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Introduction: Noma is a gangrenous infection that destroys the orofacial structures and leaves the survivors with severe functional, psychosocial, and esthetic impairments. Malocclusion is one of the central sequelae that current Noma care often neglects. Aims: This study aimed to present the pattern of malocclusion in Noma survivors and highlight the role of orthodontic and orthognathic therapy in the management. Materials and Methods: This was a cross-sectional study conducted over 6 months. After obtaining institutional ethical approval, all noma survivors with permanent teeth, including complete upper and lower molars at least on one side, who presented for review were included in the study. Patients’ demographics, Angle class of malocclusion, and various malocclusions were recorded. Data obtained were analyzed using the statistical package for the social sciences (IBM SPSS) version 25. Results: There were 35 (54.7%) males and 29 (45.3%) females in the age range of 12–36 years and a mean ± standard deviation of 22.52 ± 6.01 years. Most patients, 52 (81.3%), have Angle class 1 molar relation. Protrusion of anterior teeth was present in 34 (53.1%), posterior crossbite in 8 (12.5%), upper and lower teeth crowding in 11 (17.2%), isolated upper anterior crowding in 9 (16.7%), isolated lower anterior crowding in 4 (6.3%), and open bite in 5 (7.8%). Other dental malalignments, such as rotations and tooth displacement, were invariably present in 34 (53.1%). Conclusion: Malocclusion in noma survivors constitutes one of the most observable problems of noma sequelae. Orthodontic and orthognathic therapy could promote these patients’ surgical, esthetic, and psychosocial rehabilitation.

Objective: The objective is to evaluate dental auxiliaries’ knowledge, attitudes, and practices for the prevention of noma disease. Materials and Methods: This was a cross-sectional study conducted over 6 months. After obtaining ethical clearance from the Sokoto and Zamfara State Ministries of Health, all consenting dental assistant staff who met the selection criteria were administered a validated questionnaire containing 17 questions assessing the respondents’ knowledge, attitudes, and practices. They were recruited using a self-administered questionnaire. The overall score was classified as “low” if the average score was 50% or less (50% or less), satisfactory (51%–69%), or good (70% or more). Data were analyzed using IBM SPSS version 20 software. Results: A total of 149 respondents returned the questionnaire, of which 80 (53.7%) were men and 69 (46.3%) were women. The mean ± standard deviation age of respondents was 27.37 ± 7.00 years, with a range of 20–58 years. The age of respondents was divided into four groups, and the majority of 112 respondents (75.2%) were in their 30s. The majority of respondents, 141 (94.6%), know about the prevention of noma disease. The total respondent score was 1827 points (72.1%), which was evaluated as “good.” Conclusion: Knowledge, attitudes, and practices of dental auxiliaries in the field of noma prevention are good. Dental auxiliaries, if supervised and appropriately trained, can play a role in noma prevention by actively participating in and disseminating information on specific preventive measures such as scaling and polishing.

Background: Noma is a major cause of mortality and morbidity in Nigeria and other sub-Saharan African countries with dire far-reaching consequences on the precarious health system and socioeconomic situation of the vulnerable population of the region. Aim: This study aimed to describe the demographic and socioeconomic determinants of noma patients and proffer workable strategies to check the trend. Materials and Methods: Relevant clinical data of the subjects such as demographics, socioeconomic factors, clinical outcome, and length of hospital stay were recorded and analyzed using SPSS version 25. Results: A total of 178 case records of patients managed with noma were included and there were 76 (42.7%) males and 102 (57.3%) females. The age range of the study subjects was 1-33 years with mean±SD of 6.23±4.63. The majority of the subjects 172 (96.6%) were from rural communities, farming 126 (70.8%) was the main source of income of the study subjects. All the subjects were from poor households with low socioeconomic status and most of the subjects 175 (8.3%) were not enrolled in formal education. Measles 81 (45.5%) and malnutrition 78 (43.8%) were the most common risk factors identified. Good clinical outcome was recorded with 23 days average length of hospital stay. Conclusion: Demographic and socioeconomic determinants play a crucial role in the occurrence of noma and attention to vulnerable age groups by removing health inequities, fair distribution of resources, and poverty alleviation and improving the living conditions of the affected people would lead to the eradication of the scourge.

