Percentage Of Quarters Research Articles

P-2101. Coverage Of The Molecular Diagnostic Technology For Pulmonary Tuberculosis In Bangladesh: Diagnostic Milestone For Control Of Tuberculosis

Abstract Background Provision of early and accurate Tuberculosis (TB) diagnosis is crucial to end TB specially in a densely populated like Bangladesh. Molecular WHO-approved rapid diagnostic tests for TB (mWRDs) can significantly improve identification of undiagnosed TB cases. This study estimates the coverage of mWRDs among the total detected Pulmonary TB (PTB). Methods Monthly programmatic data on nationwide TB diagnosis in Bangladesh using mWRDs were pulled and compiled. Routine programmatic data for TB detection using mWRDs were segregated and compared quarterly for the first three quarter of 2023 to know the percentage of molecular testing coverage among presumptive TB tested and percentage of pulmonary TB notified diagnosed through molecular testing during that time. Results A total of 5,53,172 presumptive cases undergone mWRDs to detect the Mycobacterium Tuberculosis (MTB) and Rifampicin Resistant (RR) cases. Among them, 80,414 (14.54%) cases were detected as MTB including RR. During the 1st, 2nd, and 3rd quarters of 2023, the total number of presumptive tests conducted were 133,845, 175,038, and 244,289, respectively. Among them, the detected TB cases according to each quarter were 15,418 (11.52%), 24,397 (13.94%), and 40,599 (16.62%), respectively (Figure 1). With this data it was obvious that in the 3rd quarter of 2023 the percentage of case detection by mWRDs increased compared to the consecutive previous two quarters. It revealed that, percentage of case detection by mWRDs gradually increased over the time during 1st to 3rd quarter 2023. To assess the coverage of mWRDs, quarterly data was analyzed and compared. It was determined how many TB cases were confirmed using molecular technology (GeneXpert and TrueNat) out of the total number of pulmonary cases over time. The analysis revealed that the quarterly percentage coverage of mWRDs was 26.85%, 42.68%, and 68.89% during the 1st, 2nd, and 3rd quarters, respectively, indicating an increasing trend over time (Figure 2). Conclusion Scaling up the mWRDs as a point of care diagnostic test for presumptive TB cases in resource limited settings would have a significant impact to meet the SDG and End TB strategy for TB detection. Increasing coverage of molecular testing for more PTB case detection is inevitable considering the context of Bangladesh. Disclosures All Authors: No reported disclosures

U.S. trends in methamphetamine-involved psychiatric hospitalizations in the United States, 2015–2019

BackgroundIn the U.S., overdose deaths and substance treatment admissions related to methamphetamine are rising. This study aims to measure and compare U.S. temporal trends in methamphetamine-involved psychiatric hospitalizations. MethodsWe conducted a population-based, trend analysis of U.S. psychiatric hospitalizations and calculated quarterly (Q) rates per 100,000 population of substance-involved psychiatric hospitalizations. We assessed U.S. regional quarterly percentage hospitalization rate changes using Joinpoint regression. ResultsFrom Q4 2015-Q4 2019, there were 963,202 psychiatric hospitalizations, 50,223 (5.2 %) involved methamphetamine and 102,877 (10.7 %) involved opioids and/or cocaine without methamphetamine. Methamphetamine-involved psychiatric hospitalization rates increased by 68.0 %, psychiatric hospitalizations rates involving opioid and/or cocaine without methamphetamine decreased by 22 %, while nonsubstance-involved psychiatric hospitalizations rates remained unchanged. The largest significant increases in methamphetamine-involved psychiatric hospitalization rates were among people >61 years old, males, and Midwesterners. Methamphetamine-involved psychiatric hospitalization rates doubled among Black patients. The largest average percent increase among methamphetamine-involved psychiatric hospitalizations was 10.2 % from Q4 2015-Q2 2017 in the Midwest. Conclusion and relevanceMost psychiatric hospitalizations did not involve substances. Methamphetamine-involved psychiatric hospitalizations greatly increased while opioid-involved psychiatric hospitalizations decreased, but involved more total encounters. Greater access to harm reduction services, contingency management programs, and mental health services is urgently needed.

