Pre Period Research Articles

Investigating service delivery and perinatal outcomes during the low prevalence first year of COVID-19 in a multiethnic Australian population: a cohort study

ObjectiveInvestigate the impact of the COVID-19 pandemic on perinatal outcomes in an Australian high migrant and low COVID-19 prevalent population to identify if COVID-19 driven health service changes and societal...

Poster 116: Traumatic Brain Injury in High School and College American Football Athletes, 2002-2019: Increasing Risk of Injury and Fatality

Objectives:A prior report revealed an average of 7.2 (0.67 per 100,000 participants) traumatic brain injuries (TBI) per year in high school (HS) and college football players from 1989 through 2002. Our goal is to update the profile of TBI in HS and college football players and evaluate the efficacy of state laws implemented to reduce brain injuries.Methods:We retrospectively reviewed 17 academic years (July 2002 through June 2019) of TBIs catalogued by the National Registry of Catastrophic Sports Injuries (NRCSI). Descriptive statistics were collected using Excel and SPSS. The incidence of TBI was compared with the prior 13-year period. In addition, the incidence of TBI was assessed at the HS level during the pre (2002-2009[BB3] [BI([4] [BI([5] ), transitional (2009-2014), and post (2014-2019) universal adoption time periods of the Lystedt laws. Multinomial logistic regression analyses were performed to determine the odds of TBI based on level of play, Lystedt law adoption eras, and position played.Results:During the study period, there was a total of 177 TBIs (10.4 per year, 0.82 per 100,000 participants): 164 (92.7%, 0.81 per 100,000, 9.65 per year) in HS athletes and 13 (6.6%, 0.96 per 100,000, 0.76 per year) in college athletes. The risk of TBI at the HS level was significantly higher than at the college level (1.99: 95% CI, 1.137-3.517, P<0.0001). Compared to the prior 13-year period, the risk of TBI during the study period was 1.29 (95% CI, 1.004-1.656, P=0.047) with a greater increase at the college (4.40: 95% CI, 0.993-19.5, P=0.051) than the HS level (1.22: 95% CI, 0.946-1.577, P=0.124). There were 51 fatalities (3 per year, 0.24 per 100,000 participants) with a risk of 1.63 (95% CI: 0.65-4.11, P = 0.3) at the college (n=5, 0.29 per year, 0.36/100,000) compared with the HS (n=46, 2.71 per year, 0.22 per 100,000) levels. The risk of a fatality in the current study compared with the prior study was 4.32 (95% CI: 2.05-9.09, P= 0.0001) with higher risks at both the HS (5.17, 95% CI: 2.21-12.1, P =0.0002) and college (1.8, 95% CI: 0.35-9.3, P = 0.48) levels. The incidence of TBI in HS increased significantly from the pre (0.57 per 100,000) to the transitional (0.78 per 100,000, OR = 4.7, P<0.001), and from the transitional to the post universal adoption (1.17 per 100,000, OR = 13.7, P<0.0001) eras of the Lystedt law. The most common positions among HS and college athletes suffering TBI were linebacker (26, 22.6%) and running back (20, 17.4%), and defensive back (16, 13.9%).Conclusions:The incidence of TBI has increased 29% during the 2002-2019 period compared to the prior 13-year period with a 440% and 22% rise in college and HS cases, respectively. The risk of fatality increased 432% compared to the prior 13-year period with an increase of 517% and 180% at the HS and college levels, respectively. The increased incidence of TBI at the HS level has occurred despite implementation of the Lystedt laws. Further research is necessary to determine the risk factors for TBI in order to develop prevention strategies.Figure 3B.Incidence Rates During Lystedt Law Adoption Eras

Impact of the COVID-19 pandemic on the relationship between uncertainty factors, investor’s behavioral biases and the stock market reaction of US Fintech companies

