Average Duration Research Articles

Association between weekend catch-up sleep and the risk of prediabetes and diabetes: A cross-sectional study using KNHANES

BackgroundThe objectives of this cross-sectional study were to explore the relationship between weekend catch-up sleep (WCUS) and the risk of prediabetes/diabetes and to assess how this risk varies based on WCUS duration, using a large population sample in South Korea. MethodsData were sourced from the 2021 Korea National Health and Nutrition Examination Survey, involving 2472 subjects aged 30 years and above, employed, and not using blood glucose-lowering medications. Prediabetes/diabetes risk was examined based on the presence of WCUS. Participants were categorized into four groups by WCUS duration (< 1, ≥ 1 and < 2, ≥ 2 and < 3, and ≥ 3 h) to evaluate the prediabetes/diabetes risk across varying WCUS durations. ResultsNo significant difference in prediabetes/diabetes risk was observed between the WCUS and non-WCUS groups. In subgroup analysis, a WCUS duration of 1 to 2 h was related to a lower odds ratio of prediabetes (aOR = 0.618, 95% CI = 0.382–0.999), while 3 h or more was associated with a higher odds ratio of diabetes (aOR = 3.098, 95% CI = 1.561–6.149). ConclusionsIn individuals who experience insufficient sleep during weekdays and manage to achieve the optimal average sleep duration of 1 to 2 h of WCUS, WCUS was associated with improved blood glucose regulation. However, compensating for excessive weekday sleep deprivation with WCUS of 3 h or more was associated with impaired blood glucose regulation.

Impact of neuromyelitis optica spectrum disorder on employment and income in the United States.

We aim to characterize the sociodemographic and clinical factors associated with loss of jobs, income, and work hours in people with neuromyelitis optica spectrum disorder (NMOSD) in the United States. A REDCap-based survey was administered to working-age NMOSD patients (18-70 years old) querying demographic information, symptoms, immunosuppression, work hours, income, and caregiver work (11/2022-07/2023). Regression models were developed using MATLAB. Of 127 participants (97 female; 55% AQP4-antibody, 19% MOG antibody; 69% Caucasian, 7% Hispanic), with an average diagnosis age of 38.7 years, average disease duration of 6.4 years, mean 3.1 attacks, and 94% of whom were treated with immune system-directed therapy (53% rituximab, 8% satralizumab, 7% eculizumab, 6% mycophenolate mofetil, 4% inebilizumab, 2% azathioprine, 10% IVIg, 10% other), 56% lost a job due to NMOSD. Employment decreased 12% (80% pre- to 68% post-diagnosis). Thirty-six percent of participants said they no longer worked outside the home. Significant predictors for post-NMOSD diagnosis employment status included younger age, lower pain level, no walking aids, and having a job prediagnosis. Sixty-eight percent of those employed prediagnosis reduced their work hours, dropping an average of 18.4 h per month since being diagnosed (±10.1 h). Average annual income grew slowly at $1998 during the average 6.4 years of disease duration (14% of the value predicted by the U.S. Bureau of Labor Statistics). Sixty percent of participants had a regular unpaid caregiver; 34% of caregivers changed their work hours or job to help manage NMOSD. We provide a structured analysis of the impact of NMOSD on employment, work hours, and income in the United States, demonstrating its major effect on the livelihoods of patients and their caregivers.

Dietetic service provision and nutritional interventions provided to patients with head and neck sarcoma: Findings from a national United Kingdom centre five-year audit

ObjectivesHead and neck sarcomas (HNS) represent a subset of malignancies which may be treated with multiple-modalities including chemotherapy followed by surgery and/or radiotherapy. Malnutrition is common in head and neck cancer (HNC) but limited literature exists determining nutritional interventions required in HNS. This audit aimed to investigate the dietetic input and nutritional interventions in HNS at a London sarcoma centre according to evidence-based HNC nutritional guidelines. MethodsRetrospective review between January 2018 to January 2023. Adult patients (≥18 years) newly-diagnosed with HNS treated at the tertiary centre were included. Demographic data and information on nutritional interventions was collected and statistically analysed. Results337 patients were referred to the HNS multidisciplinary meeting; 154 met the inclusion criteria; 66 received dietetic intervention (age = 45 [30.5] years; 47% (n = 31) male; baseline weight = 70.3 ± 18.13 kg; BMI = 24.2 [8.47] kg/m2). 19.7% (n = 13) were malnourished at presentation. Nutritional interventions were as follows: dietary counselling 100% (n = 66); oral nutritional support 90.9% (n = 60); oral nutritional supplements 75.8% (n = 50); enteral tube-feeding 54.5% (n = 36). 15.2% (n = 10) had a prophylactic gastrostomy; n = 4 pre-surgery and n = 6 pre-radiotherapy/proton-beam therapy±chemotherapy with 100% and 33.3% using the tube for ≥4 weeks respectively. Average duration of dietetic intervention was significantly longer for patients with high grade sarcoma compared to low grade (411.5 days and 136.8 days respectively, p = 0.000039) and for those undergoing multi-modality treatment compared to single-modality (402.9 days and 187.7 days respectively, p = 0.000932). ConclusionA fifth of patients with HNS were malnourished at presentation and the majority receiving dietetic intervention required nutrition support, indicating the need for nutritional management in HNS.

