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Background: There exist a limited number of studies demonstrating the benefit of initiating anti-retroviral agents (ARVs) for the treatment of human immunodeficiency virus (HIV) in the critical care setting. However, there are physiological, practical, and ethical arguments against making HIV testing and initiation of ARVs routine practice. Methods: A self-administered, cross-sectional survey of healthcare professionals was conducted with data collected using a questionnaire distributed to delegates of the Critical Care Society of South Africa (CCSSA) 2016 Congress, and members of the society. Results: There were 101 respondents. Eight per cent would not consider testing a critically ill patient for HIV (status previously unknown), largely because they considered this unethical. Sixty-nine per cent would consider commencing ARVs in a patient newly-diagnosed with HIV during an inter-current critical illness. The factor most likely to guide them towards this was severity of illness. In general, the greatest concerns focused around biological/medical issues. However, those clinicians who would not consider initiation of ARVs were more likely than those who would, to be concerned about psychosocial issues. Conclusion: Although the majority of clinicians would consider initiation of ARVs acutely in critically ill patients, it is apparent that the clinical decision-making around this matter is complex. Advocacy is needed to further clarify relevant ethical and legal dilemmas, and in the interim consultative and collaborative care is encouraged.

India has been hard-hit by the Covid-19 pandemic. The virus has exacted a heavy toll in terms of lives lost and deteriorating health outcomes. The economic consequences of the pandemic have been similarly grim. In this paper we attempt an initial, interim, assessment of the impacts of the crisis on poverty. We review the growing literature that considers emerging poverty impacts, noting that there remain significant knowledge gaps due to limited evidence on current welfare outcomes. We analyze pre-Covid survey data to examine the incidence of chronic poverty and downward mobility during a period of rapid economic growth and declining poverty. A profile of poverty during such a period might offer a plausible, partial, window on population groups currently at risk. We suggest that, notwithstanding the severe initial impacts of the crisis on poverty, there are grounds for expecting further consequences going forward. As the virus has spread out of the relatively affluent cities, and as economic stagnation persists, rural areas, with historically higher rates of chronic poverty and vulnerability, may see particularly sharp increases in poverty. While recent vaccination developments offer some grounds for optimism, there remains an urgent need to identify, implement and amplify effective policy alleviation measures.

Background To date, health technology assessment (HTA) agencies have not been at the forefront of decision making regarding the adoption of interventions for coronavirus disease 2019 (COVID-19). Instead, policymakers have prioritised rapid action in response to the pandemic emergency, with no assessment of value for money. As COVID-19 vaccination coverage increases and healthcare systems begin to recover, HTA agencies will be expected to assess technologies for COVID-19. Objective We aimed to identify the key challenges when assessing therapeutic and diagnostic technologies for COVID-19, from the perspective of HTA agencies, and identify whether there is a case for novel HTA methods and/or processes to address them. Methods We used a mixed-methods approach, by conducting an online survey of HTA agencies, to collect data about the challenges faced when assessing or planning to assess diagnostic and therapeutic technologies for COVID-19. The online survey was followed by a ‘roundtable’ workshop of HTA agencies’ representatives to discuss the results and to elaborate on their responses. Results We received 21 completed surveys (response rate of 45%) and 11 of the respondents joined the roundtable discussion. Five themes emerged from the responses: assessing clinical effectiveness (44%), assessing cost effectiveness (19%), practical (19%), political (11%), and decision making (11%) challenges. At the roundtable, attendees elaborated on the challenges and identified two additional themes: how HTA agencies have responded to the pandemic to date, and how their role might change over time. Conclusion HTA agencies face both methodological and logistical challenges when assessing or planning to assess technologies for COVID-19. An interim best-practice HTA framework to address the key challenges would be valuable. Supplementary Information The online version contains supplementary material available at 10.1007/s40273-021-01097-4.

The expansive geography of Central Alberta presents many barriers to optimal care, including limited resources and access issues. In response to the COVID-19 pandemic, primary care networks (PCNs) within Central Alberta partnered with a technology provider to rapidly implement home health monitoring (HHM) for patients with chronic diseases. In the 37 patients evaluated in phase 1 (90 days), diabetes was most common (73%), followed by hypertension (38%), chronic obstructive pulmonary disease (27%), and heart failure (11%). Overall, patients were comfortable using the HHM technology, and >60% reported improved quality of life after follow-up. Patients also made fewer visits to their family physician/emergency department compared with the pre-enrolment period. In January 2021, the HHM initiative was expanded to a larger patient cohort (phase 2; n = 500). Interim results for 90 patients from eight PCNs up to the end of May 2021 show similar findings to phase 1.

SUMMARY This paper examines the information content of interim review assurance in the Australian mandatory disclosure setting. First, we find a strong negative market reaction to interim going concern conclusions (IGCC) contained in the review of interim financial statements. Second, we find no significant difference between the market reaction to IGCCs and annual going concern opinions (AGCO) received at the annual report audit. Finally, we show IGCCs are significant predictors of subsequent AGCOs, and provide incremental information from the previous annual report audit opinion. Overall, these results contribute to the literature on the benefits of mandatory interim assurance by showing that going concern conclusions contained in interim financial statements provide investors with new and relevant information. JEL Classifications: G38; M42; M48.

