Cumulative Number Of Days Research Articles

Outcome evaluation of pharmacist-physician collaborative protocol-based antimicrobial treatment for hospitalized stroke patients with aspiration pneumonia

ObjectivesTo evaluate the efficacy and patient outcomes of pharmacist-physician collaborative protocol-based antimicrobial treatment regimens for antimicrobial stewardship. MethodsPatients treated for aspiration pneumonia due to stroke within 48 h after admission to Kochi Medical School Hospital (January 2019 to December 2022) were included. Primary outcomes were the cumulative number of days of antimicrobial treatment and length of hospital stay. Secondary outcomes included the percentage of patients under-dosed with first-choice antimicrobial agents and inpatient mortality. ResultsGroup A (66 patients) did not receive the antimicrobial treatment protocol, whereas group B (46 patients) did. There were no differences in the patient backgrounds. Group B had a significantly lower percentage of patients who were undertreated with the first-choice antimicrobial agent (9.1 % vs. 42.9 %). There was no significant difference in inpatient mortality between group A and group B (6.1 % vs. 4.3 %). The cumulative number of days of antimicrobial administration and the length of hospital stay were significantly lower in group B: 7.0 days (95 % CI, 6.0–8.0) vs. 9.0 days (95 % CI, 8.0–11.0) for antimicrobial administration, and 28.5 days (95 % CI, 22.0–35.0) vs. 43.0 days (95 % CI, 28.0–55.0) for hospital stay. ConclusionsProtocol-based antimicrobial treatment for aspiration pneumonia supports appropriate antimicrobial usage and improves patient quality of life. These findings will assist in the effective treatment of aspiration pneumonia in an aging society.

Heyndrickxia coagulans strain SANK70258 suppresses symptoms of upper respiratory tract infection via immune modulation: a randomized, double-blind, placebo-controlled, parallel-group, comparative study.

Probiotic consumption strongly influences local intestinal immunity and systemic immune status. Heyndrickxia coagulans strain SANK70258 (HC) is a spore-forming lactic acid bacterium that has immunostimulatory properties on peripheral tissues. However, few reports have examined the detailed effectiveness of HC on human immune function and its mechanism of action. Therefore, we conducted a randomized, double-blind, placebo-controlled, parallel-group study to comprehensively evaluate the effects of HC on immunostimulatory capacity, upper respiratory tract infection (URTI) symptoms, and changes in intestinal organic-acid composition. Results of a questionnaire survey of URTI symptoms showed that runny nose, nasal congestion, sneezing, and sore throat scores as well as the cumulative number of days of these symptoms were significantly lower in the HC group than in the placebo group during the study period. Furthermore, the salivary secretory immunoglobulin A (sIgA) concentration was significantly higher, and the natural killer (NK) cell activity tended to be higher in the HC group than in the placebo group. In addition, we performed an exposure culture assay of inactivated influenza virus on peripheral blood mononuclear cells (PBMCs) isolated from the blood of participants in the HC and placebo groups. Gene-expression analysis in PBMCs after culture completion showed that IFNα and TLR7 expression levels were significantly higher in the HC group than in the placebo group. In addition, the expression levels of CD304 tended to be higher in the HC group than in the placebo group. On the other hand, the HC group showed a significantly higher increase in the intestinal butyrate concentration than the placebo group. HC intake also significantly suppressed levels of IL-6 and TNFα produced by PBMCs after exposure to inactivated influenza virus. Collectively, these results suggest that HC activated plasmacytoid dendritic cells expressing TLR7 and CD304 and strongly induced IFNα production, subsequently activating NK cells and increasing sIgA levels, and induced anti-inflammatory effects via increased intestinal butyrate levels. These changes may contribute to the acquisition of host resistance to viral infection and URTI prevention.

Parolee concentration, parolee embeddedness, and the reciprocal relationship with crime rates: A longitudinal study of neighbourhoods and re-entry

Drawing on recent scholarship on mass incarceration and prisoner re-entry, this study examines the reciprocal relationship between returning parolees and neighbourhood crime rates in five large cities in Texas. Besides the more common approach of counting the number of people on parole in communities (parolee concentration), we propose a novel approach for measuring people on parole by capturing their exposure in the community as parolee embeddedness (i.e., the cumulative number of days that people on parole resided in the neighbourhood). Results show that parolee concentration has a significant positive effect on both violent and property crime, but parolee embeddedness is significantly associated with reductions in violent and property crime. Our findings detect different effects depending on the measurement of people on parole and their community context, illustrating the need to better understand the dynamics of parolee re-entry in the era of mass incarceration.

