Number Of Days Research Articles

Central Venous Catheter-associated Venous Thromboembolism in Children: A Prospective Observational Study.

Our objective was to study the proportion of children developing Catheter-related thrombosis (CRT) following central venous Catheter (CVC) insertion and the risk factors of CRT in pediatric patients with CVC. One hundred four children aged 29 days to 18 years who had a percutaneous non-tunneled CVC inserted were enrolled. Ultrasonogram (USG) with venous Doppler scan was performed within 48 hours of CVC removal to diagnose CRT. The major indications for CVC insertion were surgical care 34 (32.6%) and ICU care 28(26.9%). The median age of the patients was 3 years, and 75% were males. The median number of CVC days was 10 (IQR 5.15). CRT was seen in 45(43.3%), of which 33 (73.3%) were asymptomatic. The rate of CRT was 35.69 cases per 1000 CVC days (95% CI 26.03-47.75). The number of days a catheter was in place and USG-guided catheter insertion was a significant risk factor. The multivariate logistic regression model showed that the duration of CVC in situ was independently associated with the development of CRT (OR, 1.06; 95% CI 1.0-1.1; P=0.02). CVC duration was a major risk factor for the development of CRT. There was a higher risk of developing a symptomatic CRT with central venous catheters than hemodialysis sheaths.

Evaluation of the Performance of Okra (Abelmoschus esculentus l. Moench) Genotypes for Growth, Yield, and Quality Parameters

The present investigation was carried out to evaluate the performance of okra genotypes for growth, yield and quality parameters. Okra is often cross-pollinated and is grown primarily for its fruits, which have various culinary uses. Tender fruits are commonly boiled or used in sliced and fried dishes. Okra fruits are also dried in the sun, canned, or dehydrated for preservation during the off-season. The study was carried out at New Orchard, Main Agricultural Research Station, UAS, Raichur, during late Kharif 2021-22 using thirty-one genotypes (including the check variety Arka Anamika) and laid out in Randomized Block Design (RBD) with three replications. The analysis of variance revealed significant differences (p < 0.05) among genotypes for all traits studied. Genotype OPL-2127 recorded the highest plant height (96.52 cm), stem girth (14.26 mm), number of leaves per plant (23.20), leaf area index (3.08), number of nodes per plant (13.60), chlorophyll content (59.61 SPAD readings), fruit length (18.69 cm), fruit yield per plant (293.53 g), fruit yield per hectare (16.4 t) and it is found to be superior over the other okra genotypes under the study. The highest fruit girth (41.36 mm) was noted in the genotypes OPL-2108. The genotype OPL-2119 recorded the minimum number of days to 50 per cent flowering (38.00) which indicates the earliness of the genotypes. OPL-2023 recorded the highest fibre content (16.09 %). The genotypes OPL-2127, OPL-2121, OPL-2116, OPL-2115 and OPL-2113 were found to be superior okra genotypes for yield and quality and they can be used in future breeding and crop improvement program.

Days to re-entrainment following the spring and autumn changes in local clock time: beyond simple heuristics

Circadian disruption, a breakdown in the regularity of activity patterns across the 24-h day, can lead to a variety of maladies. Some individuals and organizations object to the twice-yearly, seasonal changes in local time because it contributes to circadian disruption. The number of days required to re-entrain the circadian system to the new local time following transitions to or from daylight saving time is not completely understood, but several simple rules of thumb (i.e., heuristics) have been offered to minimize the days to re-entrainment and, thus, circadian disruption (e.g., go for a morning walk). Recently, the authors developed a computational model for predicting circadian phase from calibrated light-dark exposure patterns, based largely on the pioneering work of Kronauer and colleagues. This model was used here to predict the days to re-entrainment of the circadian systems of “larks” and “owls” to a new local time if they were exposed to one of three specific light interventions. Simulations showed that the timing of a light intervention must account for chronotypes (e.g., timing of minimum core body temperature) and direction of shift (i.e., phase advance or delay) to achieve re-entrainment to the time change more quickly. Simple heuristics are not necessarily adequate for minimizing the days to re-entrainment.

