Decline In Status Research Articles

A case of complete remission by cabozantinib as an end-line treatment for advanced hepatocellular carcinoma.

Cabozantinib is a multi-kinase inhibitor targeting multiple tyrosine kinases. It improves overall survival and progression-free survival in patients previously treated with sorafenib for advanced hepatocellular carcinoma (HCC) compared to the placebo in the phase 3 CELESTIAL trial. A 71-year-old man presented to our hospital for treatment of HCC with chronic hepatitis C. He was refractory to sorafenib, lenvatinib, regorafenib, and ramucirumab and started atezolizumab and bevacizumab therapy in November 2020. After administering the second cycle on December 10, 2020, the patient was diagnosed with progressive disease in January 2021. Therefore, cabozantinib (60 mg/day) was initiated on January 14, 2021. As the grade 3 aspartate aminotransferase and alanine aminotransferase levels increased, grade 3 anorexia and a decline in performance status were observed in the first week, and cabozantinib was terminated. His performance status and anorexia gradually improved, and contrast-enhanced computed tomography (CT) in June 2021 showed complete remission (CR) according to the modified Response Evaluation Criteria in Solid Tumors. The patient did not show disease progression for 11 months without receiving any treatment for HCC. To the best of our knowledge, this is the first report of CR with cabozantinib in advanced HCC.

Historical trends and current status of the European eel, Anguilla anguilla (Linnaeus, 1758) fishery in the Neretva estuary (eastern Adriatic, Croatia)

The European eel, Anguilla anguilla was the most important fishery resource in European estuaries for centuries. In more recent times, most local populations throughout the species' range have collapsed for various reasons. This article deals with the historical records and current status in the Neretva estuary (Croatia), the most important eel fishing area on the eastern Adriatic coast. The historical records were analysed by reviewing various available databases, including scientific articles and professional literature. Additional descriptions were obtained using local ecological knowledge and interviews with various stakeholders. The comparative analysis shows that the historical silver eel catch (1930-1940) under pristine habitat conditions should be estimated at 100 tons, officially recognized and additionally estimated. The decline in silver eel catches began between 1960 and 1970 and was related to the massive reclamation of important eel lagoons and wetlands for agriculture and port areas, when officially recognized silver eel catches at state stations averaged 45 tons per year. Recent scientific articles and reports as well as a survey of professional and recreational fishermen show that the annual catch in the period 2020-2022 is only 2 tons. The main reasons for this recent dramatic decline in eel fisheries and biological status in the Neretva estuary after 2015 are: a significant increase in recreational fishing, the establishment of invasive predatory fish and crab species, and the strong development of local tourism demand. The results of this study indicate that the local eel population is likely to be threatened with extinction in the near future unless various measures are developed and applied to protect it, including the restriction of fishing and better market control, habitat restoration and the control of invasive and competing species.

Occupational Balance and Meaning Mediate Higher Education Students' Mental Health During War: A Structural Equation Modeling Analysis.

Exposure to trauma and extensive changes in daily life circumstances and occupations as a result of an ongoing armed conflict can significantly affect mental health. To examine factors related to the mental health status of Israeli students during the Swords of Iron war. A cross-sectional study. Online survey. Students in higher education institutions across Israel (N = 863). Self-report validated questionnaires were used to assess students' mental health status, resilience, satisfaction with life, executive functions, environmental factors, and occupations. Moderate levels of depression (Mdn = 18, interquartile range [IQR] = 10-28), anxiety (Mdn = 10, IQR = 4-20), and stress (Mdn = 24, IQR = 14-34) were found for 50% of participants, along with extensive changes in daily life occupations, occupational balance, and meaning. Using structured equation modeling, χ2(15) = 15.969, p = .384, the authors found that satisfaction with life, psychological resilience, religious status, executive functions, occupational balance, and variability in occupational change were directly associated with mental health status, whereas occupational balance and occupational change mediated these connections. The modifiable factors related to reduced mental health after exposure to traumatic threat included change in occupational patterns, occupational balance, and sense of belonging, which may all serve as goals for occupation-based interventions and contribute to better coping mechanisms with traumatic events. This study used a cross-sectional design and an online survey with self-reported data, which may limit the generalizability of the findings. Plain-Language Summary: Higher education students in Israel were exposed to traumatic events and changes in daily life because of war. This study aimed to understand their mental health, resilience, executive functions, environments, and changes in their occupational patterns and the complex interplay between these factors. An online survey showed a notable decline in the students' mental health status, with around 50% experiencing at least moderate levels of depression, anxiety, and stress. Changes in occupations, occupational meaning, and balance were also common. The study found that satisfaction with life, mental resilience, occupational balance, religious status, executive functions, and variability in occupational change all contributed directly to the students' mental health status. The findings suggest that modifiable factors such as occupational balance and belongingness could be addressed through interventions to enhance mental health and coping mechanisms of students facing trauma and stressful life events.

