Comprehensive Outcome Research Articles

Comparing the Efficacy of Povidone-Iodine Versus Normal Saline in Laparotomy Wound Irrigation to Prevent Surgical Site Infections: A Meta-Analysis.

Surgical site infections (SSIs) are a known complication of laparotomies and intra-abdominal surgical operations leading to remarkable consequences on mortality, morbidity, and expenses. The study aims to assess the efficiency of irrigating laparotomy incision sites with povidone-iodine (PVI) or normal saline (NS) in diminishing the rate of SSIs in patients undergoing gastrointestinal operations for varying indications. Randomized controlled trials (RCTs) highlighting the contribution of laparotomy wound irrigation with PVI in opposition to NS in patients planned for laparotomy addressing numerous gastrointestinal issues, and their role in reducing SSI risk were obtained via searching of standard electronic medical databases. The analysis was conducted by utilizing meta-analysis principles procured by statistical software RevMan version 5.3 (Cochrane Collaboration, London, UK). The yield of medical databases exploration and inspection was 13 RCTs on 3816 patients who underwent laparotomy for different gastrointestinal operations. There were 1900 patients in the PVI group whereas 1916 patients received NS wound irrigations preceding closure of the laparotomy skin wound. In the random effects model analysis, the use of PVI for laparotomy wound irrigation was associated with the reduced risk (odds ratio = 0.54, 95%CI (0.30, 0.98), Z = 2.04, P = 0.04) of SSIs. Nevertheless, there was outstanding heterogeneity (Tau2=70; chi2=40.19, df=12; P = 0.0001; I2=70%) among the included studies. According to the comprehensive analysis outcomes, it has been clinically proven that the use of PVIis highly effective in reducing the occurrence of SSIs, as well as their subsequent implications.

Older age at surgery and postoperative leg length discrepancy are risk factors for unfavourable patient-reported outcome measures of knee tumour endoprostheses following resection for musculoskeletal tumour of the lower limb.

To evaluate mid-to long-term patient-reported outcome measures (PROMs) of endoprosthetic reconstruction after resection of malignant tumours arising around the knee, and to investigate the risk factors for unfavourable PROMs. The medical records of 75 patients who underwent surgery between 2000 and 2020 were retrospectively reviewed, and 44 patients who were alive and available for follow-up (at a mean of 9.7 years postoperatively) were included in the study. Leg length discrepancy was measured on whole-leg radiographs, and functional assessment was performed with PROMs (Toronto Extremity Salvage Score (TESS) and Comprehensive Outcome Measure for Musculoskeletal Oncology Lower Extremity (COMMON-LE)) with two different aspects. The thresholds for unfavourable PROMs were determined using anchor questions regarding satisfaction, and the risk factors for unfavourable PROMs were investigated. The thresholds for favourable TESS and COMMON were 64.8 and 70.4 points, respectively. Multivariate analysis showed that age at surgery (p = 0.004) and postoperative leg length discrepancy (p = 0.043) were significant risk factors for unfavourable TESS results, while age at surgery (p < 0.001) was a significant risk factor for unfavourable COMMON-LE results. Following receiver operating characteristic analysis, the threshold for both TESS and COMMON-LE was 29 years of age at surgery. Additionally, a leg length discrepancy of 8.2 mm was the threshold for unfavourable TESS. Patients aged > 29 years at the time of surgery require appropriate preoperative counselling and adequate postoperative physical and socioemotional support. Reconstruction equivalent to the length of the resected bone can reduce the risk of functional disabilities in daily living.

P115: Testing the feasibility of a multicomponent neuropsychological intervention for individuals at-risk of dementia: the REMINDER program

Objective:Interventions aimed to optimize cognitive function and functionality in individuals at risk of dementia were scarce in validity studies. While some RCTs have been developed in cognitive training interventions, studies of multicomponent interventions (cognitive, social, and behavioral) integrating intervention targeting psychosocial risk factors (social isolation, depression, low cognitive reserve) is absent. Additionally, few efforts have been made to develop such validity studies with individuals at higher risk of dementia who still do not present objective cognitive decline, despite current recommendations in this regard. We aimed to start the validation of a 20-session multicomponent intervention – REMINDER program - with a feasibility test and a preliminary efficacy testing using a comprehensive outcome assessment protocol.Methods:A feasibility randomized controlled trial (RCT) was conducted, recruiting community-dwelling individuals between 60 to 75 years old with increased risk of dementia (LIBRA dementia risk score). Fifteen participants took part in twice-a-week sessions of the REMINDER program, during twelve weeks. Data on the acceptability, satisfaction and adherence to the REMINDER program was collected, and an association between pre and post intervention motivation and knowledge about dementia risk was examined. For the preliminary efficacy testing we considered as primary outcome a performance-based functionality measure (UPSA) and secondary outcomes will include global cognition, emotional status, and lifestyle habits, tested prior and after the intervention.Results:Rates of satisfaction throughout the REMINDER program sessions were high (75%, mean) as well as the adherences that was superior to the main dementia risk reduction programs referred in literature. (83%). Post-intervention efficacy testing is ongoing, however, levels of knowledge about dementia risk increased 12% compared with pre-intervention (34% pre-intervention, to 46% post intervention; p=.045)Discussion:Preliminary data on feasibility and efficacy of the REMINDER program suggests this program is an engaging and motivating tool for dementia risk reduction, justifying the future implementation of a large-scale RCT. We expect that, with a larger efficacy study we can demonstrate the REMINDER program effects in behavior change and in the adoption of protective lifestyles for dementia prevention, and that the comprehensive outcome assessment proves to be effective and, therefore, replicable in further studies.

