Prior Usage Research Articles

Heart failure risk in patients with atrial fibrillation treated with catheter ablation vs antiarrhythmic drugs

Atrial fibrillation (AF) increases heart failure (HF) risk. Whereas the risk of HF-related hospitalization and mortality are known in the setting of AF, the impact of AF treatment on HF development is understudied. The purpose of this study was to compare HF incidence among AF patients treated with antiarrhythmic drugs (AADs) vs catheter ablation (CA). AF patients with 1 prior AAD usage were identified in 2014-2022 Optum Clinformatics database. Patients were classified into 2 cohorts: those receiving CA vs those receiving a different AAD prescription. The 2 cohorts were matched on sociodemographic and clinical covariates using propensity score matching technique. Cox regression model was used to compare incident HF risk in the 2 cohorts. Subgroup analyses were performed by race/ethnicity, sex, AF subtype, and CHA2DS2-VASc score. After matching, 9246 patients were identified in each cohort (AAD and CA). Patients receiving CA had a 57% lower risk of incident HF than those treated with AADs (hazard ratio [HR] 0.43; 95% confidence interval [CI] 0.40-0.46). Subgroup analysis by race/ethnicity depicted similar results, with non-Hispanic White (HR 0.43; 95% CI 0.40-0.46), non-Hispanic Black (HR 0.46; 95% CI 0.35-0.60), Hispanic (HR 0.53; 95% CI 0.40-0.70), and Asian (HR 0.46; 95% CI 0.24-0.92) patients treated with CA (vs AAD) having significantly lower risk of HF, respectively. The effect size of CA remained significant in subgroups defined by sex, AF subtypes, and CHA2DS2-VASc score. AF patients receiving CA had ∼57% lower risk of developing HF than those receiving AAD. The lower risk of HF associated with CA vs AAD persisted across different race/ethnicity, sex, AF subtypes, and CHA2DS2-VASc score.

Tailored Approach to Evaluation and Management of Early Onset Neonatal Sepsis in a Safety-Net Teaching Hospital in Northeast Florida.

Objective Early onset neonatal sepsis (EONS) remains a significant cause of morbidity and mortality in newborns in the immediate postnatal period. High empiric antibiotic use in well-appearing infants with known risk factors for sepsis led the American Academy of Pediatrics (AAP) to revise its 2010 guidelines for the evaluation and management of EONS to avoid overuse of antibiotics. In this recent clinical report, the AAP provided a framework that outlined several evidence-based approaches for sepsis risk assessment in newborns that can be adopted by institutions based on local resources and structure. One of these approaches, the sepsis risk calculator (SRC) developed by Kaiser Permanente, has been widelyvalidated for reducing unnecessary antibiotic exposure and blood work in infants suspected of having EONS. In order to determine the utility and safety of modifying our institution's protocol to the SRC, we implemented a two-phased approach to evaluate the use of SRC in our newborn nursery. Phase 1 utilized a retrospective review of cases with SRC superimposition. If results from Phase 1 were found to be favorable, Phase 2 initiated a trial of the SRC for a six-month period prior to complete implementation. Methods Phase 1 consisted of retrospectively applying the SRCto electronic medical records (EMR) of infants ≥ 35 weeks' gestational age admitted to the newborn nursery with risk factors for EONS between June 2016 and May 2017. We compared actual antibiotic use as determined by the unit's EONS protocol for evaluation and management based on 2010 Centers for Disease Control and Prevention (CDC) and AAP guidelines to SRC-recommended antibiotic use. We used EMR to determine maternal and infant data, blood work results, and antibiotic usage as well asused daily progress notes by the clinical team to determine the clinical status of the infants retrospectively. Based on the projected reduction in blood work and antibiotics use with the retrospective superimposition of SRC on this cohort of infants and identification of our high-risk patient subset, we developed a novel, hybrid EONS protocol that we implemented and assessed throughout Phase 2, a six-month period from August 2018 to January 2019, as a prospective observational study. Results Phase 1 (SRC superimposition) demonstrated that the use of the SRC would have reduced empiric antibiotic use from 56% to 13% in the study cohort when compared with 2010 CDC/AAP guidelines. However, these same findings revealed use of the SRC would have resulted in delayed evaluation and initiation of antibioticsin 2 of 4 chorioamnionitis-exposed infants with positive blood cultures. During Phase 2 (n=302), with the implementation of our tailored approach (SRC implementation with additional blood culture in chorioamnionitis-exposed infants), 12 (4%) neonates received empiric antibiotic treatment compared to nine (3%) neonates who would have been treated per strict adherence to SRC recommendations. No neonate had culture-positive EONS. Continued use of 2010 CDC/AAP guidelines would have led to empiric antibiotic use in 38 (12.6%) infants in this cohort. Conclusion We developed a novel hybrid approach to the evaluation and management of neonates at increased risk of EONS by tailoring SRC recommendations to our safety-net population. Our stewardship effort achieved a safe and significant reduction in antibiotic usage compared to prior usage determined using CDC/AAP guidelines.

