Days Of Test Research Articles

P-1616. Treatment Rates of Patients with Toxin Negative, PCR Positive C.difficile After a Change in Reflex Testing Order

Abstract Background On 12/11/23, our academic medical center changed from primarily GDH antigen/toxin A/B combination testing with reflex to C. difficile PCR in discordant samples (Figure 1) to PCR (either direct or from a multiplex gastrointestinal pathogen panel (GIPP)) as initial screening with positive specimens reflexed to antigen/toxin testing (Figure 2). After the algorithm change, we evaluated treatment rates for patients with positive PCR results who tested negative for C. difficile toxin. Methods New guidance for C. difficile infection (CDI) was posted on the Antimicrobial Stewardship website and education was provided to clinicians on the algorithm. Data was collected for inpatients ≥ 19 years old who were toxin negative, but antigen and PCR test positive for C. difficile from 10/1/22-3/31/24. GIPP could be ordered first during the entire period, but only in the first 3 hospital days. Treatment and recurrence rates for patients having a PCR test first were analyzed compared to rates for those with initial antigen/toxin tests. Treatment was counted if initiated within 2 days of test and continued ≥ 5 days, according to proposed NHSN definitions, and included oral vancomycin, fidaxomicin, or metronidazole if vancomycin was contraindicated. Based on estimated treatment rates, a sample size of 177 patients was targeted to detect a change from 80% to 60% treatment. Results Out of 179 discordant CDI results prior to the testing change, treatment occurred in 151 (85.4%) cases. After the change, treatment was prescribed 26 out of 46 (56.5%) times, a 34% reduction (p< 0.01). Baseline characteristics were similar in each group, and 56.9% of tests were ordered in the first 3 days of hospital stay. Overall, when an antigen test was performed first and a positive PCR reported last, treatment occurred in 84 of 91 (92.3%) cases. When a PCR test was performed first and a negative toxin resulted last, treatment was prescribed in 93 of 134 (69.4%) cases (p< 0.01). Treatment was the same in each group (99% vancomycin). Recurrence rates were similar regardless of testing order, 5.4% with antigen first vs. 4.4% with PCR test first. Conclusion Treatment rates for patients with discordant CDI results were significantly lower after the order of testing changed and when a negative toxin result was presented last. Disclosures Trevor C. Van Schooneveld, MD, FSHEA, FIDSA, AN2 Therapeutics: Grant/Research Support|BioMerieux: Grant/Research Support|BioMerieux: Honoraria|Thermo-Fisher: Honoraria

P-1607. Comparison of In-House Versus Reference Laboratory Antifungal Susceptibility Testing on De-Escalation Rates of Echinocandin Therapy for Candidemia

Abstract Background The Mycoses Study Group Education and Research Consortium recommends healthcare facilities who routinely manage invasive fungal infections have access to “timely antifungal susceptibility testing,” and the Infectious Disease Society of America recommends antifungal de-escalation in candidemia within seven days to mitigate excessive drug costs and fungal resistance. In 2020, Ascension Seton hospital network converted from in-house (INH) antifungal susceptibility testing (AFST) to reference laboratory (RFL) testing. Methods This was a multicenter, retrospective cohort study evaluating the stewardship, clinical, and financial impact of RFL use for AFST in patients with candidemia. AFST was performed INH for isolates from May 2017 to Jul 2020 and by RFL for isolates from Aug 2020 to Sep 2023. The primary outcome was rate of antifungal de-escalation from echinocandin to azole therapy by day 7. Secondary outcomes include cost of antifungal treatment, hospital and intensive care unit (ICU) length of stay, days to targeted therapy, turn around time of test (TAT), and all-cause hospital mortality. Inclusion criteria were candidemia diagnosis and empiric echinocandin treatment. Exclusion criteria were diagnoses of candidemia with ocular, meningeal, or cardiac involvement; candidemia due to C. auris; or death before susceptibility resulted. Outcomes were analyzed by Wilcoxon rank sum. Results This study included 85 patients (42 INH and 43 RFL). The most common infectious species were C. albicans (31% INH vs 35% RFL) and N. glabrata (36% INH vs 49% RFL).Rate of de-escalation by day 7 was higher in the INH than RFL group(, 67 vs 35%, p< 0.01) . RFL use significantly increased days to targeted therapy (2 INH vs 6 RFL, p < 0.01), turn around days of test (5 INH vs 12 RFL, p < 0.01), echinocandin days (4 INH vs 9 RFL, p < 0.01), and cost of antifungal treatment ($1145 INH vs $2290 RFL, p < 0.01). There were no differences in additional secondary endpoints. Conclusion Reference laboratory use for AFST was associated with significantly decreased echinocandin de-escalation rate, leading to longer turn around time of test, time to targeted therapy, and cost of antifungal treatment. In-house AFST offered faster susceptibility results and possibly cost savings. Disclosures All Authors: No reported disclosures

P-1583. Can Electronic Clinical Decision Support Systems Decrease Unnecessary Antibiotic use for Asymptomatic Bacteriuria?

