To develop this quantitative knowledge, we have performed a series of 60Co gamma irradiation studies on aqueous formic acid/formate over different pH and solution conditions. The measured species concentration changes, as a function of applied dose, are compared with the predictions of a kinetic computer model constructed from literature reactions and reported rate coefficients. The excellent agreement found between the results and modeling gives confidence in the mechanism presented here and provide the first complete computer model for the radiolytic degradation of formic acid in water.Human activities such as agriculture, aquaculture, and industry can lead to the pollution of coastal waters by trace organic contaminants (TrOCs), and the TrOCs can pose a threat to marine ecosystems. Therefore, it is essential to investigate the occurrence, distribution, and ecological risk of the TrOCs in coastal waters. Previous studies adopting conventional analytical methods have focused on a limited number of targets. Herein, a comprehensive and systematic determination was undertaken to target 484 TrOCs in the waters around the Liaodong Peninsula, China. Eighty-six TrOCs were detected at concentrations of up to 350 ng L-1, and 25 TrOCs were detected at a frequency of >50%. Pesticides were the predominant pollutants, occurring at high concentrations with large detection frequencies. Ecological risks were assessed for single pollutants and mixtures based on the risk quotient and concentration addition modeling, respectively. The detected pesticides posed relatively high risk to aquatic organisms, while pharmaceuticals, consumer products, and other pollutants posed little or no risk. TrOC mixtures posed extremely high risk to aquatic organisms, which represented a significant threat to the marine environment and local communities. The results described here provide useful information that can inform China's "Action Plan for Prevention and Control of Water Pollution".A pilot study was initiated in 2018 under the Global Atmospheric Passive Sampling (GAPS) Network named GAPS-Megacities. This study included 20 megacities/major cities across the globe with the goal of better understanding and comparing ambient air levels of persistent organic pollutants and other chemicals of emerging concern, to which humans residing in large cities are exposed. The first results from the initial period of sampling are reported for 19 cities for several classes of flame retardants (FRs) including organophosphate esters (OPEs), polybrominated diphenyl ethers (PBDEs), and halogenated flame retardants (HFRs) including new flame retardants (NFRs), tetrabromobisphenol A (TBBPA) and hexabromocyclododecane (HBCDD). The two cities, New York (USA) and London (UK) stood out with ∼3.5 to 30 times higher total FR concentrations as compared to other major cities, with total concentrations of OPEs of 15,100 and 14,100 pg/m3, respectively. Atmospheric concentrations of OPEs significantly dominated the FR pfor evaluating global exposome.The hourly concentration of six criteria air pollutants in the Harbin-Changchun region were used to investigate the status and spatiotemporal variation of target air pollutants and their relationships with meteorological factors. The annual concentrations of particulate matters during 2013-2017 were two times higher than the Chinese Ambient Air Quality Standards (CAAQS) Grade Ⅱ. The annual O3 concentration increased by two times during 2013-2018 in Harbin. The concentration of PM, SO2, NO2, and CO depicted a similar seasonal trend with an order of winter > autumn > spring > summer. The consistent interannual variation trends of PM2.5/CO, NO2 and SO2 indicated that the formation of secondary inorganic aerosols in the annual scale was dominated by the concentrations of NO2 and SO2. The interannual variations of the individual meteorological factors causing on PM2.5 and O3 during 2013-2018 varied significantly in seasonal scale. The interannual variations were stable in annual scale indicating that the continuous decline of PM2.5 during 2014-2018 can be attributed to the comprehensive and strict prohibition of small coal-fired boilers and straw burning in the study area. https://www.selleckchem.com/products/Fedratinib-SAR302503-TG101348.html Meanwhile, the increase in O3 during 2013-2018 in the study area were mainly attributed to the rapid growth of the emission of its precursor (VOCs and NOx). The influence of meteorology on PM2.5 and ozone were the most stable and strongest in winter than that in the other three seasons.Trace elements (TEs) in the insoluble particles of surface snow are less affected by melting processes and can be used as environmental proxies to reveal natural and anthropogenic emissions. Here the first comprehensive study of the 16 TEs (Al, As, Ba, Bi, Cr, Cu, Fe, Mn, Ni, Pb, Sn, Sr, Ti, U, V, and Zn) in insoluble particles (>0.45 μm) from surface snow samples collected at Urumqi Glacier No. 1 (UG1), Eastern Tien Shan, China, from February 2008 to January 2010 were presented. Results show that concentrations of most insoluble particulate TEs (TEs insol) in the snow were higher in summer while lower in winter, due to the increasing particle inputs and melting processes. The abundances of As, Cr, Cu, Ni, Pb, and Zn in some samples were higher than those in surrounding urban soils, which might due to these TEs have further anthropogenic input beyond the already contaminated re-suspended urban soil particles and TEs were mainly enriched in particles with small grain size. Based on enrichment factor (EF) and principal component analysis (PCA), our results suggest that eight TEs (Al, Fe, Ti, Ba, Mn, Sr, U, and V) mainly came from mineral dust, while the remaining eight TEs (As, Bi, Cr, Cu, Ni, Pb, Sn, and Zn) were affected by coal combustion, mining and smelting of non-ferrous metals, traffic emissions, and the steel industry. The Hybrid Single-Particle Lagrangian Integrated Trajectory (HYSPLIT) model suggests that pollutants might originate from Xinjiang province, Kazakhstan, and Kyrgyzstan. Moreover, UG1 received more significant inputs of particle-bound pollutants in summer than in winter due to the stronger convection and the prevailing valley wind that transports pollutants from the city of Urumqi.