Developing a Machine Learning Algorithm to Predict the Probability of Medical Staff Work Mode Using Human-Smartphone Interaction Patterns: Algorithm Development and Validation Study.

Traditional methods for investigating work hours rely on an employee's physical presence at the worksite. However, accurately identifying break times at the worksite and distinguishing remote work outside the worksite poses challenges in work hour estimations. Machine learning has the potential to differentiate between human-smartphone interactions at work and off work. In this study, we aimed to develop a novel approach called "probability in work mode," which leverages human-smartphone interaction patterns and corresponding GPS location data to estimate work hours. To capture human-smartphone interactions and GPS locations, we used the "Staff Hours" app, developed by our team, to passively and continuously record participants' screen events, including timestamps of notifications, screen on or off occurrences, and app usage patterns. Extreme gradient boosted trees were used to transform these interaction patterns into a probability, while 1-dimensional convolutional neural networks generated successive probabilities based on previous sequence probabilities. The resulting probability in work mode allowed us to discern periods of office work, off-work, breaks at the worksite, and remote work. Our study included 121 participants, contributing to a total of 5503 person-days (person-days represent the cumulative number of days across all participants on which data were collected and analyzed). The developed machine learning model exhibited an average prediction performance, measured by the area under the receiver operating characteristic curve, of 0.915 (SD 0.064). Work hours estimated using the probability in work mode (higher than 0.5) were significantly longer (mean 11.2, SD 2.8 hours per day) than the GPS-defined counterparts (mean 10.2, SD 2.3 hours per day; P<.001). This discrepancy was attributed to the higher remote work time of 111.6 (SD 106.4) minutes compared to the break time of 54.7 (SD 74.5) minutes. Our novel approach, the probability in work mode, harnessed human-smartphone interaction patterns and machine learning models to enhance the precision and accuracy of work hour investigation. By integrating human-smartphone interactions and GPS data, our method provides valuable insights into work patterns, including remote work and breaks, offering potential applications in optimizing work productivity and well-being.

Associations Between Self-Reported Burn Pit Exposure andFunctional Status, 1990-2021.

The Airborne Hazards and Open Burn Pit Registry (AHOBPR) allows service members to self-report exposure to burn pits during military deployments and functional status (a composite metric of physical fitness status). This study investigated whether general exposure to burn pits, specific performance of burn pit duties, or the cumulative number of days deployed in Southwest Asia was associated with a change in functional status. A retrospective cross-sectional analysis of 234,061 participants in the AHOBPR who completed questionnaires before August 2021 was conducted. Exposure was presumed if an individual reported any burn pits exposure during deployment or if an individual reported having to work at a burn pit as part of their duties and was quantified by the cumulative-reported exposure days. The outcome was the reported composite functional score. Statistical analysis used linear regression, which was adjusted for significant variables. A possible dose-response effect from cumulative deployment and burn pits exposure days was evaluated. Statistical significance was determined at P < 0.05. The burn pit exposure groups were notably different in size (exposed: 230,079, non-exposed: 3982) and were significantly different for all compared variables. There was a negative association between cumulative exposure days and functional score with a significant test for trend. There was a marginal positive significant association between cumulative deployment days and functional score with a significant test for trend. Reporting exposure to burn pit duties was also significantly associated with a lower functional score. This study suggests a dose-response relationship between cumulative burn pit exposure and decreased functional status. It also suggests a modest positive relationship between cumulative deployment days and reported function, which may represent a "healthy deployer" effect.

Effects of sulforaphane glucosinolates from broccoli seed extract on the immune system of healthy Japanese adults

