Average Number Of Days Research Articles

Myocarditis and pericarditis in young patients following Campylobacter jejuni enterocolitis infection: a systematic review of case studies

BackgroundCampylobacter is known to be the leading cause of foodborne illness. Campylobacter jejuni, specifically, most commonly causes self-limiting enterocolitis, but infection can lead to extraintestinal manifestations, including rare yet severe cardiac complications, such as myocarditis and/or pericarditis. This review aims to determine whether a relationship exists between the timing of a positive stool culture and the overall clinical course in patients with Campylobacter jejuni-associated myocarditis and/or pericarditis.MethodsA systematic search was conducted using PubMed, MEDLINE, CINAHL Ultimate, Academic Search Premier, and Nursing and Allied Health Premium databases. A gray literature search was also performed. Covidence.org was used to screen, select, and extract data by two independent reviewers. Following a full-text evaluation, the quality of each study was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Case Reports.ResultsThe search resulted in 434 records, of which 7 case reports met the inclusion criteria, each study including one patient. The average number of days from hospital presentation to obtaining a stool sample was 1.7. The average number of days from stool culture obtainment to clinical course improvement was 3.3, with four case studies reporting a range of 2–4 days.ConclusionThis systematic review raises awareness regarding the manifestations of Campylobacter jejuni, specifically the severe cardiac symptoms that may present in young individuals. Given the significant sequelae that can develop, providers must elicit a thorough history consisting of questions related to recent travel, food consumption, and gastrointestinal symptoms, especially among young individuals presenting with cardiac complaints.

Transcatheter Aortic Valve Replacement in Patients With Geographic and Socioeconomic Vulnerabilities.

Transcatheter aortic valve replacement (TAVR) is an established treatment for patients with severe aortic stenosis (AS). It remains unclear whether disparities exist in rural or socially vulnerable populations undergoing TAVR. This study assessed whether outcomes differ based on geographic location or vulnerability of patients undergoing TAVR. Patients undergoing TAVR at a single institution from August 2012 to June 2023 were studied (n = 1565). Zip codes determined Social Vulnerability Index (SVI) and measured distance to our facility. Outcomes defined by the Valve Academic Research Consortium 3 (VARC-3) included stroke, transient ischemic attack (TIA)/delirium, pacemaker implantation, new atrial fibrillation/atrial flutter, and myocardial infarction (MI). Average time between preoperative coronary angiogram (CATH)/computed tomography angiography (CTA) and TAVR was calculated. Kaplan-Meier curves estimated survival probability. The average time between CATH and TAVR in patients living furthest away was ∼9 days more than patients living closest to the implant site. The average number of days between CATH and TAVR for low and high SVI were 71 and 78 days, respectively. The average number of days between CTA and TAVR for low and high SVI were 40 and 39 days, respectively. Further distances traveled were associated with longer wait times between preoperative workup and TAVR. Patients with longer waits between CATH and TAVR had no differences in medium-term survival probability but had decreased long-term survival probability compared to patients with rapid pre-procedural evaluation. Although geographic and socioeconomic vulnerability can disadvantage patients, our study demonstrates that patients undergoing TAVR can have timely care and similar outcomes.

Unveiling Efficiency: A Research Inquiry into Technical Staff Utilization in South Indian Clinical Laboratory using Workload Indicators Staffing Need (WSN) Analysis.

Background Effective clinical laboratories are the need of the hour, they play a significant role in healthcare, providing tests for diagnosis, treatment monitoring. Having skilled and adequate staffing is crucial for clinical laboratories to operate efficiently, manage their workload effectively, and deliver test results in a timely manner. Despite being critical for healthcare delivery, ensuring adequate staffing levels in clinical laboratories remains a complex challenge for healthcare providers worldwide due to resource constraints and workforce shortages. Methods This study evaluates the effectiveness of clinical laboratory staff utilization by considering workload, work pressure, and staffing requirements. We utilized the Workload Indicators of Staffing Need (WISN) method to assess the staffing in the clinical laboratory of a tertiary care hospital. Annual hospital statistics were collected for two years from June 2021 to May 2023 to calculate the average number of days (234) worked annually, percentage of workload, distribution of activity time measurement units, and the ratio of needed, surplus, and existing staff. The findings aim to provide valuable insights for optimizing staffing levels and ensuring an efficient laboratory environment. Result The analysis found a significant workforce gap in the laboratory between the current staff numbers and the calculated staffing needs. The WISN ratios ranged from 0.2 to 0.7, indicating the existing 33 staff members face a high workload burden. The calculated ideal staffing level was 46.33 personnel. These results demonstrate staff shortage and excess workload pressure on the current laboratory employees. Conclusion The results highlight the importance of optimizing staffing levels in clinical laboratories to ensure quality service delivery. The WISN methodology can be a useful tool in healthcare facilities for making evidence -based decisions for staff allocation, maximizing the utilization of employee skill sets, and establishing standard staffing benchmarks tailored to the needs of clinical laboratories.

