Eight-week Period Research Articles

Trends of Pandemic Parenting in Medical Academia.

IntroductionThe pandemic has been difficult on physicians, with two fifths of doctors in one survey reporting that their mental health is now worse than before the pandemic. It is likely that a significant proportion of these physicians are parents of children necessitating childcare, as approximately 32% of the US workforce has someone in their household under the age of 14. We sought to study the impact of the coronavirus 2019 (COVID-19) pandemic on physician parents in academia. Our goal was to investigate the intersection of professional and personal challenges, as well as perceived impact on domestic life and professional development secondary to the COVID-19 pandemic.MethodsUsing Survey Monkey, we developed a 37-question survey to address the aim of this study. Questions were grouped into four categories: demographics; impact on childcare; impact on care; and impact on mental health/wellness. Most of the questions were multiple choice with a few fill-in-the-blank options to allow participants to provide additional information related to their experiences as physicians during the pandemic. A link to the survey was disseminated via email to physicians at our home institution, Rush University Medical Center (Chicago), via our own intra- and interdepartmental communications, We used private social media accounts such as Facebook physician groups to reach out to physicians at other academic medical centers. Survey responses were voluntary and collected anonymously over an eight-week period, without identifiable data. Inclusion criteria included any physician identifying themselves as working full or full or part time in an academic facility in the US and caregivers for children <18 years.ResultsSurvey respondents were mostly female (83.2%), practicing in the Midwest (61.2%), and ranked as assistant professor (59.5%). The majority of respondents had two children (65.1%) who were <11 years in age (85.6%). Most respondents worked full time with 72.8% working over 50% clinically. Childcare was disrupted for 171 of 232 respondents (73.7%); 62.9% struggled with balancing work with childcare; 81.9% worried often or very often about fulfilling their responsibilities. A vast majority, 210 of 232 respondents (90.5%) had some degree of concern about feeling overburdened by their roles. More than half (57.3%) worried that their professional advancement was impacted by the pandemic, and 53.9% considered making adjustments to their clinical workload/. Over half (51.6%) thought that increased domestic responsibilities impacted their professional advancement.ConclusionIn the survey, which was completed primarily by early-career women physicians practicing in a variety of specialties and geographic regions, we noted that childcare disruption amidst the pandemic was extremely prevalent. The majority of respondents reported full-time equivalent work; thus, it is reasonable to assume that significant workloads and limitations in remote work in combination with childcare constraints resulted in significant burden. A large number felt the challenges were negatively impacting their professional development and felt overburdened by their various roles.

High-intensity Training And A Low-caloric-diet Improves Maximal Oxygen Consumption And Body Composition In Overweight Adults

Obesity and low cardiorespiratory fitness are global challenges causing a massive burden on the health care system worldwide. Thus, efficient exercise and nutritional interventions are warranted. PURPOSE: We investigate the effect of high-intensity training executed as full body circuit training and a calorie-restricted diet plan on cardiorespiratory fitness and body composition in overweight sedentary adults. METHODS: Sedentary overweight men (n = 34) and women (n = 46) were recruited. The selection criteria were a sedentary lifestyle for the last five years, an age range of 25-55 yrs and a body mass index >25. The study was a randomized controlled trial, where participants were randomized gender-specifically into a high-intensity training group (HIT; age 38 ± 9 (25-54) yrs; height 174 ± 10 cm; weight 96.1 ± 19.3 kg; n = 40) and control group (CON; age 39 ± 7 (27-52) yrs, height 168 ± 8 cm, weight 89.9 ± 17.2 kg; n = 40). HIT completed full-body high-intensity circuit training with 2-4 weekly sessions combined with a calorie-restricted dietary plan for 8 wks. CON had no training or lifestyle changes in the same interval. VO2max-tests and body composition assessments were performed at baseline and post-intervention. RESULTS: VO2max was 2.3 ± 0.6 and 2.1 ± 0.5 L⸱min-1 at baseline in HIT and CON respectively and did not change during the intervention period. However, VO2max adjusted for body weight improved (P < 0.05) by ~7% in HIT (24.5 ± 5.1 vs 25.7 ± 5.5 ml⸱min-1⸱kg-1) during the intervention period with greater (P < 0.05) change score than CON where a reduction (P < 0.05) of ~5% (24.1 ± 5.1 vs 22.6 ± 4.6 ml⸱min-1⸱kg-1) was observed. Body weight decreased (P < 0.05) by 5.9 ± 3.2 kg post-intervention in HIT with higher (P < 0.05) change score than CON (+0.3 ± 1.6 kg). Also, BMI declined (P < 0.05) from 31.8 ± 5.5 to 29.9 ± 4.4 kg/m2 in HIT only. Body fat content was also lowered (P < 0.05) from 32.0 ± 9.5% at baseline to 30.9 ± 9.3% post-intervention in HIT with a greater change score compared to CON. No change was observed in skeletal muscle mass in neither HIT nor CON. CONCLUSION: High-intensity training performed as full body circuit training combined with a caloric-restricted diet over an eight-week period moderately improved body weight adjusted VO2max, but induced a marked weight loss and reduction in body fat content in overweight sedentary adults.

