Ratio Of Days Research Articles

Effect of the Temperature-Humidity Index on the Productivity of Dairy Cows and the Correlation between the Temperature-Humidity Index and Rumen Temperature Using a Rumen Sensor.

This study was conducted to evaluate the effects of high-temperature stress on dairy cow productivity and the correlation between rumen sensors. The data were collected on the temperature, humidity, milk productivity, milk components, blood components, and rumen sensor data from 125 dairy cows during the experimental period (1 May 2020 to 30 October 2020). High-temperature stress of dairy cows was evaluated based on the temperature-humidity index (THI). The correlations between the high-temperature stress, productivity, and sensor data were analyzed using SAS and R programs. The THI ranged from 46.9 to 81.0 during the experimental period, and a significant decrease was observed in the milk production of dairy cows during August (p < 0.05). Milk production was evaluated to decrease by 1.8% because of high-temperature stress during the experimental period. There was a significantly high negative correlation between the THI ratio of day and rumen temperature (r = 0.744; p < 0.001). The other rumen sensor data did not show a significant correlation with the productivity of dairy cows. The results can be utilized as a guideline for managing temperature and humidity to maintain dairy cow productivity on farms in high-temperature stress conditions.

Allometric Growth Pattern and Hunger Tolerance of Hemibarbus maculatus Bleeker Larvae.

To clarify the allometric growth pattern and hunger tolerance of Hemibarbus maculatus Bleeker larvae, the morphological lengths of their functional organs were measured continuously and their primary feeding rates under a state of starvation were studied. A control group and starvation group were set up for this study, and 10 larvae were sampled from each group every day in order to study their allometric growth pattern and starvation tolerance. The results indicated that the Hemibarbus maculatus larvae opened their mouths for feeding at 4 days after hatching, and that the yolk sac disappeared completely at 11 days after hatching. The Hemibarbus maculatus larvae preferentially developed their heads, fins, and eyes, related to the functions of feeding, balancing, and swimming, in order to cope with complex environments. The growth inflection points for the head length, pectoral fin length, dorsal fin length, eye diameter, eye spacing, snout length, and body height were characterized by total lengths of 10.93 mm, 11.67 mm, 11.67 mm, 13.17 mm, 16.53 mm, 15.13 mm, and 15.13 mm, respectively. Prior to and following the inflection point, positive allometric growth was observed in all organs. After the inflection point, the dorsal fin continued to maintain positive allometric growth, while the others changed to isometric allometric growth. A growth inflection point was not observed for trunk length or the lengths of the tail and anal fins. The trunk length always maintained negative allometry, while the tail and anal fin lengths were reversed. The growth inflection point of the tail length was at a total length of 13.68 mm. Before and after the growth inflection point, negative and isometric allometric growths were observed, respectively. According to the relationship between the total length and number of days after hatching, the growth inflection point of the Hemibarbus maculatus larvae was concentrated at TL = 10.93-16.53 mm, which was observed 14-20 days after hatching. The point of no return for the Hemibarbus maculatus larvae was 12-13 days after hatching, and the ratio of days after hatching in the mixed trophic period to the endotrophic period was 1.75, indicating that the larvae had strong hunger tolerance. Therefore, when considering a water temperature of 22.66 ± 1.56 °C, 4-5 days after hatching is the best time to cultivate in the pond, and it should not be carried out later than 12 days after hatching.

Long-term healthcare use after postoperative complications: an analysis of linked primary and secondary care routine data

BackgroundPostoperative complications are associated with reduced long-term survival. We characterise healthcare use changes after sentinel postoperative complications. MethodsWe linked primary and secondary care records of patients undergoing elective surgery at four East London hospitals (2012–7) with at least 90 days follow-up. Complication codes (wound infection, urinary tract infection, pneumonia, new stroke, and new myocardial infarction) recorded within 90 days of surgery were identified from primary or secondary care. Outcomes were change in healthcare contact days in the 2 yr before and after surgery, and 2 yr mortality. We report rate ratios (RaR) with 95% confidence intervals and adjusted for baseline healthcare use and confounders using negative binomial regression. ResultsWe included 49 913 patients (median age 49 yr [inter-quartile range {IQR}: 34–64]), 27 958 (56.0%) were female. Amongst 3883 (7.8%) patients with complications (median age 58 [IQR: 43–72]), there were 18.4 days per year in contact with healthcare before surgery and 25.3 days after surgery (RaR: 1.38 [1.37–1.39]). Patients without complications (median age 48 [IQR: 33–63]) had 12.3 days per year in contact with healthcare before surgery and 14.0 days after surgery (RaR: 1.14 [1.14–1.15]). The adjusted incidence rate ratio of days in contact with healthcare associated with complications was 1.67 (1.49–1.87). More patients (391; 10.1%) with complications died within 2 yr than those without (1428; 3.1%). ConclusionsPatients with postoperative complications are older with greater healthcare use before surgery. However, their absolute and relative increases in healthcare use after surgery are greater than patients without complications.

Differential responses to systemic therapy among patients who are financially fragile and receiving Medicaid: Results from ePRO and biometric monitoring study.

