Whole-of-school physical activity implementation in the context of the Dubai Fitness Challenge.

INTRODUCTION: Physical activity (PA) promotion among school-aged youth is a global health priority. Recommendations for such promotion include implementing whole-of-school approaches that maximize resources across the school environment. This study examined schools' participation in an annual, government-led, and emirate-wide initiative in Dubai, called the Dubai Fitness Challenge, in which the goal is to accrue 30 minutes of PA every day for 30 days (as such, the initiative is colloquially referred to as "Dubai 30x30"). METHODS: A mixed-methods design was employed for this study. Three schools were recruited using convenience sampling. Participants were 18 physical education teachers, 20 classroom teachers, 2 principals and 45 students. Data sources included surveys, focus groups, and interviews. Data were analyzed using descriptive statistics, multinomial logistic regression, and open and axial coding to develop themes. RESULTS: School staff reported that most Dubai 30x30 activities were provided in physical education, at break times during school, and before and after school. Students reported that they mainly participated in Dubai 30x30 activities during physical education and occasionally participated in activities after school and on weekends. During school, students were more likely to reach higher PA intensity levels when they were in contexts other than the regular classroom setting. Among school staff, physical education teachers were most involved and classroom teachers were least involved in promoting Dubai 30x30. Parent engagement was high. Staff perceived that Dubai 30x30 brought the community together, but physical education teachers also indicated there was a lack of implementation guidance and they felt burdened. Participants believed Dubai 30x30 increased PA participation and helped to promote their schools. DISCUSSION: This study provides an initial glimpse into schools' participation in Dubai 30x30 and suggests that a whole-of-school PA lens is useful in gleaning information that could help to increase and optimize PA opportunities for students.

Valorization and co-treatment of hazardous petroleum refinery oily sludge and sewage associated with bioenergy recovery in tubular microbial fuel cell.

Petroleum refineries generate large amounts of oily sludge which is normally loaded with different residual hazardous petroleum derivatives. Also, the residential complexes affiliated to the petroleum refineries generate considerable volumes of sewage. This study was devoted to investigate the potential of energy recovery from co-bioelectrochemical treatment of petroleum refinery oily sludge (PROS) and sewage using a tubular dual-chambers microbial fuel cell (MFC). Initially, the MFC was operated in a fill and draw mode of 4 cycles, each cycle at a different organic load (OL). The results revealed that maximum removal efficiencies of the organic content as COD were 93.67%, 98.57%, 99.64%, and 99.74%, whereby maximum power outputs were 225 ± 10, 324 ± 7, 1230 ± 18, and 1156 ± 14 mW/m3 for cycle1of OL1 (1138 ± 60 mg/L), cycle2 of OL2 (7000 ± 75 mg/L), cycle3 of OL3 (13,890 ± 50 mg/L), and cycle4 of OL4 (17,100 ± 150 mg/L), respectively. Based on those promising results, the MFC was operated continually for 60 days by feeding the MFC with PROS and sewage at organic loading of 13,000 ± 1000 mg/L. Significant results concerning COD and TPH elimination efficiency > 99.85% and 94.12%, respectively were obtained associated with power output of 1225 ± 25 mW/m3.

Pharmacological treatment and vaccines in monkeypox virus: a narrative review and bibliometric analysis.

