Support Unit Research Articles

Redefining ‘family’: Conceptualising social support networks of transfeminine women in the Western Cape, South Africa - A case descriptive study of in-depth qualitative data from the HPTN 071 (PopART) trial

Transfeminine women (assigned male sex at birth and identifying with a feminine gender identity) are at risk for intersectional stigma related to their gender, sexual orientation, and other parts of their social identities (including age, class, and race). These layered stigmas can result in increased physical and mental health concerns related to physical and emotional violence, substance use, high risk sexual behaviour and HIV exposure. Social networks are important support structures for transfeminine women to ameliorate imposed risk and stigma. We investigated the family networks, household structures and community support systems of eight transfeminine women in the Western Cape, South Africa. The data for this study are embedded in a qualitative component of the larger HPTN 071 (PopART) trial. Data included in-depth interview transcripts, genogram activities and community map drawings. We found that participants who were not living in a supportive family and household structure faced stigma and health risks. In addition, we found examples of how transfeminine women in unsupportive social situations constructed their own family and household unit for support. Our findings agree with those of other studies in that transgender people often rely on extended family members, friends, or peers as social support when their families do not support or ostracise them. Understanding how transfeminine women re-organise social units to be better supported is important so that better health services can be provided to them in the local South African and international context. Further research on family re-structuring among gender and sexual minority groups is needed.

Symposium 5: Applications of networked learning to the support of learning and teaching in higher education

This symposium is the result of a broad effort by the authors to consider the applicability of networked learning to our work to support learning and teaching across our institution. We, the authors, work in a central learning and teaching support unit within Auckland University of Technology (AUT), in Auckland, Aotearoa/New Zealand. We are concerned with how networked learning is applicable to our efforts to support learning and teaching at AUT-specifically- to operationalise the institution’s strategic commitments to learner success. Our focus on supporting learning and teaching operates at various levels, from the ‘local’ level of individual courses to the intermediate level of supporting degree programmes to the more ‘global’ level associated with developing institutional policy that supports effective academic teaching practices and the ongoing evolution of a technology infrastructure that enables and supports productive learning and teaching activity. Moreover, our work deals with questions and challenges which range from specific, situated practical challenges to broad, philosophical questions which affect learning and teaching across the institution. This symposium represents our efforts to synthesise our understandings of networked learning and connect general ideas about networked learning with specific, situated aspects of our work to support learning and teaching across the institution.

Clinical phenotypes and short-term outcomes based on prehospital point-of-care testing and on-scene vital signs

Emergency medical services (EMSs) face critical situations that require patient risk classification based on analytical and vital signs. We aimed to establish clustering-derived phenotypes based on prehospital analytical and vital signs that allow risk stratification. This was a prospective, multicenter, EMS-delivered, ambulance-based cohort study considering six advanced life support units, 38 basic life support units, and four tertiary hospitals in Spain. Adults with unselected acute diseases managed by the EMS and evacuated with discharge priority to emergency departments were considered between January 1, 2020, and June 30, 2023. Prehospital point-of-care testing and on-scene vital signs were used for the unsupervised machine learning method (clustering) to determine the phenotypes. Then phenotypes were compared with the primary outcome (cumulative mortality (all-cause) at 2, 7, and 30 days). A total of 7909 patients were included. The median (IQR) age was 64 (51–80) years, 41% were women, and 26% were living in rural areas. Three clusters were identified: alpha 16.2% (1281 patients), beta 28.8% (2279), and gamma 55% (4349). The mortality rates for alpha, beta and gamma at 2 days were 18.6%, 4.1%, and 0.8%, respectively; at 7 days, were 24.7%, 6.2%, and 1.7%; and at 30 days, were 33%, 10.2%, and 3.2%, respectively. Based on standard vital signs and blood test biomarkers in the prehospital scenario, three clusters were identified: alpha (high-risk), beta and gamma (medium- and low-risk, respectively). This permits the EMS system to quickly identify patients who are potentially compromised and to proactively implement the necessary interventions.

