Three-year Time Period Research Articles

Genomic tools for post-elimination measles molecular epidemiology using Canadian surveillance data from 2018-2020.

Measles is caused by the highly infectious measles virus, MeV, for which there is an effective vaccine. Monitoring of progress of measles elimination requires enhanced surveillance and tracking of MeV strains, including documenting the absence of an endemically circulating strain. Due to a reduction in the number of circulating genotypes, additional sequence information, beyond the standardized 450 nucleotide window of the nucleoprotein (N450), is required to corroborate the information from epidemiological investigations and, ideally, fill in gaps in the surveillance data. This study applies MeV sequencing tools, namely the N450, the non-coding region between the matrix and fusion genes (MF-NCR), and the complete coding sequence of the genome (WGS-t), to clinical specimens obtained from cases occurring over a three-year time period in Canada. This data was systematically analyzed, including with Bayesian evolutionary analysis by sampling trees (BEAST) of the WGS-t. Of the 143 reported cases, N450, MF-NCR, and WGS-t sequences were obtained from 101, 81, and 75 cases, respectively. The BEAST analysis confirmed that the two most frequently detected lineages (B3 named strain MVi/Marikina City.PHL/10.18 and D8 named strain MVs/Gir Somnath.IND/42.16) were the result of repeated importations. Of the 16 outbreaks occurring during the study period, the analysis conclusively corroborated the epidemiological information for 13. BEAST analysis of the WGS-t convincingly demonstrated the expansion of two outbreaks by the inclusion of additional contemporary cases for which the epidemiological investigation had been unable to identify links. Furthermore, the analysis revealed the existence of three additional unrecognized outbreaks among the cases categorized as unknown source. One outbreak was without WGS-t and could not be resolved. Measles WGS-t data corroborated and expanded upon the outbreak analysis from traditional epidemiological investigations of measles outbreaks. However, both are needed for fulsome investigations in elimination settings.

1COVID-19 Mortality in Kerbala-Iraq

Background: COVID 19 pandemic hit the world in December 2019 and flourished to almost all countries in the following two years killing millions and billions were infected and impact on life and health. All people are affected, but augmented in those suffering chronic non-communicable diseases. Objective: To describes the main epidemiological features of COVIUD-19 in Kerbala/Iraq during three years period. Methods: All records of confirmed cases of COVID-19 over three-year period of time (2020-2022) were included. Data were compiled in an inventory containing numbers of cases confirmed by the Iraqi Ministry Of Health official outlets supported other available sources to affirm the consistency in numbers of daily cases. Epidemic curves, tables and figures were prepared using Excel sheets. Results: A total of 97396 cases were reported. The annual distribution showed that most cases (59.7%) were in 2021 and August represented the month with greatest incidence where 26.8% of total cases happened. Males formed about 60% of the cases and the mean age of patients was 37.42±15.39 years. The case fatality of COVID 19 in Kerbala governorate was 0.99%. While 0.15 % of total patients were reported to have reinfection with COVID 19. While only 4756 patients (4.9%) had received at least one dose of the vaccine. Conclusion: The behavior of COVID-19 in Iraq as elsewhere in the world is difficult to understand. The characteristic fluctuations are likely to reflect factors related to virus behavior, population behavior and public health interventions.

Longitudinal Trends in Physical Functioning Patient-Reported Outcome Domains for Children with Sickle Cell Disease

