6-month Time Research Articles

Memantine for Pediatric Patients Receiving Cranial Irradiation: A Pilot Study

While memantine has become standard in certain adults receiving brain RT to decrease the cognitive impacts of RT, it is unknown whether pediatric patients can take and tolerate memantine or experience benefit. In this prospective single-arm feasibility study, we hypothesized pediatric patients receiving brain RT would tolerate memantine with good treatment adherence. Patients aged 4-18 years with a primary CNS malignancy (excluding WHO Grade IV astrocytoma and glioblastoma) receiving intracranial RT were eligible. A 6-month course of memantine was given during and after RT. Dosing began once daily at 5 mg with up-titration in 5 mg increments over 4 weeks to a weight-based maximum (0.4 mg/kg to the closest 5 mg), not to exceed 10 mg BID. To reduce patient and clinical research associate (CRA) burden, medication adherence was tracked via the Medisafe Pill and Reminder application which study staff helped install on the patient or parent's smart phone. A paper pill diary was provided for those unable to use the app. The primary endpoint was to achieve 80% adherence rate to memantine in 80% of patients measured 1-month post-RT. Eighteen patients (14 male and 4 female, median age 11.5 years (range: 4-18)) were enrolled from 2020-2022. The study closed early after enrolling 18 of 20 planned patients to avoid competing with the phase III randomized Children's Oncology Group (COG) study AACL2031. One patient withdrew for cognition-altering substance-use, leaving 17 patients with data available for analysis. Histologies included germ cell tumor (n = 6), craniopharyngioma (n = 3), choroid plexus papilloma (n = 2), ependymoma (n = 2), glial/astrocytoma (n = 2), medulloblastoma (n = 1), and meningioma (n = 1). Thirteen had surgery, and 9 received chemotherapy. Eight received craniospinal irradiation (CSI). Median RT dose was 54 Gy (range 36-59.4) in 30 fractions (range: 20-33). At data freeze, all 17 had passed the 1-month post-RT time point. One patient discontinued memantine after a single dose due to nausea. Pill-reports were available for 14 of the remaining 16; two patients did not complete digital pill logs. For those with complete logs, all adherence rates were above 80%, with a median of 99.32% pill completion rate (range: 92.67-100). Seven (50%) took 100% of prescribed doses. Irrespective of adherence for the 2 unavailable for evaluation, the primary endpoint was still achieved. Grade 1 toxicities included headache (n = 6, 35%) and constipation (n = 1, 6%); there were no grade 2+ toxicities. At last follow-up, 15/16 have completed the full 6-month memantine course. Secondary endpoints including neurocognitive evaluations have not yet been met and will be the subject of future reports. Memantine is a feasible and well-tolerated addition to multi-modality treatment for pediatric brain tumors. Secondary endpoints of this study and results of the ongoing COG study are awaited to define the value of memantine in this population.

Evaluating Markov chains and Bayesian networks as probabilistic meteorological drought forecasting tools in the seasonally dry tropics of Costa Rica

Meteorological drought is a climatic phenomenon that affects all global climates with social, political, and economic impacts. Consequently, it is essential to develop drought forecasting tools to minimize the impacts on communities. Here, probabilistic models based on Markov chains (first and second order) and Bayesian networks (first and second order) were explored to generate forecasts of meteorological drought events. A Ranked Probability Score (RPS) metric selected the best-performing model. Long-term precipitation data from Liberia Airport in Guanacaste, Costa Rica, from 1937 to 2020 were used to estimate the 1-month Standardized Precipitation Index (SPI-1) characterizing four meteorological drought states (no drought, moderate drought, severe drought, and extreme drought). The validation results showed that both models could reflect the climatic seasonality of the dry and rainy seasons without mistaking 4–5 months of the rain-free dry season for a drought. Bayesian networks outperformed Markov chains in terms of the RPS at both reproducing probabilities of drought states in the rainy season and when compared to the months in which a drought state was observed. Considering the forecasting capability of the latter method, we conclude that these models can help predict meteorological drought with a 1-month lead time in an operational early warning system.