Defra’s automation in horticulture review argues that the year-to-year confirmation of the SWS has acted as a disincentive to farmers to invest in automation. The first recommendation in the review, is that the SWS should be extended as it will incentivise long-term capital investments, including in automation technology. Automation in horticulture is still emerging and developing, and both availability of automated processes and their adoption at individual sites is likely to be piecemeal, with other parts of the process continuing to require labour.
https://diigo.com/0y5jh7

Results of reports must be shared quickly to enable prompt action, and penalties for non-compliance should also be raised.
Automation in horticulture is still emerging and developing, and both availability of automated processes and their adoption at individual sites is likely to be piecemeal, with other parts of the process continuing to require labour.
Some of the larger horticultural businesses are major local employers, therefore the loss of one would have a big impact on the local area, particularly as they are more likely to be in rural areas where there are fewer other employment opportunities.
Any release of additional numbers would be made on condition that the 45,000 cap had been reached and in response to economic evidence of further recruitment need.


Provide certainty around the future of the scheme
For non-users, this also caused concerns about whether Seasonal Workers would fit with their organisations. Scheme operators could allay these concerns by providing more information to employers in advance. Other issues noted among employers were scheme operators not providing the number of workers they had requested, and unexpectedly receiving workers who did not have a full 6-month visa remaining. One employer experienced having to pay the recruitment fee multiple times as a result of employee transfers.

EUSS
Several employers have called for a more streamlined process, further discussion on compliance and the potential for a single enforcement body is covered in Chapter 5. It is possible that any increase in the cost of recruiting Seasonal Workers as a result of an EPP would raise prices, and concerns were expressed that supermarkets would not pay the increased costs of produce. The British Retail Consortium (BRC) have suggested that the EPP model could be implemented if costs were shared along the full length of the supply chain, including supermarkets. In May 2024 various civil society groups addressed the 9 big supermarkets in the UK in an open letter to call for the introduction of the EPP across their supply chains including on the SWS; in response all 9 supermarkets endorsed the EPP in principle. The Horticultural Sector Committee argues that greater flexibility is needed within use of the apprenticeship levy to allow funding, or an alternative funding programme, to be used to support Seasonal Workers. The Independent Review argues that the funding should support welfare education and training schemes for Seasonal Workers.

