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AIMS: Compensatory coping, or maladaptive alterations in behavior with the intention of preventing or managing symptoms, is increasingly being explored as a key factor in how people respond to bladder conditions. Preliminary investigations have identified relations between coping behaviors and psychological distress in urologic conditions, including interstitial cystitis/bladder pain syndrome (IC/BPS). However, previous explorations of coping have not accounted for heterogeneity in coping behaviors or addressed the likelihood that some coping behaviors may be more adaptive than others. This study sought to examine how two specific types of coping behaviors, primary control coping and disengaged coping, are related to distress and symptoms in IC/BPS, and to explore the potential role of pain phenotype in this relationship. MATERIALS AND METHODS: A secondary data analysis was conducted with a large community data set (N = 677 women with IC/BPS) and employed descriptive and inferential statistics to characterize coping patterns and explore novel predictors of distress. RESULTS: Results indicated that almost all participants engaged in at least one compensatory coping behavior within the last week. Both types of coping behaviors correlated with psychological symptoms, and when controlling for relevant clinical variables (i.e., age and severity of urinary symptoms), disengaged coping behaviors were significantly associated with psychological distress. Further, the addition of pain phenotype to multiple regression models resulted in a more effective predictive model when considering the relation between coping behaviors and depression. CONCLUSIONS: By investigating more deeply the relationship between coping and distress, understanding of potential risk factors and mechanisms is increased, offering valuable insights for intervention strategies for IC/BPS patients.

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BACKGROUND: Scanning with low-dose computed tomography reduces lung cancer mortality by 20% among high-risk individuals. Despite its efficacy, the uptake of lung cancer screening (LCS) remains low. Our study aimed to estimate state-level and nationwide LCS rates among eligible individuals and to assess disparities in LCS uptake. METHODS: Data for this study were obtained from the 2022 BRFSS. Multivariable logistic regression models were used to model the associations between predictors and outcome variables and to examine LCS variability across states. RESULTS: Of the 28,071 participants eligible for LCS, 17.24% underwent LCS. Participants aged 65 -79 years were (OR: 1.75, 95%CI: 1.54 -1.99) more likely to undergo LCS than their younger counterparts. Those who were female (OR: 0.83, 95%CI: 0.73 - 0.94), divorced, separated, or widowed (OR: 0.85, 95%CI: 0.74-0.98), without health insurance (OR: 0.34, 95%CI: 0.22-0.53), without a primary care provider (OR: 0.29, 95%CI: 0.19-0.44), without COPD or those who did not disclose their COPD status ((OR: 0.35, 95%CI: 0.31-0.40) and (OR: 0.37, 95%CI: 0.19-0.73) respectively)) were less likely to undergo LCS than their respective counterparts. LCS uptake also varied significantly across U.S. states. CONCLUSIONS: We observed low uptake of LCS overall, and significant variability in LCS uptake by sociodemographic and health-related factors as well as by state of residence. IMPACT: The findings from this study have important implications for community health workers and healthcare clinicians and indicate the need to design effective interventions to increase LCS uptake targeting specific subgroups of populations and particular U.S. states.

