Additional Days Research Articles

Influences on improved confidence among allied health students in working with Australian Indigenous people during a rural placement: a pre-post survey study

BackgroundTogether with addressing social determinants of health, culturally safe healthcare provision is essential for closing the health outcomes gap experienced by Aboriginal and Torres Strait Islander (Indigenous) Australians. Rural placements potentially provide students of the health professions with opportunities to enhance their knowledge and skills regarding cultural safety. We used rural placements data systematically collected from allied health students, including commencement- and end-of-placement questionnaire responses, to investigate the determinants of confidence in working with Indigenous people.MethodsThe study comprised data from all students who provided survey data at both commencement and end of their first placement directly supervised by the administering University Department of Rural Health during the period 2019–2022. Five-point ordered responses to the question ‘How confident do you feel about working with Aboriginal people?’ were used to assess student and placement-related determinants of confidence (Confident/Very confident versus other) at baseline and increased confidence (≥ 1 point) during the placement using crude and adjusted multivariable robust Poisson regression.ResultsParticipating students (N = 489) were from diverse allied health disciplines (including pharmacy n = 94, 19.2%; chiropractic n= 66, 13.5%; physiotherapy n= 65, 13.3%; social work n = 59, 12.1%; and occupational therapy 58, 11.9%). Confidence in dealing with Aboriginal people was lower at commencement among females compared with males (adjusted relative risk [aRR] 0.65; 95% confidence interval [CI] 0.53–0.80), and higher among students of Australian rural origin compared with others (aRR 1.49; CI 1.22–1.83) and those who reported previous experience working with Indigenous people compared with those reporting none (aRR 1.40; CI 1.14–1.72). Placement attributes associated with increased confidence working with Indigenous people between placement commencement and end were interaction with Indigenous people within the placement (aRR 2.32; CI 1.24–4.34), placement model reflecting more structured academic supervision (aRR 1.18; CI 1.02–1.37), and placement length (aRR per additional day 1.002; CI 1.001–1.004). These associations were robust to modelling that accounted for a ceiling effect on increased confidence.ConclusionsWhile influenced by students’ demographic attributes and prior experiences, confidence of allied health students in working with Indigenous people is enhanced during rural placements, particularly through direct contact with Indigenous people.

Epistaxis in COVID positive ICU patients, implications, and future interventions

PurposeEpistaxis in critically ill patients may prevent the use of non-invasive ventilation and impair nasal oxygen delivery. Since the onset of COVID-19, high-flow nasal oxygen has dramatically increased. There is a paucity of literature on characteristics of epistaxis in critically ill, COVID-19 positive patients. We aimed to establish the incidence of epistaxis and identify risk factors. Materials and methodsThis was a retrospective observational study conducted at a large academic medical center. Chart review was performed on patients with an intensive care admission and COVID-19 diagnosis between January 2020 and May 2022. Data included epistaxis events, supplemental oxygen delivery and duration, anticoagulation, and antiplatelet therapies. Results932 patients met study criteria. Epistaxis incidence was 7.4 %. Of those with epistaxis, 78 % were administered supplemental oxygen. For each additional day on nasal oxygen, patients were at a 7.1 % higher risk for epistaxis (p < .001). Most antiplatelet agents and therapeutic anticoagulation were not found to increase risk. ConclusionsNasal oxygen was a major risk factor for epistaxis in this population. Nasal hygiene is a standard regimen recommended by otolaryngologists for epistaxis. Protocolizing the inclusion of nasal hygiene measures may be an easy, inexpensive way to prevent epistaxis in this already unstable patient population.

Height status matters for risk of mortality in critically ill children

BackgroundAnthropometric measurements are crucial in pediatric critical care, but the impact of height on ICU outcomes is underexplored despite a substantial number of short-for-age children in ICUs. Previous studies suggest that short stature increases the risk of poor clinical outcomes. This study examines the relationship between short stature and ICU outcomes.MethodsWe conducted a retrospective cohort study using a Japanese nationwide database (the Japanese Intensive Care Patient Database; JIPAD), which included pediatric patients under 16 years admitted to ICUs from April 2015 to March 2020. Height standard deviation scores (SD scores) were calculated based on age and sex. Short-stature patients were defined as height SD score < − 2. The primary outcome was all-cause ICU mortality, and the secondary outcome was the length of stay in ICU.ResultsOut of 6,377 pediatric patients, 27.2% were classified as having short stature. The ICU mortality rate was significantly higher in the short-stature group compared to the normal-height group (3.6% vs. 1.4%, p < 0.01). Multivariable logistic regression showed that short stature was independently associated with increased ICU mortality (OR = 2.73, 95% CI 1.81–4.11). Additionally, the Fine–Gray subdistribution hazards model indicated that short stature was associated with a lower chance of ICU discharge for each additional day (HR 0.85, 95% CI 0.81–0.90, p < 0.01).ConclusionsShort stature is a significant risk factor for increased ICU mortality and prolonged ICU stay in critically ill children. Height should be considered in risk assessments and management strategies in pediatric intensive care to improve outcomes.

