Equal Time Periods Research Articles

Clearing the Air: Acute Invasive Fungal Rhinosinusitis in Hematologic Cancer Patients.

Air quality has been shown to impact the rates of fungal infection of the airway, causing diseases such as acute invasive fungal rhinosinusitis (AIFRS), particularly in immunocompromised patients. We theorize that patients with hematologic malignancies in units with aging air handling units (AHUs) have a higher attack rate of AIFRS. Retrospective chart review identified patients with hematologic malignancy and AIFRS in two distinct and equal time periods between 2013 and 2022, representing the presence of aging AHUs and new AHUs, respectively. Cubic feet per minute (CFM) air flows, AIFRS attack rates, and clinical data were compared between the two groups and statistical analyses performed. The older AHUs produce air flow of 27,610 CFM and the newer AHUs produce air flow of 80,000 CFM. There were 18 patients with air supplied by older AHUs and 7 patients with air supplied by new AHUs who developed AIFRS. There was a significantly higher AIFRS attack rate for patients supplied by the older AHUs compared with patients supplied by newer AHUs (p = 0.033). The patients supplied by the older AHUs tended to be younger. The white blood cell counts, absolute neutrophil counts, and the mean time to diagnosis did not differ between the two groups. To our knowledge, this is the first study to examine AIFRS in immunocompromised patients' inpatient environment. Further research should explore whether higher CFM AHUs can decrease this disease among our most vulnerable patients. 3 Laryngoscope, 134:4466-4470, 2024.

Improving Clinician Awareness of and Screening for Chagas Disease with an Educational Intervention.

Chagas disease is an underrecognized, chronic, and potentially life-threatening disease caused by the parasite Trypanosoma cruzi. We aimed to improve awareness and screening for Chagas disease among patients from endemic areas using a large safety-net academic hospital system in the United States. We developed an educational intervention consisting of a case-based didactic session presented to physicians, trainees, and other healthcare providers at conferences across different departments. Performance on a knowledge assessment administered before and after the presentation was analyzed with paired Student's t-test for within-subject difference testing. Institutional testing rates for T. cruzi were evaluated for an equal time period (29 months) before and after the start of the intervention. Testing rates were compared by a Welch's unequal variances t-test and by interrupted time series based on multivariate linear regression. Eleven educational sessions were held over the intervention period, and 103 participants completed the pre- and post-presentation surveys. The mean survey scores were 59.2% before the presentation and 96.6% after presentation (P <0.001). Trypanosoma cruzi testing during the postintervention period was significantly higher than testing during the pre-intervention period (171 patients pre-intervention versus 378 patients postintervention [P = 0.015]). Notable increases in testing from the pre-intervention to postintervention periods occurred among midwives (1-68 patients tested) and trainees (57-133 patients tested). Overall, 56/537 (10.4%) nonduplicate T. cruzi commercial screening tests were positive. Testing increased over time, both at an institutional level and within targeted departments. In addition to the educational program, other factors likely influenced expanded testing.

The Sharing of Pandemic-Related Information From U.S. Government Twitter Accounts

The rapid onset of COVID-19 created a desire for information about the virus and government-directed response efforts. This study explores the sharing of Twitter posts from U.S. government officials and organizations during the onset of the COVID-19 pandemic. This study followed two paths of investigation. First, significant differences in the retweet frequency of government sources were determined based on the source (public officials and agencies, Republican- or Democrat-led states) and differentiated by equal time periods (40 days pre- or post-pandemic declaration). The study findings show that the frequency at which government accounts were retweeted in the U.S. was significantly impacted by the pandemic period, with the post-pandemic period significantly more active as governments wrestled with unprecedented economic, policy, and societal concerns related to the crisis. A greater reliance on public officials as opposed to public agencies or departments was seen, as was a greater tendency to retweet the posts of government officials from Democrat-led states. The second path examined the content of government tweets to determine the linguistic factors which predict retweet frequency. Study results found that both positive and negative emotional language in tweets predicted the frequency of retweeting government sources, though the results varied based on the source. The study results provide insight into the government-affiliated information sources users chose to share with their networks as well as the types of language that appeal to citizens during times of crisis.