Chronic kidney disease progression in diabetic patients: Real world data in general practice

Aimsthe aim of the study was to analyze glomerular filtration ratio (GFR) changes in diabetic patients assisted by General Practitioners (GPs) evaluating the risk factors related to glomerular function. Methodspatients with diabetes with at least three recorded values of creatinine were recruited in the study and GFR values were estimated. The quarterly percentage change in GFR for each patient was estimated. Nephrotoxic drugs were identified, and glucose-lowering drugs use was described. Linear regression analyses were performed to identify eGFR changes predictors. Resultsa total of 545 patients with diabetes were selected. According to the last eGFR values 64 (11.7 %) patients were classified in G1 stage, 277 (50,8 %) in G2, 175 (32.1 %) in G3a, 25 (4.6 %) in G3b and only 4 (0.7 %) in G4. Patients treated with at least one glucose-lowering drugs were 479 (87.9 %), most of them with biguanides (67.0 %). At least one nephrotoxic drug prescription was recorded in 524 (96.1 %) patients; proton pump inhibitors (74.7 %) and NSAIDs (71.6 %) were the most prescription classes. Heart failure, diabetes duration and preserved GFR values were related to reduced eGFR values. Conclusionspatients with diabetes should be more carefully observed regardless of kidney risk factors and GFR values in clinical practice.

Application of elastic net regression for modeling COVID-19 sociodemographic risk factors.

COVID-19 has been at the forefront of global concern since its emergence in December of 2019. Determining the social factors that drive case incidence is paramount to mitigating disease spread. We gathered data from the Social Vulnerability Index (SVI) along with Democratic voting percentage to attempt to understand which county-level sociodemographic metrics had a significant correlation with case rate for COVID-19. We used elastic net regression due to issues with variable collinearity and model overfitting. Our modelling framework included using the ten Health and Human Services regions as submodels for the two time periods 22 March 2020 to 15 June 2021 (prior to the Delta time period) and 15 June 2021 to 1 November 2021 (the Delta time period). Statistically, elastic net improved prediction when compared to multiple regression, as almost every HHS model consistently had a lower root mean square error (RMSE) and satisfactory R2 coefficients. These analyses show that the percentage of minorities, disabled individuals, individuals living in group quarters, and individuals who voted Democratic correlated significantly with COVID-19 attack rate as determined by Variable Importance Plots (VIPs). The percentage of minorities per county correlated positively with cases in the earlier time period and negatively in the later time period, which complements previous research. In contrast, higher percentages of disabled individuals per county correlated negatively in the earlier time period. Counties with an above average percentage of group quarters experienced a high attack rate early which then diminished in significance after the primary vaccine rollout. Higher Democratic voting consistently correlated negatively with cases, coinciding with previous findings regarding a partisan divide in COVID-19 cases at the county level. Our findings can assist regional policymakers in distributing resources to more vulnerable counties in future pandemics based on SVI.

Reduction in use of MRI and arthroscopy among patients with degenerative knee disease in independent treatment centers versus general hospitals: a time series analysis.

The use of MRI and arthroscopy are considered low-value care in most patients with degenerative knee disease. To reduce these modalities, there have been multiple efforts to increase awareness. Reductions have been shown for general hospitals (GH), but it is unclear whether this may be partly explained by a shift of patients receiving these modalities in independent treatment centers (ITCs). The aims of this study were to assess (i) whether the trend in use of MRI and arthroscopy in patients with degenerative knee disease differs between ITCs and GH, and (ii) whether the Dutch efforts to raise awareness on these recommendations were associated with a change in the trend for both types of providers. All patients insured by a Dutch healthcare insurer aged ≥50 years with a degenerative knee disease who were treated in a GH or ITC between July 2014 and December 2019 were included. Linear regression was used with the quarterly percentage of patients receiving an MRI or knee arthroscopy weighted by center volume, as the primary outcome. Interrupted time-series analysis was used to evaluate the effect of the Dutch efforts to raise awareness. A total of 14 702 patients included were treated in 90 GHs (n = 13 303, 90.5%) and 29 ITCs (n = 1399, 9.5%). Across the study period, ITCs on an average had a 16% higher MRI use (P < .001) and 9% higher arthroscopy use (P = .003). MRI use did not change in both provider types, but arthroscopy use significantly decreased and became stronger in ITCs (P = .01). The Dutch efforts to increase awareness did not significantly influence either MRI or arthroscopy use in ITCs (P = .55 and P = .84) and GHs (P = .13 and P = .70). MRI and arthroscopy uses were higher in ITCs than GHs. MRI use did not change significantly among patients ≥ 50 years with degenerative knee disease in both provider types between 2014 and 2019. MRI- and arthroscopy use decreased with ITCs on average having higher rates for both modalities, but also showing a stronger decrease in arthroscopy use. The Dutch efforts to increase awareness did not accelerate the already declining trend in the Netherlands.

