System-wide Policies Research Articles

Awareness of school teachers about students common emergencies during school time in the eastern region, Saudi Arabia: A cross-sectional study.

Schools have to ensure student safety and well-being. However, medical emergencies involving injuries are common, requiring teachers to provide prompt first aid before professional care arrives. This study assessed knowledge and awareness of first aid among school teachers to identify areas needing improvement. This cross-sectional study surveyed 371 teachers from the eastern region primary schools using a standardized questionnaire assessing first aid knowledge across areas like bleeding control, fractures, seizures, choking, and burns. Demographic factors were analyzed for correlations with knowledge levels. Pearson's Chi-square tests analyzed bivariate relationships comparing correct knowledge identification percentages across teacher sociodemographic. The level of statistical significance was at a P value <0.05 across tests. Only 157 teachers felt able to appropriately handle medical emergencies. Major knowledge gaps existed regarding airway obstruction and chemical injuries, with 168 unable to identify correct responses for choking first aid and 105 unsure of chemical burn management steps. Appropriate fracture management was lacking, with just 70 correctly endorsing nose pinch for nosebleeds. Cardiopulmonary resuscitation knowledge was inadequate, with 57 of teachers unaware of the basics. Teachers demonstrating higher knowledge levels overwhelmingly had prior first aid training (153, 66.5%) compared to untrained counterparts (89, 63.1%). The study revealed poor first aid knowledge among elementary school teachers for effectively managing child emergencies. Strategies enhancing delivery must address barriers around training access, knowledge attrition, and variability in baseline skills through sustainable system-wide policies applied nationally. Fulfilling schools' ethical obligations toward maintaining student safety requires urgent reforms to bolster emergency preparedness.

The impact of the world’s first regulatory, multi-setting intervention on sedentary behaviour among children and adolescents (ENERGISE): a natural experiment evaluation

BackgroundRegulatory actions are increasingly used to tackle issues such as excessive alcohol or sugar intake, but such actions to reduce sedentary behaviour remain scarce. World Health Organization (WHO) guidelines on sedentary behaviour call for system-wide policies. The Chinese government introduced the world’s first nation-wide multi-setting regulation on multiple types of sedentary behaviour in children and adolescents in July 2021. This regulation restricts when (and for how long) online gaming businesses can provide access to pupils; the amount of homework teachers can assign to pupils according to their year groups; and when tutoring businesses can provide lessons to pupils. We evaluated the effect of this regulation on sedentary behaviour safeguarding pupils.MethodsWith a natural experiment evaluation design, we used representative surveillance data from 9- to 18-year-old pupils before and after the introduction of the regulation, for longitudinal (n = 7,054, matched individuals, primary analysis) and repeated cross-sectional (n = 99,947, exploratory analysis) analyses. We analysed pre-post differences for self-reported sedentary behaviour outcomes (total sedentary behaviour time, screen viewing time, electronic device use time, homework time, and out-of-campus learning time) using multilevel models, and explored differences by sex, education stage, residency, and baseline weight status.ResultsLongitudinal analyses indicated that pupils had reduced their mean total daily sedentary behaviour time by 13.8% (95% confidence interval [CI]: -15.9 to -11.7%, approximately 46 min) and were 1.20 times as likely to meet international daily screen time recommendations (95% CI: 1.01 to 1.32) one month after the introduction of the regulation compared to the reference group (before its introduction). They were on average 2.79 times as likely to meet the regulatory requirement on homework time (95% CI: 2.47 to 3.14) than the reference group and reduced their daily total screen-viewing time by 6.4% (95% CI: -9.6 to -3.3%, approximately 10 min). The positive effects were more pronounced among high-risk groups (secondary school and urban pupils who generally spend more time in sedentary behaviour) than in low-risk groups (primary school and rural pupils who generally spend less time in sedentary behaviour). The exploratory analyses showed comparable findings.ConclusionsThis regulatory intervention has been effective in reducing total and specific types of sedentary behaviour among Chinese children and adolescents, with the potential to reduce health inequalities. International researchers and policy makers may explore the feasibility and acceptability of implementing regulatory interventions on sedentary behaviour elsewhere.