Treatment of the metabolic syndrome by siRNA targeting apolipoprotein CIII.

Apolipoprotein CIII (apoCIII) is increased in obesity-induced insulin resistance and type-2 diabetes. Emerging evidences support the advantages of small interfering RNAs (siRNAs) to target disease-causing genes. The aim of this study was to develop siRNAs for in vivo silencing of apoCIII and investigate if this results in metabolic improvements comparable to what we have seen using antisense oligonucelotides against apoCIII. Twenty-four siRNAs were synthesized and tested in a dual luciferase reporter assay. The eight best were selected, based on knockdown at 20 nM, and of these, two were selected based on IC50 values. In vivo experiments were performed in ob/ob mice, an obese animal model for diabetes. To determine the dose-dependency, efficacy, duration of effect and therapeutic dose we used a short protocol giving the apoCIII-siRNA mix for three days. To evaluate long-term metabolic effects mice were treated for three days, every second week for eight weeks. The siRNA mix effectively and selectively reduced expression of apoCIII in liver in vivo. Treatment had to be repeated every two weeks to maintain a suppression of apoCIII. The reduction of apoCIII resulted in increased LPL activity, lower triglycerides, reduced liver fat, ceased weight gain, enhanced insulin sensitivity, and improved glucose homeostasis. No off-target or side effects were observed during the eight-week treatment period. These results suggest that in vivo silencing of apoCIII with siRNA, is a promising approach with the potential to be used in the battle against obesity-induced metabolic disorders.

Synthesis, characterization, thermal stability, and in vitro and in vivo degradation study of polycaprolactone and polyglycolide block copolymers

Biodegradable polymer materials are attractive in various biomedical applications. Herein, we report a block aliphatic copolymer, polycaprolactone-block-polyglycolide (PCL-b-PGA, denoted as PCLGA), and explored the polymer composition effect on the thermal and degradation behaviors. Three copolymers with different PCL/PGA weight ratios were obtained by a two-step ring opening polymerization. The chemical structures and compositions of copolymers were studied by NMR and FT-IR. The thermal behaviors were investigated by DSC and TGA. The in vitro degradation in phosphate buffer saline and in vivo degradation as an implant in rats were evaluated and the hygroscopic rate and polymer weight loss changes were monitored in an eight-week period. PCLGA with a higher PCL composition showed a slower degradation in vitro and in vivo. These PCLGAs with different degradation rates could be used as biomedical implants for potential application in drug delivery and tissue repair.

Traffic crash changes following transitions between daylight saving time and standard time in the United States: New evidence for public policy making

Introduction: This study examined the impact of daylight saving time changes on traffic crashes in the United States. Using a data-driven regression analysis approach, the study analyzed 2014–2016 crash data from six states spanning all four major time zones in the contiguous United States. Method: The researchers developed regression models for a number of analysis scenarios and by days of week separately. Based on the crash data, the team used an eight-week impact period for the spring time change and a four-week impact period for the fall time change. Results: The regression analysis showed that the spring time change was followed by an overall crash reduction of 18% during the eight-week period immediately after the time change, with a considerably higher crash reduction for freeway crashes (24%), rural crashes (24%), or non-intersection crashes (21%). The time change back to SDT in fall was followed by a 6% overall crash increase during the following four weeks, with considerably higher increases for freeway crashes (15%), non-intersection crashes (9%), nighttime crashes (28%), single-vehicle crashes (28%), and crashes in urban areas (12%). This study provides additional insights, including in many cases more comprehensive knowledge on how the changes to and from DST each year affect roadway traffic crashes. Practical Applications: The findings of this project further add to the current understanding on how the time changes affect public health in the form of traffic crashes. They also serve as additional evidence for public policy makers to better weigh the benefits and impacts associated with the time changes in the United States for relevant policy makings.

