Deep learning to extract the meteorological by-catch of wildlife cameras.

Microclimate-proximal climatic variation at scales of metres and minutes-can exacerbate or mitigate the impacts of climate change on biodiversity. However, most microclimate studies are temperature centric, and do not consider meteorological factors such as sunshine, hail and snow. Meanwhile, remote cameras have become a primary tool to monitor wild plants and animals, even at micro-scales, and deep learning tools rapidly convert images into ecological data. However, deep learning applications for wildlife imagery have focused exclusively on living subjects. Here, we identify an overlooked opportunity to extract latent, ecologically relevant meteorological information. We produce an annotated image dataset of micrometeorological conditions across 49 wildlife cameras in South Africa's Maloti-Drakensberg and the Swiss Alps. We train ensemble deep learning models to classify conditions as overcast, sunshine, hail or snow. We achieve 91.7% accuracy on test cameras not seen during training. Furthermore, we show how effective accuracy is raised to 96% by disregarding 14.1% of classifications where ensemble member models did not reach a consensus. For two-class weather classification (overcast vs. sunshine) in a novel location in Svalbard, Norway, we achieve 79.3% accuracy (93.9% consensus accuracy), outperforming a benchmark model from the computer vision literature (75.5% accuracy). Our model rapidly classifies sunshine, snow and hail in almost 2 million unlabelled images. Resulting micrometeorological data illustrated common seasonal patterns of summer hailstorms and autumn snowfalls across mountains in the northern and southern hemispheres. However, daily patterns of sunshine and shade diverged between sites, impacting daily temperature cycles. Crucially, we leverage micrometeorological data to demonstrate that (1) experimental warming using open-top chambers shortens early snow events in autumn, and (2) image-derived sunshine marginally outperforms sensor-derived temperature when predicting bumblebee foraging. These methods generate novel micrometeorological variables in synchrony with biological recordings, enabling new insights from an increasingly global network of wildlife cameras.

Surveillance mammography after treatment for male breast cancer.

PURPOSE: To identify the practice patterns related to use of surveillance mammography in male breast cancer (MaBC) survivors. METHODS: Using administrative claims data from OptumLabs Data Warehouse, we identified men who underwent surgery for breast cancer during 2007-2017. We calculated the proportion of men who had at least one mammogram (a) within 13 months for all patients and (b) within 24 months amongst those who maintained their insurance coverage for at least that length of time after surgery. Multivariate logistic regression modeling was used to identify factors associated with mammography within each timeframe. RESULTS: Out of 729 total MaBC survivors, 209 (29%) underwent mammography within 13 months after surgery. Among those who had lumpectomy, 41% underwent mammography, whereas among those who had mastectomy, 27% had mammography. Amongst 526 men who maintained consistent insurance coverage for 24 months after surgery, 215 (41%) underwent mammography at least once during that 24-month period. In this cohort, the proportion who had at least one mammogram during the 24-month period was 49% after lumpectomy and 40% after mastectomy. In a multivariate logistic regression model, more recent diagnosis (2015+) and older age at diagnosis were associated with lower odds of undergoing mammography, while receipt of radiation was associated with higher odds of undergoing mammography. CONCLUSIONS: Although recent ASCO guidelines recommend surveillance mammography after lumpectomy, a minority of MaBC survivors undergo surveillance mammography, even after lumpectomy. This is likely due to the paucity of data regarding the true benefits and harms of surveillance/screening mammography for MaBC.

Evaluation for clinical benefit of metformin in patients with idiopathic pulmonary fibrosis and type 2 diabetes mellitus: a national claims-based cohort analysis.