Assessment of Quality of Life in Head and Neck Cancer Patients before and after Radiation Therapy- A Prospective, Analytical Questionnaire-Based Study from a Tertiary Cancer Centre

Head-and-neck cancer (HNC) is a major global health issue, with significantly higher incidence rates in India compared to other countries. The diagnosis and treatment of HNC can severely affect a patient’s quality of life (QoL). This study aims to evaluate and compare the QoL of head and neck cancer patients before and after radiation therapy with or without chemotherapy. We conducted a prospective study on 45 newly diagnosed HNC patients who underwent radiation therapy, either alone or in combination with chemotherapy at our department. We assessed QoL using the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30) for general assessment and the EORTC QLQ H&N-35 for head and neck-specific evaluation before starting of the treatment and 4 weeks after the completion of the treatment. We used paired t-tests, Mann-Whitney U test and Kruskal-Wallis ANOVA for statistical analysis, with a significance level set at p ≤ 0.05. The most commonly affected site was the oral cavity. All participants initially had a good performance status (PS) of either 1 or 2, with Stage IV being the most prevalent. Analysis of the EORTC QLQ-C30 revealed a decline in global health status, and the EORTC QLQ H&N-35 showed deterioration across all domains from pretreatment. On the functional scale, emotional well-being was notably more impaired, while physical, cognitive, and social functions were less affected. Pain, swallowing difficulties, mucositis, and speech issues were identified as the most severely impacted aspects of QoL. In Conclusion, our study shows a significant decline in QoL following treatment due to the acute and subacute side effects of radiation therapy and chemotherapy. These findings highlight the need for comprehensive supportive care to address the broad impact of HNC treatment on patients quality of life.

Family Socioeconomic Status and Neurodevelopment Among Patients With Dextro-Transposition of the Great Arteries

Data are limited on the longitudinal implications of socioeconomic status (SES) for neurodevelopmental outcomes among persons with complex congenital heart disease (CHD). To examine the association of family SES, maternal educational level, and maternal IQ with the neurodevelopment of individuals with dextro-transposition of the great arteries (d-TGA) from age 1 to 16 years and to identify how SES-related disparities change with age. This cohort study analyzed data of participants enrolled in the Boston Circulatory Arrest Study, a randomized clinical trial conducted in Boston, Massachusetts, from 1988 to 1992. Participants were infants with d-TGA who underwent arterial switch operation and, after operation, underwent in-person neurodevelopmental status evaluations at ages 1, 4, 8, and 16 years. Analyses were conducted from April 2021 to August 2024. Mean Hollingshead scores at birth, age 1 year, and age 4 years were used to assign participants to SES tertiles (lowest, middle, or highest). Age-appropriate neurodevelopmental outcomes assessed at 4 study time points (ages 1, 4, 8, and 16 years) via in-person administration of a range of well-validated measures. Standardized neurodevelopmental composite scores from each evaluation were derived from principal component analysis and compared across SES tertiles, adjusting for birth and medical characteristics. These scores were used to categorize the sample into latent classes; patient and medical factors for a 3-class model were used to estimate latent class using multinomial regression. The sample included 164 patients with d-TGA (123 males [75%]; mean [SD] gestational age at birth, 39.8 [1.2] weeks; 3 with Asian [2%], 6 with Black [4%], 5 with Hispanic [3%], and 146 with White [89%] race and ethnicity) and their mothers (mean [SD] age at birth, 28.5 [5.2] years). Lower SES tertile was associated with worse scores on most individual neurodevelopmental tests and worse neurodevelopmental composite scores at ages 4, 8, and 16 years. For example, mean (SD) neurodevelopmental composite scores at age 4 years were -0.49 [0.83] for lowest, 0.00 [0.81] for middle, and 0.47 [1.10] for highest SES tertile (F2 = 15.5; P < .001). When measured at consecutive time points, differences between SES tertiles were of similar magnitude. A latent class analysis produced 2- and 3-class models representing patients with stable (103 [64%] and 85 [53%]), improving (20 [13%]), and declining (57 [36%] and 55 [34%]) neurodevelopmental status. Those experiencing declines in neurodevelopmental status were more likely to have younger maternal age at childbirth (26.6 [5.1] vs 29.6 [4.9] and 29.1 [5.1] years; P = .002), lower maternal IQ (91.0 [14.1] vs 100.1 [11.1] and 96.2 [11.0]; P < .001), and lower SES (35.2 [10.8] vs 40.9 [9.9] and 35.8 [10.1]; P = .003) compared with those with stable or improving status. This cohort study of individuals with d-TGA found an association between lower family SES and worse neurodevelopmental outcomes in childhood and continuing throughout adolescence as well as greater decline in neurodevelopmental status over time. Effective strategies are needed to improve access to neurodevelopmental monitoring and intervention services for children with CHD from lower socioeconomic backgrounds.

