Comprehensive Assessment Research Articles

From Hospital to Home: Validating a Cognitive-Functional Evaluation of Elders (COFEE-HD).

Background. Increase in hospitalizations of older adults emphasizes the need for efficient hospital discharge planning to enable optimal reentry upon returning home. Yet few assessments offer an extensive picture of the older adult's functional-cognitive state. A comprehensive assessment for discharge planning together with a written summary can be beneficial to the older adult and family. Purpose. This quantitative study compared a modified version of a previously validated tool COFEE (cognitive OT functional evaluation of elders), for use in the hospital, HD (hospital discharge) with standard hospitals assessments. Methods. Of the 77 participants recruited in hospital, home assessments were conducted 4 months later on 64 participants. Findings. The COFEE-HD scores (physical functioning, personal and environmental safety and meta cognitive functioning) were significantly correlated with standard hospital measures and with the home assessment. Implications. The COFEE-HD was found to have a high level of validity in a hospital setting, and the resulting evaluation can provide important insights into function, safety and cognitive function for post-discharge behaviors.

An Advance Learning Platform for Slow Learners

LearnIt is an innovative educational system crafted to identify and support slow learners through advanced technological solutions. It employs the MERN stack (MongoDB, Express.js, React.js, Node.js) to offer a personalized learning environment tailored to meet individual student needs. This system not only enhances the educational experience for students but also provides tools to facilitate effective communication between teachers and parents, ensuring a cohesive support network for the learner. Additionally, LearnIt empowers educators with data-driven insights, allowing for informed decision-making and targeted interventions. The traditional educational model often overlooks the unique needs of slow learners, resulting in disengagement and poor academic performance. LearnIt addresses this challenge by integrating comprehensive assessment tools and personalized learning strategies within its platform. By identifying slow learners early, the system provides timely interventions that can significantly improve their learning trajectory. The use of the MERN stack ensures that LearnIt is both scalable and responsive. The assessment and monitoring module is at the core of LearnIt’s functionality. The development of LearnIt involved a detailed analysis of the educational needs of slow learners, incorporating feedback from educators, parents, and the students themselves. This user-centered approach ensured that the system's design and functionality were closely aligned with real-world requirements. Key modules of LearnIt include user management, assessment and monitoring, and communication tool. The user management module handles registration, authentication, and role-based access control, ensuring secure and personalized experiences for all users. The assessment and monitoring module is at the core of LearnIt’s functionality. It includes tools for creating and administering assessments, tracking student performance, and generating detailed reports. This module helps in identifying slow learners by analyzing their performance data and providing actionable insights to educators. With these insights, teachers can develop customized learning plans that address the specific needs of each student, fostering an inclusive and effective educational environment. Communication is another critical component of LearnIt. The platform includes features that facilitate seamless communication between teachers, parents, and students. This ensures that parents are kept informed about their child's progress and can collaborate with teachers to provide consistent support. Effective communication helps in building a supportive learning ecosystem, which is essential for the success of slow learners. The implementation of LearnIt has shown promising results. Preliminary studies indicate that the system significantly improves the identification and support of slow learners. LearnIt represents a significant advancement in the field of educational technology. By focusing on the needs of slow learners and leveraging the capabilities of the MERN stack, it offers a comprehensive solution that enhances learning outcomes. The system's personalized approach, combined with robust data analytics and effective communication tools, ensures that every student receives the support they need to thrive. As we continue to refine and expand LearnIt, its impact on educational equity and student success will undoubtedly grow, offering new opportunities for learners who have been historically underserved by traditional educational models. Keywords: Slow learners, education, literacy, mental development, intelligence.

Left atrial strain measurement in patients with heart failure and atrial fibrillation compared to a control group

Abstract Background Left atrial (LA)-strain measurement is a non-invasive and widely available echocardiographic method to detect atrial cardiomyopathy as a process of structural and functional remodeling. The aim of this study is to measure LA-strain in patients with heart failure (HF) and atrial fibrillation (AF), compared to patients without structural heart disease and to evaluate whether or not LA-Strain could be part of a multi-modality assessment that influences therapy strategies and prognosis in patients suffering AF. Methods This study includes 18 patients with HF in sinus rhythm who underwent CRT implantation (HF group), 25 patients with persistent AF and preserved ejection fraction (EF) who underwent left atrial catheter ablation (AF group) and 22 patients without structural heart disease or AF who underwent electrophysiological study (control group). All subjects received measurement of reservoir (LASr), conduit (LAScd) and contraction (LASct) LA strain imaging using two-dimensional speckle tracking echocardiography (2D-STE). Results Patient characteristics in the HF-group showed mean age 68y (SD 10,6), mean EF 29% (SD 6,8), 66% male compared to the AF-group with mean age 66y (SD 8.0), mean EF 60% (SD 5.1), 68% male. The control-group showed mean age 55y (SD 13.8), mean EF 60% (SD 5.4), 55% male. For LASr we found normal values in the control groups and reduced values in the HF und AF group (HF: mean 20% [9 – 45%], AF: mean 24% [7 – 52%], control: mean 42% [30 – 67%]). In LASr, LAScd and LASct there was a statistically significant difference between the HF and the control group (p < 0.001) as well as the AF and control group (p < 0.001), whereas there was no difference between AF and HF group (p = 0.444). Discussion Patients with persistent AF show similar LA-strain compared to patients with HF and patients without structural heart disease present significant better LA strains. The findings of this study suggest, that LA strain analysis might contribute to comprehensive assessment of patients with AF especially as a simple imaging method. A limitation of our results could be the significant younger age of our control group (p = 0.004) as fibrotic remodeling increases in advanced age. It remains to be analyzed whether early AF treatment could prevent further fibrotic remodeling and whether measuring LA strain could provide further information for risk stratification and the definition of therapeutic intervention strategies.

