Separate Periods Research Articles

Pair bond quality influences social conditioned place preference expression, passive coping behavior, and central oxytocin receptor expression following partner loss in male prairie voles

ABSTRACT The dissolving of social bonds is disruptive and leads to increased stress responsivity and a strong desire for reunion. The oxytocin (OXT) system is critical for the formation of social attachments, such as pair bonds, and is also involved in social recognition, social memory, and social vigilance. Therefore, long-term changes in the OXT system resulting from cohabitation and pair bonding may contribute to reunion-seeking behavior. Here, we employed social conditioned place preference (SCPP) and the forced swim test (FST) to examine sensitivity to partner-associated contexts and passive stress coping following a period of partner separation. We found that opposite-sex cohabitation led to SCPP formation only in male prairie voles with a strong preference for their partner, and this SCPP was maintained following short-term loss of a pair bonded partner. Furthermore, pair bonded males that were separated from their partner displayed more passive stress-coping than those that were not bonded to their lost partner, suggesting that differences in prairie vole mating tactics (i.e. formation of a bond or not) influence the behavioral response to partner separation. Finally, we found changes in OXTR binding that may reflect variation in loss-related behavioral phenotypes based on different mating strategies.

Risk of Developmental Delay in Infants Born to Perinatal COVID-19-Positive Mothers at a Tertiary Care Hospital: A Cross-Sectional Study

Purpose: Prenatal and perinatal experiences of the mother are known to influence infant development. Maternal exposure to coronavirus disease 2019 (COVID-19) during pregnancy has been associated with increased morbidity and mother-baby separation. However, the developmental outcomes of infants born to COVID-19-positive mothers remain unclear. This study represents an initial exploratory effort to assess the developmental risks faced by infants born to mothers who tested positive for COVID-19. Methods: This cross-sectional study involved telephonic interviews and developmental screenings of 45 infants, aged 9 to 15 months, who were born to perinatal COVID-19-positive mothers between July 2020 and May 2021. The Ages & Stages Questionnaire was used for the developmental assessment. The impacts of maternal, infant and separation-related factors on development were analyzed. Results: Within the study population, 28.8% (13 of 45 infants) presented with a risk of developmental delay. The gross motor and problem-solving domains were the most frequently impacted. Among the factors studied, prolonged separation period (exceeding 7 days), advanced maternal age, and gestational age (preterm birth) were associated with higher proportions of infants at risk of developmental delay; however, these associations were not statistically significant.Conclusion: This study suggests that infants born to mothers who tested positive for COVID-19 during the perinatal period face a risk of developmental delay. Factors such as maternal age, gestational age at birth, metabolic disease during pregnancy, and infant-mother separation could exacerbate this risk. Future research should prioritize objective assessments of development and long-term follow-up to monitor developmental outcomes in this population.

PHANTOM REGIONS WITH PENUMBRAL BORDERS: Discussing the Palimpsest Spatialities and Hybrid Identities of Huizhou Region, China

AbstractTransformation of regional identities by administrative spatial restructurings has been relatively little studied, particularly in the context of regional deinstitutionalization. This article develops further a theoretical and conceptual framework of regional identities in spatial restructurings by discussing how deinstitutionalized ‘phantom’ regions with ‘penumbral’ borders beget more hybrid spatial identities. Empirically, the focus is on the Huizhou region in China: we study the changes in regional identity generated by several spatial de‐ and reconstruction processes. Underlining hybridity, we show that, although regional identity is shifting away from territorial belonging to Huizhou in some parts of the region (e.g. Wuyuan County), cultural identification with the Huizhou region remains strong even after a long period of administrative separation. Relatedly, we point out that deinstitutionalization in the Huizhou region has not been exhaustive and its regional identity is being increasingly reconstructed in a utilitarian manner for economic purposes. Despite (and partly because of) this, a sense of regional belonging has been maintained. Regional identities associated with Huizhou are relational and, more precisely, hybrid, as they are connected to regions that are neither fully institutionalized nor deinstitutionalized but appear as multilayered palimpsests that are being transformed through processes of constant making and remaking.

