Control Period Research Articles

Automated oxygen control for preterm infants receiving continuous positive airway pressure in southwest Nigeria: an open-label, randomised, crossover trial.

Titration of oxygen therapy to target safe oxygen saturation (SpO2) values is a vital part of care for preterm infants, but is difficult to achieve, particularly in settings in which oxygen, monitoring technology, and human resources are scarce. We aimed to evaluate the safety and efficacy of automated titration of oxygen therapy partnered with a low-cost continuous positive airway pressure (CPAP) device versus manual oxygen control in preterm infants requiring CPAP in a high-mortality, low-resource setting. In this open-label, randomised, crossover trial, preterm infants with a gestational age younger than 34 weeks (or a birthweight <2 kg if gestation was unknown) who were aged 12 h or older and required CPAP and oxygen were recruited at two hospitals in southwest Nigeria. Participants were randomly assigned (1:1) to one of two intervention sequences (ie, to commence the study on automated oxygen control or manual oxygen control) with block randomisation (blocks of 4 and 6) and stratification by health facility. The study statistician was masked to treatment group assignment, but the participants' parents or caregivers and clinical staff were not. Participants received automated or manual oxygen control for two 24-h periods in random sequence. Automated oxygen titration was done with a control algorithm with proven efficacy in high-resource settings. During periods of manual control, oxygen therapy was adjusted by clinicians. The primary outcome was the adjusted mean difference in the proportion of time participants spent in the SpO2 target range (ie, SpO2 91-95% when receiving oxygen or SpO2 91-100% when not receiving oxygen) between automated and manual oxygen control, analysed by intention to treat with weighted repeated measures mixed model linear regression. This trial is registered with ClinicalTrials.gov, NCT05508308, and is completed. Between Sept 13, 2022, and Sept 11, 2023, 72 infants were screened, and 49 (22 female, 27 male; median gestation 29 weeks [IQR 28-31]; median birthweight 1·2 kg [1·1-1·5]) were enrolled in the study and randomly assigned. A total of 80 study periods for 46 infants contributed data to the analysis of the primary outcome as three (6%) of the 49 participants had no oxygenation data from either study period. The mean proportion of time spent in the SpO2 target range was higher during automated control periods than during periods of manual control (adjusted mean 88·1% [95% CI 84·0-92·2] vs 30·1% [20·9-39·3]; adjusted mean difference 58·0% [95% CI 48·0-67·9]; p<0·0001). There were no device-related adverse patient outcomes and short-term safety outcomes favoured automated control. Automated titration of oxygen partnered with a low-cost CPAP device improved time spent in the safe SpO2 range compared with manual control. There is high potential for this technology to mitigate the risk of oxygen-mediated complications in preterm infants in low-resource settings. National Health and Medical Research Council Australia and University of Tasmania.

Diagnoses supported by a computerised diagnostic decision support system versus conventional diagnoses in emergency patients (DDX-BRO): a multicentre, multiple-period, double-blind, cluster-randomised, crossover superiority trial.

Diagnostic error is a frequent and clinically relevant health-care problem. Whether computerised diagnostic decision support systems (CDDSSs) improve diagnoses is controversial, and prospective randomised trials investigating their effectiveness in routine clinical practice are scarce. We hypothesised that diagnoses made with a CDDSS in the emergency department setting would be superior to unsupported diagnoses. This multicentre, multiple-period, double-blind, cluster-randomised, crossover superiority trial was done in four emergency departments in Switzerland. Eligible patients were adults (aged ≥18 years) presenting with abdominal pain, fever of unknown origin, syncope, or non-specific symptoms. Emergency departments were randomly assigned (1:1) to one of two predefined sequences of six alternating periods of intervention or control. Patients presenting during an intervention period were diagnosed with the aid of a CDDSS, whereas patients presenting during a control period were diagnosed without a CDDSS (usual care). Patients and personnel assessing outcomes were masked to group allocation; treating physicians were not. The primary binary outcome (false or true) was a composite score indicating a risk of reduced diagnostic quality, which was deemed to be present if any of the following occurred within 14 days: unscheduled medical care, a change in diagnosis, an unexpected intensive care unit admission within 24 h if initially admitted to hospital, or death. We assessed superiority of supported versus unsupported diagnoses in all consenting patients using a generalised linear mixed effects model. All participants who received any study treatment (including control) and completed the study were included in the safety analysis. This trial is registered with ClinicalTrials.gov (NCT05346523) and is closed to accrual. Between June 9, 2022, and June 23, 2023, 15 845 patients were screened and 1204 (591 [49·1%] female and 613 [50·9%] male) were included in the primary efficacy analysis. The median age of participants was 53 years (IQR 34-69). Diagnostic quality risk was observed in 100 (18%) of 559 patients with CDDSS-supported diagnoses and 119 (18%) of 645 with unsupported diagnoses (adjusted odds ratio 0·96 [95% CI 0·71-1·3]). 94 (7·8%) patients suffered a serious adverse event, none related to the study. Use of a CDDSS did not reduce the occurrence of diagnostic quality risk compared with the usual diagnostic process in adults presenting to emergency departments. Future research should aim to identify specific contexts in which CDDSSs are effective and how existing CDDSSs can be adapted to improve patient outcomes. Swiss National Science Foundation and University Hospital Bern.