Background: Children with sickle cell disease (SCD) often experience pain and have impaired physical functioning. Patient Reported Outcomes Measurement Information System (PROMIS) tools have previously been shown to be valid and responsive to varied states of health for children with SCD. However, there is limited understanding of the trend of patient-reported outcomes (PROs) over time and the factors associated with this trend and time-dependent changes. The objective of this study was to determine the longitudinal trends in physical functioning domains in children with SCD over a three-year time period and identify factors associated with worse PROs. Methods: Our study included a convenience sample of children with SCD recruited from a tertiary care facility during 2017 - 2020. Eligible children with SCD to self-report PROs were 8 years and older and cognitively capable. Validated PROMIS measures were used to assess fatigue, physical stress experience, strength impact and functioning/mobility over time. The PRO questionnaires were administered every 6 months (with time windows to facilitate completeness of data) for three years to obtain longitudinal data. In addition, we collected clinical data including disease management strategy (hydroxyurea use, chronic transfusion), pain medication, prior acute care use for pain (3 years at baseline and 6 months at follow-up) disease complications (overt stroke, acute chest syndrome, priapism) and other comorbidities. Generalized Estimating Equations with patients as clusters were used to determine changes in PROs over time. This model used compound symmetry covariance structure to account for correlations over time and was adjusted for age and other clinical data. Stepwise regression model was used to identify the significant variables associated with PROs. Results: We recruited 170 children with SCD into our study. Of these, 145 (85.3%) had self-report PRO data for more than one time point. The mean age of the cohort was 10.6 (SD 3.3) years, 53.1% were female. Table 1 shows the demographic and clinical characteristics of our study population. The average T-score for fatigue, physical functioning/mobility, stress experience and strength impact were 47.9, 49.1, 57.2 and 41.5 respectively. Figure 1 shows the unadjusted T-scores over time for each of the listed domains. The regression models showed there were no significant changes in scores for fatigue and physical function mobility over time. However, the stress experience [β (time in months) = -0.13 (95% CI = -0.20 - - 0.07), p-value <0.0001] and strength impact B estimate [β (time in months) = 0.13 (95% CI = 0.08 - 0.18), p-value <0.0001] improved over time. Age at enrollment was significantly associated with strength impact where older kids had a higher strength impact [β (age) = 0.49 (95% CI = 0.15 - 0.83), p = 0.005]. However, age was not associated with any of the other physical functioning domains. Disease severity at baseline, as determined by acute care use in the past three years, was significantly associated with stress experience [β (3 or more acute care visits for pain vs none) = 6.32 (95% CI = 1.71 - 10.93), p-value =.007] and fatigue [β (3 or more acute care visits for pain vs none) = 5.31 (95% CI = 0.95 - 9.66), p-value =.03]. The extent of acute care use within 6 months at follow-up time points was significantly associated with worse fatigue [β (acute care for pain within past 6 months) = 2.19 (95% CI = 0.19 - 4.20), p-value = 0.03] and physical functioning/mobility [β (acute care for pain within past 6 months)=-1.76 (95% CI = -3.24 - - 0.28), p-value = 0.02]. Conclusions: Fatigue and functioning/mobility did not change over time in children with SCD. There were slight improvements in stress experience and strength impact, but the clinical significance of these improvements is unknown. Disease severity, as measured by acute care use at baseline, was significantly associated with worse physical health across all domains.

No Changes in the Occurrence of Methicillin-Resistant Staphylococcus aureus (MRSA) in South-East Austria during the COVID-19 Pandemic.

Methicillin-resistant Staphylococcus aureus (MRSA) is a universal threat. Once being well established in the healthcare setting, MRSA has undergone various epidemiological changes. This includes the emergence of more aggressive community-acquired MRSA (CA-MRSA) and the occurrence of MRSA which have their origin in animal breeding, called livestock-associated MRSA (LA-MRSA). Emergence of new clones as well as changes in the occurrence of some clonal lineages also describes the fluctuating dynamic within the MRSA family. There is paucity of data describing the possible impact of the COVID-19 pandemic on the MRSA dynamics. The aim of the study was the analysis of MRSA isolates in a three-year time period, including the pre-COVID-19 years 2018 and 2019 and the first year of the pandemic 2020. The analysis includes prevalence determination, antibiotic susceptibility testing, spa typing, and detection of genes encoding the PVL toxin. The MRSA rate remained constant throughout the study period. In terms of a dynamic within the MRSA family, only a few significant changes could be observed, but all except one occurred before the start of the COVID-19 pandemic. In summary, there was no significant impact of the COVID-19 pandemic on MRSA in Austria.

