Changes In Patterns Research Articles

Mind wandering is associated with worsening attentional vigilance.

The tendency for our minds to wander is a pervasive and disruptive influence on continued task performance. Models of sustained attention have implicated mind wandering, moments when attention has turned inwards toward task-unrelated thought, in characteristic patterns of worsening performance with greater time-on-task, known as the vigilance decrement. Despite their theoretical connection, associations between mind wandering and the vigilance decrement have not been investigated systematically. Across two studies (N = 730), we evaluated covariance between within-task change in rates of probe-caught mind wandering and patterns of worsening behavioral task performance that characterize the vigilance decrement. Bivariate growth curve models characterized patterns of intraindividual linear change in mind wandering alongside concomitant changes in task accuracy, response time (RT), and RT variability. Importantly, models assessing the covariance between intraindividual change in mind wandering and behavioral outcome measures confirmed that increases in mind wandering are associated with patterns of worsening behavioral performance with greater time-on-task. In addition, we investigated the role of several moderating factors associated with patterns of within-task change: self-reported task interest and motivation, and individuals' propensity for mind wandering, and mindfulness in their daily lives. These factors moderated either the overall level or rate of within-task change in mind wandering. Our results provide support for models of sustained attention that directly implicate mind wandering in worsening behavioral performance with greater time-on-task in continuous performance tasks requiring sustained attention. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Change Patterns of Major Functional Components in the Loquat Summer Shoot Leaf during Annual Growth

Loquat leaves are widely used in traditional Chinese medicine and food processing as raw materials. To provide a theoretical basis for suitable harvesting periods based on the utilization of distinct components, the change patterns of major functional components in the annual growth of loquat leaves were investigated. In this study, the summer loquat leaves were sampled regularly during their annual growth, and the contents of seven main functional components and 13 monomer components were determined. The results showed that there was a regular change pattern for major functional components during loquat annual growth from Jul 2020 to Jun 2021; however, the change trend was different among different components. Among them, the contents of total flavonoids, total phenols, total triterpenoid acids, vitamin C, asiatic acid, quillaic acid, corosolic acid, and chlorogenic acid presented an overall upward trend. The content of maslinic acid showed a downward trend, whereas the content of neochlorogenic acid did not change much throughout the whole growth period. The content changes in the loquat leaves were affected by the light durations and temperature changes in different seasons, with mutual transit during the flowering and fruit growth processes. Sampling in May to June was found to be a most optimized option when applied in Chinese medicine processing; however, the degree of fibrosis is another indicator when it is used as food raw material. This study revealed the change pattern of major functional components of loquat leaves during the annual growth period and provides a theoretical basis for the reasonable harvesting period of loquat leaves as raw materials for processing different types of products.

Investigating the response of urban surface thermal environment to urban morphology changes in Nanjing

The urbanization process has significantly impacted urban morphology, which in turn has led to changes in the urban surface thermal environment (USTE). A summarization of the empirical patterns of past urban morphology changes and an evaluation of the USTE effects produced by different patterns will contribute to the advancement of scientific knowledge regarding the response of USTE to urban morphology changes and facilitate the development of sustainable urban planning and design practices. This study investigated the response of USTE to urban morphology from the overall and local based on the Local Climate Zone (LCZ) framework during 2005–2020 in Nanjing. The results validated the rationality of the LCZ framework for describing urban morphology changes and their USTE responses. It was found that the overall USTE was continuing to deteriorate, with an increase in high temperature and sub-high temperature areas. LCZ 4, LCZ 5, and LCZ 8 were the major contributors to overall urban heat, and their growth in the amount and changes in USTE characteristics mainly caused the overall USTE deterioration. In localized areas, it was found that urban regeneration had the most potential to optimize USTE. The conversion processes of LCZ 5 to LCZ 4, LCZ 8 to LCZ 4, and LCZ 8 to LCZ 5 were considered more advantageous in improving daytime USTE, which should be advocated. The results can provide important insights into the perception of urban morphology and USTE, and support the urban regeneration policies for climate-resilient cities from the environmental performance perspective.

