Working Day Research Articles

Telehealth visit type and patient-reported outcomes among patients with cancer

BackgroundRelaxed licensing restrictions on telehealth use during the COVID-19 pandemic allowed broad use irrespective of visit type. As these telehealth waivers expire, optimal uses of telehealth must be assessed to inform policy and clinical care. We evaluated patient experience associated with telehealth and in-person new or established visits. MethodsPatients seen in-person and via telehealth for urologic cancer care from August 2019 to June 2022 received a survey on satisfaction with care, perceptions of communication during their visit, travel time, travel costs, and days of work missed. We assessed survey responses with descriptive statistics. ResultsSurveys were completed for 1,031 patient visits (N = 494 new visits, N = 537 established visits). Satisfaction rates were high for all visit modalities among new and established patients (mean score range 59.9–60.7 [maximum 63], P > 0.05). Patient-rated quality of the encounter did not differ by visit type and modality (P > 0.05, for nearly all comparisons). New in-person patient visits were associated with significantly higher travel costs (mean $496.10, SD $1021) compared with new telehealth visits (mean $26.60, SD $141; P < 0.001); 27% of new in-person patients required plane travel and 41% required a hotel stay (P < 0.001 vs. 0.8% and 3.2% of new telehealth patients, respectively). ConclusionsSatisfaction outcomes among patients with urologic cancer receiving new patient telehealth care equaled those of new patients cared for in-person while costs were significantly lower. Offering telehealth exemption beyond COVID-19 licensing waivers to include new patient visits would allow for ongoing delivery of high-quality urologic cancer care irrespective of geographic location.

Critical Station Identification of Metro Networks Based on the Integrated Topological-Functional Algorithm: A Case Study of Chengdu

Abstract As a key mode of transportation, urban metro networks have significantly enhanced urban traffic environments and travel efficiency, making the identification of critical stations within these networks increasingly essential. This study presents a novel Integrated Topological-Functional (ITF) algorithm for identifying critical nodes, combining topological metrics such as K-shell decomposition, node information entropy, and neighbor overlapping interaction with the functional attributes of passenger flow operations, while also considering the coupling effects between metro and bus networks. Using the Chengdu metro network as a case study, the effectiveness of the algorithm is validated under different conditions. The results indicate significant differences in passenger flow patterns between working and non-working days, leading to varying sets of critical nodes across these scenarios. Moreover, the ITF algorithm demonstrates a marked improvement in the accuracy of critical node identification compared to existing methods. This conclusion is supported by the analysis of changes in overall network structure and relative global operational efficiency following targeted attacks on the identified critical nodes. The findings provide valuable insights for urban transportation planning, offering theoretical and practical guidance for improving metro network safety and resilience.

Chronotype, temporal patterns of eating and diet composition on work and work-free days

ABSTRACT Temporal patterns of eating and diet composition are influenced by factors including circadian preference (chronotype) and work schedule, yet their combined influence is unknown. We investigated relationships between chronotype, temporal eating patterns (duration of eating window (DEW), time of first (FEO) and last (LEO) eating occasions), and diet composition on workdays (WD) and work-free days (FD). Non-shift workers (n = 39) completed the Chrononutrition Questionnaire (CNQ) (age: 38.8 ± 17.2 years, BMI: 24.8 ± 4.78 kg/m2, 82% female) that captures chronotype and temporal eating patterns, and returned work diaries (work schedule) and 7-day food diaries (diet composition) after 2 weeks. Twenty-nine participants provided dietary data for at least two work and work-free days. Later chronotype was associated with later FEO on FD (rs = 0.45, p = 0.004), later LEO on FD (rs = 0.60, p < 0.001) and WD (rs = 0.61, p < 0.001), and longer DEW on WD (rs = 0.37, p = 0.024). Relationships between chronotype and diet composition were small. Later FEO was associated with higher % energy from fat (rs = 0.39, p = 0.043) and lower fibre intake (rs = −0.69, p < 0.001) on WD. Later chronotypes had shorter and later eating windows on FD than WD. Our findings suggest that relationships between chronotype, temporal eating patterns, and diet composition differ by day type. Further investigation may inform dietary strategies that are day-specific.