Predictors of mortality among older adults discharged to or readmitted from a skilled nursing facility.

Previous studies have shown that patients who are readmitted to the hospital from a skilled nursing facility (SNF) have a higher mortality rate. The objective of this study is to determine factors associated with high mortality rate for older adults who require hospital readmission while on presumed short stay in SNF to trigger a goals-of-care discussion. Retrospective study of 847 patients aged 65 and above who were discharged from 1 large urban academic medical center to multiple SNF in 2019. Charts of 847 patients admitted to SNF after an acute hospital stay were reviewed; their overall 1-year mortality rate was 28.3%. The 1-year mortality rate among individuals readmitted to the hospital within 30 days of discharge to SNF was 50%, whereas for those who did not require readmission, the rate was 22%. For the most common diagnostic categories of nervous system, and musculoskeletal, patients with readmission to hospital within 30 days of discharge to SNF had a roughly threefold higher 1-year mortality rate. Worse frailty score on hospital readmission, poor nutrition, and weight loss were the most impactful individual factors carrying a higher degree of mortality of up to 83%. Hospital discharge to SNF and readmission from SNF within 30 days, further decline in functional status, and malnutrition characterize high-risk groups that should trigger care preference and prognostic discussions with patients as these events may be markers of vulnerability and are associated with high 1-year mortality rates.

Abstract 4112944: A diagnostic challenge overcome with persistent clinical suspicion in a case of cardiac AL amyloidosis

Case: A 62-year old male with a history of chronic kidney disease and paroxysmal atrial fibrillation presented with several months of fatigue, a progressive decline in functional status (NYHA IIIb-IV), weight loss, and intermittent lower extremity swelling. Blood pressure was 92/72 mmHg on presentation, and heart rate was 90 bpm. Physical examination revealed a jugular venous pressure of 12-14 cm H2O and 2+ bilateral lower extremity edema with mild wheezing. Methods/workup: Laboratories are shown in Table 1 and were notable for a serum free light chain ratio of 0.14. Transthoracic echocardiogram (figure 1) revealed a left ventricular (LV) ejection fraction of 33% with increased LV wall thickness and severe bi-atrial enlargement. Bone marrow biopsy revealed 2% lambda restricted plasma cells without evidence of amyloid deposits; metastatic bone survey was negative. A fat pad biopsy and endomyocardial biopsy stained negative for amyloid with Congo red. Cardiac MRI showed diffuse, circumferential subendocardial late gadolinium enhancement, most compatible with cardiac amyloidosis (figure 2). The patient also had a chest CT scan that demonstrated a few patchy nodular pulmonary infiltrates. Given his extensive negative workup, he was referred to pulmonary and endobronchial biopsy was positive for amyloid on Congo red staining (figure 3). Biopsy tissue typing revealed Lambda subtype AL amyloidosis. Management: The patient was started on Daratumumab, Cyclophosphamide, Bortezomib, and Dexamethasone by Hematology. Unfortunately, about a month after his diagnosis, he developed worsening heart failure despite treatment. He was admitted to an outside hospital with refractory cardiogenic shock and passed away during that admission. Discussion: The diagnosis of AL amyloidosis requires a high index of suspicion for prompt diagnosis and treatment. We present a case in which cardiac amyloidosis was suspected based on the patient’s clinical picture and cardiac imaging; however, multiple initial biopsies were negative. An expedited, multimodal and interdisciplinary diagnostic assessment is imperative as prognosis with chemotherapy is highly dependent on extent of AL disease, patient functional status, and presence of cardiac compromise. Elevated natriuretic peptides, troponins, autonomic dysfunction, and hypotension are negative prognostic features.

