Non-consecutive Months Research Articles

Copper, lead, and cadmium monitoring via the small-spotted catshark (Scyliorhinus canicula; Linnaeus, 1758): space-time driven variability in Western Mediterranean populations.

The philopatric and sedentary nature of female S. canicula, its high abundance as a bycatch and resilience to regular exploitation by bottom trawl fisheries and its widespread distribution, makes it a potentially good candidate as a biomonitor species. To evaluate this potential, microwave-assisted extraction (MAE) and Graphite Furnace Atomic Absorption Spectrometry (GF-AAS) were used to analyse Pb, Cd, and Cu in muscle tissue of individuals captured in the Western Mediterranean (Alicante, Spain). A monthly assessment of the concentration of these three analytes was conducted from November 2019 to November 2020 with 300 individuals. Results showed the existence of slightly higher mean concentrations during warmer seasons for Pb and Cd with mean concentrations for Pb and Cu peaking in Autumn 2019 and during Spring 2020 in the case of Cd. Significant differences in analyte concentrations found between non-consecutive months suggested gradual variability in time. Although space-wise, time-persistent concentration hotspots were observed throughout the sample area, the magnitude of these appeared to be variable in time and should be evaluated in future studies.

A Single-resident Experience of Overnight Call Activity at a Multi-site Academic Health System

BackgroundAfter-hours clinical coverage models vary significantly by specialty and institution. Coverage decisions must balance quality clinical care with a safe provider workload. Here, we characterize urology resident on-call activities overnight at a multi-site academic medical center and model the expected volume of clinical activity using inpatient beds, emergency room visits and attendings covered. Materials and MethodsOn-call activities for 70 thirteen-hour overnight shifts spanning five nonconsecutive months between May 2022 and February 2023 were recorded. Clinical coverage included five academic hospitals encompassing 1,761 staffed inpatient beds and an expected nightly volume of 255 Emergency Department visits. The time, source, and clinical features of every call were documented. ResultsAn average of 15 unique calls were received during each shift. Of these, 35% required an in-person evaluation and 12% required a bedside or operative procedure. Approximately a third of calls (36%) were received after midnight. An in-person evaluation occurred within the first hour of 53% of shifts and every shift required at least one evaluation. When normalized for inpatient bed volume, an average of seven unique patient communications occurred per 1,000 beds, leading to two in-person evaluations. When normalized for an expected number of overnight ED visits, an average of one new ED consultation occurred per 100 ED visits. ConclusionsPatient needs were appropriately addressed by a single overnight on-call resident, providing a robust clinical experience. The volume of patient care activities in this experience supports the practice of a “night-float” resident with the clear expectation on-site care is required.

The role of estrogen receptor gene polymorphisms in menopausal symptoms and estradiol levels in perimenopausal women – Findings from the Swiss Perimenopause Study

ObjectivesFluctuating estradiol (E2) levels seem to be associated with menopausal symptoms, though not all women suffer from these symptoms to the same extent despite experiencing these hormonal changes. This suggests underlying, interindividual mechanisms, such as single-nucleotide polymorphisms (SNPs) influencing estrogen receptors α and β, and the g-protein-coupled estrogen receptor (GPER). As research is scarce, we aimed to address this research gap by assessing genetic traits, E2 levels, and menopausal symptoms longitudinally. Study design129 perimenopausal women (aged 40–56 years) participated in the 13-month longitudinal Swiss Perimenopause Study. Main outcome measuresMenopausal symptoms were assessed fortnightly using the Menopause Rating Scale (MRS II). Salivary E2 levels were assessed 14 times over two non-consecutive months. Blood samples were collected using the dried blood spot (DBS) technique to analyze ESR1 rs2234693, ESR1 rs9340799, ESR2 rs1256049, ESR2 rs4906938, and GPER rs3808350. Group-based trajectory modeling was performed to identify interindividual trajectories of menopausal symptoms. Multinomial logistic regression models were employed to identify factors associated with these trajectories. ResultsFour distinct trajectory groups of menopausal symptoms were identified (increase, moderate, rebound, decrease). ER gene polymorphisms and E2 fluctuation were significantly associated with group membership. Furthermore, ER gene polymorphisms modulated the effect of E2 fluctuations on menopausal symptom trajectory. ConclusionsThis study illuminates the multifaceted factors contributing to the individuality of the perimenopausal experience. ER gene polymorphisms emerged as integral factors by modulating the effect of E2 fluctuations on menopausal symptom trajectory. This underscores the intricate interplay of genetic factors, E2 fluctuations, and menopausal symptoms during perimenopause.

