Total Number Of Days Research Articles

1618. Assessing and Improving Accurate Diagnosis and Reporting of Congenital Syphilis in a Tertiary Care Children's Hospital

Abstract Background Congenital syphilis (CS) occurs due to transplacental passage of active infection to the fetus during pregnancy. Clinical presentation ranges from asymptomatic to severe permanent disability. Nationally, the incidence and prevalence of syphilis among cisgender females ages 15-44 have increased, with proportional increases in rates of CS. In 2020, 19 cases of CS were reported to the Chicago Department of Public Health (CDPH), a 138% increase from 2019 (8 cases). There are circumstances where infants with a non-reactive rapid plasma reagin (RPR-) may potentially contract syphilis in the context of inadequate maternal treatment per national guidelines. (Figure 1) Currently, only infants with RPR reactivity (RPR+) are reported to CDPH, potentially underestimating the true incidence. Our project sought to identify RPR- infants who received treatment to improve reporting to CDPH, more accurately reflect the prevalence of CS in Chicago, and ultimately guide interventions to reduce and eliminate CS.Figure 1:2021 Center for Disease Control (CDC) Possible Congenital Syphilis Definition Methods Data was collected via electronic medical record (EMR) review for infants born at Comer Children’s Hospital in Chicago, IL between 2012 and 2022, filtered using ICD-9 code (090) and ICD-10 code (A50.9) for CS. Infants were excluded if diagnosis code was used in error, there was no RPR result, or diagnosis occurred at an outside institution. (Figure 2) Infants were stratified as having CS with RPR+ or RPR-. Retrospectively, each infant was also classified with a diagnosis of less likely CS, possible CS, and proven CS per national guidelines.Figure 2:Patient Stratification by ICD-9 and ICD-10 Code for Congenital Syphilis and RPR Reactivity. RPR = Rapid Plasma Reagin Results 68 infants with CS were identified. 57 infants received IV PCN with diagnoses of proven or possible CS (84%). 51 (75%) patients were RPR+ and 17 (25%) were RPR-. (Figure 3) Of the 17 RPR-, 11 had a diagnosis of possible CS (65%) and received IV PCN while 6 (35%) had less likely CS and received one dose of intramuscular (IM) PCN (Table 1). None of the RPR- infants were reported to CDPH.Figure 3:Total Number of Congenital Syphilis Cases Based on CDC Definition. CS = Congenital Syphilis, CDC = Center for Disease ControlTable 1:Total Number of Days of Intravenous or Intramuscular Penicillin Administration per RPR reactivity.. Aq PCN = Aqueous Penicillin G, Ben PCN = Benzathine Penicillin G, IM = Intramuscular, IV = Intravenous Conclusion In this retrospective analysis, reporting CS based solely on a reactive infant RPR leads to underreporting. As we confront the rising incidence of CS, (Figure 4) it is critical that we have a complete understanding of the epidemiology which may lead to increased support for public health initiatives focused on decreasing and eliminating CS.Figure 4:Timeline of Total CS and RPR- CS Cases at Hospital per Year. CS = Congenital Syphilis Disclosures Allison H. Bartlett, MD, MS, CVS/Caremark: Honoraria Jessica Ridgway, MD, Gilead Sciences: Expert Testimony

Manpower cost for a hypertension health campaign: A cross-sectional study

Introduction: The overall prevalence of hypertension is high, and many people are unaware of their condition. Screening campaigns can effectively identify this group of patients. The study aimed to determine the cost of manpower for a health campaign for detecting undiagnosed hypertension and the prevalence of hypertension. Methods: This cross-sectional study was conducted at two health centres. Sociodemographic characteristics, hypertension and treatment statuses were recorded. Blood pressure (BP) was measured by either doctors or nurses using automated BP machines. The cost of manpower was calculated as the average salaries of manpower during the 3-day health campaign divided by the total number of days. The final sum was the cost of detecting undiagnosed hypertension. Results: A total of 2009 participants median age = 50 (IQR = 18-91) were included in the study. The overall prevalence of hypertension was 41.4% (n=832). Among the patients with hypertension, 49.2% (n=409) were unaware of their hypertension status. Conversely, 21.1% (n=423) were known to have hypertension, among whom 97.4% (n=412) were on medications. Among those who were on medications, 49% (n=202) had good BP control. The average total cost of manpower during the 3-day health campaign was RM 5019.80 (USD 1059). The cost of detecting an individual with elevated BP was RM 12.27 (USD 2.59). Conclusion: The prevalence of hypertension and unawareness is high. However, the average cost of manpower to detect an individual with elevated BP is low. Therefore, regular public health campaigns aiming to detect undiagnosed hypertension are recommended.

