The role of a Medical Examiner Service in an acute NHS hospital: Perspectives from doctors and next of kin.

A new Medical Examiner system was introduced in England and Wales in 2019 to scrutinise all non-coronial deaths. The three key roles of independent Medical Examiner scrutiny are to establish accurate causes of death, determine whether coronial referral is required and identify any care concerns. This is the first published service evaluation exploring the views of doctors and next of kin with whom Medical Examiner Services interact. The aims were to understand whether the Medical Examiner Service was achieving its three main roles. Surveys were sent electronically to the qualified attending practitioners, and by post to the next of kin, of a consecutive series of deceased patients reviewed by an acute NHS hospital Medical Examiner Service in the East of England. Recruitment took place over a five month period in 2023. Results are based on 100 returned surveys from doctors (response rate 35%) and 179 completed by next of kin (response rate 65%). Findings suggest the Medical Examiner Service was successfully achieving its three key roles and well received by both doctors and next of kin. Service user feedback is clearly important as Medical Examiner Services continue to develop into the statutory phase during 2024, when they are anticipated to review approximately 400,000 deaths per annum in England and Wales. This study demonstrates such feedback is not only useful for service development, but also eminently possible.

COVID-19 Death Determination Methods, Minnesota, USA, 2020-20221.

Accurate and timely mortality surveillance is crucial for elucidating risk factors, particularly for emerging diseases. We compared use of COVID-19 keywords on death certificates alone to identify COVID-19 deaths in Minnesota, USA, during 2020-2022, with use of a standardized mortality definition incorporating additional clinical data. For analyses, we used likelihood ratio χ2 and median 1-way tests. Death certificates alone identified 96% of COVID-19 deaths confirmed by the standardized definition and an additional 3% of deaths that had been classified as non-COVID-19 deaths by the standardized definition. Agreement between methods was >90% for most groups except children, although agreement among adults varied by demographics and location at death. Overall median time from death to filing of death certificate was 3 days; decedent characteristics and whether autopsy was performed varied. Death certificates are an efficient and timely source of COVID-19 mortality data when paired with SARS-CoV-2 testing data.

Design and Implementation of an Ontology for Measurement Terminology in Digital Calibration Certificates.

Digital Calibration Certificates (DCCs) are a key focus in metrology digitalization, necessitating that they satisfy the criteria for machine readability and understandability. Current DCCs are machine-readable, but they are still missing the essential semantic information required for machine understandability. This shortfall is particularly notable in the lack of a dedicated semantic ontology for measurement terminologies. This paper proposes a domain ontology for measurement terminologies named the OMT (Ontology for Measurement Terminology), using a foundation of metrological terms from standards like the International Vocabulary of Metrology (VIM), the Guide to the Expression of Uncertainty in Measurement (GUM), and JJF1001. It also incorporates insights from models such as the SI Reference Point, the Simple Knowledge Organization System (SKOS), and the DCC Schema. The methodology was guided by Stanford's Seven-Step Method, ensuring a systematic development process tailored to the needs of metrological semantics. Through semantic expression capability verification and SPARQL query validations, the OMT has been confirmed to possess essential machine readability and understandability features. It has been successfully integrated into version 3.2.1 of DCCs across ten representative domains. This integration demonstrates an effective method for ensuring that DCCs are machine-readable and capable of interoperating within digital environments, thereby advancing the research in metrology digitization.

Coding Diagnoses from the Electronic Death Certificate with the 11th Revision of the International Statistical Classification of Diseases and Related Health Problems: An Exploratory Study from Germany.