Suicidal ideation and suicide attempt in patients with psychiatric disorders in a Mexico City hospital.

One of the population groups at higher risk of suicide is that of people who attend mental health institutions. To know the demographic and clinical characteristics of people admitted for suicidal ideation and suicide attempt to the observation area of a psychiatric hospital in a period of 10 non-consecutive months. Retrospective, descriptive, correlational study. A total of 439 medical records were collected, out of which 62.9% (n = 276) corresponded to women, 36.7% (n = 161) to men and 0.5% (n = 2) to transgender people; age ranged from 17 to 74 years. The highest incidence of cases was observed between 18 and 25 years of age; the most frequent diagnosis was depressive disorder, and 45.5% (n = 200) of the cases had a suicide attempt. The main method for committing a suicidal act was poisoning by taking various medications, followed by self-inflicted injuries with sharp objects. A positive correlation was found between suicide attempt and self-harm (c² = 1.965, p < 0.05). The findings highlight the importance of early identification of risk factors that may contribute to an increase in suicidal behaviors.

Silent Conversations: Goals of Care and End-of-Life Quality in Relapsed High-Risk Leukemia.

Advanced practice providers (APPs) affect high-quality health care through leadership, evidence-based practice implementation, and quality improvement projects. When planning solutions to clinical problems, leadership must solicit APP input to promote success. Hematology patients are more likely to receive poor-quality end-of-life (EOL) care than those with solid tumors. Regardless of disease, aggressive EOL care is increasing despite evidence that it is often inconsistent with patients' goals of care (GOC). Data regarding this phenomenon in hematology specifically is lacking. The distorted association of "end of life" with "goals of care" has "silenced" crucial goals discussions in patients with relapsed or refractory high-risk leukemia, which raises concerns for the provision of care that is inconsistent with patients' values and preferences. Hematologists may possess certain traits and distinct barriers leading to what one might call an aversion to GOC discussions in the inpatient setting. (1) Quantify hematologists' rate of participation in a GOC pathway initiative during two separate months. (2) Explore the hematologists' definition of and barriers to having GOC discussions. This is a mixed-methods, explanatory sequential design (follow-up explanations variant). Quantitative: Hematology inpatient admissions during two nonconsecutive months in 2021. Qualitative: Eighteen leukemia hematologists from one dedicated cancer center. During the 2 months, an average of 36% of admissions met the criteria for GOC pathway initiation, 19% of those had an appropriate initiation order, and < 1% had a properly documented and billed GOC discussion. Nine hematologists responded to a SurveyMonkey poll with two questions. All nine included clinical situation and communication in their definition of GOC discussions. Time limitations and prognostic uncertainty were the two most reported barriers. The findings demonstrate that the apprehension of hematologists to have GOC conversations is similarly seen in the APPs' reluctance to initiate a pathway intended to lead to GOC conversations. The percentage of eligible inpatient admissions meeting the specified criteria was similar between the 2 months; however, the number of appropriate referrals and documented or billed GOC discussions was higher in the earlier month, demonstrating temporal decline. Further research inquiry is needed to explore causation of this phenomenon.

Comparison of Predictive Models for Prevention of Missed Endoscopy Appointments- failure of a Predictive Model to Outperform Overbooking Model.

Patient late cancelation and nonattendance for endoscopy appointments is an ongoing problem affecting the productivity and wait times of endoscopy units. Previous research evaluated a model for predictive overbooking and had promising results. All endoscopy visits at an outpatient endoscopy unit during 4 nonconsecutive months were included in the data analysis. Patients who did not attend their appointment, or canceled with 48 hours of their appointment were considered nonattendees. Demographic, health, and prior visit behavior data was collected and the groups compared. 1780 patients attended 2331 visits in the study period. Comparing the attendee versus non-attendees, there were significant differences in mean age, prior absenteeism, prior cancelations, and total number of hospital visits. No significant differences were seen between groups in winter versus non-winter months, the day of the week, sex distribution, type of procedure booked, or whether the referral was from specialist clinic or direct to procedure. The visit cancelation proportion (calculated excluding current visit) was substantially higher in the absentee group (P<0.0001). A predictive model was developed and compared to current booking as well as a straight overbooking of 7%. Both overbooking models performed better than the current practice, but the predictive overbooking model did not outperform straight overbooking. Developing an endoscopy unit specific predictive model may not be more beneficial than straight overbooking as calculated by missed appointment percentage.

