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The impact of a payer-provider joint venture on healthcare value.

To examine how a novel payer-provider joint venture (JV) between one payer and multiple competitive delivery systems in New Hampshire (NH), which included value-based payment, care management, and non-financial supports, impacted healthcare value and payer and provider group experiences. We conducted a mixed-methods study. We used a quasi-experimental longitudinal difference-in-differences design to examine the impact of the JV (which started in January 2016 and ended in December 2020) on healthcare utilization, quality, and spending, using members in Maine (ME) as a control group. We also analyzed patient uptake of the JV's care management program using routinely collected administrative data and assessed payer and provider group leaders' perspectives about the JV via semi-structured interviews. We used administrative and claims data from 2013 to 2019 in a commercially insured population under 65 years in NH and ME. We also used administrative data on care management eligibility and uptake and conducted semi-structured interviews with payer and provider group leaders affiliated with the JV. The JV was associated with no sustained change in medical utilization, quality, and spending throughout the study period. In the first year of the JV, there was a $142 (95% confidence interval: $41, $243) increase in pharmaceutical spending per member and a 13% (4.4%, 25%) relative increase in days covered for diabetes medications. Only 15% of eligible members engaged in care management, which was a key component of the JV's multi-pronged approach. In a disconnect from the empirical findings, payer and provider group leaders believed that the JV reduced healthcare costs and improved quality. Our findings provide evidence for future payer-provider JVs and demonstrate the importance of having a valid control group when evaluating JVs and value-based payment arrangements.

Long-term safety and efficacy of adjunctive lacosamide in the treatment of generalized onset tonic-clonic seizures: An open-label extension trial.

This study was undertaken to assess long-term safety, tolerability, and efficacy of lacosamide (LCM) as adjunctive therapy for generalized onset tonic-clonic seizures (GTCS) in patients aged ≥4 years with idiopathic generalized epilepsy (IGE). EP0012 (NCT02408549) was a phase 3, multicenter, open-label extension (OLE) trial. Patients were enrolled from SP0982 (NCT02408523). Trial duration was ≥2 years (adults) and ≤5 years (children). The trial consisted of a treatment period, ≤4-week taper period, and 30-day safety follow-up. Safety (primary) variables were incidence of treatment-emergent adverse events (TEAEs), discontinuations due to TEAEs, incidence of onset of absence or myoclonic seizures, and increase in days with absence or myoclonic seizures per 28 days. Efficacy (secondary) variable was percent change in GTCS frequency per 28 days. Kaplan-Meier estimated retention rates and analyses by number of lifetime antiseizure medications (ASMs) were performed post hoc. Overall, 239 patients (mean age = 27.9 years, 56.1% female, 18.4% children) were enrolled and received ≥1 dose of LCM in this OLE (median treatment duration = 3.2 years); 157 (65.7%) completed the trial, and 82 (34.3%) discontinued. The most common reason for discontinuation (≥10%) was withdrawn consent (30 [12.6%]). Kaplan-Meier estimated retention rate was 87%, 72%, and 60% at 1, 3, and 5 years, respectively. Overall, 222 (92.9%) patients reported TEAEs; 19 (7.9%) discontinued due to TEAEs. Few patients had an increase in number of days with absence or myoclonic seizures, or incidence of new absence or myoclonic seizures. Median percent change in GTCS frequency per 28 days from the combined baseline was -88.6% (range = -100.0 to 465.4, n = 238). Post hoc analyses demonstrated small numerical differences between patients with 1, 2, and ≥3 lifetime ASMs. The results support the use of long-term adjunctive LCM for GTCS in patients with IGE. Long-term adjunctive LCM was efficacious and well tolerated independent of the number of ASMs used before LCM initiation. ClinicalTrials.gov: NCT02408549.

A national evaluation of QbTest to support ADHD assessment: a real-world, mixed methods approach.

