The impact of hospital rurality and weekend admission on outcomes in decompensated cirrhosis remains unclear. Studies suggest mixed effects of weekend admission on mortality and increased mortality in rural hospital admissions for decompensated cirrhosis. This study evaluated the influence of hospital rurality, weekend admission, and their interaction on outcomes in decompensated cirrhosis from 2016 to 2020. A cross-sectional analysis of the National Inpatient Sample (NIS) assessed in-hospital mortality (primary outcome), likelihood of specific procedures (esophagogastroduodenoscopy, paracentesis, TIPS, hemodialysis), and time to first procedure. Regression models adjusted for demographics, liver disease etiology, clinical severity (APR-DRG mortality risk), and other factors. Among 11,845,223 hospitalizations, rural hospitalizations were linked to lower in-hospital mortality (OR: 0.84; 95% CI: 0.80-0.86) and higher transfer rates for severe cases (7.2% vs. 2.8%, p < 0.001). Weekend admissions showed a statistically significant but only modest reduction in mortality odds (OR: 0.99; 95% CI: 0.975-0.998). No significant interaction existed between rurality and weekend admission regarding mortality. Rural hospitals showed lower odds of performing procedures (95% CIs < 1), though time to procedure was comparable, except for earlier hemodialysis (-1.35 days; 95% CI: -2.59 to -0.11). Weekend admissions did not significantly impact procedure rates, except for paracentesis (OR: 0.94; 95% CI: 0.88-0.99). Using a national cohort of hospitalized patients with decompensated cirrhosis, we showed that rural hospitals exhibited lower in-hospital mortality, fewer procedures, and higher transfer rates, and that weekend admissions showed only a minimal, clinically insignificant reduction in mortality, irrespective of hospital rurality.
Purpose This quality improvement project assessed the feasibility, safety, and patient acceptability of a student-assisted weekend robotics program in an inpatient rehabilitation facility (IRF), with an exploratory analysis of functional outcomes. Occupational therapists in an inpatient rehabilitation unit created and assessed a sustainable weekend robotics program for patients. Materials and methods The inaugural weekend program was developed using a quality improvement framework, the Plan-Do-Study-Act (PDSA) method, which aligns with the knowledge translation framework. A small, random sample of patient data was assessed to determine the efficacy of the program and the utility of the measurements for future cycles. Results Over 12 weeks, 55 patients received 120 weekend robotic sessions and showed improved shoulder flexion and high satisfaction (98% positive). Patient diagnoses included neurologic, pulmonary, and orthopedic conditions. Detailed errors in the data were identified, and these supported the quality improvement cycle as researchers learned from the issues identified. Conclusion The successes of the program included its sustainability and approval for further PDSA cycles, suggesting that weekend robotics can enhance therapy dosage and patient engagement. The failures involved methodology issues with measurements, data collection and consistency, and student and therapist training.
Temporal shifts in travel demand and activity patterns between weekdays and weekends substantially alter pedestrian exposure and crash occurrence mechanisms, implying that the contributing factors differ accordingly. In addition, although nonlinear effects and spatial heterogeneity have been widely investigated, context-dependent interactions among multiple factors in pedestrian crashes remain insufficiently understood. Ignoring such interdependencies may obscure the influence of certain factors under specific conditions and challenge the effectiveness of policies. Therefore, this study investigates the weekday-weekend variations in factors affecting pedestrian crash density by jointly accounting for nonlinear threshold effects, context-dependent effects, and spatial heterogeneity. Four years of pedestrian-vehicle crash data (2021-2024) from Mecklenburg County, North Carolina, were collected and aggregated at the census tract level, with crashes stratified into weekday and weekend periods. Then, a geospatial explainable machine learning framework integrating an XGBoost-Tweedie model tailored for zero-inflated crash data with two explainable artificial intelligence approaches, SHAP and GeoShapley, was applied to uncover these complex effects. Model comparison results indicate that the XGBoost-Tweedie model outperforms both the traditional and geographical versions of Random Forest, XGBoost, and LightGBM. Results further reveal that infrastructure characteristics play a dominant role in pedestrian crashes during both weekdays and weekends. However, spatial inequities reflected by sociodemographic characteristics (e.g., Black ratio and poverty ratio) exert stronger influences on weekend crashes. Moreover, the effects of these factors exhibit pronounced variations across different thresholds, spatial locations, and contextual settings. These findings provide critical insights for developing period-specific, location-specific, and context-specific countermeasures to enhance pedestrian safety.