Abstract Background Heart failure (HF) with preserved or mildly reduced ejection fraction includes a heterogenous group of patients. Reclassification into distinct phenogroups to enable targeted interventions is a priority. This study aimed to identify distinct phenogroups, and compare phenogroup characteristics and outcomes, from electronic health record data. Methods 2,187 patients admitted to five UK hospitals with a diagnosis of HF and a left ventricular ejection fraction ≥ 40% were identified from the NIHR Health Informatics Collaborative database. Partition-based, model-based, and density-based machine learning clustering techniques were applied. Cox Proportional Hazards and Fine-Gray competing risks models were used to compare outcomes (all-cause mortality and hospitalisation for HF) across phenogroups. Results Three phenogroups were identified: (1) Younger, predominantly female patients with high prevalence of cardiometabolic and coronary disease; (2) More frail patients, with higher rates of lung disease and atrial fibrillation; (3) Patients characterised by systemic inflammation and high rates of diabetes and renal dysfunction. Survival profiles were distinct, with an increasing risk of all-cause mortality from phenogroups 1 to 3 (p

Abstract Background Cardiac troponin is commonly raised in patients presenting with malignancy. The prognostic significance of raised troponin in these patients is unclear. Objectives We sought to investigate the relation between troponin and mortality in a large, well characterised cohort of patients with a routinely measured troponin and a primary diagnosis of malignancy. Methods We used the National Institute for Health Research (NIHR) Health Informatics Collaborative data of 5571 patients, who had troponin levels measured at 5 UK cardiac centres between 2010 and 2017 and had a primary diagnosis of malignancy. Patients were classified into solid tumour or haematological malignancy subgroups. Peak troponin levels were standardised as a multiple of each laboratory’s 99th -percentile upper limit of normal (xULN). Results 4649 patients were diagnosed with solid tumours and 922 patients with haematological malignancies. Raised troponin was an independent predictor of mortality in all patients (Troponin > 10 vs.

The physical and sorption properties of wood are critical factors influencing its performance in various applications. These properties affect the strength and durability of wood products. Understanding these properties is essential for developing wood-based materials. This study focuses on the experimental investigation of Gmelina arborea timber to evaluate its sorption properties. The methodology involved a series of tests following ASTM, ISO, and BS standards to measure density, shrinkage and other various sorption properties. Key results showed a mean green moisture content of 141.28%, a basic density of 505.03 kg/m³, a dry density of 540.28 kg/m³, and a density at 12% moisture content of 555.17 kg/m³. The timber exhibits a volumetric shrinkage and swelling of 8.71% and 8.26%, tangential shrinkage and swelling of 5.19 and 4.96%, radial shrinkage and swelling of 3.72% and 2.82%, and longitudinal shrinkage and swelling of 1.19% and 0.48% respectively. The ratio of tangential to radial shrinkage was computed as 1.4, which indicates reliable dimensional stability of the timber. Gmelina arborea absorbs 94.7% water over a soaking period of 1272 hours and loses 83.18% moisture during drying to reach an equilibrium moisture content of approximately 12%. Therefore, Gmelina arborea shows good potential for use in the development of Engineered Wood Products such as Cross-laminated timber.

Background Reduced estimated glomerular filtration rate (eGFR) is associated with lower use of invasive management and increased mortality after acute coronary syndrome (ACS). The reasons for this are unclear.Methods A retrospective clinical cohort study was performed using data from the English National Institute for Health Research Health Informatics Collaborative (2010–2017). Multivariable logistic regression was used to investigate whether eGFR

Abstract Background Canada legalized recreational cannabis in 2018, and one of the primary objectives of the Cannabis Act was to protect youth by reducing their access to cannabis and providing public education. Canada has the highest prevalence of cannabis use worldwide, particularly among youth and young adults under the age of 25. Cannabis use is linked with many adverse effects for youth and young adults including psychosis, anxiety, depression, respiratory distress, cannabinoid hyperemesis syndrome, and impaired cognitive performance. Despite the high prevalence of cannabis use and the evolution of policies in Canada and globally, significant knowledge and research gaps remain regarding youth and young adult cannabis use. The aim of this scoping review is to map the extent, nature, and range of evidence available on youth and young adult cannabis use in Canada since its legalization, in order to strengthen policies, services, treatments, training, and public education strategies. Methods Using a scoping review framework developed by Arksey and O’Malley, along with the PRISMA-ScR guidelines, we conducted a rigorous search in five academic databases: MEDLINE, Embase, APA PsycINFO, CINAHL and Web of Science Core Collection. We included empirical studies that collected data in Canada after the legalization of recreational cannabis (October 2018) and focused on youth or young adults