Effect of the otago exercise program on the lower extremity muscle strength in older women

An increased risk of falls in the elderly is associated with decreased muscle mass and strength in the lower limbs. The Otago Exercise Regimen (OEP) is a moderately challenging walking, flexibility, strengthening, and balancing exercise regimen. The Otago Exercise Program has been demonstrated to reduce the incidence of falls in elderly individuals by improving balance and muscular strength. This research sought to ascertain how the Otago Exercise Program influenced the lower limb muscular strength of older women. The research was done from October 2020 to May 2021. 26 individuals, split into a treatment group and a control group (13 people each). The moderate intensity Otago Exercise Program was administered to the treatment group for eight weeks, lasting 30 minutes three times each week. In this study, the parameter that assessed the muscular strength in the lower extremities was examined using the 30 second sit-to-stand (30STS) test. Two measurements are made: once prior to and once following the eight-week OEP period.

Effect of Small-Sided Games with and without the Offside Rule on Young Soccer Players: Reliability of Physiological Demands.

This study aimed to compare the physiological demand between three vs. three small-sided games (SSGs) with (3vs.3WITH) and without (3vs.3WITHOUT) the offside rule, as well as the within- and between-session reliability of this demand. Twenty-four U-17 soccer athletes performed various three vs. three (plus goalkeepers) SSGs with and without the offside rule. The data collection was performed within an eight-week period. Athletes’ heart rate was monitored during the SSG. The variables analyzed were the percentage mean heart rate (HRMEAN%) and the percentage peak heart rate (HRPEAK%). For the analysis of within-session reliability, the mean value of the first two and last two SSG bouts performed within one day were used. The between-session reliability was calculated using the mean value of the four SSG bouts of each SSG type performed on two different days. In both SSGs, the values for reliability were significant and were classified as moderate to excellent. There were no significant differences in the physiological demand among SSG types. We concluded that the offside rule does not influence the physiological demand in a three vs. three SSG and the HRMEAN% and HRPEAK% present moderate to excellent reliability in a three vs. three SSG with and without the offside rule.

Protective and therapeutic effectiveness of taurine supplementation plus low calorie diet on metabolic parameters and endothelial markers in patients with diabetes mellitus: a randomized, clinical trial

BackgroundTaurine supplementation as a sulfur-containing amino acid may attenuate and/or alleviate diabetes-induced complications and endothelial dysfunction via its anti-inflammatory and antioxidant activities. Our purpose was to investigate the effect of Taurine supplementation on endothelial dysfunction markers, oxidative stress, inflammation, and glycemic control in patients with type 2 diabetes mellitus (T2DM).MethodsIn the current clinical trial, 120 patients with T2DM were randomly allocated to take either Taurine (containing 1 g Taurine, n = 60) or placebo (n = 60) three times per day for an eight-week period. Moreover, all patients were on a low-calorie diet. The primary outcome was fasting blood glucose (FBG) and endothelial markers including sera intercellular adhesion molecule 1 (ICAM-1), vascular cell adhesion molecule (VCAM), and matrix metallopeptidase 9 (MMP-9). The secondary outcome was dietary intake, anthropometric indices, serum insulin and Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), total antioxidant capacity (TAC), tumor necrosis factor (TNF), high-sensitivity C-reactive protein (hs-CRP), malondialdehyde (MDA), and lipid profile.ResultsAfter 8 weeks, Taurine-supplemented patients had a considerable decrease in serum insulin and HOMA-IR compared to placebo group. However, Taurine supplementation did not improve other metabolic parameters including lipid profiles, glycated hemoglobin, and fasting blood glucose (FBG). There was a significant decline in MDA, TNF, and hs-CRP levels after these eight-week period of Taurine supplementation. In addition, the Taurine group had fewer serum levels of endothelial dysfunction markers than the placebo group.ConclusionsThe evidence from our study revealed that Taurine supplementation significantly reduced insulin and HOMA-IR, as well as oxidative stress, inflammation, and endothelial markers in individuals with T2DM.Trial registration The protocol of the study was recorded in the Iranian Registry of Clinical Trials (IRCT20180712040438N3).