A New Approach for Completing Missing Data Series in Pan Evaporation Using Multi-Meteorologic Phenomena

The most crucial losses in the hydrological cycle occur due to evaporation (EP). As a result, the accurate attainment of this complex phenomenon is critical in studies on irrigation, efficiency in the basins, dams, continuous hydrometeorological simulations, flood frequency, and water budget analysis. However, EP data sets are expensive, difficult to sustainably measure, and scarce, also, predictions are challenging tasks due to the wide range of parameters involved in these processes. In this study, the data gaps are filled with Class A evaporation pan observations through building a new meteorological station during seasons with no gauge measurements available for a three-year time period. These observations demonstrate high correlations with the readings from the Meteorology Airport Station, with a PCC of 0.75. After the continuous EP time series was completed over Kahramanmaras, these values were retrieved non-linearly via an artificial intelligence model using multi-meteorological parameters. In the study, the simulation performance is evaluated with the help of eight different statistical metrics in addition to graphical representations. The evaluation reveals that, when compared to the other EP functions, using both temperature and wind-driven simulations has the highest correlation (PCC = 0.94) and NSCE (0.87), as well as the lowest bias (PBias = −1.65%, MAE = 1.27 mm d−1, RMSD = 1.6 mm d−1, CRMSE = 24%) relative to the gauge measurements, while they give the opposite results in the solely precipitation-based models (PCC = 0.42, NSCE = 0.17, PBias = −6.44%, MAE = 3.58 mm d−1, RMSD = 4.2 mm d−1, CRMSE = 62%). It has been clearly seen that the temperature parameter is the most essential factor, while precipitation alone may be insufficient in EP predictions; additionally, wind speed and relative humidity would improve the prediction performance in artificial intelligence techniques.

Methods of stabilization of the banking sector in the crisis of the COVID-19 pandemic

The COVID-19 pandemic broke out unexpectedly for everyone. Due to the accelerated pace of the introduction of restrictions on the movement of the population and the complication of the processes of making various kinds of transactions, all sectors of the economy were unable to accumulate their resources in time to stabilize the situation, which led to the destruction of the usual standards of organizations and the outbreak of a crisis in the economy. The article examines the main problems faced by the banking sector during the COVID-19 pandemic crisis and describes the main methods of crisis stabilization used by credit institutions. Despite the three-year period of time that has passed since the beginning of the pandemic, this topic does not lose its relevance due to the serious consequences for the economy, which continue to affect all its spheres to this day.

Masters of media: A longitudinal study of parental media efficacy, media monitoring, and child problematic media use across early childhood in the United States

ABSTRACT The development of problematic media use in early childhood is not well understood. The current study examined long-term associations between parental media efficacy, parental media monitoring, and problematic media use across a three-year period of time during early childhood. Participants included 432 parents who reported on their own parenting and their child’s use of problematic media once a year for three years (M age of child at Wave 1 = 29.68 months, SD = 3.73 months). Results revealed that early parental media efficacy predicted lower levels of child problematic media use over time. Restrictive media monitoring was also related to lower levels of child problematic media use over time. Additionally, general parental efficacy was related to parental media efficacy and lower child problematic media use, both at the cross-sectional and longitudinal levels. Discussion focuses on encouraging early parental media efficacy (and exploring other potential mechanisms) as a way to mitigate the development of problematic media use over time.

Cross-sectional analysis of avoidable emergency department visits before and during the COVID-19 pandemic

