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Introduction/Objectives: Insomnia is a common sleep disorders that affects most individuals in the United States, and worldwide. Insomnia is linked with an increased risk of atrial fibrillation (AF) in adults, although the strengths of association were weak, especially in the elderly population. AF is estimated to affect approximately 3 to 6 million people in the United States. We studied the association of AF with insomnia in the elderly population. Methods: We reviewed the electronic medical records of elderly patients who received care in an internal medicine office from July 1, 2020 through June 30, 2021. Patients were grouped into AF group, and a group without AF (NOAF). Association of insomnia and other variables were compared between the 2 groups. Results: Among 2428 patients, 341 (14%) had AF. Patients in the AF group were significantly older compared to no-AF group (80.3 ± 7.9 vs 76.1 ± 7.4 years; P

OBJECTIVES: The purpose of this literature review was to describe enamel matrix derivative (EMD) and how it benefits periodontal patients. EMD's rejuvenating abilities were identified as well as the different functions of EMD. METHODS: Articles chosen for this literature review were randomized control trials that were peer reviewed and published within the last five years. PubMed was accessed through Augusta University's database for research. Keywords used to search included enamel matrix derivative, bone loss, periodontitis, enamel matrix proteins, gum disease, regeneration, therapy, and growth. RESULTS: Studies chosen for this literature review all showed that EMD improves clinical attachment level. It is able to promote hard and soft tissue regeneration because it contains the same proteins that are involved in amelogenesis. These proteins stimulate fibroblasts, anti-inflammatory cytokines, and clotting factors. All these factors make EMD a great adjunct to periodontal surgical procedures. EMD is also able to reduce inflammation, promote wound healing, and stabilize blood clots. CONCLUSIONS: Overall, EMD's ability to assist in the formation of new bone, cementum, and periodontal ligaments makes it an excellent treatment option for periodontally involved patients. It is frequently used with scaling and root planing, flap surgery, and the treatment of infrabony defects.

OBJECTIVES: The purpose of this abstract is to describe how the use of phage therapy can be used to effectively target oral bacteria such as Streptococcus mutans, Aggregatibacter actinomycetemcomitans, and Enterococcus faecalis with minimal side effects to patients. These particular bacteria are important components in the process of caries formation, periodontal disease, and failed endodontic treatment. METHODS: A search of Pubmed was conducted for peer-reviewed randomized control trials, clinical trials, and studies that were less than five years old. The keywords used to find relevant articles were: bacteria, oral bacteria, phage therapy, bacteriophage therapy, pathogenic bacteria, and dental bacteria. RESULTS: The studies that were reviewed demonstrated phage therapy to be effective in reducing oral bacteria commonly responsible for dental caries, periodontal disease, and failed endodontic treatment. The first study showed the isolated phage, SMHBZ8, targeted S. mutans and reduced both biofilm formation and demineralization of enamel. The second study demonstrated the ability of a lysogenic bacteriophage, S1249, to be induced into the lytic cycle in human serum and effectively eliminate A. actinomycetemcomitans, a bacteria implicated in aggressive periodontal disease and known to be resistant to serum. The third study found a phage, PEf771, targeting E. faecalis in endodontically treated teeth with refractory periapical periodontitis was found to have greater substantivity and antibiotic properties than traditional medicaments used in root canal treatment. CONCLUSIONS: These studies prove the viability of phage therapy as a treatment modality in targeting pathogens that contribute to major oral diseases. Benefits of phage therapy include low toxicity, high specificity, biofilm penetrating capabilities, and the ability to continuously replicate in the presence of target bacteria. IMPLICATIONS: With more research to include human trials, phage therapy could prove to be a cost-effective alternative to conventional treatments in dentistry with fewer side effects to patients. Current treatment options for these oral diseases carry risks such as antibiotic resistance, staining, and toxicity. The ability of bacteriophage to target caries-causing bacteria such as S. mutans while sparing commensal bacteria is promising for preventive dentistry while the specificity and replicating abilities are desirable for eliminating periodontal and endodontic pathogens. The use of bacteriophage in dentistry could be adapted for delivery as a rinse, dentifrice, varnish, or targeted delivery system.

