Point Reduction Research Articles

Impact of in utero tobacco exposure on fetal growth: Amount of exposure and second trimester fetal growth measurements

BackgroundResearch reveals small and inconsistent findings linking prenatal tobacco exposure and early fetal growth, but failure to consider confounding and amount of exposure many explain inconsistencies. GoalTo examine whether fetal growth effects following exposure to tobacco are evident in the second trimester, specific to certain growth parameters, and dose dependent. MethodsParticipants were pregnant women (64 smokers, 100 controls) with no other drug use. Available data included background/medical information and ultrasound measurements coded as percentiles. ResultsControlling for background differences, 10+ cig/day predicted a 10+ percentile point reduction in estimated fetal weight, femur length, head circumference, and biparietal diameter compared to non-exposed controls. Exposure to <10 cig/day predicted significant reduction in only biparietal diameter. Exposure was unrelated to abdominal circumference. ConclusionsResults demonstrate utility of considering amount of exposure when examining/quantifying fetal growth effects, and suggest even reduction in early pregnancy smoking may positively benefit aspects of fetal development.

Effect of Steroids on Patients With Fibromyalgia/Chromic Widespread Pain: An Observational Study.

Fibromyalgia causes widespread chronic pain. Pain management and treating underlying conditions are of utmost importance. Recent studies found an association of thyroid autoimmunity with fibromyalgia. Pain management of patients with anti-thyroid peroxidase antibody (anti-TPO Ab) positive was studied sparsely. To determine the effect of steroid (deflazacort) on pain management using numerical rating scale (NRS) pain score at baseline and at 3-month follow-up. A retrospective observational study was undertaken, recruiting patients diagnosed with fibromyalgia as per 2010 American College of Rheumatology guidelines and treated with the steroid, deflazacort 12 mg. Patients with missing details were excluded. Patients were categorized into negative, positive, and strongly positive anti-TPO Ab groups. Baseline and follow-up (3 months) pain score was compared across the groups. Reduction in pain was considered as a primary outcome variable. The study included 128 participants with 98 (76.6%) females and 30 (23.4%) males. The age of the study population was 48±13.29 years. The proportion of hyper, hypo, and euthyroidwas 10 (7.81%), 42 (32.81%), and 76 (59.38%), respectively. The proportion of participants with negative, positive, and strongly positive anti-TPO Ab levels was 41 (32.03)%, 50 (39.06%), and 37 (28.91%), respectively.Baseline pain score was 7.3±1.32 and 3-month follow-up was 4.7±2.46. Steroid response was found in 66 (51.6%). Negative andpositive anti-TPO Ab had a 1-point reduction in pain score from baseline, p-value <0.001. The strongly positive group had 5 points reduction, p-value<0.05. Fibromyalgia patients with thyroid autoimmunity responded well to short courses of steroids. Greater pain relief was observed among those who are strongly positive anti-TPO Ab group.

Abstract 119: Stroke Recovery and Genetic Variation: Main Results of the STRONG Study

Introduction: The STRONG (Stroke, sTress, RehabilitatiON, and Genetics) study performed detailed behavioral phenotyping to evaluate genetic variants in relation to stroke recovery and stress responses. Methods: Adults with a new stroke enrolled at 28 US sites were assessed 4 times over 1 year. Three pre-specified gene variants (ApoE-e4, rs6265 (BDNF), &amp; a dopamine polygenic score) were examined for associations with change in grip strength, function (SIS-ADL), mood (PHQ8), and cognition (tMoCA). Seven candidate gene variants (HTTLPR, rs324420, rs4291, rs6265, rs4680, rs53576, rs1360780) were examined for associations with post-stroke trauma, mood, &amp; PTSD. Data were Holm-Bonferroni corrected. Next, genome-wide association studies (GWAS) were performed to identify variants associated with 8 stroke outcomes of interest. Results: The 763 enrollees had age 63.1±14.9 yrs; initial NIHSS score 4 [2-9]; 41.2% Female; 69.4% White. Presence of the BDNF rs6265 polymorphism (in 27.1% of patients) was associated with a 0.9 point reduction in 1 yr tMoCA score (p=10^-5). Two of the 7 stress-related gene candidates [rs4291 (ACE) and rs4680 (COMT)] were risk factors linking increased post-stroke trauma with higher 1yr PHQ8 &amp; PTSD scores (p&lt;0.05). In GWAS, 4 of the 8 behavioral outcomes had significant (p&lt;5x10^-8) associations with genetic variants. Change in grip strength (from acute to d90) had the largest number of genome-wide significant (147 at p&lt;5x10^-8) and suggestive (2,541 at p&lt;5x10^-6) associations; variants with p&lt;5x10^-6 were then mapped to corresponding genes and their protein products to construct an interaction network, which had significant enrichment of protein-protein interactions (283 proteins, 69 edges, p=0.008) and which mapped (FDR&lt;0.05) to multiple gene ontology biological processes pertaining to the nervous system, including nervous system development, neurogenesis, and neuron differentiation. Conclusions: Stroke recovery occurs across many dimensions and so benefits from detailed characterization over time. Building on such assessments, current results from candidate genetic variants and GWAS provide insights into the biology of stroke recovery and inform therapeutic targets for promoting improved stroke recovery.

