Significant Mean Increase Research Articles

Improving Access to Home Blood Pressure Monitors at a Federally Qualified Health Center.

Background: Self-monitoring of blood pressure (BP) clinically decreases BP. However, cost can limit access, especially in underserved populations. Objective: This mixed-methods pilot study aims to determine the impact of providing home BP monitors free of charge to patients at a federally qualified health center (FQHC) by quantifying the effect on BP and surveying patients to measure satisfaction and engagement. Methods: One hundred eighty patients with clinically diagnosed hypertension received BP monitors. Patient charts were reviewed to collect demographics and office BP readings 3 months before and after receiving a monitor. A 13-question phone survey was conducted to a sample of patients addressing satisfaction and engagement. Answers were based on a Likert scale and dichotomous yes/no. Results were analyzed with descriptive statistics and paired t tests. Results: The chart review demonstrated a significant mean decrease in systolic BP by 5.44 mm Hg (P < 0.001, -8.03 to -2.84) and a mean decrease in diastolic BP by 2.70 mm Hg (P < 0.001, -4.08 to -1.32) after the intervention. For those included who responded to the survey (13%), there was a significant mean increase in the frequency of checking BP per week by 1.5 Likert points (P < 0.00001, -1.0 to -1.9), and a majority (57.8%) felt slightly or much more active in their health care in addition to other benefits. Conclusion: Providing BP monitors to FQHC patients free of charge may have contributed to a significantly decreased office BP, improved engagement, and satisfaction. This program removed cost barriers and allowed patients to be more active in their health care.

A 3-Dimensional Evaluation of the Effects of Unilateral Vertical Mandibular Distraction Osteogenesis on Airway Volume Among Patients With Hemifacial Microsomia.

The aim of this study was to evaluate the volumetric airway changes using three-dimensional images following unilateral vertical mandibular distraction osteogenesis (uVMD) among patients with hemifacial microsomia (HFM). This retrospective study analyzed cone-beam computed tomography (CBCT) scans of patients with HFM at three different timepoints; pretreatment (T0), posttreatment (T1), and at least 6 months post-distraction (T2). The individuals underwent uVMD between December 2018-Januaray 2021. The nasopharyngeal (NP) volume, oropharyngeal (OP) volume, and the area of maximum constriction (MC) were measured. Wilcoxon signed-rank test was used to compare the airway volumes between T0-T1, T1-T2, and T0-T2. Five patients met the inclusion criteria (mean age = 10.4 years; 1 female, 4 males). Intraclass correlation analysis showed excellent interrater reliability (r > .86, P < .001). Posttreatment, the OP airway volume exhibited a significant mean increase of 56% (P = .043) from T0 to T1, but decreased from T1-T2 by 13%. Likewise, the total airway volume presented with a significant mean increase of 48% between T0-T1 (P = .044), and a decrease of 7% from T1-T2. The changes in the NP airway volume and area of MC were not statistically significant (P > .05), but an increase in the mean values were observed. Surgical intervention with uVMD may significantly increase the OP airway volume and the total airway volume among patients with HFM immediately after distraction. However, the statistical significance diminished after six months post-consolidation, but the mean percent change may remain of clinical significance. The NP volume did not seem to show significant changes in response to uVMD.

Effects of Acute Hypoxia on Heart Rate Variability in Patients with Pulmonary Vascular Disease.

Pulmonary vascular diseases (PVDs), defined as arterial or chronic thromboembolic pulmonary hypertension, are associated with autonomic cardiovascular dysregulation. Resting heart rate variability (HRV) is commonly used to assess autonomic function. Hypoxia is associated with sympathetic overactivation and patients with PVD might be particularly vulnerable to hypoxia-induced autonomic dysregulation. In a randomised crossover trial, 17 stable patients with PVD (resting PaO2 ≥ 7.3 kPa) were exposed to ambient air (FiO2 = 21%) and normobaric hypoxia (FiO2 = 15%) in random order. Indices of resting HRV were derived from two nonoverlapping 5-10-min three-lead electrocardiography segments. We found a significant increase in all time- and frequency-domain HRV measures in response to normobaric hypoxia. There was a significant increase in root mean squared sum difference of RR intervals (RMSSD; 33.49 (27.14) vs. 20.76 (25.19) ms; p < 0.01) and RR50 count divided by the total number of all RR intervals (pRR50; 2.75 (7.81) vs. 2.24 (3.39) ms; p = 0.03) values in normobaric hypoxia compared to ambient air. Both high-frequency (HF; 431.40 (661.56) vs. 183.70 (251.25) ms2; p < 0.01) and low-frequency (LF; 558.60 (746.10) vs. 203.90 (425.63) ms2; p = 0.02) values were significantly higher in normobaric hypoxia compared to normoxia. These results suggest a parasympathetic dominance during acute exposure to normobaric hypoxia in PVD.