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BACKGROUND: Improvements in movement quality (ie, how well an individual moves) facilitate increases in movement quantity, subsequently improving general health and quality of life. Wearable technology offers a convenient, affordable means of measuring and assessing movement quality for the general population, while technology more broadly can provide constructive feedback through various modalities. Considering the perspectives of professionals involved in the development and implementation of technology helps translate user needs into effective strategies for the optimal application of consumer technologies to enhance movement quality. OBJECTIVE: This study aimed to obtain the opinions of wearable technology experts regarding the use of wearable devices to measure movement quality and provide feedback. A secondary objective was to determine potential strategies for integrating preferred assessment and feedback characteristics into a technology-based movement quality intervention for the general, recreationally active population. METHODS: Semistructured interviews were conducted with 12 participants (age: mean 42, SD 9 years; 5 males) between August and September 2022 using a predetermined interview schedule. Participants were categorized based on their professional roles: commercial (n=4) and research and development (R&D; n=8). All participants had experience in the development or application of wearable technology for sports, exercise, and wellness. The verbatim interview transcripts were analyzed using reflexive thematic analysis in QSR NVivo (release 1.7), resulting in the identification of overarching themes and subthemes. RESULTS: Three main themes were generated as follows: (1) "Grab and Go," (2) "Adjust and Adapt," and (3) "Visualize and Feedback." Participants emphasized the importance of convenience to enhance user engagement when using wearables to collect movement data. However, it was suggested that users would tolerate minor inconveniences if the benefits were perceived as valuable. Simple, easily interpretable feedback was recommended to accommodate diverse audiences and aid understanding of their movement quality, while avoiding excessive detail was advised to prevent overload, which could deter users. Adaptability was endorsed to accommodate progressions in user movement quality, and customizable systems were advocated to offer variety, thereby increasing user interest and engagement. The findings indicate that visual feedback representative of the user (ie, an avatar) should be used, supplemented with concise text or audible instructions to form a comprehensive, multimodal feedback system. CONCLUSIONS: The study provides insights from wearable technology experts on the use of consumer technologies for enhancing movement quality. The findings recommend the prioritization of user convenience and simplistic, multimodal feedback centered around visualizations, and an adaptable system suitable for a diverse audience. Emphasizing individualized feedback and user-centric design, this study provides valuable findings around the use of wearables and other consumer technologies to enhance movement quality among the general population. These findings, in conjunction with those of future research into user perspectives, should be applied in practical settings to evaluate their effectiveness in enhancing movement quality.

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During homeostasis, the endoplasmic reticulum (ER) maintains productive transmembrane and secretory protein folding that is vital for proper cellular function. The ER-resident HSP70 chaperone, binding immunoglobulin protein (BiP), plays a pivotal role in sensing ER stress to activate the unfolded protein response (UPR). BiP function is regulated by the bifunctional enzyme filamentation induced by cyclic-AMP domain protein (FicD) that mediates AMPylation and deAMPylation of BiP in response to changes in ER stress. AMPylated BiP acts as a molecular rheostat to regulate UPR signaling, yet little is known about the molecular consequences of FicD loss. In this study, we investigate the role of FicD in mouse embryonic fibroblast (MEF) response to pharmacologically and metabolically induced ER stress. We find differential BiP AMPylation signatures when comparing robust chemical ER stress inducers to physiological glucose starvation stress and recovery. Wildtype MEFs respond to pharmacological ER stress by down-regulating BiP AMPylation. Conversely, BiP AMPylation in wildtype MEFs increases upon metabolic stress induced by glucose starvation. Deletion of FicD results in widespread gene expression changes under baseline growth conditions. In addition, FicD null MEFs exhibit dampened UPR signaling, altered cell stress recovery response, and unconstrained protein secretion. Taken together, our findings indicate that FicD is important for tampering UPR signaling, stress recovery, and the maintenance of secretory protein homeostasis.

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Natural biopolymers have a rich history, with many uses across the fields of healthcare and medicine, including formulations for wound dressings, surgical implants, tissue culture substrates, and drug delivery vehicles. Yet, synthetic-based materials have been more successful in translation due to precise control and regulation achievable during manufacturing. However, there is a renewed interest in natural biopolymers, which offer a diverse landscape of architecture, sustainable sourcing, functional groups, and properties that synthetic counterparts cannot fully replicate as processing and sourcing of these materials has improved. Proteins and polysaccharides derived from various sources (crustaceans, plants, insects, etc.) are highlighted in this review. We discuss the common types of polysaccharide and protein biopolymers used in healthcare and medicine, highlighting methods and strategies to alter structures and intra- and interchain interactions to engineer specific functions, products, or materials. We focus on biopolymers obtained from natural, nonmammalian sources, including silk fibroins, alginates, chitosans, chitins, mucins, keratins, and resilins, while discussing strategies to improve upon their innate properties and sourcing standardization to expand their clinical uses and relevance. Emphasis will be placed on methods that preserve the structural integrity and native biological functions of the biopolymers and their makers. We will conclude by discussing the untapped potential of new technologies to manipulate native biopolymers while controlling their secondary and tertiary structures, offering a perspective on advancing biopolymer utility in novel applications within biomedical engineering, advanced manufacturing, and tissue engineering.

