Outcome Assessment Research Articles

Digital twin-driven cloud manufacturing system: an implementation framework, operating mechanism and key technologies

ABSTRACT Cloud manufacturing (CMfg), as a manufacturing mode to realize resource collaboration and service sharing, can help enterprises reduce costs, increase efficiency and enhance competitiveness. Existing CMfg relies on historical service evaluation results as the basis for task matching and thus lacks effective methods for the precise assessment of the adaptability to current tasks and the sustainability for future endeavors; throughout the service process, deficiencies occur including a lack of real-time assessment, prediction, and optimization capabilities for service execution outcomes. Motivated by the shortcomings of existing CMfg, this article focuses on how to enhance the dynamism and timeliness of the CMfg service process. A novel digital twin (DT)-driven CMfg service model is proposed. Specifically, a framework and an operation mechanism of DT-driven CMfg service are proposed; three key technologies related to DT in CMfg service are proposed, including model migration based matching modeling technology, multi-agent reinforcement learning based CMfg service composition optimization, and DT data-driven CMfg service performance prediction, which provide a theory and method for the DT and CMfg integration construction. The experiment demonstrates that the proposed methods have good performance for the production of cast aluminum engine fan bracket and provide a holistic understanding of DT in CMfg service.

Predictors of affective disturbances and cognitive impairment following small spontaneous supratentorial intracerebral hemorrhage.

Affective disturbances and cognitive impairment are common sequelae of intracerebral hemorrhage (ICH), yet predictive models for these outcomes remain limited, especially for spontaneous supratentorial ICH with small hematomas (<30 mL). The aim of this study was to investigate predictors of affective disturbances and cognitive impairment following small spontaneous supratentorial intracerebral hemorrhage. We retrospectively analyzed 1692 patients with spontaneous supratentorial ICH between January 2018 and December 2020 at the First Affiliated Hospital of Harbin Medical University. Of these, 1563 patients completed a median follow-up of 3.5 years. Cognitive function was evaluated using the modified Telephone Interview for Cognitive Status, and affective disturbances using the Hamilton Depression Scale and the Hamilton Anxiety Scale. Restricted cubic spline analyses were employed to examine the relationships between predictors and outcomes. In this cohort, 58.5% had cognitive impairment, 52.8% reported depressive symptoms, and 39.4% exhibited anxiety symptoms. Logistic regression models using Boruta's algorithm demonstrated strong predictive capacity, with areas under the curve of 0.82 for cognitive impairment, 0.78 for depressive symptoms, and 0.73 for anxiety symptoms. Hematoma volume was significantly linked to depressive symptoms (odds ratio [OR] 1.56, 95% confidence interval [CI] 1.38-1.76) and inversely to cognitive impairment (OR 0.67, 95% CI 0.59-0.77). Uric acid levels displayed a nonlinear relationship with cognitive impairment (OR 0.70, 95% CI 0.61-0.81). Hospitalization days significantly raised the risk of both depressive (OR 1.16, 95% CI 1.03-1.30) and anxiety symptoms (OR 1.17, 95% CI 1.04-1.31). The logistic regression model, enhanced by Boruta's algorithm, provides a valuable tool for predicting affective disturbances and cognitive impairment after ICH. It facilitates early identification and improves risk assessment for these neuropsychiatric outcomes in patients with small hematomas.

In-depth hemodynamic assessment in acute mild stroke patients with large vessel occlusion or stenosis

ObjectiveAcute treatment in mild stroke patients with acute anterior circulation large vessel occlusion/stenosis (AACLVO/S) had limited evidence. Hemodynamic play an important role in neurological deterioration. We aimed to investigate predictor value of hemodynamic assessment for clinical outcome predicting and guiding individual therapeutic decisions in those patients.MethodsWe retrospectively analyze the stroke database in our stroke center. We recruited patients with mild stroke, defined by National Institutes of Health Stroke Scale (NIHSS) score ≤ 5, caused by AACLVO/S treated with just medical management (MT). They all received cerebral autoregulation (CA) assessments within 72 h after stroke onset. The primary end point was clinical outcome at 90-day after stroke.ResultsLogistic regression analysis showed that bilateral higher baseline phase difference (PD) were independent variables related to favorable 90-day outcome, (OR 0.963, 95% CI 0.936–0.991, p = 0.040; OR 0.943, 95% CI 0.970–0.997; p = 0.008, respectively). The optimal cutoff value of bilateral PD was > 34.97º and > 14.29º respectively.ConclusionCA evaluation can provide hemodynamic status in mild stroke patients with AACLVO/S.

