Let's End HepC: Modelling Public Health Epidemiological Policies Applied to Hepatitis C in Spain

Background: The WHO has defined international targets toward the elimination of hepatitis C by 2030. Most countries cannot be on track to achieve this goal unless many challenges are surpassed. The Let's End HepC (LEHC) tool aims to contribute to the control of hepatitis C. The innovation of this tool combines the modelling of public health policies (PHP) focused on hepatitis C with epidemiological modelling of the disease, obtaining a unique result that allows to forecast the impact of policy outcomes. The model was applied to several countries, including Spain.Methods: To address the stated objective, we applied the “Adaptive Conjoint Analysis” for PHP decision-making and Markov Chains in the LEHC modelling tool. The tool also aims to be used as an element of health literacy for patient advocacy through gamification mechanisms and country comparability. The LEHC project has been conducted in several countries, including Spain. The population segments comprised in the project are: People Who Inject Drugs (PWID), prisoners, blood products, remnant population.Results: A total of 24 PHP related to hepatitis C were included in the LEHC project. It was identified that Spain had fully implemented 14 of those policies to control hepatitis C. According to LEHC's model forecast, the WHO's Hepatitis C elimination goal on reducing the number of patients living with Hepatitis C to 10% can be achieved in Spain by 2026 if current policies are maintained. The model estimates that the total population in Spain, by 2026, is expected to comprise 26,367 individuals living with hepatitis C. Moreover, if the 24 PHP considered for this study are fully implemented in Spain, the elimination goal may be achieved in 2024, with 29,615 individuals living with hepatitis C by that year.Conclusion: The findings corroborate the view that Spain has set great efforts in directing PHP toward Hepatitis C Virus (HCV) elimination by 2030. However, there is still room for improvement, namely in further implementing 10 of the 24 PHP considered for the LEHC project. By maintaining the 14 PHP in force, the LEHC model estimates the HCV elimination in the country by 2026, and by 2024 if further measures are employed to control the disease.

Digital Euro: A (Digital) Symbol of Progress and Integration in Europe

The emergence of crypto assets such as Bitcoin and Ether exposed a number of advantages that these digital assets based on distributed ledger technology (DLTs) can offer. As cash is becoming less and less popular in the eurozone, the European Central Bank (ECB) is currently looking at the scenario of creating a digital euro as a kind of central bank money that may be used by the general public. DLT may be used to tokenize central bank money via digital currencies (CBDCs) issued by central banks, as well as to digitally represent bank deposits. The purpose of this article is to analyse what are the solutions for the future digitization of the monetary and financial systems and if current CBDC projects and prototypes, including those by the Chinese and Swedish central banks and the attempts of the ECB, have the chance to succeed with or without DLT.

Epidemiologic Determinants of Dynamics in Heart Failure Prevalence and Mortality in Older U.S. Adults

Recent declines in heart failure (HF) prevalence and increases in mortality among older adults in the US suggest the need for research to investigate the relative contribution of the epidemiological determinants of these two processes to their historical and current trends. Study data were derived from a 5% sample of Medicare beneficiaries, 1991-2017. Partitioning analysis was used to decompose age-adjusted prevalence and incidence-based mortality (IBM) into their constituent components. HF prevalence trend decomposition demonstrated three phases: (a) Decelerated Increasing Prevalence (1994-2006) mainly driven by decreasing incidence, overpowering increasing survival, (b) Accelerated Declining Prevalence (2007-2014) and (c) Decelerated Declining Prevalence (2015-2017), mainly driven by declining incidence, overpowering declining survival. For HF IBM four phases were identified: (a) Decelerated Increasing Mortality (1994-2001) with declining incidence and increasing survival driving deceleration, (b) Accelerated Declining Mortality (2002-2012), (c) Decelerated Declining Mortality (2013-2016), mainly driven by declining incidence, overpowering declining survival, and (d) Accelerated Increasing Mortality (2017) mainly driven by declining survival, overpowering declining incidence. Study findings suggest that the recent decade-long decline in HF prevalence and 15-year decline in HF mortality mainly reflected decreasing incidence, while the most recent increase in mortality was due to declining survival, which may be associated with the Hospital Readmission Reduction Program. If current trends of incidence and survival persist, HF prevalence and mortality are forecasted to grow, suggesting that actions to reduce HF risk factors and improve treatment and management of HF after diagnosis are warranted.