Folinic acid as a treatment for autism in children: A within-subjects open-label study on safety and efficacy.

The folate cycle has been implicated in the pathophysiology of autism due to its role in the glutathione oxidative stress pathway, amino acid and DNA methylation reactions, and neurotransmitter synthesis pathway. Previous research on folinic acid supplementation in autistic children has suggested potential benefits. The primary aim of this pilot study was to determine the safety, feasibility and efficacy of oral folinic acid in improving communication and behaviour in autistic children. Ten autistic children were recruited into an open-label pre-post treatment within-subjects design study. At T = 0, 12 and 24 weeks, participants underwent safety evaluations, standardized assessments of language, autism symptoms, adaptive skills and global illness severity, and eye-gaze tracking. During the control period (0-12 weeks), participants continued with standard care. In the treatment period (12-24 weeks), participants took oral folinic acid at 2mg/kg/day. All 10 children (nine boys, one girl; aged 4-8years), successfully consumed oral folinic acid supplements with no adverse events. There was a reduction in Pervasive Developmental Disorder Behavior Inventory (PDDBI) Autism Composite T-score with treatment (mean [SD] T-score 49.2 [8.89] pre-treatment, 44.6 [6.19] post-treatment, p = 0.103). Although this difference was not statistically significant due to the small sample size, the effect size was medium-large, indicating that, as a group, there were clinically meaningful changes in PDDBI T-scores. There were also trends towards gains in communication scores and overall Clinical Global Impression scores. Folinic acid is a safe and feasible potential treatment for autism, and results from this pilot justify the need for a larger placebo-controlled trial.

Effect of home-based hot bathing on exercise-induced adaptations associated with short-term resistance exercise training in young men.

This study investigated whether home-based bathing intervention (HBBI) improve muscle strength gain and protect cardiovascular function by short-term resistance training (RT). Thirty-one healthy young men measured the maximum voluntary isometric contraction (MVC) of knee extensor, electrically evoked knee extension torque, and mean arterial pressure (MAP). Then, participants were divided into three groups with matching MVC: shower without bathing (control, n = 10), thermoneutral bathing (36°C-bathing, n = 10), and hot bathing (40°C-bathing, n = 11), and conducted 2 weeks of HBBI. Following familiarization for HBBI, participants completed 2 weeks of HBBI and acute RT (five sessions of three sets of 10 isometric knee extension at 60% MVC). Baseline neuromuscular and cardiovascular function was assessed again following completion of the 2 weeks of intervention. MVC was non-significantly increased after the RT period in 40°C-bathing with large effect size (partial η2 = 0.450). The electrically evoked knee extension torque (10/100-Hz ratio) was significantly increased after the RT period in control (p = 0.020). MAP did not alter due to bathing intervention and RT (all p > 0.05). HBBI improved muscle strength without RT-induced alteration of peripheral muscle condition. Shower without bathing reduced muscle strength gain but increased peripheral muscle condition. Short-term RT does not adversely affect the cardiovascular function, regardless of HBBI.

P-682. The Risk of Cardiorespiratory Events for up to 180 days Following Respiratory Syncytial Virus (RSV) Infection Hospitalization: A Self-controlled Case Series Analysis

Abstract Background Beyond the burden of acute respiratory infection, RSV can cause cardiorespiratory disease exacerbations and trigger cardiovascular events in adults. Information on these associations is limited, particularly following the acute illness phase. We evaluated the risk of common cardiorespiratory events during and following RSV hospitalization in adults. Methods We conducted a self-controlled case series analysis using data from administrative claims and electronic health records from Optum’s de-identified Market Clarity database. Adults (≥18 years) with 6 months of baseline continuous enrollment and an RSV-related hospitalization (RSV diagnosis or RSV+ test in the inpatient setting) from 01Jan17–30Jun23 (observation period) were included. Patients with the first admission for chronic obstructive pulmonary disease exacerbations (COPD-E), myocardial infarction (MI), stroke, congestive heart failure exacerbations (CHF-E), and arrhythmias during this period were identified using diagnosis codes. The risk period was defined as 0–180 days after RSV infection, including subintervals of risk periods and pre-risk periods. The remaining time outside of the 180-day risk period and the 21-day pre-risk period during the observation period formed the control period. Conditional Poisson regression adjusting for time-varying age (5-year intervals) was performed to determine the incidence rate ratio (IRR) for each event following RSV infection. Results Among 8,181 adults hospitalized with RSV, 3,494 had COPD-E 1,601 MI, 1,175 stoke, 2,879 CHF-E, and 4,083 arrhythmias during the entire observation period. The IRR during days 1–21 compared to the control period following RSV infection was 16.0 (95% CI 13.9, 18.4), 8.8 (95% CI 7.1,11.0), 9.9 (95% CI 7.9, 12.4), 9.5 (95% CI 8.1, 11.2), and 12.8 (95% CI 11.3, 14.4), respectively, for COPD-E, MI, stroke, CHF-E, and arrhythmias. IRRs were elevated for all outcomes for 42 days and attenuated over time but remained elevated for up to 180 days for stroke and CHF-E. Conclusion There is an increased risk of acute cardiorespiratory events and exacerbations following RSV infection. These cardiorespiratory events should be considered as part of the burden of RSV infection when evaluating RSV preventive interventions. Disclosures Caihua Liang, MD, PhD, Pfizer: Stocks/Bonds (Private Company) Jennifer Judy, MS, PhD, Pfizer: Employee|Pfizer: Stocks/Bonds (Public Company) Negar Aliabadi, MD, MS, Pfizer Inc: employment|Pfizer Inc: Stocks/Bonds (Public Company) Reiko Sato, PhD, Pfizer Inc: employee|Pfizer Inc: Stocks/Bonds (Private Company) Erica Chilson, PharmD, Pfizer Inc: Employee|Pfizer Inc: Stocks/Bonds (Public Company) Xin Zhao, MS, Pfizer: Xin Zhao is an employee of Genesis Research Group which received compensation from Pfizer for conducting this study. Bradford D. Gessner, M.D., M.P.H., Pfizer: Employee|Pfizer: Stocks/Bonds (Public Company) Elizabeth Begier, MD, M.P.H., Pfizer Vaccines: Employee|Pfizer Vaccines: Stocks/Bonds (Private Company)

