Percentile Scores Research Articles

Effects of Cultural Factors on Cost Performance of Multinational Construction Organizations

Purpose: This study examines the effects of cultural factors on cost performance of multinational construction project organisations with a view towards identifying the most effective cost performance variables affected by the influence of cultural practices. Purposive sampling technique was adopted in deterring the number of construction professionals identified in construction companies with international market experience involved in the delivery of building, civil, and heavy engineering construction projects within the south-east geopolitical zone of Nigeria. Outline: A well-structured questionnaire was used to sample respondent’s opinion. Data analysis was through frequencies, percentile, and Mean Item Score (MIS). Findings: Research findings proved that irrespective of the positive effects of educational culture which improves cost performance by ensuring that projects are executed at estimated cost and within client’s budget (Mean = 4.34) and the result of effective communication culture which ensures value for money and return of customer as project is designed to suite client’s budget while maintaining standard quality delivery (Mean = 4.16), political culture tends to have mixed effect on cost performance as project design cost, labour, material and equipment cost, profit and overhead cost, etc. (Mean = 4.30) is found to be responsible for cost overruns of construction projects. Research Implication: The study recommends among others that multinational construction organisations pay great attention to the political style practiced in the host community / country in which they operate.

Odor dilution sorting as a clinical test of olfactory function: normative values and reliability data.

Clinical assessment of an individual's sense of smell has gained prominence, but its resource-intensive nature necessitates the exploration of self-administered methods. In this study, a cohort of 68 patients with olfactory loss and 55 controls were assessed using a recently introduced olfactory test. This test involves sorting 2 odorants (eugenol and phenylethyl alcohol) in 5 dilutions according to odor intensity, with an average application time of 3.5min. The sorting task score, calculated as the mean of Kendall's Tau between the assigned and true dilution orders and normalized to [0,1], identified a cutoff for anosmia at a score ≤ 0.7. This cutoff, which marks the 90th percentile of scores obtained with randomly ordered dilutions, had a balanced accuracy of 89% (78% to 97%) for detecting anosmia, comparable to traditional odor threshold assessments. Retest evaluations suggested a score difference of ±0.15 as a cutoff for clinically significant changes in olfactory function. In conclusion, the olfactory sorting test represents a simple, self-administered approach to the detection of anosmia or preserved olfactory function. With balanced accuracy similar to existing brief olfactory tests, this method offers a practical and user-friendly alternative for screening anosmia, addressing the need for resource-efficient assessments in clinical settings.

Does premature birth affect Brazilian parents' practices related to infant positioning?

To verify whether the time spent in prone, supine, or seated positions differed between term and preterm infants; and to determine whether a single verbal guidance session for parents changed the time spent in different positions, and, consequently, the motor development scores, after one month in preterm infants. Sixty-one infants from a full-term and preterm group from Brazil were included. Motor development was assessed by the Alberta Infant Motor Scale (AIMS) and the parents registered the time spent in each position on a 24-hour schedule. A month after verbal guidance, a second assessment was performed only on the preterm infants. The positioning times awake determined for the full-term and preterm parents were similar. Preterm infants spent more time in the prone sleeping position (2.1 vs. 0.8 h; p=0.037) than full-term infants. The AIMS percentile scores did not differ significantly between the groups. For preterm infants, the time spent in all positions did not change during the second assessment (n=18). The fact that some parents position their infants in the prone posture during sleeping periods reinforce the importance of parental education approaches for sudden infant death syndrome (SIDS) prevention during the first months of life. The verbal guidance provided to parents of preterm infants did not influence the AIMS percentile and time spent in various positions but increased preterm parents' confidence in placing their infants in a prone position to play.

Editorial

Editorial

Comprehensive analysis of the performance of GPT-3.5 and GPT-4 on the American Urological Association self-assessment study program exams from 2012-2023.

Artificial intelligence (AI) applications, specifically generative pre-trained transformers, have shown potential in medical education and board-style examinations. To assess this capability, we conducted a study comparing the performance of GPT-3.5 and GPT-4 on the American Urological Association (AUA) 2022 self-assessment study program (SASP) exams from 2012-2023. We used a standardized prompt to administer questions from the AUA SASP exams spanning 2012-2023, totalling 1679 questions. The performance of the two AI models, GPT-3.5 and GPT-4, was evaluated based on the number of questions answered correctly. Statistical analysis was performed using Fisher's exact test and independent sample t-tests to compare the performance of GPT-4 to that of GPT-3.5 among test years and urology topic areas. Percentile scores were not calculable, however, a score of 50% is required to acquire CME credits on AUA SASP exams. The analysis showed significantly superior performance by GPT-4, which scored above 50% across all exam years except 2018, with scores ranging from 48-64%. In contrast, GPT-3.5 consistently scored below this threshold, with scores ranging from 26-38%. The total combined score for GPT-4 was 55%, significantly higher than the 33% achieved by GPT-3.5 (odds ratio [OR] 2.5, 95% confidence interval [CI] 2.2-2.9, p<0.001). GPT-4 significantly outperformed GPT-3.5 among AUA SASP test years from 2012-2023 (mean difference 23, t(22) 14, 95% CI 19-26, p<0.001), as well as among urology topic areas (mean difference 21, t(52)=5.5, 95% CI 13-29, p<0.001). GPT-4 scored significantly higher than GPT-3.5 on the AUA SASP exams in overall performance, across all test years, and in various urology topic areas. This suggests improvement in evolving AI language models in answering clinical urology questions; however, certain aspects of medical knowledge and clinical reasoning remain challenging for AI language models.