Permeability and diffusion of tritium in bentonite

Abstract. As a part of the Croatian RD&D (research, development, and demonstration) program within the Program for LILW (low- and intermediate-level waste) and SNF (spent nuclear fuel) disposal, research of permeability and the diffusion of tritium in bentonite was organized, as part of the research of the future engineering barriers for repositories of LILW and SNF. Two types of materials were prepared, namely pure sodium bentonite and a mixture of sodium bentonite (12 %) with quartz sand (88 %). Compaction of materials was conducted with a modified Proctor test, and the apparatus was designed and made at the Faculty of Mining, Geology and Petroleum Engineering at the University of Zagreb, utilizing fused deposition modeling 3D printer and PETG (polyethylene terephthalate glycol) material. Water enriched with 3H has been prepared by dilution of the National Institute of Standards and Technology (NIST) 3H standard (4926e) to 6 L. The activity of the prepared enriched water was 49 700±180 TU. One part of the device was filled with 3H-free water and the other with 3H-spiked water (0.6 L volume for each part). In total, five devices with bentonite and five devices with a sand–bentonite mixture were prepared this way. The devices were thoroughly sealed to avoid loss of sample and isotopic exchange with the atmosphere and put horizontally in holders. The water for 3H activity measurements was sampled monthly or bimonthly. A total of 8 mL of the sample was taken by syringe and transferred to a measurement vial. Each vial was additionally filled with 12 mL of a scintillator (Ultima Gold LLT, PerkinElmer) and thoroughly mixed. 3H activity was determined by a liquid scintillation counter (LSC; Quantulus 1220) at the Laboratory for Low-level Radioactivities, Ruđer Bošković Institute, Zagreb. Due to the penetration of bentonite from the barrier into the water samples, tritium-free water has relatively high activity after 2 months of the experiment (average value was 5560±240 TU). In the final sampling, after a 2-month time span, the activity reached 9670±2490 TU. Later, sampling and measurement were not possible due to the high bentonite amount within the samples. Tritium-free samples from the sand–bentonite mixture device were stable, and the first analyses (1 month after the experiment setup) showed an average activity of 533±31 TU, while the final (5-month time span from the first sampling) average activity was 12 800±3430 TU. The increase in the concentration from the beginning to the end of the experiment was almost exponential. Spiked samples from the bentonite device had an average activity of 36 950±2550 TU at the first sampling and 17 580±13 320 TU after a 1-month time leg. Later, sampling was not possible. Spiked samples from sand–bentonite mixture showed a decrease in tritium activity from the first sampling (43 390±1310 TU) to 27 210±285 TU (5 months after the first sampling). Considering the penetration of bentonite material into the water samples, only the sand–bentonite mixture can be considered for further analyses through the calculation of the diffusion.

Longitudinal associations between parental reflective functioning and maternal mind-mindedness.

Little work has examined longitudinal associations between parental reflective functioning (PRF) and mind-mindedness (MM), limiting the understanding of separate or bidirectional trajectories of these related but distinct forms of mentalization. We examined cross-lagged associations between PRF, assessed via interview, and MM, coded from play interactions, over 12 months among 90 parents (86% female; 57% White, 43% Black) of infants (Mage = 10.56 months, SD = 8.20) who were participating in The Michigan Model of Infant Mental Health Home Visiting. Data were collected at study enrollment Time 1 (T1) and at 6-month Time 2 (T2) and 12-month Time 3 (T3) postenrollment. Mind-minded comments were coded as appropriate, reflecting accurate interpretation of mental states or nonattuned, characterizing inaccurate interpretations. PRF and appropriate MM each remained stable over time. PRF at the T1 positively predicted appropriate MM at T2. No other cross-lagged associations between PRF and appropriate MM were significant. Concurrent correlations between appropriate MM and PRF were significant only at T3. Nonattuned MM showed stability from T1 to T2 but nonattuned MM at the T2 did not predict nonattuned MM at T3. Greater PRF at T1 predicted less nonattuned MM at T2. No other cross-lagged associations between PRF and nonattuned MM were significant. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Advanced Messaging Intervention for Medication Adherence and Clinical Outcomes Among Patients With Cancer: Randomized Controlled Trial.

Medication adherence is crucial for improving clinical outcomes in the treatment of patients with cancer. The lack of adherence and adverse drug reactions can reduce the effectiveness of cancer therapy including the quality of life. The commonly used intervention methods for medication adherence continue to evolve, and the age of fifth-generation (5G) messaging has arrived. In this study, we conducted a prospective, pilot randomized controlled trial to evaluate the effect of 5G messaging on medication adherence and clinical outcomes among patients with cancer in China. The research population was patients with nonsmall cell lung cancer undergoing pemetrexed chemotherapy who require regular folic acid (FA) and vitamin B12 supplements. The intervention and control groups were assigned to 5G messaging and second-generation (2G) messaging, respectively. The patients' medication adherence and quality of life were assessed at baseline and 1-month and 3-month time points. Moreover, the chemotherapy-related hematologic or nonhematologic toxicities, as well as the serum levels of FA and vitamin B12, were measured. Of the 567 patients assessed for eligibility between January and May 2021, a total of 154 (27.2%) patients were included. Overall, 80 were randomized to the control group and 74 to the intervention group. The odds of adherence in the 5G messaging intervention group were significantly higher than the control group at the 1-month (62/69, 90% vs 56/74, 76%; adjusted odds ratio 2.67, 95% CI 1.02-7.71) and 3-month (50/60, 83% vs 48/64, 75%; adjusted odds ratio 2.36, 95% CI 1.00-5.23) time points. Correspondingly, the FA and vitamin B12 serum levels of patients in the 5G messaging group were higher than those of the control group. Regarding hematologic toxicities, only the incidence of leukopenia in the intervention group was lower than that in the control group (25/80, 31% in the control group vs 12/74, 16% in the intervention group; P=.04). There were no differences in nonhematologic toxicities and quality of life between the 2 groups. In summary, we conclude that compared with conventional 2G text-based messaging, a 5G messaging intervention can better improve medication adherence and clinical outcome among patients with cancer. Chinese Clinical Trial Registry ChiCTR2200058188; https://www.chictr.org.cn/showproj.html?proj=164489.