Mpox (earlier known as monkeypox) virus infection is a recognized public health emergency. There has been little research on the treatment options. This article reviews the specific drugs used to treat mpox virus infection and the vaccines used here. Instead of focusing on the mechanistic basis, this review narrates the practical, real-life experiences of individual patients of mpox virus disease being administered these medicines. We conducted a bibliometric analysis on the treatment of the mpox virus using data from several databases like PubMed, Scopus, and Embase. The research on this topic has grown tremendously recently but it is highly concentrated in a few countries. Cidofovir is the most studied drug. This is because it is indicated and also used off-label for several conditions. The drugs used for mpox virus infection include tecovirimat, cidofovir, brincidofovir, vaccinia immune globulin, and trifluridine. Tecovirimat is used most frequently. It is a promising option in progressive mpox disease in terms of both efficacy and safety. Brincidofovir has been associated with treatment discontinuation due to elevated hepatic enzymes. Cidofovir is also not the preferred drug, often used because of the unavailability of tecovirimat. Trifluridine is used topically as an add-on agent along with tecovirimat for ocular manifestations of mpox virus disease. No study reports individual patient data for vaccinia immune globulin. Though no vaccine is currently approved for mpox virus infection, ACAM 2000 and JYNNEOS are the vaccines being mainly considered. ACAM 2000 is capable of replicating and may cause severe adverse reactions. It is used when JYNNEOS is contraindicated. Several drugs and vaccines are under development and have been discussed alongside pragmatic aspects of mpox virus treatment and prevention. Further studies can provide more insight into the safety and efficacy of Tecovirimat in actively progressing mpox virus disease.

Influence of Light Color on Power Generation and Microalgae Growth in Photosynthetic Microbial Fuel Cell with Chlorella Vulgaris Microalgae as Bio-Cathode.

Photosynthetic microbial fuel cell (PMFC) is an environmentally friendly sustainable technique for simultaneous wastewater treatment and power recovery. PMFC utilizes the microalgae to generate oxygen by photosynthesis process in the biocathode. Light sources and intensities have direct effect on chlorophyll pigment formation, photosynthesis processes and microalgae growth. In this study, Chlorella vulgaris was utilized as biocathode in PMFC fed with actual slaughterhouse wastewater. The biocathode was illuminated with florescent light as well as yellow, red and blue LED lights with light intensities of 67.46, 47.03, 26.18 and 4.70 µmol/m.s, respectively. Power output and microalgae growth were considered in evaluating the PMFC performance. Results demonstrated that the highest power output was 217.04 mW/m2 generated under florescent light compared to 28.41, 171.08, and 21.65 mW/m2 observed under yellow, red and blue LEDs, respectively. Additionally, statistical analysis was performed using fifth-degree polynomial model which fitted well the experimental data with a determination coefficient (R2) > 0.97. The results reflected a high confidence level in depicting the growth mechanism of Chlorella vulgaris under lighting sources with different light colors and intensities.

Sustainable application of tubular photosynthesis microbial desalination cell for simultaneous desalination of seawater for potable water supply associated with sewage treatment and energy recovery.

A sustainable approach for simultaneous desalination of actual seawater for potable water supply, and bioelectrochemical treatment of sewage associated with power generation was evaluated in a tubular photosynthesis desalination microbial fuel cell (PDMC) continually operated for 180 days. Anion exchange membrane (AEM) was used to separate the bioanode and desalination compartments, whereby, and cation exchange membrane (CEM) was used to separate the desalination and biocathode compartments. Mixed bacterial species and mixed microalgae were utilized for inoculation of the bioanode and biocathode, respectively. The results revealed that maximum and average desalination efficiencies of saline seawater fed to the desalination compartment were 80 ± 1 % and 72 ± 1.2 %, respectively. Maximum and average removal efficiencies of the sewage organic content in the anodic compartment were up to 99.3 ± 0.5 % and 91.0 ± 0.8 %, respectively associated with maximum power output of 430.7 ± 0.7 mW/m3. In spite of the heavy growth of the mixed bacterial species and microalgae as well, no fouling of AEM and CEM was observed during the entire period of operation. Kinetic study demonstrated that Blackman model described well the bacterial growth. Dense and healthy growth of biofilm and the microalgae in the anodic and cathodic compartments, respectively were clearly observed during the operation period. The promising outcomes of this investigation demonstrated that the suggested approach is a potential sustainable option for simultaneous desalination of saline seawater for potable water supply, biotreatment of sewage, and power generation.

Telemedicine, E-Health, and Multi-Agent Systems for Chronic Pain Management.

