Limited Evidence Research Articles

Biogeographic isolation and climate shape the evolutionary heritage of Neotropical inselbergs

AbstractAimQuaternary climatic shifts can explain the current distribution of ancient ecosystems as well as the current distributions of gradients that hold species richness and diversity of several lineages in old, climatically buffered, infertile landscapes (OCBILs) as inselbergs. Thus, the combination of phylogenetic approaches and temporal landscape connectivity allows disentangling the mechanisms involved in the origin of the disjunct distribution of plant species and the evolutionary heritage of Neotropical inselbergs.LocationBrazilian Atlantic Forest and Caatinga.Time PeriodPliocene until the current period.Major TaxaAngiosperms.MethodsWe used a compiled data set of 42 inselbergs across the Atlantic Forest and Caatinga biomes in eastern Brazil to describe their structure and phylogenetic diversity and map the landscape resistance distances and the effects of resistance on their phylogenetic beta diversity. We also aimed to identify the effectiveness of protected areas and gaps in the conservation of plant species in Brazilian inselbergs.ResultsWe found evidence of dispersal limitation in the inselberg species pool and a latitudinal gradient in plant species richness and phylogenetic diversity across the Neotropical inselberg landscape, with greater isolation between the northeastern and southeastern core areas. Our findings indicate that inselbergs can lead to a high turnover of phylogenetic diversity, thus imposing distinctiveness on the evolutionary lineages of the inselberg flora.Main ConclusionsOur results suggest that the current distribution of inselberg's flora in isolated ecosystems may result from a more connected distribution of this flora in the past, as postulated by the Pleistocene habitat fluctuations. However, the patterns of diversity have probably been influenced by events much older than Quaternary climate shifts, due to inselbergs climate stability areas (refugia) since ancient periods. Conservation of mountain vegetation is a crucial strategy for maintaining biodiversity and distinct phylogenetic lineages in the current rapid global climate and land use change scenario.

Asian swamp eels (Synbranchidae, Monopterus) in Florida: distribution, spread, and range of hydrologic tolerance over twenty-seven years (1997–2023)

Asian swamp eels (Monopterus albus/javanensis) were first reported as introduced to Florida waterbodies in 1997 near Tampa and Miami; a third population was recorded by 1999 in Homestead. Initial assessments, published soon after swamp eels in southern Florida were first recorded in wetlands beyond canals and ponds (in 2007), concluded there was little threat to Florida’s aquatic ecosystems. Long-term data now suggest they precipitated population crashes of crayfishes and small fishes in the eastern Everglades. We used records from continuous long-term monitoring programs, sporadic monitoring studies, and online databases to reconstruct swamp eel presence across Florida. Monitoring studies provided wetland hydrologic variables to assess limits for swamp eels. From 1997–2007, populations in southern Florida remained restricted to canals; initial spread from 2007–2017 across southern Everglades National Park proceeded slowly and the two populations covered ~1500 km2 of southern Florida. From 2017–2022, the rate of spread increased as they spread west and north (~5800 km2 range). Through 2014, the Tampa population occurred only along southern/eastern Tampa Bay (~60 km2) but has since spread south along the Gulf Coast, east into central Florida, and south along the Lake Wales Ridge (~11,000 km2). We found evidence of two potentially new introductions, in Palm Beach County and Orlando. There was no clear evidence of limitation of wetland drying on swamp eel occurrence in the Everglades; they were captured in marshes that dried for 1–5 months during the previous dry season, but short-hydroperiod wetlands may have slowed spread. In the Everglades, evidence suggests swamp eels may have been inadvertently spread into marshes from canals used to deliver water for flood control and hydrologic restoration. Swamp eels are currently spreading unchecked across Florida, and there should be great concern about continued spread in this region and their establishment and spread elsewhere.

