Trajectories of Blood Pressure in Midlife Women: Does Menopause Matter?

Background: Whether changes in blood pressure (BP) over women's midlife are more driven by chronological aging or the menopause transition (MT) has been debated. We sought to determine whether women can be classified into distinct trajectory groups based on pattern and level of systolic (SBP), diastolic blood pressure, pulse pressure (PP), and mean arterial pressure (MAP) over the MT, and to assess whether menopause-related factors predict the group and/or level of BP measures. Methods: Participants were from the Study of Women's Health Across the Nation (SWAN). Group-based trajectory modeling was used to identify women who shared distinct BP trajectories over time relative to menopause onset and to assess associations of menopause-related factors with trajectory group and/or level of BP measures. An accelerated rise relative to menopause onset suggests a menopause contribution. Results: The study included 3,302 multi-racial/ethnic women with BP measures over 17 follow-up visits (baseline age[SD]: 46.3[2.7]). Women were classified into either low, medium, or high trajectory group in each BP measure. The low SBP, PP, and MAP trajectories (in 35%, 53%, and 28% of the cohort, respectively) were rising slowly before menopause but showed a significant accelerated rise 1 year after menopause, indicating a menopause contribution. The remaining BP trajectories were rising up until menopause and either continued with the same rise or declined after menopause. A younger menopause age predicted the low SBP, PP, and MAP trajectories. A greater follicle-stimulating hormone level predicted lower SBP and PP levels, while vasomotor symptoms occurrence predicted higher SBP, PP, and MAP levels over time. Estradiol did not predict trajectory or level of any BP measure. Conclusions: Distinct BP trajectories over the MT exist that revealed a group of women whose SBP, PP, and MAP trajectories are consistent with a menopause contribution. Our findings support frequent monitoring of BP during the MT.

A Recent Update on Oral Anticoagulants

Atrial Fibrillation is very common among Americana; it is the irregular rhythm of the heart usually present with or without symptoms. It causes the formation of clots, clots go to the brain and cause a stroke. Anticoagulants have been known for a few decades to cause abrupt decrease around 50%) in the rate of stroke and prevent clotting at the required location and can cause bleeding. Anticoagulants aims for the safeguard and therapy of thromboembolism to prevent stroke. Previously used Anticoagulants are Warfarin, low molecular weight heparin and heparin. There were shortcoming of the drugs like parenteral route of administration, requires frequent monitoring due to variability in response, the onset of action is slow and there is bleeding in response to the drugs .In addition to heparin and vitamin k antagonist, anticoagulants that act on enzymatic agility or vigor brought about by of thrombin and factor Xa was exquisitely formulated. Implementation of the foresaid oral Anticoagulants requires knowledge of necessitate the comprehension of discrete indication, contraindications, characteristics. Research and repeated clinical trials have led to acceptance of few newer drugs which are working classically styled but better than Warfarin. In the last few years, Pradaxa (dabigatran), Xarelto (rivaroxaban), and Eliquis (dabigatran) have all been authorised by the FDA (apixaban). All three are ‘blood thinners,’ like warfarin, that lessen the overall risk of stroke associated with atrial fibrillation while also causing bleeding.

Growth and behaviour of post-weaned Mérinos d'Arles ewe lambs, as measured by a Walk-over-Weighing system under Mediterranean grazing conditions.