Long-Term Efficacy and Safety of Bimekizumab and Other Biologics in Moderate to Severe Plaque Psoriasis: Updated Systematic Literature Review and Network Meta-analysis.

Biologic treatments have made complete skin clearance in moderate to severe plaque psoriasis a real possibility. Although clinical trials demonstrated the superiority of bimekizumab over secukinumab, adalimumab, and ustekinumab, direct comparisons with other biologics are not available. This systematic literature review (SLR) and network meta-analysis (NMA) aimed to evaluate the 1-year efficacy and safety of bimekizumab versus other biologic systemic therapies for moderate to severe plaque psoriasis. We conducted an SLR to retrieve published randomised controlled trials (RCTs) in patients with moderate to severe plaque psoriasis. We searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews and PsycINFO on 13 January 2022. Two NMA types were used to analyse the long-term achievement of 100% improvement from baseline in Psoriasis Area and Severity Index (PASI100): (1) NMA of cumulative clinical benefits, based on the area under the curve, from week0 to 52; (2) multinomial NMA at weeks44‒60. Binomial NMA was used to evaluate long-term serious adverse events (SAEs). The SLR identified 38 RCTs, of which 19 were included in the NMA. Bimekizumab 320mg administered every 4weeks to week16 then every 8weeks (Q4W/Q8W) showed a greater cumulative average number of days of PASI100 response compared with all other biologics. These differences were statistically significant versus all biologics, except risankizumab 150mg. The multinomial NMA demonstrated that interleukin (IL)-17 and IL-23 inhibitors were the most efficacious treatments. No significant differences were found in long-term occurrence of SAEs. Bimekizumab 320mg Q4W/Q8W was superior to most other treatments in maintaining complete skin clearance during the first year of treatment. It demonstrated a greater cumulative average number of days with completely clear skin while displaying a comparable safety profile compared with all other biologics.

The Impact of the COVID-19 Pandemic on the Sex Ratio at Birth in Ireland.

The sex ratio at birth (SRB), calculated as male divided by total live births, is an important indicator of population health. Typically, male live births slightly outnumber female live births. Population events, including pandemics, can alter the SRB, with effects sometimes evident 9 months post-event, potentially due to changes in sexual behavior and/or stress levels. This study investigates the impact of the COVID-19 pandemic on the SRB in the Republic of Ireland. Publicly available monthly live birth data for Ireland were obtained from the Central Statistics Office for the period 2015 to 2021. Time series analysis predicted the SRB for 2020 using data from 2015 to 2019, with comparisons made between observed and predicted values. In December 2020, 9 months after the March 2020 COVID-19 declaration, the observed SRB sharply fell to 49.44% (97.80 males for every 100 females), below the 95% prediction interval of 50.31% to 52.15%, significantly deviating from the expected male predominance. December 2020 also recorded the lowest average daily number of births (n = 145) in the study period. The sharp decline in the SRB in December 2020, alongside the lowest birth count, suggests reduced sexual intercourse at the population level, particularly in March 2020, aligning with recommendations from Ireland's Health Service Executive (HSE). The HSE advocated precautionary measures such as limiting partnered sex in March 2020 to mitigate the spread of COVID-19. These findings highlight the pandemic's potential impact on population dynamics and stress the importance of SRB monitoring as a low-cost and readily available health indicator, especially during national crises.

Estimating Optimum Length of Stay in a Hospital to Control the Infection Spread during an Epidemic Using Left-Right Truncated Poisson Model

Background: The unprecedented havoc of COVID-19 pandemic stressed medical infrastructure of every affected country. The developing countries were more affected as their already inadequate medical resources were strained further. Material and Methods: In order to estimate the time of onset of recovery through the period of hospitalisation stay, the retrospective data on the number of days that 83 COVID-19 patients stayed in a hospital in New Delhi, India was obtained. A Left-Right Truncated Poisson Distribution Model (LRTPD) was developed to estimate the average number of days that patients had to spend in the hospital before the onset of recovery and they were no longer infected. Left truncation is on the ‘u’ left most classes of the random variable and right truncation is after ‘v’ classes. The parametric estimates of the LOS were validated using the Monte-Carlo method. Results and Conclusion: The models suggested that if appropriate truncation limits (both the data-specific and as per expert advice) are used in case of critical medical emergencies, approximately 90 percent of the patients will be able to get hospital admission, without over-burdening the hospital infrastructure. The median recovery onset time/ Length of stay (LOS) obtained using the Kaplan-Meier estimator was consistent with the results of the parametric modeling and simulation. However, the Kaplan-Meier method overestimated the mean LOS as compared to the parametric methods.

