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Abstract Introduction Fremanezumab, a humanized monoclonal antibody targeting calcitonin gene-related peptide, is indicated for preventive treatment of migraine in adults. Real-world evidence assessing the effect of fremanezumab on migraine-related medication use, health care resource utilization (HCRU), and costs in patient populations with comorbidities, acute medication overuse (AMO), and/or unsatisfactory prior migraine preventive response (UPMPR) is needed. Methods Data for this US, retrospective claims analysis were obtained from the Merative® MarketScan® Commercial and supplemental databases. Eligible adults with migraine initiated fremanezumab between 1 September 2018 and 30 June 2019 (date of earliest fremanezumab claim is the index date), had ≥ 12 months of continuous enrollment prior to initiation (preindex period) and ≥ 6 months of data following initiation (postindex period; variable follow-up after 6 months), and had certain preindex migraine comorbidities (depression, anxiety, and cardiovascular disease), potential AMO, or UPMPR. Changes in migraine-related concomitant acute and preventive medication use, HCRU, and costs were assessed pre- versus postindex. Results In total, 3193 patients met the eligibility criteria. From pre- to postindex, mean (SD) per patient per month (PPPM) number of migraine-related acute medication and preventive medication claims (excluding fremanezumab), respectively, decreased from 0.97 (0.90) to 0.86 (0.87) (P

Objectives This study aimed (1) to examine the association between patient engagement with a bidirectional, semiautomated postdischarge texting programme and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey outcomes, readmissions and revisit rates in a large health system and (2) to describe operational and clinical flow considerations for implementing a postdischarge texting programme.Setting The study involved 1 main academic hospital (beds: 2500+) and 6 community hospitals (beds: 190–400, averaging 300 beds per hospital) in Houston, Texas.Methods Retrospective, observational cohort study between non-engaged patients (responded with 0–2 incoming text messages) and engaged patients (responded with 3+ incoming, patient-initiated text messages) between December 2022 and May 2023. We used the two-tailed t-test for continuous variables and χ2 test for categorical variables to compare the baseline characteristics between the two cohorts. For the binary outcomes, such as the revisit (1=yes, vs 0=no) and readmissions (1=yes vs 0=no), we constructed mixed effect logistic regression models with the random effects to account for repeated measurements from the hospitals. For the continuous outcome, such as the case mix index (CMI), a generalised linear quantile mixed effect model was built. All tests for significance were two tailed, using an alpha level of 0.05, and 95% CIs were provided. Significance tests were performed to evaluate the CMI and readmissions and revisit rates.Results From 78 883 patients who were contacted over the course of this pilot implementation, 49 222 (62.4%) responded, with 39 442 (50%) responded with 3+ incoming text messages. The engaged cohort had higher HCAHPS scores in all domains compared with the non-engaged cohort. The engaged cohort used significantly fewer 30-day acute care resources, experiencing 29% fewer overall readmissions and 20% fewer revisit rates (23% less likely to revisit) and were 27% less likely to be readmitted. The results were statistically significant for all but two hospitals.Conclusions This study builds on the few postdischarge texting studies, and also builds on the patient engagement literature, finding that patient engagement with postdischarge texting can be associated with fewer acute care resources. To our knowledge, this is the only study that documented an association between a text-based postdischarge programme and HCAHPS scores, perhaps owing to the bidirectionality and ease with which patients could interact with nurses. Future research should explore the texting paradigms to evaluate their associated outcomes in a variety of postdischarge applications.

