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Background Guidelines for clinical practice have been part of the Ministry of health’s efforts to improve the quality of care for over two decades. Their benefits have been documented in Uganda. However, having practice guidelines may not always result in their use in care provision. We explored the midwives’ perceptions towards the ministry of health guidelines for providing immediate postpartum care. Methods An exploratory descriptive qualitative study was conducted in three districts in Uganda from September 2020 to January 2021. In-depth interviews with 50 midwives from 35 health centers and 2 hospitals in Mpigi, Butambala, and Gomba districts were done. Thematic analysis of data was done. Results Three themes emerged; awareness and use of the guidelines, perceived drivers, and perceived barriers to the provision of immediate postpartum care. The subthemes for theme I included; awareness of the guidelines, variations in the postpartum care practices, variations in preparedness to manage women with complications, and varied access to continuing midwifery education. Fear of complications and litigation were the perceived drivers of guideline use. On the other hand, lack of knowledge, busy maternity units, organization of the care, and the midwives’ perceptions about their clients were the barriers to guideline use. Midwives felt that new guidelines and policies regarding immediate postpartum care should be disseminated widely. Conclusion The midwives felt that the guidelines were good for the prevention of postpartum complications but their knowledge of the guidelines for the provision of immediate postpartum care was suboptimal. They desired on-job training and mentorship to help them bridge the knowledge gaps. Variations in patient assessment, monitoring, and pre-discharge care were acknowledged and said to be due to a poor reading culture and health facility factors like patient-midwife ratios, unit setup, and prioritization of labor.

PurposeAlthough few studies indicate that financial concerns matter to social entrepreneurs, the literature is unclear about the extent to which a financial motive affects the intention to start a new social enterprise. Moreover, prior research suggests that the intention to start a new enterprise heavily depends on the societal context in which the enterprise operates. Therefore, this study aims to examine the seminal model of social entrepreneurial intention (SEI) developed by Hockerts (2017) in a different social context; additionally, it proposes a new antecedent of SEI – perceived financial security.Design/methodology/approachThis study used two different measurement scales and samples (n = 436 and 241) in a developing country to validate the model and propose a new antecedent, i.e. the perceived financial security, of SEI. Furthermore, the authors employed the partial least square-structural equation model to test the hypotheses.FindingsThe results demonstrate that social entrepreneurial self-efficacy, perceived social support and perceived financial security directly predict SEI; they further mediate the relationship between prior experience and SEI. Consequently, the model by Hockerts is extended.Originality/valueThis study established perceived financial security as a strong antecedent of SEI, thereby offering a novel insight that a social entrepreneur can be motivated by potential financial concerns.

Firebrand travel and ignition of spot fires is a major concern in the Wildland-Urban Interface and in wildfire operations overall. Firebrands allow for the efficient breaching across fuel-free barriers such as roads, rivers and constructed fuel breaks. Existing observation-based knowledge on medium-distance firebrand travel is often based on single tree experiments that do not replicate the intensity and convective updraft of a continuous crown fire. Recent advances in acoustic analysis, specifically pattern detection, has enabled the quantification of the rate at which firebrands are observed in the audio recordings of in-fire cameras housed within fire-proof steel boxes that have been deployed on experimental fires. The audio pattern being detected is the sound created by a flying firebrand hitting the steel box of the camera. This technique allows for the number of firebrands per second to be quantified and can be related to the fire's location at that same time interval (using a detailed rate of spread reconstruction) in order to determine the firebrand travel distance. A proof of concept is given for an experimental crown fire that shows the viability of this technique. When related to the fire's location, key areas of medium-distance spotting are observed that correspond to regions of peak fire intensity. Trends on the number of firebrands landing per square metre as the fire approaches are readily quantified using low-cost instrumentation.

Background Nearly 60% of maternal and 45% of newborn deaths occur within 24 h after delivery. Immediate postpartum monitoring could avert death from preventable causes including postpartum hemorrhage, and eclampsia among mothers, and birth asphyxia, hypothermia, and sepsis for babies. We aimed at assessing facility readiness for the provision of postpartum care within the immediate postpartum period. Methods A cross-sectional study involving 40 health facilities within the greater Mpigi region, Uganda, was done. An adapted health facility assessment tool was employed in data collection. Data were double-entered into Epi Data version 4.2 and analyzed using STATA version 13 and presented using descriptive statistics. Results Facility readiness for the provision of postpartum care was low (median score 24% (IQR: 18.7, 26.7). Availability, and use of up-to-date, policies, guidelines and written clinical protocols for identifying, monitoring, and managing postpartum care were inconsistent across all levels of care. Lack of or non-functional equipment poses challenges for screening, diagnosing, and treating postnatal emergencies. Frequent stock-outs of essential drugs and supplies, particularly, hydralazine, antibiotics, oxygen, and blood products for transfusions were more common at health centers compared to hospitals. Inadequate human resources and sub-optimal supplies inhibit the proper functioning of health facilities and impact the quality of postpartum care. Overall, private not-for-profit health facilities had higher facility readiness scores. Conclusions Our findings suggest sub-optimal rural health facility readiness to assess, monitor, and manage postpartum emergencies to reduce the risk of preventable maternal/newborn morbidity and mortality. Strengthening health system inputs and supply side factors could improve facility capacity to provide quality postpartum care.