Tonsillar healing membrane characteristic for tonsillectomy using combined cold dissection and bipolar electrocautery

PurposeTo evaluate post-tonsillectomy healing process using combined cold dissection and bipolar cautery for hemostasis.MethodsThis case series included patients for whom tonsillectomy was done by cold dissection and limited the bipolar cautery for hemostasis and dealing with the lower pole only. Saline irrigation was used for the tonsillar bed after tonsillectomy and a wet saline-moistened pack was placed into the tonsil fossa. Intra-oral digital photographs were reviewed postoperative, at 3rd, 5th, 7th, 9th, 11th, 13th, 15th, and 21st day after surgery. Patients were asked to register their postoperative pain using a standardized visual analog scale. The time of separation of the healing membrane (HM) and any blood clot and/or bleeding surface were recorded.ResultsAmong included 114 patients, the HM color was white without odor in all cases. Extension of the HM was limited to the tonsillar bed in 112 patients (98%) and exceeded in 2 patients (2%). The mean time for HM separation was 8.8 ± 1.1 days (range = 7–14) with a significantly longer period of separation in females (p = 0.0008). There was no significant correlation between the time of the HM separation and the age of the patients (P = 0.9).ConclusionCold dissection tonsillectomy with limited hot tools usage for hemostasis by bipolar cautery with frequent saline wash leads to odorless HM and a good healing process with an average separation of the HM and so less pain and post-tonsillectomy bleeding.

‘I praie ye send for the courall’: children’s coral as the physical embodiment of parental hopes and fears in early modern England

ABSTRACT Mediterranean red coral has long been believed to be imbued with sacred, spiritual and healing power and was given to children across Europe in the form of an amulet, teether or medicine. In early modern England, portraits of children from affluent families and medical receipts provide snapshots of coral usage, a moment in time, which do not adequately reveal the spiritual, therapeutic and affective significance of this material within the context of unique family circumstances and a multitude of perceived threats to children’s health. Focusing on five case studies, this article delves into the lived experience of families who deemed coral objects an essential childhood accessory in the period from 1590 to 1775. Julian Herrick, a goldsmith’s widow, Sir John Oglander, a knight caught up in the civil war, Dr Garencières, a doctor confronting dangerous infection, Lady Blackett, a devoted grandmama, and Ann Lord, a woman facing destitution, all placed value on coral for their young children. This study draws on a diverse range of material and documentary evidence from the seventeenth and eighteenth century to unpack the significance of red coral for parents within a changing religious, political and medical landscape. Building on scholarship within material culture studies and the history of emotions, this study also situates children’s coral objects within emotional relationships and seeks to uncover the implicit meanings such objects held which could not be written or articulated due to illiteracy, controversy or persecution. By combining a micro-historical approach with a broader thematic analysis, the case studies presented indicate that coral occupies an important place in the history of the early modern family as the embodiment of the anxieties of parents and grandparents, a means to soothe and protect young children and a material expression of hope, love and faith, particularly during periods of crisis and separation.

Language Kinship between Acehnese and Tamiang Malay Language

This study aimed to determine the percentage of kinship that exists between Acehnese and Tamiang Malay language and to find out the separation period of the two languages. This research was conducted using the quantitative method in which the data in this research is statistical. The techniques used in analyzing the data were lexicostatistical techniques. It was used to calculate the percentage of kinship between the two languages and also glotochronological techniques to calculate the separation time between Acehnese and Tamiang Malay language. The results of the study found that the percentage of kinship between Acehnese and Tamiang Malay is quite high, which is as much as 39%. From the results of calculations using glotochronology techniques that have been carried out, it is found that the separation period between Acehnese and Tamiang Malay language is as far as 1,616 years.