Abstract Background Fremanezumab, a fully humanized monoclonal antibody (mAb; IgG2Δa) that selectively targets calcitonin gene-related peptide (CGRP), is approved for the preventive treatment of migraine in adults. The efficacy and safety of fremanezumab for migraine prevention have been demonstrated in randomized, double-blind, placebo-controlled trials. Real-world effectiveness data are needed to complement clinical trial data. This study assessed the effectiveness of fremanezumab across different subgroups of adult patients with episodic migraine (EM), chronic migraine (CM), or difficult-to-treat (DTT) migraine in real-world clinical settings. Methods This retrospective, panel-based online chart review used electronic case report forms. Patient inclusion criteria were a physician diagnosis of EM or CM; age ≥ 18 years at the time of first fremanezumab initiation; ≥ 1 dose of fremanezumab treatment; ≥ 1 follow-up visit since first initiation; and ≥ 2 measurements of monthly migraine days (MMD; with 1 within a month before or at first initiation and ≥ 1 after first initiation). Changes in MMD and monthly headache days were assessed during the follow-up period. These endpoints were evaluated in subgroups of patients by migraine type (EM/CM) and in subgroups with DTT migraine (diagnosis of medication overuse [MO], major depressive disorder [MDD], generalized anxiety disorder [GAD], or prior exposure to a different CGRP pathway–targeted mAb [CGRP mAb]). Results Data were collected from 421 clinicians and 1003 patients. Mean (percent) reductions from baseline in MMD at Month 6 were − 7.7 (77.0%) in EM patients, − 10.1 (68.7%) in CM patients, − 10.8 (80.6%) in the MO subgroup, − 9.9 (68.3%) in the MDD subgroup, − 9.5 (66.4%) in the GAD subgroup, and − 9.0 (68.7%) in the prior CGRP mAb exposure subgroup. Improvements in MDD or GAD severity were reported by 45.5% and 45.8% of patients with comorbid MDD or GAD, respectively. Conclusions In this real-world study, fremanezumab demonstrated effectiveness for migraine regardless of migraine type or the presence of factors contributing to DTT migraine (MO, GAD, MDD, or prior exposure to a different CGRP mAb).

Abstract Background The efficacy and tolerability of fremanezumab, a fully humanized monoclonal antibody (IgG2Δa) that selectively targets calcitonin gene-related peptide (CGRP) and is approved for the preventive treatment of migraine in adults, have been demonstrated in randomized, double-blind, placebo-controlled trials. Real-world data can further support those clinical trial data and demonstrate the full clinical benefits of fremanezumab. This chart review assessed the effectiveness of fremanezumab for improving clinical outcomes in adult patients with migraine treated according to real-world clinical practice. Methods This retrospective, panel-based, online physician chart review study used electronic case report forms with US physicians. Patient inclusion criteria were a physician diagnosis of migraine, fremanezumab treatment initiation at ≥ 18 years of age after US Food and Drug Administration approval, ≥ 1 dose of fremanezumab treatment, and ≥ 2 assessments of monthly migraine days (MMD; 1 within 30 days before treatment initiation and ≥ 1 after initiation). Changes from baseline in MMD, monthly headache days (MHD), and Migraine Disability Assessment (MIDAS) and 6-item Headache Impact Test (HIT-6) scores were assessed over 6 months. These endpoints were evaluated in the overall population and subgroups divided by dosing schedule and number of prior migraine preventive treatment failures. Results This study included data from 421 clinicians and 1003 patients. Mean age at fremanezumab initiation was 39.7 years, and most patients were female (75.8%). In the overall population, mean baseline MMD and MHD were 12.7 and 14.0, respectively. Mean (percent) reductions from baseline in MMD and MHD, respectively, were − 4.6 (36.2%) and − 4.7 (33.6%) at Month 1, − 6.7 (52.8%) and − 6.8 (48.6%) at Month 3, and − 9.2 (72.4%) and − 9.8 (70.0%) at Month 6. Mean (percent) reductions from baseline in MIDAS and HIT-6 scores also increased over the 6-month study period, from − 6.2 (21.6%) and − 8.4 (14.0%) at Month 1 to − 18.1 (63.1%) and − 16.2 (27.0%) at Month 6, respectively. Improvements in these outcomes over 6 months were observed across all evaluated subgroups. Conclusions This real-world study demonstrated effectiveness of fremanezumab treatment for up to 6 months, irrespective of dosing regimen or number of prior migraine preventive treatment failures, reflecting ongoing, clinically meaningful improvements in patient outcomes.