Background The pandemic exacerbated burnout experienced by healthcare personnel, whose mental health had long been a public health concern before COVID-19. This study used the Copenhagen burnout inventory (CBI) tool to assess burnout and identify predictors among Indian healthcare workers managing COVID-19. Methods A cross-sectional study was conducted from June to December 2022, after the third pandemic wave. A web-based, fillable Google form was used to recruit COVID-19 management professionals from multiple Jaipur district hospitals. Healthcare professionals provided socio-demographic, work-related, and CBI scores. Multiple linear regression was used to control for model covariant independent variables. Results We evaluated the responses of a total of 578 participants with a mean age of 36.59 ± 9.1 years. Based on the CBI cut-off score of 50, 68.1% reported burnout. A total of 67.5%, 56.4%, and 48.6% of healthcare workers reported work-related, personal, and patient-related burnout, respectively. High burnout scores were significantly associated with the nursing profession (β = 7.89, 95% CI; 3.66, 12.11, p

Background: Embracing women’s experiences in decision-making is imperative for continuity in effective coordination of maternal and neonatal health (MNH); women are the end users within the care ecosystem. Through women’s continuous feedback, skilled birth attendants (SBAs) and the healthcare system get to understand emerging issues based on their needs and preferences. Aim: The purpose of this article is to describe women’s experiences of continuity for effective coordination of care through the transitions in the MNH continuum in Kenya. Setting: The study was conducted in selected counties of Kenya based on birth rates per woman as follows: Wajir (7.8) Narok (6.0) Kirinyaga (2.3) and Nairobi (2.7) (1). The clients were interviewed concerning their experiences of the MNH continuum of care in English and Kiswahili. Methods: An interpretive hermeneutic phenomenological approach was used to construct the experiences of women of continuity during transitions in the MNH continuum for effective care coordination. Twelve participants were interviewed between January and April 2023. Atlas ti 22 software was used for data analysis. Results: Four women experiences were highlighted: Women unawareness of preconception care, use of prenatal care, labour, birthing and postpartum flow and the women’s view on the MNH continuum. Conclusion: The women reported their segmental and transitional experience of the MNH continuum as one that did not consistently meet their needs and preferences in order for them to fully agree that the continuum enhanced continuity for effective coordination. They felt that they experienced continuity in some segments while in some they did not. Contribution: The embrace of women’s experience of their needs and preferences through the MNH continuum (segments and transitional segments) through the lens of continuity for effective coordination is timely towards the improvement of maternal and neonatal care by 2030.

Abstract BackgroundArtificial intelligence (AI) chatbots have the potential to assist individuals with chronic health conditions by providing tailored information, monitoring symptoms, and offering mental health support. Despite their potential benefits, research on public attitudes toward health care chatbots is still limited. To effectively support individuals with long-term health conditions like long COVID (or post–COVID-19 condition), it is crucial to understand their perspectives and preferences regarding the use of AI chatbots. ObjectiveThis study has two main objectives: (1) provide insights into AI chatbot acceptance among people with chronic health conditions, particularly adults older than 55 years and (2) explore the perceptions of using AI chatbots for health self-management and long COVID support. MethodsA web-based survey study was conducted between January and March 2023, specifically targeting individuals with diabetes and other chronic conditions. This particular population was chosen due to their potential awareness and ability to self-manage their condition. The survey aimed to capture data at multiple intervals, taking into consideration the public launch of ChatGPT, which could have potentially impacted public opinions during the project timeline. The survey received 1310 clicks and garnered 900 responses, resulting in a total of 888 usable data points. ResultsAlthough past experience with chatbots (PP ConclusionsAI hesitancy is not uniform across all health domains and user groups. Despite persistent AI hesitancy, there are promising opportunities for chatbots to offer support for chronic conditions in areas of lifestyle enhancement and mental well-being, potentially through voice-based user interfaces.