Comprehensive CFD Analysis of Base Pressure Control Using Quarter Ribs in Sudden Expansion Duct at Sonic Mach Numbers

This study aims to assess the effect of rib size, shape, and location in a suddenly expanded flow at sonic Mach number. Flow from a converging nozzle is exhausted into a larger area of duct diameter of 18 mm. The geometric parameters considered are the area ratio, duct length, rib radius, and inertia parameters, which are considered the level of expansion at critical Mach number. In the present study, duct lengths were from 1D to 6D, rib radii considered were 1 mm to 3 mm, and rib locations were 0.5D, 1D, 1.5D, 2D, and 3D. Results show that when the ribs are placed near the reattachment point with a 3 mm radius, they are efficient and capable of reducing the suction in the recirculation zone and the base pressure, which was lower than the ambient pressure in the absence of ribs, is assorted larger than the back pressure. If the requirement is to equate the pressure at the base to ambient pressure, then a 2 mm radius is the right choice. Furthermore, the 1 mm rib cannot reduce the suction in the base region, and base pressure remains sub-atmospheric for the entire range of rib locations, as well as the NPRs of the present study. When the orientation of the ribs is changed, and the flow interacts with the flat surface instead of the curved surface, there is a marginal change in the flow pattern, and there is no significant change in the base pressure values.

Experimental Study of Airfoil Aerodynamic Behavior under Oscillating Motion in Ground Effect

When a flying vehicle approaches a water or land surface, it induces changes in the fluid flow field pattern known as the "ground effect." This research analyzes the ground effect phenomenon, exploring its impact on aerodynamic coefficients and flow patterns around the NACA0012 airfoil in an incompressible subsonic regime under static and dynamic conditions with pitch movements. Numerical simulations and experimental testing in an incompressible subsonic wind tunnel were deployed. The flow field solution is derived from the Navier-Stokes equations, incorporating the Transition SST turbulence model. Initially, the impact of the ground effect phenomenon was investigated at varying distances from the surface in the static state. Subsequently, the airfoil underwent a sinusoidal pitching oscillation at each distance with a specified frequency and amplitude. This allowed for examining its aerodynamic characteristics over time. The static analysis results reveal alterations in the curve's behavior and pressure distribution on the airfoil surface at close distances to the surface. This is attributed to the ground effect phenomenon, which reduces lift force to a certain height and then increases. Dynamic analysis further demonstrates changes in lift coefficient oscillation amplitude. It also exhibits a minimum and maximum lift point phase difference as the airfoil approaches the surface.

The Relationship between Event Boundary Strength and Pattern Shifts across the Cortical Hierarchy during Naturalistic Movie-viewing.

Our continuous experience is spontaneously segmented by the brain into discrete events. However, the beginning of a new event (an event boundary) is not always sharply identifiable: Phenomenologically, event boundaries vary in salience. How are the response profiles of cortical areas at event boundaries modulated by boundary strength during complex, naturalistic movie-viewing? Do cortical responses scale in a graded manner with boundary strength, or do they merely detect boundaries in a binary fashion? We measured "cortical boundary shifts" as transient changes in multivoxel patterns at event boundaries with different strengths (weak, moderate, and strong), determined by across-participant agreement. Cortical regions with different processing timescales were examined. In auditory areas, which have short timescales, cortical boundary shifts exhibited a clearly graded profile in both group-level and individual-level analyses. In cortical areas with long timescales, including the default mode network, boundary strength modulated pattern shift magnitude at the individual participant level. We also observed a positive relationship between boundary strength and the extent of temporal alignment of boundary shifts across different levels of the cortical hierarchy. In addition, hippocampal activity was highest at event boundaries for which cortical boundary shifts were most aligned across hierarchical levels. Overall, we found that event boundary strength modulated cortical pattern shifts strongly in sensory areas and more weakly in higher-level areas and that stronger boundaries were associated with greater alignment of these shifts across the cortical hierarchy.

Labor market impacts of eco-development initiatives in protected areas

Eco-development seeks to balance economic development with biodiversity conservation, enhancing the effectiveness of protected area management. This paper examines the labor market impacts of eco-development initiatives implemented in the protected areas of the Western Ghats, India, a significant biodiversity hotspot facing intense socio-economic pressures. Our findings show that eco-development has substantially altered labor market outcomes in villages within and surrounding protected areas, resulting in a higher share of non-farm employment. This shift is marked by a reduction in year-round work and an increase in seasonal employment. These effects appear to stem from the specific types of jobs created by eco-development and the changes in land use patterns it promotes, such as a higher proportion of forested land and increased reliance on rainfed agriculture over irrigated farming. Descriptive evidence also suggests that, despite improvements in literacy, the affected villages experience lower consumption levels and higher poverty rates.