Seasonal life cycle of Pintomyia longiflocosa (Diptera: Psychodidae) under semi-controlled conditions in the Huila state, Colombia.

Pintomyia longiflocosa is considered a vector of etiological agents of cutaneous leishmaniasis. The objective of this research was to establish the parameters of the life cycle of Pi. longiflocosa in semi-controlled conditions in a rural area of the Campoalegre municipality, Huila, Colombia. The life cycle of individuals of Pi. longiflocosa, obtained from two cohorts of collected, fed, and individualized females, was monitored during two different times of the year (between February and August 2020 and between July 2020 and January 2021, respectively). Determining parameters associated with the fertility and fecundity, time and attributes of development and survival, and its association with abiotic variables. The average duration of Cycle 1 (C1) and Cycle 2 (C2) was 134.9 and 148.78 days, respectively. The gonotrophic cycle of parental females presented significant differences (p-value <0.05) between C1 and C2 (8.47 and 11.42 days) as well as between fecundity and fertility parameters. The number of days it takes the development of the immature stages between the two cycles studied, also showed significant differences in the larvae II (15.21 and 22.23), larvae III (11.93 and 17.56), and pupae (24.48 and 22.9) stages. During C1, the survival rate was higher and consistent with the productivity of adult individuals (F1), compared to C2. Fecundity and fertility values were significantly higher in C2. Finally, a significant correlation between the number of individuals and temperature was evidenced in C1 while, for C2, there was a negative correlation with precipitation. Significant differences were found in several biological and reproductive parameters between the two cycles monitored. The parameters of the life cycle of Pi. longiflocosa in its natural habitat would be influenced by environmental factors related to the annual seasonality in the sub-Andean rural area, conditioning the temporal distribution of this species and, consequently, the possible transmission of causative agents of cutaneous leishmaniasis.

Prevalence and Risk Factors of Work-Related, Non-Specific Low Back Pain Among Physiotherapists in Ahmedabad City

Introduction: Low back pain (LBP) is the major public health problem across the world. Physiotherapy professionals are more prone to work related LBP because they are linked to major physical efforts such as transfers and patient handling manoeuvres, uncomfortable or prolonged working positions, trunk flexion and rotation movements and reactions to a fall or unexpected movement by the patient. LBP is a multifactorial condition. Various factors like, personal, biomechanical, psychosocial and organisational are associated with work related LBP among physiotherapists. Methodology: A link to an online self-questionnaire was sent to physiotherapists working in Ahmedabad city since last 12 months. The various patterns of practice were compared with regard to the prevalence of LBP, the total number of days with LBP during last 12 months, and the degree of exposure to organisational, biomechanical and psychosocial risk factors. Results: The result was carried out by using Microsoft excel. Results showed that there is 95% prevalence of work-related low back pain among physiotherapists specifically, those working since last 12 months. The mean score of NPRS was 7. Conclusion: There is significant prevalence of work-related low back pain among physiotherapists in Ahmedabad city. Keywords: physiotherapists, work-related, low back pain, Ahmedabad city

Enhancing Inventory Management through Safety-Stock Strategies—A Case Study

Efficient inventory management, including optimal safety-stock levels, is crucial for operational continuity and cost-effectiveness in various industries. This study seeks the optimal inventory management strategy to minimize costs and determine ideal safety-stock levels. It compares five approaches: the company’s (STAR) current “number of days” method, two alternative models from the literature (the theory of constraints (TOC) replenishment model and the service-level approach), and two newly developed hybrid methodologies (the TOC replenishment model with ABC–XYZ classification and the service-level approach with ABC–XYZ classification). The analysis focused on financial performance, considering inventory holding and shortage costs. Monthly production plans were established and fixed as constant based on predetermined optimum month-end inventory levels derived from each method. Through simulation, actual month-end inventory levels were assessed, comparing total inventory costs (TICs). While unit holding costs (UHCs) were documented in financial records in the company, unit shortage costs (USCs) were not; thus, USCs were examined in three scenarios. The results show that the second proposed hybrid model consistently outperformed the other four methods, including the company’s current approach, significantly reducing TIC. The analysis emphasizes the importance of demand variation in setting safety stocks and demonstrates the second hybrid methodology’s effectiveness in optimizing safety-stock strategies and improving overall inventory management efficiency.