The Taloka formation Sokoto Basin, Nigeria, was studied in an effort to discover and map the structural features favourable for metalliferous mineral deposits. High-resolution aeromagnetic data was subjected to structural analysis in order to map and highlight structural lineaments and their trends, as well as the depth of magnetic source bodies. Several digital filtering approaches were used to analyze, process, and interpret the data, including total gradient, total horizontal derivative of tilt of angle derivative (THDR_TDR), source parameter imaging (SPI), and spectral depth analysis. The RTE method was employed to prevent the North-South signal from predominating the results because the area was within the low latitude zones. The eastern Gundumi formation (Marafaro, Rujin Tsamia, Kwanawa, Dande, and Rikaka), the northeastern Taloka formation (Dutsen Bature, Bange, and Kumazo), and the western Taloka formation (Bejiji, Bagu, Danjiru, Baranzaki, and Awakala) are all found to have low amplitude magnetic anomalies. The research area exhibits magnetic anomalies with strong amplitudes (0.078 nT/m), which are consistent with the total gradient (AS) approach and might be caused by ferromagnetic minerals like iron stone. The aforementioned filters were also used to outline the lineaments (such as faults, fractures, or shear zones) believed to be associated with alteration zones, which are essential in locating the mineralized zones. The lineaments typically trend in the E-W, NW-SE, and NE-SW directions. Utilizing the SPI techniques, the depth of occurrence of the causative bodies was found to be below 250.3 m. The crustal magnetic field values were utilized to generate the two-dimensional Fourier transforms, from which the radial spectrum was recovered. The depth values were calculated using the slopes of the sixteen sections' spectrum energy against frequency graph. According to the findings, the study area's deeper depth lies between 1.10 and 1.69 km, while its shallower depth lies between 0.39 and 0.90 km. The study finds that alteration zones may harbour minerals and that the thickness of the sedimentary layer may not be sufficiently buoyant to support the build-up of hydrocarbons but will enhance the possibility of other mineralization.

The excessive use of glufosinateËammonium herbicide and carbofuran insecticide in agriculture leaves residues on agricultural samples and contaminates groundwater and surface water bodies through surface runoff and through leaching. To monitor pollution from the use of these pesticides, two simple, accurate and precise optical methods for their determination have been developed and validated in the commercial formulation and agricultural samples, viz., water, grains and vegetables. The first method is based on the reaction of the amino function of both pesticides with carbon disulfide and Ni(II) acetate in an aqueous acetonitrile medium and the measurement of color developed at 380 and 365 nm for glufosinateËammonium and carbofuran, respectively. Beer's law was valid within a concentration range of 0.4-8 and 0.4-9 [micro]g/mL for glufosinateËammonium and carbofuran, respectively. The second spectrofluorimetric method is based on the condensation of the primary amino group of glufosinateËammonium and carbofuran with acetylacetone and formaldehyde (Hantzsch reaction) in the presence of buffer of pH 5.5 producing a yellowËcolored product. The fluorescence intensity of the reaction products was measured at an emission wavelength of 470 nm after excitation at a wavelength of 380 nm for glufosinate-ammonium and 388 nm for carbofuran. The linearity range found was 0.13-5 and 0.14-6 [micro]g/ mL for glufosinateËammonium and carbofuran respectively. All the variables affecting the reactions, such as hydrolysis time, heating time, pH, concentration and volume of reagent were carefully studied and optimized. The high recoveries of glufosinate-ammonium and carbofuran from spiked water, grain and vegetable samples in both methods indicate good accuracy and precision of the methods., Author(s): Nisha Sharma [sup.1] , Ankita Kaura [sup.1] , Akhil Chaudhary [sup.1] Author Affiliations: (1) https://ror.org/02s5yma07, grid.412137.2, 0000 0001 0744 1069, Department of Chemistry, Himachal Pradesh University, , 171005, Shimla, [...]