1527 Background: Cancer patients with Medicaid insurance have a 50% higher risk of unplanned ED admissions during systemic chemotherapy compared to commercially insured cancer patients. In a prospective study of an ePRO app and smartwatch to remotely monitor patients receiving anti-cancer therapy, we compared symptoms and biometric data among financially fragile (able vs. not to come up with $2000 in 30 days for an unexpected expense) Medicaid enrollees and commercially insured patients with solid tumor malignancies. Methods: The study was conducted at 3 community oncology practices in WA state. (ML41539, ISRCTN25569053) The ePRO had 15 common treatment-related symptoms from the PRO-CTCAE survey. 30 patients initiating systemic treatment wore a Samsung Galaxy 3 watch and completed the ePRO daily on study provided smartphones for 2 weeks. EPRO app adherence (ratio of completed to expected entries) was 91%. Smartwatch adherence (ratio of days with any biosensor data to number of days expected) was 86%. Composite symptom scores were calculated from ePRO responses using a published mapping algorithm (Range 0-3). Repeat symptoms, number of unique symptoms scores &gt;1, and average heart rate (HR) were compared. Results: Participants’ average age was 60 (68% female; 75% no comorbidity, 45% metastatic, 10% Medicaid, 13% reported financial fragility). Treatments: chemotherapy only (56%); immunotherapy only (11%); combination therapy (33%). Financially fragile patients had significantly higher average HR, unique symptoms, and repeat symptoms (e.g., &gt;1 day with symptoms). The average composite symptom score over 2 weeks was significantly higher for Medicaid enrollees, and trended higher for financially fragile patients. 16% of daily composite symptom scores recorded by Medicaid patients were 2 or greater, versus 7% for non-Medicaid patients (p&lt;0.001). Conclusions: Medicaid-insured and financially fragile patients may have more adverse responses to systemic therapy compared to more advantaged patients. If supported in larger studies, the findings may have profound implications for research aimed at improving clinical management in financially disadvantaged cancer patients.[Table: see text]

Antibiotic therapy is associated with adverse drug events among older adults with advanced cancer: A cohort study

Background: Older adults with advanced cancer are exposed to antibiotics but estimates of adverse drug events associated with antibiotic therapy are lacking. Aim: Evaluate the association of antibiotic therapy with adverse drug events in older adults with advanced cancer. Design: Cohort study where the exposure was the ratio of days of therapy of an oral or intravenous antibiotic per patient-day and the outcome was an adverse drug event, defined as cardiotoxicity, hepatotoxicity, nephrotoxicity, Clostridioides difficile infection, or new detection of a multidrug-resistant organism. Setting/participants: Patients aged ⩾65 years with solid tumors from a tertiary care center who received palliative chemotherapy (n = 914). Results: Mean age was 75 ± 6.6 years, and 52% were female. Common tumors were lung (31%, n = 284) and gastrointestinal (26%, n = 234). Mean time from first course of palliative chemotherapy to index admission was 128 days. Five-hundred thirty (58%) patients were exposed to antibiotics during the index admission; of these, 27% (n = 143) met standardized criteria for infection. Patients were commonly exposed to cephalosporins (33%, n = 298) and vancomycin (30%, n = 276). Among patients exposed to antibiotics, 35% (n = 183/530) developed an adverse drug event. In multivariable testing, antibiotic therapy was associated with development of an adverse drug event (>0 to <1 vs 0 days of therapy/patient-day: adjusted odds ratio [aOR] = 1.9; 95% confidence interval [CI], 1.2–2.8; ⩾1 vs 0 days of therapy/patient-day: aOR = 2.1, 95% CI, 1.4–3.0). Conclusion: Antibiotic therapy was independently associated with adverse drug events in hospitalized older adults with advanced cancer. These findings may inform antibiotic decision-making among palliative care providers.

Early prediction of the failure of methotrexate treatment by Days 1–4 serum β-hCG change and 48-hour pre-treatment increment inβ-hCG

To determine whether the change of serum β-hCG levels between Days 1 and 4 and 48-h pre-treatment increment in β-hCG can early predict treatment failure of single-dose methotrexate (MTX) in tubal ectopic pregnancies (EP), a retrospective study of 1120 ectopic pregnancies treated with a regimen of a single dose of MTX was conducted in the Department of Obstetrics and Gynaecology, Shanghai First Maternity and Infant Hospital. Treatment failure was defined by an obligation to proceed to surgery or have an additional doses of methotrexate.1350 files were reviewed, with 1120 included for final analysis .64% (722/1120) had β-hCG levels increase on Day 4 after MTX treatment, while 36% (398/1120) had β-hCG levels fall. In this cohort, the treatment failure rate with a single dose of MTX was 15.7% (113/722), and the significant features in the logistic regression model of diagnosing the results of MTX treatment were the ratio of Day 1 to Day 48-h pre-treatment β-hCG values (Odds Ratio (OR) 1.221, 95% Confidence interval (CI) 1.159–1.294), the ratio of Day 4 to Day 1 β-hCG serum values (OR 1.098, 95% CI 1.014–1.226), and β-hCG values on Day 1 (OR 1.070, 95% CI 1.016–1.156). The decision tree model was developed by using increment of β-hCG in 48 h before treatment > =19%, the ratio of Day 4 to Day 1 β-hCG serum values > =36%, and β-hCG values on Day 1> =728 mIU/L to predict the failure of MTX treatment. The diagnostic accuracy, sensitivity and specificity in the test group were 97.22%, 100%, and 96.9%, respectively. IMPACT STATEMENT What is already known on this subject? A decrease of 15% β-hCG levels between Days 4 and 7 is a common protocol for predicting the success of a single-dose methotrexate therapy of an ectopic pregnancy. What do the results of this study add? This clinical study offers the cut-off values points for prediction of single-dose methotrexate treatment failure. What are the implications of these findings for clinical practice and/or further research? We identified the importance of β-hCG increase between Days 1 and 4 and β-hCG increment in 48 h pre-treatment for predicting the failure of single-dose methotrexate therapy. It can be used to aid the clinician to optimise the selection of the most appropriate treatment methods during a follow-up evaluation after MTX treatment.

