Capacity limitations threaten the survival of Tucson’s small fitness businesses | Business News

MAKING IT WORK

Concerned about whether their businesses can survive under the current capacity limitations, some owners have turned to outdoor classes, which are not limited by ADHS requirements as long as physical distancing is possible.

Soleil Chiquette, the owner of Let’s Sweat, opted to offer only outdoor classes after the second COVID-19 shutdown inhibited gyms and studios from operating in June.

Chiquette knew her customers weren’t comfortable being back inside, so she decided to offer spin and strength classes out on the Let’s Sweat patio, 439 N. Sixth Ave., and at Catalina Park instead. Let’s Sweat’s outdoor classes are popular among their clients, and they have allowed Chiquette to stay above water.

The same can be said for Lucas, the owner of Session Yoga. Lucas owns two studios at 123 S. Eastbourne Ave. and 1135 N. Jefferson Ave. One of her spaces is a strictly indoor studio that offers hot yoga classes, and the other has both indoor and outdoor options.

Lucas has been able to consistently offer outdoor classes, which has helped her keep her studios afloat.

“Luckily, I was able to continue with the outdoor yoga, so that sustained us from not closing permanently. Without that, I don’t think we would have made it,” Lucas said.

Some studio owners have been unable to transition to outdoor classes because they rely on an indoor environment to create a specific atmosphere.

At Tucson Yoga Sol, a hot yoga studio in northwest Tucson, this is the case. Instructors manipulate heaters to facilitate Bikram yoga and hot Pilates classes. The owner, Diane Van Maren, is unsure if she will be able to keep her business up and running if the current restrictions remain in place.

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Can a Healthier Diet Affect Survival in Patients With Metastatic Colorectal Cancer?

A prospective study examining links between diet quality and survival of patients with metastatic colorectal cancer (CRC) found no link between diet at the initiation of first-line treatment and overall survival.

For the study, Erin Van Blarigan, ScD, of the University of California San Francisco, and colleagues assessed “validated food frequency” questionnaires completed by 1,284 of 2,334 patients (55.0%) with metastatic CRC enrolled in the Cancer and Leukemia Group B (Alliance)/Southwest Oncology Group 80405 trial. The results, published online in JAMA Network Open, found no significant association in overall survival and any of five dietary patterns:

  • Alternative Healthy Eating Index (AHEI), which is scored from 0 to 110 and is based on vegetables (excluding potatoes), fruits, whole grains, nuts and legumes, long-chain n-3 fatty acids, polyunsaturated fatty acids, sweetened beverages and juice, red and processed meat, trans fat, sodium, and alcoholic drinks
  • Alternative Mediterranean Diet (AMED), which is scored from 0 to 9 and is based on vegetables, fruits, nuts, whole grains, legumes, fish, ratio of monounsaturated to saturated fat, red and processed meat, and alcohol
  • Dietary Approaches to Stop Hypertension (DASH) diet, which is scored from 0 to 45 and is based on fruits, vegetables, nuts and legumes, low-fat dairy, whole grains, sodium, sweetened beverages, red and processed meats, and sweets and desserts
  • The Western dietary pattern, characterized by higher intake of dairy, refined grains, condiments, red meat, and sweets and desserts

“Making lifestyle changes is hard, especially when you are dealing with cancer diagnosis and treatment,” Van Blarigan told MedPage Today. “Patients may wish to focus their energy on making changes that are most likely to be helpful. Data on diet and exercise in people with metastatic colorectal cancer are very limited, but the information we have right now suggests that patients should really prioritize exercise during and after their cancer treatments.”

Overall, none of the diet scores or patterns examined were associated with survival in metastatic CRC, the investigators reported. “We observed an inverse association between the AMED score and risk of death (HR quintile 5 [Q5] vs quintile 1 [Q1] 0.83, 95% CI 0.67-1.04, P=0.04 for trend), but point estimates were not statistically significant. Additionally, the Western diet pattern was associated with longer survival in individuals with KRAS variant tumors (HR Q5 vs Q1 0.50, 95% CI 0.32-0.77) but not those with wild-type tumors (HR Q5 vs Q1 0.95, 95% CI 0.68-1.33, P=0.02 for interaction).”

“None of the other diet scores or patterns were associated with survival, overall or in subgroups, and the results did not change when patients who died within 90 days after administration of the [questionnaire] were excluded,” the team noted.

Writing in an accompanying commentary, Cindy Kin, MD, MS, of Stanford University School of Medicine in California, pointed out that although a Western diet, high in red meat and saturated fats, has been linked to the development of colorectal cancer, the new study addresses the less well-studied area of diet quality and outcomes in CRC, particularly for those with

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Higher Donor BMI Tied to Improved Lung Transplant Survival

Lung transplant patients who received a lung from obese donors had a 15-20% reduction in mortality at 1 year in one of the first studies to examine the impact of donor body mass index (BMI) and post-transplant survival.

Findings from the retrospective trial, which included data on patients and donors registered with the United Network for Organ Sharing Standard Transplant and Analysis database, suggest that donor obesity may confer a protective benefit for transplanted lungs.