Perception of Acupuncture Compared with Biomedicine among Health Practitioners

Compared with biomedicine held by medical experts, perspectives on acupuncture may impact how the general populace uses acupuncture. Therefore, research on the opinions of medical professionals regarding acupuncture therapy is crucial. This cross-sectional study was conducted from July to September 2022 using a questionnaire. The study participants are doctors and nurses from three clinics in Bali province who had at least one year of working experience and were willing to be research respondents. Descriptive analysis and multiple logistic regression are used to determine the participants' perceptions and predictors of their perception. Of 155 participants, the majority (64%) have a positive perception of acupuncture compared with biomedicine. Participants with prior acupuncture usage were 9.01 times more likely than those without previous acupuncture use to have positive perceptions of acupuncture compared to biomedicine (Adj OR=9.01; 95% CI; p=0.001). The results of this study show that acupuncture is seen positively by health practitioners as an effective modality, has few side effects, and is supported by science. Health practitioners' perceptions are affected by their prior acupuncture experience. It is crucial to understand how medical professionals feel about acupuncture. Medical professionals' opinion impacts every patient's decision to seek therapy because one of their duties as specialists is to offer patients clinical judgment, information, and suggestions.

Risk factors for nosocomial rectal colonisation with carbapenem-resistant Gram-negative bacilli in children with haematological malignancies: a case-control study

BackgroundRectal colonisation with carbapenem-resistant Gram-negative bacilli (CR-GNB) may cause CR-GNB infection in children with haematological malignancies (HMs) haematological. To date, information on its epidemiology is limited. This study aimed to assess the the risk factors for rectal colonisation with CR-GNB in children with HMs.MethodsA case–control study in a tertiary children’s hospital in Hangzhou City, was conducted between July 2019, and September 2021. Based on the hospitalisation date, children in the CR-GNB colonisation group and control groups were matched at a ratio of 1:2. Conditional logistic regression models were used to compute the adjusted odds ratios (aORs) and 95% confidence intervals (CIs) of the risk factors for CR-GNB rectal colonisation in children with HMs.ResultsA total of 85 non-duplicated CR-GNB isolates were collected from rectal swab samples of 69 children with HMs. The 30-day mortality rates were 5.8% in the CR-GNB colonisation group and 0% in the control group (P = 0.020).colonisation In the conditional logistic regression model, the aORs were 6.84 (95% CI 1.86–25.20) for acute myeloid leukemia (AML) or acute lymphoblastic leukemia (ALL), 4.16 (95% CI 1.17–14.84) for prior concomitant infections within the last 1 month, 2.33 (95% CI 1.16–4.69) for prior carbapenems usage within the last 1 month and 7.46 (95% CI 1.81–30.67) for prior hematopoietic stem-cell transplantation (HSCT).ConclusionAML/ALL, prior concomitant infections within the last 1 month, prior carbapenems usage within the last 1 month, and prior HSCT are associated with an increased risk of rectal colonisation with CR-GNB in children with HMs.