Object: This article investigate the impact of the COVID 19 on the relationship between uncertainty factors (Economic Policy Uncertainty, Equity Market Volatility–Infectious Diseases, Financial Stress) and investors’ behavioral biases (overconfidence, herding, mental accounting and loss aversion) with the US Fintech stock market abnormal returns. Methodology: we analyze this relationship by using Johensen’s cointegration test, Granger causality test and Ordinary least square method (OLS), for the period from July 20, 2016 to December 31, 2021. Results: The Empirical results indicated the presence of a long-run equilibrium relationship between all the studied variables, before and during the COVID-19 pandemic period. In fact, the obtained results indicated that the COVID-19 pandemic is a crucial source for resulting abnormal returns in the US Fintech market. Especially, during the COVID-19 pandemic, the Fintech market under-reacted to the common signal of financial stress. Moreover, behavioral biases, especially, overconfidence and herding, have a power positive effect on the abnormal reaction of US Fintech stock market, comparatively to the pre COVID-19 period. Originality: this work could be useful for policy makers and investors in the Fintech markets since it considers the behavioral biases and uncertainty factors on their investment strategies. Keywords: Fintech; COVID-19; uncertainty factors; investors’ behavioral biases, stock market reaction, Ordinary least squares (OLS) method.

상권 입지요인이 수익형 부동산가격에 미치는 영향

This study examined the factors of COVID-19 pandemic on the actual transaction price of profitable real estate in Gangnam Station, and an empirical analysis was conducted to analyze the impact of COVID-19 pandemic. For the empirical analysis, an analysis of the Hedonic regression model and a difference in differences analysis of the distance section were conducted. As a result of the analysis, it was found that in the model for the entire period, the building coverage rate and the number of elapsed years had a negative effect on the actual transaction price. In the pre COVID-19 model, building coverage rate, the elapsed years and walking distance at Samsung office building were found to have a negative effect. In the post COVID-19 period model, it was found that only the number of floors had a negative effect on the actual transaction price. As a result of the difference in differences analysis on the distance of the station and Samsung office, it was found that walking distance at Samsung office had a negative effect on actual transaction prices for the entire period. And in the pre COVID-19 period, it was found that only in the section of walking distance less than 400 meters, it had a positive effect on the actual transaction price. The results of these studies may provide implications for investment strategies according to changes in the price factors of profitable real estate for major Trade Area in the city after the COVID-19 pandemic.

Effect of Prepartum Dietary Energy Level on Production and Reproduction in Nili Ravi Buffaloes.

Simple SummaryThe objective was to evaluate the effect of prepartum dietary energy level on performance of Nili Ravi buffaloes. Buffaloes were fed low, medium or high energy diet during 63 days prepartum and same lactation diet during 14 weeks postpartum. Buffaloes fed the high energy diet had better performance compared with buffaloes fed the medium or low energy diet. While, prepartum feeding of low energy diet adversely affected buffalo performance.The objective of this study was to evaluate the effect of prepartum dietary energy level on postpartum production and reproduction in Nili Ravi buffaloes (n = 21). The buffaloes were offered low energy (LE: 1.31 Mcal/kg DM NEL (net energy for lactation)), medium energy (ME: 1.42 Mcal/kg DM NEL) or high energy (HE: 1.54 Mcal/kg DM NEL) diet for 63 days prepartum, and received the same lactation diet (LD: 1.22 Mcal/kg DM NEL) during 14 weeks postpartum. The effects of dietary energy level and week were analyzed with Proc GLIMMIX model. Dry matter intake (DMI) was lower in buffaloes fed the LE diet compared with buffaloes fed the ME or HE diet. Calf birth weight (CBW) was higher in buffaloes fed the HE diet compared with buffaloes fed the ME or LE diet. Milk production was similar in buffaloes fed the HE, ME or LE diet within 14 weeks postpartum and throughout the lactation. Milk fat was higher in buffaloes fed the LE diet compared with buffaloes fed the ME or HE diet. Milk protein and lactose yields was high in buffaloes fed the HE diet compared with buffaloes fed the ME or LE diet. Body condition score was high in HE and was affected by diet × week interactions during pre and postpartum period. The concentrations of β-hydroxybutyrate (BHBA) and triglycerides in serum was lowest in buffaloes fed the HE diet compared with the buffaloes fed the ME or LE diet. The buffaloes fed the HE diet had early uterine involution (UI), first estrus, short dry days, and calving interval (CI) compared with buffaloes fed the ME or LE diet. None of buffaloes fed the LE diet exhibited estrus during the first 14 weeks postpartum compared with buffaloes fed the ME or HE diet. In conclusion, prepartum feeding of high energy diet can be helpful in improving the postpartum productive and reproductive performance in Nili Ravi buffaloes.