Background Nebraska Infection Control Assessment and Promotion Program (ICAP) is funded by Nebraska Department of Health and Human Services through Centers for Disease Control and Prevention (CDC) grants to support Infection Prevention and Control (IPC) activities in the state. In early 2022, ICAP launched COVID-19-specific basic infection prevention and control (IPC) training to frontline healthcare providers (HCPs) through a discussion-based webinar series using curricular materials created by the CDC Project Firstline. Here, we report pre- and post-training survey responses demonstrating improvement in participants' perceived knowledge across a number of IPC domains. Methods Training was completed over a 14-week period via a weekly, interactive 30-minute webinars with a new topic covered each week. A survey was administered to participants prior to the webinar series and at the conclusion of training to assess effectiveness. The pre-survey evaluated HCP confidence in their knowledge of each of the 14 topics to be covered in the course. The post-survey evaluated both confidence and perceived value in each of the training topics. Results Prior to the training series, a mean 40.3% of participants judge themselves “very confident” in IPC topics, versus 52.7% “somewhat confident” and 7.1% “not confident” (figure 1); by the end of the training, these levels had improved to 85.4%, 14.3%, and 0.4%, respectively (figure 2). The largest gains in the category “very confident” concerned “source control” (+65%) and “COVID-19 variants” (+63%). A majority of participants perceived each topic covered in the series to be “very valuable” (figure 3); 98% of participants indicated interest in a future IPC training series and 95% indicated that they would recommend the training series to a colleague. Figure 1Results of a pre-course survey on knowledge of training topics completed by participants.Figure 2Results of a post-course survey on knowledge of training topics completed by participants.Figure 3Results of a post-course survey on value of the training course completed by participants. Conclusion This survey data suggests that a discussion-based webinar using CDC Project Firstline materials is highly effective at conveying fundamental concepts in infection control to frontline HCPs. Moreover, HCPs rated themselves as likely to return, suggesting this format is a promising modality for simple and widespread dissemination of IPC training. Disclosures M. Salman Ashraf, MBBS, Merck & Co. Inc: Grant/Research Support.

Globally, 25% of pregnancies end up in induced abortion, the majority of which are unsafe. Abortion is safe when conducted according to WHO recommendations. The objective of the present study was to identify gaps in the data published on abortion and make recommendations to the Ministry of Health, Uganda. The search strategy included PubMed, Google Scholar articles (from October 2020 to May 2021) on unsafe abortion in Uganda, reviewed data from the Association of Obstetricians and Gynecologists of Uganda (AOGU) members' baseline survey (2019), Health Management Information System (HMIS) summary data (2015-2016 to 2019-2020), and the Uganda Demographic and Heath Survey (DHS) report (2011, 2016). From the 200 articles and national health surveys identified, 37 articles and two national representative surveys met our criteria: prevalence, factors, estimating cost of induced abortion, and complications associated with safe and unsafe abortion in both low- and high-income countries. There are many unsafe abortions in restrictive environments. Abortion is one of the leading causes of maternal and morbidity. Physicians favor dilatation and curettage over manual vacuum aspiration and medical methods for the evacuation of retained products. Several gaps still exist in the published articles, HMIS data, and DHS data, leading to missed opportunities for data to inform policy and practice.

Despite of over 20 years of community directed treatment with ivermectin (CDTI), a high prevalence of onchocerciasis and onchocerciasis-associated epilepsy were observed in rural villages in Mahenge, Tanzania. Therefore, we assessed the knowledge, attitude and practice about onchocerciasis in four rural villages in the Mahenge area. This was a qualitative study conducted between June and July 2019. Eleven focus group discussions were organized with persons with epilepsy and their caretakers, community resource persons, and community drug distributors (CDDs), and two in-depth interviews with district programme coordinators of neglected tropical diseases (NTD). Most participants were aware about symptoms of onchocerciasis using local terminologies such as “ukurutu/rough dry skin” and “kuwashwa/itching”. A small proportion of people did not take ivermectin during CDTI for fear of adverse reactions such as itching and swelling. Some men believed that ivermectin may decrease libido. Challenges for high CDTI coverage included, long walking distance by CDDs to deliver drugs to households, persons being away for farming, low awareness of the disease and limited supervision by the NTD coordinators. In conclusion, ivermectin uptake in Mahenge should be optimised by continuous advocacy about the importance of taking ivermectin to prevent onchocerciasis-associated morbidity and by improving supervision during CDTI.

Increasing fire frequency in some biomes is leading to fires burning in close succession, triggering rapid vegetation change and altering soil properties. We studied the effects of short-interval (SI) reburns on soil bacterial communities of the boreal forest of northwestern Canada using paired sites (n = 44). Both sites in each pair had burned in a recent fire; one site had burned within the previous 20 years before the recent fire (SI reburn) and the other had not. Paired sites were closely matched in prefire ecosite characteristics, prefire tree species composition, and stand structure. We hypothesized that there would be a significant effect of short vs. long fire-free intervals on community composition and that richness would not be consistently different between paired sites. We found that Blastococcus sp. was consistently enriched in SI reburns, indicating its role as a strongly ‘pyrophilous’ bacterium. Caballeronia sordidicola was consistently depleted in SI reburns. The depletion of this endophytic diazotroph raises questions about whether this is contributing to—or merely reflects—poor conifer seedling recolonization post-fire at SI reburns. While SI reburns had no significant effect on richness, dissimilarity between short- and long-interval pairs was significantly correlated with difference in soil pH, and there were small significant changes in overall community composition.

Agricultural data are crucial to many aspects of production, commerce, and research involved in feeding the global community. However, in most agricultural research disciplines standard best practices for data management and publication do not exist. Here we propose a set of best practices in the areas of peer review, minimal dataset development, data repositories, citizen science initiatives, and support for best data management. We illustrate some of these best practices with a case study in dairy agroecosystems research. While many common, and increasingly disparate data management and publication practices are entrenched in agricultural disciplines, opportunities are readily available for promoting and adopting best practices that better enable and enhance data-intensive agricultural research and production. National Institute of Food and AgricultureUnited States Department of Agriculture (USDA)National Institute of Food and Agriculture [2018-67023-27843]; Agricultural Research ServiceUnited States Department of Agriculture (USDA)USDA Agricultural Research Service [8042-31000-001-00-D, 8260-88888-001-00-D] Published version National Institute of Food and Agriculture, Grant/Award Number: 2018-67023-27843; Agricultural Research Service, Grant/Award Numbers: 8042-31000-001-00-D, 8260-88888-001-00-D

Entrepreneurs play multiple roles in their daily lives, and these roles can influence their decisions. Yet we know little about how entrepreneurs respond to simultaneous influences from different d...