Overall and patient-specific comparative effectiveness of dimethyl fumarate versus teriflunomide: A novel approach to precision medicine applied to the German NeuroTrans Data Multiple Sclerosis Registry.

Multiple sclerosis (MS) comparative effectiveness research needs to go beyond average treatment effects (ATEs) and post-host subgroup analyses. This retrospective study assessed overall and patient-specific effects of dimethyl fumarate (DMF) versus teriflunomide (TERI) in patients with relapsing-remitting MS. A novel precision medicine (PM) scoring approach leverages advanced machine learning methods and adjusts for imbalances in baseline characteristics between patients receiving different treatments. Using the German NeuroTransData registry, we implemented and internally validated different scoring systems to distinguish patient-specific effects of DMF relative to TERI based on annualized relapse rates, time to first relapse, and time to confirmed disease progression. Among 2791 patients, there was superior ATE of DMF versus TERI for the two relapse-related endpoints (p = 0.037 and 0.018). Low to moderate signals of treatment effect heterogeneity were detected according to individualized scores. A MS patient subgroup was identified for whom DMF was more effective than TERI (p = 0.013): older (45 versus 38 years), longer MS duration (110 versus 50 months), not newly diagnosed (74% versus 40%), and no prior glatiramer acetate usage (35% versus 5%). The implemented approach can disentangle prognostic differences from treatment effect heterogeneity and provide unbiased patient-specific profiling of comparative effectiveness based on real-world data.

Is ‘Cutting-Edge’ Good? Assessing Product Newness Factors in Technologically Turbulent Environments

Overview: Firms are constantly faced with the dilemma of developing products that are both cutting edge and also easily understood by customers. Customers may reject products that diverge too much from prior generations of products, but products that are too similar to prior products may not stand out. We analyzed 423 firms to better understand how both product newness to the firm and product newness to the customer impact NPD performance in varying environments. Our findings highlight that firms are generally effective at innovating on their own, but customers need some turbulence to adopt new innovations that are dissimilar to their prior usage experiences. Firms should continue to innovate and be ready when a turbulent environment provides innovative opportunities.

Does Previous Experience with the Unified Payments Interface (UPI) Affect the Usage of Central Bank Digital Currency (CBDC)?

In this study, we examined the influence of users’ experiences with the unified payments interface (UPI) system on the usage behavior of central bank digital currency (CBDC) in India. Our research developed a novel conceptual framework that investigated the relationships between technology, cognitive factors, and behavioral intentions towards CBDC use. The framework integrated UPI usage experience as a moderator within existing models of behavioral intentions and use behaviors. We collected data through a survey conducted in major Indian cities during the pilot launch of CBDC. By utilizing a partial least squares structural equation model (PLS-SEM), we analyzed the proposed model and the relationships between the constructs. Our findings revealed the significant impact of hedonic motivation and performance expectancy on users’ behavioral intentions towards CBDC. Social influence also played a significant role in CBDC usage. Furthermore, we identified that prior UPI usage negatively moderated the relationship between performance expectancy and behavioral intention, as well as the relationship between social influence and use behavior. However, prior UPI usage did not significantly moderate the relationships between perceived risk, hedonic motivation, behavioral intention, and use behavior. These findings contribute to our understanding of the factors influencing CBDC adoption and usage behavior in India.

Dynamic Charge Acceptance Compared to Electrochemical Impedance Spectroscopy Parameters: Dependencies on Additives, State of Charge, and Prior Usage

The goal of this work was to predict the dynamic charge acceptance (DCA) for cells using different additives on the negative electrode from the evaluation of small-signal measurements by electrochemical impedance spectroscopy (EIS). Thereby, various operating points were evaluated, such as state of charge (SoC) and prior usage (charge or discharge). The 2V test cells under investigation utilized plates of enhanced flooded 3P2N battery cells (EFB). They contained three positive and two negative electrodes. The latter varied in their additive composition. In total, eight different negative electrodes were investigated, five including specially synthesized amorphous carbon as an additive, two with unknown additive mixes, and one including a commercially available carbon black. The best parameters for predicting the DCA were found within the first semicircle of the negative half-cell spectra measured during a superimposed charging current.