OBJECTIVES: Evaluate the role oral hygiene plays in decreasing the risk of contracting Ventilator-Associated Pneumonia (VAP) for patients on life-support. METHODS: Five different research studies were used to measure the effectiveness of various mouthwashes ability to prevent VAP. The mouthwashes evaluated were Clove mouthwash, Ozonated Water (OZW), Chlorohexidine Gluconate (CHG), and Povidone Iodine. For each study, the patients were split into a control and experimental group. All patients were treated with the designated mouthwash, using a mouth swab for application. There was a variation of the duration of each study, as well as the time intervals of mouthwash application. The studies were conducted over the course of anywhere from a few hours to several days. There were numerous data collection instruments used throughout each study to measure the incidence of VAP contraction, such as Acute Physiology and Chronic Health Evaluation II (APACHEII), The Beck Oral Assessment Scale (BOAS), and Modified Clinical Pulmonary Infection Score (MCPIS). RESULTS: • Study One: 40% participants in Chlorohexidine group contracted VAP; double that of the Clove Extract group • Study Two: 9 out of 36 patients in OZW group contracted VAP; 17 out of 37 patients in CHG group contracted VAP • Study Three: Experimental group showed an overall reduction in bacterial growth • Study Four: 0% VAP contraction in experimental group; 10.58% contraction in control group • Study Five: 10 patients in CHG group contracted VAP; 17 patients in placebo group contracted VAP CONCLUSIONS: Overall, this literature review confirms that mouthwash solutions do have a positive effect in the reduction of VAP in critically ill patients. However, research has not consistently shown one solution to be more triumphant than another, when compared. IMPLICATIONS: In a hospital setting the findings influence clinical dentistry by showing the importance of providing professional cleanings within 24 hours of mechanical ventilation, providing oral care using an antibacterial mouthwash 3 times a day, and ensuring that patients teeth are brushed twice a day. In a private practice setting the findings show the importance/need of advocating for patients receiving proper oral care while in a critically ill state and spreading awareness on the effect that oral hygiene has on preventing VAP.

OBJECTIVES: Hyperbaric oxygen therapy (HBOT) brings several benefits to wound healing in various tissues throughout the body by delivering high concentrations of oxygen under increased atmospheric pressure for small intervals of time. In addition to routine scaling and root planning (SRP), HBOT may be able to further improve pocket depths, revive tissues, and maybe even help to regenerate parts of the periodontal ligament. METHODS: The Augusta University Greenblatt online library, Google scholar, and Galileo were used to find credible articles. Criteria for finding credible articles included articles that were published within 5 years of 2023, articles that are not literature reviews, articles that report randomized clinical trials, and articles that do not present an obvious bias. RESULTS: All studies yielded results in favor of the use of HBOT to improve periodontal health. Results included decreases in probing depths, improved clinical attachment levels, decreases in bleeding, and improved gingival indexes. Only one study yielded non-directional results with no noticeable differences between the control group and study group. CONCLUSIONS: After a thorough review of the selected research articles, it is concluded that HBOT would be an effective adjunct to SRP. Adding HBOT to a patient's treatment plan could be beneficial to many components of the periodontal ligament. IMPLICATIONS: HBOT would be a good addition to the dental field by offering a less invasive form of therapy to periodontally affected patients. Certain factors like price and duration of treatment could affect the accessibility of HBOT. Further research will help to bring HBOT into the dental field and become a widely accepted adjunct to periodontal therapy.