P901 Extended induction response over time in patients with moderately-to-severely active Ulcerative Colitis treated with mirikizumab in the LUCENT-1 and -2 trials

Abstract Background The safety and efficacy of mirikizumab (miri), an anti-IL-23p19 antibody, for moderately-to-severely active ulcerative colitis (UC) have been shown in Phase 3 trials (LUCENT-1 and -2; NCT03518086, NCT03524092).1 Extended induction with 3 additional intravenous (IV) doses of miri induced clinical response at Week (W)24 in more than 50% of patients who did not initially achieve clinical response to induction with miri at W12.2 Among the clinical non-responders, some had achieved partial response at W12 (Table 1). We assessed response over time in clinical non-responders at the end of induction who received extended induction with miri for an additional 12W. Methods In LUCENT-1, patients (N=1281) were randomly assigned 3:1 to receive miri 300mg or placebo IV at W0, W4, and W8. Patients not achieving clinical response with miri 300mg IV at W12 of LUCENT-1 (n=272) received extended induction treatment with open-label miri 300mg IV at W12, W16, and W20 (LUCENT-2). Symptomatic remission, symptomatic response, bowel urgency (BU) remission, and BU change from baseline at W16 and W20 are reported (definitions in Table 1) in addition to the previously disclosed outcomes at W24. For categorical variables, number and percentage of patients who are responders/remitters were presented. For continuous variables, mean change from baseline with standard deviation (SD) was used. Missing data were imputed as non-response. Results Among patients who were clinical non-responders to 12W of initial induction treatment (n=272), 53 (19.5%); 73 (26.8%); 101 (37.1%) achieved symptomatic remission and 144 (52.9%); 169 (62.1%); 197 (72.4%) patients achieved symptomatic response at W16, W20, and W24, respectively. Among miri induction non-responders with Urgency Numeric Rating Scale (NRS) score ≥3 at induction baseline (n=256), 10.9% achieved BU remission at W16, 14.8% at W20, and 19.9% at W24. There was a 1.8±2.4 (mean±SD) point reduction in Urgency NRS scores at W16, 2.1±2.5 reduction at W20, and 2.5±2.7 reduction at W24 (Table 1). Conclusion Among patients who were clinical non-responders to induction at W12, more than 50% achieved clinical response after 3 additional induction doses with miri. A proportion of patients benefited earlier from extended induction at W16 and W20, respectively, regarding symptomatic response and remission, and BU outcomes. The results demonstrate continued symptomatic improvement and further support the potential benefit of extended induction treatment.

P718 Observational real-world evidence on the efficacy and safety of Janus Kinase inhibitors (JAKi) in the treatment of moderate to severe Active Ulcerative Colitis (UC)