POLÍTICA DE VALORIZAÇÃO DOCENTE NAS REDES MUNICIPAIS DE EDUCAÇÃO DE CAMETÁ E CASTANHAL: AVANÇOS QUE INTERCRUZAM OS CRITÉRIOS DE PROGRESSÃO POR INTERSTÍCIOS E TITULAÇÃO E AVALIAÇÃO DE DESEMPENHO

The teacher appreciation policy in the municipal education networks of Cametá and Castanhal: “Advances that intersect the criteria of progression through interstices and titling and performance evaluation”, meets the requirement of TCC Course Completion Work, in pedagogy by the University Federal District of Pará. The objective of the research was to analyze the Teaching Position, Career and Remuneration Plans (PCCR’s) of the aforementioned municipalities, in particular the advances that intertwine the teaching valorization policy for functional progression by title, by interstices and by performance evaluation. Methodologically, the production is based on a qualitative approach, using the technique of documentary analysis and statements from the OBEDUC research report also applied to the category of teachers in education networks and the class entity that represents public education teachers in Pará – SINTEPP/PA. The research results showed that in terms of teaching appreciation, the category’s struggle had significant representation in the current Statutes and Career Plans – PCCRs. The salary evolution, the working day that includes active hours and career progression by title and length of service is due to the organization of the category that promoted the demand for the creation of the PSPN Law with repercussions for the municipalities of Cametá and Castanhal , whose dimensions intersect sometimes in frequency and sometimes in continuing teacher training actions. Performance evaluation is foreseen in the PCCRs of Castanhal and Cametá, however in the latter during the management of former mayor José Waldoli F.Valente this evaluation would be partially in force, due to lack of technical team. The progression through interstices presents class scales that differ between municipalities in terms of time interval and percentages, as well as the percentages of progression by degree, in particular, for master’s and doctorate degrees. It is necessary to rethink the valorization policy, especially in the performance evaluation process, to play a role in improving pedagogical actions and not just through productivist logic.

Microwave Energy for Managing Hidradenitis Suppurativa

Title: Microwave energy for managing Hidradenitis Suppurativa Nicole Bielecki PA-C and Aaron Hoover MD Front Range Dermatology, Greeley, CO 80634 Introduction: Treating hidradenitis suppurativa (HS) is challenging due to its chronic, recurring nature and resistance to conventional therapies like antibiotics, anti-inflammatories, and surgery. Even with new biological treatments, there are challenges with injection site reactions. The associated pain, drainage, malodor, and scarring also significantly impact patients' mental well-being, underscoring the need for novel treatments. Four cases presented here suggest that microwave energy (ME) therapy can reduce pain, erythema and inflammation in HS lesions and even assist to resolve moderate and smaller lesions. Precise and brief surface-based applications of microwave energy to HS lesions from an FDA-cleared microwave device intended for the coagulation of soft tissue were used to generate localized hyperthermic conditions in HS and pre-HS lesions. The rapid heating of the tissues led to subsequent clearance of moderate and small HS lesions. This was accompanied with a reduction in inflammation, draining and pain associated with these HS cases. While the outcomes are promising, the exact mechanism of action needs further investigation. These cases strongly support further research and demonstrate that ME holds promise as a novel, non-invasive treatment modality for the management of HS. Procedure: A total of 25 HS lesions from five patients were treated with ME energy. Five repetitive 2-second pulses of 3 to 4W of ME operating at 8GHz were applied to the full area of these lesions. Three to four treatment sessions were given ranging from 7 to 14 days apart. Two patients received ME as a monotherapy, whereas the others began regimens of isotretinoin, adalimumab, or secukinumab at the same time as the first ME treatment. Results: These five patient cases demonstrate how ME treatments can lead to a rapid reduction in reported pain and erythema as well as clinical-assessed clearance of several early and moderate state HS lesions. Two of these patients only received ME as a monotherapy. However, based on clinical experience, even patients typically on medications will not typically show improvements within 7-14 days, suggesting that ME was having a rapid impact to manage pain and inflammation associated with HS lesions and in some cases assisting to resolve these lesions entirely. Conclusions: These cases report the first step in clinical feasibility and safety of microwave energy and shows promise as a novel modality for the management of HS. Although still in the early days of feasibility work, this non-invasive, fast, well-tolerated and simple treatment of microwave energy shows promise as a novel modality for the management of HS. Financial support: This work was supported by Emblation Ltd.

Emergency Management in Japan: Human Decision‐Making Strategy Analysis During Large‐Scale Earthquake

ABSTRACTIn the context of unexpected disasters, comprehending individual decision‐making strategy is essential for governmental policy formulation and evacuation planning. The main challenges stem from the absence of large‐scale mobility data and the complex influences of multiple factors on personal strategies. To address this, this study focuses on the 2011 Tohoku earthquake in Japan as a case, which struck at 14:46 on March 11, a typical working day. Decision‐making strategies regarding how people return home from their workplaces have emerged as a primary concern. Therefore, we construct a large human mobility database for the Greater Tokyo area, and develop an empirical prediction for decision‐making strategies following earthquakes with the consideration of multiple factors. Except for users' location‐based information, we extract the grid‐based stay areas from historical stay records (normal days before disasters) and discover the functions of these areas combined with points of interest located within them. Experimental results indicate the effectiveness of our proposed framework in strategy prediction. Besides, we conduct an explainable feature importance analysis of key factors, which also provides insights for understanding human decisions during disasters.