Liveweight (LW) is a key and conventional indicator for monitoring and assessing overall animal performance and welfare, representing the progress along different physiological stages, while providing close indication of individual physical and health status. Measuring LW in practice is still, however, quite rare and infrequent under commercial sheep farming conditions, mainly because sessions are time-consuming, stressful either for the operator and the animals. A Walk-over-Weighing (WoW) system, already evaluated with other breeds under different conditions, was tested in this experiment lasting 14 weeks (i.e. 3 for acclimation and adaptation and 11 for data collection). We validated its use for routine and frequent monitoring the growth rate in post-weaned Merinos d'Arles ewe lambs, reared under Mediterranean grazing conditions. Similarly to previous work, the necessity for an initial adaptation period of the animals as well as for an essential data cleaning procedure of the raw database automatically collected by the WoW, were corroborated. Adaptation of naive ewe lambs enabled the required voluntary passages across the weigh platform and a high volume of individual and daily data after 2-3 weeks. Close monitoring of individual growth was then possible after performing sound data cleanings. A strong concordance of WoW LW data with the gold standard (a standard static scale) LW reference data was demonstrated. At the individual level, even with the lowest number of LW values collected with WoW, it was possible to monitor variations in LW at daily intervals. The establishment of an early warning system to help farmer decision making could therefore be possible. Our results show interesting perspectives for more precise and frequent monitoring of LW in grazing sheep without human intervention, compared to what is currently carried out on commercial farms.

Progressive evaluation in spectroscopic sensors for non-invasive blood haemoglobin analysis - a review

Frequent monitoring of haemoglobin concentration is highly recommended by physicians to diagnose anaemia and polycythemia Vera. Moreover, Some other conditions also demand assessment of haemoglobin, and these conditions are blood loss, before blood donation, during pregnancy, preoperative, perioperative and postoperative conditions. Cyanmethaemoglobin/haemiglobincyanide method, portable haemoglobinometers and haematology analyzers are few standard methods to diagnose mentioned ailments. However, discomfort, delay and risk of infection are typical limitations of traditional measuring solutions. These limitations create the necessity to develop a non-invasive haemoglobin monitoring technique for a better lifestyle. Various methods and products are already developed and popular due to their non-invasiveness; however, invasive solutions are still considered as the reference standard method. Therefore, this review summarizes the attributes of existing non-invasive solutions. These attributes are finalized as brief details, accuracy, optimal benefits, and research challenges for exploring potential gaps, advancements and possibilities to consider as futuristic alternative methodologies. Non-invasive total haemoglobin assessing techniques are mainly based on optical spectroscopy (reflectance/transmittance) or digital photography or spectroscopic imaging in spot check/continuous monitoring mode. In all these techniques, we have noticed that there is a need to consider different light conditions, motion artefacts, melanocytes, other blood constituents, smoking and precise fixing of the sensor from the sensing spot for exact formulation. Moreover, based on careful and critical analysis of outcomes, none of these techniques or products is used independently or intended to replace invasive laboratory testing. Therefore there is a requirement for a more accurate technique that can eliminate the requirement of blood samples and likely end up as a reference standard method.

Towards environmental DNA-based bioassessment of freshwater reservoirs with small volumes of water: robust molecular protocols

Bioassessment of freshwater quality via eDNA is rapidly developing into a powerful alternative to traditional methods involving collecting, sorting, and identifying macroinvertebrates based on morphology. Particularly attractive would be methods that can use remote-controlled boats for sampling because it would allow for cost-effective, and frequent monitoring at multiple sites. The latter will be particularly important for tropical reservoirs that require year-around surveillance. We here optimize molecular protocols for capturing reservoir-specific differences in metazoan communities based on small water volumes (15 mL). The optimization is based on samples from two freshwater reservoirs with very different water qualities ("reservoir signal"). Each reservoir was sampled at three sites ("biological replicates"). For each water sample, the DNA was extracted twice ("technical replicates"). We then tested how much DNA template (0.1 ng to 15 ng) and how many PCR cycles (25 or 35) minimized variance between technical replicates. We find that 15 mL is sufficient for capturing the reservoir signal regardless of sampling time, template amounts, or PCR cycle numbers. Indeed, extrapolation from our results suggests that <1 mL would be sufficient because only 17 of 59 metazoan mOTUs (mainly planktonic crustaceans and rotifers) detected with a 313bp COI minibarcode were shared. We find that the use of 35 PCR cycles significantly lowered the number of detected species and that template amounts <0.5 ng yielded somewhat higher variance between technical replicates. Despite extensive trials, the variance between technical replicates remained high (Bray-Curtis: 5-20%; Jaccard: 10-40%) and we predict that it will be difficult to reduce this variance further. However, the overall reservoir differences are so strong that all biological and technical replicates can be correctly assigned.

