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Anita H Sung,1 Stephan Martin,2 Bryant Phan,1 Michael Benigno,1 Jennifer Stephens,2 Richard Chambers,1 Jalal A Aram1 1Pfizer Inc, New York, NY, USA; 2OPEN Health, Bethesda, MD, USACorrespondence: Anita H SungPfizer, 235 E 42nd St, New York, NY, 10017, USATel +1 212 733-2323Email anita.sung@pfizer.comIntroduction: Diagnosis and treatment of invasive mold infections (IMI) can be challenging and IMI is a significant source of morbidity and mortality. Invasive aspergillosis (IA) and invasive mucormycosis (IM) are two of the most common mold infections. A better understanding of patient comorbidities and risk factors that predispose IMI may help clinicians to refine the difficult diagnostic and treatment process.Methods: A systematic literature review (SLR) was conducted (January 2008–October 2019) for studies reporting comorbidities/risk factors of patients with IA or IM (Phase I), followed by an analysis on the Optum® US EHR database of prominent risk factor cohorts based on SLR findings and expert opinion (Phase II). From the four identified patient cohorts: 1) patients undergoing solid organ transplant (SOT) and patients with 2) hematologic cancers, 3) diabetes, or 4) lung disease, rates of IA, IM, or concurrent IA and IM; patient comorbidities; and Charlson Comorbidity Index (CCI) scores were reported.Results: The SLR included 88 studies, and 46 were used to select comorbidities/risk factors cohorts in IA and IM patients. The most important comorbidities/risk factors in IA and IM patients were diabetes, lung disease, hematological malignances, and SOT. In the Optum database (N=101,340,454 patients), IA rates were highest in lung transplant (10.81%) patients and IM rates were highest in intestine transplant (0.83%) patients, lung transplant (0.43%), and hematopoietic stem cell transplant (0.49%). CCI scores were elevated in all mold infection groups compared to the total Optum cohort.Conclusion: The current study describes patient comorbidity and risk factors associated with IA and IM. These data can be used to refine clinical decision-making regarding when to suspect mold infections. Future research should focus on identifying whether patients respond differently to various antifungal treatments to determine if strategic recommendations should be made for certain patient groups.Keywords: invasive mold infections, systematic literature review, retrospective claims data, invasive aspergillosis, invasive mucormycosis

Viktor V Chirikov,1 Chris Walker,2 Jennifer M Stephens,1 Patricia Schepman,3 Richard Chambers,4 Mahmoud Bakir,5 Gregory W Poorman,1 Seema Haider,6 Mohammed Farghaly7 1OPEN Health, Bethesda, MD, USA; 2Global Medical Affairs, Viatris, Tadworth, UK; 3Global Health Economics and Outcomes Research, Pfizer Inc, New York, NY, USA; 4Biostatistics, Pfizer Inc, Collegeville, PA, USA; 5Upjohn Export B.V., Jeddah, Saudi Arabia; 6Pfizer Inc., Groton, CT, USA; 7Dubai Medical College, Dubai, United Arab EmiratesCorrespondence: Jennifer M StephensOPEN Health, Bethesda, MD, USATel +1 703 625 5943Email jstephens@pharmerit.comObjective: Data on osteoarthritis patients from the PRECISION trial were used to evaluate the cost-effectiveness of celecoxib (100 mg twice daily) versus ibuprofen (600– 800 mg three times daily) and naproxen (375– 500 mg twice daily). The perspective was that of the United Arab Emirates (UAE) healthcare system.Methods: Discrete-state Markov model with monthly cycles, 30-month horizon, and 3% discount rate was constructed to assess incremental costs per quality adjusted life year (QALYs) gained from reduced incidence of three safety domains examined in PRECISION: renal, serious gastrointestinal (GI), and major adverse cardiovascular events (MACE). Costs for managing these toxicities were derived from Dubai Administrative Billing Claims (2018). Median monthly drug costs were derived from UAE Ministry of Health and Prevention’s published prices ($26.98 celecoxib; $20.25 ibuprofen; $20.50 naproxen). Health utility and excess mortality associated with toxicities were sourced from the literature. The willingness-to-pay thresholds used were 1 and 3 GDP per capita ($40,000–$120,000).Results: The total average cost per patient was $812.88 for celecoxib, $775.26 for ibuprofen, and $731.17 for naproxen while cost components attributed to toxicities were lowest with celecoxib ($360.26, $438.31, and $388.60, respectively). Patients on celecoxib had more QALYs (1.339), compared with ibuprofen (1.335) and naproxen (1.337), resulting in an incremental cost-effectiveness ratio of $11,502/QALY gained for celecoxib versus ibuprofen and $39,779 for celecoxib versus naproxen. Probabilistic sensitivity analyses demonstrated celecoxib to be 81% cost-effective versus ibuprofen and 50% versus naproxen at $40,000/QALY. The most influential model parameters were MACE relative safety and drug costs.Conclusion: From UAE third payer perspective, celecoxib is a long-term cost-effective treatment for osteoarthritis patients when compared with ibuprofen, and equally likely as naproxen to be cost-effective. With the expected increasing burden of chronic diseases in the Gulf region, study findings can inform decisions regarding the cost-effective pain management of osteoarthritis in UAE.Clinicaltrials.gov Registration Number: NCT00346216.Keywords: Markov, NSAIDs, comparative effectiveness, safety, Gulf region, AfME, MENA