MakerMinds: An Exploratory Study of Making and Mindfulness Pedagogies

The purpose of this ethnographically informed research study was to explore the integration of making and mindfulness pedagogies in a single curricular intervention (“MakerMinds”) and, in particular, how making engages students in mindfulness content and encourages their independent use of mindfulness tools. Mindfulness programs have long been used to promote mental health in clinical and non-clinical settings. Related research with school-aged children is limited, however, and the problem of how to fully engage them in mindfulness programming remains unsolved. Here, we report on the experiences of 24 Grade 4 students in MakerMinds over an eight-week period. Qualitative data from multiple sources revealed a program successful in engaging students and encouraging their application of mindfulness tools as needed in their daily lives. It also positively impacted conceptual and experiential knowledge of mindfulness and developed students’ agentic awareness of themselves as problem-solving makers and nascent mindfulness practitioners.

A Randomized Controlled Trial With Female Teachers: Are there Differences Between and Within the Outcomes in Voice Therapy Groups With and Without Carryover Strategies?

We investigated if outcomes differ between voice therapy groups systematically using carryover strategies (attempts to generalize new vocal skills outside the clinic) and voice therapy with no emphasis on any generalizing process (here referred to as traditional voice therapy). A randomized controlled trial was conducted. Participants (53 female teachers with voice disorders) were randomly allocated into three groups: Carryover (a group receiving voice therapy using carryover strategies), Trad (a group receiving voice therapy with no emphasis on any generalizing process), Controls (a group on an eight-week non-therapy period). Prior to the trial a direct laryngoscopy was performed with a videolaryngostroboscopy system and/or nasofaryngofiberoscope with stroboscopy. Before and after therapy and at follow-up a voice evaluation protocol was implemented consisting of subjective assessments (Questionnaire on Voice Symptoms, and the Voice Activity and Participation Profile; VAPP), and objective measurements (voice sample recordings, acoustic analysis [SPL, sound pressure level; f0, fundamental frequency; alpha-ratio, tilt of the sound spectrum slope]). No differences were found between the groups. Several significant changes occurred within the groups between initial phase vs. post-therapy and initial phase vs. follow-up. In the Carryover group text reading the alpha-ratio became lower (P=0.011) and spontaneous speech f0 increased (P=0.024) after the therapy and [a:] SPL increased (P=0.042) at follow-up. In the Trad group post-therapy [a:] alpha-ratio became lower (P=0.012) and spontaneous speech f0 decreased (P=0.034). After therapy VAPP scores showed improvement in voice-related quality of life in both therapy groups (Carryover P=0.003; Trad P = 0.01) but only in Carryover at follow-up (P=0.000). Voice symptoms decreased in the Carryover group post-therapy (P=0.001) and at follow-up (P=0.000) and after Controls' eight-week non-therapy period (P=0.003). The results showed that carryover strategies give no additional advantages in voice therapy. However, the decreasing trend in the Carryover group's voice complaints at follow-up would suggest that carryover strategies may have long-lasting effects. The results also confirm that voice therapy is efficient in improving voice-related quality of life.

Muscle fatique and muscle damage in strength training

Background and Study Aim. The aim of this study is to investigate the effects of different types of contractions on muscle damage and muscle fatigue in sedentary individuals.&#x0D; Material and Methods. Thirty healthy male sedentary individuals participated in the study. Strength training in different types of contractions applied in the study was applied 3 times a week for 8 weeks. Before the study, the training loads were determined by making maximal force measurements of all subjects. The 30 subjects participating in the study were divided into 3 groups: isometric (n = 10), concentric (n = 10) and eccentric (n = 10) contraction group. Appropriate amount of blood samples was taken from the elbow vein 2 times from all subjects, before the studies and at the end of the 8-week strength training.&#x0D; Results. It was observed that eight-week strength training did not cause muscle fatigue in all groups and did not create a statistically significant difference (P&gt; 0.05). Strength training with isometric and concentric contractions for eight weeks significantly increased serum lactate dehydrogenase (LDH), C-reactive protein (CRP), myoglobin (Mb), interleukin 6 (IL-6) levels, while concentric strength training significantly reduced serum aspartate amino transferase (AST) levels. Strength training with eccentric contractions significantly increased serum LDH, CRP, AST, Mb and IL-6 levels, while significantly reducing serum tumor necrosis factor alpha (TNF-α) levels. Strength training with eccentric contractions significantly increased serum creatine kinase (CK), CRP, AST, IL-6 and Mb levels compared to strength training with isometric and concentric contractions at the end of the eight-week study period, but did not show the same significant effect in other parameters.&#x0D; Conclusions. As a result, it can be said that eccentric strength training performed in sedentary individuals leads to more muscle damage than isometric and concentric strength training.

