Water, Sanitation and Hygiene in Lower-Level Health Care Facilities of Dar es Salaam Region in Tanzania: Status towards Achieving the Sustainable Development Goals and Way Forward

Background: Improving Water, Sanitation and Hygiene in health care settings is a critical prerequisite for achieving national health goals and Sustainable Development Goals (SDGs). The World Health Organization (WHO) has set a target for each United Nations member state to reach by 2030. Each member state is required to reach by 2022, 2025 and 2030 at least 60%, 80% and 100%, respectively of basic level of service of the five elements which are water, sanitation, hygiene, waste management and environmental cleaning. Methods: This study aimed to evaluate and document the current state of basic water, sanitation, and hygiene services in all lower-level health care facilities in the Dar es Salaam region of Tanzania as of July 2022. A cross-sectional study was conducted in 99 public dispensaries in the Dar es Salaam region’s five councils: Ubungo, Kigamboni, Kinondoni and Temeke Municipalities, and Ilala City. The interviewee form and observational checklists were both digitalized using the Kobo tool software. The respondents were health care facility in-charges or nurse in-charges. Data were downloaded, validated, and imported to Stata version 15 for analysis. Results: The basic WASH level per JMP is far below the target in 2022. Each member state by 2022 is required to reach at least 60% of the basic level of service of each element. We found a low coverage of basic WASH in the 99 dispensaries included in this study. The basic WASH coverage was met in only 10 (10.1%) of the dispensaries, while the remaining 89 (89.9%) dispensaries fall on limited WASH services. Conclusion: This study revealed lower coverage of basic WASH services in dispensaries. An urgent need is required to improve the status of WASH in all the dispensaries and facilitate the provision of quality health care services, patient safety and reduce health care associated infections.

Accessibility and Fairness of Public Service Facilities from the Perspective of Supply and Demand Coordination: A Case Study of Old Urban Area of Guangzhou City

The accessibility and fairness of public service facilities are important manifestations of the convenience and equality of urban public service resource allocation.Optimizing the layout of urban public service facilities is an inevitable requirement for promoting the construction of people centered cities.This paper takes the old urban area of Guangzhou as the research area,measures the accessibility of multiple types of public service facilities based on an improved two-step floating catchment method,and combines Palma Ratio and location quotient methods to explore the fairness of urban public service facilities from two dimensions:social equity and spatial equity,with supply and demand relationship analysis as the main line.Research has shown that:①there is a significant spatial difference in the accessibility of public service facilities in the old urban areas of Guangzhou,and the comprehensive accessibility is generally higher in the central and southeastern regions of the old urban areas with fewer residential populations;②from the perspective of social equity,the resource allocation of public service facilities in the old urban areas of Guangzhou is in a seriously unfair state(with a fairness index of 2.99),and there are also varying degrees of unfairness within the streets;③from the perspective of spatial equity,the location quotient of public service facilities in the old urban areas of Guangzhou shows a pattern of multil center circles decreasing,indicating a significant spatial mismatch between the accessibility supply side of public service facilities and the demand side of the residential population.The research conclusion will provide scientific basis for optimizing the allocation of urban public service facilities and ensuring the equalization of public services.

Allocation of Public Service Facilities in Villages and Towns from the Perspective of Smart Contraction: A Case Study of Zixi County, Jiangxi Province

The limitation of traditional layout system and the continuous contraction of villages and towns have brought challenges to the layout of public service facilities.It is an imperative task against this background to integrate space resources and allocate public service facilities scientifically and reasonably.This paper took the system and method of rural public service facility allocation from the perspective of smart contraction as the theoretic support,and Zixi County in Jiangxi Province for example,built the four-level life circle of“county-fundamental-basic-routine”based on the influence factors of facility allocation,village and town contraction strength,rural comprehensive assessment results,residents’trip willingness and demands on public service facilities,finally proposed the suggestions for optimizing the allocation of village and town public service facilities.