The Power and Peril of Program Reviews: The Resource Paradox of Assessing for Improvement

In this essay, we explore program reviews as important sites for the tension Peter Ewell defines at the core of outcomes assessment practices: that is, between assessing for accountability and assessing for improvement. We address this tension through the example of our Industrial Design program on our urban campus in New York City. In exploring Ewell’s tension between accountability and improvement, we develop the concept of the resource paradox. Simply stated, program reviews require institutions to invest time and resources to close the loop on implementing improvements – yet those actions often require resources many institutions lack. Using our case study and reviewing the scholarship on program reviews, we address the resource paradox by describing how we’ve tried to address it, and how other institutions might also do so.

A review on efficacy of polygenic risk score information on behavioral change and clinical outcomes

Abstract Background Polygenic Risk Score (PRS) represents a promising advancement in personalized medicine, enabling the inherited risk assessment for disease outcomes based on the effect of various common genetic variants. The utilization of PRS information to promote the adoption of healthier behaviors has witnessed an increase interest in recent years, but its full potential still needs to be fully addressed. Methods This systematic review aims to assess the efficacy of disclosing PRS information on individuals’ engagement in risk-reducing interventions. CENTRAL database has been searched up to December 2023 to identify randomized controlled trials (RCTs) comparing the disclosure of PRS results, with scenarios where other or no information is provided. We performed a preliminary meta-analysis on the mean difference of clinical and psychological outcomes between the two arms. Results Out of 4419 results, we included 12 studies. Trials focused on primary (83%), secondary (8%) and tertiary (8%) preventive interventions. As for the possible diseases predicted by the PRS, cardiovascular diseases (33%) were the most common (n = 4), along with cancers (33%), diabetes (25%) and metabolic disease (8%). PRS result disclosure was compared to standard care (n = 7), no information provided (n = 4), and family risk (n = 1). By pooling data from four comparable studies, we report a reduction in the mean difference for LDL cholesterol in the intervention group of -6.39mg/dL (95%CI -10.09, -2.70, I²=0%, p &amp;lt; 0.001). No significant changes were observed for systolic and diastolic blood pressure, and weight, in 3 studies and 4 analyzed studies, respectively. An increase in anxiety levels was observed towards the PRS group in 4 studies (SMD 0.24, 95%CI 0.02, 0.46, I² = 66%, p = 0.03). Conclusions Preliminary analysis show small or no effects of PRS disclosure on intermediate health or psychological outcomes. Larger trials assessing the potentiality of PRS disclosure are still needed. Key messages • From the analysis of twelve preventive trials on the efficacy of PRS on behavior change, we report a positive effect on LDL cholesterol reduction. • Larger well conducted trials are needed to integrate PRS-based information into future preventive strategies.

ChineseCVD: a web-based Chinese-specifi c cardiovascular risk calculator incorporating long COVID, COVID-19vaccination, SGLT2i and PCSK9i treatment effects

Abstract Background Web-based risk prediction tools for cardiovascular diseases are crucial for providing rapid risk estimates for busy clinicians, but there is none available specifically for Chinese subjects. This study developed ChineseCVD, a risk calculator for cardiovascular disease. Methods Adult patients attending government-funded family medicine clinics in Hong Kong between 1st January 2000 and 31st December 2003 were included. The primary outcome was major adverse cardiovascular events (MACE) defined as a composite of myocardial infarction, heart failure, transient ischaemic attacks/ischaemic strokes, and cardiovascular mortality. Results A total of 155,066 patients were used as the derivation cohort. Over a median follow-up of 16.1 (11.6-17.8) years, 31,061 (20.44%) had MACE. Cox regression identified male gender, age, comorbidities, cardiovascular medications, systolic and diastolic blood pressure, and laboratory test results (neutrophil-lymphocyte ratio, creatinine, ALP, AST, ALT, HbA1c, fasting glucose, triglyceride, LDL and HDL) as significant predictors of the above outcomes. ChineseCVD further incorporates the impact of smoking status, COVID-19 infection, number of COVID-19 vaccination doses, and modifier effects of newest medication classes of PCSK9i and SGLT2i. The calculator enables clinicians to demonstrate to patients how risks vary with different medications. Conclusions The ChineseCVD risk calculator enables rapid web-based risk assessment for adverse cardiovascular outcomes, thereby facilitating clinical decision-making at the bedside or in the clinic.