QbTest is a commercially available, computerised test of attention, impulsivity, and activity designed to assist with the diagnosis of attention deficit hyperactivity disorder (ADHD). Health Innovation East Midlands (formerly East Midlands AHSN), led the implementation of the QbTest on behalf of the 15 Health Innovation Networks across Child and Adolescent Mental Health services (CAMHS) and Paediatric sites in England between April 2020 and March 2023. We evaluate the impact of this programme on diagnostic assessment at participating sites. A mixed-methods approach was used including: case-note data collected on 10-30 cases per site pre and post QbTest implementation; interviews with healthcare staff working with QbTest; and surveys to explore perspectives of healthcare staff and patients/carers. Case-note data was descriptively analysed to compare time to diagnosis (number of appointments and days) pre/post QbTest implementation. Survey data was analysed descriptively. Qualitative interview data was explored using thematic analysis. Case-note data was provided by 20 sites across England. Comparison of mean values pre- and post-QbTest implementation identified a decrease of 0.37 (11.5%) in number of appointments to reach a diagnostic decision, a 55-day (12.5%) increase in days from initial referral to diagnosis, and a 12-day (10.3%) increase in days to reach a diagnostic decision. Exploratory analyses indicated greater benefit for Paediatric services over CAMHS, in terms of a decrease in days from referral to diagnosis and number of appointments to diagnosis. Interviews with healthcare staff (n=21) revealed that the QbTest was perceived to support a faster, more efficient diagnostic process. Survey data (n=65 healthcare staff, n=22 patients/carers) identified that the QbTest helped patients understand their symptoms and the diagnostic decision. Although some logistical issues (e.g., room requirements) and patient issues (e.g., sensory sensitivity) were identified, healthcare staff considered that QbTest was easily incorporated into the ADHD assessment pathway. The national implementation of QbTest in ADHD clinics resulted in a small reduction in the number of clinical appointments needed to reach a diagnostic decision, with greatest benefit demonstrated in Paediatric sites. Data were impacted by COVID-19 therefore, further evaluation is warranted.

First postnatal lactate blood levels on day 1 and outcome of preterm infants with gestational age

Serum lactate levels are used as biomarkers for perinatal asphyxia, while their value for outcome prediction in preterm infants is uncertain. It was the aim of this observational study to determine the association of the first postnatal serum-lactate levels on day 1 of life and short-term outcome in preterm infants less than 29 gestational weeks. We analysed data in a population-based cohort of German Neonatal Network (GNN) preterm infants with available first postnatal lactate levels enrolled at 22-28 weeks of gestational age (GA) between 1st of April 2009 and 31st December 2020. We hypothesized that high lactate levels as measured in mmol/L increase the risk of intraventricular haemorrhage (IVH) and bronchopulmonary dysplasia (BPD) in infants with VLBW regardless of small-for-gestational-age (SGA) status. Hypotheses were evaluated in univariate analyses and multiple logistic regression models. First postnatal lactate levels were available in 2499 infants. The study population had a median GA of 26.7 [IQR 25.2-27.9] weeks and birth weight of 840 g [IQR 665-995]. Infants with short-term complications such as IVH and BPD had higher initial lactate levels than non-affected infants. The positive predictive value of a lactate cut-off of 4 mmol/L was 0.28 for IVH and 0.30 for BPD. After adjustment for known confounding variables, each 1 mmol/L increase of day 1 lactate levels was associated with a modestly increased risk of IVH (OR 1.18; 95% CI 1.03-1.37; p = 0.002) and BPD (OR 1.23; 95% CI 1.06-1.43; p = 0.005) but not with sepsis or mortality. Notably, SGA was associated with lower risk of any grade and severe IVH (OR 0.70; 95% CI 0.54-0.85; p = 0.001). In our observational cohort study higher initial lactate levels were associated with adverse outcome regardless of SGA status. However, the predictive value of lactate cut-off levels such as 4 mmol/L is low.

Feasibility test of WORK-ON: a vocational rehabilitation intervention for people with chronic inflammatory arthritis