513. Use of Antimicrobial Stewardship Program in Operationalizing Monoclonal Antibody Therapy in SARS-CoV-2 Infection

Background Antimicrobial stewardship programs (ASP) have been essential during the coronavirus disease 2019 (COVID-19) pandemic response. Use of monoclonal antibodies for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has proven difficult to operationalize, despite being available through emergency use authorization (EUA). Utilizing existing ASP and multidisciplinary approach to lead the effort, we aim to describe our experience in operationalizing monoclonal antibody therapy. Methods Retrospective study of SARS-CoV-2 infected adults receiving monoclonal antibody therapy under EUA (December 2020-April 2021). An algorithm developed by the ASP provided education and an interactive online tool allowing referring physicians and patients to assess eligibility prior to hospital arrival. Patients were screened and approved by existing ASP which included; Infectious Disease (ID) physicians, pharmacist, and ID Nurse. A multidisciplinary approach with ER staff and development of pharmacy workflow with order set were utilized as eligible patients received infusion in dedicated ER location. Data such as demographics, co-morbid condition, infusion related complications, hospitalization, and death were reviewed and collected regularly by the ASP team with frequent monitoring and regulatory reporting. Primary patient outcome was preventing hospitalization. Results 107 patients received monoclonal antibody therapy. 47% patients were male, 50% White, and 79% non-Hispanic. 87% received monotherapy (bamlanivimab) and 13% received dual therapy (bamlanivimab/etesevimab). 17 patients required hospitalization post infusion. 1 death occurred. COVID-19 related hospitalization within 30-days was avoided in 84% of treated patients. No adverse event directly related to infusion were seen. Conclusion Use of monoclonal antibody therapy under EUA for patients for SARS-CoV-2 infection led to decrease in hospitalization in this cohort. An existing ASP using an algorithmic approval process, frequent monitoring, and multidisciplinary approach successfully operationalized the use of monoclonal antibody therapy. ASP’s provide benefit and versatility beyond monitoring of antimicrobials alone and should continue to receive support by hospital leadership. Disclosures All Authors: No reported disclosures

Microchip Immunoassays for Monitoring Renal Function: Rapid, Low-Cost, and Highly Sensitive Quantification of Urinary Biomarkers of Diabetic Nephropathy

This study developed low-cost and highly sensitive immunoassay devices possessing the ability to rapidly analyze urine samples. Further, they can quantitatively detect three biomarkers indicating renal injury: monocyte chemotactic protein 1 (MCP-1), angiotensinogen (AGT), and liver-type fatty acid binding protein (L-FABP). The devices were used to successfully estimate the concentrations of the three biomarkers in urine samples within 2 min; the results were consistent with those obtained via conventional enzyme-linked immunosorbent assay (ELISA), which requires several hours. In addition, the estimated detection limits for the three biomarkers were comparable to those of commercially available ELISA kits. Thus, the proposed and fabricated devices facilitate high-precision and frequent monitoring of renal function.

