Recommendations For Interventions Research Articles

Anorexia nervosa: Disease process, challenges and hope

Anorexia nervosa, as a psychiatric disorder with a progressively high prevalence, is characterized by the following features: high mortality rate, serious harm, long-lasting effects, difficult to cure and easy to relapse. In recent years, Awareness of anorexia nervosa is different than in the past, going deeper: it is a complex disorder involving multiple systems. Many disciplines are also actively exploring it. However, there are still problems such as Pathologic mechanism unclear, no clear indicators of disease, no targeted drugs, and insufficient public awareness. This article analyses research in the fields of social environment, immunology and brain science in the order of disease onset, evolution and treatment (including difficulties in the treatment process, such as in Refeeding syndrome), and puts forward some recommendations for earlier intervention, comprehensive treatment, and optimization and maintenance of therapeutic efficacy in anorexia nervosa. It is also hoped that public awareness and attention will be raised. There are still many gaps in the road to overcoming anorexia nervosa, which has a large research space and is also not less challenging. Future research could focus on finding objective indicators for diagnosing anorexia nervosa or suggesting recovery, and finding targeted drugs from the perspective of multi-system interactions.

Promising behavior change techniques for climate-friendly behavior change - a systematic review.

Besides societal and governmental actions to mitigate greenhouse gases, individual behavioral changes are also urgently needed to limit global temperature rise. However, these individual changes have proven to be difficult to achieve in the general population. We conducted a systematic review in five electronic databases with the aim of systematically depicting the content of interventions that promote climate-friendly behavior in individuals and households in high- and upper-middle-income countries. We included 25 studies. The analyses included identification of the used Behavior Change Techniques (BCTs) and comparison of their promise ratio. Across our three outcome categories energy consumption, water consumption, and mobility the most frequently used BCT categories are not the ones that are most promising in terms of behavior change. Based on these results, our recommendation for climate change mitigation interventions is to include components that provide concrete instructions on how to perform the desired behavior (shaping knowledge), setting goals and commitments (goals and planning), substituting undesired behavior, and practicing desired behavior (repetition and substitution). Other reviews with similar aims use different wordings, definitions, or degrees of detail in their intervention component labelling which makes it difficult to compare the results. We recommend to use a standardized classification system, like the BCT taxonomy in combination with the promise ratio, which this study has shown to be a suitable tool to classify applied intervention techniques and give an indication of successful techniques.

Lifetime Experiences of Housing Insecurity among Gay Men Living with HIV at Midlife: An Exploratory Study Utilizing a Social Determinants of Health Perspective

Understanding the socioecological contexts of gay men living with HIV is critical to addressing the environmental conditions that influence their lifetime experiences of housing insecurity and homelessness. In line with the strategies of the US Center for Disease Control and Prevention to end the HIV epidemic, it is of utmost importance to recognize how the allocation of available resources impacts health inequities affecting gay men living with HIV who experience housing insecurity and homelessness. Drawing from the World Health Organization’s social determinants of health (SDoH) framework, we used an exploratory, community-based research (CBR) approach to examine the lifetime experiences and important sources of support of gay men living with HIV at midlife who have experienced housing insecurity in Southern Nevada. Thematic analysis of our semi-structured interviews with 12 gay men living with HIV at midlife revealed three overarching themes: (1) challenges to obtaining housing and related support, (2) informal support from friends, and (3) formal support from community-based sources employing diverse support strategies. In this article, we discuss the different sub-themes we identified under these overarching themes and the implications of our findings from an SDoH perspective. We conclude with a discussion on the dire need to (1) highlight the considerable value of both informal and formal sources of support for the housing insecure, and (2) generate recommendations for interventions to address housing insecurity and homelessness with greater consideration for the impacts of SDoH in the work dedicated to helping gay men living with HIV at midlife overcome housing insecurity as they age.

German Society of Neurology guidelines for the diagnosis and treatment of cognitive impairment and affective disorders in people with Parkinson's disease: new spotlights on diagnostic procedures and non-pharmacological interventions.