Physical Activity, Air Pollution Exposure, and Lung Function Interactions Among Adults with COPD.

Although physical activity is strongly encouraged for patients with chronic obstructive pulmonary disease (COPD), it is unknown if physical activity affects daily exposure to air pollution, or whether it attenuates or exacerbates the effects of pollution on the airways among adults with COPD. Thirty former smokers with moderate-to-severe COPD in Boston were followed for 4 non-consecutive months in different seasons. We assessed daily lung function (forced expiratory volume in 1 second [FEV1] and forced vital capacity [FVC]), prior-day personal pollutant exposure measured by portable air quality monitors (fine particulate matter [PM2.5] nitrogen oxide [NO2], and ozone [O3]), and daily step count. We constructed multi-level linear mixed-effects models with random intercepts for person and person-observation month, adjusting for demographic/seasonal covariates to test if step count was associated with daily pollution exposure, and if associations between prior-day pollution and lung function differed based on prior-day step count. Where effect modification was found, we performed stratified analyses by tertile of step count. Higher daily step count was associated with higher same-day personal exposure to PM2.5, and O3 but not NO2. Each interquartile range (IQR) increment in step count was associated with 0.97 µg/m3 (95%CI: 0.30, 1.64) higher exposure to PM2.5 and 0.15 parts per billion (95% CI: -0.05, 0.35) higher exposure to O3 in adjusted models. We observed an interaction between prior-day NO2 and step count on FEV1 and FVC (Pinteraction<0.05) in which the negative associations between NO2 and lung function were reduced or absent at higher levels of daily activity. For example, FEV1 was 28.5mL (95%CI: -41.0, -15.9) lower per IQR of NO2 in the lowest tertile of step count, but there was no association in the highest tertile of step count (-1.6mL, 95% CI: -18.4, 15.2). Higher physical activity was associated with modestly higher daily exposure to PM2.5 and O3 and may attenuate the association between NO2 exposure and lung function.

Characteristics of Fine Particulate Matter (PM2.5)-Bound n-Alkanes and Polycyclic Aromatic Hydrocarbons (PAHs) in a Hong Kong Suburban Area

PM2.5 samples were collected at Tung Chung (TC), Hong Kong, during four nonconsecutive months in 2011/2012 to determine the concentrations, seasonal variations, and potential sources of polycyclic aromatic hydrocarbons (PAHs) and n-alkanes (n-C15-n-C35). Samples were analyzed using the thermal desorption gas chromatography/mass spectrometry (TD-GC/MS) method. The concentrations of particulate PAHs ranged from 1.26–13.93 ng/m3 with a mean value of 2.57 ng/m3, dominated by 4-ring species. Phenanthrene (Phe) and fluoranthene (Flu) were the two most abundant species, accounting for 13% and 18%, respectively. The dominant sources of PAHs were coal and biomass burning. The inhalation cancer risk value in our study exceeded 1 × 10−6 but was below 1 × 10−4, implying that the inhalation cancer risk of PAHs at the TC site is acceptable. The average concertation of n-alkanes was 103.21 ng/m3 (ranging from 38.58 to 191.44 ng/m3), and C25 was the most abundant species. Both PAHs and n-alkanes showed higher concentrations in autumn and winter whilst these values were lowest in summer. The carbon preference index (CPI) and percent contribution of wax n-alkanes showed that biogenic sources were the major sources. The annual average contributions of higher plant wax to n-alkanes at TC were over 40%.

High Prevalence of Atrial Fibrillation in a Lithuanian Stroke Patient Cohort.