Telemedicine, telehealth, and E-health all offer significant benefits for pain management and healthcare services by fostering the physician-patient relationship in otherwise challenging circumstances. A critical component of these artificial-intelligence-based health systems is the "agent-based system", which is rapidly evolving as a means of resolving complicated or straightforward problems. Multi-Agent Systems (MAS) are well-established modeling and problem-solving modalities that model and solve real-world problems. MAS's core concept is to foster communication and cooperation among agents, which are broadly considered intelligent autonomous factors, to address diverse challenges. MAS are used in various telecommunications applications, including the internet, robotics, healthcare, and medicine. Furthermore, MAS and information technology are utilized to enhance patient-centered palliative care. While telemedicine, E-health, and MAS all play critical roles in managing chronic pain, the published research on their use in treating chronic pain is currently limited. This paper discusses why telemedicine, E-health, and MAS are the most critical novel technologies for providing healthcare and managing chronic pain. This review also provides context for identifying the advantages and disadvantages of each application's features, which may serve as a useful tool for researchers.

Immobilization of mixed bacteria by novel biocarriers extracted from Cress and Chia seeds for biotreatment of anionic surfactant (SDS)-bearing real wastewaters.

Selection of biocarrier type is an essential element for successful bacterial cells immobilization. The present investigation aimed to evaluate a novel application of Cress and Chia seeds as biocarriers for immobilization of mixed bacterial cells. Being an environmentally friendly, non-polluting, inexpensive, and non-toxic substances makes them promising biocarriers. On the other hand, there is an increasing concern about contamination by surfactants, sodium dodecyl sulfate (SDS) is among the most commonly used surfactant. The Cress and Chia seeds were cross-linked with PVA to prepare two types of beads; CrE-PVA and ChE-PVA, respectively. The beads were utilized for the SDS biodegradation in four kinds of actual SDS-bearing wastewaters originated from; carwash garage (CWW), laundry facility (LWW), and household detergent industry (HWW), in addition to domestic wastewater (DWW). The results revealed that maximum efficiencies of SDS elimination in DWW, LWW, HWW, and CWW were 98.12, 94.32, 93.04, and 99.08%, respectively, using CrE-PVA and 99.04, 94.96, 94.71, and 99.27%, respectively using ChE-PVA. Finally, both types of beads were recycled for five times without losing their stability and efficiency for SDS biodegradation. Four kinetic models were adopted which were Blackman, Monod, Haldane, and Teissier. Results revealed that Teissier model well fitted the experimental data.

Impact of COVID-19 pandemic on viral hepatitis in Africa: Challenges and way forward.

With the overwhelming COVID-19 pandemic in Africa, many other severe epidemics have been given low priority, such as viral hepatitis. Patient mortality due to viral hepatitis has raised concern to COVID-19 patients due to compromise with undiagnosed hepatitis in Africa. The pandemic has worsened the control of the viral hepatitis epidemic as healthcare control facilities have moved their focus towards curbing COVID-19 infections. However, different challenges have arisen to viral hepatitis patients because of low health attention that declines the progress of already diagnosed hepatitis patients. Follow-up plans, routine testing and treatment plans for viral hepatitis are no longer as strict with the human resources transferred towards combating the pandemic. Thus, a global effort is required to abide by renewed recommendations to eradicate viral hepatitis in Africa that also fit the current picture of the COVID-19 pandemic. The article discusses the current challenges viral hepatitis patients faced during the COVID-19 pandemic and important recommendations that can see through these challenges in Africa.

Which Road to Recovery?: Factors Influencing Postacute Stroke Discharge Destinations: A Delphi Study.