Impact of fundamentalism on human capital, women's social status and demographics: Evidence from Islamic state of Iraq and Syria (ISIS) in Iraq

I analyze the impact of the religious fundamentalists’ rule on regional human capital development and women's social status by exploiting the unexpected rise and fall of Islamic State of Iraq and Syria (ISIS) in northwestern Iraq (2014∼2017). I find a large downward impact of exposure to ISIS rule on female human capital and an upward one on fertility rate for women who were school-aged at the time of ISIS occupation. These women express more patriarchal family norms and are more likely to belong to a polygamous union, implying a decline in women's social status. This decline in human capital and the rise of patriarchal family norms doesn't cause a significant negative impact on the development of their pre-school-aged children, possibly implying that these women didn't decrease parenting effort for their children. In summary, even a brief period of extremist rule has potentially large impacts on human capital development and culture.

Pediatric liver transplant for acute liver failure: Defining the standard nutrition and clinical evolution: An observational study.

Pediatric acute liver failure (PALF) is a clinical diagnosis in which previously asymptomatic children exhibit a rapid loss of liver function. To describe the clinical and nutrition conditions at admission and during hospitalization in patients with PALF who underwent liver transplantation (LT) at a referral center and establish a possible association between nutrition status and prognosis in this population. A prospective study was conducted on children underwent LT because of PALF. Nutrition assessment was performed at admission and repeated weekly until hospital discharge, and their relationships with clinical outcomes were tested. The study population consisted of 23 patients with a median age of 60 months and, in most cases, the etiology of acute liver failure (ALF) was indeterminate (69.6%). The majority of the patients were well nourished according to the z score body mass index-for-age (82.6%) and z arm circumference-for-age (zAC/A) (82.6%). A decline in nutrition status was observed in 47.6% of the patients, as indicated by a decrease in zAC. Clinical and nutrition improvement was demonstrated by the progressive increase in zAC, serum albumin levels, and phase angle (PA) values and by the reduction in C-reactive protein levels. There was no statistically significant relationship between nutrition status and clinical outcomes. Most children and adolescents with ALF presented adequate nutrition status at the time of LT, and some patients worsened their nutrition status during hospitalization, suggesting that post-LT is a period of high nutrition risk, and early nutrition therapy (NT) must be a priority in these patients.

Bariatric Surgery in Adolescent Age Group

Obesity in children is a problematic condition which interfere with physical and mental health. It is a complicated disorder with interwoven environmental, genetic, biological components, developmental, and behavioral. A combination of medical treatment and behavioral and lifestyle modifications was typically what causes poor short-term weight loss and long-term failure. For this reason, adolescents who suffer from moderate to severe obesity and have attempted lifestyle interventions in the past but had no success should think about having bariatric surgery. Specifically, laparoscopic sleeve gastrectomy is thought to be the most often carried out bariatric procedure globally. The technique is safe and doable. It has been demonstrated that this surgical weight loss procedure is effective in young patients. However, there are obstacles that need to be removed at the levels of patients, providers, and the healthcare system. Above all, for ensuring successful long-term treatment and permit healthy growth, more should be done to stop the nutritional status decline that frequently follows bariatric surgery, as well as to prevent insufficient weight loss and weight regain. With a focus on LSG, nutritional management, and the resolution of metabolic comorbidities, we examined the clinical indications, surgical treatment options, and outcomes in adolescents with severe obesity in this narrative review.