Functional and subjective outcomes after surgical management of complex elbow dislocations: a retrospective study.

Dislocations of the elbow are the second most frequent upper-body injury after shoulder dislocations, comprising 11-28% of all elbow injuries. Complex elbow dislocations pose challenging management due to the involvement of critical stabilizing structures. This study aimed to investigate functional and subjective outcomes (MEPS, DASH, Oxford score) in 44 patients with complex elbow dislocations who underwent surgery between 2018 and 2020, with subgroup analysis focusing on gender and age differences. A retrospective analysis was conducted on patients treated at C.T.O. Hospital, Turin, for complex elbow dislocations between January 2018 and December 2020. Surgical approaches included radial head synthesis, coronoid fixation, ligamentous repair, and ulnar nerve management. Postoperatively, patients followed a standardized or individualized program. Data analysis involved t-tests to assess score differences between subgroups. Among the 44 analyzed patients, the mean age was 48years, and the mean follow-up time was 29months. Various types of complex dislocations were identified, with radial head and coronoid fractures classified accordingly. Surgical approaches included multiple methods of reduction and synthesis. While most patients adhered to postoperative programs, subsequent reoperations were conducted in 11% of cases. Scores did not significantly differ between genders, although a trend toward better DASH scores in males was observed. Younger patients showed better, though not statistically significant, outcomes in mobility and functional measures. This study underscores the importance of pre-operative assessment for positive surgical outcomes in complex elbow dislocations. Additionally, findings suggest that younger age may correlate with slightly better functional outcomes. Despite limitations such as retrospective design and sample size, the study enhances our understanding of complex dislocation outcomes and provides valuable insights for future interventions.

Based on hematoma and perihematomal tissue NCCT imaging radiomics predicts early clinical outcome of conservatively treated spontaneous cerebral hemorrhage

Spontaneous intracerebral hemorrhage (ICH) is a very serious kind of stroke. If the outcome of patients can be accurately assessed at the early stage of disease occurrence, it will be of great significance to the patients and clinical treatment. The present study was conducted to investigate whether non-contrast computer tomography (NCCT) models of hematoma and perihematomal tissues could improve the accuracy of short-term prognosis prediction in ICH patients with conservative treatment. In this retrospective analysis, a total of 166 ICH patients with conservative treatment during hospitalization were included. Patients were randomized into a training group (N = 132) and a validation group (N = 34) in a ratio of 8:2, and the functional outcome at 90 days after clinical treatment was assessed by the modified Rankin Scale (mRS). Radiomic features of hematoma and perihematomal tissues of 5 mm, 10 mm, 15 mm were extracted from NCCT images. Clinical factors were analyzed by univariate and multivariate logistic regression to identify independent predictive factors. In the validation group, the mean area under the ROC curve (AUC) of the hematoma was 0.830, the AUC of the perihematomal tissue within 5 mm, 10 mm, 15 mm was 0.792, 0.826, 0.774, respectively, and the AUC of the combined model of hematoma and perihematomal tissue within 10 mm was 0.795. The clinical-radiomics nomogram consisting of five independent predictors and radiomics score (Rad-score) of the hematoma model were used to assess 90-day functional outcome in ICH patients with conservative treatment. Our findings found that the hematoma model had better discriminative efficacy in evaluating the early prognosis of conservatively managed ICH patients. The visual clinical-radiomics nomogram provided a more intuitive individualized risk assessment for 90-day functional outcome in ICH patients with conservative treatment. The hematoma could remain the primary therapeutic target for conservatively managed ICH patients, emphasizing the need for future clinical focus on the biological significance of the hematoma itself.