ObjectiveThe COVID-19 pandemic was associated with a reduction in the incidence of myocardial infarction (MI) diagnosis, in part because patients were less likely to present to hospital. Whether changes in clinical decision making with respect to the investigation and management of patients with suspected MI also contributed to this phenomenon is unknown.MethodsMulticentre retrospective cohort study in three UK centres contributing data to the National Institute for Health Research Health Informatics Collaborative. Patients presenting to the Emergency Department (ED) of these centres between 1st January 2020 and 1st September 2020 were included. Three time epochs within this period were defined based on the course of the first wave of the COVID-19 pandemic: pre-pandemic (epoch 1), lockdown (epoch 2), post-lockdown (epoch 3).ResultsDuring the study period, 10,670 unique patients attended the ED with chest pain or dyspnoea, of whom 6,928 were admitted. Despite fewer total ED attendances in epoch 2, patient presentations with dyspnoea were increased (p

IntroductionEjection fraction (EF) is widely used to evaluate heart function during heart failure (HF) due to its simplicity compared but it may misrepresent cardiac function during ventricular hypertrophy, especially in heart failure with preserved EF (HFpEF). To resolve this shortcoming, we evaluate a correction factor to EF, which is equivalent to computing EF at the mid-wall layer (without the need for mid-layer identification) rather than at the endocardial surface, and thus better complements other complex metrics.MethodThe retrospective cohort data was studied, consisting of 2,752 individuals (56.5% male, age 69.3 ± 16.4 years) admitted with a request of a troponin test and undergoing echocardiography as part of their clinical assessment across three centres. Cox-proportional regression models were constructed to compare the adjusted EF (EFa) to EF in evaluating risk of heart failure admissions.ResultComparing HFpEF patients to non-HF cases, there was no significant difference in EF (62.3 ± 7.6% vs. 64.2 ± 6.2%, p = 0.79), but there was a significant difference in EFa (56.6 ± 6.4% vs. 61.8 ± 9.9%, p = 0.0007). Both low EF and low EFa were associated with a high HF readmission risk. However, in the cohort with a normal EF (EF ≥ 50%), models using EFa were significantly more associative with HF readmissions within 3 years, where the leave one out cross validation ROC analysis showed a 18.6% reduction in errors, and Net Classification Index (NRI) analysis showed that risk increment classification of events increased by 12.2%, while risk decrement classification of non-events decreased by 16.6%.ConclusionEFa is associated with HF readmission in patients with a normal EF.

Introduction: The escalating prevalence of obesity worldwide increases the risk of chronic diseases and diminishes life expectancy with growing economic burden necessitating intervention.1 The existing tiered approach to weight management, particularly specialist Tier 3 services, falls short of meeting the population's needs. The emergence of digital health tools, while promising, lacks exploration in specialised NHS weight management services (WMS). Methods: This was a service evaluation study to evaluate the effectiveness and clinical impact of the W8Buddy digital support tool as part of a specialist WMS. W8buddy was collaboratively developed September 2022 with input from patients and clinical teams. It is a personalised platform, offering users a tailored weight management plan to empower individuals or caregivers to cultivate the necessary attitudes, knowledge, and skills to self-manage their health. All patients accessing the service were offered W8buddy and everyone received standard of care regardless of whether they used the digital tool. No financial incentives were given for using W8Buddy. Results: Complete data was available for 226 patients (118 users, 108 non-users). W8buddy users, predominantly female (80%) and Caucasian (76%), had a mean age of 42 years, while non-users averaged 48 years (p = 0.01). Co-morbidity frequencies were comparable between users and non-users. Users had significantly higher baseline weight (135 kg vs. 123 kg, p = 0.003) and BMI (48 kg/m² vs. 45 kg/m², p = 0.009). During follow-up (3 months for users, 6 months for non-users), 28% (n = 220/783) activated the tool by June 2023, of which 93% (n = 205/220) actively engaged with the platform. W8Buddy demonstrated a substantial impact on absolute weight loss (β -1.16, SE 0.40, p = 0.004) compared to standard care alone. Time using W8Buddy was a crucial predictor of weight loss (p = 0.05), with a 0.74 kg monthly loss compared to standard care (β -0.74, 95%CI (-1.28, -0.21), p = 0.007). W8buddy users with type 2 diabetes (T2DM) experienced a significant HbA1c reduction (59.8 mmol/mol to 51.2 mmol/mol, p = 0.018) compared to non-users with T2DM. Optional surveys evaluating psychological outcomes included satisfaction with life, PHQ8, Karolinska scale, and quality of life score (EQ5D5L). W8Buddy users showed significant improvement across all psychological outcomes (p