Nintendo Switch Joy-Cons' Infrared Motion Camera Sensor for Training Manual Dexterity in People with Multiple Sclerosis: A Randomized Controlled Trial.

Background: The Nintendo Switch® (NS) is the ninth video game console developed by Nintendo®. Joy-Cons® are the primary game controllers for the NS® video game console, and they have an infrared motion camera sensor that allows capturing the patient’s hands without the need to place sensors or devices on the body. The primary aim of the present study was to evaluate the effects of the NS®, combined with a conventional intervention, for improving upper limb (UL) grip muscle strength, coordination, speed of movements, fine and gross dexterity, functionality, quality of life, and executive function in multiple sclerosis (MS) patients. Furthermore, we sought to assess satisfaction and compliance levels. Methods: A single-blinded, randomized clinical trial was conducted. The sample was randomized into two groups: an experimental group who received treatment based on Dr Kawashima’s Brain Training® for the NS® (20 min) plus conventional rehabilitation (40 min), and a control group who received the same conventional rehabilitation (60 min) for the ULs. Both groups received two 60 min sessions per week over an eight-week period. Grip strength, the Box and Blocks Test (BBT), the Nine Hole Peg Test (NHPT), the QuickDASH, the Multiple Sclerosis Impact Scale (MSIS-29), the Trail Making Test (TMT), and the Stroop Color and Word Test (SCWT) were used pre- and post-treatment. Side effects and attendance rates were also recorded. Results: Intragroup analysis showed significant improvements for the experimental group in the post-treatment assessments for grip strength in the more affected side (p = 0.033), the BBT for the more (p = 0.030) and the less affected side (p = 0.022), the TMT (A section) (p = 0.012), and the QuickDASH (p = 0.017). No differences were observed for the control group in intragroup analysis, but they were observed in the NHPT for the more affected side (p = 0.012). The intergroup analysis did not show differences between both groups. Conclusions: Our results show that an eight-week experimental protocol, after using Dr Kawashima’s Brain Training® and the right-side Joy-Con controller for the NS®, combined with a conventional intervention, showed improvements in grip strength, coordination, fine and gross motor function, executive functions, and upper limb functionality in the experimental group. However, no differences were observed when both groups were compared in the intergroup analysis. The addition of Brain Training® for the NS® for the upper limb rehabilitation did not show side effects and was rated with a high satisfaction and excellent compliance in people with MS. Trial registration: This randomized controlled trial has been registered at ClinicalTrials Identifier: NCT04171908, November 2019.

Are you listening? – an observational wake word privacy study

PurposeDigital voice assistants use wake word engines (WWEs) to monitor surrounding audio for detection of the voice assistant's name. There are two failed conditions for a WWE, false negative and false positive. Wake word false positives threaten a loss of personal privacy because, upon activation, the digital assistant records audio to the voice cloud service for processing.Design/methodology/approachThis observational study attempted to identify which Amazon Alexa wake word and Amazon Echo smart speaker resulted in the fewest number of human voice false positives. During an eight-week period, false-positive data were collected from four different Amazon Echo smart speakers located in a small apartment with three female roommates.FindingsResults from this study suggest the number of human voice false positives are related to wake word selection and Amazon Echo hardware. Results from this observational study determined that the wake word Alexa resulted in the fewest number of false positives.Originality/valueThis study suggests Amazon Alexa users can better protect their privacy by selecting Alexa as their wake word and selecting smart speakers with the highest number of microphones in the far-field array with 360-degree geometry.