Background Many people with spinal cord injury (SCI) have limited access to tailored, readily available exercise resources. As a result, exercise remains an underutilized treatment strategy for improving health and function in people with SCI. The purpose of this study is to test the effectiveness of two remotely delivered exercise programs for people with SCI. Methods The Spinal Cord Injury Program in Exercise (SCIPE) study is a three-arm adaptive randomized controlled trial examining two 8-week teleexercise interventions: Movement-to-Music (M2M) and Standard Exercise Training (SET), compared to Attention Control (AC) in 327 adults with SCI. The primary outcome is change in physical activity level at post 8-week intervention. The study contains two interim analyses. The first interim analysis will assess feasibility metrics of the protocol after 36 participants complete the 8-week intervention period. The second interim analysis will examine two effectiveness comparisons: SET vs. AC and M2M vs AC, after 165 participants complete the intervention period. Early termination of the intervention arm(s) will take place when non-significant findings are found in the corresponding intervention(s). Incorporation of such interim analysis enhances trial efficiency by dropping the intervention(s) that deemed ineffective. It provides ethical benefits and allows allocation of additional resources to explore the effective intervention(s). Discussion Delivery of teleexercise programs may be an effective strategy for addressing transportation barrier to exercise resources and increasing physical activity level and quality of life in people with SCI. Trial registration ClinicalTrials.gov Identifier NCT03925077. Registered trial name: Spinal Cord Injury Program in Exercise (SCIPE). Registered on April 23rd, 2019.

Background Wolbachia technology is a novel vector control approach that can reduce mosquito populations and the risk of mosquito-borne diseases, which has recently gained popularity amongst countries. In 2016, Singapore embarked on a multi-phased field study named Project Wolbachia – Singapore, to evaluate the use of Wolbachia technology as an Aedes aegypti mosquito population suppression tool to fight dengue. Due to the novelty of this technology in Singapore, this study aims to understand the public’s acceptance and sentiments towards the use of Wolbachia technology. Methods Several public sentiment survey approaches – including online, face-to-face in the streets, as well as door-to-door household surveys – were conducted. Results The surveys conducted prior to the first field releases and implementation of the project revealed high support for the use of Wolbachia technology in Singapore. A household perception survey conducted in the interim of the first project phase was encouraging, with the majority of the respondents being aware of the project and having no concerns with the release of male Wolbachia-carrying Aedes aegypti (Wolbachia-Aedes) mosquitoes in their neighbourhood. Conclusions The study reveal high support for the use of Wolbachia technology in Singapore and also provided invaluable insights that were used in the development of a public communications and engagement framework model, which thus helped to guide these elements in the subsequent phases and expansion of the project.

