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Genomic research emerges from collaborative work within and across different scientific disciplines. A diverse range of visualisation techniques has been employed to aid this research, yet relatively little is known as to how these techniques facilitate collaboration. We conducted a case study of collaborative research within a biomedical institute to learn more about the role visualisation plays in genomic mapping. Interviews were conducted with molecular biologists (N = 5) and bioinformaticians (N = 6). We found that genomic research comprises a variety of distinct disciplines engaged in complex analytic tasks that each resist simplification, and their complexity influences how visualisations were used. Visualisation use was impacted by group-specific interactions and temporal work patterns. Visualisations were also crucial to the scientific workflow, used for both question formation and confirmation of hypotheses, and acted as an anchor for the communication of ideas and discussion. In the latter case, two approaches were taken: providing collaborators with either interactive or static imagery representing a viewpoint. The use of generic software for simplified visualisations, and quick production and curation was also noted. We discuss these findings with reference to group-specific interactions and present recommendations for improving collaborative practices through visual analytics.

Summary: Background: Given the increasing prevalence of diabetes in low-income and middle-income countries (LMICs), we aimed to estimate the health and cost implications of achieving different targets for diagnosis, treatment, and control of diabetes and its associated cardiovascular risk factors among LMICs. Methods: We constructed a microsimulation model to estimate disability-adjusted life-years (DALYs) lost and health-care costs of diagnosis, treatment, and control of blood pressure, dyslipidaemia, and glycaemia among people with diabetes in LMICs. We used individual participant data—specifically from the subset of people who were defined as having any type of diabetes by WHO standards—from nationally representative, cross-sectional surveys (2006–18) spanning 15 world regions to estimate the baseline 10-year risk of atherosclerotic cardiovascular disease (defined as fatal and non-fatal myocardial infarction and stroke), heart failure (ejection fraction of

Summary Background The prevalence of overweight, obesity, and diabetes is rising rapidly in low-income and middle-income countries (LMICs), but there are scant empirical data on the association between body-mass index (BMI) and diabetes in these settings. Methods In this cross-sectional study, we pooled individual-level data from nationally representative surveys across 57 LMICs. We identified all countries in which a WHO Stepwise Approach to Surveillance (STEPS) survey had been done during a year in which the country fell into an eligible World Bank income group category. For LMICs that did not have a STEPS survey, did not have valid contact information, or declined our request for data, we did a systematic search for survey datasets. Eligible surveys were done during or after 2008; had individual-level data; were done in a low-income, lower-middle-income, or upper-middle-income country; were nationally representative; had a response rate of 50% or higher; contained a diabetes biomarker (either a blood glucose measurement or glycated haemoglobin [HbA1c]); and contained data on height and weight. Diabetes was defined biologically as a fasting plasma glucose concentration of 7·0 mmol/L (126·0 mg/dL) or higher; a random plasma glucose concentration of 11·1 mmol/L (200·0 mg/dL) or higher; or a HbA1c of 6·5% (48·0 mmol/mol) or higher, or by self-reported use of diabetes medication. We included individuals aged 25 years or older with complete data on diabetes status, BMI (defined as normal [18·5–22·9 kg/m2], upper-normal [23·0–24·9 kg/m2], overweight [25·0–29·9 kg/m2], or obese [≥30·0 kg/m2]), sex, and age. Countries were categorised into six geographical regions: Latin America and the Caribbean, Europe and central Asia, east, south, and southeast Asia, sub-Saharan Africa, Middle East and north Africa, and Oceania. We estimated the association between BMI and diabetes risk by multivariable Poisson regression and receiver operating curve analyses, stratified by sex and geographical region. Findings Our pooled dataset from 58 nationally representative surveys in 57 LMICs included 685 616 individuals. The overall prevalence of overweight was 27·2% (95% CI 26·6–27·8), of obesity was 21·0% (19·6–22·5), and of diabetes was 9·3% (8·4–10·2). In the pooled analysis, a higher risk of diabetes was observed at a BMI of 23 kg/m2 or higher, with a 43% greater risk of diabetes for men and a 41% greater risk for women compared with a BMI of 18·5–22·9 kg/m2. Diabetes risk also increased steeply in individuals aged 35–44 years and in men aged 25–34 years in sub-Saharan Africa. In the stratified analyses, there was considerable regional variability in this association. Optimal BMI thresholds for diabetes screening ranged from 23·8 kg/m2 among men in east, south, and southeast Asia to 28·3 kg/m2 among women in the Middle East and north Africa and in Latin America and the Caribbean. Interpretation The association between BMI and diabetes risk in LMICs is subject to substantial regional variability. Diabetes risk is greater at lower BMI thresholds and at younger ages than reflected in currently used BMI cutoffs for assessing diabetes risk. These findings offer an important insight to inform context-specific diabetes screening guidelines. Funding Harvard T H Chan School of Public Health McLennan Fund: Dean's Challenge Grant Program.

Rationale: Clinical critical care research often hinges on surrogate informed consent, as patients commonly lack decision-making capacity because of their acute illness. The surrogate informed consent process has been identified as having flaws and needing improvement. A better understanding of surrogates' perspectives is required to understand and address these shortcomings and thereby improve this process. Objectives: To explore the perspectives of surrogate decision makers of critically ill, mechanically ventilated patients about being approached about having their loved one participate in hypothetical research studies. Methods: We performed semistructured qualitative interviews of surrogate decision makers of critically ill, mechanically ventilated patients, exploring their decisional needs surrounding participation in research. These interviews were recorded and transcribed verbatim. A thematic analysis of transcripts was performed with an iterative group framework using a mixed inductive and deductive approach. Results: A sample of 21 surrogate decision makers were interviewed. Thematic saturation was achieved by the consensus of the investigators. We identified trust as a unifying domain for the themes that emerged through the analytic process. Embedded within the domain of trust, two central themes became apparent: knowledge-based trust and context-based trust. Knowledge-based trust includes subthemes of logistics, accountability, and mutual respect, whereas context-based trust includes trust in the individual clinicians and trust in the hospital system. Conclusions: Our findings highlight the nuanced layers of trust central to the surrogate informed consent process. To enhance the surrogate informed consent process for participation in critical care research studies, it is crucial that researchers recognize the inherent importance of trust to ensure an effective informed consent process.

