed. ResultsA total of 207 medication diversion cases were identified and 61 of these cases were able to be linked to state court cases. The study found that pharmacy technicians were involved in the majority of cases (77.3%). The study found that medication diversion frequently occurred in community pharmacies (59.2%), involving controlled medications (87.4%). The primary reasons for medication diversion were personal use (43.7%) and undetermined motives (48.5%). Of the 61 cases linked to court cases, prevalent disciplinary actions included “misdemeanor or felony charges” (21.4%) and “jail time, suspended” (9.2%). The findings underscore the need for robust systems and protocols within health care facilities to prevent medication diversion, particularly in pharmacy settings. Measures such as implementing physical and electronic controls, addressing flaws in operations, and conducting thorough background checks during the hiring process are crucial for minimizing the risk of diversion. Furthermore, the study reveals inconsistencies in the disciplinary actions taken by state boards of pharmacy and state legal systems, indicating the need for more standardized and consistent processes for prosecuting medication diversion cases. Future research should aim to include a broader sample size and develop standardized data collection methods to further explore medication diversion and its legal implications. ConclusionIn conclusion, addressing medication diversion requires a collaborative effort between health care facilities and regulatory bodies. By prioritizing prevention strategies and aligning disciplinary actions, the health care system can ensure patient safety, uphold professional integrity, and effectively combat medication diversion.

Characteristics and outcomes of an international cohort of 600 000 hospitalized patients with COVID-19.

We describe demographic features, treatments and clinical outcomes in the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) COVID-19 cohort, one of the world's largest international, standardized data sets concerning hospitalized patients. The data set analysed includes COVID-19 patients hospitalized between January 2020 and January 2022 in 52 countries. We investigated how symptoms on admission, co-morbidities, risk factors and treatments varied by age, sex and other characteristics. We used Cox regression models to investigate associations between demographics, symptoms, co-morbidities and other factors with risk of death, admission to an intensive care unit (ICU) and invasive mechanical ventilation (IMV). Data were available for 689 572 patients with laboratory-confirmed (91.1%) or clinically diagnosed (8.9%) SARS-CoV-2 infection from 52 countries. Age [adjusted hazard ratio per 10 years 1.49 (95% CI 1.48, 1.49)] and male sex [1.23 (1.21, 1.24)] were associated with a higher risk of death. Rates of admission to an ICU and use of IMV increased with age up to age 60years then dropped. Symptoms, co-morbidities and treatments varied by age and had varied associations with clinical outcomes. The case-fatality ratio varied by country partly due to differences in the clinical characteristics of recruited patients and was on average 21.5%. Age was the strongest determinant of risk of death, with a ∼30-fold difference between the oldest and youngest groups; each of the co-morbidities included was associated with up to an almost 2-fold increase in risk. Smoking and obesity were also associated with a higher risk of death.The size of our international database and the standardized data collection method make this study a comprehensive international description of COVID-19 clinical features. Our findings may inform strategies that involve prioritization of patients hospitalized with COVID-19 who have a higher risk of death.

Effects of long working hours on the psychological health during COVID-19 and roles of social services

Aim: This systematic review aims to consolidate global evidence regarding the prevalence and symptomatology of Long COVID in hospitalized and non-hospitalized populations, providing insights into the long-term health effects following COVID-19 infection. Methods: A comprehensive literature search identified 194 studies involving 735,006 participants. The analysis included both hospitalized and non-hospitalized cohorts, focusing on symptom prevalence and associated health outcomes at an average follow-up of 126 days post-infection. Results: The findings reveal that 45% of COVID-19 survivors report at least one unresolved symptom, with fatigue, disturbed sleep, and breathlessness being the most frequently reported issues. Hospitalized patients exhibited a higher prevalence of persistent symptoms (52.6%) compared to non-hospitalized patients (34.5%). The review highlights significant heterogeneity in study designs, methodologies, and symptom reporting, which complicates the interpretation of Long COVID'S prevalence. Conclusion: The review underscores the urgent need for standardized data collection methods to enhance the clinical relevance of future Long COVID research. Given the high incidence of unresolved symptoms, healthcare services and policymakers must prioritize Long COVID care and explore different subtypes to ensure effective, stratified healthcare.