BackgroundPeople with chronic inflammatory arthritis (IA) often have a reduced work ability. Consequently, they are at high risk of losing their jobs and being permanently excluded from the labor market. Therefore, we developed a new context-specific vocational rehabilitation intervention for people with IA based on the Medical Research Council’s framework for complex interventions. This intervention is called “WORK-ON” and consists of: (1) Initial assessment and goal setting by an occupational therapist experienced in rheumatology rehabilitation; (2) coordinated support from the same occupational therapist, including assistance in navigating the primary and secondary healthcare and social care systems; (3) group sessions for peer support; and (4) individually tailored consultations with physiotherapists, nurses, and/or social workers. This study investigates the feasibility of WORK-ON.MethodsA 6-month single-arm feasibility study with a pre-test post-test design was conducted to evaluate recruitment, intervention fidelity and delivery, data collection, and possible outcome measures. Work ability was the primary outcome, and sick leave, quality of life, fatigue, pain, physical activity, sleep, and well-being were the secondary outcomes evaluated.ResultsIn total, 19 participants (17 women and 2 men) with a median age of 55 years (range, 34–64) participated and completed WORK-ON. Of these, 17 participants completed patient-reported outcomes at baseline and follow-up, and the results indicated a tendency to improvement in work ability, quality of life, level of physical activity, decrease in pain, and increase in days of sick leave during the 6-month intervention period. The rehabilitation clinicians spent an average of 15.3 h per participant, and the participants spent an average of 13.5 h in the intervention.ConclusionsWORK-ON is considered feasible and has the potential to increase work ability among people with IA who are concerned about their future ability to keep working. Though, an adjustment of the intervention is needed before testing in a randomized controlled trial.

Trajectories of work disability among individuals with anxiety-, mood/affective-, or stress-related disorders in a primary healthcare setting

Abstract Background Anxiety-, mood/affective-, or stress-related disorders affect up to one-third of individuals during their lives and often impact their ability to work. This study aimed to delineate trajectories of work disability (WD) among individuals diagnosed with anxiety-, mood/affective-, or stress-related disorder in primary healthcare and to examine associations between trajectory group membership and sociodemographic, clinical, and clinical-related factors. Methods The study population included working-age individuals, aged 22–62 years, living in Stockholm County, Sweden, who experienced a new episode of any anxiety-, mood/affective, or stress-related disorder in primary healthcare in 2017 (N = 11,304). Data were obtained from Swedish national and regional registers and were linked using pseudonymised unique personal identification numbers. The primary outcome was days with WD (sum of sickness absence and disability pension days) during the three years before and three years after a diagnosis of anxiety-, mood/affective-, or stress-related disorders in primary healthcare. A zero-inflated Poisson group-based trajectory model was used to identify groups of individuals with similar patterns of WD over the study period, with a multinomial logistic regression used to examine associations of sociodemographic, clinical, and clinical-related factors with trajectory group membership. Results Four distinct trajectory groups were found, high increasing (5.1%), with high levels, from 16 to 80 days of WD in six-monthly intervals during follow-up, peak (11.1%), with a peak in WD, up to 32 days of WD, around the time of the diagnosis, low increasing (12.8%), with an increase in days of WD from 4 to 22 during the study period, and constant low (71.1%), with almost no WD over the study period. In multinomial regression models, diagnostic category, psychotropic medication use, a diagnosis of a psychiatric disorder within secondary healthcare, age at diagnosis, and occupation were associated with WD trajectory groups. Conclusions Around two-thirds of individuals treated for a new episode of any anxiety-, mood/affective-, or stress-related disorder in primary healthcare have an excellent prognosis regarding WD. Several sociodemographic and clinical characteristics were associated with group membership; these factors could identify individuals at risk of long-term welfare dependency and who might benefit from interventions to promote a return to work.

High-resolution projections of future FWI conditions for Portugal according to CMIP6 future climate scenarios

Wildfires are catastrophes of natural origin or initiated by human activities with high disruptive potential. "Portugal, located in western Iberia, has recently experienced several large fire events, including megafires, due to a combination of factors such as orography, vegetation, climate, and socio-demographic conditions that contribute to fuel accumulation.". One approach to studying fire danger is to use fire weather indices that are commonly used to quantify meteorological conditions that can lead to fire ignition and spread. This study aims to provide high-resolution (~ 6 km) future projections of the Fire Weather Index (FWI) for Portugal using the Weather Research and Forecasting (WRF) model, forced by the Max Planck Institute (MPI) model from the CMIP6 suite, under three emission scenarios (SSP2-4.5, SSP3-7.0, and SSP58.5) for the present period (1995–2014) and two future periods (2046–2065 and 2081–2100). The results show good agreement between FWI and its subcomponents from the WRF and reanalysis. The modelled FWI reproduced the climatological distribution of fire danger Projections indicate an increase in days with very high to extreme fire danger (FWI > 38) across all scenarios and time frames, with the southern and northeastern regions experiencing the most significant changes. The southern and northeastern parts of the territory experienced the largest changes, indicating significant changes between the scenarios and regions. This study suggests that FWI and its subcomponents should be investigated further. Our results highlight the importance of creating new adaptation measures, especially in the areas most at risk, prepared in advance by different players and authorities, so that the increasing risk of wildfires can be mitigated in the future.