Abstract 12357: Investigating Sex-Specific Factors Influencing Atrial Fibrillation Burden in Patients With Persistent Atrial Fibrillation: A DECAAF II Subanalysis

Background: Atrial Fibrillation(AF) burden provides insights beyond the common binary classification of AF recurrence after catheter ablation(CA). Objective: We sought to investigate the predictors of AF burden in patients with persistent AF(PeAF) at 1 year post-CA, with a focus on sex-based differences. The analysis was conducted separately for both female and male. Methods: We examined all PeAF patients in the DECAAF II trial and divided them into 2 groups, women and men. Baseline demographics and late gadolinium enhancement magnetic resonance imaging data were reviewed. Patients were instructed to provide single-lead home ECG strips once daily. AF burden was calculated by dividing the total number of days in AF over the total number of days when strips were sent. Univariate and multivariate analysis were performed to predict AF burden beyond the 3-month blanking period. Results: We included 658 patients(20% Female,80% male) who transmitted 215825 ECG strips. The average AF burden across the population was 17%. The mean AF burden was higher in women(21%) than in men(16%)(p<0.01). In women, on univariate analysis, baseline fibrosis(p<0.05), history of stroke(p<0.01) and left atrial(LA) volume(p<0.01) were positively correlated with AF burden. After conducting a multivariate analysis, we found that baseline fibrosis(p<0.05), history of stroke(p<0.05), vascular diseases(p<0.05), and LA volume(p<0.01) were independent predictors of AF burden. In men, on univariate analysis, age(p<0.01), baseline fibrosis(p<0.01), hyperlipidemia(p<0.01) and LA volume(p<0.01) were positively correlated with AF burden. After conducting a multivariate analysis, only LA volume (p<0.01) and age(<0.01) continued to be significantly related(Table 1). Conclusion: Sex-specific management strategies are crucial for addressing AF, as our study demonstrates a significant impact of sex on predicting AF burden monitored by a single-lead handheld smartphone ECG device.

Clinical evidence of growth hormone for infertile women with diminished ovarian reserve undergoing IVF: a systematic review and meta-analysis.

To appraise the current randomized clinical trials (RCTs) for evidence of the association of growth hormone (GH) with improved outcomes in infertile women with diminished ovarian reserve (DOR) undergoing in vitro fertilization (IVF). Relevant RCTs published in Chinese or English were identified through a comprehensive search of nine databases from the period of database inception to April 20, 2023. We included trials investigating adjuvant GH during ovarian stimulation and reported the subsequent outcomes. The group with adjuvant GH treatment and the group without adjuvant GH treatment were set up as the trial and control groups, respectively. The quality of RCTs was measured according to the Cochrane Collaboration Handbook. Of the 579 studies initially identified, 10 RCTs comprising 852 infertile women with DOR were included. The GH dose of individual trials ranged between 3 and 5 IU/day. Overall, we judged the trials to be at high risk of bias in the blinding domain. Pooled results showed that GH was associated with an increased clinical pregnancy rate (RR = 1.63, 95%CI [1.31, 2.03], p < 0.0001) and a greater number of oocytes retrieved (MD = 0.91, 95%CI [0.47, 1.35], p < 0.0001). Favorable associations were also observed when ovarian stimulation was combined with GH therapy for improving the optimal embryos rate (RR = 1.84, 95%CI [1.30, 2.59], p = 0.0005) and the number of optimal embryos (MD = 0.28, 95%CI [0.08, 0.48], p = 0.005) along with reducing the cycle cancellation rate (RR = 0.46, 95%CI [0.24, 0.89], p = 0.02). Moreover, GH resulted in an increase in the fertilization rate (RR = 1.33, 95%CI [1.18, 1.50], p < 0.00001) and the embryo implantation rate (RR = 1.56, 95%CI [1.21, 2.01], p = 0.0006). In addition, there was a significant enhancement in estradiol levels (SMD = 1.18, 95%CI [0.46, 1.91], p = 0.001) and endometrial thickness (MD = 0.75, 95%CI [0.41, 1.09], p < 0.0001) on the day of hCG. With regard to the total number of days and total dose of gonadotrophins used, GH treatment was correlated with shorter days (MD = -0.26, 95%CI [-0.46, -0.06], p = 0.01) and lower dose (MD = -460.97, 95%CI [-617.20, -304.73], p < 0.00001) of gonadotrophins applied during ovarian stimulation. Furthermore, GH in conjunction with the GnRH antagonist protocol was more conducive to improving the number of oocytes retrieved when compared with the GnRH agonist protocol (p < 0.0001). Moreover, a notable association was also seen in IVF combined with GH more than or equal to 4.5 IU/day to increase the number of optimal embryos and estradiol levels on the day of hCG (p < 0.05). For infertile women with DOR undergoing IVF, adjuvant treatment with GH during ovarian stimulation protocols showed better clinical outcomes, shorter days and lower dosages of gonadotrophin required. Furthermore, well-designed RCTs are needed to verify our results in the future. https://www.crd.york.ac.uk PROSPERO (CRD42023421739).