Increased Stillbirth Rates and Exposure to Environmental Risk Factors for Stillbirth in Counties with Higher Social Vulnerability: United States, 2015-2018.

Exposure to unfavorable environmental conditions during pregnancy, such as extreme heat and air pollution, has been linked to increased risk of stillbirth, defined as fetal mortality at or after 20 weeks' gestation, however no studies have examined its association with social vulnerability. We examined associations between county-level stillbirth rates, environmental risk factors for stillbirth, and social vulnerability in the United States. This ecologic study linked county-level data from three nationwide datasets on stillbirths (National Vital Statistics System), environmental conditions (North American Land Data Assimilation System and Environmental Protection Agency), and social vulnerability (Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry Social Vulnerability Index). Poisson and negative binomial models were fit to the variables and produced rate ratios to estimate associations among stillbirth rates, environmental risk factors, and social vulnerability. Social vulnerability was positively associated withn stillbirth rates, annual average number of extreme heat days, and ambient concentration of particulate matter ≤ 2.5μm in diameter (PM2.5). The average number of days that ozone and PM2.5 each exceeded regulatory standards were not associated with stillbirth rates or social vulnerability. A positive association between average annual PM2.5 concentration and stillbirth rates was detected; no other significant associations between environmental risk factors and stillbirth rates were observed. We found evidence of associations between social vulnerability and stillbirth rates, and between social vulnerability and environmental risk factors for stillbirth at the county level. Further research could inform understanding of how social vulnerability impacts the relationship between environmental exposures and stillbirth risk.

Impact of Psychological and Socioeconomic Factors on Management of Bone Tumours with Custom-made Endoprosthesis Reconstruction

Objectives: In the past few decades, the definitive treatment for bone tumours has evolved considerably. Resection followed by custom-made endoprosthesis reconstruction has become the standard of care. The main objective of this study is to analyse the psychological and socioeconomic factors impacting the treatment of bone tumours. Materials and Methods: Among the 53 patients who underwent bone resection with custom mega prosthesis (CMP) reconstruction between 2013 and 2022, 22 patients are in regular follow-up, 16 patients are lost in follow-up, and the remaining 15 are dead. We prepared a questionnaire which included 22 questions to assess the impact of psycho-social and economic factors on the treatment of bone tumours. Results: We included 22 patients in our study. The average total duration of disease before surgery was 95 days. The average days of in-hospital stay was 53 days. The average number of days of hospital stay after surgery was 14 days. The average amount spent during the hospital stay was about 240 Indian national rupees/day. The average loss of work was about 90 days. The average days of leave availed in school/college was 135 days. About 69.2% of patients had to go for a change of occupation. About 90.9% of patients had a fear of recurrence. About 77.2% of patients found it difficult to indulge themselves in recreational/sports activities. About 45.4% of patients felt it was difficult for their partner/family to empathise with their situation. About 59% of patients had sleep difficulties. About 36.3% of patients were well satisfied with their prosthesis. Conclusion: Being predominantly a disease of the young population, the need for comprehensive management, including psychological counselling and rehabilitation in addition to cancer treatment, seems to be the need of the hour. The fact of the high cost of non-treatment-related expenditure needs to be addressed. A frequent cancer survivor programme will aid these patients to regain their self-confidence.

Wound infection rate after skin closure of damage control laparotomy with wicks or incisional negative wound therapy: An EAST multi-center trial.

Damage control laparotomy (DCL) has a high risk of SSI and as an attempt to mitigate this, surgeons often leave the skin open to heal by secondary intention. A recent retrospective study showed that DCL wounds could be closed with the addition of wicks or incisional wound vacs with acceptable rates of wound infection. The aim of this prospective trial was to corroborate these results.This is a prospective multicenter observational trial performed by 7 institutions from July 2020 to April 2022. Adult patients who underwent DCL and fascia/skin closure with the addition of wicks or an incisional wound vac were included. Patients who died within seven days of DCL were excluded. Demographics, mechanism of initial presentation, wound classification, antibiotics given, surgical site infections, procedures performed, and mortality data was collected. Fisher's Exact test was used for categorical data and Wilcoxon Rank Sum test for continuous data. Mean days to closure was assessed using Student's t-test for independent groups. P-values <0.05 were considered indicative of statistical significance.Over the 21-month period, a total of 119 patients analyzed. Most patients were male (n = 66, 63 %), and the average age was 51 years. The average number of days the abdomen was kept open was 2.6. A majority of the DCLs were performed on acute care patients (n = 76, 63.8 %) and 92 patients (77.3 %) had a wound classification of contaminated or dirty. Most of the patients’ skin was closed with wicks in place (68.9 %). There was a 9.8 % infection rate in patient's skin closed with wicks versus 16.2 % closed with an incisional wound vac (p = 0.361).Although the wick group had a higher proportion of class III and IV wound types, patients primarily treated with wicks had a lower risk of wound infection compared to those treated with incisional wound VACs; however, this difference was not statistically significant.