Influence of home-based pulmonary rehabilitation program among people with interstitial lung disease: A pre-post study

ABSTRACT Introduction Access to interstitial lung disease programs may not be available in rural settings. Home-based pulmonary rehabilitation (PR) programs have been proposed as an alternative to hospital-based programs. Method Forty participants with ILD underwent a structured unsupervised home-based pulmonary rehabilitation program from September 2020 to September 2022. Quality of life was assessed using St. George Respiratory Questionnaire (SGRQ) and functional capacity using 6-minute walk test (6MWT). The outcome measures were assessed at baseline and 4 weeks post-unsupervised home-based PR program. Result We recruited 40 participants with ILD. There was statistically significant improvement in the 6-minute walk distance (353.8 m and 368 m, effect size – 0.5, p ≤ .001) and quality of life using SGRQ total score (38.6 and 42.35, effect size – 2.5, p ≤ .001) between before and after receiving home-based PR among all 40 participants with ILD. Conclusion Four weeks of home-based PR program, using minimal resources, deliver short-term improvements in functional exercise capacity and quality of life among ILD participants. Our home-based PR program resulted in a quarter percentage improvement in functional capacity, and we believe that if consistency is maintained, it will result in similar changes corresponding to the already established Minimal Clinically Important Difference (MCID) of 35 m.

Emergency department visits and hospital admissions for suicidal ideation, self-poisoning and self-harm among adolescents in Canada during the COVID-19 pandemic.

The COVID-19 pandemic had profound effects on the mental wellbeing of adolescents. We sought to evaluate pandemic-related changes in health care use for suicidal ideation, self-poisoning and self-harm. We obtained data from the Canadian Institute for Health Information on emergency department visits and hospital admissions from April 2015 to March 2022 among adolescents aged 10-18 years in Canada. We calculated the quarterly percentage of emergency department visits and hospital admissions for a composite outcome comprising suicidal ideation, self-poisoning and self-harm relative to all-cause emergency department visits and hospital admissions. We used interrupted time-series methods to compare changes in levels and trends of these outcomes between the prepandemic (Apr. 1, 2015-Mar. 1, 2020) and pandemic (Apr. 1, 2020-Mar. 31, 2022) periods. The average quarterly percentage of emergency department visits for suicidal ideation, self-poisoning and self-harm relative to all-cause emergency department visits was 2.30% during the prepandemic period and 3.52% during the pandemic period. The level (0.08%, 95% confidence interval [CI] -0.79% to 0.95%) or trend (0.07% per quarter, 95% CI -0.14% to 0.28%) of this percentage did not change significantly between periods. The average quarterly percentage of hospital admissions for the composite outcome relative to all-cause admissions was 7.18% during the prepandemic period and 8.96% during the pandemic period. This percentage showed no significant change in level (-0.70%, 95% CI -1.90% to 0.50%), but did show a significantly increasing trend (0.36% per quarter; 95% 0.07% to 0.65%) during the pandemic versus prepandemic periods, specifically among females aged 10-14 years (0.76% per quarter, 95% CI 0.22% to 1.30%) and females aged 15-18 years (0.56% per quarter, 95% CI 0.31% to 0.81%). The quarterly change in the percentage of hospital admissions for suicidal ideation, self-poisoning and self-harm increased among adolescent females in Canada during the first 2 years of the COVID-19 pandemic. This underscores the need to promote public health policies that mitigate the impact of the pandemic on adolescent mental health.

Drug Overdose Deaths with Evidence of Counterfeit Pill Use - United States, July 2019-December 2021.

Using data from CDC's State Unintentional Drug Overdose Reporting System, this report describes trends in overdose deaths with evidence of counterfeit pill use during July 2019-December 2021 in 29 states and the District of Columbia (DC) and characteristics of deaths with and without evidence of counterfeit pill use during 2021 in 34 states and DC. The quarterly percentage of deaths with evidence of counterfeit pill use more than doubled from 2.0% during July-September 2019 to 4.7% during October-December 2021, and more than tripled in western jurisdictions (from 4.7% to 14.7%). Illicitly manufactured fentanyls were the only drugs involved (i.e., caused death) in 41.4% of deaths with evidence of counterfeit pill use and 19.5% of deaths without evidence. Decedents with evidence of counterfeit pill use, compared with those without evidence, were younger (57.1% versus 28.1% were aged <35 years), more often Hispanic or Latino (18.7% versus 9.4%), and more frequently had a history of prescription drug misuse (27.0% versus 9.4%). Smoking was the most common noningestion drug use route among deaths with evidence of counterfeit pill use (39.5%). Overdose prevention messaging that highlights the dangers of pills obtained illicitly or without a prescription (because they might be counterfeit), encourages drug product testing by persons using drugs, and is tailored to persons most at risk (e.g., younger persons) could help prevent overdose deaths.

