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The present study proposes a hybrid numerical technique to discuss the solution of non-linear reaction-diffusion equations with variable coefficients. The perturbation parameter was assumed to be time-dependent. The spatial domain was discretized using the cubic Hermite splines collocation method. These splines are smooth enough to interpolate the function as well as its tangent at the node points. The temporal domain was discretized using the Crank-Nicolson scheme, commonly known as the CN scheme. The cubic Hermite splines are convergent of order $ h^4 $, and the CN scheme is convergent of order $ \Delta t^2 $. The technique is found to be convergent of order $ O(h^{2}\big(\gamma_2 \varepsilon_j\Delta t + \gamma_0(1+\bar{\alpha})h^2\big)+\Delta t^2) $. The step size in the space direction is taken to be $ h $, and the step size in the time direction is $ \Delta t $. Stability of the proposed scheme was studied using the $ L_2 $ and $ L_{\infty} $ norms. The proposed scheme has been applied to different sets of problems and is found to be more efficient than existing schemes.

A robust assessment of water used in agriculture, including livestock production systems and supply chains, is critical to inform diversification and the development of productivity and sustainable food production systems. This paper presents a detailed analysis of water used and consumed in nine dairy milk processing plants spread across Punjab, India’s leading dairy milk-producing state. Over the five years (2015–2019), the direct water use (DWU) was quantified at 3.31 L of groundwater per kg of milk processed. Only about 26% of the direct water used was consumed, including evaporative losses in various milk processing operations, while the remaining 74% was returned as effluent discharges. The average total water footprint (TWF), accounting for both direct and indirect water consumption, was quantified at 9.0 L of water per kg of milk processed. The majority share (~89%) of the total water footprint was contributed by the indirect water footprint associated with the consumption of electricity (energy) in dairy milk processing activities. The plant’s milk processing capacity and processing products mix also affected significant seasonal and annual variations in the direct and indirect water footprints of dairy milk processing. The analysis also found an inverse relationship between the average total water footprint and the average monthly amount of milk processed in the study plants. Therefore, efforts to reduce the indirect water footprint (associated with energy consumption), the treatment and recycling of effluent discharges, and the optimization of milk processing capacity, the dairy processing product mix, and the locations of dairy processing plants are expected to help reduce the water footprint of dairy processing in the state.

One of the most significant challenges facing the healthcare industry in the digital age is interoperability. At the present, electronic health records (EHRs) including the medical history of the patient, laboratory tests, demographics, medication and allergies, immunization status, radiology images, vital signs all are hidden in isolated databases, incompatible systems and proprietary software, which creates biggest obstacles to data exchange, analyze, and interpret. Healthcare sector is realizing the thrust of a system which allows healthcare facilities to access, analyze, and enhanced communication between systems, medical devices, and applications at a local or cross-organizational level. Application Programming Interface (API) integration has become the most popular solution for managing the flow of data between internal applications, EHRs, and other data exchange tools in the healthcare industry by enabling applications to exchange data and functionality easily and securely. In this paper, we suggest that interoperability is a must for most of the upcoming medical advancements. Among various examples of emerging technologies like IoT, SaaS and cloud computing, APIs are the best tool in order to maximize the performance in terms of earning more income, better understanding their customers, etc. The paper highlights the benefits of API and suggests a framework of API led integration to improve the interoperability of patient health information between healthcare organizations while maintaining the privacy and security of data.

An annular ring microstrip antenna (ARMSA) with metallic drilled holes and a defected ground structure is proposed for ultra-wideband applications. The annular ring microstrip patch antenna is excited by the microstrip line feed. The outer radius of the annular ring was optimized in this paper to choose the resonant frequency corresponding to the highest mode. The inner radius boosts the structure’s gain. A defected conductive strip with an arc in the center increases bandwidth at the lower end, increases gain and suppresses Co and Cross-pole isolation. Incorporating a metallic via array excites and includes several closely spaced lower order modes, increasing the fractional bandwidth to 108%. The gain of the proposed configuration is 10dBi at the resonance frequency. It offers Front to back lobe ratio (FBR) of 34dB and 97% radiation efficiency. The performance of the fabricated prototype agrees well with the simulated one.

