Multiple Usage Research Articles

The Impact of Multi-Currency System On Public Sector Procurement Performance in Zimbabwe

The purpose of the study was to examine the impact of multi-currency system on public sector procurement performance in Zimbabwe using evidence from government ministries of agriculture, defence and local government. In line with the positivism philosophical framework the study used correlational research design, deductive research approach, quantitative research methodology and a structured questionnaire to collect primary data from 171 participants comprising of procurement and finance officers in the three ministries. The study confirmed a statistically significant impact of multi-currency system on public sector procurement performance. All multi-currency system dimensions that include exchange rate fluctuations, foreign currency shortage and multiple currency usage induced inflation were found to significant positive predictors of both procurement cost and supplier price. Exchange rate fluctuations were confirmed to have the greatest positive impact on both procurement cost and supplier price in the public sector.

Comparative Evaluation of Surface Roughness of Different Rotary Nickel-Titanium (NiTi) Files After Autoclaving: An Atomic Force Microscopic Study.

Introduction Canal preparation is a critical step in endodontic therapy. Introducing nickel-titanium (NiTi) rotary instruments has significantly reduced the likelihood of errors in curved canals. However, due to their price, these instruments are often reused following autoclaving. The aim of this study is to compare and evaluate the surface characteristics of two designs of rotary NiTi files used in curved canals and subjected to multiple autoclaving cycles, utilizing an atomic force microscope for detailed analysis. Methods A total sample size of 24 files was taken, 12 files of Hyflex EDM (Coltene/Whaledent, Germany) files andWaveOne Gold (Dentsply Sirona, USA) fileswere then divided into four groups (n=6) as follows:Group I: Hyflex EDM control group;Group II: WaveOne Gold control group;Group III: Hyflex EDM experimental group; Group IV: WaveOne Gold experimental group. Sterilization using an autoclave was performed thrice for Groups I and II files. The files in Groups III and IV were used in simulated curved canals three times and autoclaved after each use. Atomic force microscopy was used to assess the surface roughness of the files after the first and third autoclave cycles. Results The results showed that, without statistical significance, Hyflex EDM exhibited the highest surface roughness after the first usage among the two file systems. Conclusion It can be concluded that both Hyflex EDM and WaveOne Gold files produced similar levels of surface changes when subjected to multiple usage and autoclaving cycles.

Phase change energy storage using boron nitride/carbonized loofah sponge

Phase change thermal energy storage is a novel option for industrial waste heat recovery with the characteristics of high safety performance and low-cost. This work explores the potential novel composite phase change materials by encapsulating polyethylene glycol with boron nitride, carbonized loofah sponge fragments and boron nitride-carbonized loofah sponge fragments mixture using melt impregnation method. The results reveal that there is no chemical reaction between polyethylene glycol and the additives of boron nitride and carbonized loofah sponge fragments. The maximum thermal conductivity of the polyethylene glycol-based composites is 1.09 times of the pure polyethylene glycol. The thermal energy storage efficiency of polyethylene glycol/carbonized loofah sponge fragments composites with 2.5 wt% additives can be up to 80.13 %. The maximum temperature variation rates in the heating and cooling processes are attributed to polyethylene glycol/carbonized loofah sponge fragments, which are 0.096 °C/s and 0.057 °C /s correspondingly. Based on the numerical simulation considering utilization of waste heat from flue gases, the total melting time of composites with boron nitride, carbonized loofah sponge fragments, and boron nitride-carbonized loofah sponge fragments are 82.61 %, 85.25 % and 81.86 % of pure polyethylene glycol. These results imply the multiple usage of additives could not have superimposed effect on decrease of latent heat, and carbonized loofah sponge fragments is a cheap alternative to boron nitride.

Flexibility of a large blindly synthetized avatar database for occupational research: Example from the CONSTANCES cohort for stroke and knee pain.