Development and Assessment of a Sustainable PhD Internship Program Supporting Diverse Biomedical Career Outcomes.

A doctoral-level internship program was developed at the University of North Carolina at Chapel Hill with the intent to create customizable experiential learning opportunities for biomedical trainees to support career exploration, preparation, and transition into their post-graduate professional roles. We report the outcomes of this program over a five-year period. During that 5-year period, 123 internships took place at over 70 partner sites, representing at least 20 academic, for-profit, and non-profit career paths in the life sciences. A major goal of the program was to enhance trainees' skill development and expertise in careers of interest. The benefits of the internship program for interns, host/employer, and supervisor/principal investigator were assessed using a mixed-methods approach, including surveys with closed- and open-ended responses as well as focus group interviews. Balancing stakeholder interests is key to creating a sustainable program with widespread support; hence, the level of support from internship hosts and faculty members were key metrics analyzed throughout. We hypothesized that once a successful internship program was implemented, faculty culture might shift to be more accepting of internships; indeed, the data quantifying faculty attitudes support this. Furthermore, host motivation and performance expectations of interns were compared with results achieved, and this data revealed both expected and surprising benefits to hosts. Data suggests a myriad of benefits for each stakeholder group, and themes are cataloged and discussed. Program outcomes, evaluation data, policies, resources, and best practices developed through the implementation of this program are shared to provide resources that facilitate the creation of similar internship programs at other institutions. Program development was initially spurred by National Institutes of Health pilot funding, thereafter, successfully transitioning from a grant-supported model, to an institutionally supported funding model to achieve long-term programmatic sustainability.

Use of SPY angiography in tissue assessment for wound healing outcomes after breast reconstruction.

The objective of this study was to evaluate whether a systematic image assessment protocol using SPY Elite images (LifeCell Corp., US) of viable tissue at the periphery of the surgical field was associated with positive wound healing outcomes following mastectomy and breast reconstruction. Patients undergoing mastectomy and subsequent breast reconstruction surgery at a single tertiary medical centre were included. SPY images were prospectively analysed using a systematic image assessment protocol, and an absolute value of mean fluorescence was calculated by measuring peripheral, in-situ tissue from each image. Patient medical records were retrospectively reviewed for demographics, surgical characteristics and postoperative outcomes. These variables were statistically tested for associations with mean fluorescence. A total of 63 patients were included in the final analysis. We found that objectively determined mean fluorescence values were not statistically significantly associated with postoperative complications. In this study, objectively measured mean fluorescence values representing breast tissue remaining after dissection showed little utility in the assessment of postoperative wound healing outcomes as they did not identify patients who would later have complications of wound healing. The authors have no conflicts of interest to declare.

Stopping anticoagulation for isolated or incidental pulmonary embolism: the STOPAPE RCT protocol.