Aim: The present study was carried out to examine the association between periodontitis and glycated hemoglobin (HbA1c) in Type 2 diabetes mellitus adults. The objective of the study was to assess the effect of nonsurgical periodontal therapy on serum levels of HbA1c in patients with Type 2 diabetes mellitus and moderate-to-severe periodontitis. Material and Methods: The study population consisted of 78 Type 2 diabetes mellitus patients aged 30–70 years suffering from chronic generalized periodontitis. The patients were selected randomly from among the patients reporting at medicine outpatient department from July 2018 to August 2019. They were assessed for the presence or absence of gingival bleeding, presence or absence of periodontal pockets, and loss of attachment using the Community Periodontal Index (World Health Organization, 2013). Data were analyzed using the statistical package SPSS (version 21.0) and paired t-test at P < 0.05. Results: The mean reduction in haemoglobin levels of patients with moderate to severe periodontitis were significantly reduced by 1.19 in Group I, 0.51 in Group II, and 0.09 in Group III respectively after 3 months of nonsurgical periodontal therapy. This periodontal therapy was clinically effective and had a significant effect on the participant's glycemic control. Conclusion: This periodontal therapy was clinically effective and had a significant effect on the participant's glycemic control.

Purpose: Code smells are residuals of technical debt induced by the developers. They hinder evolution, adaptability and maintenance of the software. Meanwhile, they are very beneficial in indicating the loopholes of problems and bugs in the software. Machine learning has been extensively used to predict Code Smells in research. The current study aims to optimise the prediction using Ensemble Learning and Feature Selection techniques on three open-source Java data sets. Design and Results: The work Compares four varied approaches to detect code smells using four performance measures Accuracy(P1), G-mean1 (P2), G-mean2 (P3), and F-measure (P4). The study found out that values of the performance measures did not degrade it instead of either remained same or increased with feature selection and Ensemble Learning. Random Forest turns out to be the best classifier while Correlation-based Feature selection(BFS) is best amongst Feature Selection techniques. Ensemble Learning aggregators, i.e. ET5C2 (BFS intersection Relief with classifier Random Forest), ET6C2 (BFS union Relief with classifier Random Forest), and ET5C1 (BFS intersection Relief with Bagging) and Majority Voting give best results from all the aggregation combinations studied. Conclusion: Though the results are good, but using Ensemble learning techniques needs a lot of validation for a variety of data sets before it can be standardised. The Ensemble Learning techniques also pose a challenge concerning diversity and reliability and hence needs exhaustive studies.

Pig farming is stepping out from subsistence farming to commercial farming. In order to enhance the commercialized pork production for gaining self-sufficiency, it is necessary to study the production and related parameters of pig at farm level. This study aims to investigate the production parameters and disposal pattern of farm waste adopted by pig farmers in the Punjab. 90 piggery units were surveyed out of which sample size of total of 82 breeding-cum-finisher units of pig were categorized into small farms (< 10 sows), medium farms (10-25 sows) and large farms (> 25 sows). The study reveals that large size category favoured the ideal pig production parameters. It was observed that the 5.17 % of breedable sows were kept on an average for producing finisher pigs for sale (44.60 %). Large category was found having largest average litter size at birth (10.2). Similarly, average weight at saleable age of finisher pig is found to be highest in large size category (102.86 kg). Majority (59.07 %) of the small pig farmers dump the manure at waste heap or dispose it in the sewage posing environmental problems.

A comprehensive two phase non-linear mathematical model has been presented with special reference to particle geometry and pore radius of particles. Model equations have been divided into bulk fluid phase and particle phase. Bulk fluid phase is characterized by external fluid whereas particle phase signifies the intraparticle solute concentration and solute concentration adsorbed on particle surface. Interparticle solute concentration and the concentration of solute adsorbed on particle surface are related by Langmuir adsorption isotherm. Model equations have been discretized numerically by Hermite collocation method with quintic basis. Effect of different parameters has been shown via breakthrough curves. Model predicted values have been compared to experimental values given in literature to check the applicability of the model. Keywords: Péclet number, Biot number, Bed porosity, Pore radius of particles, Intraparticle diffusion coefficient