Anticipatory value-in-use in early-stage digital health service transformations: How consumers assess value propositions before and after abrupt, exogenous shocks

Digital service transformations affect how consumers experience value-in-use. Yet, the process consumers use to evaluate value propositions for emergent, early-stage service transformations remains unclear. This is especially true for digital service transformations brought on by exogenous shocks requiring a near-immediate response. The abrupt lockdown of face-to-face services in response to the COVID-19 pandemic forced many organizations to launch remote offerings with little prior usage. In a telemedicine context, we develop an Anticipatory Value-in-Use Framework, investigating how consumers’ value-in-use process for a digital service transformation unfolds across three stages: value-in-use prerequisites, anticipatory value co-creation, and anticipatory value-in-use. Using SmartPLS we analyze 669 responses collected pre- and post-COVID-19 lockdown. Our results demonstrate the framework offers a consistent conceptualization of how consumers formulate anticipatory value-in-use when actual experience with the service transformation is lacking. However, consumers may weigh factors differently following exogenous shock-imposed transformations, requiring marketers to carefully articulate a transformation’s value propositions.

The comprehensive analysis of relationship between gut microbiome and treatment outcome of androgen deprivation therapy (ADT)-based treatment in patients with metastatic castration-sensitive and -resistant prostate cancer.

213 Background: Preclinical and clinical data from various types of cancer show that the gut microbiome can affect the outcome of treatments with immune checkpoint inhibitors or cytotoxic chemotherapies. However, the relationship between the microbiome and treatment outcomes in prostate cancer has remained unclear. Here, we present a comprehensive analysis of the relationship between the gut microbiome and treatment outcomes from a nationwide genome screening project (MONSTAR-SCREEN 1) in patients with metastatic castration-sensitive and -resistant prostate cancer (mCSPC and mCRPC). Methods: We performed 16S rRNA gene sequencing of fecal DNA from 73 mCSPC and 83 mCRPC patients before treatment. The microbiome data were compared using the Wilcoxon-Mann-Whitney test or Fisher’s exact test. Survival status and therapeutic efficacy of ADT based treatment were prospectively collected and estimated using the Kaplan-Meier method, and the log-rank test was used to compare survival in different strata. Results: Fecal samples from mCRPC had more Klebsiella and Enterobacteriaceae than those from mCSPC, whereas mCSPC had more Akkermansia and Bifidobacterium compared to mCRPC. Prior and concurrent usage of anti-biotics did not affect diversity of the amplicon sequence variants (ASVs), KEGG orthology and metabolism pathway representation. Anti-biotics also did not influence time to treatment failure (TTF) in mCRPC (HR:0.81, 95%CI:0.36–1.78) and mCSPC (HR:1.35, 95%CI:0.55–3.34). mCRPC had more diverse KEGG orthology compared to mCSPC ( p=0.0009), however, no statistical differences were observed in the ASV ( p=0.77) and metabolism pathway representation ( p=0.35) between mCRPC and mCSPC. High ASV tended to be associated with longer TTF rather than low ASV in both mCRPC (Adjusted HR:0.63, 95%CI:0.34–1.10) and mCSPC (Adjusted HR:0.66, 95%CI:0.31–1.40). mCRPC patients with high AVS also showed significant longer PSA-progression free survival than patients with low ASV (HR:053, 95%CI:0.28–0.99). Conclusions: This investigation revealed significant differences in the microbiome status of mCRPC compared to mCSPC. These differences and diversity might influence the outcomes of ADT based treatment in prostate cancer.