BACKGROUND: Idiopathic pulmonary fibrosis (IPF) is a chronic progressive lung disease with high morbidity and limited treatment options. Type 2 diabetes mellitus (T2DM) is a common comorbid illness among patients with IPF and is often treated with metformin, the first-line agent in the management of T2DM. There is growing evidence demonstrating metformin's anti-fibrotic properties; however, there is little real-world clinical data regarding its potential effectiveness in IPF. This study aims to evaluate the clinical benefit of metformin in patients with IPF and T2DM. METHODS: This nationwide cohort study used de-identified administrative claims data from OptumLabs® Data Warehouse to identify 3599 adults with IPF and concomitant T2DM between January 1, 2014 and June 30, 2019. Two cohorts were created: a cohort treated with metformin (n = 1377) and a cohort not treated with metformin (n = 2222). A final 1:1 propensity score-matched cohort compared 1100 patients with IPF and T2DM receiving metformin to those with both diagnoses but not receiving metformin; matching accounted for age, sex, race/ethnicity, residence region, year, medications, oxygen use, smoking status, healthcare use, and comorbidities. Outcomes were all-cause mortality (primary) and hospitalizations (secondary). RESULTS: Among 2200 patients with IPF and T2DM included in this matched analysis, metformin therapy was associated with a reduction in all-cause mortality (hazard ratio [HR], 0.46; 95% confidence interval [CI], 0.36-0.58; p < 0.001) and hospitalizations (HR, 0.82; 95% CI, 0.72-0.93; p = 0.003) compared to patients not receiving metformin. CONCLUSIONS: Among patients with IPF and T2DM, metformin therapy may be associated with improved clinical outcomes. However, further investigation with randomized clinical trials is necessary prior to metformin's broad implementation in the clinical management of IPF.

Risk of Systemic Adverse Events after Intravitreal Bevacizumab, Ranibizumab, and Aflibercept in Routine Clinical Practice.

PURPOSE: Intravitreal anti-vascular endothelial growth factor (VEGF) pharmacotherapy plays a central role in the management of neovascular age-related macular degeneration (nAMD), diabetic retinal disease (DRD), and retinal venous occlusive disease (RVO). Within clinical trials, rates of systemic serious adverse events (SAEs) after anti-VEGF treatment have been low. However, the comparative systemic safety profile of common anti-VEGF agents remains incompletely understood. The goal of this study was to compare the systemic safety of intravitreal bevacizumab, ranibizumab, and aflibercept in real-world practice. DESIGN: Retrospective cohort study. PARTICIPANTS: Using a large U.S. administrative claims database of commercially insured and Medicare Advantage enrollees, we identified adult cohorts receiving initial anti-VEGF injections for nAMD, DRD, and RVO between January 1, 2007, and June 30, 2018. We included patients with 1 year of insurance coverage before initial treatment. METHODS: We compared predefined systemic outcomes between anti-VEGF agents occurring within 180 days of treatment initiation using propensity score-weighted Cox proportional hazards models. Patients were censored upon treatment with a different anti-VEGF medication or termination of health plan coverage. MAIN OUTCOME MEASURES: Primary outcomes were acute myocardial infarction (MI), acute cerebrovascular disease (CVD), major bleeding, and all-cause hospitalization. RESULTS: A total of 87 844 patients received initial anti-VEGF injections for nAMD, DRD, and RVO between January 1, 2007, and June 30, 2018 (69 007 bevacizumab; 10 895 ranibizumab; 7942 aflibercept). Postinjection 180-day event rates per 100 patients for MI, CVD, major bleeding, and all-cause hospitalization were similar for bevacizumab (0.64, 0.59, 0.34, and 10.41, respectively), ranibizumab (0.62, 0.53, 0.40, and 9.44, respectively), and aflibercept (0.63, 0.60, 0.20, and 9.88, respectively). No differences were identified for the risk of MI, CVD, major bleeding, or all-cause hospitalization when comparing the risk-adjusted effect of treatment initiation with bevacizumab versus ranibizumab (hazard ratio [HR], 0.96 [95% confidence interval {CI}, 0.74-1.25]; HR, 1.04 [95% CI, 0.78-1.38]; HR, 0.85 [95% CI, 0.61-1.19]; HR, 1.03 [95% CI, 0.96-1.10], all P > 0.05), bevacizumab versus aflibercept (HR, 0.95 [95% CI, 0.68-1.33], HR, 0.99 [95% CI, 0.71-1.38], HR, 1.02 [95% CI, 0.60-1.74], HR, 1.01 [95% CI, 0.93-1.10], all P > 0.05), or aflibercept versus ranibizumab (HR, 0.91 [95% CI, 0.62-1.35], HR, 1.12 [95% CI, 0.74-1.69], HR, 0.96 [95% CI, 0.53-1.73], HR, 1.02 [95% CI, 0.92-1.13], all P > 0.05). CONCLUSIONS: We observed no differences in the risk of acute MI, CVD, major bleeding, or all-cause hospitalization after treatment initiation with intravitreal bevacizumab, ranibizumab, or aflibercept during routine clinical practice.