The Effects of Self-Monitoring Using a Smartwatch and Smartphone App on Stress Awareness, Self-Efficacy, and Well-Being-Related Outcomes in Police Officers: Longitudinal Mixed Design Study.

Wearable sensor technologies, often referred to as "wearables," have seen a rapid rise in consumer interest in recent years. Initially often seen as "activity trackers," wearables have gradually expanded to also estimate sleep, stress, and physiological recovery. In occupational settings, there is a growing interest in applying this technology to promote health and well-being, especially in professions with highly demanding working conditions such as first responders. However, it is not clear to what extent self-monitoring with wearables can positively influence stress- and well-being-related outcomes in real-life conditions and how wearable-based interventions should be designed for high-risk professionals. The aim of this study was to investigate (1) whether offering a 5-week wearable-based intervention improves stress- and well-being-related outcomes in police officers and (2) whether extending a basic "off-the-shelf" wearable-based intervention with ecological momentary assessment (EMA) questionnaires, weekly personalized feedback reports, and peer support groups improves its effectiveness. A total of 95 police officers from 5 offices participated in the study. The data of 79 participants were included for analysis. During the first 5 weeks, participants used no self-monitoring technology (control period). During the following 5 weeks (intervention period), 41 participants used a Garmin Forerunner 255 smartwatch with a custom-built app (comparable to that of the consumer-available wearable), whereas the other 38 participants used the same system, but complemented by daily EMA questionnaires, weekly personalized feedback reports, and access to peer support groups. At baseline (T0) and after the control (T1) and intervention (T2) periods, questionnaires were administered to measure 15 outcomes relating to stress awareness, stress management self-efficacy, and outcomes related to stress and general well-being. Linear mixed models that accounted for repeated measures within subjects, the control and intervention periods, and between-group differences were used to address both research questions. The results of the first analysis showed that the intervention had a small (absolute Hedges g=0.25-0.46) but consistent effect on 8 of 15 of the stress- and well-being-related outcomes in comparison to the control group. The second analysis provided mixed results; the extended intervention was more effective than the basic intervention at improving recovery after work but less effective at improving self-efficacy in behavior change and sleep issues, and similarly effective in the remaining 12 outcomes. Offering a 5-week wearable-based intervention to police officers can positively contribute to optimizing their stress-related, self-efficacy, and well-being-related outcomes. Complementing the basic "off-the-shelf" wearable-based intervention with additional EMA questionnaires, weekly personalized feedback reports, and peer support groups did not appear to improve the effectiveness of the intervention. Future work is needed to investigate how different aspects of these interventions can be tailored to specific characteristics and needs of employees to optimize these effects.

Self-Management Strategies for Low Back Pain Among Horticulture Workers: Protocol for a Type II Hybrid Effectiveness-Implementation Study.