Pollination by birds, non-flying mammals, and European honeybees in a heathland shrub, Banksia catoglypta (Proteaceae)

Abstract Vertebrate pollination has evolved in many plant lineages, with pollination by birds the most prevalent strategy. However, in Banksia (Proteaceae) many species are visited by a combination of nectarivorous birds, non-flying mammals (NFMs), and insects, though the relative importance of these pollen vectors for reproduction remains poorly understood. Here, we investigate the contribution to fruit set of birds, NFMs, and insects in Banksia catoglypta—a heathland shrub from south-west Australia. This species flowers in winter and produces large, golden-yellow inflorescences that are typically presented near the ground and consist of rigid, strongly scented flowers with a long stigma-nectary distance—suggesting pollination by vertebrates. The primary floral visitors were white-cheeked honeyeaters (Phylidonyris niger), honey possums (Tarsipes rostratus), house mice (Mus musculus), and introduced European honeybees (Apis mellifera), all of which carried B. catoglypta pollen. Banksia catoglypta was found to be obligately outcrossing with no evidence of pollen limitation. Selective exclusion of flying pollinators revealed that inflorescences pollinated solely by NFMs produced 50% fewer fruit than open-pollinated controls. Therefore, while mammals are pollinators of B. catoglypta, they may contribute comparatively little to fruit set in some Banksia species displaying floral traits considered adaptations to NFM pollination. Exclusion of vertebrate pollinators had no effect on fruit set, demonstrating that European honeybees can be effective pollinators of some primarily vertebrate-pollinated plants.

Exploring medicinal use of low-THC cannabis products - Comparing experienced effects and side-effects between CBD-oil-only users to users of high-THC cannabis products

Background Low-THC cannabis products have become popular worldwide and are used as self-treatment for a variety of medical conditions despite limited high-quality evidence on efficacy or long-term side-effects. Method: We compare the experiences of CBD-oil-only users to that of users, who indicated use of cannabis products conventionally higher in THC (high-THC cannabis) with respect to number of symptoms relieved, overall perceived effect on symptoms, effect on pain level and sleep duration, and perceived side-effects. A self-selected convenience sample of Danish cannabis users were recruited to an anonymous online survey. Inclusion criteria were 18 years or older and use of cannabis as medicine (CaM) (prescribed or non-prescribed). Results The final sample included 2.642 users of CaM, of which 992 were CBD-oil-only users and 1650 used high-THC products. Compared to respondents who used high-THC cannabis, CBD-oil-only users reported fewer symptoms relieved by cannabis, a slightly lower overall symptom reduction, as well as comparable pain reduction and sleep improvement. CBD-oil-only users reported fewer side-effects and were more likely to report no side-effects of cannabis. Conclusion: CBD-oils may produce less intense effects compared to high-THC cannabis products, while also producing fewer side-effects. Regulation of the legal low-THC cannabis market is needed.

What explains regional variation in privately provided out-of-area residential placement costs for people with intellectual disability in Ireland?

Expenditure on residential placements for people with intellectual disability (ID) in Ireland is considerable and expected to increase. Despite this, there is limited evidence on the factors driving variation in privately provided 'out-of-area' residential placement costs, including across Community Health Organisations (CHOs)/regions. This is important to help inform the delivery of services at best value. We analyse unit cost data from 2019 for a sample of 278 high-cost publicly funded privately provided out-of-area residential placements for people with ID in Ireland. We undertake univariate analysis of the relationship between costs and a wide range of variables using t-tests and one-way analysis of variance. We employ multivariable regression analysis to examine how raw differentials in unit costs across regions can be accounted for by individual-level characteristics. We estimate average unit costs of €264170 per annum in our sample. The univariate analysis shows considerable variation in costs across a range of personal, disability, psychiatry/psychological, forensic issues, behaviour and supports and plans related variables. We also find wide variation in average unit costs across CHOs/regions (F=4.58, P<0.001), ranging from €213380 to €331880. The multivariable analysis shows that regional differences remain even after accounting for a wide range of individual characteristics that influence costs. Our analysis shows that while the majority of differences in costs across regions can be explained, there is potential for cost savings in the provision of high-cost publicly funded out-of-area residential placements in Ireland. Overall this can help to develop and implement a more sustainable disability residential funding model in a context of rising demand for services. It also has potential implications for the approach to procurement of services.