Outcomes for hospitalized patients with idiopathic pulmonary fibrosis treated with antifibrotic medications.

BACKGROUND: Idiopathic Pulmonary Fibrosis is a chronic, progressive interstitial lung disease for which there is no cure. However, lung function decline, hospitalizations, and mortality may be reduced with the use of the antifibrotic medications, nintedanib and pirfenidone. Historical outcomes for hospitalized patients with Idiopathic Pulmonary Fibrosis are grim; however there is a paucity of data since the approval of nintedanib and pirfenidone for treatment. In this study, we aimed to determine the effect of nintedanib and pirfenidone on mortality following respiratory-related hospitalizations, intensive care unit (ICU) admission, and mechanical ventilation. METHODS: Using a large U.S. insurance database, we created a one-to-one propensity score matched cohort of patients with idiopathic pulmonary fibrosis treated and untreated with an antifibrotic who underwent respiratory-related hospitalization between January 1, 2015 and December 31, 2018. Mortality was evaluated at 30 days and end of follow-up (up to 2 years). Subgroup analyses were performed for all patients receiving treatment in an ICU and those receiving invasive and non-invasive mechanical ventilation during the index hospitalization. RESULTS: Antifibrotics were not observed to effect utilization of mechanical ventilation or ICU treatment during the index admission or effect mortality at 30-days. If patients survived hospitalization, mortality was reduced in the treated cohort compared to the untreated cohort when followed up to two years (20.1% vs 47.8%). CONCLUSIONS: Treatment with antifibrotic medications does not appear to directly improve 30-day mortality during or after respiratory-related hospitalizations. Post-hospital discharge, however, ongoing antifibrotic treatment was associated with improved long-term survival.

Body size and body composition effects on heat loss from the hands during severe cold exposure.

OBJECTIVES: This study investigated the influence of body size and composition on maintaining hand temperature during severe cold exposure. The hand's high surface area-to-volume ratio predisposes the hand to heat loss, increasing the risk of cold injury and even hypothermia, which are major selective pressures in cold environments. While vasoregulation may reduce heat loss from the hand, the effect of body form, tissue thermogenesis, and body insulation on heat loss is unknown. MATERIALS AND METHODS: Thermal imaging was used to determine heat loss during a 3-min ice-water hand immersion test carried out on 114 volunteers (female = 63, male = 51). Established anthropometric measures were used to quantify body size, and bioelectrical impedance analysis determined skeletal muscle and fat mass. RESULTS: Skeletal muscle mass relative to body mass was a highly significant predictor of heat loss, while body mass, fat mass, and stature were not. Body composition and body size had little to no significant influence during rewarming after immersion. DISCUSSION: The thermogenic properties of muscle mass support maintenance of hand temperature during severe cold exposure. The findings here suggest that muscular individuals are less susceptible to heat loss and cold injury, and may be better at manual tasks in cold conditions than nonmuscular individuals.

The thermoregulatory function of the human hand: How do palm and digit proportions affect heat loss?

