Journal articles: 'Bureau of Health Systems'

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Nairn, John, Bertram Ostendorf, and Peng Bi. "Performance of Excess Heat Factor Severity as a Global Heatwave Health Impact Index." International Journal of Environmental Research and Public Health 15, no. 11 (November 8, 2018): 2494. http://dx.doi.org/10.3390/ijerph15112494.

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The establishment of an effective policy response to rising heatwave impacts is most effective when the history of heatwaves, their current impacts and future risks, are mapped by a common metric. In response meteorological agencies aim to develop seamless climate, forecast, and warning heat impact services, spanning all temporal and spatial scales. The ability to diagnose heatwave severity using the Excess Heat Factor (EHF) has allowed the Australian Bureau of Meteorology (the Bureau) to publicly release 7-day heatwave severity maps since 2014. National meteorological agencies in the UK and the United States are evaluating global 7-day and multi-week EHF heatwave severity probability forecasts, whilst the Bureau contributes to a Copernicus project to supply the health sector with global EHF severity heatwave projection scenarios. In an evaluation of impact skill within global forecast systems, EHF intensity and severity is reviewed as a predictor of human health impact, and extended using climate observations and human health data for sites around the globe. Heatwave intensity, determined by short and long-term temperature anomalies at each locality, is normalized to permit spatial analysis and inter-site comparison. Dimensionless heatwave event moments of peak severity and accumulated severity are shown to correlate with noteworthy events around the globe, offering new insights into current and future heatwave variability and vulnerability. The EHF severity metric permits the comparison of international heatwave events and their impacts, and is readily implemented within international heatwave early warning systems.

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Rucinski, John, and Mark Jarman. "Bureau Veritas' demonstration of asset integrity." APPEA Journal 51, no. 2 (2011): 730. http://dx.doi.org/10.1071/aj10110.

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The innovative paradigm developed by Bureau Veritas has been applied to achieve superior outcomes and benefits for a major oil and gas player. The focus of this innovative approach achieved operational security and risk management for the critical ageing assets. The paradigm and its vital components will become the benchmark for the management and improvement of the performance of ageing assets and serve as a fundamental input to new generation design for oil and gas facilities. Among the key challenges in managing the performance (risk and integrity) of new and ageing assets are the understanding of process safety and critical equipment condition. When discussing with senior management the issues foremost on their minds, Bureau Veritas has found the answer is a common theme—how can I be confident the design of new or existing facilities is fit-for-purpose for the duration of the asset’s life? The integrated approach has brought together the leading concepts/tools in process risk management and prognostic health and reliability engineering. These components include rigorous risk-assessments of the process as well as sensing design based on failure mode consequence effect analysis (FMCEA), data acquisition and processing (real-time monitoring and data fusion), diagnostic and prognostic models and systems for the effective management asset(s). The result of this approach creates a value proposition of financial significance advantage.

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Dzubur, Amela, Asim Besic, Ajnija Omanic, Alen Dzubur, and Dragana Niksic. "Basic charasteristics of information system of health insurance in FB&H." Bosnian Journal of Basic Medical Sciences 4, no. 4 (November 20, 2004): 45–50. http://dx.doi.org/10.17305/bjbms.2004.3361.

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Due to the territorial and administrative division in the war period, information system of health protection after the war was divided in two systems, what matched organisation of health insurance in that period. Those information systems were incompatible, developed on different, both, hardware and software. Therefore, Ministry of Health, within the project "Basic hospital services", financed through the World Bank loan, applied new, common information system in health insurance. Goal of this paper is to present basic features of information system of healthinsurance in FB&H, as well as the way of its functioning in respect to other institutions included in the system, respective data bases, sites of entering and updating data, while using data available with Federal Bureau of Health Insurance.

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VanEnk, Lauren, Ronald Kasyaba, Prince Bosco Kanani, Tonny Tumwesigye, and Jeannette Cachan. "Closing the gap: the potential of Christian Health Associations in expanding access to family planning." Christian Journal for Global Health 4, no. 2 (June 30, 2017): 53–65. http://dx.doi.org/10.15566/cjgh.v4i2.164.

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Recognizing the health impact of timing and spacing of pregnancies, the Sustainable Development Goals call for increased access to family planning globally. While faith-based organizations in Africa provide a significant proportion of health services, family planning service delivery has been limited. This evaluation sought to assess the effectiveness of implementing a systems approach in strengthening the capacity of Christian Health Associations to provide family planning and increase uptake in their communities. From January 2014 to September 2015, the capacity of three Christian Health Associations in East Africa—Caritas Rwanda, Uganda Catholic Medical Bureau, and Uganda Protestant Medical Bureau—was strengthened in key components of a systems approach to family planning—training, supervision, commodity availability, family planning promotion, data collection, and creating a supportive environment—with the aim of improving access to women with unmet need and harmonizing faith-based service delivery contributions with the national family planning program. Community-based provision of family planning, including fertility awareness methods, was introduced across intervention sites for the first time. 547 facility- and community-based providers were trained in family planning, and 393,964 people were reached with family planning information. 32,176 clients took up a method, and 43% of clients received this service at the community level. According to a provider competency checklist, facility- and community-based providers were able to adequately counsel clients on new fertility awareness methods. Integration of Christian Health Associations into the national family planning strategy improved through participation in routine technical working group meetings, and the Ministries of Health in Rwanda and Uganda recognized them as credible family planning partners. Findings suggest that by strengthening capacity using a systems approach, Christian Health Associations can meaningfully contribute to national and international family planning goals. Increased attention to mainstreaming family planning service delivery across Christian Health Associations is recommended.

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Arehart, Kathryn Hoberg, Christine Yoshinaga-Itano, Vickie Thomson, Sandra Abbott Gabbard, and Arlene Stredler Brown. "State of the States." American Journal of Audiology 7, no. 2 (October 1998): 101–14. http://dx.doi.org/10.1044/1059-0889(1998/019).

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This study reports the results of a comprehensive survey of 16 states regarding the coordination and characteristics of universal newborn hearing screening, audiologic assessment, and intervention programs. The survey establishes a baseline assessment that was conducted by states as part of their first year of participation in a Maternal and Child Health Bureau grant on state systems for universal newborn hearing screening, assessment, and intervention. States are making progress toward achieving universal newborn hearing screening. However, several issues continue to impede the establishment of statewide systems for linking screening programs to diagnosis and intervention.

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Demichelis, Roberta, Martha Alvarado, Jule F. Vasquez, Nancy Delgado, Cynthia Gómez, Karla Adriana Espinosa, Ana Cooke, et al. "Treating Acute Leukemia during the COVID-19 Pandemic: A Multicenter Latin American Registry." Blood 136, Supplement 1 (November 5, 2020): 41–42. http://dx.doi.org/10.1182/blood-2020-139018.

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Introduction The COVID-19 pandemic has affected the entire world. Health systems have been affected in such a way that patients with diseases other than COVID-19 have suffered serious consequences. In Latin America, the disease has emerged in a fragile system with more disparities, making our patients more vulnerable. Acute leukemia patients have a high risk of severe COVID-19 disease. Various expert recommendations have emerged with the aim of minimizing the risk of COVID-19 without affecting leukemia-related outcomes. However, multiple logistical issues tangentially associated with the pandemic have also appeared, potentially limiting the quality of management of these patients. The objective of this study was to register treatment modifications associated with the COVID-19 pandemic and its short-term consequences in Latin American countries. Methods We included patients older than 14 years, from 14 centers of 4 Latin American countries (Mexico, Peru, Guatemala and Panama), with the diagnosis of acute leukemia, who were on active treatment since the first case of COVID-19 was documented in each country. We documented their baseline characteristics and followed the patients prospectively until July 15, were data-cutoff for this pre-planned analysis was performed. The primary outcome was the incidence of COVID-19 disease and its complications. Secondary outcomes included treatment and consult modifications, and cause of death during the study period. Logistic regression was performed to determine factors associated with COVID-19 and all-cause mortality. Results We recorded the information of 635 patients: 58.1% Ph-negative ALL, 25.7% AML, 9% APL and 7.2% Ph+ALL. The median age was 35 years (14-90 years); 58.8% were consideredf high-risk patients. The majority were on CR (68.3%) receiving consolidation or maintenance therapy, while 14.5% were newly diagnosed and 17.2% with relapsed/refractory disease. The majority (91.8%) were treated in centers that were also receiving COVID-19 patients, 40.2% in centers were patients could not be electively hospitalized for leukemia treatment because of the COVID-19 pandemic. The COVID-pandemic led to treatment-modifications in 40.8% of the cases. Reasons for modifications were associated with logistical issues (22.4%), medical decisions (15.1%) or patient choice (3.3%). The most frequent modification was chemotherapy delay (17.3%) followed by regimen modification (13.4%) and dose-reductions (10.1%). (Figure 1) 83 patients (13.1%) developed COVID-19 disease, the majority mild-moderate disease (54.2%), 27.7% severe disease and 18.1% critically ill; 27.7% required mechanical ventilation and 37.7% died from COVID-19 disease, representing 4.9% of the entire cohort. We identify as risk factors for COVID-19 disease the presence of active leukemia (newly diagnosed or relapsed) (OR 3.46 [95% CI: 2.16-5.5], p<0.001), high-risk leukemia (OR 1.63 [95% CI: 1.54-4.52], p<0.001) and being treated in a center were elective hospitalization was possible (OR 2.17 [95% CI 1.29-3.67], p=0.004). Treatment modifications, appointment prolongations or the use of virtual consultation were not associated with a reduction in the risk of COVID-19. On the other hand, 16.7% of patients died during period analyzed due to leukemia (57.5%), COVID-19 (29.2%) or treatment related-mortality (13.2%). Independent factors associated with mortality were AML vs. ALL (OR 1.89 [95% CI: 1.12-3.18], p=0.016), relapsed-refractory disease (OR 8.34 [95% CI: 4.83-14.41], p<0.001), induction/consolidation vs. maintenance therapy (OR 2.20 [95% CI: 1.25-3.18], p<0.001) and the use of virtual consultation (OR 0.35 [95% CI: 0.13-0.94] p=0.037). (Table 1) Discussion/Conclusions The COVID-19 pandemic led to significant modifications in the standard of care treatment of patients with acute leukemia. The incidence of COVID-19 disease in acute leukemia patients was considerable and more than a third of the patients with acute leukemia and COVID-19 disease died. Despite a short-follow up, 16.7% of the patients died and leukemia-related deaths were the most frequent. In low- and middle-income countries with fragile health systems, the collateral damage for patients with acute leukemia may be just as important as the direct consequences of COVID-19. Disclosures Alvarado: Roche: Speakers Bureau; Novartis: Speakers Bureau; Amgen: Speakers Bureau; Celgene: Speakers Bureau; Alexion: Speakers Bureau. De la Peña-Celaya:Amgen: Speakers Bureau; Janssen: Speakers Bureau; Novartis: Speakers Bureau. Perez:Roche: Speakers Bureau; Celgene: Speakers Bureau; Novartis: Speakers Bureau. Gomez-Almaguer:Amgen: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Novartis: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; AbbVie: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Janssen: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Celgene/BMS: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; AstraZeneca: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Pfizer: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Roche: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau.

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Minihan, Paula M., Sarah N. Fitch, and Aviva Must. "What Does the Epidemic of Childhood Obesity Mean for Children with Special Health Care Needs?" Journal of Law, Medicine & Ethics 35, no. 1 (2007): 61–77. http://dx.doi.org/10.1111/j.1748-720x.2007.00113.x.

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Although the obesity epidemic appears to have affected all segments of the U.S. population, its impact on children with special health care needs (SHCN) has received little attention. Children with special health care needs is a term used in the U.S. to describe children who come to the attention of health care providers and policy makers because they need different services and supports than other children. Government, at both the federal and state levels, has long felt a particular responsibility for safeguarding the health of children with special needs. The definition children with special health care needs, in fact, was developed by a work group established by the U.S. Maternal and Child Health Bureau (MCHB) to assist states in their efforts to develop community systems of services for children with complex medical and behavioral conditions.

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Obafemi, Frances Susan, Olanrewaju Olaniyan, and Frances Ngozi Obafemi. "Equity in Health Care Expenditure in Nigeria." International Journal of Finance & Banking Studies (2147-4486) 2, no. 3 (July 21, 2013): 76–88. http://dx.doi.org/10.20525/ijfbs.v2i3.155.

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Equity is one of the basic principles of health systems and features explicitly in the Nigerian health financing policy. Despiteacclaimed commitment to the implementation of this policy through various pro-poor health programmes and interventions,the level of inequity in health status and access to basic health care interventions remain high. This paper examines theequity of health care expenditure by individuals in Nigeria. The paper evaluated equity in out-of-pocket spending (OOP) forthe country and separately for the six geopolitical zones of the country. The methodological framework rests on KakwaniProgressivity Indices (KPIs), Reynold-Smolensky indices and concentration indices (CIs) using data from the 2004 Nigerian National Living Standard Survey (NLSS) collected by the National Bureau of Statistic. The results reveal that health financing is regressive with the incidence disproportionately resting on poor households with about 70% of the total expenditure on health being financed through out-of-pocket payments by households. Poor households are prone to bear most of the expenses in the event of any health shock. The catastrophic consequences thus push some into poverty, and aggravate the poverty of others. The paper therefore suggests that the country’s health financing systems must be such that allows people to access services when they are needed, but must also protect household, from financial catastrophe, by reducing OOP spending through risk pooling and prepayment schemes within the health system.

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Walker, Christopher. "An overview of the role of government in the organisation and provision of health services in Japan." Australian Health Review 19, no. 2 (1996): 75. http://dx.doi.org/10.1071/ah960075.

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This article is illustrated with reference to health services in the Tokyo Prefecture.It seeks to describe the role of government in the organisation and provision of healthservices in Japan. It is based on experiences gained from a three-month placementat the Tokyo Metropolitan Government Bureau of Public Health in late 1994.Wherever possible the article identifies similarities and differences between theJapanese and Australian health care systems. Part of the analysis has been to identifyareas where opportunities exist for Australian health service providers to developfurther cooperation with particular sectors of the Japanese health system and alsowhere the potential for the export of health services may exist.The health systems of Australia and Japan have points of similarity anddifference. Essentially both systems operate within the context of a compulsoryuniversal health insurance system. However, unlike Australia, the bulk of serviceprovision in Japan is left to the private sector, while government retains the primaryrole of regulator. It is interesting to observe that while the Australian health caresystem is currently exploring options to expand the service range and level ofparticipation of private sector services in health care delivery (within the context ofuniversal health insurance), the Japanese health care system appears to be examiningoptions through which further government intervention can improve service accessand service efficiency. Japan presents opportunities to observe the benefits anddisadvantages of predominantly private sector provision within the context ofuniversal health insurance coverage.

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Babu, Bontha V., and Yogita Sharma. "Health systems research initiative to tackle growing road traffic injuries in India." Journal of Emergency Practice and Trauma 5, no. 1 (April 18, 2018): 2–7. http://dx.doi.org/10.15171/jept.2018.03.