Transitional Care Interventions From Hospital to Community to Reduce Health Care Use and Improve Patient Outcomes

Discharge from the hospital to the community has been associated with serious patient risks and excess service costs. To evaluate the comparative effectiveness associated with transitional care interventions with different complexity levels at improving health care utilization and patient outcomes in the transition from the hospital to the community. CENTRAL, Embase, MEDLINE, and PsycINFO were searched from inception until August 2022. Randomized clinical trials evaluating transitional care interventions from hospitals to the community were identified. At least 2 reviewers were involved in all data screening and extraction. Random-effects network meta-analyses and meta-regressions were applied. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. The primary outcomes were readmission at 30, 90, and 180 days after discharge. Secondary outcomes included emergency department visits, mortality, quality of life, patient satisfaction, medication adherence, length of stay, primary care and outpatient visits, and intervention uptake. Overall, 126 trials with 97 408 participants were included, 86 (68%) of which were of low risk of bias. Low-complexity interventions were associated with the most efficacy for reducing hospital readmissions at 30 days (odds ratio [OR], 0.78; 95% CI, 0.66 to 0.92) and 180 days (OR, 0.45; 95% CI, 0.30 to 0.66) and emergency department visits (OR, 0.68; 95% CI, 0.48 to 0.96). Medium-complexity interventions were associated with the most efficacy at reducing hospital readmissions at 90 days (OR, 0.64; 95% CI, 0.45 to 0.92), reducing adverse events (OR, 0.42; 95% CI, 0.24 to 0.75), and improving medication adherence (standardized mean difference [SMD], 0.49; 95% CI, 0.30 to 0.67) but were associated with less efficacy than low-complexity interventions for reducing readmissions at 30 and 180 days. High-complexity interventions were most effective for reducing length of hospital stay (SMD, -0.20; 95% CI, -0.38 to -0.03) and increasing patient satisfaction (SMD, 0.52; 95% CI, 0.22 to 0.82) but were least effective for reducing readmissions at all time periods. None of the interventions were associated with improved uptake, quality of life (general, mental, or physical), or primary care and outpatient visits. These findings suggest that low- and medium-complexity transitional care interventions were associated with reducing health care utilization for patients transitioning from hospitals to the community. Comprehensive and consistent outcome measures are needed to capture the patient benefits of transitional care interventions.

Adherence to clinical practice guidelines for pulmonary valve intervention after tetralogy of Fallot repair: A nationwide cohort study

ObjectivesTo determine guideline adherence pertaining to pulmonary valve replacement (PVR) referral after tetralogy of Fallot (TOF) repair. MethodsChildren and adults with cardiovascular magnetic resonance imaging scans and at least moderate pulmonary regurgitation were prospectively enrolled in the Comprehensive Outcomes Registry Late After TOF Repair (CORRELATE). Individuals with previous PVR were excluded. Patients were classified according to presence (+) versus absence (−) of PVR and presence (+) versus absence (−) of contemporaneous guideline satisfaction. A validated score (specific activity scale [SAS]) classified adult symptom status. ResultsIn total, 498 participants (57% male, mean age 32 ± 14 years) were enrolled from 14 Canadian centers (2013-2020). Mean follow-up was 3.8 ± 1.8 years. Guideline criteria for PVR were satisfied for the majority (n = 422/498, 85%), although referral for PVR occurred only in a minority (n = 167/498, 34%). At PVR referral, most were asymptomatic (75% in SAS class 1). One participant (0.6%) received PVR without meeting criteria (PVR+/indication–). The remainder (n = 75/498, 15%) did not meet criteria for and did not receive PVR (PVR–/indication–). Abnormal cardiovascular imaging was the most commonly cited indication for PVR (n = 61/123, 50%). The SAS class and ratio of right to left end-diastolic volumes were independent predictors of PVR in a multivariable analysis (hazard ratio, 3.33; 95% confidence interval, 1.92-5.8, P < .0001; hazard ratio, 2.78; 95% confidence interval, 2.18-3.55, P < .0001). ConclusionsAlthough a majority of patients met guideline criteria for PVR, only a minority were referred for intervention. Abnormal cardiovascular imaging was the most common indication for referral. Further research will be necessary to establish the longer-term clinical impact of varying PVR referral strategies.