Balancing Access and Success: Admissions Officers’ Sensemaking of Test-Optional Policies at Less-Selective Public Institutions

ABSTRACT The COVID-19 pandemic pushed many institutions and higher education systems to adopt test-optional policies due to challenges accessing testing sites, expanding test-optional policies outside the traditional sphere of private liberal arts and highly selective institutions into public institutions that span from less to highly selective. As public system staff evaluate maintaining test-optional policies in the future, they must balance the needs of students, institutions, and the system. This multiple case study explores participants’ sensemaking, drawing upon interviews with admissions personnel at two public, less-selective institutions in the same state under a system-wide test-optional policy. Our findings suggest that participants’ sensemaking of the test-optional policy interacted with organizational factors to create nuanced views about maintaining the policy long term. Policymakers should account for the varied test-optional experiences at different institutions when deciding how to proceed with their test-optional policies.

CUNY case serves as reminder for colleges, universities to ensure accessibility of course content

The U.S. Department of Justice, through the U.S. Attorney for the Southern District of New York, has reached a voluntary compliance agreement with the City University of New York. The agreement requires CUNY to prepare and implement systemwide policies to ensure improved accessibility of educational content, proper training of staff and facility, and effective modifications and auxiliary aids and services (bit.ly/3OD3icq).

Driving systemic reform and enhancing professional capital: the transformative roles of excellent retired principals

PurposeThis study examines the deployment of excellent retired principals (ERPs) as system leaders to facilitate systemic professional capital building in Taipei City, Taiwan. It explores the unique approach of the Taipei City government and contributions of ERPs in driving educational reforms.Design/methodology/approachThis study combines the perspectives of system leadership and professional capital, and analyzes the roles and practices of ERPs in promoting professional capital in Taipei's local education system. It draws on qualitative data gathered through interviews and document analyses.FindingsThe findings reveal that the Taipei City government adopted a systemic approach by appointing designated retired principals as system leaders. The findings are categorized into three themes. ERPs serve as systemic capacity-builders, enhancing leadership across the local education system; ERPs act as collaborators and bridge-builders, fostering joint work and a collective sense of professional responsibility; and ERPs function as facilitators and advisors, cultivating decisional capital by providing informed decision-making support based on their experiences and wisdom. These roles challenge the notion of late-career decline, highlight the ongoing contributions of ERPs to the education system, and extend professional capital beyond teacher development, influencing system-wide collective capacity-building, collective responsibility, and policy enactments.Originality/valueThis study contributes to understanding how exceptional retired principals can drive systemic reform and build systemic professional capital. It expands previous research by highlighting the unique Chinese cultural context in Taipei City and continued contributions of retired principals to the education system.

Increasing Patient Participation in Colorectal Cancer Screening in Primary Care: An Evidence-Based Improvement Initiative

Colorectal cancer (CRC), although preventable, can be lethal. An evidence-based interprofessional improvement initiative established CRC risk categorization in patients aged 45 to 75 years using national screening guidelines. A system-wide policy was created, and the guidelines were used across 3 primary care settings during every health encounter for 12 weeks to improve compliance, screening, and referrals for CRC. The numbers of Cologuard and fecal immunochemical tests returned by patients increased statistically after implementation (P = 0.001). A clinically significant 12-fold increase in positive screens with increased referrals for colonoscopy was seen. Patient navigators are recommended as best practice in comprehensive screening programs and contribute to increased compliance.