The “vast gilded void” of Leisure: Energy and Work in The House of Mirth

Abstract Inspired by energy humanities, this article frames The House of Mirth (1905) as a novel with deep understanding of energy and labor. This article analyzes how Wharton effectively borrows from thermodynamic theories like entropy and inertia to juxtapose Lily Bart’s precarity with the elite. Against this inert milieu backdrop, Lily stands out as an energetic, if exhausted, worker. Reframed, her social status decline is a depletion of energy resulting from gendered labor. This highlights Wharton’s effective critique as her literalization of the effects of oppressive forces through work terminology and energy metaphors that portray the embodied, physic, exhaustive effects of exploitative conditions.

Exploring the Frequency and Risk Factors of Hyperprogressive Disease in Patients with Advanced Melanoma Treated with Immune Checkpoint Inhibitors.

Hyperprogressive disease (HPD) is described as the unexpected rapid growth of a tumour accompanied by a decline in performance status. While immune checkpoint inhibitors (ICIs) have improved outcomes in advanced melanoma, HPD remains a significant challenge in a subset of patients. Although HPD has been extensively studied in various solid tumours, research specifically focusing on advanced melanoma remains limited. We analysed 158 advanced melanoma patients, with 66.5% (n = 105) receiving anti-PD-1 and 33.5% (n = 53) receiving nivolumab plus ipilimumab. The median overall survival was 4.9 months for patients with HPD compared to 8.9 months for those with progressive disease without HPD (p = 0.014). Factors associated with HPD included liver metastasis (p = 0.002), three or more metastatic sites (p < 0.001), elevated lactate dehydrogenase levels (p = 0.004), and Eastern cooperative oncology group performance status ≥2 (p = 0.023). Multivariate analysis identified the Royal Marsden Hospital score (HR 3.675, 95% CI: 1.166-11.580, p = 0.026) as an independent risk factor for HPD, with the MDA-ICI score also trending towards significance (HR 4.466, 95% CI: 0.947-21.061, p = 0.059). This study provides valuable insights into the frequency and factors associated with HPD in advanced melanoma patients treated with ICIs, highlighting the relevance of clinical markers and scoring systems in predicting HPD risk.

Recipient selection for lung transplantation: perspective in decision-making.

To determine the conditions that prevented transplant in patients referred to our center due to end-stage lung disease. Descriptive study. Department of lung transplant clinic, Koşuyolu High Specialization Education and Research Hospital, Istanbul, Turkey, from December 2017 to January 2022. Patients with end-stage lung disease referred to our clinic were retrospectively evaluated with regard to reasons for exclusion, diagnosis, and demographic data. The Karnofsky Performance Status scoring scale was used to measure the functional status of the patients. A total of 311 patients were evaluated during the study period. The mean age was 44.2 (range 4-73) years. There were 207 (66.6%) male patients. The most common indications were idiopathic interstitial pneumonia in 104 (33.4%) patients, chronic obstructive pulmonary disease in 53 (17%) patients, bronchiectasis in 49 (15.7%) patients, and cystic fibrosis in 28 (9%) patients. Of the patients, 106 (34%) were not appropriate candidates for a lung transplant. The most common reasons for refusal were preventable situations such as activity limitation and poor performance in 53 (50%) patients, weight in 49 (46.2%) patients, and smoking in 10 (9.4%) patients. Impaired performance status was the most common cause of lung transplant exclusion. Weight and smoking were preventable causes of exclusion. Implementing pulmonary rehabilitation in very few patients was the most important handicap. It is believed that providing optimal treatment with a multidisciplinary approach and timely referral to transplant centers will significantly reduce the reasons for exclusion. Key message What is already known on this topic? Referring lung transplant candidates to clinics at the earliest stage is essential for assessing their condition and exploring treatment options. What this study adds? Factors like smoking, obesity, and muscle loss can hinder the transplantation process; thus, timely interventions are crucial. The primary reason for excluding candidates from lung transplantation is the decline in performance status. How this study might affect research, practice or policy? Programs focused on smoking cessation, weight management, and muscle strengthening can play a vital role in enhancing patients' health before transplantation. It is imperative to expand and enhance the accessibility of pulmonary rehabilitation programs.