The 11th Revision of the International Statistical Classification of Diseases, Injuries, and Causes of Death (ICD-11) will replace its predecessor as international standard for cause-of death-statistics. The digitization of healthcare is a main motivation for its introduction. In parallel, the replacement of the paper-based death certificate with an electronic format is under evaluation. At the moment, the death certificate is used in paper-based format with ICD-10 for coding in Germany. To be prepared for the switch to ICD-11, the compatibility between ICD-11 and the electronic certificate should be assured. Objectives were to check the appropriateness of diagnosis-related information found on death certificates for an ICD-11 coding and to describe enhancements to the certificate's structure needed to fully utilize the strengths of ICD-11. As part of an exploratory test of a respective application, information from 453 electronic death certificates were provided by one local health authority. From a sample of 200 certificates, 433 diagnosis texts were coded into the German version of ICD-11. The appropriateness of the results as well as the further requirements of ICD-11, particularly with regard to post-coordination, were checked. For 430 diagnosis texts, 649 ICD-11 codes were used. Three hundred and sixty two diagnosis texts were rated as appropriately represented through the coding result. Almost all certificates contained diagnosis texts that lacked details required by ICD-11 for a precise coding. The distribution of diseases was very similar between ICD-10 and ICD-11 coding. A few gaps in ICD-11 were identified. Information requested by ICD-11 for a mandatory post-coordination were almost entirely absent from the death certificates. The structure and content of the death certificate are currently not well prepared for an ICD-11 coding. Necessary information was frequently missing. The line-oriented structure of death certificates has to be supplemented with a more flexible approach. Then, the semantic knowledge base of ICD-11 should better guide the content related input fields of a future electronic death certificate.

Revealing rural motivations in pharmacy students pursuing a graduate certificate program.

INTRODUCTION: To assist recruitment and retention efforts and influence the need for an increased supply of future rural pharmacists, this study examines perceptions and key motivators of pharmacy students who chose to participate in the Rural Pharmacy Health Certificate (RPHC) program and pursue pathways to rural practice. METHODS: We interviewed six RPHC students prior to or shortly after beginning their first semester in the RPHC program. Interview questions assessed applicants' reasons for pursuing the RPHC, perceptions of living in and providing healthcare in rural and small communities, awareness of barriers and health disparities in rural areas, and qualities needed to be a successful rural pharmacist. We analyzed data with the Sort and Sift, Think and Shift method, a common approach to qualitative data analysis. RESULTS: Interest in pursuing rural pharmacy grew out of growing up in a rural area, as well as a desire to serve and help others. Students expected that completing the RPHC would strengthen their skillsets to provide the best care by addressing barriers such as difficulty accessing care and health literacy. Being a learner of one's community was the primary quality identified as necessary to be a successful rural pharmacist. CONCLUSION: This study identified primary motivators and perceptions that led students to pursue a rural health program at one US pharmacy school. The results can be used to identify and train good candidates for rural pharmacy practice, strengthening the rural pharmacy workforce to better meet communities' needs.

Certificate of Need Laws in Health Care: Past, Present, and Future.

Certificate of need (CON) laws limit the supply of health care services in about two-thirds of U.S. states. The regulations require those who wish to offer new services or expand existing services to first prove to a regulator that the care is needed. While advocates for the regulation have offered several rationales for its continuance, the balance of evidence suggests that the rules protect incumbent providers from competition at the expense of patients, payors, and would-be competitors. In this article, I review the history of CON laws in health care, summarize the large literature evaluating them, and briefly sketch options for reform.JEL Classification: I11, I18, H75.

Enhancing renewable energy certificate transactions through reinforcement learning and smart contracts integration.

Given the complexity of issuing, verifying, and trading green power certificates in China, along with the challenges posed by policy changes, ensuring that China's green certificate market trading system receives proper mechanisms and technical support is crucial. This study presents a green power certificate trading (GC-TS) architecture based on an equilibrium strategy, which enhances the quoting efficiency and multi-party collaboration capability of green certificate trading by introducing Q-learning, smart contracts, and effectively integrating a multi-agent trading Nash strategy. Firstly, we integrate green certificate trading with electricity and carbon asset trading, constructing pricing strategies for the green certificate, carbon, and electricity trading markets; secondly, we design a certificate-electricity-carbon efficiency model based on ensuring the consistency of green certificates, green electricity, and carbon markets; then, to achieve diversified green certificate trading, we establish a multi-agent reinforcement learning game equilibrium model. Additionally, we propose an integrated Nash Q-learning offer with a smart contract dynamic trading joint clearing mechanism. Experiments show that trading prices have increased by 20%, and the transaction success rate by 30 times, with an analysis of trading performance from groups of 3, 5, 7, and 9 trading agents exhibiting high consistency and redundancy. Compared with models integrating smart contracts, it possesses a higher convergence efficiency of trading quotes.