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Road traffic injuries (RTIs) are the sixth leading cause of deaths in India and about 400 deaths take place every day due to road traffic accidents. The present paper analyses the data of the India’s National Crime Record Bureau (NCRB) to assess the burden of RTI. In addition, it reports the health systems research initiated by the Indian Council of Medical Research (ICMR). As per NCRB data, in 2015, 6.3 million persons (50 persons per 10 million population) injured and out of them 1.4 million (11 persons per 10 million population) died in India. Except the NCRB data, there are no nation-wide data on RTI and the data remain poorly collected and sporadic in India. Hence, ICMR has initiated a multi-centric study to establish an electronic-based comprehensive and integrated RTI surveillance system. The second issue on which ICMR undertake research is timely and quality care of RTI patients as many deaths occur either at the scene or en route to the hospital. There is a clear survival and functional benefit for critically injured patients to receive appropriate care within the first 60 minutes of injury (‘golden hour’). Hence, this multicentric study has been initiated to standardize structured evidence-based intervention for safety, efficacy and quality of post-crash pre-hospital and in-hospital trauma care services to improve the outcome in RTI victims. An android-based trauma registry is being built and will be used to assess the impact of interventions. These studies will provide first comprehensive estimates on various epidemiological issues related to RTI. Also, an evidence of improvement through quality post-crash prehospital and in-hospital trauma care services will emerge. These results will contribute to the setting of research and investment priorities and to formulate policies and guidelines.

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Monzón Manzano, Elena, Ihosvany Fernandez-Bello, Raul Justo Sanz, Larissa Valor, Francisco Javier López-Longo, Angel Robles, Teresa Álvarez Roman, Miguel A. Canales, Victor Jimenez-Yuste, and Nora Butta. "Prothrombotic State, Platelet Activation and Netosis in Systemic Lupus Erythematosus." Blood 134, Supplement_1 (November 13, 2019): 1141. http://dx.doi.org/10.1182/blood-2019-127991.

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Introduction: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease of unknown origin characterized by a hypercoagulable state and a high mortality rate. Mechanisms that cause the accelerated deterioration of cardiovascular health in SLE are unknown. Objectives: to characterize the prothrombotic state in SLE patients by global coagulation assays and the contribution of platelets, endothelial damage, microparticles and neutrophil extracellular traps (NETs) in their prothombotic profile. Material and methods: 72 patients and 90 healthy controls were recruited. Patients were classified according to clinical characteristics in: 32 with lupus (SLE group), 29 with SLE and antiphospholipid antibodies (aFL, SLE+aFL group) and 12 who met the criteria for SLE and antiphospholipid syndrome (APS, SLE+APS group). Experimental protocol was approved by La Paz University Hospital Ethics Committee. Venous blood collected in BD sodium citrate tubes (3.2%) was centrifuged at 150 g for 20 min at 23ºC to obtain platelet-rich plasma (PRP). PPP was obtained by centrifugation at 1500 g for 15 min at 23ºC. To obtain neutrophils, whole blood was centrifuged to 1600 rpm 25 min using a Ficoll gradient and red cells were lysed. Rotational thromboelastometry (ROTEM®) was performed in naTEM condition. Clotting time (CT, time from start of measurement until initiation of clotting [in seconds]); alpha angle (tangent to the curve at 2-mm amplitude [in degrees]), Ax (clot firmness at time x, [in mm]) and maximum clot firmness (MCF, [in mm]) were recorded. Procoagulant activity associated to microparticle's content of tissue factor was determined in PPP by Calibrated Automated Thrombogram (CAT) using MP-reagent (4 mM phospholipids, Diagnostica Stago, Spain). We evaluated the endogenous thrombin potential (ETP, the total amount of thrombin generated over time); the lag time (the time to the beginning of the explosive burst of thrombin generation); the peak height of the curve (the maximum thrombin concentration produced) and the time to the peak. Thrombin generation associated to NETs was also measured by CAT. Neutrophils from healthy controls or from LES patients were stimulated with 100 nM PMA in RPMI medium during 45 min at 37º and then cocultivated with PRP adjusted to 105 platelets/µL. NETs formation was verified by fluorescent microscopy performed with DAPI and an anti-myeloperoxidase antibody. Plasma levels of LDL-ox, E-Selectin and PAI-1 were determined by Elisa (R&D Systems, MN, USA and Affymetrix eBioscience, Vienna, Austria, respectively). Platelet activation was analysed by flow cytometry (FCM, FACScan, BD Biosciences). Fibrinogen receptor activation was evaluated through PAC1-FITC binding and release of granule's content was assessed with monoclonal antibodies (mAbs) anti-CD63 and anti P-selectin in quiescent and 100 µM TRAP and 10 µM ADP stimulated platelets. Data were analysed with Graphpad prism and p ≤0.05 was stablished as statistical significance. Results: PAI-1 plasma level was increased in all patient's groups, whereas LDL-ox and E-selectin showed no differences with control cohort (Fig.1). ROTEM demonstrated a procoagulant profile in SLE and SLE+aPL but not in SLE+APS group (Fig. 2). PAI-1 levels correlated with several ROTEM parameters (Table 1). SLE patients and SLE+aFL showed a basal platelet activation. Moreover, SLE group exposed more P-selectin and CD63 than controls (Fig.3). Regarding thrombin generation associated to tissue-factor content of microparticles, no differences were observed between SLE patients and healthy controls. On the other hand, SLE patients had an increased peak of thrombin generation related to NETs formation (control group: 170.3± 58.0, SLE patients: 230.6±39.3, p=0.019). Conclusions: ROTEM® detected a hypercoagulable state in SLE and SLE+aPL patients. The hypercoagulable state might be linked to increased PAI-1 plasma levels and basal platelet activation in SLE and SLE+aPL groups. Moreover, neutrophils from SLE patients seemed to present a basal activation that induced a NETs-related procoagulant state in these patients. SLE+APS patients did not show a hypercoagulable state perhaps because of the presence of lupus anticoagulant and/or to therapeutic treatment of these patients. This work was supported by grants from the FIS-FONDOS FEDER (PI15/01457, NB). NVB holds a Miguel Servet tenure track grant from FIS-FONDOS FEDER (CP14/00024). Disclosures Fernandez-Bello: Novartis, Pfizer, ROCHE, Stago: Speakers Bureau. Robles:ABBVIE, SANDOZ FARMACEUTICA: Speakers Bureau. Álvarez Roman:Sobi: Consultancy, Speakers Bureau; CSL Behring: Consultancy, Speakers Bureau; Roche: Consultancy, Speakers Bureau; Pfizer: Consultancy, Speakers Bureau; Bayer: Consultancy, Speakers Bureau; Novartis: Consultancy, Speakers Bureau; Amgen: Consultancy, Speakers Bureau; Takeda: Research Funding; NovoNordisk: Consultancy, Speakers Bureau. Canales:Celgene: Honoraria; Gilead: Honoraria; Novartis: Honoraria; Janssen: Honoraria, Speakers Bureau; Sandoz: Honoraria; iQone: Honoraria; Takeda: Speakers Bureau; SOBI: Research Funding; Karyopharm: Honoraria; F. Hoffmann-La Roche Ltd: Honoraria, Speakers Bureau. Jimenez-Yuste:Bayer, CSL Behring, Grifols, Novo Nordisk, Octapharma, Pfizer, Roche, Sobi, Shire: Consultancy, Honoraria, Other: reimbursement for attending symposia/congresses , Research Funding, Speakers Bureau. Butta:Novartis: Consultancy; Roche, Pfizer: Speakers Bureau.

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Palla, Rocille Quilantang, Wilfredo Lopez Campos, and Annabelle Del Norte Campos. "HABITAT HEALTH OF ILOILO RIVER - INSIGHTS FROM A STUDY ON BENTHIC COMMUNITY STRUCTURE." Marine Research in Indonesia 38, no. 1 (April 7, 2015): 39–47. http://dx.doi.org/10.14203/mri.v38i1.55.

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In west central Philippines, the monitoring of aquatic systems traditionally focused on dissolved oxygen values and biological oxygen demand, e.g. monitoring by the Environmental Monitoring Bureau around Panay Island. However, single or two factors are considered to be insufficient to assess habitat health precisely. In this paper, we investigated a benthic community and xamined their implications to habitat health of the Iloilo River. According to a prior benthic survey, warning signs pertaining to biotic, abiotic and community factors have been detected. The disturbed onditions in Iloilo River can be attributed to 3 factors; 1) its inherent topography, where bends serve as sinks for materials; 2) the lack of vigorous water exchange that promotes deposition and hinders complete flushing; and 3) the manner of utilization of the river by the local people. We thus concluded that: 1) monitoring for water parameters only is not enough to get a clear picture of habitat health; and 2) proposed that biotic components should be included for monitoring aquatic system.

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Martínez Cordero, Humberto, Camila Peña, Dorotea Fantl, Eloisa Riva, Natalia Paola Schutz, Virginia Abello, Guillermo Ruiz Arguelles, et al. "Sars Cov-2/COVID-19 in Multiple Myeloma Latin-American Patients COVID-Lamm Study on Behalf of Gelamm (Grupo de Estudio Latino- Americano de Mieloma Múltiple)." Blood 136, Supplement 1 (November 5, 2020): 24–26. http://dx.doi.org/10.1182/blood-2020-142823.

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Background The SARS CoV-2 / COVID 19 pandemic has challenged the world's health systems, especially services that treat cancer. The first studies in China showed that cancer patients had a higher risk of becoming infected and dying. Other risk factors for mortality were age over 65 years, male sex, the presence of comorbidity, hypertension, cardiovascular disease, diabetes, and obesity. Data on the specific behavior of patients with multiple myeloma (MM) in the pandemic are scarce. The mechanisms by which MM patients may have a higher mortality are multiple, derived both from the disease itself due to cellular and humoral immunity deficiency as well as from anti-myeloma treatment. The present study aims to establish the behavior of the disease in the pandemic period in Latin America. Methods This is a retrospective case series of in and outpatients with a diagnosis of MM and COVID-19 reported from centers from Latin America between March and July 31, 2020. The analysis of demographic, clinical, laboratory, complications and therapy variables were done using descriptive statistics. A Kaplan Meier survival analysis was performed, with Log Rank statistic. Finally, a Cox regression was performed to identify independent risk factors of worse outcome. Pre-admission characteristics, MM status, and comorbidities constituted the reference model and were used to adjust the association of relevant MM characteristics with mortality. Program used for analysis was SPSS statistics 25. Results Fifty-two patients with COVID-19 and MM from 7 countries were included. Demographic characteristics, comorbidities, infection baseline clinical conditions, treatment, and outcomes are shown in Table 1. The characteristics in terms of MM status are shown in Table 2. When performing the survival analysis, it is evidenced that the survival of the entire cohort at day 49 was 67% Figure 1. When we focus on patients with comorbidities, survival drops to 53.5% +/- 10.6 (CI 95% 53.4 - 99.4 and p value of 0.041) for the same day Figure 2. When performing the obesity analysis, a drop in survival of up to 39% was observed (95% CI 24.448 - 56.76, with p = 0.00001) Figure 3. Adjusted HR for obesity is 5,078 (95% CI 1,389-18,558, α0.014) and mechanical ventilation with a HR of 3,943 (95% CI - 1,296 - 11,998, α0.016) When comparing patients with controlled MM (> PR) versus uncontrolled, the mortality rate was 84% versus 58% respectively (p = 0.109). Comorbidities (presence of either diabetes, arterial hypertension, cardiovascular disease, or "others"), obesity, need of mechanical ventilation, and <VGPR at the time of infection were independent factors of lower survival Table 3. Conclusions Patients with MM and COVID-19 has an overall mortality of approximately 30% and this is strongly influenced by the presence of comorbidities, uncontrolled disease and need of mechanical ventilation. Survival of patients without comorbidities and controlled disease is good, suggesting that this group of patients would not require modification of MM therapy. The main limitations of our study are its retrospective nature and the low number of patients. It must be highlighted that at the time of the analysis most of Latin American countries were still in the peak of the pandemic. Prospective studies are required to elucidate the behavior of these risk factors in mortality, to optimize the management of patients with MM in this period of the SARS CoV-2 / COVID-19 pandemic. Disclosures Peña: BindingSite: Research Funding; Janssen: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Sandoz: Membership on an entity's Board of Directors or advisory committees; Roche: Membership on an entity's Board of Directors or advisory committees; Abbvie: Membership on an entity's Board of Directors or advisory committees; Amgen: Speakers Bureau. Abello:Novartis: Consultancy, Honoraria; Amgen: Consultancy, Research Funding; Takeda: Honoraria, Research Funding; Dr. Reddy's: Consultancy, Research Funding; Abbvie: Consultancy, Research Funding. Idrobo:Abbvie: Honoraria, Speakers Bureau; Tecnofarma: Honoraria, Speakers Bureau; Takeda: Honoraria, Speakers Bureau; Janssen: Honoraria, Speakers Bureau; Amgen: Honoraria, Speakers Bureau. Rojas:Novartis: Consultancy; Roche: Honoraria; Sandoz: Honoraria; Abbvie: Honoraria. Remaggi:Takeda: Honoraria; Raffo Argentina: Honoraria, Research Funding; Janssen: Honoraria, Research Funding; Gador Argentina: Research Funding; Amgen: Honoraria, Research Funding. Alvarado:Celgene: Speakers Bureau; Alexion: Speakers Bureau; Amgen: Speakers Bureau; Novartis: Speakers Bureau; Roche: Speakers Bureau. De la Peña-Celaya:Amgen: Speakers Bureau; Janssen: Speakers Bureau; Novartis: Speakers Bureau. Perez:Novartis: Speakers Bureau; Celgene: Speakers Bureau; Roche: Speakers Bureau.

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Heberlein-Larson, Lea, Leah D. Gillis, Andrea Morrison, Blake Scott, Mary Cook, Andrew Cannons, Elesi Quaye, et al. "Partnerships Involved in Public Health Testing for Zika Virus in Florida, 2016." Public Health Reports 134, no. 2_suppl (November 2019): 43S—52S. http://dx.doi.org/10.1177/0033354919867720.

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The emergence of Zika virus in the Americas in 2015 and its association with birth defects and other adverse health outcomes triggered an unprecedented public health response and a demand for testing. In 2016, when Florida exceeded state public health laboratory capacity for diagnostic testing, the state formed partnerships with federal and commercial laboratories. Eighty-two percent of the testing (n = 33 802 of 41 008 specimens) by the laboratory partners, including Florida’s Bureau of Public Health Laboratories (BPHL; n = 13 074), a commercial laboratory (n = 19 214), and the Centers for Disease Control and Prevention (CDC; n = 1514), occurred from July through November 2016, encompassing the peak period of local transmission. These partnerships allowed BPHL to maintain acceptable test turnaround times of 1 to 4 days for nucleic acid testing and 3 to 7 days for serologic testing. Lessons learned from this response to inform future outbreaks included the need for early planning to establish outside partnerships, adding specimen triage strategies to surge plans, and integrating state and CDC information systems.

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Cantor, Chris, and Kerryn Neulinger. "The Epidemiology of Suicide and Attempted Suicide among Young Australians." Australian & New Zealand Journal of Psychiatry 34, no. 3 (June 2000): 370–87. http://dx.doi.org/10.1080/j.1440-1614.2000.00756.x.

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Objective: This paper summarises a report to the NHMRC the objectives of which were to review research into the epidemiology of youth suicide in Australia and identify gaps in research. Method: Literature searches were conducted. A limited amount of new data analysis was included to shed light on reliability issues of official Australian suicide data. Results: The review examined suicide data systems, including issues to do with coroners, the Australian Bureau of Statistics and alternative systems. The epidemiological areas reviewed included: all ages, youth, age and gender, geographical, socioeconomic, marital, indigenous, migrants, suicides in custody and gay and lesbian suicides. Conclusion: While much is known about the epidemiology of youth suicide, much remains to be clarified. Study of indigenous issues is perhaps the most neglected area; study of family issues may be potentially be the most productive.

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Jorgensen, Sarah, Evan J. Zasowski, Trang D. Trinh, Abdalhamid M. Lagnf, Sahil Bhatia, and Michael J. Rybak. "1227. Development of a Clinical Prediction Model for Mortality in Methicillin-Resistant Staphylococcus aureus Bacteremia." Open Forum Infectious Diseases 5, suppl_1 (November 2018): S372. http://dx.doi.org/10.1093/ofid/ofy210.1060.