Meter: A Multi-Country, Real-World Chart Review Study to Explore Treatment Patterns, Effectiveness and Healthcare Resource Utilization for Patients with Myelofibrosis

Background : Myelofibrosis (MF) is a rare myeloproliferative disorder associated with significant morbidity and mortality. The hallmarks of MF pathobiology include aberrant myeloproliferation, cytokine-induced inflammation, bone marrow reticulin fibrosis, extramedullary hematopoiesis, cytopenias, and constitutional symptoms. Hydroxyurea was the most commonly used drug in patients with MF prior to the approval of ruxolitinib (RUX), a first-in-class Janus kinase 1/2 inhibitor (JAKi) that is widely approved for symptomatic patients with MF. In addition to RUX, the JAKis fedratinib and, more recently, pacritinib have also been approved by the US Food and Drug Administration. Real-world treatment patterns and impact of currently available JAKis on patients with MF are not well understood. Several novel agents are in advanced development and will further reshape the treatment landscape of MF. A better understanding of current treatment patterns will assist in positioning novel treatments within the MF therapeutic landscape. Methods : The METER study (NCT05444972) is an ongoing multicountry noninterventional retrospective chart review assessing treatment patterns, effectiveness, and healthcare resource utilization (HCRU) in patients diagnosed with MF. Data from patients aged ≥18 years with primary or secondary MF treated on or after the local first date of RUX approval until December 31 , 2021 were assessed. Patients who received treatment for MF in a clinical trial were excluded. The primary objective is to describe real-world MF treatment patterns, including patient characteristics, time from MF diagnosis to first-line (1L) therapy, choice, duration and reason for change/discontinuation of initial and subsequent treatments for MF, and treatment procedures. Secondary objectives include assessments of days hospitalized as part of HCRU. Results : As of June 1, 2023, 928 patient charts were included, met eligibility criteria, and had initial treatment information available. Most patients were male (54%) and White (65%), and the median (range) age for patients ≤89 years of age was 66 (58-73) years; the most common geographic locations were Europe (53%), Latin America (23%), and North America (13%). Of patients, 66% (614/928) had primary MF, and 10% (97/928) were transfusion-dependent. Of patients tested for high molecular risk mutations, 50% (81/162) were positive. Of patients with available bone marrow fibrosis data, 82% (554/680) had grade ≥2 bone marrow fibrosis at diagnosis. The average interval from MF diagnosis to start of initial treatment (index date) was approximately 8.5 months. RUX was the most commonly used 1L therapy (47%; 437/928) followed by hydroxyurea (41%; 380/928). RUX was also the most common therapy used in second-line (2L), third-line, fourth-line, and fifth-line treatment for 62% (217/353), 63% (107/171), 66% (56/85), and 59% (24/41) of patients, respectively. Mean (SD) time from index date to procedural intervention was 556 (519) days; the most common procedure was stem cell transplant (n = 71) followed by splenectomy (n = 20). Of the 927 patients who received 1L therapy, 98% remained on 1L therapy through Week 24, and 66% did not initiate 2L therapy until Week 156. Median (95% CI) duration of 1L therapy was 48 (45-52) months (Figure). Median (95% CI) survival from the start of 1L therapy was 79 (71-NR) months. The estimated survival rate (95% CI) was 76% (73-79) at Week 156. Median (95% CI) overall survival was 120 (93-147) months. Median (Q1-Q3) total number of days hospitalized after the index date was 2 (0-19), and median (Q1, Q3) total number of days in the intensive care unit after the index date was 0 (0, 0). Analyses will be updated for presentation. Conclusions : In patients with MF, RUX was the most commonly used agent in all lines of therapy. The greatest reduction in duration of MF treatment occurred from 1L to 2L. Most patients remained on 1L therapy through Week 24 and did not initiate 2L therapy until Week 156. Median survival time from start of 1L therapy to death was 79 months (approximately 6 years). There was a high degree of advanced bone marrow fibrosis as well as transfusion dependence among this real-world patient population. Together, these results highlight the importance of optimizing 1L therapy.

Retrospective Analysis of the Impact of Bendamustine Dose Reduction and Chemotherapy on the Outcomes of Follicular Lymphoma

Introduction Follicular lymphoma (FL) is the most common indolent non-Hodgkin's lymphoma and primarily affects the elderly population. While bendamustine serves as a pivotal drug in standard therapy, it is often not administered as planned due to side effects, especially among the elderly. Clinical studies have shown that dose reduction and chemotherapy delays in the treatment of diffuse large B-cell lymphoma are associated with lower survival rates. However, few studies have analyzed the impact of bendamustine delays and dose reduction on the outcome of FL. Thus, the aim of our study was to clarify the effect of bendamustine dose reduction and chemotherapy course delay on treatment outcomes and to evaluate the effects of chemotherapy modification on FL. Patients and Methods This is a retrospective pooled analysis of previously untreated patients with FL who underwent consecutive bendamustine-based regimens at our institute. Patients receiving less than four courses of bendamustine-based regimens were excluded. Bendamustine dose reduction was defined as a cumulative dose reduction of at least 20% of the total prescribed dose. The total dose was defined as the sum of six cycles administered at 100% of the prescribed dose. Chemotherapy delays were defined as the total number of days of delay exceeding 21 days. The main goal of the study was to assess the impact of the chemotherapy scheme modification (dose reduction or delay) on progression-free survival (PFS) and overall survival (OS). The Kaplan-Meier method was used for single-variable survival data analysis. Differences in survival rate were determined using the log-rank test. Comparison among subgroups was performed using ANOVA for continuous covariates and Fisher's exact test for categorical variables. Results From January 2016 to June 2023, 43 untreated FL patients (23 females and 20 males) were started on rituximab-bendamustine (R-B) or obinutuzumab-bendamustine (G-B) at our institution. Median patient age was 69 years (range, 41-90 years) and the median follow-up time was 44 months (range, 5-74 months). Thirteen patients were treated with R-B, and 30 with G-B. Only one patient received obinutuzumab maintenance therapy due to the COVID-19 pandemic. Patients were divided into for three bendamustine delay/reduction groups. No bendamustine dose reduction or chemotherapy delays was observed in 27 patients (62.7%). The chemotherapy scheme was modified in 16 patients (37.2%): 10 patients (23.2%) experienced a bendamustine-only dose reduction and 6 patients (13.9%) experienced chemotherapy-only delays. None of the patients experienced both bendamustine dose reduction and delays. The main reasons for bendamustine dose reductions were the following: elderly/ frailty (60.0%), neutropenia (10.0%), thrombocytopenia (10.0%), and patient request (10.0%). The main reasons for chemotherapy delays were the following: patient request (33.3%), thrombocytopenia (33.3%), infection (16.6%), and skin rash (16.6%). Baseline characteristics were summarized in Table 1. The PFS of the three groups was comparable (Figure. 1a). The OS of the group with chemotherapy delays was comparable to the group with no dose reduction or delay, while that of the group with dose reduction was inferior (Figure. 1b). There were no differences in objective response rate (Table1). Conclusion Our study showed that chemotherapy delays or bendamustine dose reduction did not adversely affect PFS, and only chemotherapy delays adversely affected OS. No clinically significant differences in PFS were observed among patients with chemotherapy delays, which could be attributed to insufficient statistical power. Our cohorts comprised a heterogeneous population, including patients treated with R-B and G-B. However, considering the lack of evidence regarding the optimal dose intensity or chemotherapy interval for different populations, reducing the bendamustine dose may be a valid option for vulnerable patients.