Evaluation of Algal Control Measures in Eutrophic Reservoirs Based on Aquatic Ecosystem Models

The frequency of freshwater cyanobacterial blooms is increasing globally due to climate change and eutrophication, particularly in reservoirs. Reservoir ecosystems exhibit unique characteristics, and there is a complex relationship between factors such as light, temperature, nutrient salts, hydrology, and algal growth. The impact of the other factors on algal growth varies significantly among different reservoirs. Thus, it is crucial to assess the effectiveness of various algal control measures implemented in different reservoirs. This study conducted a comprehensive assessment by establishing a eutrophication model for the Shanzi Reservoir in Fuzhou City. The model incorporated meteorology, hydrology, carbon dynamics, nutrient cycling, and biological communities. The effectiveness of diverse management measures was systematically evaluated. The findings demonstrate that increasing the water level, reducing nutrient salts in sediments, and implementing ecological fish stocking effectively suppressed algal growth to varying degrees and improved nitrogen and phosphorus levels. Lower water levels and ecological fish stocking had a significant impact on algal reproduction, while sediment reduction had a minimal effect. Conversely, lower water levels and ecological fish stocking did not significantly improve nitrogen and phosphorus concentrations in the reservoir, whereas sediment reduction had a noticeable effect. Consequently, the management strategies for the Shanzi Reservoir should prioritize external control measures and the implementation of ecological fish stocking.

Enhancing cellular behavior in repaired tissue via silk fibroin-integrated triboelectric nanogenerators

Triboelectric nanogenerators (TENGs) have emerged as a promising approach for generating electricity and providing electrical stimuli in medical electronic devices. Despite their potential benefits, the clinical implementation of TENGs faces challenges such as skin compliance and a lack of comprehensive assessment regarding their biosafety and efficacy. Therefore, further research is imperative to overcome these limitations and unlock the full potential of TENGs in various biomedical applications. In this study, we present a flexible silk fibroin-based triboelectric nanogenerator (SFB-TENG) that features an on-skin substrate and is characterized by excellent skin compliance and air/water permeability. The range of electrical output generated by the SFB-TENG was shown to facilitate the migration and proliferation of Hy926, NIH-3T3 and RSC96 cells. However, apoptosis of fibroblast NIH-3T3 cells was observed when the output voltage increased to more than 20 V at a frequency of 2 Hz. In addition, the moderate electrical stimulation provided by the SFB-TENG promoted the cell proliferation cycle in Hy926 cells. This research highlights the efficacy of a TENG system featuring a flexible and skin-friendly design, as well as its safe operating conditions for use in biomedical applications. These findings position TENGs as highly promising candidates for practical applications in the field of tissue regeneration.

Performance assessment of the effective core potentials under the fermionic neural network: First and second row elements.

The rapid development of deep learning techniques has driven the emergence of a neural network-based variational Monte Carlo (VMC) method (referred to as FermiNet), which has manifested high accuracy and strong predictive power in the electronic structure calculations of atoms, molecules, and some periodic systems. Recently, the implementation of the effective core potential (ECP) scheme has further facilitated more efficient calculations in practice. However, there is still a lack of comprehensive assessments of the ECP's performance under the FermiNet. In this work, we set sail to fill this gap by conducting extensive tests on the first two row elements regarding their atomic, spectral, and molecular properties. Our major finding is that, in general, the qualities of ECPs have been correctly reflected under FermiNet. Two recently built ECP tables, namely, correlation consistent ECP (ccECP) and energy consistent correlated electron pseudopotential (eCEPP), seem to prevail in terms of overall performance. In particular, ccECP performs slightly better on spectral precision and covers more elements, while eCEPP is more systematically built from both shape and energy consistency and better treats the core polarization. On the other hand, the high accuracy of the all-electron calculations is hindered by the absence of relativistic effects as well as the numerical instabilities in some heavier elements. Finally, with further in-depth discussions, we generate possible directions for developing and improving FermiNet in the near future.