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Abstract Background Methicillin-resistant Staphylococcus aureus bloodstream infection (MRSA BSI) is associated with high mortality despite advances in medical care. Mortality prediction may have a profound impact on clinical decision making and risk stratification. Widely used scoring systems such as the Acute Physiology and Chronic Health Evaluation (APACHE) II Score and the Pitt Bacteremia Score were derived in the general critical care and Gram-negative BSI populations, respectively and may be less precise in MRSA BSI. We sought to develop a predictive model (PM) for 30-day mortality in patients with MRSA BSI based on characteristics readily assessable at initial evaluation. Methods Retrospective, singe-center, cohort study in adults with MRSA BSI 2008 to 2018. Patients who did not receive active therapy within 72 hours of index culture were excluded. Independent baseline demographic, clinical and infection predictors of 30-day mortality were identified through multivariable logistic regression analysis with bootstrap resampling and coefficient shrinkage. The PM was derived using a regression coefficient-based scoring method. PM discriminatory ability was assessed using the c-statistic. The optimal threshold score was determined using the Youden Index (J). Results A total of 455 patients were included and 30-day mortality was 16.3%. The PM consisted of five variables and a potential total score of 33. Points were assigned as follows: age (9 points ≥90 years, 6 points 80–89 years, 5 points 70–79 years, 0 points <70 years); Glasgow Coma Scale (8 points ≤9, 5 points 10–13, 0 points ≥14); 7 points infective endocarditis or pneumonia; 5 points serum creatinine ≥ 3.5 dl/L; and four points respiratory rate <10 or >24. The PM c-statistic was 0.860 (95% CI 0.818, 0.902). The PM score with the maximum J value was 13. Thirty-day mortality was 5.2% vs. 44.5% for PM score <13 vs. ≥13 points, respectively (P < 0.001). The sensitivity, specificity, positive predictive value (PV), negative PV, and accuracy using a threshold of 13 points were 77.0%, 81.4%, 44.5%, 94.8%, and 80.7%, respectively. Conclusion Our findings demonstrate a weighted combination of five independent variables readily assessable at initial evaluation can be used to predict, with high discrimination, 30-d mortality in MRSA BSI. External validation is required before wide-spread clinical use. Disclosures M. J. Rybak, Allergan: Consultant, Grant Investigator and Speaker’s Bureau, Research grant and Research support. Achaogen: Consultant, Grant Investigator and Speaker’s Bureau, Consulting fee, Research grant and Research support. Bayer: Consultant, Grant Investigator and Speaker’s Bureau, Consulting fee, Research grant and Research support. Melinta: Consultant, Grant Investigator and Speaker’s Bureau, Consulting fee, Research grant and Research support. Merck: Consultant, Grant Investigator and Speaker’s Bureau, Consulting fee, Research grant and Research support Theravance: Consultant, Grant Investigator and Speaker’s Bureau, Consulting fee, Research grant and Research support. Sunovian: Consultant, Grant Investigator and Speaker’s Bureau, Consulting fee, Research grant and Research support. Zavante: Consultant, Grant Investigator and Speaker’s Bureau, Consulting fee, Research grant and Research support. NIAID: Consultant, Grant Investigator and Speaker’s Bureau, Consulting fee, Research grant and Research support.

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Biran, Noa, Sukhmani Gill, Andrew D. Norden, David H. Vesole, Wallace G. Stephen, Kenneth D. Nahum, David S. Siegel, and Stuart L. Goldberg. "Multiple Myeloma Staging in Real World Clinical Practice Is Suboptimal: Absence of Beta-2-Microglobulin and Serum Lactase Dehydrogenase Testing Are Limiting Factors." Blood 132, Supplement 1 (November 29, 2018): 5587. http://dx.doi.org/10.1182/blood-2018-99-119559.

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Abstract Background: Staging systems, which help define prognosis and influence treatment decisions, for myeloma have evolved. The Durie-Salmon system (DS) was based largely on perceived myeloma cell tumor burden. In 2005, the International Staging System (ISS) was introduced and incorporated beta-2-microglobulin levels (a marker of tumor burden) and serum albumin (a marker of inflammatory cytokines). In 2015 the ISS was revised (R-ISS) to include high risk cytogenetics [17p-, t(4;14), t(14;16)} and serum lactase dehydrogenase (LDH) (correlating with tumor aggressiveness, extramedullary disease and proliferation rate). Although the ISS and R-ISS are relatively simple, they require additional laboratory studies outside of the diagnostic biopsy material and routine chemistry panel. The adequacy of staging using these newer systems in real world settings has not been reported, although only 69% of patients (pts) in the R-IPSS foundational study (Palumbo JCO 2015) had all of the elements available for complete staging. Methods: Cases were identified using the COTA Inc. database, which abstracts and organizes relevant demographic, diagnostic, treatment, and quality data from the electronic health records at all the clinical sites under business associate agreements. Trained COTA Inc. abstractors reviewed and confirmed the medical record-derived data. For the purposes of the present study, any laboratory or pathology report mentioning testing was counted as "tested," regardless of method, vendor, or test completeness. The data were then merged with the study population using blinded identifiers for subsequent analysis. A limitation of this review is failure to document test results (or mention of test performance) in the electronic chart or physician notes, thus tests performed but not documented may not have been counted. Results: 857 pts diagnosed with MM between Jan 1, 2013 and Dec 31, 2016 were identified from 12 northeast USA centers (1 academic and 11 community based) treated by 81 hematologist-oncologists. At the time of MM presentation 831 pts (97%) had EHR documentation of immunoglobulin levels, hemoglobin, calcium concentration, renal function and number of bone lesions to permit Durie-Salmon staging. The ISS requires B2M and albumin; at the time of initial presentation 696 pts (81%) could be classified by the ISS but 161 pts (19%) had no documentation of B2M levels and thus could not be staged. The academic center was more likely to obtain B2M to permit complete ISS (84% academic obtained vs 72% community obtained; p<0.001). The R-ISS incorporates cytogenetic abnormalities and LDH. At the time of initial presentation, in addition to the pts without B2M, 353 pts (41%) had no documentation of LDH testing, 122 pts (14%) had no documentation of t(14;16) testing, 112 pts (13%) were without documentation of t(4;14) testing, and 91 pts (11%) were without documentation of del17 testing. The academic and community centers both failed to collect LDH equally (53% academic obtained vs 56% community; p=0.37; however notable that 18% of the academic patients were referred for transplant after initial staging in the community and may not have source documentation at the Cota center). Thus, only 350 pts (41%) could be classified by R-ISS. There was no difference in adequacy of obtaining R-ISS elements before (40%) and after (44%) publication of the R-ISS in late 2015 (p=0.22). The majority of the pts in the database were DS III at presentation. However DS did not correlate with ISS or R-ISS, thus demonstrating the need to perform the complete diagnostic/staging evaluation [Table1]. Conclusions: In real world (non-research) settings staging of multiple myeloma using the ISS and R-ISS that require laboratories beyond diagnostic marrow based material (including cytogenetics) remains suboptimal and may reflect delayed incorporation of R-ISS (2015) into clinical use. Lack of obtaining B2M and LDH levels at initial presentation is the major deficiency. Table 1 Reclassification of DS staged pts by ISS and R-ISS Disclosures Biran: Amgen: Consultancy, Speakers Bureau; Takeda: Consultancy, Speakers Bureau; Celgene: Consultancy, Honoraria, Speakers Bureau; BMS: Research Funding; Merck: Research Funding. Norden:Cota Inc: Employment. Siegel:Celgene: Consultancy, Honoraria, Research Funding, Speakers Bureau; Amgen: Consultancy, Honoraria, Speakers Bureau; Karyopharm: Consultancy, Honoraria; Novartis: Honoraria, Speakers Bureau; Takeda: Consultancy, Honoraria, Speakers Bureau; Janssen: Consultancy, Honoraria, Speakers Bureau; Merck: Consultancy, Honoraria, Speakers Bureau; BMS: Consultancy, Honoraria, Speakers Bureau. Goldberg:COTA Inc.: Employment, Equity Ownership.

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Liu, Tingting, Kelly Helm Smith, Richard Krop, Tonya Haigh, and Mark Svoboda. "Critical Analysis of the Value of Drought Information and Impacts on Land Management and Public Health." Water 12, no. 4 (April 9, 2020): 1064. http://dx.doi.org/10.3390/w12041064.

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This paper reviews previous efforts to assign monetary value to climatic or meteorological information, such as public information on drought, climate, early warning systems, and weather forecast information. Methods and tools that have been explored to examine the benefits of climatic and meteorological information include the avoided cost, contingent valuation, choice experiments, benefit transfer, and descriptive approaches using surveys. The second part of this paper discusses specific considerations related to valuing drought information for public health and the Bureau of Land Management. We found a multitude of connections between drought and the land management and health sectors in the literature. The majority of the papers that we summarized only report biophysical change, because the economic losses of drought are not available. Only a few papers reported economic loss associated with drought. To determine the value of drought information, we need to know more about the role it plays in decision making and what sources of drought information are used in different sectors. This inventory of methods and impacts highlights opportunities for further research in valuing drought information in land management and public health.

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Gong, Guangwen, Yingchun Chen, Hongxia Gao, Dai Su, and Jingjing Chang. "Has the Efficiency of China’s Healthcare System Improved after Healthcare Reform? A Network Data Envelopment Analysis and Tobit Regression Approach." International Journal of Environmental Research and Public Health 16, no. 23 (December 2, 2019): 4847. http://dx.doi.org/10.3390/ijerph16234847.

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Background: A healthcare system refers to a typical network production system. Network data envelopment analysis (DEA) show an advantage than traditional DEA in measure the efficiency of healthcare systems. This paper utilized network data envelopment analysis to evaluate the overall and two substage efficiencies of China’s healthcare system in each of its province after the implementation of the healthcare reform. Tobit regression was performed to analyze the factors that affect the overall efficiency of healthcare systems in the provinces of China. Methods: Network DEA were obtained on MaxDEA 7.0 software, and the results of Tobit regression analysis were obtained on StataSE 15 software. The data for this study were acquired from the China health statistics yearbook (2009–2018) and official websites of databases of Chinese national bureau. Results: Tobit regression reveals that regions and government health expenditure effect the efficiency of the healthcare system in a positive way: the number of high education enrollment per 100,000 inhabitants, the number of public hospital, and social health expenditure effect the efficiency of healthcare system were negative. Conclusion: Some provincial overall efficiency has fluctuating increased, while other provincial has fluctuating decreased, and the average overall efficiency scores were fluctuations increase.

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Washburn, Paul Jordan. "Organic Business Modeling and the Organism-Ecosystem Unit Duality." International Journal of Patient-Centered Healthcare 9, no. 2 (July 2019): 21–43. http://dx.doi.org/10.4018/ijpch.20190701.oa1.

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The health of a corporation relies most heavily upon healthy human beings' value-based productivity for optimal growth and evolution. A duality between personhoods and their respective systems' weighted impacts are in question, as the U.S. Healthcare industries weighted impact affects all other U.S.-GDP subsectors. The author performed an analysis of 21 main U.S.-GDP subsectors based on unclassified 1960-2014 U.S. Bureau of Economic Analysis reports. The author derived a [Consumption:Value] ratio-based equation, demonstrating results in [0.0,2.0] and U.S. dollar scales. The U.S.-GDP-Healthcare subsector increased its average annual consumption by $122,232,000,000 and was part of the U.S.-GDP's 71.4% demonstrating a reduced value ratio between 1960-1969 and 2005-2014. The author describe a weighted duality of personhoods classification, a potential ripple effect violation, and presents a new description of a pathologic, malignant organic business model due to a negatively balanced [Consumption:Value] alteration. These findings highlight reduced marginal utility and value of the U.S.-Healthcare subsector.

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Wijegunasekara, Himali. "Coordination of Nutrition related Units in Sri Lanka." Journal of Medical Research 6, no. 6 (December 30, 2020): 273–77. http://dx.doi.org/10.31254/jmr.2020.6603.

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All people have a right to good nutrition. However in Sri Lanka, still anemia, underweight and stunting prevail with regional disparities. There are many determinants for poor nutrition and which leads to many adverse outcomes. As these determinants are multifaceted it requires several different sectors to work collaboratively, complement their activities and share resources to improve the nutritional status of the country. In this article; the initiatives such as development of the National Nutrition policy and Strategic frame work; establishment of Presidential Secretariat, Nutrition Secretariat, Nutrition Steering Committee and Nutrition Coordination Division; the contribution of different divisions of the Ministry of Health such as Nutrition Division, Family Health Bureau, Health Education Bureau, Epidemiology Unit, Food Safety unit, Environment and Occupational Health unit, Non Communicable Disease Unit, Youth, Elderly and Disabled unit, Estate and Urban Health Unit, Medical Research Institute, Medical Statistics Unit; Hospital Nutrition Units, food supplement programmes; the assistance of United Nations agencies, Professional Associations, other Ministries of the government and Non-Governmental Organizations; the importance of National Nutrition Surveillance system and the coordination by the Nutrition Coordination Division are described. Author’s feelings regarding the coordination between nutrition related units in the country were expressed. Subsequently, favorable aspects and deficiencies were evaluated and the possible underlying factors and consequences were analyzed. In conclusion, it can be said that a strong coordinating body for inter - sectoral coordination, information feedback, data sharing and analysis; assessment of current level of multi sectoral coordination and multi sectoral interventions; development of provincial specific strategies and micro plans at house hold level; strengthening of community based organizations, village committees and volunteers; proper streamlining of multiple information systems in the country in order to monitor & evaluate the operations to avoid duplications and negligence; are required. Accordingly, recommendations were provided to address the issue.

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Ur-Rehman, K., and A. Zimmer. "Spatial patterns of child health inequalities in the province of Punjab, Pakistan : the advantages of GIS in data analysis." Geographica Helvetica 65, no. 1 (March 31, 2010): 36–47. http://dx.doi.org/10.5194/gh-65-36-2010.

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Abstract. In the overall context of the Millennium Development Goals, Pakistan recently embarked on an effort to collect data regarding crucial issues of human development, such as health, poverty, and education. For their effective use in policy formulation, however, governments need to find ways of making the data easily accessible. It is argued that Geographical Information Systems (GIS) can play a major role here. The data compiled by the Federal Bureau of Statistics at district level are used in this article to develop maps on child health in the province of Punjab. Correlation allows identification of major determinants of the health status of children. For Punjab, these appeared to be mother literacy, vaccination coverage, and the incidence of poverty. Interpolation (here using Inverse Distant Weighting) and variable aggregation allow for easy identification of areas of concern at sub-district level. For Punjab, the areas most affected by negative health conditions are in the southwest. It is argued that health disparities can be addressed more effectively with the help of the presented methods because they help to close the information gap in the health system and contribute toward more precise allocation of funds and infrastructure.

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Garfield, Richard M., Jonathan Polonsky, and Frederick M. Burkle. "Changes in Size of Populations and Level of Conflict Since World War II: Implications for Health and Health Services." Disaster Medicine and Public Health Preparedness 6, no. 3 (October 2012): 241–46. http://dx.doi.org/10.1001/dmp.2012.37.