Repeat corneal collagen cross-linking after failure of primary cross-linking in keratoconus

BackgroundPrimary corneal collagen cross-linking (CXL) stabilises 96% of progressive keratoconus. There is limited evidence for the treatment of choice when this fails. We present 10 years of repeat CXL and...

Mass Testing and Treatment to Accelerate Malaria Elimination: A Systematic Review and Meta-Analysis.

In regions where malaria transmission persists, the implementation of approaches aimed at eliminating parasites from the population can effectively decrease both burden of disease and transmission of infection. Thus, mass strategies that target symptomatic and asymptomatic infections at the same time may help countries to reduce transmission. This systematic review assessed the potential benefits and harms of mass testing and treatment (MTaT) to reduce malaria transmission. Searches were conducted in March 2021 and updated in April 2022 and included cluster-randomized controlled trials (cRCTs) as well as nonrandomized studies (NRSs) using malaria infection incidence, clinical malaria incidence, or prevalence as outcomes. The risk of bias was assessed with Cochrane's risk of bias (RoB2) tool and Risk of Bias Tool in Nonrandomized Studies - of Interventions (ROBINS-I), and the certainty of evidence (CoE) was graded for each outcome. Of 4,462 citations identified, seven studies (four cRCTs and three NRSs) contributed outcome data. The analysis revealed that MTaT did not reduce the incidence (risk ratio [RR]: 0.95, 95% CI: 0.87-1.04; 1,181 participants; moderate CoE) or prevalence (RR: 0.83, 95% CI: 0.67-1.01; 7,522 participants; moderate CoE) of malaria infection but resulted in a small reduction in clinical malaria (RR: 0.82; 95% CI: 0.70-0.95; 334,944 participants; moderate CoE). Three studies contributing data on contextual factors concluded that MTaT is an acceptable, feasible, and cost-effective intervention. Mathematical modeling analyses (n = 10) suggested that MTaT effectiveness depends on the baseline transmission level, diagnostic test performance, number of rounds, and other co-interventions. Based on the limited evidence available, MTaT has little to no impact on reducing malaria transmission.

Development of WHO Recommendations for the Final Phase of Elimination and Prevention of Re-Establishment of Malaria.

The WHO recommends that all affected countries work toward the elimination of malaria, even those still experiencing a high burden of disease. However, malaria programs in the final phase of elimination or those working to prevent re-establishment of transmission after elimination could benefit from specific evidence-based recommendations for these settings as part of comprehensive and quality-controlled malaria guidelines. The WHO convened an external guideline development group to formulate recommendations for interventions to reduce or prevent malaria transmission in areas with very low- to low-transmission levels and those that have eliminated malaria. In addition, several interventions that could be deployed in higher burden areas to accelerate elimination, such as mass drug administration, were reviewed. Systematic reviews were conducted that synthesized and evaluated evidence for the benefits and harms of public health interventions and summarized critical contextual factors from a health systems perspective. A total of 12 recommendations were developed, with five related to mass interventions that could be deployed at higher transmission levels and seven that would be most appropriate for programs in areas close to elimination or those working to prevent re-establishment of transmission. Four chemoprevention, two active case detection, and one vector control interventions were positively recommended, whereas two chemoprevention and three active case detection interventions were not recommended by the WHO. None of the recommendations were classified as strong given the limited and low-quality evidence base. Approaches to conducting higher quality research in very low- to low-transmission settings to improve the strength of WHO recommendations are discussed.

‘You can change your life through sports’—physical activity interventions to improve the health and well-being of adults experiencing homelessness: a mixed-methods systematic review

ObjectivesSystematically synthesise evidence of physical activity interventions for people experiencing homelessness (PEH).DesignMixed-methods systematic review.Data sourcesEMBASE, Web of Science, CINAHL, PubMed (MEDLINE), PsycINFO, SPORTDiscus and Cochrane Library, searched from inception to...

