Explore the vast range of titles available.

To evaluate the impact of a novel design \"Star Home\" on the incidence of malaria, respiratory tract infections and diarrheal diseases among children, randomly selected households in Mtwara, Tanzania were offered a free, new Star Home. Drawing on longitudinal qualitative research that accompanied the Star Homes study, this article describes the experiences of residents and the wider community of living with these buildings. A total of four rounds of face-to-face interviews were undertaken with residents of Star Homes (n = 37), control (wattle/daub) homes (n = 21), neighboring households n = 6), community members (n = 17) and community leaders (n = 6). The use of Star Homes was also observed over these four time periods between 2021 and 2023. Interviews were conducted in Swahili, transcribed, and translated into English for thematic analysis. Star Homes residents appreciated several aspects of the Star Homes, including overall comfort, access to water and electricity, and clean toilets. There were concerns about some design elements, such as poorly closing doors, stoves perceived as inefficient, and the façade, which was susceptible to rainwater ingress. The houses were not always used as intended by their developers, for example, residents were sleeping downstairs instead of upstairs because of cold floors or difficulties using the stairs. Star Homes residents described how the structures triggered praise but also envy from other community members. The findings highlight the need for close attention to the use of novel design houses and careful sensitization around the potential benefits of dwellings to ensure that the intended health impacts of interventions are achieved.

Background Diarrhoeal disease is the third leading cause of death in children under 5 years old with domestic flies acting as important mechanical vectors of diarrhoeal pathogens. To assess the effectiveness of a novel house design, “Star home”, and improved toilets in reducing the abundance of domestic flies, potential carriers of diarrhoeal pathogens, a randomized controlled trial was carried out in rural Tanzania. Methods Domestic fly populations were monitored in 28 randomly selected Star homes and 28 traditional thatched roofs and mud-walled houses over 2 years from January 2022 to December 2023. Flies were sampled in kitchens and toilets using baited-fly traps from 07.00 h to 17.30 h every 7 weeks. To assess the production of flies from toilets, traps were placed over drop holes to collect emerging flies. Duration of external door openings to the kitchens was recorded with data loggers. Findings Of the 1527 flies collected, 76% were Chrysomya putoria , 16% Musca domestica and 8% Sarcophaga spp. In kitchen collections, there were 46% fewer C. putoria flies [adjusted mean rate ratio (RR) = 0.54] and 69% fewer Sarcophaga spp. (RR = 0.31) in Star homes compared to traditional houses. There was no difference in the abundance of M. domestica in the two study groups. In toilets, there was 49% fewer C. putoria (RR = 0.51), but no difference was observed for other domestic fly species. No flies emerged from Star home toilets compared with a mean of 4.2 flies/trap/day in traditional toilets. During the day, the external doors od Star homes were open for an average of 13.0 min/h less than in traditional houses. Conclusions Star homes reduced the abundance of domestic flies, apart from houseflies, in the kitchen and there were fewer C. putoria , a putative vector of diarrhoeal diseases, in Star home toilets compared to traditional houses. Changing the design of buildings can contribute to a decline in domestic flies and may lead to a reduction in diarrhoeal diseases. Graphical Abstract