Though the rise of big data in the field of occupational health offers new opportunities especially for cross-cutting research, they raise the issue of privacy and security of data, especially when linking sensitive data from the field of insurance, occupational health or compensation claims. We aimed to validate a large, blinded synthesized database developed from the CONSTANCES cohort by comparing associations between three independently selected outcomes, and various exposures. From the CONSTANCES cohort, a large synthetic dataset was constructed using the avatar method (Octopize) that is agnostic to the data primary or secondary data uses. Three main analyses of interest were chosen to compare associations between the raw and avatar dataset: risk of stroke (any stroke, and subtypes of stroke), risk of knee pain and limitations associated with knee pain. Logistic models were computed, and a qualitative comparison of paired odds ratio (OR) was made. Both raw and avatar datasets included 162,434 observations and 19 relevant variables. On the 172 paired raw/avatar OR that were computed, including stratified analyses on sex, more than 77% of the comparisons had a OR difference ≤0.5 and less than 7% had a discrepancy in the statistical significance of the associations, with a Cohen's Kappa coefficient of 0.80. This study shows the flexibility and the multiple usage of a synthetic database created with the avatar method in the particular field of occupational health, which can be shared in open access without risking re-identification and privacy issues and help bring new insights for complex phenomenon like return to work.

Leaching-Free durable antibacterial composite films constructed via delicate balance between potent contact sterilization and low adhesion

Durable antibacterial surfaces are often required high bactericidal ability and low bacterial adhesion property, but the potent bactericidal surfaces, especially based on the contact bactericidal mechanism, are often paradoxically intended to attract bacteria to adhere. In this work, a delicate balance between the potent contact bactericidal action and low bacterial adhesion was successfully achieved in quaternized fluoropolymer/SiO2 composite films (QFP/SiO2 CFs) through judicious selection of a common fluorinated monomer, a common quaternary ammonium monomer, and a common inert inorganic nanoparticle, to acquire suitable surface energy and chain mobility to ensure low bacterial adhesion, as well as to allow appropriate surface-exposed quaternary ammonium units to synergistically enhance the contact bactericidal action with the specific fluorinated side chains. The QFP/SiO2 CFs were conveniently fabricated through miniemulsion polymerization and followed squeegeeing technique. The QFP/SiO2 CF with an optimized composition exhibited extremely low initial adhesion of bacteria, potent contact bactericidal action, superior long-term antibacterial performance, easy sonication-assistant regeneration for multiple usage, and low cytotoxicity with non-leachable attribute. This work may guide the design and efficient fabrication of leaching-free durable antibacterial surfaces for biological applications, as well as provide an effective strategy to balance contact bactericidal action and low bacteria adhesion for durable antibacterial performance.

Advanced Integration of Urban Street Greenery and Pedestrian Flow: A Multidimensional Analysis in Chengdu’s Central Urban District

As urbanization accelerates, urban greenery, particularly street greenery, emerges as a vital strategy for enhancing residents’ quality of life, demanding attention for its alignment with pedestrian flows to foster sustainable urban development and ensure urban dwellers’ wellbeing. The advent of diverse urban data has significantly advanced this area of study. Focusing on Chengdu’s central urban district, this research assesses street greening metrics against pedestrian flow indicators, employing spatial autocorrelation techniques to investigate the interplay between street greenery and pedestrian flow over time and space. Our findings reveal a prevalent negative spatial autocorrelation between street greenery and pedestrian flow within the area, underscored by temporal disparities in greenery demands across various urban functions during weekdays versus weekends. This study innovatively incorporates mobile phone signal-based population heat maps into the mismatch analysis of street greenery for the first time, moving beyond the conventional static approach of space syntax topology in assessing pedestrian flow. By leveraging dynamic pedestrian flow data, it enriches our understanding of the disconnect between street greening plans and pedestrian circulation, highlighting the concept of urban flow and delving into the intricate nexus among time, space, and human activity. Moreover, this study meticulously examines multiple street usage scenarios, reflecting diverse behavior patterns, with the objective of providing nuanced and actionable strategies for urban renewal initiatives aimed at creating more inviting and sustainable urban habitats.