926 End of Life Decision-Making Inequities for Pediatric Patients With Severe Traumatic Brain Injury

INTRODUCTION: The decision to withdraw life sustaining treatment (WLST) for pediatric patients with severe traumatic brain injury (TBI) is challenging for clinicians and families with limited evidence quantifying existing practices. METHODS: This retrospective study utilized data collected from trauma centers through the American College of Surgeons Trauma Quality Improvement Program between 2017-2020. We included pediatric patients (&lt;19 years) with severe TBI and a documented decision for WLST. We utilized a random intercept multilevel logistic regression model to quantify patient, injury and hospital characteristics influencing WLST. In order to quantify the impact of disparate WLST practices on mortality, we ranked centers by their conditional random intercept computed quartile-specific adjusted mortality. RESULTS: We identified a total of 9803 children with severe TBI treated across 515 trauma centers, of which 1003 (10.2%) had WLST. Patient-level factors associated with increased likelihood of WLST were young age (&lt;3 years), higher severity intracranial and extracranial injuries and mechanism of injury related to firearms. Following adjustment for patient and hospital attributes, the median odds ratio was 1.54 (95% CI: 1.50-1.57), reflecting residual variation in WLST between centers. When centers were grouped into quartiles by their propensity for WLST, adjusted mortality was higher for fourth compared to first quartile centers (OR 1.67, 95% CI: 1.47-1.90). CONCLUSIONS: Several patient and injury factors were associated with WLST decision-making for pediatric patients with severe TBI. We also showed variation in WLST practices between trauma centers after adjustment for case mix; these differences were associated with differing quartile-specific adjusted mortality rates. Taken together, these findings highlight the presence of care provision inequities among North American trauma centers regarding WLST practice patterns for pediatric patients with severe TBI.

Validation of the Portuguese Version of the Perceived Physical Literacy Instrument.

The Perceived Physical Literacy Instrument (PPLI) has been the most adopted physical literacy instrument designed for adults to date, having been already translated to 5 languages. Still, despite its popularity, there is limited evidence of its psychometric properties. The aim of this study was to translate and adapt cross-culturally the PPLI to the Portuguese language and to analyze the psychometric properties of the Portuguese version in a sample of Portuguese-speaking adults. The study sample was composed of 434 participants (70% females) with a median age of 25 (18-39)years. Confirmatory factor analysis was used to assess psychometric properties of the scale. In addition, instrument assumptions between sexes through invariance testing were examined. Finally, concurrent validity, test-retest reliability, and test-retest agreement analyses were performed to gather additional evidence. The results of the present study generally supported the measurement model. The 9-item, 3-factor model presented a good fit to the data and adequate construct validity (χ2 = 82.859 [24], P < .001, comparative-fit index = .948, Tucker-Lewis index = .922, standardized root mean square residual = .049, root mean square error of approximation = .075). In addition, the scale presented concurrent validity. Some issues arose with measurement invariance and overtime consistency. Considering the lack of validated instruments, we suggest a fair use of Portuguese version of PPLI to access physical literacy in adults. This study contributes to the validation of the PPLI by providing evidence of its psychometric properties in the Portuguese-speaking adult population and facilitates comparative analysis with previous and future studies utilizing the PPLI instrument.

Perceived Balance, Balance Performance, and Falls Among Community-Dwelling Older Adults: A Retrospective, Cross-Sectional Study.

Objectives: To examine the extent to which older adults' perceived balance, a balance performance test, and fear of falling (FOF) were associated with falls in the last month. Methods: The Health Belief Model served as the theoretical framework. A retrospective, cross-sectional, secondary analysis using data from the National Health and Aging Trends Study was conducted (N = 7499). Results: Multiple logistic regression analysis revealed that the odds of reporting a fall in the past month were 3.3 times (p < .001) greater for participants who self-reported having a balance problem compared to those who did not. The Short Physical Performance Battery and FOF were not uniquely associated with falls. Discussion: Our findings support limited evidence suggesting that older adults' perceived balance is a better predictor of falls than balance performance. Assessing older adults' perceived balance may be a new way to assess older adults' fall risk to prevent future falls.

