Tag: nevin manimala

BMC Public Health. 2023 Aug 2;23(1):1474. doi: 10.1186/s12889-023-16352-w.

ABSTRACT

BACKGROUND: Increased coverage for institutional delivery (ID) is one of the essential factors for improved maternal and child health (MCH). Though, ID increased over time, out-of-pocket expenditure (OOPE) for the care-seeking families had been found to be growing, parallelly. Hence, we estimated OOPE in public and private health centres for ID, along with their sources and attributing factors and compared state and union territory-wise, so that financial risk protection can be improved for MCH related services.

METHODS: We used women’s data from the National Family Health Survey, 2019-2021 (NFHS-5). Reproductive aged women (15-49 years) delivering one live child in last 5 years (n = 145,386) in any public or private institutions, were included. Descriptive statistics were presented as frequency and proportions. OOPE, was summarized as median and interquartile range (IQR). To estimate the extent for each covariate’s effect, linear regression model was conducted.

RESULTS: Overall median OOPE for ID was Rs. 4066 (median OOPE: private hospitals: Rs.25600, public hospitals: Rs.2067). Health insurance was not sufficient to slash OOPE down at private facilities. Factors associated significantly to high OOPE were mothers’ education, elderly pregnancy, complicated delivery, birth order of the latest child etc. CONCLUSION: A standard norm for ID should be implemented as a component of overseeing and controlling inequality. Aiding the needy is probably just one side of the solution, while the focus is required to be shifted towards reducing disparity among the health facilities, so that the beneficiaries do not need to spend on essential services or during emergencies.

PMID:37532981 | DOI:10.1186/s12889-023-16352-w

Environ Sci Pollut Res Int. 2023 Aug 3. doi: 10.1007/s11356-023-29001-x. Online ahead of print.

ABSTRACT

In the real world, humans are exposed to multiple metal(loid)s (designated hereafter metals) that contain essential metals as well as toxic metals. Exposure to the metal mixture was assumed to be associated with renal function impairment; however, there is no consensus on available studies. Therefore, we here explored the association between multiple metals exposure and indicators of renal function in the general population from southeastern China. A total of 11 metals with 6 human essential metals and 5 toxic metals were determined in the selected 720 subjects. In addition, serum uric acid (SUA), serum creatinine (SCR), and the estimated glomerular filtration rate (eGFR) were measured or calculated as indicators of renal function. Using multiple flexible statistical models of generalized linear model, elastic net regression, and Bayesian kernel machine regression, the joint as well as the individual effect of metals within the mixture, and the interactions between metals were explored. When exposed to the metal mixture, the statistically non-significantly increased SUA, the significantly increased SCR, and the significantly declined eGFR were observed. In addition, the declined renal function may be primarily attributed to lead (Pb), arsenic (As), and nickel (Ni) exposure. Finally, interactions, such as the synergistic effect between Pb and Mo on SUA, whereas the antagonistic effect between Ni and Cd on SCR and eGFR were identified. Our finding suggests that combined exposure to multiple metals would impair renal function. Therefore, reducing exposure to toxic heavy metals of Pb, As, and Cd and limiting exposure to the human essential metal of Ni would protect renal function.

PMID:37532974 | DOI:10.1007/s11356-023-29001-x

Environ Sci Pollut Res Int. 2023 Aug 3. doi: 10.1007/s11356-023-28847-5. Online ahead of print.

ABSTRACT

We aim to study the impact of green fiscal policy on enterprise green innovation by applying a time-varying difference-in-difference (DID) model, and treat the comprehensive demonstration city of fiscal policy for energy conservation and emission reduction (CPEE) in China as a quasi-natural experiment. The results show that the CPEE can significantly improve enterprise’s green innovation performance of pilot area. This net policy effect is valid after a series of robustness tests to control for various potential confounding factors. Heterogeneity analysis reveals that the effect of CPEE is stronger for state-owned enterprises and enterprises in high energy consumption industries or industries with higher industrial concentration. In addition, the effect of CPEE is various among different categories of green patents, which is stronger for the types of alternative energy production category, waste management category, administrative supervision and design category. The mechanism test indicates that the CPEE can improve the green innovation performance by increasing enterprise’ investment in research and development, promoting territorial industrial transformation and upgrading, and enhancing enterprise executives’ environmental awareness. To achieve the carbon peaking and carbon neutrality goals, the green enabling role of fiscal reform pilot policy in transition economies and the applicability of localized policies should be excavated.

PMID:37532973 | DOI:10.1007/s11356-023-28847-5

Environ Sci Pollut Res Int. 2023 Aug 2. doi: 10.1007/s11356-023-29045-z. Online ahead of print.