Incidence and risk factors of depression in patients with metabolic syndrome.

Many studies have explored the relationship between depression and metabolic syndrome (MetS), especially in older people. China has entered an aging society. However, there are still few studies on the elderly in Chinese communities. To investigate the incidence and risk factors of depression in MetS patients in mainland China and to construct a predictive model. Data from four waves of the China Health and Retirement Longitudinal Study were selected, and middle-aged and elderly patients with MetS (n = 2533) were included based on the first wave. According to the center for epidemiological survey-depression scale (CESD), participants with MetS were divided into depression (n = 938) and non-depression groups (n = 1595), and factors related to depression were screened out. Subsequently, the 2-, 4-, and 7-year follow-up data were analyzed, and a prediction model for depression in MetS patients was constructed. The prevalence of depression in middle-aged and elderly patients with MetS was 37.02%. The prevalence of depression at the 2-, 4-, and 7-year follow-up was 29.55%, 34.53%, and 38.15%, respectively. The prediction model, constructed using baseline CESD and Physical Self-Maintenance Scale scores, average sleep duration, number of chronic diseases, age, and weight had a good predictive effect on the risk of depression in MetS patients at the 2-year follow-up (area under the curve = 0.775, 95% confidence interval: 0.750-0.800, P < 0.001), with a sensitivity of 68% and a specificity of 74%. The prevalence of depression in middle-aged and elderly patients with MetS has increased over time. The early identification of and intervention for depressive symptoms requires greater attention in MetS patients.

Survival analysis of the duration of rumors during the COVID-19 pandemic.

The emergence of the COVID-19 pandemic towards the end of 2019 triggered a relentless spread of online misinformation, which significantly impacted societal stability, public perception, and the effectiveness of measures to prevent and control the epidemic. Understanding the complex dynamics and characteristics that determine the duration of rumors is crucial for their effective management. In response to this urgent requirement, our study takes survival analysis method to analyze COVID-19 rumors comprehensively and rigorously. Our primary aim is to clarify the distribution patterns and key determinants of their persistence. Through this exploration, we aim to contribute to the development of robust rumor management strategies, thereby reducing the adverse effects of misinformation during the ongoing pandemic. The dataset utilized in this research was sourced from Tencent's "Jiao Zhen" Verification Platform's "Real-Time Debunking of Novel Coronavirus Pneumonia" system. We gathered a total of 754 instances of rumors from January 18, 2020, to January 17, 2023. The duration of each rumor was ascertained using the Baidu search engine. To analyze these rumors, survival analysis techniques were applied. The study focused on examining various factors that might influence the rumors' longevity, including the theme of the content, emotional appeal, the credibility of the source, and the mode of presentation. Our study's results indicate that a rumor's lifecycle post-emergence typically progresses through three distinct phases: an initial rapid decline phase (0-25days), followed by a stable phase (25-1000days), and ultimately, an extinction phase (beyond 1000days). It is observed that half of the rumors fade within the first 25days, with an average duration of approximately 260.15days. When compared to the baseline category of prevention and treatment rumors, the risk of dissipation is markedly higher in other categories: policy measures rumors are 3.58 times more likely to perish, virus information rumors have a 0.52 times higher risk, epidemic situation rumors are 4.86 times more likely to die out, and social current affairs rumors face a 2.02 times increased risk. Additionally, in comparison to wish rumors, bogie rumors and aggression rumors have 0.26 and 0.27 times higher risks of dying, respectively. In terms of presentation, graphical and video rumors share similar dissolution risks, whereas textual rumors tend to have a longer survival time. Interestingly, the credibility of the rumor's source does not significantly impact its longevity. The survival time of rumors is strongly linked to their content theme and emotional appeal, whereas the credibility of the source and the format of presentation have a more auxiliary influence. This study recommends that government agencies should adopt specific strategies to counter rumors. Experts and scholars are encouraged to take an active role in spreading health knowledge. It's important for the public to proactively seek trustworthy sources for accurate information. Media platforms are advised to maintain journalistic integrity, verify the accuracy of information, and guide the public towards improved media literacy. These actions, collectively, can foster a collaborative alliance between the government and the media, effectively combating misinformation.

