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Vaccination coverage for infants with CHD is unknown, yet these patients are at high risk for morbidity and mortality associated with vaccine-preventable illnesses. We determined vaccination rates for this population and identified predictors of undervaccination. We prospectively enrolled infants with CHD born between 1 January, 2012 and 31 December, 2015, seen in a single-centre cardiology clinic between 15 February, 2016 and 28 February, 2017. We assessed vaccination during the first year of life. Subjects who by age 1 year received all routine immunisations recommended during the first 6 months of life were considered fully vaccinated. We also evaluated influenza vaccination during subjects’ first eligible influenza season. We obtained immunisation histories from primary care providers and collected demographic and clinical data via a parent survey and chart review. We used multivariable logistic regression to identify predictors of undervaccination. Among 260 subjects, only 60% were fully vaccinated. Vaccination rates were lowest for influenza (64.6%), rotavirus (71.1%), and Haemophilus influenzae type b (79.3%). Cardiac surgery with cardiopulmonary bypass during the first year of life was associated with undervaccination (51.5% versus 76.4% fully vaccinated, adjusted odds ratio 2.1 [95% confidence interval 1.1–3.9]). Other predictors of undervaccination were out-of-state primary care (adjusted odds ratio 2.7 [1.5–4.9]), multiple comorbidities (≥2 versus 0–1, adjusted odds ratio 2.0 [1.1–3.6]), and hospitalisation for >25% of the first year of life (>25% versus ≤25%, adjusted odds ratio 2.1 [1.1–3.9]). Targeted quality improvement initiatives focused on improving vaccination coverage for these infants, especially surrounding cardiac surgery, are needed.
The rapid transmissibility of the severe acute respiratory syndrome-coronavirus-2 causing coronavirus disease-2019, requires timely dissemination of information and public health responses, with all 47 countries of the WHO African Region simultaneously facing significant risk, in contrast to the usual highly localised infectious disease outbreaks. This demanded a different approach to information management and an adaptive information strategy was implemented, focusing on data collection and management, reporting and analysis at the national and regional levels. This approach used frugal innovation, building on tools and technologies that are commonly used, and well understood; as well as developing simple, practical, highly functional and agile solutions that could be rapidly and remotely implemented, and flexible enough to be recalibrated and adapted as required. While the approach was successful in its aim of allowing the WHO Regional Office for Africa (WHO AFRO) to gather surveillance and epidemiological data, several challenges were encountered that affected timeliness and quality of data captured and reported by the member states, showing that strengthening data systems and digital capacity, and encouraging openness and data sharing are an important component of health system strengthening.
Epidemic intelligence activities are undertaken by the WHO Regional Office for Africa to support member states in early detection and response to outbreaks to prevent the international spread of diseases. We reviewed epidemic intelligence activities conducted by the organisation from 2017 to 2020, processes used, key results and how lessons learned can be used to strengthen preparedness, early detection and rapid response to outbreaks that may constitute a public health event of international concern. A total of 415 outbreaks were detected and notified to WHO, using both indicator-based and event-based surveillance. Media monitoring contributed to the initial detection of a quarter of all events reported. The most frequent outbreaks detected were vaccine-preventable diseases, followed by food-and-water-borne diseases, vector-borne diseases and viral haemorrhagic fevers. Rapid risk assessments generated evidence and provided the basis for WHO to trigger operational processes to provide rapid support to member states to respond to outbreaks with a potential for international spread. This is crucial in assisting member states in their obligations under the International Health Regulations (IHR) (2005). Member states in the region require scaled-up support, particularly in preventing recurrent outbreaks of infectious diseases and enhancing their event-based surveillance capacities with automated tools and processes.
OBJECTIVES/GOALS: Metabolic syndrome (MetSyn) is a risk for World Trade Center-Lung Injury (WTC-LI; defined as developing FEV1<lower limit of normal [LLN]). Metabolic health is a modifiable disease risk factor. We propose to characterize how time-dependent covariates of MetSyn are longitudinally associated with WTC-LI. METHODS/STUDY POPULATION: WTC-particulate exposed firefighters, consented, with pre-9/11 FEV1 LLN (N = 5,746). Data assessed from last pre-9/11 till August 1, 2017. Longitudinal MetSyn characteristics were assessed using 3 models: i. A linear mixed effect model to assess the effect size of longitudinal MetSyn and its components on longitudinal FEV1% predicted as an outcome; ii. a time-dependent Cox regression to assess the associations of MetSyn to time of onset of WTC-LI; iii. a novel, partially linear single index regression model with repeatedly measured MetSyn to assess their joint effects and delineate their relative contribution on the longitudinal lung function in the WTC-FDNY cohort. RESULTS/ANTICIPATED RESULTS: In Model I, BMI 30 kg/m2 had the largest effect size compared to ever-smoking, with −2.524 (95%CI: −2.708,−2.340) compared to −1.681(−2.325,−1.038) respectively. Having MetSyn, defined as 3/5 risk factors, had an effect size of −2.319(−2.526,−2.112). In Model II, hazards of triglycerides 150mg/dL were highest at 1.497(1.336, 1.677), followed by BMI 30 kg/m2 at 1.406(1.256, 1.575), and HDL<40mg/dL 1.355(1.176-1.561), compared to ever-smoking (1.201, p = 0.002). Having high exposure to PM by being present in the morning of 9/11 was a significant covariate only in Model II investigating HDL<40mg/dL or triglycerides 150mg/dL. Model III The proposed methods will be applied to our cohort study. DISCUSSION/SIGNIFICANCE OF IMPACT: MetSyn is both a predictor and concurrent marker of WTC-LI. The single index model can not only reduce dimensionality of the covariates, but also provides efficient estimates of the joint MetSyn effects, allowing linear or nonlinear effects. Future studies will investigate dietary intervention as a potential disease-modifying factor. CONFLICT OF INTEREST DESCRIPTION: NA, nothing to disclose.