A pilot exploratory study examining the potential influence of continuous positive airway pressure devices on cranial molding trajectories in preterm infants.

The objective of this exploratory study was to assess the potential impacts of two different continuous positive airway pressure (CPAP) devices on preterm infant head shape and circumference. Twenty infants born at <32 weeks gestational age requiring CPAP support were enrolled. Ten infants used the Hudson RCI Nasal Prong CPAP device and 10 infants used the Fisher-Paykel CPAP device. Infant Cranial Index (CI) and head circumference (HC) were collected weekly as well as infant gestational age at birth, and total number of days on CPAP. At baseline, average total birthweight of infants was 1021 grams (SD = 227 grams), average gestational age was 26.9 weeks (SD = 1.80), mean CI was 79.7 cm (SD = 5.95), and HC was 10.2 cm (SD = 0.92). Days on CPAP ranged from 16 to 63 days, with an average of 40.7 (SD = 13.6) days. Neither CI nor HC differed by device type; however, the Fisher-Paykel device was associated with slightly greater HC growth rate. CPAP devices and the pressures they apply plausibly contribute to preterm infant cranial molding over time, with the greatest potential impact on infants who require CPAP support for longer periods; however, these findings must be validated in larger cohorts. Additionally, positioning practices should be further examined to determine how they may contribute to or prevent the development of cranial molding deformity.

The Association Between Serum Vancomycin Level and Clinical Outcome in Patients With Peritoneal Dialysis Associated Peritonitis

Intraperitoneal (IP) vancomycin is often first-line empiric therapy and then maintenance therapy for peritoneal dialysis (PD) peritonitis. However, how vancomycin serum levels correlate with clinical outcomes remains unclear. We conducted a retrospective single-center adult cohort study of 98 patients with PD peritonitis treated with IP vancomycin between January 2016 and May 2022. The association between nadir vancomycin level and cure was evaluated in a logistic regression model, first unadjusted and then adjusted for age, sex, weight, glomerular filtration rate (GFR), and total number of days on PD. Vancomycin was assessed both as a continuous exposure (per 1 mg/l increase) and as a categorical exposure (<15 mg/l vs.≥15 mg/l). A receiver operating characteristic curve (ROC) was created to explore nadir vancomycin level thresholds in an attempt to identify an optimal target level during treatment. Of the patients, 81% achieved cure, and patients with nadir vancomycin level≥15 mg/l were 7.5 times more likely to experience cure compared to those with a nadir level<15 mg/l (odds ratio [OR] 7.58, 95% confidence interval [CI] 1.71-33.57, P= 0.008). Weight, GFR, days on PD, sex, and age were not independently associated with outcome. The vancomycin level with the greatest discriminatory capacity for cure on the ROC analysis was 14.4 mg/l. Increasing IP vancomycin serum levels are associated with increased odds of cure; and maintaining vancomycin serum levels above 14-15 mg/l throughout the course of PD peritonitis treatment is likely to improve clinical outcomes.