Bioinformatics and immunoinformatics assisted multiepitope vaccine construct against Burkholderia anthina

Burkholderia anthina is a pathogenic bacterial species belonging to the Burkholderiaceae family and it is mainly considered the etiological agent of chronic obstructive pulmonary diseases associated with cystic fibrosis, due to being intrinsic antibiotic resistant making it difficult to treat pulmonary infections. Hence increased rate of antibiotic-resistant bacterial species vaccine development is the priority to tackle this problem. In research work, we designed a multi-epitope-based vaccine construct against B. anthina using reverse vaccinology immunoinformatics and biophysical approaches. Based on the subtractive proteomic screening of core proteins we identified 3 probable antigenic proteins and good vaccine targets namely, type VI secretion system tube protein hcpBurkholderia, fimbria/pilus periplasmic chaperone and fimbrial biogenesis outer membrane usher protein. The selected 3 proteins were used for B and B cells B-derived T-cell epitopes prediction. In epitopes prediction, different epitopes were predicted with various lengths and percentile scores and subjected to further immunoinformatics analysis. In immunoinformatics screening a total number of 06, IDDGNANAL, KTVKPDPRY, SEVESGSAP, YGGDLTVEV, SVSHDTNGR, and GSKADGYQR epitopes were considered good vaccine target candidates and shortlisted for vaccine construct designing. The vaccine construct was designed by joining selected epitopes with the help of a GPGPG linker and additionally linked with cholera toxin b subunit adjuvant to increase the efficacy of the vaccine construct the sequence of the said adjuvant were retrieved from protein data bank through its (PDB ID: 5ELD). The designed vaccine construct was evaluated for its physiochemical properties analysis in which we reported that the vaccine construct comprises 216 amino acids with a molecular weight of 22.37499 kilo Dalton, 15.55 instability index (II) is computed, and this classifies that the vaccine construct is properly stable. VaxiJen v2.0 web server predicted that the vaccine construct is probable antigenic in nature with 0.6320 predicted value. Furthermore AllerTOP v. 2.0 tool predicted that the designed vaccine construct is non allergic in nature. Molecular docking analysis was done for analysis of the binding affinity of the vaccine construct with TLR-2 (PDB ID: 6NIG), the docking results predicted 799.2 kcal/mol binding energy score that represents the vaccine construct has a good binding ability with TLR-2. Moreover, molecular dynamic simulation analysis results revealed that the vaccine construct and immune cell receptor has proper binding stability over various environmental condition, i.e. change in pressure range, temperature, and motion. After each analysis, we observed that the vaccine construct is safe stable, and probably antigenic and could generate an immune response against the target pathogen but in the future, experimental analysis is still needed to verify in silico base results.

Characteristics associated with response to subcutaneously administered anti-CGRP monoclonal antibody medications in areal-world community cohort of persons living with migraine: Aretrospective clinical and genetic study.