522 Late-Breaking: Effects of Corn Processing and Age on Energy Balance, Nutrient Digestion and Rumination in Cattle

Current library values for energy content in whole or dry-rolled corn (DRC) are identical and do not differ for cattle of different age (NASEM, 2016). Calves (295 ± 29 kg) and yearlings (521 ± 29 kg) were fed whole, DRC or steam-flaked corn (SFC) to evaluate library values of energy content in different types of processed corn among cattle of different age. Cattle were fed diets comprised of 75% corn (DM-basis) to 2.5-times maintenance energy requirements using estimates of NEm in corn and SFC (NASEM, 2016). Data were analyzed using the MIXED procedure of SAS. There was no observed interaction of corn processing and cattle age (P ≥ 0.40). Time spent ruminating (min/d) was not different between dietary treatment or age. Total tract starch digestibility was greatest (P = 0.01) for cattle fed SFC (97.5%), intermediate in cattle fed DRC (92.4%) and least in cattle fed whole corn (89.5%). Nitrogen balance was not affected (P ≥ 0.30) by corn processing or age. Digestible and metabolizable energy (Mcal/kg-DMI) were greater (P ≤ 0.05) for cattle fed SFC compared to DRC or whole. A greater proportion of DE was lost to heat production (P = 0.01) in cattle fed whole corn compared to DRC and tended to be greater (P = 0.08) in cattle fed SFC than DRC. Retained energy (Mcal/d) should have been similar if current library values correctly reflect energy content in each type of processed corn. However, retained energy was greater (P < 0.01) for cattle fed DRC compared to whole corn and tended to be greater (P = 0.06) compared to SFC indicating that library values for DRC underestimate energy available to growing cattle. Measures of retained energy for cattle fed DRC indicated that energy available for gain from DRC was 42% greater than library values (NASEM, 2016).

1206Will access to Covid-19 vaccine in Aotearoa be equitable for priority populations?

Background This research examines the equity implications of the geographic distribution of COVID-19 vaccine delivery locations in Aotearoa New Zealand under five potential scenarios: (1) stadium mega-clinics; (2) Community Based Assessment Centres; (3) GP clinics; (4) community pharmacies; and (5) schools. Methods We mapped the distribution of Aotearoa New Zealand’s population and the location of potential vaccine delivery facilities under each scenario. Geostatistical techniques identified population clusters for Māori, Pacific and people aged 65 years and over. We calculated travel times between all potential facilities and each Statistical Area 1 in the country. Descriptive statistics indicate the size and proportion of populations that could face significant travel barriers when accessing COVID-19 vaccinations. Results Several areas with significant travel times to potential vaccine delivery sites were also communities identified as having an elevated risk of COVID-19 disease and severity. All potential scenarios for vaccine delivery, with the exception of schools, resulted in travel barriers for a substantial proportion of the population. Overall, these travel time barriers disproportionately burden Māori, older communities and people living in areas of high socioeconomic deprivation. Conclusions The equitable delivery of COVID-19 vaccines is key to an elimination strategy. However, if current health services and facilities are used without well-designed and supported outreach services, then access to vaccination is likely to be inequitable. Key messages Organisations need to proactively plan for equity, including the delivery of COVID-19 vaccines. A social justice approach should be prioritised, and in Aotearoa Te Tiriti o Waitangi obligations must be met.

DOES WORKING CAPITAL HAS AN IMPACT ON PROFITABILITY OF INDIAN STEEL INDUSTRY

Working capital has a major role in day to day business activities. It is simply defined as the excess amount of current assets over current liabilities. Working capital also means the fund which is needed for the operations which are taken place in a firm every day. So working capital is considered as a fund which revolves all the time. This revolving fund consists of continues conversion of cash and raw materials in to inventory, then inventory to sales or debtors and this debtors into cash or investment. The existing Working capital in the company is also commonly known as Net Working Capital or net current assets, is the excess if current assets over currentliabilities. But this is on a particular day i.e., 31st March’s position. While it is important to know whether the company really has correct level of WC which is required to them? For this purpose there is a need to find out the required working capital and its relation with the profitability. Thus, the research work has included measuring the impact of WC on profitability. Further there must be discussions with the accounting experts of the selected 10 steel companies to know what they feel about their desired level and actual level of working capital.