The present study has been carried out in South-Western and Central agro climatic regions of Punjab state for studying the cost-returns and marketing pattern of dairy and fish farming based integrated model. It was observed from the study that the net returns from crop farming was ` Rs.65,852 per farm per year, whereas the net returns on per acre basis were found to be ` Rs.32,328 per acre per year. Further, the net returns from dairy farming were found to be ` Rs. 4,928 per farm per year and ` Rs.8,822 per acre per year. From fish farming, net returns were observed to be ` Rs. 2, 47, 396 per farm per annum and ` Rs.84,725 per acre per year. Total profitability of the crop-dairy-fish farming integrated model was observed to be `Rs. 4,58,176 per farm per annum, and net returns per acre from this model were ` Rs. 53,030 per year. Hence, it may be inferred that dairy and fish farming are more profitable as compared to crops and when adopted in an integrated manner along with crops, can enhance the overall profitability of the farm by efficient utilisation of farm waste products and by-products. At the same time, there is need of creating awareness among the farmers regarding the importance of dairy and fish farming based integrated models, so that they can adopt these types of models for enhancing their income levels.

The present study has been carried out in three agro-climatic regions of Punjab state, i.e. Sub mountainous, Central and South-Western regions for examining the economics of different green fodder crops and importance of green fodder in enhancing the dairy profitability. The study consisted of a total sample size of 120 farmers growing green fodder crops and keeping dairy animals. It was observed from the study that the profitability from important green fodder crops based crop cycle is a little bit higher (bajra + berseem ` Rs.1,213) than the traditional wheat-paddy crop rotation (`Rs.49,005). It was found that proportion of green fodder in the cost of milk production was lower (12.12 per cent) if green fodder is home-produced compared to the market prices of green fodder (23.13 per cent). In this way, the expenditure on green fodder can be curtailed by about 13-14 per cent, which will curtail the overall cost of production of milk and enhance the productivity and profitability from milk production. A direct link between green fodder quantity and milk yield has been observed. Therefore, farmers need to motivated for enhancing the green fodder production for properly feeding the animals and further, they should try to increase the herd size so that higher profits from dairy farming can be realized.

The accurate simulation of microwave observations of clouds and precipitation are computationally challenging. A common simplification is the assumption of totally random orientation (TRO); however, studies have revealed that TRO occurs relatively infrequently in reality. A more appropriate assumption is that of azimuthally random orientation (ARO), but so far it has been a computationally expensive task. Recently a fast approximate approach was introduced that incorporates hydrometeor orientation into the assimilation of data from microwave conically scanning instruments. The approach scales the extinction in vertical (V) and horizontal (H) polarised channels to approximate ARO. In this study, the application of the approach was extended to a more basic radiative transfer perspective using the Atmospheric Radiative Transfer Simulator and the high-frequency channels of the Global Precipitation Measurement Microwave Imager (GMI). The comparison of forward simulations and GMI observations showed that with a random selection of scaling factors from a uniform distribution between 1 and 1.4–1.5, it is possible to mimic the full distribution of observed polarisation differences at 166 GHz over land and water. The applicability of this model at 660 GHz was also successfully demonstrated by means of existing airborne data. As a complement, a statistical model for polarised snow emissivity between 160 and 190 GHz was also developed. Combining the two models made it possible to reproduce the polarisation signals that were observed over all surface types, including snow and sea ice. Further, we also investigated the impact of orientation on the ice water path (IWP) retrievals. It has been shown that ignoring hydrometeor orientation has a significant negative impact (∼20% in the tropics) on retrieval accuracy. The retrieval with GMI observations produced highly realistic IWP distributions. A significant highlight was the retrieval over snow covered regions, which have been neglected in previous retrieval studies. These results provide increased confidence in the performance of passive microwave observation simulations and mark an essential step towards developing the retrievals of ice hydrometeor properties based on data from GMI, the Ice Cloud Imager (ICI) and other conically scanning instruments.