Background: Given the current opioid epidemic, it is crucial to highly regulate the prescription of narcotic medications for pain management. The use of electronic prescriptions (e-scripts) through the hospital’s electronic medical record platform allows physicians to fill opioid prescriptions in smaller doses, potentially limiting the total quantity of analgesics patients have access to and decreasing the potential for substance misuse. The purpose of this study is to determine how the implementation of e-scripts changed the quantity of opioids prescribed following shoulder surgeries. Methods: For this single-center retrospective study, data were extracted for all patients aged 18 years or more who received a shoulder procedure between January 2015 and December 2020. Total milligrams of morphine equivalents (MMEs) of opioids prescribed within the 90 days following surgery were compared between 3 cohorts: preimplementation of the 2017 New Jersey Opioid laws (Pre-NJ opioid laws), post-NJ Opioid Laws but pre-escripting, and postimplementation of e-scripting in 2019 (postescripting). Any patient prescribed preoperative opioids, prescribed opioids by nonorthopedic physicians, under the care of a pain management physician, or had a simultaneous nonshoulder procedure was excluded from this study. Results: There were 1857 subjects included in this study; 796 pre-NJ opioid laws, 520 post-NJ opioid laws, pre-escripting, and 541 postescripting. Following implementation of e-scripting on July 1, 2019, there was a significant decrease in total MMEs prescribed (P < .001) from a median of 90 MME (interquartile range 65, 65-130) preimplementation to a median 45 MME (interquartile range 45, 45-90) MME postimplementation Additionally, there was a statistically significant decrease in opioids prescribed for all procedures (P < .001) and for 3 (P < .001) of the 4 orthopedic surgeons included in this study. Conclusion: Our study demonstrated a significant reduction in total MMEs prescribed overall, for all shoulder surgeries, and for the majority of our institution’s providers in the postoperative period following the e-scripting implementation in July 2019. E-scripting is a valuable tool in conjunction with education and awareness on the national, institutional, provider, and patient levels to combat the opioid epidemic.

Background The Hospital Readmission Reduction Programme (HRRP) was created to decrease the number of hospital readmissions for acute myocardial infarction (AMI), chronic obstructive pulmonary disease (COPD), heart failure (HF), pneumonia (PNA), coronary artery bypass graft (CABG), elective total hip arthroplasty (THA) and total knee arthroplasty.Objectives To analyse the impact of the HRRP on readmission rates from 2010 to 2019 and how time to readmission impacted outcomes.Design Population-based retrospective study.Setting All patients included in the US National Readmission database from 2010 to 2019.Patients We recorded demographic and clinical variables.Measurements Using linear regression models, we analysed the association between readmission status and timing with death and length of stay (LOS) outcomes. We transformed LOS and charges into log-LOS and log-charges to normalise the data.Results There were 31 553 363 records included in the study. Of those, 4 593 228 (14.55%) were readmitted within 30 days. From 2010 to 2019, readmission rates for COPD (20.8%–19.8%), HF (24.9%–21.9%), PNA (16.4%–15.1%), AMI (15.6%–12.9%) and TKR (4.1%–3.4%) decreased whereas CABG (10.2%–10.6%) and THA (4.2%–5.8%) increased. Readmitted patients were at higher risk of mortality (6% vs 2.8%) and had higher LOS (3 (2–5) vs 4 (3–7)). Patients readmitted within 10 days had a mortality 6.4% higher than those readmitted in 11–20 days (5.4%) and 21–30 days (4.6%). Increased time from discharge to readmission was associated with a lower likelihood of mortality, like LOS.Conclusion Over the last 10 years, readmission rates decreased for most conditions included in the HRRP except CABG and THA. Patients readmitted shortly after discharge were at higher risk of death.

Introduction: There are a number of tools available to healthcare epidemiologists for identification and investigation of healthcare-associated infections. For example, root cause analysis (RCA) is an evidence-based strategy for identifying process failures that resulted in infection. However, RCA is most valuable on a case-by-case basis. It is not an efficient tool for investigating numerous events that trend over time. Healthcare epidemiologists must use different strategies that are both efficient and powerful. A case-control study is a valuable option to investigate rare but recurrent infection events. The objective of this study was to demonstrate the utility of a case-control study design to detect attributable risk factors of cesarean section surgical site infections (SSI). Methods: We conducted a case-control study at a Level III childbirth center with data timeframe of January 1, 2021 to May 31, 2023. The project was approved by the institutions’ Quality Improvement Review Board prior to implementation. Cases were identified using the National Healthcare Safety Network (NHSN) SSI event criteria and included all levels of SSI. Controls were selected from the NHSN surgical denominator and were matched randomly without replacement by age at a 1:4 ratio. Variables were identified in collaboration with stakeholders based on known risk factors for SSI and abstracted manually. Analyses were conducted in Stata/MP version 17.0, and we performed multivariable conditional logistic regression with an alpha of 0.05 as threshold for statistical significance. The model was built according to a priori hypotheses and results from bivariate analysis of individual risk factors. Results: There were 32 SSI among 1709 cesarean deliveries, and all cases successfully matched with 4 controls for an analytic sample of 128. Bivariate analyses identified 7 relevant variables for inclusion in the multivariable model which narrowed down significant risk factors to 3: operative time (in minutes), post-operative chlorhexidine gluconate (CHG) bathing, and number of people in the operating room. Assessment of fit indices suggested an excellent fit with pseudo R-square of 0.526. Conclusions: This study demonstrated the utility of a case-control study design to identify attributable risk factors for relatively rare but significantly trending infection events. Not only is the design more efficient (e.g., time needed to abstract 50 data points for each patient), but it also employs statistical analyses that are often lacking in case-by-case investigations or RCA. It also has the power to narrow down risk factors for focused prevention efforts to get “the most bang for the buck.”