Enhancing surgical outcomes in elderly gastric cancer patients: the role of comprehensive preoperative assessment and support

BackgroundAs the prevalence of gastric cancer rises in aging populations, managing surgical risks and comorbidities in elderly patients presents a unique challenge. The Comprehensive Preoperative Assessment and Support (CPAS) program, through comprehensive preoperative assessments, aims to mitigate surgical stress and improve outcomes by enhancing patient awareness and preparation. This study investigates the efficacy of a CPAS program, incorporating frailty and sarcopenia evaluations, to improve short-term outcomes in elderly gastric cancer patients.MethodsA retrospective analysis was conducted on 127 patients aged 75 or older who underwent surgery with CPAS between 2018 and August 2023, compared to 170 historical controls from 2012 to 2017. Propensity score matching balanced both groups based on age-adjusted Charlson Comorbidity Index and surgical details. The primary focus was on the impact of CPAS elements such as rehabilitation, nutrition, psychological support, oral frailty, and social support on short-term surgical outcomes.ResultsAmong 83 matched pairs, the CPAS group, despite 40.4% of patients in the CPAS group and 21.2% in the control group had an ASA-PS score of 3 or higher (P < 0.001), demonstrated significantly reduced blood loss (100 ml vs. 190 ml, P = 0.026) and lower incidence of serious complications (19.3% vs. 33.7%, P = 0.034), especially in infections and respiratory issues. Sarcopenia was identified in 38.6% of CPAS patients who received tailored support. Additionally, the median postoperative hospital stay was notably shorter in the CPAS group (10 days vs. 15 days, P < 0.001), with no in-hospital deaths. These results suggest that personalized preoperative care effectively mitigates operative stress and postoperative complications.ConclusionImplementing CPAS significantly enhances surgical safety and reduces complication rates in elderly gastric cancer patients, emphasizing the critical role of personalized preoperative care in surgical oncology for this demographic.

#1746 Comprehensive kidney care: adopting principles of comprehensive geriatric assessment within an advanced kidney care clinic

Abstract Background and Aims Chronic Kidney Disease (CKD) is increasingly prevalent among older people, a trend that presents significant healthcare challenges. This project introduces the Comprehensive Kidney Care (CKC) clinic model which incorporates elements from Comprehensive Geriatric Assessment within the Advanced Kidney Care clinic. By focusing on a holistic care, this model aims to enhance symptom management, facilitate appropriate referrals, improve documentation, and offer advance care planning (ACP), ultimately to improve care quality for older people with advanced CKD. Method We evaluated 27 patients ≥65 years old with CKD stage 4 and 5, attending the CKC clinic between 23/11/2022 and 22/11/2023. Demographics and clinical characteristics were recorded, including Charlson Comorbidity Index (CCI). Individual symptoms and total score were screened in each clinic using the Integrated Palliative Outcome Score (IPOS)-Renal Symptom Survey. Geriatric impairments were assessed including frailty (Clinical Frailty Scale [CFS]), mobility, polypharmacy (≥5 medications), activities of daily living (ADLs), falls and cognition. Actions were documented, including initiation of ACP discussions and other relevant interventions. Results Patients’ average age was 82 (SD 5.8), they were predominantly male (20 patients, 74%) and had a median eGFR of 18 ml/min/1.73 m2 (IQR 10). They exhibited a high burden of comorbidities (CCI mean 8.4, SD 2) and a high prevalence of geriatric impairments: 74% (20 patients) had a CFS score ≥4, 63% (17) required mobility aids, 26% (7) reported falls, 30% (8) required assistance with ADLs, and all had polypharmacy. IPOS was recorded for 20 patients. Mean total score was 10.25 (IQR 8). Fig. 1 demonstrates the symptoms reported as experienced ‘moderately’ or worse at first IPOS completion. Thirteen patients had more than one IPOS completed, allowing each symptom to be compared at two consecutive clinic attendances 239 times. Symptom improvement was more common than worsening (37 [15.5%] versus 11 [4.6%]). Most times symptoms remained stable (43, 18%) or were absent (132, 55.2%), with a minority appearing 16 times (6.7%). Seventeen relevant actions were identified, including symptom management (14 patients, 51.9%), physical activity advice (7, 25.9%), referrals to other teams (12, 44.4%; 2 referred to more than one), including dietitian (4), psychology (3), frailty team (2), physiotherapy (2), memory assessment clinic, social care, falls clinic and palliative care (1 each). Preferred kidney management was discussed with 9 patients (33%); 9 patients had documented preferences before attending the CKC clinic. Ten (37%) preferred conservative care, 4 (15%) haemodialysis and 13 (48%) remained undecided. Undecided patients had a significantly higher eGFR (median 21 [IQR 4] versus 12 ml/min/1.73 m2 [IQR 6.75], p-value 0.012). ACP was discussed with 8 patients; these patients had higher CFS scores (median 6 versus 4, IQR 1.25, p-value 0.005) and higher ADL dependence (Odds ratio 8.9, p-value 0.026). Conclusion The CKC clinic model shows promise as an effective approach for assessing and managing older people with advanced CKD. Most times symptoms improved or remained unchanged, suggesting actions were effective at managing symptom burden. ACP discussions were more commonly initiated in patients with higher frailty severity and ADL dependence; obtaining geriatric impairment information may help prompt ACP discussions.