Abstract Background Asymptomatic bacteriuria is often treated unnecessarily with antibiotics. Restricting cultures to patients who meet specific urinalysis (UA) parameters has been shown to decrease urine culture rate; however, the impact of these interventions on antibiotic use is not well established. We describe the impact of UA with reflex to culture implementation on urine culture rate and antibiotic use in a large healthcare system. Figure 1 Mean urine culture rate across system pre- and post-intervention. Each point represents the monthly average number of urine cultures per 100 patient-days across the healthcare system. Methods A retrospective cohort study was conducted in an integrated healthcare system in Northeast Ohio from June 2018 to May 2023. We initiated an intervention in June 2020 in which urine cultures were reflexively performed only for UA with ≥10 white blood cells, positive leukocyte esterase, and/or positive nitrate (UA with reflex to culture), excluding special populations. We calculated monthly rates of inpatient or emergency department urine cultures and compared average rates pre- and post-intervention. Additionally, we calculated pre- and post-intervention antibiotic use data for adults hospitalized during the study period for whom urine culture was attempted (urine culture or UA with reflex to culture ordered) to compare days of therapy (DOT) per days hospitalized and days of antibiotic spectrum coverage score (DASC) per DOT within 7 days of urine test order. Table 1 Summary of comparison of antibiotic days of therapy and days of antibiotic spectrum coverage metrics pre- and post-intervention within 7 days of urine test. Abbreviations: DOT, days of therapy; DASC, days of antibiotic spectrum coverage; CI, confidence interval. Results A total of 101,337 urine cultures among 8 hospitals met eligibility criteria during the study period. The mean monthly urine culture rate was 23.4 cultures per 100 patient-days pre-intervention and 15.5 post-intervention (mean difference 7.9, 95% confidence interval [CI] 6.6-9.2), with a large initial decrease followed by increasing rates in 2022 (Figure 1). Among adults with urine cultures, the post-intervention group had 7.5% lower DOT (rate ratio [RR] 0.916; CI 0.908, 0.924) and 5.1% lower DASC (RR 0.955; CI 0.952, 0.957) within 7 days of culture relative to the pre-intervention group (Table 1). Conclusion After implementing urine culture CDS in a large health system, hospitalized adult patients had a lower urine culture rate, and DOT and DASC were lower among those for whom urine culture testing was attempted. Further investigation is needed to determine the sustainability of the effects of CDS alone versus a multifaceted intervention and its impact of CDS on clinically relevant outcomes. Disclosures Elie Saade, MD, MPH, FIDSA, Janssen Global Services: Advisor/Consultant|Janssen Global Services: Advisor/Consultant|Janssen Research and Development: Advisor/Consultant|Janssen Research and Development: Advisor/Consultant Abhishek Deshpande, MD, PhD, AHRQ: Grant/Research Support|Clorox Healthcare: Grant/Research Support Curtis Donskey, MD, Clorox: Grant/Research Support|Pfizer: Grant/Research Support

P-1764. Point Prevalence Study of Antibiotic Appropriateness and Economical Cost in a Tertiary Care Trauma Hospital of Northern India to Tailor Antibiotic Stewardship Interventions

Abstract Background Conducting Point prevalence surveys (PPSs) is challenging, especially in developing countries, in the absence of electronic records, lack of dedicated resources and high patient load. This survey was conducted to provide background data for strengthening antimicrobial stewardship(AMS) practices and estimate the economic cost of antimicrobial resistance per antibiotic consumed in a tertiary care trauma hospital in India. Summary of Quality indicators of antibiotic prescribing (in %) Methods The survey included all inpatients admitted in wards and intensive care units of the hospital (300 beds) during World Antibiotic Awareness Week 2023. Standardised modules were adopted from the Global PPS for collecting data on patient demographics, prescribed antimicrobial agents with dosage, indication(s) and duration of treatment, and microbiolgical results. Further, the cost minimization analysis was carried out to assess the treatment cost and variations in costs arising due to generic or branded prescribing. Results Among the 254 patients admitted, the patients treated with at least one antimicrobial was 88.6% (N=225). The median (IQR) day of hospitalization was 7 (3.75) days. The highest prevalence of antimicrobial use was in the ICU (100%), followed by Emergency medicine (97.5%). The majority of patients received empiric than targeted antimicrobial therapy. Antimicrobial prescription was mostly for surgical prophylaxis (49.04%). Among patients for >7 days on treatment, microbiological culture were sent in 16.7% (5/30) patients. Antibiotic quality indicators such as reason in notes and documentation of review date were comparatively lower (Figure-1). Treatment costs varied significantly with prescriptions of maximum and minimum-priced brands, ranging from 69.81%-1490%. Branded therapy were three times costlier than generic therapy in 36 (52.9%) regimens. Conclusion Poor transition from empiricism to rationalism, continuation of surgical prophylaxis for more than one day and underutilization of microbiological tests were noted. There was large variations in treatment cost of infections depending on regimen chosen. Adherence to local antibiotic policy, optimal dosing and regular audit with positive feedback of antibiotic use to treating physician can be useful approaches to implement the AMS Program in the study centre. Disclosures All Authors: No reported disclosures