Cognitive impairment and dementia as well as affective disorders are common and debilitating syndromes that develop in people with Parkinson's disease (PwPD). The authors summarized recommendations for the 2023 updated German guidelines on "Parkinson's disease" from the German Neurological Society (DGN), focusing on the diagnosis and treatment of these disorders. The recommendations were based on literature reviews, other relevant guidelines, and expert opinions. Measurements to assess cognitive and affective states were reviewed for psychometric properties, use in routine clinical practice, and availability in German. To improve mild cognitive impairment, cognitive trainingand physical aerobic training are recommended. To treat Parkinson's disease (PD)-related dementia, cognitive stimulation (as anon-pharmacologicalintervention) and acetylcholinesterase inhibitors (AChEIs, i.e., rivastigmine) are recommended. Cognitive behavioral therapy is recommended to treat depression, anxiety, and fear of progression. Physical interventions are recommended to treat depression, fatigue, and apathy. Optimized dopaminergic treatment is the first-line pharmacological strategy recommended to manage depression, apathy, anhedonia, fatigue, and mood swings. Major depression can be additionally treated using venlafaxine or desipramine, while moderate depression can be treated pharmacologically according to its clinical phenotype (psychomotor retardation or agitation) and comorbidities (e.g., sleep disturbances, pain). Venlafaxine and nortriptyline can be used to treat anhedonia, while citalopram can be used for anxiety. In addition to the updated pharmacological treatment options, new insights into recommendations for standardized diagnostics and non-pharmacological interventions were provided for the German health care system. However, more studies are needed to explore the full potential of non-pharmacological interventions to treat and prevent cognitive impairment and affective disorders.

EVALUATING RESOURCE ALLOCATION MANAGEMENT TO HOSPITALS IN BAUCHI STATE: A CASE STUDY OF FEDERAL MEDICAL CENTRE AZARE AND PRIMARY HEALTHCARE CENTRE AZARE

Background: This study evaluates resource allocation management in hospitals in Bauchi State, focusing on Federal Medical Centre (FMC) Azare and Primary Healthcare Centre (PHC) Azare. The research addresses significant disparities in resource allocation that affect healthcare service delivery and patient outcomes. Methods: Using a mixed-method approach, the study combines quantitative data analysis of financial records, resource allocation reports, and healthcare service delivery metrics with qualitative insights from interviews and focus group discussions. Data Envelopment Analysis (DEA) was utilized to measure the relative efficiency of the hospitals in converting inputs such as financial resources, staff, and infrastructure into healthcare services and outputs. Additionally, descriptive analysis was conducted using IBM SPSS version 27 to analyze 100 questionnaire responses and demographic data. Results: The findings reveal significant disparities between FMC Azare and PHC Azare, with FMC Azare benefiting from more adequate financial resources, human resources, medical supplies, and infrastructure. These disparities lead to differences in patient satisfaction, service delivery efficiency, patient outcomes, and waiting times. Conclusions: The study underscores the need for more equitable resource allocation to improve healthcare delivery and patient outcomes at under-resourced centers like PHC Azare. Recommendations for policy interventions include addressing resource allocation inequities, staffing solutions, supply chain improvements, and infrastructure development. These recommendations aim to enhance resource allocation management, thereby improving healthcare services in Bauchi State and providing insights applicable to similar contexts in Nigeria, Africa, and globally. KEYWORDS: Resource Allocation Management, Healthcare Delivery, Data Envelopment Analysis (DEA), Federal Medical Centre, Primary Healthcare Centre.

Efficacy and threshold dose of intensive training targeting mobility for children with cerebral palsy: A systematic review and meta-analysis.