RISK PROFILE AND ANTIMICROBIAL SUSCEPTIBILITY PATTERN OF ACINETOBACTER BAUMANNIICLINICAL ISOLATES IN A TEACHING HOSPITAL IN HYDERABAD

Introduction:Acinetobacter baumannii is a frequent cause of healthcare associated infections, has the ability to develop resistance to antibiotics quickly and survive in the hospital environment over a long period, posing a challenge in treatment and infection control. Risk profile and antimicrobial susceptibility of Acinetobacter baumannii varies from place to place. Materials and methods: This study was conducted at a teaching hospital from January to December 2021. Relevant patient history regarding risk factors was taken. Acinetobacter baumannii identification and antimicrobial susceptibility testing from clinical samples was performed using the VITEK 2 system. Results: Out of a total of 3000 clinical samples processed, Acinetobacter baumannii was isolated in 114 (3.8%) of them. 61% were from males and 39% from females.62.3% isolates were from medicine department and 23.5% from general surgery.66.6% of the samples were from ICUs. Isolation was highest from respiratory samples followed by blood. Resistance was highest to cephalosporins followed by quinolones. The associated risk factors were age >50 years, co-morbidities, mechanical ventilation, prior antibiotic usage, invasive medical and surgical procedures and ICU stay. Conclusion: 74.5% of the isolates were resistant to carbapenems, which combined with risk factors noted in the study, narrows the choice of antibiotics. Varied antimicrobial susceptibility pattens across regions due to multiple reasons suggests the need for knowing local resistance rates to antibiotics. Timely and stringent infection control practices and appropriate use of antibiotics can play a vital role in reducing the burden of resistant strains while conserving and limiting antibiotic use.

P480 Ustekinumab Dose Intensification Is Effective in One-Third of Asian Inflammatory Bowel Disease Patients, Results From A Tertiary Inflammatory Bowel Disease Centre

Abstract Background Ustekinumab (UST) is an effective biologic for treatment of Inflammatory Bowel Disease (IBD). However, some patients treated with UST have suboptimal clinical response with standard induction and maintenance doses. In some patients, strategies such as dose intensification (DI) and reinduction have been used to improve response. The aims of this study are to identify factors associated with DI for our IBD cohort and also effectiveness of reinduction during DI. Methods This was a retrospective cohort study on patients with Crohn’s disease (CD) and ulcerative colitis (UC) who received UST from September 2017 to October 2022 in a tertiary center. Patients were identified from a prospectively maintained IBD registry. Patient’s demographics, biochemical profile, disease phenotype, UST intervals and previous use of biologics were retrieved. Statistical analysis was performed to identify factors which are predictive of UST DI and effectiveness of UST DI. Results A total of 63 patients with IBD on UST were identified, with most being bio-experienced (76.2%). Forty two patients (34 CD, 8 UC) underwent UST DI to either 6-weekly (n=19, 45.2%) or 4-weekly (n=23, 35.9%). The median duration of UST treatment is 108.0 weeks (IQR 44.7-185.9) while the median time to intensification was 31.1 weeks (IQR 17.8-65.7). Presence of perianal disease in CD (HR 4.9; 1.47 – 16.4) was associated with DI. However, prior usage of biologics (HR 1.61; 0.80 - 3.24) and usage of steroids during induction (HR 1.85; 0.69 – 4.91) were not significant factors for DI. After DI, there were 14 (33.3%) patients who achieved treatment end points (corticosteroid-free clinical remission, biochemical remission, endoscopic healing (for UC) or transmural healing (for CD) by week 52. In patients who had UST DI, UST re-induction was given to 13 (10 CD, 3 UC) and 4 achieved treatment endpoints but this was not statistically significant (p=0.99). There were 26 patients who failed to achieved end point at week 52 of which 8 patients were continued on UST at dose intensified regime while 11 patients were switched to other biologics. Conclusion Two third of IBD patients undergo DI while on UST treatment and the median time to DI is about 6 months after induction. CD patients with perianal disease is more likely to undergo DI. One third of dose intensified patients achieved remission at week 52 while reinduction of UST during DI did not improve outcome for patients.