The Association for the Accreditation of Human Research Protection Programs: 15 years of emphasizing research safety, ethics, and quality

This year marks the 15th anniversary of the founding of the Association for the Accreditation of Human Research Protection Programs (AAHRPP), an organization that has been instrumental in strengthening protections for research participants. AAHRPP was established by seven Founding Members in response to a series of high-profile incidents that shook the foundation of the U.S. research enterprise. The Founding Members viewed voluntary accreditation as one way to strengthen research protections and restore and preserve public trust. Today, AAHRPP accreditation is widely regarded as the gold standard for research protections. To attain accreditation, organizations must demonstrate that they adhere to rigorous standards covering three domains: The Organization, The Institutional Review Board or Ethics Committee, and Researcher and Research Staff. The emphasis is on system-wide policies and procedures that strengthen an organization’s commitment to participants and help ensure a more consistent, more effective approach to protecting them. Because AARHPP accreditation is considered an objective indicator of quality, the benefits to accredited organizations can be considerable. Their accreditation status sends a signal — to potential research partners, to sponsors and other funders, and to research participants — that the organization has the systems in place to conduct research in a scientifically and ethically sound manner.

Burden of falls attributable to low bone mineral density among people aged 60 years and over in China from 1990 to 2019.

Falls in older people have become a major public health, economic and societal problem. Osteoporosis predisposes older adults to high risk of falls, which were the most common outcome attributable to low bone mineral density (LBMD). In this study, we analyze the long-term trends in falls burden attributable to LBMD among people aged 60 years and over from 1990 to 2019, using data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019). Data from GBD 2019 were used to assess the long-term trends in mortality and disability-adjusted life-year (DALY) rates by Joinpoint regression. The age-period-cohort (APC) model was used to evaluate the effects of age, period and cohort on mortality rate of falls attributable to LBMD. The mortality and DALYs rates of falls attributable to LBMD among people aged 60 years and over increased from 1990 to 2019, with average annual percentage changes (AAPCs) of 1.74% (95% CI: -1.47 to 2.01%) and 0.99% (95% CI: 0.80-1.19%), respectively. APC analysis revealed that the mortality rate due to LBMD significantly increased among the older people over the age of 75 years. The risk of falls mortality due to LBMD during the period of 1990-2019 initially declined but later elevated. An overall increasing risk for falls death attributable to LBMD was presented across birth cohorts, but in cohorts born after 1930, the upward trend has slowed down. The overall net drift per year attributable to LBMD was above 0. The corresponding results showed that the negative impact of period and cohort effects among males was more pronounced than those among females. Falls attributable to LBMD remain an ongoing health burden in the older people in China, and the mortality has been on the rise from 1990 to 2019, especially among the older people aged 80+ years group. The prevention and treatment of LBMD should be emphasized, especially among males and oldest-old people. Furthermore, there is an urgent need to strengthen the implementation of system-wide, integrated and effective public health policies and other health interventions in China.

CUNY Settles Claim of Student with Vision Impairment

The U.S. Department of Justice, through the United States Attorney for the Southern District of New York, has reached a voluntary compliance agreement with the City University of New York. This agreement requires CUNY to prepare and implement systemwide policies to ensure improved accessibility of educational content, proper training of staff and facility, and effective modifications and auxiliary aids and services (https://bit.ly/3OD3icq).

Beyond waste-to-energy: Bioenergy can drive sustainable Australian agriculture by integrating circular economy with net zero ambitions

The race to meet net zero targets by 2050, while rapidly transitioning to a circular economy (CE) within the next decade, is shaping strategic Australian sustainability policy. While the success of integrating CE concepts relies on coordinating system-wide change, policies and strategies are still evolving under the traditional silos of waste and energy management. This presents multiple barriers to critical sectors, such as agriculture, which aims to become an $AUD100 billion industry by 2030. Agri-food systems face the challenge to meet growing global food demand, expected to increase by 70% by 2050, while decreasing emissions, resource use and waste production. Agriculture plays essential push and pull roles in meeting net zero targets and in developing a truly CE. Bioenergy, a critical part of the renewable circular bioeconomy, sits at the intersection of net zero and CE by producing renewable energy and recovering bioresources from waste biomass. By integrating agricultural end-users as key stakeholders, bioenergy can shift from a waste-to-energy process to a multi-resource generating process. These policy areas could be integrated via a similar approach to the Australian National Agricultural Innovation Policy Statement, with the goal of supporting agricultural production, while reducing emissions and maximising renewable resource use efficiency.