Predictive risk factors of phenoconversion in idiopathic REM sleep behavior disorder: the Italian study “FARPRESTO”

Most patients with idiopathic REM sleep behavior disorder (iRBD) will develop an overt α-synucleinopathy over time, with a rate of phenoconversion of 73.5% after 12 years from diagnosis. Several markers of phenoconversion were identified; however, most studies investigated biomarkers separately, with retrospective study designs, in small cohorts or without standardized data collection methods. The risk FActoRs PREdictive of phenoconversion in idiopathic REM sleep behavior disorder: the Italian STudy (FARPRESTO) is a multicentric longitudinal retrospective and prospective study with a cohort of incident (prospective recruitment) and prevalent (retrospective recruitment) iRBD patients, whose primary aim is to stratify the risk of phenoconversion, through the systematic collection by means of electronic case report forms of different biomarkers. Secondary aims are to (1) describe the sociodemographic and clinical characteristics of patients with iRBD; (2) collect longitudinal data about the development of α-synucleinopathies; (3) monitor the impact of iRBD on quality of life and sleep quality; (4) assess the correlation between phenoconversion, cognitive performance, and loss of normal muscle atony during REM sleep; (5) identify RBD phenotypes through evaluating clinical, biological, neurophysiological, neuropsychological, and imaging biomarkers; and (6) validate vPSG criteria for RBD diagnosis. The FARPRESTO study will collect a large and harmonized dataset, assessing the role of different biomarkers providing a unique opportunity for a holistic, multidimensional, and personalized approach to iRBD, with several possible application and impact at different levels, from basic to clinical research, and from prevention to management. The FARPRESTO has been registered at clinicaltrials.gov (NCT05262543).

Macrobenthic diversity and its bioindicator potential in urban reservoirs: A Sri Lanka case study

AbstractStudies addressing the macrobenthic diversity and their potential as bioindicators in water quality assessment programs are sparse for Sri Lanka. The present study investigated the macrobenthic diversity in relation to water quality parameters in some urban reservoirs in the Western Province of Sri Lanka, assessing their potential as bio‐indicators in water quality assessment programs. The six study reservoirs included the Ihalagama Tank, Peralanda Tank, Kesbewa Tank, Boralesgamuwa Tank, Bolgoda Lake and Beira Lake. The microbenthic fauna abundance at randomly selected locations (n = 9) in each reservoir and selected water quality parameters (temperature; pH; electrical conductivity; total dissolved solids; BOD5; dissolved nitrates; total dissolved phosphate and alkalinity of the overlying water at each location were measured between July 2020 and January 2021, using standard data collection methods). The species richness (SR), species heterogeneity (H′) and species evenness (J) of the macrobenthic fauna in each reservoir were calculated, and the abundance and water quality data analysed using ANOVA and PCA as appropriate. A total of 13 macrobenthic taxa (Glyphidrilus sp., Limnodrilus socialis, Dero sp., Stratiomyd larva, Chironomid larva, Bellamya sp., Melanoides tuberculata, Gyraulus sp., Lymnaea sp., Paludomus sp., Thiara sp., Ancylus sp. and Mesostoma sp.) were observed from the six study reservoirs. The oligochaete tubificid worm L. socialis dominated the sediment samples, accounting for more than 94.7% of the total macrobenthic abundance, with the highest relative abundance of this species observed in Beira Lake (99.3%). The species richness of the macrobenthic community was highest in the Ihalagama and Kesbewa tanks (SR = 5), while it was the lowest in the Peralanda Tank (SR = 2). Since the benthic community was mainly dominated by L. socialis, the lowest species heterogeneity and species evenness values were observed in Beira Lake (H′ = 0.05; J = 0.03). The values of the water quality parameters among the study reservoirs varied, with Beira Lake exhibiting significantly high BOD5, dissolved nitrate, and total dissolved phosphate values (p < .05) than the other reservoirs, indicating a higher degree of eutrophication. Furthermore, the SR, J and H′ values for the study reservoirs decreased with increasing BOD5, dissolved nitrate and total dissolved phosphate levels. Thus, it was concluded that the abundance and diversity of macrobenthic fauna are primarily governed by water quality parameters. Furthermore, L. socialis can be used as a potential bioindicator organism in water quality assessment programs in urban reservoirs.

