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Kristin Richards,1 Sneha Mantri,2 Carolyn M Brown,1 Michael Johnsrud,1 Steve Arcona,3 Rahul Sasané3 1TxCORE, College of Pharmacy, The University of Texas at Austin, Austin, Texas, USA; 2Department of Neurology, Duke University, Durham, North Carolina, USA; 3Cerevel Therapeutics, LLC, Cambridge, Massachusetts, USACorrespondence: Kristin Richards, Email krichards@austin.utexas.eduPurpose: Medication is an important component of the management of Parkinson’s disease (PD), yet few studies investigate factors that inform medication decision-making from the perspective of those who use these therapies. This qualitative study aimed to better understand the medication experiences and perspectives of people with PD (PwPD).Patients and Methods: Thirty-two PwPD recruited from five large movement disorder clinics from five US states participated in 1-hour on-line focus groups in 2022. Thematic analysis was used to analyze the data.Results: Four primary themes (subthemes in parentheses) emerged concerning PD medications: (1) medication effectiveness (uncertainty, inconsistent effects, adjusting expectations); (2) medication burden (morning doses, timing challenges, constant reminder); (3) side effects (toleration, treatment, confusion with disease symptoms); and (4) preferences/requests (important attributes, therapy advancement).Conclusion: This study identified four core dimensions associated with PD medications from the perspective of PwPD. Results indicate the need for enhanced communication between providers and patients regarding PD medication to reduce the uncertainties and burden associated with PD medication regimens and promote better health outcomes for PwPD.Keywords: Parkinson’s disease, medication, patient perspective, patient experience

The Groundwater Ubiquity Score (GUS) is widely used to indicate the relative leachability of pesticides based on the soil half-life and the adsorption partition coefficient. In this manuscript, we derive mathematically the Theoretical Groundwater Ubiquity Score (TGUS) that, based on considerations of the preferential movement of pesticides to groundwater and a first-order pesticide degradation model, leads to a similar function as the GUS model. In the preferential flow model, movement to groundwater is fast, and the adsorption partition coefficient is thus not used for calculating the travel time to the groundwater (as it is in the advective-dispersive equation) but rather only determines the distribution of the pesticide between the water and soil phases. Both the GUS and TGUS models well predict the groundwater contamination of the originally studied pesticides for rainfall event(s) that caused pesticide leaching from 30 days after application. The theoretically derived Groundwater Ubiquity Score (TGUS) shows, in accordance with experimental evidence, that for leaching events shortly after spraying, the mass lost to (and resulting concentration in) groundwater is inversely related to the adsorption partition coefficient and not necessarily to the GUS index.

Parkinson’s Disease (PD) patients are more prone to traumatic injury due to a short shuffling gait and skeletal muscle rigidity. Diabetes mellitus is a chronic metabolic syndrome that affects all vital systems, including the autonomic nervous system. Cardiac autonomic neuropathy affects the conducting system of the heart, producing cardiac arrhythmias and silent ischaemia. Here, the authors report a case of head injury with Extradural Haematoma (EDH) in a 81 year old geriatric male patient posted for EDH evacuation. Emergency craniotomy in this patient with pre-existing PD, diabetes mellitus, and new-onset atrial flutter presents a significant challenge in anaesthetic management. In addition to that, chronic alcoholism further necessitates the selection of appropriate anaesthetic techniques and vigilant perioperative management to prevent intraoperative cardiac arrhythmias, hypotension, heart failure, and pulmonary oedema.

Parelaphostrongylus tenuis causes ungulate morbidity and mortality in eastern and central North America, but no reference genome sequence exists to facilitate research. Here, we present a P. tenuis genome assembly and annotation, generated with PacBio and Illumina technologies. The assembly is 491 Mbp, with 7285 scaffolds and 185 kb N50.