BACKGROUND AND PURPOSE: The criteria for determining the level of postacute care for patients with stroke are variable and inconsistent. The purpose of this study was to identify key factors influencing the selection of postacute level of care for these patients. METHODS: We used a collaborative 4-round Delphi process to achieve a refined list of factors influencing postacute level of care selection. Our Delphi panel of experts consisted of 32 panelists including physicians, physical therapists, occupational therapists, speech-language pathologists, nurses, stroke survivors, administrators, policy experts, and individuals associated with third-party insurance companies. RESULTS: In round 1, 207 factors were proposed, with subsequent discussion resulting in consolidation into 15 factors for consideration. In round 2, 15 factors were ranked with consensus on 10 factors; in round 3,10 factors were ranked with consensus on 9 factors. In round 4, the final round, 9 factors were rated with Likert scores ranging from 5 (most important) to 1(not important). The percentage of panelists who provided a rating of 4 or above were as follows: likelihood to benefit from an active rehabilitation program (97%), need for clinicians with specialized rehabilitation skills (94%), need for active and ongoing medical management and monitoring (84%), ability to tolerate an active rehabilitation program (74%), need for caregiver training to return to the community (48%), family/caregiver support (39%), likelihood to return to community/home (39%), ability to return to physical home environment (32%), and premorbid dementia (16%). CONCLUSIONS: This study provides an expert, consensus-based set of key factors to be considered when determining where stroke patients are discharged for postacute care. These factors may be useful in developing a decision support tool for use in clinical settings.

New application of gelatin and starch as biocarriers for the biodegradation of reactive blue azo dye using immobilized mixed cells.

Reactive azo dyes, if discharged in unmonitored manner to natural water bodies, can cause remarkable irreversible damage. The current study is centered on the decolorization and biodegradation of reactive blue (RB4) azo dye in an integrated sequential anaerobic-aerobic batch mode process. The biodegradation of reactive blue (RB4) was accomplished using alternatively both starch and gelatin-immobilized mixed cells. Activated sludge freshly collected from a sewage treatment plant was used as the biocatalyst. Complete decolorization of 10 mg/L RB4 under anaerobic conditions observed within 30 h by using individually mixed bacterial cells immobilized with; (1) starch cross-linked with polyvinyl alcohol (PVA-St beads), and (2) gelatin cross-linked with polyvinyl alcohol (PVA-Ge beads). The results revealed that maximum removal efficiencies of chemical oxygen demand (COD) under aerobic conditions were 89, 88, and 86%, using PVA-St beads, whereby they were 90, 85, 84% using PVA-Ge beads occurred within 70, 90 and 100 h at detected concentrations of 10, 20, and 40 mg/L, respectively. The effect of biocarrier has been proven to be negligible as the results were comparable using both bio-carriers.

Bioelectrochemical treatment of actual carwash wastewater associated with sustainable energy generation in three-dimensional microbial fuel cell.

Carwash garages are worldwide cleaning facilities. Discharge of their untreated or improperly treated wastewaters highly contributes to the pollution of water resources. Sodium dodecyl sulfate (SDS), a widely used anionic surfactant in the carwash shampoos represents the major constituent of the carwash wastewater. In this study, a new configuration of three-dimensional MFC packed with irregular shaped graphite granules to support and join the plain anodes in the anodic section. The performance of the 3D-MFC was evaluated in two operational modes; continuous and batch. The evaluation was carried out mainly in terms of the removal efficiency of organic content, in particular SDS as well as oil and grease associated with bioenergy generation from actual carwash wastewater used to fuel the MFC. The results demonstrated that maximum removal efficiencies of COD, SDS, and oil and grease were 87%, 88%, and 90%, respectively. Also, the results demonstrated that during the continuous mode operation maximum current density and power output were 1786 mA/m3 and 482 mW/m3, respectively. At batch operation mode, the maximum current density and power output were 1793 mA/m3 and 478 mW/m3, respectively indicating that the performance of the 3D-MFC was comparable in both operation modes.

Optimizing the placement of piezoelectric wafers on closed sections using a genetic algorithm - Towards application in structural health monitoring.