Costs of multimorbidity: a systematic review and meta-analyses

BackgroundMultimorbidity is a rising global phenomenon, placing strains on countries’ population health and finances. This systematic review provides insight into the costs of multimorbidity through addressing the following primary and secondary research questions: What evidence exists on the costs of multimorbidity? How do costs of specific disease combinations vary across countries? How do multimorbidity costs vary across disease combinations? What “cost ingredients” are most commonly included in these multimorbidity studies?MethodsWe conducted a systematic review (PROSPERO: CRD42020204871) of studies published from January 2010 to January 2022, which reported on costs associated with combinations of at least two specified conditions. Systematic string-based searches were conducted in MEDLINE, The Cochrane Library, SCOPUS, Global Health, Web of Science, and Business Source Complete. We explored the association between costs of multimorbidity and country Gross Domestic Product (GDP) per capita using a linear mixed model with random intercept. Annual mean direct medical costs per capita were pooled in fixed-effects meta-analyses for each of the frequently reported dyads. Costs are reported in 2021 International Dollars (I$).ResultsFifty-nine studies were included in the review, the majority of which were from high-income countries, particularly the United States. (1) Reported annual costs of multimorbidity per person ranged from I$800 to I$150,000, depending on disease combination, country, cost ingredients, and other study characteristics. (2) Our results further demonstrated that increased country GDP per capita was associated with higher costs of multimorbidity. (3) Meta-analyses of 15 studies showed that on average, dyads which featured Hypertension were among the least expensive to manage, with the most expensive dyads being Respiratory and Mental Health condition (I$36,840), Diabetes and Heart/vascular condition (I$37,090), and Cancer and Mental Health condition in the first year after cancer diagnosis (I$85,820). (4) Most studies reported only direct medical costs, such as costs of hospitalization, outpatient care, emergency care, and drugs.ConclusionsMultimorbidity imposes a large economic burden on both the health system and society, most notably for patients with cancer and mental health condition in the first year after cancer diagnosis. Whether the cost of a disease combination is more or less than the additive costs of the component diseases needs to be further explored. Multimorbidity costing studies typically consider only a limited number of disease combinations, and few have been conducted in low- and middle-income countries and Europe. Rigorous and standardized methods of data collection and costing for multimorbidity should be developed to provide more comprehensive and comparable evidence for the costs of multimorbidity.

Consistency of parent-report SLC6A1 data in Simons Searchlight with Provider-Based Publications

BackgroundSLC6A1-related disorder is a recently identified, rare, genetic neurodevelopmental disorder that is associated with loss-of-function variants in SLC6A1. This gene encodes GABA transporter type I that is responsible for re-uptake of GABA from the synapse into the pre-synaptic terminal or circulating neuroglia. Based upon retrospective review of published cases and available research databases including Epi25 collective and SLC6A1 Connect patient database, the phenotypic spectrum is broad and includes developmental delay, epilepsy, and autism or autistic traits. SLC6A1 is one of the genes included in the Simons Searchlight registry, which includes standardized data collection across genetically identified neurodevelopmental conditions.MethodsIn this study, we compare parent-report measures of phenotypic features in the Simons Searchlight registry to previously published, provider-reported cases to assess if parent-report measures are consistent with what has been reported in the literature.ResultsThere were 116 participants in the provider-reported dataset compared to 43 individuals in the caregiver-reported dataset. Carriers in Searchlight had 83 unique pathogenic or likely pathogenic variants in SLC6A1, which were predominantly missense or nonsense variants. There was no significant difference between groups for the prevalence of developmental delay, ASD, or ADHD. Caregivers more often reported hypotonia, while epilepsy was slightly more frequently reported by providers.ConclusionsWe propose that standardized parent-report data collection methods are consistent with provider reports on many core features of SLC6A1-related disorder. The availability of patient registries and standardized natural history studies may fill an important need in clinical trial readiness programs, with larger sample sizes than smaller published case series.