340 Dupilumab treatment of children with moderate-to-severe atopic dermatitis increases bone alkaline phosphatase, a marker of bone mineralization

Abstract Children with atopic dermatitis (AD) are at risk for low bone mineral density (BMD), which is associated with an increased prevalence of osteopenia, osteoporosis, and fracture risk.1,2 Factors such as restricted nutrition, vitamin D deficiency, poor sleep and corticosteroid use contribute to lower bone alkaline phosphatase (BALP) levels, a marker of bone mineralization, seen in children with moderate-to-severe AD compared with healthy children.3 A major determinant for the lifetime risk of fractures and osteoporosis is the magnitude of peak bone mass achieved during prepubescent years. Low BALP and BMD in children with moderate-to-severe AD could contribute to a higher prevalence of osteopenia and osteoporosis. The objective of this analysis is to report the impact of dupilumab treatment on markers of bone formation in children aged ≥ 6 to &amp;lt; 12 years with moderate-to-severe AD. The analysis was performed retrospectively on sera from participants in LIBERTY AD PEDS (NCT03345914) and LIBERTY AD PED-OLE (NCT02612454). In LIBERTY AD PEDS, a double-blind, 16-week, phase 3 trial, children aged 6 to &amp;lt; 12 years were randomized 1 : 1 : 1 to 300 mg dupilumab every 4 weeks (300 mg q4w), a weight-based regimen of dupilumab every 2 weeks (100 mg q2w for patients with baseline weight &amp;lt;30 kg, and 200 mg q2w for those with baseline weight ≥30 kg), or placebo; with concomitant medium-potency topical corticosteroids (TCS). After the initial 16-week trial, children aged 6 to &amp;lt;12 years were enrolled in the open-label extension study LIBERTY AD PED-OLE. Patients received dupilumab 300 mg q4w, which could be titrated up in case of inadequate clinical response at week 16 (200 mg q2w for patients with baseline weight &amp;lt;60 kg, and 300 mg q2w for those with baseline weight ≥60 kg); with concomitant medium-potency TCS. Bone biomarkers including BALP, procollagen type 1 N-terminal propeptide, C-terminal crosslinking telopeptide of type 1 collagen, osteocalcin, and insulin-like growth factor 1 were analysed at baseline, 8, 12, 16 and BALP only at 52 weeks. Dupilumab treatment led to a rapid and significant increase in geometric mean (standard error) levels of BALP in children with moderate-to-severe AD at 16 weeks compared with patients in the placebo group (77.7(1.02) μgL−1 vs. 65.0(1.04) μgL−1; P &amp;lt; 0.0001). As well as a rapid and significant increase in BALP levels in children from the placebo group once they joined the OLE trial. BALP levels increased over 52 weeks in all treated children, reaching a level of 78–84 μgL−1 which constitutes a significant improvement compared with baseline, and is comparable to healthy reference intervals. An increasing trend from baseline to 16 weeks of dupilumab treatment was observed for other biomarkers, however, there was a limited number of data points due to insufficient volumes of serum available for analysis. These placebo-controlled results show, for the first time, a rapid and significant increase in BALP, and a possible trend in other biomarkers, in children with AD during treatment with dupilumab. These results suggest increased bone mineralization during the treatment period.

Recording of Social Determinants in Computerized Medical Records in Primary Care Consultations: Quasi-Experimental Study.

Social determinants of health may be more important than medical or lifestyle choices in influencing people's health. Even so, there is a deficit in recording these in patients' computerized medical histories. The Spanish administration and the World Health Organization are promoting the recording of diagnoses in computerized clinical histories with the aim of benefiting the individual, the professional, and the community. In most cases, professionals tend to record only clinical diagnoses despite evidence in the literature documenting that addressing the social determinants of health can lead to improvements in health and reductions in social disparities in disease. This study aims to develop and evaluate the effectiveness of a mixed intervention (face-to-face-digital) aimed at improving the quantity and quality of the records of the social determinants of health in computerized medical records at primary care clinics. A quasi-experimental, nonrandomized, controlled, multicenter study with 2 parallel study arms was conducted in the area of Central Catalonia (Spain) with primary care professionals of the Institut Català de la Salut (ICS), working from September 23, 2019, to March 31, 2020. All interested professionals were accepted. In total, 22 basic health areas were involved in the study. In Spain and Catalonia, the International Classification of Diseases is used, in which there is a coding of the social determinants of health. Five social determinants were selected by a physician, a nurse, and a social worker; these professionals had experience in primary care and were experts in community health. The choice was made taking into account the ease of use, benefit, and existing terminology. The intervention, based on the integration of a checklist, was integrated as part of the usual multidisciplinary clinical workflow in primary care consultations to influence the recording of these determinants in the patient's computerized medical record. After 6 months of implementing the intervention, the volume and quantity of records of 5 social determinants of health were compared, and a significant increase in the median number of pre- and postintervention diagnoses was observed (P≤.001). There was also an increase in the diversity of selected social determinants. Using the linear regression model, the significant mean increase of the experimental group with respect to the control group was estimated with a coefficient of 8.18 (95% CI 5.11-11.26). The intervention described in this study is an effective tool for coding the social determinants of health designed by a multidisciplinary team to be incorporated into the workflow of primary care practices. The effectiveness of its usability and the description of the intervention described here should be generalizable to any environment. ClinicalTrials.gov NCT04151056; https://clinicaltrials.gov/ct2/show/NCT04151056.