The subsidy program for diesel oil prices for fishing vessels and its impacts on the labor market and fish production in Brazil

The fishing industry worldwide has historically been leveraged by government subsidies. In Brazil, one of the main subsidies for this sector is the Subsidy Program for the Price of Diesel Oil for Fishing Vessels (PSPO). According to the ordinances published in the Federal Official Journal (DOU), the transfers allocated to this policy from 1997 to 2019 exceeded USD 483 million in subsidized oil. However, the economic, social, and environmental impacts of this type of subsidy are controversial. Regarding the effects on the labor market, there is limited evidence, particularly within the national literature, and the results do not indicate any influence of the program on the number of establishments or formal jobs in the fishing sector. Moreover, there is no indication of an impact on the increase in extractive fish production. These findings support the notion that these financial resources might be used to cover inherent costs of fishing activities, ensuring artificial profitability within a relatively stable production. This occurs in a renewable natural resource that displays signs of depletion.

Advancements in the diagnosis and management of premature ventricular contractions in pediatric patients.

Premature ventricular contractions (PVCs) are relatively common arrhythmias in the pediatric population, with implications that range from benign to potentially life-threatening. The management of PVCs in children poses unique challenges, and recent advancements in diagnostic and therapeutic options call for a comprehensive review of current practices. This review synthesizes the latest literature on pediatric PVCs, focusing on publications from the past decade. We evaluate studies addressing the epidemiology, pathophysiology, diagnosis, and treatment of PVCs in children, including pharmacological, non-pharmacological, and invasive strategies. The review identifies key advancements in the non-invasive detection of PVCs, the growing understanding of their genetic underpinnings, and the evolving landscape of management options. We discuss the clinical decision-making process, considering the variable significance of PVCs in different pediatric patient subgroups, and highlight the importance of individualized care. Current guidelines and consensus statements are examined, and areas of controversy or limited evidence are identified. Our review underscores the need for a nuanced approach to PVCs in children, integrating the latest diagnostic techniques with a tailored therapeutic strategy. We call for further research into long-term outcomes and the development of risk stratification tools to guide treatment. The potential of emerging technologies and the importance of multidisciplinary care are also emphasized to improve prognoses for pediatric patients with PVCs.

Multiplex PCR method for MinION sequencing of Bagaza virus isolated from wild caught mosquitoes in South Africa

Bagaza virus (BAGV) is a mosquito-borne orthoflavivirus known to occur in regions of southern Europe, Africa, India and the Middle East. The virus has been associated with neurological disease and fatalities in various wild bird species. Association with human disease is not confirmed although limited serological evidence has suggested human infection. Surveillance programs for screening mosquitoes for evidence of arbovirus infection play an important role in providing information regarding the circulation and spread of viruses in specific regions. BAGV was detected in a mosquito pool during surveillance of mosquitoes collected in central South Africa between November 2019 and March 2023. Homogenized mosquito pools were screened for flaviviral RNA using conventional RT-PCR and virus isolation was attempted on positive samples. BAGV was detected and subsequently isolated using cell culture. A multiplex tiling PCR method for targeted enrichment using a PCR based or amplicon sequencing approach of the complete genome of BAGV was developed and optimized. Primers were designed using alignment of complete genome sequence data retrieved from GenBank to identify suitable primer sites that would generate overlapping fragments spanning the complete genome. Six forward primers and eight reverse primers were identified that target the complete genome and amplified nine overlapping fragments, that ranged in length from 1954 to 2039 with an overlap ranging from 71 to 711 base pairs. The design strategy included multiple forward and reverse primer pairs for the 5’ and 3’ ends. Phylogenetic analysis with other isolates was performed and BAGV isolate VBD 74/23/3 was shown to share high similarity with previous BAGV isolates from all regions, with genetic distance ranging from 0.026 to 0.083. VBD 74/23/3 was most closely related to previous isolates from southern Africa, ZRU96/16/2 isolated from a post-mortem sample from a pheasant in 2016 and MP-314-NA-2018 isolated from mosquitoes in northwestern Namibia with genetic distance 0.0085 and 0.016 respectively. Currently there is limited complete genome sequence data available for many of the arboviruses circulating in Africa. The multiplex tiling method provided a simple and cost-effective method for obtaining complete genome sequence. This method can be readily applied to other viruses using sequence data from publicly available databases and would have important application facilitating genomic surveillance of arboviruses in low resource countries.

