Impact on particulate matters in India's most polluted cities due to long-term restriction on anthropogenic activities.

Our purpose of this research is to study the variation in air quality during lockdown (LD) and Post-lockdown (Post-LD) with respect to Pre-lockdown (Pre-LD) in most polluted cities of India by comparing the data of PM10 and PM2.5 in different periods: Pre-LD, LD and post-LD. We have selected top five cities of India out of the 20 most polluted cities across the world including Ghaziabad, Delhi, Noida, Greater Noida, and Lucknow (LKO). Historical data of atmospheric PM10 and PM2.5 for all cities were obtained from the Central Pollution Control Board (CPCB) online web portal of air quality data, except LKO. However, atmospheric PMs was monitored in LKO and samples of PM10 and PM2.5 were collected. During the LD and Post-LD period, due to anthropogenic emissions switch-off' a sharp decline was observed in concentrations of PM10 and PM2.5 in both circumstances (monthly and mean variation) as compared to Pre-LD in all selected cities. The Percentage changes (PCs) was found in mean concentrations of PM10 and PM2.5 during LD** and Post-LD*** with respect to Pre-LD at selected cities; Delhi -40.78%**, -58.42%*** and -57.60%**, -70.11%***; Ghaziabad -31.20%**, -53.91%*** and -57.29%**, -44.82%***; Noida -36.59&**, -53.95&*** and -58.36%**, -68.49%***; Greater Noida -39.39%**, -55.75%*** and -61.07%**, -71.56%***; LKO -57.95%**, -65.01%*** and -63.31%**, -59.95%*** respectively. The PCs of both pollutants exhibited a significant decrease in mean concentrations in all selected cities during LD and Post-LD with respect to Pre-LD period. Consequently, the results of current studies suggest that due to COVID-19 pandemic national LD restriction on anthropogenic activities, both coarse and fine pollutants have significantly reduced and air quality greatly improved during LD and Post-LD as compared to pre-LD period in all selected cities of India.

A stepped wedge cluster randomized control trial to evaluate the implementation and effectiveness of optimized initiatives in improving quality of care for ST segment elevation myocardial infarction in response to the COVID-19 outbreak.

BACKGROUND: The National Chest Pain Center Accreditation Program (CHANGE) is the first hospital-based, multifaceted, nationwide quality improvement (QI) initiative, to monitor and improve the quality of the ST segment elevation myocardial infarction (STEMI) care in China. The QI initiatives, as implementation strategies, include a bundle of evidence-based interventions adapted for implementation in China. During the pandemic of coronavirus disease 2019 (COVID-19), fear of infection with severe acute respiratory syndrome coronavirus 2, national lockdowns, and altered health care priorities have highlighted the program's importance in improving STEMI care quality. This study aims to minimize the adverse impact of the COVID-19 pandemic on the quality of STEMI care, by developing interventions that optimize the QI initiatives, implementing and evaluating the optimized QI initiatives, and developing scale-up activities of the optimized QI initiatives in response to COVID-19 and other public health emergencies. METHODS: A stepped wedge cluster randomized control trial will be conducted in three selected cities of China: Wuhan, Suzhou, and Shenzhen. Two districts have been randomly selected in each city, yielding a total of 24 registered hospitals. This study will conduct a rollout in these hospitals every 3 months. The 24 hospitals will be randomly assigned to four clusters, and each cluster will commence the intervention (optimized QI initiatives) at one of the four steps. We will conduct hospital-based assessments, questionnaire surveys among health care providers, community-based household surveys, and key informant interviews during the trial. All outcome measures will be organized using the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework, including implementation outcomes, service outcomes (e.g., treatment time), and patient outcomes (e.g., in-hospital mortality and 1-year complication). The Consolidated Framework for Implementation Research framework will be used to identify factors that influence implementation of the optimized QI interventions. DISCUSSION: The study findings could be translated into a systematic solution to implementing QI initiatives in response to COVID-19 and future potential major public health emergencies. Such actionable knowledge is critical for implementors of scale-up activities in low- and middle-income settings. TRIAL REGISTRATION: ChiCTR 2100043319 . Registered on 10 February 2021.