Exploring Family Support Work and Its Staff in Children’s Therapeutic Residential Care

ABSTRACT This is a small-scale case study set out to explore a unique role within children’s residential care in England, that of the Placement Family Support Worker and the family support work they conduct for the children in placement. This subject was explored through semi-structured interviews with seven Keyworkers and two Placement Family Support Workers in a children’s therapeutic residential care service consisting of four children’s homes. It was found that not every home had a Placement Family Support Worker, often due to staff resources and funding, and so often the children’s Keyworker would manage the family support work themselves. In either case, family support work was seen to be highly valuable and significant for the children’s development and relationships. It was found, however, that it would be more beneficial to have an independent Placement Family Support Worker managing family support work for each child in the home rather than Keyworkers for objectivity, healthy relationship management, organization, workload, multi-agency manageability, and the specific skills required. In addition to this, it was felt that emotional and practical support from the other staff in the home and management improved the quality of this work. Practice Implications Children’s residential care homes are recommended to employ a dedicated placement family support worker to manage family support work and contacts for children in placement. Independent placement family support workers will be a resource in developing, maintaining and strengthening relationships between children in placement and their family, alternatively, through objective observations of contact they can advise on continued contact as beneficial or detrimental or even reunification. There needs to be a drive toward consistent practice (initially through standardised data collection methods) and appropriate training for those conducting family support work (including social work skills or prior experience in social work). Due to the complexity of the role and relationship management involved, dedicated spaces for reflection are needed for those conducting family support work.

Adjustment of In-Depth Interview and Focus Group Discussion Guidelines for Disaster Victims Evacuation Model Development with Corona Virus Disease 2019 Pandemic

In developing the disaster victim evacuation (DVE) model, we started with exploratory study is needed to identify the related variables. The exploratory studies are in the form of qualitative and quantitative research. In this qualitative study conducted agent-based in the nursing perspective. To conduct this research, guidelines are needed that are in accordance with the actual situation, such as the global COVID-19 pandemic. Although many articles have been published regarding in-depth interview (II) and Focus Group Discussion (FGD) guidelines, all of them have to be readjusted according to the situation. This adjustment is important to do minimize problems that arise in the data collection process, such as the emergence of new clusters during pandemic of the Covid 19. This study aims to provide a detailed standard in the implementation of the data collection process using the II & FGD method for the DVE Model development and in accordance with pandemic conditions.This literature review study begins with article search and identification of scientific articles. Before the scientific articles are synthesized, a variable identification process is carried out through 2 stages, namely identification to sort articles according to variables and article selection for research main reference needs and references for discussion.. The results of this study are in the form of qualitative research guidelines presented in the form of standard data collection methods using II & FGD. In this article, we recommend aligning the II & FGD guidelines with the development of information technology in exploring Agent-based information. Keywords: In-depth Interview, FGD, disaster & Model

Do environmental variables and overstory communities affect the spatial pattern of understory vegetation? Lessons from Monotheca buxifolia (Falc.) A. DC. forests in Pakistan

The importance of understory vegetation cannot be denied as an integral component of forest ecosystems, but there is a dearth of studies to explore the effects of environmental variables and canopy species on its diversity and composition. Here we investigated the effects of environmental variables and overstory stand structure on the understory vegetation in old-growth Monotheca buxifolia dominated forests with considerable co-dominance of other broadleaved by using ecologically standardized data collection methods across Pakistan. Multivariate analyses were used to examine the vegetation composition and different species assemblages with multiple influencing variables. We found a total of 58 understory species belonging to 55 genera and 30 families mostly representing pluriregional (33.89 %) chorological affinities with therophytic (17 species) life-form dominance and microphyll (34.48 %) leaf-size spectrum. Likewise, significant differences were observed in species richness and diversity indices between different understory community types. Attributes such as elevation, aspect, soil properties, and tree canopy structure were most strongly correlated with the Redundancy Analysis (RDA-ordination), indicating that several factors exert the strongest influence and explained the spatial pattern of understory vegetation. The findings of this research can assist forestry resources managers, forest biologists and ecologists in restoration and conservation plans for understory vegetation in the region.

