Baseline Usage Research Articles

Effectiveness of sensing gloves–applied virtual reality education system on hand hygiene practice: A randomized controlled trial

We developed a virtual reality (VR) education system and evaluated its clinical utility for promoting hand hygiene practices. This prospective, 2-week, randomized controlled study conducted at Okayama University Hospital, Japan, from November 2023 to January 2024, involved 22 participants (18 medical students and 4 residents). A fully immersive 360° VR system (VIVE Pro Eye) using a head-mounted display and sensing gloves was used to develop 3 healthcare tasks in a virtual patient room-Environmental Cleaning, Gauze Exchange, and Urine Collection. After monitoring all participants' baseline usage data of portable hand-rubbing alcohol in the first week, we randomly assigned them into 1:1 groups (VR training and video lecture groups). The primary outcome was differences in hand-rubbed alcohol use before and after intervention. Before the intervention, alcohol use did not significantly differ between both groups. After the intervention, a significant increase in alcohol use was observed in the VR training group (median: 8.2g vs16.2g; P=.019) but not in the video lecture group. Our immersive 360° VR education system enhanced hand hygiene practices. Infection prevention and control practitioners and digital technology experts must collaborate to advance the development of superior educational devices and content.

In-vehicle nudging for increased Adaptive Cruise Control use: a field study

Close following to lead vehicles is associated with increased risk of rear-end crashes in road traffic. One way to reduce instances of close following is through increased use of the Advanced Driver Assistance System (ADAS) Adaptive Cruise Control (ACC), which is designed to adjust vehicle speed to maintain a safe time headway. Since the activation of ACC is driver-initiated, there is a need to influence the propensity of drivers to use the function. This research aimed to explore whether in-vehicle nudging interventions could be effective for this purpose. A field trial was conducted to consecutively assess the effects of two nudges on drivers’ utilization of ACC, compared to baseline usage. Exposing the participants (n = 49) to the first ambient design nudge resulted in a 46% increase in ACC usage on average. Following the introduction of the second nudge (a competitive leaderboard nudge), the average increase among participants (n = 48) during the complete treatment period reached 61%. The changes in ACC utilization varied between individual drivers, highlighting the need to monitor behavioral outcomes of nudges and adapt them when needed. In conclusion, this research shows that utilizing in-vehicle nudging is a promising approach to increase the use of vehicle functions contributing to improved traffic safety.

Estimated prophylactic dose required to achieve 3% trough as a function of age and concentrate class in multi-country severe WAPPS-Hemo haemophilia patients.

Web-Accessible Population-Pharmacokinetic Service-Haemophilia (WAPPS-Hemo) data are available to study factor-concentrate usage, defined as the required weekly dose to achieve a 3% trough (WD3T), across standard and extended half-life (SHL/EHL) products. To provide baseline usage data including (i) differences across plasma-derived (pdSHL) versus recombinant (rSHL) products, (ii) SHL versus EHL, and (iii) effect of age and positive inhibitor history. PK profiles (n=14,416 patients, 0.3-85.2years) and linear mixed effects models were used to estimate usage versus age, controlling for significant factors, using 95% confidence intervals to perform comparisons across all ages and posthoc tests to assess the differences. Average usage was significantly higher for pdSHL versus rSHL in patients with a positive inhibitor history (PIH; 1.9-2.5 times higher), for SHL versus EHL (4-10 times), and was significantly associated with age. Baseline usage patterns from 2017 to early 2023 provide a benchmark for assessing the impact of emerging technologies in haemophilia.

Formal and informal healthcare utilization in MCI and mild dementia due to AD: Cross‐sectional and longitudinal analyses of RUD‐Lite data from the Tauriel Study