Low back pain (LBP) is highly prevalent and disabling, especially in agriculture sectors. However, there is a gap in LBP prevention and intervention studies in these physically demanding occupations, and to date, no studies have focused on horticulture workers. Given the challenges of implementing interventions for those working in small businesses, self-management offers an attractive and feasible option to address work-related risk factors and manage LBP. This study will (1) investigate the effectiveness of self-management strategies for nursery and landscape workers by comparing within-subject control and intervention periods and (2) determine if adoption and effectiveness differs between participants randomly assigned to review self-management videos only and those who also receive multimodal implementation support. We will also identify contextual factors impacting effectiveness and implementation. A pragmatic, mixed methods, hybrid effectiveness and implementation design will be used to compare back pain with work tasks, disability, medication and substance use, and psychological factors between a baseline control and intervention periods. We aim to recruit 122 English- and Spanish-speaking horticulture workers with back pain, 30 supervisors, and 12 focus group participants. Participants will review short video modules designed to increase awareness of opioid risk and introduce self-management and ergonomic choices and use 1 self-management and 1 ergonomic strategy for 10 weeks. They will be randomly assigned to 2 implementation groups: video modules only or video + multimodal personalized support (checklist guidance, review of video feedback for ergonomic problem-solving, and text message reminders). Questionnaires will be administered at 3-month time points: baseline, pre- and postintervention, and at 3 and 6 months. Qualitative analysis of field notes, open-ended comments, and focus groups will expand understanding of results with comprehensive documentation of the context, barriers and facilitators, and reasons for adoption. The project was funded on September 29, 2023 (Centers for Disease Control and Prevention National Institute of Occupational Health and Safety, CDC NIOSH; U54OH011230-07S1), as a core research grant for the Southeast Coastal Center for Agricultural Health and Safety. The design, creation, and editing of English and Spanish videos was completed in June 2024 after comprehensive formative evaluation. Enrollment began in June 2024 with anticipated completion in 2027. We hypothesize that both self-management interventions will result in reductions in work task pain and disability and that the video enhanced with multimodal personalized support will result in greater reductions than the video alone. If self-management is effective, mitigating pain positively impacts quality of life, productivity, and retention, while increasing the use of nonpharmacological alternatives to opioids addresses an important public health issue. Implementation aims will help inform reasons for results, barriers and facilitators, and potential for similar interventions in these and similar industries with physically challenging outdoor work. ClinicalTrials.gov NCT06153199; http://clinicaltrials.gov/study/NCT06153199. DERR1-10.2196/64817.

Weed interference on organic carrot yield under different sowing methods

Weed cause serious problems to vegetable cultivation, justifying the importance of studies on the interference of these plants in agricultural crops and management techniques in the context of organic production. From this perspective, this study aimed to evaluate the interference of weed on the yield of carrot grown under different sowing methods. The study was conducted at the Seridó Ecological Station in Rio Branco, Acre, Brazil. Control and coexistence experiments with weeds were set up in a split-plot design (5 x 2), with the plot corresponding to the coexistence or control periods: 15, 20, 25, 30, and 35 days after sowing, and the subplots corresponding to the sowing methods: direct seeding and water conditioning. Cultivation followed the recommendations for carrot and for the organic system. The harvest and evaluations were performed after 80 days by evaluating the biometric variables, the carrot yield, and the weed mass. The statistical analysis consisted of the test of assumptions followed by analysis of variance. Non-linear regression was used for the yield parameters by determining the interference periods. In contrast, linear regression was used for the other variables. Carrot coexistence with weeds reduced the conventional commercial yield by 75.73% and the organic commercial yield by 57.07%. Organic carrot cultivation should occur free of weed from 21 to 28 days. Water conditioning increased the organic carrot yield.

Safety and health care utilization following COVID-19 vaccination (BNT162b2) among children and youth with juvenile idiopathic arthritis and inflammatory bowel disease: A population-based study

Abstract Objectives To evaluate among Ontario children and youth (&amp;lt;16 years old) with juvenile idiopathic arthritis (JIA) or inflammatory bowel disease (IBD), whether COVID-19 vaccines (Monovalent BNT162b2) were associated with adverse events of special interest (AESI) or health care utilization. Methods Using health administrative databases, all children/youth with JIA or IBD who received at least one vaccine were identified from November 2020 to December 2021 with follow-up until August 31, 2022. Self-controlled case series analyses were used to determine the relative incidence rates (RIR) of events in any 3-week period [AESI, Emergency Department (ED) visits, hospitalizations] and in any 1-month period [specialist visits] post-vaccine compared to control periods. Results We studied 1629 JIA and 1050 IBD patients. In the JIA cohort, the median age at vaccination was 12.0 years [Interquartile range (IQR): 10.0 to 14.0], and the median disease duration was 4.3 years (IQR: 2.0 to 7.5). By December 2021, 67.1% (n = 1093) received two doses and 24.1% (n = 393) received three doses. In the IBD cohort, the median age at vaccination was 13.0 (IQR: 11.0 to 14.0) with a median disease duration of 2.4 years (IQR: 1.1 to 4.8). Fifty-four percent (n = 565) received two doses and 36.3% (n = 381) received three doses. During risk periods, AESI was rarely reported. Relative to control periods, JIA and IBD patients demonstrated similar rates of hospitalizations [JIA: RIR: 0.76 (95% confidence interval [CI]: 0.25 to 2.33), IBD: RIR: 0.64 (95% CI: 0.29 to 1.41)], ED visits [JIA: RIR: 1.11 (95% CI: 0.77 to 1.59), IBD: RIR: 0.93 (95% CI: 0.61 to 1.43)], and specialist visits [JIA: RIR: 1.06 (95% CI: 0.89 to 1.26), IBD: RIR: 0.56 (95% CI: 0.22 to 1.43)]. Conclusions Overall, this study demonstrates the safety of the BNT162b2 vaccine in children/youths with JIA and IBD, with no associated increase in AESI or health care use.

Optimizing Post-activation Performance Enhancement in Athletic Tasks: A Systematic Review with Meta-analysis for Prescription Variables and Research Methods.