OBJECTIVES: The current study assessed whether ecogeographical patterns seen in hand proportions correlate with heat loss directly. Using a brief severe cold immersion experiment on the hand, the influence of hand and digit dimensions on heat loss was evaluated. MATERIALS AND METHODS: A sample of 113 living individuals were tested. Two-dimensional and three-dimensional scanning techniques were used to assess hand and digit dimensions. Thermal imaging analysis was used to quantify heat loss during a 3-min ice-water immersion of the hands. RESULTS: When body size was accounted for, hand width and digit length relative to total hand length were significant predictors of heat loss from the hand. DISCUSSION: The current study provides empirical evidence to support the link between thermodynamic principles relating to surface area-to-volume ratio, and ecogeographical patterns associated with temperature.

The influence of digit size and proportions on dexterity during cold exposure.

OBJECTIVES: The current study investigated whether size and proportions of the hands and digits affect dexterity during severe cold exposure. As wide hands are known to lose less heat than narrow hands, and narrow digits are associated with greater dexterity, this study aimed to test whether there was a direct trade-off between dexterity and thermoregulation that shapes hand morphology. METHODS: Participants (25 women, 15 men) carried out the Purdue Pegboard test before and after a 3-min ice-water immersion of the hand. Their hand length, hand width, digit lengths, and digit widths were measured using standard anthropometric methods. RESULTS: Wide first and third digits associated with significantly reduced dexterity after immersion relative to individuals with narrower first and third digits. Second digit width positively correlated with average digit temperature after immersion. Hand length and hand width did not influence dexterity. CONCLUSION: The current study suggests that digit width influences dexterity in cold conditions, reflecting patterns found at room temperature. Hand and digit morphology may be the product of two significant constraints on the hand: dexterity and thermoregulation. In cold conditions, hand morphology appears to be predominantly constrained by thermal stress, at the expense of dexterity. This may have important implications for interpreting the morphology of extinct and extant hominins.

Digital human ergonomics training for remote office workers: Comparing a novel method to a traditional online format.

OBJECTIVE: This randomized controlled trial investigated the effectiveness of an online ergonomics training program with a digital human compared to an online ergonomics training program without a digital human. METHOD: Remote office workers (n = 138) were randomly assigned to either a digital human training, a traditional webpage training without a digital human, or a control group. Musculoskeletal discomfort, knowledge retention, and behavior change were measured. RESULTS: The overall group differences for increased behavior change and knowledge retention were statistically significant (p < 0.05). For knowledge retention, the digital human training group showed comparable improvement in knowledge scores compared to the traditional training group. For behavior scores, the traditional training showed improvement compared to the control group. Decreases in musculoskeletal discomfort for all groups were not statistically significant (p > 0.05). CONCLUSION: Digital humans have the potential to meet large-scale remote worker training needs.

Can freshwater plants and algae act as an effective feed supplement to reduce methane emissions from ruminant livestock?

Methane production by livestock is a substantial component of greenhouse gas emissions worldwide. The marine red algae, Asparagopsis taxiformis, has been identified as a possible supplement in livestock feeds due to its potent inhibition of methane production but currently is unable to be produced at scale. Finding additional taxa that inhibit methane production is therefore desirable. Here we provide foundational evidence of methanogenesis-inhibiting properties in Australian freshwater plants and algae, reviewing candidate species and testing species' chemical composition and efficacy in vitro. Candidate plant species and naturally-occurring algal mixes were collected and assessed for ability to reduce methane in batch testing and characterised for biochemical composition, lipids and fatty acids, minerals and DNA. We identified three algal mixes and one plant (Montia australasica) with potential to reduce methane yield in in vitro batch assay trials. All three algal mixes contained Spirogyra, although additional testing would be needed to confirm this alga was responsible for the observed activity. For the two samples that underwent multiple dose testing, Algal mix 1 (predominantly Spirogyra maxima) and M. australasica, there seems to be an optimum dose but sources, harvesting and storage conditions potentially determine their methanogenesis-inhibiting activity. Based on their compositions, fatty acids are likely to be acting to reduce methane in Algal mix 1 while M. australasica likely contains substantial amounts of the flavonoids apigenin and kaempferol, which are associated with methane reduction. Based on their mineral composition, the samples tested would be safe for livestock consumption at an inclusion rate of 20%. Thus, we identified multiple Australian species that have potential to be used as a feed supplement to reduce methane yield in livestock which may be suitable for individual farmers to grow and feed, reducing complexities of supply associated with marine alternatives and suggesting avenues for investigation for similar species elsewhere.

