Extra Days Research Articles

Optimizing Lumefantrine Dosing for Young Children in High-Malaria-Burden Countries Using Pharmacokinetic-Pharmacodynamic Simulations.

Artemether-lumefantrine is the most widely used treatment for uncomplicated malaria and it is dosed based on weight bands according to World Health Organization (WHO) guidelines. However, children are vulnerable to underdosing. Inadequate dosing can lead to treatment failure and drug resistance. Nutritional parameters for 372 363 children <5 years old in 25 high-malaria-burden countries were acquired from the Demographic and Health Surveys program. Prevalence of attaining day 7 lumefantrine concentrations ≥200 ng/mL and remaining reinfection free for 42 days were evaluated using a simulation-based approach with a population pharmacokinetic-pharmacodynamic model. Besides the WHO-recommended lumefantrine dosing regimen (twice daily for 3 days), we explored 3 adjusted regimens: extended (2 extra days of dosing), increased (1 extra 120-mg tablet per dose), and intensified (thrice daily for 3 days). We also explored an alternative method dosing malnourished children based on expected weight for age. We estimated that 75% of children reached the 200 ng/mL lumefantrine threshold and 77% were malaria free for 42 days when using WHO treatment guidelines. By switching to the alternative dosing method, 5% more children achieved target lumefantrine levels; 22% more achieved the target using the alternative dosing and the extended regimen. With combined alternative plus extended dosing, 97% of children reached 200 ng/mL lumefantrine and 88% were malaria free for 42 days. This study highlights the inadequacies of weight-based lumefantrine dosing for young and underweight children and supports the need of clinical trials using extended dosing based on expected weight in malnourished children.

Management of Glucocorticoid-Induced Hyperglycemia in Cancer Patients: A Feasibility Study.

Glucocorticoids are commonly used in the management of patients with hematological and solid malignancies. However, their use may be associated with impaired glycemic metabolism and increased treatment-related morbidity and mortality. This study aimed to examine the feasibility and acceptability of a nurse-led model of care (MOC) for screening and managing glucocorticoid-induced hyperglycemia (GIH) in non-diabetic patients requiring high-dose glucocorticoid (HDG) therapies, as well as patients' and health professionals' experiences with the MOC. This study was a single-site feasibility study. Patients with hematological or oncological malignancies who were >18 years of age, receiving a chemotherapy regimen including HDGs, had no prior diagnosis of diabetes or prediabetes, and were not at the end of life were considered eligible for this study. Participants were recruited from a district hospital's Cancer Centre in Australia. All consenting participants were screened for diabetes and were provided with a blood glucose meter to monitor their blood glucose levels (BGLs) four times a day on the days of glucocorticoid therapy (GT) plus one extra day following GT, for the first four cycles of their treatment, to screen for the presence of GIH. Feasibility and acceptability were assessed using rates of consent, study completion, and staff and patient surveys. Forty-eight percent (35/74) of patients approached consented to participate in the study and had screening tests for preexisting diabetes. None were diagnosed with diabetes. Six out of 35 patients withdrew, and 10/29 patients did not complete the recommended BGL monitoring. Thirteen percent (4/29) of patients developed GIH. The most common reasons for non-participation and study withdrawal were related to the self-monitoring of BGLs. While clinical stakeholders found the MOC feasible and acceptable, the results of this study suggest that alternative methods for encouraging self-monitoring of BGL and monitoring the presence of GIH during high-dose chemotherapy need to be explored to address issues associated with adherence and sustainability.

