Median Annual Rate Research Articles

Comparison of Geographic Atrophy Measurements Between Blue-Light Heidelberg Standard Field and Green-Light Optos Ultrawide Field Autofluorescence.

This study compared geographic atrophy (GA) measurements in the macula using standard 30° field and ultrawide field (UWF) fundus autofluorescence (FAF) imaging. Participants from Age-Related Eye Disease Study 2 (AREDS2) and Optos PEripheral RetinA (OPERA) studies with GA were included for comparison between standard field FAF with Heidelberg Spectralis and Optos 200Tx UWF FAF. Two time points 5years apart were evaluated. GA area (mm2) was recorded in the macular area for both imaging types and in the peripheral field for UWF. Of 102 paired images (73 subjects), the mean (SD) baseline GA area was 5.32 (6.36)mm2 with standard and 4.79 (5.87)mm2 with UWF FAF (P < 0.001). The mean difference between the two modalities was 0.52mm2 (95% confidence interval, -2.41 to 1.37). Progression of GA in 25 eyes over 5years showed a median annual growth rate of 1.28mm2 (range, 0.02 to 4.7) for standard and 1.34mm2 (range, 0.04 to 5.3) for UWF FAF (P = 0.49). The measurement of GA is larger on standard than on UWF FAF imaging. The observed difference may be due to image averaging and the use of blue versus green FAF. Similar GA progression with standard and UWF FAF suggests either may be used longitudinally, although not interchangeably. Further investigation is required with updated UWF technology. With the increasing adoption of UWF imaging modalities, this study suggests that Optos UWF FAF may be used longitudinally as an alternative to standard field FAF to monitor GA.

Real-world experience of emicizumab prophylaxis in Korean children with severe hemophilia A without inhibitors

PurposeHemophilia A is a genetic disorder characterized by a lack of factor VIII (FVIII). Emicizumab, a recombinant humanized bispecific monoclonal antibody, mimics the function of FVIII. In this article, we present data on an initial real-world evaluation of emicizumab use in Korean children with severe hemophilia A without inhibitors.MethodsThis study was conducted from June 2020 to March 2024 at 4 centers in Korea. The participants were pediatric patients with severe hemophilia A without inhibitors who had received emicizumab treatment for over 6 months. The mean and median annualized bleeding rates (ABRs) and mean and median annual joint bleeding rates (AJBRs) were compared.ResultsEach of the 21 patients in the study received an emicizumab loading regimen of 3 mg/kg weekly for 4 weeks, followed by a modified maintenance regimen of which 2 patients (9.5%) received a 1.5 mg/kg weekly dose, 3 patients (14.3%) received a 6 mg/kg dose every 4 weeks, and the remaining 16 patients (76.2%) received a 3 mg/kg dose every 2 weeks. Before emicizumab prophylaxis initiation, the mean and median ABRs for all patients were 7.04 (SD ± 5.83) and 6.52 (range 0–21.74), respectively. After receiving emicizumab treatment, the mean and mediam ABRs decreased to 0.41 and zero, respectively. Additionally, 85.7% of the patients achieved no bleeding events within 6 months of starting the treatment.ConclusionThese first real-world data in Korea indicate that emicizumab is effective and safe for pediatric patients with severe hemophilia A without inhibitors.

GFR decline predicts total mortality and mediates the effect of tryptophan metabolism on death risk in type 2 diabetes.

The independent role of glomerular filtration rate (GFR) decline in shaping the risk of mortality in people with type 2 diabetes has only been partially addressed. The objective of the study was twofold: i) to investigate the association between all-cause mortality and eGFR changes over time; ii) to understand whether renal dysfunction mediates the effect of tryptophan metabolism on death risk. Prospective study with an average follow-up of 14.8 years. Research Hospital. The aggregate Gargano Mortality Study included 962 patients with type 2 diabetes who had at least three eGFR recordings and at least 1.5 years of follow-up. This was an observational study, with no intervention. Rate of all-cause mortality. Age and sex adjusted annual incident rate of mortality was 2.75 events per 100 person-years. The median annual rate of decline of eGFR was 1.3 ml/min per 1.73 m2 per year (range -3.7; 7.8). The decline of kidney function was strongly and independently associated with the risk of death. Serum kynurenine-to-tryptophan ratio (KTR) was associated with both eGFR decline and all-cause mortality. Causal mediation analysis showed that 24.3% of the association between KTR and mortality was mediated by eGFR decline. In patients with type 2 diabetes, eGFR decline is independently associated with the risk of all-cause mortality and mediates a significant proportion of the association between tryptophan metabolism and death.

Ultrasound study of natural progression of ovarian endometrioma.