Altered propulsive and bracing ground reaction forces from lower-body fatigue significantly impact stride length to increase weakness in dynamic elbow stabilizers and risk of medial elbow injury in baseball pitchers. This work investigated altered stride length on three-dimensional ankle joint dynamics to illustrate fatigue-induced changes in ankle motion that can also be impacted by coaching errors. Nineteen pitchers (15 collegiate and 4 high school) were randomized in a crossover design study that encouraged fatigue by throwing two simulated 80-pitch games at ±25% of their desired stride length. An integrated motion-capture system with two force plates and radar gun tracked each throw. Retrospective analysis using pairwise comparisons, including effect size calculations, were undertaken to identify differences in ankle dynamics between stride length conditions for both the drive and stride leg. Longer strides were found to be more effective in drive ankle propulsion and stride-bracing mechanics. Conversely, shorter strides delayed bracing dynamics by demonstrating continued drive ankle plantar flexion moments after stride-foot contact to extend pitchers’ time in propulsion (p < 0.001, d > 0.8). Additionally, heightened braking effects were seen during the acceleration phase of throwing with greater stride knee extension power when pitching with shorter strides (p < 0.001, d > 0.8). The knowledge gained from this work offers new insight into compensatory stride length adaptation that impacts systemic and throwing arm-specific fatigue to maintain ball velocity, as bilateral ankle joint dynamics can be significantly affected in response to cumulative workload.

Psychological mediators underlie many entrepreneurship phenomena. Unfolding psychological mechanisms enhances our understanding of theoretical relationships in entrepreneurship. This paper first reviews the current state of entrepreneurship studies examining psychological mediators and identifies the hurdles that push researchers away from employing randomized experiments to unfold the causal relationships underlying mediation. To alleviate these hurdles, we then propose parsimonious yet rigorous experimental designs that make experiments testing psychological mediators in entrepreneurship feasible and cost efficient. In addition, when manipulating the mediator is not feasible, we theorize and identify two remedies a single experiment can use to examine the causal chain underlying mediation.

Boreal wildfires are a significant source of atmospheric brown carbon (BrC), a complex mixture of thousands of light-absorbing organic compounds that contributes to the warming effects of combustion particulate matter. Here, we use size-exclusion chromatography (SEC) coupled with photodiode array detection to characterize BrC collected from the controlled combustion of boreal peat. Importantly, rather than attempting to estimate the molecular weight of BrC chromophores through the minimization and correction of secondary interactions, we instead exploit these interactions to systematically explore BrC hydrophobicity, lability, and size-dependent light absorption properties. Using this new approach, which we corroborate using independent asymmetric flow field-flow fractionation (AF4) analysis, we show that the components of fresh wildfire BrC span a wide range of sizes, polarities, and light absorption characteristics. Unlike atmospherically aged wildfire BrC, which has previously been shown to resemble terrestrial humic substances in both its absorption profile and its retention behaviour, the fresh BrC sample studied here contains both higher-MW chromophores with “humic-like” featureless absorption and smaller-MW chromophores with structured absorption, and is more susceptible to hydrophobic interactions with the column matrix. Interestingly, we find that the contribution of the low-MW fraction to overall BrC absorption increases with increasing mobile phase acetonitrile content, which suggests that the high-MW fraction consists of metastable aggregates held together by easily disrupted intermolecular forces. Together, these results highlight the compositional diversity of atmospheric BrC and the challenge and potential of SEC for the characterization of complex, and poorly defined, environmental matrices.

Opportunity identification is often considered the very first step in the entrepreneurial process, and is therefore frequently included in entrepreneurship education programs. In this paper, we examine a unique teaching method (IDEATE), rooted in experiential learning and aimed at developing novice learners’ skills for opportunity identification. Using an experimental design, we compare the innovativeness of opportunities identified by undergraduate students enrolled in introductory-level entrepreneurship courses at a southeastern university. Findings show that the opportunities identified by the students in the IDEATE group were significantly more innovative than those identified by students in the passive search group. In addition, student perceptions of fit with entrepreneurship increased for the passive search training group but not for the IDEATE group. We discuss the implications for entrepreneurship education, research, and practice.

Background/Aims The majority of maternal deaths occur during labour, delivery, or within the first 4 hours after birth. This can be reduced by the care that midwives provide. At Mulago Hospital, little is documented on midwives' current practice and their perception of care offered during labor and delivery. The number of maternal and neonatal deaths as a result of preventable causes such as postpartum haemorrhage, obstructed labour, ruptured uterus and sepsis remains high. The aim of this study was to document the current practice of midwives, explore midwives' perception towards practice and identify factors that influence practice during birth in Uganda, to identify possible areas for improvement. Methods A cross-sectional study was conducted of midwives working in the three labour wards at the Mulago National referral hospital: the general ward, the private ward and the midwifery-led ward. Midwives' perceptions were explored using a semi-structured questionnaire, which asked midwives about their current practice and their perception of the care offered. Findings Care was found to be lacking in several areas. Only one-fifth (20.0%) of midwives reported always checking temperature every 4 hours. Only 20.5% reported that women are always supported in being mobile during labour. Less than half of the midwives (44.4%) knew the recommended drugs for managing the third stage of labour. Infection prevention practices were poor. Only 54% of midwives knew how to prepare magnesium sulphate for management of severe pre-eclampsia and eclampsia. Overall, the general labour ward was found to have the most gaps in midwives' knowledge. Lack of continuing education, supplies, teamwork and clinical guidelines were reported to affect practice. Staff shortages and midwives' decisions being underlooked by obstetricians were also reported to affect practice. Conclusions Overall, the study found that midwifery practice is suboptimal in key areas such as infection prevention, use of a partograph, and management of pre-eclampsia and eclampsia. Continuous professional development, provision of resources, and strengthening teamwork are recommended to improve maternal health outcomes at Mulago Hospital.

Background Early discontinuation of implant contraceptive methods and reasons for discontinuation remains a major concern for family planning programs. Early discontinuation is related to higher rates of the overall fertility rate, unwanted pregnancies leading to possibly induced abortion. There is paucity of data on the practice of discontinuation of contraceptives in developing countries. The objective of the study was to determine the magnitude of early implants discontinuation among women receiving implants services in the study area and the factors associated with it. Methods A cross-sectional study was conducted from 2nd January to 3rd March 2020. Data were collected from 207 women who had come to remove implants on socio-demographic characteristics, obstetric history, duration of implant, and reasons for wanting to remove the implant. We computed the proportion of those who removed the implant before 18 months (early discontinuation). To assess the factors associated with early discontinuation, we estimated the prevalence ratios with a generalized linear model of the poisson family with a log link and robust error variance. Results The proportion of early implant discontinuation was 87/207(42%). Factor associated with early implant discontinuation included; experience of side effects (PR = 1.1; 95% CI 1.03–1.24; P = 0.001), not having received pre-insertion counseling about the benefits and side effects of contraceptive implants (PR = 1.5; 95% CI 1.02–1.30; P = 0.019) and staying in rural areas (PR = 1.1; 95% CI 1.03–1.27; P = 0.014). Conclusion Nearly one in every two mothers have early discontinuation of contraceptive implants. Factors associated with early implant removal include; experience of side effects, lack of counseling services, and staying in rural areas. There is a need for intervention to address high prevalence of early contraceptive removal through improving on counselling services about possible side effects.