The global, regional, and national patterns of change in the burden of congenital birth defects, 1990–2021: an analysis of the global burden of disease study 2021 and forecast to 2040

Congenital birth defects (CBDs) present enormous challenges to global healthcare systems. These conditions severely impact patients' health and underscore issues related to socioeconomic development and healthcare accessibility and efficiency. Previous studies have been geographically limited and lacked comprehensive global analysis. This study provides global, regional, and national disability-adjusted life years (DALYs) data for four major congenital birth defects-congenital heart defects (CHD), neural tube defects (NTDs), digestive congenital anomalies (DCAs), and Down syndrome (DS) from 1990 to 2021, emphasizing health inequalities. The goal is to offer scientific evidence for optimizing resource allocation, focusing on high-burden populations, and reducing disease burden. This study systematically evaluated the global, regional, and national burden of CBDs and their changes from 1990 to 2021 using the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021. To conduct a more focused analysis, four specific CBDs were selected: CHD, NTDs, DCAs, and DS. DALYs were used as the metric, combined with the sociodemographic index (SDI). Analyses included the slope index of inequality and concentration index to measure health inequalities, frontier analysis to estimate achievable outcomes based on development levels, decomposition analysis to identify drivers of disease burden changes, Joinpoint regression analysis to assess temporal trends, and the Bayesian age-period-cohort (BAPC) model to predict future disease burden trends. Compared to 1990, the global burden of the CBDs in 2021 showed a downward trend. Males had a higher burden than females, with the highest burden observed in low-SDI regions. When examining CHD, NTDs, DCAs, and DS specifically, trends in burden changes varied across different CBDs at the global, regional, and national levels. Frontier analysis revealed potential for burden improvement in various countries and territories. Decomposition analysis highlighted differences in disease burden drivers across SDI regions, showing the greatest improvement observed in low-SDI regions. Joinpoint regression analysis indicated a downward trend in DALYs burden across SDI regions, and BAPC model predictions suggested that the burden of CBDs will continue to decline in the future. CBDs pose a major challenge to global public health. Despite an overall decline in disease burden, health inequalities remain prominent, particularly in countries and territories with lower levels of development. Future public health interventions should focus on countries and territories with low levels of development by optimizing healthcare resource allocation, improving basic health infrastructure, enhancing health education, and reducing disease burden inequalities. Global collaboration and data sharing are essential to promote a lifecycle management model for CBDs research and treatment, advancing global health development. This study was supported by the National Natural Science Foundation of China (No. 82270310) and the Jiangsu Provincial Key Research and Development Program (No. BE2023662).

Molecular characterization, spatio-temporal expression patterns of crtc2 gene and its immune roles in yellow catfish (Pelteobagrus fulvidraco)

cAMP response element binding (CREB) protein 2 (CRTC2) is a transcriptional coactivator of CREB and plays an important role in the immune system. Thus far, the physiological roles of Crtc2 in teleost are still poorly understood. In this study, the crtc2 gene was identified and characterized from yellow catfish (Pelteobagrus fulvidraco; therefore, the gene is termed as pfcrtc2), and its evolutionary and molecular characteristics as well as potential immunity-related roles were investigated. Our results showed that the open reading frame of pfcrtc2 was 2,346 bp in length, encoding a protein with 781 amino acids. Gene structure analysis revealed its existence of 14 exons and 13 introns. A phylogenetic analysis proved that the tree of crtc2 was clustered into five groups, exhibiting a similar evolutionary topology with species evolution. Multiple protein sequence alignment demonstrated high conservation of the crtc2 in various vertebrates with similar structure. Syntenic and gene structural comparisons further established that crtc2 was highly conserved, implying its similar roles in diverse vertebrates. Tissue distribution pattern detected by quantitative real-time PCR showed that the pfcrtc2 gene was almost expressed in all detected tissues except for eyes, with the highest expression levels in the gonad, indicating that Crtc2 may play important roles in various tissues. In addition, pfcrtc2 was transcribed at all developmental stages in yellow catfish, showing the highest expression levels at 12 h after fertilization. Finally, the transcriptional profiles of crtc2 were significantly increased in yellow catfishes injected with Aeromonas hydrophila or Poly I:C, which shared a consistent change pattern with four immune-related genes including IL-17A, IL-10, MAPKp38, and NF-κBp65, suggesting pfCrtc2 may play critical roles in preventing both exogenous bacteria and virus invasion. Anyway, our findings lay a solid foundation for further studies on the functions of pfcrtc2, and provide novel genetic loci for developing new strategies to control disease outbreak in teleost.