An Initiative to Increase Nurse Knowledge and Decrease Postpartum Readmissions for Preeclampsia

ObjectiveTo increase nurses’ knowledge using innovative education and to improve maternal outcomes by reducing postpartum readmission rates of women with preeclampsia. DesignQuality improvement project implementing escape room–style education for nurses. Setting/Local ProblemA large tertiary hospital in southeastern Michigan with initial postpartum readmission rates of women with preeclampsia exceeding national averages. ParticipantsRegistered nurses (n = 71) working on the hospital postpartum unit; 70 completed the project. Intervention/MeasurementsParticipants completed a knowledge survey on the care and management of women in the postpartum period with preeclampsia and then engaged in an escape room game scenario involving an increasingly acute case of a woman with preeclampsia. Debriefing occurred after the education, and then participants completed the same survey. Using data collected after the project, we compared postpartum readmission rates of women with preeclampsia to the median national average of 3.55%. ResultsNurse knowledge increased by 10.5% from the pre- to posttest period. For the 2-month project time period, the average readmission rate was 1.49%. ConclusionOffering innovative, interactive education to nurses, such as an escape room game, appeared to be an effective method to increase nurses’ knowledge and may have improved maternal outcomes, as demonstrated through a readmission rate lower than the median national average. Further projects using longer time periods are needed to understand the true impact of the education on readmission rates.

Enhancing Seasonal Forecast Skills by Optimally Weighting the Ensemble from Fresh Data

Abstract Dynamical climate predictions are produced by assimilating observations and running ensemble simulations of Earth system models. This process is time consuming and by the time the forecast is delivered, new observations are already available, making it obsolete from the release date. Moreover, producing such predictions is computationally demanding, and their production frequency is restricted. We tested the potential of a computationally cheap weighting average technique that can continuously adjust such probabilistic forecasts—in between production intervals—using newly available data. The method estimates local positive weights computed with a Bayesian framework, favoring members closer to observations. We tested the approach with the Norwegian Climate Prediction Model (NorCPM), which assimilates monthly sea surface temperature (SST) and hydrographic profiles with the ensemble Kalman filter. By the time the NorCPM forecast is delivered operationally, a week of unused SST data are available. We demonstrate the benefit of our weighting method on retrospective hindcasts. The weighting method greatly enhanced the NorCPM hindcast skill compared to the standard equal weight approach up to a 2-month lead time (global correlation of 0.71 vs 0.55 at a 1-month lead time and 0.51 vs 0.45 at a 2-month lead time). The skill at a 1-month lead time is comparable to the accuracy of the EnKF analysis. We also show that weights determined using SST data can be used to improve the skill of other quantities, such as the sea ice extent. Our approach can provide a continuous forecast between the intermittent forecast production cycle and be extended to other independent datasets.

Temporal Evolution of PM2.5 Levels and COVID-19 Mortality in Europe for the 2020–2022 Period

Air pollution has a strong impact on human health, from respiratory and severe pulmonary diseases to heart attack and cancer. During the 3 years of the COVID-19 pandemic, several peaks of mortality occurred, which could be related to particulate matter (PM) pollution events. The possible effects of PM (PM10 and PM2.5, with diameters less than 10 and 2.5 µm, respectively) on COVID-19 mortality have now been established. To better understand this relationship at the European level for the period 2020–2022, data from 16 representative locations in Europe (81 million people) with PM2.5 levels (µg·m−3) ranging from low to high values were analyzed using statistical methods. The analysis confirms a temporal relation between the peaks of PM2.5 exposure and COVID-19 mortality. The best correlation was obtained considering the history of exposure to PM2.5 pollution during a 2-month integration time coupled with a one-week delay for the COVID-19 mortality. Although the trend of COVID-19 mortality vs. PM2.5 levels varies among locations, the global trend was similar, giving an estimated mean value of a 40 ± 20% mortality increase per µg·m−3 PM2.5 increase. The stronger the positive (negative) gradient of the PM peak, the stronger the positive (negative) gradient of the COVID-19 mortality. These results indicate that a succession of PM pollution peaks could be more dangerous than permanent exposure to moderate pollution levels. Finally, PM number concentrations should be used in the future rather than the PM2.5 mass concentrations (µg·m−3), with the consideration of PM composition to better evaluate the effect of submicron particles on human health, particularly for other respiratory diseases. These results must be considered in the management of future pandemics.

Delaying ACL reconstruction is associated with increased rates of medial meniscal tear.

