Thoughts on diagnosis and treatment plan of patients infected with severe acute respiratory syndrome coronavirus 2 omicron variant in large shelter hospitals in Shanghai.

The epidemic caused by the infection of severe acute respiratory syndrome coronavirus 2 omicron variant broke out in Shanghai in Mar. 2022. Omicron variant has characteristics such as strong concealment and rapid transmission, resulting in significant differences between the current round of epidemic and that in Wuhan. The number of infected patients (mainly asymptomatic infected patients) increased rapidly in a short term. Based on dynamic zero policy, shelter hospitals were set up in time in Shanghai to treat the patients. It is suggested that medical resources and patient characteristics should be taken into account in the independent cabin of a shelter hospital with more than 10 000 beds, and the clinical medical practice should be divided to 5 modes (universal education and management, community outpatient clinic, ward duty, emergency rescue, and temporary observation and transport) to optimize the allocation of medical resources, so as to further enhance the treatment capacity and efficiency of shelter hospitals.Copyright © 2022, Second Military Medical University Press. All rights reserved.

Optimization of train formation plan based on technical station under railcar demand fluctuation

Train formation planning (TFP) is essential for rail freight logistics services. The fluctuation of railcar flows dramatically compared with before the outbreak of COVID-19. This paper studies train formation planning, considering three types of train services provided for railcar flow between pairs of technical stations (TS), including direct trains, district trains, and pickup trains. This paper introduces an optimization model with average railcars flow data (OMAD) and an optimization model with dynamic railcars flow data (OMDD) for the train formation planning based on TS under railcar demand fluctuation while minimizing railcar-hour consumption. The OMAD is a deterministic model, and the OMDD is a probability constraint model. To solve the OMDD, an approach for transforming probability constraints into deterministic constraints is presented. Various groups of scenarios are given to verify the effectiveness of the proposed models. [ FROM AUTHOR] Copyright of Journal of Industrial & Production Engineering is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Winter-autumn air pollution control plan in North China modified the PM2.5 compositions and sources in Central China

The additional impact of emission-reduction measures in North China (NC) during autumn and winter on the air quality of downwind regions is an interesting but less addressed topic. The mass concentrations of routine air pollutants, the chemical compositions, and sources of fine particles (PM2.5) for January 2018, 2019, and 2020 at a megacity of Central China were identified, and meteorology-isolated by a machine-learning technique. Their variations were classified according to air mass direction. An unexpectedly sharp increase in emission-related PM2.5 by 22.7% (18.0 mug m-3) and 25.7% (19.4 mug m-3) for air masses from local and NC in 2019 was observed compared to those of 2018. Organic materials exhibited the highest increase in PM2.5 compositions by 6.90 mug m-3 and 6.23 mug m-3 for the air masses from local and NC. PM2.5 source contributions related to emission showed an upsurge from 1.39 mug m-3 (biomass burning) to 24.9 mug m-3 (secondary inorganic aerosol) in 2019 except for industrial processes, while all reduced in 2020. From 2018 to 2020, the emission-related contribution of coal combustion to PM2.5 increased from 10.0% to 19.0% for air masses from the local area. To support the priority natural gas quotas in northern China, additional coal in cities of southern China was consumed, raising related emissions from transportation activities and road dust in urban regions, as well as additional biofuel consumption in suburban or rural regions. All these activities could explain the increased primary PM2.5 and related precursor NO2. This study gave substantial evidence of air pollution control measures impacting the downwind regions and promote the necessity of air pollution joint control across the administration.Copyright © 2023 Elsevier Ltd

Exploring CBD Retail Performance, Recovery and Resilience of a Smart City Following COVID-19

The city of Christchurch, New Zealand, incurred significant damage due to a series of earthquakes in 2010 and 2011. The city had, by the late 2010s, regained economic and social normalcy after a sustained period of rebuilding and economic recovery. Through the concerted rebuilding effort, a modern central business district (CBD) with redesigned infrastructure and amenities was developed. The Christchurch rebuild was underpinned by a commitment of urban planners to an open and connected city, including the use of innovative technologies to gather, use and share data. As was the case elsewhere, the COVID-19 pandemic brought about significant disruptions to social and economic life in Christchurch. Border closures, lockdowns, trading limitations and other restrictions on movement led to changes in traditional consumer behaviors and affected the retail sector's resilience. In this study, we used CBD pedestrian traffic data gathered from various locations to predict changes in retail spending and identify recovery implications through the lens of retail resilience. We found that the COVID-19 pandemic and its related lockdowns have driven a substantive change in the behavioral patterns of city users. The implications for resilient retail, sustainable policy and further research are explored. © 2023 by the authors.