Long work hours and long commutes in the Greater Accra region of Ghana: Time Poverty and Gender

ABSTRACT Previous research suggests that women in Sub-Saharan African and other low- and middle-income countries are more time-poor than men. There is also contrary evidence that highlights differences in women's employment rates and access to basic infrastructure. This study examines gender differences in the length of the working day and time poverty in Ghana's Greater Accra Region. The analysis uses a unique primary dataset that includes time spent commuting to and from work and time in paid and unpaid work. Time spent commuting is salient in the Greater Accra Region; commute times can be long and public transport, mainly by trotro, is often uncomfortable. The analysis shows that, when time commuting and in household work are included, women's working days are longer and they are more time-poor than men. Women's greater reliance on trotros for commuting and higher rates of small scale self-employment also contribute to their longer working days. HIGHLIGHTS Time poverty limits time for leisure, sleep, and personal care, impacting life quality. In the Greater Accra Region, working days are long, averaging over twelve hours and commuting times add on average two hours to the working day. Women’s working days are 0.8 h longer, and they are more likely to be time poor. Women's time poverty reflects longer hours in unpaid household work. Self-employed women with no employees are among the most time poor.

MODVORTEx: computer vision-driven automation for magnetic domain wall velocity analysis

Abstract This paper presents Magneto Optic Domain Velocity Observation and Real-Time Extraction (MODVORTEx), a comprehensive software solution for automating domain wall (DW) velocity measurements in magnetic materials using magneto-optic Kerr effect microscopy. Building upon our previous work on bubble domain structures, we introduce a versatile graphical user interface (GUI) that accommodates arbitrary domain shapes and employs advanced computer vision techniques. The software provides different methods for DW detection and velocity calculation, catering to various domain structures of arbitrary shape. Our approach significantly reduces the time and effort required for data extraction, transforming a process that previously took days of manual work into a task completable within minutes. We provide the details of the algorithmic implementation which is organized into pre-processing, DW detection, displacement measurement, and velocity extraction. This tool is applicable to a wide range of scenarios, including bubble domain dynamics, Dzyaloshinskii–Moriya interaction studies in perpendicular magnetic anisotropy systems, current-driven DW motion in patterned strips etc. By providing both GUI and Application Programing Interface, our software offers flexibility for integration into existing measurement systems and adaptability for specific research needs. This automation promises to accelerate research in spintronics and magnetic materials, enabling more comprehensive and accurate studies of DW dynamics.

Open versus minimally invasive hepatic and pancreatic surgery: 1-year costs, healthcare utilization and days of work lost

IntroductionUtilization of minimally invasive surgery (MIS) has become increasingly popular due to its potential benefits such as earlier recovery and reduced morbidity. We sought to characterize differences in 1-year healthcare costs and missed workdays among patients undergoing MIS and open surgery for a hepatic or pancreatic indication. MethodsData on patients who underwent hepatic and pancreatic resection were obtained from the IBM Marketscan database. Generalized linear models were utilized to compare healthcare costs and missed workdays among patients undergoing MIS versus open surgery. ResultsAmong 8705 patients, 85.0 % (n = 7399) and 15.0 % (n = 1306) patients underwent an open or MIS HP procedure, respectively. In the unmatched cohort, patients who underwent MIS were more likely to be female (62.7 % vs. 54.6 %) and were less likely to have a Charlson Comorbidity Index score >2 (34.5 % vs. 49.6 %) (both p < 0.05). After entropy balancing, multivariable analysis revealed that MIS was associated with lower 1-year post discharge expenditures (mean difference -$9,739, 95%CI-$12,893, -$6585) and fewer missed workdays at 1-year post-discharge (IRR 0.84, 95%CI 0.81–0.87) (all p < 0.001). DiscussionAt index hospitalization and 1-year post-discharge, an HP MIS approach was associated with lower healthcare expenditures versus open surgery for hepatic and pancreatic resection, as well as fewer missed workdays.