CLAVICULAR OSTEOTOMY FOR SURGICAL EXPOSURE OF THE SHOULDER JOINT: FUNCTIONAL OUTCOMES, COMPLICATIONS, AND SURGICAL TECHNIQUE. A REGIONAL NZ EXPERIENCE

AimClavicular osteotomy was described as an adjunct to deltopectoral approach for improved exposure of the glenohumeral joint. This study aims to present contemporary outcomes and complications associated with the routine use of clavicular osteotomy by a single surgeon in a regional setting within New Zealand.MethodsA retrospective case series of patients who have undergone any shoulder arthroplasty for any indication between March 2017 to August 2022. This time period includes all patients who had clavicular osteotomy(OS) and patients over an equal time period prior to the routine use of osteotomy as a reference group (N-OS).Oxford Shoulder Score (OSS) and a Simple Shoulder Test (STT) were used to assess functional outcomes and were compared with the reported literature. Operative times and Complications were reviewed.Results66 patients were included in the study. 33 patients in the OS group and 33 in the N-OS group. No difference in age, sex, indications for operative intervention and the surgery provided was identified. No significant difference in operative time between groups (N-OS 121 minutes; OS 128 minutes).No clinically significant difference was identified in the OSS (N-OS; mean 38 vs OS 39) or the STT (N-OS 8.3 vs OS 9). The outcomes scores of both groups are in keeping with published literature.Two post operative clavicle fractures, one prominent surgical knot occurred in the OS that required further surgical intervention. Two cases of localized pain over the clavicle and one case of the prominent lateral clavicle were reported in the OS group. Two cases of localized pain over clavicle reported in the N-OS group.ConclusionUse of clavicular osteotomy is not associated with inferior patient reported. The osteotomy introduces specific risks, however, the study provides evidence that these complications are infrequent and avoidable. Surgeons should feel confident in using this adjunct when exposure to the shoulder is difficult.

Trends in management and outcomes of colon cancer in the United States over 15 years: Analysis of the National Cancer Database.

Management of colon cancer has changed over the last few decades. We assessed the trends in management and outcomes using the US National Cancer Database (NCDB). A retrospective analysis of all patients with colonic adenocarcinoma between 2005 and 2019 was conducted. The cohort was divided into three equal time periods: Period 1 (2005-2009), Period 2 (2010-2014), and Period 3 (2015-2019) to examine treatment and outcomes trends. The primary outcome was 5-year overall survival (OS). The study included 923,275 patients. A significant increase in patients with stage IV disease was noted in Period 3 compared to Period 1 (47.9% vs. 27.9%, respectively), whereas a reciprocal reduction was seen in patients with locally advanced disease (stage II: 20.8%-12%; stage III: 14.5%-7.7%). Use of immunotherapy significantly increased from 0.3% to 7.6%. Mean 5-year OS increased (43.6 vs. 42.1 months) despite the increase in metastatic disease and longer time from diagnosis to definitive surgery (7 vs. 14 days). A reduction in 30-day readmission (5.1%-4.2%), 30- (3.9%-2.8%), and 90-day mortality (7.1%-5%) was seen. Laparoscopic and robotic surgery increased from 45.8% to 53.1% and 2.9% to 12.7%, respectively. Median postoperative length of hospital stay decreased by 2 days. Rate of positive resection margins (7.2%-6%) and median number of examined lymph nodes (14-16) also improved. Minimally invasive surgery and immunotherapy for colon cancer significantly increased in recent years. Patient outcomes including OS improved over time.

The Impact of Overall Intervention Model on Price of Wheat

The analysis of observed data at different time points is prominent to single problems when the scientist studied random sampling data over time restricts the applicability of many traditional statistical methods that require random sampling. The analysis of this data is usually mentioned to the stochastic process, in a special case, if it relates to time, then it is called time series [1]. The aim of our study is to focus on the case of observations that are made at certain times of the year, specifically in the autumn season, in equal periods of time, and we estimate the effect of interference on wheat prices n order to obtain the best predictive model and the best order of this model for the overall effect on the price of wheat for the coming years.

Cyclicity of the Lower Buntsandstein in the eastern part of the Central European Basin: implications for Early Triassic palaeogeography and for geochronological calibration