Measuring population health and quality of life: Developing and testing of the significant quality of life measure (SigQOLM)

Quality of life (QOL) should ideally be determined by a broader spectrum of measurable parameters. This study aims to develop and validate a study instrument that is designed to determine a holistic measure of health and non-health aspects of QOL, and it is called the ‘Significant Quality of Life Measure’ (SigQOLM). This study involves five phases which aim to (i) explore and understand the subject matter content, (ii) develop a questionnaire, (iii) assess its content validity and face validity, (iv) conduct a pilot study, and lastly (v) perform a field-test by using the questionnaire. For the field-testing phase, a cross-sectional study was conducted which elicited responses from healthcare workers via a self-administered survey for all the SigQOLM items. Based on the results, the overall framework of the SigQOLM consists of four elements, 18 domains with 69 items. The element of “Health” is measured by nine domains, while “Relationships”, “Functional activities, and “Survival” are measured by three domains respectively. The SigQOLM has been developed successfully and then validated with a high level of reliability, validity, and overall model fit. Therefore, the SigQOLM will provide researchers and policymakers another viable option to elicit a more comprehensive outcome measure of QOL which shall then enable them to implement specific interventions for improving the QOL of all the people, both healthy or otherwise.

Unraveling the Transcriptional Landscape of Nodular Lymphocyte-Predominant Hodgkin Lymphoma and T-Cell/Histiocyte Rich Large B-Cell Lymphoma: Impact of Tumor Microenvironment and Checkpoint Gene Expression

Introduction: Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare B-cell malignancy with a paucity of malignant cells embedded in a diverse tumor microenvironment (TME). The histological composition of the TME is known to influence outcomes, with nodular B-cell rich TME (classical histology, Fan patterns A&amp;B) associated with indolent clinical course, while T-cell infiltration or diffuse growth (variant histology, Fan patterns C-F) may resemble aggressive T/cell-histiocyte rich large B-cell lymphoma (THRLBCL) to which NLPHL can transform. Molecular features of NLPHL and THRLBCL remain to be discovered. To gain further insights into the biology of these lymphomas, we recruited NLPHL and THRLBCL cases as part of the Atlas of Blood Cancer Genomes (ABCG) initiative, a consortium consisting of 26 institutions. Design: We collected comprehensive clinicopathological, treatment and outcome data from 154 NLPHL and 21 THRLBCL patients, with centralized pathology review performed by a panel of dedicated hematopathologists. Fan patterns of the NLPHL samples were documented in all samples where possible. RNA sequencing was performed on formalin-fixed paraffin-embedded (FFPE) diagnostic tumor samples (n=129 NLPHL; n=17 THRLBCL). Tumor-infiltrating immune cell compositions were enumerated using FARDEEP with signature matrix LM22 from CIBERSORT. Results: Median age at diagnosis for the patients with THRLBCL and NLPHL was 54 years (interquartile ratio [IQR] 43-65) and 40 years (IQR 24-53), respectively. The majority of patients with NLPHL had limited stage (74%), whereas the patients with THRLBCL predominantly had advanced stage at diagnosis (95%). In both diseases, most patients were males (NLPHL, 69%; THRLBCL, 76%). Spleen involvement was present in 11 NLPHL patients (8%) and histological growth pattern was documented in 112 patients (73%). Out of those, 47 (42%) presented with variant histology and 65 with classical histology. Variant histology was enriched in NLPHL patients with splenic involvement. During a median follow-up of 6.4 years (IQR 3.8-10.1), 12 NLPHL patients and 9 THRLBCL patients died. Patients with THRLBCL had worse 10-year overall survival (OS, 31% vs 89%; p&amp;lt;0.001) and progression-free survival (PFS, 30% vs 66%; p=0.002) compared to patients with NLPHL. Moreover, NLPHLs with variant histology had inferior 10-year OS compared to NLPHLs with classical histology (81% vs 91%; P=0.03; Figure 1). According to in silico immunophenotyping, THRLBCL cases had the highest median proportions of M1-macrophages (11.0%) and CD8+ T-cells (17.0%), followed by NLPHLs with variant histology (M1-macrophages, 6.5%; CD8+ T-cells, 14.5%), with the lowest proportion observed in NLPHLs with classical histology (M1-macrophages, 5.2%; CD8+ T-cells, 10.9%). In contrast, the median proportions of naïve B cells followed an opposite trend across subtypes (NLPHL classical histology, 15.5%; NLPHL variant histology, 11.0%; THRLBCL, 2.0%), whereas the median proportion of CD4+ T-cells was similar across both lymphomas (NLPHL classical histology, 33.9%; NLPHL variant histology, 33.9%; THRLBCL, 32.4%). Despite differences in the overall transcriptomic landscape, gene expression patterns posited THRLBCL and NLPHL as comprising a biological continuum. THRLBCL shared more similarities with NLPHL with variant histology, while NLPHLs with classical histology exhibited upregulation of genes related to cell growth and proliferation through the MYC pathway (P&amp;lt;0.001). Finally, we identified a strong association between THRLBCL and upregulation of checkpoint genes (P&amp;lt;0.001) and gene expression related to inflammatory response (P&amp;lt;0.001) (Figure 2). Furthermore, NLPHLs with a high checkpoint score (above the 75th percentile) were associated with spleen involvement (P&amp;lt;0.001) and worse outcome (5-year PFS 61% vs 87%; P=0.02). Conclusion: Our study provides the largest comprehensive clinical and transcriptomic analyses of NLPHL and THRLBCL to-date. The findings suggest that the inferior outcomes observed in THRLBCL and in a subset of NLPHL are attributable to a higher degree of inflammation in the TME, increased expression of checkpoint genes, and a high proportion of macrophages.