“Evaluating and Managing Tardive Dyskinesia in the Older Adult”

Purpose of Review Tardive dyskinesia is an iatrogenic hyperkinetic movement disorder caused by chronic exposure to antidopaminergic agents. The older adult population is particularly vulnerable to developing TD. It is also more difficult to discern the condition given the confounding medical comorbidities that may present at this age including Parkinson’s and other movement disorders that may mimic TD. Recent Findings This paper reviews the most common risk factors, including both modifiable and non-modifiable risk factors. Additionally, the possible causes and proposed pathways of TD and how to correctly diagnose and evaluate TD are discussed. We then focus on how to prevent and manage TD given the current and evolving body of knowledge and evidence. Our stepwise management approach starts by frequent monitoring, discontinuing the culprit antipsychotic, decreasing the dose otherwise; followed by switching to less potent antipsychotics and prescribing VMAT-2 inhibitors. VMAT-2 inhibitors, initially approved for management of Huntington's disease, have been recently showing favorable results in treating other hyperkinetic movement disorders like Tourette’s disease, quickly becoming the first line in the treatment of tardive dyskinesia. The properties of the three different agents belonging to this class: tetrabenazine, deutetrabenazine, and valbenazine will be examined, including side-effect profiles. Finally, recent investigational agents and treatment modalities, including neuromodulation (TMS and DBS) will be reviewed that can be considered when conventional treatment fails or is not tolerated. Summary Older adults treated with antidopaminergic medications are at greatest risk for development of tardive dyskinesia. It is important to recognize risk factors and accurately diagnose TD early. New FDA-approved treatments and investigational agents are now available to manage the condition, however further research to optimally prevent and manage TD in the older adult population remains necessary.

Insights from Water Quality of High Andean Springs for Human Consumption in Peru

The headwaters of the high Andean basin in Peru accumulate water from the mist, rain, snow, and hail, and it is transported superficially and underground to low-lying areas, mostly used for drinkable purposes. The natural water in these areas might be altered due to legal and illegal mining extraction. The aim of the study was to evaluate the water quality for human consumption. Seventeen water samples were examined from Andahuaylas (A), San Jerónimo (S), Talavera (T), and Chiara (CH) districts located between 2813 and 4004 m altitude in the Andes. We used physicochemical, microbiological, and metal parameters, and the results were compared to permissible levels established by the WHO and ECA-Peru to examine samples collected in the dry and rainy seasons in 2019. Application of principal component analysis (PCA) identified areas and conditioning parameters. Extractive mining activity influences the quality of springs due to the presence of metals, especially antimony (Sb), arsenic (As), cadmium (Cd), and lead (Pb), values of which are higher than values permissible for human consumption, being higher in the dry season (p < 0.05). In addition, the presence of cations and particulate matter affects physico-chemical parameters, for example turbidity. PCA showed that parameters for water characterization are season-independent, and water quality in the springs would be conditioned by the presence of metals, especially in Andahuaylas and Talavera zones, as well as the parameters that are associated with dissolved solids in the water (turbidity and fluorides). A frequent monitoring program of springs and groundwater is recommended, with the purpose to protect water from contamination and guarantee safe water availability in low-lying and urbanized areas.

Brain Injury Localization in Electromagnetic Imaging using Symmetric Crossing Lines Method

To avoid death or disability, patients with brain injury should undertake a diagnosis at the earliest time and accept frequent monitoring after starting any medical intervention. This paper presents a novel approach to localize brain injury using the intersection of pairs of signals from symmetrical antennas based on the hypothesis that healthy brains are approximately symmetric that the bleeding targets will lead to significantly different amplitude and phase changes if a pair of symmetrical transmit signals cross targets with the same distances. The scattered signals (S-parameters) across the band 0.5-2 GHz are acquired using 100 realistic brain models and 150 experimental data measurements. Each signal is divided into two frequency bands and then they are converted into two graphs. The neighbour pair signals from symmetric hemisphere are evaluated to detect and localize the potential abnormalities in the brain. The higher weighted pairs across the axes of symmetry are detected and used to localize any abnormal targets. The results indicate that crossing pairs of antenna signals from the hemisphere with a blood mass exhibit significantly different signal amplitude in the graph features compared to those without the target (p<0.003). The experiments show that our novel localization algorithm can achieve an accuracy of 0.85±0.08 Dice similarity coefficient based on 150 experimental measurements using an elliptical container, which is suitable for brain injury localization.