Nonlinear Radiative Response to Patterned Global Warming due to Convection Aggregation and Nonlinear Tropical Dynamics

Abstract Climate responses to global warming exhibit large dependence on the spatial pattern of sea surface temperature (SST) changes. A Green’s function (GF) approach—predicting the global climate response to a complex SST pattern change as the linear superposition of the response to finite-area SST perturbations evaluated in isolation—has been used to systematically evaluate and understand the top of atmosphere (TOA) radiation response to patterned warming. However, in general, the linear GF approach fails for TOA radiation reconstruction under future global warming scenarios in coupled models. Here, we show that the linear superposition of global mean TOA radiation responses to large SST warming perturbations at multiple patches (the GF approach prediction) overestimates the actual response to simultaneous multipatch perturbation. This is because the linear superposition overestimates tropical large-scale convection aggregation strengthening upon localized heating that enhances longwave radiative cooling, which is further explained by the overestimation of circulation response and associated horizontal water vapor transport. The nonadditivity of TOA radiation response is caused by the nonadditivity of convection aggregation, ultimately rooted in nonlinear tropical dynamics. We also demonstrate that the prediction error of the GF approach grows with decreasing patch size (equivalently, increasing patch number). We conclude that using the GF approach to predict future climate change could overestimate longwave radiative cooling and underestimate (effective) climate sensitivity. Numerical experiments may be used to identify specific perturbation patterns where the errors are smaller than the signal. Our research also highlights that an increase in the degree of large-scale convection aggregation has a nonlinear and negative feedback for mean warming.

A 28-time-point cropland area change dataset in Northeast China from 1000 to 2020

Abstract. Based on historical documents, population data, published results, remote sensing data products, statistical data, and survey data, this study reconstructed the cropland area and the spatial pattern changes at 28 time points from 1000 to 2020 in Northeast China. The period from 1000 to 1600 corresponds to historical provincial-level administrative districts, while the period from 1700 to 2020 corresponds to modern county-level administrative districts. The main findings are as follows: (1) the cropland in Northeast China exhibited phase changes of expansion–reduction–expansion over the past millennium. (2) The cropland area in Northeast China increased from 0.55×104 km2 in 1000 to 37.90×104 km2 in 2020, and the average cropland fraction increased from 0.37 % to 26.27 %; (3) from 1000 to 1200, the cropland area exhibited an increasing trend, which peaked in 1200. The scope of land reclamation was comparable to modern times, but the overall cropland fraction remained low. The cropland area significantly decreased between 1300 and 1600, with the main land reclamation area being reduced southward into Liaoning province. From 1700 to 1850, the cropland area increased slowly and the agricultural reclamation gradually expanded northward. After 1850, there was almost exponential growth, with the cropland area continuously expanding to the whole study area, and this growth trend persists until 2020; (4) the dataset of changes in the cropland of administrative districts in Northeast China, reconstructed based on multiple data sources and improved historical cropland reconstruction methods, significantly enhances time resolution and reliability. Additionally, the dataset shows relatively better credibility assessment results, which can provide a refined database for historical land use and land cover change (LUCC) dataset reconstruction, carbon emission estimation, climate data construction, etc. The dataset can be downloaded from https://doi.org/10.6084/m9.figshare.25450468.v2 (Jia et al., 2024).

Diachronic Height Changes in Europe From the Mesolithic to the Present: Exploring Possible Causes and Regional Specificities.