To determine the natural progression of ovarian endometrioma in women who are managed expectantly. This was a retrospective cohort study of 83 women with evidence of ovarian endometrioma who were managed expectantly between April 2007 and May 2022. The study was conducted in the Department of Women's Health, University College London Hospitals and The Gynecology Ultrasound Centre, London, UK. We searched our ultrasound clinic databases to identify women aged 18 years or older with evidence of ovarian endometrioma who were managed expectantly for ≥ 6 months. All women attended for a minimum of two ultrasound scans performed by a single expert ultrasound operator. In addition to patient demographics, we recorded the number, mean diameter and location of each cyst. The cyst growth rate was expressed as annual change in the mean diameter. A total of 1922 women who attended our gynecology clinic during the study period were found to have evidence of moderate or severe endometriosis on pelvic ultrasound examination. Of those, 83 women had evidence of ovarian endometrioma and were managed expectantly. The median age of women was 39 (range, 26-51) years at the initial visit. Each woman had at least two ultrasound scans performed by a single expert operator at a minimum interval of ≥ 6 months. Of 83 women diagnosed with endometrioma, 50 (60% (95% CI, 49-71%)) had a single cyst and the remainder had multiple cysts. The median number of endometriomas per patient was 1 (range, 1-5) and the median follow-up time was 634 (range, 187-2984) days. A total of 39/83 (47% (95% CI, 36-58%)) women experienced an overall reduction in size of cysts, in 18/83 (22% (95% CI, 13-32%)) the cysts increased in size and in 26/83 (31% (95% CI, 22-42%)) women, no meaningful change in size was observed. The median change in mean cyst diameter per woman during the study period was -2.7 (range, -57.7 to 39.3) mm, with a median annual regression rate of -1.7 (range, -24.6 to 42.0) mm/year/woman. Overall, when compared with the initial visit, cysts were significantly smaller at follow-up (median diameter, 22.3 (range, 6.7-77.0) mm vs 18.5 (range, 5.0-72.0) mm; P = 0.009). We did not identify any clinical characteristics that could reliably predict the chance of endometrioma progression. In the majority of women with an ultrasound diagnosis of ovarian endometrioma, the cysts do not increase in size significantly over time and they could be managed expectantly. This evidence may help clinicians when counseling asymptomatic or minimally symptomatic women about management of ovarian endometrioma. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Mitigating the Risk of Dengue Fever in Nagpur City, India: Insights from a Five-year Retrospective Study

Objectives: Dengue is a significant global threat, with millions of infections yearly, primarily transmitted by Aedes mosquitoes. Vector control is crucial as no specific treatment is available, and urbanisation has led to increased susceptibility to the disease. We aimed to study dengue fever’s incidence, mortality, and various determinants in Nagpur, India. Material and Methods: This was a retrospective record-based study conducted for the period between January 2018 and December 2022 in Nagpur, India. Results: During 2018–2022, 17,306 blood samples were tested for dengue immunoglobulin M antibodies by enzyme-linked immunosorbent assay method with 2470 positive results indicating an overall test positivity of 14.27%. A median of 27 samples was tested monthly (interquartile range [IQR]: 5–178.5) with seven dengue cases (IQR: 1–15) diagnosed per month, yielding a monthly median dengue test positivity rate of 15.3 % (IQR: 6.41–24.28). Median annual dengue incidence rate (per 1,00,000 population) was 20.12 (IQR: 21.46). The median dengue-attributable death yearly was 2 (IQR: 2.25), remaining stable over the study period. The mean annual case fatality rate (CFR) was 0.43% (standard deviation [SD]: 0.34%). During the same period, India’s mean annual dengue incidence rate (per 1,00,000 population) was 1.74 (SD: 0.81), and the mean annual CFR was 0.134 % (SD: 0.042). During the five years, action was taken on 194,698 containers. The median values of environmental factors and public health interventions, as calculated on a monthly basis, were as follows: Container index: 1.15 % (IQR: 0.7–1.98); action taken on containers: 3108.5 (IQR: 2436–4282); house index: 3.02 % (IQR: 2–4.07); guppy fishes introduced: 1736.5 (1005.5–1794.5) and rainfall (mm): 26.05 (1–69.11). The total number of dengue cases, incidence rate, and CFR showed an overall decline in year-wise evaluation. The important determinants identified were as follows: Higher container index, house index, and total blood samples tested for dengue were significant determinants of the total number of dengue cases, and environmental factors such as Aedes density, container index, and house index were significant determinants of dengue-related mortality. Introducing guppy fishes and taking action on containers successfully arrested the absolute number of dengue deaths. The container index, house index, and rainfall were significant determinants of Aedes’ density. Conclusion: Our study emphasises the effectiveness of public health interventions in reducing the incidence and fatality rate of dengue fever in Nagpur City over the past five years, particularly through introducing guppy fish and container management. Stagnant water around households has been identified as a significant risk factor for dengue transmission. Prevention strategies must prioritise tackling this issue, with enhanced monitoring during the wet season, and encourage community members to take personal responsibility for eliminating stagnant water sources in their households.