To evaluate response to anti-calcitonin gene-related peptide (CGRP) migraine preventives in a real-world community cohort of persons living with migraine and to identify clinical and genetic characteristics associated with efficacious response. Erenumab-aooeb, fremanezumab-vrfm, and galcanezumab-gnlm target CGRP or its receptor; however, many patients are non-responsive. In this retrospective clinical and genetic study, we identified 1077 adult patients who satisfied the International Classification of Headache Disorders, 3rd edition, criteria for migraine without aura, migraine with aura, or chronic migraine and who were prescribed an anti-CGRP migraine preventive between May 2018 and May 2021. Screening of 558 patients identified 289 with data at baseline and first follow-up visits; data were available for 161 patients at a second follow-up visit. The primary outcome was migraine days per month (MDM). In 198 genotyped patients, we evaluated associations between responders (i.e., patients with ≥50% reduction in MDM at follow-up) and genes involved in CGRP signaling or pharmacological response, and genetic and polygenic risk scores. The median time to first follow-up was 4.4 (0.9-22) months after preventive start. At the second follow-up, 5.7 (0.9-13) months later, 145 patients had continued on the same preventive. Preventives had strong, persistent effects in reducing MDM in responders (follow-up 1: η2 = 0.26, follow-up 2: η2 = 0.22). At the first but not second follow-up: galcanezumab had a larger effect than erenumab, while no difference was seen at either follow-up between galcanezumab and fremanezumab or fremanezumab and erenumab. The decrease in MDM at follow-up was generally proportional to baseline MDM, larger in females, and increased with months on medication. At the first follow-up only, patients with prior hospitalization for migraine or who had not responded to more preventive regimens had a smaller decrease in MDM. Reasons for stopping or switching a preventive varied between medications and were often related to cost and insurance coverage. At both follow-ups, patient tolerance (1: 92.2% [262/284]; 2: 95.2% [141/145]) and continued use (1: 77.5% [224/289]; 2: 80.6% [116/145]) were high and similar across preventives. Response consistency (always non-responders: 31.7% [46/145]; always responders: 56.5% [82/145], and one-time only responders: 11.7% [17/145]) was also similar across preventives. Non-responder status had nominally significant associations with rs12615320-G in RAMP1 (odds ratio [95% confidence interval]: 4.7 [1.5, 14.7]), and rs4680-A in COMT (0.6[0.4, 0.9]). Non-responders had a lower mean genetic risk score than responders (1.0 vs. 1.1; t(df) = -1.75(174.84), p = 0.041), and the fraction of responders increased with genetic and polygenic risk score percentile. In this real-world setting, anti-CGRP preventives reduced MDM persistently and had similar and large effect sizes on MDM reduction; however, clinical and genetic factors influenced response.

Obesity and Outcomes of Kawasaki Disease and COVID-19–Related Multisystem Inflammatory Syndrome in Children

Obesity may affect the clinical course of Kawasaki disease (KD) in children and multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19. To compare the prevalence of obesity and associations with clinical outcomes in patients with KD or MIS-C. In this cohort study, analysis of International Kawasaki Disease Registry (IKDR) data on contemporaneous patients was conducted between January 1, 2020, and July 31, 2022 (42 sites, 8 countries). Patients with MIS-C (defined by Centers for Disease Control and Prevention criteria) and patients with KD (defined by American Heart Association criteria) were included. Patients with KD who had evidence of a recent COVID-19 infection or missing or unknown COVID-19 status were excluded. Patient demographic characteristics, clinical features, disease course, and outcome variables were collected from the IKDR data set. Using body mass index (BMI)/weight z score percentile equivalents, patient weight was categorized as normal weight (BMI <85th percentile), overweight (BMI ≥85th to <95th percentile), and obese (BMI ≥95th percentile). The association between adiposity category and clinical features and outcomes was determined separately for KD and MIS-C patient groups. Of 1767 children, 338 with KD (median age, 2.5 [IQR, 1.2-5.0] years; 60.4% male) and 1429 with MIS-C (median age, 8.7 [IQR, 5.3-12.4] years; 61.4% male) were contemporaneously included in the study. For patients with MIS-C vs KD, the prevalence of overweight (17.1% vs 11.5%) and obesity (23.7% vs 11.5%) was significantly higher (P < .001), with significantly higher adiposity z scores, even after adjustment for age, sex, and race and ethnicity. For patients with KD, apart from intensive care unit admission rate, adiposity category was not associated with laboratory test features or outcomes. For patients with MIS-C, higher adiposity category was associated with worse laboratory test values and outcomes, including a greater likelihood of shock, intensive care unit admission and inotrope requirement, and increased inflammatory markers, creatinine levels, and alanine aminotransferase levels. Adiposity category was not associated with coronary artery abnormalities for either MIS-C or KD. In this international cohort study, obesity was more prevalent for patients with MIS-C vs KD, and associated with more severe presentation, laboratory test features, and outcomes. These findings suggest that obesity as a comorbid factor should be considered at the clinical presentation in children with MIS-C.

Normative Magnetic Resonance Imaging Data Increase the Sensitivity to Brain Volume Abnormalities in the Classification of Fetal Alcohol Spectrum Disorder

ObjectiveTo evaluate the use of a large MRI normative dataset to quantify structural brain anomalies that may improve diagnostic sensitivity for atypical brain volume in youth with fetal alcohol spectrum disorder (FASD). Study DesignParticipants included 48 children with prenatal alcohol exposure (PAE) and 43 controls, ages 8-17 years, from the longitudinal Collaborative Initiative on Fetal Alcohol Spectrum Disorders. Recently published lifespan brain charts were used to quantify participants’ (per)centile for brain volumes (cortical and subcortical gray matter and cortical white matter), providing an index of (dis)similarity to typically developing individuals of the same age and sex. ResultsParticipants with PAE demonstrated lower mean centile scores compared with controls. Participants with PAE and scores ≤ 10th centile on at least one brain volume metric demonstrated significantly lower performance on measures of intellectual function and aspects of executive functioning compared with participants with PAE and “typical” volumes (>10th centile). Brain volume centiles explained a greater amount of variance in IQ and improved sensitivity to brain volume anomalies in FASD compared with the most commonly used diagnostic criterion of occipitofrontal circumference (OFC) ≤ 10th. ConclusionAge- and sex-adjusted brain volumes based on a large normative dataset may be useful predictors of functional outcomes and may identify a greater number of individuals with FASD than the currently used criterion of OFC.