To systematically review the evidence for intensive mobility training in cerebral palsy (CP) and to determine the minimum effective dose to improve mobility. Randomized controlled trials (RCTs) or quasi-RCTs that included participants with CP, and which used intensive task-oriented training (TOT) mobility interventions and reported mobility outcomes, were included. Five databases were searched; two independent reviewers selected studies and extracted data. The Grading of Recommendations Assessment, Development, and Evaluation system and the Cochrane Risk of Bias 2 tool were used to rate the certainty of evidence at the outcomes level and to determine the risk of bias respectively. Meta-analyses were conducted with clinically homogeneous studies. Threshold dose was analysed through meta-regression. Forty-six RCTs with 1449 participants (mean age range 1 year 2 months to 16 years 4 months) were included. TOT had statistically and clinically significant effects on walking speed (p = 0.001), cadence (p = 0.02), gross motor function (p = 0.03), and functional mobility (p = 0.009) compared with control interventions. The threshold dose was undeterminable owing to the high heterogeneity of studies. TOT may improve walking speed, walking endurance, and balance. Studies with homogeneous samples and outcomes are needed to support clinical recommendations for intensive mobility interventions.

Engagement with online resources and widening participation status: observations from a large, diverse Foundation Year science cohort

Despite focused effort and attention over recent years, many potential barriers to progression and success remain within Higher Education. This study focuses on a cohort of 168 students studying on two semester-long Foundation Year Biological Sciences modules delivered at the University of East Anglia in the academic year 2021/22. These modules take place in consecutive semesters within the same academic year and specifically target students from underrepresented and widening participation backgrounds. This study seeks to understand whether a student’s widening participation background influences their engagement with online study resources. We analysed the engagement of individual students with resources provided on the virtual learning environment (VLE) and related this to POLAR4 quintiles. POLAR4 classifies local areas across the UK according to the young participation rate in Higher Education within that area. All POLAR4 categories saw lower modules marks as well as engagement with practice assessments VLE-hosted resources in the second of the two semesters. These differences were greatest for students from the lowest POLAR4 quintile, POLAR4q1. POLAR4q1 students have significantly lower average module grades than all other categories across both semesters but with the gap widest in semester 2, despite the student engagement score increasing. There was no difference in the engagement scores for students from POLAR4q1 backgrounds compared to others in their cohort during the autumn semester but in in the spring semester, students from POLAR4q1 backgrounds had on average, higher engagement scores. Students who grew up in a POLAR4q1 area are more likely to have had disrupted education journeys than their peers from other quintiles. As a result, it is likely they will need more than one intervention to be able to close the attainment gap that we see on these modules. We discuss this along with other potential causes and consequences for these findings alongside recommendations for interventions and further research.

Green Meal? The role of situational contexts for real-time vegetarian Meal choices

This study addresses the urgent need to decrease meat consumption by untangling in which situations urban citizens opt for vegetarian meals over meals that include meat. To do so, this study applies ecological momentary assessment (EMA) over three subsequent weeks with a sample of 82 participants and 1449 daily meal choices. Results indicate a significant association between individuals’ vegetarian meal choices and factors such as meal type, meal location, and presence of others – for instance, vegetarian meals are more likely to be eaten at breakfast, when people are at home, or when they are alone. Furthermore, individuals are much more likely to eat vegetarian when others in their company also eat a vegetarian meal. Beyond these physical and social contexts, the study finds that the likelihood of eating vegetarian decreases when people are happy, and increases when people are more relaxed in the meal situation. Based on these findings, the study offers practical recommendations for interventions targeting situations highly associated with meat consumption and calls for future research on causal evidence.

Enabling work for people with dementia - Recommendations for interventions: A mixed-methods review.

Worldwide, 50 million people are living with dementia. As more individuals develop dementia while still working, dementia will increasingly become a workplace issue and a societal concern. Interventions targeted at work retainment, can reduce, and postpone the loss of cognitive functioning following dementia. However, there is a small body of research focused on recommendations for work interventions for people with dementia. The aim of this mixed-methods review was to investigate experiences of work following a dementia diagnosis from the perspective of people with dementia, their relatives, employers, co-workers and HR-professionals, with the objective of formulating recommendations for work interventions for people with dementia. A mixed-method approach guided the review. 16 original studies published between 1989 to 2023 were included, with a collective sample of 684 participants. The review shows that it is possible to live and work well with dementia, if collaborative solutions are continuously negotiated to meet the needs of the person with dementia and the workplace, and with attention to possible contextual enablers and barriers. The review highlights four key elements for successful work interventions for people with dementia: 1) Person-centered Approach, 2) Contextual Relevance, 3) Knowledge-based and 4) Dynamic Approach.