DECREASE IN THE PLATELET-TO-LYMPHOCYTE RATIO IN DAYS AFTER ADMISSION FOR SEPSIS CORRELATES WITH IN-HOSPITAL MORTALITY.

Background: A previous study has linked an increase in platelet-to-lymphocyte ratio (PLR) to a poor prognosis; however, the relationship between early change in PLR and outcomes in sepsis patients is unclear. Methods : The Medical Information Mart for Intensive Care IV database was for this retrospective cohort analysis on patients meeting the Sepsis-3 criteria. All the patients meet the Sepsis-3 criteria. The platelet-to-lymphocyte ratio (PLR) was calculated by dividing the platelet count by the lymphocyte count. We collected all PLR measurements that were available within 3 days of admission for analysis of longitudinal changes over time. Multivariable logistic regression analysis was used to determine the relationship between the baseline PLR and in-hospital mortality. After correcting for possible confounders, the generalized additive mixed model was used to examine the trends in PLR over time among survivors and nonsurvivors. Results: Finally, 3,303 patients were enrolled, and both low and high PLR levels were significantly associated with higher in-hospital mortality in the multiple logistic regression analysis (tertile 1: odds ratio, 1.240; 95% confidence interval, 0.981-1.568 and tertile 3: odds ratio, 1.410; 95% confidence interval, 1.120-1.776, respectively). The generalized additive mixed model results revealed that the PLR of the nonsurvival group declined faster than that of the survival group within 3 days after intensive care unit admission. After controlling for confounders, the difference between the two groups steadily decreased and increased by an average of 37.38 daily. Conclusions : There was a U-shaped relationship between the baseline PLR and in-hospital mortality of sepsis patients, and there was a significant difference between the nonsurvival and survival groups in the change in PLR over time. The early decrease in PLR was related to an increase in in-hospital mortality.

DEVELOPMENT OF A METHODOLOGY FOR MODELING THE STATE OF THE WATER ECOSYSTEM BASED ON THE METHODS OF ECOLOGICAL STOICHIOMETRY, TAKING INTO ACCOUNT THE ENERGY APPROACH

The article develops a methodology for modeling the state of the food chain of the aquatic ecosystem in terms of biomass growth of producers based on ecological energy stoichiometry. The research is based on a number of sinusoidal functions developed during the simulation of the monthly solar energy arrival per unit area by latitude. The average forecast indicator of energy input for southern Ukraine of 2518 MJ/m2 is very close to the results of similar applied measurements in Odesa. For modeling, the average latitude for Ukraine is 48°23′, the average inclinations of the sun for each of the 8 months according to the astronomical calendar (about 14), as well as the average duration of a sunny day, and the angle of incidence and reflection of the sun’s rays on water are determined based on them, taking into account only the angle of incidence at noon, and changes during the day (the angle of reflection ranges from 17.5 in June to 29.26 in September). Correction coefficients for latitude were derived, the percentage ratio of days with cyclonic weather, due to which there is an increase in reflection due to cloudiness and waves, was calculated – 638 hours and 30 minutes. The efficiency of photosynthesis for the main groups of phytoplankton organisms was calculated, which is 1.98 % for Chlorophyta, 2.38 % for Cyanophyta, 1.96 % for Euglenophyta and 1.65 % for all others. The overall average efficiency of photosynthesis was thus 1.83 %. Taking into account the area of ​​the water mirror, the arrival of energy, reflection, scattering and absorption. Taking into account the efficiency of photosynthesis, a stoichiometric simulation of the increase in biomass of producers was carried out. The potential of carbon dioxide deposition is 2.6 kg/m2 per year, oxygen release is 1.92 kg/m2, and biomass growth is 1.8 kg/m2. This is the maximum potential. The study is supplemented by derived correction factors based on energy and toxicological indices of environmental safety, ORP and the Redfield ratio. This gives a real total energy per square meter of 12335.66473 kJ, biomass growth of 773.1266184 g/m2. The predictive model yields 577.6 kg/ha per year of fish, which is close to the value of natural bioproductivity for herbivorous fish (505 kg/ha). At the stage of food chain analysis, it is proposed to additionally use the deduced regularity of the effect of salinity on the growth of macroliths and correction coefficients of fish productivity for different soils. The basis for automation and local modeling is laid.

Enzobiotics-A Novel Therapy for the Elimination of Uremic Toxins in Patients with CKD (EETOX Study): A Multicenter Double-Blind Randomized Controlled Trial.