Grappling with the trade-offs of carbon emission trading and green certificate: Achieving carbon neutrality in China.

Although our knowledge of national carbon emission trading system and green certificate trading system are powerful incentive instruments that can deliver on increasingly ambitious climate targets in China, there remains an uncertainty of systems' structural reforms. This study builds on and extends a well-established dynamic computable general equilibrium (CGE) model to incorporate carbon trading system and green certificate trading system into the modeling framework, simulating a diverse of system development pathways further allows an exploration of the many possible policy effect. Then, using total factor productivity as a comprehensive indicator to asses policy effectiveness, the evolutionary trend of comprehensive effects under different paths are separately evaluated to discover the reforms' optimal range. Our work offers main results: First, these instruments provide a price signal. The introduction of a carbon allowance auction drive up carbon prices, while the implementation of a green certificate punishment and the expansion of the trading scope promote an increase in green certificate prices. Second, all policy scenarios that help reduce carbon emission intensity and optimize the power supply structure. However, in achieving the net-zero goal, the green certificate policy incurs more economic costs than the carbon trading policy. Indeed, the combination of multiple policy tools alleviates the decline of social welfare levels. Third, synergism design among policy tools: the focus should be on carbon trading policy from 2021 to 2030, green certificate trading policy from 2030 to 2050, and strengthened policy from 2050 to 2060. Reform measures within policies may need to be introduced in a timely manner. This study offers specific insights and tailored policy proposals to support policymakers in balancing environmental goals with economic and social needs in light of the aforementioned findings.

Innovation and evaluation of vocational pharmaceutical education system under the 1 + X certificate system in China.

BACKGROUND AND OBJECTIVES: The 1 + X certificate system, introduced in China in 2019, integrates academic credentials with vocational skill certificates to meet the heightened demand for skilled talents in the growing economy. This study aims to innovate and evaluate the vocational pharmaceutical education system under the 1 + X certificate framework, specifically addressing the gap between theoretical education and workplace requirements. MATERIALS AND METHODS: A retrospective observational approach analyzed 490 pharmacy students over two academic years. The 2021 cohort underwent 1 + X integrated education, while the 2020 cohort followed conventional education. We collaborated closely with industry partners to identify and compile typical job competencies, formulating work projects aligned with industry demands. Combining the skill level standards and assessment content of "1+X Pharmaceutical Purchasing and Sales" and "1+X Pharmaceutical Preparation", we revised the course standards, incorporating typical work projects into the 2021 pharmacy professional teaching curriculum. This constituted the fundamental content of the 1 + X education reform. Statistical analysis compared course scores and 1 + X certificate examination performance. RESULTS: The 2021 cohort, under the 1 + X educational model, demonstrated higher average scores in pharmacy courses, with significant improvements in pharmacology (1 + X vs. Traditional education: 58.40 ± 14.20 vs. 53.44 ± 14.67), clinical pharmacotherapy (72.74 ± 10.28 vs. 63.15 ± 11.03), and pharmaceutical distribution and marketing (79.34 ± 10.96 vs. 67.50 ± 15.82). 1 + X certificate pass rates and satisfaction with the model were also higher than the 2020 cohort. CONCLUSION: The 1 + X certificate system is useful for developing talent in Chinese vocational education, effectively integrating assessments with industry standards. Future research should aim at evaluating long-term outcomes and improving quantitative skills assessments for enhanced effectiveness.

Practical training concept for perfusionists at the heart and diabetes center Nordrhein-Westfalen.