Economic impacts of the scheme: Workers
There is no formal Home Office mechanism for requesting that the worker should return to the UK for subsequent seasons (the applicant simply makes a fresh application). However, in practice returnees are very important to scheme operators and employers (as we discuss in Chapter 4). https://www.openlearning.com/u/ydetyler-qw6y09/blog/GuidelinesForEffectiveTranslationOfKoreanTextsToEnglishPlayACrucialRoleInEnsuringHighQualityTranslations Both scheme operators and employers often have systems to register workers’ interest in returning and employers’ interest in having the same worker back.
Employers suggested that this was due to poor vetting, screening, andinterviewing by scheme operators and a lack of knowledge about the job, resulting in operators selecting unsuitable and unprepared candidates. https://postheaven.net/carlsendickerson76/title-professional-english-to-hebrew-document-translation-services We found, however, that the presentation we attended in Kyrgyzstan was very clear about the nature of the work and conditions involved, and that many of the workers we spoke to had prior experience of the SWS. There were also complaints from some employers about a lack of information on workers’ background and experience prior to arrival, which they said made matching workers to jobs difficult.


A non-profit organisation that operates independently of government, often with the purpose of addressing a social or political issue. The Independent Chief Inspector of Borders and Immigration monitors and reports on the efficiency and effectiveness of the immigration, asylum, nationality and customs functions carried out by the Home Office. The Chief Inspector is a public appointee and independent from government; their reports are laid before Parliament. There was also discriminatory behaviour/preferential treatment reported which included some nationalities being treated favourably whilst others were denied work or hours or were shouted at and humiliated.
Recruiting returnees may reduce the likelihood of extra payments in the recruitment chain as they will have greater knowledge of the scheme requirements. Some organisations have called for remediation for those who have paid illegal recruitment fees. We agree with the Independent Review that these should be in place in all key source countries and would encourage the new government to follow the same approach. Those requesting an increased visa length tended to specify 9 months as desirable in horticulture, although there was demand from mushroom growers for a specific scheme that could last up to 2 years. The House of Lords Horticulture Sector Committee has said that a 9-month visa would lower recruitment and training costs for growers, increase efficiency, and help to retain talent on UK farms.
A large vegetable and salad producer prefers to have returnee workers at the start of their season when they are busiest. Therefore, to ensure workers are not blocked to return by the requirement to spend 6 months overseas this employer had workers leave the organisation site between 2-4 weeks before the end of season. The employer then had to factor in a reduced workforce at the end of season, while the workers may have missed out on a period of earnings. Seasonal workers receive relatively low wages which means they will pay modest amounts of income tax.
Meanwhile, almost all of the UK’s supply of poultry (82% in 2023) and around half of the UK’s supply of ornamentals (55%) are produced domestically. The SWV is currently only available to foreign workers wanting to undertake jobs within horticulture (ornamental and edible), or poultry farming. The MAC’s EEA report (2018) set out the logic behind the reintroduction of a Seasonal Worker Scheme alongside a recommendation that otherwise, sector-based schemes should be avoided and that any future Seasonal Agricultural Worker Scheme (SAWS) should ensure upward pressure on wages. A new version of SAWS called the Seasonal Worker Scheme (SWS) was subsequently piloted in 2019. Separate Seasonal Work Visas (SWVs) for the poultry sector were introduced in late 2021 following labour shortages in the sector. Horticulture SWVs allow workers to spend up to 6 months in the UK, whereas poultry workers are restricted to the Christmas peak season from October to December.

Men who have sex with men (MSM) are one of the key populations driving HIV/AIDS epidemic globally. To date, MSM is the only population in Ukraine where the prevalence and incidence of HIV is increasing. As HIV-positive MSM might feel uncomfortable to report homosexual intercourses as a possible mode of transmission (MoT) of HIV, they prefer being registered as patients with heterosexual or non-defined MoT. This study aimed to calculate the proportion of misclassified MoT among HIV-positive MSM registered in Lviv oblast, Ukraine, during 2014-2018.

Cross-sectional study with 127 HIV-positive MSM patients from Lviv region for the period of 2014-2018.

Out of 127 HIV-positive MSM included in the study, 110 (86.6%) were from urban areas. In addition, 52 patients (40.9%) were diagnosed with stage 1 HIV, 16 (12.6%) - stage 2, 19 (15%) - stage 3, and 36 (28.3%) - stage 4. CD4 count < 200 cells/μL was found in 35 (27.6%) patients. Mean time from registration to antiretroviral therapy initiation was 80 days. During the first visit to medical doctor out of those 48 patients who had previously reported "other modes" of HIV transmission, 33 patients (68.7%) disclosed homosexual MoT of HIV. The remaining 15 (31.3%) patients disclosed their homosexual MoT of HIV later - during their regular follow-up visits to the doctor.