A Nerve Block Team in the Emergency Department

Objectives To improve pain management in the emergency department (ED), emergency physicians are performing an increasing number of ultrasound-guided regional anesthesia procedures (nerve blocks). We aimed to examine the effect of a dedicated emergency department (ED) nerve block team (NBT) on the number and types of ultrasound-guided nerve blocks administered in the ED. Methods We performed a retrospective chart review comparing the nine-month period before and after the creation of a dedicated NBT. This was performed at a tertiary care urban hospital that is a level 1 trauma center. We assessed and compared the number and types of nerve blocks performed, level of learners who performed nerve blocks, and time of ED arrival to disposition, before and after implementation of the NBT. Results The utilization of nerve blocks rose from 79 prior to the establishment of the NBT to 108 following its creation, representing a 36.7% increase. The average duration of stay in the emergency department decreased by 51 minutes, though this change did not demonstrate statistical significance (P=0.1237). There was an increased variety in the types of nerve blocks performed. Conclusion The introduction of a NBT led to a rise in both the quantity and diversity of nerve blocks conducted in the ED.

Glucocorticoid toxicity index in patients with systemic lupus erythematosus (preliminary data)

Objective: to investigate the contribution of glucocorticoids (GC) to the development of irreversible organ damage in patients with systemic lupus erythematosus (SLE) using the GC toxicity index (GTI).Material and methods. The study included 65 patients with SLE who met the 2012 SLICC classification criteria. GTI, disease activity according to the SLEDAI-2K index and the SLICC damage index (DI) were determined in all patients, and standard laboratory and immunological tests were performed.Results and discussion. Patients were predominantly female (n=56, 86%), median disease duration was 76 [2; 288] months, SLEDAI-2K – 8.8 [0; 26], DI SLICC – 1.0 [0; 5], DI SLICC &gt;0 was found in 28 (43%) patients. The median duration of GC therapy during the disease period was 66.0 [0; 288] months, maximum dose of GC – 32.7 [0; 80] mg, median of total GC dose during intravenous administration was 2942 [0; 17 812.5] mg, GTI at the time of enrolment in the study – 19 [0; 37] points. GTI &gt;0 was present in 47 (72%) of 65 patients. GTI correlated with disease duration (r=0.33; p&lt;0.008); maximum dose of oral GCs (r=0.31; p&gt;&lt;0.012); duration of GC use (r=0.35; p&gt;&lt;0.005); DI SLICC (r=-0.43; p&gt;&lt;0.0001). In patients with an average disease duration of more than 3 years, GTI&gt;˂0.008); maximum dose of oral GCs (r=0.31; p˂0.012); duration of GC use (r=0.35; p˂0.005); DI SLICC (r=-0.43; p˂0.0001). In patients with an average disease duration of more than 3 years, GTI was significantly higher than in patients with a disease duration of 1–3 years (p=0.023).Conclusion. An GTI&gt;0 was found in 72% of SLE patients, which increased significantly with disease duration. The GTI value was influenced by the duration of SLE, the duration of GC treatment and the maximum GC dose during the disease period. A statistically significant correlation was found between the GTI and the SLICC DI, allowing the GTI value to be used as an additional component in the assessment of the contribution of GCs to the development of irreversible organ damage in patients with SLE. It is recommended that GTI is assessed in all patients with SLE receiving long-term GC treatment for the purpose of dose adjustment.

Acceptability of 'as needed' biologic therapy in psoriasis: insights from a multi-stakeholder mixed methods study.