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Hospital-acquired infections, including central line associated bloodstream infections (CLABSI), are an ongoing source of cost, morbidity, and mortality worldwide. This article presents a summary of the impact of the recent SARS-CoV-2 pandemic on CLABSI incidence, an overview of current standard-of-care practices for reduction of CLABSI, and a look toward future changes in bacteremia metrics and challenges in prevention.

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OBJECTIVE: To investigate parasiticide use and describe signalment features in patients with sudden acquired retinal degeneration syndrome (SARDS). ANIMALS: Retrospective case-control study of dogs with (n = 71) and without (136) SARDS. METHODS: Parasiticide use, presentation season, weight, body condition, and signalment were compared between dogs diagnosed with SARDS and the reference population by use of descriptive statistics and logistic regression. RESULTS: Animals with SARDS were at a 5.99 times higher odds of having previously used imidacloprid (95% CI, 1.6 to 22.2; P = .003). However, time of last imidocloprid administration was > 6 years prior to diagnosis in 6 SARDS-affected individuals and 15, 26, or 42 months before diagnosis (n = 1 each). No other class of parasiticide had a significant association with SARDS. Seasonal variation was observed with a negative association identified between incidence of SARDS and tick season (October to January; P < .001). Overweight and obese dogs were 4.42 (95% CI, 1.9 to 10.4) and 4.96 (95% CI, 2.1 to 11.6) times more likely to have SARDS (P ≤ .001). History of polyphagia or weight gain was not associated with an increased likelihood of being overweight or obese within the SARDS-affected population (P > .108). CLINICAL RELEVANCE: While a statistically significant association was found between imidacloprid use and SARDS, this is unlikely to be clinically significant given the lack of a temporal association, sparse exposure numbers, and low point estimate of the OR. A positive association between being overweight or obese and a diagnosis of SARDS was found independent of polyphagia and weight gain, suggesting that it may be a risk factor for the development of SARDS.

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Prostate cancer (PCa) is the most common cancer diagnosed in men worldwide and was the second leading cause of cancer-related deaths in US males in 2022. Prostate cancer also represents the second highest cancer mortality disparity between non-Hispanic blacks and whites. However, there is a relatively small number of prostate normal and cancer cell lines compared to other cancers. To identify the molecular basis of PCa progression, it is important to have prostate epithelial cell (PrEC) lines as karyotypically normal as possible. Our lab recently developed a novel methodology for the rapid and efficient immortalization of normal human PrEC that combines simultaneous CRISPR-directed inactivation of CDKN2A exon 2 (which directs expression of p16INK4A and p14ARF) and ectopic expression of an hTERT transgene. To optimize this methodology to generate immortalized lines with minimal genetic alterations, we sought to target exon 1α of the CDKN2A locus so that p16INK4A expression is ablated while the exons encoding p14ARF remains unaltered. Here we describe the establishment of two cell lines: one with the above-mentioned p16INK4A only loss, and a second line targeting both products in the CDKN2A locus. We characterize the potential lineage origin of these new cell lines along with our previously obtained clones, revealing distinct gene expression signatures. Based on the analyses of protein markers and RNA expression signatures, these cell lines are most closely related to a subpopulation of basal prostatic cells. Given the simplicity of this one-step methodology and the fact that it uses only the minimal genetic alterations necessary for immortalization, it should also be suitable for the establishment of cell lines from primary prostate tumor samples, an urgent need given the limited number of available prostate cancer cell lines.

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Beginning in late 2023, Oropouche virus was identified as the cause of large outbreaks in Amazon regions with known endemic transmission and in new areas in South America and the Caribbean. The virus is spread to humans by infected biting midges and some mosquito species. Although infection typically causes a self-limited febrile illness, reports of two deaths in patients with Oropouche virus infection and vertical transmission associated with adverse pregnancy outcomes have raised concerns about the threat of this virus to human health. In addition to approximately 8,000 locally acquired cases in the Americas, travel-associated Oropouche virus disease cases have recently been identified in European travelers returning from Cuba and Brazil. As of August 16, 2024, a total of 21 Oropouche virus disease cases were identified among U.S. travelers returning from Cuba. Most patients initially experienced fever, myalgia, and headache, often with other symptoms including arthralgia, diarrhea, nausea or vomiting, and rash. At least three patients had recurrent symptoms after the initial illness, a common characteristic of Oropouche virus disease. Clinicians and public health jurisdictions should be aware of the occurrence of Oropouche virus disease in U.S. travelers and request testing for suspected cases. Travelers should prevent insect bites when traveling, and pregnant persons should consider deferring travel to areas experiencing outbreaks of Oropouche virus disease.