Cross-national comparisons of health indicators require standardized definitions and common data sources

BackgroundHealth indicators are used to monitor the health status and determinants of health of the population and population sub-groups, identify existing or emerging health problems which would require prevention and health promotion activities, help to target health care resources in the most adequate way as well as for evaluation of the success of public health actions both at the national and international level. The quality and validity of the health indicator depends both on available data and used indicator definition. In this study we will evaluate existing knowledge about comparability of different data sources for definition of health indicators, compare how selected health indicators presented in different international databases possibly differ, and finally, present the results from a case study from Finland on comparability of health indicators derived from different data sources at national level.MethodsFor comparisons, four health indicators were selected that were commonly available in international databases and available for the Finnish case study. These were prevalence of obesity, hypertension, diabetes, and asthma in the adult populations. Our evaluation has three parts: 1) a scoping review of the latest literature, 2) comparison of the prevalences presented in different international databases, and 3) a case study using data from Finland.ResultsLiterature shows that comparability of estimated outcomes for health indicators using different data sources such as self-reported questionnaire data from surveys, measured data from surveys or data from administrative health registers, varies between indicators. Also, the case study from Finland showed that diseases which require regular health care visits such as diabetes, comparability is high while for health outcomes which can remain asymptomatic for a long time such as hypertension, comparability is lower. In different international health related databases, country specific results differ due to variations in the used data sources but also due to differences in indicator definitions.ConclusionsReliable comparison of the health indicators over time and between regions within a country or across the countries requires common indicator definitions, similar data sources and standardized data collection methods.

Supplementing the Forest Health National Aerial Survey Program with Remote Sensing during the COVID-19 Pandemic: Lessons Learned from a Collaborative Approach

The COVID-19 pandemic has created unprecedented challenges in the way the USDA Forest Service conducts business. Standard data collection methods were immediately challenged due to travel restrictions and due to uncertainty regarding when it would be safe to return to a “business as usual” approach. These challenges were met with an inspiring collaboration between forest health specialists directly involved in the annual Aerial Detection Survey (ADS) program and remote sensing specialists from the Forest Service and academia. This group worked together to generate informative training materials, new workflows, and weekly help sessions to directly address problems that arose during this capacity building exercise. Small ad hoc teams were created to identify regionally specific program resources to enhance remote sensing utilization while supplementing information gaps where aerial detection surveys were either limited or not possible. The lessons learned from this challenge provide an opportunity to continue the exploration of combining ADS, remote sensing, and field data to deliver comprehensive information for managing the nation’s forests, while applying what is working and learning and growing from both successes and limitations.Study Implications: The 2020 USDA Forest Service’s (USFS) Aerial Detection Survey (ADS) program faced unprecedented challenges resulting from the COVID-19 pandemic, which limited surveys across nearly all USFS regions. However, this pandemic created an unexpected positive outcome through an ongoing and wide-reaching collaboration between federal, state, academic, and private sectors that has allowed for a strong and lasting collaboration across USFS regions. Moreover, this collaboration has provided a unique opportunity to optimize a combination of ADS, remote sensing, and field visits to deliver a comprehensive, robust, and near-real-time assessment of the health of our nation’s forests.

Using routinely recorded data in a UK RCT: a comparison to standard prospective data collection methods