Background Patients with recurrent or metastatic head and neck squamous cell carcinoma (R/M-HNSCC) have a poor prognosis and limited therapeutic options. Immune checkpoint inhibitors (ICIs) are effective in patients with tumor progression < 6 months following first-line, platinum-based chemotherapy (PBC), but data are missing for patients with progression ≥ 6 months after the last platinum dose. Methods Retrospective analysis (six French centers, 2008–2019) of all consecutive R/M-HNSCC patients. treated first-line with PBC and tumor progression ≥ 6 months after the last platinum dose. Primary endpoint: progression-free survival after second-line therapy (PFS2). Additional endpoints: overall survival from Day 1 of first-line (OS1) and second-line (OS2) therapy. Results R/M-HNSCC patients (n = 144) received cisplatinum (n = 67, 47%) or carboplatinum (n = 77, 53%) first-line. Response after first-line: complete response (CR; n = 16, 11%); partial response (PR; n = 77, 53%); stable disease (n = 22, 15%). Second-line therapy: PBC (n = 95, 66%); platinum-free regimen (PFR) (n = 25, 17%); ICI (n = 24, 17%). Median [95% confidence interval] PFS (months): PBC 5.0 [3.8–6.2]; PFR 4.0 [1–7.0]; ICI 2.0 [0.4–3.6] (p = 0.16). For PBC, PFR, and ICI, respectively: OS1 30, 23, and 29 months (p = 1.02); OS2 14, 10, and 16 months (p = 0.25); PR, 26%, 16%, and 21% patients; CR, 0%, 8%, and 4% patients. For subsequent lines, ICIs were administered for PBC (n = 11, 12%) and PFR (n = 2, 8%). No predictive factor for efficacy (PFS, OS) was identified. Conclusions Our retrospective study suggests similar efficacy regarding OS2 for second-line chemotherapy or ICI in R/M-HNSCC patients with progression ≥ 6 months after the last first-line platinum dose.

BACKGROUND Prognosis of recurrent or metastatic (R/M) head and neck squamous cell carcinoma (HNSCC) remains poor. The addition of cetuximab, to platinum and fluorouracil chemotherapy (EXTREME regimen) has been shown to improve patients’ outcomes in first‐line settings. METHODS We conducted a retrospective, multicenter study, including HNSCC that progressed after a first line of platinum‐based chemotherapy and cetuximab, treated either by paclitaxel + cetuximab (PC) or paclitaxel alone (P), between January 2010 and April 2018. The end points were overall survival (OS), progression‐free survival (PFS), and overall response rates (ORR). Patients were matched according to their propensity scores, estimated with a logistic regression model. The secondary objectives were to study the safety profile and to look for prognostic and predictive factors of effectiveness. RESULTS Of the 340 identified patients, 262 were included in the analysis, 165 received PC, and 97 received P. In unmatched population, ORR was 16.4% with PC and 6.2% for P. Median PFS was 2.9 months [95% Confidence Interval 2.7–3.0] for PC versus 2.5 months [2.2–2.7] for P, hazard ratio (HR) = 0.770 [0.596–0.996]. Median OS was 5.5 months [4.4–6.9] for PC versus 4.2 months [3.4–4.8] for P, HR = 0.774 [0.590–1.015]. In multivariate analysis, PC was associated with better PFS and OS. These results were consistent in matched‐paired population. Previous cetuximab maintenance for more than 3 months was predictive of better OS with PC. CONCLUSION Although the continuation of cetuximab in combination with paclitaxel after EXTREME provides moderate benefit, it could be an interesting option for selected patients. In this propensity score‐adjusted, multi‐institutional series, cetuximab in association with paclitaxel showed better outcomes than paclitaxel alone for patients who had disease progression after EXTREME regimen, particularly for patients who benefit the most from cetuximab in first‐line setting. This study should raise the question of the place of this association with the arrival of immune checkpoint inhibitors in first line with or without chemotherapy.

The goal of this study was to investigate the persistence with biological drugs in patients treated in rheumatology practices in Germany. This study included patients diagnosed with rheumatoid arthritis (RA), psoriatic arthritis (PA), or ankylosing spondylitis (AS) who received a first prescription of biological drugs between 2008 and 2016 (index date) in 21 rheumatology practices in Germany (n = 4925; Disease Analyzer database). The main outcome measure was the rate of persistence within 5 years of the index date. Kaplan–Meier analyses were performed to study treatment persistence as a function of diagnosis, gender and age. A Cox proportional hazards regression model was used to estimate the relationship between non-persistence and diagnosis, gender, age, and comorbidities. After 5 years of follow-up, the rate of persistence was 31.8% in patients with RA, 35.2% in those with AS, and 33.2% in those with PA (log-rank p value = 0.028). Furthermore, 33.8% of men and 31.9% of women were persistent (log-rank p value = 0.035). The rate of persistence was 20.8%, 27.9%, 33.0%, 36.6%, 35.2%, and 32.0% in people aged ≤ 30, 31–40, 41–50, 51–60, 61–70, and > 70 years, respectively (log-rank p value = 0.002). The risk of discontinuation was lower in participants diagnosed with AS than in those diagnosed with RA [hazard ratio (HR) = 0.87; 95% confidence interval (CI) 0.79–0.96]. In addition, patients aged ≤ 30 years were more likely to discontinue their biological therapy than those aged > 70 years (HR = 1.29; 95% CI 1.10–1.52). Persistence with biological drugs was low after 5 years of follow-up in rheumatology practices.