MECHANISMS OF IMPLEMENTATION OF THE POLICY OF SELECTIVE REGULATION OF COMMODITY MARKETS IN THE POST-WAR PERIOD

MECHANISMS OF IMPLEMENTATION OF THE POLICY OF SELECTIVE REGULATION OF COMMODITY MARKETS IN THE POST-WAR PERIOD

Modeling Departure time choice of Metro Passengers: A case study of Delhi metro

Delhi metro is suffering from severe congestion due to booming travel demand. Differential pricing is an important and effective measure in traffic demand management (TDM). Whether pricing strategies work depends strongly on the responses of travelers to fare changes. Normally, the fare elasticity of demand is used to describe the relationship between demand changes and fare changes at an aggregate level. It is useful to estimate demand changes for system-wide and long-term pricing policies. However, for regional and short-term (valid time window is short) fare strategies, it is hard to capture the reactions just by the fare elasticity of demand. The retiming elasticity decreases greatly with increasing shift time, and 30 minutes is almost the maximum acceptable shift time for passengers. Moreover, the retiming elasticity of passengers in the middle term is approximately twice that in the short term. Applications of fare optimization are also executed, and the results suggest that optimizing the valid time window of the discount fares is a feasible way to improve the congestion relief effect of the policy, while policymakers should be cautious to change fare structures and increase discounts. Passengers' travel responses to fare changes are very complex and related to various external factors, such as service quality, travel preference, and socioeconomic factors. Past works on travel responses are usually specific to a certain region or transit system and assume that the external factors remain the same before and after the policy. Flexi fare is a successful measure in Beijing suburban railway and it handles the booming congestion of suburb rail. Modeling in departure time choice plays a vital role in caters the congestion in the metro and distributing the commuters at different intervals of time. The objective of this study is to understand the ridership pattern, mode-choice behaviour, trip purposes of users, and willingness to shift due to fare differential during the peak and non-peak hours in the metro rail system of Delhi. To know the different modeling departure time choice, it is necessary to know the willingness to shift to an off-peak hour or hike in peak hour fare. The study result shows that the users with work trips are willing to pay more but unwilling to shift from peak hour travel, and users with leisure trips are willing to shift to non-peak hour travel if the fare in peak hour changes. Therefore, new fare strategies should be recommended.

Readiness to Change: A Pathway to the Adoption of Trauma-Sensitive Teaching.

Creating a trauma-sensitive classroom requires a shift in perspective from viewing a student's problematic behavior as a function of poor character to considering it contextually. However, a trauma-sensitive perspective may be insufficient for school staff to implement trauma-sensitive practices. Theoretically, motivation, or readiness to change (R2C), is needed to adopt any new behavior. Therefore, the purpose of this study was to examine the role of R2C in the relation between attitudes related to trauma-informed care (ARTIC) and the adoption of trauma-sensitive practices in a school setting. The targeted elementary school primarily serves Black students (83%), living below the federal poverty line. All staff attended an in-service training about trauma-sensitive schools (TSS), in which trauma-sensitive strategies were modeled, and student-friendly, emotional regulation materials were provided. Teachers and staff (n = 40) were assessed one year after receiving the TSS training. Participants reported their ARTIC, R2C, and trauma-informed strategy adoption. Using PROCESS Model 4, R2C fully mediated the relation between ARTIC and reported use of specific trauma-sensitive classroom strategies (β = 0.19, bootstrapped SE = 0.12, 95% LLCI = 0.04, 95% ULCI = 0.49). Facilitating R2C is essential when implementing trauma-sensitive school strategies. System-wide policies that may help promote the uptake of trauma-sensitive practices are described.