How does temperature affect rural income: Channels and implication of adaptation

AbstractThis paper examines the impact of daily temperature variations on rural income per capita and evaluates the effectiveness of adaptation based on China's county‐level socioeconomic statistics and household survey data. We find that high temperatures have significant negative effects on rural income per capita. Relative to the physically comfortable reference temperature between 10 and 15°C, an additional day with a daily average temperature above 30°C reduces the rural income per capita by 0.12% in the year. Evidence from micro‐data indicates that agricultural income of rural households is sensitive to high temperatures relative to other components of household income, such as wage income and transfer income, which leads to a reallocation of rural laborers across sectors. In addition, we indeed find some evidence of adaptation, but we conclude that the current adaptation pattern of rural households probably magnifies the threat of future climate change to China's agricultural sector.

Muscle-strengthening activity is associated with total alcohol consumption and binge drinking among U.S. college students

Objective: To examine the association of muscle-strengthening activity with total alcohol consumption (AC) and binge drinking (BD). Participants: College students (n = 1623) from a large United States university. Methods: Students self-reported their physical activity (PA), AC, and socio-demographic characteristics via an online survey. Hierarchical regression models were computed to examine the association of aerobic PA, and muscle-strengthening activity with total AC and BD. Results: After adjusting for socio-demographic characteristics and aerobic PA, muscle-strengthening activity and achieving muscle strengthening activity recommendations explained a significant proportion of unique variance in total AC (β = .16, p < .001 and β = .16, p < .001, respectively). Similarly, with each additional day of muscle-strengthening activity the odds of reporting BD were 20.9% higher, and individuals who met muscle-strengthening activity recommendations had 93.2% higher odds of reporting BD. Conclusions: Muscle-strengthening activity should be accounted for when examining the relationship between PA and AC.

Nightshift Rotation Schedule and Fatigue in U.K. and Italian Nurses.

Whether hours on shift might impact adaptation to night shift work is still controversial. We conducted a pooled analysis of two studies, including 170 hospital nurses working night shifts, 116 from a United Kingdom study working 12-hour rotating shifts, and 54 from Italy working 8-hour shifts. Both studies used the Epworth Sleepiness Scale (ESS) to detect sleepiness during routine daytime activities as an indicator of fatigue. We compared the prevalence of daytime sleepiness, as indicated by an ESS score≥11, resulting from either shift work schedule. We used logistic regression to calculate the risk of daytime sleepiness associated with 12-hour vs. 8-hour nightshifts, adjusting by age, sex, and parenting children aged≤4. When comparing similar work circumstances, nightshifts prolonged to 12 hours did not increase the risk of daytime sleepiness compared to 8 hours (OR=0.9, 95% CI 0.32, 2.59). Our results suggest that 12-hour rotating nightshifts with additional rest days and 8-hour rotating shift schedules do not differ in their impact on daytime sleepiness. Further research is warranted on what strategies might effectively contrast fatigue, circadian misalignment, and the related metabolic changes leading to adverse health outcomes, including cancer.