Lower Buntsandstein small–scale cycles recognized in the Central European Basin (CEB) are readily used for astrochronological calibration of the Early Triassic time scales, although they are not well studied sedimentologically. Three borehole sections from the eastern part of the CEB, forming a south-north transect perpendicular to the basin axis, were studied in terms to better understand the depositional history of the Lower Buntsandstein developed as the Baltic Formation in the studied Polish part of the basin. Eleven sedimentary facies were recognized, based on lithological and sedimentological investigations of 655.7 m of drill cores from the Otyń IG 1, Gorzów Wielkopolski IG 1 and Kamień Pomorski IG 1 boreholes. The facies can be grouped according to a lithological criterion into facies of predominantly siliciclastic lithology (including 9 facies types) and facies of predominantly carbonate lithology (including 2 facies types). Facies analysis allowed to distinguish 8 facies associations of: 1) alluvial fan, 2) playa, 3) sandy-muddy coastal plain, 4) embayment and distal delta, 5) lagoon, 6) sand bars or shoals, 7) ooidal shoals or bars, and 8) offshore. Deepening-upward (DC) and shallowing-upward (SC) sedimentary cycles were recognized in parts of the Baltic Formation, with DCs dominating in the southernmost located Otyń IG 1, and SCs dominating in Gorzów Wielkopolski IG 1, located in the axial part of the basin. Symmetrical cycles are very rare. The statistical significance of the sedimentary cycles is relatively low according to Markov-chain analysis conducted with the phpSedistat software of Stanova et al. (2009). Analysis of small–scale cycles performed on well logs of investigated boreholes and additional boreholes in the vicinity of Otyń IG 1, implementing the earlier study of Becker (2005), showed that the correlation of well-log cycles (GR cycles) and sedimentary cycles is not obvious. GR cycles can be roughly correlated with lithological carbonate–siliciclastic cycles (c-s cycles), reflecting alternations of facies groups of predominantly carbonate and siliciclastic lithology. Calibration of GR cycles to earlier magnetostratigraphic results of Nawrocki (1997) and Becker and Nawrocki (2014) showed that neither the boundaries of GR cycles serve as reference horizons, nor the cycles document equal time periods. All existing depositional models of the Lower Buntsandstein were discussed, stressing the possible simultaneous interaction of allochthonous and autochthonous processes. Moreover, the tectonic overprint of the Central European Basin system during the Early Triassic should be taken into account. The presented results suggest that the Lower Buntsandstein cyclicity of the CEB cannot serve as a basis for astrochronological analysis.

In Tribute: Reflections on the Impact of Professor Michael Turvey on Motor Development

In our tribute to Professor Michael Turvey, we have two parallel goals: 1) to highlight the scientific scope of Turvey’s impact on motor development; and, 2) to expose readers to papers that they may not have read but that might cast new light on age-old questions they confront in their current research on motor development. The paper is divided into two equal time periods. In Part 1, from 1975 to 1999, we trace the emergence and growth of Dynamic Systems/Ecological Realism (perception-action) paradigms. We explain how the existing paradigms in motor development research, the descriptive and information processing paradigms were, in part, replaced by new paradigms whose existence owes much to Michael Turvey and his colleagues. We suggest that this time period was one where Turvey had the most conceptual influence on the field. In Part 2, from 2000 to 2024, we describe how factors, including the emergence of two new paradigms in motor development research may have reduced Turvey’s direct influence. But we also note that there is still much research undertaken that builds off the bases of Dynamic Systems and Perception-Action Coupling approaches including research by Turvey and his students/colleagues. We end with the suggestion that the present generation of motor development researchers may have something to gain by re-/reading research from these perspectives regardless of whether it is directly from Professor Turvey’s pen or from those whom he influenced (or influenced him).

Impact of Regional Network on the Management of STEMI Patients in North Cairo

Abstract Background Worldwide, coronary artery disease (CAD) is the single most frequent cause of death. Over seven million people every year die from CAD. The management of patients with STElevation myocardial infarction (STEMI) is influenced by health care service organizations. Regional STEMI networks for acute myocardial infarction facilitate primary percutaneous coronary intervention (PPCI) and its efficacy in reducing mortality and improving its outcomes. Aim of the Work The aim of the present study was to examine the impact of regional STEMI network on patients' management and on hospital outcomes in north Cairo governorate, Egypt. Methods The present study is a Prospective observational multicenter study that was conducted on 352 patients with STEMI and symptom onset within 48 hours who presented to north Cairo hospitals. The patients were divided into 2 groups, group I in the first six months before establishment of a network between the north Cairo hospitals and group II in the second six months when the network between those hospitals was activated. Comparison was done between the two groups as regards patients' demographics, logistics of presentation and in hospital outcomes. Results The number of patients upon implementation of STEMI network increased from 140 to 212 (51.4%) to the same hospitals with the same facilities and in equal periods of time (6 months). It was found that the mean time of chest pain to first medical contact (FMC) between the two groups before and after establishment of STEMI network did not change, it was 4 hours in both groups (P = 0.36) while the mean door to balloon time improved from 54.3 to 44.1 minutes (P = 0.01). In our study thrombolytic therapy use declined from 36.4% before STEMI network set up to only 7.5% (P &amp;gt; 0.001), Ejection fraction (EF) improved from 51.3% to 55.4% (P &amp;gt; 0.001), mitral regurge (MR) also improved upon establishment of STEMI network from 53.6% to 78.8 with (P &amp;gt; 0.001), the mean CCU stay in group II was 2 days versus 3 days before implementation of STEMI network (P &amp;gt; 0.001), the mean door in door out from the spokes was 40 minutes. In-hospital mortality improved upon establishment of STEMI network from 6.4% to 2.8% (P = 0.10). Conclusion The establishment of the STEMI network in Egypt is feasible and can lead to improvement of patients' outcomes. Thrombolytic therapy was no longer the main reperfusion therapy and primary PCI was offered to most patients after establishment of STEMI network.