Deciphering the microbial landscape of lower respiratory tract infections: insights from metagenomics and machine learning

BackgroundLower respiratory tract infections represent prevalent ailments. Nonetheless, current comprehension of the microbial ecosystems within the lower respiratory tract remains incomplete and necessitates further comprehensive assessment. Leveraging the advancements in metagenomic next-generation sequencing (mNGS) technology alongside the emergence of machine learning, it is now viable to compare the attributes of lower respiratory tract microbial communities among patients across diverse age groups, diseases, and infection types.MethodWe collected bronchoalveolar lavage fluid samples from 138 patients diagnosed with lower respiratory tract infections and conducted mNGS to characterize the lung microbiota. Employing various machine learning algorithms, we investigated the correlation of key bacteria in patients with concurrent bronchiectasis and developed a predictive model for hospitalization duration based on these identified key bacteria.ResultWe observed variations in microbial communities across different age groups, diseases, and infection types. In the elderly group, Pseudomonas aeruginosa exhibited the highest relative abundance, followed by Corynebacterium striatum and Acinetobacter baumannii. Methylobacterium and Prevotella emerged as the dominant genera at the genus level in the younger group, while Mycobacterium tuberculosis and Haemophilus influenzae were prevalent species. Within the bronchiectasis group, dominant bacteria included Pseudomonas aeruginosa, Haemophilus influenzae, and Klebsiella pneumoniae. Significant differences in the presence of Pseudomonas phage JBD93 were noted between the bronchiectasis group and the control group. In the group with concomitant fungal infections, the most abundant genera were Acinetobacter and Pseudomonas, with Acinetobacter baumannii and Pseudomonas aeruginosa as the predominant species. Notable differences were observed in the presence of Human gammaherpesvirus 4, Human betaherpesvirus 5, Candida albicans, Aspergillus oryzae, and Aspergillus fumigatus between the group with concomitant fungal infections and the bacterial group. Machine learning algorithms were utilized to select bacteria and clinical indicators associated with hospitalization duration, confirming the excellent performance of bacteria in predicting hospitalization time.ConclusionOur study provided a comprehensive description of the microbial characteristics among patients with lower respiratory tract infections, offering insights from various perspectives. Additionally, we investigated the advanced predictive capability of microbial community features in determining the hospitalization duration of these patients.

Machine learning versus deep learning in land system science: a decision-making framework for effective land classification

This review explores the comparative utility of machine learning (ML) and deep learning (DL) in land system science (LSS) classification tasks. Through a comprehensive assessment, the study reveals that while DL techniques have emerged with transformative potential, their application in LSS often faces challenges related to data availability, computational demands, model interpretability, and overfitting. In many instances, traditional ML models currently present more effective solutions, as illustrated in our decision-making framework. Integrative opportunities for enhancing classification accuracy include data integration from diverse sources, the development of advanced DL architectures, leveraging unsupervised learning, and infusing domain-specific knowledge. The research also emphasizes the need for regular model evaluation, the creation of diversified training datasets, and fostering interdisciplinary collaborations. Furthermore, while the promise of DL for future advancements in LSS is undeniable, present considerations often tip the balance in favor of ML models for many classification schemes. This review serves as a guide for researchers, emphasizing the importance of choosing the right computational tools in the evolving landscape of LSS, to achieve reliable and nuanced land-use change data.

Mendelian randomization shows causal effects of birth weight and childhood body mass index on the risk of frailty

BackgroundThe association between birth weight and childhood body mass index (BMI) and frailty has been extensively studied, but it is currently unclear whether this relationship is causal.MethodsWe utilized a two-sample Mendelian randomization (MR) methodology to investigate the causal effects of birth weight and childhood BMI on the risk of frailty. Instrumental variables (p &amp;lt; 5E-08) strongly associated with own birth weight (N = 298,142 infants), offspring birth weight (N = 210,267 mothers), and childhood BMI (N = 39,620) were identified from large-scale genomic data from genome-wide association studies (GWAS). The frailty status was assessed using the frailty index, which was derived from comprehensive geriatric assessments of older adults within the UK Biobank and the TwinGene database (N = 175,226).ResultsGenetically predicted one standard deviation (SD) increase in own birth weight, but not offspring birth weight (maternal-specific), was linked to a decreased frailty index (β per SD increase = −0.068, 95%CI = −0.106 to −0.030, p = 3.92E-04). Conversely, genetically predicted one SD increase in childhood BMI was associated with an elevated frailty index (β per SD increase = 0.080, 95%CI = 0.046 to 0.114, p = 3.43E-06) with good statistical power (99.8%). The findings remained consistent across sensitivity analyses and showed no horizontal pleiotropy (p &amp;gt; 0.05).ConclusionThis MR study provides evidence supporting a causal relationship between lower birth weight, higher childhood BMI, and an increased risk of frailty.

Opioid metabolism and drug-drug interaction in cancer.

Concomitant use of multiple drugs in most patients with cancer may result in drug-drug interactions (DDIs), potentially causing serious adverse effects. These patients often experience unrelieved cancer-related pain (CRP) during and after cancer treatment, which can lead to a reduced quality of life. Opioids can be used as part of a multimodal pain management strategy when non-opioid analgesics are not providing adequate pain relief, not tolerated, or are contraindicated. However, due to their narrow therapeutic window, opioids are more susceptible to adverse events when a DDI occurs. Clinically relevant DDIs with opioids are usually pharmacokinetic, mainly occurring via metabolism by cytochrome P450 (CYP). This article aims to provide an overview of potential DDIs with opioids often used in the treatment of moderate-to-severe CRP and commonly used anticancer drugs such as chemotherapeutics, tyrosine kinase inhibitors (TKIs), or biologics. A DDI-checker tool was used to contextualize the tool-informed DDI assessment outcomes with clinical implications and practice. The findings were compared to observations from a literature search conducted in Embase and PubMed to identify clinical evidence for these potential DDIs. The limited results mainly included case studies and retrospective reviews. Some potential DDIs on the DDI-checker were aligned with literature findings, while others were contradictory. In conclusion, while DDI-checkers are useful tools in identifying potential DDIs, it is necessary to incorporate literature verification and comprehensive clinical assessment of the patient before implementing tool-informed decisions in clinical practice.