Special measures are needed to improve the reporting of homosexual MoT which can potentially strengthen the HIV care among MSM.
Special measures are needed to improve the reporting of homosexual MoT which can potentially strengthen the HIV care among MSM.
HIV/TB comorbidity is responsible for 1.6 million deaths worldwide. HIV/TB control and patients' survival are still among priorities of the national HIV and TB programs. https://www.selleckchem.com/products/azd3514.html We aimed to evaluate the HIV/TB survival in connection with TB treatment outcomes and factors influencing life duration of the cohort 2008-2018 in Almaty, Kazakhstan.

This retrospective cohort study extracted data for all HIV and pulmonary TB adults coinfected during 2008-2018 in Almaty from national registries to apply descriptive, Kaplan-Meier estimation, and Cox proportional hazards regression model. Survival function for the TB treatment outcomes and factors predicting the probability of survival were tested and described.

The cohort population (n = 521) mean age was 37.4 years with 405 (77.7%) males and 210 (40.3%) marrieds. More than one TB treatment had 181 (34.7%) patients, 291 (55.9%) were smear-positive (SS+), and 423 (81.2%) were on antiretroviral therapy with mean CD4 count 254.22cells/µL. Probability to live longer was higher (128 versus 37 months, p = 0.003; 95% confidence interval (CI) 71.65, 184.35) for those who succeeded in TB treatment compared to "lost to follow-up" and "failed" treatment outcomes. Adjusted Cox regression model death hazard showed association with missing ART treatment (HR 1.699, 95%CI 1.164, 2.481, p = 0.006) and having CD4 count < 499 (HR 2.398, 95%CI 1.191, 4.830, p < 0.014).

TB treatment outcomes, ART treatment, and the CD4 count of HIV/TB coinfected population substantially influence their life duration. The medical decision- and policy-makers should take this into consideration when implementing targeted improvements in the national HIV and TB programs.
TB treatment outcomes, ART treatment, and the CD4 count of HIV/TB coinfected population substantially influence their life duration. The medical decision- and policy-makers should take this into consideration when implementing targeted improvements in the national HIV and TB programs.
Tuberculosis (TB) contact investigation as a proved approach for finding new TB cases, is not fully performed in Kyrgyzstan. In 2018, the country started aligning the National Guidelines for tracking contacts with the WHO recommendations by expanding the definition for TB index cases to all close contacts, regardless of their TB risk status.

This cross-sectional census aimed to determine the active case detection changes among TB contacts after implementation of a new TB tracing strategy using the National Surveillance data. We compared populations in Chui and Issyk-Kul regions of Kyrgyzstan who had contacts with TB index cases before (2017) and after (2018) strategic changes for the rates of indexes, contacts, screened contacts, and detected TB among screened contacts.

New TB tracing strategy resulted in increased numbers of indexes (21%) and contacts (36%). Though the smaller number of contacts (1730 vs. 1590) have been screened in 2018, the proportion of TB diagnosed was substantially higher (95% CI 0.024-0.005; p = 0.002) in 2018 vs. 2017. The mean numbers of TB contacts per-one-index-case also has increased dramatically by 117% (1.8 vs. 3.9) in Chui and by 43% (3.0 vs. 4.3) in Issyk-Kul regions (95% CI 3.20-3.37; p < 0.001 and 95% CI 2.97-3.09; p < 0.001, respectively) between 2018 and 2017.

Extending new tracing approach to other regions of Kyrgyzstan will increase the number of identified contacts, leading to better TB control in the country and prevention of more severe TB development among the unidentified contacts.
Extending new tracing approach to other regions of Kyrgyzstan will increase the number of identified contacts, leading to better TB control in the country and prevention of more severe TB development among the unidentified contacts.
Tuberculosis (TB) is a global public health problem. The incidence of TB is especially high among TB key populations, such as the homeless, people who use drugs, prisoners, and migrants. The study aimed to assess the associations between affiliation to TB key populations and treatment outcome.

This retrospective cross-sectional study used data extracted from the National TB Registry of Kyrgyzstan for the region of Chuy (including the city of Bishkek) for 2015-2017. Descriptive statistics was used to summarize the data. Logistic regression was used to assess the associations.

