Colonoscopy screening rates among patients of colonoscopy-trained African American primary care physicians

Background - When performed competently, colonoscopy screening can reduce colorectal cancer rates, especially in high-risk groups such as African Americans (AAs). Training primary care physicians (PCPs) to perform colonoscopy may improve screening rates among underserved high-risk populations. Methods - We compared colonoscopy screening rates and computed adjusted odds ratios for colonoscopy-eligible patients of trained AA PCPs (study group) vs. untrained PCPs (comparison group), before and since initiating colonoscopy training. All colonoscopies were performed at a licensed ambulatory surgery center with specialist standby support. Retrospective chart review was conducted on 200 consecutive, established outpatients aged ≥50 years at each of 12 PCP offices (7 trained AA PCPs and 5 untrained PCPs, practicing in the same region), total 1,244 study group and 923 comparison group patients. Results - Post-training colonoscopy rates in both groups were higher than pre-training rates: 48.3% vs. 9.3% in the study group, 29.6% vs. 9.8% in the comparison group (both p\u3c0.001). AA patients in the study group showed over 5-fold increase (8.9% pre-training vs. 52.8% post training), with no change among Whites (18.2% vs. 25.0%). Corresponding pre- and post-training rates among comparison patients were 10.4% and 38.7% respectively among AAs (p\u3c0.001), and 13.3% vs. 13.2% respectively among Whites. After adjusting for demographics, duration since becoming the PCP\u27s patient, and health insurance, the study group had a 66% higher likelihood of colonoscopy in the post-training period (OR=1.66; CI, 1.30, 2.13), and AAs had a five-fold increased likelihood of colonoscopy relative to Whites. Conclusions - Colonoscopy-trained PCPs may help reduce colorectal cancer disparities

Residual Government Ownership in Public-Private Partnership Projects

Social and economic infrastructure are essential for economic development. However, over the last three decades, many infrastructure projects in developing countries have failed. These failures raise the question as to the role of governments in the provision, and longevity, of much needed infrastructure. In this paper, we seek to examine the significance of governments’ residual ownership in determining the failure of infrastructure projects that started as Public-Private Partnerships (PPP). We utilise duration analysis to analyse 2,721 PPP projects across six regions globally and find that assigning the residual ownership of infrastructure projects to the government reduces the probability of project failure. It may be the case that assigning the risk of residual ownership to governments makes the project more affordable to end users. We also find that both project size and sector play an important role in determining the probability of project failure. These findings provide policy insights and highlights issues around the way infrastructure projects in developing countries are negotiated between the private sector and governments

How Different Pre-existing Mental Disorders and Their Co-occurrence Affects COVID-19 Clinical Outcomes? A Real-World Data Study in the Southern United States

Background: Although a psychiatric history might be an independent risk factor for COVID-19 infection and mortality, no studies have systematically investigated how different clusters of pre-existing mental disorders may affect COVID-19 clinical outcomes or showed how the coexistence of mental disorder clusters is related to COVID-19 clinical outcomes. Methods: Using a retrospective cohort study design, a total of 476,775 adult patients with lab-confirmed and probable COVID-19 between March 06, 2020 and April 14, 2021 in South Carolina, United States were included in the current study. The electronic health record data of COVID-19 patients were linked to all payer-based claims data through the SC Revenue and Fiscal Affairs Office. Pre-existing mental disorder diagnoses from Jan 2, 2019 to Jan 14, 2021 were extracted from the patients\u27 healthcare utilization data via ICD-10 codes. Results: There is an elevated risk of COVID-19-related hospitalization and death among participants with pre-existing mental disorders adjusting for key socio-demographic and comorbidity covariates. Co-occurrence of any two clusters was positively associated with COVID-19-related hospitalization and death. The odds ratio of being hospitalized was 1.26 (95% CI: 1.151, 1.383) for patients with internalizing and externalizing disorders, 1.65 (95% CI: 1.298, 2.092) for internalizing and thought disorders, 1.76 (95% CI: 1.217, 2.542) for externalizing and thought disorders, and 1.64 (95% CI: 1.274, 2.118) for three clusters of mental disorders. Conclusions: Pre-existing internalizing disorders and thought disorders are positively related to COVID-19 hospitalization and death. Co-occurrence of any two clusters of mental disorders have elevated risk of COVID-19-related hospitalization and death compared to those with a single cluster