Is withholding anticoagulation for patients with isolated or incidental subsegmental pulmonary embolism clinically and cost-effective compared with full anticoagulation for 3 months? There has been an increase in the diagnosis of subsegmental pulmonary embolism since the advent of computed tomography pulmonary angiogram to investigate patients with suspected pulmonary embolism. Subsegmental pulmonary embolism is not often detectable with older nuclear medicine-based diagnostic imaging for ventilation/perfusion mismatch. The case fatality of pulmonary embolism has reduced as subsegmental pulmonary embolism diagnoses from computed tomography pulmonary angiogram have increased. There is growing equipoise about the optimal treatment for patients with subsegmental pulmonary embolism, given that full anticoagulation has significant risks of bleeding and subsegmental pulmonary embolism was not often diagnosed previously with ventilation/perfusion scanning and therefore most likely left predominantly untreated prior to the introduction of computed tomography pulmonary angiogram scanning. Determine whether withholding anticoagulation for isolated or incidental subsegmental pulmonary embolism (i.e. subsegmental pulmonary embolism with no coexisting deep-vein thrombosis) reduces the harms of recurrent thromboembolism and major bleeding compared with 3 months of full anticoagulation at 3, 6 and 12 months. Determine the rate of complications of anticoagulation therapy (predominantly bleeding) in patients with isolated subsegmental pulmonary embolism. Determine whether not treating isolated subsegmental pulmonary embolism is acceptable to clinicians and patients. Determine the reclassification rate of subsegmental pulmonary embolism diagnoses made by general reporting radiologists when reviewed by specialist respiratory radiologists and develop a set of rules to improve general radiologists' diagnoses of subsegmental pulmonary embolism. Assess cost-effectiveness of not treating patients with isolated subsegmental pulmonary embolism with anticoagulation, taking a health service perspective. Prospective individually randomised open controlled trial with blinded end-point committee assessment for outcomes, powered for non-inferiority for recurrent venous thromboembolism and for superiority for bleeding events. An internal pilot phase is included for feasibility and acceptability of no anticoagulation. We planned to recruit 1466 patients from at least 50 acute hospital sites. Allowing for a dropout rate of 15%, this would have given us 90% power to detect a reduction in major and clinically relevant non-major bleeding from 7.3% in the anticoagulation arm to 3% in the intervention arm. We were powered to determine that a strategy of no anticoagulation was non-inferior to anticoagulation with an upper margin of a 2.3% increase in recurrent venous thromboembolism from an expected rate of 2% in those who receive full anticoagulation. We also planned to undertake a study comparing acute reporting radiologists' diagnoses of subsegmental pulmonary embolism from all computed tomography pulmonary angiograms with specialist respiratory radiologists. This would have allowed us to determine safety in the pilot study (i.e. patients with pulmonary embolism that was in fact larger than subsegmental would have been identified) and develop guidance for subsegmental pulmonary embolism diagnosis for general radiologists. Patients with lived experience of thrombosis contributed to all aspects of the trial design and were part of the Trial Management Group. The STOPAPE trial was stopped prematurely due to a low recruitment rate in the wake of the COVID pandemic and prioritisation of recovery of the National Institute for Health and Care Research research portfolio. There are no outcome data available for this trial. Separate NIHR Library publications will detail the linked qualitative study examining the views of patients and clinicians around withholding anticoagulation for isolated subsegmental pulmonary embolism as well as presenting all collected data of recruited patients. This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number NIHR128073. A plain language summary of this research article is available on the NIHR Journals Library Website https://doi.org/10.3310/HRCW7937.

Clinical outcomes measurement in pediatric lower limb prosthetics: A scoping review.

This study aimed to identify clinical measures that have been used to evaluate function, health related quality of life (HRQoL), and/or satisfaction in children who use lower limb prostheses (LLP). The data reported on psychometric properties for children who use LLP were collected for each measure. First, PubMed, CINAHL, and Web of Science databases were searched using broad search terms to identify standardized outcome measures of function, HRQoL, and/or satisfaction with treatment used in pediatric LLP research published in 2001 or after. For each of the eligible measures found, a second search was performed to identify psychometric properties (e.g., validity, reliability) assessed with children who use LLP. Forty-four standardized outcome measures were identified from 41 pediatric LLP research articles. Five measures (i.e., Gait Outcomes Assessment for Lower Limb Differences, Functional Mobility Assessment, Child Amputee Prosthetics Project- Prosthesis Satisfaction Inventory, Child Amputee Prosthetics Project- Functional Scale Index, and Lower Limb Function Questionnaire) had data on psychometric properties for children who use LLP. Few studies report psychometric data for assessing the overall HRQoL, function, and/or satisfaction for children who use LLP. Further research is needed to validate or create new outcome measures that assess the HRQoL, satisfaction, and/or function of children who use LLP.

Optimizing Arabic Language Assessment through Anates Analysis

This study evaluates the quality of Arabic Language questions in a Mid-Semester Summative Assessment using the Anates V4.0.9 program. Employing a descriptive quantitative approach, 20 multiple-choice questions were administered to 30 class 10 students at SMA Muhammadiyah 2 Sidoarjo. Results indicate an 80% validity rate, with a reliability coefficient of 0.87, suggesting consistency. The questions demonstrate a medium level of difficulty and an 80% discriminating power, effectively distinguishing between students' understanding levels. These findings underscore the importance of rigorous assessment practices in Arabic Language education, aiding educators in enhancing assessment quality and improving student learning outcomes. Highligh: Assessment: Anates V4.0.9 Program for Arabic Language Questions Analysis. Student Understanding: 80% Question Discrimination Highlights Assessment Precision. Educational Insights: Enhancing Arabic Language Assessment for Optimal Learning Outcomes. keywoard: Arabic Language Assessment, Validity, Reliability, Difficulty Level, Distinguishing Power

Psychotherapies for the treatment of borderline personality disorder: A systematic review.