Introduction/Objectives: Chronic hepatitis B virus infection (CHBVI) is a major public health problem affecting about 296 million people worldwide. HBV infects the liver, and when it becomes chronic, may cause cirrhosis and hepatocellular carcinoma (HCC). The aim of our study was to identify the risk factors and comorbid medical conditions that were associated with HCC in patients who had CHBVI. Methods: We performed a retrospective electronic medical record review of adult patients diagnosed with CHBVI, who presented to our primary care office between October 1, 2017 and October 21, 2022. Selected variables in patients with CHBVI with HCC (HCC group) were compared to those without HCC (NoHCC group). Results: Among 125 patients with CHBVI, 24% had HCC and 76% did not have HCC. There were higher frequencies of association of certain comorbidities in the HCC group compared to NoHCC group, such as anemia (63.3% vs 26.3%; P

Background: Chronic obstructive pulmonary disease (COPD) is a common preventable illness that carries a large global economic and social burden. The global initiative for chronic obstructive lung disease (GOLD) guidelines has been utilized as a global strategy for the continued COPD diagnosis, assessment, and treatment. We aimed to determine if the adherence to the 2021 GOLD guideline directed management influenced outcomes. Materials and Methods: Retrospective medical records review of adult patients with COPD, who received care in our office during the entire year of 2021. Patients managed as per the 2021 GOLD guidelines were compared with those who received usual care. Results: Among 242 patients, 171 (70.7%) were GOLD management adherent (GA) and 71 (29.3%) were GOLD non-adherent (GNA). Certain comorbidities were associated with higher frequencies in the GA group, such as allergic rhinitis (63.2 vs. 18.3%; P < 0.001), coronary artery disease (55.9 vs. 38.0%; P = 0.011), GERD (63.2 vs. 32.4%; P < 0.001), anemia (38.6 vs. 19.7%; P = 0.004), malignancy (34.5 vs. 19.7%; P = 0.023), and immunodeficiency (12.3 vs. 1.4%; P = 0.007). There was no significant difference in the mortality between the GA and GNA groups (5.3 vs. 9.9%; P = 0.254). Although the frequency of number of exacerbations was greater in the GA group, the difference in the mean number of exacerbations was not statistically significant (0.39 ± 1.08 vs. 0.39 ± 1.14; P = 0.984). Conclusion: We found no significant difference in the patient outcomes, such as number of exacerbations of COPD and mortality, when comparing the 2021 GOLD guideline adherent versus GOLD guideline non-adherent management of COPD.

Abstract Huntington’s disease (HD) is increasingly recognized for diverse pathology outside of the nervous system. To describe the biology of HD in relation to functional progression, we previously analyzed the plasma and CSF metabolome in a cross-sectional study of participants who had various degrees of functional impairment. Here, we carried out an exploratory study in plasma from HD individuals over a 3-year time frame to assess whether differences exist between those with fast or absent clinical progression. There were more differences in circulating metabolite levels for fast progressors compared to absent progressors (111 vs 20, nominal p