One-Stop Automated Diagnostic System for Carpal Tunnel Syndrome in Ultrasound Images Using Deep Learning

Ultrasound (US) examination has unique advantages in diagnosing carpal tunnel syndrome (CTS), although identification of the median nerve (MN) and diagnosis of CTS depend heavily on the expertise of examiners. In the aim of alleviating this problem, we developed a one-stop automated CTS diagnosis system (OSA-CTSD) and evaluated its effectiveness as a computer-aided diagnostic tool. We combined real-time MN delineation, accurate biometric measurements and explainable CTS diagnosis into a unified framework, called OSA-CTSD. We then collected a total of 32,301 static images from US videos of 90 normal wrists and 40 CTS wrists for evaluation using a simplified scanning protocol. The proposed model exhibited better segmentation and measurement performance than competing methods, with a Hausdorff distance (95th percentile) score of 7.21 px, average symmetric surface distance score of 2.64 px, Dice score of 85.78% and intersection over union score of 76.00%. In the reader study, it exhibited performance comparable to the average performance of experienced radiologists in classifying CTS and outperformed inexperienced radiologists in terms of classification metrics (e.g., accuracy score 3.59% higher and F1 score 5.85% higher). Diagnostic performance of the OSA-CTSD was promising, with the advantages of real-time delineation, automation and clinical interpretability. The application of such a tool not only reduces reliance on the expertise of examiners but also can help to promote future standardization of the CTS diagnostic process, benefiting both patients and radiologists.

BrainChart cortical thickness centile scores: a generalizable tool to detect age‐inappropriate cortical neurodegeneration in Alzheimer’s disease

AbstractBackgroundIdentifying age‐inappropriate cortical neurodegeneration on structural MRI is a key component of Alzheimer’s disease (AD) assessment. However, widely available reference standards that enable objective interpretation are lacking. BrainChart (www.BrainChart.io; https://github.com/BrainChart/Lifespan) calculates age and sex adjusted centile scores for structural MRI metrics using normative data from 101,457 participants across the lifecourse and can be applied across different datasets. We applied this approach to regional cortical thickness estimates and explored its utility in identifying patients with AD associated neurodegeneration.MethodsCross‐sectional BrainChart cortical thickness centile scores were calculated for 241 individuals with pathologically confirmed AD (median scan time prior to death 5.8 years), as well as 1432 cognitively normal participants (CN) from the NACC dataset. Area under the receiver operating characteristic curve (AUC) analyses were performed to identify the cortical regions that best identified patients with pathologically confirmed AD. This approach was then applied to 305 participants from the ADNI‐3 cohort, all of whom underwent clinical amyloid (florbetapir) PET and tau (flortaucipir) PET within 6 months of structural MRI (CN = 185; Mild Cognitive Impairment (MCI) = 95); AD = 26).ResultsThe top ten performing regions for differentiating pathologically confirmed AD from CN in the NACC dataset were entorhinal, middle temporal, inferior parietal, isthmus cingulate, fusiform, supramarginal, inferior temporal, superior temporal, precuneus and temporal pole. AUCs ranged from 0.72 – 0.77 (figure 1 and table 1). Combining these ten regions into a single model significantly improved diagnostic separability (AUC = 0.81, figure 1). Optimal cut‐points for individual regions ranged from the 25th centile to the 35th centile, with sensitivities ranging from 57.7% to 68.9%, and specificities ranging from 72.6% to 80.9%. Using progressively lower centile scores increased specificity but decreased sensitivity (table 1).In ADNI‐3 participants, a combined model of the same ten regions derived from the NACC dataset was able to discriminate amyloid and tau pet positive AD patients from amyloid and tau negative CN (AUC = 0.98), as well as amyloid and tau positive MCI patients from amyloid and tau negative CN (AUC = 0.85) (figure 2).ConclusionBrainChart age and sex adjusted cortical thickness centile scores, derived from an extensive normative dataset, represent a generalizable method for objectively identifying cortical neurodegeneration in AD.