Biologic therapies have led to increasing numbers of patients with psoriasis who have clear or nearly clear skin. Current practice is that biologic therapy is continued indefinitely in these patients, contributing to a substantial long-term drug and healthcare burden. 'As needed' biologic therapy in psoriasis may address this, however our understanding of patient and clinician perceptions of this strategy is limited. We first conducted UK-wide online scoping surveys of patients with psoriasis and dermatology clinicians to explore their views on 'as needed' biologic therapy. Using topic guides informed by these survey findings, we then carried out qualitative focus groups with patients and clinicians. Themes were identified using reflexive thematic analysis. Of 67 patients and 27 clinicians completing the scoping surveys, 67% (43/64) and 78% (21/27), respectively, supported the use of 'as needed' biologic therapy. Respondents highlighted advantages such as a reduction in healthcare burden and greater ownership of care. Challenges included logistics of 'as needed' drug provision and potential risks of disease flare and drug immunogenicity. Focus groups comprised 15 patients with psoriasis (9 female [60%], average disease duration 32 years [range 9-64 years]) and 9 dermatology clinicians (8 female [89%], average dermatology experience 20 years [range 8-33 years]). Both patients and clinicians felt that an 'as needed' treatment approach will deliver a reduction in treatment burden and present an opportunity for patient-led ownership of care. Both groups highlighted the importance of ensuring ongoing access to medication and discussing the potential impact of psoriasis recurrence. Patient preferences were influenced by their lived experiences, particularly previous difficulties with medication delivery logistics and establishing disease control. Clinician perspectives were informed by personal experience of their patients adapting their own dosing schedules. Clinicians highlighted the importance of targeted patient selection for an 'as needed' approach, ongoing disease monitoring, and prompt re-access to medications upon psoriasis recurrence. These data indicate that 'as needed' biologic therapy in psoriasis is acceptable for both patients and clinicians. Formal assessment of clinical effectiveness and cost effectiveness is warranted, to enable the real-world potential of this approach to be realised.

The Study of Relationship between Plasma Fibrinogen Level and the Macrovascular Complications in Type 2 Diabetes Mellitus patients in a Tertiary Health Care Centre in Eastern India

Introduction: The macrovascular complications in patients of Type 2 Diabetes Mellitus (T2DM) are an expression of the generalized atherosclerotic process affecting the blood vessels of the body. Studies have revealed cardinal role of inflammation in the development of atherosclerosis. Literature review suggests that the level of plasma fibrinogen, an inflammatory marker, is elevated in T2DM and more so in those with the macrovascular complications. Therefore, this study was taken up with the aim to determine the association of plasma fibrinogen level with the macrovascular complications in patients of T2DM. Methods and aterials: This was a prospective observational study undertaken in Tata Main Hospital from November 2020 to October 2022. It included T2DM out-patients and those admitted in the Department of Medicine between the age group of 40 to 80 years. Patient’s clinical history and detailed physical examination were noted. Relevant blood tests (including HbA1c, lipid profile) and plasma fibrinogen levels were done. All patients were evaluated for complications of Coronary Artery Disease (CAD), cerebrovascular disease and peripheral vascular disease using appropriate investigations. The statistical association was determined by chi -square (χ2) and independent sample t-tests where appropriate. The relationship between plasma fibrinogen level and the macrovascular complications was determined using binary logistic regression. Results: The study involved 180 patients. Their mean age was 58.63 ± 7.177 years with most patients in 51-60 years age group. Male preponderance was seen and the male to female ratio was 1.86:1. While the average duration of T2DM in the study population was 6.744 ± 2.376 years, mean HbA1c level was 8.2 ± 1.9% (range: 6.2% to 9.8%). The mean Body Mass Index (BMI) was 24.57 ± 2.49 Kg/m2, with 61.67 % of cases having BMI of 25-29.9. The mean fibrinogen level in patients was 446.50 ± 28.449 mg/dl (ranged: 358.3 mg/dl to 513.0 mg/d). Diabetics without complications had mean fibrinogen level of 443.3 ± 28.3 mg/dl while those with complications had level of 469.6 ± 16.8 mg/dl (P = 0.000). 43 (23.9%) patients had macrovascular complications. Peripheral vascular disease was observed in 31(17.2%), cerebrovascular disease in 16 (8.9%) and CAD in 20 (11.1%) patients while hypertension was observed in 68 (37.8%) patients. Fibrinogen level showed a positive relation with age (R- 0.541, P &lt;0.001), male gender, BMI (R- 0.515, P=0.0001), total cholesterol levels more than 200 mg/dl (R-0.365, P = 0.0001) and HbA1c (R-0.355 with P = 0.0001). Binomial logistic regression demonstrated significant association between plasma fibrinogen level with macrovascular complications of diabetes (Wald test: 7.482, odds ratio-1.062, P&lt;0.01). Furthermore, the association was found to be independent after adjusting for the confounding factors. Conclusion: Our study suggests that plasma fibrinogen level may be viewed as an independent risk factor for the development of macrovascular complications in T2DM patients. Hence, in these patients, it can be used as a marker for the prediction of the macrovascular complications.