Abstract Background Janus kinase inhibitors (JAKi) are the first orally administered treatment for Ulcerative Colitis (UC). The JAK family comprises of four intracellular tyrosine kinases inhibitors (JAK1, JAK2, JAK3 and Tyrosine Kinase 2). Inhibition of the JAK kinases lead to dampening of the inflammatory cytokines which drive Inflammatory Bowel Disease (IBD). Tofacitinib was the first generation pan-JAKi. This was followed by second generation JAKi: Filgotinib and Upadacinib which preferentially inhibit JAK1. We report on the real-world evidence on the efficacy and safety of JAKi in the treatment of UC in a tertiary IBD treatment centre. Methods Patients attending the IBD clinic at weeks 8-12 of initiation of therapy were included. Baseline demographics, disease activity and previous therapies were recorded. Clinical response was measured using the SCCAI and biochemical response was measured using calprotectin and CRP. We defined clinical response as ≥3 points reduction from baseline SCCAI, and clinical remission as SCCAI Score of &amp;lt;2.5, and / or biochemical remission as a CRP of less than 5 mg/L and a calprotectin level of &amp;lt; 250 mg/g. We also assessed treatment persistence, and the reasons for treatment cessation. Results The UC populations are shown in Table 1. 52 patients were included and an additional 24 patients who discontinued therapy early on were assessed to review secondary outcomes. Table 1 summarises the comparative outcomes of the JAKi. 81% and 63% of patients achieved clinical and biochemical remission respectively. Overall, 31% discontinued treatment due to lack of efficacy or adverse events. 60% of patients reported adverse events (AEs), 25 % of patients discontinued treatment due to AEs and 84% of patients continued treatment despite reporting AEs. The most common AEs were hypercholesteremia and cold and flu like symptoms and the most common AEs related with treatment discontinuation were recurrent infection or persistent deranged liver functions contributed to patients’ history of primary sclerosing cholangitis. No Serious Adverse Events were reported. 60% of patients on tofacitinib developed side effects and persisted with therapy, which included hypercholesteremia (67%), shingles (11%), flu like symptom (11%) and hair loss (11%). 53% had side effects with Filgotinib; hypercholesteremia (25%), cold like symptoms (25%), chest infection (13%), shingles (13%), acne (13%). 68% developed side effects with Upadacitinib; reports of acne (20%), cold and flu (33%), shingles and mood swings (7%) and high cholesterol (67%). Conclusion In this real-world cohort of UC patients, JAKi was effective in inducing remission and had an acceptable safety profile. The observed safety profile was as expected compared to clinical data results.

Temporal Trends in Mortality of Critically Ill Patients with Sepsis in the United Kingdom, 1988-2019.

Rationale: Sepsis is a frequent cause of ICU admission and mortality. Objectives: To evaluate temporal trends in the presentation and outcomes of patients admitted to the ICU with sepsis and to assess the contribution of changing case mix to outcomes. Methods: We conducted a retrospective cohort study of patients admitted to 261 ICUs in the United Kingdom during 1988-1990 and 1996-2019 with nonsurgical sepsis. Measurements and Main Results: A total of 426,812 patients met study inclusion criteria. The patients had a median (interquartile range) age of 66 (53-75) years, and 55.6% were male. The most common sites of infection were respiratory (60.9%), genitourinary (11.5%), and gastrointestinal (10.3%). Compared with patients in 1988-1990, patients in 2017-2019 were older (median age, 66 vs. 63 yr), were less acutely ill (median Acute Physiology and Chronic Health Evaluation II acute physiology score, 14 vs. 20), and more often had genitourinary sepsis (13.4% vs. 2.0%). Hospital mortality decreased from 54.6% (95% confidence interval [CI], 51.0-58.1%) in 1988-1990 to 32.4% (95% CI, 32.1-32.7%) in 2017-2019, with an adjusted odds ratio of 0.64 (95% CI, 0.54-0.75). The adjusted absolute hospital mortality reduction from 1988-1990 to 2017-2019 was 8.8% (95% CI, 5.6-12.1). Thus, of the observed 22.2-percentage point reduction in hospital mortality, 13.4 percentage points (60% of total reduction) were explained by case mix changes, whereas 8.8 percentage points (40% of total reduction) were not explained by measured factors and may be a result of improvements in ICU management. Conclusions: Over a 30-year period, mortality for ICU admissions with sepsis decreased substantially. Although changes in case mix accounted for the majority of observed mortality reduction, there was an 8.8-percentage point reduction in mortality not explained by case mix.

Hospital Capabilities Associated With Behavioral Health Integration Within Emergency Departments.

To identify hospital capabilities associated with behavioral health (BH) processes in emergency departments (EDs). Six hundred two hospital responses to the 2017/2018 National Survey of Healthcare Organizations and Systems were linked to 2017 American Hospital Association Annual Survey data. Separate multivariable regressions estimated how hospital capabilities (the use of quality improvement methods, approaches to disseminate best patient-care practices, barriers to using care delivery innovations, and inpatient beds for psychiatric or substance use) were associated with each of 4 ED-based BH processes: mental health and substance use disorder screening, team-based approaches to BH, telepsychiatry, and direct referrals to community-based BH clinicians. Models controlled for hospital structural characteristics and area-level socioeconomic factors. Most hospitals screened for BH conditions and provided direct referrals to community-based BH clinicians. Approximately half of the hospitals used a team approach to BH. A minority had implemented telepsychiatry. Each additional process used to disseminate best patient-care practices was associated with more screening for BH conditions (an increase of 4.07 points on the screening index, P <0.01) and greater likelihood of using a team approach to BH [4.41 percentage point ( P <0.01) increase]. Hospitals reporting more barriers to the use of care delivery innovations reported less screening and use of a team approach [a decrease of 0.15 points on the screening index ( P <0.01) and 0.28 percentage points reduction in likelihood of team approach use ( P <0.001) for 1-point increase in the barrier index]. Research and interventions focused on removing innovation barriers or adding processes to disseminate best practices offer a path to accelerate BH integration in hospital EDs.