The role of mean corpuscular volume and red cell distribution width in patients with metastatic renal cell carcinoma treated with tyrosine kinase inhibitors: the MARECAP retrospective study.

Tyrosine-kinase inhibitors (TKIs) and immunotherapy represent the backbone treatment for metastatic renal cell carcinoma (mRCC) patients. The aim of the present study was to describe mean corpuscular volume (MCV) and red cell distribution width (RDW) in mRCC patients treated with pazopanib or cabozantinib, and to explore their potential impact on oncological outcomes. We conducted a multicenter retrospective observational study in mRCC patients treated with pazopanib or cabozantinib between January 2012 and December 2020 in nine Italian centers. Descriptive statistics, univariate, and multivariate analyses were performed. The primary endpoints were the incidence and trend over time of anemia, macrocytosis (elevated MCV), and anisocytosis (elevated RDW). The secondary endpoints were the correlations of MCV and RDW with objective response rate (ORR), progression-free survival (PFS), and overall survival (OS). A total of 301 patients were enrolled; mean Hb value was 12.5 g/dl, a mean increase of 1 g/dl was observed at day 15 and maintained at 3 months. Most patients had baseline macrocytosis (MCV levels > 87 fl), with a significant mean increase after 3 months of treatment. At univariate analysis patients with macrocytosis had better ORR, longer PFS, and OS. About one third of patients had baseline anisocytosis (RDW > 16%), with a significant mean increase after 3 months of treatment. At univariate analysis, patients with RDW values ⩽ 16% had higher ORR, longer PFS, and OS. At multivariate analysis, baseline macrocytosis was significantly associated with better PFS in patients treated with pazopanib and baseline anisocytosis with shorter OS in all patients. mRCC patients treated with pazopanib or cabozantinib may have baseline macrocytosis and anisocytosis. A significant increase of Hb, MCV, and RDW after TKIs start was observed. Baseline macrocytosis is positively correlated with PFS in patients treated with pazopanib and baseline anisocytosis affects survival of patients treated with TKIs.

Belumosudil Impacts Immunosuppression Pharmacokinetics in Patients with Chronic Graft-Versus-Host Disease