How a Rural Bangladeshi Institute Survives Poverty And COVID: A Case Study On Nawdabash Madrasah and Orphanage

This paper portrays the efforts made by Nawdabash Madrasah and Orphanage, one of the religious units of Bangladesh, to deal with and survive impoverishment pre, during and post Covid-19 period. The author found the organization to be doing much better in terms of basic need fulfilment, finances, and maintenance during and post Covid time.

Identity, Resistance, and Body: Reading The Cancer Journals as “Manifesto”

&#x0D; &#x0D; &#x0D; &#x0D; Audre Lorde, a black lesbian feminist author, had to undergo a mastectomy of her right breast in 1978. Her trauma of pre and post-surgery period, experience of pain, observation on the medical discrimination, and protest against prosthetic breast got a vivid expression in The Cancer Journals (1980). Instead of reflecting on the loss of her body part, she used the cancer experience as a tool not only to voice identities and differences but also to defy patriarchal politics, capitalist agenda, and medical discrimination. Lorde's construction of subjectivity and identity in The Cancer Journals is a complete break from the traditional autobiographical strategies. Her performance as a resisting subjectivity in the text coincides with Sidonie Smith's concept of the experiential politics of autobiographical manifesto's subject. Focusing on these aspects, the present paper exhibits how Audre Lorde creates a discourse of the body in her political struggle for raising women's voice in the body politic. Moreover, it argues that in its exposition of identity and resistance —as a language of the body—The Cancer Journals is an autobiographical manifesto.&#x0D; &#x0D; &#x0D; &#x0D;

COVID-19 Lockdown Impacts Among Patients with Cystic Fibrosis: An Italian Regional Reference Centre Experience

Coronavirus pandemic has influenced our society with social distancing and management of chronic disease such as cystic fibrosis (CF). During the Italian lockdown from March to May 2020, CF patients reduced the number of outpatient visits, limited social interactions and spent more time at home. The aim of this study is to evaluate the impact of the lockdown on body mass index (BMI) and lung function tests on CF patients. We retrospectively reviewed clinical data about 111 CF patients followed in our Regional Cystic Fibrosis Reference Centre (Policlinico Umberto I, Rome) according to two periods: pre-lockdown (from October 2019-March 2020) and post-lockdown (from May 2020-October 2020). We collected data on nutritional (BMI and body weight) and lung function status; we chose the best values of the 'pre-lockdown' and 'post-lockdown' period for each patient. Patients were divided into 3 groups according to FEV1 value (Forced Expiratory Volume in the 1st second): group 1 (FEV1 <40%), group 2 (FEV1 40-70%), group 3 (FEV1 >70%). All patients received a telephone interview asking for the number of hours per week devoted to physical activity, number of pulmonary acute exacerbations and subjective evaluation of adherence to medical therapy, respiratory physiotherapy and diet, during the two periods. Comparing weight, BMI and respiratory function between pre and post lockdown periods, we noticed an increase in weight during among overall patients. Male patients improved weight, BMI, FEF 25-75% (Forced Expiratory flow between 25% and 75% of vital capacity) and Tiffenau index more than female patients. The most severely compromised patients (group 1), showed a significant loss of both weight and BMI. Instead, patients with moderate respiratory function (group 2) showed a significant increase of both weight and BMI and a slightly reduced CVF (Forced Vital capacity). We found no differences among patients with good respiratory function (group 3). Comparing each clinical sub-groups, we noticed a significative improvement of weight (p = 0.018) and BMI (p = 0.030) among patients with moderate respiratory function compared to patients with compromised respiratory function. During lockdown, patients reported less physical activity, no variation in food amount and composition, more adherence to therapy (43%) and more consistent daily respiratory physiotherapy (47.6%). Lockdown period had benefit among CF patients in terms of weight in particular in male patient. The greatest benefit on nutritional state was observed in patients with moderate reduction of respiratory function. In addition, we noted a stabilization and sometimes a slight improvement of lung function, instead of a continuous and steady decline that is normally observed in CF patients. These beneficial effects are slight but significative, bearing in mind the general worsening that CF patients experience annually.

