Study Period Research Articles

Prevalence and Factors Associated with Teenage Pregnancy at Paynesville, Monrovia, Liberia: Facility Based Cross Section Study

Introduction: In Liberia, teenage pregnancy is a serious public health issue that causes social and economic hardship. Adolescent birth rates are among the highest in sub-Saharan Africa, according to statistics. There are significant differences in the prevalence of teenage pregnancy between and within nations. Most teenage pregnancies occur in places with poorer incomes and lower levels of education. The purpose of this research is to determine the prevalence of teenage pregnancy in Liberia and to investigate the risk factors related to it, particularly in the Paynesville city community of Duport Road cow field block "B.".
 Methods: The research that was done using the Duport Road Clinic as a resource center provided the data for this study. Fifty girls between the ages of 15 and 19 who visited the hospital and lived in the community throughout the study period were recruited as participants. Total population sampling was used to interview all 50 of the females. A population-based cross-sectional survey is used in this quantitative study to gather data, and IBM 20.0 SPSS was used for analysis.
 Results: According to the report, 50.2% of adolescent girls between the ages of 15 and 19 had started having children at the time of the survey. Teenage pregnancy in the community was significantly correlated with age (OR = 6.9; 95% CI: 4.647, 10.366, p – value 0.001), teenagers living with their parents (OR = 1.057; p > 0.001), non-use of contraception (OR = 2.53; 95% CI: 1.739, 3.683), and teenage girls who were aware of contraceptive methods (OR = 2.86, 95% CI = 0.443, 18.463).
 Conclusion: In conclusion, a number of factors, including early sexual initiation, cohabitation, lack of education, and contraceptive non-use, contribute to the high rate of teenage pregnancy in Liberia. Interventions including encouraging the use of contraception, discouraging early sexual beginning, and setting up family planning clinics are advised in order to lessen its prevalence.

Comparative Life Cycle Assessments and Economic Analyses of Alternative Marine Fuels: Insights for Practical Strategies

The growth of the global shipping industry has increased the interest in the environmental impact of this sector. The International Maritime Organization adopted the initial Greenhouse Gas strategy for reducing GHG emissions from ships at the 72nd Marine Environment Protection Committee in April 2018. In this study, we carried out a life cycle assessment of nine production pathways of alternative fuels, including LNG, ammonia, methanol, and biofuels, and conducted an economic analysis considering the life cycle carbon pricing of each fuel pathway. Our results indicate that biomass-based FT-diesel, e-methanol, and e-ammonia are the most environmentally friendly, with GHG reductions of 92%, 88.2%, and 86.6%, respectively. However, our net present value analysis of ship life cycle cost considering carbon price indicated that using those fuels would not be cost-effective during the target period of study. Sensitivity analysis was performed by changing the life cycle carbon pricing from the baseline scenario, and we investigated the approximate years for when these alternative fuels will become more cost-effective compared to conventional fossil fuels. Further, to provide practical implications for shipping stakeholders, we analysed the effect of blending the same kinds of fuels with different production pathways.

Declining magma supply to a poroelastic magma mush explains long-term deformation at Soufrière Hills Volcano

Volcano deformation studies traditionally consider melt-dominated magma reservoirs, often overlooking the significant role of poroelastic mush in modifying surface deformation. Here, we analyze the deformation of Soufrière Hills Volcano (SHV) with a focus on a mush-dominated, poroelastic magma reservoir, drawing on temporal deformation data from 14 continuous GPS stations during the ongoing intra-eruptive unrest period. We implemented a 3D Finite Element model and optimization to simulate the observed deformation. Our results reveal that the deformation is likely driven by ongoing, melt injection (Q = 1.1 m³ sec⁻¹) into a low permeability (k = 4.7 × 10⁻¹⁰ m²) reservoir with the injection to the base of the reservoir at 16.5 km depth below sea level. Our findings highlight temporal variations in the melt injection rate to fit the decreasing GPS-recorded deformation rates. An initial injection rate Qi = 1.9 m³ sec⁻¹ inferred at the start of our study period decreases to Qf = 0.3 m³ sec⁻¹ over a 12-year period (2010–2022). Exploratory forward modeling suggests that if current trends continue, the end of magma supply to our modelled reservoir could occur around June 2024 ± 2 years. However, this does not imply the end of associated volcanic hazards at SHV, as the poroelastic diffusion of melt will continue, causing redistribution of melt, surface deformation, and potentially initiating reservoir rupture. While our models offer new insights, inherent limitations in our simulations include interdependencies among our explored model parameters that would benefit from further refinement. Despite these limitations, the study offers crucial guidance on understanding and forecasting volcano deformation dynamics, particularly for volcanoes like SHV with crystal-rich magma reservoirs.