Quality of life in post-herpetic neuralgia in the dermatology department of Hospital Luis Vernaza

Introduction: Shingles (HZ) is the result of the reactivation of the varicella zoster virus. The main complication of HZ is post-herpetic neuralgia (PHN), pain that appears in the affected dermatome 3 months after the resolution of the cutaneous lesions. Despite the limited evidence, PHN significantly influences the patient's quality of life (QL), affecting their functional capacity, emotional state and work capacity in the active population. The objective of the present investigation was to evaluate the quality of life in NPH. Previous studies have not been done in this institution and statistics on the subject are nil in Ecuador. Materials and Methods: The study was descriptive, observational, retroprospective with a non-experimental and transversal level. The universe consisted of 141 patients with a diagnosis of PHN treated at the outpatient clinic of the dermatology service of the Luis Vernaza hospital during the period from January 1 to December 31, 2016, with a sample of 92 patients, who underwent an interview and a physical examination, using a data sheet that included the DN4 and EQ-5D-5L questionnaires. Excel tables were used to record the data. Results: Of the total of 92 patients who participated in the study, tingling was the most frequent symptom. Regarding the symptomatic load related to QL in PHN, the friction pain and numbness with P values of 0.00 show a strong statistical significance followed by a puncture with a P value of 0.03. The scatter plot to assess the level of PHN severity and its relation to quality of life indicates that QL is related to neuropathic pain (NP). The average DN4 was 4/10. 82 % of cases, with or without neuropathic pain, had a better QL; 18 %, accompanied by NP, reported affectation in their QL. The average index value of the EQ5D5L was 0.814. Conclusions: It was concluded that the quality of life is affected in patients with postherpetic neuralgia.

Deprivation and Its Association with Child Health and Nutrition in the Greater Kampala Metropolitan Area of Uganda.

African cities are experiencing increasing living standard disparities with limited evidence of intra-urban health disparities. Using data from the 2006-2016 Uganda Demographic and Health Surveys, we employed the UN-Habitat definition to examine slum-like household conditions in the Greater Kampala Metropolitan Area (GKMA). Subsequently, we developed a slum-like severity index and assessed its association with under-5 common morbidities and healthcare access. We also assessed the characteristics of people in slum-like household conditions. We identified five slum-like conditions: substandard housingconditions, limited water access, overcrowding, unclean cooking fuel, and limited toilet access. By 2016, 67% of GKMA households were classified as slum-like conditions, including 31% in severe conditions. Limited toilet access, overcrowding, and limited water access were the main forms of deprivation.Living in slum-like household conditions correlated with lower education levels, youth status, unprofessional jobs, and marriage. Compared to neighboring Kampala city urban outskirts, Kampala city households had lower slum-like prevalence. Children in GKMA living in slum-like household conditions were morelikely to experience diarrhea (moderate: OR = 1.21[95% CI: 1.05-1.39], severe: OR = 1.47 [95% CI: 1.27-1.7]); fever (moderate: OR = 2.67 [95% CI: 1.23-5.8], severe: OR = 3.09 [95% CI: 1.63-5.85]); anemia (moderate: OR = 1.18 [95% CI: 0.88-1.58], severe: OR = 1.44 [95% CI: 1.11-1.86]); and stunting (moderate: OR = 1.23 [95% CI: 1.23-1.25], severe: OR = 1.40 [95% CI: 1.41-1.47]) compared to those living in less slum-like conditions. However, seeking treatment for fever was less likely in slum-like household conditions, and the association of slum-like household conditions with diarrhea was insignificant. These findings underscore the precarious urban living conditions and the need for targeted health interventions addressing the social determinants of health in urban settings.