Integration and substitution in hybrid manufacturing and refurbishing systems

Inspired by a real-work case, this paper introduces a profit maximization model for dynamic lot sizing considering substitution and multiple usage of returns for refurbishing at different levels of quality or for disassembly to extract key parts that will be used in the manufacturing process. This model allows studying the interactions between different types of returns and decisions. To analyze the impact of uncertainty on these interactions, we develop a robust two-stage stochastic program with uncertainty on demands and returns. The resulting problems are mixed-integer linear programs that we solve using an efficient relax-and-fix and fix-and-optimize heuristic. Extensive numerical experiments are conducted to study the different trade-offs when integrating multi-usage of returns with substitution and accordingly derive managerial insights. The experiments have revealed, for example, that: (i) the profit margin of the refurbished items is the main determinant of the total profit and when such margin in high, the total profit becomes more sensitive to different cost variations; (ii) collection efficiency becomes very sensitive to collection cost and much less sensitive to refurbishing cost especially with large profit margins; (iii) when demand and returns are uncertain parameters, substitution becomes the best option as uncertainty and prices increase; (iv) when the gap between prices of different quality levels is high, lost sales occur mainly on the lowest quality product and downgrading decreases together with substitution; and (v) Sharing the production line between refurbishing and manufacturing for low-quality products is highly motivated by small upgrading costs and their substitution level increases with increasing upgrading costs.

Moderating AC Usage Can Reduce Thermal Disparity between Indoor and Outdoor Environments.

In the context of escalating urban heat events due to climate change, air conditioning (AC) has become a critical factor in maintaining indoor thermal comfort. Yet the usage of AC can also exacerbate outdoor heat stress and burden the electricity system, and there is little scientific knowledge regarding how to balance these conflicting goals. To address this issue, we established a coupled modeling approach, integrating the Weather Research and Forecasting model with the building energy model (WRF_BEP + BEM), and designed multiple AC usage scenarios. We selected Chongqing, China's fourth-largest megacity, as our study area due to its significant socioeconomic importance, the severity of extreme heat events, and the uniqueness of its energy infrastructure. Our analysis reveals that AC systems can substantially reduce indoor temperatures by up to 18 °C; however, it also identifies substantial nighttime warming (2-2.5 °C) and a decline in thermal comfort. Particularly for high-density neighborhoods, when we increase 2 °C indoors, the outdoor temperature can be alleviated by up to 1 °C. Besides, despite the limited capacity to regulate peak electricity demand, we identified that reducing the spatial cooled fraction, increasing targeted indoor temperature by 2 °C, and implementing temporal AC schedules can effectively lower energy consumption in high-density neighborhoods, especially the reduction of spatial cooled fraction (up to 50%). Considering the substantial demand for cooling energy, it is imperative to carefully assess the adequacy and continuity of backup energy sources. The study underscores the urgency of reassessing energy resilience and advocates for addressing the thermal equity between indoor and outdoor environments, contributing to the development of a sustainable and just urban climate strategy in an era of intensifying heat events.

Impact of apparent temperatures on park visitation behavior: A comprehensive analysis using large-scale mobility data

As many regions continue to show record temperatures and high frequencies of extreme climate events, climate change is disrupting human health and prosperity. This study focuses on how temperature changes and extreme heat as key climate components can impact park visitations (key physical activities indicator). Using the large mobility dataset SafeGraph, this study introduced a causal machine learning approach to estimate marginal heterogenous treatment effects (HTE) of daily apparent temperatures for different park properties and activity types. Our results revealed the declining effects of park visitations as apparent temperature increases and the significant disturbances under extreme heat. Different temperature thresholds that may harm park visitations were identified. Nearby green and public spaces (e.g. neighborhood parks) are the most susceptible category to summer heat. Dog parks, Playgrounds and Ball Field/Sports were well used during the heat. Pool/Splash pad and Community center have shown capabilities of mitigating heat stress. Effectiveness of other park facilities, including Restroom/Drinking Fountain, Water Body, Shade Area Facility were also presented. This study estimates climate impact on park behaviors for multiple usage and environmental situations. Our findings may help future planners, policymakers, landscape architects and park managers better understand climate-related risks when making investment and development decisions.