Background and Objectives: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with a five-fold increased risk for acute ischemic stroke (AIS). We aimed to estimate the prevalence of AF in a Lithuanian cohort of stroke patients, and its impact on patients regarding case fatality, functional outcome, and health-related quality of life (HRQoL) at 90 days. Materials and Methods: A single-center prospective study was carried out for four non-consecutive months between December 2018 and July 2019 in one of the two comprehensive stroke centers in Eastern Lithuania. A telephone-based follow-up was conveyed at 90 days using the modified Rankin Scale (mRS) and EuroQoL five-dimensional three-level descriptive system (EQ-5D-3L) with a self-rated visual analog scale (EQ-VAS). One-year case fatality was investigated. Results: We included 238 AIS patients with a mean age of 71.4 ± 11.9 years of whom 45.0% were female. A striking 97 (40.8%) AIS patients had a concomitant AF, in 68 (70.1%) of whom the AF was pre-existing. The AIS patients with AF were at a significantly higher risk for a large vessel occlusion (LVO; odds ratio 2.72 [95% CI 1.38–5.49], p = 0.004), and had a more severe neurological impairment at presentation (median NIHSS score (interquartile range): 9 (6–16) vs. 6 (3–9), p < 0.001). The LVO status was only detected in those who had received computed tomography angiography. Fifty-five (80.9%) patients with pre-existing AF received insufficient anticoagulation at stroke onset. All patients received a 12-lead ECG, however, in-hospital 24-h Holter monitoring was only performed in 3.4% of AIS patients without pre-existing AF. Although multivariate analyses found no statistically significant difference in one-year stroke patient survival and favorable functional status (mRS 0–2) at 90 days, when adjusted for age, gender, reperfusion treatment, baseline functional status, and baseline NIHSS, stroke patients with AF had a significantly poorer self-perceived HRQoL, indicated by a lower EQ-VAS score (regression coefficient ± standard error: β = −11.776 ± 4.850, p = 0.017). Conclusions: In our single-center prospective observational study in Lithuania, we found that 40.8% of AIS patients had a concomitant AF, were at a higher risk for an LVO, and had a significantly poorer self-perceived HRQoL at 90 days. Despite the high AF prevalence, diagnostic tools for subclinical AF were greatly underutilized.

A29 ALBUMIN UTILISATION AT A TERTIARY CARE HOSPITAL

BackgroundAlbumin is a colloidal solution with usage guided by recommendations from Canadian Blood Services (CBS). In Ontario, rates of albumin use increased substantially from 2012 to 2018 despite the lack of development of new indications for using over this time frame. Further, we recently found that >50% of albumin usage in patients with cirrhosis were non-evidence based. Albumin usage in other patient populations is not well described.AimsOur aim was to describe overall usage of albumin stratified by clinical setting, clinical indication, and dosage at a tertiary care hospital.MethodsWe retrospectively identified all albumin prescriptions during two randomly selected non-consecutive months between 2018 and 2019 at Kingston Health Sciences Centre. Data was abstracted from each hospital chart for indication, prescriber specialty, location of patient, amount of albumin ordered, and concentration (5% or 25%). Albumin prescriptions were then defined as either evidence-based or non-evidence based on published literature and guidelines. Overall cost for albumin during the study period was determined based on CBS pricing ($51.47/ 25gms).ResultsA total of 699 albumin prescriptions were dispensed to 317 individuals over December 2018 and May 2019, with a total of 38,458 grams used. Overall, 36% was prescribed for evidence-based indications. The most common indication was plasmapheresis (32%), non-sepsis volume resuscitation (23%), and cardiac surgery (17%). The majority of albumin was prescribed in dialysis unit (32%), ICU (23%), and cardiac sciences unit (11%). The largest prescribers of albumin were intensivists (26%), followed by nephrologists (17%), and cardiac surgeons (15%). There were differences in utilization based on concentration of albumin. Despite limited evidence of benefit, 25% albumin and 5% albumin were used excessively for volume resuscitation and cardiac surgery respectively. When used for an evidence-based indication, the dosing was incorrect in 45% of orders. A total of $79,176 was spent on albumin during the study period. Importantly, only $28,494 was spent on evidence-based indications with appropriate dosage and concentration.ConclusionsOverall, there is significant albumin use for indications lacking substantial evidence. This study identifies the clinical contexts in which there is opportunity to reduce non-evidence-based albumin usage and cut unnecessary expenditure. Targeted quality improvement initiatives are underway.Funding AgenciesNone

Cardiac magnetic resonance to asess aortic valve anatomy in doubtful cases. Case series from a cardiology clinic