Factors Related to Psychiatric Hospital Readmission for Survivors of Human Trafficking

ABSTRACT Human trafficking is a public health concern that has gained attention over the last 25 years. The literature has shown that survivors of trafficking tend to have higher mental health needs due to the complex trauma experienced both related to trafficking and experiences unrelated to trafficking. This study aimed to explore factors related to hospital readmission among patients with lived experiences of human trafficking in an inpatient psychiatric unit. A retrospective chart review was conducted (n = 192, age 18–69) to examine associations between readmission and demographics, trafficking typology, legal status of admission, presenting problem, primary psychiatric diagnosis, substance use diagnosis (SUD), housing status, and length of stay. Chi-square and regression analyses indicated that gender (p = .009), SUD (p = .034), and housing at discharge (p = .036) were significantly related to readmission. Specifically, men, patients with SUD, and those discharged into temporary housing were more likely to be readmitted. These findings highlight the importance of supporting this patient population at discharge. This information can be used to encourage system-wide education and policy improvements, bolster intervention efforts to promote protective factors at discharge, and support the creation of inclusive community resources for all survivors.

Graphical analysis of guideline adherence to detect systemwide anomalies in HIV diagnostic testing.

Analyses of electronic medical databases often compare clinical practice to guideline recommendations. These analyses have a limited ability to simultaneously evaluate many interconnected medical decisions. We aimed to overcome this limitation with an alternative method and apply it to the diagnostic workup of HIV, where misuse can contribute to HIV transmission, delay care, and incur unnecessary costs. We used graph theory to assess patterns of HIV diagnostic testing in a national healthcare system. We modeled the HIV diagnostic testing guidelines as a directed graph. Each node in the graph represented a test, and the edges pointed from one test to the next in chronological order. We then graphed each patient's HIV testing. This set of patient-level graphs was aggregated into a single graph. Finally, we compared the two graphs, the first representing the recommended approach to HIV diagnostic testing and the second representing the observed patterns of HIV testing, to assess for clinical practice deviations. The HIV diagnostic testing of 1.643 million patients provided 8.790 million HIV diagnostic test results for analysis. Significant deviations from recommended practice were found including the use of HIV resistance tests (n = 3,007) and HIV nucleic acid tests (n = 16,567) instead of the recommended HIV screen. We developed a method that modeled a complex medical scenario as a directed graph. When applied to HIV diagnostic testing, we identified deviations in clinical practice from guideline recommendations. The model enabled the identification of intervention targets and prompted systemwide policy changes to enhance HIV detection.

Experiences of Gender Inequity Among Women Physicians Across Career Stages: Findings from Participant Focus Groups.

Background and Purpose:Gender inequity in academic medicine persists despite efforts to the contrary. Even with increasing representation of women physicians in academic medicine, leadership positions and promotion to tenure are still not representative. This study describes the experiences of women physicians at various stages of their careers, uncovering current challenges and potential areas for improvement toward gender equity.Methods:Three focus groups were conducted (n = 28) as part of a national professional development conference: Growth, Resilience, Inspiration, and Tenacity (GRIT) for Women in Medicine: GRIT. We thematically analyzed participant responses to assess perspectives on the impact of experiences, barriers to professional growth, opportunities for improvement, and definitions of success.Results:The major issues the participants faced included subthemes of (1) systemic barriers to success, (2) implicit biases, (3) self-advocacy, and (4) burnout and stress. Solutions for issues that were discussed included (1) fostering supportive communities, (2) encouraging personal and professional development, and (3) the need for system-wide policy changes. We found that most women needed or benefited from the fostering of communities and desired opportunities for developing professional skills. Participants felt institutional transparency for grievances determined the level of support and confidence in reporting instances of mistreatment. Participants tended to define success according to (1) personal success and (2) leaving a legacy.Conclusions/Implications:Despite policy advancements and a social evolution away from discrimination against women, women in medicine continue to experience inequities across career stages. Potential solutions include fostering supportive communities, encouraging personal and professional development, and system-wide policy changes.