Calcitonin gene-related peptide (CGRP) pathway-targeted treatments have been shown to be efficacious in the prevention of episodic and chronic migraine. Currently approved therapies include monoclonal antibodies (mAbs) that target CGRP (eptinezumab, fremanezumab, and galcanezumab) and the CGRP receptor (erenumab), and small molecule CGRP receptor antagonists (atogepant and rimegepant). While CGRP pathway–targeted treatments are generally well-tolerated, in a review article by Holzer and Holzer-Petsche published in the January 2022 issue of Frontiers in Physiology the authors discussed the role of the CGRP pathway in gastrointestinal physiology, with a specific focus on constipation associated with the use of CGRP pathway–targeted treatments. The authors state that real-world surveys have shown constipation to be a “major adverse event” reported in “more than 50% of patients treated with erenumab, fremanezumab or galcanezumab.” As described in the current commentary, the limited data from the cited references in the review article by Holzer and Holzer-Petsche do not support that statement.

OBJECTIVES:. To describe the prevalence, associated risk factors, and outcomes of serious neurologic manifestations (encephalopathy, stroke, seizure, and meningitis/encephalitis) among patients hospitalized with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. DESIGN:. Prospective observational study. SETTING:. One hundred seventy-nine hospitals in 24 countries within the Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study COVID-19 Registry. PATIENTS:. Hospitalized adults with laboratory-confirmed SARS-CoV-2 infection. INTERVENTIONS:. None. RESULTS:. Of 16,225 patients enrolled in the registry with hospital discharge status available, 2,092 (12.9%) developed serious neurologic manifestations including 1,656 (10.2%) with encephalopathy at admission, 331 (2.0%) with stroke, 243 (1.5%) with seizure, and 73 (0.5%) with meningitis/encephalitis at admission or during hospitalization. Patients with serious neurologic manifestations of COVID-19 were older with median (interquartile range) age 72 years (61.0–81.0 yr) versus 61 years (48.0–72.0 yr) and had higher prevalence of chronic medical conditions, including vascular risk factors. Adjusting for age, sex, and time since the onset of the pandemic, serious neurologic manifestations were associated with more severe disease (odds ratio [OR], 1.49; p < 0.001) as defined by the World Health Organization ordinal disease severity scale for COVID-19 infection. Patients with neurologic manifestations were more likely to be admitted to the ICU (OR, 1.45; p < 0.001) and require critical care interventions (extracorporeal membrane oxygenation: OR, 1.78; p = 0.009 and renal replacement therapy: OR, 1.99; p < 0.001). Hospital, ICU, and 28-day mortality for patients with neurologic manifestations was higher (OR, 1.51, 1.37, and 1.58; p < 0.001), and patients had fewer ICU-free, hospital-free, and ventilator-free days (estimated difference in days, –0.84, –1.34, and –0.84; p < 0.001). CONCLUSIONS:. Encephalopathy at admission is common in hospitalized patients with SARS-CoV-2 infection and is associated with worse outcomes. While serious neurologic manifestations including stroke, seizure, and meningitis/encephalitis were less common, all were associated with increased ICU support utilization, more severe disease, and worse outcomes.

Abstract Background Palliative care is recognised as a public health issue with the need for earlier integration in the wider healthcare system. However, research indicates that it continues to be accessed late in the course of an illness, public understanding of palliative care is limited, and common misconceptions prevail. Strategies to address this are needed in order to reduce barriers to palliative care delivery and improve access. Methods An explanatory sequential mixed methods study, comprising a cross-sectional survey and interviews was undertaken. Sociodemographic characteristics, public awareness, knowledge and perceptions of palliative care were examined and strategies to raise awareness and overcome barriers within a public health framework were identified. Survey data were analysed using SPSS v25 with factor analysis and non-parametric statistics and qualitative data were analysed using thematic analysis. Results A total of 1201 participants completed the survey (58.3% female, mean age 61 years) and 25 took part in interviews. A fifth of participants (20.1%) had previously heard about palliative care and had an accurate understanding of the term. Being female, higher educated, married, and older, increased respondents’ levels of awareness. The three most commonly held misconceptions included: Palliative care is exclusively for people who are in the last 6 months of life (55.4% answered incorrectly); A goal of palliative care is to address any psychological issues brought up by serious illness (42.2% answered incorrectly); and a goal of palliative care is to improve a person’s ability to participate in daily activities (39.6% answered incorrectly). Talking about palliative and end of life care was advocated but societal taboos restricted this occurring with exposure limited to personal experience. Conclusions Current knowledge gaps and misconceptions derived from limited ad hoc personal experiences and fear of engaging in taboo conversations may deter people from accessing integrated palliative care services early in a disease trajectory. The results indicate the need for public education programmes that move beyond merely raising awareness but provide key messages within a public health approach, which may change attitudes to palliative care thus ultimately improving end of life outcomes.