Masa Enam Bulan Berpisah Tempat Tinggal Sebagai Syarat Formil Pengajuan Perceraian dengan Alasan Pertengkaran: Studi Putusan Mahkamah Agung No 421 K/Ag/2023)

From a jurisprudence perspective, there is no requirement for a long period of separation between husband and wife to carry out a divorce for reasons of quarrels and disputes. This research aims to analyze the six month period of separation of residence between husband and wife as a formal requirement in filing for divorce on the grounds of quarrels and disputes as stated in the consideration of Supreme Court Decision No. 421 K/AG/2023. What is the real reason and aim of the judge in requiring the 6 month period, so that the Supreme Court's decision has canceled the decision of PA Tegal No. 312/Pdt.G/2022/PA.Tg and PTA Semarang decision no. 334/Pdt.G/2022/PTA. SMg. This research is normative legal research, using secondary data sourced from primary legal materials and secondary legal materials. Primary legal material was obtained from the Supreme Court Decision, PTA Semarang and PA Tegal Decisions, while secondary legal material was obtained from fiqh books and Supreme Court Circulars. The results of the research show that the judge's reasons for requiring a six-month period of separation between husband and wife as a formal condition for filing a divorce due to arguments are based on the new provisions contained in SEMA No. 1 of 2022 which confirms that divorce cases are based on ongoing disputes and quarrels. can be granted if it is proven that the husband/wife has had continuous disputes and quarrels or separated residences for at least 6 (six) months. This judge's decision is considered aimed at increasing family resilience and making it more difficult for divorce to occur in society, which is part of the principles of marriage.

The emotional terrain of foster and kinship carers’ relationships with parents of children in care: Carers’ perspectives

Children in foster and kinship care have a right to relationships with their parents. The United Nations Convention on the Rights of the Child (UNCRC) asserts children’s right to contact with their parents and families during periods of separation, except where this is proven not to be in the child’s best interests. Foster and kinship carers can play a pivotal role in children’s opportunities for, and experiences of, connection to parents and other family. Yet, the relationship between carers and parents is often characterised by ambivalence and tensions. Emerging research suggests that training and support to carers can help them to navigate their own and children’s relationships with their families. However, such support is not routinely available, and the evidence-base for supporting carers to manage complex relationships with parents is not well-developed. In this paper, we report on a study with 113 foster and kinship carers in Queensland (Australia). We explore carers’ perceptions of the emotional aspects of their relationships with parents. A novel feature of our study is our exploration of carers’ perceptions of affiliative and threat-based emotions in their relationships with birth parents. We report that carers experience a wide spectrum of emotions in their relationships with parents, some of which strengthen these relationships while others create distance. We find also that carers receive little, if any, formal support in building relationships with parents and for supporting children’s opportunities for, and experiences of family contact. Aboriginal and Torres Strait Islander carers report being unsupported in meeting their cultural obligations in developing relationships with children’s parents and families. We discuss the implications for formal support to improve carers capacities to build and maintain their own, and children’s, relationships with parents.

Differences in germination traits of time-separated seed collections of dry forest species from Central Zambia and the potential role of climate

Abstract Time-separated seed collections with a separation period of 12–18 years were used to study recent changes in germination traits and the role of climate factors in seven tropical dry forest (TDF) woody species in Zambia, southern Africa. In all the species, peak and final germination were lower in recent (2016–2021) seed collections than in historic (1998–2005) seed collections during the first germination season. However, in species with seed dormancy, both peak and final germination after one year burial were higher in recent seed collections than in historic seed collections. Three monthly climate factors had significant effects on final germination in the different species and the timing of most of these factors was during seed development and ripening that suggest that these factors operated through mother plants. In species with seed dormancy, post-first-year germination of buried seeds responded to climate factors in the regeneration niche. Climate factors that significantly affected germination included those that changed over the separation period between historic and recent seed collections. This indicates that short-time climatic changes may have the potential to impact germination in TDF woody species of southern Africa. The germination responses to climate factors were both positive and negative and it is not clear whether these are adaptations or not. Further research is required to assess the adaptive significance of these changes in germination traits in TDF species of southern Africa.