BACKGROUND: Increasing regulations and requirements of advisory bodies, in particular the Joint Federal Committee and the Medical Service of the health insurance funds, make it necessary to employ only demonstrably well-trained perfusionists. The minimum requirement for this staff is EBCP certification. Currently there is limited availability of such specialists on the German market. Therefore, the qualification of young people in this area is of central importance. The aim of this paper is to strengthen the training of perfusionists at our centre, to standardise the process and to provide the respective student with a "roadmap" to their internship. MATERIAL & METHODS: The structure is based on a rough division of the 24 weeks of internship. This is described in detail in the following and is backed up with the learning objectives for the respective time periods. RESULTS: At our centre, practical training has been standardized and clear responsibilities have been defined. Furthermore, as a centre of maximum care in the field of cardiac surgery, we can offer students the necessary number of perfusions in just six months to meet the requirements of the ECBP for practical training. According to this concept, 20 perfusionists have been successfully trained in the last 8 years. All of them have passed the exams and have been certified according to EBCP. CONCLUSION: The aim of the practical semester is for the student to be in a position at the end of the semester to independently supervise simple cardiac surgery procedures with the aid of the Extra- Corporal Circulation (ECC) and to carry this out in accordance with the currently valid guidelines and directives (1-8) and the departmental procedural instructions based on them. Great emphasis is placed to the students becoming aware of their competence to act, knowing their limits and being able to assess when these limits have been reached and the involvement of experienced colleagues is necessary to ensure patient safety.

Lessons learned from contamination with endotoxin originated from the supplement in the cell culture medium.

Introduction: Endotoxin is a typical pyrogen derived from the outer membrane of Gram-negative bacteria. In fabricating cell-based medicinal products, it is necessary to control endotoxin in the process and the products. In the quality control tests of our clinical study, endotoxin concentration in the culture supernatant of autologous oral mucosal epithelial cell sheets exceeded the criterion value. Therefore, endotoxin measurements were conducted to clarify the cause of the endotoxin contamination. Methods: The reagents used to prepare the culture medium, the unused culture medium, and the culture supernatants were diluted with pure water. Endotoxin concentrations in the diluted samples were measured. Results: Endotoxin was detected in both the unused culture medium and the culture supernatant of the epithelial cell sheets at higher concentrations than the criterion value. Therefore, endotoxin concentrations in the reagents used to prepare the culture medium were measured and were found to be below the criterion value, except for cholera toxin. On the other hand, three lots of cholera toxin products were used for the measurement, and the endotoxin concentrations were higher than the criterion value. The results indicate that the endotoxin contamination is caused by the cholera toxin product. Conclusions: To prevent endotoxin contamination in cell-based medicinal products, endotoxin concentrations in reagents used for the fabrication should be measured in the facility conducting clinical research or confirmed by an adequate certificate of analysis from the manufacturers of the reagents.

Accuracy of routinely collected hospital administrative discharge data and death certificate ICD-10 diagnostic coding in progressive supranuclear palsy and corticobasal syndrome: a systematic review and validation study.

BACKGROUND: We conducted a systematic review to identify existing ICD-10 coding validation studies in progressive supranuclear palsy and corticobasal syndrome [PSP/CBS]) and, in a new study, evaluated the accuracy of ICD-10 diagnostic codes for PSP/CBS in Scottish hospital inpatient and death certificate data. METHODS: Original studies that assessed the accuracy of specific ICD-10 diagnostic codes in PSP/CBS were sought. Separately, we estimated the positive predictive value (PPV) of specific codes for PSP/CBS in inpatient hospital data (SMR01, SMR04) compared to clinical diagnosis in four regions. Sensitivity was assessed in one region due to a concurrent prevalence study. For PSP, the consistency of the G23.1 code in inpatient and death certificate coding was evaluated across Scotland. RESULTS: No previous ICD-10 validation studies were identified. 14,767 records (SMR01) and 1497 records (SMR04) were assigned the candidate ICD-10 diagnostic codes between February 2011 and July 2019. The best PPV was achieved with G23.1 (1.00, 95% CI 0.93-1.00) in PSP and G23.9 in CBS (0.20, 95% CI 0.04-0.62). The sensitivity of G23.1 for PSP was 0.52 (95% CI 0.33-0.70) and G31.8 for CBS was 0.17 (95% CI 0.05-0.45). Only 38.1% of deceased G23.1 hospital-coded cases also had this coding on their death certificate: the majority (49.0%) erroneously assigned the G12.2 code. DISCUSSION: The high G23.1 PPV in inpatient data shows it is a useful tool for PSP case ascertainment, but death certificate coding is inaccurate. The PPV and sensitivity of existing ICD-10 codes for CBS are poor due to a lack of a specific code.