Active efflux due to tripartite RND efflux pumps is an important mechanism of clinically relevant antibiotic resistance in Gram-negative bacteria. These pumps are also essential for Gram-negative pathogens to cause infection and form biofilms. They consist of an inner membrane RND transporter; a periplasmic adaptor protein (PAP), and an outer membrane channel. The role of PAPs in assembly, and the identities of specific residues involved in PAP-RND binding, remain poorly understood. Using recent high-resolution structures, four 3D sites involved in PAP-RND binding within each PAP protomer were defined that correspond to nine discrete linear binding sequences or "binding boxes" within the PAP sequence. In the important human pathogen Salmonella enterica, these binding boxes are conserved within phylogenetically-related PAPs, such as AcrA and AcrE, while differing considerably between divergent PAPs such as MdsA and MdtA, despite overall conservation of the PAP structure. By analysing these binding sequences we created a predictive model of PAP-RND interaction, which suggested the determinants that may allow promiscuity between certain PAPs, but discrimination of others. We corroborated these predictions using direct phenotypic data, confirming that only AcrA and AcrE, but not MdtA or MsdA, can function with the major RND pump AcrB. Furthermore, we provide functional validation of the involvement of the binding boxes by disruptive site-directed mutagenesis. These results directly link sequence conservation within identified PAP binding sites with functional data providing mechanistic explanation for assembly of clinically relevant RND-pumps and explain how Salmonella and other pathogens maintain a degree of redundancy in efflux mediated resistance. Overall, our study provides a novel understanding of the molecular determinants driving the RND-PAP recognition by bridging the available structural information with experimental functional validation thus providing the scientific community with a predictive model of pump-contacts that could be exploited in the future for the development of targeted therapeutics and efflux pump inhibitors.

Type 1 diabetes is a challenging illness and needs lifelong diabetes self-care. At the same time, there is a significant stigma associated with it, especially with relation to marriage. There are concerns related to premarriage disclosure, marital relationship, ability to procreate, risk during pregnancy in women, and the risk of disease in children. In this document, we discuss the issue of disease-related stigma which may become a significant challenge for a prospective spouse and the impact of type 1 diabetes on marital relationships and procreation. We also highlight the need for premarriage counseling to ensure long-term success in achieving both individual and interpersonal well-being.

Creating software with high quality has become difficult these days with the fact that size and complexity of the developed software is high. Predicting the quality of software in early phases helps to reduce testing resources. Various statistical and machine learning techniques are used for prediction of the quality of the software. In this paper, six machine learning models have been used for software quality prediction on five open source software. Varieties of metrics have been evaluated for the software including C & K, Henderson & Sellers, McCabe etc. Results show that Random Forest and Bagging produce good results while Naïve Bayes is least preferable for prediction.

In this paper, mathematical modelling of TDFA for broadened gain spectrum and reduced noise figure has been carried out by keeping all practical parameters in consideration. A model of TDFA has been designed based on simulation after considering all the major parameters like ASE pump and signal power. The present research claims to support 96 DWDM channels across 1479 nm-1555 nm wavelength range, with a peak gain of 26 dB (without ASE) and with a peak gain 24 dB, ASE of 1.5 dBm for optimum fiber length of TDF as 10 m. With this proposed model, the gain of 24 dB and NF of 7 dB has been achieved.

A non-linear advection dispersion model involving Peclet number (Pe) and intraparticle diffusion coefficient is proposed for displacement washing process of porous particles. Non-linear model equations are solved using cubic Hermite collocation method (HCM) to compute exit and average solute concentrations. Effect of different parameters such as Peclet number, intraparticle diffusion coefficient and bed porosity (ε) has been discussed theoretically as well as graphically. Industrial parameter such as displacement ratio (DR) is calculated by using model predicted values. Effect of different parameters on displacement ratio, exit and average solute concentrations is discussed through surface plots.

Religion has been proposed as a means of enhancing patient and community acceptance of diabetes and cultural specific motivational strategies to improve diabetes care. Sikhism is a young and vibrant religion, spread across the world and the Holy Scripture Sri Guru Granth Sahib (SGGS) is regarded as the living Guru by all Sikhs. The three key pillars of Sikhism are Kirat Karni (honest living), Vand Chakna (sharing with others) and Naam Japna (focus on God). They can help encourage the diabetes care provider, patient and community to engage in lifestyle modification, shared responsibility, positive thinking and stress management. The verses (Sabads) from the SGGS, with their timeless relevance, span the entire spectrum of diabetes care, from primordial and primary, to secondary and tertiary prevention. They can provide us with guidance towards a holistic approach towards health and lifestyle related diseases as diabetes. The SGGS suggests that good actions are based on one's body and highlights the relevance of mind-body interactions and entraining the mind to cultivate healthy living habits. The ethics of sharing, community and inclusiveness all lay emphasis on the need for global and unified efforts to manage and reduce the burden of the diabetes pandemic.