331 Prior treatment usage in patients with atopic dermatitis initiating dupilumab: an update from the GLOBOSTAD registry

Abstract The efficacy and safety of dupilumab have been reported previously based on data from controlled clinical trials. The GLOBOSTAD study extends the scope of these trials by providing real-world data. This analysis reports prior treatment usage in patients with atopic dermatitis (AD) initiating treatment with dupilumab in a real-world setting. This 5-year, international, multicentre, non-interventional study (GLOBOSTAD; NCT03992417) included patients ≥12 years-old with moderate-to-severe AD (Investigator’s Global Assessment score ≥3) who initiated dupilumab treatment based on country-specific prescribing information. Data reported are for the population at baseline (N = 952, data cut-off: March 2022). At the study entry, the mean (standard deviation) Patient-Oriented Eczema Measure (POEM) score was 19.7 (6.4). POEM range is 0–28 and scores greater than 17 are consistent with severe or very severe disease. The mean (standard deviation) pruritus on the 0–10 Numerical Rating Scale (NRS) at study entry was 6.3 (2.1). Patient use of systemic treatments such as non-steroidal immunosuppressants (32.6%) and systemic corticosteroids (17.8%), as well as non-systemic treatments such as topical corticosteroids (47.2%) and calcineurin inhibitors (14.8%) in the 12 months preceding enrolment were reported. Ultraviolet phototherapy in the past 12 months was reported for 3.4% of patients. Patient-reported outcomes, including POEM and pruritus NRS, indicate a considerable burden of disease in patients with AD initiating dupilumab in the real world. A large proportion of patients from GLOBOSTAD reported the use of AD-specific systemic and non-systemic therapies prior to dupilumab initiation.

RISK FACTORS OR PREDICTORS OF DEVELOPING CIPROFLOXACIN, TRIMETHOPRIM/SULFAMETHOXAZOLE AND THIRD GENERATION CEPHALOSPORIN RESISTANCE IN ESCHERICHIA COLI INFECTIONS: A SYSTEMATIC REVIEW AND META-ANALYSIS

The Centers for Disease Control and Prevention (CDC) estimates that by 2050, ten million people a year could be dying as a result of Anti-Microbial Resistance (AMR). An increase in resistance has been observed for trimethoprim/sulfamethoxazole followed by ciprofloxacin and third-generation cephalosporins in the management of Escherichia coli infections. To identify risk factors for ciprofloxacin (Cip-REC), trimethoprim/sulfamethoxazole (TMP/SMX-REC,) and third-generation cephalosporin (TGC-REC) resistance in Escherichia coli infection relative to controls patients. A systematic search of MEDLINE/PubMed and Embase databases identified case-control, cohort, and cross-sectional studies on risk factors for Cip-REC, TMP/SMX-REC, and TGC-REC-infected patients. A random-effects model was used to pool odds ratios (ORs) of developing resistant E. coli infection. This study was registered with PROSPERO (CRD42022297043). A total of 23 studies were included (9891 participants). Overall, 22, 8, and 11 risk factors were identified for developing Cip-REC, TMP/SMX-REC, and TGC-REC infections respectively. The prior antibiotic use [OR=3.19] reported high pooled ORs for Cip-REC infection. TMP/SMX-REC infection was associated with genitourinary abnormalities [OR=2.91]. Further analysis unveiled potential factors for TGC-REC infection; prior history of admission [OR=3.14] and hemodialysis [OR=2.20]. Prior antibiotic usage, genitourinary disorders, and admission history increase the risk of Cip-REC, TMP/SMX-REC, and TGC-REC infections. Modifiable risk factors may help prevent resistant E. coli infection. KEYWORDS: Escherichia coli, Ciprofloxacin, Trimethoprim, Sulfamethoxazole, Third Generation Cephalosporin

Lipid Profile and Small Dense Low-Density Lipoprotein in Acute Coronary Syndrome Patients: Relationships to Demographic, Clinical, Angiographic, and Therapeutic Variables.