*EG/MP Co-first authors Background: Belumosudil, a novel compound targeting the Rho-associated coiled-coil containing protein kinase 2 (ROCK2) was recently approved for the treatment of chronic graft-versus-host disease (cGVHD) in patients who failed at least two prior lines of systemic therapy (Cutler C, Blood 2021). Clinical evaluation of the pharmacokinetic (PK) effects of belumosudil (BEL) on other immunosuppressive therapies (IST) has not been performed. In vitro and pharmacokinetic modeling indicate BEL displays weak inhibition of CYP3A as well as inhibition of P-glycoprotein which are involved in the metabolism and excretion of several ISTs used concurrently for treatment of cGVHD such as tacrolimus (TAC), cyclosporine, and sirolimus (SIRO). Further evaluation of these potential interactions is crucial in optimizing initial immunosuppressive dosing with concurrent BEL use and to maintain therapeutic IST levels in cGVHD patients. The objective of this study was to determine the impact of BEL on plasma concentrations of tacrolimus and/or sirolimus in cGVHD patients. Methods: We retrospectivity evaluated 30 patients between February 2019 and July 2022 at Moffitt Cancer Center who received BEL while concurrently on TAC and/or SIRO for the treatment of cGVHD. Patients were included if they had baseline IST plasma concentration before and at least one IST level during BEL therapy. Patients receiving TAC commonly had a target range of 3-7 ng/mL while those receiving SIRO mostly had a target range of 5-10 ng/ml. IST Concentration to dose (C/D) ratios were analyzed prior to initiation of BEL and at three time points after initiation. Results: Median age was 63 years (range: 27-79); 86.7% received three or more lines of therapy and 60% had severe cGVHD per NIH consensus criteria (Jagasia MH, et al. Biol Blood Marrow Transplant. 2015). Over 50% of the patients had a Karnofsky Performance Status (KPS) less than 90% at time of BEL initiation. Additional baseline characteristics are described in Table 1. Patients taking SIRO (N = 26) or TAC (N = 12) concurrently with BEL had a statistically significant increase in mean C/D ratio between pre-BEL and all later C/D ratios while taking BEL (SIRO p<0.001, TAC p=0.014, Table 1). Upon co-administration of BEL, a higher proportion of patients on TAC and SIRO had supratherapeutic levels (25% TAC, 62% SIRO) at a median of 26 and 34.5 days, respectively (Figure 1). Most TAC levels became therapeutic after dose adjustments over evaluated time points (0%, 10% supratherapeutic), but SIRO levels were more likely to be supratherapeutic despite dose adjustment (33, 36% supratherapeutic) at later time points (Figure 1). The C/D ratio for both TAC and SIRO increased over the post-BEL assessment periods, with a significant difference between post-BEL 1 and 2 in the TAC group and a significant difference between post-BEL 1 and 3 in the SIRO group, indicating this drug interaction may require multiple dose adjustments (Figure 1). The increase in C/D ratio was significant in patients not taking a concurrent CYP3A inhibitor (N= 26, SIRO p<0.001, TAC p=0.001). The impact on the C/D ratio was less notable in patients taking a 3A4 inhibitor (N = 4) or BEL dosed daily combined with a proton pump inhibitor (N = 2), making it unclear if the potential effect of BEL is truly lessened in these patients or is reflective of small sample number. The interaction between multiple CYP3A interacting medications, such as concurrent TAC+SIRO+BEL (N = 8), is also unclear due to limited sample numbers. Eight patients discontinued BEL during the study period. After stopping BEL, 63% (N=5) required increased doses of TAC or SIRO and all 8 had a return of C/D ratios closer to pre-BEL. Conclusions: In this single center study, we found that BEL impacts IST pharmacokinetics with clinical significance requiring dose adjustments. Notably, 12/26 patients on SIRO had a level of >15 ng/mL during the study period, indicating significant risk if this interaction is unmonitored. No patient on TAC had a level >15 ng/mL, but patients in this study had lower TAC goal ranges. Based on these findings, empiric dose reductions of at least 25% for SIRO and TAC should be considered with co-administration of BEL with close monitoring of IST levels at baseline and periodically during initial months of concurrent therapy. Future studies are needed to confirm BEL impact on IST pharmacokinetics, particularly in patients taking strong CYP3A4 inhibitors. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Long-Term Effects of Proximal Splenic Artery Embolization on Splenic Volume and Platelet Count

The spleen is the most commonly injured visceral organ in blunt abdominal trauma. Post-splenectomy infection risk has led to the shift toward spleen preserving procedures and splenic artery embolization (SAE) is now the treatment of choice for hemodynamically stable patients with splenic injury. This study aims to assess the long-term effect of SAE on splenic volume and platelet count. Using CPT codes, 66 patients who underwent SAE were identified, and 14 of those who had the necessary imaging and laboratory follow-up were included in the study. Indications for SAE were portal hypertension in 8 patients, bleeding in 4 patients, and thrombocytopenia in 1, and one patient had a separate indication. Splenic volume was calculated by automated volumetric software (Aquarius, TeraRecon, Inc.). Paired t-tests were performed to compare splenic volume and platelets before and after SAE. Fourteen patients (7 males, 7 females) with a mean age of 51±11.95years underwent SAE and were followed by a repeat computed tomography scan at an average of 733.57days. Nine SAEs were performed using vascular plugs, 3 using micro coils, and 2 out of that were with Gelfoam slurry, and 2 using coils only. All embolizations were technically successful with complete cessation of flow. Mean splenic volumes pre- and post-SAE were 903.5±523.73cm3 and 746.5±511.95cm3, respectively, representing a mean decrease of 8.31% compared to baseline [P=0.346]. Minimum platelet counts (x103) pre-SAE (within 3months) and post-SAE (2weeks to 3months after the procedure) were 55.79±57.11 and 116±145.40, respectively. The minimum platelet count showed a statistically significant mean increase of 134.92% (P=0.033). The splenic volume is not altered significantly by SAE in the long term. Similarly, the platelet count is also not significantly altered at 3months follow-up. This study, although small, suggests that SAE is a safe intervention that can preserve splenic volume and function in the long term.

Spatio-temporal changes in the speed of canopy development and senescence in temperate China.

China has been suggested to be the country with the largest vegetation greenness over the last four decades. In this study, we investigated the change in the speed of canopy development and senescence as well as its linkage with climate at monthly scale across temperate China, using satellite-derived Normalized Difference Vegetation Index (NDVI) data from 1982 to 2015. A significant increase in mean monthly NDVI occurred across all growing-season months except June and November, but this greening trend was mainly contributed by the faster speed of canopy development in April and the slower speed of canopy senescence in October. The average of VNDVI (the difference in NDVI between 2 consecutive months) over temperate China is significantly increased only in April (7.75 × 10-4 year-1 , p < .05) and October (4.98 × 10-4 year-1 , p < .05). In contrast, VNDVI in November is significantly decreased, indicating an increasing trend in the magnitude of leaf fall in the last month of the growing season due to both increase in season maximum greenness and slower canopy senescence in October. We also found clear seasonal differences in the correlations between VNDVI and climatic factors, especially temperature. In April and October, the correlations between VNDVI and temperature were generally positive, while they were negative in June. VNDVI in spring (early growing season) and summer (middle growing season) was also positively correlated with precipitation in semiarid regions. Such seasonally distinct climatic controls on VNDVI should be considered in modelling vegetation responses to climate change. Overall, our findings can help quantify the contribution of different climatic drivers on the shifts in canopy development and senescence and better elucidate the change in vegetation greenness under future climate change.