The development and validation of a macronutrient and taste preference ranking task in multiethnic Asian population

Understanding how changes in individual food preferences in a dynamic environment translate into dietary choices helps to unravel the aetiology of suboptimal nutrition in the population. To facilitate the measurements of food preferences in a multiethnic Asian population, we aimed to develop and validate the Macronutrient and Taste Preference Ranking Task (MTPRT) in an Asian population. We shortlisted 1770 local food items based on the predominant macronutrient groups (≥50 % macronutrient content is protein or fat or carbohydrates), classified their taste clusters, standard-photographed a final list of 36 food items, and developed an electronic survey through cognitive interviews with 30 participants. We then validated the MTPRT amongst 66 participants (mean (SD) age = 47.4 (11.7) years, 57.6 % male, with Chinese: Malay: Indian ethnicity ratio 3:1:1), through random crossover administration of sweet and savoury standard meals with equivalent macronutrients across 2 study visits over a week. The average duration taken to complete MTPRT was 14.1 (5.3) minutes. The sweet and savoury taste preference scores were inversely correlated (r = -0.9, p < 0.0001). The liking and preference for savoury taste were reduced after consuming savoury meals (p = 0.0009). The intra-person correlations for MTPRT scores were all r > 0.6, p < 0.001. The macronutrient preference scores were all positively associated with the self-reported macronutrient intakes derived from the Food Frequency Questionnaire, independent of sex, age, ethnicity, and BMI. Our study demonstrates the validity and reproducibility of MTPRT in multiethnic Asian populations for future evaluation of food preferences in multiethnic Asian population.

Orthodontic Implant Site Development Using Labial Root Torque: A Case Series with CBCT Analysis.

This case series assessed the efficacy of Orthodontic Implant Site Development with Labial Root Torque (OISD-LRT) as a nonsurgical technique for addressing labial bone deficiencies in seven patients. The procedure involved strategically placing a multi-bracket of 2-3 mm apically on the hopeless teeth, gradually shifting them with Ni-Ti wires at the rate of 2 mm per month and maintaining overcorrection for 2 months before extraction. OISD-LRT consistently augmented tissue for flapless guided implant surgery, with an average treatment duration of 404Å}311.7 days. Cone-beam computed tomography (CBCT) scans at various stages revealed increases in both vertical and horizontal bone dimensions, especially in the sockets with complete labial bone loss. Despite inevitable post-extraction reductions in bone height and width, sufficient dimensions were maintained to ensure long-term implant stability. This case series highlights the effectiveness of OISD-LRT as a valuable method for horizontal bone augmentation, particularly in patients with labial bone deficiency. This approach provides a robust foundation for subsequent implant placement, showcasing its success in addressing challenging anatomical conditions and contributing to the broader field of implant dentistry.

Social contact patterns with acquaintances and strangers related to influenza in the post-pandemic era

Abstract Aim To investigate the social contact patterns of Chinese residents in the post COVID-19 pandemic period, explore the associations between the different contact patterns and incidence of influenza. Subject and methods A cross-sectional social contact survey was conducted on Chinese residents from December 9, 2021, to January 20, 2022. The contact was divided into participant–acquaintance (P–A) and participant–stranger (P–S), and the generalized linear model (GLM) was used to explore their impact on the incidence of influenza. Results The contact frequency of P–S was higher than that of P–A (3.41 V.S. 1.94), but the average contact duration of P–S was much shorter than that of P–A (0.20 h V.S. 5.53 h). P–A contact mainly occurred among peers as well as family members. However, P–S contact was concentrated in the middle-aged population. In GLM, the influence of P–S on the incidence of influenza was higher (OR = 2.63, 95% CI 2.29–3.02) than that of P–A (OR = 1.82, 95% CI 1.56–2.13), especially on the weekend (P–S OR = 4.31, 95% CI 2.31–8.01) and in recreation places (P–S OR = 4.94, 95% CI 2.26–10.78). Conclusions Social contact will increase the incidence rate of influenza. Therefore, when contacting with strangers, especially in recreation places, personal protective behavior should be strengthened.

Heterogeneous Effects of CPAP in Non-Sleepy OSA on CVD Outcomes: Post-hoc Machine Learning Analysis of the ISAACC Trial (ECSACT Study).

Randomized controlled trials of continuous positive airway pressure (CPAP) therapy for cardiovascular disease (CVD) prevention among patients with obstructive sleep apnea (OSA) have been largely neutral. However, given OSA is a heterogeneous disease, there may be unidentified subgroups demonstrating differential treatment effects. Apply a novel data-drive approach to identify non-sleepy OSA subgroups with heterogeneous effects of CPAP on CVD outcomes within the ISAACC study. Participants were randomly partitioned into two datasets. One for training (70%) our machine learning model and a second (30%) for validation of significant findings. Model-based recursive partitioning was applied to identify subgroups with heterogeneous treatment effects. Survival analysis was conducted to compare treatment (CPAP versus usual care [UC]) outcomes within subgroups. A total of 1,224 non-sleepy OSA participants were included. Of fifty-five features entered into our model only two appeared in the final model (i.e., average OSA event duration and hypercholesterolemia). Among participants at or below the model-derived average event duration threshold (19.5 seconds), CPAP was protective for a composite of CVD events (training Hazard Ratio [HR] 0.46, p=0.002). For those with longer event duration (>19.5 seconds), an additional split occurred by hypercholesterolemia status. Among participants with longer event duration and hypercholesterolemia, CPAP resulted in more CVD events compared to UC (training HR 2.24, p=0.011). The point estimate for this harmful signal was also replicated in the testing dataset (HR 1.83, p=0.118). We discovered subgroups of non-sleepy OSA participants within the ISAACC study with heterogeneous effects of CPAP. Among the training dataset, those with longer OSA event duration and hypercholesterolemia had nearly 2.5-times more CVD events with CPAP compared to UC, while those with shorter OSA event duration had roughly half the rate of CVD events if randomized to CPAP.