P-1777. Low adherence to institutional antibiotic clinical practice guideline in patients diagnosed with Clostridioides difficile infection

Abstract Background Previous antimicrobial therapy is a common risk factor for Clostridioides difficile infections (CDIs). Clinical practice guidelines (CPGs) assist clinicians in prescribing the correct antibiotics for various clinical syndromes to avoid unnecessary or overly broad-spectrum antibiotic use. Retrospective analysis of CDIs may serve as a guide for the high-risk antimicrobials included in CPG development. Methods Patients who tested positive for C. difficile at Brooke Army Medical Center from November 2022 to October 2023 were reviewed. Demographics, C. difficile treatment, antibiotic allergies, antibiotics received in the preceding 90 days prior to a positive test, and indication for antibiotic therapy were recorded. If a treatment indication appeared on the institutional CPG, adherence to the antibiotic recommendation was recorded. Patients who received no antibiotics or only antibiotics as guided by the correct CPG were considered unpreventable. Results During the study period, 128 positive cases were identified. The median patient age was 56.5 years [IQR: 25-75.3] (Table 1). 80% of cases were ultimately treated for infection, with fidaxomicin representing the treatment of choice in 81% of treated patients. In the preceding 3 months prior to a positive test, 67% of patients had at least one day of antibiotic exposure. The median number [IQR] of total antibiotic days within 30, 60, and 90 days of a positive test was 1 [0-7], 3.5 [0-8.75], and 5 [0-9.75] respectively. For 47 (55%) cases, all antibiotic indications within the previous 90 days appeared on the CPG. However, prescribers did not adhere to the CPG (Table 2) in 22 (47%) of these cases. The most common inpatient and outpatient indications not on the CPG were perioperative antibiotics and otitis media, respectively. Overall, only 58 cases (45%) were considered unpreventable. Conclusion In this single center study, retrospective analysis of individual C. difficile cases provided direction for the antimicrobial stewardship team by identifying CPG recommendations that were not followed as well as identifying conditions not on previous CPGs. Tying patient harm from CDIs with inappropriate antimicrobial use builds the local evidence base to prevent future CDIs. Disclosures All Authors: No reported disclosures

Impact of SARS-CoV-2 spike antibody positivity on infection and hospitalisation rates in immunosuppressed populations during the omicron period: the MELODY study.

In the UK, booster COVID-19 vaccinations have been recommended biannually to people considered immune vulnerable. We investigated, at a population level, whether the absence of detectable anti-SARS-CoV-2 spike protein IgG antibody (anti-S Ab) following three or more vaccinations in immunosuppressed individuals was associated with greater risks of infection and severity of infection. In this prospective cohort study using UK national disease registers, we recruited participants with solid organ transplants (SOTs), rare autoimmune rheumatic diseases (RAIRDs), and lymphoid malignancies. All participants were tested for anti-S Ab using a lateral flow immunoassay, completed a questionnaire on sociodemographic and clinical characteristics, and were followed up for 6 months using linked data from the National Health Service in England. SARS-CoV-2 infection was primarily defined using UK Health Security Agency data and supplemented with hospitalisation and therapeutics data, and hospitalisation due to SARS-CoV-2 was defined as an admission within 14 days of a positive test. Between Dec 7, 2021, and June 26, 2022, we recruited 21 575 participants. Anti-S Ab was detected in 6519 (77·0%) of 8466 participants with SOTs, 5594 (85·9%) of 6516 with RAIRDs, and 5227 (79·3%) of 6593 with lymphoid malignancies. COVID-19 infection was recorded in 3907 (18·5%) participants, with 556 requiring a COVID-19-related hospital admission and 17 dying within 28 days of infection. Rates of infection varied by sociodemographic and clinical characteristics but, in adjusted analysis, having detectable anti-S Ab was independently associated with a reduced incidence of infection, with incident rate ratios (IRRs) of 0·69 (95% CI 0·65-0·73) in the SOT cohort, 0·57 (0·49-0·67) in the RAIRD cohort, and 0·62 (0·54-0·71) in the lymphoid malignancy cohort. In adjusted analysis, having detectable anti-S Ab was also associated with a reduced incidence of hospitalisation, with IRRs of 0·40 (0·35-0·46) in the SOT cohort, 0·32 (0·22-0·46) in the RAIRD cohort, and 0·41 (0·29-0·58) in the lymphoid malignancy cohort. All people with immunosuppression require ongoing access to COVID-19 protection strategies. Assessment of anti-S Ab responses, which can be performed at scale, can identify people with immunosuppression who remain most at risk, providing a mechanism to further individualise protection approaches. UK Research and Innovation, Kidney Research UK, Blood Cancer UK, Vasculitis UK, and Cystic Fibrosis Trust.