Active fire observations with satellite instruments exhibit a well-documented increase of the detection threshold with increasing pixel footprint size, i.e., distance from the sub-satellite point. This results in a viewing angle-dependent, negative bias in gridded representations of the observed Fire Radiative Power (FRP), which in turn is frequently being used for climate monitoring of biomass burning and for pyrogenic emission inventories. We present a method based on quantile mapping to alleviate this bias and apply it to the gridded-FRP from the Moderate Resolution Imaging Spectroradiometer (MODIS) satellite instruments. The gridded-FRP observations are corrected with a correction function that depends on the satellite viewing angle and the magnitude of FRP in each grid cell. Assuming the fire observations at nadir to be the best representation of the truth, we derive a correction function by mapping cumulative distribution function (CDF) of off-nadir gridded-FRP to the CDF of near-nadir gridded-FRP. The method can be directly applied to correct the negative bias in gridded-FRP observations at a grid resolution of 1 ∘ or more. The performance of the correction methodology is confirmed through comparisons with co-located Visible Infrared Imaging Radiometer Suite (VIIRS) satellite observations: After bias correction, the gridded-FRP observations from both satellites agree better than before, particularly over savanna, tropical forests, and extra-tropical forests. Experiments with the Global Fire Assimilation System (GFAS) show that the impacts of the bias-corrected MODIS/Aqua gridded-FRP observations and VIIRS/Suomi-NPP gridded-FRP observations on regional FRP analyses are comparable, which confirms the potential for improving fire emission inventories and climate monitoring based on FRP.

Background: Pericoronal tissue is the soft tissue located between the bony crypt and the impacted tooth, which is histologically composed of fibrous connective tissue and is usually lined by the reduced enamel epithelium. Increased epithelial cell proliferation in the pericoronal tissue is associated with pathological changes such as development of an odontogenic cyst or an epithelial odontogenic tumor. This study is an attempt to evaluate and compare the proliferative index in the epithelium surrounding the impacted third molar teeth, dentigerous cysts, and gingiva. Materials and Methods: A case control study on pericoronal tissues and dentigerous cysts was carried out using immunomarkers. Forty pericoronal tissues were obtained from asymptomatic impacted third molars with pericoronal radiolucency less than 2.5 mm. Samples of 20 dentigerous cysts and normal gingiva were also included. Routine hematoxylin and eosin and immunostaining for Ki-67, a cell proliferation marker and Bcl-2, an anti apoptotic protein were performed on sections of pericoronal tissues, dentigerous cysts, and gingival tissues. The percentage of Ki-67-positive cells and Bcl-2 positive areas was found using the DigiPro™ version 4.0 Image analysis software. Bcl-2 immunopositivity and Ki-67-Li were analyzed using the Chi-square test and paired t-test. P- values of less than .05 were considered to indicate statistical significance. Results: The immunohistochemical analysis revealed overexpression of Bcl-2 in the pericoronal tissues with squamous metaplasia, which was comparable to the dentigerous cyst. Ki-67 Li of the pericoronal tissue with squamous metaplasia was equal to the proliferative index of the dentigerous cyst. The expression of Ki-67 Li and inflammatory cells were highly significant ( P < 0.0001). Conclusions: The results of this study indicate that the pericoronal tissues of asymptomatic impacted third molars may be actively proliferating and normal pericoronal radiolucency cannot serve as an indicator for the differentiation potential.