Branch-Price-and-Cut algorithms for the team orienteering problem with interval-varying profits

This paper studies the team orienteering problem (TOP), wherein each vertex requires two visits, and the service profit of each vertex depends on the time interval between these two visits. Motivated by scenarios like perishable product delivery, home health care scheduling, and earth observation satellite scheduling, the paper addresses two variants: the periodic orienteering problem with a focus on the number of days (NoDs) and the team orienteering problem with attention to a combination of time windows (CoTWs). It develops mixed-integer linear programming (MILP) models for both variants and devises exact Branch-Price-and-Cut (BPC) algorithms tailored to their block diagonal structures. Furthermore, this paper proposes two strategies to improve algorithm performance. A simplification strategy streamlines the directed graph network by removing redundant vertices and arcs without compromising optimality, thereby accelerating the solution of pricing problems. Additionally, a matheuristic algorithm is proposed to obtain integer solutions quickly. Computational results demonstrate the effectiveness of these algorithms, showcasing their superiority over CPLEX. The BPC algorithm, coupled with the simplification strategy, exhibits an average computational time reduction of 70 % compared to the basic strategy. The effectiveness of the matheuristic algorithm is also confirmed. Finally, the findings presented herein offer valuable insights for refining and applying BPC algorithms.

Performance of dairy cows offered silages produced from grass swards harvested on either three or five occasions during the growing season

The nutritive value of grass silage can be improved by harvesting herbage at a less mature growth stage, which in practice usually involves more frequent harvests. This study examined the performance of dairy cows offered grass silages produced from perennial ryegrass (Lolium perenne) based swards harvested at 2 different frequencies during the growing season (3-harvest (3H) vs. 5-harvest (5H)). Thirty-four mid-lactation (av. 147 d in milk) dairy cows (30 multiparous, 4 primiparous) were offered either 3H or 5H silages in a continuous design (21 wk) experiment. Within each treatment cows were offered silage from each harvest (in harvest number order) for a pre-determined number of days in proportion to herbage DM yield at each harvest. Silages were offered ad libitum while a common concentrate was offered to all cows at 12.0 kg per cow/d over the first 15 wk of the study, 8.0 kg per cow/d during wk 16 -19 and 6.0 kg cow/d during wk 20 - 21. Total yield of herbage harvested over the season from within 3H and 5H were 12.6 and 11.2 t DM/ha, respectively. Across all harvests the mean ME and CP concentration of silages were 10.9 MJ/kg DM and 131 g/kg DM for 3H, and 11.5 MJ/kg DM and 152 g/kg DM for 5H. Silage DMI was greater for cows offered 5H silages compared with 3H silages (14.1 vs. 11.7 kg/d, respectively). Cows offered 5H silages had a greater daily milk yield (33.5 vs. 31.9 kg) and ECM yield (37.4 vs. 35.6 kg) compared with cows offered 3H silages. Treatment had no effect on milk fat or protein concentration. Cows offered 5H silages produced milk with greater concentrations of CLA and n-3 fatty acids. Treatment had no effect on mean BW or BCS, or on efficiency metrics such as milk yield or ECM yield per kg of DMI. Molar proportions of VFA in ruminal fluid differed between the treatments, with cows offered 3H silages having higher proportion of total butyrate (15.9 vs. 14.4% of total VFA) and lower total valerate (3.2 vs. 3.7% of total VFA) compared with those offered 5H. The acetate: propionate and acetate plus butyrate: propionate ratios were unaffected by treatment. In conclusion, increasing herbage harvesting frequency from 3 to 5 times per year improved the nutritional value of the resulting silages, and this led to higher silage DMI, milk yield and ECM yield. However, overall production efficiency (ECM/DMI) was unaffected by treatment.

