UC Irvine Health

Blended oxygen has been shown to reduce severe retinopathy of prematurity (ROP) incidence worldwide, and more recently in Uganda. Although it has been established that ROP-driven visual impairment has a substantial societal burden and that screening and treatment programs are cost-effective in low- and middle-income countries, there is limited evidence for the economic impact of prevention with appropriate oxygen management equipment (OME) in these regions. We performed a cost-utility analysis of OME implementation comparing variations ranging between most and least favorable values. Disability-adjusted life years (DALYs) were calculated with a 3% discount rate. Calculations assumed a 62.1% incidence of visual impairment in untreated severe ROP and a disability weight of 0.184 for severe visual impairment due to ROP. One set of OME costs between $677.50-$1,844.11 USD in Uganda. We found that the cost to prevent one case of ROP-driven severe visual impairment in Uganda ranges from $25.55-$543.99, with a base case (best estimate) of $168.92 per case averted. This reflects 5.18 DALYs averted over the 58-year average Ugandan lifespan and a cost of $4.97-$104.98 to avert one DALY, with a base case of $32.60 per DALY averted. In comparison, prevention of malaria via mosquito net distribution was estimated in a 2020 meta-analysis to cost $50 for every DALY averted. The high-end estimate is roughly 10% of the annual gross domestic product per capita ($1,002.30). Therefore, OME is a cost-effective means to prevent severe visual impairment among infants in Uganda. Implementation of OME in Uganda would also reflect a clear ethical and humanitarian success.

ObjectiveNicotinic acetylcholinergic receptors (nAChRs), comprising of α and β subunits are present in the brain and whole body. The less abundant α2-subunit is a fast-acting receptor subtype and plays an important role in cognition and learning. To understand cellular functional consequences, this study evaluated glucose metabolism using [18F]FDG PET/CT in α2 knockout (α2KO) and α2 hypersensitive (α2HS) mice.MethodsControl (CN; 4M, 4F), α2 knockout (α2KO; 4M, 4F) and α2 hypersensitive (α2HS; 4M,4F), 12-16 month old mice were used. Mice were fasted and injected with [18F]FDG (3-5 MBq) while awake. After 40 minutes they underwent whole body PET/CT. On a separate day, nicotine challenge [18F]FDG studies were done. Reconstructed images were analyzed to obtain standard uptake values (SUV) of [18F]FDG in brain and interscapular brown adipose tissue (IBAT). Statistical analysis was performed.ResultsThe α2HS male mice exhibited the largest brain increase in [18F]FDG compared to α2KO male mice. The rank order of brain [18F]FDG uptake in the 3 groups: α2HS♂> CN♂> α2KO♂> CN♀= α2KO♀≥ α2HS♀. Nicotine treatment reduced brain [18F]FDG uptake in all mice. Females had lower [18F]FDG uptake compared to males and were less sensitive to α2 nAChR. In the case of IBAT, α2KO mice had significantly higher baseline [18F]FDG uptake compared to the other two groups: α2KO♂> α2KO♀> α2HS♀> α2HS♂> CN♀> CN♂. Nicotine decreased IBAT in α2KO mice rather than increase as observed in CN and α2HS mice.Conclusionsα2 nAChRs plays a significant role in brain activation as exhibited by the increase in [18F]FDG in α2HS mice. In the absence of regulatory control by the α2 nAChR, the α2KO mice IBAT exhibited higher [18F]FDG IBAT compared to controls and α2HS mice. Female mice were less affected by nicotine compared to the male mice. Overall, α2 nAChRs played a significant role in glucose metabolism in the brain and IBAT.