Ability-based design is a useful framework that centralizes the abilities (all that users can do) of people with disabilities in approaching the design of assistive technologies. However, although this framework aspires to support designing with people with all kinds of disabilities, it is mainly effective in supporting those whose abilities can be clearly defined and measured, in particular, physical and sensory attributes of ability. As a result, the ability-based design framework only provides limited guidance to design with users with intellectual disability, whose cognitive, physical, sensory, and practical abilities vary along a spectrum. In this article, we reflect on a long-term co-design study where we leveraged what we termed “competencies,” i.e., the representative practical skills people develop from their participation in life activities, in particular, mainstream technologies, such as social media and the Internet. Our reflection is based on our experience in designing SkillsTube, a web application we co-designed with young adults with intellectual disability to support them to learn life skills through videos. The app's design, which explored and leveraged their social media participation competencies, supported the fundamental participation of all participants and their peers. Their familiarity with the app's social media-inspired design features fostered confidence in their participation, usability, and engagement. Drawing on the findings and design process of the app, we discuss a Competency-based approach to designing with people with disabilities that extends upon ability-based design, by grounding it in user competencies.

Residual dissections after type A repairs are common and can result in aneurysm formation. Surgery is complex and considered high risk, particularly if there is arch involvement. A single-stage "arch-first" technique via clamshell incision is an excellent option in certain circumstances and herein we detail a variation of this approach using a trifurcated graft.

Summary Background Approximately 80% of the 463 million adults worldwide with diabetes live in low-income and middle-income countries (LMICs). A major obstacle to designing evidence-based policies to improve diabetes outcomes in LMICs is the scarce availability of nationally representative data on the current patterns of treatment coverage. The objectives of this study were to estimate the proportion of adults with diabetes in LMICs who receive coverage of recommended pharmacological and non-pharmacological diabetes treatment; and to describe country-level and individual-level characteristics that are associated with treatment. Methods We did a cross-sectional analysis of pooled, individual data from 55 nationally representative surveys in LMICs. Our primary outcome of self-reported diabetes treatment coverage was based on population-level monitoring indicators recommended in the 2020 WHO Package of Essential Noncommunicable Disease Interventions. Surveys were included if they were done in 2008 or after in an LMIC, as classified by the World Bank in the year the survey was done; were nationally representative; had individual-level data; contained a diabetes biomarker (fasting glucose, random glucose, or glycated haemoglobin); and had data on one or more diabetes treatments. Our sample included non-pregnant individuals with an available diabetes biomarker who were at least 25 years of age. We assessed coverage of three pharmacological and three non-pharmacological treatments among people with diabetes. At the country level, we estimated the proportion of individuals reporting coverage by per-capita gross national income and geographical region. At the individual level, we used logistic regression models to assess coverage along several key individual characteristics including sex, age, body-mass index, wealth quintile, and educational attainment. In the primary analysis, we scaled sample weights such that countries were weighted equally. Findings The final pooled sample from the 55 LMICs included 680 102 total individuals and 37 094 individuals with diabetes. Using equal weights for each country, diabetes prevalence was 9·0% (95% CI 8·7–9·4), with 43·9% (41·9–45·9) reporting a previous diabetes diagnosis. Overall, 4·6% (3·9–5·4) of individuals with diabetes self-reported meeting need for all treatments recommended for them. Coverage of glucose-lowering medication was 50·5% (48·6–52·5); antihypertensive medication was 41·3% (39·3–43·3); cholesterol-lowering medication was 6·3% (5·5–7·2); diet counselling was 32·2% (30·7–33·7); exercise counselling was 28·2% (26·6–29·8); and weight-loss counselling was 31·5% (29·3–33·7). Countries at higher-income levels tended to have greater coverage. Female sex and higher age, body-mass index, educational attainment, and household wealth were also associated with greater coverage. Interpretation Fewer than one in ten people with diabetes in LMICs receive coverage of guideline-based comprehensive diabetes treatment. Scaling up the capacity of health systems to deliver treatment not only to lower glucose but also to address cardiovascular disease risk factors, such as hypertension and high cholesterol, are urgent global diabetes priorities. Funding National Clinician Scholars Program at the University of Michigan Institute for Healthcare Policy & Innovation, National Institute of Diabetes and Digestive and Kidney Diseases, Harvard Catalyst, and National Center for Advancing Translational Sciences of the National Institutes of Health.

Background: Healthcare costs are increasing in the U.S. Healthcare market is fragmented and opaque. The Amazon, JP Morgan Chase, and Berkshire Hathaway partnered to form an independent healthcare company ‘Haven’, designed to support cost-containment in health care and to forge a better patient experience. Limited information is available in the public domain about Haven’s strategy to deliver cost-effective healthcare for their employees. Objective: To describe the impact of Haven Health of modern healthcare. Methods: We reviewed literature in Pubmed (MEDLINE database of references and abstracts on life sciences and biomedical topics from the USA National Library of Medicine at the National Institutes of Health) and the public domain. Results: Amazon’s expertise and abilities in e-commerce such as logistics, supply, and big data management will support Haven’s quest to resolve inefficiencies in health care. Haven may attempt to directly negotiate with providers, bypassing insurance companies, to establish themselves as an independent payor. Additionally, Haven to establish themselves as a provider by building new low-cost primary care clinics, focusing on chronic disease prevention. The new healthcare system may leverage machine learning, artificial intelligence and big data analysis to support its initiatives and other ‘big data’ analytics to drive it all. Conclusions: Heaven Health may use its expertise to disrupt everything from the pharmaceutical supply chain to primary care and telehealth. More research is needed to evaluate the impact of Haven Healthcare on disease outcomes and healthcare costs.

We previously described clinically relevant reductions in fecal microbiota diversity in patients undergoing allogeneic hematopoietic cell transplantation (allo-HCT). Recipients of high-dose chemotherapy and autologous HCT (auto-HCT) incur similar antibiotic exposures and nutritional alterations. To characterize the fecal microbiota in the auto-HCT population, we analyzed 1161 fecal samples collected from 534 adult recipients of auto-HCT for lymphoma, myeloma, and amyloidosis in an observational study conducted at 2 transplantation centers in the United States. By using 16S ribosomal gene sequencing, we assessed fecal microbiota composition and diversity, as measured by the inverse Simpson index. At both centers, the diversity of early pretransplant fecal microbiota was lower in patients than in healthy controls and decreased further during the course of transplantation. Loss of diversity and domination by specific bacterial taxa occurred during auto-HCT in patterns similar to those with allo-HCT. Above-median fecal intestinal diversity in the periengraftment period was associated with decreased risk of death or progression (progression-free survival hazard ratio, 0.46; 95% confidence interval, 0.26-0.82; P = .008), adjusting for disease and disease status. This suggests that further investigation into the health of the intestinal microbiota in auto-HCT patients and posttransplant outcomes should be undertaken.