Improvement in Patient Mobility Following Short-Term Rehabilitation in Skilled Nursing Facilities

Background: Mobility in older adults can be impaired after acute illness or hospitalization, and the level of severity can be used as a predictor of one’s ability to return to independent living. Patients are often referred to skilled nursing facilities in hopes of improving their mobility. We wanted to prove that rehabilitative services at Skilled Nursing Facilities improve overall outcomes. Methods: We conducted a retrospective analysis of data from 4612 patients admitted for short-term rehabilitation in a large nursing home chain in California. Our aim was to determine whether patients’ mobility scores, as measured by rehabilitative staff, significantly improved by time of discharge compared to their scores at admission. Mobility scores were rated from 1 to 6, with 1 being the most dependent on aid and 6 being the most independent, over a variety of tasks at admission and compared to scores at discharge. Pearson’s correlations were performed to determine if there were significant relationships in the data: the Pearson’s correlation coefficient was used to describe the relationships between patient admission to a skilled nursing facility and medical improvement upon discharge. Results: The study demonstrated a statistically significant improvement in patients’ mobility scores upon discharge, with Medicare insured patients showing on average 57% improvement and Managed Care insured patients showing on average 59% improvement. Additionally, admission scores appeared to be predictive of the patient’s outcome at discharge. Conclusions: The values and consistency of improvement support the use of acute rehabilitative services in skilled nursing facilities. An equation can be formulated that evaluates patients’ estimated mobility statuses upon discharge from facilities based on their conditions on their arrivals. With this, new interventions can be studied and compared to the current standard of care by using these measurements. They can determine if further improvements can be made to increase patient outcomes.

Pediatric and adult liver transplantation in Bahrain: The experiences in a country with no available liver transplant facilities

BACKGROUND Liver transplantation(LT)is a life-saving procedure for patients with end-stage liver disease and has become the standard and most effective treatment method for these patients.There are many indications for LT that vary between countries and settings.The outcome of LT depends on the available facilities and surgical expertise,as well as the types of liver graft donors available.AIM To assess the clinical characteristics of patients from Bahrain who underwent LT overseas,and analyze factors affecting their survival.METHODS In this retrospective cohort study,we reviewed the medical records and overseas committee registry information of all pediatric and adult patients who were sent overseas to undergo LT by the Pediatric and Medical Departments of Salmaniya Medical Complex and Bahrain Defence Force Hospital via the Overseas Treatment Office,Ministry of Health,Kingdom of Bahrain,between 1997 and 2023.Demographic data,LT indication,donor-recipient relationship,overseas LT center,graft type,post-LT medications,and LT complications,were collected.Outcomes measured included the overall and 5-year LT survival rate.Fisher’s exact,Pearsonχ2,and Mann-Whitney U tests were used to compare the pediatric and the adults’group in terms of clinical characteristics,donor-recipient relationship,medication,complications,and outcome.Survival analysis was estimated via the Kaplan-Meier’s method.Univariate and multivariate analyses were used to detect predictors of survival.RESULTS Of the 208 eligible patients,170(81.7%)were sent overseas to undergo LT while 38(18.3%)remained on the waiting list.Of the 170 patients,167(80.3%)underwent LT and were included in the study.The majority of the patients were Bahraini(91.0%),and most were males(57.5%).One-hundred-and-twenty(71.8%)were adults and 47(28.3%)were children.The median age at transplant was 50.0[interquartile range(IQR):14.9–58.4]years.The main indication for pediatric LT was biliary atresia(31.9%),while that of adult LT was hepatitis C-related cirrhosis(35.0%).Six(3.6%)patients required re-transplantation.Most patients received a living-related liver graft(82%).Pediatric patients received more living and related grafts than adults(P=0.038 and P=0.041,respectively),while adult patients received more cadaveric and unrelated grafts.Most patients required long-term immunosuppressive therapy after LT(94.7%),of which tacrolimus was the most prescribed(84.0%),followed by prednisolone(50.7%),which was prescribed more frequently for pediatric patients(P=0.001).Most patients developed complications(62.4%)with infectious episodes being the most common(38.9%),followed by biliary stricture(19.5%).Tonsilitis and sepsis(n=12,8.1%for each)were the most frequent infections.Pediatric patients experienced higher rates of infection,rejection,and early poor graft function than adult patients(P<0.001,P=0.003,and P=0.025,respectively).The median follow-up time was 6.5(IQR:2.6–10.6)years.The overall survival rate was 84.4%,the 5-year survival rate,86.2%,and the mortality rate,15.6%.Younger patients had significantly better odds of survival(P=0.019)and patients who survived had significantly longer follow-up periods(P<0.001).CONCLUSION Patients with end-stage liver disease in Bahrain shared characteristics with those from other countries.Since LT facilities are not available,an overseas LT has offered them great hope.