Pandemic-Induced Telework Challenges and Strategies.

Prior to the COVID-19 pandemic, telework was an established discretionary practice with a considerable amount of research. However, the COVID-19 pandemic forced people who had never worked from home before to do so. Our two-wave descriptive investigation provides a historical snapshot of what approximately 400 teleworkers experienced in the first two to three months of the pandemic. We explored how this experience differed for those who had previously teleworked, those who had children in their home, and those who had supervisory responsibilities. The data exposed telework challenges and pandemic-specific challenges. The results support job crafting theories that teleworkers proactively implement strategies to adjust their boundaries and relationships to meet their need (Biron et al., Personnel Review, 2022). The data also revealed that employees were still struggling two months later, despite implementing strategies like self-care, taking breaks, and psychological reframing. This research provides detailed evidence of how pandemic-induced telework is not the same as traditional telework and some initial evidence of the pandemic-induced telework adjustment time period. Supplementary Information: The online version contains supplementary material available at 10.1007/s41542-023-00151-1.

Too good to be true? Are supervisor-perspective ratings a valid substitute for actual supervisor ratings?

Due to well-known problems with self-ratings of job performance (e.g., inflation, weak correlation with supervisor ratings) and the challenges of collecting supervisor ratings of job performance, researchers sometimes use supervisor-perspective ratings (e.g., "how do you think your supervisor would rate your job performance?") instead. The assumption is supervisor-perspective ratings are less affected by the noted issues with self-ratings and therefore are more similar to actual supervisor ratings than traditional self-ratings. In fact, a considerable number of researchers have used supervisor-perspective ratings as an alternative to actual supervisor ratings. The purpose of this study is to meta-analytically determine the degree to which supervisor-perspective ratings are a valid substitute for actual supervisor ratings and identify the boundary conditions for this substitution. Our meta-analyses demonstrate that supervisor-perspective ratings are generally not a viable substitute for actual supervisor ratings. This is especially the case when (a) citizenship performance is measured, (b) data are collected in collectivistic cultures, and (c) all study data are gathered from the same source. We recommend not using supervisor-perspective ratings as a substitute for actual supervisor ratings. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Risk Perceptions in Agricultural Aviation.

BACKGROUND: Agricultural aircraft operations are an integral part of the agricultural sector. According to the National Agriculture Aviation Association (NAAA), aerial applications are conducted in all 50 states of the U.S. and account for 28% of all treated cropland. A typical application operation consists of an operator (Part 137 certificate holder, permission to apply chemicals to agricultural crops) and one or more pilots. This article explores the risk perceptions of operators (pilots with a Part 137 certificate) and non-operators (pilots without a Part 137 certificate) using data from two industry surveys. METHODS: In an effort to explain the differences between risk perceptions of operators and non-operators, a series of regression analyses were conducted controlling for age, work experience, prior encounters with hazards and history of reported injuries. In addition to exploring the aggregated perceptions across all hazards, perceptions of specific hazards were also examined. RESULTS: Data indicate that non-operators perceive hazards as significantly more dangerous than operators. Power lines are perceived as the most hazardous, followed by communication towers and meteorological towers. The regression results indicate that risk perception differences remain even after controlling for differences in age, work experiences, prior hazard encounters and injuries between the two groups. CONCLUSIONS: Heterogeneity in risk perceptions within an organization can result in discrepancies over daily decision-making concerning operations. Further research is needed to identify the causal factors behind the observed differences.