A systematic review and meta-analysis of randomised controlled trials was undertaken to determine the effects of almond consumption on blood lipid levels, namely total cholesterol (TC), LDL-cholesterol (LDL-C), HDL-cholesterol (HDL-C), TAG and the ratios of TC:HDL-C and LDL-C:HDL-C. Following a comprehensive search of the scientific literature, a total of eighteen relevant publications and twenty-seven almond-control datasets were identified. Across the studies, the mean differences in the effect for each blood lipid parameter (i.e. the control-adjusted values) were pooled in a meta-analysis using a random-effects model. It was determined that TC, LDL-C and TAG were significantly reduced by −0·153 mmol/l (P < 0·001), −0·124 mmol/l (P = 0·001) and −0·067 mmol/l (P = 0·042), respectively, and that HDL-C was not affected (−0·017 mmol/l; P = 0·207). These results are aligned with data from prospective observational studies and a recent large-scale intervention study in which it was demonstrated that the consumption of nuts reduces the risk of heart disease. The consumption of nuts as part of a healthy diet should be encouraged to help in the maintenance of healthy blood lipid levels and to reduce the risk of heart disease.
Sustaining performance is a difficult and often overlooked aspect of quality improvement and implementation science. Over a 4-year period, we observed that monthly feedback of performance data in face-to-face meetings with frontline personnel was crucial in maintaining environmental-cleaning effectiveness in adult critical care units.
This article advocates for a comparative approach to archaeological studies of colonialism that considers how Native American societies with divergent political economies may have influenced various kinds of processes and outcomes in their encounters with European colonists. Three dimensions of indigenous political economies (polity size, polity structure, and landscape management practices) are identified as critical variables in colonial research. The importance of considering these dimensions is exemplified in a case study from California, which shows how small-sized polities, weak to moderate political hierarchies, and regionally oriented pyrodiversity economies played significant roles in the kinds of colonial relationships that unfolded. The case study illustrates how the colonial experiences of Native Californians differed from those of other tribal groups that confronted similar kinds of colonial programs involving Franciscan missionaries elsewhere in North America. The article stresses that the archaeology of colonialism is not simply an arcane academic exercise but, rather, has real-life relevancy for people who remain haunted by the legacies of colonialism, such as those petitioning for federal recognition in California.
This article is a study of the concept of local self-government (difang zizht) in the context of reform efforts from 1898 to 1911. Of the institutional changes proposed, local self-government rapidly gained much support among China's educated elites. The author explores the reasons behind much enthusiasm for self-government institutions by analyzing the works of two key reformists, Kang Youwei (1858–1927) and Liang Qichao (1873–1929). While the reformist approach to local government indicated the continuing influence of the fengjian (feudal) tradition on the one hand, and the reformist notion of citizenship was suggestive of the Neo-Confucian conception of self-cultivation on the other, the article argues that the reformist thought on local self-government represents an important step in moving China beyond an imperial political order.
The enthalpy of formation of cubic ceria–zirconia solid solutions (c-Ce(1−x)ZrxO2, 0.05 ⩽ x ⩽ 0.75) at 25 °C with respect to monoclinic zirconia (m-ZrO2) and cubic ceria (c-CeO2) has been measured by high-temperature oxide melt solution calorimetry. In contrast to fluorite solid solutions containing trivalent oxides (e.g., yttria–zirconia), mixing in c-Ce1−xZrxO2 shows moderate positive deviation from ideality. Evaluating the data within the framework of a regular solution model, the interaction parameter, Ω, is +51.0 ± 8.0 kJ/mol. The introduction of undersized Zr into CeO2 severely distorts and destabilizes the oxygen sublattice. Destabilization of c-Ce1−xZrxO2 may be relieved by reduction or clustering. A stable ordered compound in the CeO2–ZrO2 system is thermodynamically unlikely.
The slogan “the personal is political” captures the distinctive challenge to the public-private divide posed by contemporary feminists. As such, feminist activism is not necessarily congruent with civic engagement, which is predicated on the paradoxical need to both bridge and sustain the public-private divide. Lee argues that rather than subverting the divide, the politics of the personal offers an alternative understanding of civic engagement that aims to reinstate individuals’ dignity and agency.
Solid solutions (1 − x)CeO2 − xYO1.5 (0 ≤ x ≤ 0.36) were prepared by coprecipitation and sol-gel methods. Their enthalpy of formation relative to the end-members, fluorite-type cubic CeO2 and C-type YO1.5 was determined by oxide melt solution calorimetry. The enthalpy of drop solution shows a roughly linear trend with composition. Extrapolation to x = 1 gives the transition enthalpy of C-type to cubic fluorite YO1.5 as 22.2 ± 6.7 kJ/mol. This linear behavior is in contrast to the strong curvature seen in the ZrO2 − YO1.5 and HfO2 − YO1.5 systems. The slightly positive enthalpy of formation of CeO2 − YO1.5 is strikingly different from the strongly negative enthalpies of formation of ZrO2 − YO1.5 and HfO2 − YO1.5. The thermodynamics of CeO2 − YO1.5 is analyzed in terms of defect association and oxygen vacancy distribution. Specifically, the association of oxygen vacancies with the tetravalent cations in the zirconia and hafnia systems, in contrast to the preference of vacancies for nearest neighbor yttrium sites in the ceria systems, may explain the different energetics.