KERALIYA CONVENTIONAL TREATMENT MODALITIES AND SANSARJANA KARMA FOR PEDIATRICS; SHORT REVIEW

Ayurveda, an ancient Indian System of Medicine, has been in mode from times immemorial to impart natural healing for various ailments. This system is believed to be quite safe and free from side effects as it is more close to nature. The development of Ayurveda in Kerala is particularly noted for its origins in non-brahminical traditions even before the entry of classical Ayurveda. Selected few brahmin households, named Ashtavaidyas, carried forward Ayurvedic tradition by practicing it as a health care service as well as by teaching its principles in the unique Gurukula tradition. The traditional practitioners of Ayurveda considered Ashtangahridaya as a primary text. .Ayurveda physicians in the state developed simplified procedures of therapies of Kerala without violating the fundamentals of Ayurveda. Sirodhara, Pizhichil, Chauthi thirumal, Navarakizhi, Thalapothichil, Pachakizhi and Podikizhi are some of the Kerala special Ayurvedic procedures developed in Kerala. After samshodhana, the expulsion of doshas and mala from body impression of Agni converted into manda(mildest form) type1, hence cannot tolerate the caliber of food articles. This procedure helps to boost the agni gradually and digestive power turn into more powerful and stable by tiny fire with the help of vayu (air) 2 The disease child should take complete rest for an equal period of time for which he has undergone the therapeutic procedure. Samsarjana krama is done as the disease child requires to regain the strength of dhatus and to come to normalcy. KEY WORDS – Agni, Dhathu, Keraliya treatments, Sansarjana Karma, samshodhana

Effects of the COVID-19 Pandemic on Primary Health Care for Chronic Conditions in Canada: Protocol for a Retrospective Pre-Post Study Using National Practice-Based Research Network Data.

Since the COVID-19 pandemic began, there have been concerns that interruptions to the health care system may have led to changes in primary care, especially for care of chronic conditions such as diabetes and heart failure. Such changes may have longer term implications for population health. This study aims to describe the impacts of the COVID-19 pandemic on indicators of primary care access, comprehensiveness, and appropriateness among adult patients, as well as on specific indictors of chronic conditions. Additionally, this study aims to determine whether any identified changes were associated with patient sociodemographic characteristics and multimorbidity. This is a retrospective, single-arm, pre-post study using Canadian Primary Care Sentinel Surveillance Network (CPCSSN) data. CPCSSN is a research network supported by a primary care electronic medical record database, comprising over 1500 physicians and nearly 2 million patients. We are examining changes in care (eg, frequency of contacts, laboratory tests and investigations, referrals, medications prescribed, etc) among adults. We will also examine indicators specific to evidence-based recommendations for care in patients with diabetes and those with heart failure. We will compare rates of outcomes during key periods of the pandemic between March 13, 2020, and December 31, 2022, with equal time periods before the pandemic. Differences will be examined among specific subgroups of adults, including by decade of age, number of comorbidities, and socioeconomic status. Regression models appropriate to outcome distributions will be used to estimate changes, adjusting for potential confounders. This analysis is part of a mixed-methods study with a qualitative component investigating how patients with diabetes with or without concurrent heart failure perceived the impact of the pandemic on access to primary care and health care-related decisions. This study was approved by the Hamilton Integrated Research Ethics Board (14782-C). The start date of this study was October 5, 2022, and the prospective end date is January 31, 2024. As of May 2023, the study cohort (n=875,934) is defined, data cleaning is complete, and exploratory analyses have begun. Extended analyses using 2022 data are planned once the new data becomes available. We will disseminate results through peer-reviewed publications and academic conference, as well as creating evidence briefs, infographics, and a video for policy maker and patient audiences. This study will investigate whether the COVID-19 pandemic has resulted in changes in the provision of primary care in Canada and whether these potential changes have led to gaps in care. This study will also identify patient-level characteristics associated with changes in care patterns across the COVID-19 pandemic. Indicators specific to chronic conditions, namely diabetes and heart failure, will also be explored to determine whether there were changes in care of these conditions. ClinicalTrials.gov NCT05813652; https://clinicaltrials.gov/ct2/show/NCT05813652. RR1-10.2196/49131.