Degradation Behavior and Mechanical Properties of Porous Biodegradable FeMnC Alloys Produced by Powder Metallurgy for Biomedical Applications

The advent of biodegradable implants represents a landmark orientation in the biomedical field toward a new generation of medical devices, offering improved patient outcomes, and eliminating the need for subsequent surgeries. FeMn alloys are well‐established as promising candidates for such applications. This study analyzes the microstructure, mechanical properties, and degradation behavior of FeMnC alloys produced via pressing and sintering process using water‐atomized FeMnC powder. To investigate the impact of pore size and volume fraction on the mechanical properties and degradation rates, two groups of FeMnC samples were prepared, one compacted at 600 MPa (CP 600) and the other at 700 MPa (CP 700). In addition, pure Fe samples compacted at 600 MPa and prepared using the same methodology were used as a reference. Chemical analysis carried out on both the pre‐alloyed powder and the resulting sintered samples (CP 600 and CP 700) revealed a significant reduction in the amount of Mn, O, and notably C after sintering. The pure Fe group showed the greatest mechanical strength with an average tensile rupture strength of 446 ± 24 MPa. Among the three groups, CP 600 exhibited the highest degradation rate (−0.339 ± 0.057 mmpy) after 14 days of static immersion degradation test in modified Hanks' solution, demonstrating a degradation behavior characterized by mass gain.

Validation of ICD-10 diagnostic coding for influenza in the Danish National Patient Registry.

The accuracy of recorded diagnosis codes for hospital admissions due to influenza in the Danish national registries is uncertain. We evaluated positive predictive value (PPV) and sensitivity of ICD-10 codes for influenza by comparing to the reference standard of influenza test results. Hospital admissions were assessed in the Danish National Patient Registry (DNPR), and influenza test results in the Danish Microbiology Database (MiBa). First, we report the proportion of positive influenza virus tests within seven days of admission among hospital admissions with a discharge influenza ICD-10 code (PPV). Second, we report the proportion with ICD-10 codes for influenza among patients with an admission registered with seven days of a positive influenza virus test (sensitivity). From January 2012 - November 2022 a total of 18,761 admissions were registered with one of the 22 influenza ICD-10 codes in DNPR. Overall, there was a positive influenza test in 16,754 of the admissions (87.9% = overall PPV, 95% CI: 87.4-88.3). The PPV was highest for older patient groups (93.7% in patients >80 years vs. 78.0% in patients < 11 years), and for admissions that occurred in recent years (95.8% in 2022 vs. 52.4% in 2012). Among 33,834 hospitals admissions with a positive influenza test, less than half (n=16,421, 48.5% = sensitivity (95% CI: 48.0 - 49.1%)) were registered with an influenza ICD-10 code. ICD-10 diagnoses codes have relatively high positive predictive value, but the sensitivity is low. Furthermore, the PPV depend on age and calendar year.

Customised 96-ocular TaqMan (iCAM) microarray PCR card for rapid diagnosis of microbial keratitis

AimTo validate the diagnostic performance of a custom 96-micro-organism TaqMan PCR card (iCAM) for microbial keratitis (MK) from a single corneal epithelial sample.MethodsPatients over the age of 18 referred to...

Validation of the Korean version of inflammatory Rasch-built Overall Disability Scale in patients with inflammatory neuropathy.

The Inflammatory Rasch-built Overall Disability Scale (I-RODS) is an effective activity measure for use in inflammatory peripheral neuropathy. The aim of this study was to validate the Korean version of the I-RODS in patients with chronic inflammatory demyelinating polyneuropathy (CIDP), Guillain-Barré syndrome (GBS), anti-myelin-associated glycoprotein (MAG) neuropathy, and autoimmune nodopathy. A total of 120 patients underwent clinical evaluations, which included the I-RODS, Inflammatory Neuropathy Cause and Treatment (INCAT) assessment, and Jamar grip strength (kg) measurement. Follow-up assessments were performed for 83 patients during their regular clinic visits. To estimate the test-retest reliability of the I-RODS, the scale was reapplied to a subset of 16 patients within 2-7 days of the initial test. Overall, reliability, validity, and responsiveness of the I-RODS were evaluated. Internal consistency was good, as indicated by a person separation index of 0.966. The raw and standardized Cronbach's alpha values were both 0.974. The test-retest reliability analyzed using the intraclass correlation coefficient (ICC) was also high (ICC = 0.972). The I-RODS showed a strong correlation with INCAT scores (ρ = -0.81, p < .001) and a moderate correlation with grip strength (ρ = 0.61, p < .001). Furthermore, the sensitivity for detecting clinically meaningful improvement was highest for grip strength (60.4%) followed by I-RODS (52.1%), while for capturing deterioration, it was highest for I-RODS (80.0%). The Korean version of the I-RODS is a reliable and valid tool for measuring disability in patients with inflammatory neuropathy. The I-RODS is useful for both clinical practice and research applications.