Background: The current NHSN guideline states that positive results from both blood cultures and non–culture-based testing (NCT) methodologies are to be used for central-line–associated bloodstream infection (CLABSI) surveillance determination. A positive NCT result in the absence of blood cultures or negative blood cultures in patients who meet CLABSI criteria is to be reported to NHSN. However, the reporting criteria for NCT changed starting January 1, 2020: If NCT is positive and the blood culture is negative 2 days before or 1 day after, the NCT result is not reported. If the NCT is positive with no blood culture within the 3-day window period, the NCT result is reported in patients who meet CLABSI criteria. We estimated the impact of the new NCT criteria on CLABSI numbers and rates compared to the previous definition. Methods: At our facility, the T2Candida Panel (T2), an NCT, was implemented for clinical use for the detection of early candidemia and invasive candidiasis. The T2 is a rapid molecular test performed directly on blood samples to detect DNA of 5 Candida spp: C. albicans/C. tropicalis , C. glabrata/C. krusei , and C. parapsilosis . In this retrospective study performed at an 877-bed teaching hospital in Detroit, we reviewed the impact of discordant T2 results (positive T2 with negative blood cultures) on CLABSI rates from January 1, 2017, to September 30, 2019, based on the current definition, and we applied the revised criteria to estimate the new CLABSI numbers and rates for the same period. Results: Of 343 positive T2 results, 202 (58.9%) were discordant and qualified for CLABSI determination during the study period. Of these, 109 (54%) met CLABSI criteria based on the current definition and 11 (5%) met CLABSI criteria using the new definition (proportional P < .001), resulting in an 89.9% reduction. The CLABSI rate per 1,000 central-line days, which includes discordant T2 results, based on the current and new NCT criteria, are listed in Table 1. Conclusions: In institutions that utilize NCT such as T2, application of the new 2020 NCT NHSN definition would significantly reduce the CLABSI number and have a significant impact on the CLABSI rates and standardized infection ratios (SIRs). Funding: None Disclosures: None

Background Traditional rural housing in hot, humid regions of sub-Saharan Africa usually consists of single-level, poorly ventilated dwellings. Houses are mostly poorly screened against malaria mosquitoes and limited airflow discourages the use of bednets resulting in high indoor transmission. This study aims to determine whether living in a novel design house with elevated bedrooms and permeable screened walls reduces malaria, respiratory tract infections, and diarrhoea among children in rural Tanzania. Methods/study design This is a household-randomized, controlled study in 60 villages in Mtwara, Tanzania. A total of 550 households are randomly selected, 110 of which are allocated a novel design house and 440 households continue to reside in traditional houses. A dynamic cohort of about 1650 children under 13 years will be enrolled and followed for 3 years, approximately 330 living in novel design houses and 1320 in traditional rural houses. The primary endpoint is the incidence of malaria; secondary endpoints are incidences of acute respiratory tract infections and diarrhoea diseases detected by passive and active surveillance. Exposure to malaria vectors will be assessed using light traps in all study houses. Structural, economic, and social science studies will assess the durability, cost-effectiveness, and acceptability of the new houses compared with traditional housing. Environmental data will be collected indoors and outdoors in study homes to assess the differences between house typologies. Discussion This is the first randomized controlled trial to assess the protective efficacy of a new house design targeting malaria in sub-Saharan Africa. The findings of this study could influence the future construction of homes in hot and humid zones of Africa. Trial registration ClinicalTrials.gov NCT04529434 . Registered on August 27, 2020