Antimicrobial resistance is a serious threat that affects all countries. The Global Action Plan on antimicrobial resistance and the United Nations Political Declaration on antimicrobial resistance set standards for countries to resolve antimicrobial resistance challenges under the One Health approach. We assess progress and challenges in implementing Thailand's national strategic plan on antimicrobial resistance 2017-2022, discuss interim outcomes and share lessons learnt. Major progress includes: establishing a national governance mechanism that leads high-impact policy on antimicrobial resistance and consolidates actions and multisectoral collaboration; creating a monitoring system and platform to track implementation of the strategic plan; and converting strategies of the strategic plan into actions such as controlling the distribution and use of antimicrobials in humans and animals. Interim results indicate that antimicrobial consumption in animals has nearly halved (exceeding the national goal of a 30% reduction) whereas other goals have not yet reached their targets. We have learnt that elevating antimicrobial resistance to high-level visibility and establishing a national governance mechanism is an important first step, and a monitoring and evaluation system should be developed in parallel with implementation. Securing funds is crucial. Policy coherence is needed to avoid duplication of actions. Highly ambitious goals, although yet to be achieved, can advance actions beyond expectations. Political commitment and collaboration across different sectors will continue to play important roles but might not be sustained without a well-designed governance structure to support long-term actions to address antimicrobial resistance.La résistance aux antimicrobiens fait peser une sérieuse menace sur la planète tout entière. Le Plan d'action mondial pour combattre la résistance aux antimicrobiens ainsi que la Déclaration politique des Nations Unies sur la résistance aux agents antimicrobiens ont défini des normes pour les pays, afin qu'ils puissent faire face aux enjeux liés à la résistance aux antimicrobiens selon l'approche «One Health». Nous avons évalué les progrès et défis de la mise en œuvre du plan stratégique national de la Thaïlande en la matière pour 2017–2022, mais aussi discuté des résultats provisoires et partagé les enseignements tirés. Parmi les principaux progrès accomplis figurent l'établissement d'un mécanisme de gouvernance national pour mener une politique à impact élevé sur la résistance aux antimicrobiens, renforcer les actions et favoriser la collaboration intersectorielle; la création d'un système de surveillance et d'une plateforme pour suivre la mise en œuvre du plan stratégique; et enfin, la conversion des stratégies du plan en actions telles que le contrôle de la distribution et de l'usage des antimicrobiens chez les humains et les animaux. Les résultats provisoires indiquent que la consommation d'antimicrobiens chez les animaux a diminué de moitié (ce qui est supérieur à l'objectif national d'une réduction de 30%), tandis que les autres objectifs n'ont pas encore été atteints. Nous avons constaté qu'accroître la visibilité de la résistance aux antimicrobiens et instaurer un mécanisme de gouvernance national constituaient des étapes cruciales, et qu'un système de surveillance et d'évaluation devait être développé parallèlement à la mise en œuvre. L'obtention de financements est elle aussi essentielle. Une politique cohérente est nécessaire pour éviter de multiplier les actions similaires. Fixer des objectifs très ambitieux, même s'ils ne sont pas encore atteints, permet en outre de faire progresser les actions au-delà des attentes. Enfin, l'engagement politique et la collaboration entre différents secteurs continueront à jouer un rôle prépondérant, mais ne pourront peut-être pas se poursuivre sans une structure de gouvernance bien conçue, capable de soutenir des actions à long terme visant à remédier à la résistance aux antimicrobiens.La resistencia a los antimicrobianos es una grave amenaza que afecta a todos los países. El Plan de Acción Mundial sobre la resistencia a los antimicrobianos y la Declaración Política de las Naciones Unidas sobre la resistencia a los antimicrobianos establecen normas para que los países resuelvan los problemas de resistencia a los antimicrobianos en el marco del enfoque «Una única salud». Evaluamos los avances y los desafíos en la aplicación del plan estratégico nacional de Tailandia sobre la resistencia a los antimicrobianos 2017-2022, analizamos los resultados provisionales y compartimos las lecciones aprendidas. Entre los principales avances se encuentran: el establecimiento de un mecanismo de gobernanza nacional que lidera la política de alto impacto sobre la resistencia a los antimicrobianos y consolida las acciones y la colaboración multisectorial; la creación de un sistema de seguimiento y una plataforma para seguir la aplicación del plan estratégico; y la conversión de las estrategias del plan estratégico en acciones como el control de la distribución y el uso de antimicrobianos en humanos y animales. Los resultados provisionales indican que el consumo de antimicrobianos en animales se ha reducido casi a la mitad (superando el objetivo nacional de una reducción del 30 %), mientras que otros objetivos aún no han alcanzado sus metas. Hemos aprendido que elevar la resistencia a los antimicrobianos a una visibilidad de alto nivel y establecer un mecanismo de gobernanza nacional es un primer paso importante, y que debe desarrollarse un sistema de seguimiento y evaluación en paralelo a la implementación. Asegurar los fondos es crucial. La coherencia política es necesaria para evitar la duplicación de acciones. Unos objetivos muy ambiciosos, aunque todavía no se hayan alcanzado, pueden hacer avanzar las acciones más allá de las expectativas. El compromiso político y la colaboración entre los distintos sectores seguirán desempeñando un papel importante, pero podrían no mantenerse sin una estructura de gobernanza bien diseñada que apoye las acciones a largo plazo para hacer frente a la resistencia a los antimicrobianos.تعتبر مقاومة مضادات الميكروبات تهديدًا خطيرًا يؤثر على كل البلدان. وضعت كل من خطة العمل العالمية بشأن مقاومة مضادات الميكروبات، والإعلان السياسي للأمم المتحدة بشأن مقاومة مضادات الميكروبات، معايير للبلدان لحل تحديات مقاومة مضادات الميكروبات في إطار نهج One Health (وان هيلث). نحن نقوم بتقييم التقدم والتحديات في تنفيذ الخطة الاستراتيجية الوطنية لتايلند بشأن مقاومة مضادات الميكروبات خلال الفترة من 2017 إلى 2022، ومناقشة النتائج المؤقتة وتبادل الدروس المستفادة. يشمل التقدم الرئيسي ما يلي: إنشاء آلية حوكمة وطنية تقود سياسة عالية التأثير بشأن مقاومة مضادات الميكروبات، ودعم الإجراءات والتعاون متعدد القطاعات؛ وإنشاء نظام ومنصة مراقبة لتتبع تنفيذ الخطة الاستراتيجية؛ وتحويل استراتيجيات الخطة الاستراتيجية إلى إجراءات مثل التحكم في توزيع واستخدام مضادات الميكروبات في البشر والحيوانات. تشير النتائج المؤقتة إلى أن استهلاك مضادات الميكروبات في الحيوانات قد انخفض إلى النصف تقريبًا (متجاوزًا الهدف الوطني البالغ 30%) في حين أن الأهداف الأخرى لم تحقق غاياتها بعد. لقد تعلمنا أن رفع مقاومة مضادات الميكروبات إلى الرؤية عالية المستوى، وإنشاء آلية حوكمة وطنية، هي خطوة أولى مهمة، كما يجب تطوير نظام للرصد والتقييم بالتوازي مع التنفيذ. كذلك، فإن تأمين الأموال أمر بالغ الأهمية. هناك حاجة لتماسك السياسات لتجنب ازدواجية الإجراءات. ويمكن للأهداف الطموحة للغاية، على الرغم من أنها لم تتحقق بعد، أن ترتقي بالإجراءات لما يتجاوز التوقعات. سوف يستمر الالتزام السياسي والتعاون عبر مختلف القطاعات، في لعب أدوار مهمة، ولكنهما قد لا يدومان دون هيكل حوكمة جيد التصميم لدعم الإجراءات طويلة الأجل لمعالجة مقاومة مضادات الميكروبات.抗生素耐药性是一个严重影响各个国家的威胁因素。《抗生素耐药性问题全球行动计划》和《联合国抗生素耐药性政治宣言》为各国在“健康全覆盖”方针指导下解决抗生素耐药性挑战确立了标准。我们评估泰国自 2017 年至 2022 年在抗生素耐药性国家战略计划实施方面所取得的进展和面临的挑战，同时还讨论所取得的阶段性成果并分享经验教训。主要进展包括：建立国家治理机制，引导制定在抗生素耐药性问题方面具有重大影响力的政策，同时开展多部门协作的联合行动；建立监控系统和平台以追踪战略计划的实施情况；以及将战略计划落实到实际行动，例如管控抗生素在人类和动物群体中的分配和使用。所取得的阶段性成果表明，动物群体中的抗生素用药量几乎减半（超出国家目标的 30%），不过其它目标尚未达到所设定的目标值。我们总结发现，提高抗生素耐药性的透明度和建立国家治理机制是重要的第一步，而且应该在实施计划的同时建立监测和评估体系。有保障的资金也是至关重要的因素。需要保持政策协调一致，以避免重复的行动。所设定的宏伟目标虽然尚未实现，但可以激发超出预期的行动力。不同部门之间坚定的政治承诺和协作将继续发挥重要的作用，但是如果没有合理而有效的治理架构来为应对抗生素耐药性问题的长期行动提供支持，那么这些承诺和协作可能难以为继。.Устойчивость к антимикробным препаратам является серьезной угрозой, которая затрагивает все страны. Глобальный план действий по борьбе с устойчивостью к антимикробным препаратам и Политическая декларация Организации Объединенных Наций по борьбе с устойчивостью к антимикробным препаратам устанавливают стандарты для стран в части решения проблем устойчивости к антимикробным препаратам в рамках подхода «Единое здоровье». Авторы оценивают прогресс и проблемы в реализации национального стратегического плана Таиланда по борьбе с устойчивостью к антимикробным препаратам на 2017–2022 годы, обсуждают промежуточные результаты и делятся полученными уроками. К значительному прогрессу относятся: создание национального механизма управления, который руководит высокоэффективной политикой в отношении устойчивости к антимикробным препаратам и объединяет действия и многосекторальное сотрудничество, создание системы мониторинга и платформы для отслеживания выполнения стратегического плана и преобразование запланированных стратегий в действия, такие как контроль распространения и использования антимикробных препаратов среди людей и животных. Промежуточные результаты показывают, что потребление антимикробных препаратов животными сократилось почти вдвое (превысив национальную цель в 30%), в то время как другие цели еще не достигли нужных показателей. Мы поняли, что привлечение как можно более широкого внимания к проблеме устойчивости к антимикробным препаратам и создание национального механизма управления являются важным первым шагом, а система мониторинга и оценки должна разрабатываться параллельно с внедрением. Обеспечение финансирования имеет решающее значение. Необходимо проводить последовательную политику во избежание дублирования действий. Весьма амбициозные цели, хотя они еще не достигнуты, могут способствовать тому, что исполнители будут действовать, превосходя предъявляемые ожидания. Политическая воля и сотрудничество между различными секторами продолжат играть важную роль, но вряд ли смогут сохранить свое действие без хорошо продуманной структуры управления, поддерживающей долгосрочные действия по борьбе с устойчивостью к антимикробным препаратам.