Standardising personalised diabetes care across European health settings: A person-centred outcome set agreed in a multinational Delphi study.

Standardised person-reported outcomes (PRO) data can contextualise clinical outcomes enabling precision diabetes monitoring and care. Comprehensive outcome sets can guide this process, but their implementation in routine diabetes care has remained challenging and unsuccessful at international level. We aimed to address this by developing a person-centred outcome set for Type 1 and Type 2 diabetes, using a methodology with prospects for increased implementability and sustainability in international health settings. We used a three-round questionnaire-based Delphi study to reach consensus on the outcome set. We invited key stakeholders from 19 countries via purposive snowball sampling, namely people with diabetes (N = 94), healthcare professionals (N = 65), industry (N = 22) and health authorities (N = 3), to vote on the relevance and measurement frequency of 64 previously identified clinical and person-reported outcomes. Subsequent consensus meetings concluded the study. The list of preliminary outcomes was shortlisted via the consensus process to 46 outcomes (27 clinical outcomes and 19 PROs). Two main collection times were recommended: (1) linked to a medical visit (e.g. diabetes-specific well-being, symptoms and psychological health) and (2) annually (e.g. clinical data, general well-being and diabetes self management-related outcomes). PROs are often considered in a non-standardised way in routine diabetes care. We propose a person-centred outcome set for diabetes, specifically considering psychosocial and behavioural aspects, which was agreed by four international key stakeholder groups. It guides standardised collection of meaningful outcomes at scale, supporting individual and population level healthcare decision making. It will be implemented and tested in Europe as part of the H2O project.

Disparities in Receipt of National Comprehensive Cancer Network Guideline-Adherent Care and Outcomes among Women with Triple-Negative Breast Cancer by Race/Ethnicity, Socioeconomic Status, and Insurance Type.

The National Comprehensive Cancer Network guidelines were designed to improve patient outcomes. Here, we examine factors that may contribute to outcomes and guideline adherence in patients with triple-negative breast cancer. This was a retrospective cohort study of women with triple-negative breast cancer using the California Cancer Registry. Adherent treatment was defined as the receipt of a combination of surgery, lymph node assessment, adjuvant radiation, and/or chemotherapy. A multivariable logistic regression was used to determine the effects of independent variables on adherence to the NCCN guidelines. Disease-specific survival was calculated using Cox regression analysis. A total of 16,858 women were analyzed. Black and Hispanic patients were less likely to receive guideline-adherent care (OR 0.82, 95%CI 0.73-0.92 and OR 0.87, 95%CI 0.79-0.95, respectively) compared to White patients. Hazard ratios adjusted for adherent care showed that Black patients had increased disease-specific mortality (HR 1.28, 95%CI 1.16-1.42, p < 0.0001) compared to White patients. A significant majority of breast cancer patients in California continue to receive non-guideline-adherent care. Non-Hispanic Black patients and patients from lower SES quintile groups were less likely to receive guideline-adherent care. Patients with non-adherent care had worse disease-specific survival compared to recipients of NCCN guideline-adherent care.