Clinical characteristics and outcomes of patients operated for primary hyperparathyroidism at Tampere University Hospital in 2017-2018.

Studies on the outcomes of parathyroid surgery are scarce. The aim was to report the outcomes and to study the association between pre- and peri-operative information with the outcomes of patients operated for primary hyperparathyroidism. This was a retrospective, descriptive study with unselected patients treated surgically for primary hyperparathyroidism from a catchment population of 704,500 in Finland. Data were acquired from the electronic hospital registers based on parathyroid surgery procedure codes between 1 January 2017 and 31 December 2018. Preoperative data, surgical data, preoperative and postoperative laboratory values, histopathological findings, and postoperative clinical data were recorded. During the 2-year study period, 149 patients with primary hyperparathyroidism were treated surgically with a 97% remission rate. Surgical complications included postoperative bleeding in two patients (1%) and vocal cord paralysis in one patient (0.6%). No postoperative infections were reported. Three patients (2%) developed postoperative hypoparathyroidism necessitating the use of alfacalcidol more than 1 month after surgery. Ionized calcium measured 0-1 days after surgery was not statistically significantly associated with remission or postoperative hypoparathyroidism. Serum parathyroid hormone (PTH) assessed 0-1 days postoperatively was associated with persistent disease, but not with postoperative hypoparathyroidism. The histopathological diagnosis was adenoma or hyperplasia in 112 patients (75%), atypical adenoma in 28 patients (19%), and carcinoma in five patients (3%). Patients with parathyroid carcinoma had higher preoperative ionized calcium and PTH values than those with adenoma or hyperplasia. Most patients who were operated due to primary hyperparathyroidism achieved normocalcemia after surgery, and the frequency of complications was low. Ionized calcium taken 0-1 days after surgery was not associated with remission of hyperparathyroidism or postoperative hypoparathyroidism. High postoperative serum PTH predicted persistent disease.

(080) Psychological Outcomes and Sexual Satisfaction Rates in Males with Phimosis Following the Novoglan Foreskin Extender Treatment

Abstract Introduction Phimosis can be associated with sexual dysfunction since it often causes discomfort or pain on erection or during sexual intercourse. While circumcision is routinely advocated in patients with phimosis, many males would prefer conservative treatment and are keen to preserve their foreskins. Novoglan foreskin tissue expander is a non-surgical device that uses a balloon to produce gradual stretching of the phimotic foreskin. Objective To assess the impact of phimosis and Novoglan treatment on sexual health and psychological domains. Methods Following Institutional Ethics Board approval (HREC/2020/QMS/66682), 20 males with phimosis were recruited across two Australian sites. Inclusion criteria include male aged ≥ 18 years, who has phimosis and normal erectile function, while those with balanoposthitis and/or recurrent UTIs were excluded. All participants received informed consent and completed questionnaires before and after the Novoglan treatment. The questionnaires included questions on pain or discomfort during sexual activity and levels of anxiety or depression. Circumcision was offered to all patients at the start and end of the study period. Results Nineteen (95%) patients with phimosis recruited in the Novoglan trial reported pain or discomfort during sexual activity, with one (5%) participant reporting pain or discomfort as severe, while moderate or mild levels were reported by ten (50%) and eight (40%) participants, respectively. The level of pain or discomfort during sexual activity improved significantly after the Novoglan treatment with no patients reporting severe level of pain or discomfort, with most males reporting mild or no pain or discomfort (80%). While all participants documented mild to moderate levels of anxiety or depression prior to treatment, 17 participants (85%) reported no anxiety or depression and only three (15%) men reported a mild degree of psychological distress. None of the participants elected for circumcision. Conclusions The Novoglan foreskin tissue expander device significantly improves the psychological outcomes and sexual function in males with phimosis. All patients reported minimal or no pain or discomfort during sexual activity, had minimal or no anxiety or depression related to foreskin issues, and declined circumcision at the end of the study period. Disclosure Yes, this is sponsored by industry/sponsor: Novoglan device company. Clarification: Industry funding only - investigator initiated and executed study.