AbstractBackgroundThe Resource Utilization in Dementia‐Lite (RUD‐Lite) scale measures both formal healthcare utilization and informal caregiver time required by individuals with cognitive impairment. The RUD‐Lite has been incorporated into multiple observational and interventional studies of participants with Alzheimer’s disease (AD) dementia of varying severity. However, RUD‐Lite data for earlier stages of AD such as mild cognitive impairment (MCI) is limited and is primarily from observational studies. As healthcare utilization may differ between participants in observational versus interventional studies, we analyzed data from the Tauriel study of semorinemab in MCI and mild dementia due to AD (NCT03289143).MethodsWe performed cross‐sectional and longitudinal RUD‐Lite comparisons between MCI (n = 160) and mild dementia (n = 288) cohorts of the Tauriel study, exploring formal healthcare usage (hospital admissions, emergency department visits, outpatient visits, and ancillary services) and informal caregiver time for assistance with basic (BADLs) and instrumental (IADLs) activities of daily living and participant supervision. Both unadjusted and adjusted (for baseline usage, age, sex) analyses were performed on longitudinal data.ResultsBaseline cross‐sectional analyses (Table 1) indicated that mild dementia participants required significantly greater caregiver time for assistance with IADLs than MCI participants. Other formal and informal healthcare utilization indices did not differ between groups. Unadjusted longitudinal analyses across 18 months (Figure 1) revealed significant increases in informal caregiver assistance with BADLs (MCI:+40%, mild dementia:+231%), IADLs (MCI:+31%, mild dementia:+34%), and supervision (mild dementia:+219%) and in ancillary service usage (mild dementia:+345%). Adjusted longitudinal analyses (Figure 2) revealed significantly greater increases in mild dementia versus MCI for assistance time with BADLs, IADLs, and supervision.ConclusionInformal caregiver time spent providing assistance in early AD increases with disease severity and longitudinal changes are detectable in MCI over 18 months. Formal healthcare utilization indices were less sensitive to disease progression. While the RUD‐Lite results from this interventional study are consistent with observational data from analogous populations, less caregiver assistance time was reported in our cohort. When using RUD‐Lite outcomes in future early AD studies, investigators may need to account for their participant population (e.g., observational versus interventional) in their study design.

Use of Random Forest to Predict Adherence in an Online Intervention for Depression Using Baseline and Early Usage Data: Model Development and Validation on Retrospective Routine Care Log Data.

Online interventions, such as the iFightDepression (iFD) tool, are increasingly recognized as effective alternatives to traditional face-to-face psychotherapy or pharmacotherapy for treating depression. However, particularly when used outside of study settings, low adherence rates and the resulting diminished benefits of the intervention can limit their effectiveness. Understanding the factors that predict adherence would allow for early, tailored interventions for individuals at risk of nonadherence, thereby enhancing user engagement and optimizing therapeutic outcomes. This study aims to develop and evaluate a random forest model that predicts adherence to the iFD tool to identify users at risk of noncompletion. The model was based on characteristics collected during baseline and the first week of the intervention in patients with depression. Log data from 4187 adult patients who registered for the iFD tool between October 1, 2016, and May 5, 2022, and provided informed consent were statistically analyzed. The resulting data set was divided into training (2932/4187, 70%) and test (1255/4187, 30%) sets using a randomly stratified split. The training data set was utilized to train a random forest model aimed at predicting each user's adherence at baseline, based on the hypothesized predictors: age, self-reported gender, expectations of the intervention, current or previous depression treatments, confirmed diagnosis of depression, baseline 9-item Patient Health Questionnaire (PHQ-9) score, accompanying guide profession, and usage behavior within the first week. After training, the random forest model was evaluated on the test data set to assess its predictive performance. The importance of each variable in predicting adherence was analyzed using mean decrease accuracy, mean decrease Gini, and Shapley Additive Explanations values. Of the 4187 patients evaluated, 1019 (24.34%) were classified as adherent based on our predefined definition. An initial random forest model that relied solely on sociodemographic and clinical predictors collected at baseline did not yield a statistically significant adherence prediction. However, after incorporating each patient's usage behavior during the first week, we achieved a significant prediction of adherence (P<.001). Within this prediction, the model achieved an accuracy of 0.82 (95% CI 0.79-0.84), an F1-score of 0.53, an area under the curve of 0.83, and a specificity of 0.94 for predicting nonadherent users. The key predictors of adherence included logs, word count on the first workshop's worksheet, and time spent on the tool, all measured during the first week. Our results highlight that early engagement, particularly usage behavior during the first week of the online intervention, is a far greater predictor of adherence than any sociodemographic or clinical factors. Therefore, analyzing usage behavior within the first week and identifying nonadherers through the algorithm could be beneficial for tailoring interventions aimed at improving user adherence. This could include follow-up calls or face-to-face discussions, optimizing resource utilization in the process.