Through the Lens of Social Studies, What Has Changed for Refugees to the U.S. since the COVID-19 Pandemic Began? An Inquiry Lesson for Secondary Education: a Journal for Readers, Students and Teachers of History

As the COVID-19 pandemic unfolds, every aspect of daily life is being altered in response to the virus. The pandemic has altered secondary education. Classes online, teachers struggling to learn Zoom and make lessons meaningful and relevant to students. Students struggling to make sense of this moment, struggling with mental health issues due to the loss of routine and in many cases contact with adult role models. Unfortunately, in times of crisis such as these some of the most disenfranchized people in society are completely overlooked and forgotten, such as refugees. However, if more teachers were to leverage the social studies potential of current events such as the Coronavirus, greater empathy would be felt for marginalized people more starkly impacted by the pandemic, leading ultimately to a heightened sense of civic engagement among the next generation. The purpose of this paper is to assist teachers in guiding their students through analyzing current events, such as COVID-19's impact on refugees, toward developing civic mindedness. In addition to this, the paper will discuss some of the broader societal impacts the virus is having within the United States, as well as ways in which this event may be viewed as a historical subject in the future. The paper will begin by building the content knowledge of high school social studies teachers through addressing the following question: "What is the difference between a refugee entering the United States now versus one year ago before the COVID-19 pandemic?” Following this, the authors will present an inquiry-based learning segment designed to teach the History correlated to the COVID-19 pandemic to a classroom of secondary education students. The inquiry template follows the standard C3 format utilized by the State of Connecticut.

An opinion paper on requirement for a practitioner's handbook designed for business continuity and resilience in government: a South African context

PurposeThis paper aims to find a suitable structure for a practitioner's handbook that addresses the structural elements of the business continuity (BC) practice.Design/methodology/approachThe case study using the mixed method, quantitative with a questionnaire and conceptual research approach was what has been chosen. The four steps to the research process are outlined: one, choosing the topic, two, collecting relevant literature, three, identifying specific variables and four, generating a structure. The design brought on by years of experience, should be put into an organised system and handbook that can be reused, without having to reinvent the wheel.FindingsA BC handbook should be as relevant to the executives and management as to their employees. By adopting a BC practice in a government department, state-owned entity, agency or municipality. Assurance will be ascertained for reliable, improved service delivery and reputation with much less interruption. Therefore a handbook with a "cradle to the grave” BC approach should outline, with examples of standards, awareness, policy, BC programme plan, BC structures, business impact and risk analysis, strategy, budgets, scorecards, monitoring and evaluation, recovery and BC plans, together with the audit and an International Standards Organization (ISO) 22301 certification process.Research limitations/implicationsThe research was limited to literature, questionnaires and identified variables pertaining to BC management (BCM) in the South African Government.Practical implicationsThe implications of the case study is that out of the variables identified and the relevant literature and standards, a structure for a relevant post-COVID-19 government practitioner's handbook could be made available.Social implicationsThe use of a BCM handbook for government would assist in the continuation of services through manmade and natural disasters. The service to the citizen, including but not limited to water, electricity, sanitation, medical and health services, and the food supply chain are just a few areas that can be positively impacted upon by good BCM. By implication the reliance of government structure are treated most in time of disasters as experienced through the two year period of the COVID-19 pandemic.Originality/valueThe government departments in South Africa do not have or have not implemented BCM due to the lack of clear guidelines. The COVID-19 pandemic however had accelerated the requirement for a top down BCM approach. To ensure that the scope of BCM is not limited, the possibility of having a set handbook for the government practitioner will ensure that service quality remains intact. Such a handbook related to government BCM practice is long outstanding.

Biomarker-guided duration of antibiotic treatment in children hospitalised with confirmed or suspected bacterial infection: statistical analysis plan for the BATCH trial and PRECISE sub-study.