Hepatitis C virus (HCV) is more prevalent among people with experience of severe mental illness compared to the general population, due in part to higher levels of injecting drug use. Delivering HCV care through mental health services may reduce barriers to care and improve outcomes. A nurse-led HCV program was established in a co-located mental health and addiction service in Melbourne, Australia. People with a history of injecting drug use, including current use, were referred for HCV testing by nurses, with support provided on-site from a general practitioner and remotely from infectious disease and hepatology specialists. A nurse practitioner, general practitioner or specialists were able to prescribe HCV treatment. One-hundred and thirty people were referred to the nurse-led service, among whom 112 (86%) were engaged in care. Of those 112, 84 (75%) were found to have detectable HCV RNA, 70 (83%) commenced treatment; 28 (40%) prescriptions were nurse initiated, 19 (27%) were general practitioner initiated and 20 (29%) were prescribed from hospital clinics or elsewhere. All people with an SVR result (48/70) achieved HCV cure (intention to treat SVR 69%, per-protocol SVR 100%). Treatment commencement was highest among people prescribed opioid agonist therapy (28/29, 96%) compared to those who were not (18/26, 69%). In conclusion, a nurse-led, HCV service for people with severe mental illness including pathways to specialist support when needed can achieve high treatment uptake and cure. Further implementation work is required to improve treatment uptake, particularly among people not prescribed opioid agonist therapy, and to improve follow-up for SVR testing.

In 2017, the participants of a higher education professional development (PD) working group (meitheal) met face-to-face and remotely to examine the National Forum for the Enhancement of Teaching an...

(2021). Films for the Colonies: Cinema and the Preservation of the British Empire. Caribbean Quarterly: Vol. 67, No. 3, pp. 363-365.

The undeniable benefit of mentorship by experience senior mentors can meaningfully increase the breadth of their experience and contributions to society as well as address the dire inequality in global health. This model captures wisdom lost to retirement, enables opportunities for purposeful lifespan, underpins sustainable health care systems, and has the potential for building multinational partnerships., Key Messages Capturing the acquired wisdom and experience of mentors in global health offers a capstone for their careers and provides a purposeful healthspan for these professionals to continue to be engaged in meaningful work while leveraging their expertise to solve challenging health care problems.Senior professionals can mentor early career leaders to help them balance their professional commitments, interest in global health, and development of needed skills, such as understanding the nuances of cultural competence and adapting solutions to different environments.Institutional leaders, particularly in academic medical centers, recognize the importance of global engagement vis-à-vis their educational mission and for recruiting and retaining faculty and can benefit economically and programmatically from supporting experienced senior faculty or retirees to support these efforts.Program builders should include the opportunity for altruistic human service as an integral part of a career and highlight that they can access senior mentors and retirees who provide world-class expertise and mentorship at “volunteer prices.”

Background: Anatomic ACL grafts routinely display the anisometric length-tension behaviour seen in the native ligament with maximum length in full knee extension. Recent improvements in hamstring graft preparation and fixation have improved graft rigidity to the point where total graft lengthening after implantation may be less than 1 mm. Despite this it remains common practice to fix these grafts in a knee flexed position. Methods: Nineteen participants underwent all-inside ACL reconstruction with optimally preconditioned 4 strand semitendinosus grafts using bi-cortical adjustable suspensory loop fixation. Using a computer navigation system, baseline measures of anisometricity, extension range, and tibial rotation were made. The graft was tensioned and provisionally fixed with the knee flexed 5° beyond its anisometric point and extension range recorded. The graft was then definitively fixed with the knee fully extended and extension range and tibial rotation recorded again. Anterior laxity measurements were made pre-operatively and postoperatively using a manual arthrometer and compared to those from the contralateral limb. Results: Fixing the graft with the knee flexed produced a mean FD of 10.9° (p

Background Processes for delivery of high-risk infusions in pediatric intensive care units (PICUs) are complex. Standard concentration infusions (SCIs), smart-pumps, and electronic prescribing are recommended medication error reduction strategies. Implementation rates in Europe lag behind those in the United States. Since 2012, the PICU of an Irish tertiary pediatric hospital has been using a smart-pump SCI library, interfaced with electronic infusion orders (Philips ICCA). The incidence of infusion errors is unknown. Objectives To determine the frequency, severity, and distribution of smart-pump infusion errors in PICUs. Methods Programmed infusions were directly observed at the bedside. Parameters were compared against medication orders and autodocumented infusion data. Identified deviations were categorized as medication errors or discrepancies. Error rates (%) were calculated as infusions with errors and errors per opportunities for error (OEs). Predefined definitions, multidisciplinary consensus and grading processes were employed. Results A total of 1,023 infusions for 175 patients were directly observed over 27 days between February and September 2017. The drug library accommodated 96.5% of infusions. Compliance with the drug library was 98.9%. A total of 133 infusions had ≥1 error (13.0%); a further 58 (5.7%) had ≥1 discrepancy. From a total of 4,997 OEs, 153 errors (3.1%) and 107 discrepancies (2.1%) were observed. Undocumented bolus doses were most commonly identified (n = 81); this was the only deviation in 36.1% (n = 69) of infusions. Programming errors were rare (0.32% OE). Errors were minor, with just one requiring minimal intervention to prevent harm. Conclusion The error rates identified are low compared with similar studies, highlighting the benefits of smart-pumps and autodocumented infusion data in PICUs. A range of quality improvement opportunities has been identified.

Building on our previous study, showing a correlation between ferritin in serum and urine, we conducted a feasibility evaluation, measuring urinary ferritin as a potential noninvasive screening test for iron deficiency among NICU patients. This was a prospective analysis of paired serum/urine ferritin levels. We defined iron-limited erythropoiesis by a RET-He

Background The purpose of this study was to evaluate the clinical and radiographic outcomes of a transosseous suture fixation technique for the treatment of unstable lateral clavicle fractures. The appropriate treatment for lateral clavicle fractures is controversial. Many authors have argued for nonsurgical treatment of these injuries; however, recent literature has shown a role for the surgical treatment of unstable fractures. The paucity of lateral clavicular bone and the unique anatomy of this area of the shoulder makes surgical treatment of these injuries challenging. This article reports a single-surgeon experience with a transosseous suture fixation technique for the treatment of unstable lateral clavicle fractures. Materials and Methods A retrospective review of all patients with unstable lateral clavicle fractures treated with a transosseous suture technique from 2015-2018 was performed. The indication for surgery was significant displacement between the main medial and lateral clavicle fragments. The surgical technique used was a modification of the technique as described by Levy. Patients were followed postoperatively with active and passive range of motion (ROM) measurements, strength testing, and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form score, visual analog scale score, and standard radiographs. Patients were followed to radiographic union. Results Twelve patients underwent surgical fixation of unstable lateral clavicle fractures from 2015-2018. All patients had excellent function, full ROM, minimal pain, and improved functional scores at final follow-up. Eleven patients achieved complete union of the fracture. One patient healed with a fibrous union; however, the fracture had maintained alignment and the patient was asymptomatic and satisfied with the result. No patient required a second surgery. Conclusion We found that the transosseous suture technique for fixation is an effective treatment for unstable lateral clavicle fracture. This technique is reproducible, cost effective, and limits the need for revision surgery often encountered with other techniques.