BrainChart cortical thickness centile scores: a generalizable tool to detect age‐inappropriate cortical neurodegeneration in Alzheimer’s disease

AbstractBackgroundIdentifying age‐inappropriate cortical neurodegeneration on structural MRI is a key component of Alzheimer’s disease (AD) assessment. However, widely available reference standards that enable objective interpretation are lacking. BrainChart (www.BrainChart.io; https://github.com/BrainChart/Lifespan) calculates age and sex adjusted centile scores for structural MRI metrics using normative data from 101,457 participants across the lifecourse and can be applied across different datasets. We applied this approach to regional cortical thickness estimates and explored its utility in identifying patients with AD associated neurodegeneration.MethodCross‐sectional BrainChart cortical thickness centile scores were calculated for 241 individuals with pathologically confirmed AD (median scan time prior to death 5.8 years), as well as 1432 cognitively normal participants (CN) from the NACC dataset. Area under the receiver operating characteristic curve (AUC) analyses were performed to identify the cortical regions that best identified patients with pathologically confirmed AD. This approach was then applied to 305 participants from the ADNI‐3 cohort, all of whom underwent clinical amyloid (florbetapir) PET and tau (flortaucipir) PET within 6 months of structural MRI (CN = 185; Mild Cognitive Impairment (MCI) = 95); AD = 26).ResultThe top ten performing regions for differentiating pathologically confirmed AD from CN in the NACC dataset were entorhinal, middle temporal, inferior parietal, isthmus cingulate, fusiform, supramarginal, inferior temporal, superior temporal, precuneus and temporal pole. AUCs ranged from 0.72 – 0.77 (figure 1 and table 1). Combining these ten regions into a single model significantly improved diagnostic separability (AUC = 0.81, figure 1). Optimal cut‐points for individual regions ranged from the 25th centile to the 35th centile, with sensitivities ranging from 57.7% to 68.9%, and specificities ranging from 72.6% to 80.9%. Using progressively lower centile scores increased specificity but decreased sensitivity (table 1). In ADNI‐3 participants, a combined model of the same ten regions derived from the NACC dataset was able to discriminate amyloid and tau pet positive AD patients from amyloid and tau negative CN (AUC = 0.98), as well as amyloid and tau positive MCI patients from amyloid and tau negative CN (AUC = 0.85) (figure 2).ConclusionBrainChart age and sex adjusted cortical thickness centile scores, derived from an extensive normative dataset, represent a generalizable method for objectively identifying cortical neurodegeneration in AD.

Quality of life in south-eastern Australia: normative values for the WHOQOL-BREF in a population-based sample of adults

ObjectivesThe abbreviated World Health Organisation Quality of Life tool (WHOQOL-BREF) is a short-form quality of life (QoL) assessment commonly used worldwide in both healthy and ill populations. Normative data for...

Abstract C075: Socioeconomic status and genetic ancestry correlate with differences in clinical outcomes for colorectal cancer patients treated at a single tertiary cancer center

Abstract Intro: Lower socioeconomic status (SES) and African ancestry have been linked to poor overall survival (OS) in colorectal cancer (CRC). To better understand the interplay between these variables, we analyzed clinical and genomic real-world data from a large cohort of patients treated at a single tertiary center. Methods: Clinical annotations including sex, primary tumor location, age and stage at diagnosis were extracted from the electronic health record for 3,817 CRC patients who underwent clinical genomic sequencing at Memorial Sloan Kettering Cancer Center between 2014 and 2022. We also cataloged each patient’s type of primary health insurance (commercial, Medicare, Medicaid or self-pay). Socioeconomic status was assessed from each patient’s billing address using the Yost index (YI), which is a location-dependent percentile score based on household incomes, house values, rent, poverty, education, and employment statistics. Genetic ancestry was determined from DNA sequencing data using reference populations from the 1000 Genomes project, including European (EUR), African (AFR), East Asian (EAS), and Southeast Asian (SAS). Specific ancestries were assigned based on an ancestral fraction of &amp;gt;80%, otherwise patients were labeled as admixed (ADM). OS was measured from time of diagnosis to last follow-up. Results: Our cohort included 2,627 EUR, 195 EAS, 206 AFR, 61 SAS and 728 ADM patients. The median YI within our cohort was 18 [IQR: 30]. No significant associations were observed between YI and primary tumor location, age or stage at diagnosis. We observed significant differences in YI based on type of health insurance (median 15 for commercial vs. 29 for Medicaid, p&amp;lt;0.0001) and sex (median 15 in males vs. 17 in females, p=0.0113). YI was also strongly associated with genetic ancestry, with AFR patients exhibiting significantly higher YI values than other ancestries (median 45.5 vs. 14, p&amp;lt;0.0001). No significant differences in YI were observed among EUR, EAS and SAS patients. When all ancestries were analyzed together, patients within the bottom YI quartile (most affluent) had significantly longer OS than patients from the top YI quartile (most deprived) (median 52.3 vs. 61.6 months, p=0.023). No differences in OS were observed between EUR, EAS and SAS patients, but patients of AFR ancestry had significantly shorter OS than the rest (median 44.5 vs. 56.5 months, p= 0.016). When the analysis was restricted to patients of EUR, EAS and SAS ancestry, OS was still significantly shorter for patients within the top vs. bottom YI quartile (median 52.6 vs. 64.4 months, p=0.011). Conclusions: Patients of African ancestry exhibited lower socioeconomic status and shorter survival. Even when the analysis was restricted to other genetic ancestries, patients with the lowest socioeconomic status still had poorer clinical outcomes. The existence of these differences within a relatively homogeneous cohort of patients treated at the same institution highlights the need to better understand and address health disparities in CRC. Citation Format: Tejiri Agbamu, Xuechun Bai, Henry Walch, Michele Waters, Anisha Luthra, Kanika Arora, Christopher Fong, Doori Rose, Hannah Williams, Michael Berger, Karuna Ganesh, Julio Garcia-Aguilar, Nikolaus Schultz, Rona Yaegar, Walid Chatila, Francisco Sanchez-Vega. Socioeconomic status and genetic ancestry correlate with differences in clinical outcomes for colorectal cancer patients treated at a single tertiary cancer center [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C075.