Design, participants, setting, and measurements: Predialysis adult participants with chronic kidney disease (CKD) and mean estimated glomerular filtration rate (eGFR) <45 mL/min per 1.73 m2) were recruited in 2019 to a multicentric double-blinded randomized controlled trial of enzobiotic therapy (synbiotics and proteolytic enzymes) conducted over 12 weeks. The primary objective was to evaluate the efficacy and safety of enzobiotics in reducing the generation of p-cresol sulfate (PCS) and indoxyl sulfate (IS), stabilizing renal function, and improving quality of life (QoL), while the secondary objective was to evaluate the feasibility of the diagnostic prediction of IS and PCS from CKD parameters. Results: Of the 85 patients randomized (age 48.76 years, mean eGFR 23.24 mL/min per 1.73 m2 in the placebo group; age 54.03 years, eGFR 28.93 mL/min per 1.73 m2 in the enzobiotic group), 50 completed the study. The absolute mean value of PCS increased by 12% from 19 µg/mL (Day 0) to 21 µg/mL (Day90) for the placebo group, whereas it decreased by 31% from 23 µg/mL (Day 0) to 16 µg/mL (Day 90) for the enzobiotic group. For IS, the enzobiotic group showed a decrease (6.7%) from 11,668 to 10,888 ng/mL, whereas the placebo group showed an increase (8.8%) from 11,462 to 12,466 ng/mL (Day 90). Each patient improvement ratio for Day 90/Day 0 analysis showed that enzobiotics reduced PCS by 23% (0.77, p = 0.01). IS levels remained unchanged. In the placebo group, PCS increased by 27% (1.27, p = 0.14) and IS increased by 20% (1.20, p = 0.14). The proportion of individuals beyond the risk threshold for PCS (>20 µg/mL) was 53% for the placebo group and 32% for the enzobiotic group. The corresponding levels for IS risk (threshold >20,000 ng/mL) were 35% and 24% for the placebo and enzobiotic groups, respectively. In the placebo group, eGFR decreased by 7% (Day 90) but remained stable (1.00) in the enzobiotic group. QoL as assessed by the adversity ratio decreased significantly (p = 0.00), highlighting an improvement in the enzobiotic group compared to the placebo group. The predictive equations were as follows: PCS (Day 0 = −5.97 + 0.0453 PC + 2.987 UA − 1.310 Creat; IS (Day 0) = 756 + 1143 Creat + 436.0 Creat2. Conclusion: Enzobiotics significantly reduced the PCS and IS, as well as improved the QoL.

Clinical severity scores as a guide for prediction of initial treatment responses in pemphigus and pemphigoid patients.

Pemphigus and pemphigoid are autoimmune blistering diseases that affect mucosa and skin. Several clinical scoring systems, including the pemphigus disease area index (PDAI) and the bullous pemphigoid disease area index (BPDAI), have been validated for managing disease activity and severity. Current guidelines recommend that treatment response be evaluated with clinical scores and that additional second-line therapies be considered if initial treatment is insufficient for disease control. However, there have been few studies analyzing correlations between PDAI/BPDAI transitions and initial treatment effects. To investigate whether PDAI/BPDAI transitions during the treatment initiation phase correlate with initial treatment responses and whether such information can be used as a guide for necessary additional treatment, we retrospectively analyzed 67 pemphigus patients and 47 pemphigoid patients who received initial treatment at Keio University between 2012 and 2018. The clinical symptoms were evaluated weekly with PDAI/BPDAI. The patients were divided into two groups: in group A, disease was controlled only with oral corticosteroids and immunosuppressants (initial treatment), whereas in group B additional therapies were required due to insufficient responses. In pemphigus, the PDAI ratio of day 7/day 0 was significantly reduced in group A compared to group B (0.548 vs 0.761, P < 0.01) after initial treatment had started. In pemphigoid, the ratios of day 7/day 0 of BPDAI (erosion/blister) and BPDAI (urticaria/erythema) significantly decreased in group A compared to group B (0.565 vs 0.901 and 0.350 vs 0.760, respectively, P < 0.05). Receiver operating characteristic analyses on PDAI, BPDAI (erosion/blister) and BPDAI (urticaria/erythema) revealed that the cut-off values in the ratios of day 7/day 0 were 0.762, 0.675, and 0.568, respectively. Our results suggest that PDAI/BPDAI transitions during the initial phase of the treatments may be useful to predict the outcome of the treatment provided and the necessity of additional therapies to achieve disease control.

Characteristics and Prognostic Factors of Non-HIV Immunocompromised Patients With Pneumocystis Pneumonia Diagnosed by Metagenomics Next-Generation Sequencing.