A meta-analysis of diachronic changes in average height across Europe from the Mesolithic to the present, based on a broad range of literature sources. The analysis of chronological height variability was based on skeletal remains (from the Mesolithic to the 19th century), from which height was reconstructed, and on data from living individuals measured from the late 19th to the early 21st century. In total, data from 73 skeletal series and 342 groups of modern populations, primarily from Eastern Europe, were analyzed. A regression analysis was performed using R to describe the patterns of variability. The findings indicate that height decreases during the Neolithic and remains relatively stable until the Medieval period. A decline in average height is observed during the High Medieval period. The Early Modern period marks a transition to the 20th century, during which there is a consistent increase in average height, most pronounced until the 1980s, after which the rate of increase slows slightly into the early 21st century. Temporal height variability in the European part of Russia shows regional differences. The results suggest a wave-like pattern of trans-epochal changes in the somatic status of populations over an extended period, likely driven by various socioeconomic factors that dominated in different historical periods: the transition to agriculture, urbanization, political systems, industrial revolutions, and significant improvements in quality of life. Diachronic changes in height exhibit regional specificities, reflected in the variability of rates and magnitudes of secular gains across different regions and time periods.

Automated home cage monitoring of an aging colony of mice—Implications for welfare monitoring and experimentation

IntroductionOur understanding of laboratory animal behavior and the implications of husbandry activities on their wellbeing remains incomplete. This is especially relevant with an aging colony as their activity patterns may change as they mature. Home Cage Monitoring (HCM) provides valuable insights into mouse activity within the animal's own environment and can shed light on acclimatization periods and responses to husbandry activities such as cage changing. The aim of this study was to monitor and explore changes in the activity and rest disturbance (RDI) patterns of an aging colony of male and female C57/BL6 mice.MethodsThe mice were housed in the Digitally Ventilated Cage® system, for up to 18 months of age. Data was then downloaded to investigate how the activity patterns and RDI of the mice changed over time. Habituation, aging and cage change assessments were conducted using linear mixed models, while cage separation and stereotypic behavior investigations were conducted by visual inspection of the data.ResultsAs expected during the study, mice were less active during the light phase compared to the dark phase. However, on arrival mice displayed heightened activity and RDI during the light phase and reduced activity and RDI during the dark phase, taking several days to adjust to baseline “acclimatized” patterns. With age, overall activity significantly decreased from 5 months until 14 months of age, after which it increased back toward baseline levels. We also observed activity spikes during our monitoring of this colony. Prolonged housing can lead to alarming stereotypic behaviors in animals. Cages of mice flagged for potential stereotypy displayed sustained activity spikes in the light and dark phases. Spikes in activity during the dark phase were much more pronounced than in the light phase. Cage changing led to an increase in the light phase activity and RDI compared to the previous day, with no observed difference in the dark phase post-cage change. This effect remained consistent as the animals aged.DiscussionThis study explores changes in the activity patterns of an aging colony of male and female C57/BL6 mice housed in the Digitally Ventilated Cage® system. We identified distinct aging phases concerning activity and RDI differences and a potential new welfare application for the DVC®, specifically for early detection of stereotypy. In conclusion, the adoption of HCM systems should be considered for long-term animal housing from both a welfare and behavioral perspective.

Changes in N-terminal pro b-type natriuretic peptide according to SGLT2 inhibitor utilization patterns in patients hospitalized for decompensated heart failure: a prospective cohort study

Abstract Introduction Sodium-glucose cotransporter-2 (SGLT2) inhibitors have found success in treating patients with chronic heart failure (HF) across the entire spectrum of left ventricular ejection fraction (EF). Their benefits may also extend to patients with acute HF decompensation, as they may aid effective decongestion. Purpose This study aims to present the various patterns in changes of N-terminal pro b-type natriuretic peptide (NT-proBNP) according to SGLT2 inhibitor use in patients hospitalized for acute HF decompensation. Methods In this prospective cohort study, we enrolled consecutive patients hospitalized for HF decompensation during a 4-month period in a cardiology department. Prior medical history and cardiovascular risk factors were recorded. The patterns in SGLT2 inhibitor use were noted and patients were classified into three groups; Group 1 (No SGLT2 inhibitor use/Discontinuation), Group 2 (Prior SGLT2 inhibitor use and continuation), and Group 2 (SGLT2i-naïve and initiation). Categorization according to left ventricular (EF) to HF with reduced EF (HFrEF), HF with mildly reduced EF (HFmrEF), and HF with preserved EF (HFpEF) was also performed. Moreover, estimated glomerular filtration rate (eGFR) was used as an estimate of renal function. Results In this analysis, 159 patients were included (median age: 79 years old, male sex: 64.8%, median duration of hospitalization: 6 days). In this population, 67.9% of the patients were not receiving a SGLT2 inhibitor on admission. Concerning demographic and clinical variables (Figure 1), there were no major differences in age, sex distribution, history of diabetes mellitus, dyslipidemia, and atrial fibrillation, as well as in renal function. Group 2 patients had a lower prevalence of arterial hypertension compared to Group 3 (36.6% vs. 52.6%, p<0.05). Moving to the changes in NTproBNP (Figure 2), we observed that patients who did not use SGLT2 inhibitors and did not initiate them during hospitalization had negligible changes in NTproBNP, either as an absolute change (Group 1: 506 (8792) pg/ml vs. Group 2: -5610 (9461) pg/ml vs. Group 3: -3602 (4409) pg/ml, p=0.001) or as percentage change (Group 1: -2.1 (63.4) % vs. Group 2: -30.3 (39.0) % vs. Group 3: -38.3 (41.5) %, p=0.001), compared to the rest of the study population who were already taking SGLT2 inhibitors or initiated them during hospitalization. Conclusion In this study we found NTproBNP, a widely used biomarker of congestion and prognosis in HF, was significantly reduced in decompensated HF patients receiving SGLT2 inhibitors, with the greatest change being observed in those being treatment-naïve prior to admission. These findings further highlight the role of this drug class even in the acute phase of the disease.Figure 1Figure 2