BackgroundIt has long been proposed that some individuals with migraine are especially prone to experience headache on weekends, however, results have been contradictory. Electronic headache diaries offer the possibility to analyze this question more thoroughly in larger populations.MethodsTwo non-overlapping samples of individuals with migraine from the DMKG-App electronic headache diary were investigated. Cluster analysis and logistic regression were performed to study existence, prevalence and predictive factors of weekend headache.ResultsWe included 1793 and 5840 patients with ≥35 headache day entries in the two samples ("registry sample" and "app-only sample"), respectively. In both samples, cluster analysis identified a cluster of patients with headache occurring preferably on weekends, accounting for 14-15% of all patients, and 18% of individuals with episodic migraine. Compared to the three other clusters identified (an early week cluster, a midweek cluster and a flat cluster without preference for a specific day), the weekend cluster was more frequent in working patients (p < 0.001, OR = 3.57 to 3.97) and in patients with lower headache frequencies (p < 0.001, OR = 0.86). A small association with older age (p < 0.001, OR = 1.01) was limited to the app-only sample. Longitudinal analysis showed that headache patterns of single patients were variable over time.ConclusionsResults from two large samples corroborate that there is a subgroup of individuals with migraine prone to weekend headache. Association with working status supports the notion that release from stress could be a trigger factor in these patients, although change in sleep, caffeine and alcohol intake and other factors might also contribute.
Physical activity (PA) is crucial for maintaining bone mass. However, it remains unclear whether the "weekend warrior" (WW) pattern, namely condensing moderate-to-vigorous physical activity (MVPA) into 1 or 2 days per week, is beneficial for bone health. This study aimed to assess the association between the WW pattern and risk of low bone mass and related fractures. We conducted a population-based study based on two nationwide databases, including 6972 participants aged 20-59 from the National Health and Nutrition Examination Survey (NHANES), 2007-2010 & 2013-2014 cycles, in which PA was self-reported via the Global Physical Activity Questionnaire; and 52,989 participants aged 37-60 years from UK Biobank (UKB), in which PA was measured by wrist-worn accelerometers over 7 days (2013-2015). In both surveys, lumbar spine and femoral neck bone mineral density (BMD) were assessed by dual-energy X-ray absorptiometry (DXA). Associations were analyzed using survey-weighted linear regression (in NHANES), multivariable linear regression (in UKB), and Cox proportional hazards models for incident fracture (in UKB). In NHANES, both the WW pattern and the regular active (RA) pattern were associated with higher femoral neck BMD compared with the inactive group (WW: β = 0.021, 95% CI 0.008-0.035, P = 0.004; RA: β = 0.015, 95% CI 0.007-0.023, P = 0.001), and both were associated with significantly lower odds of low bone mass. In UKB, similar favorable BMD associations were observed, and the WW pattern was associated with a lower hazard of incident fracture compared with both the inactive group (HR = 0.899, 95% CI 0.824-0.981, P = 0.017) and the RA group (HR = 0.897, 95% CI 0.823-0.976, P = 0.012). Meeting weekly PA guidelines is associated with favorable bone health indicators and lower fracture risk, regardless of whether activity is concentrated on weekends or distributed throughout the week. The WW pattern may serve as a time-efficient alternative for bone health maintenance.
Although weekend warrior (WW) physical activity may confer health benefits comparable with more evenly distributed activity, whether this pattern is associated with venous thromboembolism (VTE) incidence and death remains unclear. This study aimed to investigate the associations of accelerometer-derived physical activity patterns with incident VTE and all-cause death in individuals with prevalent VTE. In this prospective cohort study, we analyzed 92 392 participants free of VTE for incidence analysis and 3019 participants with prevalent VTE for mortality analysis. Physical activity was measured using wrist-worn accelerometers. Participants were classified as inactive (<150 min/wk of moderate-to-vigorous physical activity [MVPA]), regularly active (≥150 min/wk of MVPA with <50% of total MVPA accumulated over 1-2 days), or WW (≥150 min/wk of MVPA with ≥50% of total MVPA accumulated over 1-2 days). The primary outcome was incident VTE, analyzed using Cox models. Over a median follow-up of 11.1 years, 1955 incident VTE cases were recorded. In comparison with the inactive group, the WW pattern lowered the risk of incident VTE (hazard ratio [HR], 0.813 [95% CI, 0.733-0.902]) and reduced all-cause death among those with preexisting VTE (HR, 0.567 [95% CI, 0.438-0.734]). When compared with the regularly active group, the inactive group showed an increased risk, whereas the WW pattern showed no statistically significant difference. Our findings indicate that the WW pattern was associated with lower risks of incident VTE and all-cause death, with associations comparable with those observed for activity distributed more evenly across the week, suggesting that it may be a practical strategy for VTE prevention and management.