Analysis of the impact of a rhinologist-assisted endoscopic approach on a single neurosurgeon’s outcomes in transsphenoidal resection of pituitary adenomas

ObjectivesDetermine the improvements in outcomes of transsphenoidal pituitary adenoma resection following addition of a skull base rhinologist to the neurosurgical team. DesignAll patients that underwent transsphenoidal resection of pituitary adenoma were identified. Demographic data, Otolaryngology (ENT) involvement, initial adenoma size, extent of resection, hormonal secretion status, visual field exam, post-operative DI, CSF leak, recurrence, need for nasoseptal flap (NSF), re-operation rate were all collected. A linear-regression model adjusteds for confounders. SettingA single academic institution Participants271 patients who underwent transsphenoidal surgery between 2015 and 2020.Main Outcome MeasuresThe main outcome measures were Extent of Resection and Endocrinologic remission. ResultsOf the 271 patients identified, 228 (84 %) patients had macroadenomas, one-third of patients presented with bitemporal hemianopsia, and 27 % (72) were hormonally active. For these and demographics there were no statistically significant differences between the microscopic or endoscopic approach (EEA) groups. For patients with cavernous sinus invasion of >50 %, EEA was more likely to achieve gross total resection (GTR) (OR 2.6; p<0.001). For patients who had prior sellar surgery, EEA was 2.5x more likely to get a GTR (p=0.05). The EEA approach resulted in an extra hospital day (1–2 vs 2–3 p<0.05) and surgery lasted an additional hour (1.17 vs 2.5, p<0.05), but did not require fat grafts or lumbar drains on a routine basis. ConclusionsWhile the operating time and LOS were longer, the EEA approach performed by two specialized co-surgeons demonstrates superior value for adenomas that have had a prior surgical attempt or with significant cavernous sinus invasion.

Strategic cultivar and sowing time selection for weed management and higher redgram productivity in semi-arid Indian regions

IntroductionRedgram (Cajanus cajan L. Mill sp.), a leguminous crop commonly grown in tropical and subtropical climates, is highly valued for its high protein content (21%), which contributes significantly to food and nutritional security. However, its production faces challenges primarily due to terminal dryness experienced during critical growth stages because of changing rainfall patterns. To overcome this, adaptive techniques become imperative as the productivity of this crop is intricately linked to environmental factors and the crop’s growth cycle.MethodsHence, the field experiment was conducted at the National Pulses Research Centre, Vamban, Pudukkottai, Tamil Nadu, in South India under rainfed condition, during the kharif (monsoon) seasons of 2017–18 and 2018–19. The primary objectives were to determine the optimal sowing time and identify suitable redgram cultivars, especially in the context of the late onset of the monsoon in Tamil Nadu, a common issue under changing climate conditions. The experiments tested six different sowing dates with three redgram cultivars.Results and discussionThe findings highlighted the substantial influence of different redgram cultivars and sowing times on the crop’s growth characteristics and yield. Among the six sowing dates tested, planting in later half of June (S6) resulted in notably higher plant height (201 cm), a greater number of pods per plant (287), a seed yield of 1,112 kg ha−1, and a benefit-cost ratio of 2.61 Notably, this sowing period (S6) demonstrated comparable performance with the treatment of redgram sowing in the latter part of September (S4). CO 6 (V1) is the most productive of the three redgram cultivars, with the highest mean pant height (200 cm), number of pods per plant (237), grain yield (1,017 kg ha−1), and benefit cost ratio (2.38). Extended phenological phases along with extra days to reach phenological stages could account for the increased yield in comparison to the other cultivars. Among the two short-duration cultivars, VBN (Rg) 3 (V3) had a significantly higher mean grain yield of 958 kg ha−1 with the benefit-cost ratio of 2.24. Even though CO 6 (V1) obtained a higher yield due to its long duration nature, it matured in 187 days whereas VBN (Rg) 3 (V3) matured within 129 days. Consequently, the short-duration redgram cultivars emerge as highly suitable choices for integrating into crop sequences, thereby augmenting farm cropping intensity.