Email recruitment for chronic pain clinical trials: results from the LAMP trial

BackgroundRecruitment for clinical trials and large-scale studies is challenging, especially for patients with complex conditions like chronic pain. Email recruitment has the potential to increase efficiency, to reduce costs, and to improve access for underrepresented patient populations. The objective of this study was to examine the effectiveness, efficiency, and equitability of email versus postal mail recruitment for the Learning to Apply Mindfulness to Pain (LAMP) study, a three-site clinical trial of mindfulness-based interventions for chronic pain.MethodsPatients with chronic pain diagnoses were recruited from three United States Department of Veterans Affairs (VA) facilities using the VA electronic health record (EHR). Recruitment materials were sent using either postal mail (n = 7986) or email (n = 19,333). Patients in the email recruitment group were also mailed introductory postcards before any emails. Mailing addresses and email addresses were obtained from the EHR. Effectiveness was measured by the response rate of patients who logged into the secure LAMP study website. Efficiency was measured by the number of days from when the recruitment materials were sent to when patients logged into the LAMP portal as well as the estimated costs of each recruitment approach. To assess equitability, we examined whether email recruitment was less effective for underrepresented populations, based on demographic information from the EHR.ResultsEffectiveness—unadjusted response rates were greater for email versus postal-mail recruitment (18.9% versus 6.3%), and adjusted response rates were over three times greater for email recruitment (RR = 3.5, 95% CI 3.1–3.8) based on a multivariable analysis controlling for age, gender, race, ethnicity, rurality, and site. Efficiency—email recruitment had a significantly lower mean response time (1 day versus 8 days) and a lower cost. Equity—email recruitment led to higher response rates for all subpopulations, including older, non-White, Hispanic, rural, and female Veterans.ConclusionsEmail recruitment is an effective, efficient, and equitable way to recruit VA patients to large-scale, chronic pain clinical trials.Trial registrationClinical Trial Registration Number: NCT04526158. Patient enrollment began on December 4, 2020.

Evaluation of Sponge Gourd (Luffa cylindrica) Hybrids in Prayagraj Agro-Climatic Condition

An experiment was conducted to study the Evaluation of Sponge gourd (Luffa cylindrica) Hybrids in Prayagraj agro-climatic condition. at Sam Higginbottom. University of Agriculture Technology and Sciences, Prayagraj during summer 2023. From the present investigation it is concluded that the H10 Performed best in terms of growth (vine length (170.67 cm). The H9 is best performed in terms of Number of Primary branches (15.25) and The H10 is best performed in terms of maximum Number of node/plant (34.42).The treatment H4 is best performed in terms of Days to emergence of 1st male flower (42.83 days) and H11 is best performed in terms of days to emergence of 1st female flower/plant (46.8 days).The treatment H7 is best performed in terms of first appearance of male flower (2.17). The treatment H7 is best performed in terms of first appearance of female flower (2.17).The H3 and H5 is best performed in terms of Days to 50% female flower/plant (45.67).the treatment H12 performed best in term of days to 1st fruit setting/plant (48.00 Days) and the T12 best performed in terms of Number of days to first Fruit picking (51.58 Days). ). The H1 is best performed in terms of maximum number of Number of fruit/plant (28.48 Fruit),Fruit yield /plant (kg) (2.70 Kg), Fruit yield /ha (Q) (270 Q) and average weight of fruit (95.00g).The H4,H5 and H6 performed best in term of Fruit length (30.00cm). The treatment H11 is best performed in terms of fruit diameter (22.00mm). Whereas, the H1 recorded highest benefit cost ratio (2.79).