Several lines of evidence have supported small dense low-density lipoproteins (sd-LDL) as a marker of cardiovascular disease. The present study assessed the relationship between lipid profile and sd-LDL levels with demographic, clinical, angiographic, and therapeutic variables in acute coronary syndrome (ACS) patients. This was a single-centre, prospective, cross-sectional study conducted from September 2014 to September 2015. Patients with a diagnosis of ACS were included in this study. High-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) were determined by direct homogenous assay and sd-LDL levels were calculated using an earlier described equation by Srisawadi et al. Results: A total of 200 patients with a diagnosis of ACS were studied. Males constituted 78% of the population cohort and almost 45% of participants were aged <45 years. Patients aged ≤45 years displayed higher mean sd-LDL levels of 30.40 ± 14.18 mg/dL versus patients aged >45 years with mean sd-LDL levels of 28.01 ± 11.58 mg/dL, but the difference was not statistically significant (p = 0.19). Females also displayed higher mean sd-LDL levels, but the difference also failed to achieve statistical significance (30.95 ± 13.44 mg/dL and 28.54 ± 12.64, respectively; p = 0.185). Diabetics had higher mean sd-LDL levels (33.64 ± 13.01 mg/dL and 28.07 ± 12.60 mg/dL; p = 0.273) whilst smokers had lower mean levels (27.21 ± 12.12 mg/dL and 30.51 ± 13.21 mg/dL, respectively; p = 0.071). However, the ratio of sd-LDL/lb-LDL (large buoyant LDL) was significantly higher in diabetics (0.48 vs. 0.39; p = 0.023). In the angiography cohort (n = 88), single-vessel disease was the most predominant overall while among patients aged >45 years, triple-vessel disease was significantly higher (p = 0.005). Similarly, the sd-LDL levels were 33.12 ± 11.13 mg/dL, 27.68 ± 9.80 mg/dL, and 31.65 ± 15.26 mg/dL among patients with single, double, and triple-vessel disease and did not differ significantly (p = 0.262). Prior statin users had significantly lower mean sd-LDL levels of 24.79 ± 12.23 mg/dL compared to statin-naïve patients with a mean sd-LDL of 30.01 ± 12.79 mg/dL (p = 0.027). Non-HDL levels were also significantly lower in prior statin users (112.83 mg/dL vs. 128.9 mg/dL; p = 0.017). In this cohort of ACS patients, age, sex, diabetes, smoking, and the angiographic severity of coronary artery disease had no significant impact on sd-LDL levels, while prior statin usage led to significantly lower sd-LDL levels. Diabetic patients, however, did have significantly higher sd-LDL/lb-LDL ratios.

Initial statin dose after myocardial infarction and long-term cardiovascular outcomes.

Effective statin therapy is a cornerstone of secondary prevention after myocardial infarction (MI). Real-life statin dosing is nevertheless suboptimal and largely determined early after MI. We studied long-term outcome impact of initial statin dose after MI. Consecutive MI patients treated in Finland who used statins early after index event were retrospectively studied (N=72401; 67% men; mean age 68 years) using national registries. High-dose statin therapy was used by 26.3%, moderate dose by 69.2%, and low dose by 4.5%. Differences in baseline features, comorbidities, revascularisation, and usage of other evidence-based medications were adjusted for with multivariable regression. The primary outcome was major adverse cardiovascular or cerebrovascular event (MACCE) within 10 years. Median follow-up was 4.9 years. MACCE was less frequent in high-dose group compared with moderate dose [adjusted hazard ratio (HR) 0.92; P<0.0001; number needed to treat (NNT) 34.1] and to low dose [adj.HR 0.81; P<0.001; NNT 13.4] as well as in moderate-dose group compared with low dose (adj.HR 0.88; P<0.0001; NNT 23.4). Death (adj.HR 0.87; P<0.0001; NNT 23.6), recurrent MI (adj.sHR 0.91; P=0.0001), and stroke (adj.sHR 0.86; P<0.0001) were less frequent with a high- vs. moderate-dose statin. Higher initial statin dose after MI was associated with better long-term outcomes in subgroups by age, sex, atrial fibrillation, dementia, diabetes, heart failure, revascularisation, prior statin usage, or usage of other evidence-based medications. Higher initial statin dose after MI is dose-dependently associated with better long-term cardiovascular outcomes. These results underline the importance of using a high statin dose early after MI.