The preparation of polymer membrane selective to silver ion and its application to ion-selective electrode is reported here. PVC membrane contain silver-selective calix[4]arene derivative as ionophore. The membrane electrode is highly selective to silver ion and exhibit good linear response over a wide concentration range of 1.0×10-1 to 1.0×10-5M AgNO3 with Nernstian slope of 58.9 mV per decade. The detection limit of electrode is 6.31×10-6 M .The calix[4]arene based membrane electrode exhibit enhanced selectivities for silver ion over other cations; log KPotAg,Na = -2.35, log KPotAg,K= -2.65, log KPotAg,Mg = -4.57, log KPotAg,Ba = -4.10, log KPotAg,Cd = -3.42, log KPotAg,Pb = -3.45.Even the strongest interferent Hg2+ do not interfere to great extent, log KPotAg,Hg = -2.0.The electrode response is stable over wide pH range of 1.0-6.0. The response time of the sensor is 30 seconds and the membrane can be used for more than 6 months without observing any divergence. The sensor can also be applied as an indicator electrode for potentiometric titration of Ag+ ions with Cl-. It is possible to determine Ag(I) in the natural water spiked with silver with this electrode assembly.

In this article, we report on the experiences of newly arrived South Asian international students (undergraduate and graduate levels) with accessing healthcare services in a small town setting in British Columbia, Canada. The objective of the study was to better understand the barriers and facilitators of accessing healthcare services. We used a qualitative design with an exploratory approach and conducted 8 semi-structured interviews with South Asians students that had newly arrived in the city of Kamloops and had been enrolled at Thompson Rivers University (TRU) for less than 12 months. Findings included barriers such as needing more information during on campus orientation, inefficiencies of the healthcare system, and accessing healthcare service. Facilitators of accessing healthcare services included attending campus orientation, having a curiosity, and a social support system. These findings provide new knowledge regarding the barriers and facilitators of accessing healthcare in Canada. In order to better meet the needs of international students programs and services must be tailored to this unique group of students.

BACKGROUND AND OBJECTIVES: Since 2001, the American Academy of Pediatrics (AAP) has advocated for improving the effectiveness of early hearing screening, diagnosis, and intervention (EHDI) and reducing hearing health disparities through the medical home model of care (MHMOC). However, the scope of the MHMOC and its components and potential disparities among US children with deafness or hearing problems (DHH) have not been identified. METHODS: Data from the 2016 to 2020 National Survey of Children's Health (N = 174 551) were analyzed, including 12 121 children with DHH, 171 523 children without DHH, and 38 722 with other special health needs (SHCN). Univariable statistics and multivariable logistic regression were used to analyze the association of hearing problems with medical home composite and components and cohort disparities. RESULTS: After adjusting for sociodemographic characteristics,medical home carewas less likely for children with DHH (adjusted odds ratio: 0.74; 95% confidence interval: 0.56-0.97) compared with children without DHH. Children with DHH and SHCN were also less likely to receive medical home care compared with other SHCN children (adjusted odds ratio: 0.71; 95% confidence interval: 0.55-0.92). Specific medical home components significantly less prevalent among children with DHH included family-centered care, ease of referrals, and effective care coordination, whereas a usual source for sick carewasmore prevalent, although not statistically significant. CONCLUSIONS: Despite over two decades of efforts to improve EHDI through the medical home, rates of the MHMOC for children with DHH remain disparately low. Systems-level quality improvement efforts supporting the medical home will be necessary to allow the MHMOC to support early hearing detection and intervention (EHDI) systems. [ABSTRACT FROM AUTHOR]

Objective: To identify geographic, sociodemographic, and clinical factors associated with parental self‐efficacy in a diverse cohort of deaf or hard‐of‐hearing (DHH) children. Study Design: Cross‐sectional study. Setting: Tertiary children's hospital. Methods: Four hundred forty parents of DHH children aged 0 to 17 completed the 25‐item Scale of Parental Involvement and Self‐Efficacy (SPISE) survey from 2014 to 2022. Residential addresses were geocoded and assigned Area Deprivation Index and Social Vulnerability Index rankings, and univariable and multivariable analyses were conducted using sociodemographic and clinical variables, including sex, race/ethnicity, insurance type, survey language, age at the survey, comorbidities, newborn hearing screening results, and hearing loss laterality and severity. Results: Compared to English and Spanish‐speaking parents, Chinese‐speaking parents were associated with overall lower parental self‐efficacy and involvement (regression coefficient = −0.518, [−0.929, −0.106]), Cohen's d = 0.606) and lower scores on items related to their ability to affect multiple aspects of their child's development and expression of thoughts as well as competency in checking and putting on their child's sensory device. Across univariable and multivariable analyses, besides Chinese language, all other sociodemographic, clinical, and geographic variables were not associated with SPISE score. Conclusion: To achieve the best patient outcomes, care teams can use the SPISE to evaluate parental self‐efficacy and provide targeted support to parents at risk for having lower knowledge and confidence scores about critical skills necessary to facilitate their child's auditory access and language development. Notably, this study found similar reports of parental efficacy across various sociodemographic, clinical, and geographic variables but significantly lower SPISE scores in Chinese‐speaking families. [ABSTRACT FROM AUTHOR]