Financial Crisis and Leverage Determinants : A Juxtaposition of Pre and Post-Crisis Periods Using HLM

The present study examined the direct and indirect influences of firm-level and industry-level determinants on capital structure for all BSE-listed firms in India. The study analyzed financial data from 2000 – 2019 and employed the hierarchical linear modeling technique of regression as firms are a subset of industries. The output demonstrated that a few capital structure determinants either did not have any impact or had the same effect in both pre and post-crisis periods. However, a few determinants such as short-term liquidity, firm profitability, and Z - score had a conflicting impact on leverage in the two time periods. Determinants such as median industry tangibility, median industry leverage, industry munificence, industry liquidity, and industry dynamism had a significant impact in one period and an insignificant impact in another period. This showed that the direct effect of capital structure determinants changed when equity market and credit supply conditions varied. We showed that industry-level factors moderated the relationship between leverage and firm-level factors. Further, it was exhibited how economic conditions affected not just the direct influences of firm and industry level factors but also the indirect influences of industry-level factors. The results of the present study highlighted the complexity of corporate leverage decisions by exhibiting how changes in economic conditions and industry characteristics led to changes in leverage levels.

139-LB: Evaluating the Impact of Quality Initiatives on Improving Insulin Pen and Needles Prescription on Hospital Discharge in Patients with Type 2 Diabetes Mellitus

Background: Prescribing insulin pens without needles during hospital discharge was common in our hospital system. We assessed the impact of quality initiatives and prescribing guidance on the prevalence of patients discharged on insulin pens with and without an associated prescription for pen needles. Methods: We retrospectively collected data from Emory-healthcare hospitals, from January 2015-May 2018 (pre-intervention period) , then up to October 2021 (post-intervention period) . Adults (&amp;gt;18 years) with at least one prescription for insulin pens were included. As part of an updated discharge plan, an automated EMR alert was linked to orders for insulin pens without needles, aiming to reduce prescription errors at discharge. We compared the proportion of patients discharged on insulin pens with/without an associated pen needles prescription during the pre and post-intervention periods. We used interrupted time-series analysis (ITS) to examine the intervention impact on 30- and 90-day hospital readmissions. Result: Among 7654 patients discharged with insulin pens (median age 56 years, IQR 45-66) , 50.4% were Females, 65.5% were African-Americans, and mean HbA1c was 10.9±2.9%. After the intervention, the proportion of patients without an associated prescription for pen needles decreased compared to the pre-intervention (mean decrease 31.3%, 95% CI: 31.2%, 31.3%) . Inpatient diabetes education consult was more common among those with an associated pen needles prescription during the pre- (61.4% vs. 33.7%) and post-intervention period (64.7% vs. 33%) , compared to those without it, p&amp;lt;0.001. After the intervention, there was a significant improvement in 90-days hospital readmission rates (-0.99% per quarter; P&amp;lt;0.005) , whereas the change in slope was not significant for 30-day hospital readmission rates. Conclusion: Our initiative significantly decreased the prevalence of missing pen needles prescriptions by ∼30%, and was associated with less 90-days hospital readmission rates. Disclosure B. Moazzami: None. M. Wald: None. R. Jagannathan: None. R. J. Galindo: Advisory Panel; Sanofi, WW International, Inc., Research Support; Dexcom, Inc., Eli Lilly and Company, Novo Nordisk. P. Hwang: None. S. Ashraf: None. A. Van prooyen: None. H. F. Shabbir: None. M. Klimenko: None. E. Brechtelsbauer: None. E. Molitch-hou: None. M. A. Hinds: None.