Filtration performance of three models of N95 filtering facepiece respirators following clinical usage and vaporized hydrogen peroxide decontamination

N95 filtering facepiece respirators (FFRs) are essential personal protective equipment (PPE) for protecting healthcare workers from airborne pathogens. To perform the first large-scale evaluation of particulate filtration efficiency (PFE) of three models of N95 FFRs following clinical usage and vaporized hydrogen peroxide (VHP) decontamination. Three variables were assessed for effect on PFE following VHP decontamination: VHP sterilizer model, N95 respirator model, and prior N95 clinical usage. The VHP sterilizer model and N95 FFR model impacted PFE performance. Worn N95 FFRs had a 91% lower odds of exhibiting ≥95% PFE compared with the control. This work highlights the importance of validating any N95 FFR decontamination programme in its entirety, including prior clinical usage.

Inferred Properties of Planets in Mean-motion Resonances are Biased by Measurement Noise

Planetary systems with mean-motion resonances hold special value in terms of their dynamical complexity and their capacity to constrain planet formation and migration histories. The key toward making these connections, however, is to have a reliable characterization of the resonant dynamics, especially the so-called “libration amplitude,” which qualitatively measures how deep the system is into the resonance. In this work, we identify an important complication with the interpretation of libration amplitude estimates from observational data of resonant systems. Specifically, we show that measurement noise causes inferences of the libration amplitude to be systematically biased to larger values, with noisier data yielding a larger bias. We demonstrated this through multiple approaches, including using dynamical fits of synthetic radial velocity data to explore how the libration amplitude distribution inferred from the posterior parameter distribution varies with the degree of measurement noise. We find that even modest levels of noise still result in a slight bias. The origin of the bias stems from the topology of the resonant phase space and the fact that the available phase-space volume increases nonuniformly with increasing libration amplitude. We highlight strategies for mitigating the bias through the usage of particular priors. Our results imply that many known resonant systems are likely deeper in resonance than previously appreciated.

Assessment of Water Quality Index and Non-Carcinogenic Risk for Ingestion of Nitrate for Drinking Purpose of Bhosga Reservoir, Karnataka, India

Reservoirs are vital water sources that contribute significantly to local ecological and environmental balance, particularly in semi-arid regions. An evaluation of the drinking water quality index (WQI) has been conducted using ten water parameters like electrical conductivity (EC), chloride (Cl-), pH, total hardness (TH), total alkalinity (TA), phosphate (PO43-), dissolved oxygen (DO), nitrate (NO3-), total dissolved solids (TDS), and sulfate (SO42-). Weighed Arithmetic Index technique is utilized for examining drinking water quality status and USEPA model was utilized to determine the non-carcinogenic risk for ingestion of nitrate of Bhosga reservoir of Kalaburagi district which was measured at five predefined sites from October 2020 to September 2021. All the parameters of potable water were below the allowable limits based on given standards. The maximum WQI results were reported in monsoon season, with a mean WQI value of 48.14 from all the five selected sites, with the pre &amp; post-monsoon seasons a mean WQI result of 46.08 and 43.68, respectively. Overall, the WQI value signifies that the water was of good quality, making it worthy for domestic use. The outcome of this study reveals that the pH and DO position have a substantial impact on reservoir WQI. Non-carcinogenic risk for nitrate ingestion reveled that, seasonal HQ average results for adults and children are ranging between 0.036 to 0.040 and 0.065 to 0.071, respectively and the HQ results for both adults and children were below 1, indicating neither adults nor children had any negative effect. Principal component analysis and cluster analysis revealed that primary causes of water quality degradation were agricultural runoff and anthropogenic activities. To ensure the security and the quality of water supply to people who live in the surrounding region, simple filter treating of reservoir water prior usage is needed.

34332 Treatment patterns and prior medication usage before dupilumab treatment initiation in patients with AD: Real-world data from GLOBOSTAD

Background: Previous dupilumab clinical trials have demonstrated efficacy with an acceptable safety profile in patients with moderate-to-severe atopic dermatitis (AD). Here we present an analysis of prior medication usage in patients initiating treatment with dupilumab enrolled in the GLOBOSTAD registry.