6960 A Fracture Liaison Service To Address Vitamin D Deficiency For Patients Hospitalized For Osteoporotic Fracture

Abstract Disclosure: X. Sun: None. B. Leder: None. T.V. Ly: None. E. Franco-Garcia: None. M.B. Bolster: Grant Recipient; Self; Rheumatology Research Foundation Clinician Scholar Educator Award; Genentech, Cumberland, Inc, Corbus, Mitsubishi. Other; Self; Honoraria: The Merck Manual, American Board of Internal Medicine, Practice Update. W. Fan: None. Context: A Fracture Liaison Service (FLS) provides an important mechanism to address vitamin D deficiency (VDD) which is commonly found in patients hospitalized with a fragility fracture. Objectives: To study the prevalence of VDD and its associated clinical outcomes among patients hospitalized for osteoporotic fracture. To explore inpatient strategies of vitamin D repletion in the immediate post fracture setting. Design, Setting and Patients: An observational study of patients admitted to the Massachusetts General Hospital (MGH) with fractures between January 2016 to October 2023 who were cared by the FLS. Exposures and Intervention: A vitamin D repletion regimen consisting of ergocalciferol 50,000 international units (IU) oral daily for a number of days followed by maintenance cholecalciferol of 1000-1500 IU daily was studied in a subset of patients with VDD. Main Outcomes and Measures: Prevalence of VDD among MGH FLS patients. Efficacy of inpatient daily ergocalciferol administration to raise serum 25OHD. Results: Of the 2,951 consecutive patients, 724 (24.53%) were vitamin D deficient as defined by serum 25OHD level of ≤19ng/ml. Men (252 of 897, or 28.09%) were more likely than women (472 of 2,054, or 22.98%) to have VDD (p = 0.003). VDD was seen 41.79% (117 of 280), 24.41% (332 of 1,360) and 20.98% (275 out 1,311) of patients of ≤59, 60-79, and ≥80 years old, respectively (p &amp;lt; 0.00001).Of the 1,303 patients with hip fragility fractures, 327 (25.09%) had VDD. Patients with VDD, despite being younger (78.55±11.75 vs. 80.28±10.47, p=0.018), had longer average length-of-stay (aLOS) than those without VDD did (8.37±7.35 vs. 7.23±4.78 days, p=0.009). Re-admission and non-union rates up to two years following the index hip fracture were not different between the two groups.Among 32 patients, without known malabsorption or liver cirrhosis, who had 25OHD levels available before and after ergocalciferol treatment, each dose of ergocalciferol, on average, raised serum 25OHD by 3.62±2.35 (m±sd) ng/ml. Daily ergocalciferol administration did not change serum calcium and creatinine levels.Patients with chronic liver disease (CLD), who had higher prevalence of VDD (64 of 156 patients, or 41.04%), showed impaired per-dose-of-ergocalciferol 25OHD response (0.87±0.92. n=10) ng/ml. Conclusions and Relevance: Nearly 25% of patients hospitalized for osteoporotic fractures, cared for by MGH FLS, had VDD. Male sex, younger age, and CLD were associated with a higher prevalence of VDD. VDD was associated with, on average, one extra day of hospital stay among patients admitted for hip fracture. Daily ergocalciferol, with each dose of 50,000 IU raising serum 25OHD level by 3-4 ng/ml, followed by maintenance dose of cholecalciferol of 1000 to 1500 IU is potentially a practical way to quickly replete vitamin D among patients with VDD hospitalized for fracture. Presentation: 6/3/2024

Pricing effects of extreme high temperature: Evidence from municipal corporate bonds in China

Climate change and the escalation of extreme weather events jeopardize every corner of the globe. This paper investigates the impact of extreme high temperatures on the spread of newly issued municipal corporate bonds (MCBs) in China, which serves as a crucial instrument for local governments to meet the financial demands. We find that relative to the reference temperature range of 16 °C–20 °C, the issuing spread of MCBs increases by 2.48 basis points for each extra day where the mean temperature surpasses 32 °C. The findings highlight the risk-increasing effects of extreme temperatures in financial markets.

A Microbiological and Sensory Evaluation of Modified Atmosphere-Packed (MAP) Chicken at Use-By Date and Beyond.