The association between weekend catch-up sleep (WCS) and the prevalence of metabolic syndrome (MetS) remains controversial. This study aimed to investigate the association between WCS and MetS. This cross-sectional study was performed on individuals (n = 7658) based on the National Health and Nutrition Examination Survey from 2017 to 2020. Five categories of WCS were calculated: decreased (WCS < 0 hours), no change (WCS = 0 hours), short WCS (0 hours < WCS ≤ 1 hour), moderate WCS (1 hour < WCS < 2 hours), and long WCS (WCS ≥ 2 hours). Multivariate logistic regression models were used to evaluate the association between WCS and MetS, as well as its components. The analysis was further refined by integrating a restricted cubic spline, and subgroup and sensitivity analyses were then performed. The study found that moderate (1-<2 hours; odds ratio [OR] = 0.72, 95% confidence interval [CI]: 0.53-0.98) and long (≥2 hours; OR = 0.71, 95% CI: 0.52-0.98) weekly sleep durations were associated with lower odds of MetS. This association appeared to be primarily driven by a robust association with hypertension (moderate WCS: OR = 0.64, 95% CI: 0.46-0.89; long WCS: OR = 0.60, 95% CI: 0.43-0.83). In exploratory subgroup analyses, associations were observed for males, Mexican Americans, individuals who slept 6 to 9 hours/night during the weekday, and those who were sedentary for 8 hours/day; however, interaction tests were not statistically significant for most subgroups, and these findings require further validation. Sensitivity analyses confirmed the stability of the association between moderate/long WCS and lower odds of MetS. The restricted cubic spline model indicated a nonlinear relationship between WCS and MetS. Moderate to long WCS was associated with lower odds of hypertension and MetS in this cross-sectional analysis. Additional prospective studies are required to verify these findings and elucidate the underlying mechanisms.
To examine associations between accelerometer-derived "weekend warrior" (WW) physical activity pattern (most moderate-to-vigorous-intensity physical activity in 1-2 days) versus moderate-to-vigorous-intensity physical activity spread more evenly with risks of incident first cardiometabolic disease (FCMD) and cardiometabolic multimorbidity (CMM) among hypertension participants. UK Biobank participants with hypertension (n=26891) provided a full-week of accelerometer-derived physical activity data between 2013 and 2015, processed using GGIR and a machine-learning classifier. CMM was defined as the occurrence of at least 2 of type 2 diabetes, ischemic heart disease, and stroke. Three activity patterns (WW, regular, and inactive) were compared across multiple thresholds and definitions of active WW, with significance corrected for multiple comparisons at a false discovery rate of 0.05. Over 7.5 years median follow-up, 2718 individuals developed FCMD and 219 developed CMM. Using the definition of WW as guideline-based and ≥50% of total moderate-to-vigorous-intensity physical activity over 1 to 2 days via GGIR, we observed similarly lower risks of incident FCMD (WW versus inactive: hazard ratio [HR], 0.75 [95% CI, 0.69-0.82], P=1.4 × 10-3; regular versus inactive: HR, 0.85 [95% CI, 0.74-0.96], P=2.6 × 10-2) and CMM (WW versus inactive: HR, 0.59 [95% CI, 0.41-0.83], P=4.0 × 10-3). Both active WW and regular physical activity patterns were associated with lower risk of FCMD compared with inactivity, with no statistically significant differences between the 2 active patterns. However, the result of WW versus inactive for CMM showed no statistical significance. Increased activity, even when concentrated within 1 to 2 days/week may reduce cardiometabolic disease risk in individuals with hypertension.