Using the theory of planned behavior to understand student intent to use tobacco in California universities

Background: Most tobacco use, including addiction, starts between 18-26 years of age. To prevent this, the University of California (UC) and California State University (CSU) have implemented system-wide tobacco-free policies in recent years. The objective of this study was to investigate the association of the theory of planned behavior (TPB) constructs: attitude, subjective norms (SN), and perceived behavioral control (PBC) with intention to use tobacco among students in tobacco-free universities in California. Additional objectives were to understand whether these primary TPB constructs were influenced by various policy enforcement levels (i.e., communication and signage), and the availability of smoking cessation programs on campus.Methods: In this cross-sectional study conducted during March-May 2018, a survey was administered among students within select UC and CSU campuses. Students were recruited by cold-calling and emailing faculty to request assistance in disseminating an electronic survey to their students.Results: There was a total of 167 survey respondents (mean age=18-24 years). Results indicated that attitude (β=0.12, p&lt;0.025), SN (β=0.18, p&lt;0.001), and PBC (β=0.33, p&lt;0.001) were significantly and positively associated with student intention. Results showed no significant differences between different enforcement levels and TPB constructs but did show significant positive differences in student attitude between campuses that offer smoking cessation programs and campuses that do not (t=2.55, f=6.50, p&lt;0.001).Conclusions: Findings indicate tobacco-free policies positively influence shifts in student attitude and intention to use tobacco on California university campuses. Administrators are encouraged to tailor enforcement messages to increase compliance.

System-wide opioid prescription reduction after shoulder arthroplasty

BackgroundThe nonmedical use of prescription opioids is currently one of the greatest public health issues. This phenomenon was largely driven by the increase in opioid prescriptions in the past few decades. Across specialties, orthopedic surgeons are among the highest prescribers of opioids for pain control. To help individual physicians within healthcare systems adopt and maintain safe prescribing habits, system-wide policies and guidance are needed. The purpose of this study was to determine if the implementation of system-wide changes in prescription practices could result in overall reductions in opioid prescriptions after shoulder arthroplasty. MethodsAn ecological study of opioid prescriptions after shoulder arthroplasty from Q1 2016 to Q3 2018 in a closed healthcare system was conducted. The number of pills and morphine milligram equivalents (MMEs) prescribed in the 28 days immediately after surgery were collected for each patient. A multipronged systemic opioid reduction strategy was adopted over this period, which included (1) an elimination of historical physician prescribing presets in the electronic medical record, (2) a new limitation to a maximum of 20 pills per preset prescription, (3) consistent education and leadership reminders of opioid stewardship using emails, and (4) overlay of a state-mandated prescribing physician review of historical use of controlled substance use in individual patients. Univariable linear regressions were used to determine the trend in average number of pills and MMEs prescribed over the study period, and independent sample Student t-tests were used to compare prescriptions in Q1 2016 to those in Q3 2018. ResultsOver the study period, there were 872 shoulder arthroplasties performed on 840 patients. Univariable linear regression demonstrated a decrease of an average of 1.96 pills (P < .001) and 2.67 MMEs (P < .001) for each progressive quarter. The number of pills prescribed in the first 28 days after surgery decreased 18.7% from an average of 86.1 pills in Q1 2016 to 67.4 pills in Q3 2018 (P < .001). MMEs decreased 24.1% from an average of 103.3 MMEs in Q1 2016 to 78.3 MMEs in Q3 2018 (P < .001). ConclusionThis study demonstrates that it is possible to systematically reduce opioid prescriptions after shoulder arthroplasty using electronic health record changes coupled with physician guidance and state-mandated review. Although opioid needs for pain control vary per patient, system-wide policies can meaningfully reduce opioid prescriptions and help to maintain safe prescribing habits. Level of evidenceLevel III, Retrospective Cohort Designm Prognostic Study