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BACKGROUND: Our research team partnered with primary care and quality improvement staff in Federally Qualified Community Health Centers (CHCs) to develop Partnered and Equity Data-Driven Implementation (PEDDI) to promote equitable implementation of evidence-based interventions. The current study used a human-centered design methodology to evaluate the usability of PEDDI and generate redesign solutions to address usability issues in the context of a cancer screening intervention. METHODS: We applied the Cognitive Walkthrough for Implementation Strategies (CWIS), a pragmatic assessment method with steps that include group testing with end users to identify and prioritize usability problems. We conducted three facilitated 60-min CWIS sessions with end users (N = 7) from four CHCs that included scenarios and related tasks for implementing a colorectal cancer (CRC) screening intervention. Participants rated the likelihood of completing each task and identified usability issues and generated ideas for redesign solutions during audio-recorded CWIS sessions. Participants completed a pre-post survey of PEDDI usability. Our research team used consensus coding to synthesize usability problems and redesign solutions from transcribed CWIS sessions. RESULTS: Usability ratings (scale 0-100: higher scores indicating higher usability) of PEDDI averaged 66.3 (SD = 12.4) prior to the CWIS sessions. Scores averaged 77.8 (SD = 9.1) following the three CWIS sessions improving usability ratings from "marginal acceptability" to "acceptable". Ten usability problems were identified across four PEDDI tasks, comprised of 2-3 types of usability problems per task. CWIS participants suggested redesign solutions that included making data fields for social determinants of health and key background variables for identifying health equity targets mandatory in the electronic health record and using asynchronous communication tools to elicit ideas from staff for adaptations. CONCLUSIONS: Usability ratings indicated PEDDI was in the acceptable range following CWIS sessions. Staff identified usability problems and redesign solutions that provide direction for future improvements in PEDDI. In addition, this study highlights opportunities to use the CWIS methodology to address inequities in the implementation of cancer screening and other clinical innovations in resource-constrained healthcare settings.

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Background: Motor and non-motor fluctuations adversely impact quality of life in Parkinson's disease (PD). Dysautonomia, a feature frequently associated with PD and a possible adverse effect of dopaminergic therapy, may be comorbid with fluctuations. Objectives: We sought to evaluate the effect of dysautonomia on motor and non-motor fluctuations in PD. Methods: Two hundred subjects with PD were evaluated in both "on" and "off" dopamine states to assess changes in symptoms related to dopaminergic fluctuations. Multivariable logistic regression was performed to assess the association of dysautonomia with motor, cognitive, and psychiatric worsening from ON to OFF states with adjustment for disease duration, levodopa equivalent daily dosage (LEDD), and dopamine agonist LEDD. Results: Subjects with dysautonomia had greater odds of clinically meaningful change in motor features (OR 3.0), cognition (OR 3.4) and anxiety (OR 4.3) compared to those without dysautonomia. Conclusions: Dysautonomia may be a contributory mechanism behind fluctuations in PD. The exact nature of this relationship deserves further evaluation.

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BACKGROUND: Injuries to the proximal interphalangeal joint (PIPJ) of the fingers are commonly treated in hand therapy departments. Conservative management for PIPJ volar plate injuries typically involves a dorsal blocking orthosis and flexion exercises. Historically hand therapists have placed the PIPJ in varying degrees of flexion but the optimal angle is unknown. PURPOSE: To compare the outcomes of two treatment groups who received dorsal blocking orthoses: Those who the orthosis was positioned in neutral compared to those in 25-30° of flexion. STUDY DESIGN: Retrospective cohort study. METHOD: Patients treated by the hand therapy service at a major metropolitan hospital network in Melbourne, Australia, for conservative management of a PIPJ volar plate injury over a three-year period were included in our study. Data regarding patient demographics, digits affected and injury type were collected. Outcomes included presence of a fixed flexion deformity (FFD), amount of hand therapy received and total active flexion at the PIPJ. RESULTS: One hundred and eleven participants were included in our study. The mean age was 26 and 59 (53%) were males. Seventy two (64%) participants received a dorsal blocking orthosis positioned in neutral and 39 (35%) were positioned in 25-30° flexion at the PIPJ. Participants whose orthosis was positioned at 25-30° had an average of 24 more minutes in hand therapy (which equates to approximately one appointment) compared to those whose PIPJ was positioned in neutral (p=0.006, d=0.5). Eight percent less participants developed a FFD (p = 0.24) and 13% more participants achieved full flexion (p = 0.06) in the group who received a dorsal blocking orthosis in neutral, however these results were not statistically significant. CONCLUSION: PIPJ volar plate injures treated in an orthosis positioned in neutral required fewer hand therapy appointments. There was no statistically significant difference between groups regarding development of a FFD or full flexion.