Amid pressure for climate action worldwide, processes of deliberative democracy are being called upon to address public policy complexities, include citizens in decision-making, restore faith in public institutions and enhance governance processes. The citizens’ assembly model is lauded internationally for the much-needed structure it provides to support bottom-up governance efforts as well as the potential for effective citizen engagement on complex topics. The Irish Citizens’ Assembly, which took place from 2016 to 2018, is heralded as an example of best practice in design and execution. Yet, there is a dearth in analysis of its form, structure, impact and content, particularly in the climate crisis context. This paper examines one element of the deliberative democracy process that aimed to include a wider breadth of publics beyond the 99 citizens randomly selected to take part: the public submissions invited as part of the Citizens’ Assembly process. In total, 1185 submissions were received on the topic of climate change. Our study undertakes a comprehensive content analysis of these submissions. Specifically, we explore (1) the content and concerns foregrounded within the submissions, (2) the frames and rhetorical strategies employed and (3) the stakeholders and scales called upon for climate action. The study identifies trends, preoccupations and salience within the corpus of written submissions and expands our understanding of citizen perceptions of climate science and policy. We offer both operational lessons for others aiming to enact similar deliberative forums as well as communications lessons for wider efforts to deepen public engagement on the climate crisis.

This study aimed to assess fire-setting behaviors within a child welfare sample. The youth were divided into four groups based on their fire-setting behavior (e.g., no incidents, one incident, multiple minor incidents, and multiple severe incidents). Groups were compared based on five factors: overt antisocial behavior, covert antisocial behavior, global adjustment, psychiatric history, and learning deficits. Fire setters displayed more delinquent behavior and had more extensive psychiatric histories than non-fire-setting youth. Further, the youth with multiple serious incidents of fire-setting behavior displayed more delinquent behavior and had more extensive psychiatric histories than any of the fire-setting groups. These findings clearly suggest that fire setters, as a group, are not homogeneous with respect to antisocial behavior or psychiatric impairment and that gravity of fire setting increased as a function of greater psychopathology and greater delinquency when compared to their peers.

To evaluate published interventions aimed at improving the management of type 2 diabetes, hypertension and dyslipidaemia in the Caribbean.We conducted a systematic review of four databases in accordance with PRISMA guidelines. Inclusion criteria were conducted in the Caribbean among adults ≥ 18 years who had type 2 diabetes, hypertension or dyslipidaemia; controlled trials, interventions, or comparative studies with pre-post designs and reported on at least one of the clinical outcomes of interest.Seventeen studies met the criteria for inclusion. The majority were conducted in Cuba and Trinidad and Tobago, and 35% were conducted over 10 years ago. Samples were small and largely consisted of older adult females and patients with type 2 diabetes. Four of eight (50%) studies that reported on HbA1c, 5 of 12 (42%) that reported on blood pressure and 2 of 7 (29%) that reported on body mass index observed significant improvements. Study heterogeneity precluded our ability to conduct a meta-analysis. The overall quality of evidence based on GRADE criteria was low for all outcomes assessed.There is insufficient evidence on interventions to address type 2 diabetes, hypertension and dyslipidaemia in the Caribbean.Evaluer les interventions publiées visant à améliorer la prise en charge du diabète de type 2, de l'hypertension et de la dyslipidémie dans les Caraïbes. MÉTHODES: Nous avons effectué une revue systématique de quatre bases de données conformément aux directives PRISMA. Les critères d'inclusion étaient: menée dans les Caraïbes auprès d'adultes de 18 ans et plus qui souffraient de diabète de type 2, d'hypertension ou de dyslipidémie; essais contrôlés, interventions ou études comparatives avec des conceptions pré/post; et rapportant au moins 1 des résultats cliniques d'intérêt. RÉSULTATS: 17 études répondaient aux critères d'inclusion. La majorité a été réalisée à Cuba et à Trinité-et-Tobago et 35% ont été réalisées il y a plus de 10 ans. Les échantillons étaient petits et portaient en grande partie sur des femmes adultes plus âgées et des patients atteints de diabète de type 2. Quatre des 8 études (50%) qui rapportaient sur l'HbA1c, 5 des 12 (42%) qui rapportaient sur la pression artérielle et 2 des 7 (29%) qui rapportaient sur l'indice de masse corporelle ont observé des améliorations significatives. L'hétérogénéité de l'étude a empêché notre capacité de mener une méta-analyse. La qualité globale des données basées sur les critères de GRADE était faible pour résultats évalués.Il n'y a pas suffisamment de données sur les interventions pour lutter contre le diabète de type 2, l'hypertension et la dyslipidémie dans les Caraïbes.

BACKGROUND Hepatitis C virus (HCV) treatment through primary care and community-based services will be a critical component of HCV elimination. We evaluated a nurse-coordinated programme providing care across eight sites and analysed progression through the HCV care cascade. METHODS People-accessing services from six primary care clinics, a homeless crisis accommodation provider and a mental health service were directly referred to nurses or engaged by nurses during regular clinic visits. Nurses supported HCV testing, treatment and follow-up. The prescription was provided by affiliated clinicians. Logistic regression was used to examine factors associated with treatment commencement and sustained virological response (SVR) testing. RESULTS Of 640 people referred to and/or engaged by the nurses from January 2017 to July 2019, 518 had an HCV RNA test of whom 381 (74%) were HCV RNA positive. Treatment was commenced by 281 (74%) people of whom 161 had an SVR test, 157 (97.5%) were cured. Opioid agonist therapy was associated with treatment commencement (aOR 2.68, 95% CI 1.48-4.88). People who were homeless/unstably housed were less likely to commence treatment (aOR 0.45, 95% CI 0.23-0.87). Treatment prescription from a specialist (aOR 2.39, 95% CI 1.20-4.74) and recent injection drug use (

This research aims to explore how tangible technology created through co-design can be designed in a way that invites social interaction for people with intellectual disability. We conducted co-design sessions with one participant to create a sensory musical blanket. As the trials were run in a collective environment, their peers were drawn to the developing design. The design method and unique interactions are key contributions of this research.

Objectives: Our primary objective was to determine the successful rate of recanalization of M1 large vessel occlusion using either the Trevo 4 × 30 mm or 6 × 25 mm stent during mechanical thrombectomy. Our secondary objectives were to determine differences between the use of these two stent retrievers regarding first-pass effect, periprocedural complications, and mortality in the first 90 days.Methods: This is a retrospective cohort study. Data regarding the stent used, recanalization, number of passes, periprocedural complications, and mortality were determined via our mechanical thrombectomy database along with chart review.Conclusion: When comparing Trevo 4 × 30 mm to 6 × 25 mm stent retrievers used in mechanical thrombectomy for middle cerebral artery large-vessel occlusion causing stroke, there is no statistically significant difference in successful recanalization rates, first-pass effect, perioperative complications, or mortality at 90 days. Studies like this will hopefully lead to further prospective, randomized controlled trials that will help show experts in the field an additional way to perform this procedure effectively and safely.