Post-activation performance enhancement (PAPE) has demonstrated efficacy in acutely improving athletic performance. However, its distinction from general warm-up (GW) effects remains ambiguous, and experimental designs adopted in most PAPE studies exhibit important limitations. The aims of this work are to (i) examine the effects of research methodology on PAPE outcomes, (ii) explore PAPE outcomes in relation to comparison methods, performance measures, GW comprehensiveness, recovery duration, participants' characteristics, conditioning activity (CA) parameters, and (iii) make recommendations for future PAPE experimental designs on the basis of the results of the meta-analysis. Four databases were searched for peer-reviewed English-language literature. Risk of bias was assessed using a modified Cochrane Collaboration's tool and PEDro scale. PAPE groups were compared with control groups, pre-conditioning activity (pre-CA) performances were compared with post-conditioning activity (post-CA) performances throughout a verification test in PAPE groups, and control groups were compared before and after the "rest" period using a three-level meta-analysis. Further analyses, including subgroup analysis and both linear and nonlinear meta-regression methods, were used to explore the effect of different moderating factors on PAPE magnitude. A subgroup analysis of GW comprehensiveness was conducted using four classification methods. One method classified GW as non-comprehensive (stretching or jogging only), partially comprehensive (stretching, jogging, and low-intensity self-weighted dynamic exercises), and comprehensive (adding maximal or near-maximal intensity CAs to a partially comprehensive GW). The other three classifications were adjusted according to the type and number of GW exercises. Certainty of evidence was assessed using the GRADE approach. The final analysis included 62 PAPE studies (1039 participants, male: n = 857, female: n = 182) with a high risk of bias and low certainty of pooled evidence. A trivial PAPE effect was observed from pre- to post-CA (effect size [ES] = 0.12, 95% CI [0.06 to 0.19], prediction intervals [PI] = - 0.29 to 0.54); a small PAPE effect was observed when compared with a control group (ES = 0.30, 95% CI [0.20 to 0.40], PI [- 0.38 to 0.97]). The slightly greater effect against control resulted from a small decrease in performance in control groups (ES = - 0.08, 95% CI [- 0.13 to - 0.03], PI [- 0.30 to 0.14]), but there was no relationship with between PAPE recovery time (β = - 0.005, p = 0.149). Subgroup analyses showed that PAPE magnitude was greater for non-comprehensive GWs (ES = 0.16) than comprehensive (ES = 0.01) and partially comprehensive GWs (ES = 0.11). In contrast, the control group showed a decline in performance after comprehensive GW (ES = - 0.20). An inverted U-shaped PAPE was noted as a function of recovery time. In some cases, PAPE appeared to manifest at < 1min post CA. Additionally, participants with longer training experience (ES = 0.36) and higher training levels (ES = 0.38) had larger PAPE magnitudes. PAPE effect was higher in females (ES = 0.51) than males (ES = 0.32) and mixed groups (ES = 0.16) but did not reach a significant difference (p > 0.05). Plyometric exercise (ES = 0.42) induced greater PAPE amplitude than traditional resistance exercise (ES = 0.23), maximal isometric voluntary contraction (ES = 0.31) and other CA types (ES = 0.24). Although the overall pooled results for both PAPE pre- versus post-CA and PAPE versus control group comparisons showed significant improvement, the wider and past-zero prediction intervals indicate that future studies are still likely to produce negative results. The comprehensiveness of the GW, the time between GW and the pre-CA test, participant sex, training level, training experience, type of CA, number of CA sets, and recovery time after CA all influence the PAPE magnitude. The PAPE magnitude was trivial after comprehensive GW, but it was greater in studies with a control group (i.e., no CA) because performance decreased over the control period, inflating the PAPE effect. Finally, two theoretical models of PAPE experimental design and suggestions for methodological issues are subsequently presented. Future studies can build on this to further explore the effects of PAPE. The original protocol was prospectively registered (osf.io/v7sbt) with the Open Science Framework.

A Novel Artificial Intelligence-Enhanced Digital Network for Prehospital Emergency Support: Community Intervention Study.

Efficient emergency patient transport systems, which are crucial for delivering timely medical care to individuals in critical situations, face certain challenges. To address this, CONNECT-AI (CONnected Network for EMS Comprehensive Technical-Support using Artificial Intelligence), a novel digital platform, was introduced. This artificial intelligence (AI)-based network provides comprehensive technical support for the real-time sharing of medical information at the prehospital stage. This study aimed to evaluate the effectiveness of this system in reducing patient transport delays. The CONNECT-AI system provided 3 key AI services to prehospital care providers by collecting real-time patient data from the scene and hospital resource information, such as bed occupancy and the availability of emergency surgeries or procedures, using 5G communication technology and internet of things devices. These services included guidance on first aid, prediction of critically ill patients, and recommendation of the optimal transfer hospital. In addition, the platform offered emergency department medical staff real-time clinical information, including live video of patients during transport to the hospital. This community-based, nonrandomized controlled intervention study was designed to evaluate the effectiveness of the CONNECT-AI system in 2 regions of South Korea, each of which operated an intervention and a control period, each lasting 16 weeks. The impact of the system was assessed based on the proportion of patients experiencing transfer delays. A total of 14,853 patients transported by public ambulance were finally selected for analysis. Overall, the median transport time was 10 (IQR 7-14) minutes in the intervention group and 9 (IQR 6-13) minutes in the control group. When comparing the incidence of transport time outliers (>75%), which was the primary outcome of this study, the rate was higher in the intervention group in region 1, but significantly reduced in region 2, with the overall outlier rate being higher in the intervention group (27.5%-29.7%, P=.04). However, for patients with fever or respiratory symptoms, the group using the system showed a statistically significant reduction in outlier cases (36.5%-30.1%, P=.01). For patients who received real-time acceptance signals from the hospital, the reduction in the percentage of 75% outliers was statistically significant compared with those without the system (27.5%-19.6%, P=.02). As a result of emergency department treatment, 1.5% of patients in the control group and 1.1% in the intervention group died (P=.14). In the system-guided optimal hospital transfer group, the mortality rate was significantly lower than in the control group (1.54%-0.64%, P=.01). The present digital emergency medical system platform offers a novel approach to enhancing emergency patient transport by leveraging AI, real-time information sharing, and decision support. While the system demonstrated improvements for certain patient groups facing transfer challenges, further research and modifications are necessary to fully realize its benefits in diverse health care contexts. ClinicalTrials.gov NCT04829279; https://clinicaltrials.gov/study/NCT04829279.

