Enhanced postoperative surveillance versus standard of care to reduce mortality among adult surgical patients in Africa (ASOS-2) : a cluster-randomised controlled trial

Funding Information: R M Pearse reports grants from Edwards Lifesciences and Intersurgical; and personal fees from Edwards Lifesciences and GlaxoSmithKline, outside of the submitted work. R M Pearse also reports being a member of the editorial boards of the British Journal of Anaesthesia and the British Journal of Surgery. A B A Prempah was the recipient of the World Federation of Societies of Anaesthesiologists–International Anesthesia Research Society Clinical Research Fellow in Global Surgery and Anaesthesia in Africa. All other authors declare no competing interests. Funding Information: The ASOS-2 pilot and trial were partially supported by a grant (OPP#1161108) from the Bill & Melinda Gates Foundation, as a subaward from Praekelt. Researchers for the process evaluation were supported by a grant from the World Federation of Societies of Anaesthesiologists. Publisher Copyright: © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licensePeer reviewedPublisher PD

Wearable Activity Tracker Use and Physical Activity Among Informal Caregivers in the United States: Quantitative Study

Background: With an increase in aging population and chronic medical conditions in the United States, the role of informal caregivers has become paramount as they engage in the care of their loved ones. Mounting evidence suggests that such responsibilities place substantial burden on informal caregivers and can negatively impact their health. New wearable health and activity trackers (wearables) are increasingly being used to facilitate and monitor healthy behaviors and to improve health outcomes. Although prior studies have examined the efficacy of wearables in improving health and well-being in the general population, little is known about their benefits among informal caregivers. Objective: This study aimed to examine the association between use of wearables and levels of physical activity (PA) among informal caregivers in the United States. Methods: We used data from the National Cancer Institute’s Health Information National Trends Survey 5 (cycle 3, 2019 and cycle 4, 2020) for a nationally representative sample of 1273 community-dwelling informal caregivers—aged ≥18 years, 60% (757/1273) female, 75.7% (990/1273) had some college or more in education, and 67.3% (885/1273) had ≥1 chronic medical condition—in the United States. Using jackknife replicate weights, a multivariable logistic regression was fit to assess an independent association between the use of wearables and a binary outcome: meeting or not meeting the current World Health Organization’s recommendation of PA for adults (≥150 minutes of at least moderate-intensity PA per week). Results: More than one-third (466/1273, 37.8%) of the informal caregivers met the recommendations for adult PA. However, those who reported using wearables (390/1273, 31.7%) had slightly higher odds of meeting PA recommendations (adjusted odds ratios 1.1, 95% CI 1.04-1.77; P=.04) compared with those who did not use wearables. Conclusions: The results demonstrated a positive association between the use of wearables and levels of PA among informal caregivers in the United States. Therefore, efforts to incorporate wearable technology into the development of health-promoting programs or interventions for informal caregivers could potentially improve their health and well-being. However, any such effort should address the disparities in access to innovative digital technologies, including wearables, to promote health equity. Future longitudinal studies are required to further support the current findings of this study

A study of the oil and gas laws of the Kurdistan region-Iraq

This thesis examines the oil and gas legal framework of the Kurdistan Region-Iraq for the purpose of identifying current challenges in the governance of oil and gas and how such challenges can be resolved. In particular, the structure and composition of the Iraqi Constitution, the Kurdistan Region’s Oil and Gas legislation and Model Production Sharing Contract are analysed to determine how the Kurdistan Region’s oil and gas sector can be developed. Kurdish claims of ownership, management and entitlement to a share of oil and gas revenue has resulted in a strong legal case for Kurdish competency over oil and gas governance in Kurdish dominated areas in Iraq

Hospital Value-Based Payment Programs and Disparity In the United States: A Review of Current Evidence and Future Perspectives

Beginning in the early 2010s, an array of Value-Based Purchasing (VBP) programs has been developed in the United States (U.S.) to contain costs and improve health care quality. Despite documented successes in these efforts in some instances, there have been growing concerns about the programs\u27 unintended consequences for health care disparities due to their built-in biases against health care organizations that serve a disproportionate share of disadvantaged patient populations. We explore the effects of three Medicare hospital VBP programs on health and health care disparities in the U.S. by reviewing their designs, implementation history, and evidence on health care disparities. The available empirical evidence thus far suggests varied impacts of hospital VBP programs on health care disparities. Most of the reviewed studies in this paper demonstrate that hospital VBP programs have the tendency to exacerbate health care disparities, while a few others found evidence of little or no worsening impacts on disparities. We discuss several policy options and recommendations which include various reform approaches and specific programs ranging from those addressing upstream structural barriers to health care access, to health care delivery strategies that target service utilization and health outcomes of vulnerable populations under the VBP programs. Future studies are needed to produce more explicit, conclusive, and consistent evidence on the impacts of hospital VBP programs on disparities