BackgroundCOVID-19 had a significant impact on Emergency Departments (ED) with early data suggesting an initial decline in avoidable ED visits. However, the sustained impact over time is unclear. In this study, we analyzed ED discharges over a two-year time period after the COVID-19 pandemic began and compared it with a control time period pre-pandemic to evaluate the difference in ED visit categories, including total, avoidable, and unavoidable visits. MethodsThis was a retrospective, cross-sectional study assessing the distribution of visits with ED discharges from two hospitals within a health system over a three-year time period (1/1/2019–12/31/2021). Visits were categorized using the expanded NYU-EDA algorithm modified to include COVID-19-related visits. Categories included: Emergent - Not Preventable/Avoidable, Emergent – Preventable/Avoidable, Emergent - Primary Care Treatable, Non-Emergent, Mental Health, Alcohol, Substance Abuse, Injury, and COVID-19. Chi-square testing was conducted to investigate differences within the time period before COVID-19 (1/1/2019–12/31/2019) and both initial (1/1/2020–12/31/2020) and delayed (1/1/2021–12/31/2021) COVID-19 time frames and ED visit categories, as well as post hoc testing using Fisher's exact tests with Bonferroni correction. ANOVA with post hoc Bonferroni testing was used to determine differences based on daily census for each ED visit category. ResultsA total of 228,010 ED discharges (Hospital #1 = 126,858; Hospital #2 = 101,152) met our inclusion criteria over the three-year period. There was a significant difference in the distribution of NYU-EDA categories between the two time periods (pre-COVID-19 versus during COVID-19) for the combined hospitals (p < 0.001), Hospital #1 (p < 0.001), and Hospital #2 (p < 0.001). When examining daily ED discharges, there was a decline in all categories from 2019 to 2020 except for “Emergent - Not Preventable/Avoidable” which remained stable and “Substance Abuse” which increased. From 2020 to 2021, there were no differences in ED avoidable visits. However, there were increases in discharged visits related to “Injuries”, “Alcohol”, and “Mental health” and a decrease in “COVID-19”. ConclusionOur study identified a sustained decline in discharged avoidable ED visits during the two years following the beginning of the COVID-19 pandemic, which was partially offset by the increase in COVID-19 visits. This work can help inform ED and healthcare systems in resource allocation, hospital staffing, and financial planning during future COVID-19 resurgences and pandemics.

Idiopathic Scoliosis Trends One Year After COVID-19: A Retrospective Study.

Introduction The reorganization of healthcare services during the COVID-19 pandemic was associated with compromised management of conditions not related to the pandemic. Methods Aretrospective descriptive case series study was carried out that included patients followed up at the Spine Deformities (SD) consultation at Centro Hospitalar e Universitário Lisboa Centralfrom January 2019 through December 2021regarding diagnosis, treatment, referral, and the number of consultations performed. Results Referrals significantly dropped in 2020 (p<0.001).The average number of consultations per patient was found to not vary significantly in 2020despite the reorganization of our healthcare unit due to the pandemic.22% of the consultations were performed online. Idiopathic scoliosis (IS) was the primary diagnosis in 50% of the patients observed for the first time during the three-year time period. An increase of 18% was found in the number of IS patients that required bracing in 2021. However, late referrals, defined as the patient meeting surgical criteria at the time of initial presentation, did not increase. Conclusion Despite the significant decrease in primary care referrals during 2020, an overcompensation increase in referrals was not observed in 2021. However, the increase in the percentage of patients needing bracing might reflect a delayed initial presentation to the SD consultation.

Effect of Reduced Fluoroquinolone Use on Cephalosporin Use, Susceptibilities and Clostridioides difficile Infections.

Background: Overuse of fluoroquinolones has led to concerning rates of resistance, particularly among Gram-negative organisms. They are also highly implicated as a risk factor for Clostridioides difficile infection, and reports of other serious adverse events led to recommendations to restrict their use. Our health system began targeting the reduction in unnecessary fluoroquinolone prescribing in 2018, aiming to promote their safe and effective use. Broad-spectrum cephalosporins are often used as an alternative to fluoroquinolones. We sought to evaluate whether decreased fluoroquinolone use was associated with increased third- and fourth-generation cephalosporin use and whether these changes in utilization impacted other outcomes, including C. difficile infection (CDI) rates and susceptibilities among Gram-negative organisms. Methods: This retrospective descriptive analysis included adult patients who received a fluoroquinolone or broad-spectrum cephalosporin in a three-year time period across a large healthcare system. The primary objective was to evaluate the change in days of therapy (DOT) of fluoroquinolones and third- and fourth-generation cephalosporins. Secondary objectives included rates of resistance among common Gram-negative organisms, CDI, and analyses stratified by antibiotic indication. Results: Cephalosporin use increased by an average of 1.70 DOT/1000 PD per month (p < 0.001). Additionally, fluoroquinolone use decreased by an average of 1.18 DOT/1000 PD per month (p < 0.001). C. difficile infections decreased by 0.37 infections/10,000 patient-days per month (p < 0.001). Resistance to fluoroquinolones remained stable from 2018 to 2020, and a declining trend was observed in 2021. Conclusion: This study demonstrated that reduced fluoroquinolone use in a large healthcare system was associated with increased usage of broad-spectrum cephalosporins, decreased CDI and improvements in resistance patterns.