Background: Informational continuity ensures that all health and psychosocial information of the pregnant women is available at all encounters with healthcare providers. The World Health Organization recognised that ineffective informational continuity during birth contributed to fragmented care and duplication of services, which ultimately influenced the morbidity and mortality rates of the pregnant women. Aim: The aim of this study was to delve into the midwives’ experiences on informational continuity approaches that enable effective care coordination during birth within the primary health care setting. Setting: The study setting was two maternity obstetric units (MOUs) in the Western Cape, South Africa. Methods: A qualitative descriptive phenomenological design was used. Participants were recruited by using purposive sampling. Interviews were audiorecorded, transcribed verbatim and analysed. Results: Three themes emerged from the findings. Theme one: adequate sharing of information with women during the intrapartum period. Theme two: efficient transition of information among midwives and other healthcare providers during the intrapartum period. Theme three: challenges to informational continuity during the intrapartum period. Conclusion: Communication with the women as well as with other healthcare providers during birth was effective. However, with minimal challenges, informational continuity was effectuated through communication among the midwives, the pregnant women and other healthcare providers. Contribution: Informational continuity approaches among the midwives, with the women and between healthcare facilities are a prerequisite to ensure continuity of care and care coordination during birth.

Background: The near-miss approach assumes that mothers facing life-threatening conditions such as severe pre-eclampsia and postpartum haemorrhage share common risk factors. Among these women, those who survive (near-miss cases) can offer insights into the determinants, providing valuable lessons for understanding underlying factors. Aim: To investigate elements of continuity and coordination leading to obstetric near misses. Setting: A major referral hospital and its referral pathway in Kenya. Methods: Explanatory sequential mixed-methods design. Results: Near-miss survivors had lower continuity and coordination of care indices during antenatal visits (COCI = 0.80, p = 0.0026), (modified continuity of care index [MCCI] = 0.62, p = 0.034), and those with non-life-threatening morbidity in the first trimester were more likely to experience a near miss (aOR = 4.34, p = 0.001). Facilities in the western region had a higher burden of near misses compared to the Eastern region. Qualitatively, three deductive themes were identified: sequential coordination, parallel coordination and continuity, along with factors classified as access. In mixed integration, poor continuity indices were explained by quality of interpersonal relationships and woman centredness. Poor coordination was explained by inadequate teamwork between providers in referring and referral facilities and between primary health facilities and the community. Higher near-miss rates in the western region resulted from differences in human and physical resources. Conclusion: Promoting woman-centred care, teamwork, improving communication and introducing innovative coordination roles like case and care managers can enhance continuity and coordination of maternal healthcare. Contributions: This study contributes to our understanding of the challenges of continuity and coordination in maternal healthcare in resource-poor settings by applying the WHO operationalisation of continuity and coordination using mixed methodology.

The increasing demand for fine aggregates in turn has led to the astronomical increase in the cost of procuring construction materials thereby making it difficult to meet the shelter provision requirement of the teeming population of a country such as Nigeria. This study aims at optimizing and developing predictive models on the strengths and durability of reinforced laterized concrete using response surface methods with laterite being used as a partial replacement of fine aggregate in reinforced concrete. In this study, the optimized laterite content was determined at replacement level of laterite to fine aggregates at 0, 10, 20, 30 and 40% with a mix ratio of 1:2:4 and a water cement ratio of 0.65, while for the water absorption, the percentages replacement of laterite to fine aggregates was 0, 10 and 20%. The results of the strength and the durability obtained from the laboratory were subjected to statistical analysis using design expert software version 13(2021). The strength and the durability were found to be 19.044 N/mm2, 27.304 N/mm2 and 3.809% for the compressive strength, flexural strength and water absorption at 10% laterite content at 28 days curing age. It was concluded that, to achieve the maximum strength (compressive and flexural) and durability requirements of laterized concrete should be produced by replacing fine aggregate with 10% laterite and cured at 28 days. The developed models could be used for the predictions of desired strengths and durability of the reinforced laterized concrete.