Background: The Purpose of this study was to investigate the effects of sulforaphane glucosinolate (SGS) from broccoli seed extracts on immune function and common cold symptoms in healthy Japanese adults.Methods: This randomized, placebo-controlled, double-blind, parallel-group comparison study was conducted on Japanese adults who had worse health-related quality of life on the SF-8 and were more likely to catch colds from October 22, 2020 to April 2, 2021.Individuals who agreed to participate in the study were randomly assigned to either the SGS 100 mg/day group or the placebo group (n = 33 each). The intervention lasted 8 weeks. The outcomes of this study were the cumulative and the maximum number of days for which common cold symptoms persisted during the intervention period per subject (primary), and the frequency with which subjects experienced these symptoms per group (secondary). Additionally, the incidence rate of subjects infected with the influenza virus, immune indices, and SF-8 were assessed.Results: Based on a per protocol set, 64 subjects (33 in the SGS group and 31 in the placebo group) were analyzed. After the 8-week interventional period, the cumulative number of days for which common cold symptoms per subject was significantly lower for the SGS group than the placebo group (12.1 ± 13.5 for the SGS group and 20.2 ± 18.2 for the placebo group). The cumulative number of days of common cold symptoms per group was also significantly lower in the SGS group than in the placebo group (400 days in the SGS group and 626 days in the placebo group). No changes attributable to the SGS intervention were observed in the other outcomes. There were no adverse events due to food ingestion.Conclusion: A period of 8 weeks of SGS intake was shown to alleviate the onset of common cold symptoms in healthy Japanese adults who were prone to catching colds and had a low subjective sense of wellness.Keywords: Broccoli, sulforaphane, glucoraphanin, cold symptoms, immunityTrial registration: UMIN-CTR: UMIN000042195.Foundation: Murakami Farm Co., Ltd.

Antibiotic Exposure is Associated With a Risk of Esophageal Adenocarcinoma

Antibiotic exposure leads to changes in the gut microbiota. Our objective was to evaluate the association between antibiotic exposure and esophageal adenocarcinoma (EAC) risk. We performed a nested case-control study using data from the Veterans Health Administration from 2004 through 2020. The case group consisted of patients who received an incident diagnosis of EAC. For each case, up to 20 matched controls were selected using incidence density sampling. Our primary exposure of interest was any oral or intravenous antibiotic use. Our secondary exposures included cumulative number of days of exposure and classification of antibiotics by various subgroups. Conditional logistic regression was used to estimate the crude and adjusted odds ratios (aORs) for the risk of EAC associated with antibiotic exposure. The case-control analysis included 8226 EAC cases and 140,670 matched controls. Exposure to any antibiotic was associated with an aOR for EAC of 1.74 (95% confidence interval [CI], 1.65-1.83) vs no antibiotic exposure. Compared with no antibiotic exposure, the aOR for EAC was 1.63 (95% CI, 1.52-1.74; P < .001) for cumulative exposure to any antibiotic for 1 to 15 days; 1.77 (95% CI, 1.65-1.89; P < 0 .001) for 16 to 47 days; and 1.87 (95% CI, 1.75-2.01; P < .001) for ≥48 days, respectively (P for trend < .001). Exposure to any antibiotic is associated with an increased risk of EAC, and this risk increases as the cumulative days of exposure increase. This novel finding is hypothesis-generating for potential mechanisms that may play a role in the development or progression of EAC.

Effects of Highly Bioavailable Curcumin Supplementation on Common Cold Symptoms and Immune and Inflammatory Functions in Healthy Japanese Subjects: A Randomized Controlled Study

This study aimed to investigate the effects of 12-week consumption of highly bioavailable curcumin (150 mg/day of Theracurmin Super [TS-P1] or Theracurmin [CR-033P]) on common cold symptoms, immune function, and inflammatory markers. A randomized, double-blind, placebo-controlled study was conducted from November 2021 to May 2022 on 99 healthy Japanese adults. Using a computerized random number generator, each subject was randomly assigned to one of the following three groups: TS-P1, CR-033P, or placebo (n = 33 per group). For 12 weeks, each group consumed the four capsules that were given to them daily. The cumulative number of days for which common cold symptoms persisted was set as the primary outcome. Immunity parameters, inflammatory parameters, liver function parameters, and physical examination results were additional outcomes. A safety assessment was also performed. Ninety-four subjects completed the study, and the per protocol set included 30 subjects in the placebo group, 32 subjects in the TS-P1 group, and 33 subjects in the CR-033P group. The cumulative number of days for which common cold symptoms persisted was significantly lower in the TS-P1 and CR-033P groups than that in the placebo group. No adverse effects were observed. Consumption of highly bioavailable curcumin, TS-P1 or CR-033P (150 mg/day), for 12 weeks reduced the number of days for which common cold symptoms persisted in healthy Japanese adults.