Applying the standardized infection ratio for reporting surgical site infections in Australian healthcare facilities.

We explored the utility of the standardized infection ratio (SIR) for surgical site infection (SSI) reporting in an Australian jurisdiction. Retrospective chart review. Statewide SSI surveillance data from 2013 to 2019. Individuals who had cardiac bypass surgery (CABG), colorectal surgery (COLO), cesarean section (CSEC), hip prosthesis (HPRO), or knee prosthesis (KPRO) procedures. The SIR was calculated by dividing the number of observed infections by the number of predicted infections as determined using the National Healthcare Safety Network procedure-specific risk models. In line with a minimum precision criterion, an SIR was not calculated if the number of predicted infections was <1. A SIR >0 (≥1 observed SSI, predicted number of SSI ≥1, no missing covariates) could be calculated for a median of 89.3% of reporting quarters for CABG, 75.0% for COLO, 69.0% for CSEC, 0% for HPRO, and 7.1% for KPRO. In total, 80.6% of the reporting quarters, when the SIR was not calculated, were due to no observed infections or predicted infections <1, and 19.4% were due to missing covariates alone. Within hospitals, the median percentage of quarters during which zero infections were observed was 8.9% for CABG, 20.0% for COLO, 25.4% for CSEC, 67.3% for HPRO, and 71.4% for KPRO. Calculating an SIR for SSIs is challenging for hospitals in our regional network, primarily because of low event numbers and many facilities with predicted infections <1. Our SSI reporting will continue to use risk-indexed rates, in tandem with SIR values when predicted number of SSI ≥1.

Trends in Etiology-based Mortality From Chronic Liver Disease Before and During COVID-19 Pandemic in the United States

Background & AimsDuring the global coronavirus disease 2019 (COVID-19) pandemic, patients with pre-existing chronic liver disease may represent a vulnerable population. We studied the etiology-based temporal trends in mortality of chronic liver disease and the underlying cause of death in the United States before and during the COVID-19 pandemic.MethodsPopulation-based analyses were performed on United States national mortality records (2017–2020). Temporal trends in quarterly age-standardized mortality were obtained by joinpoint analysis with estimates of quarterly percentage change (QPC).ResultsQuarterly age-standardized all-cause mortality due to alcohol-related liver disease (ALD) initially increased at a quarterly rate of 1.1% before the COVID-19 pandemic, followed by a sharp increase during the COVID-19 pandemic at a quarterly rate of 11.2%. Likewise, steady increase in mortality of nonalcoholic fatty liver disease before the COVID-19 pandemic (QPC, 1.9%) accelerated during the COVID-19 pandemic (QPC, 6.6%). Although ALD-related mortality increased steeply compared with viral hepatitis-related mortality during the COVID-19 pandemic, the proportion of mortality due to COVID-19 among individuals with ALD was the lowest at 2.5%; more than 50% lower than viral hepatitis. The significant decline in all-cause mortality due to viral hepatitis before the COVID-19 pandemic plateaued during the COVID-19 pandemic due to increase in COVID-19-related mortality in individuals with viral hepatitis. Mortality due to cirrhosis increased markedly during the COVID-19 pandemic, mainly attributable to ALD.ConclusionAll-cause mortality for ALD and nonalcoholic fatty liver disease rapidly accelerated during the COVID-19 pandemic compared with the pre-COVID-19 era. There has been a significant decline in viral hepatitis; however, a significant increase in COVID-related death in this population.