SARS-CoV-2 testing, positivity, and factors associated with COVID-19 among people with HIV across Europe in the multinational EuroSIDA cohort.

Although people with HIV might be at risk of severe outcomes from infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; coronavirus 2019 [COVID-19]), regional and temporal differences in SARS-CoV-2 testing in people with HIV across Europe have not been previously described. We described the proportions of testing, positive test results, and hospitalizations due to COVID-19 between 1 January 2020 and 31 December 2021 in the EuroSIDA cohort and the factors associated with being tested for SARS-CoV-2 and with ever testing positive. Of 9012 participants, 2270 (25.2%, 95% confidence interval [CI] 24.3-26.1) had a SARS-CoV-2 polymerase chain reaction test during the study period (range: 38.3% in Northern to 14.6% in Central-Eastern Europe). People from Northern Europe, women, those aged <40 years, those with CD4 cell count <350 cells/mm3, and those with previous cardiovascular disease or malignancy were significantly more likely to have been tested, as were people with HIV in 2021 compared with those in 2020. Overall, 390 people with HIV (4.3%, 95% CI 3.9-4.8) tested positive (range: 2.6% in Northern to 7.1% in Southern Europe), and the odds of testing positive were higher in all regions than in Northern Europe and in 2021 than in 2020. In total, 64 people with HIV (0.7%, 95% CI 0.6-0.9) were hospitalized, of whom 12 died. Compared with 2020, the odds of positive testing decreased in all regions in 2021, and the associations with cardiovascular disease, malignancy, and use of tenofovir disoproxil fumarate disappeared in 2021. Among study participants, 58.9% received a COVID-19 vaccine (range: 72.0% in Southern to 14.8% in Eastern Europe). We observed large heterogeneity in SARS-CoV-2 testing and positivity and a low proportion of hospital admissions and deaths across the regions of Europe.

The clinical features, treatment and prognosis of neutropenic fever and Coronavirus disease 2019 results of the multicentre teos study

This multicentre (22 centres in Turkey) retrospective cohort study aimed to assess the clinical outcomes of patients with neutropenic fever and SARS-CoV-2 positivity. Study period was 15 March 2020–15 August 2021. A total of 170 cases (58 female, aged 59 ± 15.5 years) that fulfilled the inclusion criteria were included in the study. One-month mortality rate (OMM) was 44.8%. The logistic regression analysis showed the following significant variables for the mentioned dependent variables: (i) achieving PCR negativity: receiving a maximum of 5 days of favipiravir (p = 0.005, OR 5.166, 95% CI 1.639–16.280); (ii) need for ICU: receiving glycopeptide therapy at any time during the COVID-19/FEN episode (p = 0.001, OR 6.566, 95% CI 2.137–20.172), the need for mechanical ventilation (p < 0.001, OR 62.042, 95% CI 9.528–404.011); (iii) need for mechanical ventilation: failure to recover from neutropenia (p < 0.001, OR 17.869, 95% CI 3.592–88.907), receiving tocilizumab therapy (p = 0.028, OR 32.227, 95% CI 1.469–707.053), septic shock (p = 0.001, OR 15.4 96% CI 3.164–75.897), and the need for ICU (p < 0.001, OR 91.818, 95% CI 15.360–548.873), (iv) OMM: [mechanical ventilation (p = 0.001, OR 19.041, 95% CI 3.229–112.286) and septic shock (p = 0.010, OR 5.589,95% CI 1.509–20.700)]. Although it includes a relatively limited number of patients, our findings suggest that COVID-19 and FEN are associated with significant mortality and morbidity.