National ABSITE Preparation Practices: A Survey of General Surgery Residency Program Directors

The American Board of Surgery In-Training Examination (ABSITE) was designed as a low-stakes, medical knowledge examination for US general surgery residency programs. However, in practice, this exam has been utilized for higher stakes purposes, such as resident promotion or remediation, and fellowship selection. Several studies have demonstrated the efficacy of ABSITE preparation resources, but best practices for ABSITE preparation and national preparatory habits are currently unknown. The aim of this work was to determine current residency programs' strategies for ABSITE preparation. We distributed an electronic survey to program directors or program coordinators of US general surgery programs asking them to anonymously report program ABSITE educational practices and ABSITE scores. We analyzed the proportion of responses using descriptive statistics and compared the effect of various strategies using the Mann-Whitney testing for nonparametric data. An average ABSITE percentile score was calculated for each residency based on program self-reported scores. Association of Program Directors (APDS) Listserv PARTICIPANTS: General surgery residency programs participating at the time of distribution (278). Response rate was 24% (66/278); 41 programs (62.1%) identified as university-affiliated, and 25 (37.9%) were community-based. Median intern class size was 8 (range: 3-14), including preliminary interns. Average ABSITE percentile score was 52.8% (range 36.9%-67.6%). There were no significant differences in ABSITE scores based on affiliation or program size. Educational resources utilized for ABSITE preparation included SCORE (89.3%), Q-banks (50%), and surgical textbooks (25.8%). The majority (56.1%) of programs reported using a year-long curriculum for ABSITE preparation, and 66.6% used a time-limited curriculum completed in the months immediately prior to ABSITE. Most programs reported that ABSITE scores were a low priority (63.6%) or not a priority (13.6%). The existence of a year-long curriculum for ABSITE was positively correlated with score as compared to programs without a year-long curricula (53.9% vs 48.5%, p <0.01). Programs using a time-limited curriculum demonstrated lower scores as compared to programs without time-limited curricula (51.3% v 56.1%, p < 0.01). General surgery programs use a variety of strategies to prepare residents for the ABSITE. Despite reporting that they utilize ABSITE scores for a variety of high stakes purposes including evaluation for promotion and as a predictor of the preparedness for the ABS QE, many programs reported that they consider ABSITE scores as a low priority. A year-long focused curriculum was the only strategy correlated with increased scores, which may reflect the value of encouraging consistent studying and spaced repetition. Additional work is needed to guide programs in optimal utilization of ABSITE scores for remediation and resident evaluation, as well as understanding how ABSITE preparatory strategies correlate with clinical performance.

212 Genome-Wide Association Study Investigating the Genomic Components of Efficiency in Beef Cows

Abstract Efficiency of mature beef cows consuming high-forage diets is not comparable with standard definitions of beef cattle efficiency such as feed conversion or residual feed intake in the feedlot setting. This study aimed to conduct a genome-wide association study (GWAS) to identify regions of the bovine genome associated with efficiency in mature beef cows. Ninety-eight black Angus cows were managed under extensive feeding programs over a two-year period. Using rump fat at calving, calving date, and calf weaning weight as a percentage of the body weight of the dam, a weighted percentile scoring system was used to rank efficiency. Eighty-three of the cows were retained for the GWAS. The 20 most and 20 least efficient cows (HD dataset, n=40) were genotyped with the Illumina BovineHD BeadChip (777,000 SNPs) while the remaining cows were genotyped with the Neogen GGP Bovine 100K chip (LD dataset, n = 43). The LD dataset was imputed to the HD SNP array density using Beagle5.4 (FULL dataset, n = 83). Three separate GWAS were conducted using GAPIT (version3). The first GWAS was performed on the HD dataset using a quantitative phenotype determined by the ranking system. The second GWAS was performed with the HD dataset using a qualitative phenotype (efficient vs non-efficient cows). For the final GWAS, the FULL dataset with ranked phenotypes was used. Five models were evaluated for each GWAS, including the general linear model (GLM), mixed linear model (MLM), multiple loci mixed model (MLMM), fixed and random model circulating probability unification (FarmCPU), and Bayesian-information and linkage-disequilibrium iteratively nested keyway (BLINK). The model that best represented each dataset as determined by quantile-quantile plots was used for downstream analysis. Although results of the GWAS were not significant (Bonferroni threshold), associations were identified on BTA10, 16, 17, 25, 27 and 29. Positional candidate genes in the associated regions include: FOXN3, UPB1, SNX29, DDX54, LOC112444612, RITA1, and TACC1. Further functional analyses are required to confirm these findings; however, this work provides a foundation for identifying genes and gene mutations influencing this newly described phenotype.