Organizational climate profiles: Identifying meaningful combinations of climate level and strength.

According to situation strength theory, organizational climate should have a stronger effect on group behavior when members' perceptions of the climate are both unambiguous (i.e., very high or very low) and shared than when they are more ambiguous and less shared. In the organizational climate literature, this proposition is typically examined by testing the interaction between climate level (i.e., mean) and strength (i.e., variability); surprisingly, the preponderance of empirical research testing this interaction does not support this theoretical expectation. This may be because the traditional variable-centered approach fails to consider the possibility of overlooked subpopulations consisting of unique combinations of climate level and strength, creating distinct climate profiles. To address this issue, we use a group-centered conceptualization and analyses (i.e., latent profile analysis) to examine the extent to which 302 workgroups (Sample 1) and 107 organizations (Sample 2) evidence statistically and practically meaningful climate profiles. Results revealed four to six distinct climate profiles across multiple climate types were differentially associated with theoretically relevant outcomes, including objective financial measures. Consistent with situation strength theory, groups with strong and favorable profiles tended to have more positive outcomes, whereas groups with weaker, less favorable profiles tended to have less positive outcomes. In contrast, the traditional variable-centered approach was generally unsupportive of an interaction between climate level and strength. Overall, these findings provide evidence that the group-centered approach is a more sensitive statistical modeling technique for testing a fundamental tenet of situation strength theory in the context of organizational climate research. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Building a Covid-19 secure intensive care unit: A human-centred design approach.

Background: The Covid-19 pandemic has highlighted weaknesses in the National Health Service critical care provision including both capacity and infrastructure. Traditionally, healthcare workspaces have failed to fully incorporate Human-Centred Design principles resulting in environments that negatively affect the efficacy of task completion, patient safety and staff wellbeing. In the summer of 2020, we received funds for the urgent construction of a Covid-19 secure critical care facility. The aim of this project was to design a pandemic resilient facility centred around both staff and patient requirements and safety, within the available footprint. Methods: We developed a simulation exercise, underpinned by Human-Centred Design principles, to evaluate intensive care designs through Build Mapping, Tasks Analysis and Qualitative data. Build Mapping involved taping out sections of the design and mocking up with equipment. Task Analysis and qualitative data were collected following task completion. Results: 56 participants completed the build simulation exercise generating 141 design suggestions (69 task related, 56 patient and relative related, 16 staff related). Suggestions translated to 18 multilevel design improvements; five significant structural changes (Macro level) including wall moves and lift size change. Minor improvements were made at a Meso and Micro design level. Critical care design drivers identified included functional drivers (visibility, Covid-19 secure environment, workflow, and task efficiency) and behavioural drivers (learning and development, light, humanising intensive care and design consistency). Conclusion: Success of clinical tasks, infection control, patient safety and staff/patient wellbeing are highly dependent on clinical environments. Primarily, we have improved clinical design by focusing on user requirements. Secondly, we developed a replicable approach to exploring healthcare build plans revealing significant design changes, that may have only been identified once built.

A Taxonomy of Employee Motives for Telework.

This qualitative research contributes to the telework research literature by identifying and categorizing employee motives for teleworking. Motives for telework contextualize teleworking behavior, represent proximal telework outcomes, and serve as potential boundary conditions for telework-outcome relationships. Role identity theory (Burke & Tully Social Forces, 55(4), 881-897, 1977) and the uncertainty-reduction hypothesis (Hogg & Terry Academy of Management Review, 25, 121-140, 2000) suggest that motives may be driven by role salience and the ability to meet work and nonwork demands. In this research, we sought to identify a comprehensive list of motives as well as reconcile the wide range of categories and labels given to telework motives in the literature. We asked two independent samples of workers comprised of two subsamples of teleworkers (n 1 = 195; n 2 = 97) and a subsample of nonteleworkers (n 3 = 947) why they telework or would like to telework. A total of 2504 reasons were gathered across the three subsamples. Most respondents reported multiple reasons, especially when encouraged to list all of their reasons. After distinguishing preconditions from motives to telework, ten categories emerged from the qualitative data with "avoid commute" emerging as the most frequently reported motive. Other frequently reported motives included "tend to family demands" and "productivity." Additional motives are discussed along with implications for telework research and policy development and implementation.