Reddit and Google Activity Related to Non-COVID Epidemic Diseases Surged at Start of COVID-19 Pandemic: Retrospective Study.

Resources such as Google Trends and Reddit provide opportunities to gauge real-time popular interest in public health issues. Despite the potential for these publicly available and free resources to help optimize public health campaigns, utilization for this purpose has been limited. To determine whether early public awareness of COVID-19 correlated with elevated public interest in other infectious diseases of public health importance. Google Trends search data and Reddit comment data were analyzed from 2018 through 2020 for the frequency of keywords "Chikungunya", "Ebola", "H1N1", "MERS", "SARS", and "Zika", six highly publicized epidemic diseases in recent decades. After collecting Google Trends relative popularity scores for each of these six terms, unpaired T-tests were used to compare the 2020 weekly scores for each term to its average level over the 3-year study period. The number of Reddit comments per month with each of these six terms was collected and then adjusted for total estimated Reddit monthly comment volume to derive a measure of relative usage, analogous to the Google Trends popularity score. The relative monthly incidence of comments with each search term was then compared to the corresponding search term's pre-COVID monthly comment data, again using unpaired T-tests. P-value cutoffs for statistical significance were determined a priori with a Bonferroni correction. Google Trends and Reddit data both demonstrate large and statistically significant increases in the usage of each evaluated disease term through at least the initial months of the pandemic. Google searches and Reddit comments that included any of the evaluated infectious disease search terms rose significantly in the first months of 2020 above their baseline usage, all peaking in March 2020. Google searches for "SARS" and "MERS" remained elevated for the entirety of the 2020 calendar year, as did Reddit comments with the words "Ebola", "H1N1", "MERS" and "SARS" (P<.001, for each weekly or monthly comparison, respectively). Google Trends and Reddit can readily be used to evaluate real-time general interest levels in public health related topics, providing a tool to better time and direct public health initiatives that require a receptive target audience. The start of the COVID-19 pandemic correlated with increased public interest in other epidemic infectious diseases. We have demonstrated that for six distinct infectious causes of epidemics over the last two decades, public interest rose substantially and rapidly with the outbreak of COVID-19. Our data suggests that for at least several months after the initial outbreak, the public may have been particularly receptive to dialogue on these topics. Public health officials should consider utilizing Google Trends and social media data to identify to patterns of engagement with public health topics in real-time, and to optimize timing of public health campaigns.

Examination of Text Message Plans and Baseline Usage of Families Enrolled in a Text Message Influenza Vaccine Reminder Trial: Survey Study.

Mobile health (mHealth) is quickly expanding as a method of health promotion, but some interventions may not be familiar or comfortable for potential users. SMS text messaging has been investigated as a low-cost, accessible way to provide vaccine reminders. Most (97%) US adults own a cellphone and of those adults most use SMS text messaging. However, understanding patterns of SMS text message plan type and use in diverse primary care populations needs more investigation. We sought to use a survey to examine baseline SMS text messaging and data plan patterns among families willing to accept SMS text message vaccine reminders. As part of a National Institutes of Health (NIH)-funded national study (Flu2Text) conducted during the 2017-2018 and 2018-2019 influenza seasons, families of children needing a second seasonal influenza vaccine dose were recruited in pediatric primary care offices at the time of their first dose. Practices were from the American Academy of Pediatrics' (AAP) Pediatric Research in Office Settings (PROS) research network, the Children's Hospital of Philadelphia, and Columbia University. A survey was administered via telephone (Season 1) or electronically (Season 2) at enrollment. Standardized (adjusted) proportions for SMS text message plan type and texting frequency were calculated using logistic regression that was adjusted for child and caregiver demographics. Responses were collected from 1439 participants (69% of enrolled). The mean caregiver age was 32 (SD 6) years, and most children (n=1355, 94.2%) were aged 6-23 months. Most (n=1357, 94.3%) families were English-speaking. Most (n=1331, 92.8%) but not all participants had an unlimited SMS text messaging plan and sent or received texts at least once daily (n=1313, 91.5%). SMS text messaging plan type and use at baseline was uniform across most but not all subgroups. However, there were some differences in the study population's SMS text messaging plan type and usage. Caregivers who wanted Spanish SMS text messages were less likely than those who chose English to have an unlimited SMS text messaging plan (n=61, 86.7% vs n=1270, 94%; risk difference -7.2%, 95% CI -27.1 to -1.8). There were no significant differences in having an unlimited plan associated with child's race, ethnicity, age, health status, insurance type, or caregiver education level. SMS text messaging use at baseline was not uniform across all subgroups. Nearly three-quarters (n=1030, 71.9%) of participants had received some form of SMS text message from their doctor's office; most common were appointment reminders (n=1014, 98.4%), prescription (n=300, 29.1%), and laboratory notifications (n=117, 11.4%). Even the majority (n=64, 61.5%) of those who did not have unlimited plans and who texted less than daily (n=72, 59%) reported receipt of these SMS text messages. In this study, most participants had access to unlimited SMS text messaging plans and texted at least once daily. However, infrequent texting and lack of access to an unlimited SMS text messaging plan did not preclude enrolling to receive SMS text message reminders in pediatric primary care settings.