80 Yearly change in child zBMI and the COVID-19 pandemic in Canada: A cohort study

Abstract Background Emerging literature suggests accelerated weight gain in children during the pandemic; however, data from Canadian children are limited and individual factors underlying this trend remain unclear. Objectives To determine whether the COVID-19 pandemic was associated with increased yearly change in age- and sex-standardized body mass index (zBMI) in Canadian children and whether staying at home during the pandemic was associated with increased change in zBMI per year. Design/Methods A repeated-measures longitudinal study was conducted with children from an existing practice-based research network in Canada age 1-18y with at least one zBMI measurement pre- and post-onset of the pandemic. Height and weight were measured through primary care office visits and supplemented with at-home parent measurements post-pandemic. Weekly questionnaires were used to measure days stayed at home per week. Piecewise linear mixed effects models accounting for repeated measures through random effects were used to assess yearly change in zBMI. A knot location was placed at the start of the pandemic (March 14, 2020) to compare slopes pre- and post-pandemic onset. Similar mixed effects models were used to explore the association between days at home per week and change in zBMI post-pandemic onset. Stratification by sex and a sensitivity analysis in children with clinic-measured anthropometrics were explored. All models were adjusted for covariates identified a priori. Results In the overall population (n=849 children, 5070 observations), there was no significant difference in slope for yearly change in zBMI post-pandemic (Mar 2020-Sept 2022) compared to prior (Oct 2004-Mar 2020) in fully adjusted models accounting for child age, sex, maternal ethnicity, maternal BMI, family income, birthweight, breastfeeding duration, anthropometrics measurement method (clinic vs parent) and pre-COVID zBMI (post-COVID β=0.03; 95%CI -0.02,0.08; pre-COVID β=0.009; 95%CI-0.009,0.027; p-interaction=0.46). In children with clinic-measured anthropometrics (n=849, 4318 observations), there was a significant increase in yearly change in zBMI after the onset of the pandemic in the fully adjusted model (β=0.07; 95%CI 0.02,0.12) compared to prior (β=0.004; 95%CI -0.01,0.02; p-interaction=0.01). This was driven by changes in boys (post-COVID β=0.08; 95%CI 0.007,0.15; pre-COVID β=-0.003; 95%CI-0.03,0.02; p-interaction 0.04). In boys with clinic-measured anthropometrics post-pandemic onset (n=77 children, 85 observations), there was marginal evidence for increase in yearly zBMI change for every additional day at home per week in the fully adjusted model (β=0.16; 95%CI -0.006,0.32; p=0.06). Conclusion The COVID-19 pandemic was associated with accelerated increase in zBMI per year in Canadian children with clinic-measured height and weight, particularly among boys. Potential competing interests Funding was obtained by J.J. Joseph Jamnik for consultant work for Nutrigenomix Inc, a University of Toronto start-up which offers evidence-based genetic testing for personalized nutrition. Consulting work terminated July 1, 2023. This relationship is unrelated to the work submitted. Research funding: Understanding and mitigating the impacts of the COVID-19 pandemic on children, youth and families in Canada - Operating Grant. CIHR grant 468613. 2021-2024.

Estimating the impact on patient safety of enabling the digital transfer of patients’ prescription information in the English NHS

ObjectivesTo estimate the number and burden of medication errors associated with prescription information transfer within the National Health Service (NHS) in England and the impact of implementing an interoperable prescription...

Correlation of CT measurements of total body gas volume and hounsfield units with post-mortem interval

Accurate estimation of the post-mortem interval (PMI) may be a matter of crucial importance in forensic investigations.A preliminary investigation to assess whether longitudinal changes in organ Hounsfield units (HU) and total body gas volume (TBGV), as measured from serial PMCT scans, correlate with postmortem interval (PMI).: Eight euthanised lambs each had five whole body CT scans performed over seven days and measurements were taken from the brain, heart, lungs, liver, kidneys and spleen. HU tissue density was measured directly from the PMCT images, while TBGV was calculated using ImageJ software. A random effect model was fitted with the subject fitted as a random intercept. Ethical and Animal Welfare approval was obtained. : The average increase in TBGV was 422 ml/Kg with a change of 77 ml/Kg per day. For each additional post-mortem day, the HU of the brain, heart, lung, liver and spleen decreased by per day since death, while HU for the kidneys increased by day since death. Expect for the kidney where it increased, there was clear and progressive decrease in tissue densities and for all organs there was an increase in TBGV over time. However, the overlap in values between cases indicates that more work is required before either HU or TBGV can be developed as non-invasive methods to reliably determine time of death in humans.

Participation in organised sports and longitudinal development of physical activity in Swiss youth: the population-based SOPHYA cohort

BACKGROUND: Maintaining physical activity throughout life is crucial for overall health and wellbeing. Yet the age-related decline in average physical activity, a natural phenomenon also observed in animals, poses a challenge. This study aimed to investigate whether participation in organised sports supported by the Swiss Youth+Sports (Y+S) programme is associated with sustaining or enhancing physical activity among children and adolescents during 5 years of follow-up. METHODS: The longitudinal study was nested in the population-based SOPHYA (Swiss children’s Objectively measured PHYsical Activity) cohort. Participants aged 6–16 years at SOPHYA1 (2014) with complete accelerometer data from baseline and follow-up assessment (SOPHYA2, 2019) were included. The primary exposure was participation in organised sport during the follow-up period, calculated by linkage with the Y+S database as the number of days with at least one activity in Y+S-offered programmes for ages 5 to 20 years. The primary outcome was the categorisation of participants into physical activity “improvers” or “worseners”. Improvers in the respective physical activity categories – total activity counts per minute (CPM), minutes in moderate-to-vigorous activity (MVPA), minutes in light activity (LPA) and minutes in sedentary behaviour (SB) – increased or maintained their active physical activity during the 5 follow-up years. Information on confounders and effect modifiers (sex, age, body mass index (BMI), language region, household income, education) was obtained by self-report at baseline. Logistic regressions examined the relationship between organised sport participation and the probability of being a physical activity improver in each physical activity intensity category separately. Covariates for the final models were selected through a stepwise procedure based on the Bayesian information criterion from a maximal model containing all covariates as well as all two-way interactions with organised sport and between them. All models were a priori adjusted for technical variables (season of measurement; wear time; duration of follow-up). RESULTS: The analysis included 432 participants. There was a strong CPM, MVPA and LPA decline from 2014 to 2019, but an increase in SB. Nevertheless, the prevalence of improvers was 22.5% for CPM, 9.5% for MVPA, 26.9% for LPA and 9.7% for SB. Engagement in organised sport between 2014 and 2019 was positively associated with CPM, MVPA and SB, but not with LPA improver status. For 30 additional days of participation in organised sport over the five years of the study, the odds of being an improver vs being a worsener increased by 4.0% for CPM (95% CI: 0.13–7.69), 6.2% for MVPA (95% CI: 0.82–11.54) and 6.0% for SB (95% CI:−1.49–13.97). CONCLUSION: The results provide supporting evidence that organised sport in the context of the Swiss Y+S programme may empower the young to maintain an active lifestyle and even offset the age-related decline in physical activity.