Coastal marine habitats deterioration according to users’ perception: the case of Cap de Creus Marine Protected Area (NE Spain)

Assessing how different users of a Marine Protected Area perceive environmental changes can contribute to design management strategies. We assess how locals and tourists perceive environmental changes in the Cap de Creus protected area (NW Mediterranean, Spain). To identify locally perceived changes, we first conducted semi-structured interviews with locals (n = 38). Reported environmental changes were then used to construct a survey applied to locals and tourists (n = 427). In semi-structured interviews, environmental changes were the least reported changes compared to economic and social changes; reports of negative environmental changes dominated over reports of positive environmental changes. Overall, all survey participants reported a decline of the health status of the local environment, with locals displaying higher levels of agreement with statements referring to coastal environmental deterioration than tourists. The predominance of responses reporting economic versus environmental changes can be explained by the recent radical transformation of the area towards tourism. Reports of coastal marine area deterioration are in line with available instrumental data. Higher levels of agreement with statements referring to environmental deterioration among locals than among tourists highlight the importance of people’s connection with nature to assess change. Considering that Cap de Creus has been protected for more than two decades, our findings raise concerns regarding its ongoing deterioration and underscore the importance of monitoring the effectiveness of marine protection to modulate management strategies.

Multimodal prehabilitation to enhance functional capacity of patients with esophageal cancer during concurrent neoadjuvant chemotherapies-a randomized feasibility trial.

Esophageal adenocarcinoma continues to bear high morbidity and mortality. Prehabilitation, using exercise, nutrition, and psychosocial strategies to optimize patients prior to surgical resection, is largely underexplored in this malignancy, especially in patients undergoing neoadjuvant chemotherapy. Objectives of this study were (i) to determine feasibility of prehabilitation during treatment in patients with esophageal cancer and (ii) to establish differences between hospital and home-based exercise. Patients were recruited from August 2019 - February 2023 and blindly randomized to either supervised or homebased exercise, receiving identical nutritional and psychosocial support. The main outcome measures were recruitment, retention, and dropout rates. The secondary outcomes included cardiorespiratory fitness, functional capacity, and quality of life. Forty-four subjects were blindly randomized: 23 to supervised exercise and 21 to home-based exercise (72% recruitment rate). Overall compliance for the supervised group was 72%; home-based group was 77%. Baseline to pre-operative, both groups experienced significant increases in sit-to-stand, arm curls, and amount of weekly moderate-vigorous physical activity. The home-based group experienced an additional considerable decrease in up-and-go test times. Both groups maintained cardiorespiratory fitness and saw substantial increases in some quality-of-life scores. Multimodal prehabilitation is feasible for patients with esophageal cancer undergoing neoadjuvant chemotherapy. In both groups, patient fitness, which is relevant for this patient population given the anticipated decline in functional status during this period, was maintained. This study provides a foundation for future prehabilitation interventions in this patient population.

Mapping the Evidence for Measuring Energy Expenditure and Indicating Hypermetabolism in Motor Neuron Disease: A Scoping Review.

To map the international methods used to measure energy expenditure of adults living with motor neuron disease (MND) and to highlight discrepancies when indicating hypermetabolism in the MND literature. A decline in the nutritional status of patients is associated with exacerbated weight loss and shortened survival. Assessments of energy expenditure, using a variety of methods, are important to ensure an adequate energy intake to prevent malnutrition-associated weight loss. Assessments of energy expenditure are also commonly used to indicate hypermetabolism in MND, although these approaches may not be optimal. A protocol based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews Guidelines was developed. Three electronic databases (Medline [Ovid], CINAHL [EBSCO], and Web of Science) were exhaustively searched. Identified publications were systematically screened according to predefined PICOS eligibility criteria. The primary outcome was the identification of methods used to measure energy expenditure in MND. The secondary outcome was the identification of applications of energy expenditure assessments to indicate hypermetabolism in MND. Thirty-two observational primary research publications were identified. Thirteen (40.6%) were longitudinal in design, with data on repeated measurements of energy expenditure presented in 3 (9.4%). Thirteen (40.6%) were case-control studies, of which 11 use a matched control group. Pulmonary function was used to assess eligibility in 10 publications. Energy expenditure was measured using indirect calorimetry (IC) in 31 studies. Discrepancies in the durations of fasted, measurement, and washout periods were observed. Of all included publications, 50% used assessments of resting energy expenditure to identify hypermetabolism. Bioelectrical impedance analysis was used to assess body composition alongside energy expenditure in 93.8% of publications. Resting energy expenditure is most frequently measured using an open-circuit IC system. However, there is a lack of a standardized, validated protocol for the conduct and reporting of IC and metabolic status in patients with MND.