Role of regular medical visits in mitigating increased suicide risk during the early COVID-19 pandemic in Kobe, Japan

BackgroundJapan has one of the lowest COVID-19 death rates, while the annual suicide rate in 2020 has risen for the first time since 2007. This study aimed to identify high-risk populations and assess the impact of medical visits on suicide trends post-COVID-19 pandemic in Japan.MethodThis quasi-experimental study analyzed a population-based database from Hyogo Prefecture (2012–2022). Interrupted time-series analyses identified level and trend changes in monthly suicide rates per 1 million population during the exposure period (2020–2022) versus the control period (2012–2019). Regular visits to primary care and psychiatry stratified analysis.Results2181 cases were analyzed, with two-thirds male and a median age of 54. Primary care physicians and psychiatric history were present in 69% and 40% of patients. The study found significant level changes in suicide rates overall (4.14, 95% CI: 1.70, 6.58) among individuals without regular primary care physician visits (2.83, 95% CI: 1.35, 4.32) and without psychiatric visits (2.85, 95% CI: 0.56, 5.14). In contrast, no significant changes were observed in individuals with regular primary care (0.99, 95% CI: -0.78, 2.76) or regular psychiatric visits (0.59, 95% CI: -0.98, 2.16). The trend changes were not significant in any of the groups.ConclusionThis study suggests that a history of attending a medical institution may have prevented the rapid increase in suicides during the early stages of the COVID-19 pandemic.

Effectiveness of a Strobing Light System for Deflecting Downstream Migrating European Silver Eels (Anguilla anguilla)

ABSTRACTAnthropogenic structures, such as dams, delay, injure and kill during downstream migrating silver‐phase Anguillid eels. To enhance spawner escapement from rivers, efforts are being made to develop devices that guide eels towards safe passage routes. We tested the ability of a strobing light array to deflect downstream migrating European silver eels (Anguilla anguilla) by comparing the distribution of eel catches in a series of nets when lights were on (treatment periods) and off (control periods). Deflection efficiency of the light array was 80.6% (95% CL = 74.3%–85.3%), estimated by comparing the proportion of the total biomass captured in nets located immediately downstream of the light array during control and treatment periods. Eels caught during treatment periods (Mean ± S.E.; 452 ± 11 mm) were significantly smaller than those caught during control periods (538 ± 8 mm), which suggested that smaller eels were less capable of avoiding the light array. Future research should determine specifications for operation of strobe light arrays, including effects of light intensity and strobe rate, angle of array deployment, and effects of environmental factors on deflection efficiency.

Progressive Increase in Renal Sympathetic Nerve Activity Induced by Cold Exposure.

Exposure to cold environments is linked to cold-induced hypertension due to activated sympathetic nerve activity (SNA) and arterial baroreceptor reflex dysfunction. However, direct measurement of SNA during cold-induced hypertension and changes in baroreflex control of SNA remain unexplored. Chronically instrumented rats were exposed to cold temperatures (10 °C) over 4 days after a control period (24 °C), and renal and lumbar sympathetic nerve activities were simultaneously measured during cold-induced hypertension. Baroreflex curves for renal SNA (RSNA) and lumbar SNA and heart rate were generated by altering arterial pressure via a bolus intravenous infusion of vasoactive drugs. RSNA increased immediately after cold exposure, increased progressively throughout the 4-day period, and remained high after the cold exposure ended. Cold exposure shifted the RSNA baroreflex curve to the right and upward, gradually increasing the upper plateau (maximum capacity of sympathetic drive). The upper plateau remained elevated even after the cold exposure ended. Conversely, cold exposure increased lumbar SNA, heart rate, and arterial pressure, which subsequently returned to control levels after the cold exposure ended. These data indicate that cold exposure increases the maximum capacity to drive renal SNA in a regionally different and time-dependent manner through cumulative effects. Four days of cold exposure resulted in reversible effects increasing arterial pressure via lumbar SNA and heart rate, alongside time-dependent cumulative effects on RSNA. This study provides direct evidence of a self-activating pathway for RSNA that is activated by cold exposure, thus initiating cold-induced hypertension.