P44 An acutely unwell and rare presentation of systemic lupus erythematosus; a case report

Abstract Introduction Systemic lupus erythematosus (SLE) is a systemic autoimmune disease with multisystem involvement. The condition has varying clinical presentations from mild mucocutaneous manifestations to severe multiorgan and central nervous system involvement. It is challenging to diagnose someone with SLE during acute admission. Apart from infection and malignancies, autoimmune and connective tissue diseases should always be one of our differentials in an acutely unwell patient with multisystem involvement. This case demonstrates how unwell and rare a patient with SLE can present. We also acknowledge the need to further understand and raise awareness of this uncommon condition. Case description A 48 year old Thai lady with no known medical illness presented with 2-3 weeks history of viral like illness. On admission, she was tachycardic, hypotensive and hypoxic. Clinical examination revealed bi-basal crepitations and elevated JVP. Her ECG showed sinus tachycardia. Admission bloods showed anemia, raised white cell count, lymphopenia, thrombocytopenia, raised inflammatory markers and acute kidney injury (AKI). CT scan revealed evidence of pericardial effusion with small free fluid in abdomen and pelvis. ECHO showed large pericardial effusion and pericardiocentesis was performed which drained purulent fluid. Blood culture was positive for E. Coli. 3rd Day blood tests were strongly positive for CTD screening. She was reviewed by the rheumatology team and was diagnosed as acute presentation of SLE causing serositis having fulfilled the SLICC criteria with E. Coli bacteremia. SLE DAI – 2K score was 11. She reported history of Raynaud’s since moving to UK, hair loss and two miscarriages in the past. She denied history of oral ulcers, facial rash or significant joint involvement. Renal team advised that AKI was due to infection rather than lupus. She was commenced on high dose oral prednisolone (40 mg/day) and antibiotics. Her condition responded to steroids and subsequently was commenced on mycophenolate as outpatient. Discussion SLE is an autoimmune disease that affects multiple organ systems. Symptoms and signs can vary although majority of patients present with cutaneous manifestation. Most of the clinical manifestations of the disease are due to abnormal inflammatory response. Patients with SLE are usually diagnosed at outpatient settings although they can present acutely unwell as seen in this patient. Serositis refers to inflammation of serous tissue which includes pleura, pericardium and peritoneum. It is considerably a rare condition which is only seen in only around 10% of patients with SLE. Patients can present with shortness of breath, abdominal pain, diarrhoea, fatigue chest pain and even cardiac tamponade. Due to the heterogeneity of SLE presentations, it is challenging for clinicians to diagnose and manage the symptoms. Besides infection and malignancies, it is always important to consider connective tissue disease as one of the differentials in an acutely unwell patient presenting with multisystem involvement. SLICC criteria can be used as a diagnosing tool for SLE which includes clinical and immunological criteria. SLEDAI-2K score can be used to assess disease activity. Her biochemical parameters as well as clinical symptoms drastically improved following steroid initiation. Early recognition and treatment initiation can improve mortality and morbidity significantly. Despite how unwell she was during admission; she improved quickly and was discharged relatively early. Her condition continues to improve on DMARDs, and she is on regular clinic follow up. Key learning points • A good clinical history and examination is essential and aids reaching a diagnosis. As reflected in this case, our patient was a female at childbearing age, south Asian (non-Caucasian ethnicity) who presented with multisystem involvement. Her initial finding of serositis, acute kidney injury, anemia, raised ESR and E. coli bacteremia were not fitting with a typical sepsis picture. There should be strong grounds for considering SLE during such clinical presentations. Suspecting SLE in an acute setting is really challenging due to various reasons, like wide symptomology of SLE, minimal exposure of SLE to physicians and their tendency of leaning towards other common conditions, like sepsis. As SLE is mostly diagnosed as outpatient, inpatient presentations are rare. Furthermore, blood results for connective tissue disease which is a major criteria for diagnosis, can take between 3 to 5 working days to be reported. However, early and appropriate consideration of autoimmune conditions as differentials of an acutely ill patient with multisystem involvement can expedite the process of diagnosis, involvement of related specialty and commencement of appropriate treatment. This approach will benefit patients producing favourable outcomes and minimal hospital stay.

Finding Joy as a Manager - Even on Bad Days

This article explores strategies for cultivating joy as a manager, even on challenging work days. Through a review of positive psychology and resilience research, the brief establishes why joy matters significantly for managerial performance, decision-making, coping abilities, and growth over time. Key studies linking joy to upward spirals in well-being, higher cognitive functioning, and resilience are referenced. Practical joy-boosting strategies drawn from evidence are then presented, such as expressing gratitude, fostering positive relationships, celebrating wins, and taking brief renewal breaks. Real-world industry examples showcase how managers in retail, higher education, and non-profits have applied these strategies when facing stresses. The article argues managers should recognize cultivating joy as a strategic competency to maximize their own and their teams' potential over the long run. Simple practices can help tap into inner reservoirs of positive emotion and broaden mindsets even amid difficulties.

