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OBJECTIVES: Demonstrate the feasibility of weekly data collection and analysis of public health emergency (PHE) data. Assess fluctuations in, and challenges of, resource matching and potential effect on patient care for influenza in ICUs. DESIGN: Multicenter prospective noninterventional study testing effectiveness of leveraging the Discovery Critical Care Research Network Program for Resilience and Emergency Preparedness (Discovery-PREP) in performing PHE research. A 20-question internet survey was developed to prospectively assess ICU influenza-related resource stress. An informatics tool was designed to track responses; data were analyzed within 24 hours of weekly survey completion by the team biostatistician for timely reporting. PARTICIPANTS: Critical care and Emergency Medicine Discovery-PREP network investigators self-selected to participate in the voluntary query. SETTING: ICUs of 13 hospitals throughout the United States, 12 academic, and one community. INTERVENTIONS: ICU physicians were electronically surveyed weekly over 17 weeks during the influenza season (January 2018-April 2018). Responses were collected for 48 hours after each email query. MEASUREMENTS AND MAIN RESULTS: The average weekly response among the sites was 79% (range, 65-100%). Significant stress, defined as alterations in ICU staffing and/or resource allocation, occurred in up to 41% of sites during the national peak of influenza activity. These alterations included changes in staffing, not accepting external patient transfers, and canceling elective surgery. During this same period, up to 17% of the sites indicated that these changes might not have been sufficient to prevent potentially avoidable patient harm. CONCLUSIONS: This novel approach to querying ICU operational stress indicated that almost half of participating sites experienced critical care resource limitations during peak influenza season and required process and/or staffing changes to better balance resources with patient care demands. This weekly national reporting infrastructure could be adapted and expanded to better inform providers, hospital emergency management teams, and government leaders during PHEs.
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Acute effects of high-sugar/low-fiber meals vs low-sugar/high-fiber meals on hormones and behavior were studied in 10 overweight Latina females, age 11 to 12 years, using a crossover design. In this exploratory pilot study, participants arrived fasted at an observation laboratory on two occasions and randomly received either a high-sugar/low-fiber meal or a low-sugar/high-fiber meal at each visit. Glucose, insulin, and leptin were assayed from serum drawn at 0, 15, 30, 60, 90, and 120 minutes. Ad libitum snacks were provided at 120 minutes. Physical activity was measured using an observational system that provides data on time spent lying down, sitting, standing, walking, and in vigorous activity. Data were collected between March 2005 and July 2006. In the high-sugar/low-fiber condition, glucose and leptin levels decreased more slowly, glucose levels were higher at 60 minutes (111.2 mg/dL vs 95.4 mg/dL, P=0.03), and leptin levels were higher at 90 minutes (49.3 ng/mL vs 46.7 ng/mL, P=0.017) than in the low-sugar/high-fiber condition. Meals did not affect insulin or ad libitum dietary intake. Sitting, standing, lying down, and vigorous activity differed by condition, but not walking. Participants were significantly more active in the first 30 to 60 minutes after the high-sugar/low-fiber meal, but after 60 minutes there was a trend for activity to be lower after the high-sugar/low-fiber meal vs the low-sugar/high-fiber meal. High-sugar meals sustain glucose and leptin levels longer, which may play an important role in modulating levels of physical activity in this group at high risk for obesity-related disease.