Impact of an Educational Measure on the Quality of Medical Certificate of Cause of Death at a Tertiary Care Teaching Hospital: A Pre-post Interventional Study.

Background A death certificate is an important document that serves as a tool for gathering epidemiological data and as an essential legal document. Although it is a mandatory document to be given for all deaths, the quality of its filling is often an ignored aspect and errors are frequently encountered. This documentation process can be mastered with minimal educational efforts. This study aimed to determine the utility of an educational measure in improving the accuracy of death certificate documentation. Methods and materials This pre- and post-interventional study was conducted at Maharaja Agrasen Medical College, Agroha, a tertiary care teaching hospital in Hisar, Haryana, India, wherein an audit of death certificates was done before and after an educational intervention on doctors responsible for filling death certificates. Errors in the death certificates were classified into major and minor errors and compared in the pre- and post-intervention groups. Results A total of 184 pre-intervention and 136 post-intervention death certificates were audited. In the pre-intervention certificates, at least one major and one minor error were present in 88% and 92.93% of the certificates, respectively, which was reduced to 33% (p < 0.01; relative risk (RR) = 3.62; 95% confidence interval (CI) = 2.69-4.91) and 38% (p < 0.01; RR = 3.33; 95% CI = 2.53-4.37), respectively, post-intervention. Reduction in all types of major and minor errors was statistically significant (p < 0.05). Conclusions Errors in death certification are a common but frequently ignored problem that can have a negative impact on epidemiological data and can be drastically reduced with simple educational measures, which need to be carried out regularly.

Urologists have a duty to think about occupational urinary cancers.

More than 11% of employees are exposed to carcinogens in the usual course of their work. The benefits of recognition as an occupational disease (OD) allow victims of work firstly to benefit from a disability compensation. But there are collective challenges. It is important to understand that accidents at work and recognised OD are not financially covered by health insurance, which is financed by everyone, but by a specific branch, known as "professional risks/occupational risks", financed by employers alone. Being recognised as having an OD modifies the benefits: 100% coverage of all the costs inherent to the OD, including transport costs, increase of daily allowances, payment of a pension (or of a lump sum if the Permanent Incapacity rate is<10%). A survivor's pension may be paid to the beneficiaries in the event of the patient's death. OD "is presumed to be of occupational origin: any disease designated in a table of OD and contracted under the conditions set out in this table". Although the declaration of OD must be made by the victim (or his dependents) to the national health insurance fund, it can only exist on condition that a doctor has drawn up a descriptive Initial Medical Certificate (IMC), taking care to use the exact terms of the tables (15 ter and 16 bis) and the professional/occupational origin.

Public attitudes towards COVID-19 vaccine mandates and vaccine certificates in Canada: a time series study.

INTRODUCTION: Since the beginning of the pandemic, numerous public health measures such as COVID-19 vaccines, vaccine mandates and vaccination certificates have been introduced to mitigate the spread of COVID-19. Public opinion and attitudes towards these measures have fluctuated in response to the dynamic political, social, and cultural landscape of the pandemic. METHODS: We conducted a time-series study consisting of national cross-sectional surveys between November 2021 to March 2022 to evaluate the Canadian public's attitudes towards COVID-19 vaccine mandates and vaccine certificates. RESULTS: When examining public sentiment towards COVID-19 vaccine certificates and proof of vaccination measures, there was a shift in responses over time. The proportion of participants "strongly supporting" these measures decreased from 66.0 to 43.1% between W25(Capacity Limits), -W32 (Mask Mandate Removed), whereas "strongly oppose" was the second most common response and rose from 15.9 to 20.6% during this same time period. Concurrently, when examining participants views surrounding mandates, many participants believed that their province was reopening at "about the right pace", which remained relatively stable over time (33.0-35.4%) between W28 (Emergency Act)-W32 (Mask Mandate Removed). CONCLUSION: Our study's findings on the public's attitudes towards COVID-19 vaccine mandates and vaccine certificates in Canada may aid to guide and streamline the implementation of future similar public health interventions. Future research should include extended follow-up and a more comprehensive examination of trust in government institutions and polarized perspectives on vaccine mandates.