Impacto asistencial de la electroencefalografía realizada durante la guardia de Neurofisiología Clínica en un hospital de tercer nivel

IntroductionThe electroencephalogram (EEG) is a useful tool in the diagnosis of pathologies such as non-convulsive status epilepticus (NCSE) or brain death (BD), cardiac arrest (CA), and status epilepticus (SE) treatment monitoring. In addition, it provides irreplaceable information depending on the time it is performed, as is the case with the diagnosis of epilepsy after a first epileptic seizure (ES) or to differentiate these from non-epileptic paroxysmal events (NEPE). Its usefulness is maintained outside the usual working day, but it is not available in many centers. Subjects and methodsRetrospective observational study based on the clinical history of 86 patients who underwent an on-call EEG (ocEEG) at our hospital during 2020. ResultsOne hundred two records requested by Intensive Care (41.1%), Neurology (37.3%), Pediatrics (17.6%) or other services (4%) were made. Suspected NCSE represented 56.7%, followed by treatment monitoring in EE (21.6%). The ME accounted for only 6.9% of the total. The ocEEG avoided potential iatrogenesis in a 56.3% of cases with therapeutic implications, allowed to treat 27.58% of patients who would have remained without treatment until the conventional EEG. An increase in the level of care was required in only 22.2% of all cases. The ocEEG was anticipated a mean of 31.6h to the next conventional EEG that would have been available. ConclusionsThe availability of ocEEG is beneficial in terms of diagnosis, therapy, and hospital management, advancing decision-making and avoiding iatrogenesis. Its availability should become widespread.

End-To-End Automated Intact Protein Mass Spectrometry for High-Throughput Screening and Characterization of Bispecific and Multispecific Antibodies.

Bispecific antibodies (bsAbs) and multispecific antibodies (msAbs) represent a promising frontier in therapeutic antibody development, offering unique capabilities not achievable with traditional monoclonal antibodies. Despite their potential, significant challenges remain due to their increased molecular complexity. One prominent challenge is the correct assembly of light and heavy chains, as improper pairing leads to mispaired or incompletely assembled species that lack therapeutic efficacy and possess undesired properties, impairing the developability, manufacturability, and safety. There is a critical need for rapid, sensitive analytical tools to monitor and control these undesired species and ensure the quality assessment of bsAbs and msAbs. To address this need, we present a novel high-throughput, format-agnostic intact mass workflow that significantly enhances the efficiency of detecting and quantifying biotherapeutic products and related impurities. This workflow integrates automated sample preparation, novel high-resolution rapid mass detection powered by SampleStream-MS, and an advanced data analysis pipeline. It offers increased throughput and data quality while substantially reducing analysis turnover time and labor. This was demonstrated in a pilot program where ∼800 multispecific antibodies were processed in 10 working days. The article details the evaluation and validation of our method, demonstrating its repeatability and intermediate precision in terms of measurement accuracy and relative quantification of various product-related species. We underscore the transformative potential of this end-to-end high-throughput workflow in expediting bispecific and multispecific antibody discovery, optimizing production processes, and ensuring high-quality development and manufacturing for therapeutic antibodies.

Improving truck service performance in transporting rock aggregate using Genetic Ant Colony Algorithm

Inter-island shipment requests for rock aggregate products are served through the terminal for their own needs (TFON). The high demand for rock aggregate products causes many ships to queue up to be loaded. However, this condition is not comparable to the availability of dump trucks used to serve loading and unloading activities. This study aims to improve the performance of dump truck service in transporting rock aggregate so that the number of dump truck vehicles and optimal loading and unloading service times from the stockpile to ship at TFON are obtained. The research location was carried out at active rock mining companies in the Central Sulawesi region. The data collection method is carried out using field surveys (observations) using a time recording device by recording the process of transporting rock aggregates from the stockpile location to the ship in TFON and collecting secondary data on the demand for rock aggregates to be transported. The analysis method uses the hybrid Genetic Ant Colony Algorithm (ACO-GA) method namely a combination method between the Ant Colony Optimization algorithm and the Genetic Algorithm which aims to maximize the optimal number of trucks used in the transportation process and minimize the time in the loading and unloading process. The results showed that there had been an increase in service performance of the dump truck used in transporting rock aggregate with the longest distance of 2.3 km with a total of 5 dump trucks. The number of dump trucks of 5 units was selected because it falls within the fitness value criteria which is closest to the optimum value or equal to the value of the resources owned. Meanwhile, the optimal loading and unloading process time is in the range of 1.81–3.34 working days

Effects of Sedentary Behavior Reduction on Blood Pressure in Desk Workers: Results From the RESET-BP Randomized Clinical Trial.