Improvement of Activities of Daily Living (ADL) for Patients Treated in Skilled Nursing Facilities (SNFs)

Background: Self-care tasks or activities of daily living (ADL)’s performance are often disrupted after an older adult sustains an injury or illness, which can be a determining factor for discharge placement after hospitalization, or it can determine the level of assistance required after discharge from a skilled nursing facility (SNF). We believe that comprehensive rehabilitation can improve a patient’s overall functioning during their short term stay in SNFs. The purpose of this study is to determine if an individual’s level of independence improved after admission to a skilled nursing facility and procurement of rehabilitation services. Methods: This study retrospectively reviewed 4612 nursing home patients in California who underwent rehabilitative services at skilled nursing facilities to determine how the patients responded to their environments, therapy interventions, and any other additional supportive measures. The records of patients who were admitted for short-term rehabilitation were reviewed in a blinded fashion, looking specifically at Section GG of the Minimum Data Set (MDS). Self-Care Section GG scores recorded by rehabilitative staff provide objective data and measure patients’ levels of assistance that were required. Each activity is scored from 1, being completely dependent, to 6, being entirely independent, with varying levels of assistance with scores in between. The admission scores versus the discharge scores can be compared to determine if a patient improved their level of functioning upon discharge. Results: Utilizing the Pearson’s correlation coefficient, a strong correlation of improvement in ADL performance on Section GG between the admission and discharge scores was identified, implying significant improvement in functional independence upon discharge. The average percent improvement for Managed Care patients was ~35.4% and ~39.4% for Medicare patients. Conclusions: The results support the benefits of rehabilitation services in skilled nursing facilities, and the data suggests that admission scores can be used as a predictive tool for functional outcomes.

Reflection on the Integrated Development of Marine Fisheries and Tourism Based on the Transformation of Fishery Facilities: A Case Study of Ningde City of Fujian Province, China

Based on the analysis on the current situation of marine fishery resources and development in Ningde City,this paper plans a spatial pattern for the integration of marine fishery and tourism of the“one belt,three zones,and multiple points”,designs key projects,analyzes the existing problems in the integrated development of fishery and tourism,and proposes relevant countermeasures and suggestions.

Analysis of the Impact of Road Traffic Safety Facilities on Traffic Safety

The development of the national economy is closely tied to infrastructure construction.In recent years,China has seen a significant increase in the number and scale of road construction projects,aimed at facilitating the flow of goods and enabling convenient travel for the masses.However,this surge in road construction also raises concerns about road traffic safety.Road traffic safety facilities play a crucial role in warning and protecting against traffic accidents.To ensure their effective implementation,this paper analyzes the essence of road traffic facilities and their impact on traffic safety.By identifying challenges in the application of traffic safety facilities and adhering to safety facility application principles,suggestions are proposed to enhance traffic safety management.

Effects of Facilities Condition on Occurrence of Freeze Injury and Fresh Pod Yield of Broad Bean

Using Tongxian No.2 as material, the effects of different film-covering time, different sowing time and different planting density on the occurrence of freeze injury and yield of fresh broad beans were investigated. The randomized block design was adopted. The results showed that with the delayed film covering, the incidence of mild freeze injury and number of headless seedlings were increased correspondingly, but the yield was increased; with the delayed sowing, the branch number per plant, effective branch number per plant, incidence of mild freeze injury and number of headless seedlings were all reduced, and the broad beans, sowed on September 30 th, obtained the highest yield; planting density showed on effect on the occurrence of freeze injury, and the yield was increased with the increase of planting density. Under the same film-covering time, the incidence of freeze injury was reduced with the delayed sowing time and it showed no changes when planting density was changed, but the yield was increased with the increase of planting density and it was highest when broad bean seeds were sowed on September 30th;under the same sowing time, the incidence of freeze injury was increased with the delayed film-covering time and it showed no changes when planting density was changed, and the yield was increased with the delayed film-covering time and increased planting density; under the same planting density, the incidence of freeze injury was increased with the delayed film-covering time but was reduced with the delayed sowing time, and the yield was increased with the delayed film-covering time and it was highest when the broad bean seeds were sowed on September30 th. Under same film-covering time and sowing time, the total branch number per plant and effective branch number per plant were reduced, but the yield was increased with the increase of planting density; under same film-covering time and planting density, the incidence of freeze injury was reduced with the delayed sowing time, and the yield was highest when broad bean seeds were sowed on September30th; under same sowing time and planting density, the incidence of freeze injury and the yield were all increased with the delayed film-covering time.