Justifying an application of the explanatory sequential mixed methods research design in maritime research

ABSTRACT Despite the efficacy of the mixed methods research design, there appears to be a need for more application in the maritime theme areas. This paper demonstrates the use of explanatory sequential mixed methods research (MMR) design in investigating the retention of ship officers. Previous studies often relied on the lopsided viewpoint of industry employers (using qualitative-oriented mono-methods) without capturing the employee side of the discourse. A web-based survey of 305 ship officers and a semi-structured telephone interview with 20 senior managers helped identify factors predicting the departure of ship officers to landside jobs. A long period of separation from family is a vital issue. Analysis of the interview transcripts helped explain the survey results. Sustainable HR practices are needed among shipping industry employers. Many respondents indicated that personal reasons accounted for the departure to landside jobs. The lack of support from employers during times of crisis compounds a high turnover conundrum among highly skilled ship officers. Shipping industry employers need to dedicate more resources to seafarer training even as the emergence of new technologies on board ships is placing existing skills out of fashion.

Parents’ experience of children’s transitions from intensive care unit after liver transplantation: A qualitative study

ObjectiveThe aim of this study was to understand parents’ perspectives on caring for children who underwent liver transplantation in the intensive care unit transition period and to provide a reference for the development of targeted intervention strategies. MethodsThirteen parents of children who underwent liver transplantation at a tertiary hospital in Hangzhou, Zhejiang Province were chosen for in-depth semi-structured interviews via purposive sampling. The interview data were analyzed and summarized via content analysis. FindingsThree themes were extracted, including a period of separation and suffering (being apart from child is tough, chilling atmosphere, and limited family access); being an overwhelming caregiver (hope coupled with worry, conflict of roles, and existential care dilemmas); and facing a new normal: searching for information and support (information on medical conditions, post-discharge care assistance, educational support, and peer support). ConclusionFor parents whose child underwent liver transplantation, the transition period from the intensive care unit to the general ward is challenging. Parents are burdened with several caregiving responsibilities and require a variety of information and support. It is advised that nurses should offer sufficient information and suitable educational approaches to enhance these parents’ capacity to care for their children and assist children and their parents in making a smooth transition. Implications for clinical practiceThis study highlights parents’ perspectives on caring for children with liver transplants transferred from the intensive care unit to a general ward. Transitional care is strenuous, evoking different feelings before and after transfer. The health care professionals should focus on the needs and challenges faced by parents who are caring for children with liver transplants during the intensive care unit transition period. To achieve this, it is critical to establish a supportive environment and provide suitable information and education for parents to enhance their caregiving abilities.

Assessment of the living standard of elderly people and their well-being in a changing social environment

The current scientific article presents the results of assessing the living standard of elderly people, their well-being, livelihoods in conditions of economic instability and changing social space. Global and all-Russian official statistics indicate an increase in the ageing process of the population. Besides, there is a steady growth in the share of pensioners in its structure. In recent years, in the Russian Federation in general and in the Republic of Bashkortostan in particular, there has been a real trend of ageing population, longer life expectancy (73 years), and a greater number of senior citizens in total (28.5 %). Old age is associated with a period of loss and separation from the usual way of life. The assessment found the key problems of this category: deterioration of health, narrowing of the social world, loneliness, low living standard, and financial difficulties. It is identified that the Russian pensioners belong to the main group of the poor, especially the lonely ones. Their poverty is determined by a decline in living standards and material security, rising inflation, and the high cost of medical care along with utilities. It was revealed that for an elderly person, the main income source is a pension, and in-kind income from personal subsidiary farms is an additional one. Despite the generally low level of pensions, a significant part of non-working pensioners provides financial support to their family members at the cost of personal well-being. Therefore, family values dominate in the minds of older people, and many of their needs are realised in the household.