Development of Innovative Assessment Methods in the Context of Modern Learning

The purpose of this research is to develop innovative assessment methods in the context of modern Learning. In today's digital age, traditional approaches to learning assessment are often no longer sufficient to holistically assess student progress and success. Thus, this study proposes a more innovative and comprehensive assessment method that uses modern technology and considers students' individual needs. This study identified and tested promising new assessment tools and techniques through pilot projects, such as digital portfolios, peer assessment, and realistic simulations. In addition, this study also explores how technologies such as learning analytics can be used to provide more meaningful and timely feedback to students and teachers. The results of this study indicate that this innovative assessment method can improve student engagement, comprehension, and learning outcomes. These findings also suggest that teachers and educators can use technology and data to make more informed decisions about how to develop and implement assessment strategies. In conclusion, developing innovative assessment methods in modern learning environments is essential for more inclusive, adaptive, and practical education. By integrating technology and new assessment approaches, this research significantly contributes to our understanding of creating more effective and engaging assessment systems in this digital era.

Enhancing Symptom Management and Coordination of Breast Cancer Care at Secondary Hospitals in Saudi Arabia

The passage highlights the complexity of integrated breast cancer care and the importance of effective communication in ensuring treatment compliance, reducing errors and complications, and managing co-morbidities. It emphasizes the need for clarity in the role of the care director to prevent patients from getting lost across different departments. Digital tools are recognized as valuable resources for improving care communication, but their directives and integration within the care team need to be clearly defined. Multidisciplinary team meetings are essential for driving care planning, establishing directives, and collecting structured data. Nurse navigators play a pivotal role in ensuring care continuity and assuming the director's role in the complex landscape of breast cancer care. While AI-driven planning can facilitate their tasks, human intervention remains crucial for providing psychosocial support and addressing unexpected urgencies. The allocation of patients across different healthcare centers is often managed manually and through phone communication, resulting in time-consuming processes and discontinuous system solutions. Privacy rules and competition among providers further limit the effectiveness of current solutions. Additionally, the collection of comprehensive outcome information is currently limited to specific collaborative networks. To address these challenges, AI tools can play a role in facilitating care allocation and predicting risks by leveraging data continuity over time. This can help identify non-compliance issues caused by factors such as limited local resources, distance, and costs. However, it is essential to conduct applied research to bring AI modeling into clinical practice and promote well-coordinated, patient-centric cancer care within the complex healthcare landscape.

What Aspects of Quality of Life are Important from Palliative Care Patients' Perspectives? A Framework Analysis to Inform Preference-Based Measures for Palliative and End-of-Life Settings.

Preference-based outcome measures are commonly applied in economic analyses to inform healthcare resource allocation decisions. Few preference-based outcome measures have been specifically developed for palliative and end-of-life settings. This study aimed to identify which quality-of-life domains are most important to Australians receiving specialised palliative care services to help determine if the development of a new condition-specific preference-based outcome measure is warranted. In-depth face-to-face interviews were conducted with 18 participants recruited from palliative care services in South Australia. Data were analysed using a framework analysis drawing on findings from a systematic review of international qualitative studies investigating the quality-of-life preferences of patients receiving palliation (domains identified included cognitive, emotional, healthcare, personal autonomy, physical, preparatory, social, spiritual). Participants identified missing or irrelevant domains in the EQ-5D and QLU-C10D questionnaires and ranked the importance of domains. A priori domains were refined into cognitive, environmental, financial, independence, physical, psychological, social and spiritual. The confirmation of the eight important quality-of-life domains across multiple international studies suggests there is a relatively high degree of convergence on the perspectives of patients in different countries. Four domains derived from the interviews are not covered by the EQ-5D and QLU-C10D (cognitive, environmental, financial, spiritual), including one of the most important (spiritual). Existing, popular, preference-based outcome measures such as the EQ-5D do not incorporate the most important, patient-valued, quality-of-life domains in the palliative and end-of-life settings. Development of a new, more relevant and comprehensive preference-based outcome measure could improve the allocation of resources to patient-valued services and have wide applicability internationally.

Interleukin-6 and the determinants of severe COVID-19: A retrospective cohort study.