ABSTRACT

In the design waste collection systems, it is common practice to use a constant specific fuel consumption (e.g. litres per amount of waste collected or distance travelled). This is also the approach used in many cases for fleet management, namely, for decision-making on more fuel-efficient equipment acquisition. However, the specific fuel consumption is not constant and there are spatial and temporal variations. Accounting for this variability becomes relevant if a more refined cost or environmental optimization is intended. The present research effort evaluates the energy intensity of the waste collection service in the Cascais municipality, reporting the differences and the magnitude of the variability for the mixed waste collection service. Statistically significant differences are found between the circuits, the trucks, months of the year and days of the week. It is discussed that extrapolating average fuel consumption rates for decision-making in new waste collection systems may be prone to substantial error.

PMID:37532971 | DOI:10.1007/s11356-023-29045-z

J Math Biol. 2023 Aug 2;87(2):36. doi: 10.1007/s00285-023-01967-9.

ABSTRACT

We prove that it is possible to obtain the exact closure of SIR pairwise epidemic equations on a configuration model network if and only if the degree distribution follows a Poisson, binomial, or negative binomial distribution. The proof relies on establishing the equivalence, for these specific degree distributions, between the closed pairwise model and a dynamical survival analysis (DSA) model that was previously shown to be exact. Specifically, we demonstrate that the DSA model is equivalent to the well-known edge-based Volz model. Using this result, we also provide reductions of the closed pairwise and Volz models to a single equation that involves only susceptibles. This equation has a useful statistical interpretation in terms of times to infection. We provide some numerical examples to illustrate our results.

PMID:37532967 | DOI:10.1007/s00285-023-01967-9

Mar Pollut Bull. 2023 Jul 31;194(Pt B):115293. doi: 10.1016/j.marpolbul.2023.115293. Online ahead of print.

ABSTRACT

This study aimed to investigate the sediment transport pathways and geochemical parameters in the Izmir Gulf to determine the heavily impacted areas by natural and anthropogenic parameters. The grain size trend analysis was used to determine sediment transport patterns and, statistical methods were employed to identify the sources and distribution of chemical elements in sediments. The main factors that were affecting the area were identified as lithogenic, anthropogenic, maritime traffic, biogenic and shipyard activities. The tannery industry (Cr), maritime traffic and shipyard/dock activities (Cu and Zn), road traffic run-offs (Pb and Zn), and untreated domestic waste discharges (TOC and S) were identified as the sources of metals. Contamination rankings based on metal concentrations indicated higher pollution levels in the Inner Gulf compared to the Central Gulf. Zinc and chromium were found to pose significant risks to benthic organisms. The pollutants tended to accumulate in deposition zones, following sediment transport directions.

PMID:37531664 | DOI:10.1016/j.marpolbul.2023.115293

J Infect Dis. 2023 Aug 2:jiad305. doi: 10.1093/infdis/jiad305. Online ahead of print.

ABSTRACT

BACKGROUND: The epidemiology of respiratory viral infections is complex. How infection with one respiratory virus affects risk of subsequent infection with the same or another respiratory virus is not well described.

METHODS: We retrospectively analyzed data from a longitudinal household cohort study from October 2019-June 2021. Enrolled households completed active surveillance for acute respiratory illness (ARI), and participants with ARI self-collected nasal swabs; after April 2020, participants with ARI or laboratory-confirmed SARS-CoV-2 and their household members self-collected nasal swabs. Specimens were tested via multiplex RT-PCR for respiratory viruses. A Cox regression model with a time-dependent covariate examined risk of subsequent detections following a specific primary viral detection.

RESULTS: Rhinovirus was the most frequently detected pathogen in study specimens (n=406, 9.5%). Among 51 participants with multiple viral detections, rhinovirus to seasonal coronavirus (8, 14.8%) was the most common viral detection pairing. Relative to no primary detection, there was a 1.03-2.06-fold increase in risk of subsequent virus detection in the 90 days following primary detection; risk varied by primary virus: parainfluenza, rhinovirus, and respiratory syncytial virus were statistically significant.

CONCLUSIONS: Primary virus detection was associated with higher risk of subsequent virus detection within the first 90 days after primary detection.

PMID:37531658 | DOI:10.1093/infdis/jiad305

J Contin Educ Nurs. 2023 Aug;54(8):367-376. doi: 10.3928/00220124-20230711-07. Epub 2023 Aug 1.

ABSTRACT

BACKGROUND: New nurses report feeling unprepared and having low levels of self-confidence. High-fidelity simulation (HFS) is frequently used to increase confidence and improve patient safety. This study assessed whether HFS training increased new nurses’ self-confidence and activation of the rapid response team (RRT) when caring for patients with clinical deterioration.