Evaluation of sow thermal preference across three stages of reproduction

The metabolic heat production of modern pigs has increased by an average of 16%, compared to sows of thirty years ago. Therefore, it is likely that temperature recommendations require updating to meet the needs of modern pigs. The objective of this study was to evaluate whether different reproductive stages of sows altered thermal preference and if current recommendations required updating. Twenty multi-parous sows (3.4 ± 1.2 parity) in different reproductive stages (non-pregnant: n=7; mid-gestation: 58.5 ± 5.68 d, n=6; and late-gestation: 104.7 ± 2.8 d, n=7) were tested. Thermal preference was individually tested and sows could freely choose a temperature, using a thermal gradient between 10.4 to 30.5°C. Sows were given 24 h to acclimate to the thermal apparatus. Before testing began, sows were given daily feed allotment and returned to the apparatus. Video from the 24 h test period was used to record sow behavior (time spent inactive), posture (upright, sternal and lateral lying), and location using instantaneous scan samples every 15 min. Data were analyzed using PROC MIXED in SAS 9.4. A cubic regression model was used to calculate the sow’s most preferred temperature based on the location, or temperature, in which they spent the most time. The preference range was calculated using peak temperature preference ±SE for each sow. The reproductive stage altered where sows spent their time within the thermal gradient (P < 0.01). Late-gestation sows preferred cooler temperatures (14.0°C) than mid-gestation (14.8°C; P < 0.01) and non-pregnant sows (14.8°C; P < 0.01). In summary, sow thermal preferences were within the lower half of the current recommended range (10 to 25°C). This indicates that temperatures at the higher end of the recommended range could be uncomfortable to sows and that the thermal comfort zone of sows may be narrower than recommendations indicate.

The effects of TENS, interferential stimulation, and combined interferential stimulation and pulsed ultrasound on patients with disc herniation-induced radicular pain

BACKGROUND: Electrotherapy is part of a physician’s toolbox for treating various musculoskeletal conditions, including radicular pain, but the preferred modality is yet unclear. OBJECTIVE: To compare the short-term efficacy of three electrotherapeutic modalities in relieving lumbar disc herniation (LDH)-induced radicular pain. METHODS: Fourteen patients with LDH-induced radicular pain attended a single session of electrotherapy, which included four 10-min consecutive treatments: transcutaneous electrical nerve stimulation (TENS), interferential (IF) stimulation, a combined treatment with pulsed ultrasound and IF current (CTPI), and a sham control. Treatments were randomized and the straight leg raise (SLR) degree was measured immediately before and after each treatment. RESULTS: Each of the three active modalities significantly improved the SLR score. The most prominent improvement was observed in the CTPI condition, followed by IF and, finally, TENS. The sham stimulation did not affect the SLR scores. CONCLUSIONS: A single session with either TENS, IF current or CTPI is sufficient to improve the range of motion and degree of radicular pain associated with LDH. CTPI appears to be the most effective modality of the three, possibly due to greater penetration efficiency of the induced current. The effects of a long-term treatment schedule are yet to be identified.

Using syndromic measures of mortality to capture the dynamics of COVID-19 in Java, Indonesia, in the context of vaccination rollout

Background As in many countries, quantifying COVID-19 spread in Indonesia remains challenging due to testing limitations. In Java, non-pharmaceutical interventions (NPIs) were implemented throughout 2020. However, as a vaccination campaign launches, cases and deaths are rising across the island. Methods We used modelling to explore the extent to which data on burials in Jakarta using strict COVID-19 protocols (C19P) provide additional insight into the transmissibility of the disease, epidemic trajectory, and the impact of NPIs. We assess how implementation of NPIs in early 2021 will shape the epidemic during the period of likely vaccine rollout. Results C19P burial data in Jakarta suggest a death toll approximately 3.3 times higher than reported. Transmission estimates using these data suggest earlier, larger, and more sustained impact of NPIs. Measures to reduce sub-national spread, particularly during Ramadan, substantially mitigated spread to more vulnerable rural areas. Given current trajectory, daily cases and deaths are likely to increase in most regions as the vaccine is rolled out. Transmission may peak in early 2021 in Jakarta if current levels of control are maintained. However, relaxation of control measures is likely to lead to a subsequent resurgence in the absence of an effective vaccination campaign. Conclusions Syndromic measures of mortality provide a more complete picture of COVID-19 severity upon which to base decision-making. The high potential impact of the vaccine in Java is attributable to reductions in transmission to date and dependent on these being maintained. Increases in control in the relatively short-term will likely yield large, synergistic increases in vaccine impact.

Environmental Load Evaluation of Nipigon River Bridge

If current climate trends continue, climate change will be inevitable and designing infrastructure which can withstand changing environmental loads will be a concern. Furthermore, current infrastructure will be affected and may require retrofitting or rehabilitation in order to meet safety and code requirements. The scope of this report is to determine the effect of increased environmental load factor coefficients on Nipigon River Bridge. An FEA model was created and the results from the model show that the bridge is sensitive to changes in environmental loads, particularly those of wind and temperature. An increase of 10% in wind and temperature load coefficients was enough to change the governing load combination and surpass the estimated moment capacities.