Biomass, carbohydrate, and leakage conductance in buds of six ornamental tree species subjected to a “false spring” in Northeast China

Information is highly scarce about the possible effect of a late spring frost on physiological response of buds in ornamental trees. In this study, spring temperature of Changchun at Northeast China was recorded to identify the characteristics of a false spring by detecting extraordinary warming and sudden freeze in early April of 2017. Buds of six local ornamental tree species were investigated for their dynamics in biomass, non-structural carbohydrates, frost resistance on days of 7, 14, 21, and 28 April 2017. According to a comparison with spring temperature records historically from 2007 to 2016, a false spring was determined. Black pine (Pinus tabuliformis var. mukdensis) had greater bud biomass than apricot (Prunus sibirica L.). Peach (Prunus persica L. var. persica f. rubro-plena Schneid.) reserved greater non-structural carbohydrate content in post-chilling buds than black pine, and apricot and willow (Salix babylonica L.) had greater soluble sugars and starch contents in buds, respectively. Cumulative number of days with temperature below 12°C had a negative relationship with relative conductance in sorbus (Sorbus pohuashanensis [Hance] Hedl.). Chokecherry (Padus virginiana ‘Canada Red’) had greatest bud starch content on 21 April. Overall, a late spring frost imposed interruption on carbohydrate metabolism rather than direct damage on buds of ornamental trees before late April. Advanced warming induced more pronounced negative impact of a false spring than the sudden decline of minimum temperature.

Readmission after transcatheter aortic valve implantation according to frailty

Abstract Background Readmissions and time spent hospitalized following transcatheter aortic valve implantation (TAVI) are important parameters of patient autonomy, particularly for frail patients with limited life-expectancy. Yet, such data remain scarce. Purpose To investigate actual time spent hospitalized the first year after TAVI. Secondly, to investigate time spent hospitalized according to frailty risk. Methods Through Danish, nationwide registries, we included all patients undergoing TAVI and alive at discharge between January 2008 and June 2020. From discharge, patients were followed until death, emigration, end of study period, or one year of follow-up, whichever came first. During follow-up, all in-patient hospital admissions were identified according to ICD-10 diagnosis codes. Length of stay was calculated, and cumulative numbers of days hospitalized was presented. Further, the proportion of patients dying within one year of follow-up was calculated. Using The Hospital Frailty Risk Score, a validated frailty risk assessment tool, patients were categorized as low, intermediate, and high frailty risk. We then evaluated the time spent hospitalized stratified by frailty risk group. Results The study population comprised 5,464 patients undergoing first-time TAVI with a median age of 81 years among whom 55.2% were males. After one year, 445 (8.1%) patients had died. In total, 2,452 (44.9%) of TAVI patients survived one year and were never admitted, whereas 3,012 (55.1%) patients were admitted at least once or died within one year of TAVI. Of these, 1,200 (21.9%) patients were admitted for more than two weeks or died within one year of TAVI (Figure 1). Regarding frailty, 3,296 (60.3%), 1,965 (36.0%), and 203 (3.7%) patients were classified as low, intermediate, and high frailty risk, respectively. In the low frailty risk group, 6.2% of patients died within one year and 50.4% survived one year without a hospital admission. By contrast, 16.7% of patients in the high frailty risk group died within one year and only 24.6% survived one year without a hospital admission. Further, 17.1% of patients in the low frailty risk group were admitted for more than two weeks or died within one year of TAVI compared with 47.3% in the high frailty risk group (Figure 2). Conclusion Readmissions in the first year after transcatheter aortic valve implantation were common and time spent hospitalized after transcatheter aortic valve implantation was significant. Our results were clearly related to frailty, which should be considered for future prevention strategies. Funding Acknowledgement Type of funding sources: None.

The short-term effects of fine dust on suicide death in Korea

Air pollution can cause various respiratory and neurological diseases and lead to death if continuously exposed. Previous studies have reported that fine dust increases the risk of mental illness such as stress, depression, suicidal ideation, and physical health problems. This study aims to identify the relationship between air pollution and suicide deaths. Fine dust data from the Korea Environment Corporation, autopsy data from the National Police Agency, and death statistics database from the National Statistical Office were used. Additionally, meteorological data and claim data were used. The study design was time series analysis, and we confirmed the effect of single lag, cumulative lag, and moving average of the amount of fine dust from day 0 to day 7 using a distributed non-linear model. We analyzed 64,150 people who died by suicide from 2013 to 2017 and confirmed the statistically significant result that as the PM₁₀ concentration increased, the risk of suicide death increased. Also, as the cumulative number of days increased from 1 to 7 days, the dose-response effect of increasing the risk of suicide was confirmed. Stratified analysis was performed according to gender, age, presence of a suicide note, presence of mental illness, and presence of warning signs before suicide. In particular, in subjects with psychiatric disorders, when the cumulative concentration of PM₂.₅ until 3 days and 5 days before suicide death increased by 10&amp;#x3bc;g/m³, the risk of suicide death increased by 3.1% and 3.2%, respectively. These results show an association between short-term exposure to fine dust and suicide deaths. It can be suggested that more attention should be paid to fine dust exposure, especially in the group with a vulnerable mental illness.