Consumers are responsible for a large proportion of food waste, and food that has reached its use-by or best-before date is often discarded, even if edible. In this study on fresh chicken, the suitability of use-by dates currently used in the EU was evaluated by using microbial and sensory analyses. This was carried out by analyzing bacterial populations of chicken breast fillets (M. pectoralis major) at three different time points (use-by date, 2 days past use-by date, 4 days past use-by date) and two different storage temperatures (4 °C, 8 °C). A discrimination triangle test was performed to check for sensory differences between chicken breast fillets cooked at the three selected time points for both storage temperatures. A consumer preference test was also performed for chicken breast fillets that had been stored at the highest recommended temperature (4 °C) and after being cooked at the three time points. Changes in populations of total aerobic count (TAC), Enterobacteriaceae (EB), and lactic acid bacteria (LAB) were recorded over time. Despite large differences in bacterial counts at the selected time points, with TAC populations of approximately 6.5 and 8.0 log CFU/g at use-by date and four days after use-by date, respectively, storage for two or four extra days had no significant effect on the sensory parameters of cooked chicken compared with chicken consumed at its use-by date. Since the TAC populations were close to or above levels that are associated with spoilage, more work is needed to explore if shelf life can be extended.

Artificial Intelligence-Clinical Decision Support System in Infectious Disease Control: Combatting Multidrug-Resistant Klebsiella pneumoniae with Machine Learning.

The World Health Organization has identified Klebsiella pneumoniae (KP) as a significant threat to global public health. The rising threat of carbapenem-resistant Klebsiella pneumoniae (CRKP) leads to prolonged hospital stays and higher medical costs, necessitating faster diagnostic methods. Traditional antibiotic susceptibility testing (AST) methods demand at least 4 days, requiring 3 days on average for culturing and isolating the bacteria and identifying the species using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), plus an extra day for interpreting AST results. This lengthy process makes traditional methods too slow for urgent clinical situations requiring rapid decision-making, potentially hindering prompt treatment decisions, especially for fast-spreading infections such as those caused by CRKP. This research leverages a cutting-edge diagnostic method that utilizes an artificial intelligence-clinical decision support system (AI-CDSS). It incorporates machine learning algorithms for the swift and precise detection of carbapenem-resistant and colistin-resistant strains. We selected 4307 KP samples out of a total of 52,827 bacterial samples due to concerns about multi-drug resistance using MALDI-TOF MS and Vitek-2 systems for AST. It involved thorough data preprocessing, feature extraction, and machine learning model training fine-tuned with GridSearchCV and 5-fold cross-validation, resulting in high predictive accuracy, as demonstrated by the receiver operating characteristic and area under the curve (AUC) scores, laying the groundwork for our AI-CDSS. MALDI-TOF MS analysis revealed distinct intensity profiles differentiating CRKP and susceptible strains, as well as colistin-resistant Klebsiella pneumoniae (CoRKP) and susceptible strains. The Random Forest Classifier demonstrated superior discriminatory power, with an AUC of 0.96 for detecting CRKP and 0.98 for detecting CoRKP. Integrating MALDI-TOF MS with machine learning in an AI-CDSS has greatly expedited the detection of KP resistance by approximately 1 day. This system offers timely guidance, potentially enhancing clinical decision-making and improving treatment outcomes for KP infections.

A modeling framework for evaluating proactive and reactive nurse rostering strategies — A case study from a Neonatal Intensive Care Unit

We develop a modeling framework for rostering, absence and demand uncertainty realization, and rerostering to perform detailed quantitative analyses of the robustness of nurse rosters. The framework reflects a real-life problem observed at the Department of Neonatal Intensive Care (DNIC) at St. Olavs Hospital in Trondheim, Norway, but is general and has a high transfer value with respect to using it to analyze roster robustness at other departments. We present multiple proactive strategies to enhance the stability of a roster and a reactive rerostering problem used to improve the flexibility. An extensive case study is performed using historical data from the department. The results show that there is a great potential to improve the stability and flexibility of the rosters using the best combination of strategies. We show that allowing nurses to trade extra weekend work for extra days off, assign surplus work hours evenly over all work shifts, and consider the absence profile of nurses when making the rosters are key strategies to create robust rosters.