Hyperbaric oxygen therapy in outpatient care

Hyperbaric oxygen therapy, or high pressure oxygen therapy, is a highly specialised branch of medicine. Applications and results date back to the 1960s and it has been used, researched and developed ever since. During the treatment, patients breathe 100% oxygen in a pressurised chamber. For clinical purposes, as defined, the pressure must equal or exceed 1.4 atmosphera absolute, most of the cases typically higher (2.0-2.5 atmosphera absolute). Oxygen dissolves by pressure in body fluids, transported by circulation to all tissues. Cellular regeneration and tissue processes are induced by both the increased oxygen supply and the intermittent change in tissue partial oxygen pressure associated with treatment. The effect can be used in the treatment of many diseases, usually as part of a complex treatment plan. Additional advantage is that it is a non-invasive and pain-free therapy. Evidence-based indications and general baseline usage are regulated by the European Underwater and Baromedical Society through the European Committee of Hyperbaric Medicine, in accordance with the principles of evidence-based medicine. The authors describe three cases in their publication where hyperbaric oxygen therapy significantly contributed to the success of overall treatment. Orv Hetil. 2023; 164(25): 993-996.

Internet usage and the prospective risk of dementia: A population-based cohort study.

Little is known about the long-term cognitive impact of internet usage among older adults. This research characterized the association between various measures of internet usage and dementia. We followed dementia-free adults aged 50-64.9 for a maximum of 17.1 (median = 7.9) years using the Health and Retirement Study. The association between time-to-dementia and baseline internet usage was examined using cause-specific Cox models, adjusting for delayed entry and covariates. We also examined the interaction between internet usage and education, race-ethnicity, sex, and generation. Furthermore, we examined whether the risk of dementia varies by the cumulative period of regular internet usage to see if starting or continuing usage in old age modulates subsequent risk. Finally, we examined the association between the risk of dementia and daily hours of usage. Analyses were conducted from September 2021 to November 2022. In 18,154 adults, regular internet usage was associated with approximately half the risk of dementia compared to non-regular usage, CHR (cause-specific hazard ratio) = 0.57, 95% CI = 0.46-0.71. The association was maintained after adjustments for self-selection into baseline usage (CHR = 0.54, 95% CI = 0.41-0.72) and signs of cognitive decline at the baseline (CHR = 0.62, 95% CI = 0.46-0.85). The difference in risk between regular and non-regular users did not vary by educational attainment, race-ethnicity, sex, and generation. In addition, additional periods of regular usage were associated with significantly reduced dementia risk, CHR = 0.80, 95% CI = 0.68-0.95. However, estimates for daily hours of usage suggested a U-shaped relationship with dementia incidence. The lowest risk was observed among adults with 0.1-2 h of usage, though estimates were non-significant due to small sample sizes. Regular internet users experienced approximately half the risk of dementia than non-regular users. Being a regular internet user for longer periods in late adulthood was associated with delayed cognitive impairment, although further evidence is needed on potential adverse effects of excessive usage.

Adherence to antimicrobial agent recommendations and utilization during drug shortages.