Dickson polynomial-based secure group authentication scheme for Internet of Things.

Internet of Things (IoT) paves the way for the modern smart industrial applications and cities. Trusted Authority acts as a sole control in monitoring and maintaining the communications between the IoT devices and the infrastructure. The communication between the IoT devices happens from one trusted entity of an area to the other by way of generating security certificates. Establishing trust by way of generating security certificates for the IoT devices in a smart city application can be of high cost and expensive. In order to facilitate this, a secure group authentication scheme that creates trust amongst a group of IoT devices owned by several entities has been proposed. The majority of proposed authentication techniques are made for individual device authentication and are also utilized for group authentication; nevertheless, a unique solution for group authentication is the Dickson polynomial based secure group authentication scheme. The secret keys used in our proposed authentication technique are generated using the Dickson polynomial, which enables the group to authenticate without generating an excessive amount of network traffic overhead. IoT devices' group authentication has made use of the Dickson polynomial. Blockchain technology is employed to enable secure, efficient, and fast data transfer among the unique IoT devices of each group deployed at different places. Also, the proposed secure group authentication scheme developed based on Dickson polynomials is resistant to replay, man-in-the-middle, tampering, side channel and signature forgeries, impersonation, and ephemeral key secret leakage attacks. In order to accomplish this, we have implemented a hardware-based physically unclonable function. Implementation has been carried using python language and deployed and tested on Blockchain using Ethereum Goerli's Testnet framework. Performance analysis has been carried out by choosing various benchmarks and found that the proposed framework outperforms its counterparts through various metrics. Different parameters are also utilized to assess the performance of the proposed blockchain framework and shows that it has better performance in terms of computation, communication, storage and latency.

A new approach for national-scale Building Energy Models based on Energy Performance Certificates in European countries: The case of Spain.

Urban Building Energy Models (UBEMs) are useful instruments to know the energy consumption of building stocks at urban and national levels. UBEMs can be classified into different types and subtypes. The current detailed physics-based bottom-up UBEMs at a national scale play a crucial role in assessing the energy efficiency of national building stocks and defining improvement strategies. These models heavily rely on archetypes and energy simulations, demanding significant computational resources. We propose here a new type of national-scale detailed physics-based UBEM based on Energy Performance Certificates (EPCs), and other open big data, which has the advantage that it can be automatically updated, in a short time, and with standard computer means. In this paper, we define the methodology to build this new type of national-scale EPC-based UBEM. We have checked that the model for the case of Spain can be automatically generated and updated in less than 6 h with a standard computer, and it generates results that match official data in more than 98 % for four indicators. The generated model contains information about 10,939,801 buildings in Spain, out of which 1,202,708 have EPCs. The model allows us to map and analyse the buildings in the country by integrating multiple variables of different nature, such as geographical (Autonomous Community, municipality, type of municipality), physical (area, number of floors, date of construction), use-related (main use of the building and use of each of its building units), and energy-related (climate zone, energy class, energy consumption, CO2 emissions). In this paper, we have proven that the model allows for the development of some indicators to measure the progress of decarbonisation trajectories whose development will become mandatory for European Member States soon.

Do Death Certificate Errors Decrease as Clinical Experience in an Emergency Department Increases?