METHOD: A quality improvement design was used. New nurses on two units at a Level I trauma center completed a 70-minute HFS. The change in self-confidence was measured by Grundy’s C-Scale, and the change in percentage of staff-initiated RRT calls versus auto-triggered calls was calculated 3 months after HFS.

RESULTS: All 12 nurses who participated in the HFS showed improved self-confidence immediately after simulation. A Wilcox-on signed-rank paired data test showed statistically significantly improved confidence scores for all five items of the C-Scale from preintervention to immediately postintervention as well as 5 months later. One unit showed an increase in percentage of staff-initiated RRT calls 3 months postsimulation, and the other unit showed a decline in staff-initiated versus auto-triggered RRT calls.

DISCUSSION: The HFS increased self-confidence scores from preintervention to immediately postintervention, with the increase sustained 5 months later. However, how this increase translated into practice when activating RRT calls cannot be determined because many factors can influence RRT call patterns.

CONCLUSION: The literature review and study results suggest that HFS training embedded into an existing nurse residency program can build self-confidence in caring for patients with clinical deterioration. [J Contin Educ Nurs. 2023;54(8):367-376.].

PMID:37531656 | DOI:10.3928/00220124-20230711-07

J Comput Assist Tomogr. 2023 Aug 3. doi: 10.1097/RCT.0000000000001517. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the utility of texture analysis in detecting osseous changes associated with hyperparathyroidism on neck CT examinations compared with control patients and to explore the best regions in the head and neck to evaluate changes in the trabecular architecture secondary to hyperparathyroidism.

METHODS: Patients with hyperparathyroidism who underwent a 4D CT of the neck with contrast were included in this study. Age-matched control patients with no history of hyperparathyroidism who underwent a contrast-enhanced neck CT were also included. Mandibular condyles, bilateral mandibular bodies, the body of the C4 vertebra, the manubrium of the sternum, and bilateral clavicular heads were selected for analysis, and oval-shaped regions of interest were manually placed. These segmented areas were imported into an in-house developed texture analysis program, and 41 texture analysis features were extracted. A mixed linear regression model was used to compare differences in the texture analysis features contoured at each of the osseous structures between patients with hyperparathyroidism and age-matched control patients.

RESULTS: A total of 30 patients with hyperparathyroidism and 30 age-matched control patients were included in this study. Statistically significant differences in texture features between patients with hyperparathyroidism and control patients in all 8 investigated osseous regions. The sternum showed the greatest number of texture features with statistically significant differences between these groups.

CONCLUSIONS: Some CT texture features demonstrated statistically significant differences between patients with hyperparathyroidism and control patients. The results suggest that texture features may discriminate changes in the osseous architecture of the head and neck in patients with hyperparathyroidism.

PMID:37531643 | DOI:10.1097/RCT.0000000000001517

Biostatistics. 2023 Aug 2:kxad015. doi: 10.1093/biostatistics/kxad015. Online ahead of print.

ABSTRACT

Cluster randomized trials (CRTs) often enroll large numbers of participants; yet due to resource constraints, only a subset of participants may be selected for outcome assessment, and those sampled may not be representative of all cluster members. Missing data also present a challenge: if sampled individuals with measured outcomes are dissimilar from those with missing outcomes, unadjusted estimates of arm-specific endpoints and the intervention effect may be biased. Further, CRTs often enroll and randomize few clusters, limiting statistical power and raising concerns about finite sample performance. Motivated by SEARCH-TB, a CRT aimed at reducing incident tuberculosis infection, we demonstrate interlocking methods to handle these challenges. First, we extend Two-Stage targeted minimum loss-based estimation to account for three sources of missingness: (i) subsampling; (ii) measurement of baseline status among those sampled; and (iii) measurement of final status among those in the incidence cohort (persons known to be at risk at baseline). Second, we critically evaluate the assumptions under which subunits of the cluster can be considered the conditionally independent unit, improving precision and statistical power but also causing the CRT to behave like an observational study. Our application to SEARCH-TB highlights the real-world impact of different assumptions on measurement and dependence; estimates relying on unrealistic assumptions suggested the intervention increased the incidence of TB infection by 18% (risk ratio [RR]=1.18, 95% confidence interval [CI]: 0.85-1.63), while estimates accounting for the sampling scheme, missingness, and within community dependence found the intervention decreased the incident TB by 27% (RR=0.73, 95% CI: 0.57-0.92).

PMID:37531621 | DOI:10.1093/biostatistics/kxad015