Real-world cost-effectiveness of multi-gene panel sequencing to inform therapeutic decisions for advanced non-small cell lung cancer: a population-based study

Multi-gene panel sequencing streamlines treatment selection for advanced non-small cell lung cancer (NSCLC). Implementation continues to be uneven across jurisdictions, partly due to uncertain clinical and economic impacts. In British Columbia (BC), Canada, the public healthcare system reimbursed a multi-gene panel in September 2016. This study determined the population-level cost-effectiveness of publicly reimbursed multi-gene panel sequencing compared to single-gene testing for advanced NSCLC. Our population-based retrospective study design used patient-level linked administrative health databases. We considered adult BC residents with a panel-eligible lung cancer diagnosis between September 2016 and December 2018. Using a machine learning approach, we conducted 1:1 genetic algorithm matching of recipients receiving multi-gene panel sequencing to controls receiving single-gene testing, maximising balance on observed demographic and clinical characteristics. Following matching, we estimated mean three-year survival time and costs (public healthcare payer perspective; 2021 CAD) and calculated the incremental net monetary benefit (INMB) for life-years gained (LYG) at conventional willingness-to-pay thresholds using inverse probability of censoring weighted linear regression and nonparametric bootstrapping. We matched 858 panel-eligible advanced NSCLC patients to controls, achieving balance for the 16 included covariates. Average test turnaround times were 18.6 days for multi-gene panel sequencing and 7.0 days for single-gene testing. After matching, mean incremental costs were $3529 (95% CI:-$4268, $10,942) and mean incremental LYG were 0.08 (95% CI:-0.04, 0.18). Among the 1000 bootstrap samples, 14.5% had lower costs and increased survival and 78.6% had higher costs and increased survival. The INMB was $523 (95% CI:-$6256, $7023) at $50,000/LYG, with a 57.5% probability of being cost-effective, and $4575 (95% CI:-$5468, $14,064) at $100,000/LYG, with an 84.0% probability of being cost-effective. Using population-based real-world data, we found a moderate to high probability that panel-based testing to inform targeted treatment for NSCLC would be cost-effective at higher thresholds. This research was supported by Genome British Columbia/Genome Canada (G05CHS) and the Terry Fox Research Institute.

Evaluation of perforation-mediated modified atmosphere packaging for the commercialization of bulk purple passion fruit under refrigeration.

Modified atmosphere packaging (MAP) is widely used to preserve fresh fruits. In the case of exporting products in bulk formats (2-5kg), perforated MAP can help extend shelf life if appropriately configured to reach suitable gas levels. This study evaluated the configuration of a perforated MAP system for purple passion (Passiflora edulis Sims) fruits based on modeling and simulation of changes in gas levels within the package headspace and experimental data on the respiration and transpiration of the fruits. For this evaluation, perforation-mediated multilayer bags made of polyamide and low-density polyethylene were adjusted to preserve 2kg of purple passion fruits. The number of perforations made in the bags was predefined by performing predictive calculations to reach favorable gas levels in the packaging headspace. Subsequently, storage tests were conducted at the laboratory level (6 and 17±1°C) and then at the pilot level (6±2 and 17±3°C), obtaining steady molar fractions of O2 of 0.122-0.128 and CO2 of 0.098-0.100 and shelf life of 36 days for the fruits packaged at 6°C. Additionally, the accumulated weight loss of the fruits was monitored, obtaining values close to those previously modeled. The pre-configuration of the perforations resulted in suitable O2 and CO2 levels in the MAP, achieving up to 36 days of shelf life at 6°C and 24 days at 17°C. Likewise, moisture permeation through the bags resulted in low condensation with fruit weight losses of 4.8% at 6°C after 55 days in the pilot test. PRACTICAL APPLICATION: This study evaluated using perforated PA/LDPE multilayer bulk bags (2kg) to preserve purple passion fruits. The package was preconfigured (with a predefined number of perforations necessary to achieve favorable levels of O2, CO2, and humidity) and was compared against a commercial factory-made perforated package. By performing predictive calculations to define a suitable number of perforations, it was possible to regulate the respiration and transpiration of the packaged fruit to increase its shelf life under controlled and real conditions. This approach can be extended to any bulk-packaged fruit, and it can help select, design, and develop breathable packages that prevent decay.