Antimicrobial shortages occur frequently, but the impact on antimicrobial use is not well defined. The study objectives were to characterize utilization of antimicrobial agents with established restrictions during a medication shortage, assess utilization of shortage antimicrobials following shortage resolution, and examine use of recommended alternative antimicrobials during the shortage period. Five antimicrobials were restricted due to shortages from 2015 through 2020. Chart review of inpatients receiving a shortage medication during each restriction period was performed to determine factors influencing adherence to established restriction criteria. To assess antimicrobial utilization during shortages and following shortage resolution, days of therapy per 1,000 patient days were analyzed for each shortage and alternative antimicrobial. Across 266 patients receiving shortage antimicrobials, antimicrobial use was adherent to restriction criteria for 151 patients (57%). Meropenem, ampicillin/sulbactam, and piperacillin/tazobactam had the greatest adherence. Median duration of therapy was shorter in the nonadherent group than in the adherent group (4 vs 2 days, P < 0.0001). Shortage antimicrobial use was more likely to be nonadherent for indications such as sepsis rule out, surgical prophylaxis, and urinary tract infection. Adherence increased with use of visual cues in the chart (99% vs 94%, P = 0.03). Utilization of shortage agents decreased during shortage and restriction periods. After shortage resolution, utilization exceeded baseline usage for all agents except meropenem and metronidazole, for which usage returned to baseline. Utilization of 1 to 2 recommended alternative agents for each shortage agent significantly increased during the shortage and restriction periods. Current strategies for restriction significantly decreased utilization of shortage antimicrobials, but additional opportunities exist. Identifying alternative agents and providing visual cues increased adherence.

Initial statin dose after myocardial infarction and long-term cardiovascular outcomes.

Effective statin therapy is a cornerstone of secondary prevention after myocardial infarction (MI). Real-life statin dosing is nevertheless suboptimal and largely determined early after MI. We studied long-term outcome impact of initial statin dose after MI. Consecutive MI patients treated in Finland who used statins early after index event were retrospectively studied (N=72401; 67% men; mean age 68 years) using national registries. High-dose statin therapy was used by 26.3%, moderate dose by 69.2%, and low dose by 4.5%. Differences in baseline features, comorbidities, revascularisation, and usage of other evidence-based medications were adjusted for with multivariable regression. The primary outcome was major adverse cardiovascular or cerebrovascular event (MACCE) within 10 years. Median follow-up was 4.9 years. MACCE was less frequent in high-dose group compared with moderate dose [adjusted hazard ratio (HR) 0.92; P<0.0001; number needed to treat (NNT) 34.1] and to low dose [adj.HR 0.81; P<0.001; NNT 13.4] as well as in moderate-dose group compared with low dose (adj.HR 0.88; P<0.0001; NNT 23.4). Death (adj.HR 0.87; P<0.0001; NNT 23.6), recurrent MI (adj.sHR 0.91; P=0.0001), and stroke (adj.sHR 0.86; P<0.0001) were less frequent with a high- vs. moderate-dose statin. Higher initial statin dose after MI was associated with better long-term outcomes in subgroups by age, sex, atrial fibrillation, dementia, diabetes, heart failure, revascularisation, prior statin usage, or usage of other evidence-based medications. Higher initial statin dose after MI is dose-dependently associated with better long-term cardiovascular outcomes. These results underline the importance of using a high statin dose early after MI.

Focal Therapy for Prostate Cancer: The Impact on Sexual Function

Focal therapy (FT) has emerged as a potential treatment for localized prostate cancer (PCa) with encouraging functional outcomes. According to the compelling evidence based on meta-analyses and recent trials, erectile function (EF) is mostly retained at 6 and 12 months after FT when compared to baseline. These findings are consistent across different energy sources reported to date. However, overall, quality of life, including impotence, was not the endpoint for most studies. Additionally, impotency has not been consistently reported in most of the recent literature. Furthermore, confounding factors such as baseline potency and usage of phosphodiesterase 5 inhibitors (PDE5-I) were also frequently undisclosed. Long-term functional outcomes are awaited. To fully comprehend how FT affects EF, more extensive long-term randomized clinical trials using EF as a primary outcome are needed.

The effect of public transport disruption on bicycle usage. Evidence from a natural experiment in Budapest

Abstract In this article we use a natural experiment to assess the effects of a public transport disruption on the bicycle sharing system ridership. We exploit maintenance work on a major tram line in Budapest. Fixed effects panel regressions are applied in a difference-in-difference setting. Our results show that bicycle sharing usage significantly increased on weekdays during the disruption, however, this effect is not substantial relative to the baseline usage of the tram service. These findings raise interesting policy questions.