Risk assessment of organ transplant operation: A fuzzy hybrid MCDM approach based on fuzzy FMEA.

Nowadays, most fatal diseases are attributed to the malfunction of bodily. Sometimes organ transplantation is the only possible therapy, for instance for patients with end-stage liver diseases, and the preferred treatment, for instance for patients with end-stage renal diseases. However, this surgical procedure comes with inherent risks and effectively managing these risks to minimize the likelihood of complications arising from organ transplantation (maximizing life years from transplant and quality-adjusted life years) is crucial. To facilitate this process, risk ranking is used to identify and promptly address potential risks. Over recent years, considerable efforts have been made, and various approaches have been proposed to enhance Failure Modes and Effects Analysis (FMEA). In this study, taking into account the uncertainty in linguistic variables (F-FMEA), we introduce an approach based on Fuzzy Multi Criteria Decision Making (F-MCDM) for effectively evaluating scenarios and initial failure hazards. Nevertheless, the results of ranking failure modes generated by different MCDM methods may vary. This study is a retrospective study that suggests a comprehensive unified risk assessment model, integrating multiple techniques to produce a more inclusive ranking of failure modes. Exploring a broad spectrum of risks associated with organ transplant operations, we identified 20 principal hazards with the assistance of literature and experts. We developed a questionnaire to examine the impact of various critical factors on the survival of transplanted organs, such as irregularities in immunosuppressive drug consumption, inappropriate dietary habits, psychological disorders, engaging in strenuous activities post-transplant, neglecting quarantine regulations, and other design-related factors. Subsequently, we analyzed the severity of their effects on the durability of transplanted organs. Utilizing the Mamdani algorithm as a fuzzy inference engine and the Center of Gravity algorithm for tooling, we expressed the probability and severity of each risk. Finally, the failure mode ranking obtained from the F-FMEA method, three fuzzy MCDM methods, and the proposed combined method were identified. Additionally, the results obtained from various methods were evaluated by an expert team, demonstrating that the highest consistency and effectiveness among different methods are attributed to the proposed method, as it achieved a 91.67% agreement with expert opinions.

Computed tomography imaging in preprocedural planning of transcatheter valvular heart interventions.

Cardiac Computed Tomography (CCT) has become a reliable imaging modality in cardiology providing robust information on the morphology and structure of the heart with high temporal and isotropic spatial resolution. For the past decade, there has been a paradigm shift in the management of valvular heart disease since previously unfavorable candidates for surgery are now provided with less-invasive interventions. Transcatheter heart valve interventions provide a real alternative to medical and surgical management and are often the only treatment option for valvular heart disease patients. Successful transcatheter valve interventions rely on comprehensive multimodality imaging assessment. CCT is the mainstay imaging technique for preprocedural planning of these interventions. CCT is critical in guiding patient selection, choice of procedural access, device selection, procedural guidance, as well as allowing postprocedural follow-up of complications. This article aims to review the current evidence of the role of CCT in the preprocedural planning of patients undergoing transcatheter valvular interventions.

Cognitive trajectories preluding the onset of different dementia entities: a descriptive longitudinal study using the NACC database

ObjectiveTo describe the 10-year preclinical cognitive trajectories of older, non-demented individuals towards the onset of the four most prevalent types of dementia, i.e., Alzheimer’s disease(AD), Lewy body(LBD), vascular(VD) and frontotemporal dementia(FTD).MethodsOur analysis focused on data from older (≥ 60years) NACC (National Alzheimer’s Coordinating Center) participants. Four distinct presymptomatic dementia groups (AD-LBD-VD-FTD) and a comparison group of cognitively unimpaired(CU) participants were formed. Comprehensive cognitive assessments involving verbal episodic memory, semantic verbal fluency, confrontation naming, mental processing speed – attention and executive function – cognitive flexibility were conducted at baseline and on an approximately yearly basis. Descriptive analyses (adjusted general linear models) were performed to determine and compare the yearly cognitive scores of each group throughout the follow-up. Exploratory analyses were conducted to estimate the rates of cognitive decline.ResultsThere were 3343 participants who developed AD, 247 LBD, 108 FTD, 155 VD and 3398 composed the CU group. Participants with AD performed worse on episodic memory than those with VD and LBD for about 3 to 4 years prior to dementia onset (the FTD group documented an intermediate course). Presymptomatic verbal fluency and confrontation naming trajectories differentiated quite well between the FTD group and the remaining dementia entities. Participants with incident LBD and VD performed worse than those with AD on executive functions and mental processing speed-attention since about 5 years prior to the onset of dementia, and worse than those with FTD more proximally to the diagnosis of the disorder.ConclusionsHeterogeneous cognitive trajectories characterize the presymptomatic courses of the most prevalent dementia entities.