Retention of internal teat sealants over the dry period and their efficacy in reducing clinical and subclinical mastitis at calving

Internal teat sealants (ITS) reduce the risk of new intramammary infections over the dry period by forming a physical barrier to pathogen ingress. As the first and last 2 wk of the dry period are high-risk periods for new infections, maintaining an effective barrier in this period is a key requirement. Few studies have systematically examined sealant retention and none have done so under New Zealand pastoral conditions, where cows frequently move to separate grazing for dry periods, typically 80 to 90 d long. This multi-herd study was a split-udder equivalence trial comparing 2 ITS formulations for retention and efficacy in preventing periparturient clinical and subclinical mastitis. Both ITS contained 65% (2.6 g) bismuth salts, which contribute to the barrier within the teat canal, emulsified in ≤1.4 g of mineral oil. However, one ITS additionally contained <10% amorphous silica. At dry-off, treatment was randomly allocated to diagonal teat-pairs within 409 cows on 4 farms. All cows met industry best practice criteria for ITS treatment alone. The study unit was quarter within cow and farm. Outcomes included clinical mastitis (CM) incidence for the last 7 d of the dry period and first 42 d of lactation, subclinical mastitis (SCM) incidence 96 h after calving, and quantity of residual after centrifuging 50 mL of colostrum collected from each quarter within 24 h of calving. Proportional outcomes were analyzed using Bayesian mixed models with a binomial distribution and logit link function, whereas the quantity of residual was analyzed using Bayesian finite mixture models and cluster bootstrapping. We set a region of probable equivalence (ROPE) of ±2.5% between proportions and ±0.2 g for residual weight. Records were available for 1,596 quarters (399 cows). We detected no meaningful difference in incidence of CM or SCM attributable to differences in sealant: the model predicted treatment differences of 0.00 with a 95% highest density interval (HDI) of ±1.00%. Across all cows and farms, the marginal difference in the percentage of quarters with CM was 0.11% (95% HDI: -2.11 to 2.49%), and for SCM 0.00 (95% HDI: -1.98 to 1.94%). Including the quantity of residual recovered at calving did not improve fit or predictive ability of the models predicting CM or SCM, and the coefficient spanned the null value. The distribution of the weight of material recovered at calving was multi-modal; for 25% of quarters, more residual was recovered than inserted. When the residual weight was less than or equal to the median residual weight (2.06 g; range: 0.19-6.03 g), there was a ≥90% probability that any treatment difference in residual was ≤0.2 g. When the residual weight was between the median and 75th percentile (4.40 g; 95% HDI: 4.00 to 4.75 g), there was no clear difference in residual between products. Above the 75th percentile, there was a 90% probability that the residual from quarters differed by product type (difference = 0.36 g, 90% HDI: 0.20 to 0.54 g). In conclusion, both products had equivalent efficacy for SCM and CM. As the quantity of residual increased, the difference in residual weight recovered increased but this may represent increases in debris rather than indicating a more effective barrier.

A159 OPIOID USE IS DECLINING AMONG PEOPLE WITH INFLAMMATORY BOWEL DISEASE: A POPULATION-BASED STUDY

BackgroundPatients with inflammatory bowel disease (IBD) are more likely to use opioids than those without IBD and are more susceptible to the negative consequences of opioid use, including increased risk of death.AimsExamine trends in the use of opioids among people with and without IBD, where opioids were prescribed, and who prescribed them.MethodsWe identified Ontarians with IBD (7/2012–3/2017) from population-based health administrative data using validated algorithms. We matched each patient with IBD on age and sex to 5 people without IBD. We calculated age- and sex-standardized quarterly rates of patients taking opioids, characterized as any, chronic (>90 days), or acute (≤90 days) among people with and without IBD. Among people with IBD, we identified the location of the last healthcare interaction prior to filling the prescription (hospital, emergency department [ED], outpatient clinic), presuming this was where the opioid was prescribed. Opioids prescribed after outpatient visits were stratified by specialty (gastroenterologist, family physician/internist, surgeon, other). Average quarterly percentage change was calculated using Poisson regression, adjusting for age, sex, income, and rural/urban household.ResultsOf 92,233 IBD patients (mean 47 y at study entry, 45% male, 50% Crohn’s), 56% had at least 1 opioid prescription during the study period. Opioid use was more common among people with IBD (any: IRR 2.11, 95% CI 2.08–2.14; chronic: IRR 2.61, 95% CI 2.54–2.69; acute: IRR 1.82, 95% CI 1.79–1.94), Figure A. Among IBD patients, any opioid use decreased by 0.5% (95%CI 0.4–0.5) per quarter, from 13.4% (95%CI 13.1–13.6) to 12.7% (95%CI 12.5–13.0). Chronic opioid use decreased by 0.3% (95%CI 0.2–0.4) per quarter while acute opioid use among IBD patients decreased by 0.6% (95% CI 0.5–0.7) per quarter. Most opioids were prescribed after an outpatient visit (70.2%), most often (82.7%) by a family physician or internist. Total outpatient prescriptions declined by 1.9% (95%CI 1.7–2.0) per quarter, from 5.8% (95%CI 5.6–5.9) to 3.8% (95%CI 3.7–3.9). Relative quarterly decreases were similar across all specialties, Figure B.ConclusionsOpioid use remains common among IBD patients but has decreased since 2012. The prescriptions most often originated after outpatient visits to family physicians and internists rather than gastroenterologists or surgeons. Trends in (A) the acute and chronic opioid use among those with and without IBD and (B) the specialist prescribing opioids to IBD patients when the most recent healthcare contact was an outpatient visit.Funding AgenciesAmerican College of Gastroenterology