A Qualitative Analysis of Barriers to Evidence-Based Care in the Prehospital Management of Patients with Suspected Acute Coronary Syndrome

Objectives Prehospital electrocardiogram (ECG) and administration of aspirin are evidence-based strategies for patients with acute coronary syndrome (ACS). However, emergency medical services (EMS) compliance in patients with suspected ACS varies widely. We sought to understand the barriers to prehospital ECG acquisition and aspirin administration for patients with suspected ACS. Methods In this qualitative study, we interviewed EMS clinicians at three geographically diverse United States (U.S.)-based EMS agencies. We interviewed practicing clinicians and quality and operations leaders at these agencies. Based on the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, interviews were recorded, transcribed, and analyzed using a grounded qualitative approach with open coding. The Systems Engineering Initiative for Patient Safety (SEIPS) framework and a constant comparison technique were used to identify and refine themes. Results Twenty-five paramedics and 20 additional agency personnel participated. Median age was 41 (IQR: 34–51) years and 13 (29%) were female. Themes were organized using SEIPS and longitudinally through four phases of an EMS call. During the pre-arrival phase, staffing challenges, training quality, and dispatch may anchor EMS clinicians on a diagnosis. During the diagnosis and treatment phase, safety and communication barriers may take priority over care delivery. Additionally, EMS clinicians must allocate assets (e.g. whether to send an advanced life support unit) and financial resources; veteran EMS clinicians identified their experience whereas newer clinicians cited their recent education when making these decisions. Also, diagnostic uncertainty due to increasing patient complexity and atypical presentations contributed to diagnostic errors. During the response and transport phase, the scope of practice limits the use and interpretation of the ECG, with clinicians reporting that liberal use of ECG led to more rapid decision-making. Finally, in the after phase, personnel reported the “psychologically taxing” nature of the job contributing to biases, bad habits, and burnout. Performance feedback was desired for personal development, though currently perceived as infrequent and punitive. Conclusions Multiple, interrelated themes underscored the complexities of delivering evidence-based care to prehospital patients with ACS. Education in ECG interpretation, resource allocation, bias, and enhancing feedback may serve as strategies to address the identified barriers.

Making the Student Experience Everybody’s Business: Cultivating Collaboration in the Exosphere

It has long been recognised that a key element in improving student transition, retention and success in higher education is cross-institutional consistency and unity of action among disparate academic, policy and support units. However, transferring this principle into practice often requires overcoming departmental silos, negotiating shared understandings of key concepts, and establishing patterns of cross-institutional collaboration in spaces where this may have been lacking. This study examines the effect of a program of supported communities of practice among teaching academics that sought to improve the culture of learning and teaching in a large science, health and engineering faculty in an Australian university. We found indications that these communities of practice promoted collaboration by functioning as loci of cross-institutional consultation and coordination, providing the basis for an enhanced student experience. We interpret this finding through the lens of Bronfenbrenner’s ecological model of development, and propose an approach based on academic communities of practice as a way of building cross-institutional unity of action and making the student experience everybody’s business.

Difficult Terrains of Research Publications Faced by Researchers: A Cross-Sectional Study.

Background The publication of scholarly work in peer-reviewed journals is a well-established method for disseminating knowledge and findings to a global audience. However, the publishing process is constantly evolving and encountering various obstacles that hinder progress. Despite a significant increase in the number of research projects undertaken, there are few studies evaluating the challenges faced by investigators in publishing their research. This study aims to identify the factors and elements that influence the publication process after the completion of research. Methods This study included 759 projects approved by the Institutional Ethics Committee (IEC) from 2016 to 2021 at a tertiary care centre in South India. A list of these approved projects was analysed for overall output in terms of publication and completion. Investigators were contacted and interviewed using a validated, 15-question survey to identify various factors influencing scientific publications. Results A total of 759 projects approved by the IEC from 2016 to 2021 were analyzed. It was found that only 36.72% of studies were completed by faculty members, and the publication conversion rate was 34.24%. A single-point analysis showed a statistically significant lower conversion rate for resident articles (p = 0.032). The 15-point analysis detailed the factors influencing publication conversion, revealing that the majority of researchers publish based on academic and research interests (68.89% and 72.12%, respectively). Various deterrents to publication, such as study design, statistical analysis, journal selection, and knowledge about journal submission, were identified. Notably, 98.4% of researchers expressed a desire to publish more in the future, highlighting the importance of this study. Conclusion The study highlights areas that require attention to facilitate and augment research. It identifies the real gaps in the publication process and suggests points of intervention needed to enhance the research environment, increase publication rates, and establish demand-based research support units in the medical education sector.