ObjectiveThe aim of this study was to evaluate the potential of metagenomic next-generation sequencing (mNGS) for the diagnosis of pneumocystis pneumonia (PCP) in patients with non-human immunodeficiency virus-infection and to discuss the clinical characteristics and identify prognostic factors associated with patients with non-HIV PCP.MethodsForty-six patients with PCP who were admitted in respiratory intensive care unit (ICU) between May 2018 and May 2020 were retrospectively reviewed. The subjects were divided into survivor and non-survivor groups according to the patients' outcome. Conventional methods and mNGS for detecting Pneumocystis jirovecii (P. jirovecii) were analyzed. The patients' demographics, comorbidities, laboratory parameters, and treatments were compared and evaluated in both groups to identify risk factors for mortality by using univariate and multivariate logistic regression.ResultsMetagenomic next-generation sequencing (mNGS) showed a satisfying diagnostic performance of 100% positive of detecting P. jirovecii from bronchoalveolar lavage (BAL) specimens in forty-six patients with non-HIV PCP, compared to only 15.2% for Gomori Methenamine silver (GMS) staining and 84.8% for Serum 1,3-beta-D-glucan (BDG). Among them, the mean age was 46.4-year-old (range 18–79-year-old) and mortality rate was 43.5%. The dominant underlying conditions were connective tissue diseases (34.8%), autoimmune kidney diseases (30.4%), followed by hematologic malignancies (10.9%), and solid organ transplantation (6.5%). A total of 38 cases (82.6%) received glucocorticoid and 19 cases (41.3%) used immunosuppressant within 3 months before diagnosed PCP. Multiple infections were very common, over two thirds' cases had mixed infections. Compared with survivors, non-survivors had a higher acute physiology and chronic health evaluation II (APACHE II) score (14.4 ± 4.8 vs. 10 ± 3.4), Procalcitonin (PCT) [ng/ml: 0.737 (0.122–1.6) vs. 0.23 (0.095–0.35)], lactic dehydrogenase (LDH) [U/L: 1372 (825.5–2150) vs. 739 (490.5–956)], and neutrophil-lymphocyte ratio (NLR) [21.6 (15.67–38.2) vs. 11.75 (5.1–15.52)], but had a lower PaO2/FiO2 ratio (mmHg:108.8 ± 42.4 vs. 150.5 ± 47.5), lymphocytes [×109/L: 0.33 (0.135–0.615) vs. 0.69 (0.325–1.07)] and CD4+ T cells [cell/μl: 112 (53.5–264) vs. 255 (145–303.5)], all P < 0.05. Furthermore, we found non-survivors' PaO2/FiO2 ratio of day 3 and day 7 had not improved when compared with that of day one, and platelet level and NLR became worse. Multivariate analysis showed that other pathogens' co-infection (OR = 9.011, 95% CI was 1.052–77.161, P = 0.045) and NLR (OR = 1.283, 95% CI was 1.046–1.547, P = 0.017) were the independent risk factors of poor prognosis.ConclusionmNGS is a very sensitive diagnostic tool for identifying P. jirovecii in patients who are non-HIV immunocompromised. PCP in patients who are non-HIV infected is associated with a high rate of multiple infections and severe condition. Mixed infection and elevation of NLR were the independent risk factors of poor prognosis.

Differential Effects of Gamma-Aminobutyric Acidergic Sedatives on Risk of Post-Extubation Delirium in the ICU: A Retrospective Cohort Study From a New England Health Care Network.

To evaluate whether different gamma-aminobutyric acidergic (GABAergic) sedatives such as propofol and benzodiazepines carry differential risks of post-extubation delirium in the ICU. Retrospective cohort study. Seven ICUs in an academic hospital network, Beth Israel Deaconess Medical Center (Boston, MA). Ten thousand five hundred and one adult patients mechanically ventilated for over 24 hours. None. We tested the hypothesis that benzodiazepine versus propofol-based sedation is associated with fewer delirium-free days within 14 days after extubation. Further, we hypothesized that the measured sedation level evoked by GABAergic drugs is a better predictor of delirium than the drug dose administered. The proportion of GABAergic drug-induced deep sedation was defined as the ratio of days with a mean Richmond Agitation-Sedation Scale of less than or equal to -3 during mechanical ventilation. Multivariable regression and effect modification analyses were used. Delirium-free days were lower in patients who received a high proportion of deep sedation using benzodiazepine compared with propofol-based sedation (adjusted absolute difference, -1.17 d; 95% CI, -0.64 to -1.69; p < 0.001). This differential effect was magnified in elderly patients (age > 65) and in patients with liver or kidney failure (p-for-interaction < 0.001) but not observed in patients who received a low proportion of deep sedation (p = 0.95). GABAergic-induced deep sedation days during mechanical ventilation was a better predictor of post-extubation delirium than the GABAergic daily average effective dose (area under the curve 0.76 vs 0.69; p < 0.001). Deep sedation during mechanical ventilation with benzodiazepines compared with propofol is associated with increased risk of post-extubation delirium. Our data do not support the view that benzodiazepine-based compared with propofol-based sedation in the ICU is an independent risk factor of delirium, as long as deep sedation can be avoided in these patients.

Factors influencing medication adherence among U.S. Medicare beneficiaries with Alzheimer’s disease and related dementia (ADRD)

AbstractBackgroundFor persons with ADRD, access to specialist physicians facilitates appropriate medication use and adherence with treatment. Our objective was to ascertain whether system‐level factors, including availability of specialty physicians predicts ADRD medication adherence among community‐dwelling older adults.MethodWe conducted secondary analyses of claims data for Medicare beneficiaries with ADRD in 2013‐2015. Medication adherence was measured using the proportion of days covered (PDC); i.e., ratio of days with ADRD prescriptions over total days of follow‐up. Adherence was defined as PDC &gt;=0.8. Multivariable‐adjusted Modified Poisson regression was used to examine associations of adherence with physicians' availability (defined as number of neurologists and psychiatrist per 1K county population from Area Health Resources File [AHRF]). Analyses adjusted for predisposing factors (sex, race, and age); enabling factors (Medicare/Medicaid dual eligibility, Area Deprivation Index), need factors Alzheimer's disease vs. other) and comorbidities. Context level characteristics from AHRF included county‐level education, urban/rural residence, income/poverty indicator, and mental health professionals shortage area. Because the “Deep South” (DS) region of the US has a shortfall of specialists, we also considered geographic location.ResultWe identified 54,194 Medicare Beneficiaries. The race/ethnicity distribution of the sample was 81.44% white, 9.17 % black, 6.24 % Hispanic, 2.25 % Asian, and 1% other; 71.8 % were female, and 42.36% were &gt;85 years. Bivariate analyses revealed significant differences between DS and non‐DS in all individual and contextual characteristics except sex and comorbidities. Specialists' availability was not significantly associated with adherence to ADRD medication: Neurologists RR: 1.0080, CI (0.9789‐1.0380) and Psychiatrists RR: 1.0066 CI (0.9948‐1.0186). Age, dual eligibility, and living in non‐large metropolitan areas were associated with a higher probability of adherence. Race, comorbidities, having ≥1 visit with specialists, and context factors such as living in deprived and lower education areas were associated with a lower probability of adherence.ConclusionAdherence to ADRD medications was not associated with specialist availability but was related to individual and socioeconomic context factors in community‐dwelling older individuals with ADRD. Research should continue ascertaining factors that may influence medication adherence, particularly communities with a higher prevalence of ADRD risk factors, a greater proportion of minorities and socially at‐risk people, and health disparities.