Sedentary behavior (SB) is observationally associated with cardiovascular disease risk. However, randomized clinical trials testing causation are limited. We hypothesized that reducing SB would decrease blood pressure (BP) and pulse wave velocity (PWV) in sedentary adults. This parallel-arm, 3-month randomized clinical trial recruited desk workers, age 18 to 65 years, with systolic BP 120 to 159 or diastolic BP (DBP) 80 to 99 mm Hg, off antihypertensive medications, and reporting <150 min/wk of moderate to vigorous intensity physical activity. Participants were randomized to a SB reduction intervention or a no-contact control group. The intervention sought to replace 2 to 4 h/d of SB with standing and stepping through coaching, a wrist-worn activity prompter, and a sit-stand desk. SB and physical activity were measured with a thigh-worn accelerometer and quantified during all waking hours and separately during work and nonwork times. Clinic-based resting systolic BP (primary outcome) and DBP, 24-hour ambulatory BP, and PWV were assessed by blinded technicians at baseline and 3 months. Participants (n=271) had a mean age of 45 years and systolic BP/DBP 129/83 mm Hg. Compared with controls, intervention participants reduced SB (-1.15±0.17 h/d), increased standing (0.94±0.14 h/d), and increased stepping (5.4±2.4 min/d; all P<0.05). SB and activity changes mainly occurred during work time and were below the goal. The intervention did not reduce BP or PWV in the intervention group compared with controls. Between-group differences in resting systolic BP and DBP changes were -0.22±0.90 (P=0.808) and 0.13±0.61 mm Hg (P=0.827), respectively. The findings were similarly null for ambulatory BP and PWV. Decreases in work-time SB were associated with favorable reductions in resting DBP (r=0.15, P=0.017). Contrary to our hypotheses, reductions in work-time SB (r=-0.19, P=0.006) and increases in work-time standing (r=0.17, P=0.011) were associated with unfavorable increases in carotid-femoral PWV. As expected, increases in nonwork-time standing were favorably associated with carotid-femoral PWV (r=-0.14, P=0.038). A 3-month intervention that decreased SB and increased standing by ≈1 hour during the work day was not effective for reducing BP. Future directions include examining effects of interventions reducing SB through activity other than work-time standing and clarifying association between standing and PWV in opposite directions for work and nonwork time. URL: https://www.clinicaltrials.gov; Unique identifier: NCT03307343.

Eating jetlag and risk of cardiovascular disease: prospective study of the NutriNet-Santé cohort

Abstract Background Social jetlag corresponds to the misalignment between biological circadian rhythms and the social rhythm imposed by society, resulting in discrepant activity/sleep schedules during work and free days. It has been associated with worsened biological parameters such as BMI or glycemic control. Eating jetlag is a related yet emerging concept defined as the difference of meal timing between free and work days. However, it has been little explored. This study aims to evaluate the association between eating jetlag and the risk of cardiovascular disease (CVD). Methods Dietary, anthropometric, socio-demographic and health data of 104,837 participants (79% women, mean age=42.7 years (14.6 SD)) were collected from the NutriNet-Santé cohort. Eating jetlag was calculated using time of first and last meals on weekdays and weekends, from repeated 24 dietary records, averaged during the 2 first years. It was assessed as a continuous variable or as 3 categories: ‘Advance’, ‘Maintenance’, ‘Delay’, compared to work days. CVD was self-reported and validated against medical records. The associations between eating jetlag and CVD risk were assessed through adjusted Cox models. Results During a median follow-up time of 8.1 years, 2,368 CVD cases were diagnosed. Eating jetlag showed a U-shaped association with CVD risk (HR Advance vs. Maintenance=1.05(95% CI: 0.87-1.26); HR Delay vs. Maintenance=1.08(0.96-1.21)). When the absolute value of eating jetlag was considered, there was a linear association with CVD risk (HR per 1-hour increase=1.05(1.00-1.12)). These linear trends were confirmed in categorial models (Low: ≤1h; Moderate: 1h&amp;lt; to ≤ 2h; High: &amp;gt;2h): HR Moderate vs. Low=1.05(0.94-1.18), and HR High vs. Low=1.13(0.94-1.37); however, statistical significance was not reached. Conclusions Our results suggest a potential role for meal timing regularity between free and work days in CVD etiology. They need to be replicated in other studies and mechanisms are yet to be fully understood. Key messages • Adopting regular meal timing schemes on work and free days could be associated with a lower risk of cardiovascular diseases. • Meal regularity between work and free days could play a role in cardiovascular health and should be further investigated.