The aim of this study was to evaluate the relationship between the time from injury to ACL reconstruction (ACLR) and the rate as well as repairability of meniscal tears. Secondary aims were to evaluate the relationship between meniscal injury and Tegner Activity Scale, age, BMI, and gender. Between 2012 and 2022, 1,840 consecutive ACLRs were performed. A total of 1,317 ACLRs were included with a mean patient age of 31.2years ± 10.5 [16-60]. Meniscal tear was assessed during arthroscopy using the ISAKOS classification. Time from injury to ACLR, Tegner Activity Scale, age, BMI and gender were analysed in uni- and then in multivariate analyses. Patients were divided into four groups according to the time from injury to surgery: < 3months (427; 32%), 3-6months (388; 29%), 6-12months (248; 19%) and > 12months (254; 19%). Delaying ACLR > 12months significantly increased the rate of medial meniscal (MM) injury (OR 1.14; p < 0.001). No correlation was found between a 3- or 6-month time from injury to surgery and MM tear. Performing ACLR > 3, 6, or 12months after injury did not significantly increase the rate of lateral meniscal (LM) injury. Increasing Tegner activity scale was significantly associated with a lower rate of MM injury (OR 0.90; p = 0.020). An age > 30years (OR 1.07; p = 0.025) and male gender (OR 1.13; p < 0.0001) was also associated with an increased rate of MM injury. Age > 30years decreased the rate of MM repair (OR 0.85; p < 0.001). Male gender increased the rate of LM tear (OR 1.10; p = 0.001). Performing ACLR more than 12months after injury was associated with increased rates of MM injury but not with lower rates of repairable lesions. An increased pre-injury Tegner activity score was associated with a decreased rate of MM tear. Age > 30years was associated with an increased rate of MM tear with concomitant ACL injury and a decreased rate of repairability of MM tear. ACLR should be performed within 12months from injury to prevent from the risk of MM injury. Level III.

A randomized controlled trial examining a Tranquil sitting intervention compatible with Confucian values.

During the COVID-19 pandemic in China, the silent management (Lockdown) policy has caused severe sleep problems for university students. Long-term isolation may further deteriorate sleep quality, and it requires practical interventions. Today in mental and sleep health, interventions based on Buddhist, Taoist and Confucian ethics have been proven effective in reducing cognition and sleep disorders. However, such interventions also have limitations. They tend to focus on peace of mind or some technical means with the main direction of symptom improvement but neglect the mundane activities of daily life. We conducted an innovative tranquil sitting intervention program based on the Chinese Confucian value of the "tranquility and reverence" method, integrating various intervention techniques traditionally recognized as effective for achieving more lasting mental health and sleep quality. This study aims to assess the effectiveness and feasibility of a tranquil sitting intervention in improving sleep problems in isolated university students. Using a randomized control trial (RCT), the participants in the intervention program (n = 35) practiced the tranquil sitting intervention program for ten weeks. They had their PSQI scores measured at the pre-experimental, post-test, and 1-month follow-up time points and compared to the control group (n = 35). The participants who received the tranquil sitting intervention had significantly better sleep quality than the control group, with moderate to large effect sizes in the middle and late stages. The instructor may challenge the intervention group at the beginning of the tranquil sitting technique. However, the improvement in sleep quality was significant after fully mastering the method. The intervention program in this study emphasized the importance of "tranquility" and showed the same sleep improvement as in other traditional interventions. In conclusion, this intervention is a feasible and promising new approach to improving sleep quality among youths.

Sustainable employability and work engagement: a three-wave study.

The recent concept of sustainable employability (SE), which refers to being able and enabled to achieve valuable work goals, has lately attracted substantial attention in many developed countries. Although limited cross-sectional studies found that SE in the form of capability set was positively associated with work outcomes, why and through which mechanism SE is related to crucial work outcomes remains still unexplored. Therefore, the present three-wave study aimed to (1) investigate the SE-work outcomes linkage over time, and (2) uncover the psychological pathway between SE and two work outcomes (i.e., task performance and job satisfaction) by proposing work engagement as a mediator. To test the mediation process, we approached CentERdata to collect data among a representative sample of 287 Dutch workers. We used a three-wave design with approximately a 2-month time lag. The results of bootstrap-based path modeling indicated that SE was a significant predictor of task performance but not job satisfaction over time. Work engagement mediated the relationships between SE and (a) task performance and (b) job satisfaction. These findings suggest that organizations may foster workers' task performance and job satisfaction by configuring a work context that fosters SE-allowing workers to be able and be enabled to achieve important work goals.