Treatment-Switching Adjustment of Overall Survival in CheckMate 227 Part 1 Evaluating First-Line Nivolumab Plus Ipilimumab Versus Chemotherapy for Metastatic Nonsmall Cell Lung Cancer

ObjectivesCheckMate 227 (NCT02477826) evaluated first-line nivolumab-plus-ipilimumab versus chemotherapy in patients with metastatic nonsmall cell lung cancer (NSCLC) with programmed death ligand 1 (PD-L1) expression ≥ 1% or < 1% and no EGFR/ALK alterations. However, many patients randomized to chemotherapy received subsequent immunotherapy. Here, overall survival (OS) and relative OS benefit of nivolumab-plus-ipilimumab were adjusted for potential bias introduced by treatment switching. Materials and methodsTreatment-switching adjustment analyses were conducted following the NICE Decision Support Unit Technical Support Document 16, for CheckMate 227 Part 1 OS data from treated patients (database lock, July 2, 2019). Inverse probability of censoring weighting (IPCW) was used in the base-case analysis; other methods were explored as sensitivity analyses. ResultsOf 1166 randomized patients, 391 (PD-L1 ≥ 1%) and 185 (PD-L1 < 1%) patients received nivolumab-plus-ipilimumab; 387 (PD-L1 ≥ 1%) and 183 (PD-L1 < 1%) patients received chemotherapy, with 29.3-month minimum follow-up. Among chemotherapy-treated patients, 169/387 (43.7%; PD-L1 ≥ 1%) and 66/183 (36.1%; PD-L1 < 1%) switched to immunotherapy poststudy. Among treated patients, median OS was 17.4 months with nivolumab-plus-ipilimumab versus 14.9 months with chemotherapy (hazard ratio [HR], 0.80; 95% confidence interval [CI], 0.68-0.95) in the PD-L1 ≥ 1% subgroup and 17.1 versus 12.4 months (HR, 0.62; 95% CI, 0.49-0.80) in the PD-L1 < 1% subgroup. After treatment-switching adjustment using IPCW, the HR (95% CI) for OS for nivolumab-plus-ipilimumab versus chemotherapy was reduced to 0.68 (0.56-0.83; PD-L1 ≥ 1%) and 0.53 (0.40-0.69; PD-L1 < 1%). Sensitivity analyses supported the robustness of the results. ConclusionTreatment-switching adjustments resulted in a greater estimated relative OS benefit with first-line nivolumab-plus-ipilimumab versus chemotherapy in patients with metastatic NSCLC.

Numerical and experimental investigations on dynamic response of twin-barge floatover system in standby phase

The twin-barge floatover installation method is an efficient method for the mega topsides installation for the offshore platform because of the large capacity and the gap-free for the substructures. This paper develops the dedicated software TBF-TJU (Twin-Barge Floatover by TJU) for dynamic response analysis of the twin-barge floatover installation system. A numerical model of the elastically-connected twin-barge floatover installation system was developed to analyze the coupled dynamic response of topsides and barges. The motion equations of the twin-barge and the topsides with consideration of the mechanical connections and the hydrodynamic interactions are derived and then solved in the time domain. The loads on mating units DSU(Deck Support Unit) in head and beam seas are numerically and experimentally investigated in detail. The numerical results are compared to the results of the corresponding tests in regular and random waves. Time-series and statistical comparisons of the motions and loads indicate that the numerical model can provide a reasonable estimation of the dynamic response of the twin barges and the topsides. The motion of the upwind barge is significantly larger than that of the leeward barge in beam sea due to the shielding effect and the hydrodynamic interactions.