Borderline personality disorder (BPD) is the most common personality disorder, affecting 1.8% of the general population, 10% of psychiatric outpatients, and 15%-25% of psychiatric inpatients. Practice guidelines recommend psychotherapies as first-line treatments. However, psychotherapies commonly used for the treatment of BPD are numerous, and little is known about the comparative effectiveness of each individual psychotherapy versus treatment as usual (TAU) or other psychotherapies. To systematically assess the comparative effectiveness of commonly used psychotherapies versus TAU or versus other psychotherapies for BPD treatment. We conducted systematic literature searches in MEDLINE, EMBASE, the Cochrane Library, and APA PsycINFO up to July 14, 2022, and searched reference lists of pertinent articles and reviews. Inclusion criteria were (a) patients 13 years or older with a diagnosis of BPD, (b) treatment with commonly used psychotherapies, (c) comparison with TAU or another psychotherapy, (d) assessment of relevant BPD-related health outcomes, and (e) randomized or nonrandomized trials or controlled observational studies. Two investigators independently screened abstracts and full-text articles and graded the certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. We found 25 psychotherapy studies meeting inclusion criteria with data on 2,545 participants. Seventeen studies compared nine psychotherapies with TAU and nine studies compared eight psychotherapies with another psychotherapy for the treatment of BPD. Overall, both TAU and included psychotherapies were effective in treating the severity and symptoms of BPD. Moderate certainty of evidence suggests that systems training for emotional predictability and problem solving is more effective than TAU for the treatment of BPD; low certainty of evidence suggests that dialectical behavior therapy, schema therapy, transference-focused psychotherapy, acceptance and commitment therapy, manual-assisted cognitive therapy, and cognitive behavioral therapy are more effective than TAU for treating BPD. We were unable to draw conclusions from head-to-head comparisons of psychotherapies, which were limited to single studies with very low to low certainty of evidence. All commonly used psychotherapies improve BPD severity, symptoms, and functioning. Our assessment found no strong evidence suggesting that any one psychotherapy is more beneficial than another. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Comprehensive Assessment of the Functional Outcomes of Partial Turbinectomy: A Prospective Clinical Trial.

The inferior and middle turbinates have crucial roles in nasal function, but their enlargement can cause obstructive effects, which can lead to breathing difficulties, sleep and smell disorders, and headaches. Partial turbinectomy is a common surgical technique used to address this issue during septorhinoplasty, but it carries risks such as empty nose syndrome. A clinical trial was designed to evaluate the functional outcomes of middle and inferior partial turbinectomy with a holistic approach. Patients with NOSE questionnaire scores of 30 or higher, and grade 4 inferior turbinates and/or advanced middle concha bullosa were included. Patients completed questionnaires related to breathing, empty nose syndrome, headache, and olfaction preoperatively and at one-month, three-month, six-month, and first-year periods postoperatively. The partial excisions of the inferior and middle turbinates were carried out with serrated scissors while trying to preserve adequate turbinate size to maintain function. This study found that NOSE scores, headache frequency, and severity improved postoperatively. The olfactory-related quality of life of the patients with impairments in this area significantly improved found to be improved at all postoperative evaluations. None of the patients experienced prolonged bleeding requiring surgical intervention. No cases of anosmia and empty nose syndrome were reported. Partial turbinectomy of middle and inferior turbinates during septorhinoplasty can alleviate symptoms of turbinate hypertrophy, such as breathing issues, olfactory disorders, and headaches. It is an easy, reliable, and efficient surgical maneuver. Proper technique can minimize the risk of empty nose syndrome and other complications of turbinectomy surgery. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

A day in the life: Couples' everyday communication and subsequent relationship outcomes.