Natural history of lower urinary tract symptoms among men undergoing stereotactic body radiation therapy for prostate cancer with and without a Rectal Hydrogel Spacer.

Stereotactic body radiation therapy (SBRT) is increasingly used for prostate cancer, but has morbidity as both the bladder and rectum are radiated during treatment. Our goal was to document and compare lower urinary tract symptoms (LUTS) among men who underwent SBRT with and without SpaceOAR hydrogel (Augmenix, Inc., Bedford, MA). We performed a retrospective analysis of 87 men (50 SpaceOAR and 37 non-SpaceOAR) who underwent SBRT. Primary outcomes were patient reported symptoms during radiation therapy, pharmacotherapy usage, and urologic and bowel survey scores up to 6-months post-SBRT. 78% of men were on α-inhibitors at the end of SBRT, an increase from 27.6% baseline usage (p < 0.001). Post-SBRT urinary frequency was more common in the non-SpaceOAR group versus the SpaceOAR group (68% versus 38%, p = 0.006), as was nocturia (35% vs. 8%, p = 0.002). Acute gastrointestinal symptoms did not differ. 58.8% of men were on α-inhibitors at 6-months of follow-up post-SBRT, an increase from 27.6% baseline usage (p < 0.001). Importantly, there was a difference of α-inhibitor use between non-SpaceOAR and SpaceOAR groups at the end of SBRT and at 1.5-, 3-, and 6-months follow up (86% vs. 53% [p = 0.002], 83% vs. 53% [p = 0.005], 72% vs. 49% [p = 0.038], respectively). LUTS after SBRT remains a significant problem for men undergoing treatment for prostate cancer. LUTS affects men during and up to 6-months following SBRT. Owing to these increased LUTS, preemptive minimally invasive solutions and their mechanisms of protection, including the SpaceOAR, should be further investigated.

Prevalence, progression and implications of breast artery calcification in patients with chronic kidney disease.

ABSTRACTBreast arterial calcification (BAC) is increasingly recognized as a specific marker of medial calcification. The present retrospective observational cohort study aimed to define the prevalence, progression rate, risk factors and clinical implications of BAC in chronic kidney disease (CKD) patients across stages of disease. The presence and extent of BAC were determined on mammograms in 310 females (58.7 ± 10.8 years, Caucasian) with CKD across various stages of disease [CKD G2–5D n = 132; transplant (Tx) recipients n = 178]. In a subset of 88 patients, repeat mammography was performed, allowing us to calculate the annualized BAC rate. Overall, BAC was observed in 34.7% of the patients. BAC prevalence (P = 0.02) and BAC score (P = 0.05) increased along the progression of CKD. In the overall cohort, patients with BAC were characterized by older age, more cardiovascular disease, more inflammation, higher pulse pressure and borderline higher prevalence of diabetes and were more often treated with a vitamin K antagonist (VKA). The BAC progression rate was significantly lower in Tx patients as compared with CKD G5D. Progressors were characterized by more inflammation, worse kidney function, higher BAC score and higher serum phosphate level (Tx only) at baseline and were more often treated with a VKA. Major adverse cardiovascular event-free survival was significantly worse in Tx patients with BAC. In conclusion, BAC is common among CKD patients, progresses at a slower pace in Tx patients as compared with CKD 5D and associates with dismal cardiovascular outcomes. BAC score, kidney function, serum phosphate at baseline and VKA usage seem to be important determinants of progression.

Effects of metreleptin in patients with lipodystrophy with and without baseline concomitant medication use