Supporting Ontario public health units to address adverse childhood experiences in pandemic recovery planning: A priority-setting exercise

BackgroundAdverse childhood experiences (ACEs) are potentially traumatic exposures experienced during childhood, for example, neglect. There is growing evidence that the coronavirus disease 2019 (COVID-19) pandemic and related socioeconomic conditions contributed to an increased risk of ACEs. As public health programs/services are re-evaluated and restored following the state of emergency, it is important to plan using an ACEs-informed lens. The aim of this study was to identify and prioritize initiatives or activities that Public Health Ontario (PHO) could undertake to support Ontario public health units’ work towards ACEs-informed pandemic recovery plans.MethodsThe Child Health and Nutrition Research Initiative method was adapted to conduct a priority-setting exercise (May–October 2022). Two online surveys were administered with members of the Healthy Growth and Development (HGD) Evidence Network, comprised of public health unit staff working in child and family health/HGD from Ontario’s 34 public health units. In the first survey, participants were asked to propose activities or initiatives that PHO could undertake to support Ontario public health units’ work towards ACEs-informed planning. In the second survey, participants were asked to score the final list of options against pre-determined prioritization criteria (for example, relevance). Responses were numerically coded and used to calculate prioritization scores, which were used to rank the options.ResultsIn all, 76% of public health units (n = 26) responded to the first survey to identify options. The 168 proposed ideas were consolidated into a final list of 13 options, which fall under PHO’s scientific and technical support mandate areas (data and surveillance, evidence synthesis, collaboration and networking, knowledge exchange and research). A total of 79% of public health units (n = 27) responded to the follow-up survey to prioritize options. Prioritization scores ranged from 76.4% to 88.6%. The top-ranked option was the establishment of a new provincial ACEs community of practice.ConclusionsOver three quarters of public health units contributed to identifying and ranking 13 options for PHO to support public health units in considering and addressing ACEs through pandemic recovery planning. In consultation with the ACEs and Resilience Community of Practice, recently formed on the basis of this exercise, PHO will continue to use the ranked list of options to inform work-planning activities/priorities.

Capacity-building during public health emergencies: perceived usefulness and cost savings of an online training on SARS-CoV-2 real-time polymerase chain reaction (qPCR) diagnostics in low- and middle-income settings during the COVID-19 pandemic.

Upon the onset of the COVID-19 pandemic, the Public Health Laboratory Support Unit (ZIG4) at the Robert Koch Institute (RKI), the German National Public Health Institute, developed and delivered an online training on SARS-CoV-2 qPCR diagnostics to 17 partner countries in low- and middle-income countries (LMIC). This article analyses the usefulness and cost savings of this training. The authors performed a concurrent mixed-methodology study based on key informant interviews, interviewer-administered questionnaires, and document reviews. Economic costs were estimated from the perspective of RKI. Responding participants indicated that the course provided good and comprehensive information on up-to-date scientific knowledge and laboratory practice in PCR diagnostics. Respondents appreciated how the technical content of the training enhanced their ability to apply diagnostic methods in their daily work. Interviewees highlighted that the fast implementation and the low threshold of attending an online training had allowed them to quickly build skills that were crucial during, and beyond, the COVID-19 crisis. The total estimated cost of the online SARS-CoV-2 qPCR training was 61,644 euros. The total estimated cost of the equivalent face-to-face training was estimated at 267,592 euros. Programme weaknesses identified included the top-down approaches taken, lack of interactive components and opportunities to directly engage with other course participants and with teachers. An online training was developed and implemented to support RKI partner countries in SARS-CoV-2 qPCR diagnostics during the COVID-19 pandemic, thereby strengthening pandemic response and health system resilience. The training incurred in important cost savings compared to the equivalent face-to-face training. Post-pandemic studies could usefully build on these research findings and explore ways to enhance end user involvement and improve interactive features to build stronger communities of learners and facilitate exchange of information and mutual learning.