Can a gradual weaning and separation process reduce weaning distress in dam-reared dairy calves? A comparison with the 2-step method

The weaning and separation phase remains one of the biggest challenges for cow-calf-contact systems, but a gradual process that better mimics the naturally occurring reduction in milk intake has not yet been scientifically investigated. Therefore, the aim of our study was to compare behavioral and physiological indicators of distress in 3 mo-old dam-reared dairy calves (with previous full-time cow-calf contact) weaned and separated either via gradual reduction of contact time with the dam (GR, 1 week half day contact, 1 week morning contact, 1 week fence-line contact before complete separation, n = 18) or via 2-step weaning using a nose flap (NF, 2 weeks access to dam with a nose flap, 1 week fence-line contact before complete separation, n = 18). Behavior was recorded 1 week before (or for lying 3 weeks before) weaning start and during the 3 week weaning and separation period with direct observations on 4 d per week or via accelerometers (locomotor play, lying behavior). Blood and fecal samples were taken twice per week from weaning start until 3 weeks after weaning start. Calves were weighed weekly. Statistical analysis was conducted using (generalized) linear mixed models. Over the whole weaning and separation phase, NF calves showed a stronger decrease in the number of lying bouts, amount of locomotor play and average daily weight gains, as well as a higher increase in total mixed ration feeding time compared with GR calves, whereas GR calves vocalized more often and showed more searching behavior than NF calves. Also, the neutrophil:lymphocyte ratio of NF calves was elevated on d 3 after insertion of the nose flaps compared with baseline, but showed no change for GR calves on any sampling day. Overall, results point toward a favorable effect of a gradual weaning strategy on reduction of weaning and separation distress in dam-reared dairy calves, but the method requires further improvement from the protocol used in our study.

Cerai Gugat dalam Putusan Pengadilan Agama Stabat Nomor 2119/ Pdt.G/ 2023/ PA. Stb.( Ditinjau dalam Perspektif Undang-Undang Nomor 23 Tahun 2004 tentang Penghapusan Kekerasan dalam Rumah Tangga dan Pasal 116 Kompilasi Hukum Islam)

The panel of judges as representatives of the state has the authority and power to decide cases, whether to reject the divorce lawsuit or grant the divorce lawsuit. A divorce that occurs will certainly have legal consequences for husband and wife and children. Many divorce cases are not granted by the panel of judges, one of which is the Stabat Religious Court Decision Number 2119/ Pdt.G/ 2023/ PA. Stb. This research aims to further examine the judge's decision from the perspective of Law No. 23 of 2004 and the Compilation of Islamic Law. This research uses a statutory approach. The findings of this research are that the results of the lawsuit are rejected by arguing that the plaintiff and defendant's households have not entered the broken marriage stage, taking into account the length of the marriage period, the minimum period of separation between the plaintiff and the defendant, which in this consideration is contrary to Article 116 of the Compilation Islamic law, the divorce lawsuit is rejected.

An Examination of the Writing Process in the Pre-Islamic Arab Period in the Pre-Islamic Arab History Book by Dr. Jawwad Ali

The process of writing in pre-islamic Arabia had several periods and there were several factors that influenced the development of literary writing in Pre-Islamic Arabia, which had five separate periods at each time. This paper aims to examine more deeply the process of literary writing in pre-Islamic Arabia, which is studied through the book Pre-Islamic Arabic History written by Dr. Jawwad Ali. This study uses a literature study that explores Jahiliyyah Arabic literature from the perspective of social, religion and thoughts that influenced Jahiliyyah Arabic literature. The results of the study of Jahiliyyah Arabic literature are expected to increase the understanding of Arabic literature reviewers towards society and knowledge and aspirations about the culture of Jahiliyyah Arabic society from the perspective of historical and literary experiences

Sex-specific modulation of early life vocalization and cognition by Fmr1 gene dosage in a mouse model of Fragile X Syndrome