სოციალურ-ეკონომიკური ფაქტორების გავლენა შობადობის თანამედროევე ტენდენციებზე

სოციალურ-ეკონომიკური ფაქტორების გავლენა შობადობის თანამედროევე ტენდენციებზე

HEMODIALYSIS EFFECTS ON AUTONOMIC FUNCTION: RESULTS OF LINEAR AND NON-LINEAR ANALYSIS OF HEART-RATE-VARIABILITY AT REST AND IN RESPONSE TO PHYSICAL AND MENTAL STRESS TESTS

Objective: Cardiac arrhythmias are the most common cause of death in hemodialysis. Autonomic dysfunction plays a central role in this arrhythmogenic background. Previous studies on hemodialysis-related changes in heart-rate-variability(HRV) give contradictory results. This study investigated HRV indices both at rest and in response to physical and mental stimulation maneuvers at multiple time-points around and during the hemodialysis procedure. Design and method: Autonomic function was assessed by linear and non-linear HRV indices at pre-dialysis, during-dialysis(3 equal time-periods), post-dialysis, and on the non-dialysis day in 36 hemodialysis patients. Continuous measurement of beat-by-beat heart-rate was recorded with Finometer-PRO(The Netherlands) at rest and after orthostatic, sit-to-stand, handgrip and mental-arithmetic test. Results: The RMSSD, SD1, and SD2 indices significantly increased during dialysis(early-HD, mid-HD, late-HD periods) compared with the pre-dialysis levels(p&lt;0.05) and returned to baseline post-dialysis(RMSSD: 54.39±83.73 vs 137.98±109.53* vs 119.85±97.34* vs 144.47±88.74* vs 85.82±121.43msec, *p&lt;0.05 vs pre-dialysis and post-dialysis). No differences were detected in the above indices between the pre-dialysis and non-dialysis day. However, post-dialysis, the HRV responses to orthostatic and sit-to-stand tests were more exaggerated than in the pre-dialysis measurements (p&lt;0.05). The HRV responses both at resting and physical tests in the non-dialysis day were similar to the pre-dialysis levels. HRV indices in mental-arithmetic test during hemodialysis were much higher than at the non-dialysis day(RMSSD: 77.05 (180.41) vs 19.75 (105.47)msec; p = 0.031) were detected. Conclusions: Hemodialysis causes marked changes in autonomic function. Resting HRV indices return to baseline post-dialysis, but HRV responses to physical stress remain exaggerated and return to baseline on the non-dialysis day. Detecting patients with significant autonomic dysfunction may help towards reduction of arrhythmia risk through individualized approaches.