Denitrifying bioreactors and dissolved phosphorus: Net source or sink?

Understanding the world through a lens of phosphorus (P), as Dr. Andrew Sharpley aimed to do, adds a deeper dimension for water quality work in the heavily tile-drained US Midwest where nitrate is often the nutrient of biggest concern. Denitrifying woodchip bioreactors reduce nitrate pollution in drainage water, but dissolved phosphorus leached from the organic fill is a possible pollution tradeoff. Recent work by Dr. Sharpley and others defined such tradeoffs as strategic decisions in which a negative outcome is accepted with prior knowledge of the risk. In this vein, we assessed 23 site-years from full-size bioreactors in Illinois to determine if bioreactors were a net dissolved reactive phosphorus (DRP) source and, if so, to determine flow-related correlation agents (1904 sample events; 10 bioreactors). DRP was removed across the bioreactors in 15 of 23 site-years. The 23 site-years provided a median annual DRP removal efficiency of 12% and a median annual DRP removal rate of 7.1mg DRP/m3 bioreactor per day, but the ranges of all removal metrics overlapped zero. The highest daily bioreactor DRP removal rates occurred with high inflow concentrations and under low hydraulic retention times (i.e., under higher loading). Dr. Sharpley was one of the first to explore losses of DRP in subsurface drainage and performed decades of useful applied studies that inspired approaches to management of P loss on both drained and undrained land. We seek to honor this legacy with this practical study of the DRP benefits and tradeoffs of denitrifying bioreactors.

Prevalence and progression of arterial calcifications on computed tomography in humans with knee osteoarthritis.

Ectopic bone deposition plays an important role in osteoarthritis (OA) and in arterial wall disease. We aimed to investigate the prevalence and progression of arterial calcifications on whole-body computed tomography (CT) in persons with knee OA. We included 118 (36 male) participants who satisfied the clinical American College of Rheumatology classification criteria for knee OA. Baseline investigations included Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Kellgren-Lawrence grading. At baseline and after two years, a whole-body CT was performed using the same scanner and protocol. Calcifications were quantified in the carotid, brachiocephalic, coronary, thoracic aortic, abdominal aortic, iliac, femoropopliteal and crural arteries. Multivariable linear and logistic regression modeling was used for analyses. At baseline males were 66.9 ± 7.7 and females were 68.0 ± 5.6 years old. Calcifications were common, all participants except two females had some calcification, and prevalence ranged between 41.8% and 94.4% for various arterial beds. Baseline femoropopliteal calcifications were associated with a higher Kellgren-Lawrence grade (more severe knee OA). Median annual progression rate was 13.1% in males and 15.7% in females. Structural OA severity was not associated with progression, but a five points lower (worse) WOMAC was associated with 1% faster progression of arterial calcifications (p= 0.008). Around age 70 nearly all persons with knee OA have arterial calcifications, which progress substantially. For further investigation into shared causality intervention studies are needed.

Examination of Pediatric Burn Incidence and the Impact of Social Determinants of Health in Florida.