BackgroundPup-dam ultrasonic vocalizations (USVs) are essential to cognitive and socio-emotional development. In autism and Fragile X Syndrome (FXS), disruptions in pup-dam USV communication hint at a possible connection between abnormal early developmental USV communication and the later emergence of communication and social deficits.MethodsHere, we gathered USVs from PND 10 FXS pups during a short period of separation from their mothers, encompassing animals of all possible genotypes and both sexes (i.e., Fmr1-/y vs. Fmr1+/y males and Fmr1+/+, +/-, and -/- females). This allowed comparing the influence of sex and gene dosage on pups’ communication capabilities. Leveraging DeepSqueak and analyzing vocal patterns, intricate vocal behaviors such as call structure, duration, frequency modulation, and temporal patterns were examined. Furthermore, homing behavior was assessed as a sensitive indicator of early cognitive development and social discrimination. This behavior relies on the use of olfactory and thermal cues to navigate and search for the maternal or nest odor in the surrounding space.ResultsThe results show that FMRP-deficient pups of both sexes display an increased inclination to vocalize when separated from their mothers, and this behavior is accompanied by significant sex-specific changes in the main features of their USVs as well as in body weight. Analysis of the vocal repertoire and syntactic usage revealed that Fmr1 gene silencing primarily alters the USVs’ qualitative composition in males. Moreover, sex-specific effects of Fmr1 silencing on locomotor activity and homing behavior were observed. FMRP deficiency in females increased activity, reduced nest-reaching time, and extended nest time. In males, it prolonged nest-reaching time and reduced nest time without affecting locomotion.ConclusionsThese findings highlight the interplay between Fmr1 gene dosage and sex in influencing communicative and cognitive skills during infancy.

Exploring the intra-individual reliability of tDCS: A registered report

Transcranial direct current stimulation (tDCS), a form of non-invasive brain stimulation, has become an important tool for the study of in-vivo brain function due to its modulatory effects. Over the past two decades, interest in the influence of tDCS on behaviour has increased markedly, resulting in a large body of literature spanning multiple domains. However, the effect of tDCS on human performance often varies, bringing into question the reliability of this approach. While reviews and meta-analyses highlight the contributions of methodological inconsistencies and individual differences, no published studies have directly tested the intra-individual reliability of tDCS effects on behaviour. Here, we conducted a large scale, double-blinded, sham-controlled registered report to assess the reliability of two single-session low-dose tDCS montages, previously found to impact response selection and motor learning operations, across two separate time periods. Our planned analysis found no evidence for either protocol being effective nor reliable. Post-hoc explorative analyses found evidence that tDCS influenced motor learning, but not response selection learning. In addition, the reliability of motor learning performance across trials was shown to be disrupted by tDCS. These findings are amongst the first to shed light specifically on the intra-individual reliability of tDCS effects on behaviour and provide valuable information to the field.

Positive Effect of a Financial Incentive on Radiologist Compliance With Quality Metric Placement in Knee Radiography Reports

PurposeOngoing quality improvement (QI) processes in the authors’ department include the insertion of a Kellgren-Lawrence (KL) osteoarthritis grading template in knee radiography reports to decrease unnecessary MRI. However, uniform adoption of this grading system is lacking. Department-wide financial incentives were instituted to improve compliance with QI metrics. The purpose of this study was to evaluate the effect of a financial incentive on KL grading system use and to compare compliance rates of musculoskeletal (MSK) radiologists with those of general radiologists who were not financially incentivized to use KL grading. MethodsPercentages of all knee radiography reports containing KL grading with standardized follow-up recommendations were determined by querying the departmental radiology database before and after the introduction of the new quality-based financial incentive. Preincentive compliance rates for MSK and general radiologists were compared with an adoption period and two separate 6-month postincentive periods. ResultsIn total, 52,673 reports were retrospectively analyzed for KL grading use (41,670 reports interpreted by MSK radiologists and 11,003 interpreted by general radiologists). Increase in compliance was greatest among MSK radiologists’ reports during the incentivized adoption period (from 36.1% to 53.2%). This improvement was sustained among MSK radiologists and averaged 62.7% during the most recently studied postimplementation period. A lesser degree of improvement in compliance was observed in nonincentivized general radiologists’ reports (from 19.3% to 27.5%); during the postimplementation follow-up period, their compliance decreased to 26.5%. ConclusionsThe introduction of a financial incentive resulted in significantly increased adoption of QI practices with sustained improvement among incentivized MSK radiologists compared with nonincentivized general radiologists.