Funding AcknowledgementsType of funding sources: None.IntroductionBicuspid aortic valve (BAV) is the most common congenital cardiac malformation, affecting 1-2% of the population, and several types have been described, each one with different prevalence. Partial raphae have also been described and much rarer congenital affectations of aortic valve also exist (unicuspid, quadricuspid), with its own classification. Although echocardiogram is usually enough for diagnosis, sometimes other exams are needed to assess the anatomy of the valve. In these cases, due to lack of radiation, Magnetic Resonance (MRI) can be performed.MethodsWe reviewed cases from a single general cardiology clinic in which MRI was needed for asses aortic valve anatomy during a period of 9 non-consecutive (due to Covid-19 pandemic) months, Characteristics of the patients, as well as valvular and aortic characteristics, were reported.ResultsThere 8 doubtful cases. 5 men. Mean Age 60 years old (range 21-77, 6 patients 58 or more). 6 cases were non-tricuspid aortic valve: 5 bicuspid, 1 quadricuspid. Except in rare anatomies (bicuspid with 2 cusps type lateral and quadricuspid), with age 21 and 38 respectively (both men), the mean age was 70, ranging from 58 to 77, with 3 cases (50%) women. Except 2 cases, MRI was performed after the first visit, without follow-up time. Taking into account all patients, mean time from first visit to perform MRI was 1,12 years (maximum 6 years in the quadricuspid case). 6 cases had valvular functional anomalies greater than mild (3 women). 5 cases presented aortic dilatation (3 men), 1 man without valvular functional anomalies, 1 woman with tricuspid aortic valve. BAV with 2 cusps type lateral and quadricuspid cases had no aortic dilatation. There were no extracardiac findings in the exams. Figure shows characteristics of patients. Figure 2 shows images from exams (in the superior left and inferior right part of the image are shown BAV with 2 cusps and quadricuspid valve repectively, in diastole and systole).ConclusionsClinicians usually think BAV is a problem of young people, but can be even diagnosed in the eighth decade of life. In these cases, senile changes with valvular degeneration make diagnosis more challenging with doubtful cases. Rare anatomies may be also challenging. MRI seems useful to assess doubtful cases. Although usually performed in the first visit, in some cases it can take years before MRI is performed. In older cases, there may be no sex predominance for BAV. Table: Characteristics of patients Figure. Images from exams

Abstract WP118: Characteristics And Short-term Outcomes Of Delirium After Acute Ischemic Stroke

Background: Delirium after acute ischemic stroke is a common clinical occurrence, associated with longer hospital admissions, worse functional outcomes, and increased mortality. We aim in a prospective study to assess the characteristics and risk factors for delirium after acute ischemic stroke (AIS) in a US population. Methods: Between September 2019 and June 2021, patients diagnosed with AIS within 48 hrs of stroke onset were prospectively evaluated for delirium using the Confusion Assessment Method (CAM)-ICU daily for the first eight days of their hospital stay. Patients with severe stroke and expected mortality within the first month at the time of admission or with severe aphasia unable to follow commands were excluded. Data regarding demographics, co-morbidities, hospital stay, stroke metrics, lab work, and medications were analyzed. Results: Over 12 non-consecutive months (due to pandemic interruptions), we evaluated 213 patients, of which 179 could be assessed with the CAM-ICU. Delirium was present in 89 (49.7%), occurring within the first 24 hours of admission in 33.6% and for longer than one day in 32.0%. There were no statistically significant differences in age, gender, race, co-morbidities, or TOAST etiology among patients with and without delirium (Table 1). Patients with delirium had higher NIHSS and were more likely to receive tPA. Patients with delirium were more likely to be discharged to inpatient rehabilitation facilities than home (p=0.05). Only patients with delirium had unexpected mortality after admission, but this statistic failed to show significance. Conclusion: In a cohort of AIS patients without significant expected mortality on admission, the incidence of delirium is high. Our study confirms prior results demonstrating higher inpatient mortality, longer hospital admissions among patients with delirium, and more delirium in patients receiving tPA.

Steroid Hormone Secretion Over the Course of the Perimenopause: Findings From the Swiss Perimenopause Study.