Migraine is a highly disabling and often chronic neurological disease that affects more than one billion people globally. Preventive migraine treatment is recommended for individuals who have frequent and/or disabling attacks; however, many of the medications used for migraine prevention (e.g., antiepileptics, antidepressants, antihypertensives) were not specifically developed for migraine, and often have limited efficacy or poor tolerability. Four monoclonal antibodies targeting the calcitonin gene-related peptide (CGRP) pathway, which is believed to play a crucial role in the pathophysiology of migraine, have been approved by the US Food and Drug Administration for the preventive treatment of migraine in adults. All four migraine-specific treatments have demonstrated efficacy based on reductions in monthly days with migraine for patients with both episodic and chronic migraine, including those with comorbidities. They have also demonstrated favorable safety and tolerability profiles. Based on these accounts, CGRP pathway-targeted monoclonal antibodies have the potential to revolutionize preventive treatment for patients with migraine.

The COVID-19 pandemic has highlighted aspects that require greater attention in residential buildings, especially in social housing developments. For example, thermal comfort and air renewal, play an important role in the environmental quality of housing and control of spreading pathogens, including coronavirus. The challenge is adequately providing these attributes in Brazilian social housing (SH) as naturally ventilated buildings where predominantly low-income families live. Considering it, a study was developed using computational simulation to evaluate the interaction between the indicators of thermal comfort (using the adaptive model) and air renewal (in air changes per hour - ACH) in a horizontal semi-detached typology of social housing provided by the Brazilian government program Minha Casa, Minha Vida, located in Uberlândia city, Minas Gerais state, Brazil. Ventilated roofs, variable window opening patterns, effective ventilation areas, and horizontal window shadings were the behavioral and physical interventions suggested to comparative analyses according to their performance to the indicators. The paper aims to present and discuss the main results obtained in terms of positive trends for the analyzed indicators’ performance and for the typology and location studied, seeking the achievement of better ventilated and thermally comfortable habitats. Additionally, a brief study on the most appropriate adaptive thermal comfort model for studies in the city of Uberlândia is presented, contributing to the future performance of more accurate thermal comfort analyses in SH, aiming at more assertive and resilient provision of guidances for renovations.

This paper deals with digital POE methods focusing on their reached potential in facilitating the face-to-face experiments demanded by the project. Recognized as a set of methods and instruments applied in environments during use, Post-Occupancy Evaluation (POE) can help manage the project process, providing diagnoses and recommendations that feed new projects and interventions in environments in use. POE approaches have been continually restructured in the face of new environmental, social, economic and especially technological demands. In early 2020, the Covid-19 pandemic, lockdowns and quarantines made it challenging to continue to apply traditional face-to-face POE-based tools and techniques. Simultaneously, the MORA Housing Research Group was carrying out a research project in the city of Uberlândia (Brazil) focusing on the understanding of the relationship between the incidence of arboviruses in the case study social housing neighbourhood, the occupants’ practices, and the built environment management, through POE. The social distancing measures applied during the Covid-19 pandemic led the research team to transform methods from face-to-face to hybrid ones, comprising digital and physical approaches to co-produce durable solutions against dengue. The work comprises a five stage method using on-shelf digital platforms and designing other 2 specifically for the project’s purposes. By introducing the digital/physical hybrid POE format, the use of social networks and messaging applications significantly reduced the number of necessary visits by researchers to the neighbourhood from 20 to 5 in the first stage of the work, saving a lot of time and effort. The new tools were easy to use for all users. Users reported finding it pleasant to participate in activities with digitally remote researchers. The findings from this project indicate that the incorporation of new digital tools to facilitate physical POE research as a novel hybrid approach provides a successful alternative approach to standard POE processes that are based on face-to-face participation.