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ABSTRACTBackground: Armed conflicts include declared cross-border and internal wars and political, ethnic, and religious hostilities. The number of conflicts worldwide and their level of intensity have varied widely during the last 5 decades. Tracking conflicts throughout this period has focused predominantly on the number of individuals killed or displaced from these hostilities through count-based estimation systems, or establishing rates of excess mortality from demographic surveys. This report focuses on people living in areas with conflict by applying an estimated level of conflict intensity to data on the population of each territory with hostilities during 1946 to 2007.Methods: Data from the Uppsala Conflict Data Program/Peace Research Institute Oslo (UCDP/PRIO) Armed Conflict project database on 324 conflicts of any type in countries with populations greater than 500 000 were combined with conflict-intensity estimates from the Center for Systemic Peace and population data from the US Census Bureau International Data Base.Results: More than half a billion people lived in conflict-affected areas in 2007. An increasing proportion of those affected by conflict lived in early postconflict areas, where hostilities were judged or declared during the last 5 years. In the past 2 decades, the average intensity of conflict among those living in areas with a current conflict has gradually declined.Conclusions: A burgeoning population lives in areas where conflict has recently ended, yet most of the world's large-scale medical responses to emergencies focus on high-intensity conflicts. Effective emergency and reconstruction activities in the health sector will depend on reorganizing services to increasingly focus on and transition to low-level and postconflict environments.(Disaster Med Public Health Preparedness. 2012;6:241–246)

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Varela, Ana Ines, Georgina Bendek, Carolina Pavlovsky, Maria Josefina Freitas, Veronica Ventriglia, Alicia Enrico, Maria Elisa Riva, et al. "Real World Efficacy Evaluation of Branded and Copy Imatinib in Chronic Myeloid Leukemia: A Retrospective Multicentric Study from Argentina." Blood 136, Supplement 1 (November 5, 2020): 36–37. http://dx.doi.org/10.1182/blood-2020-137792.

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Background: Data on the safety and efficacy of copy drugs is usually unavailable. Imatinib mesylate is used to treat chronic myeloid leukemia (CML) patients in Argentina since 2002. During the last decade more than ten different imatinib copies are marketed by the different health-care systems in the country, usually for cost issues. In spite of the undoubted benefit of this tyrosine-kinase inhibitor indication in CML, there is no solid evidence that supports copy drug equivalent outcomes for this patient population. Aim: To compare the clinical presentation, treatment response and outcome of a chronic phase (CP) CML patient cohort treated with branded and copy imatinib in the real-life setting. Methods: Multicentric, retrospective trial based on data obtained from medical charts of adult CP CML patients treated with imatinib in 9 centers in Argentina from 2002 to 2020.We analyzed demographic characteristics and clinical characteristics described for branded and copy imatinib treated cohorts. Frequency of complete cytogenetic response (CCyR) at 12 months, Major molecular response or better(≥MMR) at 12, 18 and 24 months and overall MR4.0, MR4.5 and deep molecular response (MR4.0 +MR4.5 IS) were analyzed. Event was defined as failure, progression or CML related death. Kaplan Meier comparison of event free, progression free and overall survival. Statistics: IBM SPSS version 1. Results: A total of 568 CP CML adult patients (pt) treated with imatinib were included. Mean age at diagnosis: 45.7 years (range 18 - 85). Male 55.6% (316/568). Sokal Score was recorded in 471 pt: 57% (269/471) low, 26% (122/471) intermediate and 17% (80/471) high-risk. Median follow-up 107 months (RIQ: 36-149). Branded imatinib treatment 330 (58%) and imatinib copies 238 (42%). For branded and copy imatinib cohorts mean age 46,1 (18-85) and 45.3(18-80), male 53% (175/330) and 59% (141/238), median follow up 102 (RIQ 101-130) and 61 (RIQ 62-146) respectively. Sokal score low 58% (164/284) and 56% (105/187), intermediate 27% (77/284) and 24% (45/187) and high 15% (43/284) and19% (37/187). Frequency of CCyR at 12 months 71% (67/94) and 69% (41/59), ≥MMR at 12 months 57% (79/138) and 43% (39/89), ≥MMR 18m 66 % (61/92) and 71% (43/60), ≥MMR 24m 65% (96/147) and 79% (58/73). Overall MR4, MR 4.5 and Deep MR with branded imatinib 62.4% (186/298), 42% (118/276) and 63% (189/300), compared to 45(97/214), 24% (50/207) and 46% (99/215) with copies. Difference in evaluation throughout the treatment periods with loss of data did not allow response rate statistical comparison in predetermined timepoints. Kaplan Meier Event free survival median 229 months vs 75 months p 0.001, Progression free survival mean 318 months vs 208 pt 0.034 and Overall Survival mean 275 months vs 206 months for branded and copy imatinib respectively. Discussion: Several case reports have shown poor outcomes in patients treated with imatinib copy drugs, including loss of responses previously attained with branded imatinib. This study reports data from a large cohort of CP CML patients treated in daily practice during a long period of time. Treatment results at determined timepoints is comparable. Although management and treatment decisions were performed in different time periods, results show different outcomes in EFS and PFS between patients treated with branded vs copy imatinib. Overall survival in both cohorts is comparable. As studies assesing the safety and efficacy of the copy drugs compared with branded imatinib will hardly be performed this evidence calls for careful attention and strict follow up measures when managing CML patients with copy imatinib. Figure Disclosures Varela: Novartis: Consultancy, Speakers Bureau. Pavlovsky:Pint Pharma: Speakers Bureau; Pfizer: Speakers Bureau; BMS: Speakers Bureau; Novartis: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Freitas:Pfizer: Consultancy, Other: Advisory Board. Pavlovsky:Varifarma: Speakers Bureau; Astra Zeneca: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Janssen: Membership on an entity's Board of Directors or advisory committees, Other: travel grants, Speakers Bureau; Abbvie: Membership on an entity's Board of Directors or advisory committees, Other: Travel grants, Speakers Bureau. Moiraghi:Novartis: Speakers Bureau; BMS: Speakers Bureau.

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Draper, Brian, and Dave Anderson. "The baby boomers are nearly here – but do we have sufficient workforce in old age psychiatry?" International Psychogeriatrics 22, no. 6 (June 3, 2010): 947–49. http://dx.doi.org/10.1017/s1041610210000566.

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In 2011, the baby boomer generation officially commences its residency in the 65 years and over age group (U.S. Census Bureau, 2006). The much anticipated rapid growth in the population aged 65 years and over between 2011 and 2030 will challenge health care systems worldwide. Mental health services for older people will need to prepare for a near doubling of possible demand based upon estimates of the increase in prevalence of mental disorders in late life in this period in the developed world, with the increase likely to be greater in low and middle income countries (Bartels, 2003; Alzheimer's Disease International, 2009). The pressures that this will place upon the old age psychiatry workforce has contributed to the impetus for the Faculties of Psychiatry of Old Age of the Royal College of Psychiatrists and the Royal Australian and New Zealand College of Psychiatrists to prepare a ‘Joint Statement on Specialist Old Age Psychiatry Workforce and Training’ (see Appendix).

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Lisenko, Katharina, Thomas Bruckner, Michael Hundemer, Anita Schmitt, Joe Puthenparambil, Petra Pavel, Jens Hillengass, et al. "A Single Center Comparison Between Two Different Apheresis Systems for Peripheral Blood Stem Cell Collections." Blood 126, no. 23 (December 3, 2015): 1900. http://dx.doi.org/10.1182/blood.v126.23.1900.1900.

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Abstract Introduction: Terumo BCT recently introduced a new system for collecting peripheral blood stem cells (PBSC) with the Spectra Optia® apheresis machine comprising a redesigned disposable kit and an upgraded software version 11.2 (cMNC). This system allows continuous collection of PBSCs, in contrast to the original system where the kit included a chamber for two-step cell separation. The aim of this study was to compare the new cMNC system with the original collection system (MNC) using previously described quality assurance and benchmarking standards [Rosenbaum ER, Wuchter P, et al. Blood (ASH Annual Meeting Abstracts), 2014;124:2458]. Patients and Methods: We performed a retrospective analysis of collection data on 180 patients who underwent PBSC collection between March 2014 and May 2015 at our institution. From March until October 2014 PBSC collection was carried out using the original MNC program with software version 7.2, and from November 2014 the cMNC program with software version 11.2 was used. To achieve a matched comparison, patients were divided into two subgroups according to diagnosis and previous therapy: a homogeneous group of multiple myeloma patients receiving first line therapy (MM group, n=88) and a heterogeneous group of all other patients, including healthy allogeneic stem cell donors (non-MM group, n=92). Patient/donor characteristics are summarized in Table 1. Prediction of the minimum expected CD34+ cells collected /L blood processed was calculated using the formula: (peripheral blood CD34+ cells/µL) × (estimated collection efficiency of 30%) / body weight (kg) [Rosenbaum et al. Cytotherapy, 2012;14:461-466]. To benchmark every LP session, we compared the number of collected CD34+ cells with the predicted number and assessed the performance ratio (collected/predicted CD34+ cells expressed as %). Results: Overall, 61 MNC and 55 cMNC collection days in the MM group and 56 MNC and 55 cMNC collection days in the non-MM group were evaluated. In the MM group 6.2 and 6.0 ×106 CD34+ cells/kg bw were collected using MNC and cMNC systems, respectively (p=0.194). In the non-MM group 5.8 and 5.4 ×106 CD34+ cells/kg bw were collected using MNC and cMNC systems, respectively (p=0.546). The median performance ratio in the MM group receiving first line therapy was 163% with the MNC and 166% with the cMNC system. The median performance ratio in the non-MM group was 137% with the MNC and 125% with the cMNC system. In none of the groups were significant differences in the performance ratio observed for both collection systems (Table 2). Conclusions: No significant difference in collection efficiency and performance ratio between the Spectra Optia® MNC system (software version 7.2) and the new cMNC system (software version 11.2) was seen. This supports the notion, that the cMNC system can be implemented without loss of collection efficiency in a broad variety of autologous patients as well as in allogeneic stem cell donors. Table 1. Patient Characteristics MNC cMNC P-value Multiple myeloma Total patient number n=47 n=41 Age in years (range) 62 (44-74) 55 (40-70) 0.009 Gender 0.942 Male n=26 n=23 Female n=21 n=18 Body weight in kg (range) 79 (54-108) 80 (54-118) 0.722 Non-myeloma Total patient number n=48 n=44 Acute myeloid leukemia n=1 n=0 AL-amyloidosis n=1 n=4 Allogeneic donors n=17 n=13 Germ cell tumor n=2 n=1 Hodgkin lymphoma n=2 n=2 Multiple sclerosis n=0 n=1 Non-Hodgkin lymphoma n=16 n=13 Relapsed multiple myeloma n=3 n=2 Sarcoma n=6 n=8 Age in years (range) 47 (18-71) 43 (13-64) 0.582 Gender 0.157 Male n=31 n=22 Female n=17 n=22 Body weight in kg (range) 72 (49-106) 74 (50-126) 0.368 Table 2. PBSC Collection Parameters and Daily Collection Results Multiple myeloma Non-myeloma Collection regimen MNC cMNC P-value MNC cMNC P-value Total LP sessions 61 55 - 56 55 - Peripheral blood CD34+/µl 74 (12-433) 69 (6-336) 0.520 73 (6-1850) 58 (4-862) 0.928 Predicted result (range) in CD34+ cells ×106 /kg bw 3.76 (0.6-19.4) 3.6 (0.6-14.4) 0.459 4.5 (0.5-55.5) 4.1 (0.3-17.0) 0.637 Collection result (range) in CD34+ cells ×106 /kg bw 6.2 (1.1-40.4) 6.0 (0.7-16.8) 0.194 5.8 (0.5-43.5) 5.4 (0.3-23.7) 0.546 Performance ratio % (range) (actual/predicted coll. result) 163 (74-387) 166 (92-251) 0.886 137 (23-309) 125 (28-432) 0.929 Disclosures Hundemer: EngMab AG: Research Funding. Hillengass:Novartis: Membership on an entity's Board of Directors or advisory committees, Research Funding; Sanofi: Research Funding; Takeda: Honoraria, Other: Travel support; Janssen-Cilag: Honoraria, Other: Travel support; Celgene: Honoraria, Other: Travel support. Witzens-Harig:Roche: Honoraria; Pfizer: Honoraria, Research Funding. Goldschmidt:Millenium: Honoraria, Research Funding, Speakers Bureau; Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Chugai: Honoraria, Research Funding, Speakers Bureau; Onyx: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Celgene: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Bristol-Myers Squibb: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Takeda: Consultancy, Membership on an entity's Board of Directors or advisory committees; Janssen-Cilag: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Amgen: Consultancy, Membership on an entity's Board of Directors or advisory committees. Ho:Genzyme/Sanofi-Aventis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees. Wuchter:Sanofi-Aventis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees.

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Mukherjee, Sudipto, Mehrdad Abedi, Harry P. Erba, Daniel A. Pollyea, Gail J. Roboz, Michael A. Thompson, Chrystal U. Louis, et al. "Healthcare Resource Utilization (HCRU) in Patients (pts) with Newly Diagnosed (ND) Acute Myeloid Leukemia (AML) Treated in the Connect® MDS/AML Disease Registry." Blood 132, Supplement 1 (November 29, 2018): 4736. http://dx.doi.org/10.1182/blood-2018-99-112935.