The aim of this study was to analyze current trends in screen exposure and to provide a deeper understanding of the relationships between temperament, screen exposure, and psychological adjustment in preschoolers. The study was conducted in kindergartens and one health center in the city of Zagreb, using a convenience sample of 115 mothers who assessed their preschool children's screen exposure, temperament, and psychological adjustment. Descriptive data analysis indicated that children's screen time generally fell within the American Academy of Child and Adolescent Psychiatry's recommended guidelines. Correlation analysis indicated that externalizing problems were significantly positively correlated with impulsivity, activity, emotionality, and weekend screen time. Conversely, prosocial behavior was negatively correlated with impulsivity and weekend screen exposure. Moderation analyses revealed that weekend screen time significantly altered the associations between temperament and externalizing problems. Specifically, longer weekend screen exposure weakened the relationships between Impulsivity and externalizing problem and between Activity and externalizing problems, suggesting that screen time may buffer the impact of high-risk temperament profiles on behavioral difficulties. Weekend screen time did not moderate the relationship between Emotionality and externalizing problems. Similarly, longer screen exposure weakened the negative association between Impulsivity and prosocial behavior, indicating that screen time may reduce the extent to which impulsive temperament undermines prosocial functioning in preschool children. These findings provide deeper insight into the role of temperament and screen time exposure in predicting both maladaptive and prosocial behaviors among preschool-aged children.
Eating jetlag (variation in eating times between weekdays and weekends) may increase obesity risk in adults, but studies in children are lacking. The potential moderating roles of social jetlag (SJL, variation in sleep timing between weekdays and weekends) and chronotype (an individual's intrinsic circadian rhythm) also remain unclear. We examined whether eating jetlag is associated with adiposity in Finnish preschoolers and whether chronotype or SJL moderate these associations. Data included 639 children (3-6 years, 48% girls) from the cross-sectional DAGIS study (2015-2016). Diet was assessed using 3-day food records. SJL and chronotype were assessed from hip-worn accelerometer data. Six eating jetlag indicators were derived as weekend-weekday differences: first/last eating occasion jetlag, eating/energy intake midpoint jetlag and morning/evening latency jetlag. Adiposity was measured by BMI z-score and waist-to-height ratio (WHtR). Linear regression with interaction terms was used, with significant interactions examined in moderator-stratified analyses. Eating jetlag indicators were not associated with adiposity in the full sample. However, interaction analyses indicated moderation by SJL. Among children with high SJL (median 62 min, IQR 17), greater eating midpoint jetlag was associated with lower BMI z-score (β: - 0.65, 95% CI: - 1.21 to - 0.10), whereas greater morning latency jetlag was associated with higher BMI z-score (0.83, 0.19 to 1.46) and WHtR (0.035, 0.013 to 0.058). No consistent interactions were observed for chronotype. Although no associations were observed between eating jetlag and adiposity in the full sample, associations varied by SJL. However, these findings require confirmation in longitudinal studies.
Cardiovascular (CV) prevention in young adults is pivotal due to escalating morbidity and mortality rates in this demographic. Assessing CV awareness and its socio-behavioural correlates is essential for developing effective prevention strategies. This study assessed CV awareness and lifestyle behaviours among Polish 18-year-olds, hypothesising that significant gender-specific disparities exist at the threshold of adulthood. A nationwide, representative survey was conducted over 10,000 students in final-year grades from 250 Polish secondary schools. Sampling employed a stratified cluster method. Data were weighted to ensure national representativeness. Awareness of CV risk factors and lifestyle behaviours (diet, physical activity, sleep, and substance use) were evaluated. Of 10,095 participants (6,076 females, 4,019 males), overweight and obesity were recorded at 17.0% and 4.1% in males, and 8.4% and 2.1% in females, respectively (p < 0.001). Only 14.6% of women and 14.3% of men knew their current blood pressure values (p = 0.48). Weekday screen time averaged 5.9 ± 2.7 hours, rising to 6.7 ± 2.8 hours on weekends, with significant gender differences on weekends (p = 0.009). Sleep duration was concerning, with 52.6% of women and 40.5% of men sleeping under seven hours on weekdays (p < 0.001), though 95% slept sufficiently on weekends. Awareness of sleep-related diabetes and obesity risks was minimal. Men had higher alcohol consumption, with 20.5% consuming 100g or more weekly, compared to 12.6% of women (p < 0.001). Smoking was prevalent, with 22.8% of women and 23.7% of men smoking daily. Exercise adherence varied, with only 61.0% of women and 76.7% of men meeting guidelines in summer, declining in winter (p < 0.001). Men generally consumed unhealthy foods more often. While most recognized common myocardial infarction risk factors, under 65% identified high cholesterol as a risk, with women generally performing better in awareness. Polish 18-year-olds exhibit distinct, gender-specific cardiovascular risk profiles. While females possess superior theoretical knowledge, they are more prone to physical inactivity and poor sleep hygiene. In contrast, males are primarily burdened by adverse dietary habits and substance use. These findings indicate that public health interventions should be gender-tailored: prioritising physical activity for young women and focusing on dietary improvements and addiction prevention for young men to effectively mitigate future cardiovascular risk.