S614 Positive Pre-Procedure COVID-19 Rates Trend Downward as Community Vaccination Rates Rise

Introduction: In response to the COVID-19 pandemic and national guidelines, UCLA Health implemented system-wide policies for resuming safe non-urgent endoscopy on 4/13/2020. These policies included mandatory COVID-19 testing 48 hours prior to all outpatient procedures. In light of declining COVID-19 cases and increasing vaccination rates in the surrounding community in early 2021, we aimed to determine the COVID-19 positive rate among outpatients presenting for elective endoscopy. Methods: UCLA health is a large, integrated health system with 5 outpatient endoscopy units. Our study cohort included all patients scheduled for ≥ 1 outpatient procedures (colonoscopy, EGD, sigmoidoscopy, manometry, pH study, small bowel enteroscopy, manometry, EUS, ERCP) who underwent pre-procedure COVID-19 testing between 4/13/2020 and 4/22/2021. We queried the electronic health record for patient data (age, sex, race/ethnicity), procedure date & type, and COVID-19 test results 48 hours prior to procedure. Our primary outcome was the pre-procedure COVID-19 positive test rate. We compared this rate to the Los Angeles (LA) County COVID-positive test rate and LA county vaccination rates over the same period. We assessed overall COVID-positive test rate by patient demographic characteristics and used univariate and multivariable logistic regression to determine factors associated with a positive test, controlling for age, sex, and race/ethnicity. Results: The study cohort included 17,278 patients, representing 18,533 total scheduled outpatient procedures (Table 1). The cumulative pre-procedure COVID-19 positive test rate in the study cohort was 0.43% (n=79) and the inconclusive rate was 0.11% (n=21). For LA County, the COVID-19 positive test rate was 1.1-15.4% and the vaccination was 1.0-57.7% during the study period (Figure 1). Hispanic race/ethnicity was significantly associated with a positive pre-procedure COVID-19 test result after adjusting for age and sex (adjusted OR: 3.22, 95% CI: 1.82-5.69). Conclusion: The positive test rate in a mandatory pre-procedure COVID-19 testing program was overall low, even during months of high community prevalence. Notably, the monthly COVID-positive rate in our cohort paralleled monthly trends in the surrounding community, and both declined as COVID-19 vaccination rates steadily increased after December 2020. Our results support new guidance to stop routine COVID-19 testing prior to endoscopy given low overall prevalence and risk of transmission.Figure 1.: Trends in UCLA Health COVID-19 positive test rate (red), Los Angeles County COVID-19 positive test rate (blue), and Los Angeles County COVID-19 vaccination rate (green) during the study period.Table 1.: Patient Characteristics and Adjusted Analysis Results. * 2173 cases with missing or unknown race/ethnicity ^ P-value was obtained from tests comparing the demographic characteristics among patients with negative, inconclusive, and positive results using chi-square or student’s t-test. £ Odds ratios were adjusted odds ratios derived from multivariable logistic regression model that included age, gender, and race/ethnicity.

АНГЛИЙСКИЙ ЯЗЫК В КЫРГЫЗСТАНЕ: ВОЗНИКНОВЕНИЕ, ДИНАМИКА РАЗВИТИЯ И ПРОГНОЗ ПРИНЯТИЯ

This article is devoted to the role and status of English language and the development of the English language in Kyrgyzstan, taking into account the global processes related to its functioning in the world and in the post-Soviet Kyrgyzstan. Considering language as a multidimensional phenomenon implies a multiplicity of its complementary statuses and the sociolinguistic functions it performs. The proposed approach is the implementation of the principles of a system-wide linguistic policy based on the assessment of the sociolinguistic situation in Kyrgyzstan, focused on the harmonization of functional and instrumental factors that determine the functioning of the English language in the country. The article analyses the relationship between the sociolinguistic functions of the English language in Kyrgyzstan and the existing mechanisms of national and international law required for their adequate implementation.