Changes in infant respiratory pathogens pre-, during, and post-COVID-19 non-pharmacological interventions in Beijing

BackgroundTo explore the effect of non-pharmacological interventions (NPIs) on respiratory pathogen profiles among hospitalized infants aged 0–3 months in Beijing during the coronavirus disease 2019 (COVID-19) pandemic.MethodsRespiratory specimens were collected from 1,184 infants aged 0–3 months who were hospitalized for acute respiratory infection at the Children’s Hospital affiliated with the Capital Institute of Pediatrics from January 2018 to December 2023. The data were divided into three groups—the pre-epidemic (January 2018 to December 2019), epidemic prevention and control (January 2020 to December 2022), and post-epidemic (January 2023 to December 2023) groups—based on the outbreak of COVID-19 and the implementation and termination of NPIs. The specimens were tested for 14 respiratory pathogens, including influenza virus A (Flu A), influenza virus B, respiratory syncytial virus, parainfluenza virus (PIV), adenovirus (ADV), human metapneumovirus (HMPV), human bocavirus, human rhinovirus (HRV), coronavirus, Chlamydia trachomatis, Chlamydia pneumoniae (C.pn), Mycoplasma pneumoniae, Bordetella pertussis, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).ResultsA total of 1,184 infants, including 649 males and 535 females, with acute respiratory infections were admitted. The positive detection rate for respiratory pathogens was 51.77% (n = 613). In 2023, the proportion of infants with respiratory infections after the epidemic was 19.4% (319/1646), the positive detection rate of respiratory pathogens was 68.3% (218/319), and the mixed infection detection rate of respiratory pathogens was 16.1% (35/218). Prior to the epidemic, these rates were 11.9% (431/3611), 37.1% (160/431), and 5.0% (8/160), respectively. During the epidemic prevention and control period, these rates significantly increased to 12.4% (434/3486), 54.1% (235/434), and 11.1% (26/235) (P < 0.05), respectively. Post-epidemic, the proportion of newborns testing positive for respiratory pathogens decreased, while the number of infants aged 29–90 days significantly increased. The proportion of admission weight and contact history with respiratory patients increased significantly compared to before and during the epidemic, with statistical significance (P < 0.05). After the epidemic, a total of 13 respiratory pathogens were detected throughout the year. There were statistically significant differences in the detection rates of Flu A, PIV, SARS-CoV-2, HRV, HMPV, ADV, and C.pn before, during, and after implementation of the NPIs during the COVID-19 epidemic (P < 0.05). Post-epidemic, the detection rates of Flu A, PIV, and SARS-CoV-2 were significantly higher than those before and during the epidemic (P < 0.017). The detection rates of HRV, HMPV, and ADV significantly increased after the epidemic compared to those before the epidemic (P < 0.017). Before the epidemic, the positivity rate of respiratory pathogens was high in the first and fourth quarters. After the termination of NPIs, the positive detection rate decreased in the first quarter but increased in the second, third, and fourth quarters, with a statistically significant difference (P < 0.05).ConclusionThe implementation and lifting of COVID-19 NPIs have caused significant changes in the detection and seasonal distribution of respiratory pathogens in infants aged 0–3 months in Beijing. NPIs temporarily reduced the detection rate of respiratory pathogens in infants during the prevalence of COVID-19. Understanding the prevalence of respiratory pathogens before and after the epidemic is particularly important for the prevention and control of respiratory diseases in infants.

Boat noise reduces vocalization rate and alters vocal characteristics in wild plainfin midshipman fish.

Anthropogenic noise pollution has been accelerating at an alarming rate, greatly altering aquatic soundscapes. Animals use various mechanisms to avoid acoustic masking in noisy environments, including altering calling rates or the frequency (pitch) of their vocalizations or increasing the amplitude (loudness) of their vocalizations (i.e., exhibiting the Lombard effect), but few studies have examined this vocal plasticity in fishes. We tested the effects of in situ motorboat noise on the agonistic and mating vocalizations of nesting plainfin midshipman fish (Porichthys notatus), and found that midshipman fish reduce and alter their vocalizations in the presence of boat noise. During boat noise, fish produced four times fewer agonistic vocalizations compared to ambient control periods. The fish also increased the frequency of mating hums and the amplitude of grunts and growls during boat noise. This study is the first to experimentally demonstrate the Lombard effect in fishes using real motorboat noise.

Two-week Paramedic Hospital Training Augments Blood Pressure Response to Isometric Handgrip Exercise in Healthy Young Men.

Persistent stressful situations can have detrimental cardiovascular effects; however, effects on the blood pressure (BP) response to exercise have not been fully examined. This study investigated the impact of a 2-week stressful situation on the exercise pressor response. Eight healthy male university paramedic trainees underwent a 2-week paramedic hospital training and a control period study. Pre- and post-intervention, BP responses to the exercise test (2-min submaximal isometric handgrip [IHG] exercise followed by post-exercise muscle ischemia [PEMI]) and cold pressure test (CPT) were assessed. A stress biomarker, salivary alpha-amylase (sAA) activity, significantly increased after hospital training (Pre: 8.8 ± 4.6; Post: 15.5 ± 7.3 kU/L; P = 0.036), whereas no significant changes were observed in the control period (Pre: 11.3 ± 3.6; Post: 10.4 ± 4.5 kU/L). Although no significant trial (hospital training vs. control)-by-intervention (pre- vs. post-2-week period) interactions were detected in the mean arterial pressure (MAP) response to PEMI or CPT, a significant interaction in the MAP response to IHG exercise was noted (Δ48.9 ± 11.2 to Δ55.5 ± 9.1 mmHg, hospital training; Δ53.2 ± 14.1 to Δ51.2 ± 11.9 mmHg, control; P = 0.035). Consequently, changes in the sAA and MAP pre-intervention to post-intervention showed a significant correlation (τ = 0.397, P = 0.036). Results showed that stressful paramedic hospital training augmented BP response to IHG exercise. This suggests that prolonged stressful situations increase pressor response to exercise, particularly in cases involving healthy young men.