0209 Cardiovascular Measures Display Robust Phenotypic Stability to Total Sleep Deprivation Across Long-Duration Intervals

Abstract Introduction For the first time, we determined whether individual differences in cardiovascular (CV) measures are observed in response to total sleep deprivation as well as the stability of such responses across 4-month and 8-month long-duration studies. Methods We conducted a five-day experiment twice (at months 2 and 4) in a 4-month study (N=6 healthy adults; 3 females), and a similar five-day experiment three times (at months 2, 4, and 8) in an 8-month study (N=5 healthy adults; 2 females). During these repeated experiments, CV measures were collected via echocardiography or blood pressure monitor [systolic blood pressure (SBP)] at three assessment time points: 1) after two baseline 8h time in bed (TIB) nights (BL); 2) after a night of total sleep deprivation (TSD); and 3) after two recovery nights of 8-10h TIB (REC). Seated SBP, stroke volume (SV), heart rate (HR), cardiac index (CI), left ventricular ejection time (LVET), and systemic vascular resistance index (SVRI) were collected. Data did not significantly differ between the two studies and therefore were pooled together for analysis (N=11). Intraclass correlation coefficients (ICCs) assessed the stability of CV measures during TSD. Spearman’s rho assessed the relative rank of individuals’ averaged TSD-TSD responses across CV measures. Results TSD ICCs across months 2 and 4 were substantial to almost perfect for all CV measures (0.755-0.962). In the 8-month sample subset, TSD ICCs were moderate to almost perfect across 2, 4, and 8 months for all CV measures (0.643-0.944). Individuals also exhibited significant consistency of responses within CV measures: SV was positively correlated with LVET (ρ=0.791, P=0.004), HR was negatively correlated with LVET (ρ=-0.627, P=0.039) and CI was negatively correlated with SVRI (ρ=-0.936, P&amp;lt; 0.001). Conclusion Vulnerability to repeated TSD exposures showed trait-like stability in CV measures across months 2, 4, and 8, with significant consistency of responses within CV measures. For the first time, we demonstrate robust phenotypic stability of cardiovascular measures during total sleep deprivation across 2-month, 4-month and 8-month time points in long-duration studies. Our results herald the use of biomarkers and countermeasures for prediction and mitigation of this critical vulnerability. Support (if any) NASA grants NNX14AN49G and 80NSSC20K0243 (NG)

Enduring Positive Impact of a Virtual Communication Skills Workshop of VitalTalk Pedagogy in a Non-U.S. Setting.

While in-person workshops on serious illness communication skills using VitalTalk pedagogy have been shown to have a long-lasting impact, whether changing the format into virtual would maintain its enduring impact is unknown. Objectives. To examine long-term impacts of a virtual VitalTalk communication workshop. Physicians in Japan who participated in our virtual VitalTalk workshop were asked to complete a self-assessment survey at 3 time points: before, immediately after, and 2 months after the workshop. We examined self-reported preparedness in 11 communication skills on a 5-point Likert scale at 3 time points, as well as self-reported frequency of practice on 5 communication skills at the pre- and 2-month time points. Between January 2021 and June 2022, 117 physicians from 73 institutions across Japan completed our workshop. Seventy-four participants returned the survey at all the 3 time points. Their skill preparedness significantly improved upon the completion of the workshop in all 11 skills (P < .001 for all items). The improvement remained at the same level at 2 months in 7 skills. In 4 of the 11 skills, there was further improvement at the 2-month point. The frequency of self-directed skill practice also increased significantly in the 2-month survey for all 5 skills. A virtual workshop of VitalTalk pedagogy improved self-reported preparedness of communication skills, and the impact was long-lasting in a non-U.S. setting as it likely induced self-practice of skills. Our findings encourage the use of a virtual format in any geographical location considering its enduring impact and easy accessibility.

Cost Utility and Value of Information Analysis of Femtosecond Laser–Assisted Cataract Surgery

The efficacy and safety of femtosecond laser-assisted cataract surgery is well documented. An important requirement for decision makers is the evaluation of the cost-effectiveness of femtosecond laser-assisted cataract surgery (FLACS) over a sufficiently long horizon. Evaluating the cost-effectiveness of this treatment was a preplanned secondary objective of the Economic Evaluation of Femtosecond Laser Assisted Cataract Surgery (FEMCAT) trial. To estimate the cost utility of FLACS compared with phacoemulsification cataract surgery (PCS) on a 12-month time horizon. This multicenter randomized clinical trial compared FLACS with PCS in parallel groups. All FLACS procedures were performed using the CATALYS precision system. Participants were recruited and treated in ambulatory surgery settings in 5 university-hospital centers in France. All consecutive patients eligible for a unilateral or bilateral cataract surgery 22 years or older with written informed consent were included. Data were collected from October 2013 to October 2018, and data were analyzed from January 2020 to June 2022. FLACS or PCS. Utility was measured through the Health Utility Index questionnaire. Costs of cataract surgery were estimated by microcosting. All inpatient and outpatient costs were collected from the French National Health Data System. Of 870 randomized patients, 543 (62.4%) were female, and the mean (SD) age at surgery was 72.3 (8.6) years. A total of 440 patients were randomized to receive FLACS and 430 to receive PCS; the rate of bilateral surgery was 63.3% (551 of 870). The mean (SD) costs of cataract surgery were €1124.0 (€162.2; US $1235) for FLACS and €565.5 (€61.4; US $621) for PCS. The total mean (SD) cost of care at 12 months was €7085 (€6700; US $7787) in participants treated with FLACS and €6502 (€7323; US $7146) in participants treated with PCS. FLACS yielded a mean (SD) of 0.788 (0.009) quality-adjusted life-years (QALYs), and PCS yielded 0.792 (0.009) QALYs. The difference in mean costs was €545.9 (95% CI, -434.1 to 1525.8; US $600), and the difference in QALYs was -0.004 (95% CI, -0.028 to 0.021). The incremental cost-effectiveness ratio (ICER) was -€136 476 (US $150 000) per QALY. The cost-effectiveness probability of FLACS compared with PCS was 15.7% for a cost-effectiveness threshold of €30 000 (US $32 973) per QALY. At this threshold, the expected value of perfect information was €246 139 079 (US $270 530 231). The ICER of FLACS compared with PCS was not within the $50 000 to $100 000 per QALY range frequently cited as cost-effective. Additional research and development on FLACS is needed to improve its effectiveness and lower its price. ClinicalTrials.gov Identifier: NCT01982006.