Early events during axolotl limb regeneration include an immune response and the formation of a wound epithelium. These events are linked to a clearance of damaged tissue prior to blastema formation and regeneration of the missing structures. Here, we report the resorption of calcified skeletal tissue as an active, cell-driven, and highly regulated event. This process, carried out by osteoclasts, is essential for a successful integration of the newly formed skeleton. Indeed, the extent of resorption is directly correlated with the integration efficiency, and treatment with zoledronic acid resulted in osteoclast function inhibition and failed tissue integration. Moreover, we identified the wound epithelium as a regulator of skeletal resorption, likely releasing signals involved in recruitment/differentiation of osteoclasts. Finally, we reported a correlation between resorption and blastema formation, particularly, a coordination of resorption with cartilage condensation. In sum, our results identify resorption as a major event upon amputation, playing a critical role in the overall process of skeletal regeneration.

Brazilian social housing is used to address the country’s housing deficit through government programs with the massive production of standardised affordable housing. This non-systemic approach is shown to neglect residents’ changing needs over time and results in inflexible housing in relation to environmental, constructive, and social issues. The use of inappropriate spatial patterns fails to account for residents’ current socioeconomic and spatial realities. Quantitative/qualitative methods involving residents ('n' = 162) and two case studies are used to assess resilience in social housing. The costs and implications arising from a lack of housing adaptability are identified. An ‘impact assessment’ tool is employed to document the shocks and tensions experienced by residents along with the negative effects on the house and its occupants. These impacts increase the vulnerability of families and hinder their adaptive capacity. The identification of major impacts and residents’ perceptions can be used to establish priorities for action. 'Policy relevance' Post-occupancy evaluation (POE) processes provide a more systemic approach to identifying and resolving the problems of creating housing fit for purpose. An impact evaluation tool was developed to help with a positive transformation. This indicates how architects, urban planners, and communities can act to mitigate and solve the problems experienced by users of social housing. The use of systemic POE in social housing can inform policies and planning practices that address the needs of residents. It is also intended to provide design information to agents involved in the production of social housing in Brazil, notably designers and users, in order to foster effective strategies to promote more resilient housing, especially in scenarios of intervention and renovations during use. These tools and processes contribute to fulfilling Habitat III’s New Urban Agenda and the United Nations’ Sustainable Development Goals (SDGs 1, 10, and 11).

Habitações de interesse social (HIS) produzidas pelo Programa Minha Casa, Minha Vida (PMCMV) no Brasil têm apresentado reduzida resiliência. No escopo deste trabalho, a resiliência no ambiente construído é interpretada como a capacidade deste em resistir, adaptar-se e transformar-se para lidar com impactos e/ou mudanças impostos ao longo do tempo. Este trabalho deriva de pesquisa de mestrado que analisou a resiliência no ambiente construído de HIS, dando enfoque em dois de seus atributos propostos: conforto ambiental e adequação ambiental. Para isso, foram desenvolvidos procedimentos metodológicos de Avaliação Pós-Ocupação (APO) para observação desses atributos no estudo de caso nomeado Residencial Sucesso Brasil (Uberlândia, MG, Brasil). O artigo apresenta os resultados obtidos que caracterizaram baixo conforto ambiental no estudo de caso elencado. Considera-se que o conforto ambiental é uma qualidade que HIS devem perseguir visando a redução dos impactos derivados de sua operação, incidentes sobre a saúde dos moradores e relacionados ao consumo energético das envoltórias, visando, afinal, à promoção da saúde dos moradores e à otimização dos recursos nelas investidos. Como principal contribuição do trabalho, destaca-se a identificação de soluções projetuais que devem ser encorajadas nesses projetos de HIS a fim de amplificar seu conforto ambiental e, por conseguinte, sua resiliência. Com isso, a pesquisa desenvolvida alinha-se aos objetivos de agendas urbanas de relevância internacional, que colocam a resiliência como motor no combate à vulnerabilidade das grandes cidades.