Background Perinatal mortality remains high globally and remains an important indicator of the quality of a health care system. To reduce this mortality, it is important to provide the recommended care during the perinatal period. We assessed the prevalence and factors associated with appropriate perinatal care (antenatal, intrapartum, and postpartum) in Bunyoro region, Uganda. Results from this study provide valuable information on the perinatal care services and highlight areas of improvement for better perinatal outcomes. Methods A cross sectional survey was conducted among postpartum mothers attending care at three district hospitals in Bunyoro. Following consent, a questionnaire was administered to capture the participants’ demographics and data on care received was extracted from their antenatal, labour, delivery, and postpartum records using a pre-tested structured tool. The care received by women was assessed against the standard protocol established by World Health Organization (WHO). Poisson regression with robust standard errors was used to assess factors associated with appropriate postpartum care. Results A total of 872 mothers receiving care at the participating hospitals between March and June 2020 were enrolled in the study. The mean age of the mothers was 25 years (SD = 5.95). None of the mothers received appropriate antenatal or intrapartum care, and only 3.8% of the participants received appropriate postpartum care. Factors significantly associated with appropriate postpartum care included mothers being >35 years of age (adjusted prevalence ratio [aPR] = 11.9, 95% confidence interval [CI] 2.8–51.4) and parity, with low parity (2–3) and multiparous (>3) mothers less likely to receive appropriate care than prime gravidas (aPR = 0.3, 95% CI 0.1–0.9 and aPR = 0.3, 95% CI 0.1–0.8 respectively). Conclusions Antenatal, intrapartum, and postpartum care received by mothers in this region remains below the standard recommended by WHO, and innovative strategies across the continuum of perinatal care need to be devised to prevent mortality among the mothers. The quality of care also needs to be balanced for all mothers irrespective of the age and parity.

Background Ulnar collateral ligament injuries are rampant in the sport of baseball where kinetic chain impacts, stemming from misappropriation of stride length or changes that occur in competition due to fatigue, have not been evaluated for dynamic elbow stability effects. Hypothesis/Purpose To examine the relationship between clinical measures of grip strength and altered stride length in baseball pitchers. It is believed that shorter stride lengths would reduce grip strength in baseball pitchers. Study Design Crossover Study Design Methods A total of 19 uninjured pitchers (15 collegiate and 4 high school) (age 18.63 ± 1.67 years, height 1.84 ± 0.054 m, mass 82.14 ± 0.054 kg) threw two simulated 80-pitch games at ±25% of their desired stride length recorded by motion capture with two force plates and a radar gun to track each throw. A handheld grip dynamometer was used to record the mean change in grip strength after games from baseline measures. Pairwise comparisons at baseline and post-game denoted grip strength changes and dominant grip strength offsets for stride length conditions. Results Subjects with shorter stride lengths revealed a significant decline in grip strength in the dominant arm from baseline (pre-game; 45.1 kg vs. post-game; 43.2 kg, p=0.017, ES=0.28), however all other tests involving dominant grip strength changes and offset analyses were not statistically different for under-stride and over-stride length conditions. Conclusions Clinical evaluation of grip strength has the potential to identify altered lower body mechanics and may be considered as a safe and effective monitoring strategy to integrate with motion capture in determining optimal stride lengths for baseball pitchers. Level of Evidence Level 3

While childbirth self-efficacy is a very important feature for normal birth, this concept has received limited scholarly attention, particularly in developing countries. This study explored childbirth self-efficacy and the associated factors amongst pregnant women.A descriptive cross-sectional study. We used the Childbirth Self-Efficacy Inventory to assess childbirth self-efficacy for normal birth. and determined the associated factors.Jinja regional referral hospital, Uganda.425 pregnant women at ≥ 28 weeks of gestation were included.Participants with summated self-efficacy scores ≥ median were considered to have high childbirth self-efficacy, and those with less than the median summated score were considered to have low childbirth self-efficacy. Bivariate and multivariate binary logistic regressions were used to determine the factors associated with low childbirth self-efficacy.The Childbirth Self-Efficacy Inventory items consistently measured childbirth self-efficacy with a Cronbach's α 0.934. Childbirth self-efficacy scores ranged from 84 to 303 with a median score of 233 and a mean score of 228.7 (SD: 40.9). Dissatisfaction with prenatal care (aOR = 2.687; 95% CI: 1.124-6.427; P = 0.026), perception of community social support for women during childbirth as lacking (aOR = 2.274; 95% CI: 1.159-4.458; P = 0.017) and use and/or intention to use herbal medicines in the current pregnancy (aOR = 2.850; 95% CI: 1.553-5.232; P = 0.001) were associated with low childbirth self-efficacy for normal birth.Low childbirth self-efficacy for normal birth was associated with dissatisfaction with prenatal care, lack of community social support for women during childbirth and use or intention to use herbal medicines in the current pregnancy. Identifying the associated characteristics and developing interventions for low childbirth self-efficacy is of clinical importance to promote normal birth.

During primary total hip arthroplasty (THA), some surgeons use an intra-articular injection (IAI) containing 200 mg ropivacaine to target postoperative pain. There is no clear consensus on the efficacy of an IAI alone. The purpose of this study is to evaluate the effect of a 200 mg ropivacaine IAI on pain scores, opioid consumption, and mobility for primary THA patients.We retrospectively reviewed 571 patients who underwent primary THA at a single institution. Patients were grouped according to those who received a 200 mg ropivacaine IAI and those who did not. Primary outcome measures for this study included pain scores, morphine milligram equivalents (MMEs) dosed, distance of ambulation achieved, and time to ambulation.The intervention group reported higher average pain scores with activity than the control group (P = .024). The intervention group also required higher MMEs. When striated by hour, a statistically significant uptick in pain started at 16 hours (P = .0009) and persisted to 28 hours (P = .032) in patients receiving a 200 mg ropivacaine IAI. This correlated with an increase in MMEs seen at hour 24 through 32 (P = .003 to P = .012). Level of ambulation, time to ambulation, and distance ambulated did not differ between groups. An IAI of 200 mg ropivacaine also appeared to lead to higher pain scores and higher opioid doses in males.The IAI does not appear to reduce postoperative pain scores or MMEs dosed for THA patients. More research is needed to look at the utilization and efficacy of intra-articular ropivacaine, especially focusing on functional outcomes and gender differences.