Understanding an urban forest’s structure, function, and value can promote management decisions that will improve environmental quality and human health. Using i-Tree Eco software and its sampling and data collection protocol, an assessment of the baseline condition, ecological function, and value of the urban forests in Scotlandville (Louisiana, USA) was conducted during 2014. A stratified (by land use type) random sample plot map of the town was generated. Data from 170 field plots located throughout Scotlandville were collected, including tree species, diameter at breast height, total tree height, height to live top, height to crown base, crown width, crown dieback, crown light exposure, percent impervious surface under the tree, and direction and distance to building. Data were then entered into i-Tree Eco v5.0 and analyzed. Modeling results indicated that there are a total of 31 species and an estimated 239.000 trees in Scotlandville with a tree canopy cover of 23.7 percent; the three most common species are Black willow (Salix nigra), Water oak (Quercus nigra), and American elm (Ulmus americana); the overall tree density is 77 trees per hectare and trees with diameters of more than 15 cm (6 inches) constitute 56.5% of the population. The model estimated that annually, the urban forests in Scotlandville remove 96 tons of air pollutants; gross sequestration is about 3.880 tons of carbon and net carbon sequestration is about 3.650 tons. Each year, trees in Scotlandville are estimated to store 88.700 tons of carbon, produce 9.720 tons of oxygen, reduce runoff by 121.200 m3, reduce energy-related costs by $324.000 USD, and provide an additional $52.595 in value by reducing the amount of carbon released by power plants (a reduction of 739 tons of carbon emissions). The structural value for Scotlandville community forest is estimated at $185 million and the annual ecological functional value is estimated at 9 million USD. These results provide baseline information for management recommendations to maximize the ecological benefits provided by trees.

Ashraf El Houfi,1 Nadeem Javed,2 Caitlyn T Solem,3 Cynthia Macahilig,4 Jennifer M Stephens,3 Nirvana Raghubir,5 Richard Chambers,6 Jim Z Li,7 Seema Haider81Dubai Hospital, Dubai, UAE; 2Rashid Hospital, Dubai, UAE; 3Pharmerit International, Bethesda, MD, USA; 4Medical Data Analytics, Parsippany, NJ, USA; 5Pfizer, New York, NY, USA; 6Pfizer, Collegeville, PA, USA; 7Pfizer, La Jolla, CA, USA; 8Pfizer, Groton, CT, USAObjectives: To describe real-world treatment patterns and health care resource use and to estimate opportunities for early-switch (ES) from intravenous (IV) to oral (PO) antibiotics and early-discharge (ED) for patients hospitalized in the United Arab Emirates (UAE) with methicillin-resistant Staphylococcus aureus (MRSA) complicated skin and soft tissue infections.Methods: This retrospective observational medical chart review study enrolled physicians from four UAE sites to collect data for 24 patients with documented MRSA complicated skin and soft tissue infections, hospitalized between July 2010 and June 2011, and discharged alive by July 2011. Data include clinical characteristics and outcomes, hospital length of stay (LOS), MRSA-targeted IV and PO antibiotic use, and ES and ED eligibility using literature-based and expert-validated criteria.Results: Five included patients (20.8%) were switched from IV to PO antibiotics while being inpatients. Actual length of MRSA-active treatment was 10.8±7.0 days, with 9.8±6.6 days of IV therapy. Patients were hospitalized for a mean 13.9±9.3 days. The most frequent initial MRSA-active therapies used were vancomycin (37.5%), linezolid (16.7%), and clindamycin (16.7%). Eight patients were discharged with MRSA-active antibiotics, with linezolid prescribed most frequently (n=3; 37.5%). Fifteen patients (62.5%) met ES criteria and potentially could have discontinued IV therapy 8.3±6.0 days sooner, and eight (33.3%) met ED criteria and potentially could have been discharged 10.9±5.8 days earlier.Conclusion: While approximately one-fifth of patients were switched from IV to PO antibiotics in the UAE, there were clear opportunities for further optimization of health care resource use. Over half of UAE patients hospitalized for MRSA complicated skin and soft tissue infections could be eligible for ES, with one-third eligible for ED opportunities, resulting in substantial potential for reductions in IV days and bed days.Keywords: IV-to-PO switch, length of stay, clinical criteria, antibiotic therapy, economics

Introduction: Student wellbeing is a growing concern for physiotherapy and other health professional students, with potential impacts on academic success, patient care and future personal wellbeing. The purpose of this study was to determine the predictors of future stress, anxiety, depression, study engagement and academic performance in physiotherapy students, including a subgroup who undertook a mindfulness training program. Methods: Predictors of outcome were obtained from a prospective cohort study involving 83 penultimate-year physiotherapy students, who could volunteer to participate in a 6-week mindfulness training program during semester (n = 17) or complete outcome measures without mindfulness training (n = 66). Baseline predictors of outcome were obtained at the start of Semester 1: age, gender, trait mindfulness, study engagement, training (mindfulness training or no training), stress, anxiety and depression. Outcomes were measured at the end of Semester 1 (study engagement, stress, anxiety, depression, grade point average) and at the end of the course (grade point average). Multiple regression was used to determine the ability of baseline characteristics to predict outcomes. Results: Psychological distress (stress, anxiety and depression) increased across the full study cohort between the start and end of the semester as exams approached (p < .05). Completion of mindfulness training was significantly associated with better academic performance and lower levels of depression at follow-up. Female gender, lower baseline depression scores and higher study engagement were also significant predictors of superior academic performance, while older age and higher trait mindfulness predicted greater study engagement at end of semester (p < .05). Conclusions: Potentially modifiable factors (study engagement, depression and mindfulness training) were associated with future wellbeing and academic success in physiotherapy students. Further research is warranted to explore interventions to address these outcomes in randomised controlled trials. [ABSTRACT FROM AUTHOR]