Analysis of the Influence of Machine Operation Parameters on the Technical Characteristics of the Elevator in the Point of Cleaning and Washing of the Equipment Park

Purpose. The study is aimed at determining the nature of the influence of the operating parameters of the enterprise's machines (the number of tracked and wheeled machines, the annual consumption rates of their motor resources) on the technical characteristics of the elevator for cleaning the dirt settler of the vehicle cleaning and washing equipment park, in particular, the height of the elevator and its productivity, as well as building analytical and graphical dependencies of these values on the operating parameters of the machinery. Methodology. To achieve this goal, we used the calculation algorithms presented in the modern technical literature and analyzed the factors and values that affect the height and capacity of the elevator of the station. It has been established that in order to determine the design parameters of the elevator, it is necessary to have statistical data on the operation of machinery at the enterprise and to carry out a detailed calculation, which includes: the mathematical expectation of the average daily number of machine trips from the fleet for different types of machinery, as well as the total value, the number of numbered machine servicing, the number of external machine washing stations, and the geometric parameters of the dirt tank. Findings. A graphical analysis of the influence of the number of tracked and wheeled vehicles and their annual consumption rates of motor resources on the value of its height and productivity was carried out for the elevator of the cleaning and washing station of the fleet of a particular enterprise, which is intended for cleaning the sludge tank. It was found that the functions of change in productivity and height are linearly increasing (with other parameters fixed). Originality. The authors first investigated the dependencies of the design parameters (height and capacity) of the elevator, built analytical dependencies of the mathematical expectation of the average daily number of machine trips for wheeled and tracked vehicles on the number of relevant machines and annual motor resource consumption rates, as well as the height and capacity of the elevator. For the examples of enterprise fleets with equipment operation parameters taken from statistical data, a graphical analysis of the constructed dependencies was carried out. Practical value. The use of the constructed dependencies makes it possible to determine the general nature and range of changes in the above design parameters in the case of varying equipment performance at a particular enterprise. The proposed dependencies can be used to quickly determine the required design parameters of an elevator based on specific data on the operation of equipment.

Integrated transcriptomic and metabolic analyses reveal the early response mechanism of Pinus tabulaeformis to pine wood nematodes

Pine wilt disease (PWD) is a devastating disease of pine trees caused by the pine wood nematode (Bursapherenchus xylophilus, PWN). To study how Pinus tabulaeformis responds to PWD infection, we collected 3-year-old P. tabulaeformis seedlings at 2 days, 5 days, and 8 days after being infected with B. xylophilus. We identified genes and metabolites early responding to infection using transcriptome and metabolomic data obtained by high-throughput mRNA sequencing (RNA-seq) and liquid chromatography-tandem mass spectrometry (LC-MS/MS)-based assays, respectively. The following results were obtained: (1) After inoculation with PWN, the average number of days taken for 3-year-old P. tabulaeformis seedlings to develop symptoms was 8 days. (2) Combined transcriptome and metabolome analysis revealed that phenylpropanoid biosynthesis and flavonoid biosynthesis are critically important pathways for P. tabulaeformis to respond to PWD. (3) The response of P. tabulaeformis to stress was mainly through positive regulation of gene expression, including some key genes related to plant hormones or transcription factors that have been widely studied. Genes related to pathways such as photosynthesis, plant-pathogen interactions, and DNA replication were downregulated. (4) Terpenoid biosynthesis genes involved during the development of pine wilt disease. This study demonstrated the defence and pathogenic mechanisms of P. tabulaeformis against PWD, providing a reference for the early diagnosis of PWD.

367 Changing the conversation: Evaluating feedyard closeouts and the beef system on a carcass basis

Abstract Beef cattle genetics, management, technologies and nutritional strategies are ever evolving, and current US trends favor feeding cattle to heavier carcass endpoints and optimizing quality grade. The average number of days on feed (DOF) in the US has increased year after year, averaging 195 and 183 DOF for steers and heifers, respectively, as reported by Elanco Benchmark data in 2021. As DOF increase, cattle live performance, including average daily gain and feed efficiency decline; however, hot carcass weight (HCW) becomes significantly heavier. Although a reduction in live feed conversion occurs as cattle are fed for extended DOF, the kilograms of additional live gain that result as kilograms of gain on the carcass, termed carcass transfer, increase linearly. As DOF are extended, carcass transfer has been reported to increase up to 88 %. As a result of genetic advancements, technologies, and feeding longer, HCW has trended heavier over the last 60 yr, with 2024 USDA HCW reported for April as 11.3 and 9.5 kg heavier for steers and heifers, respectively, year after year. According to mandatory price reporting data, approximately 74 % of fat cattle marketed in the US are sold as dressed beef. As we continue to feed to heavier endpoints and longer DOF, the profitability of selling on a carcass-basis increases. With the increase in carcass transfer as DOF extend, this presentation will attempt to address that cattle live performance should be adjusted to a carcass-basis for feedyards to appropriately capture the inflection point at which cost of additional gain equals the price received for the additional gain.