Background and Objective Enthusiasm for the use of outcomes-based managed entry agreements (OBMEAs) to manage uncertainties apparent at the time of appraisal/pricing and reimbursement of new medicines has waned over the past decade, as challenges in establishment, implementation and re-appraisal have been identified. With the recent advent of innovative treatments for rare diseases that have uncertainties in the clinical evidence base, but which could meet a high unmet need, there has been renewed interest in the potential of OBMEAs. The objective of this research was to review the implementation of OBMEAs for two case studies across countries in the European Union, Australia and Canada, to identify good practices that could inform development of tools to support implementation of OBMEAs. Methods To investigate how OBMEAs are being implemented with rare disease treatments, we collected information from health technology assessment/payer experts in countries that had implemented OBMEAs for either nusinersen in spinal muscular atrophy or tisagenlecleucel in two cancer indications. Operational characteristics of the OBMEAs that were publicly available were documented. Then, the experts discussed issues in implementing these OBMEAs and specific approaches taken to overcome challenges. Results The OBMEAs identified were based on individual outcomes to ensure appropriate use, manage continuation of treatment and in two cases linked to payment schedules, or they were population based, coverage with evidence development. For nusinersen, population-based OBMEAs are documented in Belgium, England and the Netherlands and individual-based schemes in Bulgaria, Ireland, Italy and Lithuania. For tisagenlecleucel, there were population-based schemes in Australia, Belgium, England and France and individual-based schemes in Italy and Spain. Comparison of the OBMEA constructs showed some clear published frameworks and clarity of the uncertainties to be addressed that were similar across countries. Agreements were generally made between the marketing authorisation holder and the payer with involvement of expert physicians. Only England and the Netherlands involved patients. Italy used its long-established, national, web-based, treatment-specific data collection system linked to reimbursement and Spain has just developed such a national treatment registry system. Other countries relied on a variety of data collection systems (including clinical registries) and administrative data. Durations of agreements varied for these treatments as did processes for interim reporting. The processes to ensure data quality, completeness and sufficiency for re-analysis after coverage with evidence development were not always clear, neither were analysis plans. Conclusions These case studies have shown that important information about the constructs of OBMEAs for rare disease treatments are publicly available, and for some jurisdictions, interim reports of progress. Outcomes-based managed entry agreements can play an important role not only in reimbursement, but also in treatment optimisation. However, they are complex to implement and should be the exception and not the rule. More recent OBMEAs have developed document covenants among stakeholders or electronic systems to provide assurances about data sufficiency. For coverage with evidence development, there is an opportunity for greater collaboration among jurisdictions to share processes, develop common data collection agreements, and share interim and final reports. The establishment of an international public portal to host such reports would be particularly valuable for rare disease treatments. Supplementary Information The online version contains supplementary material available at 10.1007/s40273-021-01050-5.