Critical climate-stress moments for semi-arid farming systems in India

In the face of the increasing frequency of climate stresses, climate change projections can help in adaptation planning and resilience-building. However, typical climate change projections, such as annual average rainfall and temperature increases, are not helpful for farmers in understanding specific climate risks, like crop loss, and making adaptation decisions. Our study aims to identify and characterise context- and time-specific climate stresses in terms of climate conditions of concern to improve the understanding of future climate risks and enhance the climate resilience of semi-arid farming systems in India. Utilising the concept of critical climate-stress moments, we employ an innovative bottom-up methodology integrating insights from focus group discussions with farmers, key informant interviews, and an ensemble of downscaled and bias-corrected Coupled Model Intercomparison Project Phase 6 (CMIP-6) models. Our case studies include (i) a mixed crop-livestock farming system, (ii) a horticulture-based farming system, (iii) a cash crop–dominant farming system, and (iv) a cereal-dominant farming system. The specific climate conditions of concern identified were (i) increasing volume of late-monsoon rainfall, (ii) rising winter temperatures, (iii) increase in the number of days with temperatures exceeding 40 °C, (iv) increase in days with heavy rainfall (> 25 mm), and (v) increasing rainfall during the dry season. Identifying these critical moments improves understanding of both the temporal and spatial variations in climate risks, providing valuable inputs for targeted and implementable climate resilience–building actions. We recommend revising national and state action plans on climate change by utilising such region-specific assessments of critical climate-stress moments.

Dopamine production in neurotensin receptor 1 neurons is required for diet-induced obesity and increased day eating on a high-fat diet.

This study aimed to determine a dopaminergic circuit required for diet-induced obesity in mice. We created conditional deletion mutants for tyrosine hydroxylase (TH) using neurotensin receptor 1 (Ntsr1) Cre and other Cre drivers and measured feeding and body weight on standard and high-fat diets. We then used an adeno-associated virus to selectively restore TH to the ventral tegmental area (VTA) Ntsr1 neurons in conditional knockout (cKO) mice. Mice with cKO of Th using Vglut2-Cre, Cck-Cre, Calb1-Cre, and Bdnf-Cre were susceptible to obesity on a high-fat diet; however, Ntsr1-Cre Th cKO mice resisted weight gain on a high-fat diet and did not experience an increase in day eating unlike their wild-type littermate controls. Restoration of TH to the VTA Ntsr1 neurons of the Ntsr1-Cre Th cKO mice using an adeno-associated virus resulted in an increase in weight gain and day eating on a high-fat diet. Ntsr1-Cre Th cKO mice failed to increase day eating on a high-fat diet, offering a possible explanation for their resistance to diet-induced obesity. These results implicate VTA Ntsr1 dopamine neurons as promoting out-of-phase feeding behavior on a high-fat diet that could be an important contributor to diet-induced obesity in humans.

The regionality and seasonality of tornado trends in the United States

Continued efforts to build human resilience to the impacts of tornadoes require updated knowledge of tornado occurrences as well as how their occurrence characteristics may be changing in time and varying by region. We have temporally and geospatially disaggregated annual tornado reports in the United States and revealed that significant, long-term decreases in tornado days from 1960 to 2022 have occurred over the months of June through August, primarily within the Southern Great Plains. In contrast, long-term increases in days of tornado outbreaks have occurred over this period, particularly within the Southeast U.S. and during warm- as well as cool-season months. There are indications that these dichotomous linear trends in tornado days and tornado outbreaks have relaxed over the most recent decade. Our study highlights the need to better understand the role of internal climate variability and anthropogenic forcing in modulating tornado activity.