OPTIMIZATION OF TROLLEYBUS TRACTION BATTERY PARAMETERS WHEN PARTIAL AUTONOMOUS RUNNING

The article describes the method of determining the optimal capacity of the traction battery of a trolleybus with autonomous travel depending on the share of the route without a catenary. In modern cities, there is often a situation in which on some sections of trolleybus routes for various reasons there is no contact network for trolleybus traffic. The solution to the problem of ensuring the movement of trolleybuses on such routes may be the use of autonomous trolleybuses, which use the energy of the traction battery (TAB). The battery may be partially or fully recharged while the trolleybus is running on mains power. In case of incomplete charging of the battery while driving on the route, the TAB can receive a full charge during the sludge of the trolleybus in the park after the change at the night rate, which is usually less than the day rate for electricity. The optimal capacity of the traction battery in such conditions corresponds to the minimum cost of energy and equipment for trolleybus traffic, depends on the size of the route without a catenary, the physical capacity of the network to charge the battery, and the ratio of day and night electricity tariffs. Determining the optimal capacity of TAB for operation on routes where there is no contact network is an important task. The article shows that the minimum capacity of the TAB Етаб should be such as to ensure the movement of the trolleybus on the site without a catenary. In this case, there is a value of the share of the route without a catenary, at which the TAB can be fully charged from the network when moving on the section with the network. Further, when increasing the share of the route without a catenary, the TAB of the trolleybus needs to be recharged either at the end of the route or after the change in the depot or sludge point and a corresponding increase in the required capacity of the TAB by the amount of undercharging. In this case, it may be more cost-effective to charge the TAB using the night rate, which is usually much lower than the day rate. It is determined that in terms of the cost of electricity per movement when charging TAB at the night rate, the use of an electric bus can be more cost-effective compared to an autonomous trolleybus, especially in the complete absence of a catenary. The method does not take into account energy losses in accordance with the factors of operation climatic conditions as well as the efficiency of chargers and associated automatic control, the design possibility of energy recovery on the route, the load of the trolleybus during the work shift, which requires a separate study. The results of the article can be used when autonomous trolleybuses production. Projected assumptions about the development of the object of study – further research should be aimed at a detailed study of the impact of all components of the vehicle on the cost of its operation in different conditions.

P–518 Assessment of mitochondrial DNA viability ratio in day–4 biopsied embryos as an add-in to select euploid embryos for single embryo transfer

Abstract Study question Is mitochondrial DNA viability ratio of day–4 biopsied embryos associated with embryo implantation potential? Summary answer The mitochondrial DNA viability ratio is significantly higher in embryos that implant. The score might help to select euploid embryos for single embryo transfer. What is known already Embryo euploidy is a critical factor for successful pregnancy outcomes. However, transfer of euploid embryos does not invariably result in implantation, thus indicating that other factors may play a role. Metabolic rates and adenosine triphosphate content vary significantly in oocytes and embryos and might affect embryo viability. Embryo function, indirectly measured by mitochondrial DNA viability ratio (mtV) has emerged as a potential quantitative biomarker for embryonic selection before the transfer, but clinical data remains limited. The purpose of this study is to characterize and compare mtV in euploidy day 4 embryos. Study design, size, duration Retrospective cohort study carried out between Jan. 2017 to Jan. 2020, involving 75 infertile couples undergoing IVF-ICSI with PGT-A and single embryo transfer (SET) of day 4 euploid embryos. Participants/materials, setting, methods We compared the mtV ratios of 34 non-pregnant patients with those of 41 patients who achieved clinical pregnancy after SET. The mtV ratio was obtained from a cohort of 75 euploidy embryos. The embryos were biopsied 80–85 hours post–ICSI and subjected to next-generation sequencing (NGS). The mtV was determined using Multiple of Mean (MoM) values, obtained by dividing the mtV ratio of individual embryos by the mean mtV value of all implanted embryos. Main results and the role of chance The mean mtV ratio (1.51; 95% confidence interval [CI] 1.25–1.77) of non-pregnant patients was significantly lower than those of pregnancy counterparts (2.5; 95% CI 1.82–2.68; p &amp;lt; 0.01). At a 0.5 MoM cutoff, the sensitivity and specificity of mtV ratio to discriminate between implanted embryos versus non-implanted embryos were 35.3% and 78.2%, respectively., with a positive predictive value (PPV) of 41.4%. Limitations, reasons for caution Our study is limited by the small sample size and lack of stratification by causes of female/male infertility. Endometrial receptivity issues, which could have contributed to implantation failure, was not evaluated. Wider implications of the findings: Assessment of mtV ratio could provide additional prognostic information for selecting euploid embryos for transfer in SET programs. Further research is warranted to establish the clinical utility of routine application of mtV evaluation in PGT programs. Trial registration number N/A