Introduction Burn injuries are a major mechanism of trauma worldwide, caused by friction, cold, heat, radiation, chemical, or electric sources. Most often, burn injuries occur due to heat contact from hot liquids, solids, or fire, termed scald burns and flame burns, respectively. These types of injuries are complex and carry major injury and mortality risks, especially in pediatric populations. Burn trauma prevention has been a major focus in the US, with initiatives to increase public health outreach and safety measures. Unfortunately, children in socioeconomically disadvantaged situations may face these types of injuries at disproportionately higher rates, and we aim to highlight these disparities, if any, within our Florida community. Materials and methods This study was designed as a retrospective observational analysis using publicly available data from the Florida Health Community Health Assessment Resource Tool Set (CHARTS). Data was extracted for nonfatal burn injuries resulting in ED visits in the years 2018-2020. This data was limited to those ranging from 0 to 19 years old and converted to rates of burn injuries per 100,000. Sociodemographic details for each county were recorded from County Health Rankings & Roadmaps and compared with burn data in each respective county. Frequencies were generated for categorical data, and statistical analyses for burn rates and sociodemographic details were performed with a generalized linear model using a Poisson distribution and bivariate correlation for a p < 0.05. Results In Florida, the median annual burn rate per 100,000 was 136 (IQR: 96-179), with Jackson county holding the highest rate of 323 and Glades, Hardee, and Lafayette each holding a rate of 0. Of the 18 socioeconomic factors examined, a total of five were found to have no statistically significant effect on nonfatal burn injury ED visits: severe housing problems, percentage of Asians, teen births, percentage of children (<18 years) in poverty, and severe housing cost burden. The two most important factors to be found in nonfatal burn ED visits of pediatric patients were the percentage of those younger than 19 years old without health insurance and the average grade level performance of third-grader reading scores. When adjusting for the small sample size using Firth's bias-adjusted estimates and overdispersion, both reading scores and those without insurance play a significant role in pediatric burn injuries. For each increase in a single point in reading scores, the incidence rate ratio decreases by 97.1% (95% CI). For every percentage increase in children insured, there is a 28.8% decrease in pediatric burn injuries (95% CI). Conclusions This analysis highlights increased pediatric burn rates across multiple social determinants of health (SDOH) in all 67 Florida counties. The findings here demonstrate that there may continue to be a disproportionate distribution of burn rates among lower and higher sociodemographic areas. This study further highlights this trend within the Florida community, and continued research will be necessary to meet the needs of lower sociodemographic areas to improve burn rates in vulnerable populations, such as children, who are at increased risk of injury.

Imaging as an early biomarker to predict sensitivity to everolimus for progressive NF2-related vestibular schwannoma

PurposeNF2-related schwannomatosis (NF2) is characterized by bilateral vestibular schwannomas (VS) often causing hearing and neurologic deficits, with currently no FDA-approved drug treatment. Pre-clinical studies highlighted the potential of mTORC1 inhibition in delaying schwannoma progression. We conducted a prospective open-label, phase II study of everolimus for progressive VS in NF2 patients and investigated imaging as a potential biomarker predicting effects on growth trajectory.MethodsThe trial enrolled 12 NF2 patients with progressive VS. Participants received oral everolimus daily for 52 weeks. Brain imaging was obtained quarterly. As primary endpoint, radiographic response (RR) was defined as ≥ 20% decrease in target VS volume. Secondary endpoints included other tumors RR, hearing outcomes, drug safety and quality of life (QOL).ResultsEight participants completed the trial and four discontinued the drug early due to significant volumetric VS progression. After 52 weeks of treatment, the median annual VS growth rate decreased from 77.2% at baseline to 29.4%. There was no VS RR and 3 of 8 (37.5%) participants had stable disease. Decreased or unchanged VS volume after 3 months of treatment was predictive of stabilization at 12 months. Seven of eight participants had stable hearing during treatment except one with a decline in word recognition score. Ten of twelve participants reported only minimal changes to their QOL scores.ConclusionsVolumetric imaging at 3 months can serve as an early biomarker to predict long-term sensitivity to everolimus treatment. Everolimus may represent a safe treatment option to decrease the growth of NF2-related VS in patients who have stable hearing and neurological condition. TRN: NCT01345136 (April 29, 2011).

Long-term clinical outcomes of patients with drug-induced type 1 Brugada electrocardiographic pattern: A nationwide cohort registry study

BackgroundThere are limited real-world data on the extended prognosis of patients with drug-induced type 1 Brugada electrocardiogram (ECG). ObjectiveWe assessed the clinical outcomes and predictors of life-threatening arrhythmias in patients with drug-induced type 1 Brugada ECG. MethodsThis multicenter retrospective study, conducted at 21 Italian and Swiss hospitals from July 1997 to May 2021, included consecutive patients with drug-induced type 1 ECG. The primary outcome, a composite of appropriate ICD therapies and sudden cardiac death, was assessed along with the clinical predictors of these events. ResultsA total of 606 patients (mean age 49.7 ± 14.7 years; 423 [69.8%] men) were followed for a median of 60.3 months (interquartile range 23.0–122.4 months). Nineteen patients (3.1%) experienced life-threatening arrhythmias, with a median annual event rate of 0.5% over 5 years and 0.25% over 10 years. The SCN5A mutation was the only predictor of the primary outcome (hazard ratio 4.54; P = .002), whereas a trend was observed for unexplained syncope (hazard ratio 3.85; P = .05). In patients who were asymptomatic at presentation, the median annual rate of life-threatening arrhythmias is 0.24% over 5 years and increases to 1.2% if they have inducible ventricular fibrillation during programmed ventricular stimulation. ConclusionIn patients with drug-induced type 1 Brugada ECG, the annual risk of life-threatening arrhythmias is low, with the SCN5A mutation as the only independent predictor. Unexplained syncope correlated with worse clinical outcomes. Ventricular fibrillation inducibility at programmed ventricular stimulation significantly increases the median annual rate of life-threatening arrhythmias from 0.24% to 1.2% over 5 years.