Effect of intra-session exercise sequence on the load–velocity relationship variables after a concurrent sprint interval and resistance training program

This study aimed to examine the effects of altering the intra-session exercise sequence of a concurrent training program on the load–velocity relationship variables obtained from different compound exercises. Physically active subjects ( n = 24, age = ∼21 years) were assigned to one group that performed sprint interval training (sprints: 4–6; intensity: all-out; duration: 30 s; rest: 4 min) followed by resistance training (exercises: back squat and bench press; sets per exercise: 4–6; load: 60–80% of the one-repetition maximum; repetition in reserve: 6–1; rest: 2 min) (SIT + RT) or another group that performed the opposite sequence (RT + SIT). Exercises modes were separated by 10 min. Both groups trained three times per week over an eight-week period. The individualized load–velocity relationships were assessed before and after training through an incremental loading test during the back squat and bench press exercises and three variables were subsequently calculated: load-axis intercept ( L0), velocity-axis intercept ( v0), and area under the line ( Aline = L0⋅ v0/2). Regardless of exercise sequence, both groups increased L0 (ES range = 0.78–0.91) and Aline (ES range = 0.50–0.55) but decreased v0 (ES range = −0.36 to −0.46) during the back squat exercise, while all load–velocity relationship variables were increased (ES range = 0.04–2.20) during the bench press exercise. The SIT + RT group showed a moderately greater bench press v0 increase compared to the RT + SIT group (ES = −1.07). These results indicate that both intra-session exercise sequences can induce comparable improvements in the load–velocity relationship variables after an eight-week concurrent training program.

Reflection in alignment to professional standards: What did the student teachers highlight?

This study investigates the professional development of elementary student teachers in a teacher education program. Student teaching is a process for pre-service teachers to apply learning in an authentic school context, and one critical aspect of professional development is through reflection. The participants were primarily examined through their weekly reflections on teaching and learning experiences over an eight-week period. Using the state Standards for the Teaching Profession as a framework, the student teachers chose to reflect on topics they were most interested in exploring. Results indicated that the participants gave predominant attention to classroom management; the standards that received the least reflection were organizing curriculum and planning instruction. Analysis of the reflection journals also revealed how the student teachers grew as individuals and in interaction with others in a learning community. Based on the results, implications for teacher education are proposed. Limitations are also discussed.

The Effects of Meteorological Factors on Dengue Cases in Malaysia.

Dengue is a vector-borne disease affected by meteorological factors and is commonly recorded from ground stations. Data from ground station have limited spatial representation and accuracy, which can be overcome using satellite-based Earth Observation (EO) recordings instead. EO-based meteorological recordings can help to provide a better understanding of the correlations between meteorological variables and dengue cases. This paper aimed to first validate the satellite-based (EO) data of temperature, wind speed, and rainfall using ground station data. Subsequently, we aimed to determine if the spatially matched EO data correlated with dengue fever cases from 2011 to 2019 in Malaysia. EO data were spatially matched with the data from four ground stations located at states and districts in the central (Selangor, Petaling) and east coast (Kelantan, Kota Baharu) geographical regions of Peninsular Malaysia. Spearman’s rank-order correlation coefficient (ρ) was performed to examine the correlation between EO and ground station data. A cross-correlation analysis with an eight-week lag period was performed to examine the magnitude of correlation between EO data and dengue case across the three time periods (2011–2019, 2015–2019, 2011–2014). The highest correlation between the ground-based stations and corresponding EO data were reported for temperature (mean ρ = 0.779), followed by rainfall (mean ρ = 0.687) and wind speed (mean ρ = 0.639). Overall, positive correlations were observed between weekly dengue cases and rainfall for Selangor and Petaling across all time periods with significant correlations being observed for the period from 2011 to 2019 and 2015 to 2019. In addition, positive significant correlations were also observed between weekly dengue cases and temperature for Kelantan and Kota Baharu across all time periods, while negative significant correlations between weekly dengue cases and temperature were observed in Selangor and Petaling across all time periods. Overall negative correlations were observed between weekly dengue cases and wind speed in all areas from 2011 to 2019 and 2015 to 2019, with significant correlations being observed for the period from 2015 to 2019. EO-derived meteorological variables explained 48.2% of the variation in dengue cases in Selangor. Moderate to strong correlations were observed between meteorological variables recorded from EO data derived from satellites and ground stations, thereby justifying the use of EO data as a viable alternative to ground stations for recording meteorological variables. Both rainfall and temperature were found to be positively correlated with weekly dengue cases; however, wind speed was negatively correlated with dengue cases.