ST-elevation myocardial infarction incidence in a high-risk seismic zone.

Earthquakes are unpredictable natural events that can elicit acute physiological responses, potentially triggering cardiovascular events. This study investigates the association between seismic activity and ST-elevation myocardial infarction (STEMI) admissions in a tertiary care hospital in an earthquake-prone region over 19years. We analyzed STEMI admissions at a tertiary center in Mexico City from October 2005 to August 2024. Earthquakes with a magnitude ≥6.0 and geographic relevance to Mexico were identified using the USGS database. Admission rates were compared for ±7days surrounding each earthquake and control periods derived from the same date in the previous year, adjusted for overlaps and seismic events. Poisson regression analyses were used to compare admission rates. Among 9611 STEMI patients, 904 admissions occurred near earthquake periods, with 863 during controls. Post-earthquake admissions rose significantly on the day earthquake (day 0) with an incidence rate ratio (IRR)=1.49 (95% CI 1.17-1.89, P=0.001), and in the post-quake (+1 to +7days) IRR=1.19 (95% CI 1.03-1.36, P=0.015) compared to the pre-quake (-7 to -1days) period. Notably, admissions on days +1 and+2 (IRR=1.54 [95% CI 1.11-2.14] and 1.58 [95% CI 1.07-2.34]) showed a significant increase compared to controls. Elevated systolic blood pressure was observed post-quake, while demographics, severity, and mortality showed no significant differences. Our findings suggest a significant association between earthquake events and increased STEMI admissions within the days following an earthquake in a high-seismic area. Compared to pre-earthquake and control periods, the observed rise in post-earthquake admissions indicates that seismic stress may contribute to STEMI events.

Clinical and intracranial electrophysiological signatures of post-operative and post-ictal delirium.

(1) Gain insight into the mechanisms of postoperative delirium (POD). (2) Determine mechanistic overlap with post-ictal delirium (PID). Epilepsy patients undergoing intracranial electrophysiological monitoring can experience both POD and PID, and thus are suitable subjects for these investigations. POD was assessed daily after surgery. PID was assessed following seizures. Resting state data were collected following delirium assessments, during a control period, and during sleep. Slow-wave activity (SWA: 1-4Hz) and resting state functional connectivity were compared between different time points and according to delirium status. POD was present in 6 of 20 participants. Post-operatively, SWA was globally elevated in all participants but highest in POD+participants. POD+participants exhibited altered functional connectivity compared to POD-. These differences persisted even after resolution of delirium. PID was present in 7 of 15 participants and was predicted by seizures involving prefrontal cortex. PID+participants exhibited higher post-ictal SWA versus PID-; no differences in functional connectivity were observed. Post-operative and post-ictal SWA was comparable to sleep in some participants. Elevated SWA may predispose patients to both post-operative and post-ictal delirium and may indicate overlapping mechanisms. Delirium treatments focused on SWA may be most effective for ameliorating cognitive symptoms.

Impact of Earthquakes During COVID-19 Lockdown on the Pediatric Injury Pattern in the Zagreb Urban Area.

Background/Objectives: Previous works on the epidemiology of pediatric trauma during the COVID-19 lockdown observed a decrease in pediatric surgical emergency consultations and fracture referrals. None of those works describes a unique situation in which there is the coexistence of another opposing factor, like an earthquake, that influences the number of injured children's referrals. Therefore, this study aimed to investigate the influence of earthquakes during the COVID-19 lockdown on pediatric injury pattern referrals at a tertiary care hospital in a urban setting. Methods: A retrospective single-center case-control study comprised a time interval at the time of the COVID-19 lockdown, starting with a day when the biggest earthquake happened and finishing at the end of the confinement period in Zagreb, Croatia (22 March-27 April 2020). The control group comprised the identical time interval in 2019. We identified all successive pediatric trauma patients referred to the Pediatric Emergency Department. Demographics and leading injury characteristics were analyzed. Results: We analyzed data from 1166 patients. In the case group, the median age was lower than in the control group but without gender differences. We detected a decrease in Pediatric Emergency Department referrals and a reduced proportion of pediatric trauma patients in the case group. Additionally, the proportion of shoulder/elbow injuries and head injuries was higher, and the proportion of foot/ankle injuries was lower in the case period than in the control period. Conclusions: Earthquakes during the COVID-19 lockdown changed the pattern of pediatric injuries. These data can be used to restructure health resources during similar conditions to provide optimal health care to children.