Objective To evaluate the effects of metreleptin in distinct subgroups of patients with generalized lipodystrophy (GL) and partial lipodystrophy (PL), using multivariate linear regression modeling to account for the role of patients’ baseline usage of concomitant glucose and lipid-lowering medications and other covariates on their outcomes. Materials and methods A post-hoc statistical analysis of two published single-arm, interventional, phase 2 clinical trials at NIH was conducted. Concomitant medication use was assessed for the clinical trial population using prescription fill data, measured at baseline and the post-one year following metreleptin initiation. Pre-specified co-primary efficacy endpoints measured were change from baseline in HbA1c at month 12, and the percent change from baseline in fasting serum triglycerides (TG) at month 12. Descriptive and statistical analyses were conducted for the overall population, the separate populations with GL and PL, and additional PL subgroups defined by baseline metabolic markers of elevated HbA1c and elevated fasting TG. Results As previously reported, improvement in HbA1c and fasting TG from baseline to 12 months on metreleptin were observed in the overall population (mean change −1.57 percentage points and median change −37.9%, respectively) and subgroups. For both HbA1c and TG, baseline levels were significant predictors of changes after metreleptin. After considering baseline characteristics such as disease type, age, sex, and baseline HbA1c, baseline insulin use was not found to be a significant predictor of HbA1c improvement following metreleptin initiation. Similar results were seen for TG levels, with the use of any lipid-lowering medications at baseline not found to be a significant predictor of reductions in fasting TG levels. Conclusions Patients treated with metreleptin experienced statistically significant improvement in metabolic markers of glycemic and hypertriglyceridemic control—e.g. HbA1c and triglyceride levels—across various subgroups after controlling for baseline characteristics and concomitant medication usage.

Greening the operating room, one procedure at a time

Abstract Background/Purpose There is growing interest within the anesthesia community regarding sustainability practices. A quality improvement initiative at a large, urban, academic medical center provided anesthesia practitioners education to promote change in practice to reduce our overall carbon footprint in the operating room. This endeavor provided cost-savings to the healthcare system and positioned the anesthesia department as environmental advocates. Methods Institutional Review Board approval was granted for non-human subject research. A retrospective chart review was completed examining inhalational agent usage and fresh gas flow rate over thirty days (n = 304). Next, an education on sustainability practices with an overview of inhaled anesthetics and their impact on the environment, based on global warming potential, was delivered during department grand rounds. Afterwards, data was collected for 30 days with the same sampling technique (n = 285). Six weeks later, desflurane vaporizers were removed from anesthesia machines. After removal, data was collected once again to determine desflurane usage (n = 289). Results A retrospective chart review of 878 patients undergoing general anesthesia showed an average baseline usage of desflurane at 8.3%. A reduction to 3% was noted after implementation of sustainability education. Desflurane usage further decreased to 0.3% after desflurane vaporizer removal. Discussion This quality improvement initiative resulted in cost savings and provided a significant environmental impact while providing the tools for a conscious, deliberate decision in care based on current literature to decrease global warming impact while preserving the practitioners right to choose an inhalational agent.

Sensitivity analysis of household factors and energy consumption in residential houses: A multi-dimensional hybrid approach using energy monitoring and modeling

The energy forecast modeling has long been referred to as the function of estimating the energy consumption of a building and providing sustainable design options for energy-efficient policies. In addition to the existing conventional schemes for energy performance and energy simulation, there is the potential to connect steady-state energy modeling to energy monitoring data, along with household factors such as family size, housing design, and occupancy ratio to better understand hard-to-measure energy-related behaviors. This paper introduces a multi-dimensional hybrid approach that combines multiple interactions between observation-based and simulation-based data using energy modeling’s graphical interface software. Compared to the observed energy consumption, the model samples show an average Pearson coefficient of determination in the range of 72% to 76% probability of the energy model data. Accordingly, research has carried out specific air conditioning set points and schedules within each household. Finally, the variation of simulated household models illustrates the greatest effect of air conditioning setpoint on savings of 20% to 60%, compared to the baseline usage. Sensitivity analysis shows that larger household size, higher occupancy ratio, lower thermal resistance for wall insulation, and slighter airflow rate can reduce the end-use and the gross site or source energy. The study underlines the diverse interactions among household characteristics, occupant schedules, and energy monitoring data, which are prospective to stimulate the application of building energy modeling in the early design stage and the optimization of energy efficiency in the operational phases.