Cytokines, notably interleukin-6 (IL-6), increase considerably in patients with severe corona virus disease 2019 (COVID-19). This vigorous immune response may cause end-organ failure or death; hence, measuring IL-6 in the context of patient characteristics may help predict outcomes and encourage early comprehensive therapy. This study investigated the association between serum IL-6 levels, COVID-19 severity, and demographic, clinical, and biochemical characteristics. COVID-19 inpatients in NMC hospitals were investigated between November 2020 and November 2021. Several patient variables related to serum IL-6 and COVID-19 severity have been examined. The study included 374 COVID-19 inpatients, 235 of whom had severe disease with a median age of 51. The elderly had an increased risk of severe COVID-19 (73.8%) compared with young adults (71%), with higher white blood cells, D-dimer, Lactate dehydrogenase, creatinine, ferritin, prothrombin time, Procalcitonin, and fibrinogen levels (P < .001). C-reactive protein, troponin, intensive care unit admission, disease severity score, and mortality were significantly associated with higher serum IL-6 levels (P = .05) in the univariate analysis, but this significance disappeared in the multivariate analysis. IL-6, along with other demographic and clinical variables affected COVID-19 severity. These characteristics may predict patients at risk of severe disease and assist in establishing early comprehensive disease outcome strategies. Large-scale clinical research is needed to emphasize IL-6 and COVID-19.

Enhanced Pelican Optimization Algorithm with Deep Learning-Driven Mitotic Nuclei Classification on Breast Histopathology Images.

Breast cancer (BC) is a prevalent disease worldwide, and accurate diagnoses are vital for successful treatment. Histopathological (HI) inspection, particularly the detection of mitotic nuclei, has played a pivotal function in the prognosis and diagnosis of BC. It includes the detection and classification of mitotic nuclei within breast tissue samples. Conventionally, the detection of mitotic nuclei has been a subjective task and is time-consuming for pathologists to perform manually. Automatic classification using computer algorithms, especially deep learning (DL) algorithms, has been developed as a beneficial alternative. DL and CNNs particularly have shown outstanding performance in different image classification tasks, including mitotic nuclei classification. CNNs can learn intricate hierarchical features from HI images, making them suitable for detecting subtle patterns related to the mitotic nuclei. In this article, we present an Enhanced Pelican Optimization Algorithm with a Deep Learning-Driven Mitotic Nuclei Classification (EPOADL-MNC) technique on Breast HI. This developed EPOADL-MNC system examines the histopathology images for the classification of mitotic and non-mitotic cells. In this presented EPOADL-MNC technique, the ShuffleNet model can be employed for the feature extraction method. In the hyperparameter tuning procedure, the EPOADL-MNC algorithm makes use of the EPOA system to alter the hyperparameters of the ShuffleNet model. Finally, we used an adaptive neuro-fuzzy inference system (ANFIS) for the classification and detection of mitotic cell nuclei on histopathology images. A series of simulations took place to validate the improved detection performance of the EPOADL-MNC technique. The comprehensive outcomes highlighted the better outcomes of the EPOADL-MNC algorithm compared to existing DL techniques with a maximum accuracy of 97.83%.

Abstract 13760: Systematic Review and Meta-Analysis of Clinical Outcomes in Cardiac Sarcoidosis: A Comprehensive Review

Introduction: Cardiac sarcoidosis (CS), often overlooked due to its myriad and non-specific presentation, is mainly understood through small studies. Hypothesis: What comprehensive evidence exists regarding the cumulative clinical outcomes in CS patients? Methods: A literature search in PubMed and EMBASE was conducted until September 8, 2022. Data from Kaplan-Meier curves were reconstructed using WebPlotDigitizer, with subsequent analysis was conducted via Cox proportional hazards models and non-parametric methods. Results: We reviewed 183 studies with 29,830 CS-diagnosed patients, and CS predominantly affected middle-aged, White, and Black individuals, with data primarily derived from Europe, North America, and Japan. The prevalent arrhythmias were ventricular arrhythmias (25%) and conduction block (low-degree, 21%; high-degree, 15%). Steroids were the primary treatment, with implantable cardioverter-defibrillators (ICD) used in 20% of cases (Image 1) . Survival meta-analysis showed that immunosuppressants significantly lower mortality risk in CS patients (HR: 0.52, 95% CI: 0.38-0.7, p &lt; 0.0001) compared with the general CS population. ICD implanted for primary prevention in CS patients was associated with lower risk of inappropriate ICD therapy compared with ICD for secondary prevention (HR: 0.29, 95% CI: 0.19-0.44, p &lt; 0.0001). Post-transplant survival was superior in CS patients than non-CS patients (HR: 0.58, 95% CI: 0.46-0.72, p &lt; 0.0001) (Image 2) . Conclusions: This study is the first to provide comprehensive outcomes in CS patients. We encourage global research efforts to include underrepresented population in order to better understand CS.

Comprehensive Outcome Assessment and Quality of Life Following Epilepsy Surgery.