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OBJECTIVE: The present study aimed to examine: (a) whether distinct momentary emotion dysregulation dimensions differentially mediated momentary associations between affect and disordered eating behaviours (DEBs) in the natural environment; (b) whether these associations differed based on affect, emotion dysregulation, and DEB type. METHOD: 150 women with eating disorder pathology (Mage = 20.95, SD = 4.14) completed 4 surveys targeting affect, emotion dysregulation, and DEBs each day for a 10-day ecological momentary assessment period. Multilevel structural equation models examined whether four momentary emotion dysregulation dimensions (difficulties with emotional and behavioural modulation, lack of emotional acceptance, awareness, and clarity) mediated momentary associations between negative and positive affect (PA), and loss of control eating, overeating, and dietary restriction. RESULTS: Momentary difficulties with emotional and behavioural modulation mediated momentary associations between negative affect (NA) and women's loss of control eating and overeating. These findings did not extend to PA, the other emotion dysregulation dimensions, or dietary restriction. CONCLUSIONS: Collectively, these results support emotional and behavioural modulation deficits in the natural environment as potential transdiagnostic maintenance mechanisms of overeating and loss of control eating. These findings also support the potential benefits of targeting NA and this type of emotion dysregulation in existing and novel real-time eating disorders interventions.

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BACKGROUND: Experiential avoidance (EA) may serve as a risk factor for a wide range of anxiety-related psychopathology. Anxiety is thought to trigger the use of EA, while also serving as a consequence of EA efforts. Previous ecological momentary assessment (EMA) studies found that EA was associated with greater anxiety in nonclinical undergraduates and patients with social anxiety disorder. METHODS: The present study examined the in-the-moment, bidirectional relationship between EA, perceived stress, and two facets of anxiety (autonomic arousal and worry/misery) in a sample of treatment-seeking patients broadly diagnosed with an anxiety-related disorder (N = 46). Participants completed a baseline assessment followed by an EMA assessment period (assessments three times daily for seven days). We hypothesized that there would be a bidirectional relationship between EA and anxiety/stress. RESULTS: Results largely supported a unidirectional relationship such that greater EA at one time point predicted higher stress at a later time point controlling for previous stress levels and linear time. Trend-level associations between EA and anxiety symptoms are discussed. CONCLUSIONS: The current study provides important insight into the relationship between EA and anxiety symptoms in a clinical sample of participants with anxiety-related disorders.

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Previous research exploring the effects of tactile feedback in standing balance protocols may have generated results that misrepresent the modulatory capabilities of cutaneous afference on generating motor output responses. The neurosensory mechanism of textured foot orthoses to maximize the activation of cutaneous mechanoreceptors is through repetitive foot sole skin indentation. Thus, the purpose of this experimental protocol was to investigate muscular activity amplitude changes during the stance phase of gait, specifically when walking on level ground and when stepping onto a raised wedge, and while wearing textured foot orthoses compared to orthoses without texture. Twenty-one healthy young adults were fit to a standardized neutral running shoe and completed five level and wedged walking trials wearing both orthoses. Kinematic, kinetic and electromyography (EMG) data were recorded from eight lower limb muscles. The results of this study revealed EMG suppression of lower leg musculature during stance when walking in textured foot orthoses, and this was most pronounced when lower leg musculature is typically most active. The addition of texture in foot orthoses design, spanning the entire length of the foot sole, appears to be a clear mechanism to modulate neurosensory feedback with intent to suppress EMG of shank musculature during gait.