Implementation research on kangaroo mother care, Bangladesh.

ObjectiveTo describe the implementation, coverage and performance of the national kangaroo mother care programme in Bangladesh.MethodsKangaroo mother care services for clinically stable babies with birth weight under 2000 g were set up in government-run health-care facilities in rural and urban areas of Bangladesh. Each facility provided counselling on kangaroo mother care, ensured adequate nutrition, and followed up mothers and babies. We studied implementation of the programme from January 2016 to March 2020 using data from the national database. We tracked the number of eligible babies enrolled and their outcomes, mortality and post-discharge follow-up.FindingsThe numbers of kangaroo mother care facilities increased from 16 in 2016 to 108 in 2020. Over the 4-year period 64 426 babies weighing under 2000 g were born in these facilities, 6410 of whom received kangaroo mother care. The quarterly percentage of eligible babies receiving kangaroo mother care increased from 4.7% (37/792) during the first quarter to 21.7% (917/4226) during the last five quarters of the programme. Deaths of babies receiving kangaroo mother care showed a downward trend over the study period. The overall mortality was 1.2% (77/6410), with large quarterly fluctuations in mortality. Post-discharge follow-up was low and only 15–20% of babies received four follow-up visits.ConclusionImplementation of kangaroo mother care interventions is feasible in low-resource settings. Such care has the potential to reduce mortality among low-birth-weight and premature babies. Challenges include low coverage, expanding the programme to the community and strengthening the monitoring system.

Characteristics of renal cell carcinoma in Saudi patients below the age of 50 years.

Background:The incidence of renal cell carcinoma (RCC) in young adults has started to increase in recent years.Objectives:The objective of the study was to describe and compare the mode of presentation, incidence, risk factors, histopathological features, nephrectomy modalities used, and outcome in patients diagnosed with RCC below the age of 50.Materials and Methods:A total of 139 confirmed RCC patients diagnosed below the age of 50 years who underwent nephrectomy from January 1990 to April 2019 were included in this retrospective review. We compared the characteristics of two age groups (≤40 years and 41–50 years) and evaluated incidentally discovered versus symptomatic tumors in patients below 50 years.Results:Loin pain contributed to most symptomatic presentations in the older group (55%) (P = 0.014). Hypertension and diabetes were present in 24% of patients from 41 to 50 years of age versus 3.8% for hypertension and 5.7% for diabetes in the young group. (P = 0.001 and P = 0.004, respectively). Chromophobe was the second most common pathology (26.5%). Tumor size tended to be larger in the older group (P = 0.006). Fuhrman's grade was significantly lower in incidentally diagnosed patients (88.2%) (P = 0.006). The T stage was significantly lower in the incidental group (P = 0.005), but the mortality rate was higher in symptomatic patients (9.6%) (P = 0.013).Conclusion:RCC increases after the age of 40–50 years in the presence of other risk factors. Chromophobe represented almost a quarter percentage of the pathology, while partial nephrectomy yielded a better outcome.

High-risk opioid analgesic dispensing to adolescents 12-18 years old in South Carolina: 2010-2017.