Prostate cancer temporal and regional trends in Brazil.

The Brazilian Unified Health System (Sistema Único de Saúde-SUS) is the universal public healthcare system of Brazil that maintains a nationwide database of its patients. Our primary objective was to analyze regional and temporal trends, while our secondary goal was to establish correlations between states' health economy status and their prostate cancer (PCa) epidemiology. We analyzed Brazil's nationwide data on prostate cancer (PCa) incidence, mortality, and care gathered between 2013 and 2021 by the Information Technology Department of SUS (DATA-SUS), updated monthly using the International Classification of Diseases (ICD-10) code. In the period, 273,933 new cases of PCa and 135,336 PCa deaths were reported in men aged 50 years or over in Brazil. The median annual PCa-specific incidence rate (PCSIR) ranged from 14.7 in the Southeast to 6.9 in the North region and the median annual PCa-specific mortality rate (PCSMR) ranged from 7.7 in the Northeast to 6.0 in the South region (per 10,000 men >50). The median annual mortality to incidence ratio (MIR) was highest in the North (0.88) and lowest in the Southeast region (0.44). There were significant regional differences in PCa treatment rates (per new cases); the Midwest region had the highest median annual surgery rate (0.63) while the North region had the highest median annual systemic therapy rate (0.75) and the lowest radiation therapy rate (0.06). Temporal analysis of the data showed significant change in annual rate trends after the year 2018 for PCSIR (coefficient [β] = +3.66, p < 0.001), any treatment (β = -0.06, p = 0.016), surgery ([SR] β = +0.05, p = 0.017) radiation therapy ([RTR] β = -0.06, p = 0.005) and systemic therapy ([STR] β = -0.10, p = 0.002). After the 2020 pandemic, annual PCSIR decreased (β = -2.15, p = 0.002) but annual PCSMR, MIR, and treatment rates remained stable. Correlation studies showed that the PCSIR was strongly negatively correlated with STR (p < 0.001) and positively correlated with RTR (p = 0.004). MIR was positively correlated with STR (p < 0.001) and negatively correlated with the number of robotic surgical systems per million population (p = 0.003). Our data shows that PCa care is dependent on the region and is likely influenced by access to treatment options. Furthermore, changes after the year 2018 underscore the influence of international guidelines on Brazilian clinicians' decision-making especially concerning population screening which in turn affected incidence and treatment rates. Limitation of our study includes limited patient-related information and data on private practices as well as an unknown impact of traveling patients.

Exploration of high-quality development path of tourism and culture industry in the context of smart tourism

Abstract The emergence of intelligent tourism as a new trend in the travel industry has raised the bar for the excellent growth of the travel and cultural sectors. The merger of the artistic and tourist industries significantly advances tourism’s modernization and evolution. Finding a high-quality growth path for the tourist and culture industries within the context of intelligent tourism is a significant problem that must be overcome in order to achieve the two sectors’ in-depth integration and synergistic growth. A scientific assessment system and model analysis is necessary to uncover practical ways to support industry integration and upgrading based on the current industrial development status quo. A strong connection between this province’s cultural and tourism sectors is indicated by the coupling degrees generally higher than 0.85. Although the degree of coupling coordination has improved annually, many cities are still unable to achieve a higher level of coordination, according to an analysis. This study utilizes the degree of coupling coordination model as a basis for creating a coupling index for the culture and tourist industries and examining the growth situation of an area from 2015 to 2022. In a particular province, the median annual growth rates for the tourism and cultural sectors between 2015 and 2022 are 19.18% and 32.11%, respectively. This suggests that there is still more room for growth and integration between the two sectors in the context of intelligent tourism. The tourism industry is developing more slowly than the cultural industry. The research suggests ways to aid the integration and superior growth of the tourist and cultural sectors, including boosting infrastructure construction and enhancing employee knowledge.

Coverage, Trends, and Inequalities of Maternal, Newborn, and Child Health Indicators among the Poor and Non-Poor in the Most Populous Cities from 38 Sub-Saharan African Countries.