CROP PRODUCTION FLUCTUATION AND AGRICULTURAL TRANSFORMATION: IMPACTS OF CONSTRUCTING A CLOSURE DAM

A closure dam was constructed on Little Feni River at Musapur Union, Noakhali District by Bangladesh Water Development Board (BWDB) in 2016. The study assessed crop production fluctuations between pre and post period of the construction of this dam. Data were collected from Department of Agricultural Extension (DAE), Companiganj Upazila, and BWDB, Noakhali. Besides, an inception meeting was arranged at DAE with different participants for two consecutive days and three focused group discussions (FGD) from almost all stakeholders were done to triangulate the result. The trend was calculated by the data retrieved from 2011 to 2018 for the projection of the study. The result showed a revolutionary increasing trend for Brassica juncea, Arachis hypogaea, and Allium sativum with 1214%, 1400%, and 1600%, respectively. Followed by, the positive trend was showed for Oryza sativa, Cajanus cajan, Pisum sativum, Capsicum annuum, wintry vegetables and Cucumis sativus with 30.97%, 116.41%, 200%, 145.83%, 52%, 475%, respectively. And nearly stable trend was found for Ipomoea batatas, spices and Lathyrus sativus with a positive trend of 4%, negative trend of 7.59% and 8.86%, respectively. The study concluded that construction of closure dam might be greatly influenced in the high production rate of crops in the study area.

Effect of Mindfulness-Based Stress Reduction on the Well-Being, Burnout and Stress of Italian Healthcare Professionals during the COVID-19 Pandemic.

COVID-19 has overwhelmed healthcare systems and increased workload and distress in healthcare professionals (HCPs). The objective of this study was to evaluate baseline distress before and after the pandemic, and the effect of Mindfulness-Based Stress Reduction (MBSR) training on well-being (PGWBI), stress (PSS) and burnout (MBI) in Italian HCPs. Moreover, the “fear of COVID-19” (FCV-19S) questionnaire was administered to HCPs participating in the post-emergency MBSR program. Baseline distress results were moderate in all groups. No differences between baseline distress were observed between the groups of HCPs beginning the MBSR courses in the pre or post pandemic period. Total PGWBI lowered with aging. Additionally, FCV-19S positively correlated with age. MBSR was able to lower distress levels, except for depersonalization, which increased, while emotional exhaustion decreased in the group enrolled in the last post-pandemic MBSR course. Levels of fear of COVID-19 in HCPs significantly decreased after MBSR training. The lack of change in baseline distress over time indicates that it is more influenced by work-related distress than by the pandemic in our HCPs. In view of its beneficial effects on psycho-emotional status, MBSR training may represent an effective strategy to reduce distress in emergency periods as well as an essential part of HCPs’ general training.

Validity of the Edinburgh Postnatal Depression Scale for screening pregnant and postpartum adolescents: a systematic review

Objective: To examine the validity of the Edinburgh Postnatal Depression Scale (EPDS) for screening depression in pregnant and postpartum adolescents. Background: The incidence of postpartum depression (PPD) in 15 to 19-year olds is double the rate reported among mothers older than 25 years. EPDS threshold scores that indicate possible depression among adolescents have not been established and may differ from those validated for adults. Study design and methods: A systematic review of the literature between 1987 and 2020 was conducted using five databases: CINAHL, EMBASE, MEDLINE, MIDIRS and PsycInfo. Studies that sampled adolescent mothers in the perinatal period, that screened for depressive symptoms using the EPDS, and which assessed the validity of the tool were included. The studies were grouped according to their methodology with results presented as a narrative synthesis. Two researchers independently reviewed search results, study selection and data extraction, and undertook quality appraisals using the Quality Assessment of Diagnostic Accuracy Studies checklist. Results: Five studies that sampled a total of 1,241 participants were included in the review: four validated the EPDS against diagnostic reference standards and one against other depression screening tools. The EPDS demonstrated high levels of sensitivity and specificity although optimal cut-off scores for possible depression were between 2 and 7 points lower than that recommended for adult samples. Overall performance of the EPDS was equivalent or better when compared to other screening tools. Discussion: The standard EPDS cut-off score (≥12) does not identify all adolescents at high risk of depression during the perinatal period. Scores of ≥9 may be more appropriate. However, different reference standards and sampling methods used in the studies compromise the review’s strength of evidence. Conclusion: Despite development of the EPDS more than 30 years ago, research into its validity among adolescents is still in its infancy. This review makes an important contribution to that body of evidence by revealing its limitations and highlighting trends upon which further research can build. Implications for research, policy and practice: Although Australian guidelines for perinatal depression screening are some of the most detailed in the world, limited guidance is offered for EPDS use among adolescents. The findings of this review raise important points for that guidance and for practitioners. Concerns for possible depression in adolescents should be triggered at an advisory EPDS cut-off score of ≥9. Further research is needed to confirm or refute these findings. What is already known about the topic? Postpartum depression (PPD) among adolescents is prevalent and a recognised public health concern due to its significant association with morbidity. Perinatal screening for depression using validated instruments, including the Edinburgh Postnatal Depression Scale (EPDS), is recommended in national and international guidance. There is no validated version of the EPDS for adolescents although there is evidence to suggest that cut-off scores indicative of possible depression may need to be lower than those recommended for adults. What this paper adds: The paper synthesises evidence that demonstrates the EPDS is a valid scale for perinatal screening of depression in adolescents. It identifies lower cut-off scores for suspected depression among adolescents compared to adults, and also highlights score differences in the pre and postnatal periods. The paper provides advisory screening guidance for practitioners and emphasises the importance of monitoring for depressive symptoms in perinatal adolescents at every healthcare encounter.