The findings were presented this week in a poster session at the virtual CHEST conference, the annual meeting of the American College of Chest Physicians.

The BMI of lung transplant recipients has been shown to be an independent predictor of mortality, with studies showing an increased risk of death following transplant in patients who are either underweight or overweight, said Sung Choi, MD, of Rutgers New Jersey Medical School in Newark, who presented the findings.

For example, in a 2017 study involving over 17,000 lung transplants performed in the U.S. from 2005 to 2016, underweight and overweight lung recipients (i.e., BMI ≤20 and ≥28 at the time of listing) were found to be at increased risk for both short- and long-term mortality.

Recipient weight-loss prior to lung transplantation was also associated with a reduction in mortality and days on mechanical ventilation in a 2015 study, with greater reductions in BMI associated with greater survival benefit.

And, in a 2014 consensus statement, the International Society for Heart and Lung Transplantation recommended that a BMI of 30 or greater be considered a relative contraindication to lung transplantation.

Regarding donor BMI, however, Choi told MedPage Today that there hasn’t been prior research examining the impact on lung recipient outcomes and that the findings from his team’s study were a surprise: “We really weren’t expecting this result,” he said.

“We thought greater donor BMI might be associated with an increase in recipient mortality or maybe a null finding. What we found was striking to us. There appeared to be a dose-dependent relationship, with higher donor BMI associated with lower recipient mortality at 90 days and 1 year after the transplant,” Choi said.

Close to 16,000 adult patients who received single- or double-lung transplants from 2005 to 2018 were included in the analysis. Median age of the lung recipients was 59, and roughly 60% were male. Donors were categorized as underweight (BMI <18.5), normal weight (18.5 to <25), overweight (25 to <30), class I obesity (30 to <35), class II obesity (35 to <40), and class III obesity (≥40.0).

Average donor BMI was 25.9, and 45% were classified as normal weight.

A survival benefit at 1 year was observed among patients who received a lung transplant from donors in obesity class 1 (HR 0.867, 95% CI 0.772-0.975, P<0.01) and obesity classes II/III (HR 0.804, 95% CI 0.688-0.941, P<0.01) compared with lungs from normal-weight donors, the researchers reported.

In adjusted analyses, the team reported lower odds of survival with increased donor age, male sex, and presence of diabetes.

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‘Weekend Effect’ Affects Survival Odds for Rural Stroke Patients | Health News

By Robert Preidt, HealthDay Reporter

(HealthDay)

WEDNESDAY, Oct. 21, 2020 (HealthDay News) — Stroke patients have a higher risk of death if they’re admitted to a rural hospital on the weekend, a new study finds.

University of Georgia researchers analyzed 2016 data on stroke deaths at U.S. hospitals to learn whether the so-called “weekend effect” influenced stroke outcomes.

“The weekend effect is the phenomenon where the risk of bad or adverse outcomes, such as mortality in our study, increases for those who are admitted to the hospital over the weekend as opposed to a weekday,” said lead author Birook Mekonnen, who was a graduate student in the College of Public Health when the research was conducted.

There was evidence to support the weekend effect in all hospitals. But outcomes were especially poor for rural patients who had hemorrhagic (bleeding) strokes on a weekend, as opposed to ischemic strokes (ones caused by blocked blood flow to the brain).

But the time of week may be just one factor in unfavorable outcomes for rural stroke patients, according to study co-author Donglan Zhang, an assistant professor of health policy and management in public health.

Zhang noted that rural hospitals tend to have fewer resources, including stroke specialists and equipment for particularly severe cases. They also serve a wider area and it’s not uncommon for rural patients to be more than an hour’s drive from the nearest hospital.

The researchers said one way to protect stroke patients from the weekend effect is to invest in telemedicine. They noted that more rural hospitals are joining telestroke care networks, enabling them to connect with specialists and collaborate on treatment for stroke patients.

Mekonnen advised people who are at risk for stroke or other major health problems to look into the telemedicine options available to them. “This may be the new norm,” he said in a university news release.

The findings were published in the October issue of the Journal of Stroke & Cerebrovascular Diseases.

The American Academy of Family Physicians has more on stroke.

Copyright © 2020 HealthDay. All rights reserved.

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Prehospital Plasma Boosts Survival in Traumatic Brain Injury

Prehospital plasma, administered soon after injury, appears to improve survival for patients with traumatic brain injury (TBI), results of a new analysis suggest.

Administration of prehospital plasma demonstrated a strong survival benefit and was associated with a 45% lower risk for mortality in TBI patients, Danielle S. Gruen, PhD, and colleagues write in their report, published online October 15 in JAMA Network Open.

The finding is from a post hoc secondary analysis of a prespecified subgroup from the Prehospital Air Medical Plasma (PAMPer) randomized clinical trial, published in 2018 in The New England Journal of Medicine.

PAMPer studied the safety and efficacy of prehospital administration of thawed plasma in injured patients at risk for hemorrhagic shock. It included 501 patients; 230 received prehospital plasma, and 271 received standard-care resuscitation that did not include prehospital plasma administration.