Constantinos Kallis,1– 3 Amit Kaura,1,3 Nathan A Samuel,4 Abdulrahim Mulla,3 Ben Glampson,3 Kevin O’Gallagher,5 Jim Davies,4 Dimitri Papadimitriou,3 Kerrie J Woods,4 Anoop D Shah,6,7 Bryan Williams,6,7 Folkert W Asselbergs,6,7 Erik K Mayer,3,8 Richard W Lee,1,9 Christopher Herbert,10 Stuart W Grant,11 Nick Curzen,12 Iain B Squire,13 Thomas Johnson,14 Ajay M Shah,15 Divaka Perera,5 Rajesh K Kharbanda,4 Riyaz S Patel,6 Keith M Channon,4 Jamil Mayet,1,3 Jennifer K Quint1– 3 1National Heart and Lung Institute, Imperial College London, London, UK; 2School of Public Health, Imperial College London, London, UK; 3NIHR Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, London, UK; 4NIHR Oxford Biomedical Research Centre, University of Oxford and Oxford University Hospitals NHS Foundation Trust, Oxford, UK; 5NIHR King’s Biomedical Research Centre, King’s College London and King’s College Hospital NHS Foundation Trust, London, UK; 6NIHR University College London Biomedical Research Centre, University College London and University College London Hospitals NHS Foundation Trust, London, UK; 7Institute of Health Informatics, University College London, London, UK; 8Imperial Clinical Analytics, Research & Evaluation (iCARE) and Department of Surgery & Cancer, Imperial College London, London, UK; 9Early Diagnosis and Detection Centre, NIHR BRC at The Royal Marsden and Institute of Cancer Research, London, UK; 10NIHR Leeds Clinical Research Facility, Leeds Teaching Hospitals Trust and University of Leeds, Leeds, UK; 11NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust and the University of Manchester, Manchester, UK; 12NIHR Southampton Clinical Research Facility and Biomedical Research Centre, Faculty of Medicine, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK; 13NIHR Leicester Biomedical Research Centre, Glenfield Hospital, and Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; 14NIHR Bristol Biomedical Research Centre, University of Bristol and University Hospitals Bristol NHS Foundation Trust, Bristol, UK; 15NIHR Guys & St Thomas’ Hospital Clinical Research Facility, King’s College Hospital, and King’s College London British Heart Foundation Centre of Excellence, London, UKCorrespondence: Jennifer K Quint, School of Public Health, Imperial College London, Floor 9, Sir Michael Uren Building, 86 Wood Ln, London, W12 0BZ, United Kingdom, Email j.quint@imperial.ac.ukBackground: No single biomarker currently risk stratifies chronic obstructive pulmonary disease (COPD) patients at the time of an exacerbation, though previous studies have suggested that patients with elevated troponin at exacerbation have worse outcomes. This study evaluated the relationship between peak cardiac troponin and subsequent major adverse cardiac events (MACE) including all-cause mortality and COPD hospital readmission, among patients admitted with COPD exacerbation.Methods: Data from five cross-regional hospitals in England were analysed using the National Institute of Health Research Health Informatics Collaborative (NIHR-HIC) acute coronary syndrome database (2008– 2017). People hospitalised with a COPD exacerbation were included, and peak troponin levels were standardised relative to the 99th percentile (upper limit of normal). We used Cox Proportional Hazard models adjusting for age, sex, laboratory results and clinical risk factors, and implemented logarithmic transformation (base-10 logarithm). The primary outcome was risk of MACE within 90 days from peak troponin measurement. Secondary outcome was risk of COPD readmission within 90 days from peak troponin measurement.Results: There were 2487 patients included. Of these, 377 (15.2%) patients had a MACE event and 203 (8.2%) were readmitted within 90 days from peak troponin measurement. A total of 1107 (44.5%) patients had an elevated troponin level. Of 1107 patients with elevated troponin at exacerbation, 256 (22.8%) had a MACE event and 101 (9.0%) a COPD readmission within 90 days from peak troponin measurement. Patients with troponin above the upper limit of normal had a higher risk of MACE (adjusted HR 2.20, 95% CI 1.75– 2.77) and COPD hospital readmission (adjusted HR 1.37, 95% CI 1.02– 1.83) when compared with patients without elevated troponin.Conclusion: An elevated troponin level at the time of COPD exacerbation may be a useful tool for predicting MACE in COPD patients. The relationship between degree of troponin elevation and risk of future events is complex and requires further investigation.Keywords: COPD, CVD, exacerbation