MP28-01 CYTOREDUCTIVE NEPHRECTOMY PERIOPERATIVE OUTCOMES HAVE SIGNIFICANTLY IMPROVED IN RECENT YEARS

You have accessJournal of UrologyCME1 Apr 2023MP28-01 CYTOREDUCTIVE NEPHRECTOMY PERIOPERATIVE OUTCOMES HAVE SIGNIFICANTLY IMPROVED IN RECENT YEARS Arighno Das, Daniel Shapiro, Jose Karam, Viraj Master, Philippe Spiess, Jay Raman, Ashanda Esdaille, Logan Zemp, Pranav Sharma, Wade Sexton, Datta Patil, Glenn Allen, Surena Matin, and E. Jason Abel Arighno DasArighno Das More articles by this author , Daniel ShapiroDaniel Shapiro More articles by this author , Jose KaramJose Karam More articles by this author , Viraj MasterViraj Master More articles by this author , Philippe SpiessPhilippe Spiess More articles by this author , Jay RamanJay Raman More articles by this author , Ashanda EsdailleAshanda Esdaille More articles by this author , Logan ZempLogan Zemp More articles by this author , Pranav SharmaPranav Sharma More articles by this author , Wade SextonWade Sexton More articles by this author , Datta PatilDatta Patil More articles by this author , Glenn AllenGlenn Allen More articles by this author , Surena MatinSurena Matin More articles by this author , and E. Jason AbelE. Jason Abel More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003256.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Few data are available describing perioperative outcomes for cytoreductive nephrectomy (CN) or how changes in patient selection may have impacted modern cohorts. This study investigated factors associated with perioperative outcomes in a multi-institutional cohort of patients treated with CN. METHODS: Data was analyzed for metastatic renal cell carcinoma patients treated with CN at 6 tertiary centers from 2005-2019. Outcomes included: Clavien-Dindo complications, mortality, length of hospitalization, and 30-day readmission rate. Multivariable logistic regression was used to evaluate variables associated with perioperative outcomes. Patients were stratified into 3 equal time periods to evaluate changes in outcomes over time. RESULTS: A total of 1,272 patients were treated with CN at 6 centers including 369 (29%) from 2005-2009, 557 (44%) from 2010-2014, and 346 (27%) from 2015-2019. Patients treated in 2015-2019 vs 2005-2009 were less likely to have received pre-surgical systemic therapy (19% vs 26%, p=0.02). Perioperative outcomes are shown in Table. Mortality at 90 days was lower for patients treated in 2015-2019 vs 2005-2009 (5% vs 10%, p=0.02). Patients treated in 2015-2019 vs 2005-2009 had lower overall (22% vs 39%, p<0.001) and major (Clavien-Dindo ≥ 3) complications from surgery (10% vs 16%, p=0.02). Median hospital stay was shorter for patients treated 2015-2019 vs 2005-2009 (4 days vs 5 days, p<0.001) but 30-day readmission rate was also higher (12% vs 7%, p=0.02). On multivariable analysis, patients undergoing CN in 2015-2019 had significantly lower odds of major complications (OR 0.57, 95%CI 0.36-0.90) and 90-day mortality (OR 0.49, 95%CI 0.27-0.89) compared to undergoing CN in 2005-2009. Receipt of presurgical systemic therapy was not associated with increased odds of high-grade complications (OR 0.79, 95%CI 0.52-1.19). CONCLUSIONS: In this large multi-institutional study, perioperative complications have significantly decreased over time. Prospective studies should investigate how to further improve outcomes and select patients. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e369 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Arighno Das More articles by this author Daniel Shapiro More articles by this author Jose Karam More articles by this author Viraj Master More articles by this author Philippe Spiess More articles by this author Jay Raman More articles by this author Ashanda Esdaille More articles by this author Logan Zemp More articles by this author Pranav Sharma More articles by this author Wade Sexton More articles by this author Datta Patil More articles by this author Glenn Allen More articles by this author Surena Matin More articles by this author E. Jason Abel More articles by this author Expand All Advertisement PDF downloadLoading ...

385. Impact of the COVID-19 Pandemic First Wave on Clostridioides difficile Infection

Abstract Background Clostridioides difficile infection (CDI) is the leading cause of nosocomial diarrhea and a costly burden on the healthcare system. The COVID-19 pandemic brought enhanced infection control measures that could hypothetically decrease CDI transmission. Nonetheless, diarrhea secondary to COVID-19 and increased usage of broad-spectrum antibiotics could potentially increase testing for or frequency of CDI. We aimed to assess variations in CDI testing and frequency during the first surge of the COVID-19 pandemic in a tertiary community medical center in the Southern United States. Methods Records from adult patients were retrospectively reviewed at Princeton Baptist Medical Center, Birmingham, AL. Three groups spanning equal time periods were created based on the CDC COVID-19 rate curves for Alabama: PPG (pre-pandemic, 03/01/2020 to 05/31/2020), PG (pandemic, 06/01/2020 to 08/31/2020), and SCG (seasonal control, 06/01/2019 to 08/31/2019). We included patients ≥ 18 years old and excluded readmissions and follow-up visits. We determined the frequency, testing rates, and positivity rates for CDI in each group to assess their differences. Also, we measured the rate of coinfection between C. difficile and SARS-CoV-2. CDI cases were defined as positive toxin enzyme-linked immunosorbent assay (EIA) and glutamate dehydrogenase (GDH), or positivity of either in addition to positive nucleic acid amplification test (NAAT). Differences in frequencies and rates across groups were compared with Fisher exact test. Results Overall, 7,252 hospitalized patients and 29,671 outpatients were included (Figure 1). No outpatient CDI cases were detected. Outpatient testing rates were: PPG 3 (0.05%), PG 4 (0.05%), and SCG 9 (0.06%). Among inpatients, 3,912 (53.9%) were female with a mean ± SD age of 61.2 ± 17.5 years. Overall, CDI frequency, testing rates, and positivity rates did not vary significantly among all groups (Table 1). Among those tested, the only case of C.difficile/SARS-CoV-2 coinfection corresponded to PPG. Figure 1:Patient distributionTable 1:Frequency of CDI and COVID-19 infection in inpatients Conclusion There were no statistically significant differences in CDI frequency, or positivity rate between the pre-pandemic, pandemic, and seasonal control groups for inpatients. No CDI cases were detected in outpatients. This is likely due to a low testing rate in our population. Disclosures All Authors: No reported disclosures.