INTRODUCTION: The BATCH trial is a multi-centre randomised controlled trial to compare procalcitonin-guided management of severe bacterial infection in children with current management. PRECISE is a mechanistic sub-study embedded into the BATCH trial. This paper describes the statistical analysis plan for the BATCH trial and PRECISE sub-study. METHODS: The BATCH trial will assess the effectiveness of an additional procalcitonin test in children (aged 72 h to 18 years) hospitalised with suspected or confirmed bacterial infection to guide antimicrobial prescribing decisions. Participants will be enrolled in the trial from randomisation until day 28 follow-up. The co-primary outcomes are duration of intravenous antibiotic use and a composite safety outcome. Target sample size is 1942 patients, based on detecting a 1-day reduction in intravenous antibiotic use (90% power, two-sided) and on a non-inferiority margin of 5% risk difference in the composite safety outcome (90% power, one-sided), while allowing for up to 10% loss to follow-up. RESULTS: Baseline characteristics will be summarised overall, by trial arm, and by whether patients were recruited before or after the pause in recruitment due to the COVID-19 pandemic. In the primary analysis, duration of intravenous antibiotic use will be tested for superiority using Cox regression, and the composite safety outcome will be tested for non-inferiority using logistic regression. The intervention will be judged successful if it reduces the duration of intravenous antibiotic use without compromising safety. Secondary analyses will include sensitivity analyses, pre-specified subgroup analyses, and analysis of secondary outcomes. Two sub-studies, including PRECISE, involve additional pre-specified subgroup analyses. All analyses will be adjusted for the balancing factors used in the randomisation, namely centre and patient age. CONCLUSION: We describe the statistical analysis plan for the BATCH trial and PRECISE sub-study, including definitions of clinical outcomes, reporting guidelines, statistical principles, and analysis methods. The trial uses a design with co-primary superiority and non-inferiority endpoints. The analysis plan has been written prior to the completion of follow-up. TRIAL REGISTRATION: BATCH: ISRCTN11369832, registered 20 September 2017, doi.org/10.1186/ISRCTN11369832. PRECISE: ISRCTN14945050, registered 17 December 2020, doi.org/10.1186/ISRCTN14945050.

Enhance Access to Kidney Transplantation and Living Kidney Donation (EnAKT LKD): Statistical Analysis Plan of a Registry-Based, Cluster-Randomized Clinical Trial.

Background: Enhance Access to Kidney Transplantation and Living Kidney Donation (EnAKT LKD) is a quality improvement intervention designed to enhance access to kidney transplantation and living kidney donation. We conducted a cluster-randomized clinical trial to evaluate the effect of the intervention versus usual care on completing key steps toward receiving a kidney transplant. Objective: To prespecify the statistical analysis plan for the EnAKT LKD trial. Design: The EnAKT LKD trial is a pragmatic, 2-arm, parallel-group, registry-based, open-label, cluster-randomized, superiority, clinical trial. Randomization was performed at the level of the chronic kidney disease (CKD) programs (the "clusters"). Setting: Twenty-six CKD programs in Ontario, Canada. Participants: More than 10 000 patients with advanced CKD (ie, patients approaching the need for dialysis or receiving maintenance dialysis) with no recorded contraindication to receiving a kidney transplant. Methods: The trial data (including patient characteristics and outcomes) will be obtained from linked administrative health care databases (the "registry"). Stratified covariate-constrained randomization was used to allocate the 26 CKD programs (1:1) to provide the intervention or usual care from November 1, 2017, to December 31, 2021 (4.17 years). CKD programs in the intervention arm received the following: (1) support for local quality improvement teams and administrative needs; (2) tailored education and resources for staff, patients, and living kidney donor candidates; (3) support from kidney transplant recipients and living kidney donors; and (4) program-level performance reports and oversight by program leaders. Outcomes: The primary outcome is completing key steps toward receiving a kidney transplant, where up to 4 unique steps per patient will be considered: (1) patient referred to a transplant center for evaluation, (2) a potential living kidney donor begins their evaluation at a transplant center to donate a kidney to the patient, (3) patient added to the deceased donor transplant waitlist, and (4) patient receives a kidney transplant from a living or deceased donor. Analysis plan: Using an intent-to-treat approach, the primary outcome will be analyzed using a patient-level constrained multistate model adjusting for the clustering in CKD programs. Trial Status: The EnAKT LKD trial period is November 1, 2017, to December 31, 2021. We expect to analyze and report the results once the data for the trial period is available in linked administrative health care databases. Trial Registration: The EnAKT LKD trial is registered with the U.S. National Institute of Health at clincaltrials.gov (NCT03329521 available at https://clinicaltrials.gov/ct2/show/NCT03329521). Statistical Analytic Plan: Version 1.0 August 26, 2022.