Understanding how communication processes contribute to well-functioning versus distressed couple relationships has relied largely on brief, laboratory-based conversations. Harnessing technological advancements, the present study extends the literature by capturing couples' naturalistic communication over one full day at Time 1 (T1). This study tested associations between data-driven categories of couple communication behaviors and relationship outcomes (i.e., relationship aggression, satisfaction, and dissolution) at Time 2 (T2), approximately 1 year later. Emerging adults in different-gender dating couples (n = 106 couples; 212 individuals; Mage = 22.57 ± 2.44; M relationship length = 30.49 months ± 24.05; 72.2% non-White) were each provided a smartphone programmed to audio record approximately 50% of a typical day. Interactions between partners were transcribed and coded for location, activity, affect, and a range of positive and negative communication behaviors for each partner. Even after controlling for T1 assessments of the relevant outcome, one's own hostility and one's partner's hostility at T1 were each positively associated with T2 relationship aggression and negatively associated with T2 relationship satisfaction. One's own withdrawal at T1 was positively associated with T2 relationship aggression perpetration, whereas one's partner's withdrawal was negatively linked to relationship satisfaction at T2. One's own playfulness, unexpectedly, was linked to lower subsequent relationship satisfaction. Withdrawal increased the likelihood of relationship dissolution, whereas warmth and playfulness decreased the likelihood of dissolution. The relevance of couples' ordinary, everyday communication for meaningful relationship outcomes is discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

758 An Appraisal of the Quality of Development and Reporting of Predictive Models in Neurosurgery

INTRODUCTION: Overwhelming evidence indicates that the quality of reporting of predictive models is poor, often being confounded by small datasets, inappropriate statistical methods, a lack of validation, and reproducibility. METHODS: Articles reporting prediction models published in the top five neurosurgery journals by SJR2-rank (Neurosurgery, Journal of Neurosurgery, Journal of Neurosurgery: Spine, Journal of NeuroInterventional Surgery, and Journal of Neurology, Neurosurgery, and Psychiatry) between January 1st, 2018, and January 1st, 2023, were identified via a PubMed search strategy that combined terms related to machine learning and prediction models. The identified original research articles were analyzed against the TRIPOD criteria. RESULTS: 110 articles were included and analyzed against the TRIPOD checklist. Among the articles screened, the median compliance was 57.4% (50.0-66.7%). Models utilizing machine learning-based models exhibited lower compliance on average compared to conventional learning-based models (57.1%, 50.0-66.7% vs. 68.1%, 50.2-68.1%, p = 0.472). Among the TRIPOD criteria, the lowest compliance was observed in blinding the assessment of predictors and outcomes (n = 7, 12.7% and n = 10, 16.9%, respectively), including an informative title (n = 17, 15.6%) and reporting model performance measures including confidence intervals (n = 27, 24.8%). Few studies provided sufficient information to allow for the external validation of results (n = 26, 25.7%). CONCLUSIONS: Published machine learning models predicting outcomes in neurosurgery often fall short of meeting the established guidelines laid out by TRIPOD for their development, validation, and reporting. This lack of compliance may indicate the extent to which these models have been subjected to external validation or adopted into routine clinical practice in neurosurgery.

Economic evaluation of non-invasive liver tests for the diagnosis of liver fibrosis in chronic liver diseases: a systematic review protocol.

The objective of this review is to determine the costs and benefits of non-invasive liver tests vs liver biopsy in patients with chronic liver diseases. Hepatic diseases can lead to liver fibrosis, cirrhosis, and hepatocellular carcinoma. In the past, liver biopsy was the only option for diagnosing fibrosis degree. Liver biopsy is an invasive procedure that depends on the sample size to be able to deliver an accurate diagnosis. In recent years, non-invasive liver tests have been increasingly used to estimate liver fibrosis degree; however, there is a lack of economic assessments of technology implementation outcomes. This review will include partial (cost studies) and complete economic evaluation studies on hepatitis B, hepatitis C, alcoholic liver disease, and non-alcoholic fatty liver disease that compare non-invasive liver tests with liver biopsies. Studies published in English, French, Spanish, German, Italian, or Portuguese will be included. No date limits will be applied to the search. This review will identify published and unpublished studies. Published studies will be identified using MEDLINE (PubMed), Cochrane Library (CENTRAL), Embase, Web of Science, Scopus, and LILACS. Sources of unpublished studies and gray literature will include sources from health technology assessment agencies, clinical practice guidelines, regulatory approvals, advisories and warnings, and clinical trial registries, as well as Google Scholar. Two independent reviewers will screen and assess studies, and extract and critically appraise the data. Data extracted from the included studies will be analyzed and summarized to address the review objective using narrative text, and the JBI dominance ranking matrix. PROSPERO CRD42023404278.