Association of park renovation with park use in New York City

Abstract Background Equity-driven citywide park redesign and renovation, such as the Community Parks Initiative (CPI), has the potential to increase park use and opportunities for physical activity in underserved communities. The objective of this study was to evaluate changes in patterns of park use following park redesign and renovation in low-income New York City (NYC) neighborhoods. Methods The Physical Activity and Redesigned Community Spaces study was a prospective quality improvement pre-post intervention study design with 33 intervention and 21 matched control neighborhood parks. Data were collected at baseline (prerenovation) and 2 follow-up points (3 months and 1-year post renovation) between 2016 to 2022 summers. Main outcomes encompassed park use and physical activity levels assessed using the well-validated System for Observing Play and Recreation in Communities. Park use was quantified by total number of park users, categorized by age group (≤20 years vs ≥ 21 years), sex, and physical activity level (sitting or standing vs walking or vigorous activity). Changes in outcomes between groups were compared via the generalized estimation equation. Results A total of 28,322 park users were observed across 1,458 scans. At baseline, 59.7% were 20 years or younger, 46.3% were female, and 43.8% were sitting or standing. Intervention parks showed more net park users compared with control parks from baseline to the final follow-up (difference-in-difference relative rate ratio, 1.69 [95% CI, 1.22-2.35] users/scan). The association was driven by a significant increase in adult users at intervention parks and an overall decrease in all users at control parks. Conclusions In this quality improvement study, park redesign and renovation were positively associated with park use in low-income neighborhoods. However, park renovations may need to be accompanied by other programmatic strategies to increase physical activity.

Trajectories of physical activity among participants of six-month mobile app-based disease management program for cardiovascular risk: a group-based trajectory modelling approach

