Ascension

This retrospective cohort study evaluated the relationship between patient falls, Morse Fall Scale (MFS) items, patient demographics, length of stay and hospital site. Data were acquired from 72 hospitals in a health system. Logistic regression models were conducted including MFS items, demographics, length of stay, and interaction terms. The final mixed effects logistic regression model included significant patient-level covariates as fixed effects and hospital site as a random effect. 6531 of 978,920 total admissions included a patient fall. Four MFS items (fall history, secondary diagnosis, gait weak/impaired, mental status-overestimates/forgets limitations) and three demographic items (male gender, increased age, longer length of stay) were associated with increased likelihood of falling. Two MFS items (ambulatory aids, intravenous therapy/lock) and Hispanic ethnicity were associated with decreased risk of falling. An interaction effect was present between male gender and mental status. Males who overestimate/forget limitations had 3.16 times higher odds of falling than females oriented to their own ability. The proportion of variance in falls between hospitals was 0.23 and the median odds ratio (MOR) 1.57. This study uniquely assessed fall risk at the level of the patient and hospital, using data from nearly 1 million admissions at 72 hospitals. Controlling for patient characteristics, results demonstrate variability in fall risk among hospitals. Research informing hospital differences as well as gender and racial/ethnic differences in falls is needed to identify appropriate interventions. As hospitals increasingly adopt risk-directed fall prevention, assessment tools should be re-evaluated for clinical utility and corresponding prevention practices. The MFS may be enhanced by removing intravenous lock as a risk and screening for additional risks such as medications and medical equipment. Quality improvement efforts must also consider the hospital's environment and processes that may further contribute to fall risk. Authors adhered to STROBE guidelines for reporting. No Patient or Public Contribution.

BackgroundPeople living with HIV (PLWH) experience up to twofold increased risk of cardiovascular disease compared to the general population. The coronary artery calcium (CAC) score offers a non-invasive and quantifiable assessment of subclinical coronary artery disease (CAD), making it a valuable tool for early detection and risk stratification in this high-risk population.MethodsA systematic review and meta-analysis were conducted to quantify the percentage of detectable CAC among PLWH. Detectable CAC was defined as a CAC >0 based on the Agatston method. CAC scores were further categorized into mild (1–100), moderate (101–399), and high ( >400). Pooled percentages with corresponding 95% confidence intervals (95%CI) were calculated. Subgroup analyses were performed by continent to assess geographic variations in the prevalence of detectable CAC among PLWH.ResultsA total of 56 studies were included, with a pooled percentage of detectable CAC among PLWH of 45.7% (95%CI 36.5-48.2). The pooled percentage with mild CAC was 27.7% (95%CI 22.7-32.9%, N=17), moderate CAC was 9.8% (95%CI 7.7-12.0, N=16) and high CAC 4.4% (.8-6.3%, N=10). Significant regional variations were found in the percentage of PLWH with detectable CAC (p< 0.01): with the highest percentage reported in North America (49.3%, 43.6-55.1, N=35) followed by Asia (42.3%, 95%CI 37.7-48.2, N=5), Europe (42.3%, 95%CI 36.5-48.2, N=12) and Africa (13.4%, 95%CI 9.6-17.6, N=3). A single study from South America reported a pooled percentage of PLWH with detectable CAC of 67.4% (95%CI 50.9-81.4).ConclusionAlmost half of PLWH had detectable CAC, indicating a substantial burden of subclinical coronary artery disease in this population. The higher prevalence observed in North America highlights the importance of targeted preventive strategies, including lifestyle interventions and pharmacologic therapies. The scarcity of data from South America, Oceania and Africa highlights a critical need for further research in these underrepresented regions.DisclosuresAniruddha Hazra, MD, Gilead Sciences: Advisor/Consultant|Gilead Sciences: Grant/Research Support|ViiV Healthcare: Advisor/Consultant

Abstract The impact of shifting marine conservation policy, including marine protected area (MPA) designation, in shaping interactions between humans and imperilled species, such as sharks, remains understudied, despite its importance in determining the success of these interventions. We investigated perceptions of shark–human interactions (SHI) among the community in a remote, large‐scale MPA (Ascension Island) where two recent shark attacks and perceived general increases in interactions (mostly with Galapagos and silky sharks), including depredation in recreational fisheries, have occurred. From 2023 to 2024, informal semistructured interviews ( n = 34) were conducted with island residents and analysed using two theory‐driven thematic frameworks to understand the level and drivers of conflict. We showed considerable social impact of SHI, including reduced human well‐being and substantial lifestyle changes, with both depredation and human attacks driving dispute‐level conflict. Strong social and familial connections on island resulted in narratives around attacks persisting and trauma resulting from attacks drove heightened perceived risk. Underlying conflict was further exacerbated by the perceived recurrent and unpredictable nature of negative SHI compounded with the interactions being perceived as abnormal with limited information on socio‐ecological drivers. Some felt excessive chumming by historic recreational fisheries, mostly engaged in by non‐residents, had also involuntarily exposed them to heightened risk by increasing SHI. There was also no consensus of what shark species were behind the increased interactions. Management resolutions were perceived as minimal but were not widely viewed as negative. However, divergent views on the use of lethal control and the need for conservation measures, such as banning shark exploitation, were evident. A key theme emerged around the need for wider community participation in the research and management processes. Policy implications . Our results highlight the critical importance of demystifying marine species, particularly in terms of understanding socio‐ecological drivers of human–wildlife interactions, to combat escalation into human–wildlife conflict. This is particularly important to maintain support for large‐scale MPAs and species‐specific conservation. Read the free Plain Language Summary for this article on the Journal blog.

Background: Upper respiratory infections (URIs) are a common cause of outpatient visits in adults. While most URIs are viral, antimicrobial prescribing rates remain high. The COVID-19 pandemic disrupted usual practices, necessitating an evaluation of the post-pandemic landscape for antimicrobial prescribing for URIs. This study sought to characterize factors contributing to variability in utilization in a large multi-state health system. Methods: Retrospective analysis of antimicrobial prescribing in patients ≥18 years of age for URI diagnosis codes in 863 outpatient sites (eight states), including office visits, urgent care, and telemedicine between July 1, 2023 to June 30, 2024. Primary outcome was antimicrobial prescribing rates for URIs overall and by individual URI diagnosis (sinusitis, bronchitis, pharyngitis, otitis media). HEDIS definitions were applied where appropriate. Logistic regression machine learning models were used with SHapley Additive exPlanations (SHAP) analysis to show feature contributions to antimicrobial prescribing. Results: A total of 84,724 patient encounters were included with four URI diagnoses. Antimicrobial prescribing rates varied by diagnosis (sinusitis: 60%, bronchitis: 48%, pharyngitis: 33%, otitis media: 35%, p<0.001). Prescribing ranged from 37%-58% across states (p<0.001). Sinusitis diagnosis and specific states had the strongest positive associations with antimicrobial prescribing, while race and social vulnerability index (SVI) were not associated. Conclusions: In this study in a large multi-state US health system, antimicrobials were most commonly prescribed for patients with sinusitis. Regional variation was also associated with increased prescribing. These data support efforts to standardize practices and address clinical variation.