Orthomolecular Therapy for Management &amp; Prevention of SARS-CoV-2 Disease

The renowned coronavirus spread throughout the entire world within a short duration of time and in the process it destroyed everything it encountered in its path, like an invisible fire. This article is to review some of the key features of the coronavirus pandemic and also the virus that causes it. That is, to review the covid-19 virus, which is also known as SARS-CoV-2 (Severe Acute Respiratory Syndrome – Corona Virus – 2). Several vaccines have been developed worldwide for the prevention and treatment of this virus, but due to the limitation of their distribution and manufacturing capacities, the targeted global “herd immunity” has not been achieved. Meanwhile, SARS-CoV-2 is constantly mutating and that unfortunately limits the effectiveness of various vaccination campaigns, notwithstanding the speed of the campaigns. Meanwhile, the current antiviral drugs being used including ivermectin, hydroxychloroquine, ritonavir and lopinavir have not resulted into any conclusive benefits to those infected. Therefore, more effective treatments that are affordable, safe and available globally are urgently needed for targeting the SARS-CoV-2 infections. Covid-19 infections affects the upper respiratory tract and also the lower respiratory tract. However, about 80% of the patients with the disease will not require any hospitalization because their symptoms are relatively mild. But, for the remaining 20% patients, the disease deteriorates to the lower respiratory tract and results into pneumonia. Unfortunately, about 6% of the covid-19 patients with pneumonia (out of the 20% patients with lower respiratory tract involvement) eventually develop respiratory failure which usually require urgent admission to an Intensive Care Unit (ICU) for adequate support. The most frequent and commonly reported symptoms of covid-19 infections are cough, shortness of breath, and fever. The clinical diagnosis for covid-19 infections can be made using the symptoms, chest imaging, and exposures history. In addition to that, an individual that is suspected to have covid-19 can be evaluated and thereafter confirmed for SARS-CoV-2 based on quantitative Real Time – Polymerase Chain Reaction (qRT-PCR), which is a viral nucleic acid test. So far, covid-19 has proven to be a serious global health threat and it has strained the global healthcare capacity. Therefore, it is very important and necessary to really study it and develop more effective pharmacological treatments which are effective for the treatment and prevention of the disease. In this article, we will review an anti-viral therapy made up of quercetin, zinc and ascorbic acid (vitamin C) combination. This combination has proven to be quite effective and safe. Also, various clinical studies and anecdotal evidence supports its efficacy in the management and prevention of covid-19 infections. The evidence includes a study done at Liaquat University of Medical and Health Sciences (LUMHS), Jamshoro, Pakistan and another study at the Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, China.

A Study on Equipment Support Unit and Its Evaluation Based on The Entropy and Objective Weighting

A Study on Equipment Support Unit and Its Evaluation Based on The Entropy and Objective Weighting

Impact of a multidisciplinary collaborative nutritional treatment model in patients who are critically ill with neurological disorders: A randomized controlled trial.

Malnutrition is a widespread problem in critically ill patients with neurological disorders. The purpose of this study is to investigate the effect of a multidisciplinary collaborative nutritional treatment mode based on a standardized unit for nutritional support on the outcome metrics in patients with neurological disorders who are critically ill. We enrolled 84 participants who were hospitalized in the intensive care unit (ICU) of Yancheng No. 1 People's Hospital for neurological disorders between June 2018 and December 2021. The participants were randomly assigned to the control group and the test group. The control group received traditional nutritional support, while the test group was treated with a multidisciplinary collaborative nutritional treatment mode based on a standardized unit for nutritional support. We collected the general information, feeding tolerance (FT), nutritional risk score, and laboratory indicators before intervention, after intervention for one week, and after intervention for 2 weeks, and other data of the participants. After the intervention, the test group scored significantly lower than the control group in the incidence of gastroparesis and diarrhea, as well as the NUTRIC score, with statistically significant differences (P< 0.001). The prealbumin levels in the test group increased progressively prior to intervention, after intervention for one week, and after intervention for two weeks. Compared to the control group, the test group had higher prealbumin levels prior to intervention, after intervention for one week, and after intervention for two weeks, with statistically significant differences (P< 0.001). We developed a multidisciplinary collaborative nutritional treatment model based on a standard unit for nutritional support. This model can improve neural function, FT, and pertinent outcome indicators and is generally applicable.

Isoproterenol improves hemodynamics and right ventricle-pulmonary artery coupling after heart transplantation.