Abstract Background Mobile app-based health promotion is an emerging preventive intervention for cardiovascular disease that allows for the frequent and longitudinal monitoring of physical activity (PA). Previous studies exploring PA trajectories categorized participants in a limited number of follow-up assessments and did not consider dynamic nature with changes that occur over the intervention period. Purpose This study explored the trajectories of PA during mobile app-based disease management programs in adults with cardiovascular risk using group-based trajectory modelling (GBTM). Methods Participants who completed a six-month disease management program using a mobile app were enrolled. The program promoted behavioural changes for the management of cardiovascular risk factors in individuals with one or more of hypertension, diabetes, or dyslipidaemia. Daily step count was measured using a wrist-worn activity tracker (Fitbit devices). Each participant was encouraged to wear a tracker for the monitoring of exercise and physical activity. To analyse relatively physically inactive participants, we included those with baseline step count <8,000 steps/day. GBTM was conducted to identify distinct patterns of longitudinal step count changes of baseline, 3-22 weeks, and 24 weeks. Participants with PA measurements <4 time points were excluded. The baseline characteristics and indicators related to mobile app usage during the first two weeks were compared among the trajectory groups. Results A total of 1,760 participants were included in the analysis (age: median 55 years; 83.8% men; body mass index (BMI): median 27.0 kg/m²; baseline step count: median 6,118 steps/day). GBTM identified four step count trajectory groups: rapid increase (T1, rapid increase in the first three months; 5%), gradual increase (T2, gradual increase in the first three months; 24%), moderate activity (T3, maintained at around 7,000 steps/day; 45%), and physically inactive (T4, around 4,500 steps/day throughout the program; 26%) (Figure 1). The trajectory groups that showed increasing PA patterns were older (T1: median 57 years; T2: 55 years; T3: 55 years; T4: 54 years; p=0.040) with a lower baseline BMI (T1: median 26.6 kg/m²; T2: 26.4 kg/m²; T3: 27.0 kg/m²; T4: 27.7 kg/m²; p<0.001) and were predominantly men (T1: 89.5%; T2: 87.4%; T3: 82.8%; T4: 81.1%; p=0.028). PA increasing patterns were associated with a longer time of mobile app use (T1: median 8.5 min/day; T2: 5.5 min/day; T3: 5.5 min/day; T4: 4.9 min/day; p=0.012) and more login times (T1: median of daily average 3.9/day; T2: 3.0/day; T3: 3.1/day; T4: 2.9/day; p=0.003) during the first two weeks of the program. Conclusions GBTM showed that 30% of participants in the mobile app-based intervention showed significant PA improvement during the first 12 weeks. Results of this study suggest that the response to PA intervention may be associated with lifestyle prior to the program and willingness to use the mobile app.Figure 1.Step count trajectories

Left fascicular pacing is not inferior to left bundle branch pacing in preserving ventricular mechanical synchrony and cardiac function

Abstract Background Left bundle branch pacing (LBBP) has emerged as a more physiological alternative to right ventricular pacing.However, capturing the pre-divisional LBB is not easy to accomplish. This study investigates if left fascicular pacing(LFP), defined as the capture of one of the LBB fascicles, could achieve comparable left ventricular (LV) mechanical synchronicity and cardiac function compared to LBBP. Methods Thirty-one patients with pacing indication for bradycardia were retrospectively collected: LBBP was successfully performed in 13 patients and 18 achieved LFP. All patients underwent echocardiography before and after implantation and at one-year follow-up. Left ventricular (LV) volumes, ejection fraction (EF) and global longitudinal strain (GLS) were measured. The lateral-septal (LW-SW) work difference was used as a measure of mechanical dyssynchrony. Septal flash, apical rocking and septal strain patterns were also assessed. Results Although LW-SW work difference were significantly higher in the LBBP groups than that in the LFP group at baseline(272±269 mmHg*% vs 25±279mmHg*%,p=0.02), a similar increase in LW-SW work difference was observed during follow-up(199±342 mmHg*% vs 371±384mmHg*%,p=0.21). In addition, both LFP and LBBP induced septal flash or apical rocking in some patients, and resulted in subtle changes in strain patterns, which were not significantly different between groups. At one year follow-up, LV ejection fraction (EF) remained almost unchanged in both LBBP and LFP patients(ΔLVEF: 1.1+3.1% vs -0.3±4.8%,p=0.35) , and global longitudinal strain (GLS) was slightly and equally decreased in LFP compared to LBBP (ΔLVGLS: -1.6±2.3% vs -1.2±2.7%,p=0.69). Conclusion LFP and LBBP did not differ in mechanical dyssynchrony or LV remodelling.

Impact of bundled payments on healthcare use and costs for cardiovascular diseases in the Netherlands

Abstract Background Bundled payments for patients with cardiovascular diseases (CVD) aim to enhance primary care utilization in the Netherlands. This study assesses changes in healthcare utilization patterns and costs for CVD between 2015 and 2019, while investigating the potential association with bundled payment adoption. Methods We studied patients at very high risk for CVD using routinely recorded nationwide healthcare data. Multilevel logistic- and gamma regressions were conducted to assess healthcare utilizations patterns between 2015 and 2019, and the impact of bundled payments on the likelihood of receiving medical specialist care and the height of associated costs. Results The odds of medical specialist involvement declined over time for the 148,876 patients included in our study. This decline was significantly associated with practices’ use of bundled payments. Medical specialist costs did also significantly decrease between 2015 and 2019, and patients in practices with the highest level of bundled payments had significantly lower medical specialist costs. When general practice costs were included however, healthcare costs per patient stayed the same, both over time and stratified by use of bundled payments. Conclusions Our findings suggest an association between bundled payments and specialized healthcare use, potentially facilitating the transition to primary care. While we found no evidence for costs savings, our findings do support a reduction in spending growth. Key messages • We evaluated the impact of bundled payments as a means to facilitate integrated care, and found that bundled payments were associated with lower uptake of specialized medical care. • We found no cost savings were found, but findings do support reduced spending growth.