Cost effective utilization of apheresis for stem cell transplantation in multiple myeloma.

e19528 Background: Salvage autologous stem cell transplantation (ASCT) is an effective and feasible treatment option for patients with relapsed multiple myeloma (MM). It is standard practice to collect stem cells adequate for two transplants for ASCT eligible patients with newly diagnosed MM (NDMM). Stem cell collection is an expensive procedure due to the cost of granulocyte-colony stimulating factor, plerixafor, apheresis, chemotherapy in select cases and finally cryopreservation. However, the rate of utilization of second ASCT is not known. Methods: We conducted a single institution, retrospective study of 511 consecutive patients with NDMM who underwent ASCT to identify the proportion of patients receiving second ASCT. Patients received ASCT as front-line therapy between 1/1/2015-2/13/2019. Demographic and disease characteristics were summarized using median and range for continuous variables, and frequency and percentages were calculated for categorical variables. The cumulative incidence of second ASCT was estimated using the Fine and Gray method, and competing risk regression models were used to estimate the hazard ratios for risk of second ASCT. All statistical tests were two-sided with a type 1 error of &lt; 0.05 indicating statistical significance. All estimates were reported with 95% confidence intervals (95% CI). Results: At a median follow-up of 4.7 years, 25 out of 511 patients received a second ASCT. The cumulative incidence rate at 5 years was 2.6% (95% CI 1.4-4.4%).Age at diagnosis, age at first ASCT and Charlson comorbidity index (CMI) were significantly associated with the risk of second ASCT in univariable analysis (UVA). In multivariable analysis (MVA) age at first ASCT was the only factor that was predictive of a second ASCT. We devised a predictive score for utilization of second ASCT using hazard ratios for each of the three significant factors noted in the UVA. Scoring was done as follows: age &lt; 65 years – 1 point, &gt; 65 years – 7 points; 1 point for CMI 0-1, 2 points for CMI 2 or higher; serum creatinine ≤1.2 – 1 point, &gt; 1.2 – 3 points. Based on the total score, patients are grouped into low ( &lt; = 3), medium (4-6) and high (7+) likelihood categories, with cumulative incidence rates of receiving second ASCT at 4.0% (95% CI: 1.3-9.1%), 3.4% (95% CI 1.4-7.0%) and 0.6% (95% CI 0.1-3.1%) respectively. Patients older than 65 years were 87% less likely to receive a second ASCT compared with those younger than 65 years (HR = 0.13, 95% CI 0.02-0.98). Conclusions: Using this predictive score, goal of stem cell collection for patients with MM could be determined more efficiently. This could avoid extra days of apheresis, chemo mobilization, hospitalizations and need for cryopreservation at least for patients with a low likelihood of second ASCT, translating into cost effective utilization of resources. We plan to validate this score prospectively in a larger group of patients with NDMM undergoing ASCT in the future.

Особливості застосування змістовних теорій мотивування працівників в умовах воєнного стану

The article examines the intricacies of staff motivation at Ukrainian enterprises in the conditions of unprecedented challenges associated with the ongoing crisis and martial law. Modern motivation strategies, aimed at identifying and satisfying actual needs, should contribute to the formation of conditions that provide staff with a sense of stability and security, thereby contributing to an increase in their productivity and satisfaction at the workplace. By studying the main theories of motivation, such as Abraham Maslow’s hierarchy of needs, the theory Alderfer’s ERG, McClelland’s acquired needs theory, and Herzberg’s two-factor theory, the authors highlight the multifaceted implications of each perspective, especially as applied to the unique context of wartime. The scholarly study begins with a comprehensive analysis of motivation theories, providing readers with a detailed understanding of their applicability and challenges in various contexts. The article outlines Maslow’s hierarchical progression of needs as opposed to her more variable Alderfer classification. The researchers proposed A. Maslow’s Adapted Pyramid of Needs for motivating employees in martial law conditions, which, when used effectively, will help managers create the necessary psycho-emotional environment and minimize staff turnover. In addition, David McClelland’s emphasis on achievement, affiliation, and power needs, which are not the priority desires of employees compared to safety needs, is explored in detail. Herzberg’s dichotomy between hygiene and motivational factors is also described, which gives insight into the importance of balancing the satisfaction of hygiene and motivating needs. This article highlights the renewed relevance of foundational motivational theories in shaping pragmatic strategies in a changing business landscape. In particular, Maslow’s hierarchy and Herzberg’s two-factor theory become the main guidelines for the development of effective motivational interventions, especially taking into account the urgent needs of employees, such as physiological and safety requirements, which are the most important in the modern Ukrainian environment. The authors of the article give examples of specific measures that Ukrainian enterprises can take. use to increase the motivation of personnel in wartime conditions. In particular, intangible incentives such as support, team building, volunteering, extra days off and vacations are effective. At the end of the article, the importance of understanding and adapting motivation theories to the specific context of Ukrainian enterprises during the war is emphasized. By recognizing the nuances of their workforce’s needs, managers can effectively implement motivational strategies that promote employee engagement, productivity, and resilience in the face of conflict.