Pelvic floor muscle training combined with electroacupuncture for bladder dysfunction after incomplete spinal cord injury: a randomized controlled trial

To observe the efficacy of pelvic floor muscle training combined with electroacupuncture (EA) for bladder dysfunction after incomplete spinal cord injury (SCI). Ninety patients with bladder dysfunction after incomplete SCI were randomly divided into an EA group (30 cases), a pelvic floor muscle training group (30 cases, 1 case dropped out), and a combined group (30 cases, 1 case dropped out). All groups received routine rehabilitation. The EA group received EA at Zhongji (CV 3), Guanyuan (CV 4), Mingmen (GV 4), Yaoyangguan (GV 3), bilateral Shenshu (BL 23), Ciliao (BL 32), and Pangguangshu (BL 28), with continuous waves at frequency of 100 Hz, and the needles were retained for 30 min, once daily, 6 times a week for 6 weeks. The pelvic floor muscle training group underwent pelvic floor muscle training two times a day, for 6 weeks. The combined group received both EA and pelvic floor muscle training. The daily average number of urinations, daily average number of urinary leakages, urodynamic indexes (residual urine volume, maximum bladder capacity, bladder compliance, and maximum urine flow rate), and generic quality of life inventory-74 (GQOLI-74) were compared before and after treatment in each group. Compared before treatment, the daily average number of urinations and urinary leakages were decreased (P<0.05), residual urine volume, maximum bladder capacity, and bladder compliance were reduced (P<0.05), and maximum urine flow rate and GQOLI-74 scores were increased (P<0.05) after treatment in all groups. After treatment, the combined group showed greater differences in the daily average number of urinations, daily average number of urinary leakages, residual urine volume, maximum bladder capacity, bladder compliance, maximum urine flow rate, and GQOLI-74 score compared to the EA group and the pelvic floor muscle training group (P<0.05). There was no statistically significant differences in the changes in these indexes between the EA group and the pelvic floor muscle training group (P>0.05). Pelvic floor muscle training combined with EA can effectively alleviate urination problems in patients with bladder dysfunction after incomplete SCI, improve bladder function, and enhance patients' quality of life.

Gestational and postnatal exposure to wildfire smoke and prolonged use of respiratory medications in early life

As wildfire frequency and severity increases, smoke exposures will cause increasingly more adverse respiratory effects. While acute respiratory effects of smoke exposure have been documented in children, longer term sequelae are largely unstudied. Our objective here was to examine the association between gestational and postnatal exposure to wildfire smoke and prolonged use of prescription medication for respiratory conditions in early childhood. Using Merative MarketScan claims data, we created cohorts of term children born in western states between 1 January 2010-31 December 2014 followed for at least three years. Using NOAA Hazard Mapping System data, we determined the average number of days a week that >25% of the population in a metropolitan statistical area (MSA) was covered by smoke within each exposure period. The exposure periods were defined by trimester and two 12 week postnatal periods. Medication use was based on respiratory indication (upper respiratory, lower respiratory, or any respiratory condition) and categorized into outcomes of prolonged use (⩾30 d use) (PU) and multiple prolonged uses (at least two prolonged uses) (MPU). We used logistic regression models with random intercepts for MSAs adjusted for child sex, birth season, and birth year. Associations differed by exposure period and respiratory outcome, with elevated risk of MPU of lower respiratory medications following exposure in the third trimester and the first 12 postnatal weeks (RR 1.15, 95% CI 0.98, 1.35; RR 1.21, 95% CI 1.05, 1.40, respectively). Exposure in the third trimester was associated with an increase in MPU of any respiratory among males infants only (male RR 1.22, 95% CI 1.00, 1.50; female RR 0.93, 95% CI 0.66, 1.31). Through novel use of prescription claims data, this work identifies critical developmental windows in the 3rd trimester and first 12 postnatal weeks during which environmental inhalational disaster events may impact longer-term respiratory health.

Effects of fremanezumab on migraine-associated symptoms and medication use in Japanese and Korean patients with episodic migraine: Exploratory endpoint analysis of a multicenter, randomized, double-blind, placebo-controlled trial.