#2099 Long term outcomes in chronic kidney disease patients with heart failure with preserved ejection fraction

Abstract Background and Aims Heart failure (HF) is frequent in chronic kidney disease (CKD) and leads to high morbidity and mortality in this patient category. The aim of our study is to assess the clinical and biological profile, and outcomes in CKD patients with preserved left ventricular ejection fraction (LVEF). Method We prospectively enrolled CKD patients (pts) in pre-dialysis, stratified in two groups by the presence of heart failure symptoms: pts with NYHA class 1-2 (asymptomatic HF) versus pts with NYHA class 3-4 (symptomatic HF). Demographics, clinical history, co-morbidities, physical exam, ambulatory blood pressure monitoring, extensive blood chemistry, systemic inflammation and mineral bone disease parameters were recorded. Cardiac structure and systolic and diastolic function were assessed by echocardiography. Carotid Doppler ultrasound assessed intima media thickness (IMT). Al patients were followed until death of loss from records; patients with less than 6 months of surveillance were excluded. Primary endpoint was all-cause mortality. Secondary endpoints were cardiovascular mortality, a composite cardiac endpoint composite cardiac endpoint comprising coronary heart disease, heart failure hospitalization and new-onset arrhythmia, and reaching the end stage of renal disease (ESRD). Results We included 76 CKD patients (2 pts CKD stage 1, 9 pts CKD stage 2, 19 pts CKD stage 3a, 28 pts CKD stage 3b, 18 pts CKD stage 4) with LVEF ≥ 50%. Mean age 64.7 ± 11.4 years (yrs), men = 56 (73.7%). Mean follow up period was 86 ± 46.4 months (range 6-156 months). Patients with symptomatic HF (54 pts, 71.1%) were older (68 ± 9 vs 56 ± 12 yrs), hypertensive (98.1% vs 86.4%, p &amp;lt; 0.05), more frequent coronary artery disease (66.7% vs 27.3%, p &amp;lt; 0.05), had worse baseline biological profile: lower eGFR (36.9 ± 12.9 vs 55.5 ± 22.7 ml/min/1.73 m2, p &amp;lt; 0.05), lower serum albumin (4.1 ± 0.5 vs 4.4 ± 0.4 g/dl, p &amp;lt; 0.05), as well as higher levels of osteoprotegerin and fetuin A (p &amp;lt; 0.05). Also, symptomatic HF pts had more severe endothelial disease (higher IMT 0.81 ± 0.14 vs 0.63 ± 0.11 mm, p &amp;lt; 0.05), more severe subclinical LV dysfunction revealed by less negative global longitudinal strain GLS (−16.7 ± 2.66 vs −19.2 ± 2.95, p &amp;lt; 0.05) and higher ratio of mitral velocity to early diastolic velocity of the mitral annulus E/E` (12.64 ± 3.63 vs 9.68 ± 2.73, p &amp;lt; 0.05), as well as higher LV mass index (121.5 ± 31 vs 104.9 ± 22.7 g/m2, p &amp;lt; 0.05) and higher left atrial volume index LAVI (42.8 ± 16.8 vs 31.8 ± 11.3 ml/m2, p &amp;lt; 0.05) All-cause mortality was 17.1% (13 events), while cardiovascular mortality was 6.6% (5 events). All deaths were recorded in the symptomatic HF group. Also, a higher percent of pts from symptomatic HF group reached the composite cardiac endpoint (44.4% vs 22.7%) and ESRD (33.3% vs 18.2%) compared to asymptomatic HF group. Kaplan-Meier survival analysis showed significantly higher all-cause mortality (log rang = 0.008) and lower ESRD-free survival (log rank= 0.045) in symptomatic HF group. All-cause mortality was significantly correlated with NYHA class (p &amp;lt; 0.0001), etiology of CKD (p = 0.038), eGFR (p &amp;lt; 0.0001), proteinuria (p = 0.001), intact PTH (p = 0.008), osteocalcin (p = 0.012), osteopontin (p = 0.029), FGF23 (p = 0.044), IL6 (p = 0.037), GLS (p = 0.023), E/E` (p = 0.009). Cardiovascular mortality was significantly correlated with NYHA class (p = 0.019), etiology of CKD (p = 0.008), eGFR (p = 0.011), proteinuria (p = 0.001), intact PTH (p = 0.008), osteocalcin (p = 0.011), osteopontin (p = 0.006), FGF23 (p = 0.006). Cox regression analysis identified NYHA class (p = 0.004), FGF23 (p = 0.009) and IL6 (p = 0.025) as predictors for all-cause mortality, while E/E` (p = 0.032) and intact PTH (p-0.042) were predictors for cardiovascular mortality. Conclusion In our study, CKD pts with symptomatic HF carry a significant burden of morbidity and mortality, even in the case of preserved LV ejection fraction. This emphasizes the need for more comprehensive regular assessments of subclinical cardiac dysfunction in CKD pts. This approach might support targeted interventions, better symptom control, and improved long term outcomes.