Constructing an optimal portfolio on the Bulgarian stock market using hybrid genetic algorithm for pre- and post-COVID-19 periods

In the aftermath of the COVID-19 pandemic, global financial markets have seen growing uncertainty and volatility and as a consequence, precise prediction of stock price trend has emerged to be extremely challenging. In this background, we propose two time frameworks wherein the Hybrid genetic algorithm (HGA) is used to set up an optimal portfolio included ten stocks traded in Bulgarian stock market during pre and post COVID-19 periods. The fitness function values of constructed HGA during pre- and post-COVID-19 periods were −7.194e[Formula: see text] and −7.014e[Formula: see text], respectively. The estimated nonzero portfolio weights during pre-COVID-19 period were ALCM (0.025), HNVK (0.253), HVAR (0.378), MSH (0.204), NEOH (0.038), and SFT (0.102) while during post-COVID-19 period were AGH (0.003), ALCM (0.015), HNVK (0.272), HVAR (0.460), MSH (0.142), NEOH (0.057), SFT (0.031), and SPH (0.021). The corresponding expected portfolio return and portfolio risk during pre-COVID-19 period were 9.825e[Formula: see text] and 7.163e[Formula: see text] while during post-COVID-19 period were 9.656e[Formula: see text] and 6.895e[Formula: see text], respectively.

Effect of an intervention for patients 65 years and older with blunt chest injury: Patient and health service outcomes

IntroductionBlunt chest injury in older adults, aged 65 years and older, leads to significant morbidity and mortality. The aim of this study was to evaluate the effect of a multidisciplinary chest injury care bundle (ChIP) on patient and health service outcomes in older adults with blunt chest injury. MethodsChIP comprised multidimensional implementation guidance in three key pillars of care for blunt chest injury: respiratory support, analgesia, and complication prevention. Implementation was guided using the Behaviour Change Wheel. This proof-of-concept controlled pre- and post-test study with two intervention and two control sites in Australia was conducted from July 2015 to June 2019. The primary outcomes were non-invasive ventilation (NIV) use, unplanned Intensive Care Unit (ICU) admissions, and in-hospital mortality. Secondary outcomes were health service and costing outcomes. ResultsThere were 1122 patients included in the analysis, with 673 at intervention sites (331 pre-test and 342 post-test) and 449 at control sites (256 pre-test and 193 post-test). ChIP was associated with unplanned ICU admissions and in NIV use with a reduction of the odds in the post vs the pre periods in the intervention sites when compared to the controls (ratio of OR=0.13, 95%CI=0.03-0.55) and (ratio of OR=0.14, 95%CI=0.02-0.98) respectively. There was no significant change in mortality. Implementing ChIP was also associated with health service team reviews with an increased odds in the post vs pre periods in the intervention sites in comparison to the controls for surgical review (ratio of OR =6.93, 95%CI=4.70-10.28), ICU doctor (ratio of OR =5.06, 95%CI=2.26-9.25), ICU liaison (ratio of OR =14.14, 95%CI=3.15-63.31), and pain (ratio of OR =5.59, 95%CI=3.25-9.29). ChIP was also related to incentive spirometry (ratio of OR=6.35, 95%CI= 3.15-12.82) and overall costs (ratio of mean ratio=1.34, 95%CI=1.09-1.66) with a higher ratio for intervention sites. ConclusionImplementation of ChIP using the Behaviour Change Wheel was associated with reduced unplanned ICU admissions and NIV use and improved health care delivery. Trial registrationANZCTR: ACTRN12618001548224, approved 17/09/2018

How far damming induced wetland fragmentation and water richness change affect wetland ecosystem services?