To describe exploratory endpoints from a previous phase 2b/3 placebo-controlled trial conducted in Japan and Korea, specifically investigating the effect of fremanezumab or placebo on migraine-associated symptoms and acute headache medication use in patients with episodic migraine (EM). EM is associated with non-head pain symptoms, including nausea, vomiting, photophobia, or phonophobia, which contribute substantially to the disease burden, healthcare resource utilization, and impaired quality of life. Current EM treatments include a mix of nonspecific/migraine-specific acute headache medications, but medication overuse can induce headaches and progression from EM to chronic migraine (CM). In multiple phase 2b/3 trials, the monoclonal antibody fremanezumab significantly reduced the average number of monthly migraine days experienced by patients with EM/CM compared with placebo. This was a prespecified analysis of exploratory endpoints in a multicenter, randomized, double-blind, placebo-controlled, phase 2b/3 trial conducted in Japanese and Korean patients with EM (NCT03303092). Patients were randomized to receive fremanezumab, either monthly or quarterly, or matching placebo, administered subcutaneously at 4-week/28-day ("monthly") intervals to maintain blinding. Exploratory endpoints reported here were the mean change from baseline in the number of days/month with (i) the use of any acute headache medication, (ii) the use of any migraine-specific acute headache medication, (iii) nausea or vomiting, and (iv) photophobia and phonophobia. Overall, 357 Japanese and Korean patients with EM received either monthly (n = 121) or quarterly (n = 119) fremanezumab or placebo (n = 117). Compared with placebo, fremanezumab administered monthly or quarterly was associated with a significant reduction from baseline in the average number of days/month with acute headache medication use over three months (difference vs. placebo -2.81 [95% confidence interval (CI) -3.52, -2.11]; p < 0.001 and -2.79 [95% CI -3.50, -2.08]; p < 0.001, respectively). Similar findings were observed in the monthly average number of days with migraine-specific acute headache medications (difference vs. placebo with monthly and quarterly fremanezumab, -2.63 [95% CI -3.31, -1.95] for both; p < 0.001), the average number of days/month with nausea or vomiting (difference vs. placebo -1.09 [95% CI -1.60, -0.58]; p < 0.001 for monthly fremanezumab and -1.37 [95% CI -1.88, -0.86]; p < 0.001 for quarterly fremanezumab), and the average number of days with photophobia and phonophobia (difference vs. placebo -1.22 [95% CI -1.80, -0.65]; p < 0.001 and -1.64 [95% CI -2.22, -1.06]; p < 0.001, respectively). Monthly and quarterly administered fremanezumab effectively prevented EM in Japanese and Korean patients. Fremanezumab also improved other disease aspects including the need for acute headache medications and the frequency of migraine-associated symptoms.

Optimizing care pathways: A study of the urgent dispatch program and its impact on emergency department visits

IntroductionThe use of acute hospital-level care at home (hospital-at-home) for patients who are chronically ill has led to decreased medical costs, amount of sedentary time, and hospital admissions. Our large integrated healthcare system identified the need to develop a mechanism through which to decrease emergency department (ED) visits in this patient population by creating a home acute care program called Urgent Dispatch. The primary objective of this study was to determine the medical condition for referral and seven and 30-day ED visit rates. MethodsThis was a retrospective cohort of all patients referred to the Urgent Dispatch program from April 1, 2021, through February 28, 2022. We assessed encounters for patient demographics, referral source, reason for visit, number of at home visits, total number of days in the program, and determined if the patient had an ED encounter within seven and 30 days of participation in the program. The healthcare system includes 10 hospitals (academic, community and rural), 17 emergency departments (hospital-based and freestanding) and their associated outpatient clinics. ResultsA total of 2218 orders were placed with 1530 (70.8 %) resulting in enrollment in the Urgent Dispatch program. The majority were elderly (75 ± 15.6), white (70 %), female (64.4 %), and had Medicare as their primary insurance (82 %). The average number of visits made by Urgent Dispatch was 1.46 (SD ± 0.95). The average number of days enrolled in the program was 2.4 (SD ± 4.1). The top three referral sources to the program were outpatient primary care (42 %), home care (28 %) and emergency medicine (20 %). The top body systems requiring a visit were cardiovascular (22 %), general (18 %), and respiratory (17.2 %). Of the 1530 urgent dispatch referrals, 19.8 % (n = 303) had an ED visit within seven days, 12 % (n = 183) had an ED visit within eight to 30 days, and 68.2 % (n = 1044) had no ED visit. ConclusionA home-based care model of healthcare delivery for patients with chronic medical conditions can provide effective care, with 80.2 % of patients avoiding an ED visit within seven days and 68.2 % avoiding an ED visit within 30 days.