Relocation Patterns and Predictors of Relocation and Mortality in Swedish Sheltered Housing and Aging in Place

A reported objective of Swedish sheltered housing is to postpone care needs and relocation. The aim of this study was to describe migration patterns and explore predictors of relocation to nursing homes and mortality, in a sample of residents in sheltered housing and aging in place. To explore longitudinal differences between groups, study data were combined with registry data. The results showed that a higher percentage of residents in sheltered housing had relocated to a nursing home and deceased over a three-year time period, compared to aging in place, implying further interventions may be required to promote health in sheltered housing.

Adolescence exposure to China\u2019s great famine period and the association of metabolic syndrome in adulthood: a retrospective study

BackgroundExposure to famine during early life is related to several adverse health outcomes in adulthood, but the effect of famine exposure during adolescence is unclear. This study aims to examine whether exposure to famine in adolescence is associated with metabolic syndrome (MetS) in adulthood.MethodsThis study included 4130 Chinese adults (2059 males and 2071 females) aged 59–71 from the 2011 China Health and Retirement Longitudinal Study (CHARLS). All the selected participants were exposed to the three-year time period (1959–1961) of China’s Great Famine. Participants were categorized into an adolescent-exposed group (born 01/01/1944–12/31/1948) and a non-adolescent-exposed group (born 01/01/1940–12/31/1941 and 01/01/1951–12/31/1952). Sex-stratified multiple logistic regression models were used to estimate the association between exposure to famine in adolescence and MetS.ResultsParticipants exposed to famine during adolescence were more likely to report MetS (aOR = 1.35; 95%CI 1.01–1.78) compared to the non-adolescent-exposed group. Further, males were 45% less likely to report MetS than females (aOR = 0.55; 95%CI 0.36–0.83). After stratification by sex, the effects of famine exposure during adolescence on MetS were detected among males only (aOR = 1.97; 95%CI 1.20–3.24). Additionally, males with a history of drinking were more likely to report MetS compared to those with no history of drinking (aOR = 2.63; 95%CI 1.41–4.90).ConclusionsOur findings reveal that exposure to famine during adolescence is associated with higher odds of MetS in adulthood overall, and this association is only pronounced among males. This study emphasizes that undernutrition in early life, including adolescence, may have a long-term effect and be associated with adverse health events in middle-to-late life. Targeting those elderly people who suffered famine during adolescence may help prevent the development of MetS in later life.

Trends in Health Disparities of Rural Latinos Pre- and Post-Accountable Care Organization Implementation.