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Abstract Introduction: A number of treatment (Tx) options are available for ND AML pts including high-intensity (HI) chemotherapy ("7+3" regimen) followed by consolidation chemotherapy or allogeneic hematopoietic cell transplantation, low/intermediate-intensity (LI) therapies (low-dose cytarabine or hypomethylating agents), best supportive care (BSC), or no Tx. While data describing HCRU by AML pts informs health systems, clinicians, and pts of the requirements for managing AML pts, HCRU studies in this population are lacking. An analysis of ND AML pts from the Connect® MDS/AML Disease Registry was conducted to examine HCRU in pts receiving different Tx modalities. Methods: The Connect MDS/AML Disease Registry (NCT01688011) is an ongoing, prospective observational cohort study of pts in the USA with ND AML (aged ≥ 55) or myelodysplastic syndromes (aged ≥ 18). All interventions are conducted in accordance with physicians' standard of care. Pt demographics, disease characteristics, and Tx information were collected at screening and every 3 months from AML pts enrolled from December 2013 to March 2018. HCRU was assessed in ND AML pts according to Tx groups defined as HI, LI, BSC, or no Tx initiated ≤ 45 days post-diagnosis. Unplanned hospitalizations related to disease or Tx-related complications were assessed in all pts at 3 and 6 months post-enrollment. Response to Tx was analyzed in pts receiving HI and LI therapy only. Number of transfusion episodes (red blood cell or platelet) was calculated over 6 months post-enrollment, and at each month in pts receiving HI or LI therapy; data for partial months were excluded to accurately assess transfusion episodes/month. Results: A total of 434 AML pts, treated at 20 academic and 85 community/government centers, were included in the analysis. Median age was 70 years (range 55-92), 65% were male, and 83% were white. 95 (21.9%) pts received BSC/no Tx, 153 (35.3%) received LI therapy and 186 (42.9%) received HI therapy. A higher proportion of pts receiving HI therapy had ≥ 1 hospitalization compared with LI and BSC/no Tx groups (59.7% vs 49.0% vs 24.2%; P < 0.05). Mean number of hospitalization days/month in the HI, LI, and BSC/no Tx groups was 6.8 vs 5.7 vs 3.2 days, respectively. During the first 3 months of Tx, pts in the HI group spent a mean of 20.5 days in hospital vs 11.4 days for pts in the LI group, and 9.5 days for pts receiving BSC/no Tx. During the last 3 months of the study period, the number of hospitalization days decreased across all Tx groups to 10.4, 7.0, and 7.7 days, respectively. There were significant differences in mean monthly transfusion burden over the first 6 months of the study for pts in the HI and LI groups (4.9 vs 2.7 transfusion episodes/month; P < 0.01). During month 1 post-enrollment, the mean number of transfusion episodes in the HI group was 8.3 vs 3.4 in those receiving LI therapy (P < 0.01 after adjusting for insurance status). Over the 6-month study period, the transfusion rate decreased in both groups with a mean decrease of 6.3 and 1.8 transfusion episodes from month 1 to month 6 for HI and LI therapy, respectively (P < 0.01). At month 4, the transfusion rate in pts receiving HI therapy fell below that of the LI group (Figure), coinciding with the end or near completion of consolidation chemotherapy in the HI group. In logistic regression analyses, pts receiving HI therapy were significantly more likely to achieve complete remission (CR) vs pts receiving LI therapy, after adjusting for age, comorbidities, and disease risk (odds ratio = 4.2, 95% confidence interval 1.7-9.1; P < 0.01). Results from a sensitivity analysis, which excluded pts who had received a transplant, were consistent with the main analysis. Mortality rates were not significantly different between LI and HI groups at day 30 and day 60 but were at day 180 (P < 0.01; Table). Conclusions: These findings from the Connect MDS/AML Disease Registry highlight the level of HCRU in ND AML pts treated with different intensity therapies. While HCRU, as measured by transfusion burden and unplanned hospitalizations, was highest in the HI group, pts in the HI group were significantly more likely to achieve CR, and had lower mortality rates at a 180-day landmark. Higher HCRU rates during early Tx in the HI group are likely a reflection of cytopenia-related complications due to the highly myelosuppressive nature of HI regimens. Therefore higher HCRU during early therapy in the HI group may be offset by improved pt outcomes. Disclosures Abedi: BMS: Speakers Bureau; CIRM: Research Funding; Amgen: Research Funding; Celgene: Research Funding; Gilead: Speakers Bureau; Seattle Genetics: Speakers Bureau; Takeda: Speakers Bureau; Celgene: Speakers Bureau. Erba:Astellas: Research Funding; Janssen: Research Funding; Janssen: Research Funding; Glycomimetics: Consultancy, Other: Chair, Data and Safety Monitoring Committee; Amgen: Research Funding; Pfizer: Consultancy, Other: grant; Novartis: Consultancy, Speakers Bureau; Amgen: Research Funding; Novartis: Consultancy, Speakers Bureau; Astellas: Research Funding; Celgene: Consultancy, Speakers Bureau; Jazz: Consultancy, Speakers Bureau; Seattle Genetics: Consultancy, Research Funding; Daiichi Sankyo: Consultancy, Research Funding; Astellas: Research Funding; Janssen: Research Funding; Celgene: Consultancy, Speakers Bureau; Incyte: Consultancy, Speakers Bureau; Amgen: Research Funding; Immunogen: Consultancy, Research Funding; Novartis: Consultancy, Speakers Bureau; Janssen: Research Funding; Amgen: Research Funding; Jazz: Consultancy, Speakers Bureau; Immunogen: Consultancy, Research Funding; Incyte: Consultancy, Speakers Bureau; Astellas: Research Funding; Glycomimetics: Consultancy, Other: Chair, Data and Safety Monitoring Committee; Pfizer: Consultancy, Other: grant; Daiichi Sankyo: Consultancy, Research Funding; Seattle Genetics: Consultancy, Research Funding; Novartis: Consultancy, Speakers Bureau; Takeda/Millenium: Research Funding; Pfizer: Consultancy, Other: grant; Takeda/Millenium: Research Funding; MacroGenics: Consultancy; Pfizer: Consultancy, Other: grant; MacroGenics: Consultancy; Juno: Research Funding; Juno: Research Funding; Seattle Genetics: Consultancy, Research Funding; Agios: Consultancy, Speakers Bureau; Agios: Consultancy, Speakers Bureau; Seattle Genetics: Consultancy, Research Funding; Incyte: Consultancy, Speakers Bureau; Takeda/Millenium: Research Funding; Incyte: Consultancy, Speakers Bureau; Jazz: Consultancy, Speakers Bureau; Takeda/Millenium: Research Funding; Immunogen: Consultancy, Research Funding; MacroGenics: Consultancy; Jazz: Consultancy, Speakers Bureau; Celgene: Consultancy, Speakers Bureau; MacroGenics: Consultancy; Immunogen: Consultancy, Research Funding; Glycomimetics: Consultancy, Other: Chair, Data and Safety Monitoring Committee; Juno: Research Funding; Celgene: Consultancy, Speakers Bureau; Daiichi Sankyo: Consultancy, Research Funding; Juno: Research Funding; Glycomimetics: Consultancy, Other: Chair, Data and Safety Monitoring Committee; Agios: Consultancy, Speakers Bureau; Daiichi Sankyo: Consultancy, Research Funding; Agios: Consultancy, Speakers Bureau. Pollyea:Pfizer: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; AbbVie: Consultancy, Research Funding; Celgene: Membership on an entity's Board of Directors or advisory committees; Argenx: Consultancy, Membership on an entity's Board of Directors or advisory committees; Celyad: Consultancy, Membership on an entity's Board of Directors or advisory committees; Gilead: Consultancy; Curis: Membership on an entity's Board of Directors or advisory committees; Karyopharm: Membership on an entity's Board of Directors or advisory committees; Agios: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding. Roboz:Novartis: Consultancy; Aphivena Therapeutics: Consultancy; Argenx: Consultancy; Celgene Corporation: Consultancy; Roche/Genentech: Consultancy; Eisai: Consultancy; Astex Pharmaceuticals: Consultancy; Pfizer: Consultancy; Janssen Pharmaceuticals: Consultancy; Otsuka: Consultancy; Sandoz: Consultancy; Daiichi Sankyo: Consultancy; Janssen Pharmaceuticals: Consultancy; Orsenix: Consultancy; AbbVie: Consultancy; Eisai: Consultancy; Cellectis: Research Funding; Astex Pharmaceuticals: Consultancy; Argenx: Consultancy; Sandoz: Consultancy; Roche/Genentech: Consultancy; Bayer: Consultancy; Pfizer: Consultancy; Novartis: Consultancy; AbbVie: Consultancy; Jazz Pharmaceuticals: Consultancy; Celltrion: Consultancy; Aphivena Therapeutics: Consultancy; Celgene Corporation: Consultancy; Daiichi Sankyo: Consultancy; Celltrion: Consultancy; Jazz Pharmaceuticals: Consultancy; Orsenix: Consultancy; Otsuka: Consultancy; Bayer: Consultancy; Cellectis: Research Funding. Louis:Celgene: Employment; Cellmedica: Patents & Royalties. Flick:Celgene: Employment. Nifenecker:Celgene: Employment. Kiselev:Celgene: Employment, Equity Ownership. Swern:Celgene: Employment, Equity Ownership. Cogle:Celgene: Other: Steering Committee Member of Connect MDS/AML Registry.

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Salih, Shahla O., Stefania Moramarco, Daniele Di Giovanni, Sivar A. Qadir, Haveen H. Alsilefanee, Faiq B. Basa, and Leonardo Emberti Gialloreti. "Ten-Year Mortality Trends and Natural Causes of Death in the Iraqi Kurdistan." Open Public Health Journal 14, no. 1 (July 13, 2021): 264–71. http://dx.doi.org/10.2174/1874944502114010264.

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Background: Mortality and causes of death are among the most important statistics used in assessing the effectiveness of a country’s health system. Several countries do not have information systems for collecting these data, and they must therefore be estimated from surveys. Objective: This study analyzes mortality data retrieved from official government databases in Iraqi Kurdistan to describe ten-year trends in natural causes of death. Methods: Data for natural causes of death, reported from 2009 to 2018, were extracted from the databases of the Registration Bureau of Births and Deaths and of the Forensic Medicine of the Province of Sulaymaniyah. A sample of 16,433 causes of death was analyzed. Results: Causes of death were coded according to the ICD-10 classification. Overall, cardiovascular diseases were the leading cause of mortality (52.6%), followed by neoplasms (17.7%), infectious and parasitic diseases (8.9%), and genitourinary diseases (6.3%). Neonatal conditions, congenital anomalies, and neurological conditions each accounted for less than 1% each. Numbers of natural deaths by cause and cause-specific mortality rates have been estimated for the entire Region of Iraqi Kurdistan. Comparisons with other sources suggest that there is a substantial amount of underreporting, especially in relation to deaths of infants and under-five children. Conclusion: Our findings confirm that the region is facing a burden of non-communicable diseases, coupled with high proportions of infectious diseases. However, the lack of effective vital statistics with combined under-reported data collection highlights the need for implementation of health monitoring systems. Advancements in generating high-quality data are essential in improving health and reducing preventable deaths. The establishment of a novel Health Information System is discussed.

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Alimam, Samah, Jessica Ann Timms, Richard Dillon, Tracey Mare, Deepti Radia, Hugues De Lavallade, Claire N. Harrison, Shahram Kordasti, and Donal P. McLornan. "Attenuated Immune Responses to the Annual Influenza A Vaccine in Patients with Myeloproliferative Neoplasms." Blood 134, Supplement_1 (November 13, 2019): 1673. http://dx.doi.org/10.1182/blood-2019-129091.

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Background The inflammatory process plays a pivotal role in the pathogenesis of Myeloproliferative neoplasms (MPN)and immune dysregulation has been well described in this population, who may display both impaired regulatory T cell and CD4/natural killer cell function (Barosi, 2014).This inherent immune incompetence means that infections such as Influenza A (H1N1) may cause significant morbidity, even mortality, for these patients and, in general, the seasonal influenza A vaccination is recommended in immunocompromised MPN patients. To date, knowledge concerning the protective efficacy of the vaccine in this cohort is limited (Ljungman, 2005; Rieger, 2018). The aim of this study was to determine whether patients with MPN mount an adequate protective immunological response to the Influenza A vaccine (2016) when compared with healthy controls. Mass cytometric analysis using a panel of 35 antibodies was employed to assess the immune response generated following Influenza A vaccination by interrogating both innate and adaptive immune cells. Methods and Results MPN patients were invited to receive the seasonal Influenza A vaccination as recommended by the WHO in October 2016. Vaccination was administered subcutaneously with inactivated influenza A vaccine (split viron) and peripheral blood samples were collected at both 3- weeks and 3- months post vaccination. A total of 19 patients and 2 HDs were enrolled. The median age of the MPN cohort was 50 years (range 30-78). As regards disease type, 8 patients had Essential Thrombocythaemia, 7 patients Polycythaemia vera and 4 patients Myelofibrosis, of this cohort, 5 were treatment naïve, 6 patients were treated with interferon, 4 with hydroxycarbamide and 4 with a JAK inhibitor. Deep immunophenotyping was performed using a focussed high-dimensional single-cell analysis with Mass Cytometry (CyTOF). Peripheral blood mononuclear cells (PBMCs) were isolated from MPN patients 3 weeks post- (n=16), and matched 3 months' post-vaccine (n=17); and HDs 3 weeks post- (n=2), and 3 months' post-vaccination (n=2). PBMCs were stained with 35 metal-tagged antibodies and analysed using CyTOF. Automated dimension reduction method including viSNE to identify cell populations in combination with FlowSOM clustering were used. The identified cell clusters and the marker expression of each cluster of cells are summarised in figure 1. In MPN patients, an increase in abundances were identified at 3 months' post-vaccination, in a cluster of central memory (CM) CD4 T cells (p= 0.02); and Innate lymphoid cells (ILCs) (p= 8.98 x 10-4). However, the majority of defined immune cell clusters showed no significant differences in either abundances or marker expression post-vaccination (Figure 1). In contrast, for the HDs, several immune cell clusters were expanded in response to vaccination, including NK cells,CM CD4 T cells,naïve CD8 T cells, and naïve CD4 T cells. In addition, the expression of defining markers were decreased in naïve and CM CD4+T cells (p= 9.16 x 10-3), ILCs (p= 0.02); and naïve and transitional B cells (p= 0.03) between these time points. Conclusions Cell mediated immunity plays a central role in defence against the influenza infection. Vaccine mediated protection is dependent upon innate and adaptive subsystems with both T helper and cytotoxic T cell responses demonstrated in healthy individuals (Guthrie, 2004).Our data suggests that while influenza vaccination can elicit some immune response in MPN, it is not as comprehensive as that generated in HDs and the overall resultant change in immune profile of MPN patients is minimal, both in abundances and change in expression of markers across immune cell clusters and throughout both time points measured. We would also expect to observe a switch from increased proliferation of naïve cell populations to a memory phenotype, providing evidence for an adequate memory type immune response to the vaccine, but this was not the case for the analysed MPN patients. It appears that although the immune systems of MPN patients were able to recognise the Influenza A vaccine, the response was not as comprehensive as the HDs. Given the relatively low numbers of patients we have tested it is not possible to identify a single treatment or disease subtype effect and indeed these findings may not relate to either factor. Further work is required to establish if this phenomenon is treatment related or driven by the underling immune dysregulation. Disclosures Dillon: Novartis: Consultancy, Honoraria; Abbvie: Consultancy, Honoraria; Pfizer: Consultancy, Honoraria; TEVA: Consultancy, Honoraria. Radia:Blueprint Medicines: Consultancy; Novartis: Consultancy, Speakers Bureau. De Lavallade:BMS: Honoraria, Research Funding, Speakers Bureau; Incyte biosciences: Honoraria, Research Funding, Speakers Bureau; Pfizer: Honoraria, Speakers Bureau; Novartis: Honoraria, Speakers Bureau. Harrison:Incyte: Speakers Bureau; AOP: Honoraria; Gilead: Speakers Bureau; Novartis: Honoraria, Research Funding, Speakers Bureau; Sierra Oncology: Honoraria; Promedior: Honoraria; Roche: Honoraria; Janssen: Speakers Bureau; Celgene: Honoraria, Speakers Bureau; CTI: Speakers Bureau; Shire: Speakers Bureau. Kordasti:Celgene: Research Funding; Novartis: Research Funding; Boston Biomed: Consultancy; API: Consultancy. McLornan:Jazz Pharmaceuticals: Honoraria, Speakers Bureau; Novartis: Honoraria.

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Privett, Natalie, and Shanice Guerrier. "Estimation of the Time Needed to Deliver the 2020 USPSTF Preventive Care Recommendations in Primary Care." American Journal of Public Health 111, no. 1 (January 2021): 145–49. http://dx.doi.org/10.2105/ajph.2020.305967.

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Objectives. To reexamine the time required to provide the US Preventive Services Task Force (USPSTF)–recommended preventive services to a nationally representative adult patient panel of 2500. Methods. We determined the required time for a single physician to deliver the USPSTF preventive services by multiplying the eligible population, annual frequency, and patient-contact time required for each recommendation, all calculated by using data from the recommendations themselves and literature. We modeled a representative panel of 2500 adults based on the 2010 US Census Bureau data. Results. To deliver the USPSTF recommended preventive services across a 2500 adult patient panel would require 8.6 hours per working day, accounting for 131% of available physician time. Compared with 2003, there are fewer recommendations in 2020, but they require 1.2 more physician patient-contact hours per working day. Conclusions. The time required to deliver recommended preventive care places unrealistic expectations on already overwhelmed providers and leaves patients at risk. This is a systems problem, not a time-management problem. The USPSTF provides a set of recommendations with strong evidence of positive impact. It is imperative that our health care system is designed to deliver.

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Tudor-Locke, Catrine, Tracy L. Washington, Barbara E. Ainsworth, and Richard P. Troiano. "Linking the American Time Use Survey (ATUS) and the Compendium of Physical Activities: Methods and Rationale." Journal of Physical Activity and Health 6, no. 3 (May 2009): 347–53. http://dx.doi.org/10.1123/jpah.6.3.347.