BackgroundRoutinely recorded data held in electronic health records can be used to inform the conduct of randomised controlled trials (RCTs). However, limitations with access and accuracy have been identified. Objective: Using epilepsy as an exemplar condition, we assessed the attributes and agreement of routinely recorded data compared to data collected using case report forms in a UK RCT assessing antiepileptic drug treatments for individuals newly diagnosed with epilepsy.MethodsThe case study RCT is the Standard and New Antiepileptic Drugs II (SANAD II) trial, a pragmatic, UK multicentre RCT assessing the clinical and cost-effectiveness of antiepileptic drugs as treatments for epilepsy. Ninety-eight of 470 eligible participants provided consent for access to routinely recorded secondary care data that were retrieved from NHS Digital Hospital Episode Statistics (N=71) and primary and secondary care data from The Secure Anonymised Information Linkage Databank (N=27). We assessed data items relevant to the identification of individuals eligible for inclusion in SANAD II, baseline and follow-up visits. The attributes of routinely recorded data were assessed including the degree of missing data. The agreement between routinely recorded data and data collected on case report forms in SANAD II was assessed using calculation of Cohen’s kappa for categorical data and construction of Bland-Altman plots for continuous data.ResultsThere was a significant degree of missing data in the routine record for 15 of the 20 variables assessed, including all clinical variables. Agreement was poor for the majority of comparisons, including the assessments of seizure occurrence and adverse events. For example, only 23/62 (37%) participants had a date of first-ever seizure identified in routine datasets. Agreement was satisfactory for the date of prescription of antiepileptic drugs and episodes of healthcare resource use.ConclusionsThere are currently significant limitations preventing the use of routinely recorded data for participant identification and assessment of clinical outcomes in epilepsy, and potentially other chronic conditions. Further research is urgently required to assess the attributes, agreement, additional benefits, cost-effectiveness and ‘optimal mix’ of routinely recorded data compared to data collected using standard methods such as case report forms at clinic visits for people with epilepsy.Trial registrationStandard and New Antiepileptic Drugs II (SANAD II (EudraCT No: 2012-001884-64, registered 05/09/2012; ISRCTN Number: ISRCTN30294119, registered 03/07/2012))

Quality of Early Essential Newborn Care in hospitals in Gaza: a pre-intervention and post-intervention study

BackgroundIn 2017, the Ministry of Health in Gaza introduced Early Essential Newborn Care (EENC) as its primary maternal and neonatal care strategy. EENC comprises a package of simple evidence-based interventions that are delivered during labour and delivery, and in the early post-partum period, to prevent or treat the most important causes of morbidity and mortality in newborn babies. Four public maternity hospitals in Gaza, responsible for approximately 75% of all deliveries, began implementation of EENC in June, 2017. Clinical coaching was delivered by national facilitators over 2 days, and targeted all clinical staff in maternity and neonatal units. Subsequently, EENC quality improvement teams were formed to address contextual factors that influence practice. This study aimed to determine whether introduction of EENC resulted in changes in clinical practices for vaginal births. MethodsA pre-intervention and post-intervention design was used to review key clinical practices before and after EENC introduction in the four hospitals. Trained data collection staff visited each hospital for 1 day in each of the months of March and June, 2017 (before EENC implementation), January and April, 2018 (in the early stages of EENC implementation), September, 2018, and June, 2019 (after full EENC implementation). Standard WHO data collection methods and tools were used to gather practice data using exit interviews and chart reviews of 10–15 randomly selected post-partum mothers who had delivered vaginally in the previous 2–24 h and had not experienced a newborn death or stillbirth. Delivery observations were conducted for five to ten randomly selected vaginal deliveries using a standard clinical skills observation checklist, beginning at the second stage of labour. The Ministry of Health in Gaza approved EENC assessments for programme use, and informed verbal consent was obtained before maternal interviews. No personal identifiers were used in assessments. Findings259 maternal post-partum interviews and 139 observations of birth practices were done across the four maternity hospitals, representing 8·8% (259 of 2940) and 4·7% (139) of expected vaginal births during the observation periods, respectively. Comparing practices at baseline, early implementation, and after full implementation, significant trend improvements were noted for proportion of babies receiving thorough drying (0% [0 of 12], 49% [32 of 66], 72% [43 of 60], respectively, p<0·0004), immediate skin-to-skin contact (SSC) for less than 1 min (0% [0 of 14], 33% [43 of 127], 66% [72 of 110], p<0·0001), uninterrupted SSC for at least 60 min (0% [0 of 14], 21% [27 of 129], 48% [53 of 111], p<0·0001), uninterrupted SSC for at least 90 min (0% [0 of 14], 10% [13 of 129], 36% [39 of 110], p<0·0001), early breastfeeding (15–90 min after birth) (0% [0 of 15], 39% [50 of 130], 61% [65 of 107], p<0·0001), breastfeeding before separation (0% [0 of 15], 28% [36 of 131], 52% [56 of 108], p<0·0001), and exclusive breastfeeding before discharge (33% [5 of 15], 68% [89 of 131], 81% [87 of 107], p=0·0010). Average clinical practice scores rose from five of 42 (12%) to 16 of 42 (38%) and 24 of 42 (57%). Practice improvements were supported by updated clinical guidelines, hospital policies, and routines, by reorganisation of work, and by the provision of simple supplies, including gowns for mothers and caps for newborn babies. InterpretationThe EENC clinical coaching approach coupled with regular self-assessments and action by hospital teams has significantly improved care practices during delivery and in the early post-partum period. It is possible that periodic cross-sectional practice reviews were not representative of routine practices, which may have varied with time of day, case load, and case complexity. Limitations were mitigated by assessing a systematic random sample of post-partum women delivering throughout the previous 24 h, and by measuring practices in two different time periods in each phase of implementation. Post-partum interviews were used to limit the Hawthorne effect. No other maternal or newborn initiatives were introduced during the study period, and no additional staff training was available, therefore the EENC approach was the primary influence on health worker practices. FundingSupport for this work was provided by WHO, occupied Palestinian territory.