The study included 1,526 patients among whom more than half (52.5%) fell into the youngest group (18-35 years old). Migrants were the most highly represented group comprising 67.8% of all TB key populations. Men (63.0%) and patients with pulmonary TB (83.0%) prevailed in the cohort. The proportions of patients who had completed the treatment were high among all the key populations. Logistic regression was used to assess the association between affiliation to a certain TB key population and the TB treatment outcome.

Continued emergence and spread of circulating vaccine-derived type 2 polioviruses and vaccine-associated paralytic poliomyelitis from Sabin oral poliovirus vaccines (OPVs) has stimulated development of two novel type 2 OPV candidates (OPV2-c1 and OPV2-c2) designed to have similar immunogenicity, improved genetic stability, and less potential to reacquire neurovirulence. We aimed to assess safety and immunogenicity of the two novel OPV candidates compared with a monovalent Sabin OPV in children and infants.

We did two single-centre, multi-site, partly-masked, randomised trials in healthy cohorts of children (aged 1-4 years) and infants (aged 18-22 weeks) in Panama a control phase 4 study with monovalent Sabin OPV2 before global cessation of monovalent OPV2 use, and a phase 2 study with low and high doses of two novel OPV2 candidates. All participants received one OPV2 vaccination and subsets received two doses 28 days apart. Parents reported solicited and unsolicited adverse events. Type 2 poliovirus neutrging Countries and Bill & Melinda Gates Foundation.
Fighting Infectious Diseases in Emerging Countries and Bill & Melinda Gates Foundation.
Phase 3 clinical studies showed non-inferiority of long-acting intramuscular cabotegravir and rilpivirine dosed every 4 weeks to oral antiretroviral therapy. Important phase 2 results of every 8 weeks dosing, and supportive modelling, underpin further evaluation of every 8 weeks dosing in this trial, which has the potential to offer greater convenience. Our objective was to compare the week 48 antiviral efficacy of cabotegravir plus rilpivirine long-acting dosed every 8 weeks with that of every 4 weeks dosing.

ATLAS-2M is an ongoing, randomised, multicentre (13 countries; Australia, Argentina, Canada, France, Germany, Italy, Mexico, Russia, South Africa, South Korea, Spain, Sweden, and the USA), open-label, phase 3b, non-inferiority study of cabotegravir plus rilpivirine long-acting maintenance therapy administered intramuscularly every 8 weeks (cabotegravir 600 mg plus rilpivirine 900 mg) or every 4 weeks (cabotegravir 400 mg plus rilpivirine 600 mg) to treatment-experienced adults living with HIV-1. Eliing every 4 weeks were similar. These results support the use of cabotegravir plus rilpivirine long-acting administered every 2 months as a therapeutic option for people living with HIV-1.

ViiV Healthcare and Janssen.
ViiV Healthcare and Janssen.
Decisions about the continued need for control measures to contain the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) rely on accurate and up-to-date information about the number of people testing positive for SARS-CoV-2 and risk factors for testing positive. Existing surveillance systems are generally not based on population samples and are not longitudinal in design.

Samples were collected from individuals aged 2 years and older living in private households in England that were randomly selected from address lists and previous Office for National Statistics surveys in repeated cross-sectional household surveys with additional serial sampling and longitudinal follow-up. Participants completed a questionnaire and did nose and throat self-swabs. The percentage of individuals testing positive for SARS-CoV-2 RNA was estimated over time by use of dynamic multilevel regression and poststratification, to account for potential residual non-representativeness. Potential changes in risk facver of increased positivity rates in the second wave. For example, the estimated percentage of individuals testing positive was more than six times higher in those aged 17-24 years than in those aged 70 years or older at the end of September, 2020. A substantial proportion of infections were in individuals not reporting symptoms around their positive test (45-68%, dependent on calendar time.

Important risk factors for testing positive for SARS-CoV-2 varied substantially between the part of the first wave that was captured by the study (April to June, 2020) and the first part of the second wave of increased positivity rates (end of August to Nov 1, 2020), and a substantial proportion of infections were in individuals not reporting symptoms, indicating that continued monitoring for SARS-CoV-2 in the community will be important for managing the COVID-19 pandemic moving forwards.