Kristin Richards,1 Michael Johnsrud,1 Christopher Zacker,2 Rahul Sasané2 1TxCORE, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA; 2Cerevel Therapeutics, LLC, Cambridge, MA, USACorrespondence: Kristin Richards, TxCORE, College of Pharmacy, The University of Texas at Austin, 2409 University Avenue, Mail Stop A1930, Austin, TX, 78712, USA, Tel +1 512 471 5607, Email krichards@austin.utexas.eduPurpose: To examine 1-year persistence with oral atypical antipsychotics (OAAPs) for Medicaid patients with schizophrenia and assess the association between OAAP persistence and hospital and emergency department (ED) resource utilization.Patients and Methods: Using 2016– 2020 multi-state Medicaid claims data, this retrospective study followed patients diagnosed with schizophrenia for 12 months after initiating OAAP therapy. Patients started on an OAAP with no evidence of antipsychotic use in the previous 6 months were included if they had a diagnosis of schizophrenia, were not dually enrolled in Medicaid and Medicare, did not switch to a long-acting injectable antipsychotic, and were continuously eligible 6 months before and 12 months after the initial OAAP prescription (index date). OAAP persistence was measured allowing for a < 60-day gap. All-cause and schizophrenia-related inpatient and emergency department (ED) resource utilization during the follow-up period were compared between OAAP persistent and non-persistent groups.Results: The study sample of 13,007 had an average age of 39.1 years and 57.0% were male. Patients were persistent with their index OAAP for 135 days on average and 73.1% had a ≥ 60-day gap in antipsychotic therapy post-index. While 32.8% and 28.6% of patients who did not persist with their index OAAP restarted the index OAAP or switched to a different OAAP medication later in the year, respectively, a larger proportion (38.6%) had no further OAAP prescriptions. After adjustment for demographic and clinical variables, compared to non-persistent patients, persisting with OAAPs was significantly associated with fewer all-cause and schizophrenia-related hospitalizations (Incidence Rate Ratio [IRR]=0.742, p< 0.001; IRR=0.823, p< 0.001; respectively) and ED visits (IRR=0.759, p< 0.001; IRR=0.773, p< 0.001; respectively).Conclusion: Non-persistence with OAAP medication is common among patients with schizophrenia and associated with negative outcomes including increased utilization of hospital and ED resources. Patient-centered interventions that improve antipsychotic persistence should be implemented to facilitate optimal outcomes in this population.Keywords: antipsychotic medication, persistence, healthcare resource utilization, Medicaid, schizophrenia

Minna Richards,1 Saija Inkeroinen,1 Jouko Katajisto,2 Sasu Muje,1 Heli Virtanen,1 Helena Leino-Kilpi1,3 1Department of Nursing Science, University of Turku, Turku, Finland; 2Department of Mathematics and Statistics, University of Turku, Turku, Finland; 3Turku University Hospital, Turku, FinlandCorrespondence: Saija Inkeroinen, Department of Nursing Science, University of Turku, Medisiina B, Kiinamyllynkatu 10, Turku, 20520, Finland, Email saanin@utu.fiPurpose: Feedback from service users is a valuable source for improving the quality of care and services, potentially reflecting the successes and failures in providing empowering healthcare. In supporting empowerment, the multidimensionality of knowledge of service users is assumed to be a crucial factor, yet feedback has not been explored from the perspective of empowering knowledge. In this study, the aim was to analyze the knowledge areas expressed in the service users’ feedback from the point of view of empowering knowledge.Patients and Methods: This was a retrospective study utilizing systematically collected service-user feedback from a feedback register of one university hospital district in Finland. Free-form feedback (n = 26,374) along with structured evaluative feedback was given by the patients themselves or their significant others, either by text message or using a feedback form, in 2019. The content of the feedback was analyzed according to the empowering knowledge areas (biophysiological, cognitive, functional, experiential, ethical, social, and financial), quantified, and analyzed statistically in relation to the background characteristics of service users.Results: Service users gave multidimensional free-form feedback about the knowledge and educational practices in care and services. In the free-form feedback, the most common empowering knowledge areas were biophysiological and cognitive ones, whilst experiential, ethical, social, and financial areas were the least common. The highest ratings of structured evaluative feedback were associated with the cognitive and ethical areas.Conclusion: Register-based feedback is systematic data for quality evaluation. In this study, service users seem to actively evaluate the knowledge procession in care and services, and therefore, they can be actors involved in developing the quality of educational practices. It does, however, indicate a need to add multidimensionality and improve the quality of the knowledge, and by that, advance the potential of empowerment among diverse service users.Keywords: empowerment, feedback, health information, hospitals, district, knowledge, patient satisfaction, service users