Assessment of effects of duration and dosage of Amlodipine on gingival health - A Prospective Study

Objectives: Calcium channel blockers are one of the most commonly used drugs for the management of cardiovascular disorders and are known for causing gingival overgrowth as an adverse effect. Disfiguring gingival overgrowth triggered by this medication is not only esthetically displeasing but also often impairs nutrition and access to oral hygiene, resulting in increased susceptibility to oral infection, caries, and periodontal diseases. The present study aimed to correlate the incidence of the extent of gingival enlargement in hypertensive patients receiving amlodipine and also a correlation of the extent of gingival enlargement with the dosage and duration of intake of Amlodipine. Materials and Methods: Hypertensive patients attending the outpatient of the Department of Oral Medicine and Radiology were selected for the study. A detailed history of the subjects was recorded for single or multiple drug usage, including the intake of amlodipine medications for hypertension, the dose and duration of the drug usage, following which a clinical examination was performed to evaluate the grades of gingival enlargement and local factors affecting the same. Results: The majority of the patients (81%) received 5 mg of amlodipine medication, and more than 40% of patients were receiving amlodipine for more than one year. More than 50% of patients had grade 2 gingival enlargement. There was a significant correlation between gingival enlargement and amlodipine dosage. Also noted was an association between gingival enlargement and duration of receiving amlodipine. Conclusion: Even with a minimal dose of amlodipine, significant gingival enlargement is seen; hence, regular follow-up with a suitable dental evaluation referral for examining gingival and periodontal status becomes imminent. Therefore, dental professionals need to identify and then guide the patient to seek the necessary medical intervention for the same.

Unusually Sensitive Solid State Emissive 1,8-naphthalimide for Detection of Acid Vapors in Turn-off Mode and Base Vapors in Turn-on Mode.

A 4-amino-1,8-naphthalimide containing tetramethylpiperidine in N-position was synthesized. The prepared 1,8-naphthalimide was found to possess bright yellow-green fluorescence in a solid state, which could be switched-off in the presence of acid vapors and then switched-on after exposure on base vapors. The observed fluorescence quenching or enhancement, respectively, was more than 10-fold. This behavior was quite opposite to that of the similar 4-oxy-1,8-naphthalimide, in which a well-pronounced PET process operates. In addition, the observed fluorescence quenching was accompanied with color change from yellow to red. Based on these results, the reported 4-amino-1,8-naphthalimide was successfully applied as a reversible solid-state emissive chemosensing material for rapid detection of acid-base vapors for multiple usage.

Time-encoded electrical detection of trace RNA biomarker by integrating programmable molecular amplifier on chip

One of the serious challenges facing modern point-of-care (PoC) molecular diagnostic platforms relate to reliable detection of low concentration biomarkers such as nucleic acids or proteins in biological samples. Non-specific analyte-receptor interactions due to competitive binding in the presence of abundant molecules, inefficient mass transport and very low number of analyte molecules in sample volume, in general pose critical hurdles for successful implementation of such PoC platforms for clinical use. Focusing on these specific challenges, this work reports a unique PoC biosensor that combines the advantages of nanoscale biologically-sensitive field-effect transistor arrays (BioFET-arrays) realized in a wafer-scale top-down nanofabrication as high sensitivity electrical transducers with that of sophisticated molecular programs (MPs) customized for selective recognition of analyte miRNAs and amplification resulting in an overall augmentation of signal transduction strategy. The MPs realize a programmable universal molecular amplifier (PUMA) in fluidic matrix on chip and provide a biomarker-triggered exponential release of small nucleic acid sequences easily detected by receptor-modified BioFETs. A common miRNA biomarker LET7a was selected for successful demonstration of this novel biosensor, achieving limit of detection (LoD) down to 10 fM and wide dynamic ranges (10 pM–10 nM) in complex physiological solutions. As the determination of biomarker concentration is implemented by following the electrical signal related to analyte-triggered PUMA in time-domain instead of measuring the threshold shifts of BioFETs, and circumvents direct hybridization of biomarkers at transducer surface, this new strategy also allows for multiple usage (>3 times) of the biosensor platform suggesting exceptional cost-effectiveness for practical use.