Contexte: EnAKT LKD est une intervention d'amélioration de la qualité visant à améliorer l'accès à la transplantation rénale et au don vivant de rein. Nous avons mené un essai clinique randomisé par grappes afin d'évaluer l'effet de l'intervention, par rapport aux soins habituels, sur le taux d'étapes clés réalisées dans le processus de réception d'une greffe de rein. Objectif: Exposer les grandes lignes du plan d'analyse statistique de l'essai EAKT LKD. Conception: EAKT LKD est un essai clinique pragmatique ouvert, à deux bras, en groupes parallèles, basé sur un registre, et randomisé en grappes. La randomisation a été réalisée au niveau des programmes d'insuffisance rénale chronique (IRC) (les « grappes ¼). Cadre: 26 programmes d'IRC en Ontario (Canada). Sujets: Plus de 10 000 patients atteints d'IRC de stade avancé (des patients approchant le besoin de dialyse ou recevant une hémodialyse d'entretien) sans contre-indication documentée à la greffe rénale. Méthodologie: Les données de l'essai (y compris les caractéristiques et les résultats des patients) seront obtenues à partir de bases de données administratives en santé (le « registre ¼). La randomisation stratifiée avec contraintes de covariables a servi à répartir les 26 programmes d'IRC (1:1) selon qu'ils allaient fournir l'intervention ou les soins habituels entre le 1er novembre 2017 et le 31 décembre 2021 (4,17 ans). Les programmes d'IRC du bras d'intervention ont eu droit au soutien suivant: (1) des équipes locales d'amélioration de la qualité et du soutien administratif; (2) de l'information et des ressources sur mesure pour le personnel, les patients et les donneurs vivants; (3) du soutien de la part de receveurs et de donneurs vivants; et (4) des rapports sur le rendement au niveau du programme et une surveillance assurée par les chefs de programme. Résultats: Le principal critère d'évaluation est le taux d'étapes clés accomplies vers la réception d'une greffe de rein, où jusqu'à quatre étapes uniques par patient seront comptabilisées: (1) le patient est aiguillé vers un centre de transplantation pour évaluation; (2) un possible donneur vivant de rein contacte un centre de transplantation pour un receveur en particulier et amorce son évaluation; (3) le patient est ajouté à la liste d'attente pour une transplantation d'un donneur décédé, et (4) le patient reçoit une greffe de rein d'un donneur vivant ou décédé. Plan d'analyse: Selon une approche fondée sur l'intention de traiter, le critère d'évaluation principal sera analysé au niveau du patient en utilisant un modèle multiétats contraint, corrigé dans les programmes d'IRC en fonction du regroupement. Statut de l'essai: L'essai EnAKT LKD s'est tenu du 1er novembre 2017 au 31 décembre 2021. Nous analyserons les résultats et en rendrons compte dès que les données seront disponibles dans les bases de données administratives couplées du système de santé.

Statistical analysis plan for HOMESIDE: a randomised controlled trial for home-based family caregiver-delivered music and reading interventions for people living with dementia.

BACKGROUND: Most people with dementia live in the community, not in residential care. Therefore, quality informal care for them is critical for managing behavioural and psychological symptoms of dementia (BPSD). Music therapy has been shown to reduce BPSD. However, no randomised controlled trial has examined the effects of music interventions delivered by caregivers in home settings. The HOME-based caregiver-delivered music intervention for people living with dementia (HOMESIDE) trial aims to evaluate the effectiveness of a 12-week music intervention in addition to standard care for BPSD. This article describes the statistical analysis plan. METHODS AND ANALYSIS: HOMESIDE is a large, pragmatic international three-arm parallel-group randomised controlled trial. Dyads (persons with dementia and caregiver) in Australia, Germany, the UK, Poland and Norway were randomised to receive music and standard care, reading and standard care or standard care alone. The primary outcome is BPSD (proxy) of the person living with dementia, measured using the Neuropsychiatric Inventory-Questionnaire (NPI-Q) at 90 and 180 days post-randomisation. Longitudinal analysis will compare NPI-Q severity between music and standard care versus standard care alone. Secondary outcomes include quality of life and depression (both person with dementia and caregiver), cognition (person with dementia only), distress, resilience, competence and caregiver-patient relationship (caregiver only). Treatment effects will be obtained at 90 and 180 days post-randomisation, where applicable. Safety outcomes (adverse events, hospitalisations, deaths) will be summarised. DISCUSSION: This statistical analysis plan provides a detailed methodology for the analysis of HOMESIDE and will improve the validity of the study and reduce the potential for bias. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12618001799246. Registered on November 05, 2018. CLINICALTRIALS: gov NCT03907748. Registered on April 09, 2019.