To evaluate "high-risk" opioid dispensing to adolescents, including daily morphine milligram equivalents (MME) above recommended amounts, the percentage of extended-release opioid prescriptions dispensed to opioid-naïve adolescents, and concurrent use of opioids and benzodiazepines, and to evaluate changes in those rates over time. Retrospective cohort study of one state's prescription drug monitoring program data (2010-2017), evaluating adolescents 12-18 years old dispensed opioid analgesic prescriptions. Outcomes of interest were the quarterly frequencies of the high-risk measures. We utilized generalized linear regression to determine whether the rate of the outcomes changed over time. The quarterly percentage of adolescents ages 12-18 years old dispensed an opioid who received ≥90 daily MME declined from 4.1% in the first quarter (Q1) of 2010 to 3.4% in the final quarter (Q4) of 2017 (p < 0.0001). The frequency of adolescents dispensed ≥50 daily MME changed little over time. In 2010, the percentage of adolescents receiving an extended-release opioid who were opioid naïve was 60.7%, declining to 50.6% by Q4 of 2017 (p > 0.10 overall change 2010-2017). The percentage of adolescent opioid days overlapping with benzodiazepine days was 1.6% in Q1 of 2010, declining to 1.1% by Q4 of 2017 (p < 0.001). Among persons 12-18 years old dispensed an opioid analgesic, receipt of ≥90 daily MME declined during the years 2010-2017, as did the percentage of adolescent opioid days that overlapped with benzodiazepines. More than half of the individuals who received extended-release opioid analgesics were identified as opioid naïve and, counter to guidelines, received products intended for opioid-tolerant individuals.

Evaluation of fully oxidised β-carotene as a feed ingredient to reduce bacterial infection and somatic cell counts in pasture-fed cows with subclinical mastitis

ABSTRACT Aims To assess the effect of oral supplementation with fully oxidised β-carotene (OxBC) on bacteriological cure, the incidence of clinical mastitis, and somatic cell counts (SCC) in pasture-fed cows with subclinical intramammary infection. Methods Cows from four dairy herds were enrolled in early lactation if they had quarter-level SCC >200,000 cells/mL and they had a recognised bacterial intramammary pathogen in one or more quarters. They were randomly assigned to be individually fed from Day 0, for a mean of 40 days, with 0.5 kg of a cereal-based supplementary feed that either contained 300 mg of OxBC (treatment; n = 129 quarters) or did not (control; n = 135 quarters). Quarter-milk samples were collected on Days 21 and 42 for microbiology and SCC assessment. Bacteriological cure was defined as having occurred when the bacteria present on Day 0 were not isolated from samples collected on Days 21 or 42. A new intramammary infection was defined as a bacterial species isolated either on Day 21 or 42 differing from that isolated on Day 0. Clinical mastitis was diagnosed and recorded by herdowners up to Day 42. Results The bacteriological cure rate was greater for quarters from cows in the treatment group (13.9 (95% CI = 4.1–23.7)%) than for cows in the control group (6.9 (95% CI = 4.8–9.1)%; p = 0.02). The percentage of quarters that developed a new intramammary infection at Day 21 or 42 was greater for cows in the treatment group (17.9 (95% CI = 6.7–29.1)%) than for cows in the control group (13.0 (95% CI = 4.3–21.8)%; p < 0.01). The prevalence of quarters that were infected on Day 42 was less in cows in the treatment group (79.9 (95% CI = 62.3–97.6)%) than the control group (88.2 (95% CI = 78.4–97.9)%; p = 0.009). The incidence of quarters diagnosed with clinical mastitis by Day 42 was lower in cows from the treatment group (1/129 (0.78 (95% CI = 0.02–4.24)%)) than in cows from the control group (6/135 (4.44 (95% CI = 1.65-9.42)%; p = 0.03)). Mean quarter-level SCC was not statistically different between treatment groups (p = 0.34). Conclusions and clinical relevance Feeding 300 mg/cow/day of OxBC resulted in a higher bacteriological cure rate, a lower prevalence of intramammary infection, and a lower incidence of clinical mastitis compared to untreated controls. However new intramammary infections increased in treated cows, and the magnitude of the increased bacteriological cure was low, resulting in 80% of cows remaining infected at Day 42. Therefore treatment with OxBC should be considered as an adjunct to other mastitis control measures.

Do specific antimicrobial stewardship interventions have an impact on carbapenem resistance in Gram-negative bacilli? A multicentre quasi-experimental ecological study: time-trend analysis and characterization of carbapenemases.