Consensus recommendations for acute trauma care & outcomes in LMICs from the transdisciplinary research, advocacy & implementation network for trauma in India.

Background & objectives Injuries profoundly impact global health, with substantial deaths and disabilities, especially in low- and middle-income countries (LMICs). This paper presents strategic consensus from the Transdisciplinary Research, Advocacy, and Implementation Network for Trauma in India (TRAIN Trauma India) symposium, advocating for enhanced, system-level trauma care to address this challenge. Methods Five working groups conducted separate literature reviews on pre-hospital trauma care, in-hospital trauma resuscitation and training, trauma systems, trauma registries, and India's Towards Improving Trauma Care Outcomes (TITCO) registry. Using a Delphi approach, the TRAIN Trauma India Symposium generated consensus statements and recommendations for interventions to streamline trauma care and reduce preventable trauma mortality in India and LMICs. Experts prioritized interventions based on cost and difficulty. Results An expert panel agreed on four pre-hospital consensus statements, eight hospital resuscitation consensus statements, six system-level consensus statements, and six trauma registry consensus statements. The expert panel recommended six pre-hospital interventions, four hospital resuscitation interventions, nine system-level interventions, and seven trauma registry interventions applicable to the Indian context. Of these, 14 interventions were ranked as low cost/low difficulty, five high cost/low difficulty, five low cost/high difficulty, and three high cost/high difficulty. Interpretation & conclusions This consensus underscores the urgent need for integrated and efficient trauma systems to reduce preventable mortality, emphasizing the importance of comprehensive care that includes community engagement and robust pre-hospital and acute hospital trauma care pathways. It highlights the critical role of inclusive, system-wide approaches, from enhancing pre-hospital care and in-hospital resuscitation to implementing effective trauma registries to improve outcomes and streamline care across contexts.

Effective Interventions to Reduce Burnout in Social Workers: A Systematic Review

Abstract Social workers are at risk of developing burnout, which is associated with many adverse implications including increased risk of depression. A number of intervention studies have aimed to reduce burnout in this population; however, a systematic review of the evidence has yet to be performed. This review therefore aimed to fill that gap. A comprehensive search of major academic databases was conducted and the inclusion criteria were interventions that reported pre- and post-measures of burnout outcomes within a population of qualified social workers. Of the 2,456 records identified, nine were included in the review. Results showed that a number of burnout interventions have been developed for social workers, including mindfulness-based interventions, group-based skills training, exercise and taking a sabbatical. However, the overall quality of the studies was poor and therefore definitive recommendations for effective interventions could not be offered. Mindfulness-based and group skills development interventions warrant further investigation and organisational or institutional change to tackle burnout, alongside individual-level interventions, is crucial. It was concluded that future burnout intervention researchers should implement a greater methodological rigour, use theory to underpin intervention approaches, adopt a longitudinal design where possible, and administer validated measures of burnout.

Income Diversification of Rural Households in Bangladesh (2022-23)

This study examines income diversification and inequality among rural households in Bangladesh in 2022- 23, focusing on agricultural and non-agricultural sources of income. The analysis includes three districts: Chadpur, Sirajganj and Rajshahi, with specific economic activities. Data were collected through household surveys that collect income from agriculture, livestock, fishing, services and industries, and demographic data. Rajshahi has the highest income, due to high income from cattle, while Chadpur has the lowest. The results show significant income disparities, high levels of animal activity and differences in economic activity between regions. Larger houses in Rajshahi reflect changes in family structure. The main challenges identified were land fragmentation, climate change and limited access to finance and infrastructure. Recommendations for policy interventions include targeting support to low-income areas, investing in livestock development, promoting income diversification, improving infrastructure, strengthening climate livelihoods, expanding access to finance, the adoption of technology and the implementation of family planning programs. These strategies aim to reduce income inequality, improve economic opportunities and promote sustainable development in rural Bangladesh.