[No Abstract Available], Wellcome Trust [209553/Z/17/Z]; UCLH Biomedical Research Centre, This study was supported by Wellcome Trust grant 209553/Z/17/Z and the UCLH Biomedical Research Centre. Funding information for this article has been deposited with the Crossref Funder Registry.

© 2021 American Academy of Neurology, Objective: To measure the global impact of COVID-19 pandemic on volumes of IV thrombolysis (IVT), IVT transfers, and stroke hospitalizations over 4 months at the height of the pandemic (March 1 to June 30, 2020) compared with 2 control 4-month periods. Methods: We conducted a cross-sectional, observational, retrospective study across 6 continents, 70 countries, and 457 stroke centers. Diagnoses were identified by their ICD-10 codes or classifications in stroke databases. Results: There were 91,373 stroke admissions in the 4 months immediately before compared to 80,894 admissions during the pandemic months, representing an 11.5% (95% confidence interval [CI] -11.7 to -11.3, p < 0.0001) decline. There were 13,334 IVT therapies in the 4 months preceding compared to 11,570 procedures during the pandemic, representing a 13.2% (95% CI -13.8 to -12.7, p < 0.0001) drop. Interfacility IVT transfers decreased from 1,337 to 1,178, or an 11.9% decrease (95% CI -13.7 to -10.3, p = 0.001). Recovery of stroke hospitalization volume (9.5%, 95% CI 9.2-9.8, p < 0.0001) was noted over the 2 later (May, June) vs the 2 earlier (March, April) pandemic months. There was a 1.48% stroke rate across 119,967 COVID-19 hospitalizations. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was noted in 3.3% (1,722/52,026) of all stroke admissions. Conclusions: The COVID-19 pandemic was associated with a global decline in the volume of stroke hospitalizations, IVT, and interfacility IVT transfers. Primary stroke centers and centers with higher COVID-19 inpatient volumes experienced steeper declines. Recovery of stroke hospitalization was noted in the later pandemic months.

There is accumulating anecdotal evidence that anosmia and dysgeusia are associated with the COVID-19 pandemic. To investigate their relationship to SARS-CoV2 infection, the American Academy of Otolaryngology-Head and Neck Surgery developed the COVID-19 Anosmia Reporting Tool for Clinicians for the basis of this pilot study. This tool allows health care providers to confidentially submit cases of anosmia and dysgeusia related to COVID-19. We analyzed the first 237 entries, which revealed that anosmia was noted in 73% of patients prior to COVID-19 diagnosis and was the initial symptom in 26.6%. Some improvement was noted in 27% of patients, with a mean time to improvement of 7.2 days in this group (85% of this group improved within 10 days). Our findings suggest that anomia can be a presenting symptom of COVID-19, consistent with other emerging international reports. Anosmia may be critical in timely identification of individuals infected with SARS-CoV2 who may be unwittingly transmitting the virus.

Background Radiographic imaging is essential in assessing the severity and treatment of injuries. However, when a radiographic series is of poor quality, its diagnostic utility is limited, especially in cases involving pediatric elbow injuries. Objectives This study aims to investigate the variability of elbow radiographs in the injured child, review parameters used to assess diagnostic quality, and introduce the lateral distal humeral metaphyseal-diaphyseal (LDHMD) ratio as a potential measurement of the quality of a lateral elbow radiograph. Methods A retrospective review was performed of elbow radiographs of children who presented to our hospital. Demographic data, injury, location where the radiograph was obtained, and presence of immobilization were collected. Radiographs were subjectively classified as optimal, adequate, or suboptimal based on several radiographic parameters, one of which was the LDHMD ratio. Results There were 286 radiographic series reviewed. Per our assessment of the anteroposterior images, 81% were found to be optimal, 18% adequate, and 1% suboptimal. In contrast, only 24% of the lateral images were deemed optimal, 63% adequate, and 13% suboptimal, therefore making the lateral radiographs the focus of our investigation. The LDHMD ratios of the optimal (n = 21) and suboptimal (n = 11) lateral radiographs without definite fracture were 0.96 and 0.84, respectively (p Conclusions An LDHMD ratio that is approximately 1 and an hourglass sign appearing in the anterior third of the humerus are criteria for determining true pediatric lateral radiograph, and with increased awareness, will lead to improved diagnostic utility of radiographs when assessing the injured child's elbow and determining management.

Irish agriculture is currently dominated by a cattle economy that can be traced from its historical origins under British imperialism to subsequent expansion and intensification since Ireland’s acc...

Cancer is now the second leading cause of death in the Caribbean. Despite this growing burden, many Caribbean small island nations have health systems that struggle to provide optimal cancer care for their populations. In this Series paper, we identify several promising strategies to improve cancer prevention and treatment that have emerged across small island nations that are part of the Caribbean Community. These strategies include the establishment of a Caribbean cancer registry hub, the development of resource-appropriate clinical guidelines, innovations in delivering specialty oncology services (eg, paediatric oncology and palliative care), improving access to opioids, and developing regional training capacity in palliative medicine. These developments emphasise the crucial role of public-private partnerships in improving health care for the region and show how fostering strategic collaborations with colleagues and centres in more developed countries, who can contribute specialised expertise and improve regional collaboration, can improve care across the cancer control continuum.

Food is traded across the global markets to satisfy consumer demands, mainly from developed countries, for year-round access to a wide range of foods. This has resulted in an increasingly complex network of food trade and has made importing countries vulnerable to the spread of foodborne disease outbreaks originating from “foreign” food networks. Analysis of these networks can provide information on potential food safety risks and also on the potential spread of these risks through the food network in question. In this study, network theory has been used to analyse global trade. A mathematical model was developed enabling a simulation of the distribution of food products based on the publicly available data on international imports, exports and production provided by the Food and Agriculture Organization of the United Nations. Through numerical simulations we demonstrate, for the first time, the impact that the network structure has on the distribution of food products in terms of food safety risks. As a case study, a recent trans-national food safety incident was analysed, illustrating the potential application of the model in a foodborne pathogen outbreak. Using only the type of contaminated food and the countries where the outbreak was reported, the model was used to identify the most likely origin of the contaminated eggs, narrowing down the options to three countries (including the actual origin). Furthermore, it is used to identify those countries with significant food safety risks, due to imports of food produced in these three countries. The approach can help regulatory agencies and the food industry to design improved surveillance and risk mitigation actions against transnational food safety risks.