Rapid urbanization is likely to be associated with suboptimal access to essential health services. This is especially true in cities from sub-Saharan Africa (SSA), where urbanization is outpacing improvements in infrastructure. We assessed the current situation in regard to several markers of maternal, newborn, and child health, including indicators of coverage of health interventions (demand for family planning satisfied with modern methods, at least four antenatal care visits (ANC4+), institutional birth, and three doses of DPT vaccine[diphtheria, pertussis and tetanus]) and health status (stunting in children under 5 years, neonatal and under-5 mortality rates) among the poor and non-poor in the most populous cities from 38 SSA countries. We analyzed 136 population-based surveys (year range 2000-2019), contrasting the poorest 40% of households (referred to as poor) with the richest 60% (non-poor). Coverage in the most recent survey was higher for the city non-poor compared to the poor for all interventions in virtually all cities, with the largest median gap observed for ANC4+ (13.5 percentage points higher for the non-poor). Stunting, neonatal, and under-5 mortality rates were higher among the poor (7.6 percentage points, 21.2 and 10.3 deaths per 1000 live births, respectively). The gaps in coverage between the two groups were reducing, except for ANC4, with similar median average annual rate of change in both groups. Similar rates of change were also observed for stunting and the mortality indicators. Continuation of these positive trends is needed to eliminate inequalities in essential health services and child survival in SSA cities.

1735. Impact of Children Universal Pneumococcal Vaccination (PCV7v/PCV13v) on Pneumococcal Invasive Disease Hospitalizations in a Private General Hospital, Uruguay

Abstract Background In 2008 Uruguay included pneumococcal conjugate vaccine (PCV) 7valent in children´s vaccination program (2+1). In 2010 PCV13 replaced PCV7. Since 2015, adults at risk of invasive pneumococcal disease (IPD) may receive 23 valent polysaccharide vaccine (PV23) or combined schedule PCV13+PV23. Objective: to assess the impact of this strategy on IPD hospitalization. Methods Rates per 10,000 discharges (Confidence Interval 95 %), diseases and serotypes (ST) are described before PCV7 vaccination (2006-2007), the year of vaccine implementation (2008), early after implementation (2009-2015) and late after implementation (2016-2022), the last 3 years during COVID-19 pandemic. Results In 2006-2022 were 33 IPD cases in children and 88 in adults over 15 years old. Children´s hospitalization median annual rates were as follow 2006-2007: 50 (25-75); 2008: 18,5 (-2-39); 2009-2015: 8,5 (3-14); 2016-2022: 4 (0-8); percentages of rate reduction were 82,5% and 92% (p&amp;lt; 0.0000). In adults 2006-2007: 17 (10-25); 2008: 13,4 (4,62-22,1); 2009-2015: 6,6 (4,4-9); 2016-2022: 6 (3,5-8,5); percentages of rate reduction were 63,5% and 66 % (p= 0,0001). Pneumococcal pneumonia (PP) was the most frequent disease in children 22/33 (66,6%), followed by bacteremia 8/32. PP was also in adults 68/88 (77.2,7%), followed by meningitis (7/88). One non vaccinated child died in 2008. Case fatality rate in adults was 9% (8/88), 3 died in 2006-2007, 2 in 2009-20215 and 3 in 2016-2022. 24 different ST were isolated in adults. Most frequent ST were 12F(15), 7F(11), 1(8), 8(7), 3(6) and 5(6). PCV13 would cover 38/88 (43%). A significant decline in PCV13 serotypes (PCV13-ST) was observed comparing the period prior PCV 17/22 (77%) with the late period 8/24 (34%) (p&amp;lt; 0.0000). 15 different ST were isolated in children: 26 PCV13-ST. 16 prior 2008: most frequent ST 1(5), 14(4), 3(2) and 5(2). In 2009-2022 13 hospitalizations; PCV13-ST: 1(2), 19A(2), 14(1), 6B&amp;lt; (1), 9V(1), 3(1) and non PCV13-ST: 7B/C(1), 24F(1), 13(1), 15A(1), 15B(1). A significant decline of PCV13-ST was observed comparing the period prior PCV (15/16, 94%) with the late period (2/4, 50 %) (p&amp;lt; 0.0000). Conclusion There was a reduction in children’s discharge rates and in adults´ probably due to herd effect. Adult vaccination will improve individual immunization. Disclosures María Catalina Pírez, Pediatrician, Pediatric infectologist, microbiologist Professor of pediatric, Degree V, Merck, Pfizer: Expert Testimony|Merck, Pfizer: Honoraria

Projecting forest cover in Madagascar's protected areas to 2050 and its implications for lemur conservation