Sarcopenia (SP) is increasingly recognized as a poor prognostic factor for patients with Crohn's disease (CD). We aimed to use radiographically-measured SP to determine a disease-specific definition and measure its association with CD-related outcomes. This retrospective study included adults with CD seen at our outpatient tertiary center between 2019 and 2021 who underwent a CT scan within 3 months of visit. Using axial cross-sectional measurements at the L3 vertebral level, skeletal muscle area was indexed to height to derive skeletal muscle index (SMI). Demographics, comorbidities, CD phenotype, and outcomes, including hospitalization at 1 year, were analyzed in univariate and multivariate models. One hundred twenty-four patients with CD were included, with a mean age of 52.2±16.6 years and 53.2% (66/124) women. Overall, 33.1% (41/124) had SP based on sex-specific cutoffs with men representing 75.6% (31/41) of the sarcopenic population. In bivariate analysis, patients with SP had a higher likelihood of hospitalization (43.9% vs. 22.9% for non-SP, P=0.02) and penetrating CD phenotype (20.0% vs. 2.3% for non-SP, P<0.05). On multivariate regression, higher SMI was associated with decreased hospitalization, with each 10-unit increase in SMI conferring 0.54 lower odds (OR: 0.54 [95% CI: 0.32-0.92], P=0.02). Patients with higher SMI trended towards lower use of biologics (OR: 0.70 [95% CI: 0.45-1.09], P=0.12). Our novel SP definition derived from an IBD population performed similarly to definitions from the literature. Our study demonstrates the application of an automated algorithm for the quantification of body composition based on CT scan in patients with CD. SP and low SMI were associated with increased hospitalization at 1 year.

Abstract Background Most hospitalized patients do not need central venous catheters (CVCs) and can be safely managed with catheters that have lower central line associated bloodstream infection (CLABSI) risk, such as peripherally inserted central catheters (PICCs), midlines, and peripheral intravenous (PIV) catheters. We evaluated the impact of a catheter selection and de-escalation program that included electronic nursing and physician assessment of catheter necessity on device use.Figure 1:Nursing Electronic Medical Record Figure 1: Flowsheet Assessment of Catheters Eligible for De-Escalation with Automated Physician Progress Note Flagging and Documentation of Line NecessityFigure 1: (A) Nursed enter daily assessment of line indication and evaluate for removal or de-escalation to a line with lower infection risk. (B) Physician progress note auto-populates with notification from nurse flagging potential candidates for catheter removal/de-escalation.Figure 2:Device Utilization Rate Per Patient Day Before and After De-Escalation InterventionFigure 2: Monthly device utilization rates (catheter-days divided by patient-days ) before and after implementation of a catheter de-escalation program consisting of (a) electronic nursing assessments of central venous catheters that could be removed or de-escalated to a catheter with lower infection risk (PICC, midline, or peripheral IV), (b) automated notification within physician progress notes for documentation of line necessity, and (c) education. Methods In this prospective cohort study, we evaluated hospitalized adults with CVCs, PICCs, midlines, and PIVs at a large academic medical center during baseline (1/2022-8/2022) and after intervention (9/2022-6/2024), consisting of: (1) daily nursing assessment and electronic health record documentation of catheters for removal or de-escalation (e.g., from CVC to PICC, or from PICC to midlines/PIVs), (2) automated cascading of potential candidates for de-escalation into physician progress notes, and (3) nursing/physician education to use catheters with the lowest infection risk (Figure 1). We assessed demographics, device type, and device utilization rates (DUR, catheter-days/patient-days). T-test compared mean baseline and intervention DURs. Results Across the study period there were 46,542 patients (692,649 patient-days), mean (SD) age was 59.4 (17.2), 58% (26761) were male. There were 4,074 CVCs, 4,133 PICCs, 1,985 midlines, and 48,318 PIVs. CVC DURs decreased 23% (p&amp;lt; 0.01) from mean (SD) 48.8 (10.3) to 37.7 (6.3) during the baseline and intervention periods, respectively. PICC DURs increased 15% (p&amp;lt; 0.01) from 108.7 (6.1) to 125.7 (12.7); midline DURs increased 9% from 41.6 to 45.3 (p=0.10); PIV DURs increased 2.6% (p=0.05) from 788.7 to 811.3 (Figure 2). Conclusion A central line de-escalation protocol that included electronic flagging of CVCs that could be de-escalated to less invasive catheters with lower infection risk, coupled with education, successfully reduced CVC utilization. Disclosures Susan Huang, MD, MPH, Xttrium: Conducting studies in which participating nursing homes and hospitalized patients receive contributed antiseptic products|Xttrium Laboratories: Conducting studies in which participating nursing homes and hospitalized patients receive contributed antiseptic product