93 Red clover as a functional feed: Effects on rumen microbiota of finishing ram lambs

Abstract Red clover (RC) contains bioactive isoflavones. Supplementing RC as a functional feed (as little as 7.5% of the total diet) has been shown to alter ruminal fermentation and improve feed efficiency in ram lambs fed high-concentrate finishing diets. The objectives of this study were to determine if reduced RC inclusion will produce similar rumen microbiological effects. It was hypothesized that RC supplementation below 7.5% RC will alter rumen microbial community composition during the finishing period. Sixteen individually housed Polypay ram lambs (age; 134 ± 2.5 d; initial body weight: 31 ± 0.53 kg) were used in a complete block design and fed one of four isocaloric and isonitrogenous diets (85:15 concentrate:roughage ratio; n = 4 rams diet1): a control diet in which the roughage component (15.0% wt/wt of total diet) consisted of orchardgrass hay, 2.5%-RC (roughage: 2.5% RC; 12.5% orchardgrass wt/wt), 5.0%-RC (roughage: 5.0% RC; 10% orchardgrass wt/wt), and 7.5%-RC (roughage: 7.5% RC; 7.5% orchardgrass wt/wt). Rumen fluid was collected via oral intubation at 0, 2, 4, 6, and 8 h post-feeding at the end of the adaptation period (14 d; all rams on control diet) and at 21-d intervals during the trial. Rumen functional bacterial guilds, including hyper-ammonia-producing bacteria (HAB), amylolytic, lactate-utilizing (LU), and cellulolytic bacteria were enumerated via serial dilution at 4 h post-feeding. Data were analyzed using PROC MIXED with repeated measures in SAS (v.9.4, SAS inst. Inc., Cary, NC). There were no differences between diets on d 0 for any variable (P &amp;gt; 0.05). At d 21, all RC-containing diets exhibited a 10- to 100-fold reduction in ruminal HAB compared with the control (P &amp;lt; 0.05). While suppression of HAB was no longer apparent by d 42 in 2.5%-RC, HAB had decreased 100-fold (109 to 107) in lambs fed the 5.0%-RC and 7.5%-RC diets (P &amp;lt; 0.01). No differences in amylolytic bacteria were detected on d 21 (P &amp;gt; 0.05), but were 10-fold less in all diets containing RC by d 42 in comparison with control (109 to 108; P = 0.08). In contrast, LU increased by d 21 and were 100-fold greater (106 to 108) by d 42 when compared with the control for all levels of RC supplementation (P &amp;lt; 0.05). Cellulolytic bacteria also increased across the study period in all lambs fed RC diets, with 100-fold greater cellulolytics (106 to 108) by d 42 (P &amp;lt; 0.05). Consistent with the hypothesis, supplementing RC at levels as low as 2.5% wt/wt of the total diet decreased protein-wasting HAB and amylolytic bacteria while coincidingly increasing LU and cellulolytic bacteria in the rumen. These results indicate that adding red clover to finishing diets has the potential to increase lamb growth and feed efficiency through a functional feed action.

Characteristics of the most severely ill and injured patients in a Norwegian helicopter emergency medical service: a retrospective cohort study

BackgroundPhysician-staffed helicopter emergency medical services (HEMS) are dispatched to a variety of incidents, ranging from less serious to life-threatening. The skillset of a physician may be important to provide appropriate care for the most critically ill and severely injured patients. A better understanding of these patients may therefore be important to optimize dispatch criteria, training, and equipment setups for HEMS units.The aim of this study was to describe the characteristics of patients with the national advisory committee on aeronautics (NACA) score 5 and 6, primarily by diagnostic group and interventions performed.MethodsRetrospective cohort study on aggregated data from the HEMS-base in Trondheim, Norway. All patients with NACA score 5 and 6 in the 10-year period from 2013 to 2022 were included. Patients with return of spontaneous circulation (ROSC) after successful cardiopulmonary resuscitation were described separately from non-cardiac arrest patients.ResultsOut of 9546 patient encounters, 2598 patients were included, with 1640 in the NACA 5 and 958 in NACA 6 group. Patient age was median 63 (interquartile range 45–74) and 64% of the patients were male. Post-ROSC patients accounted for 24% of patients. Of the non-cardiac arrest patients, the most frequent aetiology was trauma (16%), cardiac (15%), neurologic (14%) and respiratory (11%). The most common physician-requiring advanced interventions were general anaesthesia (22%), intubation (21%), invasive blood pressure monitoring (21%) and ventilator treatment (18%). The mean number of advanced interventions per mission were consistent during the study period (1,78, SD 0,25).ConclusionTwenty-seven percent of all HEMS dispatches were to NACA 5 and 6 patients. Twenty-four percent of these were post-ROSC patients. Sixty-three percent of all patients received at least one advanced physician-requiring intervention and the average number of interventions were consistent during the last 10 years. Hence, the competence a physician-staffed HEMS resource provide is utilized in a high number of critically ill and injured patients.