Urinary Steroid Metabolome Signature is Associated With Cognitive Function in Older Adults

Abstract Background: Elevated urine cortisol (&amp;lt;1% of urinary steroid metabolome) was reported to predict future development of dementia. Our objective was to determine the association of urine steroid metabolome and its diurnal variation with cognitive function in men and women. Methods: Cross-sectional study of community-dwelling adults ≥ 50 years. Participants with adrenal disorders, end-stage renal or liver disease, on exogenous steroids or drugs affecting steroid metabolism were excluded. All participants completed day and night separate urine collection. A series of seven IPad-based tests using the National Institute of Health Toolbox Cognition Battery were administered to evaluate five key domains; performance was reported using fully corrected T-scores for age, sex, education, and race with a national normative mean of 50. T-scores were generated for the two summary measures: 1) fluid cognition (includes executive function, episodic memory, working memory, and processing speed), and 2) total composite (composite of fluid and language score). Urine samples were analyzed with the liquid-chromatography, high-resolution, accurate-mass mass spectrometry for 25 urine steroid metabolites. Results: Of 109 participants, 56 (51%) were women, and age and educational status were similar in men and women. On cognitive assessment, men and women had similar median composite cognition (T-score of 53 vs 54, p=0.74) and fluid cognition (T-score of 53 vs 51, p-value 0.96). Urine steroid metabolome analysis demonstrated 21/25 steroids were higher in men vs women. In both women and men, the ratio of total cortisol metabolites/total androgen metabolites (TCM/TAM) was associated with lower fluid cognition (women: ρ= -0.34, p=0.01, men: ρ= -0.43, p=0.001) and composite cognition (women: ρ= -0.27, p=0.04, men: ρ= -0.39, p=0.004). Higher ratio of day to night TCM were associated with a better fluid cognition in men (ρ= 0.35, p=0.01), but not in women (ρ= -0.11, p=0.41). Steroid ratios suggesting a relative enzymatic deficiency of 5α-Reductase type 2 was associated with lower fluid cognition in women (ρ= -0.29, p=0.03). In men, the fluid composite score was associated with a relative deficiency in 21-Hydroxylase (ρ= 0.42, p=0.002), 3β-Hydroxysteroid dehydrogenase (ρ= 0.43, p=0.001), and P450oxidoreductase (ρ= -0.35, p=0.01). Conclusion: We showed that a higher glucocorticoid to androgen ratio and a flattened circadian steroid variation were associated with lower global and fluid cognition score. Steroid ratios reflecting steroidogenesis enzymatic activity demonstrated sex differences in relation to cognition. Additional studies should examine whether the steroid fingerprint associated with lower cognition is predictive of a future dementia onset.

Digital PCR Detection of mtDNA/gDNA Ratio in Embryo Culture Medium for Prediction of Embryo Development Potential.

PurposeThe ratio of mitochondrial DNA to genomic DNA (mtDNA/gDNA) in embryo culture medium as a predictor of embryonic development is a new method of noninvasive embryo screening. However, current tests based on this concept have proven inconsistent. The aim of this study was to define the predictive value of the ratio of mtDNA/gDNA for embryonic developmental potential.Materials and MethodsWe used digital PCR to measure mtDNA/gDNA ratios in day 3 culture media of 223 embryos from 56 patients. We compared the relationship between the predictive value of mtDNA/gDNA ratio and each of embryo fragmentation, embryo morphological grade, and blastocyst formation.ResultsmtDNA/gDNA ratio decreased significantly with a decrease in embryo rating: 22.54 (44.66); 31.25 (36.97) and 46.33 (57.11); Grades A vs C, P = 0.006; B vs C, P = 0.015. mtDNA/gDNA ratio increased overall with an increase in embryo fragment content but did not differ significantly between high-, -medium, and poor-quality embryos. Interestingly, this trend differed from that of the unformed blastocysts. mtDNA/gDNA ratio of cleavage stage embryos forming blastocysts was lower (P=0.005). Trends of mtDNA/gDNA ratio differed according to inner cell mass (ICM) and trophectoderm (TE) levels, but not significantly. mtDNA/gDNA ratio in day 3 culture medium was not significantly improved over morphological scores.ConclusionWe hereby show the correlation of mtDNA/gDNA ratio in the culture medium of developing embryos. The correlation between the mtDNA/gDNA ratio and early embryonic development was controversial. Furthermore, an increase in mtDNA/gDNA ratio might indicate reduced development potential, but the difference remains insufficient for application as a clinical predictor.

Effectiveness of chest physiotherapy using passive slow expiratory techniques in dogs with airway fluid accumulation: A randomized controlled trial.