Covariation between glucocorticoids, behaviour and immunity supports the pace-of-life syndrome hypothesis: an experimental approach.

The biomedical literature has consistently highlighted that long-term elevation of glucocorticoids might impair immune functions. However, patterns are less clear in wild animals. Here, we re-explored the stress-immunity relationship considering the potential effects of behavioural profiles. Thirteen captive roe deer (Capreolus capreolus) were monitored over an eight-week period encompassing two capture events. We assessed how changes in baseline faecal cortisol metabolite (FCM) concentrations following a standardized capture protocol and an immune challenge using anti-rabies vaccination affected changes in 13 immune parameters of innate and adaptive immunity, and whether these changes in baseline FCM levels and immune parameters related to behavioural profiles. We found that individuals with increased baseline FCM levels also exhibited increased immunity and were characterized by more reactive behavioural profiles (low activity levels, docility to manipulation and neophilia). Our results suggest that the immunity of large mammals may be influenced by glucocorticoids, but also behavioural profiles, as it is predicted by the pace-of-life syndrome hypothesis. Our results highlight the need to consider covariations between behaviour, immunity and glucocorticoids in order to improve our understanding of the among-individual variability in the stress-immunity relationships observed in wildlife, as they may be underpinned by different life-history strategies.

Protecting the mental and physical well-being of frontline health care workers during COVID-19: Study protocol of a cluster randomized controlled trial

IntroductionThe COVID-19 pandemic has placed health care workers at unprecedented risk of stress, burnout, and moral injury. This paper describes the design of an ongoing cluster randomized controlled trial to compare the effectiveness of Stress First Aid (SFA) to Usual Care (UC) in protecting the well-being of frontline health care workers. MethodsWe plan to recruit a diverse set of hospitals and health centers (eight matched pairs of hospitals and six pairs of centers), with a goal of approximately 50 HCW per health center and 170 per hospital. Participating sites in each pair are randomly assigned to SFA or UC (i.e., whatever psychosocial support is currently being received by HCW). Each site identified a leader to provide organizational support of the study; SFA sites also identified at least one champion to be trained in the intervention. Using a “train the trainer” model, champions in turn trained their peers in selected HCW teams or units to implement SFA over an eight-week period. We surveyed HCW before and after the implementation period. The primary outcomes are posttraumatic stress disorder and general psychological distress; secondary outcomes include depression and anxiety symptoms, sleep problems, social functioning problems, burnout, moral distress, and resilience. In addition, through in-depth qualitative interviews with leaders, champions, and HCW, we assessed the implementation of SFA, including acceptability, feasibility, and uptake. DiscussionResults from this study will provide initial evidence for the application of SFA to support HCW well-being during a pandemic.Trial registration: (Clinicaltrials.govNCT04723576).

Efficacy of short duration versus conventional electroacupuncture in the treatment of obesity: a randomized crossover study.

To compare the efficacy of short duration electroacupuncture (EA) with conventional EA to reduce weight and other parameters in obese Thai women. A randomized crossover study was conducted in 76 simple obese women. Participants were randomized to undergo either eight weeks of 30-minute EA (EA30) followed by an eight-week washout period, then eight weeks of five-minute EA (EA5), or EA5 followed by a washout period, then EA30. Electro-acupuncture was performed at 14 acupoints for two sessions per week. Participants were randomized to undergo either eight weeks of EA30 followed by an eight-week washout period, then eight weeks of EA5, or EA5 followed by a washout period, then EA30. Electro-acupuncture was performed using a stainless silver needle at 14 acupoints for two sessions per week. The needle was connected to an electric stimulator that delivered a constant current, 40 Hz and 3 mA, for 30 or five minutes according to the assigned treatment period. The primary outcome was the difference in weight reduction between the short-duration and the conventional EA while differences in other anth-ropometric parameters and biochemical parameters were considered as secondary outcomes. After each treatment period, all anthro-pometric characteristics of both groups decreased from the baseline regardless of the treatment sequence, including body weight (1.4-1.8 kg; 0.01), body mass index (0.56-0.70 kg/m ; 0.01), waist and hip circumference, skinfold thickness and body fat percentage as well as the improvement in fasting blood glucose and lipid profiles. There were no significant differences of the treatment effects on anthropometric parameters and biomedical chemistries between conventional and short-duration EA. No adverse effects were reported. Short duration EA at 14 acupuncture points had comparable efficacy to conventional EA in reduction of weight and other anthropometric parameters as well as to improve biochemistry parameters in obese women.