Yoga as a non-pharmacologic therapy to reduce dinutuximab-induced pain in patients with neuroblastoma.

Anti-GD2 antibodies are key components of treatment for high-risk neuroblastoma; however, they cause neuropathic pain. Yoga therapy may help reduce pain and distress associated with anti-GD2 therapy. Children 3years of age or older with neuroblastoma participated in individualized yoga therapy while receiving the anti-GD2 antibody dinutuximab (DIN). Yoga therapy was deemed feasible if patients participated during 60% or more of DIN admissions. Patients and caregivers assessed pain/distress before and after yoga therapy with a distress thermometer (DT) and Wong-Baker FACES pain rating scale and completed questionnaires regarding satisfaction with yoga therapy. Therapy was deemed efficacious if there was a ≥1 point pain score change and reduction in distress after yoga. Eighteen patients were enrolled; 52 encounters (admissions for DIN) were evaluable. Ten of 18 were female, three of 18 were Hispanic, and 10/18 were White. Median age at enrollment was 5.5years (range: 3-11). Yoga therapy was feasible in 39/52 (75%) encounters. Significant reductions in caregiver-reported pain and distress and reductions in patient-reported pain and distress after yoga therapy were reported. Twelve of 18 caregivers completed questionnaires: seven agreed/strongly agreed that yoga was valuable, and nine agreed/strongly agreed to continued participation in yoga. Thirty-four of 36 clinicians reported that they would recommend yoga therapy for other patients receiving DIN. Yoga therapy was feasible during DIN therapy and may be effective in reducing DIN-associated pain and distress. Future studies are needed to evaluate changes in opioid usage with the addition of yoga therapy during anti-GD2 antibody therapy.

Remote Delivery of the Cuidándome Telehealth Intervention for Self-Management of Depression and Anxiety Among Latina Immigrant Women: Randomized Controlled Trial.

Growing evidence suggests that Latina immigrant survivors of adverse childhood experiences (ACEs) are at increased risk for developing and remaining with either depression or anxiety or both symptoms. This study examined the feasibility and acceptability of a telehealth intervention-Cuidándome (quee-DAN-doh-meh, "taking care of myself"). Cuidándome is a 10-week, patient-centered, trauma-informed intervention delivered by a trained facilitator that promotes self-management of depression and anxiety symptoms through improved problem-solving skills and strategies. The aim of this study was to examine the feasibility and acceptability of Cuidándome delivered remotely (via Zoom) with Latina immigrant ACE survivors with either depression or anxiety or both symptoms. We also estimated the effect sizes associated with the intervention on decreasing depression and anxiety symptoms and improving social problem-solving styles. We evaluated Cuidándome using a randomized controlled trial design. Latina immigrants (N=47) who had experienced at least 1 ACE and had at least mild depression or anxiety symptoms were randomized to Cuidándome or a comparison group delivered by trained facilitators. We assessed for changes in depression and anxiety symptoms as well as social problem-solving styles at baseline, post intervention, and 3- and 6-month follow-up. Analyses indicated significant decreases over time within both Cuidándome and comparison groups for depression and anxiety symptoms and maladaptive problem-solving. The intervention effect was largest for anxiety; at 6-month follow-up, Cuidándome participants had significantly lower anxiety scores than the comparison group. In addition, we observed a greater average point reduction in depression symptoms at 6 months among Cuidándome participants (5.7 points) than in the comparison group (3.7 points). A mental health program delivered via Zoom by a trained facilitator was feasible and acceptable to Latina immigrant women and can be beneficial for reducing anxiety and depression symptoms. More research is needed to assess the effectiveness of Cuidándome among a powered sample size of Latina immigrants. ISRCTN Registry ISRCTN16668518; https://www.isrctn.com/ISRCTN16668518.

Combination of β-mannanase plus multi-carbohydrase complex in simple or complex post-weaned pig diets on nutrient metabolism and gut health.