Effects of different inspiratory muscle warm-up loads on mechanical, physiological and muscle oxygenation responses during high-intensity running and recovery

Inspiratory muscle warm-up (IMW) has been used as a resource to enhance exercises and sports performance. However, there is a lack of studies in the literature addressing the effects of different IMW loads (especially in combination with a shorter and applicable protocol) on high-intensity running and recovery phase. Thus, this study aimed to investigate the effects of three different IMW loads using a shorter protocol on mechanical, physiological and muscle oxygenation responses during and after high-intensity running exercise. Sixteen physically active men, randomly performed four trials 30 s all-out run, preceded by the shorter IMW protocol (2 × 15 breaths with a 1-min rest interval between sets, accomplished 2 min before the 30 s all-out run). Here, three IMW load conditions were used: 15%, 40%, and 60% of maximal inspiratory pressure (MIP), plus a control session (CON) without the IMW. The force, velocity and running power were measured (1000 Hz). Two near-infrared spectroscopy (NIRS) devices measured (10 Hz) the muscle’s oxygenation responses in biceps brachii (BB) and vastus lateralis (VL). Additionally, heart rate (HR) and blood lactate ([Lac]) were also monitored. IMW loads applied with a shorter protocol promoted a significant increase in mean and minimum running power as well as in peak and minimum force compared to CON. In addition, specific IMW loads led to higher values of peak power, mean velocity (60% of MIP) and mean force (40 and 60% of MIP) in relation to CON. Physiological responses (HR and muscles oxygenation) were not modified by any IMW during exercise, as well as HR and [Lac] in the recovery phase. On the other hand, 40% of MIP presented a higher tissue saturation index (TSI) for BB during recovery phase. In conclusion, the use of different loads of IMW may improve the performance of a physically active individual in a 30 s all-out run, as verified by the increased peak, mean and minimum mechanical values, but not in performance assessed second by second. In addition, 40% of the MIP improves TSI of the BB during the recovery phase, which can indicate greater availability of O2 for lactate clearance.

Assessment of serum electrolytes levels among sickle cell patients in South-Eastern Nigeria

Background: Sickle cell disease is a common genetic disorder mainly characterized by vascular occlusion and haemolysis and it constitutes a major public health problem. The aim of this study is to assess the serum electrolyte levels in sickle cell patients attending the University of Nigeria Teaching Hospital, Enugu. Materials and methodology: A total of 66 subjects, ages 18 – 40 years, were recruited for this study with thirty sickle cell subjects (female = 16, Male = 14) as test subjects and thirty non-sickle cell subjects (female = 21, male = 9) as control subjects. A total of 5mls of venous blood was collected from each subject. The serum obtained from each sample was analyzed for serum electrolytes (sodium, potassium, chloride, and bicarbonate) by potentiometry using a sensacore autoanalyzer. The data were analyzed using Statistical Package for the Social Sciences (SPSS) version 22. Results: Anthropometric results obtained from this study showed a significant decrease (P &lt; 0.05) in mean ± SD of systolic blood pressure, diastolic blood pressure, and body mass index (BMI) in the test subjects compared to the control subjects respectively. The electrolyte analyses showed a significant increase (P &lt; 0.05) in mean ± SD of potassium and chloride in the test subjects compared to the control subjects respectively. The control subjects have a non-significant increase (P &gt; 0.05) mean ± SD of sodium compared to the sickle cell subjects while the sickle cell subject has a non-significant increase (P &gt; 0.05) mean ± SD of bicarbonate compared to the control subjects. There was a positive correlation between sodium and bicarbonate, while in the other parameters; no significant correlation existed. Conclusion: This study concludes that sickle cell anaemia subjects are predisposed to electrolyte variations, hence, the need to check these electrolyte values in sickle cell subjects.