Sensor network design is essential to efficiently integrate Structural Health Monitoring (SHM) systems in aerospace, automotive, and civil structures. This study describes an optimization model for piezoelectric (PZT) wafer placement on curved structures and closed sections. The proposed approach relied on the transformation of any complex/closed surface regardless of the shape of its cross-section into a flat plate and imposed a set of boundary conditions to account for the wave propagation characteristics. Because the structure was continuous and the wave could propagate in every direction, for simplicity and without sacrificing accuracy, our model assumed that a pair of PZT elements communicated information in the two shortest directions. Thus, the concept of having two paths for each PZT couple was introduced to tackle this multidirectional behavior. The plate was then discretized into a set of control points that represented the structure geometry. The PZT couples covered the control points along the line of sight and in the neighborhood of their direct and indirect paths. The objective function was to maximize the number of covered points while minimizing the number of PZT wafers. The proposed model was solved using a genetic algorithm and was validated on circular and square sections. Sensors were spread on the circumference of the structure rather than mounting them in the form of rings or axial lines. The optimized PZT networks had high coverage that reached 99% in simulations. Notably, the optimized model improved the preliminary solution coverage by 14%. Experimental validation was performed on the circular section (pipe). The results demonstrated the proficiency of the developed model in distributing the PZT wafers on closed sections. The coverage was further evaluated by assessing if damaged areas on the pipe surface could be identified. Artificial damage was accurately located within 18 mm from the actual location. These results demonstrate that our model efficiently distributes PZT wafers on closed structures.

Self-Medication in Africa during COVID-19 Pandemic.

Self-medication is known as "the usage of drugs, herbs or home remedies on one's own initiative, or on the advice of another person, without consulting a doctor'. In Africa, self-medication has reached a critical stage, with people using and taking any drug regardless of how poisonous the material may be as long as unprofessional suggestions advocate it as a solution to their health problem. In this article, we looked at the consequences, effects, and recommendations for reducing the use of self-medication as a habit among Africans.

Biodegradation of reactive yellow dye using mixed cells immobilized in different biocarriers by sequential anaerobic/aerobic biotreatment: experimental and modelling study.

In this study, the application of immobilized mixed cells for decolourization, biodegradation, and detoxification of reactive yellow dye (RY15) in textile wastewater was investigated via a sequential anaerobic-aerobic process in bench-scale bioreactors and lab-scale bioreactors as well. The mixed cultures were immobilized using three different biocarriers which were sodium alginate (SA), starch (St), and Gelatin (Ge), by the cross-linking with polyvinyl alcohol (PVA). Results revealed that the immobilized cultures had a potential degrading efficiency in the anaerobic and aerobic environment, targeting the initial structure and the formed compounds, respectively. Complete decolourization (100%) of RY15 was observed with a significant chemical oxygen demand (COD) removal, which enhanced the subsequent aerobic phase. Results demonstrated that COD removals were 92% ± 6.8, 96% ± 3.5, and 100%, using PVA-SA, PVA-St, and PVA-Ge at RY15 initial concentrations of 10 mg/L, respectively. The experimental work was extended to investigate the dye biodegradation in real textile wastewater using mixed cells in immobilized in PVA-SA. The Overloading rate (OLR) and Hydraulic retention time (HRT) of the aerobic bioreactor are 24.5 mg/L h and 41.37 h, respectively. The experimental profiles of RY concentration, COD reduction along with biomass growth, were in good agreement with the model predicted profiles. The effectiveness factors were 0.96 and 0.99 for the anaerobic and aerobic phases, respectively.

The Impact of Population Ageing: A Review.

Background: Population aging refers to the increase in number and percentage of older population aged 60 yr and above, and at the same time, decreasing in number and percentage of the young population aged 15 yr old and below. Starting in developed countries, population aging has now become a distinctive demographic phenomenon in developing countries. Nowadays developing countries have become the home to the largest proportion of older people in the world. This paper aimed to analyze the impact of population aging in Malaysia. Methods: We employed a secondary data analysis related to the impact of population aging in Malaysia. In analyzing the data, the paper detailed, segmented, coded and, formulated the text into themes through a thematic approach. The themes that emerged from the data were family changes, migration of youth, support and care, health problems, financial security as well as housing problems. These emerged themes mapped the shared patterns of the impacts of the population aging. Results: With the increasing of the older population in Malaysia, there are various impacts of population aging emerged, particularly in terms of family changes, youth migration to cities, support and care, health, financial security and housing. The discussion in this article is revolved around these impacts. Conclusion: The growth of older people and the impact emerging from it has certain policy implications for the government of the country. Thus, the government needs to prepare for adequate policies and resources for future older people.