Joy is a powerful and necessary counterpoint to the challenges faced by sexual and gender minoritized (SGM) communities. This study explores how SGM young adults of color in Orange County, California, cultivate joy as a form of everyday resistance and well-being in the face of systemic oppression. Drawing on a participatory action research approach, we used PhotoVoice to engage 19 Black, Indigenous, and people of color (BIPOC) SGM young adults as co-researchers. Participants documented and reflected on everyday experiences of joy through photographs and accompanying narratives, which were thematically analyzed. Informed by Johansson and Vinthagen's Everyday Resistance framework, we found that participants engaged in acts of detachment as a strategy for cultivating joy and resisting the demands of neoliberal productivity culture, including expectations of constant self-optimization, emotional endurance, and conformity. The study affirms the value of PhotoVoice in capturing the complex interplay between identity, environments, and systemic oppression. Centering joy in public health research can inform more affirming and culturally responsive interventions.

BACKGROUNDOld donor allografts in liver transplantation (LT) account for 25% of all allografts, and their utilization is projected to increase with the aging general population. Older allografts are associated with higher rates of all-cause mortality and graft failure; however, there is limited literature exploring the specific phenotypic changes (e.g., functional status, cause-specific mortality) observed in different donor:recipient age pairs.AIMTo investigate differences in functional impairment and cause-specific mortality between different donor:recipient age pairs.METHODSThis was a retrospective analysis of LT patients from the Scientific Registry of Transplant Recipients from 2002 to 2022. Donors were categorized into younger age donors, ≤ 45-years (YAD), middle-aged donors, 46-69-years (MAD), and older age donors, ≥ 70-years (OAD). Recipients were categorized into younger age recipients, ≤ 55-years (YAR) and older age recipients, > 55-years (OAR) age recipients. Multivariate Fine-Gray competing risk and logistic regression analyses identified independent risk factors for cause-specific mortality and improvements in functional status, respectively.RESULTSOverall, 126185 patients were included in the analysis: YAD:YAR (32.7%), YAD:OAR (25.2%), MAD:YAR (17.5%), MAD:OAR (20.7%), OAD:YAR (1.3%), and OAD:OAR (2.7%). Compared to YAD:YAR, OAD pairs had the lowest likelihoods of improved functional status 5 years post-LT (OAD:YAR odds ratio 0.53, 95% confidence interval 0.42-0.67, P < 0.001; OAD:OAR odds ratio 0.67, 95% confidence interval 0.51-0.89, P = 0.006). Donor:recipient age pairs with older donors had higher rates of graft- and infection-related mortality compared to those with younger donors (P < 0.001). Meanwhile, donor:recipient age pairs with older recipients had higher cardioneurovascular- or malignancy-related deaths compared to those with younger recipients (P < 0.001).CONCLUSIONDonor:recipient age mismatch was associated with differences in cause-specific mortality and functional status. These insights could potentially inform age-matched organ allocation strategies, though future work is warranted.

To investigate histopathological conjunctival changes associated with topical netarsudil 0.02%. Observational comparative case series. Histopathological analysis of conjunctival specimens taken from adult patients undergoing glaucoma surgery. Inflammation score was graded by three independent pathologists. 29 samples were included for analysis. Mean age was 72.4 years and 44.8% were female. Most patients underwent trabeculectomy with mitomycin C (22/29, 76%) while the remainder underwent tube shunt surgery, and one patient underwent insertion of an experimental NT-501 intravitreal implant. All patients were taking ≥2 topical IOP lowering medications, and 12 patients (41.3%) were using topical netarsudil, with mean duration 26.8 months. Compared to those on other glaucoma medications, patients taking netarsudil had significantly thicker conjunctival epithelium (mean 90.1 µm vs 43.2 µm, p = 0.03) and a trend toward higher epithelial cell thickness count (mean 7.7 cells thick vs. 4.9 cells thick, p = 0.07), both of which remained significant and trending respectively when adjusted for confounders (p = 0.02 and p = 0.06). All netarsudil treated samples demonstrated inflammation (graded score ≥0.5) compared to 64.7% of those not on netarsudil (p = 0.03). There were no significant differences in any histopathological parameters in patients who had ceased netarsudil prior to analysis (n = 7) compared to those who had never taken netarsudil (p > 0.05 for all). Conjunctiva treated with netarsudil may be more likely to demonstrate inflammation compared to those treated with other combinations of glaucoma medications. These findings may have surgical implications and additional studies correlating clinical outcomes are required.