AbstractPredicting future conservation needs can help inform conservation management but is subject to uncertainty. We measured deforestation rates during 2015–2017 for 114 protected areas in Madagascar, linked deforestation to the status of protection according to IUCN categories I–VI, used recent deforestation rates to extrapolate forest cover over 2017–2050 and linked the size of forest blocks to the projected persistence of lemur subpopulations. In the six IUCN categories for protected areas in Madagascar the median size of forest blocks is 9–37 km2 and median annual deforestation rates range from 0.02% in the single IUCN category III site to 0.19% in category II and 1.95% in category VI sites. In 2017, 40% of all forest blocks within protected areas were &lt; 10 km2, and this is projected to increase to 45% in 2050. Apart from these small forest fragments, the modal site of forest blocks was 160–320 km2 in 2017, and this is projected to decrease to 80–160 km2 in 2050. The range of &gt; 50% of all lemur species exclusively contains forest blocks of &lt; 10 km2. The modal size of forest blocks &gt; 10 km2 is predicted to remain at 120 km2 until 2050. Although uncertainty remains, these analyses provide hope that forest blocks within the protected areas of Madagascar will remain large enough to maintain lemur subpopulations for most species until 2050. This should allow sufficient time for the implementation of effective conservation measures.

Abstract 230: Epidemiology of Out-of-Hospital Cardiac Arrest Incidence and Field Termination in the US

Introduction: While registry-based OHCA research produces high quality information on treatment and outcomes, it lacks the ability to place OHCA in context with EMS-treated conditions. We sought to estimate the rate of OHCA in a national sample of EMS emergency responses and describe national trends in occurrence and field termination. Methods: Using the National EMS Information System (NEMSIS) Public-Release Datasets, we conducted a retrospective analysis of EMS runs for OHCA. EMS agencies were analyzed using a masked ID constant across data years. To be included, a run must be documented as “cardiac arrest prior to EMS arrival” and the agency must report more than 10 total Emergency Response runs for each data year. The OHCA rates were calculated and presented as OHCA per 1000 runs. Median rates were compared using Mood’s test. To compare agency level trends in care delivery, agencies had to document &gt;5 OHCA runs in each study year. Results: From 2019-2021, there were 83,914,470 Emergency Response runs submitted to NEMSIS. Of these, 840,620 (1.0%) were documented as cardiac arrest (CA) prior to EMS arrival. The OHCA cohort was 37% female, 13% Black, 5% Hispanic/Latinx, 39% White and 41% Not Documented. The mean age was 59 years (SD 21) with 21% missing. The national incidence of OHCA was 10 CA per 1,000 runs. Most agencies saw 13 or fewer OHCA per year (median: 13, IRQ: 5, 44). Agency level rates varied with a median annual rate of 12.6 per 1,000 runs (IQR: 8.5, 18.7). Median agency rates were similar across all three years (11.4 vs 13.0 vs 12.5, p&gt;0.05 for all). Overall, field termination was 47%, with more occurring in 2020 compared to 2019 and 2021 (19-20: 44% vs 49%; 20-21: 49% vs 47%; p &lt;0.001 for all). Agency field termination percentage was positively correlated with ROSC percent among transported patients (ρ = 0.12, p &lt;0.001) but negatively correlated with overall ROSC (ρ = -0.34, p&lt;0.001). Conclusion: Despite perceived limitations of non-registry data, significant information about OHCA care is widely available from existing public data. Absent a population-level OHCA rate, by benchmarking OHCA with all EMS runs, we can monitor for significant changes in OHCA incidence. Field terminations appear to be associated with more ROSC among transported patients, but not overall.

Real-Life Data on the Use of Omalizumab in Patients with Severe Asthma and Chronic Urticaria and Mepolizumab in Patients with Severe Asthma: A Retrospective Study

This study aimed to assess the real-life effectiveness of omalizumab and mepolizumab in patients with severe asthma and chronic spontaneous urticaria (CSU), explicitly examining changes in IgE levels and eosinophil counts during treatment. This retrospective study involved patients with severe asthma or CSU treated with biologic agents, including omalizumab and mepolizumab. The primary outcome measures were serum IgE levels, eosinophil counts, urticaria activity scores (UAS), and asthma control test scores (ACT). We studied 61 patients with severe asthma or chronic urticaria treated with biological agents. Patients with asthma exhibited a significant reduction in the median annual attack rate from 4 to 0 with omalizumab (p&amp;lt;0.001) and from 6 to 1 with mepolizumab (p&amp;lt;0.001). Eosinophil counts, and ACT scores significantly decreased with mepolizumab (p&amp;lt;0.001). Six patients who transitioned from omalizumab to mepolizumab did not experience severe asthma attacks in the first six months following the treatment switch. Patients with CSU showed a significant response to omalizumab (p&amp;lt;0.001). We observed significant improvements in various markers, including total IgE levels, eosinophil counts, UAS, and ACT scores, indicating that these treatments can effectively manage the symptoms of both conditions. These findings underscore the potential benefits of using these treatments as effective therapeutic options.