Summary Background Evidence from nationally representative studies in low-income and middle-income countries (LMICs) on where in the hypertension care continuum patients are lost to care is sparse. This information, however, is essential for effective targeting of interventions by health services and monitoring progress in improving hypertension care. We aimed to determine the cascade of hypertension care in 44 LMICs—and its variation between countries and population groups—by dividing the progression in the care process, from need of care to successful treatment, into discrete stages and measuring the losses at each stage. Methods In this cross-sectional study, we pooled individual-level population-based data from 44 LMICs. We first searched for nationally representative datasets from the WHO Stepwise Approach to Surveillance (STEPS) from 2005 or later. If a STEPS dataset was not available for a LMIC (or we could not gain access to it), we conducted a systematic search for survey datasets; the inclusion criteria in these searches were that the survey was done in 2005 or later, was nationally representative for at least three 10-year age groups older than 15 years, included measured blood pressure data, and contained data on at least two hypertension care cascade steps. Hypertension was defined as a systolic blood pressure of at least 140 mm Hg, diastolic blood pressure of at least 90 mm Hg, or reported use of medication for hypertension. Among those with hypertension, we calculated the proportion of individuals who had ever had their blood pressure measured; had been diagnosed with hypertension; had been treated for hypertension; and had achieved control of their hypertension. We weighted countries proportionally to their population size when determining this hypertension care cascade at the global and regional level. We disaggregated the hypertension care cascade by age, sex, education, household wealth quintile, body-mass index, smoking status, country, and region. We used linear regression to predict, separately for each cascade step, a country's performance based on gross domestic product (GDP) per capita, allowing us to identify countries whose performance fell outside of the 95% prediction interval. Findings Our pooled dataset included 1 100 507 participants, of whom 192 441 (17·5%) had hypertension. Among those with hypertension, 73·6% of participants (95% CI 72·9–74·3) had ever had their blood pressure measured, 39·2% of participants (38·2–40·3) had been diagnosed with hypertension, 29·9% of participants (28·6–31·3) received treatment, and 10·3% of participants (9·6–11·0) achieved control of their hypertension. Countries in Latin America and the Caribbean generally achieved the best performance relative to their predicted performance based on GDP per capita, whereas countries in sub-Saharan Africa performed worst. Bangladesh, Brazil, Costa Rica, Ecuador, Kyrgyzstan, and Peru performed significantly better on all care cascade steps than predicted based on GDP per capita. Being a woman, older, more educated, wealthier, and not being a current smoker were all positively associated with attaining each of the four steps of the care cascade. Interpretation Our study provides important evidence for the design and targeting of health policies and service interventions for hypertension in LMICs. We show at what steps and for whom there are gaps in the hypertension care process in each of the 44 countries in our study. We also identified countries in each world region that perform better than expected from their economic development, which can direct policy makers to important policy lessons. Given the high disease burden caused by hypertension in LMICs, nationally representative hypertension care cascades, as constructed in this study, are an important measure of progress towards achieving universal health coverage. Funding Harvard McLennan Family Fund, Alexander von Humboldt Foundation.

Context\ud Previous studies have raised concerns about the analysis and meta-analysis of crossover experiments and we were aware of several families of experiments that used crossover designs and meta-analysis.\ud \ud Objective\ud To identify families of experiments that used meta-analysis, to investigate their methods for effect size construction and aggregation, and to assess the reproducibility and validity of their results.\ud \ud Method\ud We performed a systematic review (SR) of papers reporting families of experiments in high quality software engineering journals, that attempted to apply meta-analysis. We attempted to reproduce the reported meta-analysis results using the descriptive statistics and also investigated the validity of the meta-analysis process.\ud \ud Results\ud Out of 13 identified primary studies, we reproduced only five. Seven studies could not be reproduced. One study which was correctly analyzed could not be reproduced due to rounding errors. When we were unable to reproduce results, we provide revised meta-analysis results. To support reproducibility of analyses presented in our paper, it is complemented by the reproducer R package.\ud \ud Conclusions\ud Meta-analysis is not well understood by software engineering researchers. To support novice researchers, we present recommendations for reporting and meta-analyzing families of experiments and a detailed example of how to analyze a family of 4-group crossover experiments.

Fibromyalgia (FM) is a prevalent syndrome, characterised by chronic widespread pain, fatigue, and impaired sleep, that is challenging to diagnose and difficult to treat. The microbiomes of 77 women with FM and that of 79 control participants were compared using 16S rRNA gene amplification and whole-genome sequencing. When comparing FM patients with unrelated controls using differential abundance analysis, significant differences were revealed in several bacterial taxa. Variance in the composition of the microbiomes was explained by FM-related variables more than by any other innate or environmental variable and correlated with clinical indices of FM. In line with observed alteration in butyrate-metabolising species, targeted serum metabolite analysis verified differences in the serum levels of butyrate and propionate in FM patients. Using machine-learning algorithms, the microbiome composition alone allowed for the classification of patients and controls (receiver operating characteristic area under the curve 87.8%). To the best of our knowledge, this is the first demonstration of gut microbiome alteration in nonvisceral pain. This observation paves the way for further studies, elucidating the pathophysiology of FM, developing diagnostic aids and possibly allowing for new treatment modalities to be explored.

To determine whether a continuous intravenous infusion of standard amino acids could preserve kidney function after on-pump cardiac surgery.Adult patients scheduled to receive cardiac surgery lasting longer than 1 hour on-pump were randomized to standard care (n = 36) or an infusion of amino acids initiated immediately after induction of anesthesia (n = 33). The study's primary outcome measurements assessed renal function. These assessments included duration of renal dysfunction, duration and severity of acute kidney injury (AKI), estimated glomerular filtration rate (eGFR) over time, urine output, and use of renal-replacement therapy. Complications and other measures of morbidity were also assessed.Sixty-nine patients (mean age 71.5 [standard deviation 9.2] years; 19 of 69 women) were enrolled and randomized. Patients received coronary artery bypass graft surgery (37/69), valve surgery (24/69), coronary artery bypass graft and valve surgery (6/69), or other procedures (2/69). Mean on-pump time was 268 [standard deviation 136] minutes. Duration of renal dysfunction did not differ between the groups (relative risk, 0.86; 95% confidence interval [CI], 0.19-3.79, P = .84). However, patients who received the amino acid infusion had a reduced duration of AKI (relative risk, 0.02; 95% CI, 0.005-0.11, P .0001) and greater eGFR (+10.8%; 95% CI, 1.0%-20.8%, P = .033). Daily mean urine output was also significantly greater in patients who received the amino acid infusion (1.4 ± 0.5 vs 1.7 ± 0.9 L/d; P = .046).Commencing an infusion of standard amino acids immediately after the induction of anesthesia did not alter duration of renal dysfunction; however, other key measures of renal function (duration of AKI, eGFR and urine output) were significantly improved. These results warrant replication in multicenter clinical trials.