Heggar Venkataramana Sudeep,1 Sriram Rashmi,2 Thomas V Jestin,3 Aleksander Richards,4 Kuluvar Gouthamchandra,1 Kodimule Shyamprasad1 1Department of Biomedicinal Research, R&D Center for Excellence, Vidya Herbs Pvt Ltd, Bangalore, Karnataka, India; 2BGS Global Institute of Medical Sciences, Bangalore, Karnataka, India; 3Department of Clinical Research, Leads Clinical Research and Bio Services Private Ltd, Bangalore, Karnataka, India; 4Department of Clinical Studies, R&D, Vidya Herbs, Red Bank New Jersey USACorrespondence: Heggar Venkataramana Sudeep, Department of Biomedicinal Research, R&D Center for Excellence, Vidya Herbs Pvt Ltd, Bangalore, Karnataka, India, Email research@vidyaherbs.com; sudeepkashyap.82@gmail.comPurpose: Androgenetic alopecia (AGA) is the most common type of hair loss in humans, affecting self-esteem and emotional well-being. This study aimed to assess the safety and efficacy of VISPOTM, a standardized saw palmetto oil (2– 3% β-sitosterol), in subjects with mild-to-moderate AGA.Methods: In a double-blind, placebo-controlled, four-arm clinical study, 80 healthy male and female subjects aged 18– 50 years were randomly allocated (1:1:1:1) to receive either 400 mg capsules of VISPO or 5 mL of a topical formulation containing 20% VISPO or the respective placebo once daily for 16 weeks. The primary endpoints included hair count (hair comb and hair pull tests) and the self-assessment of perceived efficacy. Objective evaluation was performed using the global photographic assessment score. Hair density, thickness, and anagen/telogen ratio were evaluated using phototrichogram analysis.Results: At the end of the study, oral and topical formulations of VISPO reduced hair fall by up to 29% (p< 0.001) and 22.19% (p< 0.01) from the baseline, respectively. Hair density increased by 5.17% and 7.61% in the oral and topical VISPO groups, respectively (p< 0.001). In addition, oral ingestion of VISPO resulted in a marked reduction in serum dihydrotestosterone (DHT) levels in the subjects compared to placebo (p< 0.001). However, the effect of the VISPO formulations on the anagen/telogen ratio was insignificant. No serious adverse effects were observed during the study.Conclusion: VISPO formulations reduced hair fall and promoted hair regrowth and scalp appearance in AGA patients.Keywords: hair loss, androgenetic alopecia, saw palmetto, β-sitosterol, fatty acids

Cory Dugan,1 Aaron Simpson,1 Peter Peeling,1 Jayne Lim,2 Amelia Davies,2 Paige Buissink,2 Beth MacLean,2 Pradeep Jayasuriya,2 Toby Richards2 1School of Human Sciences, University of Western Australia, Perth, WA, Australia; 2UWA Medical School and Division of Surgery, University of Western Australia, Perth, WA, AustraliaCorrespondence: Cory Dugan, School of Human Sciences, the University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia, Tel +61 0401910790, Email cory.dugan@research.uwa.edu.auBackground: Patient perceptions of iron deficiency and efficacy of iron therapy may differ from the interpretations of doctors. Qualitative investigation at an individual level related may help define patient expectations and therapeutic targets. Therefore, we aimed to explore this concept in exercising females of reproductive age.Methods: Exercising females (n = 403) who either (a) were currently experiencing iron deficiency, or (b) have experienced iron deficiency in the past were included. A survey comprising open-ended text response questions explored three ‘domains’: (1) the impact of iron deficiency, (2) the impact of iron tablet supplementation (where applicable), and (3) the impact of iron infusion treatment (where applicable). Questions were asked about training, performance, and recovery from exercise. Survey responses were coded according to their content, and sentiment analysis was conducted to assess responses as positive, negative, or neutral.Results: Exercising females showed negative sentiment toward iron deficiency symptoms (mean range = − 0.94 to − 0.81), with perception that fatigue significantly impacts performance and recovery. Iron therapies were perceived to improve energy, performance, and recovery time. Participants displayed a strong positive sentiment (mean range = 0.74 to 0.79) toward iron infusion compared to a moderately positive sentiment toward oral iron supplementation (mean range = 0.44 to 0.47), with many participants perceiving that oral iron supplementation had no effect.Conclusion: In Australia, women prefer an iron infusion in treatment of iron deficiency compared to oral iron.Keywords: Iron deficiency, Women’s health, iron supplementation, iron supplementation preference, adherence, sentiment