Significance Black spruce is the dominant tree species in boreal North America and has shaped forest flammability, carbon storage, and other landscape processes over the last several thousand years. However, climate warming and increases in wildfire activity may be undermining its ability to maintain dominance, shifting forests toward alternative forested and nonforested states. Using data from across North America, we evaluate whether loss of black spruce resilience is already widespread. Resilience was the most common outcome, but drier climatic conditions and more severe fires consistently undermine resilience, often resulting in complete regeneration failure. Although black spruce forests are currently moderately resilient, ongoing warming and drying may alter this trajectory, with large potential consequences for the functioning of this globally important biome., Intensifying wildfire activity and climate change can drive rapid forest compositional shifts. In boreal North America, black spruce shapes forest flammability and depends on fire for regeneration. This relationship has helped black spruce maintain its dominance through much of the Holocene. However, with climate change and more frequent and severe fires, shifts away from black spruce dominance to broadleaf or pine species are emerging, with implications for ecosystem functions including carbon sequestration, water and energy fluxes, and wildlife habitat. Here, we predict that such reductions in black spruce after fire may already be widespread given current trends in climate and fire. To test this, we synthesize data from 1,538 field sites across boreal North America to evaluate compositional changes in tree species following 58 recent fires (1989 to 2014). While black spruce was resilient following most fires (62%), loss of resilience was common, and spruce regeneration failed completely in 18% of 1,140 black spruce sites. In contrast, postfire regeneration never failed in forests dominated by jack pine, which also possesses an aerial seed bank, or broad-leaved trees. More complete combustion of the soil organic layer, which often occurs in better-drained landscape positions and in dryer duff, promoted compositional changes throughout boreal North America. Forests in western North America, however, were more vulnerable to change due to greater long-term climate moisture deficits. While we find considerable remaining resilience in black spruce forests, predicted increases in climate moisture deficits and fire activity will erode this resilience, pushing the system toward a tipping point that has not been crossed in several thousand years.

Background Pelvic organ prolapse (POP) is a significant public health issue that negatively affects the Quality of Life (QOL) of women in both low and high-income countries. About 20% of women will undergo surgery for POP over their lifetime. However, there is a paucity of information on the effect of surgery on QOL especially in resource-limited settings. We therefore assessed the QOL among women with symptomatic POP living in rural southwestern Uganda and the impact of surgery on their quality of life. Methods We conducted a prospective cohort study among 120 women with symptomatic POP scheduled for surgery at the urogynecology unit of Mbarara Regional Referral Hospital. The QOL at baseline and at 1 year after surgery in the domains of physical performance, social interaction, emotional state, sexual life, sleep quality, personal hygiene and urinary bladder function was determined using a King’s Quality of Life questionnaire. A paired t-test was used to compare the difference in mean scores at baseline and at 1-year post-surgery. Results Of the 120 participants that were enrolled at baseline, 117(98%) completed the follow-up period of 1 year. The baseline QOL was poor. The domains with the poorest QOL were physical, social, sexual, emotional and sleep quality. The mean QOL scores in all the domains and the overall QOL significantly improved 1 year after surgery (p Conclusions The QOL was poor among women with symptomatic POP and surgery improved the QOL in all the domains of life. We recommend that surgery as an option for treatment of symptomatic POP should be scaled up to improve on the QOL of these women.

In this exploratory study, we examined the extent to which practicing entrepreneurs regret entering entrepreneurship, the antecedents of regret, and the impact this has on their exit intentions. While business underperformance can stimulate regret, regretful thinking can also be stimulated by other variables related to well-being such as health and marital status. As expected, the findings indicate that entrepreneurs who were less satisfied with their business' performance experienced more intense regret. However, those entrepreneurs who had poorer health also experienced more intense regret. Additionally, married female and unmarried male entrepreneurs experienced more regret compared to their counterparts. Regretful thinking in turn increases exit intention. Implications for research and practice are discussed.

In the boreal plains ecozone, black spruce (Picea mariana (Mill.) Britton, Sterns & Poggenb.) peatlands can represent large parts of the expanding wildland–urban interface (WUI) and wildland–indust...

Introduction and hypothesis This study was aimed at determining the recurrence rate and risk factors for the recurrence of pelvic organ prolapse (POP), at 1 year post-vaginal reconstructive surgery in a resource-limited setting. Methods We enrolled women who underwent vaginal surgery for POP at the urogynecology unit of Mbarara Regional Referral Hospital (MRRH) in southwestern Uganda between December 2018 and February 2020. The surgeries that were performed include anterior colporrhaphy for cystocele, posterior colporrhaphy for rectocele, vaginal hysterectomy with vault suspension for uterine prolapse, and cervicopexy in those with uterine prolapse where uterine-sparing surgery was desired. The women were followed up for a period of 1 year after surgery. Pelvic examinations in lithotomy position under maximum strain were carried out to assess for recurrence using the Pelvic Organ Quantification (POP-Q) system. Recurrence was defined as a prolapse of ≥POP-Q stage II. Descriptive analyses and multivariate log binomial regression were performed to determine risk factors for recurrence. Results Of the 140 participants enrolled, 127 (90.7%) completed the follow-up at 1 year. The recurrence rate was 25.2% (32 out of 127). Most (56.3%) of the recurrences occurred in the anterior compartment and in the same site previously operated. Women aged p = 0.018) and those who had postoperative vaginal cuff infection (RR = 2.54; 95% CI: 1.5–4.3; p = 0.001) were at risk of recurrence. Conclusion Recurrence of POP was common. Younger women, and those with postoperative vaginal cuff infection, were more likely to experience recurrent prolapse after vaginal repair.