Seizure freedom without deficits is the primary goal for epilepsy surgery. However, patients with medically refractory epilepsy commonly suffer from many co-morbidities related to mood, cognition, and sleep as well as social problems and resultant stigma. While epilepsy surgery literature does describe quality of life (QOL) and neuropsychological outcomes, there is a paucity of information on various common non-seizure outcomes, especially pertaining to mood, sleep, cognition, and social aspects. The objective of this study was to evaluate the role of various non-seizure parameters on post-epilepsy surgery QOL. Consecutive adult patients operated for refractory epilepsy at least 1 year prior to initiation of this study were included and classified as seizure-free (group 1) or non-seizure-free (group 2). QOL was assessed using the QOLIE-31 instrument; patients with a T score less than 40 were categorized as "poor QOL." Non-seizure parameters assessed were cognition, mood disturbances, social improvement, social stigma, and sleep disturbances. Categorization into "good" and "poor" outcome subgroups on each item was carried out by dichotomization of scores. Thirty-seven patients (16 F) [mean age 23.5 ± 5.6 years] were evaluated; 26 were seizure-free (group 1). In this group, impaired memory, lower language scores, depression, not having been employed, not receiving education prior to surgery, and experiencing social stigma were factors significantly associated with poor QOL. In group 2, all patients had poor QOL scores. Non-seizure factors related to common epilepsy co-morbidities and social issues are highly prevalent among seizure-free patients reporting poor QOL after epilepsy surgery.

International Coordination of Research on Infectious Animal Diseases (ICRAD) First Call: Editorial and Abstracts

The ICRAD ERA-NET launched its first call in 2020, with funding partners from twenty European countries. The aim was to foster a collaborative and interdisciplinary approach towards developing innovative instruments for the control and prevention of animal infectious diseases. Particularly, with a focus on creating vaccine and diagnostic technology platforms to enhance preparedness for major epidemic threats such as African swine fever and animal influenza. The first ICRAD call received significant support, totaling €17.4 million from partner countries alongside an additional €6.7 million top-up from the European Commission (EC). These funds were allocated to nineteen research project consortiums, consisting of researchers from across Europe. Through their collective efforts, these consortia have made remarkable progress in addressing various infectious disease risks faced by European animal health and the livestock industry. The following text encapsulates abstracts from eleven out of the nineteen projects that received funding through the first ICRAD research call. It’s noteworthy to observe that several of these projects are addressing pressing issues related to ongoing animal health outbreaks. For instance, three of these funded projects are dedicated to enhancing our comprehension of the African swine fever virus (ASFV) and fostering the development of a potential vaccine. Another project is honing its focus on avian influenza, with the objective of deciphering the factors contributing to increased virulence in low pathogenic avian influenza (LPAI) viruses. This could potentially enable us to better predict the severity of emerging avian influenza virus (AIV) strains. In addition, there are several other projects that align seamlessly with the overarching goals of ICRAD. These include but are not limited to, the development of innovative DNA vaccine technologies and the creation of diagnostic tools for a spectrum of pig diseases. Overall, we have funded a range of projects that align excellently with the overall goals of ICRAD, supporting innovative, cross-cutting research on animal health and welfare, with associated benefits for the environment and the economy. These projects represent significant strides in improving animal health, welfare, and food production throughout Europe. By fostering collaboration between partner institutes and bringing together experts from various countries and disciplines, these joint efforts can effectively combine knowledge, resources, and expertise to address complex challenges and threats. This coordination is crucial for identifying, preventing, and responding to emerging animal diseases that could not only endanger animal health but also have direct or indirect implications for human well-being. Moreover, this cross-border cooperation can yield more comprehensive research outcomes while developing innovative solutions and strategies for disease prevention and control. Ultimately, international scientific coordination on animal health showcased in the following abstracts demonstrates a strong commitment to cooperation while providing robust evidence to safeguard the health of animals, humans, and the environment. ICRAD, which organized this call and allocated grants to these projects is an ERA-NET, a co-funded project under the European Union’s Horizon 2020 Research and Innovation program.