Towards Environmental Sustainability: Integrating RS and GIS for Ecology Assessment

The environment provides numerous benefits for human well-being, such as ecosystem services. These services directly and indirectly depend on the physical state of the ecosystem. However, the over-exploitation of natural resources along with socio-economic factors, i.e. economic growth, poverty, agriculture expansion, population growth and weak environmental governance and regulation for fulfilling the human needs for food, fuel, and shelter, is leading to the degradation of the ecological health of an area. Therefore, monitoring and assessment of spatial and temporal changes in the ecology of a region in terms of vital ecological services is very critical and would help the decision-makers to develop and plan appropriate adaptation and mitigation measures for the conservation of natural ecosystems at various scales to ensure environmental sustainability. The present study aimed to assess the ecological status of the Mahi Bajaj Sagar catchment area in Rajasthan (India) from the year 2000 to 2020, using remote sensing-based indices. Indicators such as greenness, dryness, and heat index have been selected as per the pressure-state-response (PSR) framework. Multi-spectral remote sensing data and image processing methods have been used to estimate these indicators, and a remote sensing-based Ecological Status Index (RSBI) has been generated by their integration using the principal component analysis (PCA) to assess the ecological status of the Mahi Bajaj Sagar catchment. Findings from the study indicate a consistent decline in the overall ecological status of the Mahi Bajaj catchment, where decreased forest areas have a pronounced effect on ecological health. Interestingly, approximately 43.6% of the area displayed resilience to changes in ecological status; however, 36.4% of the area exhibited signs of ecological degradation. Our study underscores the efficacy of a remote sensing-based approach in quantifying and detecting ecological changes, offering a promising methodology for monitoring and assessing the ecological health of large areas that can help promote environmental sustainability. Keywords: Environmental Sustainability, Ecological Status, RSBI, Remote Sensing, PSR Framework

Effect of Atrial High-Rate Episodes (AHRE) on the Response to Cardiac Resynchronization Therapy (CRT) in Heart Failure Patients with Reduced Ejection Fraction (HFrEF)

Abstract Aim and Objectives To evaluate the burden and impact of AHRE on the functional capacity and quality of life of HFrEF patients treated with CRT. Patients and Methods This study included a group of 100 HFrEF patients treated with CRT who came for regular follow up at electrophysiology clinic. Device interrogation was done to assess the burden of AHRE, followed by assessment of functional capacity using the standard 6-minute walk test and assessment of quality of life using the Minnesota living with heart failure questionnaire. Results There was no statistically significant correlation between AHRE prevalence and distance walked during 6MWT, however, when compared to the distance expected for an equivalent healthy individual, there was a highly statistically significant difference (82.02±17.22% in non-AHRE group vs. 75.15±15.78% in AHRE group, P-Value &amp;lt;0.001). As regards the quality of life, there was a statistically significant correlation between the prevalence of AHRE and the total MLHFQ score (mean score of 36.97±7.76 in non-AHRE group vs 46.76±9.82 in AHRE group, P-value 0.032), however there was no statistically significant correlation with QoL class (28.8% poor QoL in non-AHRE group vs 50% in AHRE group, P-value 0.09). Conclusion AHRE is associated with a significant decline in functional status and perceived quality of life in HFrEF patients treated with CRT. Presence of AHRE longer than 5 minutes during CRT interrogation at least 6 months after implantation was associated with a poorer performance on 6MWD as well as a higher MLHFQ score denoting a decline in perceived quality of life.

Unusual Presentation of Confusion: Hyperammonaemic Hepatic Encephalopathy Due To Intrahepatic Portosystemic Venous Shunt In An Older Patient