Assessing the predictability of fungicide resistance evolution through in vitro selection

Plant pathogens are highly adaptable, and have evolved to overcome control measures including multiple classes of fungicides. More effective management requires a thorough understanding of the evolutionary drivers leading to resistance. Experimental evolution can be used to investigate evolutionary processes over a compressed timescale. For fungicide resistance, applications include predicting resistance ahead of its emergence in the field, testing potential outcomes under multiple different fungicide usage scenarios or comparing resistance management strategies. This review considers different experimental approaches to in vitro selection, and their suitability for addressing different questions relating to fungicide resistance. When aiming to predict the evolution of new variants, mutational supply is especially important. When assessing the relative fitness of different variants under fungicide selection, growth conditions such as temperature may affect the results as well as fungicide choice and dose. Other considerations include population size, transfer interval, competition between genotypes and pathogen reproductive mode. However, resistance evolution in field populations has proven to be less repeatable for some fungicide classes than others. Therefore, even with optimal experimental design, in some cases the most accurate prediction from experimental evolution may be that the exact evolutionary trajectory of resistance will be unpredictable.

Is infertility more common among patients with multiple sclerosis? Implications for utilization of assisted reproductive techniques

Research questionIs fertility affected in women with multiple sclerosis (MS), and what is their usage of assisted reproductive technology (ART)? DesignData regarding multiple sclerosis and ART usage among patients with multiple sclerosis were extracted from the Israeli health maintenance organization Clalit Health Service database. Data regarding the diagnosis and treatment of multiple sclerosis, cause of infertility and use of fertility treatments were collected for all female multiple sclerosis patients aged 18–45 years between 2005 and 2021. Each patient was matched by age in a 1:10 ratio with reference women from the general population. The prevalence of infertility was compared between the two groups. Univariate and multivariate statistical tests were used to analyse the association between multiple sclerosis and fertility treatments including IVF and ovarian stimulation. ResultsDuring the study period, 1309 multiple sclerosis patients were compared with 13,090 controls from the general population matched for age. The mean age was 29 ± 7.8 years. The overall prevalence of infertility was 15.4% (202/1309) among the multiple sclerosis patients, similar to the general population (16.3%; 2129/13090) (P = 0.436). The prevalence of IVF and ovarian stimulation was similar among multiple sclerosis patients and matched controls from the general population (8.1% versus 7.2%, P = 0.240; 13.8% versus 14.3%; P = 0.624, respectively). ConclusionsThe results show similar rates of infertility and fertility treatments among multiple sclerosis patients and the general population. This provides reassurance that fertility among women with multiple sclerosis does not differ from that of women in the general population, and indicates there is no excessive usage of ART.

Outcomes in Older Inpatients with Hyperkalemia: A Follow-up Observational Study

Abstract Objectives: Hyperkalemia is a common electrolyte disturbance encountered in hospitalized older patients secondary to age-related physiological changes in the kidneys, multiple comorbidities, and the burden of multiple medication usage. Metabolic acidosis, rhabdomyolysis, and tumor lysis syndrome cause the shift of potassium into the extracellular space. This contributes to hyperkalemia. This study aims to determine the outcomes in patients with hyperkalemia admitted to a tertiary care center and to list the factors contributing to the development of hyperkalemia in these patients. Methods: This was a prospective observational study conducted among older inpatients (≥60 years of age) admitted to the geriatric and medical wards in a tertiary care hospital. The patients with hyperkalemia were followed up till discharge or death. Results: Among the 225 study participants who presented with hyperkalemia, the mortality rate was found to be 22.2%. In the multivariate analysis, older people aged more than 70 years (P = 0.007) and those who were male had a significantly higher mortality (P = 0.009). The use of angiotensin-converting enzyme inhibitors (ACEIs) (P = 0.049) and beta-blockers (P = 0.02) was significantly associated with the development of hyperkalemia. Conclusions: ACEIs and beta-blockers increased the risk of developing hyperkalemia in the study population. Hyperkalemia was found to be associated with an increase in mortality, especially in the very old (>70 years) and in males.