Explaining the negative impact of workplace incivility on work and non-work outcomes: The roles of negative rumination and organizational support.

Research studies have shown that workplace incivility is associated with numerous negative work and non-work outcomes. The underlying mechanisms explaining why workplace incivility is associated with these outcomes, as well as contextual buffers of these relationships, have received less attention. This study extends workplace incivility research by examining the mediating role of negative rumination as a potential factor undergirding the relationship between experiences of incivility from colleagues at work and detrimental outcomes. We also investigated perceived organizational support and family supportive work environment as potential mitigators of the indirect relationship between incivility and negative outcomes. Data were collecfrom 154 university faculty members on two occasions. The results showed that negative rumination mediated the relationships between workplace incivility and both work (job satisfaction, burnout) and non-work (work-to-family conflict, life satisfaction) outcomes. Furthermore, results from the moderated mediation analyses revealed that perceived organizational support buffered the mediated effect of negative rumination and job satisfaction and a family-supportive work environment buffered the mediated effect of negative rumination on work-to-family conflict. Overall, the results demonstrate that negative rumination helps explain why workplace incivility negatively affects both work and non-work outcomes and underscores the important role of organizational context as buffers for these relationships.

Adoption of the Antifibrotic Medications Pirfenidone and Nintedanib for Patients with Idiopathic Pulmonary Fibrosis.

Rationale: In October 2014, the antifibrotic medications pirfenidone and nintedanib became the first medications approved by the U.S. Food and Drug Administration for use in patients with idiopathic pulmonary fibrosis (IPF). Since approval, there has been no nonregistry analysis of the real-world adoption of these medications in everyday clinical practice. Objectives: To evaluate the adoption, persistence, and out-of-pocket (OOP) costs of pirfenidone and nintedanib since their approval in the United States in 2014. Methods: A retrospective cohort analysis was performed by identifying privately insured and Medicare Advantage beneficiaries with IPF. We then split the patients into three cohorts: those who were untreated and those who filled a prescription for either pirfenidone or nintedanib between October 1, 2014, and July 31, 2019. The primary outcome was adoption of the medications. Secondary outcomes included medication persistence and prescription drug costs. Results: A total of 10,996 patients with IPF were identified in the data set. A minority of patients (26.4%) with IPF identified in the cohort had started either medication since approval in 2014, with the adoption of both medications being comparable at around 13.2%. Those receiving the medications were younger (72 vs. 73.9 yr; P < 0.0001) and healthier (3.9 vs. 4.9 comorbidities; P < 0.0001) than those not receiving treatment. Men were significantly more likely to receive treatment than woman (30.0% vs. 21.9%; P < 0.0001). Among treated patients, 42.8% discontinued the medications during the study period. Patients' OOP expenses per month were high for both drugs (mean, $397.51 for nintedanib; mean, $394.49 for pirfenidone). Conclusions: The adoption of both the antifibrotic medications in the United States in everyday practice has been low since approval and may be associated with the high OOP cost.

Use of Post-Acute Care Services and Readmissions After Acute Myocardial Infarction Complicated by Cardiac Arrest and Cardiogenic Shock.