A brief web-based depression literacy, efficacy, and stigma intervention among college students

ABSTRACT Objective The purpose of this study was to examine the impact of a brief web-based depression literacy intervention compared to a control condition on depression literacy, depression literacy efficacy, self-stigma, perceived public stigma, and personal stigma toward depression. Method College students (N = 210) from a large university in the southeastern United States were recruited via a human subject pool and randomly assigned to the intervention (web-based depression literacy) or control condition. Participants completed online surveys at pre-intervention, post-intervention, and 1-month follow-up time points. A short qualitative reflection question was also responded to post-intervention. Results No significant intervention condition by time interactions were seen across any variables included in the study. Significant main effects of time were found for the depression literacy, depression literacy efficacy, self-stigma, and personal stigma variables. Qualitative results show participants reported gaining a general understanding of depression in addition to more specific information such as knowing different treatment options or depression related resources. Discussion Education through a brief web-based depression literacy intervention did not improve college students’ literacy, confidence in recognising, managing, and preventing depression, or stigma towards this mental health disorder, compared to an active control condition.

Concurrent and lagged effects of drought on grassland net primary productivity: a case study in Xinjiang, China

Xinjiang grasslands play a crucial role in regulating the regional carbon cycle and maintaining ecosystem stability, and grassland net primary productivity (NPP) is highly vulnerable to drought. Drought events are frequent in Xinjiang due to the impact of global warming. However, there is a lack of more systematic research results on how Xinjiang grassland NPP responds to drought and how its heterogeneity is characterized. In this study, the CASA (Carnegie Ames Stanford Application) model was used to simulate the 1982–2020 grassland NPP in Xinjiang, and the standardized Precipitation Evapotranspiration Index (SPEI) was calculated using meteorological station data to characterize drought. The spatial and temporal variability of NPP and drought in Xinjiang grasslands from 1982 to 2020 were analyzed by the Sen trend method and the Mann-Kendall test, and the response characteristics of NPP to drought in Xinjiang grasslands were investigated by the correlation analysis method. The results showed that (1) the overall trend of NPP in Xinjiang grassland was increasing, and its value was growing season &amp;gt; summer &amp;gt; spring &amp;gt; autumn. Mild drought occurred most frequently in the growing season and autumn, and moderate drought occurred most frequently in spring. (2) A total of 64.63% of grassland NPP had a mainly concurrent effect on drought, and these grasslands were primarily located in the northern region of Xinjiang. The concurrent effect of drought on NPP was strongest in plain grassland and weakest in alpine subalpine grassland. (3) The lagged effect is mainly in the southern grasslands, the NPP of alpine subalpine meadows, meadows, and alpine subalpine grasslands showed mainly a 1-month time lag effect to drought, and desert grassland NPP showed mainly a 3-month time lag effect to drought. This research can contribute to a reliable theoretical basis for regional sustainable development.

Monthly streamflow forecasting by machine learning methods using dynamic weather prediction model outputs over Iran