Chrono-nutrition and post-bariatric weight loss: insights from the Portuguese ChronoWise cohort

Abstract Background Post-bariatric weight loss varies substantially, and a large proportion of patients respond poorly. The literature highlights the importance of chrono-nutrition for weight regulation. This study aims to explore the chrono-related factors associated with poorer weight loss. Methods This study was conducted within the ChronoWise project, an ongoing prospective cohort study following patients undergoing bariatric surgery at the Santo António Local Health Unit, Porto. The sample included patients evaluated at both pre-surgery and 3 months post-surgery. Baseline information on meal timing was gathered through the Chrononutrition Profile-Questionnaire. The eating midpoint (midpoint between first and last meal) was calculated for work and free days. Chronotype was determined using the Munich Chronotype Questionnaire. Weight loss was expressed as the percent of total weight loss (%TWL = [(initial weight − current weight)/(initial weight)]×100). Chrono-related variables were compared according to %TWL (dichotomized by the median) using the Mann-Whitney test. Results Sixty patients were included (72% female; mean age 45±11.8). The mean baseline BMI was 44±5.6 kg/m2, which decreased to 35±5.3 kg/m2 at 3 months post-surgery, resulting in an average 20±3.9 %TWL. On free days, participants with lower %TWL tend to do the first meal later in the day (9h45 vs. 9h10, р=0.367), and later lunch on workdays (12h45 vs 12h30, р=0.531) compared with individuals with higher %TWL. Lower %TWL is typically observed in individuals having later eating midpoints (15h00 vs. 14h15 for workdays, р=0.011; 15h07 vs. 14h44 for free days, р=0.205). A later chronotype (3h37 vs 3h30, р=0.347) was also linked with poorer weight loss. Conclusions Eating later during the day and later chronotype may contribute to poorer post-bariatric weight loss. Funding: This work was supported by FCT - Fundação para a Ciência e Tecnologia [2021.01096.CEECIND, UIDB/04750/2020,LA/P/0064/2020&amp;SGITR2023/EPIUnit]. Key messages • Recognizing meal timing as a modifiable lifestyle factor may optimize current approaches by aligning food intake with circadian clock. • A later chronotype, i.e. a behavioural expression of an individual’s internal circadian clock system as a preference for eveningness or later sleep timing, may negatively influence weight loss.

The safety of standardized management of suspected cardiovascular immune-related events in patients treated by immunecheckpoints inhibitors

Abstract Background Immune checkpoint inhibitors (ICIs) treatment carries a risk of immune-related adverse events (irAEs), including cardiovascular (CV) events. Current guidelines recommend troponin testing to detect early CV irAEs, especially myocarditis, prompting hospital admission. However, high volumes might hinder hospital admission for all suspected CV irAEs patients. Purpose To assess the safety of standardized management in outpatients with suspected irAEs. Methods A prospective single-center cohort study was conducted, including all adults referred to our unit for suspected CV irAEs. Patients exhibiting CV symptoms, receiving double ICIs, or showing ECG changes were referred to cardiology or intensive care based on severity. Patients with no CV symptoms or ECG changes, on single ICI therapy, and no other immune disorder were assessed in a day stay within 8 working days. Patients underwent serial serum testing, ECG, transthoracic echocardiogram, and cardiac magnetic resonance imaging (cMRI) and were assessed by a multidisciplinary team (MDT) including cardiology and internal medicine specialists. Coronary artery imaging and endomyocardial biopsy were performed when deemed necessary (Figure 1). The primary endpoint was CV mortality at 30 days after referral. Secondary endpoints included identifying factors associated with the diagnosis of CV irAEs at referral. Events were adjudicated by a panel of experts (FC, MM, SH) who reviewed the MDT's weekly meeting conclusions. Results 175 patients were enrolled from March 2022 to October 2023; 40 (22.89%) were male, median age 61 (IQR 48.0-72.0) years. 146 (83.4%) were seen in the outpatient clinic. No CV deaths occurred within the initial 30 days. 95 patients (54.1%) had CV irAEs at referral, including 72 (41.1%) with myocarditis; 10 (5.7%) with acute coronary syndromes; 9 (5.1%) with pericarditis; 7 (4.0%) with heart failure; 4 (2.3%) with high-degree conduction or ventricular arrhythmias; and 1 (0.6%) with Tako-Tsubo. 8 (4.6%) had a combination of CV irAEs. The majority of patients admitted to the hospital had CV irAEs (24, 82.7%). On multivariable regression analysis(Figure 2), CV or muscle symptoms(OR 2.677 [CI 1.207-5.937], p=0.015), prior CV disease history(OR 3.668 [CI 1.486-9.057], p=0.0048), and abnormal ECG (OR 2.855 [CI 1.074-7.589], p=0.035) remained associated with CV irAEs at referral. Including global longitudinal strain (GLS) in the model, we identified prior CV disease history. (OR 7.011 [CI 2.217-22.167], p=0.0009) and GLS &amp;lt;16% (OR 2.774 [CI 1.07-7.17], p=0.035) as significant. Conclusions We demonstrate the safety of a standardized outpatient management approach for most patients referred for suspected CV irAEs, mainly triggered by asymptomatic elevation of troponin. No patient experienced CV death at 30 days. When suspecting a CV irAEs, CV or muscle symptoms, previous history of CV disease, and abnormal ECG should prompt speedy assessment given the higher likelihood of CV irAEsFigure 1