This study was conducted to evaluate whether adding β-mannanase alone or in combination with a multi-carbohydrase complex to simple and complex diets could improve diet digestibility, nutrient and energy metabolism, and gut health in weaned pigs. Thirty pigs (7.9 kg ± 0.851 kg) weaned at 28 days were randomly split into a 2 × 3 factorial arrangement, considering a simple (corn and soybean meal-based diet) or complex diet (13% point reduction in inclusion of soybean meal, 5% of whey power, and 2.5% of spray-dried plasma compared to the simple diet) and diet without any addition (control) or the addition of β-mannanase (BM; 0.300 g/kg of the diet) or β-mannanase plus a multi-carbohydrase complex blend such as xylanase, β-glucanase, and arabinofuranosidases (BM + MCC; 0.300 + 0.050 g/kg of the diet) for 17 days post-weaned. Total fecal and urine samples were collected on days 11-17. Fecal samples were collected from all pigs to identify fecal biomarkers using commercial ELISA tests. Blood samples were collected from all pigs at the end of the experimental period to assess serum concentrations of acute-phase proteins. All pigs were euthanized on day 18 for intestinal tissue collection. The simple diet had greater (p < 0.05) protein digestibility and metabolizability coefficients than the complex diet. Greater (p < 0.05) energy digestibility and energy metabolizability coefficients were observed in the BM and BM+ MCC compared to the control diet. On average, BM improved by 64 kcal/kg and BM + MCC improved by 100 kcal/kg of metabolizable energy. Furthermore, the addition of BM and BM + MCC to the diets led to lower fecal moisture and fecal output. Moreover, the BM and BM + MCC diets also reduced fecal calprotectin concentrations by 29 and 46%, respectively, compared to control pigs (p < 0.001). We conclude that simple diets are a suitable alternative to complex diets, without compromising the nutrient digestibility and gut health of post-weaned pigs. The addition of exogenous enzymes improves nutrient and energy utilization, as well as the absorption area, and decreases calprotectin concentrations.

Comparative impact of the affordable care act on breast cancer outcomes among women in two US states.

Since the implementation of the Patient Protection and Affordable Care Act (ACA) and Medicaid expansion, states that adopted the policy have seen reduced uninsured rates. However, it is unclear whether increased healthcare access, particularly for minority and socioeconomically disadvantaged groups, has translated into measurable improvements in health outcomes. Our study aims to evaluate the impact of the ACA and Medicaid expansion on breast cancer outcomes in Louisiana, which has implemented the policy, compared to Georgia, which has not, as of 2024. We conducted a retrospective study using SEER registry data from January 2011 to December 2021, including women aged 18-64 diagnosed with breast cancer. The impact of the ACA and Medicaid expansion on cancer-specific survival (CSS), overall survival (OS), and stage at presentation was evaluated. The cohort was divided into pre-ACA (2011-2015) and post-ACA (2017-2021) periods, with a one-year washout (2016). A difference-in-difference (DID) approach compared outcomes between Louisiana and Georgia. The study analyzed 62,381 women with breast cancer, with 32,220 cases in the pre-ACA period (51.7%) and 30,161 in the post-ACA period (48.3%). In Georgia, 43,279 women were included (52.3% pre-ACA vs. 47.7% post-ACA), while Louisiana had 19,102 women (50.1% pre-ACA vs. 49.9% post-ACA). Medicaid expansion in Louisiana was associated with a 0.26 percentage point reduction in overall deaths (95% CI: -10.9 to 10.4) and a 5.97 percentage point reduction in cancer-specific mortality (95% CI: -26.1 to 14.2). There was also no significant difference in disease stage at presentation compared to Georgia. This study found no significant differences in overall mortality, cancer-specific mortality, or disease stage at presentation among women with breast cancer in Louisiana, which implemented Medicaid expansion in 2016, compared to Georgia, which has not expanded Medicaid.

From pain compliance to leverage-based control: Evidence of reduced use of force severity and injuries following police training

Abstract Training is a frequently requested response to contentious police use of force incidents. Yet limited research evaluating use of force training has been conducted and most has focussed on officer perceptions of training, as opposed to the impact of training on use of force in the field. We address this gap through evaluating a 120-h Response to Resistance and Aggression training developed and implemented by the Saint Paul Police Department. By integrating leverage-based control and de-escalation techniques, this program sought to reduce the severity of force used by police officers. Results from machine learning models indicate that training did reduce reliance on pain-compliance techniques. Adjusting for factors including encounter, subject, and officer characteristics, training was associated with an estimated 3.3 percentage point reduction in officer injuries and a 1.3 percentage point reduction in significant subject injury. These findings contribute to the evidence base surrounding effective police training programs.