To determine the point prevalence of PICU patients with siblings, and if they have siblings, whether they visited the PICU and their interactions. A single-site point prevalence study conducted in a specialist Australian PICU. Survey data were collected at eight time points over a 3-week period, from February 13, 2025, to March 4, 2025. Eight PPS time points included four weekdays and four weekend days. The survey was completed by bedside PICU nurses who collected information on patient characteristics, the existence of siblings, details related to sibling visits in the PICU, and any nursing staff concerns. Data were summarized using descriptive and inferential statistics. Associations between variables were investigated using chi-square and Mann-Whitney U tests. A 22-bed quaternary care PICU in Australia. All patients were admitted to the PICU at the point of data collection. None. The survey was completed for 159 of 163 patients (97.5%) admitted to the PICU on a prevalence study day. Overall, 100 of 159 patients (62.9%) had siblings. Only 28 of 100 patients (28%) had one or more siblings visit on a prevalence study day: eight sibling visits occurred on weekdays and 20 on weekends. A total of 32 siblings visited these 28 patients. Siblings of 1-4 years old visited more often than other age groups. We failed to identify an association between the occurrence of a sibling visit and distance from the hospital, patient length of stay, or intubation status. In this point prevalence study carried out on our PICU in Australia, in 2025, we found that around two-thirds of admissions had siblings. However, sibling visits were limited, primarily occurring on weekends. Our results will inform future planning of PICU family-centered care models with out-of-hours professional support.
The findings of previous works of literature on the effects of off-hours admission on in-hospital mortality in sub-Saharan Africa were inconsistent and inconclusive. However, there is paucity of information as single summarized finding. Therefore, this review aimed to determine the pooled effects of off-hours admission on the in-hospital mortality in sub-Saharan Africa. A systematic review and meta-analysis were conducted using studies from PubMed, MEDLINE, Cochrane Library, Web of Science, African Journals Online, and Google Scholar up to 30/12/2025. Study quality, heterogeneity and publication bias were assessed accordingly. Pooled estimates were estimated using a random-effects model. Subgroup and sensitivity analyses were performed. Odds ratios with 95% confidence intervals were used to quantify the association between off-hours admission and in-hospital mortality. This review included 14 primary studies. The pooled magnitude of off-hours in-hospital mortality among all hospital admissions in sub-Saharan Africa was 12.39% (95% CI: 9.76, 15.02%). The nighttime mortality among the nighttime admissions was 26.1% (95%CI: 18.6, 33.6%). Besides, the pooled weekend's in-hospital mortality among weekends' admissions in sub-Saharan Africa was 31.5% (95% CI: 23.5, 39.5%). The pooled effects of off-hours admission on in-hospital mortality was higher for weekend admission (OR = 1.22, 95% CI: 1.01, 1.47) and nighttime admission (OR = 2.36, 95% CI: 1.40, 4.00) compared with weekday admission. Off-hours admission may be associated with increased mortality; however, the findings should be interpreted cautiously due to substantial heterogeneity and variability in study definitions. The protocol was registered at PROSPERO with reg. no "CRD42024621339".