The interventions of the Italian Recovery and Resilience Plan: digitalization in cities

Starting from the relationship between urban planning and mobility management, TeMA has gradually expanded the view of the covered topics, always following a rigorous scientific in-depth analysis. This section of the Journal, Review Notes, is the expression of a continuous updating of emerging topics concerning relationships among urban planning, mobility and environment, through a collection of short scientific papers. The Review Notes are made of five parts. Each section examines a specific aspect of the broader information storage within the main interests of TeMA Journal.This section of the Review Notes deals with the new frontiers of urban development through the lenses of the European program NextGenerationEU.In particular, this contribution deepens the topic of digitalization in urban areas within the framework of the Italian National Recovery and Resilience Plan. It provides an overview of the proposed reforms, strategies and interventions to boost the digital economy and digitalize public services within the urban context.

Laboratory

The laboratory plays an integral part in providing quality, accurate, and reliable services to satisfy clinicians' needs, help improve patient outcomes, and safeguard public health. During a crisis and especially in a pandemic, laboratory may struggle to work on an existing continuity plan, potentially rendering it incapable of providing timely services. This possibility became a reality during the COVID-19 pandemic surge in the Spring of 2020 in New York City, and laboratory experienced a shortage of labor force, necessary tools, personal protective equipment, testing equipment, supplies, and an inability to store bodies in response to mass fatality. The importance of a laboratory response during a crisis, including effective preparation, and the necessity of having a continuity plan were refined. This chapter was developed based on lessons learned during COVID-19 pandemic at the SBH Health System, Bronx, New York, to provide guidelines to better manage a healthcare crisis, including the development of a more effective continuity plan to prevent disruption of laboratory services, enabling laboratory to continue providing accurate, reliable, and quality services to clinicians for timely decision-making in managing patient treatment and resultant fatality management. In addition, this chapter may help minimize and overcome the interruption in laboratory-continued operations if the crisis has already occurred, ensuring that rapid recovery is initiated, and laboratory operations can be resumed within an acceptable period of time to safeguard public health. © SBH Health System 2022.

Short-Duration Crash Modeling to Understand the Impact of Operating Speed on Freeway Crashes During COVID-19

Gaining an understanding of speed–crash relationships is a critical issue in highway safety research. Because of the ongoing pandemic (COVID-19) there has been a reduction in traffic volume, and some early studies explain that speeding in an environment with less traffic is associated with a high number of crashes, especially fatal and serious injury crashes. This study aims to quantify the impact of operating speed on traffic crash occurrences. The study conflated several databases (speed data, roadway inventory data, and crash data) that contain data from Dallas, Texas, spanning from 2018 to 2020, to examine the speed–crash association. Using the negative binomial Lindley regression model, this study showed that the trends of crash prediction models vary over the years (2018, 2019, and 2020) by different injury severity levels (i.e., fatal crashes, fatal and incapacitating injury crashes). The 2020 models show that operating speed measures (i.e., average operating speed) have a significant impact on crash frequencies. The magnitudes of the speed measures show variations across the models at different injury severity levels.

Waste Management in the Laboratories of the University of Evora (2007-2021)

Waste generated in university laboratories is an important component of university waste management, especially regarding their hazardousness and, also, the cost involved in their forwarding. To make a good management of this waste, it is essential to know the amount generated and the composition. However, this type of information remains scarce. In this work, waste from the laboratories of the University of evora (Portugal) was surveyed from 2007 to 2021, using existing records. In the 15 years under analysis, the laboratories of the University of evora generated about 61 tonnes of waste, 88% of which were hazardous and 66% were in the liquid state. In addition, only 3% of this waste was subjected to recovery operations. Moreover, the COVID-19 pandemic contributed to a double increase in hospital waste generated and to a substantially decreased of hazardous liquid waste from the laboratory activity, especially in the first year of the pandemic. In 2021, the second year of the pandemic, there was a "return to normality", reaching the highest value of waste generated in the laboratories, of 8.6 tonnes. Finally, possible solutions for improving laboratory waste management were also discussed.