On May 10, 2021, the Food and Drug Administration (FDA) expanded its Emergency Use Authorization for the Pfizer-BioNTech COVID-19 vaccine to include adolescents aged 12-15 years; this authorization was followed by interim recommendations from the Advisory Committee on Immunization Practices (ACIP) for the vaccine among this age group (1). Using data from nonprobability-based Internet panel surveys administered by the Healthcare and Public Perceptions of Immunizations (HaPPI) Survey Collaborative, the acceptability of adolescent COVID-19 vaccination and self-reported factors increasing vaccination intent were assessed among independently recruited samples of 985 adolescents aged 13-17 years and 1,022 parents and guardians (parents) of adolescents aged 12-17 years during April 15-April 23, 2021, prior to vaccine authorization for this age group. Approximately one quarter (27.6%) of parents whose adolescents were already vaccine-eligible (i.e., aged 16-17 years) reported their adolescent had received ≥1 COVID-19 vaccine dose, similar to the proportion reported by vaccine-eligible adolescents aged 16-17 years (26.1%). However, vaccine receipt reported by parents of adolescents differed across demographic groups; parents identifying as female or Hispanic, or who had an education lower than a bachelor's degree reported the lowest adolescent COVID-19 vaccination receipt. Among parents of unvaccinated adolescents aged 12-17 years, 55.5% reported they would "definitely" or "probably" have their adolescent receive a COVID-19 vaccination. Among unvaccinated adolescents aged 13-17 years, 51.7% reported they would "definitely" or "probably" receive a COVID-19 vaccination. Obtaining more information about adolescent COVID-19 vaccine safety and efficacy, as well as school COVID-19 vaccination requirements, were the most commonly reported factors that would increase vaccination intentions among both parents and adolescents. Federal, state, and local health officials and primary care professionals were the most trusted sources of COVID-19 vaccine information among both groups. Efforts focusing on clearly communicating to the public the benefits and safety of COVID-19 vaccination for adolescents, particularly by health care professionals, could help increase confidence in adolescent COVID-19 vaccine and vaccination coverage.

Background Novel-coronavirus 2019 (COVID-19) disease is currently a worldwide health risk and public health emergency concern. The virus is transmitted from an infected person to another person through close contact and droplets. Frontline health care workers are the most at risk of infection, and so a WHO interim guidance document was issued by the World Health Organization (WHO) which underscores the importance of proper sanitation and waste management practices for COVID- 19 in health-care settings. This study aimed at assessing knowledge and preventive practices towards Covid-19 among health care providers in selected health facilities of Illu Aba Bor and Buno Bedele zones, Southwest Ethiopia. Methods An institution-based cross-sectional study was conducted from April to May 2020 among 330 health workers in selected health facilities of Illu Aba Bor and Buno-Bedelle Zones, Southwest Ethiopia. Data were collected using a self-administered structured questionnaire. The collected data were entered into Epidata version 3.1 and exported to SPSS version 23 for analysis. Bivariate and multivariable logistic regression analysis was used to identify independent predictors of preventive practices towards Covid-19. Statistical significance was declared at a p-value of Result The majority of respondents (93.3%) demonstrated good knowledge of COVID-19, and the mean (SD) knowledge score was 9.04 ± 1.06. Nearly two-thirds (64.2%) of the study participants had good infection prevention practices. Being male (AOR = 3.65, 95% CI: (1.96, 6.80)), education level (AOR = 1.82, 95% CI (1.02, 3.22)), profession (AOR = 3.17, 95% CI (1.08, 9.33)), service year (5–10 years) (AOR = 2.00 (1.02, 3.92)) and more than 10 years (AOR = 3.14 (1.51, 6.52)), availability of personal protective equipment (AOR = 1.96 (1.06, 3.61)) and Knowledge level (AOR = 2.61 (1.48, 4.62)) were independent predictors of COVID-19 preventive practices. Conclusion The overall level of knowledge of HCWs was good. However, the practice was relatively low. Gender, educational status, profession, year of service, knowledge towards COVID-19, and availability of personal protective equipment were independent predictors of good infection prevention practices. Optimizing the infection prevention and control loop of the health facilities is recommended.