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Background:The 2003 Bureau of Labor Statistics American Time Use Survey (ATUS) contains 438 distinct primary activity variables that can be analyzed with regard to how time is spent by Americans. The Compendium of Physical Activities is used to code physical activities derived from various surveys, logs, diaries, etc to facilitate comparison of coded intensity levels across studies.Methods:This article describes the methods, challenges, and rationale for linking Compendium estimates of physical activity intensity (METs, metabolic equivalents) with all activities reported in the 2003 ATUS.Results:The assigned ATUS intensity levels are not intended to compute the energy costs of physical activity in individuals. Instead, they are intended to be used to identify time spent in activities broadly classified by type and intensity. This function will complement public health surveillance systems and aid in policy and health-promotion activities. For example, at least one of the future projects of this process is the descriptive epidemiology of time spent in common physical activity intensity categories.Conclusions:The process of metabolic coding of the ATUS by linking it with the Compendium of Physical Activities can make important contributions to our understanding of American’s time spent in health-related physical activity.

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Wineman, Nicole V., Barbara I. Braun, Joseph A. Barbera, and Jerod M. Loeb. "Assessing the Integration of Health Center and Community Emergency Preparedness and Response Planning." Disaster Medicine and Public Health Preparedness 1, no. 2 (November 2007): 96–105. http://dx.doi.org/10.1097/dmp.0b013e318158d6ee.

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ABSTRACTBackground: To assess the state of health center integration into community preparedness, we undertook a national study of linkages between health centers and the emergency preparedness and response planning initiatives in their communities. The key objectives of this project were to gain a better understanding of existing linkages in a nationally representative sample of health centers, and identify health center demographic and experience factors that were associated with strong linkages.Methods: The objectives of the study were to gain a baseline understanding of existing health center linkages to community emergency preparedness and response systems and to identify factors that were associated with strong linkages. A 60-item questionnaire was mailed to the population of health centers supported by the Health Resources and Services Administration’s Bureau of Primary Health Care in February 2005. Results were aggregated and a chi square analysis identified factors associated with stronger linkages.Results: Overall performance on study-defined indicators of strong linkages was low: 34% had completed a hazard vulnerability analysis in collaboration with the community emergency management agency, 30% had their role documented in the community plan, and 24% participated in community-wide exercises. Stronger linkages were associated with experience responding to a disaster and a perception of high risk for experiencing a disaster.Conclusions: The potential for health centers to participate in an integrated response is not fully realized, and their absence from community-based planning leaves an already vulnerable population at greater risk. Community planners should be encouraged to include health centers in planning and response and centers should receive more targeted resources for community integration. (Disaster Med Public Health Preparedness. 2007;1:96–105)

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Frustaci, Anna Maria, Michele Nichelatti, Marina Deodato, Maddalena Mazzucchelli, Marco Montillo, Roberto Cairoli, and Alessandra Tedeschi. "Health-Related Quality of Life in Waldenstrom Macroglobulinemia (WM) and IgM Monoclonal Gammopathy of Undeterminated Significance (IgM-MGUS)." Blood 132, Supplement 1 (November 29, 2018): 3593. http://dx.doi.org/10.1182/blood-2018-99-111444.

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Abstract The clinical course of WM widely differs among patients, with some manifesting symptoms as a consequence of the monoclonal IgM component or lymphoma infiltration. IgM-MGUS is generally asymptomatic while, in some cases, paraprotein-related manifestations may occur. Patients with IgM-MGUS should perform a regular follow-up as they are at risk of developing WM or other B-cell lymphoproliferative disorders (1.5-2% per year). Although WM typically afflicts the elderly, there are no studies addressing the impact of ECOG performance status and comorbidities on patients' outcome. Furthermore, to our knowledge health-related quality of life (HRQOL) has never been evaluated in this category. The aim of this study is to analyze the impact of diagnosis and patients' characteristics on quality of life. From October 2017, HRQOL was assessed in 103 patients (37 WM with previous or ongoing treatment [tWM]; 29 asymptomatic MW [aWM]; 37 IgM-MGUS) by the administration of EORTC QLQ-C30, HADS, FACT-GOG neurotoxicity and EQ-5D-5L questionnaires. Demographic anamnestic and disease-related data were also collected for each patient. The same questionnaires continue to be administered every 6 months for 3 years, in order to capture changes in HRQOL over time. Patients features are reported in table 1. No significant differences in terms of age, sex distribution, age at diagnosis, months from diagnosis, ECOG performance status, CIRS or number of concomitant medications, were detected among the 3 groups (table 1). As regards CIRS, the organ systems mainly involved resulted: vascular and genitourinary for tWM, genitourinary for aWM and vascular, respiratory and genitourinary for IgM-MGUS. Among the 3 groups no statistical differences were reported when analyzing: EORTC QLQ-C30 global health status, functional scales (physical, role, emotional, cognitive and social functioning) and symptoms scale, EQ-5D VAS score, HADS anxiety and depression scores or FACT-GOG neurotoxicity score. Males had higher global health status and emotional function when compared to females both in IgM-MGUS and WM patients. Higher CIRS score and ECOG status negatively impacted on global health status, physical function, EQ-5D VAS score and anxiety both in WM and IgM-MGUS. WM patients with longer time from diagnosis showed a significantly worse emotional function. Patients-reported symptoms that could be referred to peripheral neuropathy (PN, 39 patients) resulted the only significant parameter negatively impacting on HRQOL (global health status, functional and symptoms scales according to EORTC QLQ-C30 and EQ-5D VAS score) and also affecting HADS anxiety score. The diagnosis of PN was confirmed by neurologic tests only in 16/39 subjects that, compared with the rest of the population, showed older age (p .019), older age at diagnosis (p . 015) and higher ECOG status (p .005). In these patients, EORTC QLQ-C30 detected a reduced cognitive function (p .0031), while HADS a greater perception of anxiety (p .0015). No differences were recorded for EQ-5D VAS score or HADS depression scale. In conclusion, in our series diagnosis per se didn't seem to affect HRQOL which was negatively influenced by high ECOG status and comorbidities. Emotional function meaningfully deteriorated as the time lapse from diagnosis became longer. Quality of life was significantly altered in patients reporting symptoms of PN and this was confirmed by all the questionnaires. Longer follow up is needed to confirm these preliminary data. Disclosures Montillo: Roche: Consultancy, Honoraria, Research Funding; Janssen: Consultancy, Honoraria; AbbVie: Consultancy, Honoraria, Speakers Bureau; Gilead: Consultancy, Honoraria, Speakers Bureau. Tedeschi:Janssen: Consultancy, Speakers Bureau; AbbVie: Consultancy; Gilead: Consultancy.

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Mendiola Iparraguirre, Andrea Patricia, Maria Restrepo-Toro, Natalia Gomez, Mark Costa, and Esperanza Diaz. "Learning and Teaching Latino Mental Health, Social Justice and Recovery to Visiting Students: A Pilot Study." Revista Iberoamericana de Psicología 14, no. 2 (May 31, 2021): 33–45. http://dx.doi.org/10.33881/2027-1786.hrip.14104.

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Almost 18% of the U.S. population is estimated to be Hispanic (United States Census Bureau, 2019), and of that, 15% had a diagnosable mental illness in the past year (Substance Abuse and Mental Health Services Administration, 2020); still, Latinos receive half as often mental health services compared to Caucasians (Office of Mental Health, 2020). Evidence suggests that minority ethnic groups may receive more inferior care standards due to biased beliefs or attitudes held by health professionals (Shepherd et al., 2018). The number of Latino Psychiatrists is not enough to care for the on-growing Latino population in the U.S. (Alarcón, 2001; American Psychiatric Association, 2017). There is a need to train medical students and residents in cultural competencies pertained to the Latino Culture and Health Services (Alarcón, 2001). We developed a pilot study of a curriculum created by Latino bilingual and bicultural mental health providers. The course lessons include (a) Health Disparities and Implicit Bias, (b) Recovery in Mental Health, (c) Immigration and Acculturation, (d) Cultural Formulation Interview, (e) Latino Values, and (f) Mental Health Systems. All topics focused on Latino Mental Health and used the “reverse classroom” teaching technique with interactive exercises. We measured the impact on knowledge, attitudes, and comfort level related to the concept taught in the lessons of this course. Teaching Latino Mental Health has a positive impact on improving the comfort level and knowledge of students. Nevertheless, there are not enough educational opportunities and information about these topics. Therefore, replicating this curriculum and expanding the education in Latino Mental Health will improve the health services provided to this community.

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Kassa, Melkamu Dugassa, and Jeanne Martin Grace. "A mixed-method study of quality, availability and timeliness of non-communicable disease (NCD) related data and its link to NCD prevention: Perceptions of health care workers in Ethiopia." Health Information Management Journal 48, no. 3 (August 20, 2018): 135–43. http://dx.doi.org/10.1177/1833358318786313.

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Background: Three-quarters of non-communicable disease (NCD) mortality occurs in low- and middle-income countries. However, in most developing countries, quality and reliable data on morbidity, mortality and risk factors for NCD to predict its burden and prevalence are less well understood and availability of these data is limited. To better inform policymakers and improve healthcare systems in developing countries, it is also important that these factors be understood within the context of the particular country in question. Objective: The aim of this study is to further inform practitioners in Ethiopia about the availability and status of NCD information within the Ethiopian healthcare system. Method: A mixed method research design was used with data collected from 13 public referral hospitals in Ethiopia. In phase 1 quantitative data were collected from 312 health professionals (99 physicians; 213 nurses) using a cross-sectional survey. In phase 2, qualitative data were collected using: interviews ( n = 13 physician hospital managers); and one focus group ( n = 6 national health bureau officers). Results: Results highlighted the lack of NCD morbidity, mortality and risk factor data, periodic evaluation of NCD data and standardised protocols for NCD data collection in hospitals. The study also identified similar discrepancies in the availability of NCD data and standardised protocols for NCD data collection among the regions of Ethiopia. Conclusion: This study highlighted important deficiencies in NCD data and standardised protocols for data collection in the Ethiopian healthcare system. These deficiencies were also observed among regions of Ethiopia, indicating the need to strengthen both the healthcare system and health information systems to improve evidence-based decision-making. Implications: Identifying the status of NCD data in the Ethiopian healthcare system could assist policymakers, healthcare organisations, healthcare providers and health beneficiaries to reform and strengthen the existing healthcare system.

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Gómez-De León, Andrés, Perla R. Colunga Pedraza, Luz del Carmen Tarín Arzaga, Emmanuel Bugarin-Estrada, David Gómez-De León, Lillian Sung, and David Gomez-Almaguer. "Contributions to Global Hematology from Low and Middle-Income Countries: Insights from ASH 2018." Blood 134, Supplement_1 (November 13, 2019): 2123. http://dx.doi.org/10.1182/blood-2019-130053.

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Background. Establishing research capacity in low and middle-income countries (LMIC) is key for improving health systems and implementing actionable programs through evidence-based assessments. Few studies have analyzed hematology research capacity in LMICs. The American Society of Hematology (ASH) annual meeting is the largest hematology event where peer-reviewed contributions from researchers worldwide are selected for presentation based on scientific merit. Therefore, it can provide a useful snapshot of the current status of hematology research in a single point in time. For this reason, we analyzed abstracts presented at the 2018 ASH annual meeting (ASH18) with a focus on those from authors working in a LMIC. Objective. To describe the proportion of abstracts presented at ASH18 from an LMIC and analyze their characteristics as a surrogate for academic contributions to global hematology. Methods. We reviewed all abstracts presented at ASH18 in an oral presentation or poster form published online in the supplemental edition of Blood 2018;132 (Suppl 1). LMICs were selected according to the World Bank classification including countries or territories with a gross national income <$12,056 USD per capita. We described all abstracts that had a co-author with an affiliation from an institution in a LMIC, regardless of their position. We categorized studies as clinical vs. basic and single vs. multicenter nature. We also identified the presence of conflict-of interest statements (COI) and identifiable industry sponsors. We compared abstracts that had co-authors from high-income countries (HIC+LMIC) vs. those from LMIC countries alone. Comparison across groups was performed using chi-square and Fisher's exact test. Results. A total of 4,871 abstracts presented at ASH 2018, with 1,026 oral presentations and 3,845 posters were available online. Among them, 510 abstracts (10.5%) had a contributing author from an institution in an LMIC, corresponding to 92 (9%) of all oral presentations and 418 (10.9%) of all posters (Figure 1). LMIC-only contributions represented 4.7% of all abstracts (n=229). The most common LMIC of origin for LMIC-only contributions was China with 133 (58.1%) (Figure 1). Most abstracts were clinical and multicentric in nature (62 and 70.2%, respectively), and in 42.5% of them a COI was reported. Clinical trials reflected 19% of all LMIC contributions. In 31.9% of cases the first author was affiliated to an institution in a HIC. Mixed LMIC/HIC contributions had significantly more COIs and industry sponsors than those from LMIC-only institutions (Table 1). When comparing between oral vs poster LMIC presentations, works selected for an oral presentation were significantly more clinical and multicentric, had a higher proportion of clinical trials, more COIs and identified industry sponsors (Table 2). Conclusions. LMICs, where more than 80% of the world population resides, were responsible for only a small fraction of contributions to ASH18, half of them representing a form of international collaboration, with a high number of COI disclosures. Disclosures Gomez-Almaguer: Amgen: Consultancy, Speakers Bureau; Janssen: Consultancy, Speakers Bureau; Teva: Consultancy, Speakers Bureau; Takeda: Consultancy, Speakers Bureau; Celgene: Consultancy, Speakers Bureau.

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CHANG, M., S. L. GROSECLOSE, A. A. ZAIDI, and C. R. BRADEN. "An ecological analysis of sociodemographic factors associated with the incidence of salmonellosis, shigellosis, and E. coli O157:H7 infections in US counties." Epidemiology and Infection 137, no. 6 (October 24, 2008): 810–20. http://dx.doi.org/10.1017/s0950268808001477.

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SUMMARYIdentifying county-level sociodemographic and economic factors associated with the incidence of enteric disease may provide new insights concerning the dynamics of community transmission of these diseases as well as opportunities for prevention. We used data from the National Notifiable Diseases Surveillance System, the U.S. Census Bureau, and the Health Resources and Services Administration to conduct an ecological analysis of 26 sociodemographic and economic factors associated with the incidence of salmonellosis, shigellosis, and E. coli O157:H7 infections in US counties for the period 1993 to 2002. Our study indicates that race, ethnicity, place of residence, age, educational attainment, and poverty may affect the risk of acquiring one of these enteric bacterial diseases. The lack of specificity of information regarding salmonellae and shigellae serotypes may have led to less specific associations between community-level determinants and reported incidence of those diseases. Future ecological analyses should use serotype-specific data on incidence, which may be available from laboratory-based surveillance systems.

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Nolan, Melissa S., Ana Zangeneh, Salma A. Khuwaja, Diana Martinez, Susan N. Rossmann, Victor Cardenas, and Kristy O. Murray. "Proximity of Residence to Bodies of Water and Risk for West Nile Virus Infection: A Case-Control Study in Houston, Texas." Journal of Biomedicine and Biotechnology 2012 (2012): 1–6. http://dx.doi.org/10.1155/2012/159578.

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West Nile virus (WNV), a mosquito-borne virus, has clinically affected hundreds of residents in the Houston metropolitan area since its introduction in 2002. This study aimed to determine if living within close proximity to a water source increases one’s odds of infection with WNV. We identified 356 eligible WNV-positive cases and 356 controls using a population proportionate to size model with US Census Bureau data. We found that living near slow moving water sources was statistically associated with increased odds for human infection, while living near moderate moving water systems was associated with decreased odds for human infection. Living near bayous lined with vegetation as opposed to concrete also showed increased risk of infection. The habitats of slow moving and vegetation lined water sources appear to favor the mosquito-human transmission cycle. These methods can be used by resource-limited health entities to identify high-risk areas for arboviral disease surveillance and efficient mosquito management initiatives.