Thoughts on diagnosis and treatment plan of patients infected with severe acute respiratory syndrome coronavirus 2 omicron variant in large shelter hospitals in Shanghai

The epidemic caused by the infection of severe acute respiratory syndrome coronavirus 2 omicron variant broke out in Shanghai in Mar. 2022. Omicron variant has characteristics such as strong concealment and rapid transmission, resulting in significant differences between the current round of epidemic and that in Wuhan. The number of infected patients (mainly asymptomatic infected patients) increased rapidly in a short term. Based on dynamic zero policy, shelter hospitals were set up in time in Shanghai to treat the patients. It is suggested that medical resources and patient characteristics should be taken into account in the independent cabin of a shelter hospital with more than 10 000 beds, and the clinical medical practice should be divided to 5 modes (universal education and management, community outpatient clinic, ward duty, emergency rescue, and temporary observation and transport) to optimize the allocation of medical resources, so as to further enhance the treatment capacity and efficiency of shelter hospitals.Copyright © 2022, Second Military Medical University Press. All rights reserved.

Recovery From Crisis

Whilst there is no universally agreed definition of ‘recovery' in the context of a healthcare system post-crisis, for the purpose of this chapter, recovery is defined as the change to functioning and operations in acute care hospitals from crisis state to non-crisis state. This chapter will present a summary of some of the experiences of healthcare systems worldwide to the COVID-19 pandemic including the successes and shortcomings from all levels within the system. We will present the impact of the pandemic on the building blocks of the healthcare system and outline considerations for its recovery as the early pandemic surge subsides. We will then present a case study of the recovery process from the perspective of SBH Health System in Bronx, USA, following the first surge of COVID-19 in March 2020. Within this, we intend to highlight specific areas for improvement that were indicated by our healthcare system during the crisis and use these lessons learned to implement a plan for recovery of hospital services, continued improvements in-patient care and preparedness for future crises. © SBH Health System 2022.

The Introduction of the National Recovery and Resilience Plans in the Light of the Visegrád Grup Countries' Experience

National Recovery and Resilience Plans (NRPs) set out the objectives for recovery and building the socio-economic resilience of EU Member States following the crisis caused by COVID-19. In their framework, countries also declare the introduction of structural reforms and investments for their implementation. The author aims to offer a closer look at and characterize the adoption procedure and basic assumptions of the National Recovery and Resilience Plans developed by Visegrád Group Member States, which are among the greatest beneficiaries of the Plans. Thus, it is worth zooming in on the national design and approval procedures for the various recovery plans, their basic assumptions, and procedures for their approval by Union bodies. The reason for researching this issue is the characteristic distribution of accents in existing research. On the one hand, there are many publications on the European Instrument for Reconstruction and Enhancement of Resilience. On the other hand, the analysis of the National Recovery and Resilience Plans of the Visegrad Group countries has not, so far, been the scope of broader legal and comparative research. © 2023, Spoldzielczy Instytut Naukowy. All rights reserved.

PNRR AND HEALTH IN THE DYNAMICS OF THE FORM OF STATE

This research, through the filter of the "health” subject, intends to investigate the interconnection between technology and autonomy in the State-Region relationship. Due to its nature, technique require uniformity of application, affecting the constitutional division of competences and favouring the phenomenon of the centralisation of powers at State level to the detriment of peripheral ones. This phenomenon, which was highlighted during the Covid-19 pandemic, is confirmed with the recovery plan and resilience. The marginal role accorded to territorial representation in the Plan's governance system, distances the goal of eliminating territorial disparities, which is a necessary condition for the Country's effective recovery © 2023, BioLaw Journal.All Rights Reserved.

Role of pharmaceutical care in therapeutic regimens within the community pharmacy.