Correlating area deprivation index with initial stage at presentation and with follow up and recurrence within an advanced practice provider-led survivorship clinic

IntroductionLiving in disadvantaged neighborhoods has been shown to result in worse healthcare outcomes. The Area Deprivation Index (ADI) is a metric that ranks neighborhoods by socioeconomic disadvantage utilizing numerous factors including income, education, employment, and housing quality. MethodsA retrospective review of all patients who underwent surveillance in an APP-led head and neck cancer survivorship clinic from Dec 2016 to Oct 2020 at an academic tertiary care center were included. Tumor characteristics, visit frequency, recurrence, number of missed appointments, loss of follow up, and ADI scores were collected. Results543 patients were included in the study. A majority were male (69.9 %) and white race (84.9 %) with an average age of 64.6 years old. Average ADI national percentile score was 71.6(range: 17 to 100). ADI national percentile score was not predictive of tumor characteristics at initial presentation: lymphovascular invasion (p = 0.940; OR 1.0 [95 % CI: 0.9 to 1.1]), extranodal extension (p = 0.576; OR 1.0 [95 % CI: 0.9 to 1.2]), positive margins (p = 0.069; OR 0.9 [95 % CI: 0.9 to 1.0]). ADI national percentile score was not significantly correlated with loss to follow up (p = 0.153; OR 1.2 [95 % CI: 0.9 to 1.7] or cancer recurrence (p = 0.594; OR 1.0 [95 % CI: 0.9 to 1.1]). Missing one or more clinic visits was correlated with loss to follow up (p = 0.029; OR 13.1 [95 % CI: 1.3 to 131.7]. ConclusionLiving in a disadvantaged neighborhood did not correlate with negative tumor characteristics, loss to follow up, or recurrence within an APP-led survivorship head and neck cancer clinic.

39 Neurocognitive Function in People Living with HIV from Tijuana: a Comparison Between Norms for Latin-American Population and Norms for US-Mexico Border Region

Objective:Global neurocognitive impairment (NCI) has been reported in white people living with HIV/AIDS (PLWHA) in 40%. In Latino populations there have been variable rates described from 30 to 77%. This variation has to do with the lack of normative data for Latino population and the application of norms for English-speakers, increasing the probability of misidentification of NCI. Thus, recognizing which are the best norms available for the Mexican population is important for the accurate identification of NCI. The aim of the present study was to investigate the rate and pattern of HIV associated neurocognitive impairment (NCI) and to compare rates of NCI between rates calculated using norms for the Latin-American population (NLAP) and norms for the US-Mexico border region (NP-NUMBRS).Participants and Methods:CIOMS international ethical guidelines for the participation of human subjects in health research were followed. 82 PLWHA living in Tijuana (Mexico) participated in the study (Age: Mean=39.6, SD=10.9; 28.3% Female; Years of education: Mean=8.5, SD=3.6). PLWHA were recruited from the board-and-care home “Las Memorias” (73.4% on antiretroviral therapy; Years since HIV diagnosis: Mean=9.9, SD=7.1). Participants completed a neuropsychological test battery sensitive to detect HIV associated NCI that assessed four cognitive domains (verbal fluency, speed of information processing, executive function and learning/memory). Raw scores in these tests were transformed to percentiles using LAPN and transformed to T-scores using NP-NUMBRS. T-scores were averaged across tests to compute domain specific and global impairment scores. NCI was defined as percentile scores &lt;16 and T-scores &lt; 40. McNemar’s tests were used to compare the rate of NCI utilizing NLAP vs NP-NUMBRS.Results:According to NLAP, rates of global NCI were about 13.4%. Utilizing NP-NUMBRS rates of global NCI were about 34.1%. However, there is a positive and significant correlation between Global Neurocognitive Function score in PLWHA according to NLAP and NP-NUMBRS (r=0.66, p&lt;.05). Rates of global NCI in PLWHA were significantly lower when using LAP norms (McNemar Chi-Square=29.89; p&lt;.001). Regarding the pattern of NCI according both norms learning and memory was the most affected cognitive domain with 34% of impairment according to NLAP vs 51% of impairment according to NP-NUMBRs.Conclusions:Utilizing NP-NUMBRS, rates of NCI are consistent with findings of prior studies. Employing norms for LAP the rates of NCI are lower that the ones reported in the literature. This is an important finding since PLWHA included in the sample have several vulnerable factors such as deportation, prostitution, drug abuse and discrimination for sexual preference, factor that could impact cognition. The pattern of neurocognitive function was also similar to those of prior studies in HIV. To accurately make NCI diagnosis it is important to use norms that consider specific characteristics of the population. The diagnosis of NCI is important since these deficits present a strong risk of concurrent problems in a wide range of health behaviors like medication non-adherence in PLWHA.