We present findings from a longitudinal investigation, the purpose of which was to compare health disparities of rural Latino older adult patients diagnosed with diabetes to their non-Latino White counterparts. A pre-post design was implemented treating Medicare Accountable Care Organization (ACO) participation by Rural Health Clinics (RHCs) as an intervention, and using diabetes-related hospitalizations to measure disparities. Data for a nationwide panel of 2,683 RHCs were analyzed for a study period of eight years: 2008 - 2015. In addition, data were analyzed for a subset of 116 RHCs located in Florida, Texas, and California that participated in a Medicare ACO in one or more years of the study period. Two broad findings resulted from this investigation. First, for both the nationwide panel of RHCs and the three-state sample of "ACO RHCs," there was a decrease in the mean disparities in diabetes-related hospitalization rates over the eight-year study period. Second, in comparing a three-year time period after Medicare ACO implementation in 2012 to a four-year period before the implementation, a statistically significant difference in mean disparities was found for the nationwide panel. There are a number of factors that may contribute to the decrease in diabetes-related hospitalization rates for Latinos in more recent years. Future research will identify specific contributors to reducing diabetes-related hospitalization disparities between Latinos and the general population, including the possible influence of ACO participation by RHCs. This paper presents original research conducted using data related to rural Latino older adults. The data represent multiple states and an eight-year time period. The U.S. Latino population is growing at a rapid pace. As a group, they are at a high risk for developing diabetes, the complications of which are serious and costly to the patient and the U.S. healthcare system. With the continued growth of the Latino population, it is critical that their health disparities be monitored, and that factors that contribute to their health and well-being be identified and promoted.

Free-roaming dog population dynamics in Ranchi, India

Rabies causes approximately 20,000 human deaths in India each year. Nearly all of these occur following dog bites. Large-scale, high-coverage dog rabies vaccination campaigns are the cornerstone of rabies elimination strategies in both human and dog populations, although this is particularly challenging to achieve in India as a large proportion of the dog population are free-roaming and unowned. Further, little is known about free-roaming dog ecology in India which makes defining optimum vaccination strategies difficult. In this study, data collected using a mobile phone application during three annual mass vaccination and neutering (surgical sterilisation of both males and females) campaigns of free-roaming dogs in Ranchi, India (during which a total of 43,847 vaccinations, 26,213 neuter surgeries and 28,172 re-sight observations were made) were interrogated, using two novel approaches to estimate the proportion of neutered dogs that were lost from the city (assumed due to mortality or migration) between campaign years. Analysis revealed high losses of neutered dogs each year, ranging from 25.3% (28.2–22.8) to 55.8% (57.0–54.6). We also estimated that the total population declined by 12.58% (9.89–15.03) over the three-year period. This demonstrates that there is a high turnover of free-roaming dogs and that despite neutering a large number of dogs in an annual sterilisation campaign, the decline in population size was modest over a three-year time period. These findings have significant implications for the planning of rabies vaccination campaigns and population management programmes as well as highlighting the need for further research into the demographics of free-roaming, unowned dogs in India.

Prediagnostic expressions in health records predict mortality in Parkinson's disease: A proof-of-concept study

IntroductionThe relationship of prodromal markers of PD with PD mortality is unclear. Electronic health records (EHRs) provide a large source of raw data that could be useful in the identification of novel relevant prognostic factors in PD. We aimed to provide a proof of concept for automated data mining and pattern recognition of EHRs of PD patients and to study associations between prodromal markers and PD mortality. MethodsData from EHRs of PD patients (n = 2522) were collected from the Turku University Hospital database between 2006 and 2016. The data contained >27 million words/numbers and >750000 unique expressions. The 5000 most common words were identified in three-year time period before PD diagnosis. Cox regression was used to investigate the association of expressions with the 5-year survival of PD patients. ResultsDuring the five-year period after PD diagnosis, 839 patients died (33.3%). If expressions associated with psychosis/hallucinations were identified within 3 years before the diagnosis, worse survival was observed (hazard ratio = 1.71, 95%CI = 1.46–1.99, p < 0.001). Similar effects were observed for words associated with cognition (1.23, 1.05–1.43, p = 0.009), constipation (1.34, 1.15–1.56, p = 0.0002) and pain (1.34, 1.12–1.60, p = 0.001). ConclusionsAutomated mining of EHRs can predict relevant clinical outcomes in PD. The approach can identify factors that have previously been associated with survival and detect novel associations, as observed in the link between poor survival and prediagnostic pain. The significance of early pain in PD prognosis should be the focus of future studies with alternate methods.