Influence of occupational exposure on hyperuricemia in steelworkers: a nested case–control study

BackgroundOccupational exposure may be associated with an increased risk of developing hyperuricemia. This study sheds lights on the association between occupational exposure and hyperuricemia in steelworkers.MethodA nested case–control study was conducted within a cohort of workers in steel companies to explore the association between occupational exposure and hyperuricemia. The case group consisted of a total of 641 cases of hyperuricemia identified during the study period, while 641 non-hyperuricemia subjects with the same age and gender distribution were randomly selected from the cohort as the control group.ResultsThe incidence rate of hyperuricemia among workers in the steel company was 17.30%, with an incidence density of 81.32/1,000 person-years. In comparison to the reference group, the risks of developing hyperuricemia for steelworkers undergoing ever shifts, current shifts, heat exposure, and dust exposure were 2.18 times, 1.81 times, 1.58 times and 1.34 times higher respectively. The odds ratios (ORs) and 95% confidence intervals (CIs) were 1.87(1.12–3.13) and 2.02(1.21–3.37) for the cumulative number of days of night work at 0–1,972.80 and ≥ 1,972.80 (days), respectively. Compared to the group with the cumulative heat exposure of 0 (°C/year), the ORs (95% CI) for the risk of developing hyperuricemia in the groups with the cumulative heat exposure of 0–567.83 and ≥ 567.83 (°C/year) were 1.50(1.02–2.22) and 1.64(1.11–2.43), respectively. The OR (95% CI) for the risk of developing hyperuricemia was 1.56(1.05–2.32) at the cumulative dust exposure of ≥ 30.02 (mg/m3/year) compared to that at the cumulative dust exposure of 0 (mg/m3/year). Furthermore, there was a multiplicative interaction between heat exposure and dust exposure in the development of hyperuricemia.ConclusionShift work, heat, and dust are independent risk factors for the development of hyperuricemia in steelworkers. Additionally, there is a multiplicative interaction between heat exposure and dust exposure in the development of hyperuricemia. Interventions for shift work, heat and dust may help to reduce the incidence rate of hyperuricemia and improve the health of steelworkers.

Developing an optimized faulting prediction model in Jointed Plain Concrete Pavement using artificial neural networks and random forest methods

ABSTRACT Predicting faulting failure is useful in the optimal concrete pavement design. In this study, artificial neural networks and the random forest method have been used to predict the amount of this failure. The general prediction model was created by inserting 32 available input variables into artificial neural networks. An integer two objectives optimisation problem was designed to select features that significantly affect the faulting. After applying this method, 19 important variables were identified and used to develop two simplified models based on artificial neural networks and the random forest method. It is shown that the simplified model developed by artificial neural networks is the best model to accurately predict the faulting considering the number of input variables. The cumulative number of days when the precipitation is more than 12.7 mm, the elastic modulus of concrete slab, the number of days passed since the pavement was built, base thickness, the cumulative ESALs in the traffic lane, and the annual average number of days when the temperature is more than 32°C were identified as the most important parameters in predicting faulting using the random forest method. A Sensitivity analysis has been then performed on these variables and optimal values were determined.

The Effect of Elexacaftor/Tezacaftor/Ivacaftor on Hospitalizations and Intravenous Antibiotic Use.

Elexacaftor/tezacaftor/ivacaftor (ETI) is a highly effective cystic fibrosis transmembrane conductance regulator modulator. It has been shown to improve lung function and decrease pulmonary exacerbations in short-term clinical trials. The effect of ETI on hospitalization and intravenous (IV) antibiotic rates is not known. We performed a single-institution, retrospective review comparing these rates before and after the initiation of ETI. Among patients taking the cystic fibrosis modulator ETI, we compared the cumulative number of days per month hospitalized and cumulative number of days per month on IV antibiotics before and after the initiation of ETI. Electronic medical records from 37 patients were reviewed from 2016 through 2020 to identify demographic data, hospitalizations, and antibiotic use. Results were then stratified by severity of lung disease. Following the initiation of ETI, there was a decline in days per month hospitalized and on IV antibiotics. The cumulative average number of days per month patients were hospitalized decreased 86% from 27 to 4 after starting ETI. The cumulative average number of days per month on IV antibiotics decreased by 80% (32.5 to 6.4). Most of these reductions occurred among patients with severe lung disease. At our institution, we saw a decline in cystic fibrosis-related hospitalizations and in the use of outpatient IV antibiotics following the initiation of ETI. These reductions were most pronounced among patients with severe lung disease. The initiation of ETI was associated with a decline in days hospitalized and days on IV antibiotics.