Abstract Background People Who Use Drugs (PWUD) have lower vaccination uptake than the general population, and disproportionately experience the burden of harms from vaccine-preventable diseases. We conducted a national qualitative study to: (1) identify the barriers and facilitators to receiving COVID-19 vaccinations among PWUD; and (2) identify interventions to support PWUD in their decision-making. Methods Between March and October 2022, semi-structured interviews with PWUD across Canada were conducted. Fully vaccinated (2 or more doses) and partially or unvaccinated (1 dose or less) participants were recruited from a convenience sample to participate in telephone interviews to discuss facilitators, barriers, and concerns about receiving COVID-19 vaccines and subsequent boosters, and ways to address concerns. A total of 78 PWUD participated in the study, with 50 participants being fully vaccinated and 28 participants partially or unvaccinated. Using thematic analysis, interviews were coded based on the capability, opportunity, and motivation-behavior (COM-B) framework. Results Many partially or unvaccinated participants reported lacking knowledge about the COVID-19 vaccine, particularly in terms of its usefulness and benefits. Some participants reported lacking knowledge around potential long-term side effects of the vaccine, and the differences of the various vaccine brands. Distrust toward government and healthcare agencies, the unprecedented rapidity of vaccine development and skepticism of vaccine effectiveness were also noted as barriers. Facilitators for vaccination included a desire to protect oneself or others and compliance with government mandates which required individuals to get vaccinated in order to access services, attend work or travel. To improve vaccination uptake, the most trusted and appropriate avenues for vaccination information sharing were identified by participants to be people with lived and living experience with drug use (PWLLE), harm reduction workers, or healthcare providers working within settings commonly visited by PWUD. Conclusion PWLLE should be supported to design tailored information to reduce barriers and address mistrust. Resources addressing knowledge gaps should be disseminated in areas and through organizations where PWUD frequently access, such as harm reduction services and social media platforms.

Childbearing is associated with memories from experiences encountered during the childbearing journey. Besides the physiological and biological nature of pregnancy and birth, culture influences experiences and the meanings of surroundings. Care providers should be prepared to provide culturally safe care for a positive childbearing experience. Therefore, this study aimed to explore women's experiences with cultural practices during pregnancy and birth for insights to advise responsive healthcare to optimise positive childbearing outcomes. Methods: A qualitative phenomenological study was conducted between October 2020 and January 2021. A semi-structured interview guide was piloted with two women (one during pregnancy and the other postpartum). Individual interviews and data analysis were conducted inductively and iteratively. Saturation of themes was achieved after interviewing sixteen participants. Two additional interviews did not elicit any new information. Audio-recorded interviews were transcribed and analysed using ATLAS. ti Software version 8.4.4 (1135), following Van Manen's five steps of thematic analysis. Findings: Three themes emerged: Sexual and Reproductive Health (SRH) encounters, exposure to Cultural Practice during birth, and what women want during pregnancy and childbirth. Conclusion: Women's voices echoed diverse cultural encounters and exposures that modified their experiences during pregnancy and birth. The study offered a safe platform for the women to provide their narratives while expressing their cultural needs and the care providers' expectations. There is a need to design or reinforce strategies that foster collaborative care and synergy between the triad stakeholders' (skilled birth attendant-woman-traditional birth attendant) care partnership.

Background: Informational continuity (IC) is one of the four approaches that enables integrated people-centered health services. IC enables the availability of all health and psychosocial information of the pregnant women at all health encounters. World Health Organization (WHO) recognised that ineffective IC results in fragmented health care and duplication of services. Hence, IC may assist in the reduction of maternal morbidity and mortality. Aim: The purpose of this study was to explore and describe the experiences of skilled birth attendants (SBAs) with IC during the antenatal period Setting: Three primary healthcare centers in Maseru district, Lesotho. Methods: A qualitative descriptive phenomenological design was used with purposive sampling to choose nine participants. Results: Four themes emerged; Theme one: SBAs and pregnant women information communication, theme two: Information communication between the SBAs, theme three: information collection during ANC and theme four: guidelines used during ANC to standardise care. Several challenges regarding information communication form the sources of information, transition of information, information between caregivers and women which demonstrated the frustration between the women and the SBAs during ANC leading to ineffective care coordination. Conclusion: Enabling IC during ANC enables effective data collection from the sources of information, transition of information during care giving within and between health facilities. Contribution: Effective informational continuity enables effective care coordination in ANC in Lesotho.