Comparison of Short vs. Extended Antibiotic Durations for Patients in the Neonatal Intensive Care Unit with Late Onset, Culture-negative Sepsis

Abstract Background Culture-proven late-onset sepsis in neonates and preterm infants, defined as symptom onset after 3-7 days of life, is a common cause of morbidity and mortality. Some patients are treated with antibiotics for sepsis despite lack of positive cultures after 48 hours of incubation, potentially due to the non-traditional signs of sepsis. Controversy remains over optimal treatment durations of culture-negative sepsis with durations reported as 2 to 7 days, and rarely longer than 7 days. The primary outcome of this study is to compare lack of symptom resolution at 7 days in patients with negative cultures treated with antibiotics for either ≤72 hours or &amp;gt;72 hours. Methods This was a single-center, retrospective, cohort study with Institutional Review Board approval at a 60 bed, level 4, surgical referral neonatal intensive care unit from January 1, 2020, to December 31, 2021. Patients were included for screening if they were ≥7 days of age, ≤ 44 weeks postmenstrual age, and received more than 1 day of antibiotics for possible late-onset, culture-negative sepsis. Patients were then excluded if they had positive culture results from any site, diagnosis of pneumonia, were being treated for suspicion of necrotizing enterocolitis, received antibiotics prior to obtaining cultures, or had continued treatment of prior infection. Patients were divided into two groups based on antibiotic duration: ≤72 hours or &amp;gt;72 hours. Presenting symptoms and symptom resolution at 72 hours and 7 days were assessed. Chi-squared or Fisher’s exact tests were used for categorical comparisons. Results Of the 909 patients screened, 68 were included: 42 in the ≤72 hours group and 26 in the &amp;gt;72 hours group. The most prevalent symptoms prompting antibiotic initiation were elevated CRP (64.7%) and bradycardia/oxygen desaturations (78%), with elevated CRP being the initiating symptom more frequently in the &amp;gt;72-hour group (92% vs 48%, p&amp;lt;0.001). If patients had 2 or more symptoms, they were more likely to receive &amp;gt;72 hours of antibiotics (85% vs 62%, p=0.034). At 7 days, 28 (41%) patients had complete symptom resolution. Antibiotic duration ≤72 hours was not associated with symptom resolution at 7 days (50% symptom resolution in the ≤72-hour group vs 27% in the &amp;gt; 72-hour group, p=0.06). Lack of symptom resolution at 72 hours of antibiotics was associated with lack of resolution at 7 days (p&amp;lt;0.001). Among patients without symptom resolution at 7 days, 65% of patients had a persistently elevated CRP and 68% of patients continued to have bradycardia/oxygen desaturations. Conclusion In neonates and preterm infants with negative cultures but possible signs of sepsis, antibiotic duration does not impact 7-day symptom resolution. Results indicate that if the initiating symptom is not resolved at 72 hours despite negative cultures, it is unlikely to be resolved with additional days of antibiotics. This is likely due to the multifactorial potentially non-infectious etiology of initiating symptoms in these patients. It is appropriate to discontinue antibiotics if cultures are negative after 48 hours of incubation in this population.