The concept of pharmaceutical care (PC) has existed as a professional philosophy for more than 30 years. However, for a long period of time, little had been done for its integration into the regular practice of healthcare provision. The COVID-19 pandemic and the resulting increase in patient influx in the community pharmacies (CP) encouraged the exploration and establishment of new healthcare services provided within the CP. Nevertheless, these services of PC are still novel, and more can be done to expand the community pharmacists' current role in primary healthcare. This can be achieved by improving and expanding the newly established services, all while incorporating new ones, for the benefit of public health and the reduction of avoidable healthcare expenditures. This article reviews information about the benefits of this service regarding patient health and the reduction of financial expenses pertinent to adverse drug events within the setting of the CP. Adverse drug events account for significant healthcare expenses and patient distress due to relevant symptoms, emergency doctor visits, and increased hospitalization rates. Several studies conducted internationally have investigated the positive impact of PC practiced by community pharmacists. In spite of results sometimes presenting a non-continuous pattern, PC applied under specific conditions has tangible positive outcomes. Congestive heart failure and type 2 diabetes mellitus patients presented fewer hospital admissions, better symptom control, and higher adherence in comparison to control groups, while a study on asthma patients revealed improved inhalation techniques. All intervention groups reported psychological improvement and a better understanding of their treatment. Special reference is made to the importance of this service for patients receiving anti-cancer treatment and how community pharmacists can have a crucial role in designing, monitoring, and re-designing these therapeutic schemes whose complexity and related adverse drug events negatively affect patient adherence. The role of community pharmacists was very important, especially for primary care, for both patients and healthcare systems during the pandemic, and it seems that it will remain decisive in the post-COVID era as well. The increased complexity of therapy and polypharmacy creates the need for organized, active participation of pharmacists in healthcare provision so that they can use their knowledge and skills under continuous cooperation with other healthcare professionals, thus providing coordinated services for the benefit of the patient.

Nursing home infection control strategies during the COVID-19 pandemic.

BACKGROUND: The American Rescue Plan Act of 2021 awarded $500 million toward scaling "strike teams" to mitigate the impact of Coronavirus Disease 2019 (COVID-19) within nursing homes. The Massachusetts Nursing Facility Accountability and Support Package (NFASP) piloted one such model during the first weeks of the pandemic, providing nursing homes financial, administrative, and educational support. For a subset of nursing homes deemed high-risk, the state offered supplemental, in-person technical infection control support. METHODS: Using state death certificate data and federal nursing home occupancy data, we examined longitudinal all-cause mortality per 100,000 residents and changes in occupancy across NFASP participants and subgroups that varied in their receipt of the supplemental intervention. RESULTS: Nursing home mortality peaked in the weeks preceding the NFASP, with a steeper increase among those receiving the supplemental intervention. There were contemporaneous declines in weekly occupancy. The potential for temporal confounding and differential selection across NFASP subgroups precluded estimation of causal effects of the intervention on mortality. CONCLUSIONS: We offer policy and design suggestions for future strike team iterations that could inform the allocation of state and federal funding. We recommend expanded data collection infrastructure and, ideally, randomized assignment to intervention subgroups to support causal inference as strike team models are scaled under the direction of state and federal agencies.

Statistical Analysis Plan for the INTEnsive Care Bundle with Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial: A Stepped-Wedge Cluster Randomized Controlled Trial.

The third INTEnsive care bundle with blood pressure Reduction in Acute Cerebral hemorrhage Trial (INTERACT3) is an international, multicenter, stepped-wedge (4 phases/3 steps) cluster randomized trial involving 110 hospitals in mainly low- and middle-income countries during 2017-2022. The aim is to determine the effectiveness of a goal-directed care bundle of intensive blood pressure (BP) lowering, glycemic control, antipyrexia, and anticoagulation reversal treatment versus usual standard of care, in patients with acute intracerebral hemorrhage (ICH). After a "usual care" period, hospitals were randomly allocated to implementing care-bundle protocols for control targets (systolic BP <140 mm Hg; glucose 6.1-7.8/7.8-10.0 mmol/L according to diabetes mellitus status; temperature ≤37.5°C; normalization of anticoagulation). A sample size of 8,360 patients (mean 19 per phase per site) provides 90% power (α = 0.05) for a 5.6% absolute improvement in the primary outcome of scores on the modified Rankin scale at 6 months, analyzed by ordinal logistic regression. A detailed statistical analysis plan (SAP) was developed to prespecify the method of analysis for all outcomes and key variables collected in the trial. The primary analysis will use ordinal logistic regression adjusted for the stepped-wedge design. The SAP also includes planned sensitivity analyses, including covariate adjustments, missing data imputations, and subgroup analysis. This SAP allows transparent, verifiable, and prespecified analyses in consideration of the challenges in conducting the study during the COVID pandemic. It also avoids analysis bias arising from prior knowledge of the findings in determining the benefits and harms of a care bundle in acute ICH.