Objective: To identify sociodemographic factors associated with pediatric late‐identified hearing loss (LIHL) and classify novel subgroups within the LIHL population. Study Design: Retrospective cohort. Setting: Tertiary children's hospital. Methods: Our cohort included children with permanent hearing loss (HL) between 2012 and 2020 (n = 1087). Patients with early‐identified HL were compared to patients with LIHL (>6 months of age at diagnosis), and 3 subgroups: (1) late‐identified congenital HL: failed NHS but had a diagnostic audiogram >6 months old; (2) late‐onset HL: passed NHS and identified with HL after 6 months old; (3) late‐identified, unknown‐onset: unknown NHS results, identified after 6 months old. Geospatial analysis was performed using ArcGIS Pro. Results: Compared with early‐identified children, children with LIHL were more likely to have more comorbidities (odds ratio [OR] = 1.12, [1.01, 1.23]), be an under‐represented minority (URM) (OR = 1.92, [1.27, 2.93]) and have a higher social vulnerability index (SVI) (adjusted odds ratio [AOR] = 2.1, [1.14, 3.87]). However, subgroups in the LIHL cohort had variable associations. Children with late‐identified unknown onset hearing loss were uniquely associated with a primarily non‐English speaking household (AOR = 1.84, [1.04, 3.25]), whereas children with late‐onset hearing loss were less likely to have public insurance (AOR = 0.47, [0.27, 0.81]. There were no significant associations for children with late‐identified congenital hearing loss. Neighborhood disadvantage, as measured by SVI, had an increased association with late‐identified unknown onset HL (AOR = 4.08, [2.01, 8.28]) and a decreased association with late‐onset HL (AOR = 0.40, [0.22, 0.72]). Conclusion: Sociodemographic factors serve as proxies for health care access, and these factors vary across LIHL pathways. Understanding the risk factors associated with each LIHL subgroup may help address disparities in pediatric HL identification. [ABSTRACT FROM AUTHOR]

Objective: Examine the association between sociodemographic factors and Individualized Education Program (IEP) establishment. Design: Retrospective cohort study. Setting: Tertiary referral center. Methods: Participants included deaf or hard‐of‐hearing children who were eligible for an IEP with "deafness" or "hard of hearing" as a primary or secondary disability. Primary outcome measures were time intervals between initial referral for services and parental consent; parental consent to determination of eligibility; and initial referral to eligibility (the sum of the previous 2 intervals). Student's t tests and linear regression were used to examine the association between sociodemographic factors and the primary outcome variables. Results: Of the 88 participants, 51 (58%) were male, 45 (51%) were from underrepresented minority (URM) groups, 35 (40%) spoke a primary language other than English, and 53 (60%) utilized public insurance. IEP establishment was significantly delayed in participants who required an English‐language interpreter. Most of the delay occurred in the time between the initial referral and parental consent (mean: 115 vs 37 days, P =.02). There were also significant delays from the time of referral for services to eligibility in URM participants (mean: 159 vs 85 days, P =.04). Significant delays were also associated with Minority Status and Language within social vulnerability index percentile rankings. Conclusion: This study found that IEP establishment was delayed in both URM participants and those who required an English‐language interpreter. These results highlight the importance of clear communication between the school system and caregivers in the IEP establishment process, particularly with families who require an English‐language interpreter or identify as URM. [ABSTRACT FROM AUTHOR]