The impacts of global warming on climate zones over China based on CMIP6 models

AbstractClimate zones are expected to shift in response to climate change, which significantly influences vegetation distribution and provides essential guidance for human activities including production, lifestyle and economic development. Quantifying the shifts in climate zones due to global warming is therefore crucial. The primary metric for categorizing climate zones is the number of days with a daily mean temperature above 10°C (DT10). Utilizing DT10 and the ERA5 reanalysis data, it is observed that climate zones in China have gradually shifted northward over the past 65 years. Notably, the interdecadal changes in the climate zones differ between the eastern and western regions divided by the 110°E longitude. The western regions show minimal shifts, whereas the eastern regions, particularly the central and southern parts of Northeast China, exhibit obvious northward shifts. Consequently, the simulation capabilities of 41 CMIP6 models for Chinese climate zones were assessed, and it was found that 11 models demonstrated robust performance. These models were further used to analyse interdecadal variations and project future shifts in climate zones in China. The results show that the spatial pattern of climate zones in China can be well captured by the CMIP6 models, except for ACCESS‐CM2, FGOALS‐g3 and GFDL‐CM4. Each CMIP6 model seems to be more suitable for specific climatic zones concerning trends and decadal variations in China. By 2100, a northward shift is projected for all climate zones in the east of 110°E under SSP2‐4.5 and SSP5‐8.5 emission scenarios, particularly in northern China. It should be noted that the potential disappearance of the northern subtropical belt, likely to be replaced by the middle subtropical belt in the future.

Evaluation of impact of adherence to inhaled therapy and critical mistakes in inhalation technique on clinical outcomes in patients with obstructive airway diseases in India

Adherence to inhaled therapy is more relevant in respiratory diseases because, to achieve therapeutic efficacy, it is necessary that the patient adhere to the recommended therapy as well as use their inhalers correctly with appropriate inhalation technique.This was a prospective, observational study that included 126 patients &amp;#62;18 years of age of all genders, diagnosed with an obstructive airway disease, and prescribed inhaler medication. Adherence was assessed using the Test of Adherence to Inhalers (TAI) questionnaire, and inhaler device technique was assessed every 3 months. At the end of one year, outcome data like the number of exacerbations, the number of admissions, including critical-care admissions, the number of days of hospitalization, adverse events, and their associations were analyzed.Poor adherence to inhaled therapy was found in 40.48% of patients, with the majority of patients (69.05%) having an unwitting or ignorant pattern of non- adherence. Out of 75 patients using MDI (Metered Dose Inhaler), 34.67% had critical mistakes in technique, and out of 51 patients using Rotahaler, 23.53% had critical mistakes in technique. There was no significant relationship between level of adherence and critical mistakes with gender, BMI category, or past history of smoking. Patients with poor adherence and those with critical mistakes in inhalation technique had poor health outcomes.This study highlights the role of adherence and identifies barriers responsible for non-adherence to inhaled therapy. Identifying the behaviors responsible for non-adherence and counseling the patients on the correct inhalation technique can improve the health outcomes of chronic respiratory diseases.

Air Pollution Increases Risk of Occurrence of Intracerebral Haemorrhage but Not of Subarachnoid Haemorrhage: Time-Series Cross-Sectional Study.

(1) Background: Haemorrhagic strokes (HS), including intracerebral (ICH) and subarachnoid haemorrhages (SAH), account for approximately 10-15% of strokes worldwide but are associated with worse functional outcomes and higher rates of mortality, and financial burden than ischemic stroke. There is evidence that confirmed poor air quality may increase the incidence of haemorrhagic strokes. The aim of our study was to evaluate the association between individual ambient air pollutants and the risk of haemorrhagic stroke in an urban environment without high levels of air pollution. (2) Methods: A time-series cross-sectional study design was used. A daily air pollution concentration (Agency of Regional Air Quality Monitoring in the Gdansk Metropolitan Area) and incidence of haemorrhagic strokes (National Health Fund) were obtained and covered the time period from 1 January 2014 to 31 December 2018. A generalised additive model with Poisson regression was used to estimate the associations between 24-h mean concentrations of SO2, NO, NO2, NOx, CO, PM10, PM2.5, and O3 and a daily number of haemorrhagic strokes. (3) Results: The single-day lag model results showed that NO2, NO and NOx exposure was associated with increased risk of ICH (88% events) with RR of 1.059 (95% CI: 1.015-1.105 for lag0), 1.033 (95% CI: 1.007-1.060 for lag0) and 1.031 (95% CI: 1.005-1.056 for lag0), but not for SAH (12% events). Exposure to CO was related to a substantial and statistically significant increase in incidence for 1.031 (95% CI: 1.002-1.061 for lag0) but not for SAH. Higher SO2, PM10, PM2.5, and O3 exposures were not significantly related to both ISC and SAH. (4) Conclusions: In this time-series cross-sectional study, we found strong evidence that supports the hypothesis that transient elevations in ambient NO2, NO and CO are associated with a higher relative risk of intracerebral but not subarachnoid haemorrhage.