Health-related quality of life and frailty in liver cirrhosis

Background and objectivesThere is limited evidence concerning the predictive value of health-related quality of life (HRQoL) on the presence of frailty in the context of cirrhosis. We aimed to elucidate...

Predictors and disturbances of sleep quality between men and women: results from a cross-sectional study in Jordan

BackgroundSleep disturbances, a public health concern that may lead to critical physiological conditions, are associated with personal characteristics such as gender. Limited evidence is available from the Middle East population on the gender disparities in sleep quality. Therefore, the current study examined gender-specific differences in sleep quality and disturbances among Jordanian citizens.MethodA cross-sectional design was used to recruit a convenient sample of 1,092 adults from different Jordanian cities. Data was collected using a self-reported questionnaire comprising the Pittsburgh Sleep Quality Index (PSQI), which was distributed online via social media networks. The participants were categorized according to their global PSQI scores into poor (PSQI ≥ 5) and good sleepers (PSQI < 5). The analysis focused on finding differences between women and men in terms of sleep quality and the effects of demographic, lifestyle, and socioeconomic factors on reported sleep problems.ResultsWomen were revealed to have a higher prevalence of all types of sleep disturbances than men. Women who were over 55 (compared to younger than 20 years), did not smoke, had multiple jobs or part-time employment (compared to unemployed women), and had a monthly income of more than 500 JD (compared to those with an income of < 500 JD) were less likely to experience poor sleep than other women. In contrast, men who neither smoked nor drank coffee, ate no sweets or only one to two pieces daily (compared to participants who ate more than two pieces daily), and worked fixed night shifts (compared to alternating shifts workers) were less likely to experience poor sleep than other men.ConclusionThis study builds a more nuanced understanding of how different demographic, lifestyle, and socioeconomic factors - such as a participant’s age, time of working duty, income, daily sweet consumption, daily caffeine consumption, and smoking - affect the sleep quality of men and women. Thus, promoting a healthier lifestyle for both genders by modifying risk factors - such as smoking cessation, as well as reducing their intake of caffeine and sweets - is the first step toward improving their sleep quality. Further studies are needed to examine how the social role of Arabic women affects their sleep.

Hospital-Level Care at Home for Patients with Cirrhosis.

Patients with cirrhosis have a 30-day readmission rate of over 30%. Novel care delivery models are needed to reduce healthcare costs and utilization associated with cirrhosis care. One such model is Home Hospital (HH), which provides inpatient-level care at home. Limited evidence currently exists supporting HH for cirrhosis patients. The aims of this study were to characterize patients with cirrhosis who received hospital-level care at home in a two-site clinical trial and to describe the care they received. Secondary aims included describing their outcomes, including adverse events, readmissions and mortality. We identified all patients with cirrhosis who enrolled in HH as part of a two-site clinical trial between 2017 and 2022. HH services include daily clinician visits, intravenous and oral medications, continuous vital sign monitoring, and telehealth specialist consultation. We collected sociodemographic data and analyzed HH stays, including interventions, outcomes, adverse events, and follow-up. 22 patients with cirrhosis (45% Hispanic; 50% limited English proficiency, median MELD-Na 12) enrolled in HH during the study period. Interventions included lab chemistries (82%), intravenous medications (77%), specialist consultation (23%), and advanced diagnostics/procedures (23%). The median length of stay was 7days (IQR 4-12); 186 bed-days were saved. Two patients (9%) experienced adverse events (AKI). No patients required escalation of care; 9% were readmitted within 30days. In this two-site study, HH was feasible for patients with cirrhosis, holding promise as a hepatology delivery model. Future randomized trials are needed to further evaluate the efficacy of HH for patients with cirrhosis.