The newly diagnosed stage of type 2 diabetes mellitus (T2DM) represents a "critical window" for delaying disease progression through lifestyle intervention. Insufficient physical activity and sleep disorders are both known risk factors for metabolic disorders. However, evidence regarding the independent and combined effects of sleep patterns and physical activity on weekdays and weekends in newly diagnosed patients is currently lacking. This study employed a cross-sectional design and included 340 patients with newly diagnosed type 2 diabetes who had not received any hypoglycemic medical treatment previously. The average sleep duration on weekdays and weekends was collected through standardized sleep diaries, and the physical activity level was calculated in metabolic equivalents (METs) using the long-form International Physical Activity Questionnaire (IPAQ). Multivariate linear regression models and generalized additive models were performed to analyze the associations between sleep, physical activity, fasting blood glucose, and glycated hemoglobin. A combined grouping variable of sleep and physical activity was constructed to evaluate the potential interaction effects. We found that there was a statistically significant U-shaped association between sleep duration on weekdays and fasting blood glucose (p < 0.05), with the optimal point at around 6.92 hours. Physical activity could be a protective factor for glycemic control. Compared with the low-activity group, both moderate-intensity and high-intensity activities were significantly associated with lower fasting blood glucose (β = -2.76 and -3.22) and glycated hemoglobin (β = -1.50 and -2.01) levels, but there was no significant difference observed when comparing the moderate- and high-intensity activity groups. The interaction analysis of the groups shown that moderate to high-intensity physical activity may have promising glycemic control effects. On weekdays, "moderate sleep & high physical activity" (β = -3.57, p < 0.001) and on weekends, "long sleep & high physical activity" (β = -4.25, p < 0.001) respectively showed a potential notable glycemic control benefits. In newly diagnosed type 2 diabetes patients, maintaining a sleep duration of approximately 7 hours​ on workdays and engaging in at least moderate-intensity physical activity are associated with​ better early glycemic control. Moderate- to high-intensity physical activity is crucial and may partially offset the adverse glycemic effects of insufficient sleep.
Ischemic stroke is a leading cause of death and disability worldwide. Whether different weekly physical activity patterns confer similar protection remains unclear, and genetic susceptibility may further influence risk. We therefore examined the associations of physical activity pattern, polygenic risk, and their joint categories with incident ischemic stroke. In this prospective UK Biobank analysis, 84,006 participants with valid accelerometer data were classified by weekly moderate-to-vigorous physical activity (MVPA) pattern (inactive, active regular, or weekend warrior) and polygenic risk score (PRS) category (low, intermediate, or high). Cox models were used to estimate HRs and 95% CIs for incident ischemic stroke, including joint analyses across nine combined categories. At ≥150 min/week of MVPA, both weekend warrior and active regular patterns were associated with lower ischemic stroke risk than inactivity, with no statistically significant difference observed between the two active patterns. High, but not intermediate, polygenic risk was associated with increased risk (HR 1.83, 95% CI 1.35-2.47). In joint analyses, excess risk was evident only in inactive participants with intermediate or high genetic risk. Physical activity pattern and PRS were both associated with incident ischemic stroke. Meeting weekly MVPA recommendations, whether regularly or as a weekend warrior, was associated with lower risk, whereas higher genetic risk was associated with greater risk.
Children with life-limiting conditions often have complex care needs, and their caregivers require expert clinical support after-hours and over weekends to support care at home. This quality improvement initiative examined usage patterns and impact on caregiving of the nurse-led 24-Hour Clinical Care Line initiated in 2018 by the Canuck Place Children's Hospice, which provides inpatient and community-based pediatric palliative care and respite for children with life-limiting conditions in British Columbia and the Yukon in Canada. Phone call tracking logs and clinical profiles were analyzed to examine user demographics, temporal usage patterns, and reasons for calling. Families were asked to provide feedback on the service for quality improvement. From June 2020 to March 2024, 194 families placed 1106 calls. Mothers/foster mothers made 67% of the calls. Caregivers of children with central nervous system (CNS) and metabolic conditions made a significantly higher number of calls per child on average. Caregivers calling about children aged <1 year represented a disproportionately large group of callers. Parents of children >15 years made significantly fewer calls. The most common call reason was family support (73.1%), followed by providing an update on child status (58.5%), pain and symptom management (50.9%), and care planning (10.9%). Call volume peaked at bedtime and was consistent over nighttime hours and weekends. Late winter and spring were the most popular seasons for calls, following typical temporal influenza patterns.