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BACKGROUND: Cervical auscultation (CA) involves listening to swallowing and respiratory sounds and/or vibrations to detect oropharyngeal aspiration (OPA). CA has shown promising diagnostic test accuracy when used with the clinical swallowing examination and is gaining popularity in clinical practise. There has not been a review to date analysing the accuracy of CA in paediatric and adult populations with meta-analyses. OBJECTIVES: To determine the accuracy of CA in detecting OPA in paediatric and adult populations, when compared to instrumental assessments. SEARCH METHODS: Databases searched included MEDLINE, PubMed, Embase, CINAHL, AustHealth, Cochrane and Web of Science. The search was restricted between 01 October 2012 and 01 October 2022. SELECTION CRITERIA: Inclusion criteria included (a) all clinical populations of all ages, (b) who have had an instrumental assessment and (c) CA. All study types were included. DATA COLLECTION AND ANALYSIS: Studies were reviewed independently by two authors. The methodological quality of the studies was analysed using the QUADAS-2. MAIN RESULTS: Ten studies met the inclusion criteria for this review and meta-analyses. The pooled diagnostic performance of CA in detecting OPA was 0.91 for sensitivity and 0.79 for specificity. The area under the curve summary receiver operating curve (sROC) was estimated to be 0.86, thereby indicating good discrimination of OPA. Most studies scored high for risk of bias in at least one domain in the QUADAS-2, likely attributed to a lack of high-quality prospectively designed studies. CONCLUSIONS: There are promising diagnostic test accuracies for the use of CA in detection of OPA. Future research could include using CA in specific clinical populations and settings, and identifying standardised criteria for CA.

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The chemotherapeutic agent, cisplatin, accumulates in the kidneys leading to acute kidney injury (AKI). Pre-clinical and clinical studies have demonstrated sex-dependent outcomes of cisplatin-AKI. Deranged histone deacetylase (HDAC) activity is hypothesized to promote the pathogenesis of male murine cisplatin-AKI; however, it is unknown if there are sex differences in the kidney HDACs. We hypothesized that there would be sex specific Hdac expression, localization, or enzymatic activity and this may explain sexual-dimorphic responses to cisplatin-AKI. In normal human kidney RNA samples, HDAC10 was significantly greater in the kidney of women compared to men, while HDAC1, HDAC6, HDAC10, and HDAC11 were differentially expressed between the kidney cortex and medulla, regardless of sex. In a murine model of cisplatin-AKI (3 days post a 15 mg/kg injection) we found few sex- or cisplatin- Hdac kidney transcript differences among the mice. Although Hdac9 was significantly greater in female mice compared to males, HDAC9 protein localization did not differ. Hdac7 transcripts were greater in the inner medulla of cisplatin-AKI mice, regardless of sex, and this agreed with a greater HDAC7 abundance. HDAC activity within the cortex, outer, and inner medullae was significantly lower in cisplatin-AKI mice but did not differ between the sexes. In agreement with these findings a class I HDAC inhibitor didn't improve kidney injury or function. In conclusion, even though cisplatin-AKI was evident and there were transcript level differences among the different kidney regions in this model, there were few sex or cisplatin-dependent effects on kidney HDAC localization or activity.

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BACKGROUND: Persistent vasopressor requirements are a common reason for delayed liberation from the intensive care unit (ICU) and adjunct oral agents are sometimes used to hasten time to vasopressor discontinuation. We sought to describe the use of droxidopa for vasopressor weaning in critically ill patients with prolonged hypotension. MATERIALS AND METHODS: This retrospective, single-arm, observational study included adult patients admitted to an ICU at two academic centers between 06/2016-07/2023 who received droxidopa for vasopressor weaning. Patients who received droxidopa prior to admission or for another indication were excluded. The primary outcome was time to vasopressor discontinuation, defined as when vasopressors were stopped and remained off for at least 24 h. Secondary outcomes included rates of tachycardia and hypotension post-initiation, norepinephrine equivalents pre- and post-initiation, concomitant oral agent use, and dosing. A subgroup analysis was conducted in patients receiving droxidopa via feeding tubes. RESULTS: A total of 30 patients met inclusion criteria. Median age was 62 years old, 12 (40%) were female, and 73% were in a cardiac/cardiac surgical ICU. Patients were on vasopressors for a median of 16 days prior to droxidopa initiation. Median (IQR) time to vasopressor discontinuation was 70 h (23-192) and norepinephrine equivalents decreased immediately after initiation (0.08 vs 0.02 mcg/kg/min, p < 0.001). MAP increased after droxidopa initiation (68.8 vs 66.5 mm Hg, p = 0.008) while heart rates were unchanged (86 vs 84 BPM, p = 0.37) after initiation. Patients who weaned from vasopressors within 72 h versus longer than 72 h after droxidopa initiation were more likely to be on lower norepinephrine equivalents prior to initiation (0.05 vs 0.12 mcg/kg/min, p = 0.013). Feeding tube administration did not impact time to vasopressor discontinuation (p = 0.93). CONCLUSIONS: Droxidopa may be considered an adjunct therapy for vasopressor weaning. Effects were similar when analyzing patients receiving droxidopa via feeding tube.