PURPOSE This study aimed to compare the accuracy (trueness and precision) of interim crowns fabricated using DLP (digital light processing) according to post-curing time. MATERIALS AND METHODS A virtual stone study die of the upper right first molar was created using a dental laboratory scanner. After designing interim crowns on the virtual study die and saving them as Standard Triangulated Language files, 30 interim crowns were fabricated using a DLP-type 3D printer. Additively manufactured interim crowns were post-cured using three different time conditions-10-minute post-curing interim crown (10-MPCI), 20-minute post-curing interim crown (20-MPCI), and 30-minute post-curing interim crown (30-MPCI) (n = 10 per group). The scan data of the external and intaglio surfaces were overlapped with reference crown data, and trueness was measured using the best-fit alignment method. In the external and intaglio surface groups (n = 45 per group), precision was measured using a combination formula exclusive to scan data (10C2). Significant differences in accuracy (trueness and precision) data were analyzed using the Kruskal-Wallis H test, and post hoc analysis was performed using the Mann-Whitney U test with Bonferroni correction (α=.05). RESULTS In the 10-MPCI, 20-MPCI, and 30-MPCI groups, there was a statistically significant difference in the accuracy of the external and intaglio surfaces (P

Background Involving the end-users of scientific research (patients, carers and clinicians) in setting research priorities is important to formulate research questions that truly make a difference and are in tune with the needs of patients. We therefore aimed to generate a national research agenda for Juvenile Idiopathic Arthritis (JIA) together with patients, their caregivers and healthcare professionals through conducting a nationwide survey among these stakeholders. Methods The James Lind Alliance method was used, tailored with additional focus groups held to involve younger patients. First, research questions were gathered through an online and hardcopy survey. The received questions that were in scope were summarised and a literature search was performed to verify that questions were unanswered. Questions were ranked in the interim survey, and the final top 10 was chosen during a prioritisation workshop. Results Two hundred and seventy-eight respondents submitted 604 questions, of which 519 were in scope. Of these 604 questions, 81 were generated in the focus groups with younger children. The questions were summarised into 53 summary questions. An evidence checking process verified that all questions were unanswered. A total of 303 respondents prioritised the questions in the interim survey. Focus groups with children generated a top 5 of their most important questions. Combining this top 5 with the top 10s of patients, carers, and clinicians led to a top 21. Out of these, the top 10 research priorities were chosen during a final workshop. Research into pain and fatigue, personalised treatment strategies and aetiology were ranked high in the Top 10. Conclusions Through this study, the top 10 research priorities for JIA of patients, their caregivers and clinicians were identified to inform researchers and research funders of the research topics that matter most to them. The top priority involves the treatment and mechanisms behind persisting pain and fatigue when the disease is in remission.

The understanding of coronavirus disease 2019 (COVID-19) is evolving periodically. There is also a marked increase in COVID-19 patients’ demand for the provision of COVID-19 convalescent plasma (CCP) therapy. With the review of the literature, the stage of speculation is quickly moving towards conformity, with the interim guidelines given by the Food and Drug Administration (FDA) in the United States, United Kingdom’s blood transfusion services, Saudi’s FDA, and the Indian Council for Medical Research, in addition to the European health authorities. It is prudent to address the ethical concerns that merit consideration while harvesting and utilizing CCP as a therapeutic tool in local hospital setting.

Based on Article 72 of the Indonesia Limited Company Law, companies are allowed to distribute dividends before the company closes the annual book and the General Meeting of Shareholders (GMS) by giving temporary dividends (interim). In this case, if the company suffers a loss at the closing of the annual book according to the Indonesia Limited Company Law, the shareholders must return the dividends they have received. If the shareholders do not return it, the directors and commissioners must be joint responsibility to cover company losses. Based on these reasons, the researcher examined the useful aspects of the interim dividend arrangement in Article 72 of the Indonesia Limited Company Law based on Jeremy Bentham's Utilitarianism theory and found the form of norms regarding the return of interim dividends in Indonesian legislation using Hans Kallsen's Hierarchy theory. This research is a normative study with a conceptual approach. The results of the study suggest that; Article 72 paragraphs 1 to 4 of the Indonesia Limited Company Law can benefit the public because Bentham places benefits on individual happiness on a materialistic basis and practical social goals that can balance various interests. However, paragraphs 5 and 6 discussing the return of interim dividends that have been distributed, if, at the end of the closing of the book the company suffers a loss, in terms of the principle of benefit, Bentham does not provide benefits because it cannot provide a happiness effect for many people. The form of regulation on the distribution and return of interim share dividends in Indonesia is Statutes and Bylaws (C & B). C & B are a creative dimension in the form of living law or actions taken by the community. In terms of civil law, C & B has the same position as the law but cannot apply to the public.

We use data from the UK Household Longitudinal Study (UKHLS) to compare measures of socioeconomic inequality in psychological distress, measured by the General Health Questionnaire (GHQ), before (Waves 9 and the Interim 2019 Wave) and during the first wave of the COVID‐19 pandemic (April to July 2020). Based on a caseness measure, the prevalence of psychological distress increased from 18.5% to 27.7% between the 2019 Wave and April 2020 with some reversion to earlier levels in subsequent months. Also, there was a systematic increase in total inequality in the Likert GHQ‐12 score. However, measures of relative socioeconomic inequality have not increased. A Shapley‐Shorrocks decomposition analysis shows that during the peak of the first wave of the pandemic (April 2020) other socioeconomic factors declined in their share of socioeconomic inequality, while age and gender account for a larger share. The most notable increase is evident for younger women. The contribution of working in an industry related to the COVID‐19 response played a small role at Wave 9 and the Interim 2019 Wave, but more than tripled its share in April 2020. As the first wave of COVID‐19 progressed, the contribution of demographics declined from their peak level in April and chronic health conditions, housing conditions, and neighbourhood characteristics increased their contributions to socioeconomic inequality.