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Shin, Eun Kyong, Youngsang Kwon, and Arash Shaban-Nejad. "Geo-clustered chronic affinity: pathways from socio-economic disadvantages to health disparities." JAMIA Open 2, no. 3 (August 1, 2019): 317–22. http://dx.doi.org/10.1093/jamiaopen/ooz029.

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Abstract Objective Our objective was to develop and test a new concept (affinity) analogous to multimorbidity of chronic conditions for individuals at census tract level in Memphis, TN. The use of affinity will improve the surveillance of multiple chronic conditions and facilitate the design of effective interventions. Methods We used publicly available chronic condition data (Center for Disease Control and Prevention 500 Cities project), socio-demographic data (US Census Bureau), and demographics data (Environmental Systems Research Institute). We examined the geographic pattern of the affinity of chronic conditions using global Moran’s I and Getis-Ord Gi* statistics and its association with socio-economic disadvantage (poverty, unemployment, and crime) using robust regression models. We also used the most common behavioral factor, smoking, and other demographic factors (percent of the male population, percent of the population 67 years, and over and total population size) as control variables in the model. Results A geo-distinctive pattern of clustered chronic affinity associated with socio-economic deprivation was observed. Statistical results confirmed that neighborhoods with higher rates of crime, poverty, and unemployment were associated with an increased likelihood of having a higher affinity among major chronic conditions. With the inclusion of smoking in the model, however, only the crime prevalence was statistically significantly associated with the chronic affinity. Conclusion Chronic affinity disadvantages were disproportionately accumulated in socially disadvantaged areas. We showed links between commonly co-observed chronic diseases at the population level and systematically explored the complexity of affinity and socio-economic disparities. Our affinity score, based on publicly available datasets, served as a surrogate for multimorbidity at the population level, which may assist policymakers and public health planners to identify urgent hot spots for chronic disease and allocate clinical, medical and healthcare resources efficiently.

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Czarnogorski, Maggie, Cindy Garris, Paul Wannamaker, Ronald D’Amico, Carolyn Selenski, Will Williams, Colleen A. McHorney, et al. "1037. Qualitative Findings from a Hybrid III Implementation-Effectiveness Study to Explore Perspectives of Health-care Staff on Early Implementation of Cabotegravir and Rilpivirine Long Acting (CAB+RPV LA) Injectable HIV treatment in the US (CUSTOMIZE)." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S549. http://dx.doi.org/10.1093/ofid/ofaa439.1223.

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Abstract Background CAB+RPV LA administered monthly for HIV treatment is non-inferior to daily oral ART at maintaining HIV suppression but concerns about implementation of this novel treatment paradigm remain. CUSTOMIZE, an implementation-effectiveness study, examined barriers and facilitators to successful implementation of CAB+RPV LA in US HIV clinics. Methods Semi-structured qualitative interviews were conducted with physicians, injectors, and administrators across diverse clinics in US without previous CAB+RPV LA experience at Baseline (BL) (N=26) and after patients received the 4th monthly injection of CAB + RPV LA (interim) (N=24). Consolidated Framework for Implementation Research (CFIR) guided the interviews to evaluate barriers and facilitators to implementation. Interviews were recorded, transcribed, and coded using ATLAS.ti then analyzed for trends. Results At BL, 58% of study staff expected CAB+RPV LA would meet the needs of patients. Staff reported perceived advantages for patients: reduced stigma of pill bottles (38%), ability to live/travel in a “carefree” manner (31%) and removing the daily reminder of HIV (20%). At BL, most administrators had resource concerns: additional refrigeration, transportation, and staffing. Some clinics (38%) needed to purchase a refrigerator to store CAB+RPV LA. Some physicians noted a potential need for improved parking or expanded hours. At interim, most staff (71%) reported no change in official clinic hours; but 50% of injectors and 38% of administrators reported changing work hours to accommodate injection visits before clinic or at lunchtime. Existing appointment reminder systems and transportation support were reported as facilitators to implementation. Many staff (46%) noted additional visits increased coordination of other care needs. Most staff (67%) noted high patient acceptance and positive attitudes facilitated successful implementation of CAB + RPV LA. Conclusion Some staff had concerns about implementation initially, but at study interim minimal practice changes were needed to operationalize CAB+RPV LA effectively. Patient interest heightened staff desire to implement CAB+RPV LA in their clinics. Staff are optimistic that monthly CAB+RPV LA is manageable with minimal disruption to routine care in US HIV care settings. Disclosures Maggie Czarnogorski, MD, MPH, ViiV Healthcare (Employee) Cindy Garris, MSPH, GlaxoSmithKline (Other Financial or Material Support, Stockholder)ViiV Healthcare (Employee) Paul Wannamaker, BA, ViiV Healthcare (Employee) Ronald D’Amico, DO, MSc, GlaxoSmithKline (Shareholder)ViiV Healthcare (Employee) Carolyn Selenski, PhD, GSK (Employee, Shareholder) Colleen A. McHorney, PhD, Evidera (Employee) Larissa Stassek, MPH, Evidera (Employee) Gary I. Sinclair, MD, ViiV (Speaker’s Bureau) Leandro A. Mena, MD, MPH, Binx Health (Grant/Research Support)Evofem (Grant/Research Support)Gilead Science (Consultant, Grant/Research Support, Speaker’s Bureau)GSK (Grant/Research Support)Janssen (Grant/Research Support)Merck (Consultant, Grant/Research Support)Roche Molecular (Consultant, Grant/Research Support)SpeedDx (Grant/Research Support)ViiV Healthcare (Consultant, Grant/Research Support, Speaker’s Bureau) David Margolis, MD, MPH, GlaxoSmithKline (Shareholder)ViiV Healthcare (Employee)

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Mesleh Shayeb, Akram, Richard Barnes, Nicolas Gallastegui Crestani, Cris Hanacek, Peter Aguero, Andres Flores, Rebecca Kruse-Jarres, et al. "Validity of Quantitative Measurements By the Joint Tissue Examination and Damage Exam (JADE) with Musculoskeletal Ultrasound for the Longitudinal Assessment of Hemophilic Arthropathy." Blood 136, Supplement 1 (November 5, 2020): 20–21. http://dx.doi.org/10.1182/blood-2020-143133.

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Introduction: Clinical scoring systems, such as the Hemophilia Joint Health Score (HJHS), and imaging modalities (radiographs and magnetic resonance) are important instruments for the evaluation of hemophilic joint health. However, they are semi-quantitative scales, exhibit ceiling effects, and may not capture subtle dynamic changes of intra-articular structures. We developed the Joint tissue Activity and Damage Exam (JADE) protocol to quantitatively evaluate the extent of hemophilic arthropathy at the tissue level, individualize management, and objectively assess the efficacy of novel therapies. JADE is an economical, convenient, and radiation free point-of-care musculoskeletal ultrasound protocol. JADE uses quantitative numerical measurements (1/10th of millimeter) for osteochondral alterations, cartilage thickness and soft tissue expansion in hemophilic joints and is validated per international OMERACT guidelines for pathological tissue recognition with high intra/inter-rater and inter-operator reliability. Furthermore, we previously reported JADE association with clinical and functional joint assessments at baseline for patients with hemophilia. Herein, we examined JADE protocol ability to capture tissue changes over time and their associations with HJHS, a clinical joint assessment. We assumed the regression lines for joint HJHS on each JADE measurement at each time point would lie parallel to each other. Verifying this assumption would enhance JADE protocol validity and provide confidence that it could be used to monitor hemophilic arthropathy progression by quantifying specific tissue abnormalities. Methodology: We recruited adult patients (≥ 18 years) with congenital hemophilia and arthropathy in a prospective study performed at 3 sites in North America. We assessed joint HJHS and JADE parameters for each patient (n=44; 264 joints [bilateral elbows, ankles, and knees]) at study entry (baseline), at ~12-18 months (midpoint), and ~24-36 months (final). JADE measurements included osteochondral alterations, cartilage thickness, and soft tissue expansion at sentinel positions for each joint. The association between joint HJHS and each JADE variable was examined by fitting random intercept models with outcomes transformed to ensure normal residuals. We examined the assumption of parallel regression lines for the three time points by applying a test for homogeneity of slopes. If no difference between slopes was found, then we applied an analysis of covariance to test whether the lines for each joint were coincident. Results: Joint HJHSs deteriorated measurably during the study period, reflecting clinically worsening arthropathy over time. Importantly, clinical assessment of deterioration for the elbows, knees, and ankles was associated with JADE measurements that changed in the expected direction, namely increased length of osteochondral alterations, decreased cartilage thickness, and increased soft tissue expansion. As an example, figure 1 shows the association of deteriorating HJHS and osteochondral alterations for elbows, knees, and ankles at baseline, midpoint, and final visits. In each graph, the regression lines were similar in shape. Lines were parallel for the elbow (midpoint vs baseline: p = 0.185; final vs baseline: p = 0.398), and the ankle (midpoint vs baseline: p = 0.225; final vs baseline: p = 0.293). But, the assumption of parallel lines was rejected for the knee (midpoint vs baseline: p = 0.047; final vs baseline: p = 0.024). Conclusions: This study demonstrates a tight association between JADE direct ultrasonographic measurements and clinical deterioration (HJHSs) during several assessments over 3 years. Importantly, the associations are consistent across time, despite clinical joint health examinations and ultrasound measurements being performed at three different centers by multiple providers, with long intervals between assessments. Altogether, these findings constitute a major milestone for the clinical relevance validity of the JADE protocol as a precise instrument for tissue-specific alterations measurements over time. These findings support the use of the JADE protocol to monitor the progression of hemophilic arthropathy longitudinally, permit prompt identification of potentially reversible osteochondral and/or soft tissue changes, and study early interventions that could curb arthropathic progression. Disclosures Kruse-Jarres: F. Hoffmann-La Roche Ltd: Speakers Bureau; Biomarin, Chugai Pharmaceutical Co., CSL Behring, CRISPR Therapeutics, Genentech, Inc.: Honoraria; CSL Behring, Genentech, Inc., Spark: Research Funding; Biomarin, Chugai Pharmaceutical Co., CSL Behring, CRISPR Therapeutics, Genentech, Inc.: Consultancy. Steiner:Uniqure: Consultancy, Membership on an entity's Board of Directors or advisory committees; Sanofi/Genzyme: Consultancy, Membership on an entity's Board of Directors or advisory committees; Genentech: Consultancy, Membership on an entity's Board of Directors or advisory committees; Roche: Consultancy, Membership on an entity's Board of Directors or advisory committees. Quon:Bayer: Honoraria; Orthopaedic Institute for Children: Current Employment; Biomarin: Honoraria, Speakers Bureau; Novo Nordisk: Honoraria, Speakers Bureau; Bioverativ/Sanofi: Honoraria, Speakers Bureau; Genentech, Inc./F. Hoffmann-La Roche Ltd: Honoraria, Speakers Bureau; Octapharma: Honoraria; Shire/Takeda: Speakers Bureau. von Drygalski:Biomarin: Honoraria; Hematherix LLC: Membership on an entity's Board of Directors or advisory committees, Other: co-founder; Uniqure: Honoraria; Bioverativ/Sanofi: Honoraria, Research Funding; Pfizer: Research Funding; Novo-Nordisk: Honoraria; Takeda: Honoraria.

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Namgay, Tashi. "Nation’s waste on the scale: The first Bhutan waste inventory report." Statistical Journal of the IAOS 36, no. 4 (November 25, 2020): 915–24. http://dx.doi.org/10.3233/sji-200742.

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Knowing the quantity and the composition of waste is essential to designing and delivering sound waste management policies and waste management systems. Bhutan’s 12th Five-Year Development Plan emphasizes effective waste management as one of its key performance indicators and globally, the 2030 Agenda for Sustainable Development emphasizes the importance of waste in two of its seventeen Sustainable Development Goals. In 2019, the Bhutan National Statistics Bureau undertook its first ever survey of solid waste management. The survey covered waste generating sectors including households, commercial units, institutes, health centers, industries, Government offices and vegetable markets. Results show Bhutan generated more than 170 metric tons of waste daily – equivalent to 170,000 kilograms of sugar. More than 50 percent of solid wastes came from households, almost 50 percent was food waste, and around 50 percent was potentially recyclable. The survey posed many challenges for Bhutan, a land-locked least developed country in the Eastern Himalayas in South Asia, yet provided the opportunity to strengthen stakeholder engagement in the Bhutan National Statistical System and delivered statistics which meet a practical use for Bhutan and its people.

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Zhan, Shu Lin, Fang Huang, and Jun Ying Lai. "Optimal Sensor Placement for High-Rise Building via Genetic Algorithms and Improved Information Matrix Criterion." Advanced Materials Research 368-373 (October 2011): 1653–59. http://dx.doi.org/10.4028/www.scientific.net/amr.368-373.1653.

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To improve the accuracy of parameter identification and to reduce the test cost in the high-rise structure health monitoring systems , the paper proposes an optimal placement method combines genetic algorithms with improved information matrix criterion (GA-IIM). With traditional improved effective independent method (EFI-DPR), it is easily trapped into bureau of optimum solution, and the proposed method can resolve this problem. The solutions were coded by a two-dimensional integer array, each line stored a feasible solution and compulsory mutation was adopted to avoid the solution reappeared in the same position. To improve the convergence speed, each generation of optimal group was kept to the next one to participate in the competition. With the improved information matrix criterion embedded in the genetic algorithms, the placement design was produced. This technique was used to optimize the sensor placement of a nineteenth layer frame structure. Comparing the optimized sensor placement of the proposed method with that of improved effective independent method by the modal assurance criterion and the mean square error, the proposed method performs better.

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LIAO, JHIH-RONG, CHYI-CHEN HO, and CHIUN-CHENG KO. "Predatory mites (Acari: Mesostigmata: Phytoseiidae) intercepted from samples imported to Taiwan, with description of a new species." Zootaxa 4927, no. 3 (February 15, 2021): 301–30. http://dx.doi.org/10.11646/zootaxa.4927.3.1.

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Global trade has increased the invasion risk of exotic organisms and damaged agricultural and natural ecosystems. The Bureau of Animal and Plant Health Inspection and Quarantine (BAPHIQ) handles quarantine services of animal- and plant-associated pests and diseases in Taiwan. The predatory mite family Phytoseiidae (Acari: Mesostigmata) is a well-known group due to the potential use of certain species as biocontrol agents for small phytophagous pests. Some species are available in commercial markets and frequently used in biological control in many agricultural systems, especially in greenhouse crops. However, exotic biological control agents may interfere with natural or naturalised populations of predatory mites and they may threaten indigenous populations via intraguild predation. The present study aims to provide a checklist of phytoseiid mite species found in plant quarantine from 2006–2013. Twenty-five species belonging to two subfamilies and eight genera were found in samples imported to Taiwan from twelve countries, including one new species Typhlodromus (Anthoseius) ueckermanni sp. nov. from South Africa. The checklist provides distribution, remarks, and also an identification key for all species.

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BI, P., J. E. HILLER, A. S. CAMERON, Y. ZHANG, and R. GIVNEY. "Climate variability and Ross River virus infections in Riverland, South Australia, 1992–2004." Epidemiology and Infection 137, no. 10 (March 19, 2009): 1486–93. http://dx.doi.org/10.1017/s0950268809002441.

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SUMMARYRoss River virus (RRV) infection is the most common notifiable vector-borne disease in Australia, with around 6000 cases annually. This study aimed to examine the relationship between climate variability and notified RRV infections in the Riverland region of South Australia in order to set up an early warning system for the disease in temperate-climate regions. Notified data of RRV infections were collected by the South Australian Department of Health. Climatic variables and monthly river flow were provided by the Australian Bureau of Meteorology and South Australian Department of Water, Land and Biodiversity Conservation over the period 1992–2004. Spearman correlation and time-series-adjusted Poisson regression analysis were performed. The results indicate that increases in monthly mean minimum and maximum temperatures, monthly total rainfall, monthly mean Southern Oscillation Index and monthly flow in the Murray River increase the likelihood, but an increase in monthly mean relative humidity decreases the likelihood, of disease transmission in the region, with different time-lag effects. This study demonstrates that a useful early warning system can be developed for local regions based on the statistical analysis of readily available climate data. These early warning systems can be utilized by local public health authorities to develop disease prevention and control activities.