Increasing burn rates (percentage area burned annually) in some biomes are leading to fires burning in close succession, triggering rapid vegetation change as well as altering soil properties. Despite the importance of soil microbes for nutrient cycling and as plant symbionts, the effects of increased fire frequency on belowground microbial communities remain largely unknown. We present a study of the effects of short interval reburns (defined here as Blastococcus sp. that was consistently enriched in short interval reburns, in both wetlands and uplands, indicating its role as a strongly “pyrophilous” bacterium. We also identified an abundant Callaberonia sordidicola taxon as being consistently depleted in short interval reburns. This endophytic diazotrophic organism is a robust colonizer of pine and spruce seedlings and has the ability to increase seedling growth, due in part to large contributions of fixed nitrogen. Its depletion in short-interval reburn sites raises questions about whether this is contributing to – or merely reflects – poor conifer seedling recolonization post-fire at short-interval reburns.

Background Whereas many adolescents and young people with HIV require the transfer of care from paediatric/adolescent clinics to adult ART clinics, this transition is beset with a multitude of factors that have the potential to hinder or facilitate the process, thereby raising ethical challenges of the transition process. Decisions made regarding therapy, such as when and how to transition to adult HIV care, should consider ethical benefits and risks. Understanding and addressing ethical challenges in the healthcare transition could ensure a smooth and successful transition. The purpose of this study was to analyze the ethical challenges of transitioning HIV care for adolescents into adult HIV clinics. Methods Data presented were derived from 191 adolescents attending nine different health facilities in Uganda, who constituted 18 focus group discussions. In the discussions, facilitators and barriers regarding adolescents transitioning to adult HIV clinics were explored. Guided by the Silences Framework for data interpretation, thematic data analysis was used to analyze the data. The principles of bioethics and the four-boxes ethics framework for clinical care (patient autonomy, medical indications, the context of care, and quality of life) were used to analyze the ethical issues surrounding the transition from adolescent to adult HIV care. Results The key emerging ethical issues were: reduced patient autonomy; increased risk of harm from stigma and loss of privacy and confidentiality; unfriendly adult clinics induce disengagement and disruption of the care continuum; patient preference to transition as a cohort, and contextual factors are critical to a successful transition. Conclusion The priority outcomes of the healthcare transition for adolescents should address ethical challenges of the healthcare transition such as loss of autonomy, stigma, loss of privacy, and discontinuity of care to ensure retention in HIV care, facilitate long-term self-care, offer ongoing all-inclusive healthcare, promote adolescent health and wellbeing and foster trust in the healthcare system. Identifying and addressing the ethical issues related to what hinders or facilitates successful transitions with targeted interventions for the transition process may ensure adolescents and young people with HIV infection remain healthy across the healthcare transition.

BACKGROUND Self-reporting digital apps provide a way of remotely monitoring and managing patients with chronic conditions in the community. Leveraging the data collected by these apps in prognostic models could provide increased personalization of care and reduce the burden of care for people who live with chronic conditions. This study evaluated the predictive ability of prognostic models for the prediction of acute exacerbation events in people with chronic obstructive pulmonary disease by using data self-reported to a digital health app. OBJECTIVE The aim of this study was to evaluate if data self-reported to a digital health app can be used to predict acute exacerbation events in the near future. METHODS This is a retrospective study evaluating the use of symptom and chronic obstructive pulmonary disease assessment test data self-reported to a digital health app (myCOPD) in predicting acute exacerbation events. We include data from 2374 patients who made 68,139 self-reports. We evaluated the degree to which the different variables self-reported to the app are predictive of exacerbation events and developed both heuristic and machine learning models to predict whether the patient will report an exacerbation event within 3 days of self-reporting to the app. The model’s predictive ability was evaluated based on self-reports from an independent set of patients. RESULTS Users self-reported symptoms, and standard chronic obstructive pulmonary disease assessment tests displayed correlation with future exacerbation events. Both a baseline model (area under the receiver operating characteristic curve [AUROC] 0.655, 95% CI 0.689-0.676) and a machine learning model (AUROC 0.727, 95% CI 0.720-0.735) showed moderate ability in predicting exacerbation events, occurring within 3 days of a given self-report. Although the baseline model obtained a fixed sensitivity and specificity of 0.551 (95% CI 0.508-0.596) and 0.759 (95% CI 0.752-0.767) respectively, the sensitivity and specificity of the machine learning model can be tuned by dichotomizing the continuous predictions it provides with different thresholds. CONCLUSIONS Data self-reported to health care apps designed to remotely monitor patients with chronic obstructive pulmonary disease can be used to predict acute exacerbation events with moderate performance. This could increase personalization of care by allowing preemptive action to be taken to mitigate the risk of future exacerbation events.

Soil testing is an important practice for nutrient management in agricultural production systems. In the United States, soil‐test methods and interpretations vary across state lines, making institutional collaborations challenging and crop fertilization guidelines inconsistent. Uniformity and transparency in P and K soil fertility testing and fertilizer recommendations are needed to enhance end‐user adoption. The Fertilizer Recommendation Support Tool (FRST) project is developing a comprehensive database of P and K correlation–calibration results that can be accessed through an online tool for use in research and fertilizer recommendation development. This collaborative project, which includes over 30 land‐grant universities, the USDA‐ARS, the USDA‐NRCS, and several not‐for‐profit organizations, contains a national survey describing the current status of soil testing, minimum requirements for correlation–calibration data inclusion, and database population and creating FRST as a user‐friendly online decision support tool. The FRST project will provide more consistent, transparent, and science‐based information for crop nutrient recommendations across the United States.