Analysis of the therapeutic effort and economic cost of the care provided to a group of hospitalized end-of-life patients

AimThere are social inequalities in access to health care that affect therapeutic effort. The aim of the present study was to determine whether there are differences in expenditure according to days of admission and tests performed by age, sex and population of origin in patients at the end of life. MethodsCross-sectional descriptive study, with review of clinical histories of terminally ill patients admitted to a hospital, recruited on the basis of the administration of transfusions, who underwent numerous tests and interventions during their last admission before death. Sociodemographic and clinical variables were studied, as well as the cost of admission and tests. ResultsThe 140 patients were hospitalized for an average of 17.41 days (SD: 14.323), with an average cost of 8,264.19 euros (SD: 6,799.8788) per stay. They underwent 59 tests, which amounted to €532,209.68. Being male, of advanced age and of rural origin saw an increase in the number of days of admission. Older people and women received more tests. No relationship was found between days of hospitalization and expenditure with sociodemographic and clinical variables. There was a relationship between surgical interventions and sex (p = 0.047); between age and receiving oncological treatments (p < 0), other techniques (p < 0), nuclear medicine tests (p = 0.02) and electrocardiograms (p = 0.052). ConclusionsMany palliative patients die in hospitals receiving numerous tests that increase the number of days of hospitalization and costs. Advanced age determines hospital admissions, but not sex or population of origin.

Impact on healthcare costs of adding telemedicine to a multidisciplinary disease management program for heart failure: a sub-analysis of the iCOR trial

Abstract Background Impact of telemedicine on heart failure outcomes has shown conflicting results. Little is known about the effect of these programs on mid-term healthcare costs. Purpose To evaluate the cost-efficacy of a comprehensive telemonitoring program within the vulnerable post-discharge period after an acute heart failure admission. Methods The insuficiència cardiaca Optimizació Remota (iCOR) trial was a single-centre, randomized, open-label study designed to evaluate the efficacy of the addition of telemonitoring and teleintervention to a specialized multidisciplinary nurse-led heart failure (HF) program. Adult patients with a recent hospital admission for acute HF and an acceptable social support and cognitive ability were recruited. This sub-analysis evaluates the effect of telemedicine on mid-term healthcare costs, including clinical events, drugs and devices, technology purchase and maintenance, outpatient care, days of hospitalization, procedures and complementary tests. t-test via bootstrap estimation is used to compare differences between the telemedicine (TM) and the usual care (UC) groups. Results 81 patients were assigned to the TM group and 97 patients to the UC group. Mean age was 74 years, more than 50% had HF with preserved ejection fraction and 25% were frail. Baseline characteristics were well-balanced between groups. Among the TM subgroup, adherence was very high (&amp;lt; 1% of missed biometric daily transmissions). During 6 months of follow-up, mean total healthcare cost per patient was 7949 euros (€) in the UC cohort and 4383 € in the TM cohort (relative risk reduction [RRR] of 45%; between-group differences 3546 €, 95% confidence interval 627-6464 €, bootstrap achieved significance level 0.022). This result was consistent across several subgroups (age, sex, frailty, left ventricular ejection fraction, educational level) and mainly driven by a 63% RRR in costs of hospitalization (which accounted for two-thirds of the total costs) in the TM cohort. 20 patients required HF admissions in the TM group, compared to 51 patients in the TM group (p &amp;lt; 0.001). This was associated with a 59% RRR in the need for diagnostic procedures. Total number of days of hospitalization per patient decreased from 12.2 in the UC group to 4.2 days in the TM group (p = 0.003), impelled by a reduction in HF and cardiovascular days of hospital stay. On the contrary, ambulatory care costs increase two-fold in the TM group compared to UC group. Nevertheless, these costs only accounted for a 19% of the total costs. Cost of devices needed to implement TM supposed 698 € per patient. Use of TM was associated with a 355 € increase in the cost of ambulatory neurohormonal treatment for HF. Conclusions TM implementation during the vulnerable phase after an acute HF admission was associated to a 45% RR reduction in mean total healthcare cost per patient. This result was driven by an almost two-thirds decrease in costs of hospitalization.UC and TM total healthcare costs

Time-varying deterioration of bamboo mechanical properties

Bamboo is a type of fast-growing and renewable natural resource that is an ideal building material. In this study, the longitudinal tensile, longitudinal compressive, flexural, longitudinal shear, transverse tensile, and transverse compressive stress-strain and strength properties of bamboo with a period of 240 days were conducted to study the time-varying deterioration performance of bamboo. The results showed that the mechanical properties of bamboo decreased gradually with the passage of time. The transverse compressive strength deteriorated the most, and the longitudinal tensile strength deteriorated the least. After 240 days of tests, bamboo CCS decreased by 52.5% and UTS decreased by 25.4%. Formulas to predict deterioration of mechanical properties were put forward and validated. It was found that the nodes of bamboo influenced its mechanical properties. The deterioration degree of the test specimens with nodes was slightly higher than that of the test specimens without nodes. These findings provide evidence about the deterioration mechanism of bamboo and are significant for promoting the development of bamboo architecture.