Guidelines for Increasing Access to Mindfulness-Based Interventions in Under-Resourced Schools

AbstractMindfulness-based interventions (MBIs) in schools have become increasingly popular, as these practices can be integrated into classrooms by teachers, adapted to fit the individual needs of students or groups of students, and implemented as a schoolwide commitment to improve well-being. Research shows that MBIs are broadly effective for improving a variety of social, emotional, behavioral, and academic outcomes for diverse students. However, implementation of MBIs in under-resourced schools presents a unique set of challenges for school staff. This paper addresses this issue constructively by providing guidelines for increasing access to MBIs in under-resourced schools. First, we provide a brief overview of common ecological barriers—and potential solutions—to implementing MBIs in under-resourced schools at the individual-level, team-level, school-level, and macro-level. This overview is followed by recommendations for de-implementing outdated interventions and implementing MBIs instead. Finally, we complete our guidelines by describing the Adapting Strategies to Promote Implementation Reach and Equity (ASPIRE) framework and how this heuristic can be applied to guide culturally sensitive and equity-focused adaptations to MBIs in under-resourced schools.

Exploring the Work-Life Balance of Single Parents and Its Impact on Life Satisfaction: The Interactive Roles of Social Support and Demographic Factors

This research paper, "Exploring the Work-Life Balance of Single Parents and Its Impact on Life Satisfaction: The Interactive Roles of Social Support and Demographic Factors," investigates the complex relationship between work-life balance, social support, and demographic factors and their combined influence on the life satisfaction of single parents. Grounded in an intersectional theoretical framework, the study sheds light on the challenges single parents face and their potential connection to issues of discrimination and disadvantage. While not its primary focus, the research indirectly addresses these concerns by examining the correlations between the identified factors and life satisfaction among single parents. The study's objectives encompass understanding the work-life dynamics of single-parent households, the role of social support, and the moderating effects of demographic characteristics. The research not only provides insights into the struggles faced by single parents but also offers recommendations for supportive interventions and policies. The findings suggest that improving work-life balance and fostering social support networks can significantly enhance the well-being of single parents, with particular attention to the unique needs of female business owners. This research serves as a foundation for further exploration of family dynamics and well-being within diverse family structures, contributing to developing more inclusive and supportive policies for single parents and their families.

Dampak Media Sosial terhadap Perilaku Konsumtif Remaja di Era Digital

The development of information and communication technology has brought significant changes in various aspects of life, including the consumer behavior of teenagers. This study aims to examine the impact of social media on teenage consumer behavior using the Systematic Literature Review (SLR) method. Analysis of various studies shows that social media has a significant influence on teenage consumer behavior. Targeted advertisements, influencers, and social media content are the main factors influencing teenagers' purchasing decisions. Intensive use of social media is also correlated with an increase in unhealthy and excessive consumer behavior. This research highlights the importance of education on healthy social media usage, the role of families and schools in guiding teenagers, and stricter government policies regarding social media advertisements. Recommendations for further research and practical interventions are also provided to mitigate the negative impact of social media on teenage consumer behavior.

Decision support system (DSS) for facilities rehabilitation and management (part 2): development of optimized intervention strategy

PurposeThis paper (Part 2 of 2) aims to expand the previously developed performance assessment model (PAM) into a decision support system (DSS) to produce optimized decisions on rehabilitation of facilities.Design/methodology/approachThe research includes a comprehensive PAM that integrates analytical hierarchy process-multi attribute utility theory methods for the physical, operational, and environmental aspects of the mosque, as described in Part 1 of the study. An optimized intervention tool is added to the PAM to complete the DSS development. The tool determines the optimum maintenance decisions that are in line with the budget and condition criticality. The deterioration measures are created using a deterministic straight-line extrapolation technique, and the intervention actions used in the optimization are specified through literature review and in-depth interviews with 11 experts. The optimization model was simplified into a user-friendly visual basic application and applied to an existing facility case study depicting its useful functionality.FindingsThe optimization model recommendation of interventions recovered the overall condition rating index (CRI) of the facility while maintaining budget constraints. The CRI in the first approach (minimum budget to achieve acceptable overall performance) was improved from 6.5 to 7.76, costing 275,850 SAR. While the second approach (Maximum recovery with a selected budget constraint, 300,000 SAR in this case) CRI was improved from 6.5 to 8.3, costing 299,850 SAR.Originality/valueThe presented DSS in this paper offers a tool that enables the rehabilitation and overall management of any facility by its managers. The DSS can also be further customized to fit the facility manager’s specific strategies and achieve desired objectives.