New application of Orchis mascula as a biocarrier for immobilization of mixed cells for biodegradation and detoxification of reactive azo dyes.

In this study, the application of novel biocarrier Orchis mascula plant for immobilization of non-adapted mixed cells biodegrade reactive azo dyes in aqueous solution was investigated via a sequential anaerobic-aerobic process. Three reactive azo dyes including red (RR2), blue (RB4), and yellow (RY15) were individually used as the target pollutants. Results revealed that the immobilized biocatalysts had a potential degrading efficiency, targeting the initial structure and the formed aromatic/aliphatic compounds, respectively. Complete decolorization (100%) of RR2, RB4, and RY15 was observed in the anaerobic phase with significant COD removal which has been enhanced during the subsequent aerobic phase. Results demonstrated that COD removals at 10, 20, and 40 mg/L were 100 ± 0.13%, 95 ± 0.05%, and 90 ± 0.03% for RR2; 90 ± 0.11%, 85 ± 0.9%, and 81 ± 0.18% for RB4; and 100 ± 0.08%, 92 ± 0.16%, and 86 ± 0.06% for RY15, respectively. Immobilized cells exhibited better performance compared with free cells, particularly for high dye concentration up to 100 mg/L.

Catheterization Laboratory Activation Time in Patients Transferred With ST-Segment-Elevation Myocardial Infarction: Insights From the Mission: Lifeline STEMI Accelerator-2 Project.

BACKGROUND: Catheterization laboratory (cath lab) activation time is a newly available process measure for patients with ST-segment-elevation myocardial infarction requiring inter-hospital transfers for primary percutaneous coronary intervention that reflects inter-facility communication and urgent mobilization of interventional laboratory resources. Our aim was to determine whether faster activation is associated with improved reperfusion time and outcomes in the American Heart Association Mission: Lifeline Accelerator-2 Project. METHODS AND RESULTS: From April 2015 to March 2017, treatment times of 2063 patients with ST-segment-elevation myocardial infarction requiring inter-hospital transfer for primary percutaneous coronary intervention from 12 regions around the United States were stratified by cath lab activation time (first hospital arrival to cath lab activation within [timely] or beyond 20 minutes [delayed]). Median cath lab activation time was 26 minutes, with a delayed activation observed in 1241 (60.2%) patients. Prior cardiovascular or cerebrovascular disease, arterial hypotension at admission, and black or Latino ethnicity were independent factors of delayed cath lab activation. Timely cath lab activation patients had shorter door-in door-out times (40 versus 68 minutes) and reperfusion times (98 versus 135 minutes) with 80.1% treated within the national goal of ≤120 minutes versus 39.0% in the delayed group. CONCLUSIONS: Cath lab activation within 20 minutes across a geographically diverse group of hospitals was associated with performing primary percutaneous coronary intervention within the national goal of ≤120 minutes in >75% of patients. While several confounding factors were associated with delayed activation, this work suggests that this process measure has the potential to direct resources and practices to more timely treatment of patients requiring inter-hospital transfer for primary percutaneous coronary intervention.

Are Stroke Survivors Discharged to the Recommended Postacute Setting?