Abstract Background Delirium is an acute, usually reversible neuropsychiatric syndrome and often presents as confusion, especially in the older population. Early detection and management of causes is vital to reduce mortality, morbidity, and long-term cognitive status decline. Intrahepatic portosystemic venous shunts are rare vascular malformations. These malformations can be congenital or acquired and may manifest as heart failure, hepatic encephalopathy, or pulmonary hypertension. Methods A 75-year-old man presented to the emergency department with a 5-week history of confusion, daytime somnolence, and fatigue. His physical examination was unremarkable. His symptoms were initially thought to be due to sub-optimally controlled Obstructive Sleep Apnoea. Nevertheless, his confusion progressed further during admission and required admission to the intensive care unit and intubation. Investigations initially showed deranged Liver function tests. Extensive investigations were done, including CT brain, MRI brain, septic screen, Arterial blood gas, and Lumbar puncture, which were all inconclusive. An Electroencephalogram was suggestive of Encephalopathy. His Ammonia level was high (123). Further investigations, Triphasic CT liver, revealed Intrahepatic portosystemic venous shunt and was diagnosed with hyperammonaemic hepatic encephalopathy due to Intrahepatic portosystemic venous shunt. Results Management included the commencement of lactulose, rifaximin, and L-ornithine L-aspartate (LOLA). An IR-guided embolisation of the porto-venous shunt was performed. At two-months review, the patient reported no further episodes of confusion. Conclusion Intrahepatic portosystemic venous shunts should be considered in the differential diagnosis of patients presenting with confusion or other unexplained neurological symptoms, especially in the presence of liver dysfunction. Early diagnosis and appropriate management are crucial for favourable outcomes.

Abstract B116: Overcoming barriers in recruiting medically underserved patients with lung cancer: The NutriCare study, a "Food is Medicine" intervention

Abstract Despite recent efforts to expand clinical trial eligibility criteria to involve traditionally underserved patient populations, less than 5% of patients diagnosed with cancer choose to participate in clinical trials (lifestyle, behavioral or pharmaceutical), of which only a small fraction represents underserved or vulnerable populations. The barriers that contribute to these trends are multifactorial. Examining sociodemographic and clinical characteristics may provide insight into successful participant recruitment and retention of underrepresented groups in clinical trials. The NutriCare study (NCT04986670) is a national, multisite, randomized controlled trial evaluating the impact of medically tailored meals plus weekly nutritional counseling on the outcomes of vulnerable patients with treatment-naïve lung cancer initiating treatment. Eligibility criteria defining vulnerability included: ≥65 years of age; underrepresented minority; rural resident; no health insurance; or income ≤130% of federal poverty line. To remain on study, eligible participants also completed a 90-minute baseline assessment within 8 weeks of study consent. A comprehensive list of screened patients was maintained throughout the course of the study, including approach attempts and refusal reasons for participation. Strategies to improve recruitment included obtaining referrals from the treating physician and inclusion of the study dietitian during the informed consent process. Descriptive statistics were used to summarize the recruitment and retention of vulnerable patients. Overall, 438 participants were screened in Phase I of this study at The Ohio State University and MD Anderson (Nov, 2020 – Aug, 2022), of which 116 (26%) participants consented to the study. Of these 116 participants, 76 (66%) were 65 years of age or older, 42 (36%) lived in a rural area, 21 (18%) identified as a racial or ethnic minority, and 27 (23%) met federal poverty levels. As the study progressed, 44 (38%) patients withdrew between baseline to 3-months,18 (16%) patients withdrew between the 3-month to 8-month timepoints, and a total of 54 (47%) participants completed the study. The highest retention rates were identified among those &amp;lt;65 years (58%), males (52%), early-stage lung cancer (69%), racial or ethnic minorities (62%), non-rural residents (50%) and those above the federal poverty line (48%). Barriers to completing the study included rapid decline in performance status among those diagnosed with late/extensive stage lung cancers (16%), treatment impacting taste and appetite (8%), and logistical complications with the meal intervention (3%). Barriers to recruitment and willingness to participate during the NutriCare trial were similar across recruiting sites. Future trials should consider implementation of a crossover study design, local and customized food delivery services, and measurements of time toxicity related to survey completion as an outcome. These efforts may improve clinical trial participation and provide more supportive care needs for vulnerable patients with lung cancer. Citation Format: Hazel M. Antao, Kenneth Kwan Ho Chui, Jade Smith, Pooja Vibhakar, Mary Kathryn Cohen, Jessica Bauman, Saumil Gandhi, Joya Chandra, Lori Pai, Fang Fang Zhang, Colleen Spees, Carolyn Presley. Overcoming barriers in recruiting medically underserved patients with lung cancer: The NutriCare study, a "Food is Medicine" intervention [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B116.