In inland wetland, river and lakes, the ecosystem service values (ESV) vary from 4267 to 25682 US$/ha/year, but when the landscape gets fragmented and becomes hydrologically inconsistent, will they produce the same ESV? With this fundamental query, the present work evaluated the ESV in different fragmented wetland units and over different water richness zones in reference to hydrological alteration introduced by damming (1992) over Punarbhaba river (a transboundary of India and Bangladesh). The wetlands were mapped using the support vector machine (SVM) model for pre and post-dam conditions. Subsequently, satellite image-derived parameters, such as hydro-period, water depth, and water presence consistency, were prepared and used for spatial weighted and fuzzy logic-based water richness modelling and wetland fragmentation analysis for both pre (1989) and post-dam periods (2019). Results showed that wetland area was reduced from 205.24 km2 to 73.22 km2 in between pre-and post-dam periods, and consequently, the ESV was reduced from 10596 × 104 US$ to 3874 × 104 US$. Damming effect has decreased the high-water richness area from 71.83% to 7.65%, which caused a 62% of ESV reduction in the post-dam period. Due to increasing patch frequency and decreasing the core area in the post-dam period, the ESV value was reduced by 45%, which could be considered the fragmentation effect. As the study identified the areas with decreasing ESV values, this work has very good policy implications on a priority basis for wetland conservation.

Adolescent Trauma During the COVID Pandemic: Just Like Adults, Children, or Someone Else?

COVID-19 stay-at-home (SAH) orders were impactful on adolescence, when social interactions affect development. This has the potential to change adolescent trauma. A post-hoc multicenter retrospective analysis of adolescent (13-17 years-old) trauma patients (ATPs) at 11 trauma centers was performed. Patients were divided into 3 groups based on injury date: historical control (CONTROL:3/19/2019-6/30/2019, before SAH (PRE:1/1/2020-3/18/2020), and after SAH (POST:3/19/2020-6/30/2020). The POST group was compared to both PRE and CONTROL groups in separate analyses. 726 ATPs were identified across the 3 time periods. POST had a similar penetrating trauma rate compared to both PRE (15.8% vs 13.8%, P = .56) and CONTROL (15.8% vs 14.5%, P = .69). POST also had a similar rate of suicide attempts compared to both PRE (1.2% vs 1.5%, P = .83) and CONTROL (1.2% vs 2.1%, P = .43). However, POST had a higher rate of drug positivity compared to CONTROL (28.6% vs 20.6%, P = .032), but was similar in all other comparisons of alcohol and drugs to PRE and POST periods (all P > .05). Hence ATPs were affected differently than adults and children, as they had a similar rate of penetrating trauma, suicide attempts, and alcohol positivity after SAH orders. However, they had increased drug positivity compared to the CONTROL, but not PRE group.

Evaluation of parameters related with upper lip aesthetics and dynamic smile following Le Fort I osteotomy

ObjectiveThe present study aimed to investigate how upper lip aesthetic and dynamic smile parameters are changed following a Le Fort I osteotomy. MethodsTwenty-seven patients who underwent Le Fort I osteotomy with or without mandibular osteotomy were included in this retrospective study. Upper lip aesthetic parameters which were Cupid's bow angle, lip angle, lip length, lip width, philtrum width and lip corners were evaluated on pre and postoperative rest photos using Image J software. Lip corner movement direction, buccal corridor area with respect to canine and last visible tooth were also measured on posed smile photos with respect to dynamic smile evaluations. Measured variables were submitted to statistical analysis and significance level was determined as 0.05. ResultsThere was a significant reduction in buccal corridor area according to last visible teeth for right and left side at postoperative period. However, buccal corridor area with respect to canine for the right and left side was not significant. The angle between the lip corner movement direction and Y-axis of the face for the right and left sides was not significant between pre and postoperative period. The changes in this angle were not also correlated with the changes in buccal corridor area and maxillomandibular movements. Not only the Cupid's bow angle, lip angle but also lip length, lip width, philtrum width and lip corner have not been changed significantly. ConclusionBuccal corridor area investigated in dynamic smile shows significant improvement after orthognathic surgery especially in the means of maxillary impaction. Lip corner movement during smile was not associated with the changes in buccal corridor area. Landmarks around perioral area in static state were affected clinically with no statistical significance following the surgery.