Observations key to understanding solar cycles: a review

A paradigm shift is taking place in the conception of solar cycles. In the previous conception, the changing numbers of sunspots over intervals of 9–14 years have been regarded as the fundamental solar cycle although two average 11-year cycles were necessary to account for the complete magnetic cycle. In the revised picture, sunspots are a phase in the middle of two 22-year overlapping solar cycles that operate continuously with clock-like precision. More than 20 researchers have contributed to the initial research articles from 2014 through 2021 which are dramatically altering the perception of solar cycles. The two 22-year cycles overlap in time by 11 years. This overlap is coincidentally the same average duration as the sunspot phase in each 22-year cycle. This coincidence and the relative lack of knowledge of the large numbers of small active regions without sunspots is what led to the previous paradigm in which the 11-year sunspot phases were misinterpreted as a single fundamental solar cycle. The combination of the two 22-year solar cycles, with their large numbers of short-lived active regions and ephemeral active regions are now understood to be the fundamental cycle with the proposed name “The Hale Solar Cycle.” The two 22-year solar cycles each occupy separate but adjacent bands in latitude. The orientations of the majority of bipolar magnetic regions in the two adjacent bands differ from each other by ∼180°. Both bands continuously drift from higher to lower latitudes as has been known for sunspot cycles. However, the polarity reversal occurs at the start of each 22-year cycle and at higher latitudes than it does for the sunspot cycles. This paradigm shift in the concept of solar cycles has resulted in major reconsiderations of additional topics on solar cycles in this review. These are 1) the large role of ephemeral active regions in the origin of solar cycles, 2) the depth of the origin of active regions and sunspots, 3) the mechanisms of how areas of unipolar magnetic network migrate to the solar poles every 11 years, and 4) the nature of the polarity reversal in alternate 22-year cycles rather than 11-year cycles.

Shift-Level Team Familiarity Is Associated with Improved Outcomes in Mechanically Ventilated Adults.

Organizing intensive care unit (ICU) interprofessional teams- nurses, physicians, and respiratory therapists -is high priority due to workforce crises but how often clinicians work together (i.e., interprofessional familiarity) remains unexplored. Determine if mechanically ventilated patients cared for by teams with greater familiarity have lower mortality, shorter duration of mechanical ventilation (MV) and greater spontaneous breathing trial (SBT) implementation. Using electronic health records from 5 ICUs (2018-2019), we identified the interprofessional team that cared for each mechanically ventilated patient each shift, calculated familiarity and modeled familiarity exposures separately on ICU mortality, duration of MV and SBT implementation using encounter-level generalized linear regression models with a log link, unit-level fixed effects adjusting for cofounders, including severity of illness. Familiarity was defined as how often clinicians worked together for all patients in an ICU (i.e., coreness) and for each patient (i.e., mean team value). Among 4,292 patients (4,485 encounters, 72,210 shifts), unadjusted mortality was 12.9%, average duration of MV was 2.32 days and SBT implementation was 89%. An increase in coreness and mean team value, by each's standard deviation, was associated with lower probability of dying (coreness, adjusted marginal effect (AME) = -0.038, 95% CI (-0.07, -0.004); mean team value, AME=-0.0034 (-0.054, -0.014), greater probability of receiving SBT when eligible (coreness, 0.45, (0.007, 0.083); mean team value, 0.012 (-0.017, 0.042)) and shorter duration of MV (coreness, -0.23 (-0.321, -0.139)). Interprofessional familiarity was associated with improved outcomes; assignment models that prioritize familiarity might be a novel solution.

Outcomes after chronic isolated epididymal pain: A retrospective study.