Integrated logistics facilities network design for 3PLS under uncertainty

According to the operational characteristics of the logistics networks for the third party logistics supplier （3PLS）, the forward and reverse logistics networks together for 3PLS under the uncertain environment are designed. First, a fuzzy model is proposed by taking multiple customers, multiple commodities, capacitated facility location and integrated logistics facility layout into account. In the model, the fuzzy customer demands and transportation rates are illustrated by triangular fuzzy numbers. Secondly, the fuzzy model is converted into a crisp model by applying fuzzy chance constrained theory and possibility theory, and one hybrid genetic algorithm is designed for the crisp model. Finally, two different examples are designed to illustrate that the model and solution discussed are valid.

I MWth Test Facilities for Circulating Fluidized Bed Combustion

This paper presents the technical parameters and features of 1 MWth test facilities for circulating fluidized bed combustion (CFBC) at Thermal Power Research Institute (TPRI) of State Power Corporation (SP), introduces the test items that can be proceeded and trial combustion projects completed. The development status of CFBC technologies abroad and the level of China in this field are also introduced in the paper.

Study on the Tourism Facilities Construction in Agricultural Demonstration Zone——A Case Study of Southern Jiangsu Area

[Objective] To investigate and analyze the existing problems in the agricultural tourism facilities construction in southern Jiangsu area,and put forward the improvement measures so as to effectively promote the overall development of agricultural tourism and the construction of new rural area. [Method] Adopting questionnaire survey and analyzing the differences of tourism facilities. [Result] The overall satisfaction of tourists in tourism facilities is 47.2%,a basically satisfying level; the least satisfaction level is 31.8% in public sanitation facilities after the satisfaction in recreation and explanation facilities. [Conclusion] With experiencing the ecology and returning to the nature as characteristics,the construction of facilities should comply with the theme of agricultural tourism to demonstrate the characteristics of agriculture and the local area,and in the scale of planning,architectural style and subject selection also should follow this principle. Investigations about the tourists resources should be carried on,the construction and management of transportation,greening and public sanitation facilities should be proceeded effectively to attract tourists to stay or come again and to realize the sustainable development of agricultural tourism.

Survey and Countermeasures on the Public Facilities in Urban Parks——with Urban Parks in Nanjing City as Study Cases

Urban park is an important outdoor leisure space for urban citizens. The public facility in urban park is a functional environmental element connecting human beings and environment. Through analyzing the present situation and application of public facilities in urban parks of Nanjing City, the existing problems and countermeasures were pointed out, in order to provide theoretical references for the construction of public facility in the urban parks.

Application of Environmental Psychology in Urban Space Design of China——A Case Study of Environmental Facilities Design of Urban Streets

After analyzing the concept of urban social psychology and environmental psychology, the paper considers that the city is an object shared by thousands of people from different classes, nationalities and characters, and streets and roads are the skeleton and venation of the city, serving for transport and as spaces. Then, it has proposed principles for road landscape design. Based on environmental facilities on streets, urban environmental psychology has been put forward because transport function has been highlighted while space function has been neglected in urban construction, so that facilities' design and construction can be considered from the perspective of human. Finally, some suggestions have been raised in view of problems in mechanism and management during the design and construction of domestic street facilities.

Effects of China's National Essential Medicines Policy on the Use of Injection in Primary Health Facilities

The overuse of injection exists more than 20 years since economic reform in China.It is a persistent problem and seems becoming a new challenge in the new health reform period.This study was designed to assess the effect of national essential medicines policy(NEMP) on injection use at primary health facilities in China by investigating their prescription information.Questionnaires were designed and disseminated to collect empirical data on injection use at 120 primary health facilities in 6 provinces from January to September in 2010 and 2011.The injection use was measured as the indicator as the percentage of prescriptions with one or more injections.The results showed that the percentage of prescriptions with one or more injections was decreased from 38.91% to 36.82%(2 =11.158,P=0.001) in the all survey areas during the NEMP reform.The difference in level of the injection use in 2011 was significant among the eastern,central and western regions(2 =223.584,P=0.000);level of the injection use in western region was the lowest(27.73%),while that in the central region was the highest(43.10%).The level of the injection use in 2011 among different provinces was also of great difference(26.00%-58.25%,range:32.25%).The level of the injection use in 2011 was still much higher than the standard suggested by WHO for developing countries(13.4%-24.1%).It was concluded that NEMP has improved injection use in China,but the injection abuse situation remains serious,indicating that one of the priorities to the next stage of NEMP is to promote the rational use of drugs,especially the injection use.