Combined use of solar and hydraulic power by independent consumers

The study deals with depleted zones of stages in OTsK, GTsK and GPU metals (copper, alpha -iron, zirconium). The work is aimed at investigation into mechanisms of generation and growth of vacancy clusters in stage regions of damage. Mechanisms of formation of different vacancy clusters in depleted zones of stages OTsK, GTsK and GPU of metals are first proposed. The acquired knowledge on mechanisms of cluster generation makes it possible to explain many of experimental results on studying into the microstructure of irradiated metalsAvailable from VNTIC / VNTIC - Scientific & Technical Information Centre of RussiaSIGLERURussian Federatio

Enhanced postoperative surveillance versus standard of care to reduce mortality among adult surgical patients in Africa (ASOS-2): a cluster-randomised controlled trial

Background: Risk of mortality following surgery in patients across Africa is twice as high as the global average. Most of these deaths occur on hospital wards after the surgery itself. We aimed to assess whether enhanced postoperative surveillance of adult surgical patients at high risk of postoperative morbidity or mortality in Africa could reduce 30-day in hospital mortality. Methods We did a two-arm, open-label, cluster-randomised trial of hospitals (clusters) across Africa. Hospitals were eligible if they provided surgery with an overnight postoperative admission. Hospitals were randomly assigned through minimisation in recruitment blocks (1:1) to provide patients with either a package of enhanced postoperative surveillance interventions (admitting the patient to higher care ward, increasing the frequency of postoperative nursing observations, assigning the patient to a bed in view of the nursing station, allowing family members to stay in the ward, and placing a postoperative surveillance guide at the bedside) for those at high risk (ie, with African Surgical Outcomes Study Surgical Risk Calculator scores ≥10) and usual care for patients at low risk (intervention group), or for all patients to receive usual postoperative care (control group). Health-care providers and participants were not masked, but data assessors were. The primary outcome was 30 day in-hospital mortality of patients at low and high risk, measured at the participant level. All analyses were done as allocated (by cluster) in all patients with available data. This trial is registered with ClinicalTrials.gov, number NCT03853824. Findings Between May 3, 2019, and July 27, 2020, 594 eligible hospitals indicated a desire to participate across 33 African countries; 332 (56%) were able to recruit participants and were included in analyses. We allocated 160 hospitals (13 275 patients) to provide enhanced postoperative surveillance and 172 hospitals (15 617 patients) to provide standard care. The mean age of participants was 37·1 years (SD 15·5) and 20 039 (69·4%) of 28 892 patients were women. 30-day in-hospital mortality occurred in 169 (1·3%) of 12 970 patients with mortality data in the intervention group and in 193 (1·3%) of 15 242 patients with mortality data in the control group (relative risk 0·96, 95% CI 0·69–1·33; p=0·79). 45 (0·2%) of 22 031 patients at low risk and 309 (5·6%) of 5500 patients at high risk died. No harms associated with either intervention were reported. Interpretation This intervention package did not decrease 30-day in-hospital mortality among surgical patients in Africa at high risk of postoperative morbidity or mortality. Further research is needed to develop interventions that prevent death from surgical complications in resource-limited hospitals across Africa. Funding Bill & Melinda Gates Foundation, the World Federation of the Societies of Anaesthesiologists

Sleep, Health, and Wellbeing Among Middle-Aged and Older Adults: Impact of Insomnia Symptoms on Incident Heart Failure, Cognitive Performance, and All-Cause Mortality