Abstract PS8-09: Dietary supplement use in a healthy eating and exercise lifestyle intervention in breast cancer survivors: The lifestyle exercise and nutrition (LEAN) study

Abstract Background: Dietary supplements (DS), defined as herbal preparations, vitamins and minerals (DSHEA Act 1994), are used by 70% of cancer survivors. The World Cancer Research Fund/American Institute for Cancer Research 2018 Cancer Prevention Recommendations specify not to use DS to protect against cancer. There is some evidence that DS are linked to harmful outcomes, including increased mortality and breast cancer recurrence. DS have potential pharmacokinetic interactions via cytochrome P450 enzyme and pharmacodynamic interactions via estrogenic or hepatotoxic activity, which may increase or reduce clinical efficacy or potentiate adverse effects of Tamoxifen and Aromatase Inhibitors (AIs). This analysis examines baseline usage of DS and potential interactions with Tamoxifen and AIs among breast cancer survivors enrolled in the Lifestyle, Exercise, and Nutrition (LEAN) study, a randomized healthy eating and exercise lifestyle intervention. Methods: We examined the use of DS in 151 breast cancer survivors enrolled in the LEAN Study. Women with a body mass index (BMI) ≥ 25 kg/m 2 were randomly assigned to a 6-month healthy eating and exercise lifestyle intervention (n=93) or to usual care (n=58). At baseline and 6 months, we asked participants to self-report regular DS use, defined as at least 3 times a week for at least one month. The intervention group received evaluation and counseling of DS use by a Registered Dietitian (RD) with a Certified Specialty in Oncology Nutrition (CSO). Potential interactions of moderate and major ratings between DS with Tamoxifen and AIs (Letrozole, Exemestane and Anastrozole) were identified through the Natural Medicines Database by both a pharmacist specializing in oncology and a RD, CSO. Results: Out of 151 women, at baseline 120 (80%) reported using DS. Fifty-four different formulations were enumerated. The majority of women (72, 60%) were taking ≥ 3 formulations. One quarter of women (29, 24%) were taking ≥ 5 formulations (range = 1 - 20). Of the 54 formulations, 33% had potential interactions with Tamoxifen and/or AIs according to the Natural Medicines Database. Total interactions by medication were: 18 Tamoxifen, 14 Letrozole, 14 Exemestane, 9 Anastrozole. The majority of these interactions (87%) were associated with herbal preparations. Conclusions: Our findings are indicative of the high prevalence of DS use among breast cancer survivors and the potential risk of interactions with prescribed hormonal therapy. More research is needed to test if counseling from a RD, CSO can reduce DS use and ultimately lead to better outcomes due to fewer interactions with breast cancer treatments. Citation Format: ThaiHien Nguyen, Maura Harrigan, Courtney Mcgowan, Annette Hood, Fangyong Li, Brenda Cartmel, Leah Ferrucci, Melinda L Irwin, Tara Sanft. Dietary supplement use in a healthy eating and exercise lifestyle intervention in breast cancer survivors: The lifestyle exercise and nutrition (LEAN) study [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS8-09.

Characterizing standardized patients and genetic counseling graduate education.

Standardized patients (SPs) are laypersons trained to portray patients, family members, and others in a consistent, measurable manner to teach and assess healthcare students, and to provide practice for emotionally and medically challenging cases. SP methodology has been studied with practicing genetic counselors; however, there is minimal empirical evidence characterizing its use in genetic counseling (GC) education. The Accreditation Council for Genetic Counseling (ACGC) Standards of Accreditation for Graduate Programs in Genetic Counseling include SP sessions as one way to achieve up to 20% of the 50 participatory cases required for graduation. The purpose of the current project was to determine the scope, frequency, and timing of SP methodology in ACGC-accredited programs to establish baseline usage, which happened prior to the SARS-CoV-2 pandemic. A 40-item investigator-created survey was developed to document the scope and frequency of SP use among programs. The survey was distributed through the Association of Genetic Counseling Program Directors' (AGCPD) listserv to 43 accredited and 6 programs under development. Surveys were analyzed from 25 accredited programs (response rate=58%). Seventeen of these programs report inclusion of SP methodology in the curricula (68%), of which 13 report working with an established SP program. SPs are used predominantly for role-plays (70.6%), individualized instruction and remediation (29.4%), and for other reasons such as lecture demonstration, final examinations, practicing skills, and assessing students' goals. Sixteen of the participating programs use SPs to give GC students experience disclosing positive test results. Other details vary among the GC programs including the use of trained SPs, volunteer or paid SPs, actors with and without SP training, or GC students acting as patients. This study demonstrates that GC program SP experiences differ, but are largely viewed as valuable by the programs. Many GC programs report using SP encounters to create multiple opportunities for students to practice and refine clinical skills similar to SPs in medical school.