Hemodialysis Effects on Autonomic Function: Results of Linear and Nonlinear Analysis of Heart Rate Variability at Rest and in Response to Physical and Mental Stress Tests

Introduction: Cardiac arrhythmias are the most common cause of death in hemodialysis. Autonomic dysfunction plays a central role in this arrhythmogenic background. Previous studies on hemodialysis-related changes in heart rate variability (HRV) give contradictory results. This study investigated HRV indices both at rest and in response to physical and mental stimulation maneuvers at multiple time-points around and during the hemodialysis procedure. Methods: Autonomic function was assessed by linear and nonlinear HRV indices at predialysis, during dialysis (3 equal time-periods), postdialysis, and on the nondialysis day in 36 hemodialysis patients. Continuous measurement of beat-by-beat heart rate was recorded with Finometer-PRO (The Netherlands) at rest and after orthostatic, sit-to-stand, handgrip, and mental-arithmetic test. Results: The RMSSD, SD1, and SD2 indices significantly increased during dialysis (early-HD, mid-HD, late-HD periods) compared with the predialysis levels (p < 0.05) and returned to baseline postdialysis (RMSSD: 54.39 ± 83.73 vs. 137.98 ± 109.53* vs. 119.85 ± 97.34* vs. 144.47 ± 88.74* vs. 85.82 ± 121.43msec, *p < 0.05 vs. predialysis and postdialysis). No differences were detected in the above indices between the predialysis and nondialysis day. However, postdialysis, the HRV responses to orthostatic and sit-to-stand tests were more exaggerated than in the predialysis measurements (p < 0.05). The HRV responses both at resting and physical tests in the nondialysis day were similar to the predialysis levels. HRV indices in the mental arithmetic test during hemodialysis were much higher than at the nondialysis day (RMSSD: 77.05 [180.41] versus 19.75 [105.47] msec; p = 0.031). Conclusions: Hemodialysis causes marked changes in the autonomic function. Resting HRV indices return to baseline postdialysis, but HRV responses to physical stress remain exaggerated and return to baseline on the nondialysis day. Detecting patients with significant autonomic dysfunction may help towards reduction of arrhythmia risk through individualized approaches.

Drought Indication in Lake Hawassa Watershed, Southern Ethiopia

Trend analysis was conducted by using nonparametric trend tests (Mann-Kendall and Sen’s slope). Lake Hawassa watershed station showed statistically significant downward trend from January to April, October, and December, and upward trend from May up to September and November. For the metrological drought severity and occurrence analysis, SPI at 3 month time scales was applied by dividing the whole period in to seven equal time periods. By analyzing the drought severity, it was observed that drought severity is increasing with time for near normal except for 2070s and 2080s, increasing with time for moderate drought, and constant for extreme droughts 2020s and 2030s and vice versa for severe drought. The drought occurrence in the study area experience mostly near normal drought that account at least 43% for all time periods, severe that account at least 27%, moderate that account at least 11% and null except for 2020s and 2030s for extreme drought. The observed inter-annual variability in the study area mostly experienced near normal inter-annual variability (about 73.33%). Keywords: drought, Climate change, SPI and Lake Hawassa watershed DOI: 10.7176/JETP/12-4-01 Publication date: October 31 st 2022

Arterial thoracic outlet syndrome: a 30-year experience in a high-volume referral center.

The purpose of this study was to assess the clinical presentation and contemporary management of arterial thoracic outlet syndrome (TOS) in high-volume referral center. We conducted a retrospective review of a prospectively maintained database of patients with TOS of any etiology between January 1st 1990 and 2021. Supra-, or combined supra-/infraclavicular approaches have been used for decompression/vascular reconstructions. The group was divided into two equal time periods: period 1 (1990-2006, N.=27) and period 2 (2006-2021, N.=36). Sixty-three consecutive patients underwent surgical treatment due to arterial TOS. Period 2 had more patients who were asymptomatic (N.=16, 44.4% vs. N.=0, 0%, P<0.001) and those presenting with critical hand ischemia (N.=12, 33.3% vs. N.=0, 0%, P=0.01), while acute limb ischemia was more common in period 1 (N.=16, 59.2% vs. N.=5, 13.9%, P<0.001). SA compression without lesion was more common in period 2 (N.=16, 44.4% vs. N.=0, 0%, P<0.001), while SA intimal damage with mural thrombus formation was more common in the period 1 (N.=12, 44.4% vs. N.=1, 2.7%, P<0.001). Decompression as an isolated procedure was performed in 25.4% (N.=16) of all asymptomatic patients, while combined decompressive and vascular procedure in 71.4% (N.=45) of patients. The most common postoperative complication was pneumothorax (N.=7, 11.1%). The supraclavicular approach with its modifications provides adequate decompression and allows also repair or reconstruction of the SA, as well as complete additional revascularization of the upper extremity without the need for further patient repositioning. While treatment methods and early outcomes have not changed significantly over time, there has been a trend towards different clinical and SA pathomorphological presentation.