Department of Health and Social Care.
Department of Health and Social Care.
Kyrgyzstan has made considerable progress in reducing child mortality compared with other countries in the region, despite a comparatively low economic standing. However, maternal mortality is still high. Given the availability of an established birth registration system, we aimed to comprehensively assess the trends and determinants of reproductive, maternal, newborn, and child health in Kyrgyzstan.

For this Countdown to 2030 country case study, we used publicly available data repositories and the national birth registry of Kyrgyzstan to examine trends and inequalities of reproductive, maternal, and newborn health and mortality between 1990 and 2018, at a national and subnational level. Coverage of newborn and maternal health interventions was assessed and disaggregated by equity dimensions. We did Oaxaca-Blinder decomposition to determine the contextual factors associated with the observed decline in newborn mortality rates. We also undertook a comprehensive review of national policies and programmes, a the potential for further reduction. To achieve and exceed the Sustainable Development Goal 3 targets for newborn survival and reducing stillbirths, Kyrgyzstan needs to scale up packages of interventions for the care of small and sick babies, assure quality of care in all health-care facilities with regionalised perinatal care, and create a linked national registry for mothers and neonates with rapid feedback and accountability.

US Fund for UNICEF under the Countdown to 2015, UNICEF Kyrgyzstan Office.
US Fund for UNICEF under the Countdown to 2015, UNICEF Kyrgyzstan Office.
There is major concern about the impact of the global COVID-19 outbreak on mental health. Several studies suggest that mental health deteriorated in many countries before and during enforced isolation (ie, lockdown), but it remains unknown how mental health has changed week by week over the course of the COVID-19 pandemic. https://www.selleckchem.com/products/ko143.html This study aimed to explore the trajectories of anxiety and depression over the 20 weeks after lockdown was announced in England, and compare the growth trajectories by individual characteristics.

In this prospective longitudinal observational study, we analysed data from the UCL COVID-19 Social Study, a panel study weighted to population proportions, which collects information on anxiety (using the Generalised Anxiety Disorder assessment) and depressive symptoms (using the Patient Health Questionnaire) weekly in the UK since March 21, 2020. We included data from adults living in England who had at least three repeated measures between March 23 and Aug 9, 2020. Analyses were done using latent growth models, which were fitted to account for sociodemographic and health covariates.

ng nurses, their perceptions of adequate staffing and fair treatment were associated with lower distress. https://www.selleckchem.com/products/mptp-hydrochloride.html Addressing inadequate staffing and unfair treatment may decrease burnout and other dimensions of distress among nurses, and improve their work experience and patient outcomes.
Although levels of burnout and distress were high among nurses, their perceptions of adequate staffing and fair treatment were associated with lower distress. Addressing inadequate staffing and unfair treatment may decrease burnout and other dimensions of distress among nurses, and improve their work experience and patient outcomes.
Burnout and distress have a negative impact on physicians and the treatment they provide. Our aim was to measure the prevalence of burnout and distress among physicians in a cardiovascular centre of a quaternary hospital network in Canada, and compare these outcomes to those for physicians at academic health science centres (AHSCs) in the United States.

We conducted a survey of physicians practising in a cardiovascular centre at 2 quaternary referral hospitals in Toronto, Ontario, between Nov. 27, 2018, and Jan. 31, 2019. The survey tool included the Well-Being Index (WBI), which measures fatigue, depression, burnout, anxiety or stress, mental and physical quality of life, work-life integration, meaning in work and distress; a score of 3 or higher indicated high distress. We also evaluated physicians' perception of the adequacy of staffing levels and of fair treatment in the workplace, and satisfaction with the electronic health record. We carried out standard univariate statistical comparisons using the re (2.4 v. 1.8,
= 0.004) and reported a higher prevalence of burnout (65.4% v. 56.6%,
= 0.048).