Three year experience of Upper Gastrointestinal Endoscopic procedures at a tertiary care hospital of South Punjab

Introduction: Endoscopy has become a necessity in diagnosing gastrointestinal (GI) disorders. The objective of our study was to evaluate the different indications and findings of upper GI endoscopy. Methods: This retrospective analysis was undertaken at department of Gastroenterology, Nishtar Hospital Multan. Records of all upper GI endoscopic procedures from 1st January 2018 till 31st December 2020 were evaluated. Results: A total 3299 upper GI endoscopic procedures were perfumed during the three-year time period. Mean age was 47 years. Majority of patients were males. Almost 48% of patients belonged to the middle-aged group. The most common indication was upper GI bleeding (57%), followed by dyspepsia (15%). The most common finding was esophageal varices (43%), followed by portal gastropathy (26%) and gastritis (16%). Conclusion: This study concludes that the majority of endoscopies are being undertaken as a result of complications of cirrhosis and portal hypertension. Keywords: Endoscopy, audit, indications, findings

Application of the International System for Reporting Serous Fluid Cytopathology with Cytohistological Correlation and Risk of Malignancy Assessment.

The International System for Reporting Serous Fluid Cytopathology (TIS) classifies serous effusions into five categories: non-diagnostic (ND), negative for malignancy (NFM), atypia of unknown significance (AUS), suspicious for malignancy (SFM) and malignant (MAL). The main objectives of this classification comprise the establishment of a universal code of communication between cytopathologists and clinicians and histopathologists, as well as between different laboratories worldwide, paving the way for the setting of clinical management guidelines based on the risk of malignancy assessment for each diagnostic category. We retrieved the total number of pleural and peritoneal effusion cases of our department for the three-year time period between 2018 and 2020, yielding a total of 528 and 500 cases, respectively. We then proceeded to reclassify each specimen according to TIS guidelines and calculate the risk of malignancy (ROM) for each category by searching each patients’ histology records, medical history and clinical follow-up. For pleural effusions, 3 (0.57%) cases were classified as ND, 430 (81.44%) cases as NFM, 15 (2.84%) as AUS, 15 (2.84%) as SFM and 65 (12.31%) as MAL. ROM amounted to 0%, 5.3%, 33.33%, 93.33% and 100% for each category, respectively. As far as peritoneal effusions are concerned, 6 (1.2%) were categorized as ND with ROM estimated at 16.66%, 347 (69.4%) as NFM (ROM = 9%), 13 (2.6%) as AUS (ROM = 38.46%), 12 (2.4%) as SFM (ROM = 83.33%) and 122 (24.4%) as MAL (ROM = 100%). Our results underline the utility of the current classification, both as a means of communication between doctors of different specialties and as general guidelines for the further clinical management of patients.