The evolving treatment landscape of multiple myeloma in Portugal: A nation‐wide retrospective cohort study of real‐world clinical practice

AbstractObjectivesTo characterize variations in real‐world treatment patterns in multiple myeloma (MM) in Portugal over a 5‐year period.MethodsA retrospective cohort multicenter study using secondary data of national hospital drug consumption database from 11 Portuguese public hospitals between 2017 and 2022.ResultsNumber of MM‐treated patients increased 53% over 5 years (from 825 to 1266 patients). Constant slight predominance of male patients (55%), 82% over 60 years old (median age, 70 years), and half of newly diagnosed patients were transplant‐eligible. The highest growth rate was in second‐line treatments, with a sixfold increase in patients in fourth‐line or beyond. First‐line treatment pattern remained stable both in transplant‐eligible (bortezomib, cyclophosphamide and dexamethasone (VCd_, bortezomib, thalidomide and dexamethasone (VTd), and bortezomib, lenalidomide and dexamethasone (VRd)) and noneligible patients (bortezomib, melphalan and prednisolone (VMP), VCd, and lenalidomide, dexamethasone (Rd)). Maintenance therapy increased from 5% to 16%, shifting from thalidomide to lenalidomide. Second and third lines were dominated by daratumumab‐based regimens after 5 years. No standard of care in fourth‐line treatment. Treatment duration increased in transplant‐eligible due to maintenance therapy and in noneligible due to fourth‐line treatments. Patients moved from first‐ to second‐line more rapidly over time.ConclusionsThere was an increase in MM patients reaching advanced treatment lines and significant changes in the treatment patterns, driven by access to more effective frontline treatments and longer duration of treatment.

Antimicrobial resistance trends in Italian hospitals: insights from two point prevalence surveys

Abstract Background Antimicrobial resistance (AMR) presents a critical challenge to global healthcare systems, necessitating vigilant surveillance efforts. The European Centre for Disease Prevention and Control (ECDC) conducts point prevalence surveys (PPSs) to monitor AMR trends across European hospitals. This study focuses on comparing AMR patterns in Italian hospitals using data from two surveys: PPS2 (2016-2017) and PPS3 (2022-2023). Methods A total of 140 hospitals enrolling 28991 patients participated in PPS2, while 325 hospitals with 58506 patients contributed data to PPS3. Microbiological samples were collected and tested for antimicrobial susceptibility. Prevalence ratios (PR) with corresponding 95% confidence intervals (CI) were calculated to assess changes in resistance patterns between PPS2 and PPS3. Statistical significance was determined with p-value <0.05. Results Staphylococcus aureus showed a trend towards decreased oxacillin resistance, (PR: 0.77, 95% CI: 0.60 - 0.99). Enterococcus faecalis exhibited a non-significant decrease in glycopeptide resistance. Pseudomonas aeruginosa and Acinetobacter baumannii maintained stable carbapenem resistance between the two surveys. Escherichia coli and Klebsiella pneumoniae showed a decreasing trend in resistance to carbapenems and third-generation cephalosporins, but only Klebsiella pneumoniae was found to be significant (PR: 0.69, 95% CI: 0.55 - 0.88, p 0.004 and PR: 0.78, 95% CI: 0.66 - 0.94, p 0.01, respectively). Conclusions These findings underscore the importance of surveillance in monitoring AMR trends. Observed decreases, especially in Klebsiella pneumoniae, suggest potential improvements. However, the overall stability of resistance highlights the ongoing challenge of combating AMR. A multifaceted approach, including antimicrobial stewardship and One Health initiatives, is crucial to address this global health threat effectively. Key messages • Surveillance efforts are crucial to understand antimicrobial resistance (AMR) trends, as demonstrated by comparing data from two surveys in Italian hospital. • Results highlight the need for data-driven interventions, guiding future strategies within a One Health framework to address antimicrobial resistance comprehensively.