Seroprevalence of Anti-Cytomegalovirus Antibodies in Pregnant Women from South-West Romania.

Cytomegalovirus (CMV), in addition to other agents, is part of the TORCH complex (Toxoplasma gondii, Rubella virus, Cytomegalovirus, Herpes simplex viruses, and other agents). CMV infection is the most frequent cause of congenital malformations. This study aimed to establish the variation of prevalence of anti-CMV antibodies in pregnant women from the South-West region of Romania, according to demographic factors, such as age and area of residence, in two separate time periods (2013-2016 and 2019-2022). We collected from the hospital records the age, place of residence, and anti-CMV antibody test results using immune electrochemiluminescence and chemiluminescence. This study found that the seroprevalence of anti-CMV IgM antibodies increased slightly from 2013-2016 to 2019-2022, from 1.92% to 2.26%, and for IgG antibodies from 93.68% to 94.96%. In both groups was observed a descending trend of anti-CMV IgM seroprevalence with an increase in age, showing a decrease in seroprevalence from 3.57% to 1.09% in pregnant women from rural areas in the 31-35 years age group, while in urban areas, we observed a decrease in seroprevalence from 11.11% to 3.06% in the <20 years age group. The IgG seroprevalence showed an increase both in rural areas (from 93.97% to 95.52%) and urban areas (from 93.52% to 94.27%). In both groups, seroprevalence was higher in rural areas compared to urban regions. These results show a high rate of immunization against CMV in pregnant women in South-West Romania, which led to a low risk of acquiring the primary infection during pregnancy. However, the increase in the rate of primary CMV infections in pregnancy suggests the need for prioritizing screening programs and improving the existing protocols to enhance maternal and child healthcare.

Resource utilization and cost assessment of a proactive penicillin allergy de-labeling program for low-risk inpatients.

Resource utilization and costs can impede proactive assessment and de-labeling of penicillin allergy among inpatients. Our pilot intervention was a proactive penicillin allergy de-labeling program for new inpatients with penicillin allergy. Patients deemed appropriate for a challenge with a low-risk penicillin allergy history were administered 250mg amoxicillin and monitored for 1h. We performed an explorative economic evaluation using various healthcare professional wages. Over two separate 2-week periods between April 2021 and March 2022, we screened 126 new inpatients with a penicillin allergy. After exclusions, 55 were appropriate for formal assessment. 19 completed the oral challenge, and 12 were directly de-labeled, resulting in a number needed to screen of 4 and a number needed to assess of 1.8 to effectively de-label one patient. The assessor's median time in the hospital per day de-labeling was 4h08 with a range of (0h05, 6h45). A single-site annual implementation would result in 715 penicillin allergy assessments with 403 patients de-labeled assuming 20,234 annual weekday admissions and an 8.9% penicillin allergy rate. Depending on the assessor used, the annual cost of administration would be between $21,476 ($53.29 per effectively de-labeled patient) for a pharmacy technician and $61,121 ($151.67 per effectively de-labeled patient) for a Nurse Practitioner or Physician Assistant. A proactive approach, including a direct oral challenge for low-risk in-patients with penicillin allergy, appears safe and feasible. Similar programs could be implemented at other institutions across Canada to increase access to allergy assessment.