An algorithm to analyse long‐term tendencies of pressure systems over Europe

AbstractClimate change is associated with the modification of the polar jet stream, cyclone tracks and corresponding circulation patterns over midlatitudes. To apply these synoptic changes on regional climate, the changing sensitivity of a specific location to different pressure centre regions must be studied. An automated, objective circulation pattern detection method was developed to investigate the evolution of cyclonic and anticyclonic influence at any specific point within the European domain. The algorithm was used to assign each location to influencing low‐ or high‐pressure centres within the domain. Pressure centre displacements and the frequency redistribution among different centres were studied for each location. The 180‐year (January 1836–December 2015) mean sea level pressure dataset on the European domain with a 0.703° × 0.702° spatial and daily temporal resolution was obtained from NOAA 20th Century Reanalysis project. The presented method can apply the continental‐scale changes to specific locations. A significant increase of anticyclonic influence was found in southern and central Europe, in line with the northward displacement of Atlantic cyclones. Hundred and eighty year (180‐year) change of the number of days with anticyclonic versus cyclonic influence was found to be between +10% and 15% in the Mediterranean and +2% and 10% in most of Europe. The increasing anticyclonic influence in central Europe was strongest in the spring and the winter and was most attributable to the eastern European anticyclone. Results highlight the importance of research on the dynamical climate response of anticyclonic pressure systems.

Predictors of High Healthcare Cost Among Patients with Generalized Myasthenia Gravis: A Combined Machine Learning and Regression Approach from a US Payer Perspective.

High healthcare costs could arise from unmet needs. This study used random forest (RF) and regression methods to identify predictors of high costs from a US payer perspective in patients newly diagnosed with generalized myasthenia gravis (gMG). Adults with gMG (first diagnosis = index) were selected from the IQVIA PharMetrics® Plus database (2017-2021). Predictors of high healthcare costs were measured 12 months pre-index (main cohort) and during both the 12 months pre- and post-index (subgroup). Top 50 predictors of high costs [≥ $9404 (main cohort) and ≥$9159 (subgroup) per-patient-per-month] were identified with RF models; the magnitude and direction of association were estimated with multivariable modified Poisson regression models. The main cohort and subgroup included 2739 and 1638 patients, respectively. In RF analysis, the most important predictors of high costs before/on the index date were index MG exacerbation, all-cause inpatient admission, and number of days with corticosteroids. After the index date, these were immunoglobulin and monoclonal antibody use and number of all-cause outpatient visits and MG-related encounters. Adjusting for the top 50 predictors, post-index immunoglobulin use increased the risk of high costs by 261%, monoclonal antibody use by 135%, index MG exacerbation by 78%, and pre-index all-cause inpatient admission by 27% (all p < 0.05). This analysis links patient characteristics both before the formal MG diagnosis and in the first year to high future healthcare costs. Findings may help inform payers on cost-saving strategies, and providers can potentially shift to targeted treatment approaches to reduce the clinical and economic burden of gMG.

The association between social risks and days at home for older veterans.