Compound droughts under climate change in Switzerland

Abstract. The co-occurrence of meteorological, agricultural, and hydrological droughts (multivariate compound droughts) in Switzerland during growing season is problematic due to limitations in water abstractions from rivers during low-flow periods, while at the same time the need for irrigation is high. We analyse compound droughts for 52 catchments in Switzerland during the extended summer season (May–October) using the transient climate and hydrological scenarios for Switzerland (CH2018 and Hydro-CH2018) for both a scenario with mitigation (representative concentration pathway 2.6 (RCP2.6), 8 model chains) and a scenario without mitigation (RCP8.5, 20 model chains). In the RCP8.5 scenario the number of compound drought days is projected to significantly increase by mid-century across all greater regions of Switzerland. The increased frequency is mainly a result of more frequent events (significant) rather than longer event durations (non-significant). Models generally agree on the sign of change. By 2085, compound drought events are projected to occur in median once per catchment per extended summer season north of the Alps and every 1–2 years south of the Alps. Further, the increases in compound drought days mainly occur between May–October, leading to a shift in the main agricultural production season and a more pronounced seasonality with the highest occurrence probabilities between mid-July and the beginning of October. Coupled to the increase in days and events, significantly more catchments are projected to be affected by compound droughts at the same time. In the RCP2.6 (mitigation) scenario, the increase in the number of compound drought days and events is not significant by the end of the 21st century. In comparison with RCP8.5, the number of compound drought days is reduced by 50 %–55 % north of the Alps and by up to 75 % south of the Alps by the end of the century. This emphasizes the need for coordinated adaptation in combination with mitigation measures taken at an early stage.

Laboratory evaluation of different eco-friendly insecticides against the Egyptian fluted scale, Icerya aegyptiaca

Lac cultivation is generally carried out on a limited number of indigenous tree species found scattered in forests and cultivable land. Recent studies show that Flemingia semialata Roxb. (Leguminosae) is an excellent bushy host plant for the cultivation of the kusmi strain of lac insects. The present investigation was carried out with the objective of getting acquainted with the different eco-friendly insecticides under laboratory evaluation against the Egyptian fluted scale, Icerya aegyptica. Maximum nymphal mortality of 81.67 per cent and 78.34 per cent was observed at 0.2 per cent Pestoguard and Neemazal after 12 days of treatment, which is statistically at par with each other. 51.67 per cent mortality was achieved after 12 days of treatment at 1 per cent Uro-insecticide and Green mealikil, which is a microbial pesticide that is also effective against the Egyptian fluted scale, Icerya aegyptiaca. The mortality percentage was low after 1, 3 days and seven days, but it gradually increased after 12 days of treatment, obtaining 48.34% mortality, which is statistically at par with Uro-insecticide. All the eco-friendly insecticides used in the present experiment (Uroinsecticides, Pestoguard, green mealikil and neemazal) are effective in controlling the population of Icerya aegyptiaca. Unlike Malathion and Imidacloprid, they don’t have a quick knockdown effect; however, the mortality due to exposure significantly increases as there is an increase in days or duration of application, and they are safe for the lac insect.

Impact of the COVID-19 pandemic on disease progression in patients with hepatobiliary and pancreatic cancer.