CLINICAL OUTCOMES IN PATIENTS AGED 80 YEARS OR MORE ADMITTED TO ICU WITH SEPSIS

TOPIC: Critical Care TYPE: Original Investigations PURPOSE: Advanced interventions which are associated with admission to the intensive care units (ICU) may be an onerous burden to elderly patients (1). In developed countries, these units are catering to a higher proportion of older adult patients (2). Furthermore, these numbers are projected to increase further in the coming years (3). Through our study, we aimed to describe the characteristics and outcomes in elderly patients admitted to the ICU with sepsis. METHODS: A retrospective chart review of all patients aged 80 years and above who were admitted to the medical intensive care unit at John Dempsey Hospital over a three-year time period was performed. Data including age, laboratory data at the time of admission to ICU, discharge diagnoses, length of hospital stay, and discharge disposition was reviewed for all patients. RESULTS: A total of 99 patients who carried an admission diagnosis of sepsis were included in this analysis. Mean age was 87.1±4.9 years (Range 80-102 years). Males were 51/99 (51.5%). A large majority of the patients were Caucasians (97.0%). At the time of admission, 45.4% patients were living at a skilled nursing facility, and 50.5% patients were living at home. Mean length of stay in the hospital was 10.0±9.7 days. Most common discharge diagnosis was sepsis secondary to urinary source (26.2%) and lungs (26.2%), followed by a gastrointestinal cause (11.1%). Mean SOFA score was calculated in 58 patients and was 5.5 at the time of admission. Requirement for interventions were as follows: vasopressors (46.4%), intubation (25.2%), artificial feeding (27.2%) and renal replacement therapy (8.1%). None of the patients required tracheostomy tube placement. Fifty-seven percent of the patients were discharged to skilled nursing facilities, 11.1% were discharged home, and 27.2% patients expired and 4.0% were discharged to hospice. Forty-eight patients were alive at 90 days from hospital discharge. CONCLUSIONS: Our study showed that more than half of the patients aged 80 years or older are discharged to a skilled nursing facility after an ICU admission due to sepsis. Almost one-fourth of the patients died while in the hospital. Data published previously has been variable. A French study including patients aged 80 years or older identified a mortality of 37% at ICU discharge with an additional 45% mortality at hospital discharge (4). Another study from Texas looking at end-of-life hospitalizations in patients older than 65 years of age with dementia demonstrated an in-hospital mortality of 7.1%, with an additional 7.4% of patients were discharged to hospice (5). CLINICAL IMPLICATIONS: Patients 80 years and older do not have a good outcome following ICU admission secondary to sepsis with only about one tenth being discharged home (with or without healthcare services), and more than one-fourth not surviving the hospitalization. Factors associated with poor outcome apart from age in the elderly need to be elaborated in future prospective studies. DISCLOSURES: No relevant relationships by Mythri Anil Kumar, source=Web Response No relevant relationships by Debapriya Datta, source=Web Response No relevant relationships by Suong Nguyen, source=Web Response No relevant relationships by Hira Shahzad, source=Web Response

Human Trafficking Cases Presenting within Child Advocacy Centers

ABSTRACT Although human trafficking of minors is an increasing concern within the United States, very little information is known about how trafficking cases are processed within child advocacy centers (CACs). The current study addresses this gap in the literature by providing descriptive information about victims, service referrals, and prosecutorial outcomes for human trafficking cases presenting at CACs across a Midwestern state. The data originates from a state-wide study focused on understanding the scope of human trafficking cases. Specifically, the dataset includes 210 youth presenting at CACs over a three-year period of time. In this sample, the typical human trafficking case involved sex trafficking of a self-identified white female victim, with an offender known to the victim. Most child survivors passing through CACs were referred to medical and mental health services, although these service referrals did not greatly differ across at-risk versus substantiated trafficking cases. Overall, the findings suggest that CACs are uniquely positioned to encounter human trafficking cases and provide needed services to trafficking survivors. Finally, recommendations are provided for CACs regarding the intake and identification of trafficking cases more broadly.

Individual DNA Methylation Pattern Shifts in Nanoparticles-Exposed Workers Analyzed in Four Consecutive Years.

A DNA methylation pattern represents an original plan of the function settings of individual cells and tissues. The basic strategies of its development and changes during the human lifetime are known, but the details related to its modification over the years on an individual basis have not yet been studied. Moreover, current evidence shows that environmental exposure could generate changes in DNA methylation settings and, subsequently, the function of genes. In this study, we analyzed the effect of chronic exposure to nanoparticles (NP) in occupationally exposed workers repeatedly sampled in four consecutive years (2016–2019). A detailed methylation pattern analysis of 14 persons (10 exposed and 4 controls) was performed on an individual basis. A microarray-based approach using chips, allowing the assessment of more than 850 K CpG loci, was used. Individual DNA methylation patterns were compared by principal component analysis (PCA). The results show the shift in DNA methylation patterns in individual years in all the exposed and control subjects. The overall range of differences varied between the years in individual persons. The differences between the first and last year of examination (a three-year time period) seem to be consistently greater in the NP-exposed subjects in comparison with the controls. The selected 14 most differently methylated cg loci were relatively stable in the chronically exposed subjects. In summary, the specific type of long-term exposure can contribute to the fixing of relevant epigenetic changes related to a specific environment as, e.g., NP inhalation.