Detecting the Concentration of Some Trace Elements in Blood Samples of Fuel Station Workers

Trace elements mediate critical biological events by functioning as cofactors or catalysts for numerous enzymes and as centers for enzyme and protein structure stabilization. As a result, imbalances in trace element metabolism and homeostasis (deficiency or excess) may play a role in a number of disorders. The aim of this study was to investigate the blood concentration of essential trace elements of fuel station workers blood in AL-Ramadi city compared with any people who didn’t work in fuel station (control) by measurement of zinc (Zn), copper (Cu), iron (Fe) because they have negative effects on metabolism and considered to be carcinogenic factors. Total 50 male fuel workers and 50 control from ten fuel stations at Al-Ramadi City- Iraq, were participated in the present study. The levels of Zn, Cu and Fe in serum were measured spectrophotometrically by using laboratory kits. The result clarified that there was a significant increase in zinc, copper and iron mean (p 0.05) in fuel workers group compared to control group. Age had a significant correlation with copper levels and no correlation with zinc and iron. The daily hours of exposure showed no significant correlation with zinc, copper and iron. There was a significant increase in zinc levels in smokers compared to nonsmokers; copper and iron showed no correlation with smoking. The years of work in fuel stations significantly correlated with zinc and copper levels, while it showed no correlation with iron levels. The results of this study showed that there is no significant correlation between zinc, copper and the worker’s weight, while it showed a significant weak positive correlation between iron and the worker’s weight (p 0.05). There was a significant increase in copper levels in the workers with chronic illnesses compared to healthy workers, while zinc and iron had no correlation with chronic illnesses. The conclusion of study is the role of the increase of trace elements on the health of the fuel workers group, attention to use of safety gloves and face mask is recommended for fuel workers and a long follow-up to the studied group is necessary to discover the developments. Also, it is highly recommended to reduce the working hours for fuel workers in order to decrease the accumulative effects of benzene exposure and to allow the body to detoxify the blood.

An Online Study of MBBS Student Performance in Internal Assessment of a Pre-clinical Department during the COVID-19 Pandemic

Background: The COVID-19 pandemic has had a significant impact on medical education. As the crisis persists, it is critical to develop valid and reliable assessment methodologies. Aims: The aims of this study were to determine the impact of competency-based medical education (“COMPETENCY-BASED MEDICAL EDUCATION”) implemented online in the biochemistry department during the pandemic on the results of online internal assessments. Materials and Methods: After receiving institutional clearance in 6 months, this pilot study was done on 150 1st-year MBBS students at IQ City Medical College and Hospital, Durgapur. In 6 months, two internal assessments have to be completed online. Multiple choice questions, short answer type questions, orals, and spots were divided into four compartments during our internal evaluation sessions, which were held 3 times a month. A survey was conducted to gather data pertaining to student stress levels during offline and online examinations. Statistical analysis: The data were analyzed using the paired t-test. Reliability of data was checked using Cronbach’s alpha. Results: Participants ranked Expected Offline Examination Stress Risk higher (M = 4.7200, Standard deviation [SD] = 1.58906) as opposed to the Expected Online Examination Stress Risk (3.6800, SD = 1.53841), a statistically significant mean increases of 1.04000, and 95% confidence interval (CI) [0.81192, 1.26808], t (149) = 9.010, P &lt; 0.001. In case of perceived risks, participants ranked Perceived Offline Examination Stress Risk higher (M = 4.7600, SD = 1.64533) as opposed to the Perceived Online Examination Stress Risk (M =3.6867, SD = 1.63081), a statistically significant mean increases of 1.07333, 95% CI [0.83098, 1.31568], t (149) = 8.751, P &lt; 0.001. Conclusions: According to the findings of this study, students expect and perceive online examination stress risk to be lower than that of offline examinations. The research also revealed that students were able to score higher in online tests than in offline exams, implying that the department of biochemistry may conduct internal assessments as well as implement “COMPETENCY-BASED MEDICAL EDUCATION” online.

Influence of the Trendelenburg position and carboxyperitoneum on cerebral tissue oximetry values

Background. Cerebral tissue oximetry (rSO2) can be used to assess cerebral circulation. Cerebral tissue oximetry studies have been performed in the Trendelenburg position (30º), but data for 45 o are not available.Objective. To study the effect of the Trendelenburg position (45°) under carboxyperitoneum conditions on rSO2 and hemodynamic parameters.Design and methods. A single-center, prospective, descriptive study was conducted among patients (n = 30) who underwent robot-assisted laparoscopic prostatectomy. We measured rSO2 on the left and right, central venous pressure (CVP), mean arterial pressure (MAP), venous saturation at points: T1 — after induction of anesthesia and start of measurements; T2 — 5 minutes after positioning the patient in the Trendelenburg position of 45o; T3 — 15 minutes; T4 — 30 minutes; T5 — after returning to a horizontal position. Cerebral perfusion was assessed using cerebral perfusion pressure (CPP).Results. rSO2 on the right and left at points T2, T3 and T5 significantly exceeded T1. There was a significant increase in BP mean at T2 and T3, as well as a significant increase in CVP at T2, T3 and T4 compared to T1. The CPP significantly decreased compared to T1 at points T3, T4 and T5.Conclusions. The Trendelenburg position with a tilt angle of 45º in combination with carboxyperitoneum is accompanied by an increase in rSO2, blood pressure and CVP.