In this three-paper dissertation, we used longitudinal data from the Health and Retirement Study (HRS) to investigate prospective associations between time-varying insomnia symptoms (difficulty initiating sleep, difficulty maintaining sleep, early-morning awakening, non-restorative sleep) and incident heart failure (HF), cognitive impairmentno dementia (CIND), and all-cause mortality among middle-aged and older adults (aged 50 years). In each study, we implemented a marginal structural modeling approach to generate the average causal effects of insomnia symptoms, while taking into account time-dependent biological, psycho-cognitive, behavioral, and lifestyle factors, and adjustments for selection bias.The first paper employed data from the 2002 through 2018 waves of HRS, with a sample of 12,761 individuals who were free from HF at baseline in 2002. Marginal structural discrete-time survival analyses were conducted. During the 16-year follow-up, 1,730 sample respondents had incident HF. Individuals experiencing one (hazard ratio [HR]=1.22; 95% CI: 1.081.38), two (HR=1.45; 95% CI: 1.211.72), three (HR=1.66; 95% CI: 1.372.02), or four (HR=1.80; 95% CI: 1.252.59) insomnia symptoms had a higher hazard of incident HF than asymptomatic respondents. In the second paper, we used data from a cohort of 14,530 cognitively healthy HRS respondents (2004 baseline) and followed participants for 12 years (through 2016). We evaluated cognitive performance biennially (CIND vs. normal) and then employed marginal structural generalized estimating equations. The association between insomnia symptoms and CIND varied with respondents age. For those 50 to 64 years old, experiencing two (odds ratio [OR]=1.38; 95% CI: 1.191.63) and three or four (OR=1.39; 95% CI: 1.161.65) insomnia symptoms were associated with higher risks of CIND compared to being symptom-free. For those 65 to 74 years old, experiencing three or four insomnia symptoms was significantly associated with the risk of CIND (OR=1.31; 95% CI: 1.081.58). Among respondents aged 75 or older, insomnia symptoms were not associated with CIND. In the third and final paper, we obtained data from 2004 (baseline) through 2018 survey waves of HRS for a sample of 15,511 individuals. During 14 years of follow-up, 5,878 respondents (31.9%) died. We performed marginal structural discrete-time survival analyses. Respondents who experienced one (HR=1.11; 95% CI: 1.031.20), two (HR=1.12; 95% CI: 1.011.23), three (HR=1.15; 95% CI: 1.051.27), or four (HR=1.32; 95% CI: 1.121.56) insomnia symptoms had on average a higher hazard of all-cause mortality, compared to those who were symptom-free. Our findings indicate that insomnia symptoms are significantly associated with incident HF and all-cause mortality among middle-aged and older adults regardless of age category and that the symptoms could negatively impact cognition by increasing the risks of CIND among middle-aged and, to a lesser extent, older adults. Expanding public health awareness about insomnia and increasing screening for insomnia symptoms in at-risk populations can be an essential prevention strategy. Future studies could investigate complex mechanisms linking insomnia symptoms and these adverse health outcomes

HUBUNGAN PERSEPSI TERHADAP PROGRAM KESELAMATAN DAN KESEHATAN KERJA DENGAN KEPUASAN KERJA PETUGAS DAMKAR KOTA PADANG

Keselamatan dan kesehatan kerja merupakan salah satu faktor yang mencapai kepuasan kerja. Tujuan penelitian ini adalah apakah terdapat hubungan antara persepsi terhadap program keselamatan dan kepuasan kerja (K3) dengan kepuasan kerja. Penelitian ini menggunakan pendekatan kuantitatif yang bertipe penelitian korelasional yang bertujuan untuk meneliti sejauh mana variabel satu berkaitan dengan variabel lain berdasarkan koefisien korelasi. Subjek penelitian ini adalah petugas Damkar Kota Padang yang berjumlah 65 orang. Karena subjek kurang dari seratus maka penelitian ini menggunakan semua populasi untuk penelitian.Hasil penelitian membuktikan Petugas Damkar Kota Padang, memiliki tingkat persepsi yang positif terhadap program K3, dibuktikan dengan 39 orang atau 60% memiliki tingkat persepsi terhadap program K3 yang positif, dan 26 orang atau 40% memiliki tingkat persepsi terhadap program K3 yang negatif dan juga memiliki tingkat kepuasan kerja yang tinggi, ini dibuktikan dengan sebanyak 47 orang atau 72% memiliki tingkat kepuasan kerja yang tinggi dan sebanyak 18 orang atau 28% memiliki tingkat kepuasan kerja yang rendah. Hal ini membuktikan bahwa ada hubungan antara persepsi terhadap program K3 dengan kepuasan kerja pada petugas Damkar kota Padang.Kata Kunci: Persepsi Terhadap Program K3, Kepuasan Kerj