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BACKGROUND: Anemia is an independent predictor of mortality, which may be utilized as a signal of deteriorating health. We estimated the association between anemia severity categories and mortality following the initiation of antiretroviral therapy (ART) among people with HIV (PWH) in North America. METHODS: Within the NA-ACCORD, annual median hemoglobin measurements between 01/01/2007-12/31/2016 were categorized using World Health Organization criteria into mild (11.0-12.9g/dL men, 11.0-11.9g/dL women), moderate (8.0-10.9g/dL men/women) and severe (<8.0g/dL men/women) anemia. Discrete time-to-event analyses using complementary log-log link models estimated mortality hazards ratios adjusted for demographics, comorbidities, and HIV clinical markers with 95% confidence intervals for the association between anemia and mortality. RESULTS: Among 67,228 PWH contributing a total of 320,261 annual median hemoglobin measurements, 257,293 (80%) demonstrated no anemia, 44,041 (14%) mild, 18,259 (6%) moderate, and 668 (0.2%) severe anemia during follow-up. Mortality risk was 5.6-fold higher among PWH with (vs. without) anemia. The association was greater among males (aHR=5.8 [5.4, 6.2]) versus females (aHR=4.1 [3.2, 5.4]). Mortality risk was 3.8-fold higher among PWH with mild anemia, 13.7-fold higher with moderate anemia, and 34.5-fold higher with severe anemia (vs. no anemia). Median hemoglobin levels significantly declined within 4 years prior to death, with the maximum decrease the year prior to death. Macrocytic anemia was associated with an increased and microcytic anemia a decreased mortality risk (vs. normocytic anemia). CONCLUSIONS: Anemia among PWH who have initiated ART is an important predictive marker for mortality with macrocytic anemia having an increased and microcytic anemia a decreased association with mortality compared with normocytic anemia.

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ObjectiveConsumer involvement is when patients (their families, friends, and caregivers) work with researchers on research projects. While health services are expected to support consumer-researcher collaborations, conducive environments still need to be developed, with limited research into how Australian health services support this practice. This study explores current consumer involvement in research activity and staff perceptions at an Australian tertiary hospital and health service.MethodsResearch-active employees at a health service were invited to participate in an online cross-sectional survey. It assessed experience with and confidence in involving consumers in research, the perceived value of consumer involvement, and considerations related to challenges, facilitators, and solutions to enhance consumer involvement in health service research.ResultsAmong 83 respondents, including medical, nursing, and allied health professionals, 54 completed the survey. Approximately half had experience with involving consumers in research. Over 80% recognised that involving consumers enhanced research relevance. Identified barriers included challenges in finding (46.6%) and compensating (59.3%) consumers, as well as deficiencies in researcher skills, knowledge (32.2%), and time constraints (39%). Facilitators comprised access to experienced researchers and educational opportunities. Moreover, 87% advocated for increased support to involve consumers within health services, with the appointment of a designated consumer involvement officer deemed the most beneficial solution by 92.5% of respondents.ConclusionsWhile individual barriers inhibit consumer involvement in research, more prominent institutional factors such as financial and technical support may determine successful and meaningful collaborations. As health services evolve towards co-design models in research, the outcomes of this study will guide initiatives aimed at enhancing consumer involvement in the research process within Australian health services.