Use of Drains in Spine Surgery Systematic Review & Meta-Analysis

Abstract Background Wound suction drains have been used to decrease the rate of postoperative hematoma formation and thus wound infections for many years throughout all surgical subspecialties. Although the use of surgical drains dates back to the years of Hippocrates, in the orthopedic literature these drains have not been shown to be beneficial in decreasing the rates of these complications, especially in orthopedic procedures including fracture fixation or arthroplasty surgeries. However, these drains are still commonly used throughout the orthopedic community, including spine surgery. Aim of the Work This study aims to review the use of closed suction drains in spine surgery. It aims to perform a systematic review and meta-analysis of the outcome of use of drains, their method and provide intervention recommendation by the best available evidence. Material and Methods We followed the PRISMA statement guideline during this systematic review and meta-analysis preparation and performed all steps according to the Cochrane handbook of systematic reviews of intervention. We searched PubMed, Scopus, Cochrane Central Register of Controlled Trials, Web of Science, Embase, and Science Direct till September 2021 relevant keywords. We used the following search strategy for searching different databases. “Wound drain” OR “Suction drainage” OR “Drain” OR “Spine Surgery” OR “Spine” OR “SSI” OR “Surgical Site Infection” OR “Hematoma”) AND (“Vertebral Column” OR “Column, Vertebral” OR “Columns, Vertebral” OR “Vertebral Columns” OR “Spinal Column” OR “Column, Spinal” OR “Columns, Spinal” OR “Spinal Columns” OR Vertebra OR Vertebrae). All the references of the included studies were searched for relevant studies. Results In contrast to other spine procedures, posterior spinal fusion as a surgical treatment for adolescent idiopathic scoliosis necessitates big skin incisions, a lengthy operating duration, and a higher rate of blood transfusion. This meta-analysis comprised four studies. Surprisingly, drains had no effect on total blood loss, the rate of post-surgical infection, the rate of post-operation hematoma, or hospital stay. The drain group required greater blood transfusion than the non-drain group, according to. A drain could also result in a post-durotomy fistula. Drain use is not required after intra-dural spinal cord tumor surgery. Regarding the difference in hemoglobin between preoperative and day 3 postoperative 3 studies, no difference was found between the drain group and the no drain group in all spine surgeries. Conclusion The routine use of a drain in post-operative spine surgery appears to have no effect on the likelihood of post-operative surgical site infections or post-operative epidural hematoma, according to this study. It does, however, increase total estimated blood loss without lowering hemoglobin levels, and has no effect on hospital stay length. To further strengthen any meta- analysis in the future, high-quality studies addressing their use in the spine are require.

Cardiovascular Interventions in Patients With Active and Advanced Malignancy: An Updated Review.

In the context of active, advanced malignancies, the recommendation for invasive cardiac interventions is grounded primarily in evidence from trials focused on specific cardiovascular conditions. However, the inclusion of individuals with advanced malignancies in these trials has historically been limited, and the intricate interplay between cancer and cardiovascular disease poses unique challenges for treatment decisions. In this comprehensive review, we delve into the complex landscape of invasive cardiac interventions and their applicability in patients with active, advanced cancer. Our analysis encompasses a range of cardiovascular scenarios, including ST-segment elevation myocardial infarction, non-ST-segment elevation acute coronary syndromes, multivessel coronary disease, severe symptomatic aortic stenosis, and cardiomyopathy. We critically examine the available data and evidence, shedding light on the benefits and potential risks associated with invasive cardiac procedures in the presence of advanced malignancies. Acknowledging the competing risk of mortality posed by advanced cancers, we delve into the contemporary survival expectations for patients across various types of active, advanced malignancies. By synthesizing current literature and exploring cardiovascular interventions within these populations, we aim to establish a well-informed framework. Our ultimate goal is to provide clinicians with a rational guide for making nuanced clinical recommendations regarding the utilization of invasive cardiac interventions in the challenging context of active, advanced cancer.