Right ventricular failure (RVF) is a major cause of early mortality after heart transplantation (HT). Isoproterenol (Iso) has chronotropic, inotropic, and vasodilatory properties, which might improve right ventricle function in this setting. We aimed to investigate the hemodynamic effects of isoproterenol on patients with post-HT RVF. We conducted a 1-yr retrospective observational study including patients receiving isoproterenol (Iso) and dobutamine for early RVF after HT. A comprehensive multiparametric hemodynamic evaluation was performed successively three times: no isoproterenol, low doses: 0.025 µg/kg/min, and high doses: 0.05 µg/kg/min (henceforth, respectively, called no Iso, low Iso, and high Iso). From June 2022 to June 2023, 25 patients, median [interquartile range (IQR) 25-75] age 54 [38-61] yr, were included. Before isoproterenol was introduced, all patients received dobutamine, and 15 (60%) were on venoarterial extracorporeal membrane oxygenation (VA-ECMO). Isoproterenol significantly increased heart rate from 84 [77-99] (no Iso) to 91 [88-106] (low Iso) and 102 [90-122] beats/min (high Iso, P < 0.001). Similarly, cardiac index rose from 2.3 [1.4-3.1] to 2.7 [1.8-3.4] and 3 [1.9-3.7] L/min/m2 (P < 0.001) with a concomitant increase in indexed stroke volume (28 [17-34] to 31 [20-34] and 33 [23-35] mL/m2, P < 0.05). Effective pulmonary arterial elastance and pressures were not modified by isoproterenol. Pulmonary vascular resistance (PVR) tended to decrease from 2.9 [1.4-3.6] to 2.3 [1.3-3.5] wood units (WU), P = 0.06. Right ventricular ejection fraction/systolic pulmonary artery pressure (sPAP) evaluating right ventricle-pulmonary artery (RV-PA) coupling increased after isoproterenol from 0.8 to 0.9 and 1%·mmHg-1 (P = 0.001). In conclusion, in post-HT RVF, isoproterenol exhibits chronotropic and inotropic effects, thereby improving RV-PA coupling and resulting in a clinically relevant increase in the cardiac index.NEW & NOTEWORTHY This study offers a detailed and comprehensive hemodynamic investigation at the bedside, illustrating the favorable impact of isoproterenol on right ventricular-pulmonary arterial coupling and global hemodynamics. It elucidates the physiological effects of an underused inotropic strategy in a critical clinical scenario. By enhancing cardiac hemodynamics, isoproterenol has the potential to expedite right ventricular recovery and mitigate primary graft dysfunction, thereby reducing the duration of mechanical support and intensive care unit stay posttransplantation.

Online Assessment in the Spotlight: A Case Study in a Spanish University

Objective. This exploratory case study aims to analyze the attitudes, practices and preferences of higher education faculty and students in relation to online assessment. Methodology. A quantitative methodology based on a questionnaire was used, and a descriptive and correlational analysis was conducted. Participants included students and faculty members from a Spanish on-site university. Results. Certain similarities and differences in attitudes, practices and preferences between students and teachers are presented. Some relationships, albeit weak, were also identified between the online assessment practices used and some characteristics of the teachers’ profile or teaching (teaching experience, teaching load and class size). Conclusions. The findings show that a large part of the teaching staff shows some reluctance in the design and implementation of online assessment strategies beyond traditional exams, as well as a great concern about student control and the danger of fraud. On the other hand, students show generally more positive attitudes towards online assessment than the teaching staff. The recommendations point to the consideration of the role of institutional support and teacher training units for the improvement of teachers’ digital competence in relation to online assessment, the importance of updating security systems in technical infrastructures, and adjusting the effects of teaching load and class size when online assessment is applied.

Carbon Dioxide as a Novel Blood Pressure Therapy for Neurogenic Orthostatic Hypotension