John Cade Wheelwright, Riley Pence, Boyd Richards, Susan Stroud, Robert Stephen, Megan L Fix Emergency Medicine Department, University of Utah School of Medicine, Salt Lake City, UT, USACorrespondence: John Cade Wheelwright, Emergency Medicine Department, University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT, 84132, Tel +1 580 504 9689, Email Cade.wheelwright@hsc.utah.eduPurpose: Shadowing is an important part of medical student education. The COVID-19 pandemic limited medical students’ hospital access. At the same time, virtual access to learning experiences has expanded greatly. In response, we implemented a novel virtual shadowing system to provide students with convenient and safe exposure to the Emergency Department (ED).Patients and Methods: Six EM faculty hosted 2-hour virtual shadowing for up to 10 students per experience. Students registered via signupgenius.com. Virtual shadowing was conducted using a HIPAA-compliant ZOOM account on an ED issued mobile telehealth Monitor/iPad. The physician would bring the iPad into the room, obtain consent from patients, and ensure students were able to see the encounter. Between visits, students were encouraged to ask questions using the chat function and microphone. A short de-briefing followed each shift. Each participant received a survey about the experience. The survey consisted of 4 questions for demographics, 9 Likert style questions to assess efficacy, and 2 free response sections for comments and feedback. All survey responses were anonymous.Results: In total, 58 students participated in 18 virtual shadowing sessions with an average of 3– 4 students per session. Survey responses were collected between October 20, 2020 and November 20, 2020. The overall response rate was 96.6% (56/58 surveys completed). Of respondents, 46 (82.1%) rated the experience as “effective” or “very effective” at providing exposure to Emergency Medicine. Fifty-three (94.6%) said they would participate in virtual shadowing in the ED again, and 48 (85.7%) would do virtual shadowing in another specialty were it available.Conclusion: We found virtual shadowing to be an easy to implement and effective way for students to shadow physicians in the ED. Even in post-pandemic times, virtual shadowing should be explored as an accessible and effective way to expose students to a broad array of specialties.Keywords: medical education, virtual teaching, career exploration, emergency medicine

Shibandri Das,1 Christian Mehregan,1 Collin Richards,2 Michael Schneider,1 Kim Le,3 Xihui Lin1 1Kresge Eye Institute Department of Ophthalmology, Visual and Anatomic Sciences, Wayne State University School of Medicine, Detroit, MI, USA; 2Wayne State University School of Medicine, Detroit, MI, USA; 3Department of Ophthalmology, Henry Ford Hospital, Detroit, MI, USACorrespondence: Xihui Lin, Kresge Eye Institute, Department of Ophthalmology, Visual and Anatomic Sciences, Wayne State University School of Medicine, Detroit, MI, USA, Tel +1 314-359-2691, Fax +1 313 577-9675, Email xihui.lin@wayne.eduPurpose: To evaluate surgeon performance and intraoperative complication rates of cataract surgery after resumption of elective surgeries following the operating room (OR) shutdown from the coronavirus disease 2019 (COVID-19) pandemic. Subjective surgical experience is also evaluated.Methods: This is a retrospective comparative study which analyzes cataract surgeries performed at an inner city, tertiary academic center. Cataract surgeries were categorized into Pre-Shutdown (January 1–March 18, 2020), and Post-Shutdown, for all cases which occurred after surgeries resumed (May 11–July 31, 2020). No cases were performed between March 19 and May 10, 2020. Patients undergoing combined cataract and minimally invasive glaucoma surgery (MIGS) were included, but MIGS complications were not counted as cataract complications. No other combined cataract-other ophthalmic surgeries were included. A survey was used to gather subjective surgeon experience.Results: A total of 480 cases (n=306 Pre-Shutdown and n=174 Post-Shutdown) were analyzed. Although there was a higher frequency of complex cataract surgeries performed Post-Shutdown (5.2% vs 21.3%; p< 0.00001), complication rates before versus after the shutdown were not statistically significant (9.2% vs 10.3%; p=0.75). Phacoemulsification was the step of cataract surgery in which residents were most concerned about when returning to the OR.Conclusion: After the surgical hiatus due to COVID-19, significantly more complex cataract surgeries were reported and surgeons reported higher general anxiety level when first returning to the OR. Increased anxiety did not lead to higher surgical complications. This study provides a framework to understand surgical expectations and outcomes for patients whose surgeons faced a prolonged two-month hiatus from cataract surgery.Keywords: cataract surgery, cataract surgery complication rate, COVID-19 pandemic, simulation training in residency, cataract surgery training, lapse in cataract surgery training