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Ayah, Richard, John Ong'ech, Edwin Maina Mbugua, Rose Chepchumba Kosgei, Katie Waller, and David Gathara. "Responding to maternal, neonatal and child health equipment needs in Kenya: a model for an innovation ecosystem leveraging on collaborations and partnerships." BMJ Innovations 6, no. 3 (April 24, 2020): 85–91. http://dx.doi.org/10.1136/bmjinnov-2019-000391.

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BackgroundUp to 70% of medical devices in low-income and middle-income countries are partially or completely non-functional, impairing service provision and patient outcomes. In Sub-Saharan Africa, medical devices not designed for local conditions, lack of well-trained biomedical engineers and diverse donated equipment have led to poor maintenance and non-repair. The Maker Project’s aim was to test the effectiveness of an innovative partnership ecosystem network, the ‘Maker Hub’, in reducing gaps in the supply of essential medical devices for maternal, newborn and child health. This paper describes the first phase of the project, the building of the Maker Hub.MethodsKey activities in setting up the Maker Hub—a collaborative partnership between the University of Nairobi (UoN) and the Kenyatta National Hospital (KNH), catalysed by Concern Worldwide Kenya—are described using a product development partnership approach. Using a health systems approach, a needs assessment identified a medical equipment shortlist. Design thinking with a capacity building component was used by the UoN (innovators, public health specialists, engineers) working closely and with KNH nurses, physicians and biomedical engineers to develop the prototypes.ResultsTo date, four medical device prototypes have been developed. Two have been evaluated by the National Bureau of Standards and one has undergone clinical testing.ConclusionsWe have demonstrated an innovative partnership ecosystem that has developed medical devices that have undergone national standards evaluation and clinical testing, a first in Sub-Saharan Africa. Promoting a robust innovation ecosystem for medical equipment requires investment in building trust in the innovation ecosystem.

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Wetterslev, M., W. P. Maksymowych, R. G. Lambert, I. Eshed, S. Juhl Pedersen, M. Stoenoiu, S. Krabbe, et al. "OP0149 RELIABILITY AND RESPONSIVENESS OF TWO OMERACT WHOLE-BODY MRI SCORES OF ENTHESEAL AND JOINT INFLAMMATION IN THE KNEE REGION IN SPONDYLOARTHRITIS." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 89–90. http://dx.doi.org/10.1136/annrheumdis-2021-eular.755.

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Background:Inflammation in peripheral joints and entheses is common in spondyloarthritis (SpA). Whole-body magnetic resonance imaging (WB-MRI) allows assessment of the overall inflammatory status of arthritis patients including joints and entheses. The OMERACT MRI Whole-body scoring system for Inflammation in Peripheral joints and Entheses (MRI-WIPE) [1] has been developed and validated for the entire body assessment, including the knee, but not separately validated for the knee joint region. Detailed MRI scoring systems exist for heels, hands and feet, but although knee arthritis is a key cause of functional impairment, no detailed scoring system has been validated for inflammatory arthritides. The Knee Inflammation MRI Scoring System (KIMRISS) [2] was developed and validated in osteoarthritis and demonstrated good reliability.Objectives:To perform region-based development of whole-body MRI through validation of two knee region scoring systems in SpA.Methods:Assessment of inflammation was performed in the knee region on sagittal WB-MRIs using 2 scoring systems, MRI-WIPE and KIMRISS (Figure 1), in 4 iterative multi-reader exercises. In the final exercise, images (psoriatic arthritis, axial and peripheral SpA) were obtained before and after TNF-inhibitor.Results:In the final exercise (exercise 4), reliability was mostly good for experienced readers with the overall highest interreader agreement in the previous exercise (exercise 3). Median pairwise single measure intraclass correlation coefficients for osteitis and synovitis/effusion for status/change were 0.71/0.48 (WIPE osteitis), 0.48/0.77 (WIPE synovitis/effusion), 0.59/0.91 (KIMRISS osteitis) and 0.92/0.97 (KIMRISS synovitis/effusion) (Table 1). Wilcoxon signed-rank test showed significant change in synovitis/effusion for both methods and they correlated significantly regarding status in osteitis (0.92, p<0.001) and synovitis/effusion (0.89, p=0.001) and change in synovitis/effusion (0.89, p<0.001). Standardized response mean was 0.74 (WIPE synovitis/effusion) and 0.78 (KIMRISS synovitis/effusion).Table 1.MRI-WIPE knee and KIMRISS interreader reliability for OMERACT exercises 3 and 4MRI-WIPE KneeKIMRISSOsteitisSynovitis/effusionOsteitisSynovitis/effusionVariablesNo. patientsType of scoreMean scoreICCMean scoreICCMean scoreICCMean scoreICCExercise 39 readers11Status3.6 (0-16)0.57 (-0.06-0.98)1.8 (0-4)0.47 (0.05-0.85)32.3 (1-224)0.87 (0.66-0.99)29.9 (11-60)0.34 (-0.62-0.87)11Change1.1 (-2-6)0.53 (0.03-0.90)0 (-2-1)0.32 (-0.13-0.76)27.7 (-9-131)0.58 (-0.30-0.96)-1.6 (-33-11)0.48 (-0.32-0.95)Exercise 33 readers11Status3.1 (0-16)0.83 (0.71-0.97)2.5 (0-5)0.59 (0.51-0.71)34.4 (0-233)0.89 (0.83-0.99)36.5 (16-78)0.59 (0.08-0.86)11Change0.9 (-3-6)0.72 (0.57-0.83)0 (-2-1)0.63 (0.49-0.76)19.3 (-23-86)0.46 (0.18-0.83)-1.8 (-45-17)0.89 (0.82-0.95)Exercise 49 readers10Change-0.25 (-4-5)0.38 (-0.35-0.94)-1.0 (-3-1)0.30 (-0.43-0.89)-0.45 (-37-65)0.26 (-0.86-0.97)-14.7 (-48-0.20)0.48 (-0.39-0.99)20Status2.9 (0-7)0.50 (-0.01-0.84)2.1 (0-4)0.44 (-0.21-0.79)15.2 (0-66)0.35 (-0.04-0.89)55.6 (1-122)0.54 (0.01-0.96)Exercise 43 readers10Change0.2 (-2-6)0.48 (0.16-0.66)-1.4 (-5-0)0.77 (0.70-0.82)5.8 (-27-111)0.92 (0.90-0.94)-20.7 (-65-28)0.97 (0.96-0.98)20Status2.3 (0-6)0.71 (0.60-0.80)2.7 (0-5)0.48 (0.42-0.57)11.4 (0-36)0.59 (0.39-0.71)69.4 (1-153)0.91 (0.87-0.93)Sum scores are mean (range) of the patients scores. ICC values are mean (range). ICC is 2-way mixed model, single measure, by absolute agreement.Conclusion:MRI-WIPE and KIMRISS may both be useful as part of modular whole-body evaluation in clinical studies.References:[1]Krabbe S et al. J Rheum. 2019;46(9):1215-21[2]Jaremko JL et al. RMD Open. 2017;3(1):e000355Acknowledgements:We thank CARE Aarthritis Limited (carearthritis.com) for help with setting up the web-based scoring interface, the scoring exercises, and the web-based meetings. We thank all who participated in the SIG (Special Interest Group) virtual OMERACT meeting 29 October 2020. HMO, GDM and PGC are supported in part by the National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, United Kingdom. The views expressed in this study are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.Disclosure of Interests:Marie Wetterslev: None declared, Walter P Maksymowych Speakers bureau: AbbVie, Janssen, Novartis, Pfizer and UCB, Consultant of: AbbVie, Boehringer Ingelheim, Celgene, Eli Lilly, Galapagos, Janssen, Novartis, Pfizer and UCB, Grant/research support from: AbbVie, Novartis, Pfizer and UCB, Robert G Lambert Consultant of: Parexel and Pfizer, Iris Eshed: None declared, Susanne Juhl Pedersen Speakers bureau: MSD, Pfizer, AbbVie, Novartis and UCB, Consultant of: AbbVie and Novartis, Grant/research support from: AbbVie, MSD, and Novartis, Maria Stoenoiu: None declared, Simon Krabbe: None declared, Paul Bird Speakers bureau: Janssen, Abbvie, UCB, Celgene, BMS, Novartis, Pfizer, Gilead, Eli-Lilly, Consultant of: Janssen, Abbvie, UCB, Celgene, BMS, Novartis, Pfizer, Gilead, Eli-Lilly, Violaine Foltz: None declared, Ashish Jacob Mathew: None declared, Frederique Gandjbakhch: None declared, Joel Paschke: None declared, Philippe Carron Speakers bureau: Pfizer, MSD, Novartis, BMS, AbbVie, UCB, Eli Lilly, Gilead and Celgene, Consultant of: Pfizer, MSD, Novartis, BMS, AbbVie, UCB, Eli Lilly, Gilead and Celgene, Grant/research support from: UCB, MSD and Pfizer, Gabriele De Marco: None declared, Helena Marzo-Ortega Speakers bureau: AbbVie, Celgene, Janssen, Lilly, Novartis, Pfizer, Takeda and UCB, Grant/research support from: Janssen and Novartis, Anna Enevold Fløistrup Poulsen: None declared, Jacob L Jaremko: None declared, Philip G Conaghan Speakers bureau: AbbVie, AstraZeneca, BMS, Eli Lilly, EMD Serono, Flexion Therapeutics, Galapagos, Gilead, Novartis, Pfizer and Stryker, Consultant of: AbbVie, AstraZeneca, BMS, Eli Lilly, EMD Serono, Flexion Therapeutics, Galapagos, Gilead, Novartis, Pfizer and Stryker, Mikkel Østergaard Speakers bureau: Abbvie, BMS, Boehringer-Ingelheim, Celgene, Eli-Lilly, Hospira, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sandoz, Sanofi and UCB, Consultant of: Abbvie, BMS, Boehringer-Ingelheim, Celgene, Eli-Lilly, Hospira, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sandoz, Sanofi and UCB, Grant/research support from: Abbvie, BMS, Boehringer-Ingelheim, Celgene, Eli-Lilly, Hospira, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sandoz, Sanofi and UCB

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Martin, Patti, Nannette Nicholson, and Charia Hall. "Family Support in Early Hearing Detection and Intervention (EHDI) Systems." Perspectives on Hearing and Hearing Disorders in Childhood 22, no. 1 (March 2012): 11–21. http://dx.doi.org/10.1044/hhdc22.1.11.

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Family support has evolved from a buzzword of the 1990s to a concept founded in theory, mandated by federal law, valued across disciplines, and espoused by both parents and professionals. This emphasis on family-centered practices for families of young children with disabilities, coupled with federal policy initiatives and technological advances, served as the impetus for the development of Early Hearing Detection and Intervention (EHDI) programs (Nicholson & Martin, in press). White, Forsman, Eichwald, and Muñoz (2010) provide an excellent review of the evolution of EHDI systems, which include family support as one of their 9 components. The National Center for Hearing Assessment and Management (NCHAM), the Maternal and Child Health Bureau, and the Center for Disease Control Centers cosponsored the first National EHDI Conference. This conference brought stakeholders including parents, practitioners, and researchers from diverse backgrounds together to form a learning collaborative (Forsman, 2002). Attendees represented a variety of state, national, and/or federal agencies and organizations. This forum focused effort on the development of EHDI programs infused with translating research into practices and policy. When NCHAM, recognizing the critical role of family support in the improvement of outcomes for both children and families, created a think tank to investigate the concept of a conference centered on support for families of children who are deaf or hard of hearing in 2005, the “Investing in Family Support” (IFSC) conference was born. This conference was specifically designed to facilitate and enhance EHDI efforts within the family support arena. From this venue, a model of family support was conceptualized and has served as the cornerstone of the IFSC annual conference since 2006. Designed to be a functional framework, the IFSC model delineates where and how families find support. In this article, we will promote and encourage continued efforts towards defining operational measures and program components to ultimately quantify success as it relates to improved outcomes for these children and their families. The authors view this opportunity to revisit the theoretical underpinnings of family support, the emerging research in this area, and the basics of the IFSC Model of Family Support as a call to action. We challenge professionals who work with children identified as deaf or hard of hearing to move family support from conceptualization to practices that are grounded in evidence and ever mindful of the unique and dynamic nature of individual families.

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Ayanlade, Oluwatoyin S., David O. Baloye, Margaret O. Jegede, and Ayansina Ayanlade. "A Geo-Informatics Technique for the Management of Meningitis Epidemic Distributions in Northern Nigeria." Information Resources Management Journal 28, no. 3 (July 2015): 15–28. http://dx.doi.org/10.4018/irmj.2015070102.

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This study aims at examining and mapping the spatiotemporal distribution of meningitis epidemic, in relation to climate variability, using GIS and Remote Sensing techniques. Using the northern part of Nigeria as a case study, data on meningitis epidemic were obtained from the archive of National Bureau of Statistics, Nigeria for the periods between 1998 and 2013. The data were updated with collection from Nigeria Demographic and Health Survey (NDHS). Also, Nigerian Ministry of Health has compiled consistent statistics on meningitis incidence for the periods. A meningitis distribution map was derived from an environmentally-driven form of predicted probability of epidemic experience as it is in International Research Institute for Climate and Society (IRI) Database. The results showed that Meningitis Epidemic is very high during months with low rainfall. Thus, seasonality of rainfall and temperature are important determinants of Meningitis Epidemic incidence in the Northern part of Nigeria. Therefore, it can be confirmed, as cited in some literatures, that the distribution of the epidemics has a strong association with the environment, especially climate variability. Although meningitis surveillance systems in Nigeria have improved, they still fall short of the sensitivity required to demonstrate incidence changes in vaccinated and non-vaccinated cohorts and complementary approaches may be needed to demonstrate the impact of the vaccines. There is however, a need for a new technology and innovation like an integrated GIS, and other environmental modeling system, to allow health practitioners as well as policy makers, for better management, productivity and profitability.

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Pithouse, Andrew, Alyson Rees, Charlotte Brookfield, and Alf Djupvik. "Understanding social work-force satisfaction." Journal of Social Work 21, no. 1 (August 8, 2019): 107–27. http://dx.doi.org/10.1177/1468017319868121.

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Summary A Guardian Newspaper survey of social workers in the UK published in 2015 suggested that ‘The happiest social workers are in Wales’. In exploring why this may be so, the authors undertook an in-depth national online survey in 2017 of all social workers in Wales registered ( n = 5564) as employed at that point and from which some 997 responded. The survey sought a wide field of information about the occupational experience, and this article reports on selected aspects of knowledge, evidence-base, aims, competence and quality as perceived by respondents. Findings The workforce, durable, mostly white, aging and female, consider their services of good quality despite insufficiencies in staff capacities and material resources. While most acknowledged the influence on their practice of psycho-social, cognitive and systems paradigms, they also cited as major sources of knowledge, their clients, work experience, colleagues, case-procedures and in-house training. There seemed much less affirmation of evidence-based techniques and relatively little use of social work journals, books and professional magazines once qualified and in practice. Applications The emphasis by many upon the bureau or department as both ‘habitus’ and heuristic for much everyday practice raises important questions for how we understand and enhance practitioner knowledge and ensure equivalent social worker competence across the workforce.

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Journal articles on the topic 'Bureau of Health Systems'

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