Physicians in this study had high levels of burnout and distress, driven by the perception of inadequate staffing levels and being treated unfairly in the workplace. Addressing these institutional factors may improve physicians' work experience and patient outcomes.
Physicians in this study had high levels of burnout and distress, driven by the perception of inadequate staffing levels and being treated unfairly in the workplace. Addressing these institutional factors may improve physicians' work experience and patient outcomes.
People with a recent history of homelessness are believed to be at high risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and, when infected, complications of coronavirus disease 2019 (COVID-19). We describe and compare testing for SARS-CoV-2, test positivity and hospital admission, receipt of intensive care and mortality rates related to COVID-19 for people with a recent history of homelessness versus community-dwelling people as of July 31, 2020.

We conducted a population-based retrospective cohort study in Ontario, Canada, between Jan. 23 and July 31, 2020, using linked health administrative data among people who either had a recent history of homelessness or were dwelling in the community. People were included if they were eligible for provincial health care coverage and not living in an institutionalized facility on Jan. 23, 2020. We examined testing for SARS-CoV-2, test positivity and complication outcomes of COVID-19 (hospital admission, admission to intensive care-17.93) and over 5 times more likely to die within 21 days of their first positive test result (adjusted HR 5.73, 95% CI 3.01-10.91).

In Ontario, people with a recent history of homelessness were significantly more likely to be tested for SARS-CoV-2, to have a positive test result, to be admitted to hospital for COVID-19, to receive intensive care for COVID-19 and to die of COVID-19 compared with community-dwelling people. People with a recent history of homelessness should continue to be considered particularly vulnerable to SARS-CoV-2 infection and its complications.
In Ontario, people with a recent history of homelessness were significantly more likely to be tested for SARS-CoV-2, to have a positive test result, to be admitted to hospital for COVID-19, to receive intensive care for COVID-19 and to die of COVID-19 compared with community-dwelling people. People with a recent history of homelessness should continue to be considered particularly vulnerable to SARS-CoV-2 infection and its complications.
Surgeons frequently care for children who have sustained gunshot wounds (GSWs). However, firearm safety education is not a focus in general surgery training. We hypothesised that firearm safety discussions do not routinely take place when children present to a trauma centre with a GSW.

A retrospective review of patients <18 years presenting with GSWs to a level 1 paediatric trauma centre from 2009 to 2019 was performed. The primary outcome was discussion of firearm safety with the patient or family. The secondary outcome was notification of child protective services (CPS).

A total of 226 patients with GSWs were identified, 22% were unintentional and 63% were assault. Firearm safety discussions took place in 10 cases (4.4%). Firearm safety discussions were more likely to occur after unintentional injuries compared with other mechanisms (16.0% vs 1.3%, p<0.001). CPS was contacted in 29 cases (13%). CPS notification was more likely for unintentional injuries compared with other mechanisms (40% vs 3.9%, p<0.001) and for younger patients (7 years vs 15 years, p<0.001).

At a paediatric trauma centre, firearm safety discussions occurred in 4.4% of cases of children presenting with a GSW. There is a significant room for improvement in providing safety education interventions.
At a paediatric trauma centre, firearm safety discussions occurred in 4.4% of cases of children presenting with a GSW. There is a significant room for improvement in providing safety education interventions.Effectiveness of health interventions can be substantially impaired by implementation failure. Context-driven implementation strategies are critical for successful implementation. However, there is no practical, evidence-based guidance on how to map the context in order to design context-driven strategies. Therefore, this practice paper describes the development and validation of a systematic context-mapping tool. The tool was cocreated with local end-users through a multistage approach. As proof of concept, the tool was used to map beliefs and behaviour related to chronic respiratory disease within the FRESH AIR project in Uganda, Kyrgyzstan, Vietnam and Greece. Feasibility and acceptability were evaluated using the modified Conceptual Framework for Implementation Fidelity. Effectiveness was assessed by the degree to which context-driven adjustments were made to implementation strategies of FRESH AIR health interventions. The resulting Setting-Exploration-Treasure-Trail-to-Inform-implementatioN-strateGies (SETTING-tool) consisted of six steps (1) Coset study priorities with local stakeholders, (2) Combine a qualitative rapid assessment with a quantitative survey (a mixed-method design), (3) Use context-sensitive materials, (4) Collect data involving community researchers, (5) Analyse pragmatically and/or in-depth to ensure timely communication of findings and (6) Continuously disseminate findings to relevant stakeholders.