Comparative effectiveness of factor Xa non-vitamin K antagonist oral anticoagulants versus phenprocoumon in patients with non-valvular atrial fibrillation

BackgroundNon-vitamin K antagonist oral anticoagulants (NOACs) have largely supplanted vitamin K antagonists (VKAs) for oral anticoagulation in non-valvular atrial fibrillation (NVAF). However, data on the real-world effectiveness of NOACs vs. phenprocoumon, a VKA widely used in Germany, are limited. The RELOADED study aimed to compare effectiveness of factor Xa NOACs and phenprocoumon in NVAF in clinical practice. MethodsPatients who started on a factor Xa NOAC or phenprocoumon for NVAF during the study period were enrolled from the Institute for Applied Healthcare Research Berlin. Patients were followed from first prescription until the end of exposure or available data. Primary outcomes were analyzed by Cox proportional hazard regression models and included ischemic stroke and systemic embolism for effectiveness, and intracranial hemorrhage (ICH) for safety. Subgroups of interest were patients with diabetes and patients with renal impairment. ResultsThe total study population was 64,920; 36.3% of patients initiated phenprocoumon, 34.4% initiated rivaroxaban, 25.0% apixaban, and 4.4% edoxaban. Treatment with phenprocoumon is associated with a similar risk of ischemic stroke/systemic embolism as treatment with rivaroxaban or apixaban; while rivaroxaban (adjusted hazard ratio [HR] 0.57, 95% confidence interval [CI] 0.43–0.75) and apixaban (adjusted HR 0.43, 95% CI 0.31–0.6) were associated with a lower risk of ICH compared to phenprocoumon in NVAF patients. The use of rivaroxaban and apixaban was associated with a lower risk of developing kidney failure in patients with diabetes or renal impairment in comparison to those treated with phenprocoumon. ConclusionThe factor Xa NOACs rivaroxaban and apixaban demonstrated similar effectiveness and lower rates of ICH compared with phenprocoumon in this study.

Ventriculoperitoneal shunt infection rate and other associated complications of VP shunt insertion in Abuja, Nigeria

BackgroundComplications associated with ventriculoperitoneal shunt insertion constitute a significant cause of morbidity and mortality among hydrocephalus patients. Despite this, VP shunt placement has remained the mainstay of treatment for hydrocephalus. The aim of this study is to evaluate the complications of VP shunt surgery in our environment and to identify the risk factors associated with it. MethodologyPatients who had VP shunt surgery over a period of two years (Jan 2015–December 2016) were evaluated retrospectively by reviewing their hospital records. The patients’ demography, aetiology and clinical presentation of the hydrocephalus, and complications were analysed using SPSS version 26.0. Results were presented in tables and figures. ResultsA total of 69 patients who had VP shunt over the study period had complete medical records available for review. Their age ranged between 2days and 68years with a male to female ratio of 1.8:1. Overall complication rate was 30.4%. Shunt malfunction (11.5%) and shunt infection (7.2%) were the commonest complications recorded. Late presentation was the most important risk factor for shunt complications. ConclusionThe rate of shunt complications seen in this study compares fairly with studies in other parts of the world.

48 The ruminal microbiome of conventionally and artificially raised lambs fed high-concentrate and high-forage post-weaning diets

Abstract Artificially rearing lambs on milk replacer impacts development of the ruminal microbiome. The objective was to evaluate the extent to which pre-weaning management influences the ruminal microbiome of lambs during finishing. A finishing study was conducted using 32 Polypay conventionally-raised (CR; n = 10 rams, 6 ewes) or artificially raised (AR; n = 10 rams, 6 ewes) lambs weaned at 56 d of age. Following weaning, lambs were adapted to a HC (85:15 concentrate:forage) diet for 35 d. Lambs were then blocked by sex and body weight and randomly assigned to either continue receiving HC or abruptly transition to a HF (50:50 concentrate:forage) diet. Individually-housed lambs were fed ad libitum through a target slaughter weight (rams: 59.0; ewes: 54.4 kg). Rumen fluid samples were collected via oral intubation on d 0, 14, 28, and when lambs reached slaughter weight. Analysis of 16S rRNA gene sequences was conducted in QIIME 2 (v.2023.2). Taxonomy was assigned with SILVA (SSU 138). Diversity was analyzed by PERMANOVA. Random forest classification was applied to determine if pre-weaning management and diet could be predicted using microbial composition. Alpha diversity did not differ in CR vs. AR lambs at the initial sampling (P &amp;gt; 0.22), but species richness was greater in HR lambs regardless of pre-weaning management from d 14 through slaughter (P &amp;lt; 0.01). Beta diversity did differ between CR and AR at the initial sampling (P ≤ 0.02). The influence of pre-weaning management was still present in weighted UniFrac distances by d 14 (P = 0.09), but effects of pre-weaning management were no longer apparent from d 28 through slaughter (P ≥ 0.28). Similarly random forest modeling was able to predict pre-weaning management in initial samples (accuracy: 0.75 ± 0.15). Accuracies decreased over the study period (d 14: 0.58 ± 0.07; d 28: 0.50 ± 0.15; slaughter: 0.45 ± 0.07), whereas model performance improved for prediction of diet (d 14: 0.83 ± 0.15; d 28: 0.87 ± 0.12; slaughter: 0.97 ± 0.07). The most important feature in predicting pre-weaning management at initial sampling belonged to Ruminococcus, and 9 ASV assigned to Prevotella were among the most important features in the model. Five features were present in the top 20 most important features for both the initial and finishing models, and included ASV assigned to Streptococcus, Lactobacillus, and Bifidobacterium. These results illustrated continued impacts of early-life management on ruminal microbiome composition at the beginning of the finishing period, even though CR and AR lambs had been adapted to the same diet for more than 1 mo. While pre-weaning effects were muted over the course of finishing as diet became the predominant factor, the influence of early-life management was still detectable by the end of the finishing period.