Background: Perimenopause is characterized by a decline in the steroid hormones, estradiol, and progesterone. By contrast, the steroid hormone cortisol, a marker of the hypothalamic–pituitary–adrenal (HPA) axis, increases. Recent longitudinal studies reported fluctuations in steroid hormone levels during perimenopause, and even increases in estradiol levels. To understand these confounding results, it is necessary to conduct a longitudinal, highly standardized assessment of steroid hormone secretion patterns in perimenopausal women.Methods: This longitudinal study investigated 127 perimenopausal women aged 40–56 years for 13 months. Estradiol, progesterone, and cortisol were assessed using saliva samples, which were collected for two (during months 2 and 12 for estradiol and progesterone) or three (during months 2, 7, and 12 for cortisol) non-consecutive months over the course of the study. A total of 14 saliva samples per participant were analyzed to investigate the courses of estradiol and progesterone. Cortisol awakening response and fluctuations of cortisol throughout the day were measured using a total of 11 saliva samples per participant (on awakening, +30 min, +60 min, at 12:00 p.m., and before going to bed) for months 2, 7, and 12.Results: Multilevel analyses revealed variance in intercept and slope across participants for estradiol [intercept: SD = 5.16 (95% CI: 4.28, 6.21), slope: SD = 0.50 (95% CI: 0.39, 0.64)], progesterone [intercept: SD = 34.77 (95% CI: 25.55, 47.31), slope: SD = 4.17 (95% CI: 2.91, 5.99)], and cortisol (intercept: SD = 0.18 (95% CI: 0.14, 0.23), slope: SD = 0.02 (95% CI: 0.01, 0.02)]. Time predicted cortisol levels [b = −0.02, t(979) = −6.63, p < 0.0001]. Perimenopausal status (early vs. late) did not predict estradiol [b = −0.36, t(1608) = −0.84, p = 0.400], progesterone [b = −4.55, t(1723) = −0.87, p = 0.385], or cortisol [b = 0.01, t(1124) = 0.61, p = 0.542] scores over time.Discussion: Our results are consistent with previous findings emphasizing highly individual fluctuations of estradiol and progesterone levels during perimenopause. However, our findings do not suggest a continuous decline during the observed transition phase, implying relatively stable periods of fluctuating hormone levels. Furthermore, given the lack of significant group differences, it may not be necessary to differentiate between early and late perimenopause from the standpoint of hormonal progression.

Air Pollution Exposure and Daily Lung Function in Chronic Obstructive Pulmonary Disease: Effect Modification by Eosinophil Level.

Rationale: Few studies have assessed personal exposure to pollutants and lung function among adults with chronic obstructive pulmonary disease (COPD). Blood eosinophil level may be a biomarker of airway inflammation and pollution susceptibility. Objectives: To evaluate if daily pollutant exposures are associated with lung function and if associations are modified by eosinophil level in COPD. Methods: We recruited 30 former smokers with moderate to severe COPD living in the Boston area and followed them for up to 4 nonconsecutive months in different seasons. Participants measured morning lung function and carried a portable air quality monitor daily. Previous-day exposure to pollutants (particulate matter ⩽2.5 μm in aerodynamic diameter, nitrogen dioxide [NO2], and ozone) were measured by portable and community monitors. We constructed multilevel linear mixed-effects models with random intercepts for person and observation month, adjusted for temperature, humidity, age, sex, race, height, weight, income, and season, to assess associations of previous-day pollutant exposure with lung function and effect modification by eosinophil count (<150/μl vs. ⩾150/μl). Results: A total of 3,314 observations with exposure and lung function data were collected. Each interquartile range (5.1 parts per billion [ppb])-higher previous-day personal exposure to NO2 was associated with an 11.3 ml (95% confidence interval [CI], -18.7 to -4.0) lower forced expiratory volume in 1 second (FEV1) and an 18.0 ml (95% CI, -32.0 to -4.2) lower forced vital capacity. Personal and community-level exposure to particulate matter ⩽2.5 μm in aerodynamic diameter and community-level NO2 were negatively associated with FEV1 among the 55.2% of participants with the higher eosinophil level (Pinteraction < 0.05). Conclusions: Our study highlights the need to address air pollution exposure among patients with COPD. Future research is needed to verify if eosinophil level is a biomarker for susceptibility to air pollution in COPD.

Grooming site preferences in black capuchin monkeys: Hygienic vs. social functions revisited.