OBJECTIVE: To evaluate post-acute care utilization and readmissions after cardiac arrest (CA) and cardiogenic shock (CS) complicating acute myocardial infarction (AMI). METHODS: With use of an administrative claims database, AMI patients from January 1, 2010, to May 31, 2018, were stratified into CA+CS, CA only, CS only, and AMI alone. Outcomes included 90-day post-acute care (inpatient rehabilitation or skilled nursing facility) utilization and 1-year emergency department visits and readmissions. RESULTS: Of 163,071 AMI patients, CA+CS, CA only, and CS only were noted in 3965 (2.4%), 8221 (5.0%), and 6559 (4.0%), respectively. In-hospital mortality was noted in 10,686 (6.6%) patients: CA+CS, 1935 (48.8%); CA only, 2948 (35.9%); CS only, 1578 (24.1%); and AMI alone, 4225 (2.9%) (P<.001). Among survivors, post-acute care services were used in 67,799 (44.5%), with higher use in the CS+CA cohort (1310 [64.6%]; hazard ratio [HR], 1.19; 95% CI, 1.06 to 1.33; P=.003) and CA cohort (2738 [51.9%]; HR, 1.27; 95% CI, 1.20 to 1.35; P<.001) but not in the CS cohort (3048 [61.2%]; HR, 1.03; 95% CI, 0.97 to 1.11; P=.35) compared with the AMI cohort (60,703 [43.3%]). Compared with the AMI cohort (48,990 [35.0%]), patients with CS only (2,085 [41.9%]; HR, 1.16; 95% CI, 1.10 to 1.22; P<.001) but not those with CA+CS (724 [35.7%]; HR, 1.07; 95% CI, 0.98 to 1.17; P=.14) had higher rates of readmissions (P=.03). Readmissions were lower in those with CA (1,590 [30.2%]; HR, 0.94; 95% CI, 0.89 to 0.99). Repeated AMI, coronary artery disease, and heart failure were the most common readmission reasons. There were no differences for emergency department visits. CONCLUSION: CA is associated with increased post-acute care use, whereas CS is associated with increased readmission risk in AMI survivors.

Variations in Postoperative Opioid Prescription Practices and Impact on Refill Prescriptions Following Lumbar Spine Surgery.

OBJECTIVE: Understanding postsurgical prescribing patterns and their impact on persistent opioid use is important for establishing reasonable opioid prescribing protocols. We aimed to determine national variation in postoperative opioid prescription practices following elective lumbar spine surgery and their impact on short-term refill prescriptions. METHODS: The OptumLabs Data Warehouse was queried from 2016 to 2017 for adults undergoing anterior lumbar fusion, posterior lumbar fusion, circumferential lumbar fusion, and lumbar decompression/discectomy for degenerative spine disease. Discharge opioid prescription fills were obtained and converted to morphine milligram equivalents (MMEs). Age- and sex-adjusted MMEs and frequency of discharge prescriptions >200 MMEs were determined for each U.S. census division and procedure type. RESULTS: The study included 43,572 patients with 37,894 postdischarge opioid prescription fills. There was wide variation in mean filled MMEs across all census divisions (anterior lumbar fusion: 774-1147 MMEs; posterior lumbar fusion: 717-1280 MMEs; circumferential lumbar fusion: 817-1271 MMEs; lumbar decompression/discectomy: 619-787 MMEs). A significant proportion of cases were found to have filled discharge prescriptions >200 MMEs (posterior lumbar fusion: 78.6%-95%; anterior lumbar fusion: 87.5%-95.6%; circumferential lumbar fusion: 81.4%-96.5%; lumbar decompression/discectomy: 80.5%-91%). Multivariable logistic regression showed that female sex and inpatient surgery were associated with a top-quartile discharge prescription and a short-term second opioid prescription fill, while the opposite was noted for elderly and opioid-naïve patients (all P ≤ 0.05). Prescriptions with long-acting opioids were associated with higher odds of a second opioid prescription fill (reference: nontramadol short-acting opioid). CONCLUSIONS: In analysis of filled opioid prescriptions, we observed a significant proportion of prescriptions >200 MMEs and wide regional variation in postdischarge opioid prescribing patterns following elective lumbar spine surgery.