e16246 Background: The COVID-19 pandemic has posed challenges to healthcare systems, notably impacting cancer care. For patients with Hepatobiliary and Pancreatic Cancer, there has been a reported decline in median survival. The etiology of this decline, whether it is attributed to an escalation in disease severity or to delays in diagnosis and treatment remains unclear. Methods: This retrospective study analyzed the National Cancer Database (NCDB 2004-2020) data from 2018 to 2020. We compared time from diagnosis to initial treatment, AJCC (2017) TNM clinical stage distribution, and pathological variables suggestive of tumor aggression between the pre-pandemic and pandemic periods, as well as within COVID-19 positive (C19+) and negative (C19-) patients. Results: The study included 17,429 liver cancer (LC), 37,185 pancreatic cancer (PC), 1,684 gallbladder cancer (GC), and 3,651 intrahepatic biliary cancer (IBC) patient’s pre-pandemic, and 14,420 LC and 35,456 PC, 1,457 GC, and 3,792 IBC patients during the pandemic. The time to initial treatment did not significantly differ in the before and during the pandemic groups for all types of cancer. However, for GC, there was a significant increase in days to definitive surgery during the pandemic 54 ±73 days compared to pre-pandemic 28±53 days (p < 0.01). There was also a notable increase in the time to initial treatment and definitive surgery for pancreatic cancer in C19+ patients (46±51, 118±104 days) compared to C19- patients (35±37, 97±89 respectively) (p < 0.01). For LC and GC, there was a significant increase in late-stage diagnoses during the pandemic period. LC (stage III: 23.67% and stage IV: 21.10%) compared to pre-pandemic (stage III: 22.71% and stage IV: 19.02%, p < 0.01). GC (stage IV: 77.0%) compared to pre-pandemic (stage IV: 71.85%, p < 0.01). Lympho-vascular invasion rates and node positivity ratios in HC, GC, and IBC patients remained unchanged. For PC there was no change in late stage distribution and IBC there were no significant differences in overall stage distribution or lympho-vascular invasion rates. However, a significant increase in node positive/node harvested ratio was observed in stage III C19+ PC patients (0.308±0.322) compared to C19- (0.134±0.181, p < 0.01). Conclusions: Cancer screening delays during the pandemic led to an increase in late-stage diagnoses for LC and GC but stage distributions for PC and IBC were largely unchanged. However, the pandemic's impact was subtly observed in the form of increased node positivity in stage III C19+ pancreatic cancer patients possibly due to their delay in initial treatment and surgery. There was also an increase in time to definitive surgery in gallbladder cancer. These findings underscore the importance of maintaining robust cancer care pathways, particularly for high-risk groups, to prevent adverse stage migration and ensure timely management, even in the face of global health emergencies.

Cancer Treatment Before and After Physician-Pharmacy Integration

Integration of pharmacies with physician practices, also known as medically integrated dispensing, is increasing in oncology. However, little is known about how this integration affects drug use, expenditures, medication adherence, or time to treatment initiation. To examine the association of physician-pharmacy integration with oral oncology drug expenditures, use, and patient-centered measures. This cohort study used claims data from a large commercial insurer in the US to analyze changes in outcome measures among patients treated by pharmacy-integrating vs nonintegrating community oncologists in 14 states between January 1, 2011, and December 31, 2019. Commercially insured patients were aged 18 to 64 years with 1 of the following advanced-stage diagnoses: breast cancer, colorectal cancer, kidney cancer, lung cancer, melanoma, or prostate cancer. Data analysis was conducted from May 2023 to March 2024. Treatment by a pharmacy-integrating oncologist, ascertained by the presence of an on-site pharmacy or nonpharmacy dispensing site. Oral, intravenous (IV), total, and out-of-pocket drug expenditures for a 6-month episode of care; share of patients prescribed oral drugs; days' supply of oral drugs; medication adherence measured by proportion of days covered; and time to treatment initiation. The association between an oncologist's pharmacy integration and each outcome of interest was estimated using the difference-in-differences estimator. Between 2012 and 2019, 3159 oncologists (745 females [27.1%], 2002 males [72.9%]) treated 23 968 patients (66.4% female; 53.4% aged 55-64 years). Of the 3159 oncologists, 578 (18.3%) worked in practices that integrated with pharmacies (with a low rate in 2011 of 0% and a high rate in 2019 of 31.5%). In the full sample (including all cancer sites), after physician-pharmacy integration, no significant changes were found in oral drug expenditures, IV drug expenditures, or total drug expenditures. There was, however, an increase in days' supply of oral drugs (5.96 days; 95% CI, 0.64-11.28 days; P = .001). There were no significant changes in out-of-pocket expenditures, medication adherence, or time to treatment initiation of oral drugs. In the breast cancer sample, there was an increase in oral drug expenditures ($244; 95% CI, $41-$446; P = .02) and a decrease in IV drug expenditures (-$4187; 95% CI, -$8293 to -$80; P = .05). Results of this cohort study indicated that the integration of oncology practices with pharmacies was not associated with significant changes in expenditures or clear patient-centered benefits.