257 Breaking the Mold: An International, Multicenter Study on Active and Continuous Irrigation With Cerebrospinal Fluid Exchange for Improving Outcomes in Cerebral Ventriculitis

INTRODUCTION: Cerebral ventriculitis remains one of the most challenging neurosurgical conditions, with poor outcome and a long course of treatment and duration of hospital stay. Despite the current conventional management plans, i.e., using antibiotics in addition to CSF drainage, the outcome remains unsatisfactory in some cases, with no definitive therapeutic guidelines. METHODS: We conducted a multicenter, international, retrospective study of ventriculitis patients treated with a novel automated active irrigation, and drainage system. Data collected included patients’ demographics, comorbidities, admission Glasgow Coma Scale (GCS) score, and pre-hospital modified Rankin Scale (mRS). Catheter occlusions, infections, and shunt placement was recorded for outcome assessment, along with discharge mRS, and in-hospital mortality. RESULTS: Four centers (3 from U.S and 1 from Finland) contributed data for a total of 21 ventriculitis patients who had IRRAflow placement. Thirteen (61.9%) were males (mean age = 49.8 ± 14.87 years). The baseline median mRS was 1 and the median GCS at time of ventriculitis diagnosis was 13. Etiology of ventriculitis was iatrogenic in 12 (57.4%), and secondary to abscess in 9 (42.6%). No cases reported hemorrhage, or failure of IRRAflow placement. Antibiotics were administered in through the IRRAflow in 13 (61.9%) cases in addition to systemic dosing. Sixteen (76.19%) patients had significant clinical improvement and resolution of ventriculitis. Seven (33.33%) patients required shunt placement after resolution. There were 6 (28.6%) in-hospital mortalities reported. CONCLUSIONS: Use of active and continuous irrigation with drainage for continuous delivery of intraventricular irrigation fluid with antibiotics led to dramatically lower mortality when compared to literature (mortality approx. 70%). In our case series, it led to marked improvement in neurologic status, imaging findings, and CSF profiles making it technically feasible and safe treatment for ventriculitis.

A text message intervention aimed at nurturing peer outreach to help meet drinking limit goals: A remote pilot randomized trial in non-collegiate young adults

ObjectiveScalable interventions attempting to nurture peer outreach to help young adults meet drinking limit goals remain under-developed. To address this gap, we developed ASPIRE, a text message intervention focused on coaching individuals to engage with close peers to assist them in meeting drinking limit goals. MethodNon-collegiate young adults who had reported one or more heavy drinking days in the preceding month and were at least contemplating change were recruited through social media. Participants were randomly assigned to one of three 6-week text message interventions: Control, Goal Support, or ASPIRE. All groups completed baseline assessments and received weekly text message assessments on Thursdays and Sundays. Control and ASPIRE groups were prompted to complete web-based outcome assessments at 6- and 12-weeks. ResultsWe enrolled 92 young adults from 31 US states (65% female; 73% White). All groups had high text response rates but intervention usability was sub-optimal. Follow-up rates were 87% at 6-weeks and 79% at 12-weeks. Compared to Control, ASPIRE participants reported significantly more peer support and less peer pressure to drink. ASPIRE exhibited higher goal confidence compared to the Goal Support group. Using multiple imputation, there were no significant differences in drinking outcomes between groups. ConclusionsPreliminary findings from this pilot study suggest that a text message intervention focused on nurturing peer outreach to help meet drinking limit goals holds promise in altering peer support and pressure as well as boosting drinking limit goal confidence. Design improvements are needed to reduce alcohol consumption.