Results showed that mortality at 30 days, the trial’s primary endpoint, was significantly lower in the plasma group than in the standard-care group (23.2% vs 33.0%; P = .03).

The current analysis explored the association between prehospital plasma resuscitation and survival in a subgroup of 166 patients with TBI. Of these, 74 patients received prehospital plasma, and 92 received standard care.



Dr Jason Sperry

“If you give prehospital plasma to injured patients, there is a survival benefit, as PAMPer showed, and the current study demonstrates that the signal is strongest in patients who have traumatic brain injury,” senior author Jason L. Sperry, MD, MPH, professor of surgery and critical care, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, told Medscape Medical News.

“We think that giving plasma as soon as possible improves survival via several mechanisms,” he said. “These include volume expansion to restore perfusion, an alteration in the inflammatory response, a reduction in endothelial injury, and the prevention or mitigation of coagulopathy.”

The median age of the patients with TBI was 43 years (range, 25 – 60 years). Brain injury was shown on CT imaging. Most patients with TBI were men (n = 125, 75.3%), and all had blunt trauma injuries. The median Injury Severity Score was 29 (interquartile range [IQR], 22 – 38).

Patients with TBI were more severely injured than those without TBI, and the incidence of prehospital intubation was higher for those patients. In addition, they were more likely to receive in-hospital vasopressors, the length of stay in the intensive care unit was longer, they spent more days on mechanical ventilation, and 24-hour mortality rates (P = .001) and 30-day mortality rates (P = < .001) were higher.

Except for the plasma intervention, there were no significant differences in fluid administration during transport to the hospital. However, in-hospital transfusion requirements differed between the two groups. Patients with TBI who were treated with prehospital plasma received less crystalloid fluid, vasopressors, and packed red blood cells in the first 24 hours.

In addition, for patients with TBI who received prehospital plasma, international normalized ratios were lower (median, 1.20 [IQR, 1.10 – 1.40] vs 1.40 [IQR 1.20 – 1.80]).

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Data Presented at TCT Connect Finds Pre-PCI Use of Impella for AMI Cardiogenic Shock is Associated with Higher Survival, Particularly in Women

Two studies of AMI cardiogenic shock (AMICS) patients found higher survival when Impella was placed pre-PCI, compared to when Impella was placed after PCI. The findings were presented at TCT Connect, the 32nd annual scientific symposium of the Cardiovascular Research Foundation.

This press release features multimedia. View the full release here: https://www.businesswire.com/news/home/20201016005118/en/

Figure 1 (Graphic: Business Wire)

In the first study, presented by Hemindermeet Singh, MD, of Ascension St. John Hospital, researchers compared 649 patients from two cohorts: a recent cohort (2017–2019) from the RECOVER III post-market approval (PMA) study, after the widespread adoption of the best practice of placing Impella pre-PCI, and a cohort from before PMA (2008–2014) when the practice of placing Impella pre-PCI was not yet widely adopted. Researchers found an 18% relative improvement in overall survival in the recent cohort, indicating an associated benefit to placing Impella pre-PCI. The recent cohort also had lower incidences of peri-PCI acute kidney injury (AKI) and major bleeding or vascular complications. This is despite a higher prevalence of hypertension, smoking, stroke, and New York Heart Association (NYHA) class III/IV heart failure in the recent cohort. (see figure 1)

“This data shows increased adoption of the cardiogenic shock best practices over the last three years has led to an improvement in overall survival rates,” said Amir Kaki, MD, the study’s senior author, an interventional cardiologist and director of mechanical circulatory support at Ascension St. John Hospital. “In order to improve outcomes for our patients, it is important for practitioners to apply these best practices, which include early identification of shock, use of a right heart cath, reduction of toxic inotropes and use of Impella prior to the PCI.”

“Our study demonstrates growing physician and institutional experience. The implementation of standardized cardiogenic shock protocols and the increasing use of strategies to reduce vascular and bleeding complications are associated with better survival. In-depth understanding of these factors has significant potential of improving outcomes in cardiogenic shock patients in the community at large,” said Dr. Singh.

The second study, presented by Tayyab Shah, MD, of the Yale School of Medicine, analyzed data collected from the RECOVER III trial between 2017-2019. It found that placing Impella pre-PCI in AMICS patients is associated with higher survival than placing Impella post-PCI, especially in women. Study investigators determined women had a 74% relative survival benefit with Impella use pre-PCI as compared to post-PCI. The study authors conclude early implantation of Impella provides a significant survival benefit, particularly to women. (see figure 2)

“This study suggests that the early use of the Impella device to support patients in cardiogenic shock, before PCI and inotrope/vasopressor usage, may provide a survival benefit particularly to females,” said Dr. Shah. “This is an interesting result from an observational study with meaningful clinical implications, which need to be further explored in the upcoming RECOVER IV randomized controlled trial.”

Since FDA PMA approval, Abiomed (NASDAQ: ABMD) has collected data on nearly 100% of U.S. Impella patients in the observational

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