Clostridioides difficile infection in hospitalized patients with leukemia: A nationwide analysis of incidence and outcomes.

e19042 Background: Clostridioides difficile infection (CDI) is the most common cause of nosocomial diarrhea. The incidence and severity of CDI have increased in adults. However, CDI has not been well studied in leukemia patients in the recent years. This study aims to evaluate incidence, mortality, and health care burden in patients with acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), chronic myeloid leukemia (CML) and chronic lymphocytic leukemia (CLL). Methods: The United States Nationwide Inpatient Sample was used to extract hospitalization data of patients admitted between Jan 1st, 2016, to Dec 31st, 2019. Using International Classification of Diseases 10th revision codes, we identified adults with a discharge diagnosis of CDI and a concomitant leukemia diagnosis. The control group included non-leukemia patients with CDI. Primary outcome was in-hospital mortality. Secondary outcomes were length of stay (LOS) and hospital charges. Multivariate logistic regression was used to adjust for relevant variables. Results: An estimated 1,235,465 patients were admitted with CDI during the study period. CDI incidence per 100 discharges was higher among leukemia patients, particularly in AML and ALL patients (4.1 and 3.6, respectively) vs. 1 in general population. After adjusting for comorbidities and demographic variables, AML and ALL were independently associated with increased odds of mortality (adjusted odds ratio [AOR] 2.19 and 1.90 respectively: P &lt;0.01). Additionally, both AML and CML had significant mean increase in length of stay (7.2 and 3.1 days respectively; P &lt;0.01) and hospital charges (115,245$ and 87,198$ respectively; P &lt;0.01) compared to non-leukemia patients. Conclusions: Among leukemia patients admitted with CDI, those with AML and ALL have significantly higher adjusted odds of mortality, length of stay, and hospital charges. AML and ALL patients also had the highest incidence of CDI. Applying antibiotic stewardship and appropriately diagnosing and treating CDI is pertinent in these high-risk patients.[Table: see text]

A Case-Control Study on the Changes in Natural Killer Cell Activity following Administration of Polyvalent Mechanical Bacterial Lysate in Korean Adults with Recurrent Respiratory Tract Infection.

Polyvalent mechanical bacterial lysate (PMBL) is used for the treatment and prevention of recurrent respiratory tract infections. Although PMBL is an immunostimulant, it remains unknown whether treatment with PMBL influences natural killer cell activity (NKA). Hence, this case-control study compared the changes in IFN-γ levels (surrogate index for NKA) following PMBL treatment or time passing between the PMBL-treated group and controls. The treatment group included adults who had a PMBL prescription for three months against recurrent respiratory tract infection from an outpatient clinic, while the control group had healthy adults visiting the health promotion center for periodic health check-ups. The control group (N = 506) showed no change in IFN-γ levels, while the treatment group (N = 301) showed a significant increase in mean from 462.8 to 749.3 pg/mL after PMBL treatment. In the subgroup with IFN-γ <500 pg/mL, IFN-γ levels significantly increased in both groups. However, the change in the treatment group (287 ± 822 pg/mL) was greater than that in the control group (58 ± 809 pg/mL), and the interaction between the visit and case/control was significant (p = 0.030) in a generalized estimating equation model. In conclusion, NKA increased in the subjects with recurrent respiratory tract infections with PMBL treatment.

Projection of Hot and Cold Extremes in the Amu River Basin of Central Asia using GCMs CMIP6

The extreme temperature has become more frequent and intense due to global warming, particularly in dry regions, causing devastating impacts on humans and ecosystems. The transboundary Amu river basin (ARB) is the most vulnerable region in Central Asia (CA) to extreme weather linked to climate change. This study aimed to project warm and cold extremes in ARB for four Shared Socioeconomic Pathways (SSP1-2.6, SSP2-4.5, SSP3-7.0 and SSP5-8.5) and two time-horizons, 2020–2059 and 2060–2099, using daily maximum (Tmax) and minimum temperature (Tmin) simulations of global climate models (GCMs) of Coupled Model Inter-comparison Project phase six (CMIP6). Results revealed that the basin’s west experiences more hot extremes and the east more cold extremes. Climate change would cause a significant increase in the annual mean of Tmax and Tmin. However, the increase in mean Tmin would be much higher (5.0ºC ) than the mean Tmax (4.6ºC ). It would cause an increase in the hot extremes and a decrease in the cold extremes in the basin. The higher increase in the hot extremes would be in the west, while the higher decrease in the cold extreme in the basin’s east. The number of days above 40℃ would increase from 45 to 60 days in the basin’s west and northwest compared to the historical period. The number of days below − 20℃ would decrease up to 45 days in the basin’s east. Overall, the decrease in cold extremes would be much faster than the increase in hot extremes.