Racial, Ethnic, and Socioeconomic Disparities in Pediatric Aquaporin-4-Positive Neuromyelitis Optica Spectrum Disorder

BackgroundOnly 5% of aquaporin-4-positive neuromyelitis optica spectrum disorder (AQP4+ NMOSD) cases emerge during childhood. Poorer outcomes have been suggested in black/African American (AA) adults with NMOSD; however, conflicting and limited data exist for pediatric-onset NMOSD. This study evaluates racial, ethnic, and socioeconomic disparities in pediatric AQP4+ NMOSD outcomes. MethodsThirty-eight pediatric patients with AQP4+ NMOSD cared for at three pediatric tertiary care centers between 2009 and 2021 were identified. Patient addresses connected to socioeconomic measures available from the US Census. Demographic characteristics, pertinent clinical outcomes, and health care utilization in the two years following diagnosis were captured. ResultsCompared with non-Hispanic White children, Black/AA children had a significantly higher Expanded Disability Status Scale (EDSS) (2.46 vs 0.33, P = 0.003), 2.37 more hospital admissions (P = 0.002), and 28.40 additional inpatient days (P = 0.002) in the two years following their NMOSD diagnosis. Additionally, children with public insurance had higher relapse rates than those with private insurance (P = 0.046). At two years and at the most recent follow-up, a significantly higher EDSS was correlated with children living in census tracts with a lower median income, higher deprivation index, and higher proportion of population on assisted income, in poverty, and with vacant housing (all P < 0.05). ConclusionsWe identified racial, ethnic, and socioeconomic disparities in clinical outcomes and health care utilization in pediatric AQP4+ NMOSD. Further prospective and household-level data are needed to dissect the interplay of genetics, structural racism, and social determinants of health so that interventions to optimize care and outcomes for this population may be developed.

6603 Impact of the Monocarbonyl Analogs of Curcumin, C66 and B2BrBC, on the Protein Expression of Epithelial and Mesenchymal Markers in MCF-7 Breast Cancer Cells

Abstract Disclosure: R. Stojchevski: None. A. Lavi: None. J. Bogdanov: None. N. Hadzi-Petrushev: None. M. Mladenov: None. L. Poretsky: None. D.B. Avtanski: None. The synthesis of monocarbonyl analogs of curcumin (MACs) presents a solution to the challenges posed by curcumin, a natural polyphenol extracted from the roots of the turmeric plant (Curcuma longa), which is known for its antioxidant and anti-inflammatory properties. The limitations of curcumin, including poor stability, low bioavailability, and rapid metabolism, hinder its application, and MACs, designed without a β-diketone moiety, address these drawbacks and exhibit enhanced stability and bioavailability. This study aimed to assess the effects of two monocarbonyl analogs of curcumin, (2E,6E)-2,6-bis[(2-trifluoromethyl)benzylidene]cyclohexanone (C66) and (2E,6E)-2,6-bis(2-bromobenzylidene)cyclohexanone (B2BrBC), on epithelial-to-mesenchymal transition (EMT) in MCF-7 breast cancer cells using western blot analysis. Our previous findings indicated that these analogs can potentially affect EMT by modulating the epithelial and mesenchymal gene expression. MCF-7 cells were cultured in complete medium supplemented with EMT-inducing factors for two days, followed by C66 and B2BrBC administration (100 µM) for three additional days. After the experiments, proteins were extracted, and western blot analyses were performed to measure the expression levels of various epithelial and mesenchymal markers (E-cadherin, N-cadherin, SNAI1, and Claudin-1). The results revealed that both C66 and B2BrBC increased the protein levels of the epithelial marker E-cadherin and suppressed those of the mesenchymal marker N-cadherin. Moreover, C66 and B2BrBC decreased the protein expression of the transcription factor SNAI1 and transmembrane protein Claudin-1. Between the two MACs, B2BrBC showed a more pronounced effect on N-cadherin expression, while C66 was more potent in suppressing SNAI1 protein expression. Our findings demonstrate that C66 and B2BrBC counteract EMT, contributing to the potential therapeutic applications of MACs in managing breast cancer progression. Presentation: 6/3/2024

6603 Impact Of The Monocarbonyl Analogs Of Curcumin, C66 And B2BrBC, On The Protein Expression Of Epithelial And Mesenchymal Markers In MCF-7 Breast Cancer Cells