Improving accountability for equitable health and well-being in urban informal spaces: Moving from dominant to transformative approaches

This article critically reviews the literature on urban informality, inequity, health, well-being and accountability to identify key conceptual, methodological and empirical gaps in academic and policy discourses. We argue that critical attention to power dynamics is often a key missing element in these discourses and make the case for explicit attention to the operation of power throughout conceptualization, design and conduct of research in this space. We argue that: (a) urban informality reflects the exercise of power to confer and withhold advantage; (b) the dominant biomedical model of health poorly links embodied experiences and structural contexts; (c) existing models of accountability are inadequate in unequal, pluralistic governance and provision environments. We trace four conceptual and empirical directions for transformative approaches to power relations in urban health equity research

Residual government ownership in public-private partnership projects

Social and economic infrastructure are essential for economic development. However, over the last three decades, many infrastructure projects in developing countries have failed. These failures raise the question as to the role of governments in the provision, and longevity, of much needed infrastructure. In this paper, we seek to examine the significance of governments' residual ownership in determining the failure of infrastructure projects that started as Public-Private Partnerships (PPP). We utilise duration analysis to analyse 2,721 PPP projects across six regions globally and find that assigning the residual ownership of infrastructure projects to the government reduces the probability of project failure. It may be the case that assigning the risk of residual ownership to governments makes the project more affordable to end users. We also find that both project size and sector play an important role in determining the probability of project failure. These findings provide policy insights and highlights issues around the way infrastructure projects in developing countries are negotiated between the private sector and governments

Vulnerability of a Tunisian Coastal Aquifer to Seawater Intrusion: Insights from the GALDIT Model

International audienceThe Korba region in northwestern Tunisia has a coastal aquifer that is impacted by intensive irrigation, urban expansion, and sensitivity to SWI. We assessed the vulnerability extent of Korba’s GW to SWI. We utilized a parametric model for GW vulnerability assessment, the GALDIT, which considers six parameters to determine SWI effects. The GALDIT map has four rating categories (≥7.5, 7.5–5, 5–2.5, and <2.5), representing very high, high, moderate, and low vulnerability, respectively. Most of the region was found to be highly vulnerable (44.2% of the surface area), followed by areas characterized by very high (20.3%) and moderate (19.3%) vulnerability. Only 16.2% was found to have low vulnerability. A parameter sensitivity analysis showed that distance from shore and depth of GW represent the determining factors for SWI with variation index values of 24.12 and 18.02%, respectively. Inland advancement of seawater is causing GW salinity to rise, as indicated by a strong Pearson correlation coefficient of 0.75 between SWI indices and the electrical conductivity. Suitable areas for artificial recharge were mainly distributed in the alluvial plains, with a total area of 32.85 km2. Inhibiting SWI requires about 11.31 MCM of artificial recharge in the two most suitable recharge zones in the region

The use of crop residues for biofuel production

Fossil fuels are a finite source of energy and are going to deplete with the passage of time, possibly running out in a couple of decades. The importance of environmentally friendly biofuels has been realized in the last few decades. The climate and global warming issues associated with burning fossil fuels provide the initiative to look for a substitute fuel to meet the energy demand in the future. Generally, biomass is considered as a new energy source and has sufficient energy value per unit mass, but which is lower than that of fossil fuels. The use of biomass as a valuable energy source is a promising area of interest for researchers. Biomass is a renewable feedstock used to produce biofuels (in solid, liquid, and gas forms) for sustainable development in the future. A variety of crop residues are being produced around the world that can be converted into biofuels using different treatment and production methods, such as thermochemical conversion (e.g., combustion, pyrolysis, hydrothermal liquefaction, and gasification), biochemical conversion (e.g., microbial fermentation, enzymatic hydrolysis, and anaerobic digestion), and chemical treatment (e.g., transesterification). However, concerns such as environmental forfeits of contending uses of crop residues must be evaluated with short- and long-term perception considering its impact on agricultural land and biofuel production