Introduction Micro-health insurance (MHI) has been identified as a possible interim solution to foster progress towards Universal Health Coverage (UHC) in low- and middle- income countries (LMICs). Still, MHI schemes suffer from chronically low penetration rates, especially in sub-Saharan Africa. Initiatives to promote and sustain enrolment have yielded limited effect, yet little effort has been channelled towards understanding how such initiatives are implemented. We aimed to fill this gap in knowledge by examining heterogeneity in implementation outcomes and their moderating factors within the context of the Redesigned Community Health Fund in the Dodoma region in Tanzania. Methods We adopted a mixed-methods design to examine implementation outcomes, defined as adoption and fidelity of implementation (FOI) as well as their moderating factors. A survey questionnaire collected individual level data and a document review checklist and in-depth interview guide collected district level data. We relied on descriptive statistics, a chi square test and thematic analysis to analyse our data. Results A review of district level data revealed high adoption (78%) and FOI (77%) supported also by qualitative interviews. In contrast, survey participants reported relatively low adoption (55%) and FOI (58%). Heterogeneity in adoption and FOI was observed across the districts and was attributed to organisational weakness or strengths, communication and facilitation strategies, resource availability (fiscal capacity, human resources and materials), reward systems, the number of stakeholders, leadership engagement, and implementer’s skills. At an individual level, heterogeneity in adoption and FOI of scheme components was explained by the survey participant’s level of education, occupation, years of stay in the district and duration of working in the scheme. For example, the adoption of job description was statistically associated with occupation (p = 0.001) and wworking in the scheme for more than 20 months had marginal significant association with FOI (p = 0.04). Conclusion The study demonstrates that assessing the implementation processes helps to detect implementation weaknesses and therefore address such weaknesses as the interventions are implemented or rolled out to other settings. Attention to contextual and individual implementer elements should be paid in advance to adjust implementation strategies and ensure greater adoption and fidelity of implementation.

As of January 20, 2021, a total of 24,135,690 cases of coronavirus disease 2019 (COVID-19) and 400,306 associated deaths had been reported in the United States (https://covid.cdc.gov/covid-data-tracker/#cases_casesper100klast7days). On December 18, 2020, the Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) for Moderna COVID-19 vaccine administered as 2 doses, 1 month apart to prevent COVID-19. On December 19, 2020, the Advisory Committee on Immunization Practices (ACIP) issued an interim recommendation for use of Moderna COVID-19 vaccine (1). As of January 10, 2021, a reported 4,041,396 first doses of Moderna COVID-19 vaccine had been administered in the United States, and reports of 1,266 (0.03%) adverse events after receipt of Moderna COVID-19 vaccine were submitted to the Vaccine Adverse Event Reporting System (VAERS). Among these, 108 case reports were identified for further review as possible cases of severe allergic reaction, including anaphylaxis. Anaphylaxis is a life-threatening allergic reaction that occurs rarely after vaccination, with onset typically within minutes to hours (2). Among these case reports, 10 cases were determined to be anaphylaxis (a rate of 2.5 anaphylaxis cases per million Moderna COVID-19 vaccine doses administered), including nine in persons with a documented history of allergies or allergic reactions, five of whom had a previous history of anaphylaxis. The median interval from vaccine receipt to symptom onset was 7.5 minutes (range = 1-45 minutes). Among eight persons with follow-up information available, all had recovered or been discharged home. Among the remaining case reports that were determined not to be anaphylaxis, 47 were assessed to be nonanaphylaxis allergic reactions, and 47 were considered nonallergic adverse events. For four case reports, investigators have been unable to obtain sufficient information to assess the likelihood of anaphylaxis. This report summarizes the clinical and epidemiologic characteristics of case reports of allergic reactions, including anaphylaxis and nonanaphylaxis allergic reactions, after receipt of the first dose of Moderna COVID-19 vaccine during December 21, 2020-January 10, 2021, in the United States. CDC has issued updated interim clinical considerations for use of mRNA COVID-19 vaccines currently authorized in the United States (3) and interim considerations for preparing for the potential management of anaphylaxis (4).

When planning a Phase III clinical trial, suppose a certain subset of patients is expected to respond particularly well to the new treatment. Adaptive enrichment designs make use of interim data in selecting the target population for the remainder of the trial, either continuing with the full population or restricting recruitment to the subset of patients. We define a multiple testing procedure that maintains strong control of the familywise error rate, while allowing for the adaptive sampling procedure. We derive the Bayes optimal rule for deciding whether or not to restrict recruitment to the subset after the interim analysis and present an efficient algorithm to facilitate simulation‐based optimisation, enabling the construction of Bayes optimal rules in a wide variety of problem formulations. We compare adaptive enrichment designs with traditional nonadaptive designs in a broad range of examples and draw clear conclusions about the potential benefits of adaptive enrichment.