The most common causes of early primary failures of a vascular access (VA) is related to small caliber vessels. Weight gain between dialyses expands both extracellular and blood volume, which may lead to rises in intravascular filling and vessels caliber. If patients presented after weekend, their weight and probably volemia would be higher. We hypothesized that preoperative volume status may influence vascular filling and vessels diameter with a significant impact on VA outcomes. A clinical, prospective, randomized, open-label, single-center within-patient physiological crossover evaluation trial. age 18-80 years, under regular hemodialysis (three per week) Exclusion criteria: >3 sessions/week, heart failure (HF), and acute pulmonary edema on the previous year. Before the last-week session, patient's clinical parameters were recorded. BIA and ultrasound vascular mapping were performed. After this first evaluation, dry weight was increased 0.5 kg, and after weekend, the same protocol was conducted. Primary end point was to compare vein diameters. One hundred twenty-six vessels were evaluated (84 veins and 42 arteries) from 21 patients. Mean age was 69 ± 10 years and 52% female. Other than humeral arterial blood flow, every parameters evaluated through ultrasound mapping significantly increased (p < 0.05), however, most patients had a mild-moderate OH (86%-90%). Patient-level paired analysis confirmed a significant increase in mean venous diameter after volume expansion (p = 0.002). No complications were reported. Preoperative volume status appears to be an underrecognized and potentially modifiable determinant of vascular access conditions. Mild preoperative volume expansion was associated with increased venous diameter, a surrogate for AVF feasibility and maturation. BIA and lung ultrasound may be future tools that combined to vascular ultrasound could be a safe and effective way to optimize and evaluate preoperative conditions to improve VA outcomes. Future multicenter prospective studies should assess whether preoperative volume optimization translates into improved AVF creation, maturation, and long-term patency outcomes.
Carbon monoxide (CO) and nitrogen dioxide (NO2) are combustion pollutants that disproportionately harm communities of color in US cities. While distributive inequalities are established, we have lacked observational constraints on variability in air pollution mixtures and the sources that drive exposure disparities. We present the first application of the TROPOspheric Monitoring Instrument (TROPOMI) to describe census tract-scale CO inequalities and population-weighted NO2/CO enhancement ratios (ΔXNO2/ΔXCO) in six major US urbanized areas (UAs). Because CO has a long atmospheric lifetime, we develop an approach to describing CO inequalities using column-averaged dry-air mole fractions normalized by the daily urban variation (XCOnorm). Annual daily mean inequalities in XCOnorm are significant in some UAs, e.g., Los Angeles, Phoenix, New York City, and Chicago, where they are 7-11% for Black, 7-15% for Latino, and 1-11% for Asian residents compared to non-Hispanic/Latino white residents; however, in Houston and Atlanta, inequalities in XCOnorm are near or indistinguishable from zero. We report direct satellite evidence of cumulative exposure burdens as CO and NO2 disparities are correlated across cities (r = 0.89). We compare inequalities on weekdays and weekends and with conditions that differently affect short- and long-lived, primary and secondary species, with evidence suggesting that CO inequalities are influenced not only by gasoline vehicles but also chemical production. TROPOMI ΔXNO2/ΔXCO indicate that combustion mixtures in primarily Black, Latino, and Asian neighborhoods are disproportionately influenced by heavy-duty diesel vehicles (HDDVs), even on weekends. To address exposure disparities, efforts should focus on differences in source composition not just magnitude. Spatial discrepancies between ΔXNO2/ΔXCO and the 2020 National Emissions Inventory (NEI20) suggest the NEI20, at least without downscaling, underpredicts the extent to which Black, Latino, and Asian neighborhoods are affected by high NO2/CO sources, e.g., HDDVs. Such errors in the NEI20 potentially direct attention and resources away from HDDV controls with environmental justice benefits.