Seasonal hydrological forecasts play a critical role in water resources management. The Copernicus Climate Change Service (C3S) data store provides open access to monthly hydrological forecasts for up to six-months. This study aims to evaluate, for the first time, 1- to 3-month runoff forecasts using the European Centre for Medium-Range Weather Forecasts (ECMWF) ensembles of precipitation, runoff, and temperature in 1981–2015 period over a total of 30 s-level basins in Iran. We adopted the 5th, 50th and 95th ECMWF ensemble quantiles for each variable that represent low, medium and high probability of occurrence, respectively. Pearson correlation analysis (Pca), Recursive Feature Elimination (RFE) via random forest (RF) model, and Bayesian Networks (BN) feature selection algorithms were used in order to reduce input variable dimension and select potential predictors to be fed to the machine learning models. Multiple Linear Regression (MLR), Artificial Neural Networks (ANN), Support Vector Regression (SVR), Random Forest (RF), and eXtreme Gradient Boosting (XGBoost) machine learning models were used with Repeated K-Fold cross validation (rK-Fold CV) while model efficiency was evaluated using modified Kling-Gupta efficiency coefficient (KGE’), Nash-Sutcliffe Efficiency coefficient (NSE), and Normalized Root Mean Square Error (NRMSE). Results of this study revealed that C3S runoff ensembles have the highest impact on forecast accuracy of streamflow, followed by precipitation and temperature. Overall, model performance yield a best-to-worst ranking of ANN, XGBoost, RF, MLR, and SVR with KGE’ values of 0.70, 0.68, 0.66, 0.57, and 0.41, respectively. The predictive performance of all models decreased with lead times beyond 1-month, where ANN and XGBoost outperformed other models with KGE’ of 0.65 for 2-month lead time and 0.60 for 3-month lead time. The three superior models of XGBoost, ANN, and RF, were employed with RFE and BN FSAs most frequently across Iran’s 30 s level basins in all lead times. Almost all models in the arid central region of Iran showed the lowest performance while highest skills were achieved in the western regions of Iran. Finally, for all models and over all regions, the model performance reduced by increase in lead-time.

MP74-05 WHAT FACTORS DETERMINE WHICH FEMALE PATIENTS WITH OVERACTIVE BLADDER FOLLOW-UP?

You have accessJournal of UrologyCME1 Apr 2023MP74-05 WHAT FACTORS DETERMINE WHICH FEMALE PATIENTS WITH OVERACTIVE BLADDER FOLLOW-UP? Connelly Miller, Arshia Harandi, Jonathan Aronov, Jennifer Ramgopal, Philip Fonesca, Holly Smith, Brian Shkolnik, Jacob Hartman-Kenzler, Aaron Huang, and Jason Kim Connelly MillerConnelly Miller More articles by this author , Arshia HarandiArshia Harandi More articles by this author , Jonathan AronovJonathan Aronov More articles by this author , Jennifer RamgopalJennifer Ramgopal More articles by this author , Philip FonescaPhilip Fonesca More articles by this author , Holly SmithHolly Smith More articles by this author , Brian ShkolnikBrian Shkolnik More articles by this author , Jacob Hartman-KenzlerJacob Hartman-Kenzler More articles by this author , Aaron HuangAaron Huang More articles by this author , and Jason KimJason Kim More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003348.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Overactive bladder (OAB) is a common condition responsible for significant morbidity in female patients. Treatment can be complex and multifaceted, requiring strict treatment compliance and often several clinical encounters for effective symptom management. Recognizing risk factors for loss to follow-up is critical to identifying patients who may require supplementary interventions to improve adherence. METHODS: Adult female patients presenting for a new patient visit for OAB symptoms (frequency, urgency, incontinence, nocturia) were identified at an outpatient urology clinic between July 2020 and June 2021. Medical records were abstracted for demographic data, smoking history, medical comorbidities, and baseline OAB symptom severity. Prospective chart review was performed to identify additional urology clinic visits for any reason at 1-month, 3-month, and present-day time horizons. The Student’s t-test for quantitative variables and the chi-squared test for qualitative variables were used to compared characteristics of patients who did and did not have follow-up visits by those time horizons. RESULTS: 816 female patients were included in the analysis, of which 63.1% had a follow-up visit recorded between the initial visit and present-day. There was no difference in follow-up by age or race (see Table 1). Patients with follow-up visits within the catchment period were more likely to live closer (p<.05), have neurogenic OAB (p<.05), and endorse incontinence (p<.05). They were also more likely to have a history of hypertension (p<.01) and heart disease (p<.05), and at the 1-month and 3-month time horizons to report a history of chronic pain (p<.05 and p<.01, respectively). CONCLUSIONS: This study recapitulates known associations between distance to clinic and baseline symptom severity with chance of follow-up, but also reveals a correlation between follow-up for overactive bladder and certain medical comorbidities, which may provide real-world evidence for the potential role of multidisciplinary approaches in the treatment of OAB. The lack of age-based and racial inequity in follow-up rates is also noteworthy. Further research could target interventions to reduce attrition through the creation of a hazard score to identify patients at high-risk for loss to follow-up. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1070 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Connelly Miller More articles by this author Arshia Harandi More articles by this author Jonathan Aronov More articles by this author Jennifer Ramgopal More articles by this author Philip Fonesca More articles by this author Holly Smith More articles by this author Brian Shkolnik More articles by this author Jacob Hartman-Kenzler More articles by this author Aaron Huang More articles by this author Jason Kim More articles by this author Expand All Advertisement PDF downloadLoading ...