Product-specified dual-channel retail management with significant consumer service

If the product has been decided for the retail industry, single-channel retail management is enough to obtain profit for the retail management. Though a single-channel is enough, a dual-channel may provide much more benefit than a single-channel. If the single-product is to be specified, then a specific type of dual-channel can be improvised for that. A product-specific dual-channel strategy of a manufacturing firm is observed in this study for consumer non-durable goods. The manufacturing firm utilizes technical support to provide essential consumer services to consumers for non-durable goods. As consumer non-durable goods are fast consuming products, consumers buy these products more than once within a certain duration. This makes the consumer non-durable goods is an essential products within that certain duration. Due to multiple usage within a certain duration, consumers prefers to choose non-durable goods based on the quality and price of those products. The global maximum profit of the dual-channel is found by analytic method and established by numerical solutions. Results prove that internet of things-based blockchain essential consumer service increases the total profit of the manufacturing firm by 29.12% than no essential consumer services-based manufacturing firm. Six numerical experiments and four special cases are provided to establish the theoretical model. The sensitivity analysis is performed using profit increment. Essential consumer service is the most sensitive to the total profit of the manufacturing firm whereas the holding cost is the second most sensitive parameter. More increment in holding cost causes profit to decrease by 16.98%.

Prognostic impact of polypharmacy and discharge medications in octogenarians and nonagenarian patients with acute heart failure.

With the increasing frequency of heart failure (HF) in elderly patients, polypharmacy has become a major concern owing to its adverse outcomes. However, reports on the clinical impact of polypharmacy and discharge medications in hospitalized super-aged patients with acute HF are rare. Data from 682 patients aged 80years or older, hospitalized for treating acute HF, were analyzed. We recorded the number of medications at discharge and classified them into three groups: HF, non-HF cardiovascular, and non-cardiovascular medications. We investigated the correlation of polypharmacy, defined as daily administration of 10 or more medications at discharge, and the use of discharge medications with post-discharge prognosis. Polypharmacy was recorded in 24.3% of enrolled patients. Polypharmacy was not an independent predictor of all-cause mortality, the incidence of cardiac-related death, or HF-associated rehospitalization; however, the number of non-cardiovascular medications, multiple usage of potentially inappropriate medications, use of mineralocorticoid receptor antagonists, and doses of loop diuretics were associated with poor prognosis. Polypharmacy was significantly associated with higher mortality in patients with Barthel index ≥ 60 at discharge; hence, physical function at discharge was useful for the stratification of prognostic impacts of polypharmacy. The current study demonstrated that polypharmacy was not essentially associated with poor prognosis in super-aged patients with acute HF. Appropriate medications that consider the patient's physical function, rather than polypharmacy itself, are important for the management of HF.

The Path Towards Virtualized Wireless Communications: A Survey and Research Challenges

To keep up with the increasing number of connected devices in people’s daily lives, it is necessary to develop intelligent mechanisms that perform the entire network management, interconnecting Wi-Fi, and the emerging beyond Fifth-Generation (5G) communications. Hence, it is essential to consider multiple usage scenarios, while managing end devices’ limitations. As a result, developing a system that allows network operators to link Wi-Fi services on their main networks becomes a critical issue. These include a new paradigm that tackles optimal and dynamic resource allocation techniques. Thus, to consider in a combined way, the applications requirements, the resources available, and the different tiers involved, mechanisms such as virtualization and slicing have emerged to handle the heterogeneous context of the next-generation wireless communications. Moreover, the allocation of Radio Access Network (RAN) resources needs to be addressed. For this purpose, Open-RAN has in mind an open environment, which relies on virtualized functions and is mostly vendor agnostic. This technology will enable high data rates while maintaining adequate Quality of Service (QoS) in wireless communications. This paper advances current literature, which mainly discusses these themes individually, by providing a comprehensive survey in Next Generation Wireless Communications, highlighting their integration with beyond 5G Communications. First, we introduce the Wi-Fi evolution and explain the main standards developed over the years. Second, we present the most recent Wi-Fi standards, Wi-Fi 6 and 7, compared with 5G and beyond. Lastly, we explain the concepts related to slicing, virtualization, RAN, Open-RAN and the open research challenges.

