Background: Acetazolamide is the most common medication used for prevention of acute mountain sickness (AMS), usually administered the day or night before ascent. The objective of this study was to evaluate the efficacy of day of ascent dosing of acetazolamide for AMS prevention. Methods: Double-blind, randomized, controlled noninferiority trial of acetazolamide 125 mg twice daily beginning either the night before or the morning of ascent. Healthy low altitude adults ascended from 1240 m (4100 ft) to 3810 m (12,570 ft) during summer 2018 on White Mountain, California. Primary outcome was incidence of AMS with the two different dosing patterns, assessed by the 1993 Lake Louise Questionnaire (LLQ) of ‡3 with headache and a minimum of 1 for other symptom. Results: One hundred four participants completed the study, with 54 (52%) randomized to night before acetazolamide and 50 (48%) to day of ascent dosing, without differences in baseline characteristics. There was 9% greater incidence of AMS in the day of ascent acetazolamide group (48.0% vs. 39%, 95% confidence interval [CI]-11.8 to 30, p = 0.46, number needed to treat [NNT] = 5.6 vs. 3.7), with the CI just surpassing the predetermined 26% noninferiority margin. There was a lower incidence of severe AMS (1993 LLQ >5) in the day of ascent group (n = 5, 10%, NNT = 2.3) compared with night before dosing (n = 12, 22%, NNT = 3.1) (95% CI-28 to 3.6), and lower average symptom severity in the day of ascent group (3 vs. 3.5, 95% CI-0.5 to 1.4). Conclusions: Day of ascent acetazolamide demonstrated higher rates of AMS compared with traditional dosing by a small margin. With similar rates of severe AMS and overall symptom severity, the potential for improved convenience and compliance may support day of ascent use.

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ObjectiveWe aim to examine the prevalence of shared placement in nonmarital cases, and we then consider whether and how nonmarital shared placement cases differ from sole mother cases across a variety of case characteristics and child support outcomes.BackgroundIn recent decades, shared placement has become increasingly common after divorce, but less is known about the prevalence of shared placement in nonmarital cases. Shared placement may have important implications for families, and little is known about its prevalence in cases of unmarried parents or about characteristics of nonmarital families that have shared placement arrangements.MethodLeveraging unique administrative data on more than 6,000 nonmarital court cases, we examine the prevalence of shared placement, case characteristics of shared placement compared with sole placement cases, and child support measures by placement type. We use multivariate regression and bivariate analyses.ResultsAlthough sole mother placement remains the norm, data indicate an increase in shared placement arrangements in recent cohorts of nonmarital cases. We find parents with shared placement arrangements tend to be slightly more advantaged across several measures. On average, shared placement cases have lower child support orders and payments and substantively higher compliance rates in the year after petition.ConclusionShared placement is increasing in nonmarital cases in recent years. Nonmarital families who have shared placement arrangements differ in important ways from families with sole mother custody.ImplicationsFindings suggest the importance of expanding the relevant shared placement literature and policy discussion to consider nonmarital cases in addition to divorce cases.

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Acute mountain sickness (AMS) typically peaks following the first night at high altitude (HA) and resolves over the next 2-3 days, but the impact of active ascent on AMS is debated. To determine the impact of ascent conditions on AMS, 78 healthy Soldiers (mean±SD; age=26±5yr) were tested at baseline residence, transported to Taos, NM (2845m), hiked (n=39) or were driven (n=39) to HA (3600m), and stayed for 4 days. AMS-Cerebral Factor Score (AMS-C) was assessed at HA twice on day 1 (HA1), five times on days 2 and 3 (HA2 and HA3) and once on day 4 (HA4). If AMS-C was ≥0.7 at any assessment, individuals were AMS susceptible (AMS+;n=33); others were non-susceptible (AMS─;n=45). Daily peak AMS-C scores were analyzed. Ascent conditions (active vs. passive) did not impact the overall incidence and severity of AMS at HA1-HA4. The AMS+ group, however, demonstrated a higher (p<0.05) AMS incidence in the active versus passive ascent cohort on HA1 (93 vs. 56%), similar incidence on HA2 (60 vs. 78%), lower incidence (p<0.05) on HA3 (33 vs. 67%), and similar incidence on HA4 (13 vs. 28%). The AMS+ group also demonstrated a higher (p<0.05) AMS severity in the active versus passive ascent cohort on HA1 (1.35±0.97 vs. 0.90±0.70), similar score on HA2 (1.00±0.97 vs. 1.34±0.70), and lower (p<0.05) score on HA3 (0.56±0.55 vs. 1.02±0.75) and HA4 (0.32±0.41 vs. 0.60±0.72). Active compared to passive ascent accelerated the time course of AMS with more individuals sick on HA1 and less individuals sick on HA3 and HA4.

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