To rest or to compete? A 4-week cohort study of analgesic use and willingness to compete hurt in Danish youth elite athletes

ObjectivesTo assess the association between analgesic use and willingness to compete hurt (WCH) in Danish youth elite athletes, and to explore factors associated with such willingness. Design4-week prospective cohort study. Methods592 Danish youth elite athletes (15–20 years) completed a baseline questionnaire assessing demographic information, sport history, and WCH, and provided weekly reports on analgesic use for 4 weeks via text messages. Analgesic use was categorized as no use (0 weeks) or use across 1, 2, 3, or 4 weeks, and as the total number of days with analgesic use. Multinomial logistic regression and zero-inflated negative binomial regression analyses estimated the association between analgesic use and WCH. Linear backward stepwise regression analysis was used to identify factors associated with WCH. ResultsOverall, risk of analgesic use increased significantly with increasing WCH scores (relative risk ratios ranging from 1.06 (95% CI 1.0 to 1.12%) to 1.34% (95% CI 1.15 to 1.57)). The incidence rate of analgesic use increased significantly with increasing WCH scores (incidence rate ratio 1.09 (95% CI 1.04 to 1.14)). Associations between the investigated possible antecedent factors and WCH were weak and not considered practically important (R2 = 0.05 or lower). ConclusionsHigher WCH scores were associated with increasing risk of analgesic use, irrespective of the underlying reason for the use, in Danish youth elite athletes, suggesting that analgesics may be an ingrained part of a sport-specific culture of risk acceptance. Future studies should include measures of culture, norms, and social interaction to better explain the variance in WCH.

Environmental spatial mapping within equine indoor arenas

Equine indoor arenas are unique infrastructure investments found at equine farms and facilities. Environmental concerns within these facilities (temperature, respirable dust, moisture, and air movement) have been identified through surveys and small research studies. Thirty-seven indoor arenas at equine facilities within 160 km (100 miles) of Lexington, KY, were visited from August 2018 to August 2021. Semi-structured interviews were conducted to gather more information regarding the environment within the indoor arena and information about the equine facility. Site assessments were also conducted and temperatures (footing or ground level, air at 1.37 m above the footing, and roof), air speeds at 1.37 m above the footing, and light levels at 1.37 m above the footing across the indoor arena spaces were measured, in addition to the total number of horses at the facilities and daily average and maximum use of the indoor arenas. Spatial mapping was conducted using ArcMap 10.7 (Esri; Redlands, California), with kriging being used for the interpolation. The created maps were used to determine the variability of the temperatures, air speed, and lighting within the indoor arenas. These variabilities were examined for the statistical significance for variables of the indoor arenas that were determined by structural and design aspects and for facility usage information gathered from the semi-structured interviews. The variables that were statistically significant were roof ventilation for roof temperature variability, roof insulation for footing temperature variability, building enclosure for lighting variability, total number of horses at the facility for lighting variability, and total daily number of horses in the indoor arena for the ambient air temperature variability. One of the most significant results was the lack of air movement observed in the majority of the indoor arenas. Over 80% of the indoor arenas were experiencing still air speed conditions (&amp;lt; 0.51 m/s) during the site assessment. There is a need for more research on the environmental conditions within indoor arenas, the potential health impacts to the humans and horses in the spaces, and how design changes to the facilities could improve these environments.

Impact of diarrhoea and acute respiratory infection on environmental enteric dysfunction and growth of malnourished children in Pakistan: a longitudinal cohort study.

Diarrhoea and acute respiratory infections (ARI) are assumed to be major drivers of growth and likely contribute to environmental enteric dysfunction (EED), which is a precursor to childhood malnutrition. In the present study, we checked the correlation between diarrhoeal/ARI burden and EED using a novel duodenal histological index. Between November 2017 and July 2019, a total of 365 infants with weight-for-height Z scores (WHZ score) of <-2 were enrolled, and 51 infants with WHZ scores of >0 and height-for-age Z scores (HAZ scores) of >-1 were selected as age-matched healthy controls. Morbidity was assessed weekly and categorised as the total number of days with diarrhoea and acute respiratory infection (ARI) from enrolment until two years of age and was further divided into four quartiles in ascending order. The HAZ declined until two years of age regardless of morbidity burden, and WHZ and weight-for-age Z scores (WAZ scores) were at their lowest at six months. Sixty-three subjects who had a WHZ score <-2 and failed to respond to nutritional and educational interventions were further selected at 15 months to investigate their EED histological scores with endoscopy further. EED histological scores of the subjects were higher with increasing diarrhoeal frequency yet remained statistically insignificant (p=0.810). There was not a clear correlation between diarrhoea and ARI frequency with growth faltering, however, children with the highest frequency of diarrhoea had the highest EED histological scores and growth faltering. Bill and Melinda Gates Foundation and The National Institutes of Health.

Evaluation of an integrated care pathway for out-of-hospital treatment of older adults with an acute moderate-to-severe lower respiratory tract infection or pneumonia: protocol of a mixed methods study

IntroductionOlder adults with an acute moderate-to-severe lower respiratory tract infection (LRTI) or pneumonia are generally treated in hospitals causing risk of iatrogenic harm such as functional decline and delirium. These...

Google Maps Timeline: An open-access digital tool to monitor walking abilities in people with multiple sclerosis.

Gait impairment is common in multiple sclerosis (MS), but difficult to evaluate in clinical practice. In this proof-of-concept observational study, we compared walking ability recorded by Google Maps Timeline to conventional clinical measures in people with MS. We used open-access Google Maps Timeline to record the total number of days with walking activity, walking distance, walking time, and walking speed. Each Google Maps Timeline variable was included in a different stepwise linear regression model including all conventional clinical variables. We included nine people with MS (age 43.1 ± 6.6 years; females 55.6%; disease duration 12.7 ± 3.1 years; median Expanded Disability Status Scale 3.0 (range 1.0-5.5)). Higher percentage of days with recorded walking was associated with lower Fatigue Severity Scale (p = 0.01), and higher MS Walking Scale (p = 0.04). Longer average daily walking distance was associated with shorter Timed-25 Foot Walking Test (p = 0.02), lower Expanded Disability Status Scale (p = 0.01), and higher Euro-Quality of Life (p = 0.04). Longer average daily walking time was associated with shorter Timed-25 Foot Walking Test (p = 0.03). Higher walking speed was associated with lower Fatigue Severity Scale (p = 0.04). Google Maps Timeline parameters provide actual estimates of daily walking activities in MS.