Abstract Disclosure: R. Stojchevski: None. A. Lavi: None. J. Bogdanov: None. N. Hadzi-Petrushev: None. M. Mladenov: None. L. Poretsky: None. D.B. Avtanski: None. The synthesis of monocarbonyl analogs of curcumin (MACs) presents a solution to the challenges posed by curcumin, a natural polyphenol extracted from the roots of the turmeric plant (Curcuma longa), which is known for its antioxidant and anti-inflammatory properties. The limitations of curcumin, including poor stability, low bioavailability, and rapid metabolism, hinder its application, and MACs, designed without a β-diketone moiety, address these drawbacks and exhibit enhanced stability and bioavailability. This study aimed to assess the effects of two monocarbonyl analogs of curcumin, (2E,6E)-2,6-bis[(2-trifluoromethyl)benzylidene]cyclohexanone (C66) and (2E,6E)-2,6-bis(2-bromobenzylidene)cyclohexanone (B2BrBC), on epithelial-to-mesenchymal transition (EMT) in MCF-7 breast cancer cells using western blot analysis. Our previous findings indicated that these analogs can potentially affect EMT by modulating the epithelial and mesenchymal gene expression. MCF-7 cells were cultured in complete medium supplemented with EMT-inducing factors for two days, followed by C66 and B2BrBC administration (100 µM) for three additional days. After the experiments, proteins were extracted, and western blot analyses were performed to measure the expression levels of various epithelial and mesenchymal markers (E-cadherin, N-cadherin, SNAI1, and Claudin-1). The results revealed that both C66 and B2BrBC increased the protein levels of the epithelial marker E-cadherin and suppressed those of the mesenchymal marker N-cadherin. Moreover, C66 and B2BrBC decreased the protein expression of the transcription factor SNAI1 and transmembrane protein Claudin-1. Between the two MACs, B2BrBC showed a more pronounced effect on N-cadherin expression, while C66 was more potent in suppressing SNAI1 protein expression. Our findings demonstrate that C66 and B2BrBC counteract EMT, contributing to the potential therapeutic applications of MACs in managing breast cancer progression. Presentation: 6/3/2024

Influence of telecommuting on out-of-home time use and diversity of locations visited: Evidence from the COVID-19 pandemic

The COVID-19 pandemic has led to unforeseen changes in travel and activity behavior, most notably the wide adoption of telecommuting across various sectors of the workforce. This paper investigates the impact of telecommuting on time use and the number of unique locations visited, both of which have been shown to be closely linked to well-being. Previous telecommuting research often relies on cross-sectional data for which it is difficult to control for unobserved confounding, only analyzes impacts of time-use at the daily level, and has yet to quantify the impact of telecommuting on diversity of locations visited. We use quasi-experimental designs to control for unobserved confounders and extend previous research to identify whether the daily impacts of telecommuting on time-use are additive or substitutional at the weekly level. We use passively collected Point of Interest (POI) data between January 2020 and September 2022, supplemented by five waves of survey responses throughout the COVID-19 pandemic (August 2020, October 2020, December 2020, April 2021, and July 2021) from a panel of U.S. smartphone users. We find that on telecommuting days, workers spend significantly more time at out-of-home non-work locations, estimated to be 114 min prior to the COVID-19 pandemic, decreasing in the early stages of the pandemic to 63 min, and recovering to approximately 120 min in 2022, estimates that are within the range of estimates presented in previous literature. While existing literature focuses on single day analyses, our weekly analysis suggests that daily differences due to telecommuting are substitutional, with the effect of an additional day of telecommuting on time-use at the weekly level being null. Our extension to analyze the impacts of telecommuting on the number of unique locations visited shows that an additional day of telecommuting results in an average decrease of 0.35 in the number of unique weekly locations visited. Collectively, our findings suggest that while telecommuting does not diminish the overall weekly time spent at out-of-home non-work locations, it decreases the diversity of such locations on a weekly level.

Prognostic significance of plasma cytomegalovirus (CMV) DNA load in immunocompetent patients with CMV pneumonia: A retrospective cohort study.

Cytomegalovirus (CMV) pneumonia, often presented as pneumonitis, is characterized by respiratory failure and large interstitial infiltrates visible on chest radiographs. This retrospective cohort study investigates the predictive significance of plasma CMV DNA load on the short- and long-term mortality among immunocompetent patients diagnosed with CMV pneumonia. The study included 61 immunocompetent patients suspected of having CMV pneumonia, treated with intravenous ganciclovir after positive CMV DNA results from bronchoalveolar lavage or plasma. Our multivariate Cox regression analysis identified several independent predictors of mortality. Having idiopathic pulmonary fibrosis (IPF) significantly increased the risk of in-hospital mortality (HR: 7.27, 95% CI: 1.62-32.52, p = 0.009), as did shorter durations of antiviral therapy (HR: 0.90, 95% CI: 0.84-0.97, p = 0.005) and higher CMV DNA levels (>3870 IU/mL; HR: 9.63, 95% CI: 2.32-39.98, p = 0.002). High CMV DNA levels (>5154 IU/mL) were also predictors of 30-day mortality (HR: 9.39, 95% CI: 2.20-40.01, p = 0.002). For 1-year mortality, the presence of IPF (HR: 2.96, 95% CI: 1.08-8.06, p = 0.034), hypersensitivity pneumonia (HP) (HR: 4.30, 95% CI: 1.57-11.78, p = 0.005), shorter duration of total antiviral therapy (HR: 0.95, 95% CI: 0.93-0.99, p = 0.010), and higher CMV DNA levels (>327 IU/mL) (HR: 3.36, 95% CI: 1.33-8.47, p = 0.010) were identified as independent determinants. The study reveals that IPF increases short and long-term mortality risks, while HP increases long-term mortality. Extended antiviral treatment duration results in a 10% reduction in in-hospital mortality for each additional day of treatment. Furthermore, elevated viral loads are associated with higher mortality rates, highlighting the necessity for careful monitoring.