The epidemiology of employee injuries in a monitoring sentinel unit of a coastal area in China:A nine-year retrospective analysis of clinical data

The epidemiology of injury among subgroups of minors, older adults, students, and athletes has previously been investigated; however, studies investigating employee-related injuries are limited. We aimed to retrospectively analyze the epidemiological characteristics and dynamic change trends of injury among employees over a nine-year period in a coastal area in China to provide a reference for formulating injury prevention and control measures among employees. All 14,168 employee injury cases registered in a hospital injury monitoring system were analyzed from January 2013 to December 2021. The male-to-female sex ratio of the employee injury cases was 3.52:1. The floating-to-registered residence population ratio was 2.05:1. March, May, July, and September–October were peak months for employee injuries. Within the day, the injury cases of employees reached five peaks at 0800, 1000, 1500, 1800, and 2000 h. The highest five causes of injury were falling, blunt injuries, motor vehicle accidents, sharps injuries, and non-motor vehicle accidents. The highest five injury types were fracture; concussion or contusion of the brain; injury from a sharp instrument, bite, or open wound; contusion or abrasion; and sprain or strain. The main locations of the injuries were roads and streets, industrial and building sites, and homes. Vulnerable body regions included the upper limbs, lower limbs, head, trunk, and multiple regions. The independent predictors of all outcomes were census register classification; age; injury causes, locations and types; vulnerable body regions; and injury severity; on multivariate logistic regression analysis (P < 0.05). The average durations of missed work in the different injury outcome groups due to injuries among employees were 50.21, 42.57, 44.57, and 38.20 days, respectively. The average number of missed work days due to injuries was 49.77 days, with an increasing annual trend (F = 79.872, P < 0.01). The average hospitalization cost for employee injuries was ¥16250.37, with a decreasing annual trend (F = 4.621, P < 0.01). The average length of hospitalization was 15.22 days, with a decreasing annual trend (F = 76.657, P < 0.01), and the average number of days of missed work due to injuries was 49.77 days, with an increasing annual trend (F = 79.872, P < 0.01). The correlation coefficients showed a significant positive correlation between the average length of hospitalization and average hospitalization expenses, with an increasing trend from 2014 to 2021 (P < 0.05). Most employee injuries occurred in the male and floating populations. Targeted intervention measures should be implemented according to the epidemiological characteristics of injuries in relation to different populations, sexes, and ages to prevent and control injuries.

Forecasting demand for air conditioning in the Brazilian residential sector

Brazil is among the ten largest air-conditioning consumers in the world. The estimated electricity demand for air conditioners in the residential sector has more than tripled in the last twelve years, while household air conditioner ownership increased by 9 % per year. This trend is expected to continue in the upcoming decades as a result of population growth rate, higher incomes, and individual preferences for thermal comfort. This work assess the current use of air conditioning in the Brazilian residential sector and attempts to forecast its future demand. Forecasting is based on a proposed methodology which includes weather data monitored by 265 meteorological stations during eight years. Empirical correlations are used to determine daily average indoor temperatures for typical residential buildings and the ANSI/ASHRAE standard for indoor thermal comfort is applied to estimate the average number of cooling days (CD) and heating days (HD). These two parameters indicate the yearly average number of days in which thermal comfort condition is not reached and consequently the use of air conditioning is necessary. Northern and Northeastern Brazil are the regions with the highest CD for masonry residential buildings, approximately 318 days annually. Efforts are made to project the electricity consumption by space cooling in the residential sector until 2035 considering several effects, such as population growth, ownership of ACs, cooling capacity, and equipment efficiency. Southeastern Brazil had the highest electricity consumption for space cooling in 2022, at 12.06 TWh. The research forecasts a rise to 44.77 TWh by 2035, though improved equipment efficiency could lower this to 33.51 TWh. Future energy policies should emphasize efficient AC usage and stricter EER standards.

Biopsychosocial conditions of patients in the rheumatology department of a university hospital.