Does the way workplace canteens are managed influence users’ plate waste?

Abstract Background Plate waste (PW) is part of the food waste and is defined as the amount of edible food served not eaten. There are few estimates of PW in the food services, mainly in school canteens, where PW appears to differ depending on the provider. Our aim was to analyse the role of different canteen management in determining PW in three hospital canteens in Italy. Methods On 5 working days between August and September 2022, healthcare workers’ trays were photographed before and after meal consumption. We compared two canteens managed by an external catering service (EC) with one internally managed (IC). The two canteens with similar sample size had different management. A modified visual Comstock scale was used to assess the PW. The Carbon Footprint (CF), Water Footprint (WF), energy and nutrient content were estimated using the SU-EATABLE LIFE database and the Italian Food Composition Database for Epidemiological Studies (www.bda-ieo.it). Significance was set at p &amp;lt; 0.05. Results 1227 trays were analysed (1026 in EC; 201 in IC), most of which contained no waste. The percentage of trays with leftovers was higher in EC (34%) than in IC (21%), as was the mean amount of PW (104g EC vs 60g IC) (p &amp;lt; 0.001). The PW contained significantly more energy (125 kcal vs 73 kcal) and protein (6.0g vs 2.4g) and had higher CF (204 CO2eq EC vs 76 CO2eq IC) and WF (178 LH20 EC vs 75 LH20 IC) in CE than in IC. The significance was confirmed independently to the sample size of the canteens, and when the analysis was repeated and only the first access of each user was considered. Conclusions Results suggest that an internally managed canteen produces less leftovers than a canteen operated by an external provider. This could be because an internally managed canteen is more adaptable to users in terms of food offerings and portion sizes, despite a smaller number of food options. However, further studies are needed to confirm our findings and to identify the causes of PW in food service. Key messages • Internally managed canteens seem to reduce plate waste, probably due to certain flexibility according to users’ plate waste. • Non-served food of the canteen should be estimated to confirm our data.

Let’s Get Walking: Establishing Workplace Walking Groups in a regional Public Health Department

Abstract Maintaining staff health and wellbeing (HWB) is an ongoing priority for the Department of Public Health HSE Dublin and Midlands (PHD). This is particularly important in the context of an ongoing programme of reform for Public Health in Ireland. To support this priority, in November 2023 a pilot Workplace Walking Groups initiative was established to increase workplace physical activity and build team relationships. The initiative was designed following staff feedback on team HWB initiatives in September 2023. The Model for Improvement (which includes the Plan-Do-Study-Act cycle) was used to take a structured quality improvement approach to the development and evaluation of the 4-week pilot, led by the PHD HWB Committee. Staff joined across 3 sites. Lunchtime walks were arranged for 1-2 days per week. WhatsApp groups and email supported group communication. Quantitative data on registration and attendance were collected via Microsoft Excel. A virtual focus group was arranged to gather participant feedback, which was analysed into themes. Group registration (n = 10, n = 9, n = 5) and weekly attendance varied by site (n = 10, n = 9, n = 5). Key benefits noted by participants included physical activity, building relationships with colleagues, and getting fresh air. The main barrier was the impact of work schedules on attendance. There was broad support for re-establishment of Workplace Walking Groups for 2024. This pilot Workplace Walking Groups initiative achieved its dual aim of increasing physical activity and social connection among staff. Learning from this pilot informed the launch of a 3-month Walking Groups term for Spring 2024. The initiative is now established practice and is a component of the Department’s blended working policy, being a feature of on-site working days. Key messages • Our successful pilot Workplace Walking Groups project has translated into a sustainable health and well-being initiative for staff, during a time of ongoing reform across Public Health in Ireland. • A structured approach to designing and implementing staff health promotion initiatives is crucial to support the cycle of learning and improvement, and to sustain change over time.