Changes in wet bulb globe temperature and risk to heat-related hazards in Bangladesh

The rise in temperatures and changes in other meteorological variables have exposed millions of people to health risks in Bangladesh, a densely populated, hot, and humid country. To better assess the threats climate change poses to human health, the wet bulb globe temperature (WBGT) is an important indicator of human heat stress. This study utilized high-resolution reanalysis data from the fifth-generation European Centre for Medium-Range Weather Forecasts (ECMWF ERA5) to analyze the spatiotemporal changes in outdoor WBGT across Bangladesh from 1979 to 2021, employing Liljegren's model. The study revealed an increase in the annual average WBGT by 0.08–0.5 °C per decade throughout the country, with a more pronounced rise in the southeast and northeast regions. Additionally, the number of days with WBGT levels associated with high and extreme risks of heat-related illnesses has shown an upward trend. Specifically, during the monsoon period (June to September), there has been an increase of 2–4 days per decade, and during the pre-monsoon period (March to May), an increase of 1–3 days per decade from 1979 to 2021. Furthermore, the results indicated that the escalation in WBGT has led to a five-fold increase in affected areas and a three-fold increase in days of high and extreme heat stress during the monsoon season in recent years compared to the earlier period. Trend and relative importance analyses of various meteorological variables demonstrated that air temperature is the primary driver behind Bangladesh's rising WBGT and related health risks, followed by specific humidity, wind speed, and solar radiation.

Influence of COVID-19 pandemic on mandible fracture patterns in a German cranio-maxillofacial trauma center: PreCOVID (2019) versus IntraCOVID (2020).

The COVID-19 (Coronavirus Disease-2019) pandemic confronted the global healthcare system with a variety of challenges. The pandemic and the associated lockdowns also had an impact on multiple medical disciplines (i.e. delay of surgery, change of hospital admissions). The aim of this study was to analyze the impact of the COVID-19 pandemic on mandible fracture patterns/distributions and circumstances in a German cranio-maxillofacial trauma center. This retrospective study compared the mandible fracture patterns of patients in the PreCOVID (PC) era (February 2019-January 2020) with patients in the IntraCOVID (IC) era (February 2020-January 2021). In addition to baseline characteristics, the number/type of mandible fractures, location of the mandible fracture, circumstances leading to mandible fracture, and hospital admissions/treatments were analyzed. A total of 127 patients was included in this study. In the IC period, the absolute frequencies of mandible fractures decreased (PC = 72 vs. IC = 55). There were minor changes in the mandible fracture locations. An increase of concomitant facial soft tissue injuries (IC = 69.1% vs. PC = 58.3%), as well as higher rates of traumatic tooth loss (IC = 32.7% vs. PC = 22.2%), was observed. Regarding the causes/accidents leading to mandible fractures, there were significant increases in falls and significant decreases in sports accidents as well as interpersonal violence during the IC period. A significant increase in accidents at home and domestic violence during the COVID-19 pandemic, with a simultaneous decrease in weekend and night-time trauma leading to mandible fractures was observed. Furthermore, a significant increase in days from trauma to surgery was recorded. The COVID-19 pandemic had a significant impact on mandibular fracture patterns. The locations and types of mandibular fractures changed slightly. However, significant differences in the circumstances leading to mandible fractures (increased falls, decreased interpersonal violence) were recorded.

Immunoinformatic of novel self-amplifying mRNA vaccine lipid nanoparticle against SARS-CoV-2.

We developed innovative self-amplifying mRNA (sa-mRNA) vaccine based on the derivative of S and Nsp3 proteins, which are considered crucial adhering to human host cells. We performed B-cell, Major histocompatibility complex (MHC) I, and II epitope which were merged with the KK and GPGPG linker. We also incorporated 5' cap sequence, Kozak sequence, replicase sequence, 3'/5' UTR, and poly A tail within the vaccine structure. The vaccine structure was subsequently docked and run the molecular dynamic simulation with TLR7 molecules. As the results of immune response simulation, the immune response was accelerated drastically up to >10-fold for immunoglobulin, interferon-γ, interleukin-2, immunoglobulin M (IgM) + immunoglobulin G (IgG) isotype, IgM isotype, and IgG1 isotype in secondary and tertiary dose, whereas natural killer cells, macrophages, and dendritic cells showed relatively high concentrations after the first dose. As our finding, the IgM + IgG, IgG1 + IgG2, and IgM level (induced by sa-mRNA vaccine) ensued three times with two-fold increase in days 25, and 50, then decreased after days 70-150. However, 150-350 days demonstrated constantly in the range of 20,000-21,000.

Standardization on Effect of Storage and Packaging Materials on Shelf Life and Quality of Ridge Gourd (Luffa acutangula L.)