OBJECTIVE: To examine the processes and barriers involved in providing postdischarge stroke care. DESIGN: Prospective study of discharge planners' (DP) and physical therapists' (PT) interpretation of factors contributing to patients' discharge destination. SETTING: Twenty-three hospitals in the northeastern United States. PARTICIPANTS: After exclusions, data on patients (N=427) hospitalized with a primary diagnosis of stroke between May 2015 and November 2016 were examined. Of the patients, 45% were women, and the median age was 71 years. DPs and PTs caring for these patients were queried regarding the selection of discharge destination. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Comparison of actual discharge destination for stroke patients with the destinations recommended by their DPs and PTs. RESULTS: In total, 184 patients (43.1%) were discharged home, 146 (34.2%) to an inpatient rehabilitation facility, 94 (22.0%) to a skilled nursing facility, and 3 (0.7%) to a long-term acute care hospital. DPs and PTs agreed on the recommended discharge destination in 355 (83.1%) cases. The actual discharge destination matched the DP and PT recommended discharge destination in 92.5% of these cases. In 23 cases (6.5%), the patient was discharged to a less intensive setting than recommended by both respondents. In 4 cases (1.1%), the patient was discharged to a more intensive level of care. In 2 cases (0.6%), the patient was discharged to a long-term acute care hospital rather than an inpatient rehabilitation facility as recommended. Patient or family preference was cited by at least 1 respondent for the discrepancy in discharge destination for 13 patients (3.1%); insurance barriers were cited for 9 patients (2.3%). CONCLUSIONS: Most stroke survivors in the northeast United States are discharged to the recommended postacute care destination based on the consensus of DP and PT opinions. Further research is needed to guide postacute care service selection.

Stroke Center Certification and Performance: A Longitudinal Analysis of the Northeast Cerebrovascular Consortium Region.

Background: The NorthEast Cerebrovascular Consortium (NECC) was established in 2006 to improve stroke-systems-of-care models. Methods: This study evaluates the increase in stroke quality over time in NECC and Non-NECC regions, defined as the change in proportion of hospitals over time who received State or National Primary/Comprehensive Stroke Center (PSC/CSC) certification, participated in a national quality program (Get-With-The-Guidelines-Stroke (GWTG-S)), or received GWTG-S Performance Achievement Awards (PAA) from 2005-2013. Analysis of trends was performed (Cochran-Armitage/Cochran-Mantel-Haenszel tests; Generalized-Estimating Equations). As an exploratory analysis eight NECC region Departments of Health (DOH) were surveyed regarding perceptions of the NECC. Results: During the study period, there were 433.1 ± 10.2 vs 3986.4 ± 187.7 hospitals per year in the NECC vs non-NECC regions. Rate of growth per year increased in both groups for each measure but to a greater degree in the NECC vs Non-NECC regions: PSC/CSC (5.4%/yr vs 3.2%/yr), GWTG-S participation (5.0%/yr vs 2.9%/yr), and PAAs (5.2%/yr vs 2.1%/yr), with state-based certification growth also being higher in the NECC region (4.2%/yr vs 0.4%/yr; all comparisons p < 0.0001). After adjusting for year, significantly more NECC hospitals had PSC/CSC certification, GWTG-S participation, and GWTG-S PAAs than non-NECC sites (all analyses p < 0.0001). One hundred percent of NECC region DOHs were aware of the NECC and involved in functions, 87.5% indicated the NECC provided beneficial assistance. Conclusions: There has been a higher rate of growth of state certification contrasted to national PSC/CSC certification, and a higher rate of growth of participation and achievement in GWTG-S in the northeast region compared to other US regions.

The Leadership Style of "The People's Doctor": A Contemporary Look Back at New York State Commissioner of Health David Axelrod, MD.

David Axelrod, MD, New York State's commissioner of health from 1979 to 1991, had a panoramic view of public health and a legendary track record of tackling complex issues ranging from the Love Canal environmental disaster to HIV/AIDS and end-of-life ethics. Many raved about Axelrod's leadership, whereas others criticized his response and style. Two decades later, we describe his leadership attributes. Our retrospective review incorporates interviews with former staff and coworkers and information from historical archives. Axelrod's leadership style mirrored that of business leaders, goal driven and focused on execution, as opposed to the typical style of public health leaders, more sympathetic to needs of the team. He framed his mission within the context of social justice and data-driven science. His story, one in which leadership inspired passion and loyalty to science, is driven by a laser-sharp focus on the public good. In today's resource-deprived, politically charged environment, Axelrod's methods for achieving positive community health outcomes warrant close scrutiny. (Am J Public Health. 2019;109:85-91. doi:10.2105/AJPH.2018.304710).