A feasibility study of a pharmacist led proton pump inhibitor deprescribing intervention in older patients in an Irish hospital

Abstract Introduction Proton pump inhibitors (PPIs) are over-prescribed and prescribed inappropriately in the older population and have the potential for long-term adverse effects e.g. increased fracture risk, C. difficile infection, chronic kidney disease and drug interactions (1). Hospitalisation of older patients presents an opportunity for review of the PPI indication and potential for deprescribing. Aim The study aimed to assess the feasibility of a pharmacist led intervention to deprescribe inappropriately prescribed PPIs in patients ≥65 years in an Irish teaching hospital. Methods A multi-component feasibility intervention consisting of an education session for the medical team, followed by pharmacist-led screening of patients for potential PPI deprescribing, was conducted. The education session was delivered by the pharmacist to a geriatric medical team and the content outlined the prevalence of PPI prescribing, potential long-term effects of PPIs, and implementation of a PPI deprescribing algorithm. Over an eight-week period (May-June 2021), new admissions to the geriatric team were screened daily by the pharmacist and PPI prescribing patterns and indications were recorded. Patients ≥65 years were reviewed for PPI appropriateness based on their medical history and use of a PPI deprescribing algorithm (2). If the PPI was eligible for deprescribing (i.e. dose reduction or discontinuation) this was discussed with the geriatric team and the patient’s primary care general practitioner (GP) and the patient. Patients were counselled and educated on this by the pharmacist. Patients whose PPI was deprescribed were followed up at 4- and 12- weeks post deprescribing to assess their symptoms and satisfaction with deprescribing in the interim period. An online survey was sent to the geriatric team doctors evaluating their views on the study process and implementation of PPI deprescribing in practice; data was analysed descriptively using Microsoft Excel®. Written, informed consent was obtained from all patients and doctors involved. Results Of a total of 133 patient charts reviewed over the 8-week period, 94 patients were prescribed a PPI, with esomeprazole 40mg (43/94, 45.7%) being most commonly prescribed PPI, followed by pantoprazole 40mg (17/94, 18.1%). PPIs were inappropriately prescribed as per the indication in 36 cases (36/94, 38.3%). Following GP and Geriatric team discussion, 7/94 (7.4%) of patients were eligible for deprescribing, of which 5 had their PPI dose reduced (5/94, 5.3%). One patient declined the deprescribing, in another case the GP declined the deprescribing recommendation. The 5 patients deprescribed had their esomeprazole 40mg daily dose reduced to 20mg daily. This was sustained at the 12-week follow up and patients reported satisfaction with the change with no negative outcomes reported. Of the 12 geriatric doctors in the study, 6 completed the online survey. The majority reported barriers to PPI deprescribing being uncertainty regarding the indication (5/6) and being unable to monitor the patient after hospital discharge (5/6). All doctors agreed that pharmacists have a positive role to play in implementing PPI deprescribing. Conclusion This study found that esomeprazole 40mg daily was the most commonly prescribing PPI in this hospital cohort, with the majority of PPI prescribing found to be inappropriate according to the indication. The feasibility study resulted in a number of patients having their PPI safely deprescribed with a dose reduction. Despite the limitation of a small sample size and small rates of deprescribing, a strength of the study was that a pharmacist led PPI deprescribing initiative resulted in reducing inappropriate PPI prescribing in older patients, with positive engagement from the geriatric medical team. Further resources and research are required to implement this initiative on a wider scale. References (1) Wilsdon TD, Hendrix I, Thynne TR, Mangoni AA. Effectiveness of Interventions to Deprescribe Inappropriate Proton Pump Inhibitors in Older Adults. Drugs Aging. 2017 Apr;34(4):265-287. doi: 10.1007/s40266-017-0442-1. PMID: 28220380. (2) National Health Service. Proton Pump Inhibitor (PPI): Deprescribing algorithm (adult) [Internet]. [cited 2021 Aug 6]. Available from: https://www.dorsetccg.nhs.uk/Downloads/aboutus/medicines-management/Other Guidelines/prescqipp proton-pump-inhibitor-desprescribing-algorithm.pdf