#1555 The effects of different interdialytic intervals on cardiorespiratory fitness assessed with CPET in hemodialysis patients

Abstract Background and Aims Long interdialytic interval in thrice-weekly hemodialysis is associated with excess cardiovascular and all-cause mortality risk. Impaired cardiorespiratory fitness is a strong predictor of mortality in hemodialysis. This study investigated differences in cardiorespiratory fitness assessed with cardiopulmonary exercise testing (CPET) between the end of the 2-day and the 3-day interdialytic interval. Method A total of 28 hemodialysis patients, randomized in two different sequences of evaluation underwent CPET and spirometry examination at the end of the 2-day and the 3-day intervals. The primary outcome was the difference in oxygen uptake at peak exercise [VO2peak (ml/kg/min)] assessed with CPET. Volume status was assessed with interdialytic-weight-gain (IDWG), lung ultrasound, bioimpedance spectroscopy (BIS), and inferior vena cava measurements. A total of 14 age- and sex-matched controls were also evaluated. Results Hemodialysis patients at the end of both 2-day and 3-day intervals presented lower values in all major CPET parameters than controls. VO2peak (ml/kg/min) was significantly higher at the end of the 2-day than the 3-day interval (15.24 ± 4.18 vs 13.64 ± 2.76; p &amp;lt; 0.001); similar were the results for VO2peak (ml/min) (1188 ± 257 vs 1074 ± 224; p &amp;lt; 0.001) and VO2peak (%predicted) (58.9 ± 9.2 vs 52.3 ± 8.6; p &amp;lt; 0.001). Numerical but no statistically significant differences were detected in VO2-anaerobic-threshold(ml/kg/min) and VO2-anaerobic-threshold(ml/min) between the two time-points. Maximal work load (90.1 ± 23.2 vs 79.3 ± 25.1; p &amp;lt; 0.001), exercise duration, HR at peak exercise and oxygen pulse also showed lower values at the end of the 3-day interval. FEV1 levels were similar between the two evaluations. Generalized-linear-mixed-model analysis including IDWG as random covariate attenuated the observed differences in VO2peak (ml/kg/min). Changes in BIS-derived overhydration indexes were moderately correlated with changes of VO2peak (ml/kg/min). Conclusion The 3-day interval was associated with further impairment of VO2 at peak exercise. This effect was predominantly driven by excess fluid accumulation during the extra interdialytic day.

THE EFFECTS OF DIFFERENT INTERDIALYTIC INTERVALS ON CARDIORESPIRATORY FITNESS ASSESSED WITH CARDIOPULMONARY EXERCISE TESTING IN HEMODIALYSIS PATIENTS