Chronic epididymitis imposes significant physical and psychosocial distress on affected patients. Despite being a commonly encountered urologic condition, there remains a paucity of understanding and literature surrounding the management and natural history of isolated epididymal pain. Typically, patients who do not respond to conservative management undergo an epididymectomy.; however, the literature on its efficacy is also scarce, with success rates varying widely from 10-90% in existing studies. Our goal was to better describe the etiology, and natural history of isolated epididymal pain. Furthermore, we aimed to describe the rates of success associated with epididymectomy. A retrospective case-control study was conducted at the Manitoba Men's Health Clinic, with the approval of the University of Manitoba Research Ethics Board. All patients presenting with chronic epididymitis, defined as discomfort or pain localized to the epididymis for at least three months, were identified. Information regarding patient demographics, past medical and surgical history, duration of pain, localization of pain, findings on previous ultrasounds, prior conservative therapies trialed and response rates, as well as response rates to surgical therapy were collected. From April 2022 to 2023, a total of 275 patients with chronic orchialgia were identified, and among them, 74 patients specifically presented with chronic isolated epididymal pain. The average duration of symptoms was as follows: 22.9% of patients experienced symptoms for 3-6 months, 10% for 6-12 months, and 67.1% for over 12 months; 13.5% (n=10) had associated ejaculatory pain, 8.1% (n=6) had lower urinary tract symptoms, and 4.1% (n=3) had erectile dysfunction. Ultrasound findings were observed in 68.9% of patients, with 31.1% having an epididymal cyst, 27.1% having a varicocele, 5.4% having a spermatocele, and 4.1% having a hydrocele. Among those who underwent conservative therapy, only 36.2% of patients reported a positive response. Surgical intervention was performed on 23 patients, including 16 who underwent an epididymectomy, three who underwent cord denervation, and two who underwent vasovasostomy and spermatocelectomy each. Most (81.3%, n=13) patients who underwent an epididymectomy had a positive response to the surgical intervention, defined as no pain on followup, while all patients undergoing other surgical interventions experienced a positive response. Chronic epididymal pain is a condition with limited data surrounding its management. Prior to referral, a large proportion of patients did not undergo any conservative treatment, and of those that did, there was limited response. For those who underwent surgical intervention, all were pain-free on followup, except three patients who underwent epididymectomy.

Sleep duration and perceptions of sleep quality in British Army recruits during basic training - an observational analysis.

Sleep is critical to the health, wellbeing and performance of military personnel during basic training. This two-part study evaluated sleep-wake patterns and sleep disturbances in junior soldiers (JS) and infantry recruits in Autumn 2021 (study 1), and non-infantry recruits in spring 2022 (study 2). During studies 1 and 2, validated wearable technology combined with a sleep diary was used to quantify sleep-wake indices, sleep disturbances and perceptions of sleep quality. Sleep diary data was analysed descriptively. A series of repeated-measures ANOVAs examined differences in objective sleep-wake indices. Correlation analysis determined associations between time in bed (TIB) and total sleep time (TST). Significant (p < 0.05) differences in most sleep-wake indices were observed between weeks of basic training for all cohorts. Strong positive correlations between TIB and TST were observed for each cohort across basic training (r = 0.681 - 0.970, p < 0.001), with longer TST associated with greater TIB. The mean±SD sleep duration (hours and mins [hm]) for JS (06:22 ± 00:27hm), non-infantry (05:41 ± 00:47hm) and infantry (05:46 ± 00:34hm) recruits across basic training was consistently below national recommendations. The mean±SD bed and wake times for JS (bedtime: 23:01 ± 00:32hm; awake: 05:34 ± 00:10hm), non-infantry (bedtime: 23:38 ± 01:09hm; awake: 04:47 ± 00:58hm), and infantry (bedtime: 23:13 ± 00:29hm; awake: 05:38 ± 00:26hm) recruits varied across weeks of basic training, with over 80% reporting "fairly bad" or "very bad" sleep quality and frequent periods of "dozing off" during daytime activity. The most commonly reported sleep disturbing factors identified during basic training involved: late-night military admin (e.g., ironing, boot cleaning, kit set up etc), early morning wake times, extraneous noise, light and hot room temperatures within the primary sleeping environment, bed/mattress discomfort, muscle soreness and feelings of stress and anxiety. Our findings contribute to the existing evidence that long-term sleep loss is pervasive during initial military training programmes. The average sleep durations indicate chronic and unrecoverable sleep loss which would be expected to significantly impair physical and cognitive military performance, and increase the risk of injury, illness and attrition rates during basic training. Changes in the design and scheduling of basic training programmes to enable, at the least, minimum sleep recommendations to be met, and to improve sleep hygiene in the primary sleeping environment are warranted.