Prophylactic use of an ultra-diluted complex on health, metabolism, and performance of weaned Holstein calves and its carryover effect up to first lactation

The objective of this study was to evaluate the effect of an ultra-diluted complex supplemented as a prophylactic strategy on the incidence risk of diseases, metabolism, and performance of weaned Holstein calves immediately after grouping. Additionally, the objective was to investigate the carryover effects on heifer-raising and first-lactation periods, in a double-blind, placebo-controlled trial. A total of 184 weaned Holstein calves (83 ± 7.9 d of life; 112.5 ± 11.7 kg of body weight; values are mean ± standard deviation) were allocated to 8 paddocks in a completely randomized block design experiment. During a 112-d period, animals received a total mixed ration and were randomly allocated into 2 groups: (1) CON: placebo-control (basal diet + calcium carbonate, top-dressed at 30 g/animal per day of placebo), or (2) UD: ultra-diluted complex (basal diet + TopVita-Real H, top-dressed at 30 g/animal per day of sulfur (10-60) + viola tricolor (10-14) + caladium seguinum (10-30) + zincum oxydatum (10-30) + phosphorus (10-60) + carduus marianus (10-60) + colibacillinum (10-30) + podophyllum (10-30) + vehicle: calcium carbonate; quantum sufficit 1 kg). Incidence risk of diseases, number of days with disease, and mortality events were recorded daily. Performance measurements and blood collection were carried out at enrollment and every 28 d until the end of the study period. The incidence risk of digestive problems was higher for the CON group. Additionally, the CON group had higher cumulative number of days per calf affected by tick-borne disease. Blood analysis revealed that CON calves had increased mean corpuscular hemoglobin amount and concentration than UD calves on d 28 after enrollment and had increased serum albumin and total protein concentration on d 84. Furthermore, higher albumin to globulin ratio was found in CON calves than in those of UD group at enrollment; however, on d 56, the inverse was observed. On d 28 after enrollment, CON calves had increased serum cortisol concentration. Regarding body measurements, higher withers height and body depth were detected in UD calves, on d 28 and d 84, respectively. Finally, higher culling risk was observed in the CON group during the heifer-raising period. In conclusion, a lower incidence risk of digestive problems and days with tick-borne disease were detected in the UD group. Additionally, systemic inflammation was improved by UD complex based on circulating inflammation and stress biomarkers on specific days after enrollment. However, UD product did not improve performance at the post-weaning, heifer-raising, and first-lactation periods.

Tympanostomy Tubes or Medical Management for Recurrent Acute Otitis Media

BackgroundOfficial recommendations differ regarding tympanostomy-tube placement for children with recurrent acute otitis media.MethodsWe randomly assigned children 6 to 35 months of age who had had at least three episodes of acute otitis media within 6 months, or at least four episodes within 12 months with at least one episode within the preceding 6 months, to either undergo tympanostomy-tube placement or receive medical management involving episodic antimicrobial treatment. The primary outcome was the mean number of episodes of acute otitis media per child-year (rate) during a 2-year period.ResultsIn our main, intention-to-treat analysis, the rate (±SE) of episodes of acute otitis media per child-year during a 2-year period was 1.48±0.08 in the tympanostomy-tube group and 1.56±0.08 in the medical-management group (P=0.66). Because 10% of the children in the tympanostomy-tube group did not undergo tympanostomy-tube placement and 16% of the children in the medical-management group underwent tympanostomy-tube placement at parental request, we conducted a per-protocol analysis, which gave corresponding episode rates of 1.47±0.08 and 1.72±0.11, respectively. Among secondary outcomes in the main analysis, results were mixed. Favoring tympanostomy-tube placement were the time to a first episode of acute otitis media, various episode-related clinical findings, and the percentage of children meeting specified criteria for treatment failure. Favoring medical management was children’s cumulative number of days with otorrhea. Outcomes that did not show substantial differences included the frequency distribution of episodes of acute otitis media, the percentage of episodes considered to be severe, and antimicrobial resistance among respiratory isolates. Trial-related adverse events were limited to those included among the secondary outcomes of the trial.ConclusionsAmong children 6 to 35 months of age with recurrent acute otitis media, the rate of episodes of acute otitis media during a 2-year period was not significantly lower with tympanostomy-tube placement than with medical management. (Funded by the National Institute on Deafness and Other Communication Disorders and others; ClinicalTrials.gov number, NCT02567825.)