The aim was to examine biopsychosocial conditions of patients hospitalized in the rheumatology department of a university hospital. Ninety-six patients (mean age: 53.14 ±16.83 years) receiving inpatient treatment at the rheumatology service of a university hospital were included. Chest circumference, manual muscle testing, general well-being (Visual Analogue Scale - VAS), the Fatigue Severity Scale, the Rivermead Mobility Index, the Beck Anxiety Inventory, and the Nottingham Health Profile were used for evaluation. The average number of days hospitalized was 15.57 ±15.11. Mean disease duration was 7.91 ±9.34 years. Respiratory rate per minute was 22.55 ±6.03. Chest circumference measurement at rest was 97.01 ±9.70 cm, inspiration was 99.71 ±9.67 cm, expiration was 94.10 ±13.91 cm. Quadriceps muscle strength (on a scale of 0-5) was 4.26 ±0.74 on the right and 4.16 ±0.76 on the left; biceps brachii muscle strength was 4.46 ±0.64 on the right and 4.39 ±0.78 on the left. The VAS score was 6.03 ±2.51; the Rivermead Mobility Index was 11.41 ±4.11; the Nottingham Health Profile total score was 39.18 ±22.44; the energy level sub-score was 52.89 ±37.06. History of previous hospitalization was found in 42 patients (43.8%). Five patients (5.2%) were at bed level, 4 patients (4.2%) were at sitting level, 7 patients (7.3%) were at standing level, and 80 patients (83.3%) were at walking level. Seventeen patients (17.7%) used assistive devices for mobilization. Sixty-one patients (63.5%) were fatigued, and 21 patients (21.9%) had moderate anxiety. Inspiratory capacity of patients hospitalized in rheumatology service is low. Their respiratory rate is higher than the normal value. Their mobility and energy levels are at average values while fatigue and anxiety levels need to be considered. In addition to pharmacological treatments, we recommend that patients hospitalized in rheumatology service be supported by appropriate exercises provided by physiotherapists.

A Study of the Influence of Meteorological and Environmental Factors on Otitis Media with Effusion in Lanzhou.

In observational studies, a possible correlation between atmospheric environmental factors and the number of daily outpatient visits by Otitis media with effusion(OME) patients has been observed. However, the causal relationship is not clear.To study the relationship between the incidence of OME and meteorological factors and air pollutants in the main urban areas of Lanzhou, it is helpful to further understand the health effects of meteorological and environmental factors on OME and to prevent and treat the disease, it is of great academic and practical significance to the prevention, treatment and prognosis of diseases. The levels of AQI、PM2.5、PM10、NO2、O3、SO2、CO、AP、RH、W and T were obtained from local monitor stations. Data of patients with OME were collected from two Grade A Level hospitals in Lanzhou from January 1, 2014 to December 31, 2016. Descriptive analysis of data was carried out for the study subjects. Spearman correlation coefficients between atmospheric environmental factors and daily visits of patients with OME were calculated by SPSS statistical software. Lag effects, relative risks(RR) and exposure-response curves were calculated by generalized additive model (GAM) with R software. (1) The incidence of OME in winter and spring was more than that in summer and autumn, which was consistent with the seasonal variation of meteorological environmental factors of Lanzhou. That was, the meteorological conditions and air quality in winter and spring were poor, while in summer and autumn they were relatively good. (2) The number of male outpatients were 1.05, 1.08 and 1.09 times of female outpatients during the period 2014-2016, respectively. And aged 0-10 years old outpatients accounted for 31% of the total OME outpatients. (3) Exposure-response curve showed that PM2.5, PM10, NO2 and SO2 were positively correlated with OME, T was negatively correlated with OME. When concentration < 1mg/m3, CO was positively correlated with OME. When concentration>1mg/m3, CO was negatively correlated with OME. When concentration<30 ug/m3, O3 was positively correlated with OME. When concentration>30ug/m3, O3 was negatively correlated with OME. (4) The factors we studied could significantly affect the number of OME outpatients within 2-3 days of single lag effects, and 3-4 days of cumulative lag effects.(5) The influential factors on OME were as follows: PM2.5、NO2、SO2、O3、 CO and T. The daily average number of OME patients in different seasons was different in major region of Lanzhou city, with more in winter、spring and fewer in summer、autumn. Age and sex were the important factors affecting the daily average number of OME patients. Males were more susceptible to OME than females and children awere moresusceptible to OME than adults. The change of OME patients was related to air quality, air pressure and temperature. The worse the air quality, the higher the air pressure, the lower the temperature, the more the average daily number of OME patients. Meteorological environmental factors affected the visits of OME, and the lagging effect time of different factors were different. Most of the research factors within 3-4 days had a significant impact on the number of patients of OME. 1.The number of OME visits in the Lanzhou was more seasonal in winter and spring than in summer and fall. 2.Age and sex were the most important factors affecting the number of patients with OME. According to the prevalence of OME in Lanzhou, children were more likely to have OME than adults and men were more likely to have OME than women. 3.The number of OME patients was related to air quality, air pressure and temperature. 4.The meteorological factors have a delayed effect on the onset of OME, and the time of delayed effect is different for different factors. The single delayed effect of 2-3 days and the cumulative delayed effect of 3-4 days have a significant effect on the change of the number of patients with OME. To study the relationship between the incidence of OME and meteorological factors and air pollutants in the main urban areas of Lanzhou, it is helpful to further understand the health effects of meteorological and environmental factors on OME and to prevent and treat the disease, it is of great academic and practical significance to the prevention, treatment and prognosis of diseases.