Threat of Climate Change

The anthropogenic activities of mankind have led to an unprecedented rise in global greenhouse concentrations since the industrial revolution. The consequence of this unequivocal rise in global surface temperature has been witnessed over the last century and more so after 1970. The global surface temperature in the last twenty years (2001-2020) was 0.9°C higher than what was registered during 1850-1900 (IPCC, 2023). This has also been observed that the number of hot days every year has been on the increase when the temperature around touches 50°C. There are multiple reports which have predicted very hot summers across the globe in the coming days and the report further reveals that the total number of days when the temperature crossed 50°C in different parts of the world was 14 in the years between 1980 and 2009 whereas this rose to 26 days during 2010-2019. The year 2022 witnessed the hottest summer in many western and south-western European countries where the temperature was above 2.3°C above the pre-industrial average and this extraordinary temperature rise in different parts of Europe exacerbated many unimaginable things like a severe forest fire, drought, drying up of many water bodies and heat-related deaths.

Threat of Climate Change

The anthropogenic activities of mankind have led to an unprecedented rise in global greenhouse concentrations since the industrial revolution. The consequence of this unequivocal rise in global surface temperature has been witnessed over the last century and more so after 1970. The global surface temperature in the last twenty years (2001-2020) was 0.9°C higher than what was registered during 1850-1900 (IPCC, 2023). This has also been observed that the number of hot days every year has been on the increase when the temperature around touches 50°C. There are multiple reports which have predicted very hot summers across the globe in the coming days and the report further reveals that the total number of days when the temperature crossed 50°C in different parts of the world was 14 in the years between 1980 and 2009 whereas this rose to 26 days during 2010-2019. The year 2022 witnessed the hottest summer in many western and south-western European countries where the temperature was above 2.3°C above the pre-industrial average and this extraordinary temperature rise in different parts of Europe exacerbated many unimaginable things like a severe forest fire, drought, drying up of many water bodies and heat-related deaths.

Threat of Climate Change

The anthropogenic activities of mankind have led to an unprecedented rise in global greenhouse concentrations since the industrial revolution. The consequence of this unequivocal rise in global surface temperature has been witnessed over the last century and more so after 1970. The global surface temperature in the last twenty years (2001-2020) was 0.9°C higher than what was registered during 1850-1900 (IPCC, 2023). This has also been observed that the number of hot days every year has been on the increase when the temperature around touches 50°C. There are multiple reports which have predicted very hot summers across the globe in the coming days and the report further reveals that the total number of days when the temperature crossed 50°C in different parts of the world was 14 in the years between 1980 and 2009 whereas this rose to 26 days during 2010-2019. The year 2022 witnessed the hottest summer in many western and south-western European countries where the temperature was above 2.3°C above the pre-industrial average and this extraordinary temperature rise in different parts of Europe exacerbated many unimaginable things like a severe forest fire, drought, drying up of many water bodies and heat-related deaths.

The impact of aggregate positive lifestyle behaviors on low back pain resilience and care seeking

BACKGROUND CONTEXTLow back pain (LBP) is a global issue, and the high associated costs are mainly attributed to a small proportion of people with LBP who seek care. Importantly, the impact of aggregate positive lifestyle behaviors on LBP resilience and care seeking is not known. PURPOSEThis study aimed to evaluate the relationship between positive lifestyle behaviors and LBP resilience. STUDY DESIGNThis study was a prospective longitudinal cohort study. PATIENT SAMPLEData was collected as part of the AUstralian Twin BACK Study (AUTBACK). Participants who reported a lifetime previous history of LBP at baseline were included in this analysis (n = 340). OUTCOME MEASURESThe outcomes of interest were the number of weeks without activity limiting LBP and total number of days of healthcare usage, health practitioner care, self-management care, and medication intake. METHODSA lifestyle behavior score was built using variables of body mass index (BMI), physical activity, smoking status, and sleep quality. Negative binomial regression analyses were used to assess the relationship between the positive lifestyle behavior score and the count outcomes of number of weeks without activity limiting LBP and number of days participants used care. RESULTSAfter adjusting for covariates, no association was found between participants’ positive lifestyle behavior score and their number of weeks without activity limiting LBP (IRR: 1.02, 95% CI 1.00–1.05). There was a statistically significant relationship between higher positive lifestyle behavior scores and fewer number of days of participants’ total healthcare usage (IRR:0.69, 95% CI 0.56–0.84), healthcare practitioner visits (IRR:0.62, 95% CI 0.45–0.84), use of self-management strategies (IRR:0.74, 95% CI 0.60–0.91), and use of pain medication (IRR:0.55, 95% CI 0.44–0.68). CONCLUSIONPeople who adopt optimal lifestyle behaviors, such as engaging in adequate physical activity, achieving optimal quality sleep, maintaining an ideal BMI, and not smoking, may not experience less time suffering from activity limiting LBP, but are less likely to use healthcare and pain medication for their LBP.