Heat Stress Metrics, Trends, and Extremes in the Southeastern United States

Abstract Humid heat and associated heat stress have increased in frequency, intensity, and duration across the globe, particularly at lower latitudes. One of the more robust metrics for heat stress impacts on the human body is wet-bulb globe temperature (WBGT), because it incorporates temperature, humidity, wind speed, and solar radiation. WBGT can typically only be measured using nonstandard instrumentation (e.g., black globe thermometers). However, estimation formulas have been developed to calculate WBGT using standard surface meteorological variables. This study evaluates several WBGT estimation formulas for the southeastern United States using North Carolina Environment and Climate Observing Network (ECONet) and U.S. Military measurement campaign data as verification. The estimation algorithm with the smallest mean absolute error was subsequently chosen to evaluate summer WBGT trends and extremes at 39 ASOS stations with long continuous (1950–2023) data records. Trend results showed that summer WBGT has increased throughout much of the southeastern United States, with larger increases at night than during the day. Although there were some surprisingly large WBGT trends at higher elevation locations far from coastlines, the greatest increases were predominantly located in the Florida Peninsula and Louisiana. Increases in the intensity and frequency of extreme (90th percentile) WBGTs were particularly stark in large coastal urban centers (e.g., New Orleans, Tampa, and Miami). Some locations like New Orleans and Tampa have experienced more than two additional extreme heat stress days and nights per decade since 1950, with an exponential escalation in the number of extreme summer nights during the most recent decade. Significance Statement Humid heat and associated heat stress pose threats to health in the moist subtropical climate of the southeastern United States. Wet-bulb globe temperature (WBGT) is a robust metric for heat stress but must be estimated using complex algorithms. We first evaluated the accuracy of three WBGT algorithms in the southeastern United States, using measured verification data. Subsequently, we used the most accurate algorithm to investigate WBGT trends and extremes since 1950 in 39 cities. Results showed that summer heat stress has increased throughout the region, especially at night. Increases in the intensity and frequency of extreme heat stress were most prevalent at urban coastal locations in Florida and Louisiana, emphasizing the impacts of increased urbanization and evaporation on heat stress.

The time toxicity efficacy-effectiveness gap: A population-based study of stage III/IV non-small cell lung cancer (NSCLC) in Ontario, Canada.

133 Background: While patients enrolled in clinical trials tend to have superior cancer-specific outcomes relative to those in routine practice (the ‘’efficacy-effectiveness gap’’), it is unknown if this gap extends to time toxicity. While trial protocols can impose additional contact days, trial participants also tend to be healthier, perhaps needing fewer contact days. We sought to evaluate the time toxicity efficacy-effectiveness gap among patients with stage III/IV NSCLC. Methods: We created a population-based, retrospective cohort with health administrative data covering the population of Ontario, Canada (15.5 million), of adults aged ≥20 years diagnosed with stage III/IV NSCLC in 2014-2017 and died in 2014-2019, receiving palliative systemic anti-cancer drug(s) as part of a trial. We matched patients 1:1 to those who received the same drug(s) in the real world (post-approval) in the same line of treatment, and received the same total lines of therapy. We calculated contact days (days with healthcare contact outside the home) from diagnosis to death and measured overall survival. We plotted, normalized, and fitted with cubic splines the weekly percentage of contact days to obtain trajectories over the disease course. Results: We identified and matched 55 trial participants to 55 patients in routine practice. Trial participants were younger (median age, 62 vs 66 years), had fewer co-morbidities (hypertension, 35% vs 53%), and more often had de novo metastatic disease (82% vs 67%). Median lines of therapy were 2. Systemic therapy regimens most commonly included immunotherapy (n=41, 75%). Trial participants initiated systemic therapy sooner than in routine practice (median 2.0 vs 2.4 months). Trial participants had a longer overall survival (median 13.8 vs 11.6 months) and a similar number of contact days (median 79 vs 78 days). The percentage of contact days was lower in trial participants due to longer survival (median 19% vs 22%). Trial participants had similar acute/assisted institutional care contact days (median 19 vs 18 days), but more days with laboratory tests (median 23 vs 17 days), systemic therapy (median 9 vs 6 days), and radiotherapy visits (median 15 vs 11 days). Normalized trajectories for both cohorts followed a ‘’U-shape’’; the difference between the maximal peak and trough was smaller in trial participants. Conclusions: We describe a novel efficacy-effectiveness gap in time toxicity, in addition to the previously established efficacy-effectiveness gap in overall survival. Encouragingly, trial participants did not experience delays in treatment, and initiated treatments sooner than in routine practice. Among trial participants, the higher number of contact days for tests, and the shallower U-shaped curve (indicating frequent visits even when relatively well) indicate potential opportunities to decrease trial-related time toxicity.