Eco-friendly and easy-to-prepare three-dimensional network constructed by tannic acid/polypyrrole/sodium alginate via triple action mechanism of Fe3+ for highly-efficient solar evaporation

Solar-driven interfacial evaporation (SIE) represents a promising desalination technology leveraging solar energy and seawater. Nevertheless, the majority of SIE systems face constraints such as high costs, intricate fabrication processes, and limited tolerance to salt. Therein, we designed and developed an eco-friendly, simple, and low-cost way to construct independent and elastic three-dimensional networks using tannic acid (TA), polypyrrole (PPy), and sodium alginate (SA) via the triple action mechanism of Fe3+ for efficient water evaporation (TPS-x). When the mass ratios of PPy and TA are designed as 1:2, 1:1, 2:1, and 3:1, and crosslinked with sodium alginate and FeCl3, four composites (TPS-1, TPS-2, TPS-3, and TPS-4) are obtained, in which the light absorption and evaporation properties of TPS-3 are the optimal, with an evaporation rate up to 2.451 kg m−2 h−1 and a photothermal conversion efficiency up to 84.74 %. Additionally, the TPS-3 evaporator has excellent stability and salt tolerance, maintaining more than 95.5 % of its original evaporation rate after 20 days of cycling tests. Due to its exceptional photothermal evaporation performance, TPS-3 shows potential for practical commercial applications, particularly in the fields of wastewater treatment and desalination.

Burden of disease and cost of illness of infants less than 6 months of age hospitalised with respiratory syncytial virus in Denmark – a 10-year national register-based study

BackgroundRespiratory syncytial virus (RSV) is the most common cause of hospitalisation in infants aged ≤ 6 months in Western countries. Nearly 1,500 infants under six months of age are hospitalised with RSV annually in Denmark. This nationwide study describes the healthcare resource utilisation and costs related to RSV hospitalisation in this vulnerable age group.MethodsRSV cases were identified in the Danish National Patient Register. Infants were included if they at the age of 0–5 months had a (1) respiratory related hospital admission (duration > 12 h), (2) within 10 days of a positive RSV test, (3) between January 2013 and December 2022. Each case was matched with five individuals never diagnosed with RSV on age, sex, region of residence, birth (pre/full term), number of siblings < 7 years old, and parents’ education. An episode of RSV was defined as the seven days prior to hospitalisation to 30 days after initial hospitalisation. Study outcomes included contacts with hospital and primary care, and total healthcare costs defined as the sum cost of hospital care, primary care, and prescription medicine. Cost and contacts attributable to RSV was calculated in a diff-in-diff framework, as the difference between case and reference group.ResultsThe study population comprised of 8,428 RSV cases and 41,725 reference individuals. Cases generated 1.58 (p < 0.001) attributable inpatient contacts, 0.84 (p < 0.001) outpatient contacts, and 1.19 (p < 0.001) primary care contacts during their RSV episode. An additional 0.6 (p < 0.001) inpatient, 1.08 (p < 0.001) outpatient and 2.42 (p < 0.001) primary care contacts were attributed to RSV in the year following the RSV episode. Total cost of an RSV episode was EUR 2,997 (p < 0.001) with an additional EUR 1,428 (p < 0.001) in the following year.ConclusionRSV hospitalisations of infants are associated with substantial healthcare utilisation and costs. The same pattern was observed in the year following the RSV episode. If the new RSV prevention options are introduced nationwide, the overall burden of RSV is expected to be substantially reduced in the future.

The time toxicity efficacy-effectiveness gap: A population-based study of stage III/IV non-small cell lung cancer (NSCLC) in Ontario, Canada.