Caregiver Burden in Substance Use Disorders Patients

Background: Substance Use Disorders (SUDs) impose significant challenges not only on individuals grappling with addiction but also on the caregivers who provide support and care. The caregiving role is associated with multifaceted burdens that require understanding and targeted interventions. Recognizing the diverse dimensions of caregiver burden is crucial for offering effective support. Objective: The study aimed to find out the caregiver burden in substance use disorder patients, examining severity and socio-demographic correlations, contributing insights into effective support strategies. Methodology: The cross-sectional observational study took place at Sylhet MAG Osmani Medical College's Psychiatry Department and a private psychiatric and drug rehabilitation center in Sylhet from September 1, 2018, to August 31, 2020. The research focused on substance use disorder patients and their caregivers, involving 50 eligible patients selected through inclusion and exclusions criteria. Diagnoses followed DSM IV criteria. Socio-demographics were gathered via semi-structured questionnaires. Caregiver burden was assessed using the Bengali Zarit Burden Interview (ZBI) scale through approximately hour-long interviews, with 1-2 daily. Ethical procedures encompassed informed consent and confidentiality assurance. Result: The study included 50 male participants. Patients mean age was 31.92 (±8.21) and caregivers mean age was 41.68 (±12.89). Mainly, caregivers were mothers (40%) and wives (34%). Caregivers experiencing moderate to severe burden were 58%, mild to moderate burden were 26%, and severe burden were 16%. Mean ZBI score was 48.22±13.55. Higher burden correlated with illiteracy, low family income, excessive drug spending, prolonged substance use, and multiple drug usage. Alcohol users faced more burden than other substance users. Female caregivers, younger age, and housewives experienced heightened burden. No burden links were found with marital status, habitat, religion, family type, or drug administration method. Conclusion: This study concluded that Substance use heightens caregiver burden, notably among female, young, and housewife caregivers. Addressing these trends is vital for effective care of substance use

Abstract 16479: The Effects of Pulmonary Artery Catheter Usage and Treatment Intensity on Mortality in Patients With Cardiogenic Shock by Etiology

Background: The routine usage of pulmonary artery catheter (PAC) in the management of cardiogenic shock (CS) by etiology remains controversial. Objectives: We sought to study the prognostic effects of PAC usage and the escalation of care in a large CS cohort. Methods: Multicenter, retrospective, observational study from the Cardiogenic Shock Working Group registry (CSWG) registry. The baseline characteristics, hospital course, and outcome of patients (pts) with acute decompensated heart failure-CS (ADHF) and acute myocardial infarction-CS (AMI) who had PAC during hospitalization were obtained. Different types of interventions were analyzed and compared between survival and non-survival by etiology. Results: The registry had 3524 pts (58% ADHF, 28% AMI). The overall mortality rate was significantly higher in the AMI group (41 vs 29%, p <0.0001). There was no difference in PAC usage (68 vs 62%). In ADHF, the mortality was significantly lower when PAC was used (22 vs 35%, P<0.0001). However, in AMI, there was no significant mortality difference with PAC usage (40 vs 46%, P=0.052).Pts who had PAC (n=2260, 71% male, 2/3 ADHF) were then analyzed. ADHF had longer duration of PAC (6.3 vs 4.7 days). ADHF pts had more comorbidities (CKD, DM, AF) and better admission and max SCAI stage. However, AMI pts were older (60±14 vs 66±12 year p<0001), more HTN and higher transfer rate. During hospitalization, the effect of treatment intensity with mechanical circulatory support (MCS) and drugs usage on mortality is summarized in fig.1 (a,b). Conclusions: In a large CS registry, we identified that ADHF is more common with much better prognosis than AMI despite similar PAC and drugs usage, and less MCS usage. This can be explained by the difference in baseline characteristic and the shock severity. PAC usage did correlate with better survival only in ADHF group. Multiple MCS and multiple drugs usage were associated with higher mortality in both groups. IABP, when used alone, had better survival.