#2502 The CONVINCE randomized trial found positive effects of hemodiafiltration on quality of life in patients with kidney disease on dialysis

Abstract Background and Aims Health-related quality of life of ESKD patients is negatively affected by disease-specific symptoms and can additionally be impaired by renal replacement therapy. Previous studies indicate that hemodiafiltration (HDF) may have a positive impact on the patients’ perceived health status compared to hemodialysis (HD), but overall evidence has been inconclusive. We investigated whether HDF is beneficial with respect to the patients’ perceived health status in the CONVINCE Trial. Method The CONVINCE Trial is an international multi-center, prospective, randomized, open label, controlled trial, comparing benefits and safety high-dose HDF versus high-flux HD. All-cause mortality was the primary outcome of the trial and a broad range of Patient-Reported Outcomes (PROs) were investigated as secondary outcomes. Eight generic health domains (Physical Function, Pain Intensity, Pain Interference, Fatigue, Sleep Disturbance, Depression, Anxiety, Ability to Participate in Social Roles and Activities) were assessed using the Patient-Reported Outcome Measurement Information System, PROMIS®-29 v2.0 profile, and an additional PROMIS short-form assessing Cognitive Function. PROs were collected every three months over the course of the study. As the perceived health status is likely related to mortality, we estimated the effect of HDF on PROs using a joint modelling approach to account for potential bias by selective dropout due to death. Results A total of n = 1 360 patients have been randomized to HD (n = 677) and HDF (n = 683). Both groups were comparable at baseline, with physical function (44.0 on the PROMIS T-score metric) considerably lower than the general population. Median follow-up was 30 months. We could obtain 84% of the planned PRO follow-up assessments on average. Overall, we found a steady decline in Health-Related Quality of Life (HRQoL) over the observation period; with statistically significant group differences for Physical Function (P = .047), Cognitive Function (P = .049), Pain Interference (P = .027) and the Ability to Participate in Social Roles and Activities (P = .023), all favouring HDF over HD. Conclusion Within the CONVINCE trial we have applied a comprehensive assessment of PROs comparing HDF with HD. Along with a beneficial effect on survival rates, we observed a slower decline in patients perceived health status when treated with HDF compared to HD. CONVINCE provides further evidence that HDF is beneficial in terms of quality of life.

Socioeconomic inequalities in access to online learning and its association with early childhood development during the COVID-19 pandemic in Yunnan Province, China

While online learning was widely adopted by schools during the COVID-19 pandemic globally, little is known about its effects on preschool children’s development in China. Using a unique dataset collected in Yunnan Province, China in 2020, with a sample of 11,990 children aged 3–5 years from 285 kindergartens, we provide the first comprehensive assessment of socioeconomic inequalities in access to online learning and its association with early childhood development (ECD). The study demonstrates significant inequalities in access to online learning. Particularly, preschoolers with rural household residential registration (Hukou), lower maternal schooling, and lower family income are less likely to have access to online learning than their counterparts. Regression results based on the Generalized Linear Model (GLM) and the Instrumental Variable (IV) method show that access to online learning is positively associated with a child’s ECD score. The empirical evidence of the unequal access to online learning and its possible consequence in ECD during the pandemic has policy implications that the ever-widening developmental gap for those lacking access to online learning needs to be addressed accordingly when the pandemic is over.

#1519 Nutritional impact of ketoanalogue supplementation with protein-restricted diets in advanced chronic kidney disease

Abstract Background and Aims The benefits and risks of a protein-restricted diet supplemented with ketoanalogues (KA) in patients with chronic kidney disease (CKD) are still being explored. Combining KA supplementation with a protein-restricted diet may potentially preserve the glomerular filtration rate (GFR) in CKD patients. However, concerns about protein-energy wasting and the nutritional benefits of KA supplementation remain uncertain. Previous systematic reviews have often included crossover or non-randomized studies and combined data from CKD and dialysis patients, potentially introducing heterogeneity when assessing the effects of KA supplementation in CKD patients. We aim to provide an updated and comprehensive assessment of the impact of combining KA supplementation with a protein-restricted diet on the nutritional status of advanced CKD patients compared to the effects of a protein-restricted diet alone. Method We conducted systematic literature searches of PubMed, Embase, Scopus, and Cochrane Library up to September 2023. We selected parallel-design randomized controlled trials comparing KA supplementation to a low- or very low-protein diet (VLPD) versus a low-protein diet (LPD) alone in adults with stages 3-5 CKD. Outcomes included serum albumin, triceps skinfold (TSF), and mid-arm muscle circumference (MAMC). Pooled estimates of effect measures were calculated using the random-effects model and presented as standardized mean differences (SMDs) with 95% confidence intervals (CIs). Given the variation in CKD stages among the included studies, subgroup analyses were conducted based on baseline renal function (GFR &amp;lt; 20 vs. ≥ 20 mL/min/1.73 m²). To assess the robustness of our meta-analyses, we conducted sensitivity analyses by excluding studies with an in-trial follow-up duration of less than one year. Results We identified 13 trials with 974 participants and a median follow-up of 12 months. KA supplementation combined with an LPD or a VLPD significantly increased TSF compared to an LPD alone (SMD, 0.25; 95% CI, 0.04, 0.45; P = 0.02; Fig. 1). No significant differences were observed in serum albumin (SMD, 0.28; 95% CI, -0.05, 0.61; P = 0.10; Fig.) and MAMC (SMD, 0.10; 95% CI, -0.12, 0.32; P = 0.37; Fig. 1). KA supplementation significantly increased serum albumin in patients with a baseline GFR ≥ 20 mL/min/1.73 m² (SMD 0.52; 95% CI, 0.20, 0.84; P = 0.001), but not in those with a baseline GFR &amp;lt; 20 mL/min/1.73 m² (SMD, -0.04; 95% CI, -0.41, 0.34; P = 0.85), and this difference between the subgroups was statistically significant (P = 0.03; Fig. 2). Sensitivity analysis that excluded studies with an in-trial follow-up duration of less than one year yielded results similar to the main analysis, except that the difference in TSF between the intervention and control arms became nonsignificant. Conclusion In patients with stages 3-5 CKD, KA supplementation with a protein-restricted diet did not adversely affect nutritional status. These findings remained consistent in sensitivity analyses of RCTs with a follow-up of more than one year and in subgroup analyses based on baseline GFR. The addition of KAs to protein-restricted diets improved serum albumin levels in patients with a baseline GFR of ≥ 20 mL/min/1.73 m². Our analyses confirmed the efficacy and safety of KA supplementation on nutritional status in advanced CKD patients over a one year follow-up period.