Many health systems are trying to support the ability of older adults to remain in their homes for as long as possible. Little is known about the relationship between patient-reported social risks and length of time spent at home. We assessed how social risks were associated with days at home for a cohort of older Veterans at high risk for hospitalization and mortality. A prospective cross-sectional study using a 2018 survey of 3479 high-risk Veterans aged ≥65 linked to Veterans Health Administration data. Social risks included measures of social resources (i.e., no partner present, low social support), material resources (i.e., not employed, financial strain, medication insecurity, food insecurity, and transportation barriers), and personal resources (i.e., low medical literacy and less than high school education). We estimated how social risks were associated with days at home, defined as the number of days spent outside inpatient, long-term care, observation, or emergency department settings over a 12-month period, using a negative binomial regression model. Not having a partner, not being employed, experiencing transportation barriers, and low medical literacy were respectively associated with 2.57, 3.18, 3.39, and 6.14 fewer days at home (i.e., 27% more facility days, 95% confidence interval [CI] 8%-50%; 42% more facility days, 95% CI 7%-89%; 34% more facility days, 95% CI 7%-68%; and 63% more facility days, 95% CI 27%-109%). Experiencing food insecurity was associated with 2.62 more days at home (i.e., 24% fewer facility days, 95% CI 3%-59%). Findings suggest that screening older Veterans at high risk of community exit for social risks (i.e., social support, material resources, and medical literacy) may help identify patients likely to benefit from home- and community-based health and social services that facilitate remaining in home settings. Future research should focus on understanding the mechanisms by which these associations occur.

Association of Alzheimer's disease polygenic risk score with concussion severity and recovery metrics.

Identification of genetic alleles associated with both Alzheimer's disease (AD) and concussion severity/recovery could help explain the association between concussion and elevated dementia risk. However, there has been little investigation into whether AD risk genes associate with concussion severity/recovery, and the limited findings are mixed. We used AD polygenic risk scores (PRS) and APOE genotypes to investigate any such associations in the NCAA-DoD Grand Alliance CARE Consortium (CARE) dataset. We assessed six outcomes in 931 total participants. The outcomes were two concussion recovery measures (number of days to asymptomatic status, number of days to return to play (RTP)) and four concussion severity measures (scores on SAC and BESS, SCAT symptom severity, and total number of symptoms). We calculated PRS using a published score [1] and performed multiple linear regression (MLR) to assess the relationship of PRS with the outcomes. We also used t-tests and chi-square tests to examine outcomes by APOE genotype, and MLR to analyze outcomes in European and African genetic ancestry subgroups. Higher PRS was associated with longer injury to RTP in the normal RTP (<24 days) subgroup ( p = 0.024), and one standard deviation increase in PRS resulted in a 9.89 hour increase to the RTP interval. There were no other consistently significant effects, suggesting that high AD genetic risk is not strongly associated with more severe concussions or poor recovery in young adults. Future studies should attempt to replicate these findings in larger samples with longer follow-up using PRS calculated from diverse populations.

Antigen titers in cryptococcal meningitis: what determines how fast they fall?

Follow-up of previously healthy patients surviving cryptococcal meningitis found that cryptococcal antigen could be detected for more than one year in serum from 38 of 44 (86%) patients and in CSF from 20 of 31 patients (67%), far beyond the time of culture conversion. The speed of titer decline, measured as the number of days for a two fold drop in titer to occur, was slower in serum than in CSF. Speed of decline of antigen titers was much slower in serum and CSF for patients infected with C. gattii than C. neoformans. The speed of decline in CSF and serum titers was also much slower in patients who had received a ventriculoperitoneal shunt for increased intracranial pressure. The variable and extraordinarily slow rate of clearance in our patients did not appear to reflect differences in disease control but rather differences in species and shunting for increased intracranial pressure.

Antigen titers in cryptococcal meningitis: what determines how fast they fall?

Follow-up of previously healthy patients surviving cryptococcal meningitis found that cryptococcal antigen could be detected for more than one year in serum from 38 of 44 (86%) patients and in CSF from 20 of 31 patients (67%), far beyond the time of culture conversion. The speed of titer decline, measured as the number of days for a two fold drop in titer to occur, was slower in serum than in CSF. Speed of decline of antigen titers was much slower in serum and CSF for patients infected with C. gattii than C. neoformans. The speed of decline in CSF and serum titers was also much slower in patients who had received a ventriculoperitoneal shunt for increased intracranial pressure. The variable and extraordinarily slow rate of clearance in our patients did not appear to reflect differences in disease control but rather differences in species and shunting for increased intracranial pressure.