Social networks and HIV treatment adherence among people with HIV initiating treatment in rural Uganda and peri-urban South Africa

Timely initiation of and adherence to antiretroviral therapy (ART) is critical for improving HIV outcomes and reducing HIV transmissibility. Social networks, or the social relationships individuals have with each other, have been linked with positive health outcomes, but less is known about the extent to which social network composition and structure are associated with improved ART adherence among people living with HIV (PLWH). We conducted an ego-centric network study among 828 previously ART-naïve PLWH presenting for ART initiation at 11 clinics in Mbarara, Uganda (rural population) and Gugulethu, South Africa (peri-urban population). We collected social network data using name generator and name interpreter questions. ART adherence was monitored over 12 months using wireless monitors (Wisepill). Our primary outcome of interest was ART adherence during the 12-month follow-up period. We used generalized linear models to estimate the associations between network measures and ART adherence. PLWH at the Uganda site (compared with the South Africa site) were less isolated, had larger social networks, and had more social ties providing sufficient social support; they were also more likely to bridge different social groups whereby not all social ties were connected to each other. In Uganda, social isolation was associated with a 5.5 percentage point reduction in ART adherence (95% confidence interval [CI] −9.95 to −1.13; p = 0.014), while having more same gender social ties was associated with higher ART adherence (b = 0.13, 95% CI 0.02–0.25, p = 0.025). In South Africa, there was no association between social isolation and ART adherence, and having more friendship ties (vs. family ties) was associated with lower ART adherence (b = −2.20, 95% CI −3.56 to −0.84; p = 0.002). Identifying and supporting PLWH who are isolated may facilitate optimal adherence, but understanding how networks differentially affect ART adherence by country context is important.

Palmer amaranth (Amaranthus palmeri) control affected by weed size and herbicide spray solution with nozzle type pairings

Abstract Palmer amaranth can grow 4.2 mm in height per degree day; hence, delays of a few days in weed control deployment can result in applications of herbicides to weeds that are larger than those for which the herbicide label recommends. Therefore, it is critically necessary to understand the effect of plant size at the time of herbicide application in conjunction with herbicide spray solution and nozzle type pairings on the effectiveness of weed management programs in the Enlist E3 and XtendFlex production systems. Field experiments were conducted in 2020, in no-crop conditions, at two locations in Arkansas, to evaluate the influence of Palmer amaranth size on its control with glufosinate, dicamba, and 2,4-D applied alone and in mixture with specific nozzle pairings as mandated by label requirements. Also, a laboratory experiment was conducted to evaluate the droplet size and velocity of the spray solutions and nozzles used in the field experiments. A 5- and 10-percentage point reduction in control was observed when dicamba (66%) and 2,4-D (63%) were applied alone, respectively, compared with those herbicides mixed with glufosinate (71% and 73%, respectively). Palmer amaranth density increased to 55, 73, 100, 115, and 140 plants m−2 when plants were sprayed at heights of 15, 25, 41, 61, and 76 cm, respectively, compared with plants that were sprayed when they were 5 cm tall (9 plants m−2). Nozzle type did not affect weed control or density. The percentage of driftable fines increased when a mixture of glufosinate and 2,4-D were used compared with 2,4-D alone. Effective short-term and long-term chemical control of Palmer amaranth will require growers to correctly time their weed management practices and overlay residuals, and expect the need for sequential applications.

INNOVATIVE APPROACHES TO MENTAL HEALTH SERVICES FOR DIVERSE COMMUNITY OLDER ADULTS

Abstract Addressing the triple stigma (age, mental health, race) faced by older adults in need of mental health services has necessitated innovations that move the service provision needle. Co-located services within community settings, mental health interventions addressing those with nutritional needs, and victims of elder abuse and elder crime benefit from innovative services. The following session will highlight research outcomes from innovative treatment models: (a) In a sample of 138 diverse individuals participating in PROTECT (a brief behavioral intervention for late-life depression among elder abuse/crime victims) showed 5.15 point reductions in PhQ-9 scores across the sample and found video-delivery was non-inferior to traditional in-person therapy. Those receiving video therapy completed treatment faster, with more rapid rate of symptom reduction. (b) Do More Feel Better (a 9-week peer-led manualized intervention for those with depression and nutritional needs) found 78% experienced clinically significant reduction in depressive symptoms and over two-thirds (66%) reported satisfaction with the program. (c) DGMH (mental health services co-located in older adult centers) data indicate that of the 4,118 clients assessed, 3,373 endorsed at least one mental health need (81.9%), significantly higher than the mental health literature indicates. Over 2,133 clients have been treated in 67,597 sessions since program inception in 2018. Within 3-months of treatment, 60.8% and 52% showed clinically significant improvements in depression and anxiety, respectively. A third reported decreased loneliness and 39.4% indicated feeling less socially isolated. Further data will be presented (demographic, racial, ethnic differences). Data supported efficacy lend support to innovative mental health treatment approaches.