An experiment was conducted on ‘‘Standardization on effect of storage and packaging materials on shelf life and quality of ridge gourd (Luffa acutangula L)’’ during Kharif 2021 and Summer 2022 on shelf life and quality of ridge gourd at PG laboratory, College of Horticulture, Rajendranagar. The experiment design is factorial completely randomized design with eight packaging materials as factor-1 and three elite treatments as factor-2 with a total of twenty four (24) treatments replicated thrice. The results revealed that, the Polyethylene 200 gauge with 2% vent and Vermicompost 12 t/ha + Arka microbial consortium recorded lowest physiological loss in weight, titrable acidity and highest shelf life, TSS, ascorbic acid, firmness, chlorophyll content with increase in days of storage.

Correlation between lymphopenia and other hematological parameters with duration of hospital stay as a measure of severity in Covid-19: a retrospective study

PurposeThe SARS-CoV-2 (corona) virus is evolving fast because of the scale at which it has infected people around the world. Updated data is needed to manage Covid-19 efficiently with limited resources. After thorough literature review, there were very few studies that correlated variation of hematological parameters with duration of hospital stay.Here, the aim of the study was to determine correlation between variation in hematological parameters and duration of hospital stay as a predictor of severity of disease.MethodologyThe study was conducted at central laboratory of HIMS, Varanasi. The present study was an observational study done retrospectively. The study duration was from 1st July, 2020 to 30th October, 2020. RT-PCR-positive confirmed cases admitted in the institute whose CBC data was available over a period of multiple days were included in the study to find out the correlation.Study designPatients were categorized into two study groups. Group I (A and B): duration of hospital stay from 2 to 10 days and Group II (A, B, and C): duration of hospital stay more than 11 days. Chi-square test was applied to both the groups to see whether correlation between variation in hematological parameters and duration of hospital stay was significant or not.ResultA total of 276 Covid-19 patients were included in the study. Patients were divided into groups and subgroups according to the duration of hospital stay. A total of 50% (103) of patients in Group I (hospital stay from 2 to 10 days) had lymphopenia as compared to 72.86% (51) of patients with lymphopenia in Group II (hospital stay from 11 to 40 days). Similarly, 44.17% (91) of patients in Group I had leukocytosis as compared to 72.86% (51) of patients with leukocytosis in Group II. The percentage increase in lymphopenia and leukocytosis in Group II was same, and this increase was found to be statistically significant (p-value < 0.05). Both these variables were increasing with increase in days of hospital stay.ConclusionHence, to conclude, complete blood count parameters especially lymphopenia and leukocytosis are most significant and economical in guiding the management protocol of Covid-19 patients as well as in predicting the number of days of hospital stay.

Real-World Dispensing of Buprenorphine in California during Prepandemic and Pandemic Periods.

The opioid overdose crisis in the United States has become a significant national emergency. Buprenorphine, a primary medication for individuals coping with opioid use disorder (OUD), presents promising pharmacokinetic properties for use in primary care settings, and is often delivered as a take-home therapy. The COVID-19 pandemic exacerbated the scarcity of access to buprenorphine, leading to dire consequences for those with OUD. Most existing studies, primarily focused on the immediate aftermath of the COVID-19 outbreak, highlight the challenges in accessing medications for opioid use disorder (MOUDs), particularly buprenorphine. However, these studies only cover a relatively short timeframe. To bridge this research gap, in our study, we utilized 33 months of California's prescription drug monitoring program (PDMP) data to provide insights into real-world buprenorphine dispensing trends since the onset of the pandemic from 2018 to 2021, focusing on outcomes such as patient counts, prescription volumes, prescriber involvement, days' supply, and dosage. Statistical analysis employed interrupted time series analysis to measure changes in trends before and during the pandemic. We found no significant impact on patient counts or prescription volumes during the pandemic, although it impeded the upward trajectory of prescriber numbers that was evident prior to the onset of the pandemic. An immediate increase in days' supply per prescription was observed post-pandemic. Our findings differ in comparison to previous data regarding the raw monthly count of patients and prescriptions. The analysis encompassed uninsured patients, offering a comprehensive perspective on buprenorphine prescribing in California. Our study's insights contribute to understanding the impact of COVID-19 on buprenorphine access, emphasizing the need for policy adjustments.