Macular hole following scleral buckling for rhegmatogenous retinal detachment: a case series

BackgroundMacular hole (MH) development following scleral buckling (SB) surgery for rhegmatogenous retinal detachment (RRD) repair is rare. This study presents both full-thickness MH (FTMH) and lamellar MH (LMH) cases following SB for the treatment of RRD.MethodsClinical records of patients undergoing SB surgery for treatment of RRD at the Xi’an People’s Hospital (Xi’an Fourth Hospital) from January 2016 to December 2021 were reviewed, and cases with postoperative MH were selected. Clinical features and follow-up data were summarised, and possible causes were analysed.ResultsAmong 483 identified cases (483 eyes), four eyes (three male patients, one female patient) had postoperative MH, with prevalence, mean age, and mean axial length of 0.83%, 43.5 ± 10.66 years, and 29.13 ± 3.80 mm, respectively. All patients did not undergo subretinal fluid (SRF) drainage. The mean time for detecting MH was 26 ± 15.5 days postoperatively. Macula-off RRD with high myopia and FTMH combined with retinal re-detachment were diagnosed in three patients. One patient had macula-on RRD with outer LMH. The average follow-up duration was 7.25 ± 1.5 months. The FTMH closed successfully after reoperation, while the outer LMH closed without intervention. Visual acuity insignificantly improved or slightly decreased in all patients.ConclusionsPatients with high myopia combined with macula-off RRD might be more susceptible to FTMH, causing MH related retinal detachment. Additionally, LMH following SB was noted in patients with macula-on RRD. Therefore, we should raise awareness of MH following SB for RRD repair.

Effect of Novel Laser Shoe Photobiomodulation on Neuropathic Pain and Plantar Pressure Profile in Type 2 Diabetes Mellitus with Peripheral Neuropathy.

Photobiomodulation (PBM) or Low-level laser is used to treat diabetic foot complications. The existing method of laser application to the foot did not cover the foot's entire area to improve the foot's microcirculation. Therefore, we have developed a cost-effective Special LASER Shoe device, focusing exclusively on the entire foot region to manage neuropathic pain and other symptoms in individuals with type 2 diabetes mellitus. The main objective of the present study was to evaluate the effect of this newly developed special laser shoe PBM on neuropathic pain and plantar pressure profile in individuals with type 2 diabetes mellitus with neuropathy. We included 60 participants with diabetic peripheral neuropathy of both genders and age more than 20 years. Participants were treated with PBM by a specially designed novel Laser Shoe. Outcomes were clinical variables like Vibration Perception Threshold (VPT), Visual Analogue Scale (VAS), Michigan neuropathy screening instrument A&B, Ankle-Brachial Index (ABI), and Static dynamic gait parameters. Participants were with an average age of 62, and the average duration of diabetes was 11 years. Analysis showed a significant difference in VPT, VAS, Michigan neuropathic screening inventory, and ankle-brachial index. (P < 0.05). We conclude that Novel laser shoe photobiomodulation using 'Laser Shoe' effectively reduces peripheral neuropathic pain. It is also effective in reducing average and maximum plantar pressure. Reduction in neuropathic pain and improvement in plantar pressure distribution can reduce further complications.

Surgical Outcome of Torcula Herophili Meningioma: An Institutional Experience

IntroductionResection of meningiomas (THM) at the Torcular Herophili poses challenges to surgeons due to complex regional anatomy. The current study aims to evaluate factors affecting the extent of resections, progression-free survival, and the role of radiation. Material & MethodsWe did a retrospective study of all the THM patients treated at our institute between May 1987 and June 2022. The demographic data, signs & symptoms, surgical notes, postoperative details & radiotherapy were gathered retrospectively. Survival analysis was done with Kaplan Meir tests along with predictors of the extent of resection as well as recurrence. Results39 patients qualified to be included in the study with 10 males(male-to-female ratio::1:2.9) and an average age of 50.8years. The average follow-up duration was 75.9months. Simpson's Grade 2 excision was achieved in maximum number of 19(48.7 %) patients, followed by Simpson's Grade 3 excision in 17 patients(43.6 %). Progression-free survival in Subtotal resection was 60months, while 100months in Gross total resection. Statistically, the extent of the resection was determined by the involvement of sinuses/torcula and the number of quadrants involved around torcula. A total of 16patients received radiosurgery for the residual or small reccurrence of the lesion. Follow-up revealed reccurrence in five cases. ConclusionTorcular meningiomas are relatively uncommon, described in a few reports and represent a therapeutic dilemma. Though some experts recommend complete removal of tumor and reconstruction of the sinus, others suggest maximum safe resection, followed by radiosurgery. The present study reflects reasonable control of the residual lesion with radiosurgery after maximum safe resection.