#2199 Kidney involvement aspects in women with Fabry disease from the Romanian cohort

Abstract Background and Aims Fabry disease (FD) is an X-linked rare lysosomal storage disease causing progressive nervous system, kidney and heart disorders. Progressive kidney impairment is common, and an important cause of morbidity and mortality. In FD females, treatment guidelines recommend therapy initiation when there is evidence of organ involvement, but determining the proper moment to start FD specific treatment could be a real challenge in the cases. The aim of our retrospective study is to investigate clinical and histological aspects of kidney involvement in female patients with genetically confirmed FD evaluated in our Expert Center for Rare Diseases of the Reno-Urinary System between 2015–2023, with focus on the clinical phenotype and initiation of FD specific treatment. Method All patients had comprehensive assessment for target organ manifestations of Fabry disease. Renal function was assessed using serum creatinine, albumin creatinine ratio and proteinuria. Also, 14 (40%) FD females underwent kidney biopsy (KB) in order to reveal the FD specific lesions and/or to establish the indication for FD pathogenic therapy. Kidney biopsy specimens were analyzed by light and electron microscopy. Results Our study included 35 heterozygous adult females with FD from 25 unrelated families. Most females (91.4%) were diagnosed through family screening, while 3 females (8.6%) were index cases. The mean age at diagnosis was 43.8 ± 15.3 years (range 17-73 years), although mean age of symptoms onset was 34.3 ± 13.5 years (range 14-61 years). Six women from our cohort were considered healthy carriers, three females presented only neurological manifestations, nine patients had combined renal and neurological involvement, one patient had cardiac and renal involvement and the others presented multiple organ involvement. Significant co-morbidities were: arterial hypertension in 13 patients, diabetes mellitus in 2 patients, and obesity in 9 patients. Overall baseline mean eGFR was 79.9 ± 28.2 (range 25-135) ml/min/1.73 m2. Eleven patients had no obvious kidney involvement, 10 patients presented chronic kidney disease (CKD) stage 2, 11 patients CKD stage 3, one CKD stage 4 and 1 was hemodialyzed. Seventeen patients presented normal UACR, thirteen patients showed microalbuminuria, and four patients presented macroalbuminuria. Overt proteinuria (&amp;gt; 0.3 g/24 h) was noticed in 8 patients. Thirteen females performed KB before the initiation of FD specific treatment, and one patient was already treated. At the moment of KB, five patients had normal biologic kidney assessment, three patients presented CKD stage 2 (microalbuminuria in 2 cases and proteinuria in 1 case), and five patients presented CKD stage 3 (normoalbuminuria in 1 case, microalbuminuria in 1 case and overt proteinuria in 3 cases). All KBs showed lysosomal accumulation in the podocytes, 92.8% showed inclusions in the parietal cells of the Bowman capsule, 85.7% in the tubules, while vascular inclusions were found in 78.5% of cases. Also, we observed segmental glomerular sclerosis in 5 cases, interstitial fibrosis and tubular atrophy in 3 cases, each. Only 2 patients were treated with pathogenic therapy before the first evaluation in our center. After multidisciplinary evaluation, 22 patients (62.8%) from our cohort received recommendation to initiate FD specific treatment, and 11 patients entered in our follow-up program. Evidence of specific FD lesions in KB was a strong reason to support the recommendation to initiate FD specific treatment. Conclusion Our results showed that kidney involvement in FD females can vary from asymptomatic or mildly symptomatic, to severely symptomatic, with end stage kidney disease. Thus, females should be carefully evaluated and monitored in a multidisciplinary team, in order to diagnosed FD affected organs. Also, we underline that a normal standard assessment of the kidney cannot rule out kidney involvement in female patients with FD, and strengthen the importance of KB for detection of early kidney involvement and for additional support for early initiation of FD specific therapy.