To examine the relationship between changes in prostate-specific antigen (PSA) by midpoint of salvage radiotherapy (SRT) for biochemically recurrent prostate cancer and long-term clinical outcomes. We conducted a retrospective study of men treated with SRT for biochemically recurrent prostate cancer at a single practice from 2004 to 2016. Patients were grouped based on PSA response at treatment midpoint: group 0, no change; group 1, decrease; group 2, increase. The primary endpoint was clinical failure measured from time of SRT completion and defined as serum PSA ≥ 0.2 ng/mL above post-radiotherapy nadir, initiation of androgen deprivation therapy, development of bone metastasis, or death from prostate cancer. The Kaplan-Meier method was used to estimate freedom from clinical failure for each group, and differences between groups were examined using pairwise multiple comparison. Median follow-up was 51.6 months (range, 3.3–138.0). Of 76 eligible men, 13.1% experienced no change in PSA at midpoint of SRT (group 0), 68.4% experienced a decrease (group 1), and 18.4% experienced an increase (group 2). Four-year freedom from clinical failure rates were as follows: group 0, 60.0%; group 1, 58.3%; and group 2, 41.7%. Median time to clinical failure was 71.7 months (95% confidence interval, 46.9–96.5) for group 1; 26.8 months (95% confidence interval, 0.0–55.9) for group 2; and was not reached for group 0. There was a significant difference in four-year freedom from clinical failure between groups 1 and 2 (p = 0.036). PSA changes by the midpoint of SRT predict long-term prostate cancer control with increases in PSA associated with decreased freedom from disease progression.

Objective: To determine the status of existing violence and injury prevention (VIP) efforts and surveillance systems in the Caribbean. Methods: The Caribbean Public Health Agency (CARPHA) undertook a survey to gather evidence of VIP in 24 CARPHA member states. The survey was administered to national epidemiologists and non-communicable disease focal points in October 2015 using an online tool, ‘Survey Monkey’. Questions were asked about the availability in each country of VIP representative surveys, policies, action plans, laws, victim support services, and surveillance systems. Results: Nineteen (79%) countries completed the VIP survey. Only three (16%) countries indicated having conducted a nationally representative survey. Twelve (63%) had not developed a national policy, and 14 (74%) had not implemented an action plan on VIP. Each country reported the existence of VIP laws and offered victim support services, though average law enforcement ranged from 40% to 79%. Nine (47%) countries indicated using an injury registry, and 15 (79%) reported collecting injury data using in-patient records, mainly from public hospitals. All 19 countries confirmed that records of reported violent incidents were maintained by the police. Unique identifiers were generally lacking in registries and data collected by the police. Only four (44%) countries with registries, 10 (67%) countries with in-patient injury data, and 12 (63%) countries with police records indicated that the data were shared with other organizations. Conclusion: Each country reported some level of injury surveillance system. However, such systems should be harmonized to produce more complete baseline data. The use of unique identifiers is required to reduce duplication and effectively link surveillance systems available in countries.

Objective To construct a comprehensive picture of the typical chronic rhinosinusitis (CRS) patient in the United States including the demographics, comorbidities, and geographic prevalence. The study will also identify the diagnostic and treatment regimens, their cost, and pattern of use for both medically and surgically managed patients. Study design Historical cohort study utilizing private and public payer databases. Methods Medical claims data from the Truven Health MarketScan Research Databases from the years 2010 to 2012 for patients with acute rhinosinusitis (ARS) and CRS 18 and older were analyzed. Results There were 54 million unique patients in the databases from 2010 to 2012. Approximately 8 million had at least one diagnosis of ARS and 298,337 had a diagnosis of CRS. Females represented 63.7% of patients with ARS and 59.4% with CRS. Medicare patients represented 6.7% of the ARS population and 10.2% of the CRS population. The mean cost of a CRS episode for those commercially insured was $1024 and $762 in Medicare. CRS patients underwent diagnostic procedures including diagnostic endoscopy (55.1%), cultures (23.6%), sinus CT scan (82.1%) and MRI (0.2%). Endoscopic sinus surgery (ESS) was performed on 14.4% of those patients with CRS. Change in frequency of medication use from the 6 months prior to ESS to the 6 months post-ESS yielded a reduction in total costs of 34.2% or $3.9 M. The most commonly operated sinuses (with or without septoplasty on same day as ESS) were the maxillary (94%/76.1%); followed by ethmoid (82.1%/66.6%); frontal (38.8%/35.1%); and sphenoid (28.5%/28.1%). In total, 16.6% had one sinus operated on, 39.1% had two, 24.6% had three, and 18.7% had four sinuses operated on. Conclusions This data paints a much clearer understanding of the current medical and surgical management. This study confirms the previously described "value proposition" for the surgical management of those CRS patients refractory to medical management. Level of evidence 4.

Background Uncertainty within cost-effectiveness analysis, often driven by lack of mature data from large clinical trials, plays a key role in decisions made by the National Institute for Health and Care Excellence (NICE), particularly for early access medicines and orphan drugs. Objectives In this case study, we used real-world evidence to address the uncertainty in the cost-effectiveness case for lenalidomide in transfusion-dependent low- and intermediate-1-risk myelodysplastic syndrome (MDS) deletion 5q [del(5q)], affecting a small but unique subpopulation with an orphan disease. Methods As part of a submission to NICE, we developed a cost-effectiveness model for lenalidomide, resulting in eventual recommendation. Results Due to data limitations within the trial evidence available, the model was based on surrogate outcomes supported by a disease-wide literature review. The validity of modelled estimates for critical long-term outcomes in terms of time on treatment (32% reaching 26 cycles when the patient access scheme applied in the model vs. 28% in the real-world data) and survival was confirmed using real-world evidence (projected median survival for best supportive care of 4.3 years vs. real-world evidence showing median survival with low- and intermediate-1-risk MDS of 5.7 and 3.5 years, respectively). Conclusion This case study demonstrates the usefulness and relevance of the application of real-world data when trial data are limited. Electronic supplementary material The online version of this article (10.1007/s41669-018-0110-3) contains supplementary material, which is available to authorized users.