Sustained Attention and Working Memory Predict the Number of Days on Health-Related Benefits in the Year Following Occupational Rehabilitation

Purpose The objective of this study was to investigate the association between cognitive and emotional functioning and the number of days on health-related benefits such as sick leave, work assessment allowance and disability pension. We investigated whether cognitive and emotional functioning at the start of rehabilitation and the change from the start to the end of rehabilitation predicted the number of days on health-related benefits in the year after occupational rehabilitation. Methods A sample of 317 individuals (age 19–67 years), mainly diagnosed with a musculoskeletal or mental and behavioural ICD-10 disorder, participated. The sample was stratified depending on the benefit status in the year before rehabilitation. Those receiving health-related benefits for the full year comprised the work assessment allowance and disability pension (WAA) group and those receiving benefits for less than a year comprised the sick leave (SL) group. The participants were administered cognitive and emotional computerised tests and work and health questionnaires at the beginning and end of rehabilitation. The cumulative number of days on health-related benefits during 12 months after rehabilitation was the primary outcome variable and age, gender, educational level, subjective health complaints, anxiety, and depression were controlled for in multiple regression analyses. Results The WAA group (n = 179) was significantly impaired at baseline compared to the SL group (n = 135) in focused attention and executive function, and they also scored worse on work and health related variables. Higher baseline scores and change scores from the start to the end of rehabilitation, for sustained attention, were associated with fewer number of health-related benefit days in the WAA group, while higher baseline scores for working memory were associated with fewer number of health-related benefit days in the SL group. Conclusions New knowledge about attention and memory and return to work in individuals with different benefit status may pave the way for more targeted programme interventions. Rehabilitation programmes could benefit from designing interventions that respectively improve sustain attention and working memory related to working life in individuals on sick leave or work assessment allowance and disability pension.

Feed intake and feeding behavior traits for gestating sows recorded using electronic sow feeders.

Electronic sow feeding (ESF) systems are used to control feed delivery to individual sows that are group-housed. Feeding levels for gestating sows are typically restricted to prevent excessive body weight gain. Any alteration of intake from the allocated feeding curve or unusual feeding behavior could indicate potential health issues. The objective of this study was to use data recorded by ESF to establish and characterize novel feed intake and feeding behavior traits and to estimate their heritabilities. Raw data were available from two farms with in-house manufactured (Farm A) or commercial (Farm B) ESF. The traits derived included feed intake, time spent eating, and rate of feed consumption, averaged across or within specific time periods of gestation. Additional phenotypes included average daily number of feeding events (AFE), along with the cumulative numbers of days where sows spent longer than 30 min in the ESF (ABOVE30), missed their daily intake (MISSF), or consumed below 1 kg of feed (BELOW1). The appetite of sows was represented by averages of score (APPETITE), a binary value for allocation eaten or not (DA_bin), or the standard deviation of the difference between feed intake and allocation (SDA-I). Gilts took longer to eat than sows (15.5 ± 0.13 vs. 14.1 ± 0.11 min/d) despite a lower feed allocation (2.13 ± 0.00 vs. 2.36 ± 0.01 kg/d). The lowest heritability estimates (below 0.10) occurred for feed intake traits, due to the restriction in feed allocation, although heritabilities were slightly higher for Farm B, with restriction in the eating time. The low heritability for AFE (0.05 ± 0.02) may have reflected the lack of recording of nonfeeding visits, but repeatability was moderate (0.26 ± 0.03, Farm A). Time-related traits were moderately to highly heritable and repeatable, demonstrating genetic variation between individuals in their feeding behaviors. Heritabilities for BELOW1 (Farm A: 0.16 ± 0.04 and Farm B: 0.15 ± 0.09) and SDA-I (Farm A: 0.17 ± 0.04 and Farm B: 0.10 ± 0.08) were similar across farms. In contrast, MISSF was moderately heritable in Farm A (0.19 ± 0.04) but lowly heritable in Farm B (0.05 ± 0.07). Heritabilities for DA_bin were dissimilar between farms (Farm A: 0.02 ± 0.02 and Farm B: 0.23 ± 0.10) despite similar incidence. Individual phenotypes constructed from ESF data could be useful for genetic evaluation purposes, but equivalent capabilities to generate phenotypes were not available for both ESF systems.