Aim This study was aimed to translate an updated European Organization for Research and Treatment of Cancer (EORTC) quality of life module for head and neck (EORTC QLQ-H&N43) in grammatically and conceptually acceptable Marathi language and its linguistic validation. Materials and Methods Approval was obtained from the Institutional Ethics Committee. The permission for translation was obtained from the EORTC translation unit (TU). The EORTC guidelines for the translation were followed to form a translation for pilot testing which was administered to 10 Marathi speaking head and neck squamous cell cancer (HNSCC) patients who gave informed written consent for the participation in the study. Patients were interviewed personally. The final Marathi translation was prepared and sent to EORTC TU for approval. Statistical analysis was performed using SYSTAT version 12 by Cranes software, Bengaluru, Karnataka, India. Results After getting permission, the translation files were received from EORTC TU, including Marathi EORTC QLQ-H&N35 for reference. Two forward translations, reconciled translation, back translations, first interim translation, translation for proof editing, and second interim translation (SIT) were prepared. This SIT was pilot tested in 10 Marathi-speaking HNSCC patients. Each patient was interviewed regarding difficulty in answering, confusing or offensive word, and reframing sentence. The questionnaire was well understood by patients reflecting its linguistic validity. After incorporating the changes as per the patient’s interview, updated translation was prepared and sent to EORTC TU which was accepted and approved by EORTC. The psychometric analysis of pilot testing showed that the questionnaire is acceptable. Conclusion Marathi translation of EORTC QLQ-H&N43 is well accepted and understandable. It can be used for future studies.

Elections occurring during the coronavirus disease 2019 (COVID-19) pandemic have been affected by notable changes in the methods of voting, the number and type of polling locations, and in-person voting procedures (1). To mitigate transmission of COVID-19 at polling locations, jurisdictions have adopted changes to protocols and procedures, informed by CDC's interim guidance, developed in collaboration with the Election Assistance Commission (2). The driving principle for this guidance is that voting practices with lower infection risk will be those which reduce the number of voters who congregate indoors in polling locations by offering a variety of methods for voting and longer voting periods. The guidance for in-person voting includes considerations for election officials, poll workers, and voters to maintain healthy environments and operations. To assess knowledge and adoption of mitigation strategies, CDC collaborated with the Delaware Department of Health and Social Services and the Delaware State Election Commission on a survey of poll workers who served during the statewide primary election on September 15, 2020. Among 522 eligible poll workers, 93% correctly answered all three survey questions about COVID-19 transmission. Respondents noted that most voters and poll workers wore masks. However, masks were not always worn correctly (i.e., covering both the nose and mouth). Responses suggest that mitigation measures recommended for both poll workers and voters were widely adopted and feasible, but also highlighted gaps in infection prevention control efforts. Strengthening of measures intended to minimize the risk of poll workers acquiring COVID-19 from ill voters, such as additional training and necessary personal protective equipment (PPE), as well as support for alternative voting options for ill voters, are needed. Adherence to mitigation measures is important not only to protect voters but also to protect poll workers, many of whom are older adults, and thus at higher risk for severe COVID-19-associated illness. Enhanced attention to reducing congregation in polling locations, correct mask use, and providing safe voting options for ill voters are critical considerations to minimize risk to voters and poll workers. Evidence from the Delaware election supports the feasibility and acceptability of implementing current CDC guidance for election officials, poll workers, and voters for mitigating COVID-19 transmission at polling locations (2).

Background Coronavirus disease 2019 (COVID-19) is a disease caused by severe acute respiratory syndrome-coronavirus-2. Consensus suggestions can standardise care, thereby improving outcomes and facilitating future research. Methods An International Task Force was composed and agreement regarding courses of action was measured using the Convergence of Opinion on Recommendations and Evidence (CORE) process. 70% agreement was necessary to make a consensus suggestion. Results The Task Force made consensus suggestions to treat patients with acute COVID-19 pneumonia with remdesivir and dexamethasone but suggested against hydroxychloroquine except in the context of a clinical trial; these are revisions of prior suggestions resulting from the interim publication of several randomised trials. It also suggested that COVID-19 patients with a venous thromboembolic event be treated with therapeutic anticoagulant therapy for 3 months. The Task Force was unable to reach sufficient agreement to yield consensus suggestions for the post-hospital care of COVID-19 survivors. The Task Force fell one vote shy of suggesting routine screening for depression, anxiety and post-traumatic stress disorder. Conclusions The Task Force addressed questions related to pharmacotherapy in patients with COVID-19 and the post-hospital care of survivors, yielding several consensus suggestions. Management options for which there is insufficient agreement to formulate a suggestion represent research priorities., For patients with acute COVID-19 pneumonia who require oxygen support, the International Task Force made suggestions for remdesivir and dexamethasone, but against hydroxychloroquine. Post-discharge management of COVID-19 survivors is a research priority. https://bit.ly/32B96uI

Highlights • COVID-19 pandemic has changed the risk-benefit balance for cardiopulmonary resuscitation [CPR]. • Amongst many aerosol producing procedures performed on patients, CPR is a highly aerosol-generating procedure. • Available literature is inadequate to direct clinicians towards keeping low or high threshold for performing CPR in COVID-19 patient.