3D Scanning as a Tool to Measure Growth Rates of Live Coral Microfragments Used for Coral Reef Restoration

Rapid and widespread declines in coral health and abundance have driven increased investments in coral reef restoration interventions to jumpstart population recovery. Microfragmentation, an asexual propagation technique, is used to produce large numbers of corals for research and restoration. As part of resilience-based restoration, coral microfragments of different genotypes and species are exposed to various stressors to identify candidates for propagation. Growth rate is one of several important fitness-related traits commonly used in candidate selection, and being able to rapidly and accurately quantify growth rates of different genotypes is ideal for high-throughput stress tests. Additionally, it is crucial, as coral restoration becomes more commonplace, to establish practical guidelines and standardized methods of data collection that can be used across independent groups. Herein, we developed a streamlined workflow for growth rate quantification of live microfragmented corals using a structured-light 3D scanner to assess surface area (SA) measurements of live tissue over time. We then compared novel 3D and traditional 2D approaches to quantifying microfragment growth rates and assessed factors such as accuracy and speed. Compared to a more conventional 2D approach based on photography and ImageJ analysis, the 3D approach had comparable reliability, greater accuracy regarding absolute SA quantification, high repeatability, and low variability between scans. However, the 2D approach accurately measured growth and proved to be faster and cheaper, factors not trivial when attempting to upscale for restoration efforts. Nevertheless, the 3D approach has greater capacity for standardization across dissimilar studies, making it a better tool for restoration practitioners striving for consistent and comparable data across users, as well as for those conducting networked experiments, meta-analyses, and syntheses. Furthermore, 3D scanning has the capacity to provide more accurate surface area (SA) measurements for rugose, mounding, or complex colony shapes. This is the first protocol developed for using structured-light 3D scanning as a tool to measure growth rates of live microfragments. While each method has its advantages and disadvantages, disadvantages to a 3D approach based on speed and cost may diminish with time as interest and usage increase. As a resource for coral restoration practitioners and researchers, we provide a detailed 3D scanning protocol herein and discuss its potential limitations, applications, and future directions.

Core components of infection prevention and control programs at the facility level in Georgia: key challenges and opportunities