Syphilis and congenital syphilis (CS) cases have been rising in the U.S. and internationally since the 2000s. Social factors have been shown to increase the risk of CS transmission. The COVID-19 pandemic may have contributed to increased syphilis transmission. We aimed to quantify the rise in congenital syphilis (CS) rates at a large urban hospital and the impact of the COVID-19 pandemic on CS rates. We completed a retrospective chart review of 61 pregnant women with a positive test or previous diagnosis of syphilis at an urban academic hospital between 1 January 2016 and 1 June 2022. Maternal syphilis and CS rates increased over the 5 years (p < 0.001), particularly pre- and post-COVID-19 (p < 0.001). Of the mothers studied, 34.6% received adequate prenatal care, 62.7% received adequate screening, and 81.3% received adequate treatment. Stillbirth was noted in 6.6% of pregnancies. Of liveborn infants, 97.6% received appropriate treatment, and 45.1% received adequate follow-up. CS development was significantly associated with homelessness (p = 0.028) and past opioid use (p = 0.031). We concluded that maternal syphilis and CS rates have increased at our hospital, particularly during the COVID-19 pandemic. Access to prenatal care and timely maternal treatment are target areas for improvement.

Introduction/Objective: Chronic pain disorders affect about 20% of adults in the United States, and it disproportionately affects individuals living in the neighborhoods of extreme socioeconomic disadvantage. In many instances, chronic pain has been noted to arise from an aggregation of multiple risk factors and events. Therefore, it is of importance to recognize the modifiable risk factors. The aim of this study was to investigate the comorbid medical conditions and risk factors associated with chronic pain disorders in patients aged 65 years and older. Methods: Our team retrospectively reviewed medical records of elderly patients (65 years and older) who were evaluated in our outpatient medicine office between July 1, 2020 and June 30, 2021 for acute problems, management of chronic medical problems, or well visits. We divided our patients into a group who suffered from chronic pain disorder, and another group who did not have chronic pain disorder. The association of variables were compared between those groups. Results: Of the 2431 patients, 493 (20.3%) had a chronic pain disorder. A higher frequency of females in the group with chronic pain disorder was found compared to the group without a chronic pain disorder (60.6% vs 55.2%; P = .033). The mean ages between the two groups were similar in the group with a chronic pain disorder compared to the group without (76.35 ± 7.5 year vs 76.81 ± 7.59 year; P = .228). There were significant associations of certain comorbidities in the group with a chronic pain disorder compared to the group without a chronic pain disorder, such as depression (21.9% vs 15.2%; P

Lucilia silvarum Meigen (Diptera: Calliphoridae) is widespread throughout North America and Europe. Described in 1826, this blow fly was quickly associated with myiasis in amphibians, and to date has rarely been reported in carrion. There is limited data regarding the time of colonization of animals with fur and the interpretation of this data is difficult due to variation in the animal models used. During an examination of initial insect colonization of cats (Felis catus) with light and dark fur, twelve domestic short-haired cats were placed in cages 15.2 m apart in a grassy field in West Lafayette, Indiana, USA. Eggs from initial oviposition events were collected and reared to identify the colonizing species. Three species of Lucilia (Diptera: Calliphoridae), including L. silvarum, colonized the cats on the initial day of placement. In this study, L. silvarum was the primary colonizer of cats, and this may be the first study where a large number of L. silvarum were collected. Further studies should include development studies on L. silvarum to understand its life history and aid in time of colonization estimations. More work regarding the colonization of furred mammals is needed to further examine L. silvarum as a primary colonizer.

ABSTRACT The recent upsurge in the use of common marmosets (Callithrix jacchus) as a desirable model for high‐priority biomedical research has challenged local and global suppliers struggling to provide sufficient numbers of marmosets for large‐scale projects. In laboratories, random male‐female pairings are often unsuccessful, with intervals of several months before attempting alternate pairings. Here we address this challenge through a behavioral task that promotes self‐directed female selection of potential mates to increase the efficiency of breeding in captive marmosets. We created a partner preference test in which nulliparous females (n = 12) had the opportunity to select between two eligible males (n = 23) at a time, in a forced choice test. In this test, both males and females displayed sexual solicitations. However, the females displayed a clear preference for one male by directing affiliative behaviors toward him including proceptive tongue‐flicking, approach, and grooming. Her preference remained consistent across three consecutive test sessions. This method resulted in a 2.5‐fold improvement in breeding success within 90 days compared to random pairings. This cost‐effective and straightforward pairing practice can be used to enhance breeding efficiency in both small and large marmoset colonies. [ABSTRACT FROM AUTHOR]