Time Series Cleaning Methods for Hospital Emergency Admissions

Due to the nature of hospital emergency services, density cannot be easily estimated. It is one of the important issues that should be planned for emergency service managers to have sufficient resources continuously in services that develop suddenly, and emergency interventions are made for human life. Effective and efficient management and planning of limited resources are important not only for hospital administrators but also for people who will receive service from emergency services. In this situation, estimating the number of people who will request service in the emergency service with the least error is of great importance in terms of resource management and the operations carried out in the emergency services. The density of patients coming to the emergency department may vary according to the season, special dates, and even time zones during the day. The aim of the study is to show that more successful results will be obtained because of processing the time series by considering the country and area-specific features instead of the traditional approach. In this paper, the patient admission dataset of the public hospital emergency service in Turkey was used. Data cleaning and arranging operations were carried out by considering the official and religious special days of Turkey and the time periods during the day. The data set is first handled holistically, and its performances are measured by making predictions with the LSTM (Long Short Term Memory) model. Then, to examine the effect of time zones, performance values were calculated separately by dividing each day into 3 equal time zones. Finally, to investigate the effect of triage areas on the total density, the model performance was measured by dividing the data forming each time zone into 3 different triage areas in 3 equal time periods. Three stages were applied both on the raw data set and on the data created by extracting the official, religious holidays, and weekend data specific to Turkey. According to the MAPE (Mean Absolute Percentage Error) and RMSE (Root Mean Square Error) results, more successful results are obtained thanks to the cleaning and editing processes. Thanks to the study, it is thought that the data sets used for demand forecasting studies in the health sector will produce results closer to reality by determining and standardizing the purification criteria in this way.

Intraoperative opioid and analgesic adjuvant administration practice patterns following implementation of an enhanced recovery after surgery protocol for laparoscopic donor nephrectomy

Study objectiveThe primary aim of this study is to understand how intraoperative medication administration patterns change in response to ERAS® protocol implementation for patients who underwent laparoscopic donor nephrectomy. DesignSingle-center, retrospective analysis of laparoscopic donor nephrectomy patients. SettingLarge tertiary academic medical center. PatientsWe divided all cases of laparoscopic donor nephrectomies (n = 929) over seven years into three approximately equal time periods: Pre-ERAS 1 (n = 317), Pre-ERAS 2 (n = 297) and Post-ERAS (n = 315). MeasurementsWe examined patient demographics, intraoperative opioid and non-opioid pain adjuvant administration, Post Anesthesia Recovery Unit (PACU) pain scores and opioid use as well as PACU and hospital lengths of stay (LOS). Main resultsSegmented regression analysis of interrupted time series was utilized to evaluate the association of ERAS protocol implementation with the amount of intraoperative opioid and non-opioid pain adjuvant use. In adherence to our institutional ERAS protocol, there was a significant reduction in intraoperative fentanyl use after ERAS protocol of −70.2μg (95% CI -106.0, −34.2, p < 0.001) and a significant increase in intraoperative hydromorphone use of 0.47 mg (95% CI 0.284, 0.655, p < 0.001). However, in contrary to our ERAS protocol, we found no significant change in odds of receiving IV acetaminophen OR 1.31 (95% CI 0.450, 3.76, p = 0.613) or IV ketorolac OR 1.65 (95% CI 0.804, 3.41, p = 0.172) after ERAS protocol implementation. We found a significant reduction in PACU opioid use of −9.68 Morphine Milligram Equivalents (MME) (95% CI -17.1, −2.31, p = 0.010) but no significant change in PACU initial pain score, PACU LOS and hospital LOS. ConclusionsWe examined intraoperative practice pattern changes by anesthesiologists in response to ERAS protocol implementation for laparoscopic donor nephrectomies. Our results suggest that there was a variable uptake of recommendations from ERAS protocol. While ERAS protocols are often studied as a bundle of best practice recommendations, understanding the variability of provider adherence represents an important future research direction for the ERAS initiative.