INTRODUCTION: Breast cancer-related lymphedema occurs in up to 30% of women following axillary lymph node dissection (ALND) and less commonly following sentinel lymph node biopsy. To quantify disability in these patients, patient-reported outcome measures (PROMs) have proven useful; however, given the overlap of symptoms between ALND and lymphedema, examination of their accuracy, sensitivity, and specificity in detecting lymphedema in breast cancer patients undergoing ALND is needed. METHODS: The Lymphedema Life Impact Scale (LLIS) and the Upper Limb Lymphedema-27 scale (ULL27) were administered to patients who had undergone ALND at least 2 years prior and either did or did not develop lymphedema. Survey responses and the degree of disability were compared to generate receiver operator characteristic (ROC) curves and the sensitivity and specificity of PROMs to diagnose lymphedema were analyzed. RESULTS: Both PROMs were highly accurate, sensitive, and specific for detecting lymphedema. The LLIS had an accuracy of 97%, sensitivity of 100%, and specificity of 84.8% at a cutoff of ≥ 5.88 overall percent impairment score (higher scores indicate worse disability). The ULL27 had an accuracy of 93%, sensitivity of 88.6%, and specificity of 90.9% at a cutoff of ≤ 83.3 global score (lower scores indicate worse disability). CONCLUSIONS: The LLIS and the ULL27 appear to be highly specific for lymphedema and capable of differentiating it from symptoms resulting from ALND alone. Our findings suggest that use of these questionnaires with a threshold may be effective for diagnosing lymphedema, potentially reducing the need for frequent clinic visits and time-consuming measurements.

Wildlife calls are the best witnesses to the health of ecosystems, if only we know how to listen to them. Efforts to understand and inform restoration of healthy ecosystems with environmental audio recordings languish from insufficient tools to learn and identify sounds in recordings. To address this problem, we designed and playtested the Bristle Whistle Challenge prototype with ten players. We explored how to design delightful interactions with audio for gaining awareness of nature sounds and supporting wildlife conservation through citizen science. We found that rather than presenting audio alone, it was necessary to connect sounds to other senses and experiences in creative ways to impart meaning and enhance engagement. We offer recommendations to design creative and contextual interactions with media to build awareness of nature's wonders. We call for greater efforts in interaction design to engage people with nature, which is the key to turning around our environmental crisis.

Zoo-housed pelicans are commonplace, but their breeding record is poor and little research is published on the activity patterns, as potential predictors of nesting, of captive flocks. Existing literature shows that comparative research can provide useful information for husbandry and conservation planning for pelican populations. The opportunity arose to investigate the time-activity budget and social network of a breeding flock of captive great white pelicans. Three chicks were hatched in June and July 2016 and one in March 2017. Data on state behaviors, space use, and association preferences were collected around these nesting events, from October 2016 to February 2017 and July to October 2017. Results suggest that pre-nesting periods were associated with heightened flock-wide vigilance, suggesting that vigilance may be a precursor for courtship or nesting activity. Social network analysis revealed nonrandom associations between birds and a social structure across the flock, in which subadults seemed to associate more with each other than with adult birds. A limited visitor effect was noted; whilst no overall behavior change was apparent with different numbers of visitors, pelicans did widen their enclosure usage with increased visitor presence. These data are relevant to those attempting to breed this pelican, who wish to know more about the daily behavior patterns of this species across the season and physiological state, and who wish to understand pelican social structure, which is useful to the planning and implementation of bird moves or changes to the social environment of the flock. Further extending such research to include uninterrupted observation over a successful breeding event is recommended.

Background Global cardiovascular disease (CVD) burden is high and rising, especially in low-income and middle-income countries (LMICs). Focussing on 45 LMICs, we aimed to determine (1) the adult population’s median 10-year predicted CVD risk, including its variation within countries by socio-demographic characteristics, and (2) the prevalence of self-reported blood pressure (BP) medication use among those with and without an indication for such medication as per World Health Organization (WHO) guidelines. Methods and findings We conducted a cross-sectional analysis of nationally representative household surveys from 45 LMICs carried out between 2005 and 2017, with 32 surveys being WHO Stepwise Approach to Surveillance (STEPS) surveys. Country-specific median 10-year CVD risk was calculated using the 2019 WHO CVD Risk Chart Working Group non-laboratory-based equations. BP medication indications were based on the WHO Package of Essential Noncommunicable Disease Interventions guidelines. Regression models examined associations between CVD risk, BP medication use, and socio-demographic characteristics. Our complete case analysis included 600,484 adults from 45 countries. Median 10-year CVD risk (interquartile range [IQR]) for males and females was 2.7% (2.3%–4.2%) and 1.6% (1.3%–2.1%), respectively, with estimates indicating the lowest risk in sub-Saharan Africa and highest in Europe and the Eastern Mediterranean. Higher educational attainment and current employment were associated with lower CVD risk in most countries. Of those indicated for BP medication, the median (IQR) percentage taking medication was 24.2% (15.4%–37.2%) for males and 41.6% (23.9%–53.8%) for females. Conversely, a median (IQR) 47.1% (36.1%–58.6%) of all people taking a BP medication were not indicated for such based on CVD risk status. There was no association between BP medication use and socio-demographic characteristics in most of the 45 study countries. Study limitations include variation in country survey methods, most notably the sample age range and year of data collection, insufficient data to use the laboratory-based CVD risk equations, and an inability to determine past history of a CVD diagnosis. Conclusions This study found underuse of guideline-indicated BP medication in people with elevated CVD risk and overuse by people with lower CVD risk. Country-specific targeted policies are needed to help improve the identification and management of those at highest CVD risk., Author summary Why was this study done? CVD burden in low-income and middle-income countries (LMICs) is high and rising. CVD risk estimation using validated risk prediction equations is recommended in most guidelines; however, there are few population-representative analyses of CVD risk and its association with socio-demographic characteristics. Despite guidelines recommending using CVD risk estimates as an essential first step in guiding management practices, the extent to which risk-based approaches are being implemented in LMICs is not well characterised. What did the researchers do and find? We analysed population-representative survey data from 45 LMICs to determine country-specific levels of CVD risk, associations between socio-demographic factors and levels of CVD risk, and adherence to WHO guidelines on use of blood pressure medication. We found high variation in CVD risk profiles, with higher levels of risk in the Europe and the Eastern Mediterranean region and lower levels of risk in sub-Saharan Africa, as well as an inverse association between CVD risk and higher education and employment in most countries. We found an underuse of medicines in people at elevated CVD risk across all countries (only 24.2% of males and 41.6% of females at high CVD risk are taking guideline-recommended BP medication) and an overuse of medicines in people at lower levels of CVD risk, with 47% of all BP medication being used by people at low CVD risk without a guideline indication for use. What do these findings mean? There is large variation in CVD risk across LMICs, and an inverse association between CVD risk and higher education and employment in most countries. There is an overuse of medicines in people at lower levels of CVD risk and an underuse of medicines in people at elevated CVD risk across all countries. The large heterogeneity of the findings in this study reflects varying country contexts. Country-specific targeted policies are needed to improve the identification and management of those at highest CVD risk.