Objective assessment of patients with idiopathic normal pressure hydrocephalus following ventriculoperitoneal shunt placement using activity-monitoring data: pilot study

Idiopathic normal pressure hydrocephalus (iNPH) results in significant morbidity in the elderly with symptoms of dementia, gait instability, and urinary incontinence. In well-selected patients, ventriculoperitoneal shunt (VPS) placement often results in clinical improvement. Most postshunt assessments of patients rely on subjective scales. The goal of this study was to assess the utility of remote activity monitoring to provide objective evidence of gait improvement following VPS placement for iNPH. Patients with iNPH were prospectively enrolled and fitted with 5 activity monitors (on the hip and bilateral thighs and ankles) that they wore for 4 days preoperatively within 30 days of surgery and for 4 days within 30 days postoperatively. Monitors collected continuous data for number of steps, cadence, body position (upright, prone, supine, and lateral decubitus), gait entropy, and the proportion of each day spent active or static. Data were retrieved from the devices and a comparison of pre- and postoperative movement assessment was performed. The gait data were also correlated with formal clinical gait assessments before and after lumbar puncture and with motion analysis laboratory testing at baseline and 1 month and 1 year after VPS placement. Twenty patients fulfilled the inclusion and exclusion criteria (median age 76 years). The baseline median number of daily steps was 1929, the median percentage of the day spent inactive was 70%, the median percentage of the day with a static posture was 95%, the median gait velocity was 0.49 m/sec, and the median number of steps required to turn was 8. There was objective improvement in median entropy from pre- to postoperatively, increasing from 0.6 to 0.8 (p = 0.002). There were no statistically significant differences for any of the remaining variables measured by the activity monitors when comparing the preoperative to the 1-month postoperative time point. All variables from motion analysis testing showed statistically significant differences or a trend toward significance at 1 year after VPS placement. Among the significantly correlated variables at baseline, cadence was inversely correlated with percentage of gait cycle spent in the support phase (contact with ground vs swing phase). This pilot study suggests that activity monitoring provides an early objective measure of improvement in gait entropy after VPS placement among patients with iNPH, although a more significant improvement was noted on the detailed clinical gait assessments. Further long-term studies are needed to determine the utility of remote monitoring for assessing gait improvement following VPS placement.

MP06-04 TRANSFORMING PERIOPERATIVE PROCESSES: COLLABORATION, EVALUATION, AND IMPROVEMENT

You have accessJournal of UrologyCME1 Apr 2023MP06-04 TRANSFORMING PERIOPERATIVE PROCESSES: COLLABORATION, EVALUATION, AND IMPROVEMENT Brittany Levy, Julia Haye, Wesley Wilt, Raymond Young, Emily Eichinger, and Andrew Harris Brittany LevyBrittany Levy More articles by this author , Julia HayeJulia Haye More articles by this author , Wesley WiltWesley Wilt More articles by this author , Raymond YoungRaymond Young More articles by this author , Emily EichingerEmily Eichinger More articles by this author , and Andrew HarrisAndrew Harris More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003217.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: On-time first case starts (FCS) is a nationally recognized indicator for operating room efficiency. While much attention is given to the minutes surrounding in-room time, opportunities for efficiency start from the moment the patient arrives in the hospital. Therefore, initial processes surrounding patient registration and rooming play an important role in achieving an on-time operating room (OR) start. We hypothesize LEAN methodology process improvement could enhance perioperative efficiency and standardization. METHODS: The Parallel Process Quality Improvement Initiative was conducted from 7/2022-9/2022 in the main OR of a tertiary care academic center. 844 visits pre-implementation and 244 visits post-implementation were audited over the study period. The QI initiatives were developed in concert with a QI experienced urology faculty member. Both leadership and frontline stakeholders were engaged, including perioperative leadership, perioperative staff, and administrative staff to identify current workflows and potential interventions targeting outpatient elective procedures. Process mapping outlined current rooming workflows. Benchmarks were developed through stakeholder team collaboration, and outcomes based on these benchmarks were obtained. RESULTS: Preliminary data revealed 844 patients who underwent elective FCS outpatient surgeries over a 2-month time period. Pre-implementation, patients were roomed by a mean time of 6:06 AM. However, after collaboration with the multidisciplinary team, 6 AM was chosen as the benchmark for FCS rooming. Overall, pre-implementation, 33% of FCS patients were roomed by 6 AM. Process mapping revealed a sequential process, which was converted to a parallel process. Implementation of the parallel process rendered an improved 6 AM rooming rate to 81% of FCS patients (Figure 1). Additionally, the parallel process reduced downtime for perioperative staff, by an average of 9 minutes (IQR=0, 13 min). CONCLUSIONS: Using LEAN methodology of process improvement and collaboration, perioperative processes can be evaluated and improved. Benchmarking, process evaluation, and auditing are needed for sustainable improvement. Standardized, parallel processes support enhanced efficiency in the perioperative process. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e54 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Brittany Levy More articles by this author Julia Haye More articles by this author Wesley Wilt More articles by this author Raymond Young More articles by this author Emily Eichinger More articles by this author Andrew Harris More articles by this author Expand All Advertisement PDF downloadLoading ...