OBJECTIVES: To identify neuromuscular attributes associated with mobility and changes in mobility over two years of follow-up among patients with and without SLSS. DESIGN: Secondary analysis of a longitudinal cohort study. SETTING: Outpatient rehabilitation center. PARTICIPANTS: Community-dwelling older adults ≥65 years with self-reported mobility limitations. SLSS was determined using self-reported symptoms of neurogenic claudication and imaging-detected lumbar spinal stenosis. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Basic and advanced mobility as measured by the Late-life Function and Disability Instrument (LLFDI). RESULTS: Among 430 community-dwelling older adults 54 (13%) patients met criteria for SLSS while 246 (57%) did not. On average LLFDI basic and advanced mobility scores decreased significantly from baseline through year two for participants with SLSS (basic: p=0.04, 95% CI 0.18, 5.21; advanced p=0.03, 95% CI 0.39, 7.84). Trunk extensor muscle endurance (trunk endurance) and leg strength were associated with baseline basic mobility (R(2)=0.27, p

The size and frequency of large wildfires in western North America have increased in recent years, a trend climate change is likely to exacerbate. Due to fuel limitations, recently burned forests resist burning for upwards of 30 years; however, extreme fire-conducive weather enables reburning at shorter fire-free intervals than expected. This research quantifies the outcomes of short-interval reburns in upland and wetland environments of northwestern Canadian boreal forests and identifies an interactive effect of post-fire drought. Despite adaptations to wildfire amongst boreal plants, post-fire forests at paired short- and long-interval sites were significantly different, with short-interval sites having lower stem densities of trees due to reduced conifer recruitment, a higher proportion of broadleaf trees, less residual organic material, and reduced herbaceous vegetation cover. Drought reinforced changes in proportions of tree species and decreases in tree recruitment, reinforcing non-resilient responses to short-interval reburning. Drier and warmer weather will increase the incidence of short-interval reburning and amplify the ecological changes such events cause, as wildfire activity and post-fire drought increase synergistically. These interacting disturbances will accelerate climate-driven changes in boreal forest structure and composition. Our findings identify processes of ongoing and future change in a climate-sensitive biome.

Propulsion and bracing ground reaction force (GRF) in overhand throwing are integral in propagating joint reaction kinetics and ball velocity, yet how stride length effects drive (hind) and stride (lead) leg GRF profiles remain unknown. Using a randomised crossover design, 19 pitchers (15 collegiate and 4 high school) were assigned to throw 2 simulated 80-pitch games at ±25% of their desired stride length. An integrated motion capture system with two force plates and radar gun tracked each throw. Vertical and anterior-posterior GRF was normalised then impulse was derived. Paired t-tests identified whether differences between conditions were significant. Late in single leg support, peak propulsion GRF was statistically greater for the drive leg with increased stride. Stride leg peak vertical GRF in braking occurred before acceleration with longer strides, but near ball release with shorter strides. Greater posterior shear GRF involving both legs demonstrated increased braking with longer strides. Conversely, decreased drive leg propulsion reduced both legs' braking effects with shorter strides. Results suggest an interconnection between normalised stride length and GRF application in propulsion and bracing. This work has shown stride length to be an important kinematic factor affecting the magnitude and timing of external forces acting upon the body.

N ational and international open-access agricultural research databases are needed to help solve problems at watershed, regional, and national scales, and to connect productivity, soil health, and environmental quality to food quantity and quality. There are some established, open-access agricultural research networks with extensive research data in the United States, but there is a major need to improve connections between those networks and the emerging data in order to address complex questions. Improving the connections and flow of information among agricultural research networks will enhance the scientific community's ability to simultaneously increase crop yield, sustainability of natural resources, and environmental quality, as well as food, feed, and forage quality, and thus human and animal health. Establishing a network of agricultural databases is crucial for facilitating information flow among different research disciplines. Doing so will also enhance multidisciplinary research opportunities and help build transdisciplinary teams that can provide answers to complex, whole-system research questions and thus solve some of the globe's greatest challenges. GLOBAL CHALLENGES The ever-growing human population is facing one of the greatest challenges of the twenty-first century: to ensure the sustainability of agricultural and natural systems. Both are under the pressure of a changing climate and the increase in…

Background Long-term care facility (LTCF) residents are at increased risk of severe COVID-19, with CMS data indicating > 20% mortality. BLAZE-1 trial noted lower hospitalization rates in high-risk patients receiving monoclonal antibody (mAb) vs placebo (4.2% vs 14.6%) for mild to moderate infections, making it a treatment option for LTCF residents; however, many LTCF lack staff to prepare and administer mAb therapy. To address this need, Region VII Disaster Health Response Ecosystem (R7DHRE) coordinated via NE Medical Emergency Operations Center (NEMEOC) an ASPR pilot project to facilitate infusion of COVID-19 mAb therapeutics for LTCF residents in the state. Methods R7DHRE partnered with Great Plains Health, Nebraska DHHS, Nebraska Antimicrobial Stewardship Assessment and Promotion Program (ASAP) and Infection Control Assessment and Promotion Program (ICAP) to surveil cases in the state, establish distribution/administration pathways, and educate providers on mAb therapeutics. A multi-hub-and-spoke model was created to allow LTCF to work with regional hospitals or pharmacy services to administer drug in their facilities, reducing time to therapy and transmission risk associated with patient transport. A centralized request process was created using a REDCap platform and verification of patient eligibility by ASAP. This request link, informational documents, fact sheets, and custom-built order form templates were hosted on a dedicated ASAP webpage, and details were shared during weekly ICAP LTCF webinars. Outcomes data, including 14- and 28-day COVID-related hospitalizations and mortality, were collected using databases from Nebraska Health Information Initiative and Nebraska DHHS. Results Through this program, 513 doses were administered to LTCF residents. Average time from symptom onset to infusion was 2.6 days. COVID- related hospitalization and mortality rates were lower than previously reported for LTCF residents (Table 1). Table 1. Debographics and Outcomes of mAb Infusions Conclusion By utilizing existing relationships with LTCFs in the region, we established a program to promptly distribute, prepare, and administer monoclonal antibody therapy to LTCF residents in need, preventing COVID-related hospitalizations and deaths. Disclosures James Lawler, MD, MPH, FIDSA, Kinsa Health (Advisor or Review Panel member)Takeda Pharmaceuticals (Advisor or Review Panel member) M. Salman Ashraf, MBBS, Merck & Co. Inc (Grant/Research Support, I have recieved grant funding for an investigator initiated research project from Merck & Con. Inc. However, I do not see any direct conflict of interest related to the submitted abstract)