Characterization of Change in Tree Cover State and Condition over the Conterminous United States

Variability in the effects of disturbances and extreme climate events can lead to changes in tree cover over time, including partial or complete loss, with diverse ecological consequences. It is therefore critical to identify in space and time the change processes that lead to tree cover change. Studies of change are often hampered by the lack of data capable of consistently detecting different types of change. Using the Landsat satellite record to create a long time-series of land cover and land cover change, the U.S. Geological Survey Land Change Monitoring Assessment and Projection (LCMAP) project has made an annual time series of land cover across the conterminous United States for the period 1985 to 2018. Multiple LCMAP products analyzed together with map validation reference plots provide a robust basis for understanding tree cover change. In LCMAP (Collection 1.2), annual change detection is based on harmonic model breaks calculated at each Landsat pixel from the Continuous Change Detection and Classification (CCDC) algorithm. The results showed that the majority of CCDC harmonic model breaks (signifying change) indicated partial tree cover loss (associated with management practices such as tree cover thinning) as compared to complete tree cover loss (associated with practices like clearcut harvest or fire disturbance). Substantially fewer occurrences of complete tree cover loss were associated with change in land cover state. The area of annual tree cover change increased after the late 1990s and stayed high for the rest of the study period. The reference data showed that tree harvest dominated across the conterminous United States. The majority of tree cover change occurred in evergreen forests. Large estimates of disturbance-related tree cover change indicated that tree cover loss may have previously been underreported due to omission of partial tree cover loss in prior studies. This has considerable implications for forest carbon accounting along with tracking ecosystem goods and services.

VARIATIONS OF δ18О AND δ2H VALUES OF PRECIPITATION IN MOSCOW FROM 2017 TO 2019

To reveal variations in the iso topic composition of O and H in the atmospheric precipitation in Moscow and the processes influencing the isotope composition, all events of precipitation in 2017-2019 were sampled at the Meteorological Observatory of the Moscow State University: 158 samples in 2017, 119 samples in 2018 and 143 samples in 2019. The study is a prolongation of continuous measurements of the isotope composition of precipitation, started by authors in 2014. The study of the isotope composition of precipitation at the MSU Meteorological Observatory was supported by the IAEA and became a part of the Global Network of Isotopes in Precipitation (GNIP) database. It has been found that the intra-annual variability of the isotop e composition of precipitation has a pronounced seasonality. The most isotopically heavy precipitation falls from May to August, and the most isotop ically light precipitation at December-February, mainly due to seasonal air temperature variations. The ratio of the average monthly δ18O values in precipitation and air temperature for the study period varied from 0.34 to 0.39‰/°C, which is consistent with the previously obtained data for precipitation in Moscow. The δ2H-δ18O ratio in precipitation was clos e to that of the Global Meteoric Water Line, pointing to the equilibrium conditions during precipitation formation. It was established that in the summer months isotopic composition is significantly influenced by undercloud evaporation. The deuterium excess va lues in precipitation are not markedly seasonal; however, lower dexc values (below the 3-year average of 11‰) are typical for the summer months (July-August). It is most likely due to undercloud evaporation in conditions of low relative humidity and high air temperatures. Higher dexc values (above 11‰) prevailed from October to April.