When primates groom each other, they tend to concentrate on those parts of the body they cannot efficiently self-groom (i.e., not visually accessible), and prefer to intensify grooming in areas with high hair density, thus suggesting a hygienic function. However, preferences for some body sites over others during social grooming may also result from different degrees of social bonding and relative dominance. To assess the relative importance of physical (hygienic) and social factors, we examined grooming interactions in two groups of wild black capuchin monkeys (Sapajus nigritus) during 15 nonconsecutive months. We evaluated the distribution of social grooming across body sites according to their accessibility by self-grooming and hair density. At the same time, we assessed whether the degree of dyadic social bonding affects the relative body orientation between groomer and groomee and the access to vulnerable body sites (e.g., face, throat, groin) during grooming. As expected, capuchins preferentially groomed inaccessible body sites (e.g., back and head), with a disproportionate effort directed to the tufts of their partners. We found that dyadic social bond strength, together with rank distance, significantly affected the proportion of grooming in ventro-ventral body relative orientation only in dominant-subordinate groomer-groomee dyads. This may indicate that, when two individuals differ in rank but are strongly bonded, the level of uncertainty related to the social context is already resolved and thus grooming per se is no longer perceived by the subordinate as an uncertain/risky situation. We found no effect of social bonding on grooming vulnerable body sites for any type of dyad. Our findings suggest that grooming site preferences in black capuchin monkeys simultaneously reflect hygienic and social functions.

Seasonal Variation of Carbonaceous Species of PM2.5 in a Small City in Sichuan Basin, China

Organic carbon (OC) and elemental carbon (EC) concentrations were measured in daily PM2.5 samples collected over four non-consecutive months representing four seasons from 2016 to 2017 in a small city in the east of Sichuan Basin. The average concentrations of OC and EC during the study periods were observed to be 15.5 ± 13.5 and 5.2 ± 4.7 μg∙m−3, respectively, both with the highest in winter. The OC and EC correlated well in fall and winter, implying that OC and EC were attributed to common emission sources. The estimated secondary OC (SOC) represented 37.2%, 46.7%, 26.9%, and 40.7% of the OC in spring, summer, fall, and winter, respectively. The highest concentration of SOC was found in winter, while the proportion of SOC/OC was highest in summer. Strong correlations were observed between OC vs. K+ and EC vs. K+ in fall and winter, suggesting that biomass burning was a significant source of carbonaceous aerosols. Four sources of OC and EC were resolved by the positive matrix factorization (PMF) model, including coal combustion (5.5% and 12.1%), building and road dust (19.7% and 18.1%), biomass burning (38.7% and 33.1%), and vehicle emission (36.1% and 36.7%), respectively. The potential source contribution function (PSCF) analysis signified that the main source areas of OC and EC were distributed in or nearby Wanzhou.

Hematological detraining-related changes among elderly individuals with high blood pressure

The aim of the present study was to compare the effects of detraining on physical performance, blood pressure, biologic and anthropometric variables of hypertensive elderly individuals, grouped by two levels of previous physical activity. A total of 87 elderly individuals (70 to 93 years old) with systolic/diastolic blood pressure levels above 120/80 mmHg who participated during 18 non-consecutive months in 2 years in physical exercise programs offered in northern Portugal communities were included in the study. Tests were performed before and after three months of no exercise. Attendance to the exercise sessions, hematological markers, cardiorespiratory function, and anthropometric variables were assessed. The results were analyzed according to the fulfillment of the WHO recommendations on moderate physical activity (at least 150 minutes/week). Weight, total cholesterol, and glucose were influenced by the amount of physical activity performed previously to the detraining period. After the detraining period, the total cholesterol, glucose, insulin, and weight had significant differences influenced by the amount of physical activity previously performed (p<0.05). The number of minutes per week of aerobic and resistance exercise training over 18 non-consecutive months was not a significant determinant factor in the development of hypertension during the three months of detraining.

Multiple Interventions for Improving Food Safety Practices in 2 Small Beef Abattoirs of Honduras and Associated Impacts on Risk-Mitigation Management.