Objective: Long interdialytic interval in thrice-weekly hemodialysis is associated with excess cardiovascular and all-cause mortality risk. Impaired cardiorespiratory fitness is a strong predictor of mortality in hemodialysis. This study investigated differences in cardiorespiratory fitness assessed with cardiopulmonary exercise testing (CPET) between the end of the 2-day and the 3-day interdialytic interval. Design and method: A total of 28 hemodialysis patients, randomized in two different sequences of evaluation underwent CPET and spirometry examination at the end of the 2-day and the 3-day intervals. The primary outcome was the difference in oxygen uptake at peak exercise [VO2peak(ml/kg/min)] assessed with CPET. Volume status was assessed with interdialytic-weight-gain (IDWG), lung ultrasound, bioimpedance spectroscopy (BIS), and inferior vena cava measurements. A total of 14 age- and sex-matched controls were also evaluated. Results: Hemodialysis patients at the end of both 2-day and 3-day intervals presented lower values in all major CPET parameters than controls. VO2peak(ml/kg/min) was significantly higher at the end of the 2-day than the 3-day interval (15.24±4.18 vs 13.64±2.76;p&lt;0.001); similar were the results for VO2peak(ml/min) (1188±257 vs 1074±224;p&lt;0.001) and VO2peak(%predicted) (58.9±9.2 vs 52.3±8.6;p&lt;0.001). Numerical but no statistically significant differences were detected in VO2-anaerobic-threshold(ml/kg/min) and VO2-anaerobic-threshold(ml/min) between the two time-points. Maximal work load (90.1±23.2 vs 79.3±25.1;p&lt;0.001), exercise duration, HR at peak exercise and oxygen pulse also showed lower values at the end of the 3-day interval. FEV1 levels were similar between the two evaluations. Generalized-linear-mixed-model analysis including IDWG as random covariate attenuated the observed differences in VO2peak(ml/kg/min). Changes in BIS-derived overhydration indexes were moderately correlated with changes of VO2peak(ml/kg/min). Conclusions: The 3-day interval was associated with further impairment of VO2 at peak exercise. This effect was predominantly driven by excess fluid accumulation during the extra interdialytic day.

A New Tool to Assess the Economic Impact of Q Fever on Dairy Cattle Farms.

To support farmers in their decisions related to Q fever, a dedicated economic assessment tool is developed. The present work describes the calculator, its economic rationale, and the supporting assumptions. The calculator integrates a yearly compartmental model to represent population dynamism and the main interactions between disorders linked to Q fever, especially reproductive disorders (abortion, retained foetal membranes, purulent vaginal discharge and endometritis, extra services, and calving-conception delays). The effects of the nontangible cost of the disease on human health, the welfare of the animals, and the workload of farmers were not integrated into the model. The model shows high-level sensitivity to the prevalence of Q fever in the herd prevaccination and to the costs of abortion and extra days of calving-conception intervals. Breakeven points, i.e., cost values that allow us to achieve positive vaccination benefits, are also reported. For herds with moderate or high prevalence rates of Q fever prevaccination (>30%), a vaccination benefit is observed. The vaccine should be considered a type of insurance in herds with low prevalence rates of Q fever prevaccination (≤20%). The calculator was developed to aid decision-making at the farm level, and no conclusion can be extrapolated as a generic trend based on the present work.

Extreme heat and firms' robot adoption: Evidence from China

This is the first study to explore the relationship between extreme heat and firms' robot adoption. The findings demonstrate that, relative to a day in the reference temperature bin, an extra day with an average temperature above 30°C reduces the probability of a firm adopting robots and the cumulative number of robots a firm has adopted. The channels of tightened financial constraints and the increased comparative advantages of industrial robots over labor are important in explaining the documented impacts. The negative effects of extreme heat are only pronounced for non-state-owned enterprises, firms with negative working capital, and firms in industries with fewer automation opportunities. Moreover, local adaptation in high-temperature regions mitigates the negative impacts of extreme heat on robot adoption. This study focuses on firms' adaptive behavior under extreme heat, which previous studies have largely overlooked, with implications for policymakers concerned with climate change adaptation and industrial automation.

Exploring the association between cognitive activity and symptom resolution following concussion in adolescents aged 11–17 years

ObjectiveAs opposed to postconcussion physical activity, the potential influence of cognitive activity on concussion recovery is not well characterised. This study evaluated the intensity and duration of daily cognitive activity...