Analysis of the dynamics and precipitation regime in the cross-border region Poland-Belarus- Ukraine (2010-2018)

&#x0D; &#x0D; &#x0D; The work analyzes the dynamics and regime of atmospheric precipitation in the cross-border region of Poland-Belarus-Ukraine during the period 2010-2018. This time period was chosen, in particular, due to the need to find the prerequisites for the strong shallowing of lake complexes and the depletion of groundwater in the Polish region in 2019, which caused significant social and scientific resonance. The source data for the statistical part of the work were archival information from 17 weather stations in the specified region for this period. The main results of the study: 1) the dynamics of the average monthly precipitation amounts for each meteorological station were calculated and analyzed (Lutsk, Svityaz, Manevychi, Kovel, Liubeshiv, Volodymyr, Rivne, Dubno, Sarny, Brody, Rava-Ruska, Kamianka-Buzka, Pinsk, Pruzhany, Terespol, Wlodawa, Zamosc), the average amounts of precipitation that fell during the warm season of the year (IV-X months) and the cold season of the year (XI-III months), average annual precipitation amounts and precipitation amounts for the entire period, which was investigated (2010-2018). All calculated indicators were compared with the data of the climatic norm of 1961-1990). The annual number of days with precipitation, the warm and cold periods of the year, and the average values of this indicator were also determined. Based on the results of the statistical analysis, charts, cartograms, and several diagrams were developed that visually represent the peculiarities of the dynamics of atmospheric precipitation in the studied region during the analyzed period (2010-2018). 2) on the basis of the calculated indicators, maps of the geographical distribution of precipitation amounts on the territory of the cross-border region Poland-Belarus-Ukraine during the studied period (annual amounts, cold and warm season amounts) were constructed. When comparing them with maps of the period of the 20th century. Changes in the geography of distribution and trends of modern growth of precipitation amounts in the study region were revealed. After the analysis, a number of conclusions and generalizations were made: 1. During the period 2010-2018 in the territory of the cross-border region Poland-Belarus- Ukraine, the average annual amounts of precipitation increased by 20-45 mm compared to the climatic standard, while the average annual number of days with precipitation decreased by 25-30%. 2. Annual amounts of precipitation exceeded 600 mm at almost all (16 out of 17) meteorological stations whose data were analyzed. 3. The distribution of days with atmospheric precipitation during the seasons of the year has changed. The ratio between the amounts of precipitation that fell in the warm and cold periods of the year changed from 75/25 to 60/40 on average. In general, in the studied region, there are trends towards a slight increase in annual precipitation amounts, a redistribution of precipitation amounts in liquid and solid state in favor of rains, and a reduction in the total number of days with precipitation during the year and a more even distribution of them during the warm and cold seasons, compared to the climatic norm.&#x0D; &#x0D; &#x0D;

P-236 IL-6 levels in follicular-fluid and day5/6 spent culture drops indicate its role as a biomarker of oocyte maturation and an embryokine influencing embryo developmental competence