Association of Medicaid Expansion with Reduction in Racial Disparities in the Timely Delivery of up-front Surgical Care for Patients with Early-Stage Breast Cancer.

We evaluated the association between Medicaid expansion and time to surgery among patients with early-stage breast cancer (BC). Delays in surgery are associated to adverse outcomes. It is known that underrepresented minorities are more likely to experience treatment delays. Understanding the impact of Medicaid expansion on reducing racial and ethnic disparities in healthcare delivery is critical. This was a population-based study including women ages 40-64 with stage I-II BC who underwent upfront surgery identified in the National Cancer Database (2010-2017) residing in states that expanded Medicaid on January 1, 2014. Difference-in-difference (DID) analysis compared rates of delayed surgery (>90d from pathological diagnosis) according to time period (pre-expansion [2010-2013] and post-expansion [2014-2017]) and race/ethnicity (White vs. racial and ethnic minority), stratified by insurance type (private vs. Medicaid/uninsured). Secondary analyses included logistic and Cox proportional hazards regression. All analyses were conducted among a cohort of patients in the non-expansion states as a falsification analysis. Finally, a triple-differences approach compared pre-expansion with the post-expansion trend between expansion and non-expansion states. Among Medicaid expansion states, 104,569 patients were included (50,048 pre- and 54,521 post-expansion). In the Medicaid/uninsured subgroup, Medicaid expansion was associated with a -1.8% point (95% CI -3.5% to -0.1, P =0.04) reduction of racial disparity in delayed surgery. Cox regression models demonstrated similar findings (adjusted DID hazard ratio 1.12 [95% CI 1.05-1.21]). The falsification analysis showed significant racial disparity reduction among expansion states but not among non-expansion states, resulting in a triple-difference estimate of -2.5% points (95% CI -4.9% to -0.1%, P =0.04) in this subgroup. As continued efforts are being made to increase access to healthcare, our study demonstrates a positive association between Medicaid expansion and a reduction in the delivery of upfront surgical care, reducing racial disparities among patients with early-stage BC.

Is the phone mightier than the virus? Cellphone access and epidemic containment efforts

This paper examines the impact of cellphone access on the containment of an epidemic. We study this question in the context of the 2014 Ebola Virus Disease (EVD) outbreak in Liberia. Combining novel data on cellphone towers and EVD cases, we estimate a high-resolution radio-wave propagation model that uses variations in terrain topography and the spatial distribution of cellphone towers to predict signal strength on the ground. We then employ a regression discontinuity design that compares villages at the margin of the signal strength threshold required for coverage. We find that having access to cellphone coverage leads to a 10.8 percentage point reduction in the likelihood that a village has an EVD case. Results from a novel survey collected following the epidemic suggest that this may be explained by cellphone access facilitating treatment provision. However, we cannot fully exclude that improving access to preventive care or information could have also contributed to containment.

Effectiveness of an amino acid beverage formulation in diarrhea-predominant irritable bowel syndrome: A pragmatic real-world study.

Amino-acid based medical foods have shown promise in alleviating symptoms of drug induced gastrointestinal side effects; particularly, diarrhea-predominant symptoms. Irritable bowel syndrome (IBS) is a gastrointestinal disorder that affects up to 9% of people globally, with diarrhea predominant IBS (IBS-D) being the most prevalent subtype. Further trials are needed to explore potential added benefits when integrated into standard care for IBS-D. To assess the effectiveness of an amino acid-based medical food as an adjunct to standard of care for adults with IBS-D. This is a pragmatic, real world, open label, single arm study comparing a 2-week baseline assessment to a 2-week intervention period. One hundred adults, aged 18 to 65 years, with IBS-D, according to Rome IV criteria, were enrolled after completing a 2-week baseline assessment period and received a 2-week supply of an amino acid based medical food which was consumed at home twice daily on top of their standard of care. The primary outcome was an assessment of tolerability after 2-weeks of consumption, while secondary outcomes included changes in stool consistency (Bristol Stool Form Scale), severity of abdominal pain & discomfort, symptoms of urgency, Global Improvement Survey (GIS), and the IBS severity scoring system (IBS-SSS). The test product was well-tolerated as each participant successfully completed the full 14-day trial, and there were no instances of dropouts or discontinuation of the study product reported. Forty percent of participants achieved a 50% or more reduction in the number of days with type 6-7 bowel movements (IBS-D stool consistency responders). Fifty-three percent of participants achieved a clinically meaningful reduction of 30% in mean weekly pain scores, and 55% experienced the same for mean weekly discomfort scores (IBS-D pain and discomfort responders). Participants experienced a mean -109.4 (95% confidence interval: -130.1, -88.8) point reduction on the IBS-SSS and 52% experienced a minimally clinically important difference of > 95 points. An IBS-SSS category shift from severe to moderate or mild occurred in 69% of participants. For functional symptoms, 76% of participants reported symptom relief on the GIS. The amino acid-based medical food was well-tolerated, when added to the standard of care, and demonstrated improvements in both overall IBS symptom severity and IBS-D symptoms within just 2 wk.