Changes in End-of-Life Symptom Management Prescribing among Long-Term Care Residents during COVID-19

ObjectiveTo examine changes in the prescribing of end-of-life symptom management medications in long-term care (LTC) homes during the COVID-19 pandemic. DesignRetrospective cohort study using routinely collected health administrative data in Ontario, Canada. Setting and ParticipantsWe included all individuals who died in LTC homes between January 1, 2017, and March 31, 2021. We separated the study into 2 periods: before COVID-19 (January 1, 2017, to March 17, 2020) and during COVID-19 (March 18, 2020, to March 31, 2021). MethodsFor each LTC home, we measured the percentage of residents who died before and during COVID-19 who had a subcutaneous symptom management medication prescription in their last 14 days of life. We grouped LTC homes into quintiles based on their mean prescribing rates before COVID-19, and examined changes in prescribing during COVID-19 and COVID-19 outcomes across quintiles. ResultsWe captured 75,438 LTC residents who died in Ontario's 626 LTC homes during the entire study period, with 19,522 (25.9%) dying during COVID-19. The mean prescribing rate during COVID-19 ranged from 46.9% to 79.4% between the lowest and highest prescribing quintiles. During COVID-19, the mean prescribing rate in the lowest prescribing quintile increased by 9.6% compared to before COVID-19. Compared to LTC homes in the highest prescribing quintile, homes in the lowest prescribing quintile experienced the highest proportion of COVID-19 outbreaks (73.4% vs 50.0%), the largest mean outbreak intensity (0.27 vs 0.09 cases/bed), the highest mean total days with a COVID-19 outbreak (72.7 vs 24.2 days), and the greatest proportion of decedents who were transferred and died outside of LTC (22.1% vs 8.6%). Conclusions and ImplicationsLTC homes in Ontario had wide variations in the prescribing rates of end-of-life symptom management medications before and during COVID-19. Homes in the lower prescribing quintiles had more COVID-19 cases per bed and days spent in an outbreak.

Bicycle-related accidents in Rome: Investigating clinical patterns, demographics, injury contexts, and health outcomes for enhanced public safety

IntroductionThis study aims to analyze the clinical characteristics, demographic features, and injury circumstances of patients admitted to the Emergency Department (ED) at Fondazione Policlinico Universitario A. Gemelli (IRCCS) in Rome, Italy, due to bicycle accidents. MethodsData on clinical characteristics, accident timing, injury circumstances, and helmet use were collected for ED patients involved in bicycle accidents from January 2019 to December 2022. Subsequently, Abbreviated Injury Scale codes of all diagnoses were recorded and the Injury Severity Score was calculated. ResultsOver the study period, 763 patients were admitted to the ED following bicycle accidents, with a 0.3 % fatality rate and a 30.4 % frequency of multitrauma. Multivariate analysis revealed that collisions with other vehicles increased trauma severity and the risk of ICU admission. Conversely, helmet use was associated with reduced severity of head trauma and a lower likelihood of ICU admission. Notably, toxicological investigations were not conducted for any ED-admitted patients. ConclusionsAlthough a low mortality rate and a low incidence of multi-trauma have been shown in comparison to other nations, it is necessary to adopt prevention strategies like safety devices, more cycle paths, and better infrastructures on the one hand, and stricter laws on the other. It is essential to require toxicological testing in Italy for all accidents involving this means of transport, and to make helmet use compulsory for all ages.

Comparison of K-Nearest Neighbor Classification Methods and Support Vector Machine in Predicting Students’ Study Period.

Comparison of K-Nearest Neighbor Classification Methods and Support Vector Machine in Predicting Students’ Study Period.