Capturing MRSA Diversity by Integrating Genomic and Epidemiological Data of Patients and their Spaces

Background: Methicillin-resistant S. aureus (MRSA) is known to cause frequent and severe infections in community living centers, potentially resulting in significant mortality for elderly patients. More research is needed to understand how to utilize genomic and epidemiological data to understand characteristics that may lead to increased transmission. We hypothesized that combining genomic and epidemiological information to sample patients and their environments during long-term stays, we will be able to capture a diverse set of MRSA strains. Method: This work included genome sequencing of patient and environmental samples from 11 patients within the VA Ann Arbor Healthcare System from May 4, 2021- November 16, 2022. All 11 patients tested positive for MRSA during their stay (mean days = 31). Patient and environmental samples were taken throughout their stays, screened for MRSA, and whole-genome sequenced. Single nucleotide variants (SNVs) were identified by mapping reads and calling variants against strain-specific reference genomes. We used ape v5.6-2 in R v4.2.2 to analyze and infer evolution, acquisition, and transmission events based on pairwise SNV distances. Genomic clusters were determined using stats v3.6.2, with a SNV distance threshold of 20. Result: Samples that were collected from patient bodily sites were able to reveal 20 distinct genomic clusters of MRSA (patient hands: n = 10, nares: n = 7, groin: n = 3). Environmental samples from patient environments also revealed distinct genomic MRSA clusters (tv remote: n = 9, toilet seat and bed rail: n = 6, table top, bed control, and call button: n = 5, bed curtain: n = 4, pulse ox = 2, cell phone, tray, pulse ox, mat, body hoist wrap, and bed: n = 1). Conclusion: The identification of various genomic clusters from patients and their environmental reservoirs suggests intrahost variation that can only be captured by using a more holistic approach of integrating epidemiology and genomic sequencing. Developing studies that incorporate genomic data, various environmental sources, and multiple isolates over time within community living centers can increase our understanding of strains that are more likely to transmit, survive on living and non-living surfaces and therefore lead to improved recommendation for infection prevention interventions and drivers of endemicity.Disclosure: Lona Mody: NIH, VA, CDC, Kahn Foundation; Honoraria: UpToDate; Contracted Research: Nano-Vibronix

Non-islet cell tumor hypoglycemia that required immediate surgery after a long-term asymptomatic state: recommendation for early intervention.

An 82-year-old woman with a 60-year history of a lung tumor presented with hypoglycemia. Non-islet cell tumor hypoglycemia (NICTH) was suspected; however, her hypoglycemia stabilized with supplemental food. She was discharged, based on her wishes, and planned to undergo surgery later. After discharge, the hypoglycemia worsened rapidly and required immediate resection. Postoperatively, the hypoglycemia resolved. Western immunoblot analysis confirmed the presence of big insulin-like growth factor 2, confirming NICTH. This patient experienced the rapid progression of symptoms after an unprecedentedly long-term asymptomatic state. Therefore, when NICTH is suspected, early intervention is recommended regardless of the presence of asymptomatic state. In patients with NICTH, the onset of hypoglycemia is usually within a year of tumor detection, and few reports regarding long-term asymptomatic NICTH have been documented. NICTH can cause rapidly progressive symptoms after a long-term asymptomatic state, as in this case, and an asymptomatic state does not preclude the necessity for intervention, especially when patients are at risk for malnutrition. Tumor resection is the only curative treatment for patients with NICTH, but there is no consensus regarding the timing of surgery. However, considering the possibility of rapid symptom progression, patients should be examined and treated in a timely manner.