The Impact of State Dementia Training Requirements for Nursing Homes on Antipsychotic Medication Use

ObjectivesNursing home (NH) staff often report not having adequate dementia-specific knowledge to effectively care for these residents. Between 2011 and 2019, 9 states in the United States implemented dementia training requirements for NH staff. This study evaluated whether the state-mandated dementia training for NH staff was associated with improving resident outcomes. DesignCompared trends in antipsychotic medication before and after implementation of state training requirements to trends in states without requirements. Setting and ParticipantsNHs. MethodsData from Care Compare for NHs and LTCFocus were linked to state policy data. We excluded 14 states that had implemented training requirements before the start of the study period in 2011. We estimated difference-in-differences models that compared trends in antipsychotic medication use before and after implementation of training requirements in states that have newly implemented requirements to trends in states without requirements. We also investigated whether the impact of training was larger in states with more stringent training requirements (eg, specifying a minimum number of training hours) and in NHs with a special care unit for dementia and examined similar analyses for restraint use and falls. ResultsWe found that training requirements were associated with a 0.59–percentage point reduction (95% CI −0.91 to −0.27) in antipsychotics use. Effects were larger in NHs with a special care unit for dementia and in states that had stricter training requirements. We also found that training requirements were associated with a 0.17–percentage point reduction (95% CI −0.26 to −0.07) in restraint use measure and had no impact on falls. Conclusions and ImplicationsState requirements for NH staff dementia training were associated with a small, but significant, reduction in the use of antipsychotic medication and physical restraints.

Assessing the impact of a comprehensive mental health program on frontline health service workers.

Mental health issues are a growing concern in the workplace, linked to negative outcomes including reduced productivity, increased absenteeism, and increased turnover. Employer-sponsored mental health benefits that are accessible and proactive may help address these concerns. The aim of this retrospective cohort study was to evaluate the impact of a digital mental health benefit (Spring Health) on frontline healthcare service workers' clinical and workplace outcomes. The benefit was sponsored by a national health services company from 2021-2022 and included mental health screening, care navigation, psychotherapy and/or medication management. We hypothesized program use would be associated with improvements in depression and anxiety symptoms, and increased productivity and retention. Participants were employees enrolled in the benefit program, had at least moderate anxiety or depression, at least 1 treatment appointment, and at least 2 outcome assessments. Clinical improvement measures were PHQ-9 scale (range, 0-27) for depression and GAD-7 scale (range, 0-21) for anxiety; workplace measures were employee retention and the Sheehan Disability Scale (SDS) for functional impairment. A total of 686 participants were included. Participants using the mental health benefit had a 5.60 point (95% CI, 4.40-6.79, d = 1.28) reduction in depression and a 5.48 point (95% CI, 3.88-7.08, d = 1.64) reduction in anxiety across 6 months. 69.9% (95% CI, 61.8%-78.1%) of participants reliably improved (≥5 point change) and 84.1% (95% CI, 78.2%-90.1%) achieved reliable improvement or recovery (<10 points). Participants reported 0.70 (95% CI, 0.26-1.14) fewer workdays per week impacted by mental health issues, corresponding to $3,491 (95% CI, $1305-$5677) salary savings at approximately federal median wage ($50,000). Furthermore, employees using the benefit were retained at 1.58 (95% CI, 1.4-1.76) times the rate of those who did not. Overall, this evaluation suggests that accessible, proactive, and comprehensive mental health benefits for frontline health services workers can lead to positive clinical and workplace outcomes.