Assessing Bladder Radiotherapy Response With Quantitative Diffusion-Weighted Magnetic Resonance Imaging Analysis

AimsRadiotherapy with radiosensitisation offers opportunity for cure with organ preservation in muscle-invasive bladder cancer (MIBC). Treatment response assessment and follow-up are reliant on regular endoscopic evaluation of the retained bladder. In this study we aim to determine the role of diffusion-weighted magnetic resonance imaging (DWI) and apparent diffusion coefficient (ADC) analysis to assess bladder radiotherapy response. Materials and methodsPatients with T2-T4aN0-3M0 MIBC suitable for radical radiotherapy were recruited prospectively to an ethics approved protocol. Following transurethral resection of the bladder tumour and prior to any treatment, magnetic resonance imaging including DWI was performed on a 1.5T system using b values of 0, 100, 150, 250, 500, 750 s/mm2. DWI was repeated 3 months after completing radiotherapy. Cystoscopy and tumour site biopsy were undertaken following this. The response was dichotomised into response (<T2) or poor response (≥T2). Tumour region of interest was delineated on b750 s/mm2 image and transferred to the ADC map to calculate per pixel ADC values for all b values (ADCall) and high b values (ADCb100). ADC mean, percentiles, skew, kurtosis and their change (ΔADC and %ΔADC) were determined. Threshold predictive of response with highest specificity was ascertained using receiver operating characteristic analysis. ResultsThirty-four patients were evaluated. Response was associated with a significant increase in ΔADC mean compared with poor response at ΔADCall (0.57 × 10−3 mm2/s versus –0.01 × 10−3 mm2/s; P < 0.0001) and ΔADCb100 (0.58 × 10−3 mm2/s versus –0.10 x 10−3 mm2/s; P = 0.007). A 48.50% increase in %ΔADCall mean was seen in response compared with a 1.37% decrease in poor response (P < 0.0001). This corresponded to a %ΔADCb100 mean increase of 50.34% in response versus a 7.36% decrease for poor response (P < 0.0001). Significant area under the curve (AUC) values predictive of radiotherapy response were identified at ΔADC and %ΔADC for ADCall and ADCb100 mean, 10th, 25th, 50th, 75th and 90th percentiles (AUC >0.9, P < 0.01). ΔADCall mean of 0.16 × 10−3 mm2/s and ΔADCb100 mean 0.12 × 10−3 mm2/s predicted radiotherapy response with sensitivity/specificity/positive predictive value/negative predictive value of 92.9%/100.0%/100.0%/75.0% and 89.3%/100.0%/100.0%/66.7%, respectively. ConclusionsQuantitative DWI analysis can successfully provide non-invasive assessment of bladder radiotherapy response. Multicentre validation is required before prospective testing to inform MIBC radiotherapy follow-up schedules and decision making.

Statistical Attribution of the Influence of Urban and Tree Cover Change on Streamflow: A Comparison of Large Sample Statistical Approaches

AbstractThe strengths and weaknesses of different statistical methodologies for attributing changes in streamflow to land cover are still poorly understood. We examine the relationships between high (Q99), mean (Qmean), and low (Q01) streamflow and urbanization or tree cover change in 729 catchments in the United States between 1992 and 2018. We apply two statistical modeling approaches and compare their performance. Panel regression models estimate the average effect of land cover changes on streamflow across all sites, and show that on average, a 1%‐point increase in catchment urban area results in a small (0.6%–0.7%), but highly significant increase in mean and high flows. Meanwhile, a 1%‐point increase in tree cover does not correspond to strongly significant changes in flow. We also fit a generalized linear model to each individual site, which results in highly varied model coefficients. The medians of the single‐site coefficients show no significant relationships between either urbanization or tree cover change and any streamflow quantile (although at individual sites, the coefficients may be statistically significant and positive or negative). On the other hand, the GLM coefficients may provide greater nuance in catchments with specific attributes. This variation is not well represented through the panel model estimates of average effect, unless moderators are carefully considered. We highlight the value of statistical approaches for large‐sample attribution of hydrological change, while cautioning that considerable variability exists.

Factors that Sustained the Integration of Behavioral Health into Nurse-Led Primary Care.

Lack of access to primary and behavioral healthcare is prevalent in communities experiencing systematically greater obstacles to healthcare. This study describes the implementation of the Coordinated Care Model in a nurse-led primary care clinic and identifies the essential factors for sustained integration. A mixed-methods explanatory sequential study design was used to collect and analyze quantitative and qualitative data. Participants reported an overall statistically significant mean increase (M = 2.47, SD ± 2.01, p < 0.001) in the level of integration pre-and post-integration. Qualitative results indicated that the optimization and accentuation of team strengths, the Lundeen model of holistic care, and addressing physical and psychological barriers lead to sustained level of integration. Integrated practices are essential in assessing and supporting the holistic needs of individuals, families, and communities. Future studies should examine facilitators or impediments to integrated practice in other healthcare settings, long-term health outcomes of clients in integrated care, and the cost-effectiveness of integration.