Abstract Study question To elucidate the role of IL-6 in folliculogenesis and embryo development during human in-vitro culture Summary answer High IL-6 levels in follicular-fluid positively correlate with oocyte maturity status whereas higher IL-6 secretome in day5/day6 spent culture media inversely correlates with blastocyst/ICM grades What is known already Although some studies have attempted to explore the correlation of FF IL-6 with fertilization and embryo development rates; the results have been inconclusive. Similarly, studies comparing FF IL-6 levels with endometrial receptivity and pregnancy outcomes have been ambiguous and contradictory. Recent research has reported improvement in bovine blastocyst ICM grades in culture media supplemented with IL-6. No study has yet evaluated the role of IL-6 as a biomarker of oocyte maturity nor investigated IL-6 as an embryokine that could regulate embryo developmental competence in humans. We have employed the FF metabolomic and Secretomic approach for IL-6 in human IVF cycles. Study design, size, duration Prospective study in women (25-35 years) undergoing IVF cycles (n = 256) for unexplained/tubal-factor infertility from 2018-2020. Only those women whose FF and day5/6 spent culture media sample could be obtained, were included. Women with endometriosis, PID, Genital Kochs were excluded. IL-6 levels were measured by diagnostic kit in spent micro-drops and FF (pooled per patient per cycle). Cycles were divided into Low and High IL-6 groups (FF: ≤ 47.5 and &amp;gt;47.5pg/ml; Spent Medium: &amp;lt;0.5 and ≥0.5pg/ml). Participants/materials, setting, methods Antagonist cycles involving COH with r-FSH and ICSI for all. Noted oocyte Nuclear maturity (GV/MI/MII). Oocyte Cytoplasmic maturity graded as Top and non-Top, based on presence of granulation, refractile bodies, sER, visco-elasticity. Post ICSI, oocytes cultured individually in 50µl single-step media micro-drops till day3 and shifted to fresh 50µl micro-drops for extended culture till day5/6. Blastocyst gradation was done using Gardner’s classification for expansion, ICM and trophectodermal cells. Statistical analysis done using graph-pad prism VI Main results and the role of chance High FF/IL-6 group (n = 103) had significantly higher proportion of MII (92.08 vs. 76.33%; p &amp;lt; 0.001) and top-quality (88.10 vs. 70.0%; p &amp;lt; 0.001) oocytes and fertilization rates (89.45 vs. 77.30%; p = 0.009) compared to Low FF/IL-6 group (n = 153) although total number of days of stimulation/gonadotropin dose, mean oocytes retrieved did not differ significantly between the two groups. Cleavage (84.64 vs. 75.92%; p = 0.061) and blastocyst formation (53.86 vs. 42.37%; p = 0.053) rate, although higher, did not differ significantly between the two FF/IL-6 groups. FF/IL-6 level correlated strongly with overall oocyte maturity status (Pearson r = 0.61, 95% CI 0.52-0.8). Threshold FF/IL-6 level for obtaining top-quality MII oocytes was &amp;gt;39.2pg/ml (ROCAUC = 86%, Sensitivity = 78%, Specificity = 83%). In D5/6 spent culture drops, likelihood of top-quality blastocyst formation (expansion grade ≥3 and ICM/TE grades AA/AB/BA) increased by 41% (odds ratio: 0.44, 95%CI: 0.4-0.5; χ2 p &amp;lt; 0.0001) if IL-6 concentration was &amp;lt;0.5 pg/ml. Lower culture-drop IL-6 levels correlated strongly with top ICM grades (Pearson r = −0.66, 95% CI 0.6-0.7). Highest IL-6 levels were found in spent culture-drops containing grade-C blastocysts whether on day5 or day6. IL-6 levels were comparatively higher in day6 than in day5 micro-drops, correlating with higher percentage of top-quality blastocysts on day5 than on day6. Threshold micro-drop IL-6 level for top-grade blastocyst &amp;lt;0.42 pg/ml. Limitations, reasons for caution We estimated IL-6 levels in pooled FF (per patient, per cycle). Although cumbersome &amp; time-consuming, it would be worthwhile to evaluate individual FF (per follicle, per patient, per cycle). Also, measuring IL-6 in spent media involving group embryo culture, may facilitate study of the probable paracrine effects of this ‘embryokine’. Wider implications of the findings IL-6 is a pleiotropic cytokine and its role/s in folliculogenesis, embryo development and endometrial receptivity is not yet clearly etched out. This study attempts to elucidate the functions of IL-6 in a systematic manner by deriving threshold values for obtaining top quality oocytes and blastocysts in human in-vitro culture conditions. Trial registration number NOT APPLICABLE

P-475 Effect of transdermal estradiol on endometrial preparation in frozen-thawed embryo transfer: A randomized control study.

Abstract Study question Is patient usage of transdermal estradiol more effective than oral estradiol on endometrial preparation in frozen-thawed embryo transfer cycles? Summary answer This study showed no significant differences in clinical pregnancy rates between the 2 groups. Transdermal gel have advantage of better patient comfort, lesser side effects. What is known already Estrogen and progesterone are crucial factors for endometrial preparation in frozen embryo transfer (FET) cycles. Studies assessing different forms of estradiol in FET have already been published. However, literature and studies in Vietnam are still limited to evaluating, research evaluating transdermal estrogen in ART. This study aimed to evaluate the use of transdermal estradiol gel and compare it with oral estradiol for the endometrium preparation in frozen-thawed embryo transfer (FET) cycles. Study design, size, duration This randomized clinical trial (RCT) included 380 frozen embryo transfer (FET) cycles from February 2020 to August 2021 at the IVF Department, Hung Vuong Hospital. Participants/materials, setting, methods They were randomized into one of the two groups. Group A (n = 190) received oral estradiol and group B (n = 190) received estradiol gel. In both groups, medication was started on day 2 of the menstrual, and endometrial thickness was monitored by ultrasound. Main outcomes were the following: serum estradiol level , endometrial thickness,.... Secondary outcomes were CPR, MR, and side effects in the 2 groups. Statistical testing was performed with Stata 14. Main results and the role of chance There was a significant difference in estradiol level on the day of progesterone administration and embryo transfer between the two groups (270.5 pg/ml versus 186.5 pg/ml, p, p. &amp;lt;0.001). According to the comparison, the two groups were not significantly different in the endometrial thickness on the day of progesterone administration (p = 0.85). as the data suggest, the total dose of estradiol used and the total number of days of dosing were similar in the two groups. The biochemical and clinical pregnancy rates were similar between the two groups and did not a significantly differ (56.2% vs. 52.2%, p = 0.474). The rate of miscarriage was higher than in the study group, but it was not statistically significant. Almost 20.3% of patients (n = 37) in group A had mild adverse effects when compared with only 10.1% (n = 18) in group B, and this was clinically significant (P = 0.007). Limitations, reasons for caution The limitation of our study was not asses ongoing pregnancy rate and live-birth rate. Wider implications of the findings Patients who estradiol valerate is contraindicated such as, high risk for deep vein thrombosis, hyperlipidemia, and clotting disturbance we can use oestrogel to be safe. It is suggested that estradiol transdermal patches be used instead of oral estradiol in FET cycles Trial registration number ISRCTN15301227