BACKGROUND: This study aimed to evaluate the relationship between clinical experience and death certificate (DC) errors by analyzing DCs written by experienced emergency physicians (EPs). METHODS: DCs issued by four experienced EPs over a 10-year period were retrospectively reviewed. DC errors were divided into major and minor errors based on whether they affected the cause of death (COD) determination. The errors were judged through first and second evaluations. Basic information regarding DCs and 10-year changes in DC errors were analyzed. RESULTS: A total of 505 DCs were analyzed, with an average of 34 to 70 for each study year. The number of CODs written in the DCs tended to decrease over time. The presentation of major DC errors did not show a tendency to change over time. However, the sum of the major and minor errors tended to increase over time. Secondary conditions as the underlying COD tended to increase, and the incompatible causal relationships between CODs tended to decrease over time in the detailed analysis of major errors. The increasing tendency for incorrect other significant conditions, incorrect type of accident, incorrect intention of the external cause, no record of the trauma mechanism, and record of the trauma mechanism without another COD were found in the detailed analysis of minor errors. CONCLUSION: DC errors did not decrease as clinical experience increased. Education to reduce DC errors and a feedback process for written DCs are necessary, regardless of clinical experience.

How Much is too Much? High Utilization of Prenatal Care and Its Impact on Primary Cesarean Birth Among Women in the United States.

INTRODUCTION: Nationally, cesarean birth is one of the most performed surgical procedures, yet cesarean births have been linked to an increased risk of delivery complications. Prenatal care (PNC) and education are possible strategies to reduce the number of cesarean births. However, there is scant research assessing the impact of these strategies on safely reducing primary cesarean births. This study evaluates the association between the adequacy of PNC utilization and primary cesarean birth. METHODS: The analysis used 2018 birth certificate data, and the sample included nulliparous women with no reported pregnancy or delivery complications (N = 729,140). Logistic regression was used to model the association between the adequacy of PNC utilization and delivery method, as well as identify other factors associated with the delivery method. RESULTS: Among women with a primary cesarean birth, 36.2% had received adequate plus PNC. After adjustment, there was no significant association between women receiving inadequate, intermediate, or adequate PNC and primary cesarean birth. However, women who received adequate plus PNC had an increased odds of having a primary cesarean birth compared to women with no PNC (OR, 1.23; 95% CI, 1.18-1.28). DISCUSSION: Findings from this study highlight the need to further understand the role of PNC and its potential impact on the delivery method. Within the patient-provider relationship, healthcare providers have the unique opportunity to provide education and inform patients of the risks and benefits of all delivery options. Thus, there is an increased opportunity to safely reduce primary cesarean births.

The effectiveness of multivariate and univariate spectrophotometric techniques for the concurrent estimation of ornidazole and ciprofloxacin HCl in tablet formulation and spiked serum: estimating greenness and whiteness profile.

In this manuscript, the effectiveness of multivariate and univariate tools in conjunction with spectrophotometric techniques was evaluated for the concurrent analysis of ciprofloxacin (CI) and ornidazole (OR) in prepared mixtures, tablets, and human serum. The artificial neural network was chosen as the multivariate Technique. Bayesian regularization (trainbr) and Levenberg-Marquardt algorithms (trainlm), were constructed and trained using feed-forward back-propagation learning. The optimal logarithm was determined based on mean recovery, mean square error of prediction (MSEP), relative root mean square error of prediction (RRMSEP), and bias-corrected MSEP (BCMSEP) scores. Trainbr outperformed trainlm, yielding a mean recovery of 100.05% for CI and 99.84% for OR, making it the preferred algorithm. Fourier self-deconvolution and mean-centering transforms were chosen as the univariate Techniques. Fourier self-deconvolution was applied to the zero-order spectra of ciprofloxacin and ornidazole by electing an appropriate full width at half maximum, enhancing peak resolution at 380.1 nm and 314.2 nm for CI and OR, respectively. Mean centering transform was applied to CI and OR ratio spectra to eliminate constant signals, enabling accurate quantification of CI and OR at 272.0 nm and 306.2 nm, respectively. The introduced approaches were optimized and validated for precise CI and OR analysis, with statistical comparison against the HPLC method revealing no notable differences. The sustainability of these approaches was confirmed through the green certificate (modified eco-scale), AGP, and whiteness-evaluation tool, corroborating their ecological viability.