PCN348 Long-Term Healthcare Resource Utilization and Costs Associated with Patients Treated with Nivolumab for Advanced Non-Small Cell Lung Cancer

In advanced non-small cell lung cancer (aNSCLC), healthcare resource utilization (HCRU) and costs usually increase until end of life. Few studies describe long-term HCRU and costs associated with aNSCLC patients treated with immunotherapy. The objective of this analysis was to describe 3-year HCRU and costs associated with previously treated aNSCLC patients who initiated nivolumab. Based on the National hospitals database (PMSI), we constituted a retrospective cohort of all aNSCLC patients initiating nivolumab in 2015-2016 and followed until Dec 2018. HCRU, described for each year after nivolumab initiation, included hospital visits (i.e. one-day stays, emergency visits, consultations) and hospitalizations (i.e. intensive/reanimation care, palliative care, rehabilitation care, hospitalization at home, other hospitalizations). Trends in HCRU were analyzed with Mann-Kendall test. 10,452 patients initiated nivolumab during the inclusion period. The mean number of hospital visits per patient diminished over the follow-up (p<0.001): 21.1 in the first year (Y1; n=10,452), 19.6 in the second year (Y2; n=4636) and 13.1 the third year (Y3; n=2514). One-day stays represented the highest proportion of hospital visits (66% in Y1, 61% in Y2 and 57% in Y3). Regarding hospitalizations, the mean cumulative number of days per patient decreased from 27.6 in Y1 to 22.0 in Y2 and 13.5 in Y3 (p<0.001). During Y1, palliative care represented 31% of hospitalization days while it constituted 28% in Y2 and 23% in Y3. Hospital visits and hospitalization costs per patient decreased from 16,790€ in Y1 (hospital visits/days of hospitalization: 38%/62%) to 13,405€ in Y2 (41%/59%) and 8524€ in Y3 (41%/59%) (p<0.001). HCRU and costs associated with patients receiving nivolumab tended to decrease over the 3 years. This suggests that care needs and also intensity of care decrease over time for patients benefiting from immunotherapy. Further research on long-term survivors could explore the relationship between HCRU and quality-of-life.

Statistical Analysis versus the M5P Machine Learning Algorithm to Analyze the Yield of Winter Wheat in a Long-Term Fertilizer Experiment

To compare how different analytical methods explain crop yields from a long-term field experiment (LTFE), we analyzed the grain yield of winter wheat (WW) under different fertilizer applications in Müncheberg, Germany. An analysis of variance (ANOVA), linear mixed-effects model (LMM), and MP5 regression tree model were used to evaluate the grain yield response. All the methods identified fertilizer application and environmental factors as the main variables that explained 80% of the variance in grain yields. Mineral nitrogen fertilizer (NF) application was the major factor that influenced the grain yield in all methods. Farmyard manure slightly influenced the grain yield with no NF application in the ANOVA and M5P regression tree. While sources of environmental factors were unmeasured in the ANOVA test, they were quantified in detail in the LMM and M5P model. The LMM and M5P model identified the cumulative number of freezing days in December as the main climate-based determinant of the grain yield variation. Additionally, the temperature in October, the cumulative number of freezing days in February, the yield of the preceding crop, and the total nitrogen in the soil were determinants of the grain yield in both models. Apart from the common determinants that appeared in both models, the LMM additionally showed precipitation in June and the cumulative number of days in July with temperatures above 30 °C, while the M5P model showed soil organic carbon as an influencing factor of the grain yield. The ANOVA results provide only the main factors affecting the WW yield. The LMM had a better predictive performance compared to the M5P, with smaller root mean square and mean absolute errors. However, they were richer regressors than the ANOVA. The M5P model presented an intuitive visualization of important variables and their critical thresholds, and revealed other variables that were not captured by the LMM model. Hence, the use of different methods can strengthen the statement of the analysis, and thus, the co-use of the LMM and M5P model should be considered, especially in large databases involving multiple variables.