Whether admission timing influences outcomes after surgery for acute Stanford type A aortic dissection (TAAD) remains uncertain. This study examined the association between off-hour admission and in-hospital mortality in a nationwide cohort, including seasonal, weekday, and time-of-day variation. All surgically or hybrid-treated TAAD cases were identified in the German Diagnosis Related Groups database from 2010 to 2023. Multilevel logistic regression was used to evaluate factors associated with in-hospital mortality, adjusting for age, sex, comorbidity burden (Elixhauser score), annual hospital volume, and temporal variables (season, weekday, and time of admission). Among 25,608 patients (median age 65 years; 62.4% male), overall in-hospital mortality was 19.0%. Mortality showed no seasonal variation after adjustment. In contrast, significant off-hour effects were observed. Weekend admissions were associated with greater mortality compared with Monday (Saturday: adjusted odds ratio [aOR], 1.20; 95% CI ,1.05-1.36; P = .006; Sunday: aOR, 1.25; 95% CI, 1.10-1.42; P < .001). Nighttime admissions (12:00 to 8:00 am) also had greater mortality than daytime admissions (aOR, 1.11; 95% CI, 1.01-1.22; P = .04). Greater annual hospital TAAD case volume was associated with reduced mortality (aOR, 0.93; 95% CI, 0.86-0.99; P = .038). Seasonal patterns are not related with outcomes, but weekend and nighttime admissions were independently associated with increased in-hospital mortality after TAAD repair, adding further population-level evidence to an ongoing debate. These findings support centralized 24/7 aortic emergency care, consistent team availability, and optimized regional transfer pathways to mitigate temporal disparities and improve survival.
Sleep-duration abnormality and depressive symptoms are both associated with cardiometabolic health, and they often co-exist. Current research has largely focused on the separate associations of abnormal sleep duration or depressive symptoms with cardiometabolic indicators, whereas fewer studies have examined their joint association and potential interaction across population subgroups. This study aimed to evaluate the co-occurrence of sleep-duration abnormality and depressive symptoms in relation to cardiometabolic indicators and to explore whether these associations differed by gender and age using NHANES 2013-2023 data. This study utilized publicly available data from the National Health and Nutrition Examination Survey (NHANES) 2013-2023. Adult participants with complete data on sleep-duration variables, depression assessment, and cardiometabolic indicators were included. Sleep exposure was operationalized using NHANES Sleep Questionnaire variables for usual weekday/workday sleep duration (SLD012) and weekend/non-workday sleep duration (SLD013). Sleep-duration abnormality was defined as short sleep duration (< 7 h) or long sleep duration (> 9 h) on either weekday/workday or weekend/non-workday measures. Depressive symptoms were evaluated using the Patient Health Questionnaire-9 (PHQ-9). Cardiometabolic indicators included systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI), total cholesterol, and high-sensitivity C-reactive protein (hs-CRP). Survey-weighted multivariable logistic regression was used to examine the associations between sleep-duration abnormality, depressive symptoms, and cardiometabolic indicators. The adjusted models included demographic, socioeconomic, lifestyle, and clinical covariates, including age, gender, race/ethnicity, education level, household income, smoking status, alcohol consumption, diabetes history, and BMI where appropriate. Multiplicative interaction was assessed by including a product term between sleep-duration abnormality and depressive symptoms in the regression models. For hypertension, additive interaction was further evaluated using the relative excess risk due to interaction (RERI) and the attributable proportion due to interaction (AP). Gender- and age-stratified analyses were also conducted. Participants with both sleep-duration abnormality and depressive symptoms had higher levels or prevalence of several adverse cardiometabolic indicators, including hypertension, obesity, and elevated hs-CRP, than those without either condition. For hypertension, the odds ratio associated with the co-occurrence of sleep-duration abnormality and depressive symptoms was 3.02 (95% CI: 2.56-3.56), compared with 1.48 (95% CI: 1.26-1.74) for sleep-duration abnormality alone and 1.62 (95% CI: 1.38-1.91) for depressive symptoms alone. Evidence of interaction for hypertension was observed on both the multiplicative scale (interaction P < 0.001) and additive scale (RERI = 1.21, 95% CI: 0.93-1.49; AP = 40.1%, 95% CI: 31.5-48.7%). Stratified analyses suggested that the additive interaction for hypertension was more apparent among women and older adults. The co-occurrence of sleep-duration abnormality and depressive symptoms was associated with less favorable cardiometabolic indicators in this cross-sectional NHANES analysis. Evidence of additive interaction was observed for hypertension, particularly among women and older adults. These findings support the need to consider abnormal sleep duration and depressive symptoms jointly when evaluating cardiometabolic health, while causal and mechanistic interpretations require confirmation in longitudinal studies.