Transdermal Carboxytherapy for Treating Vulvovaginal Atrophy: A Pilot Study

Objective: Genitourinary syndrome of menopause (GSM) is a prevalent disorder that can negatively impact the overall health, sexual function, and quality of life of affected women; however, available data do not support specific treatment protocols. A novel product enables the noninvasive transdermal administration of carboxytherapy with a topical gel (CO2Lift®, Lumisque, Inc.; Weston, FL). The following randomized, placebo-controlled pilot study assessed the safety and efficacy of the transdermal carboxytherapy gel for treating GSM-related vulvovaginal changes. Methods: Menopausal or postmenopausal women 40 to 70 years old with signs or symptoms of vulvovaginal atrophy and Female Sexual Dysfunction were randomized to receive topical carboxytherapy gel (n=40) or placebo gel (n=10) in a randomized, double-blind fashion. The assigned treatments were placed into the vagina and on the vulva for 45 minutes before removal. Treatment was applied daily for 5 days, stopped for 2 days, then continued for 5 additional days. Subjects completed four validated pre- and posttreatment questionnaires to assess female sexual function, sexual health, and genital self-image. Additionally, control (n=10) and treatment subjects (n=10) were randomized to undergo 3 mm pre- and posttreatment punch biopsies of vulva and vaginal tissue. Results: Overall, carboxytherapy-treated subjects achieved significant improvements in Female Sexual Function Index scores with strong positive correlations between sexual desire and arousal, arousal and sexual satisfaction, and sexual satisfaction and desire. The Day-to-Day Impact of Vaginal Aging Questionnaire results demonstrated a significant difference in mean pre- and posttreatment values for each assessment among subjects receiving topical carboxytherapy. Biopsy improvements included hyperplasia of the keratinized squamous epithelium, discrete hyperplasia of the basal layer and neovascularization, and increased thickness of mucous squamous epithelium. There were no adverse events. Conclusion: Transdermal carboxytherapy represents a safe, noninvasive means of treating the genitourinary syndrome of menopause symptoms and is suitable for home use. Additional research on this treatment is warranted.

Analysing the influence of dapagliflozin on urinary tract infection vulnerability and kidney injury in mice infected with uropathogenic Escherichia coli.

Sodium-glucose co-transporter-2 (SGLT2) inhibitors have revolutionized clinical medicine, but their association with urinary tract infection (UTI) risk remains debated. This study investigates the influence of dapagliflozin on UTI outcomes, focusing on kidney injury. Female non-diabetic C57BL/6J and C3H/HeOuJ mice, along with diabetic db/db mice, were orally administered dapagliflozin (1 mg/kg or 10 mg/kg) for 7 days before transurethral uropathogenic Escherichia coli (UPEC) infection. Mice were killed either 24 h after UTI or after six additional days of dapagliflozin treatment. UPEC titers were enumerated, and kidney histopathology, injury, fibrosis and function were assessed. Vehicle- and dapagliflozin-treated C57BL/6J mice exhibited similar urine and bladder UPEC titers, with minimal kidney burden 24 h after UTI. In C3H/HeOuJ mice, UPEC burden was comparable in vehicle- and 1 mg/kg dapagliflozin-treated groups both 24 h and 7 days after UTI. However, C3H/HeOuJ mice receiving 10 mg/kg dapagliflozin had increased UPEC titers in the urine, bladder and kidneys at both endpoints. Kidney injury and fibrosis markers, as well as kidney function, were similar in vehicle and dapagliflozin groups. In diabetic db/db mice receiving dapagliflozin, UPEC strain UTI89 titers were reduced 7 days after UTI compared to vehicle-treated mice, but no difference in UPEC titers was observed when mice were infected with UPEC strain CFT073. Kidney injury and fibrosis markers and kidney function remained similar across treatment groups. Dapagliflozin does not consistently influence UTI susceptibility and shows limited impact on kidney injury or fibrosis, suggesting SGLT2 inhibitors have minimal effects on UTI-related kidney complications.