Disturbance intensification is altering the trait composition of Caribbean reefs, locking them into a low functioning state

Anthropogenic climate change is intensifying natural disturbance regimes, which negatively affects some species, while benefiting others. This could alter the trait composition of ecological communities and influence resilience to disturbance. We investigated how the frequency and intensification of the regional storm regime (and likely other disturbances) is altering coral species composition and in turn resistance and recovery. We developed regional databases of coral cover and composition (3144 reef locations from 1970 to 2017) and of the path and strength of cyclonic storms in the region (including 10,058 unique storm-reef intersections). We found that total living coral cover declined steadily through 2017 (the median annual loss rate was ~ 0.25% per year). Our results also indicate that despite the observed increase in the intensity of Atlantic cyclonic storms, their effect on coral cover has decreased markedly. This could be due in part to selection for disturbance-resistant taxa in response to the intensifying disturbance regime. We found that storms accelerated the loss of threatened acroporid corals but had no measurable effect on the cover of more resilient “weedy” corals, thereby increasing their relative cover. Although resistance to disturbance has increased, recovery rates have slowed due to the dominance of small, slow-growing species. This feedback loop is locking coral communities into a low-functioning state dominated by weedy species with limited ecological or societal value.

Setting Dengue Fever Epidemic Thresholds Between 2016 and 2021 in the Central Health Region, Burkina Faso: An Ecological Study.

Dengue fever (DF) is endemic in Burkina Faso, with 70% of its burden supported by the Central Health Region. Then, a single confirmed case can no longer mean an epidemic. This study aimed at describing trends and setting epidemic thresholds of DF in the Central Health Region. An ecological study was conducted using monthly data from DF surveillance between 2016 and 2021. Three methods were applied to set alert and intervention thresholds of DF monthly incidence rate: mean [mean + 2 SD], median [3rd quartile] and cumulative sum (C-sum) [C-sum + 1.96 SD]. These thresholds were plotted with the monthly incidence rates for 2021. In total, 54,429 cases were reported between 2016 and 2021. Dengue cases increasedbiannually.The median annual incidence rate did not vary significantly across years [Kruskal-Wallis: χ2(5) = 9.825; p = 0.0803]. Within a year, the monthly incidence rate fell under 48.91 cases per 100,000 inhabitants between January and September and peaked in October or November. With the mean and C-sum methods, the 2021 monthly incidence rate remained below the intervention thresholds (Mean + 2 SD and C-sum + 1.96 SD). With the median method, the incidence rate exceeded the alert and intervention thresholds in July-September 2021. If the DF incidence varied within a year due to the seasons, it was relatively stable between 2016 and 2021. The mean and C-sum methods based on the mean were subject to extreme values, giving high thresholds. The median method seemed better for capturing the abnormal increase in dengue incidence.

Organ donation by children in Australia, 2000-2019: impact of the 2009 National Reform Program. Apopulation-based registry data study.

To assess the impact of the 2009 National Reform Program for organ donation in Australia on the number and characteristics of organ donors under 16 years of age. Retrospective observational time series study; analysis of Australia and New Zealand Organ Donation (ANZOD) registry data for all consented potential deceased organ donors under 16 years of age during 2000-2019, and of numbers of donors aged 16 years or more reported in ANZOD annual reports. Difference between 2000-2008 (pre-reform) and 2009-2019 (reform period) in annual organ donor rates (donors per million population), by age group (under 16 years, 16 years or more), reported as incidence rate ratio (IRR). Differences in child donor characteristics during 2000-2008 and 2009-2019. During 2000-2019, 400 children under 16 years of age were consented potential deceased organ donors, of whom 374 were actual deceased donors (94%): 146 during 2000-2008, 228 during 2009-2019. The median annual rate was 3.3 (interquartile range [IQR], 3.0-4.3) actual donors per million population during 2000-2008 and 4.2 (IQR, 3.6-5.2) donors per million population during 2009-2019 (IRR, 1.15; 95% confidence interval [CI], 0.93-1.42). In contrast, the difference between the two periods was statistically significant for donors aged 16 years or more, rising from 11.7 (IQR, 11.2-11.8) to 19.9 (IQR, 18.3-24.4) actual donors per million population (IRR, 1.75; 95% CI, 1.66-1.85). The median age of actual organ donors under 16 was similar during 2000-2008 (11 years; IQR, 7-14 years) and 2009-2019 (10 years; IQR, 4-14 years), as was the proportion of donors in this age group under 10 kg (2000-2008: four of 146, 3%; 2009-2019: 14 of 228, 6%). Despite its overall effect on organ donation rates, the National Reform Program was not effective in increasing the numbers of donors under 16 years of age. Relying on broad initiatives for adult donors may not be appropriate for achieving this aim.