Background In 2020, the Nebraska Infection Control Assessment and Promotion program began collaborating with the Nebraska Department of Health and Human Services (NE DHHS) and the CDC to distribute infection prevention and control (IPC) training to frontline healthcare professionals (HCPs), focusing on nursing assistants (NAs), dentists, and other groups not traditionally targeted by IPC training. We conducted a learning needs assessment of these workers to plan high-yield curricula for each group. Methods We distributed an online survey to Nebraska’s frontline HCPs via local professional society email lists and the NE DHHS’s weekly newsletter. The survey asked respondents to identify their professional role, practice setting (urban vs suburban vs rural), preferred sources and formats of training, and perceived need for additional training across multiple IPC topics. Results 456 HCPs completed our survey, including 177 NAs, 72 nurses, and 59 dentists; most HCPs practiced in a rural setting (62%). HCPs viewed the CDC as the most trustworthy source of IPC training (92% trusted, vs 71% for local health authorities, 64% for professional societies, and 43% for academic institutions); versus other respondents, NAs had substantially lower trust in all groups except the CDC. Respondents were more often interested in self-paced learning (63%) or interactive discussion with experts (53%) versus peer discussions (40%) or lectures (34%). Compared with other respondents, dentists were least interested in peer discussions (27%) and NAs in lectures (15%). Triage and screening was the only IPC training topic a majority of all respondents (51%) requested, though majorities of nurses (58%) and dentists (51%) also wanted training on environmental cleaning. Hand hygiene (12%) and personal protective equipment use (27%) were the least requested IPC topics, especially among NAs (5% and 18%). Conclusion Nebraska’s frontline healthcare workers express high confidence in the CDC as a source of IPC training and prefer self-paced and expert discussion learning modalities. Key between-group differences indicate that individualizing curricula for NAs, dentists, and other HCPs may improve IPC training quality. Disclosures M. Salman Ashraf, MBBS, Merck & Co. Inc (Grant/Research Support, I have recieved grant funding for an investigator initiated research project from Merck & Con. Inc. However, I do not see any direct conflict of interest related to the submitted abstract) Nicolas W. Cortes-Penfield, MD, Nothing to disclose

This research examines a prevailing yet understudied phenomenon—a cofounder's unethical pro-venture behavior. We identify two antecedents - psychological ownership and equity ownership of a cofounder. Data collected from 139 cofounders show a curvilinear relationship between psychological ownership and unethical pro-venture behavior. More interestingly, the incongruence between psychological ownership and equity ownership, particularly when psychological ownership exceeds equity ownership, increases the likelihood of such behavior.

Although wildfires are an important ecological process in forested regions worldwide, they can cause significant economic damage and frequently create widespread health impacts. We propose a network optimization approach to plan wildfire fuel treatments that minimize the risk of fire spread in forested landscapes under an upper bound for total treated area. We used simulation modeling to estimate the probability of fire spread between pairs of forest sites and formulated a modified Critical Node Detection (CND) model that uses these estimated probabilities to find a pattern of fuel reduction treatments that minimizes the likely spread of fires across a landscape. We also present a problem formulation that includes control of the size and spatial contiguity of fuel treatments. We demonstrate the approach with a case study in Kootenay National Park, British Columbia, Canada, where we investigated prescribed burn options for reducing the risk of wildfire spread in the park area. Our results provide new insights into cost-effective planning to mitigate wildfire risk in forest landscapes. The approach should be applicable to other ecosystems with frequent wildfires.

We incorporate psychological ownership theory and adversity literature to examine the joint effect of psychological ownership and adversity on entrepreneurs persistence decision. The results of two experiments and one survey show that both low adversity and high psychological ownership for the venture increase entrepreneurs likelihood of persistence. We also identify the moderating effect of adversity. Psychological ownership is more relevant to the likelihood of persistence when adversity is high than when it is low. Our research contributes to psychological ownership theory and the entrepreneur- ial persistence literature and has practical implications for entrepreneurs.

Objectives To identify differences in health factors, neuromuscular attributes, and performance-based mobility among community-dwelling older adults with symptomatic lumbar spinal stenosis; and to determine which neuromuscular attributes are associated with performance-based measures of mobility. Design Cross-sectional; secondary data analysis of a cohort study. Setting Outpatient rehabilitation center. Participants Community-dwelling adults aged ≥65 years with self-reported mobility limitations and symptomatic lumbar spinal stenosis (N=54). Interventions Not applicable. Main Outcome Measures Short Physical Performance Battery score, habitual gait speed, and chair stand test. Results Symptomatic lumbar spinal stenosis was classified using self-reported symptoms of neurogenic claudication and imaging. Among 430 community-dwelling older adults, 54 (13%) met criteria for symptomatic lumbar spinal stenosis. Compared with participants without symptomatic lumbar spinal stenosis, those with symptomatic lumbar spinal stenosis had more comorbidities, higher body mass index, greater pain, and less balance confidence. Participants with symptomatic lumbar spinal stenosis had greater impairment in trunk extensor muscle endurance, leg strength, leg strength asymmetry, knee flexion range of motion (ROM), knee extension ROM, and ankle ROM compared with participants without symptomatic lumbar spinal stenosis. Five neuromuscular attributes were associated with performance-based mobility among participants with symptomatic lumbar spinal stenosis: trunk extensor muscle endurance, leg strength, leg strength asymmetry, knee flexion ROM, and knee extension ROM asymmetry. Conclusions Community-dwelling older adults with self-reported mobility limitations and symptomatic lumbar spinal stenosis exhibit poorer health characteristics, greater neuromuscular impairment, and worse mobility when compared with those without symptomatic lumbar spinal stenosis. Poorer trunk extensor muscle endurance, leg strength, leg strength asymmetry, knee flexion ROM, and knee extension ROM asymmetry were associated with performance-based mobility among participants with symptomatic lumbar spinal stenosis.

Although it is increasingly accepted that young (e.g., ≤30 years) stands originating from wildfire are considerably less flammable than older stands in the boreal forest of North America, the role of fuel availability and structure in this phenomenon has not been thoroughly investigated. As a regional study in a high-frequency fire regime, detailed wildfire fuel loading and structure were measured in 66 sites including both wetlands and uplands in the Boreal Plains landscape of Wood Buffalo National Park in northwestern Canada. Overall, a significant increase in total flammable biomass occurred in upland sites over 97 years, but this increase was not consistently observed in wetlands, except where there was dense tree cover. Fuel accumulation was highly moderated by canopy fuels, as surface fuels were relatively constant across differing site types and time since fire, averaging 0.4 kg·m−2. Significant but gradual canopy fuel accumulation was observed in moist conifer upland forests dominated by mature black spruce (Picea mariana (Mill.) B.S.P.) or white spruce (Picea glauca (Moench) Voss) over 100 years since fire. Outside of these mature moist conifer uplands, there was no difference in total fuel loading between other upland forests and across the gradient of treed to open wetlands.