Nasal sprays and behavioural interventions compared with usual care for acute respiratory illness in primary care: a randomised, controlled, open-label, parallel-group trial

A small amount of evidence suggests that nasal sprays, or physical activity and stress management, could shorten the duration of respiratory infections. This study aimed to assess the effect of nasal sprays or a behavioural intervention promoting physical activity and stress management on respiratory illnesses, compared with usual care. This randomised, controlled, open-label, parallel-group trial was done at 332 general practitioner practices in the UK. Eligible adults (aged ≥18 years) had at least one comorbidity or risk factor increasing their risk of adverse outcomes due to respiratory illness (eg, immune compromise due to serious illness or medication; heart disease; asthma or lung disease; diabetes; mild hepatic impairment; stroke or severe neurological problem; obesity [BMI ≥30 kg/m2]; or age ≥65 years) or at least three self-reported respiratory tract infections in a normal year (ie, any year before the COVID-19 pandemic). Participants were randomly assigned (1:1:1:1) using a computerised system to: usual care (brief advice about managing illness); gel-based spray (two sprays per nostril at the first sign of an infection or after potential exposure to infection, up to 6 times per day); saline spray (two sprays per nostril at the first sign of an infection or after potential exposure to infection, up to 6 times per day); or a brief behavioural intervention in which participants were given access to a website promoting physical activity and stress management. The study was partially masked: neither investigators nor medical staff were aware of treatment allocation, and investigators who did the statistical analysis were unaware of treatment allocation. The sprays were relabelled to maintain participant masking. Outcomes were assessed using data from participants' completed monthly surveys and a survey at 6 months. The primary outcome was total number of days of illness due to self-reported respiratory tract illnesses (coughs, colds, sore throat, sinus or ear infections, influenza, or COVID-19) in the previous 6 months, assessed in the modified intention-to-treat population, which included all randomly assigned participants who had primary outcome data available. Key secondary outcomes were possible harms, including headache or facial pain, and antibiotic use, assessed in all randomly assigned participants. This trial was registered with ISRCTN, 17936080, and is closed to recruitment. Between Dec 12, 2020, and April 7, 2023, of 19 475 individuals screened for eligibility, 13 799 participants were randomly assigned to usual care (n=3451), gel-based nasal spray (n=3448), saline nasal spray (n=3450), or the digital intervention promoting physical activity and stress management (n=3450). 11 612 participants had complete data for the primary outcome and were included in the primary outcome analysis (usual care group, n=2983; gel-based spray group, n=2935; saline spray group, n=2967; behavioural website group, n=2727). Compared with participants in the usual care group, who had a mean of 8·2 (SD 16·1) days of illness, the number of days of illness was significantly lower in the gel-based spray group (mean 6·5 days [SD 12·8]; adjusted incidence rate ratio [IRR] 0·82 [99% CI 0·76-0·90]; p<0·0001) and the saline spray group (6·4 days [12·4]; 0·81 [0·74-0·88]; p<0·0001), but not in the group allocated to the behavioural website (7·4 days [14·7]; 0·97 [0·89-1·06]; p=0·46). The most common adverse event was headache or sinus pain in the gel-based group: 123 (4·8%) of 2556 participants in the usual care group; 199 (7·8%) of 2498 participants in the gel-based group (risk ratio 1·61 [95% CI 1·30-1·99]; p<0·0001); 101 (4·5%) of 2377 participants in the saline group (0·81 [0·63-1·05]; p=0·11); and 101 (4·5%) of 2091 participants in the behavioural intervention group (0·95 [0·74-1·22]; p=0·69). Compared with usual care, antibiotic use was lower for all interventions: IRR 0·65 (95% CI 0·50-0·84; p=0·001) for the gel-based spray group; 0·69 (0·45-0·88; p=0·003) for the saline spray group; and 0·74 (0·57-0·94; p=0·02) for the behavioural website group. Advice to use either nasal spray reduced illness duration and both sprays and the behavioural website reduced antibiotic use. Future research should aim to address the impact of the widespread implementation of these simple interventions. National Institute for Health and Care Research.