Based on the Characteristics of Respondents and the Voice of the Urban Neighborhood Public Space Business Facilities Noise Environment Evaluation Research

Comfort is one of the important indicators evaluation of voice. In order to understand the urban neighborhood public space environment of comfort,this paper is to explore characteristics of consumer society on the public space environment evaluation of the effect,and using the questionnaire survey method,to evaluate the Harbin city neighborhood area public space as the typical case analysis. Based on one of the main sound source in neighborhood public space,environment,business facilities environment as the breakthrough point,it is to consider neighborhood public space environment evaluation and social characteristics.

Preliminary design of a femtosecond timing system for large accelerator facilities

Large accelerator facilities require clocks and triggers with high accuracy to synchronize equipment and devices. A new femtosecond timing system was designed to meet the demands of new facilities. In this system, the radio-frequency signal is modulated in a continuous-wave laser carrier with frequency stabilization, and timing events are distributed in the same fiber. The phase drift is detected precisely, based on the principle of the Michelson interferometer. The phase drift is compensated with coarse and fine correctors afterward. We aim to realize the stable transmission of the RF signal and timing events for a long distance and duration, with the phase drift and additive jitter in femtoseconds. After the extension, the system will become a complete solution for the clock-and-trigger distribution of synchrotron radiation facilities, free-electron lasers, and other accelerators. The physics design, simulation analysis, and preliminary results are included in the paper.

Dignity and its related factors among older adults in long-term care facilities:A cross-sectional study

Objectives:This study aimed to explore the dignity and related factors among older adults in long-term care facilities.Methods:Cross-sectional data were obtained from a sample of 253 Chinese older adults dwelling in long-term care facilities.Dignity among older adults was measured using the Dignity Scale,and its potential correlates were explored using multiple linear regressions.Results:Results showed that the total score of the Dignity Scale is 151.95±11.75.From high to low,the different factors of dignity among older adults in long-term care facilities were as follows:caring factors(4.83±0.33),social factors(4.73±0.41),psychological factors(4.66±0.71),value factors(4.56±0.53),autonomous factors(4.50±0.57),and physical factors(4.38±0.55).A higher score of the Dignity Scale was associated with higher economic status,fewer chronic diseases,less medication,better daily living ability and long-time lived in cities.Conclusion:Older adults with low economic status,more chronic diseases,and poor daily living ability,taking more medications,or the previous residence in rural areas seem to be most at low-level dignity in long-term care facilities and thus require more attention than their peers.

Survey of <i>C. difficile</i>-Specific Infection Control Policies in Local Long-Term Care Facilities

Introduction: The incidence and severity of Clostridium difficile infection (CDI) has been increasing and long-term care facility (LTCF) residents are at high risk given their age, co-morbidities, and high antibiotic exposure. Infection control policies are crucial for controlling CDI, but there are currently no regulatory guidelines in the United States. Therefore, we evaluated infection control policies in local LTCFs to define the CDI-specific policies and the administrative and staff understanding of CDI, so as to identify perceived barriers for compliance. Methods: IRB approval was sought and exemption granted, all 8 local LTCFs were asked to participate. Each facility was visited by study personnel who interviewed the administrative Infection Control Practitioner (ICP) and 3-4 Licensed Practical Nurses (LPNs) with distinct survey format. Infection control policies were then compared to the SHEA recommendations for CDI in LTCFs. Results: Of the eligible facilities, 75% (n = 6) participated. ICP (n = 6) and LPNs (n = 21) were interviewed. All facilities accept residents with active CDI and 2 had written CDI-specific infection control policies. All facilities had hand hygiene or glove use policies and 2 had policies for the use of sporicidal environmental cleaning. No facility restricted antibiotic use. Each facility has a policy to instruct their staff through in-services, either annually or upon new hire, but 33% (n = 7) LPNs reported no facility-based CDI training. While 80% (n = 17) of LPNs felt comfortable with the facility CDI policies, only 11 accurately restated it. ICPs felt the most relevant barrier to staff compliance was time constraints (n = 4, 67%), however, LPNs felt it was limited knowledge (n = 10, 48%) and poor communication (n = 2, 10%). Discussion and Conclusions: With the increasing incidence and severity of CDI in LCTF, few of the facilities surveyed had CDI-specific policies. Despite CDI-specific training, there is a perceived knowledge and communication gap for staff caring for residents with CDI.