Second-breeding events of the common kestrel (Falco tinnunculus) in the Czech Republic

Abstract The laying of two clutches in a single breeding season can increase the fitness of the parent birds and stabilise a population. Our study analysed the rate of second-breeding attempts in the common kestrel (Falco tinnunculus) population in the Czech Republic. In the research, a total of 8,049 common kestrel nests were checked between 1979 and 2019. Of the 1,197 breeding events recorded during the study period in Moravia, 1,184 cases were first clutches and 13 cases (1.1%) were second breeding attempts. In Bohemia, a total of 6,852 breeding events were observed during the same study period, of which 6,811 were first clutches, 32 cases were late breeding attempts and 9 cases (0.1%) were second clutches. Second breeding events occurred only rarely, mainly during population outbreaks of prey species. During the mass outbreak of the common vole (Microtus arvalis) population in the Czech Republic in 2019, 5 (5.2%) of the 97 studied common kestrel pairs nested for the second time in Moravia; in Bohemia, second clutches were recorded in 3 (8.1%) of the 37 studied pairs. The second breeding attempts were recorded at an altitude of 272 ± 123 m (mean ± SD, range 179–560 m, n = 22) and commenced between 24 June and 25 July (29 June on average, n = 5). The range of the time gap between the first and the second clutch was 54 to 92 days (70.8 ± 16.3 days, n = 5). The second clutches consisted of an average of 4.1 ± 0.9 eggs (range 3–6, n = 12), with an average of 3.7 ± 0.9 fledglings in each successful breeding pair (range 2–5, n = 11) and 2.6 ± 1.9 fledglings for each initiated breeding attempt (range 0–5, n = 16).

Association of Pre-Pandemic Telehealth With Emergency Department and Telehealth Usage During the Pandemic.

Objectives Aims were to quantify the association of pre-COVID-19 pandemic telehealth use and separately: 1) likelihood of an emergency department (ED) visit, 2) likelihood of a telehealth visit in older people during the pandemic. Design A retrospective cohort study to measure odds ratios (ORs) of telehealth usage before the pandemic and likelihood of an ED visit and telehealth visit during the study period. Setting and Patients Adults 65 years of age and older (N = 39,214) in the University of California COVID Research Data Set (UC CORDS). Main Outcomes Primary outcome was occurrence of one or more ED visits. Secondary outcome was occurrence of one or more telehealth visits. Results A telehealth visit before the pandemic was associated with reduced likelihood of an ED visit with an OR of 0.33 (95% confidence interval [CI] 0.200.55). Pre-pandemic telehealth was associated with an increased likelihood of telehealth use during the pandemic with an OR of 4.66 (95% CI 3.52-6.18). Conclusion Older people who utilized telehealth before the pandemic were less likely to receive emergency care and were more likely to use telehealth during the pandemic. Approaches to enhance and measure telehealth access for older people are necessary.

Action Of Homoeopathy In Chronic Diseases – A Retrospective Analysis

Background: Homeopathy, as a holistic system of medicine, plays a pivotal role in the management of both acute and chronic diseases, offering a potential for permanent cure without causing harm to the patient. This retrospective analysis aims to underscore the advantages of homeopathy, focusing on common chronic ailments such as irritable bowel syndrome (IBS), polycystic ovarian syndrome (PCOD), bronchial asthma, allergic rhinitis, and low backache. Materials and Methods: The study was conducted retrospectively among patients attending the general Outpatient Department (OPD 2) at the National Homeopathy Research Institute in Mental Health, Kottayam, Kerala, every Tuesday from January 2023 to July 2023 (7 months). Analysis of data from 1677 patients revealed patterns of frequently indicated medicines. Results: A total of 1677 patients were included in the study, revealing distinct patterns in demographics and health conditions. The age distribution (Table 1, Figure1) indicated a higher prevalence among individuals aged 51-60 years (24%), while those in the 91-100 age group showed the least representation (1%). Notably, a predominant male presence was observed, constituting 51% of the patient population(Table2, Figure2). Among the patients, 197 were new attendees, while 1480 were returning patients, highlighting the sustained engagement of individuals with homeopathic care over time (Table 3, Figure3). The most prevalent disorders encountered during the study period (Table4, Figure4) were Bronchial Asthma (10%), Acid Peptic Disease (9%), and Diabetes Mellitus (9%). The most frequently used remedies were Sulphur, Pulsatilla, Nuxvomica, and RhusToxicodendron. Conclusion: In summary, this retrospective study involving 1677 patients at the National Homeopathy Research Institute in Mental Health revealed a predominant male demographic, with a concentration of cases in the 51-60 age group. Common disorders included Bronchial Asthma, Acid Peptic Disease, and Diabetes Mellitus, while Sulphur, Pulsatilla, Nuxvomica, and Rhustox emerged as frequently indicated remedies. Notably, the study showcased a remarkable improvement in all patients, affirming the efficacy and significance of homeopathy in achieving positive therapeutic outcomes.