Risk-stratified posthepatectomy pathways based upon the Kawaguchi–Gayet complexity classification and impact on length of stay

BackgroundThe Kawaguchi–Gayet classification is a validated system to stratify open liver resections by complexity and postoperative complications. We hypothesized that Kawaguchi–Gayet classification could be used to create and implement risk-stratified posthepatectomy pathways to reduce length of stay and variation in care. MethodsClinicopathologic data from hepatectomy patients (1/2017–6/2020) were abstracted from a prospective database. All open hepatectomies were assigned to groups based on 2 levels of Kawaguchi–Gayet classification, and corresponding risk-stratified posthepatectomy pathways were created to decrease length of stay by 1day compared to patients who were historically treated without a pathway: low–intermediate risk (open Kawaguchi–Gayet I/II) and high risk (open Kawaguchi–Gayet III). Outcomes were compared between periods before ("PRE"; 1/1/2017–9/30/2019) and after ("POST"; 10/1/2019–6/30/2020) implementation. ResultsAmong 487 open hepatectomies (PRE: 374, POST: 113), 55.0% (n=268) were low–intermediate risk and 45.0% (n=219) were high risk. Major complications were similar PRE/POST: low–intermediate risk (PRE: 7.8%, POST: 9.4%, P=.681) and high risk (PRE: 18.9%, POST 10.0%, P=0.139). Risk-stratified posthepatectomy pathway implementation reduced median length of stay for both low–intermediate risk (4 to 3.5days, P=.009) and high risk (5 to 4days, P=0.022) patients. Risk-stratified posthepatectomy pathways decreased length of stay variation, reflected in mean and standard deviation for all patients (PRE 5.5±7.5 vs POST 4.4±2.8days). There was no difference in 90-day readmission rates between PRE (12.6%) and POST (8.8%) periods (P=.278). ConclusionThe creation and implementation of risk-stratified posthepatectomy pathways reduced length of stay without increasing readmissions after hepatectomy. These generalizable risk-stratified posthepatectomy pathways preoperatively stratify patients a priori into pathways for individualized preoperative discussions on realistic postoperative complications and length of stay expectations.

Prepartum and/or postpartum supplementation with monensin-molasses multinutrient blocks to optimize fertility and calf performance in primiparous beef cows.

Pregnant Nelore heifers (n = 417) were used to evaluate the effects of supplementation with monensin-molasses multinutrient block (B) during pre and/or postpartum on reproductive and progeny performance. Heifers were allocated in four treatments: i) CC: heifers received control supplement (C) in loose meal form (0.06% of body weight [BW] offered daily before and after parturition; n = 108); ii) CB: received C before parturition and B (0.07% of BW offered weekly after parturition; n = 117); iii) BC: received B before and C after parturition (n = 103) and iv) BB: received B before and after parturition (n = 89). During pre and postpartum periods, concentration of metabolites/hormones and cow/calf performance was evaluated over time. Cows were synchronized twice for fixed timed artificial insemination (FTAI) using an estradiol/progesterone-based protocol. Data was analyzed by orthogonal contrasts (C). B increased pregnancy at first FTAI (p = 0.04) and overall pregnancy rate (C1: CC vs BB+BC+CB; p = 0.05). Supplemented cows had greater body condition score (BCS) only at parturition (D0; p = 0.04) and at D40 (p = 0.02). B increased BW (p = 0.03), glucose concentrations (p = 0.01) and subcutaneous fat thickness (p = 0.03) only at D40. Concentrations of insulin were higher in supplemented cows (p = 0.008). Calves born by cows supplemented before and after parturition (C2: BB vs BC+CB) were heavier at 80 (p<0.001), 120 (p<0.001), 170 (p = 0.002) and 210 (p = 0.02) days old. Regardless of period of treatment, block supplementation increased pregnancy at first FTAI and overall pregnancy rate. Additionality, block supplementation during both pre and postpartum periods improved progeny weight until weaning. Block supplementation can be a tool to optimize fertility and calf performance in Nelore primiparous cows.