Ventilator-associated events in adults: A secondary analysis assessing the impact of monitoring ventilator settings on outcomes

BackgroundVentilator-associated events (VAE) is a tier implemented for surveillance by the CDC in the USA. Implementation usefulness for clinical decisions is unknown. MethodsWe conducted a secondary analysis from a prospective, multicentre, international study, to assess the impact on outcomes of using tiers with shorter follow-up (VAE24), lower oxygenation requirements (light-VAE) or both (light VAE24). ResultsA cohort of 261 adults with 2706 ventilator-days were included. The median (IQR) duration of mechanical ventilation (MV) was 9 days (5–21), and the median (IQR) length of stay in the intensive care unit (ICU) was 14 days (8–26). A VAE tier was associated with a trend to increase from 32% to 44% in the ICU mortality rates. VAE Incidence was 24 per 1,000 ventilator-days, being increased when reduced the oxygenation settings requirement (35 per 1,000 ventilator-days), follow-up (41 per 1,000 ventilator-days) or both (55 per 1,000 ventilator-days). A VAE tier was associated with 13 extra (21 vs. 8) days of ventilation, 11 (23 vs. 12) ICU days and 7 (31 vs. 14) hospitalization days, outperforming the modified tiers’ performance. ConclusionsThe modification of ventilator settings (consistent with ventilator-associated events) was associated with worse outcomes among adults with prolonged mechanical ventilation. Monitoring ventilator-associated events at the bedside represents a new tool for quality improvement.

The relationship of age and comorbid conditions to hospital and nursing home days in Medicaid recipients with HIV.

To determine how aging impacts healthcare utilization in persons with HIV (PWH) compared with persons without HIV (PWoH). Matched case-control study. We studied Medicaid recipients in the United States, aged 18-64 years, from 2001 to 2012. We matched each of 270 074 PWH to three PWoH by baseline year, age, gender, and zip code. Outcomes were hospital and nursing home days per month (DPM). Comorbid condition groups were cardiovascular disease, diabetes, liver disease, mental health conditions, pulmonary disease, and renal disease. We used linear regression to examine the joint relationships of age and comorbid conditions on the two outcomes, stratified by sex at birth. We found small excesses in hospital DPM for PWH compared with PWoH. There were 0.03 and 0.07 extra hospital DPM for female and male individuals, respectively, and no increases with age. In contrast, excess nursing home DPM for PWH compared with PWoH rose linearly with age, peaking at 0.35 extra days for female individuals and 0.4 extra days for male individuals. HIV-associated excess nursing home DPM were greatest for persons with cardiovascular disease, diabetes, mental health conditions, and renal disease. For PWH at age 55 years, this represents an 81% increase in the nursing home DPM for male individuals, and a 110% increase for female individuals, compared PWoH. Efforts to understand and interrupt this pronounced excess pattern of nursing home DPM among PWH compared with PWoH are needed and may new insights into how HIV and comorbid conditions jointly impact aging with HIV.

An additional 1,440 minutes: What will you do with an extra day?

An additional 1,440 minutes: What will you do with an extra day?

A European multicenter outcome study on the different perioperative airway management policies following midface surgery in syndromic craniosynostosis: a proposal for a Standard Operating Procedure.

Perioperative airway management following midface advancements in children with Apert and Crouzon/Pfeiffer syndrome can be challenging, and protocols often differ. This study examined airway management following midface advancements and postoperative respiratory complications. A multicenter, retrospective cohort study was performed to obtain information about the timing of extubation, perioperative airway management, and respiratory complications after monobloc / le Fort III procedures. Ultimately, 275 patients (129 monobloc and 146 Le Fort III) were included; 62 received immediate extubation and 162 delayed extubation; 42 had long-term tracheostomies and nine perioperative short-term tracheostomies. Short-term tracheostomies were in most centers reserved for selected cases. Patients with delayed extubation remained intubated for three days (IQR 2 - 5). The rate of no or only oxygen support after extubation was comparable between patients with immediate and delayed extubation, 58/62 (94%) and 137/162 (85%) patients, respectively. However, patients with immediate extubation developed less postoperative pneumonia than those with delayed, 0/62 (0%) versus 24/161 (15%) (P = 0.001), respectively. Immediate extubation also appeared safe in moderate/severe OSA since 19/20 (95%) required either no or only oxygen support after extubation. The odds of developing intubation-related complications increased by 21% with every extra day of intubation. Immediate extubation following midface advancements was found to be a safe option, as it was not associated with respiratory insufficiency but did lead to fewer complications. Immediate extubation should be considered routine management in patients with no/mild OSA and should be the aim in moderate/severe OSA after careful assessment.