Carbapenem-resistant Gram-negative bacilli (CR-GNB) are among the most threatening microorganisms worldwide and carbapenem use facilitates their spread. Antimicrobial stewardship programmes (ASPs) can help to optimize the use of antibiotics. This study evaluates the impact of a multifaceted educational ASP on carbapenem use and on the epidemiology of CR-GNB. We conducted a quasi-experimental, time-series study in seven hospitals, from January 2014 to September 2018. The key intervention was composed of educational interviews promoting the appropriate use of carbapenems. The primary endpoints were carbapenem consumption and incidence density (ID) of CR-GNB. All non-duplicated CR-GNB clinical isolates were tested using phenotypic assays and PCR for the presence of carbapenemases. Joinpoint regression and interrupted time-series analyses were used to determine trends. A decrease in carbapenem consumption throughout the study period [average quarterly percentage change (AQPC) -1.5%, P < 0.001] and a -8.170 (-16.064 to -0.277) level change following the intervention were observed. The ID of CR-Acinetobacter baumannii decreased (AQPC -3.5%, P = 0.02) and the overall ID of CR-GNB remained stable (AQPC -0.4%, P = 0.52). CR-GNB, CR-Pseudomonas aeruginosa and CR-A. baumannii IDs per hospital correlated with the local consumption of carbapenems. The most prevalent carbapenem resistance mechanisms were OXA-23 for CR-A. baumannii (76.1%), OXA-48 for CR-Klebsiella pneumoniae (66%) and no carbapenemases for CR-P. aeruginosa (91.7%). The epidemiology of carbapenemases was heterogeneous throughout the study, especially for carbapenemase-producing Enterobacteriaceae. In conclusion, a multifaceted, educational interview-based ASP targeting carbapenem prescribing reduced carbapenem use and the ID of CR-A. baumannii.

Jumbo rates below conforming rates: When did this happen and why?

AbstractWe show that jumbo mortgage rates were above conforming rates before the financial crisis, consistent with previous studies, and that the spread between them widened during the crisis. However, the spread turned negative in 2013 and remained so through 2019, with jumbo rates about a quarter percentage point below conforming rates. A rise in the government‐sponsored enterprise (GSE) guarantee fees appears to be the main reason for the change. Increased bank supply of jumbo loans also may have played some role, though the evidence is weak. With the onset of the Covid‐19 pandemic, we estimate that the jumbo‐conforming spread increased enough to move slightly above zero.

Variance Homogeneity Test Based on Cumulative Wavelet Coefficients

The aim of this paper is to address the problem of variance break detection in time series in wavelet domain. The maximal overlapped discrete wavelet transform (MODWT) decomposes the series variance across scales into components known as the wavelet variances. We introduce all scale wavelet coefficients based test statistic that allows detecting a break in the homogeneity of the variance of a series through changes in the mean of wavelet variances. The statistic makes use of the traditional CUSUM (cumulative sum) based test designed to test for a break in the mean and constructed using cumulative sums of the square of wavelet coefficients. Under moments and mixing conditions, the test statistic satisfies the functional central limit theorem (FCLT) for a broad class of time series models. The overall performance of our test statistic is compared to the traditional Inclan [8] test statistic. The effectiveness of our statistic is supported by good performances reported in simulations and is as reliable as the traditional statistic. Our method provides a nonparametric test procedure that can be applied to a large class of linear and non linear models. We illustrate the practical use of our test procedure with the quarterly percentage changes in the Americans personal savings data set over the period 1970-2016. Both statistics detect a break in the variance in the second quarter of 2001.

Improving Respiratory Support Practices to Reduce Chronic Lung Disease in Premature Infants.

We implemented a bundle of respiratory care practices and optimized delivery of continuous positive airway pressure (CPAP) to reduce the incidence of chronic lung disease (CLD) among very low birth weight (VLBW) infants born before 33 weeks gestation. Our multidisciplinary task force utilized 6 plan-do-study-act cycles to test our interventions. The primary outcome was the quarterly percentage of infants diagnosed with CLD; other outcomes included the percentage of infants initially managed with CPAP, intubation <72 hours of age, use of a nasal cannula, and days of ventilation, oxygen, and/or CPAP. Process measures included compliance with each of the 5 components of the bundle; balancing measures included mortality and complications of prematurity. Demographics were similar in the 55 infants born before and 76 infants born after the task force interventions, except for gestational age, which was lower before. CLD decreased by 55.5% (from 37.5% to 16.7%). Quarterly percentage of infants requiring intubation decreased from 87.5% to 40.8%. Quarterly average days of ventilation decreased from 11.2 to 6.1, and days of supplemental oxygen declined from 44.1 to 25.4, while the use of CPAP increased. There were no differences in adverse events including mortality, pneumothorax, use of postnatal steroids, or any retinopathy of prematurity. The incidence of patent ductus arteriosus declined from 60% to 33% (P < 0.01). We reduced the incidence of CLD among our very low birth weight infants born before 33 weeks gestation by over 50% without increasing any measured adverse outcomes. The incidence of patent ductus arteriosus declined.