BackgroundThe Georgia Ministry of Labor, Health, and Social Affairs is working to strengthen its Infection Prevention and Control (IPC) Program, but until recently has lacked an assessment of performance gaps and implementation challenges faced by hospital staff.MethodsIn 2018, health care hospitals were assessed using a World Health Organization (WHO) adapted tool aimed at implementing the WHO’s IPC Core Components. The study included site assessments at 41 of Georgia’s 273 hospitals, followed by structured interviews with 109 hospital staff, validation observations of IPC practices, and follow up document reviews.ResultsIPC programs for all hospitals were not comprehensive, with many lacking defined objectives, workplans, targets, and budget. All hospitals had at least one dedicated IPC staff member, 66% of hospitals had IPC staff with some formal IPC training; 78% of hospitals had IPC guidelines; and 55% had facility-specific standard operating procedures. None of the hospitals conducted structured monitoring of IPC compliance and only 44% of hospitals used IPC monitoring results to make unit/facility-specific IPC improvement plans. 54% of hospitals had clearly defined priority healthcare-associated infections (HAIs), standard case definitions and data collection methods in their HAI surveillance systems. 85% hospitals had access to a microbiology laboratory. All reported having posters or other tools to promote hand hygiene, 29% had them for injection safety. 68% of hospitals had functioning hand-hygiene stations available at all points of care. 88% had single patient isolation rooms; 15% also had rooms for cohorting patients. 71% reported having appropriate waste management system.ConclusionsAmong the recommended WHO IPC core components, existing programs, infrastructure, IPC staffing, workload and supplies present within Georgian healthcare hospitals should allow for implementation of effective IPC. Development and dissemination of IPC Guidelines, implementation of an effective IPC training system and systematic monitoring of IPC practices will be an important first step towards implementing targeted IPC improvement plans in hospitals.

Employing Standardised Methods to Compare Injury Risk Across Seven Youth Team Sports.

Injury surveillance systems seek to describe injury risk for a given sport, in order to inform preventative strategies. This often leads to comparisons between studies, although these inferences may be inappropriate, considering the range of methods adopted. This study aimed to describe the injury epidemiology of seven youth sports, enabling valid comparisons of injury risk. Consistent methods were employed across seven sports [male American football, basketball, soccer, rugby league, rugby union; female soccer and rugby union] at a high school in England. A 24-hour time-loss injury definition was adopted. Descriptive statistics and injury incidence (/1000 match-hours) are reported. In total, 322 injuries were sustained by 240 athletes (mean age=17.7±1.0) in 10 273 player-match hours. American football had a significantly greater injury incidence (86/1000 h; 95% CI 61-120) than all sports except female rugby union (54/1000 h; 95% CI 37-76). Concussion was the most common injury (incidence range 0.0-26.7/1000 h), while 59% of injuries occurred via player contact. This study employed standardized data collection methods, allowing valid and reliable comparisons of injury risk between youth sports. This is the first known study to provide epidemiological data for female rugby union, male basketball and American football in an English youth population, enabling the development of preventative strategies.

Abstract 13462: 6-minute Walk Test Variability May be Reduced by a Structured Training and Monitoring Program, Potentially Facilitating Detection of Treatment Effects

Background: The 6-minute walk test (6MWT) is well established for evaluation of functional exercise capacity in patients with conditions such as pulmonary hypertension, peripheral arterial disease and heart failure. Its popularity as an endpoint in heart failure trials has increased in parallel with health authority acceptance of the test as a measure of patients' function. Minimizing variability is key to the successful conduct and outcome of trials with 6MWT endpoints. We assessed the impact on walking distance variability of a structured training and monitoring program Methods: After systematically observing conduct of 6MWT worldwide, our core lab developed a multifaceted approach including inspection and standardization of the walking course, standardized training, review of the first 3 tests for each test administrator and random tests thereafter, standardized data collection methods, and assessment of intra-test inconsistencies with feedback. Variability of walking distance using this structured approach is descriptively compared with 6MWT data from the literature. Results: In a multicenter trial which used the structured program, the standard deviation (SD) of distance walked was 21.7% of the mean at baseline and 22.6% at Week 4 (Table). For comparison, we reviewed 2018-19 reports of 6MWT not utilizing this structured approach and identified 5 multicenter studies of patients with heart failure which reported mean and SD of distance walked (Table). Baseline distance walked ranged from 104 to 385 m (weighted mean 220.4 m); SD of distance walked ranged from 28% to 135% of distance walked (weighted mean 70.9%). Conclusion: Standardization of the 6MWT walking course, structured training of test administrators and monitoring of test quality may reduce test variability which could improve accuracy of treatment effect assessment and possibly require smaller sample sizes.