BACKGROUND: On standing, people with neurogenic orthostatic hypotension (nOH) experience plummeting blood pressure (&gt;20/10mmHg), crippling symptoms, and syncope. Current blood pressure therapies lack effcacy and have serious side effects. In healthy people, increased inspired CO2 increases blood pressure. This raises the tantalizing possibility that increased inspired CO2 may effectively treat nOH patients. OBJECTIVE: We aimed to understand if increased inspired CO2 can increase standing blood pressure in nOH. METHODS: Seventeen patients with nOH (F=5; 71±8 years) completed three randomized sit-to-stand tests with inspired CO2 maintained 0mmHg (0CO2), +5mmHg (+5CO2) or +10mmHg (+10CO2) relative to baseline. Respiratory and hemodynamics (blood pressure, heart rate, stroke volume, cardiac output, systemic vascular resistance) were continuously measured. Data are reported as mean ± SD. The change (stand-sit) in respiratory and hemodynamics between 0mmHg, +5mmHg and +10mmHg were compared using a repeated measures ANOVA with a Bonferroni correction. RESULTS: Inspired CO2 caused a dose-dependent increase in standing blood pressure (0CO2:-43±25mmHg; +5CO2:-22±26mmHg; +10CO2:-4±30mmHg; p&lt;0.001). Blood pressure changes were predominantly facilitated by increased stroke volume (0CO2:-10±10mL; +5CO2:-5±10mL; +10CO2:0.1±10mL;p&lt;0.001) and cardiac output (0CO2:-0.2±0.6L/min; +5CO2:0.2±0.5L/min; +10CO2:0.7±0.5L/min; p&lt;0.001) as neither the changes in heart rate (p=0.2) nor systemic vascular resistance (p=0.6) were different across CO2 conditions. Breathing CO2 decreased the percentage of time that standing systolic blood pressure dropped ≥20mmHg (0CO2:75±35%; +5CO2:48±38%; +10CO2:32±37%; p&lt;0.001) and fewer patients met the blood pressure criteria for orthostatic hypotension (p=0.02). CONCLUSION: Our data indicates increased inspired CO2 can increase standing blood pressure in nOH patients by increasing stroke volume and cardiac output. CO2 may offer a novel pressor therapy for patients with nOH. This work was supported by a University of Calgary Seed Funding (S.R.R). J.R.B is supported by a Canadian Institutes of Health Research (CIHR) Fellowship, a Libin Cardiovascular Institute Post-Doctoral Fellowship in Women’s Cardiovascular Health, the Natural Sciences and Engineering Research Council of Canada (NSERC) Brain CREATE Program, and a Canadian Cardiovascular Society Fellowship. S.I.R. is supported by the NSERC Brain CREATE Program, an Alberta Graduate Excellence Scholarship, and an Alberta Strategy for Patient Oriented SUPPORT Unit scholarship. A.V.I is supported by a CIHR Fellowship and an Achievers in Medical Science Postdoctoral Fellowship. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Development of physical model test system for fault-slip induced rockburst in underground coal mining

A complex geological environment with faults can be encountered in the process of coal mining. Fault activation can cause instantaneous structure slipping, releasing a significant amount of elastic strain energy during underground coal mining. This would trigger strong rockburst disasters. To understand the occurrence of fault-slip induced rockbursts, we developed a physical model test system for fault-slip induced rockbursts in coal mine drifts. The boundary energy storage (BES) loading apparatus and bottom rapid retraction (BRR) apparatus are designed to realize energy compensation and continuous boundary stress transfer of the surrounding rocks for instantaneous fault slip, as well as to provide space for the potential fault slip. Taking the typical fault-slip induced rockburst in the Xinjulong Coal Mine, China, as the background, we conducted a model test using the test system. The deformation and stress in the rock surrounding the drift and the support unit force during fault slip are analyzed. The deformation and failure characteristics and dynamic responses of drifts under fault-slip induced rockbursts are obtained. The test results illustrate the rationality and effectiveness of the test system. Finally, corresponding recommendations and prospects are proposed based on our findings.