133 Background: While patients enrolled in clinical trials tend to have superior cancer-specific outcomes relative to those in routine practice (the ‘’efficacy-effectiveness gap’’), it is unknown if this gap extends to time toxicity. While trial protocols can impose additional contact days, trial participants also tend to be healthier, perhaps needing fewer contact days. We sought to evaluate the time toxicity efficacy-effectiveness gap among patients with stage III/IV NSCLC. Methods: We created a population-based, retrospective cohort with health administrative data covering the population of Ontario, Canada (15.5 million), of adults aged ≥20 years diagnosed with stage III/IV NSCLC in 2014-2017 and died in 2014-2019, receiving palliative systemic anti-cancer drug(s) as part of a trial. We matched patients 1:1 to those who received the same drug(s) in the real world (post-approval) in the same line of treatment, and received the same total lines of therapy. We calculated contact days (days with healthcare contact outside the home) from diagnosis to death and measured overall survival. We plotted, normalized, and fitted with cubic splines the weekly percentage of contact days to obtain trajectories over the disease course. Results: We identified and matched 55 trial participants to 55 patients in routine practice. Trial participants were younger (median age, 62 vs 66 years), had fewer co-morbidities (hypertension, 35% vs 53%), and more often had de novo metastatic disease (82% vs 67%). Median lines of therapy were 2. Systemic therapy regimens most commonly included immunotherapy (n=41, 75%). Trial participants initiated systemic therapy sooner than in routine practice (median 2.0 vs 2.4 months). Trial participants had a longer overall survival (median 13.8 vs 11.6 months) and a similar number of contact days (median 79 vs 78 days). The percentage of contact days was lower in trial participants due to longer survival (median 19% vs 22%). Trial participants had similar acute/assisted institutional care contact days (median 19 vs 18 days), but more days with laboratory tests (median 23 vs 17 days), systemic therapy (median 9 vs 6 days), and radiotherapy visits (median 15 vs 11 days). Normalized trajectories for both cohorts followed a ‘’U-shape’’; the difference between the maximal peak and trough was smaller in trial participants. Conclusions: We describe a novel efficacy-effectiveness gap in time toxicity, in addition to the previously established efficacy-effectiveness gap in overall survival. Encouragingly, trial participants did not experience delays in treatment, and initiated treatments sooner than in routine practice. Among trial participants, the higher number of contact days for tests, and the shallower U-shaped curve (indicating frequent visits even when relatively well) indicate potential opportunities to decrease trial-related time toxicity.

Inborn errors of immunity are associated with increased COVID-19–related hospitalization and intensive care compared to the general population

BackgroundIt is thought that patients with inborn errors of immunity (IEI) are more susceptible to severe Covid-19 than the general population, but a quantification of this potential risk is largely missing. ObjectiveTo assess the impact of Covid-19 on patients with IEI. MethodsA nationwide cohort study was performed to estimate the relative risk (RR) for hospitalization, intensive care, and death within 30 days after a positive SARS-CoV-2 test in an IEI population (n=2392) compared to the general population (n=8,270,705) using data from Swedish national registries. Three time-periods were studied: Pre-vaccination, Alpha/Delta, and Omicron. Adjustment was made for demographics, income, comorbidities, and vaccination status. ResultsDuring the Pre-vaccination period 25.2% of the IEI population were hospitalized, compared to 17.5% and 5.2% during the Alpha/Delta and Omicron periods, respectively. For the three time periods the adjusted RR for hospitalization in the IEI population compared to the general population was 3.1 [95% CI 2.1–4.2], 3.5 [2.4–4.8], and 4.3 [2.5–6.7], respectively. The adjusted RR for intensive care after Covid-19 were 5.6 [2.6–10.8], 4.7 [1.7–10.1], and 4.7 [1.7–10.1] for the three periods. Five patients (0.6%) in the IEI population died within 30 days of a positive PCR test compared to 18,773 (0.2%) in the general population during the three study periods. ConclusionPatients with IEI had 3-4 times higher risk for hospitalization and 5 times higher risk for intensive care during Covid-19, compared to the general population.

Anti-seepage performance and oxygen barrier performance of the three-layered landfill cover system comprising neutralized slag under extreme climate conditions

For acidic industrial solid wastes, an effective cover system is needed to reduce the rainwater infiltration and oxygen intrusion, thus reducing the generation of acid mine drainage (AMD) from wastes. A three-layered cover using low-permeability neutralized slag (abbreviated as TCNS) at the bottom of the traditional capillary barrier cover is proposed, in line with the novel concept of “waste protecting waste”. This study investigates the anti-seepage performance and oxygen barrier performance of TCNS under extreme climate conditions, through laboratory column test and numerical simulations. The results show that the water content of the neutralized slag (NS) layer remained stable (i.e., changed by less than 0.02) under either extremely wet condition or extremely dry condition. Under extremely wet condition (i.e., heavy rainfall corresponding to a 50-year return period), no water percolation was observed at the cover bottom; under extremely dry conditions, oxygen diffusion was greatly impeded, e.g., after 208 days of column test, the SO42− concentration in the AMD of the exposed (i.e., uncovered) waste rock was 4.6 times higher than that of the waste rock covered by TCNS. Numerical simulations considering two realistic climate conditions (i.e., humid and arid) showed that TCNS were effective in controlling water percolation and oxygen intrusion. The saturated permeability coefficient (ks) and initial saturation degree (Se) of the NS layer have significant effects on the performance of TCNS, i.e., decreasing ks or increasing Se can effectively reduce the water percolation and oxygen flux. In sum, TCNS is an effective barrier for controlling water percolation and oxygen intrusion, even in extreme climate conditions. Consequently, it can effectively minimize AMD leakage and thus reduce geological disasters such as groundwater contamination.