Despite the central role of microorganisms in soil fertility, little understanding exists regarding the impact of management practices and soil microbial diversity on soil processes. Strong correlations among soil microbial composition, management practices, and microbially mediated processes have been previously shown. However, limited integration of the different parameters has hindered our understanding of agroecosystem functioning. Multivariate analyses of these systems allow simultaneous evaluation of the parameters and can lead to hypotheses on the microbial groups involved in specific nutrient transformations. In the present study, using a multivariate approach, we investigated the effect of microbial composition (16SrDNA sequencing) and soil properties in carbon mineralization (CMIN) (BIOLOG™, Hayward, CA, USA) across different management categories on coffee agroecosystems in Mexico. Results showed that (i) changes in soil physicochemical variables were related to management, not to region, (ii) microbial composition was associated with changes in management intensity, (iii) specific bacterial groups were associated with different management categories, and (iv) there was a broader utilization range of carbon sources in non-managed plots. The identification of specific bacterial groups, management practices, and soil parameters, and their correlation with the utilization range of carbon sources, presents the possibility to experimentally test hypotheses on the interplay of all these components and further our understanding of agroecosystem functioning and sustainable management.

Chile es un caso emblemático en la apertura de la educación superior al libre mercado y en la reformulación de las lógicas que regulan la producción científica en las universidades. Esto se traduce en un sistema de gestión del personal académico orientado por bonos de productividad asociados a las publicaciones de alto impacto, distribución de fondos de investigación condicionados a la productividad de investigadores y jerarquización de las tareas académicas. En este artículo presentamos los resultados de un estudio que buscó explorar y comprender cómo académicas y académicos de ciencias sociales, altamente productivas y productivos, describen la escritura científica desde la práctica laboral cotidiana enmarcada en nuevas regulaciones de la producción científica. A partir del análisis de 20 entrevistas, proponemos que hay facetas fundamentales para definir la escritura científica: la afectividad, la fragilidad y la estrategia. Éstas dan cuenta de aspectos cotidianos, así como de tensiones y conflictos presentes en el proceso de escritura científica

La falsificación de todo tipo de productos ha alcanzado grandes proporciones en el comercio mundial y se ha visto facilitada por la internacionalización de la economía y por los avances tecnológicos, así como por deficiencias en la legislación y el control en ciertos países. Este estudio aborda el fenómeno desde la perspectiva del consumidor ecuatoriano, investigandosus características, comportamiento de compra, percepciones y actitudes ante la falsificación. Para este fin, se utilizó una muestra de 522 individuos, distribuidos en las 5 ciudades más pobladas del país; el 61% de tales individuos reconoce haber adquirido falsificaciones duranteel año 2014. El estudio representa un aporte para conocer mejor al consumidor ecuatorianoy poder diseñar políticas dirigidas a reducir el consumo de falsificaciones en el país. CITACIÓN: Rodríguez Morales, K., Bonnard Feijoó, V., & Carranza Rodríguez, K. (2016). El comportamiento del consumidor frente a los productos falsificados en el Ecuador. Podium, 29, 79–92. doi:10.31095/podium.2016.29.5 ENLACE DOI: https://doi.org/10.31095/podium.2016.29.5

Ancestral Coast Salish societies in the Pacific Northwest kept long-haired "woolly dogs" that were bred and cared for over millennia. However, the dog wool-weaving tradition declined during the 19th century, and the population was lost. In this study, we analyzed genomic and isotopic data from a preserved woolly dog pelt from "Mutton," collected in 1859. Mutton is the only known example of an Indigenous North American dog with dominant precolonial ancestry postdating the onset of settler colonialism. We identified candidate genetic variants potentially linked with their distinct woolly phenotype. We integrated these data with interviews from Coast Salish Elders, Knowledge Keepers, and weavers about shared traditional knowledge and memories surrounding woolly dogs, their importance within Coast Salish societies, and how colonial policies led directly to their disappearance.