BackgroundProlonged slow expiration (PSE) and assisted cough (AC) are airway clearance techniques feasible and well tolerated in dogs.ObjectivesTo evaluate the effectiveness of PSE and AC as chest physiotherapy (CP) techniques in dogs with airway fluid accumulation.AnimalsThirty‐one client‐owned dogs hospitalized in an intensive care unit from October 2014 to May 2018.MethodsProspective randomized controlled trial. Dogs presented with or developing acute dyspnea during hospitalization associated with airway fluid accumulation were assigned to CP group (medical treatment and CP, 15 dogs) or control group (medical treatment alone, 16 dogs). The arterial partial pressure of oxygen (PaO2) to fraction of inspired oxygen (FiO2) ratio (P/F ratio; PaO2/FiO2 × 100) was calculated daily for the 1st 48 hours of hospitalization and using the last arterial blood gas performed before discharge or death. The ratio of days of hospitalization with oxygen/total number of hospitalization days (ratio of oxygen‐free‐days [O2Free]) was calculated.ResultsDuring the 1st 48 hours, the P/F ratio increased significantly in the CP group compared to the control group (+ 35.1 mm Hg/day; 95% confidence interval [CI] = 0.4‐57.5; P = .03). The (median; 1st quartile to 3rd quartile) difference between the P/F ratio at discharge and inclusion was significantly higher in the CP group (178 mm Hg; 123‐241) than in the control group (54 mm Hg; −19 ‐ 109; P = .001). Mean O2Free increased by 46.4% in the CP group compared with control group (95% CI = 16‐59; P = .001). Mortality was 13% (2/15) in the CP group and 44% (7/16) in the control group (P = .07).Conclusions and Clinical ImportanceProlonged slow expiration and AC improved P/F ratio within 48 hours and decreased need for oxygenation in dyspneic dogs with acute airway fluid accumulation.

Correlating the field water balance derived crop coefficient (Kc) and canopy reflectance-based NDVI for irrigated sugarcane

Studies of crop coefficients as a function of vegetation indices are reported less often for sugarcane than other crops because of the variation in crop evapotranspiration (ETc) and spectral response over the long growth period. In this study, the possibility of correlating crop coefficient (Kc) and ground based normalized difference vegetation index (NDVI) of a sugarcane crop was investigated based on 2 years field experiments conducted in 2015 and 2016 in semi-arid India. The Kc values for the full crop season were determined by the field water balance method and ground NDVI was estimated from spectral reflectance measurements using a field spectro-radiometer. The sugarcane Kc values for the tillering (development stage), grand growth (mid-season) and maturity stages (end season) were 0.70, 1.20 and 0.78, respectively. The results found that the Kc was 16.6% less than that suggested by FAO-56. The sugarcane NDVI ranged from 0.48 to 0.69 at the tillering stage and 0.69 to 0.93 in the grand growth stage. Unlike other crops, sugarcane NDVI at the maturity stage did not reduce from 0.85 even at harvest due to the continued production of fresh green leaves at the top of the plant. Regression equations were developed to estimate the seasonal distribution of Kc with NDVI as the dependent variables and ratio of days $$\left(\frac{t}{T}\right)$$ after planting (t) to the total crop period (T) as the independent variable. The relationship between crop Kc and NDVI was characterized with 2nd order polynomial regression but correlation was moderately strong (r = 0.75, n = 315). Stronger correlations between Kc and NDVI were obtained by splitting growth period into the growth phase (r = 0.98, n = 245) and decline phase (r = 0.99, n = 70). The estimated Kc will be helpful for correcting irrigation scheduling of sugarcane in semi-arid conditions. The Kc-NDVI relationships for sugarcane investigated in this study are important for potential real time irrigation water management in the future.

Effect of manganese supplementation on the carcass traits, meat quality, intramuscular fat, and tissue manganese accumulation of Pekin duck

Manganese (Mn) is a trace element present in all tissues and is essential for animal growth and health; it also has an antioxidant capacity in tissues. The effect of Mn on meat quality and the mechanism of fat deposition of the breast muscle is still unclear. Therefore, the present study aimed to investigate the effect of Mn supplementation on the growth performance, meat quality, the activity and transcription of antioxidant enzymes, and fatty acid profile in the breast muscle, and the Mn deposition in tissues of Pekin ducks. A total of 896 one-day-old Pekin ducks were allocated into 7 groups, with 8 replicates, each replicate containing 16 ducks. The treatment diets consisted of basal diet supplemented with manganese sulfate at levels 30, 60, 90, 120, 150, 240 mg/kg (as Mn). Results showed that ducks fed diets supplemented with Mn had no effect on the growth performance but decrease in the feed-to-gain ratio of day 1–14 (P < 0.01). Dietary Mn increased significantly the a∗ (redness) value of the duck breast meat at 24 h and intramuscular fat (P < 0.05), and decreased drip loss and shear force of the breast meat (P < 0.05). Manganese supplement significantly reduced the malondialdehyde content (P < 0.05), and significantly increased the mRNA expressions of manganese superoxide dismutase, thioredoxin 2, peroxiredoxin 3, and catalase (P < 0.05). About the fatty acid profile, dietary Mn increased (P < 0.05) the proportions of the C20 family. Manganese accumulation in the heart, breast muscle, and tibia was increased with Mn supplementation (P < 0.05), and Mn content of the heart conforms to the quadratic curve. Besides, Mn supplementation notably increased mRNA expression in genes involved in lipogenesis and deposition and decreased in genes associated with lipolytic in the breast muscle. These findings reveal that dietary Mn could improve meat quality and enhance antioxidant activity and intramuscular fat, which via regulated gene expression involved in lipogenesis and lipolytic.