Norms for the Triana Test: A Story Recall Test Based on Emotional Material.

The "Triana Test" is a novel story recall test based on emotional material with demonstrated accuracy in diagnosing mild cognitive impairment patients. This study aims to obtain normative data for the "Triana Test". A normative study was conducted at a university hospital in Spain. Partners of patients were systematically recruited if eligible (age ≥50, no memory complaints, and a total TMA-93 score at or above the 10th percentile). The "Triana Test" was administered and scored. For developing the normative data, a regression-based method was followed. The final sample included 362 participants (median age = 66, range = 50-88; 64.9% females). A model including age and educational level better predicted the total scores. Combinations of these variables resulted in different 10th percentile scores. Norms for using the "Triana Test" are now available. The provided cutoffs for the 10th percentile will aid in the diagnosis of prodromal Alzheimer's disease.

40 Metamemory performance of children with ADHD in comparison to typically developing children.

Objective:Metamemory is an aspect of metacognition that is one's knowledge of memory and understanding of their own memory performance (Kreutzer et al., 1975). Executive function skills are foundational skills required for the development of metamemory in early school-age children (Lockl &amp; Schneider, 2007; Lecce et al., 2015). Previous studies have suggested children with Attention-Deficit/Hyperactivity Disorder (ADHD) may have weaker study and organizational strategies, suggesting weaker metamemory skills (O'Neill &amp; Douglas, 1991; Voelker et al., 1989). The current study aimed to examine the metamemory knowledge of typically developing (TD) children and children with ADHD on a novel declarative metamemory questionnaire. We hypothesized that the ADHD group would have worse metamemory performance than the TD group and that executive functioning skills would be significantly associated with metamemory for all groups.Participants and Methods:The current study recruited a total of 93 English-speaking children between the ages of 6 to 12 years old, including 70 typically developing (TD) children (M age=9.1+1.92; females 49%), and 23 children with diagnoses of ADHD (M age=9.56+1.27; females 57%). Fifty-seven percent of the ADHD group reported daily use of stimulant medication, but no participants took medication on the day of testing. The participant groups did not significantly differ regarding age or sex. Participants completed the Measure of Metamemory (MoM-10) which included 10 multiple choice questions (i.e., Accuracy) and asked participants to explain their multiple-choice answer (i.e., Explanation). This provided three scores: Accuracy (max 10 points), Explanation (max 20 points), and Total (max 30 points). Additionally, participants' parents completed the 12-item Behavior Rating Inventory of Executive Function, 2nd Edition (BRIEF-2) Screening form, evaluating the child's executive functioning, which provided a percentile based on age and sex.Results:Within the ADHD group, BRIEF-2 percentiles and MoM-10 scores did not differ between those who were medicated and those who were not. As previous literature has shown, the TD and ADHD groups significantly differed on the BRIEF-2 screening score percentiles (t(91)=-5.78, p&lt;0.001; TD M=52.89+26.1; ADHD M=85.26+13.82). The TD and ADHD groups did not significantly differ on either the MoM-10 Accuracy (p=0.13; TD M=7.22+1.84; ADHD M=7.87+1.32), the Explanation (p=0.08; TD M=9.34+3.80; ADHD M=10.57+2.92), or Total (p=0.13). There was a trend towards a significant correlation between the Explanation scores and BRIEF-2 for TD participants (r=-0.23, p=0.06), but there was no significant correlation between Explanation, Accuracy, or Total scores and the BRIEF-2 for the ADHD group.Conclusions:Our results tentatively suggest a possible association between metamemory and parent reported executive functioning for TD children, supporting the expected association between the development of executive functioning and the development of metamemory. However, there was no association between metamemory and executive functioning for children with ADHD, likely due to the restricted range of executive functioning scores for this group (i.e., M=85.25+13.82; Range 55-99). Additionally, metamemory did not significantly differ between diagnostic groups. Children with ADHD may have comparable metamemory knowledge to TD children as a result of executive functioning instruction and support they have received. Rather, there may be group differences in the application of metamemory judgement and strategies.