Mitigation of risk for Shiga toxin-producing Escherichia coli (STEC) and Salmonella contamination was evaluated after a multiple-intervention approach (comprising food safety education and training, implementation of customized food safety practices and programs, and environmental monitoring programs with audits and corrective actions) in 2 small Honduran beef abattoirs. Previously, neither abattoir had food safety programs in place nor were they subjected to strict food safety regulatory surveillance. Abattoirs A and B were sampled on 4 nonconsecutive months each. Swab samples of abattoir A (n = 160, 40 samples per sampling date) and abattoir B (n = 78, 16-22 samples per sampling date) were taken from direct and indirect food contact surfaces, screened by BAX real-time polymerase chain reaction (PCR) assays and confirmed using immunomagnetic separation, selective media, and latex agglutination. In abattoir A, Salmonella presence was negligible, whereas presumptive STECs were present in 10%, 12.5%, 0%, and 5% of the environmental samples respective to each sampling month, indicating a reduction of STEC (P = .06) by the third and fourth sampling months. Conversely, presumptive STEC presence was negligible in abattoir B, whereas Salmonella presence for each sampling month was of 5.6%, 6.3%, 27.3%, and 0.0%, respectively. Upon the increased pathogen presence detected on the third sampling month, additional actions were taken to reinforce the implementation of food safety practices and programs, which resulted in a Salmonella reduction to 0% by the fourth sampling month (P = .013). The satisfactory results strongly suggest that a multiple-intervention approach is crucial to improve food safety in this type of premises.

Dietary habits of wild Javan lutungs (Trachypithecus auratus) in a secondary-plantation mixed forest: Effects of vegetation composition and phenology

This study investigated the seasonal dietary habits of wild Javan lutungs (Trachypithecus auratus) inhabiting the secondary-plantation mixed forest of Pangandaran Nature Reserve, West Java, Indonesia, in relation to vegetation composition and phenology. We conducted behavioral observations of a habituated group for 16 non-consecutive months. The lutungs fed on 164 items (leaf, fruit, flower, etc.) from 85 different plant species. Number of main plant species (>1% usage) was 20, and accumulated percentage of feeding (all plant parts combined) for the top five, 10, and 20 plant species was 43.4%, 63.8%, and 81.2%, respectively. The percentage of feeding on each plant species was positively correlated with the total number of trees and total crown volume. However, selectivity varied; for instance, plant species with a lower crown volume were preferred. The lutungs mainly fed on young leaves (average over the study period, 69.9%), with fruits (both mature and young, 21.2%) contributing more in certain months. The higher percentage of folivory was similar to that found in previous studies for this species and other Trachypithecus species. The category-based analyses revealed a significant positive correlation between the percentage of young fruit and their availability, whereas most other relationships were not significant. The percentage of feeding on young leaves showed a significant negative correlation with the percentage of feeding on mature leaves and dietary diversity, whereas the percentage of feeding on mature leaves had a positive correlation with that of young fruits. Species-based analyses showed that the percentage of feeding on three main diet items had a significant positive relationship with their availability. Our results imply that the dietary composition of the lutungs in our study site is determined by vegetation composition, while the seasonal change in diet is characterized by the availability of main food parts (young leaves and young fruits).

Clinical and environmental factors are not associated with establishment of pre-hospital intravenous access.

Background: Establishing intravenous (IV) access is part of the paramedic scope of practice and in critically ill patients the procedure is essential to administer fluids and/or drugs. However, in the unique pre-hospital setting clinical and environmental factors may challenge the procedure. Previous studies have investigated IV procedure time and overall success-rates with little or no attention to the impact of challenging factors. The aim of this study was to investigate clinical and environmental factors associated with the first attempt of IV access establishment.&#x0D; Methods: Data containing information on IV procedure characteristics, patient condition and environmental factors were obtained by paramedics operating in the Capital Region of Denmark. Data was collected during three non-consecutive months in 2017 and 2018. Data was exported to IBM’s Statistical Package for the Social Sciences (SPSS) for analysis. A chi-square test for independence (with Yates’ Continuity Correction for 2x2 tables and likelihood ratio for expected count violations) was applied to test for association between first attempt of IV access establishment, patient condition and environmental factors.&#x0D; Results: A total of 259 datasets were available. Statistical analysis revealed a significant association between first attempt of IV access establishment and assessed level of difficulty (p=0.00). No significant association was found between first attempt of IV access establishment and presence of radial pulse (p=0.21), patient triage category (p=0.35), size of catheter (p=0.80), site of catheter insertion (p=0.11), light conditions (p=0.26) and procedure location (p=0.31).&#x0D; Conclusion: This study concludes that first-attempt IV access establishment was significantly associated with assessed level of difficulty, and non-significantly associated with the investigated clinical end environmental factors. Based on the findings, paramedics should reconsider IV access for patients where the procedure is considered difficult, and consider other available administration options. On the contrary, paramedics should not refrain from attempting IV access establishment based on present clinical and environmental factors thought to challenge the procedure.