Introducing a new national tool to monitor the carbon footprint of inhalers

Abstract Introduction The Welsh Government launched its National Health Service (NHS) Wales decarbonisation strategic delivery plan in March 2021.[1] The plan includes a number of actions related to the carbon footprint of inhalers. The National Prescribing Support Unit was requested to provide data for the carbon footprint of inhalers, and develop an analysis tool to measure progress in reducing the carbon footprint and movement towards the all Wales target of 20,000 carbon dioxide (CO2) tonnes per annum. Aim To introduce a new tool for monitoring the carbon footprint of inhalers used in Wales. Methods The data requirements for the tool were determined using a nominal group technique. A literature search was conducted to identify any available sources of inhaler carbon footprint values that would be used to inform the required analyses. A collaborative approach with specialist groups was adopted to develop and pilot the dashboard. Results The nominal group technique identified the essential minimal dataset required. These were data relating to quantity, cost, and carbon footprint of the inhalers prescribed. Data for quantity and cost of inhalers used were already available to the unit. A literature search revealed a reliable source of inhaler carbon footprint values for developing the initial dashboard, and any updating required as additional inhalers are presented within the dataset.[2] Through the collaborative approach with specialist groups, a dashboard was developed and piloted with selected individuals within Wales. Feedback was then attained and actioned upon where appropriate, before the dashboard was made readily available to all NHS Wales employees. Conclusion The new monitoring tool went live in January 2022 and provides data on inhaler quantity, spend and carbon footprint at an all Wales, Health Board, cluster and GP practice level. This enables reporting at a national and organisational level, as well as lower down to specific geographies. Ongoing work involves the addition of new inhalers, refreshing with the most recent data, and updating the background carbon footprint values held within the tool. These are instigated on an issuing of changes in the supporting reference data values.[2] The availability of a tool to report on the carbon footprint of inhalers used within Wales provides a consistent data source to support the strategic delivery plan targets. A strength of this work has been to deliver a meaningful tool in support of this aim. Whilst a limitation is that we do not know the exact impact of the tool in making the change happen, we are aware that the tool is used on a regular basis by stakeholders.

A review on the pharmacology of cariprazine and its role in the treatment of negative symptoms of schizophrenia.

Management of negative symptoms is one of the most challenging and important unmet needs of schizophrenia treatment. Negative symptoms together with positive symptoms result in significant psychosocial impairment and poor quality of life. Existing studies on atypical antipsychotics reported limited treatment adherence due to higher prevalence of treatment-emergent adverse events, such as diabetes, weight gain, hyperlipidemia, hyperprolactinemia and hypertension. A compound with greater affinity for dopamine D2/D3 receptors may improve negative symptoms, mood, and cognitive impairment associated with schizophrenia. In 2015, the US FDA has approved cariprazine, a partial D2/D3 agonist for treatment of schizophrenia, mania or mixed episodes. Midlands and Lancashire Commissioning Support Unit, UK (2019) has particularly suggested cariprazine for the treatment of predominant negative symptoms of schizophrenia. India's Central Drugs Standard Control Organization (CDSCO) has approved cariprazine in 2021 for the treatment of schizophrenia, manic or mixed episodes associated with bipolar I disorder. A ten-fold greater affinity for D3 receptors and partial agonism to serotonin receptors, along with longer half-life make cariprazine distinct when compared with other atypical antipsychotics. Cariprazine is also reported to have fewer incidents of metabolic and hormonal adverse events, and has been shown to provide better relapse prevention. Recent evidence indicates promising effect of cariprazine in ameliorating negative symptoms as well as psychotic symptoms in patients with schizophrenia. In addition, improved adherence to treatment (adjunctive/monotherapy) with cariprazine in patients having inadequate response to an ongoing antipsychotic treatment has also been clinically established. This review presents the evidence-based safety and efficacy of cariprazine for treatment of predominant negative symptoms of schizophrenia.

A new comprehensive and stratified concept for supportive care in cancer patients.

Supportive care in oncology has evolved alongside effective anticancer treatments since the 1960s, beginning with the advent of chemotherapy for acute leukemia. It was initially focused on managing treatment-induced complications, and expanded to address broader aspects of patient well being; the scope of supportive care needs to be periodically re-assessed. Early palliative care interventions, and more recently advance care planning emerged as vital components, improving patient outcomes and quality of life. Despite barriers, such as prognostic uncertainty, these approaches have demonstrated significant benefits for patients with advanced disease. Additionally, the management of cancer survivors requires ongoing medical surveillance and psycho-social support. In the last years, integrative medicine has also emerged as a complementary approach to address survivors' holistic needs. A proposed stratified model of supportive care emphasizes interventions based on patients' prognosis, with interdisciplinary collaboration ensuring comprehensive care across all stages of the cancer journey. This model provides a framework for the development of integrated supportive care units.