48 Longitudinal Language Outcomes in Pediatric Brain Tumor Patients Diagnosed in Early Childhood

Objective:Pediatric brain tumor (PBT) survivors are at risk for speech (e.g., articulation, prosody, fluency) and language (e.g., vocabulary, grammar, narratives, pragmatics) difficulties (Hodges et al., 2020). It is important to understand what treatment and/or demographic factors are associated with language functioning soon after diagnosis, and what factors are associated with language functioning years after treatment completion. This study characterizes longitudinal language functioning for clinically referred PBT survivors diagnosed in early childhood.Participants and Methods:Participants were 48 PBT patients (54% supratentorial, 6% disseminated), 21% with NF-1, who were diagnosed by age 6 (M = 43.2 months, SD 24.5) and received tumor-directed intervention including surgery (85%), chemotherapy (69%), and/or radiation therapy (50%). Hearing concerns existed for 29% of the patients. Age at first neuropsychological evaluation was 2-15 years (M=7.6, SD=3.63), age at second neuropsychological evaluation was 5-19 years (M=12.04, SD=3.86), with an average of 4.42 years (SD=2.37) between evaluations. Patients were 63% male, 77% White, 94% non-Hispanic, and fluent English speakers. Verbal IQ, working memory, fluencies, comprehension, memory, and parent-reported functional communication outcomes were assessed as part of comprehensive batteries. Rates of weak performance (1 SD&lt;Mean) were compared to the expected base rate of 16%.Results:Group means significantly diverged from age-expected performance by the second evaluation in all domains except semantic fluency. Weakness was identified on at least 1 verbal subtest for 79% of the sample at the first evaluation, and for 85% of the sample at the second evaluation. As a group, patients showed a significant increase in the number of weaknesses identified on performance-based measures from the first to second evaluation [t(47) = -3.60, p &lt;.001]. Over half of the sample showed an increase in the rate of verbal weaknesses identified (56.3%). Those with more weaknesses over time had lower IQ at the initial evaluation [t(36) =-2.61, p=.013]. An increase in the number of weaknesses from first to second evaluation was not associated with tumor type/location, treatment modality, or demographic variables.Conclusions:Brain tumor diagnosis in early childhood during rapid language development is associated with language impairments soon after diagnosis, and years after treatment completion. Causes for continued and increased impairment are multifactorial and risk cannot clearly be identified by demographic and treatment variables alone. Any early language weakness identification should signal need for intervention as the causes for difficulty are complex and these weaknesses are likely to persist and increase over time.

Comprehensive Long-Term Outcomes Following Mandibular Distraction Osteogenesis.

To describe long-term outcomes and complications following mandibular distraction osteogenesis (MDO) in a diverse patient cohort. Cross-sectional study. Single tertiary-care pediatric center. Forty-eight patients previously undergoing MDO with minimum 4-year follow-up. Respiratory outcomes, feeding patterns, dental development, motor/sensory nerve function, temporo-mandibular joint function, and postsurgical scarring. Forty-six patients with a median age of 7 years were evaluated. Of 20 nonsyndromic patients, none required additional airway procedures, none required continuous positive airway pressure (CPAP) during sleep, and 19 (95%) fed exclusively by mouth. Among 26 syndromic patients, 7 (27%) required CPAP and 8 (31%) were tube fed. Permanent first molar differences were seen in the majority of subjects; patterns of damage interfering with function were more common in syndromic (13/28, 46%) compared to nonsyndromic (5/24, 21%; P = .014) subjects. MDO prior to age two was associated with more frequent and worse dental damage (P = .001). Inferior alveolar nerve and marginal mandibular nerve function were fully intact in 37 (80%) and 39 (85%) of patients, respectively. Three patients (6%), all with associated genetic syndromes, demonstrated severe nerve impairment. By the Vancouver scar scale, ≥ 80% of surgical scars were rated in the most favorable category for each quality assessed. Temporomandibular joint dysfunction was rare. MDO shows highly favorable long-term respiratory, feeding, nerve, and scar outcomes in nonsyndromic patients, although permanent molar changes not precluding tooth viability are commonly seen. Patients with associated syndromes demonstrate respiratory and feeding benefits, but higher rates of dental and nerve abnormalities.

Realizing high energy density and discharge energy density in high hardness Ba1.938Bi0.375Nb5O15-based glass ceramics

The practical utility of glass-ceramics-based (GCs) energy storage materials is limited due to their low energy density. In this work, we synthesized the unleaded GCs containing two crystalline phases: Ba1.938Bi0.375Nb5O15 and BaNb2O6. An increase in crystallization time at a specific temperature initially leads to a decrease and then an increase in the dielectric permittivity (εr) and breakdown strength (BDS) due to changes in crystallinity. Specifically, at a crystallization temperature of 750 °C for 4 h, the BDS reaches approximately 1422 kV/cm, driven by a lower oxygen density, higher activation energy, and the formation of a fine-grained structure in the compact GCs. Numerical simulation was employed to uncover the underlying mechanism behind the enhanced BDS achieved through changing crystallization time. As a result of the enhanced BDS and polarization, this study achieved remarkable and comprehensive outcomes: a high efficiency (η) of 85.89%, a high energy density (Wrec) of 3.79 J/cm3, an ultrahigh discharge energy density (Wdis) of 3.26 J/cm3 and a high Vickers hardness (Hv) of 6.85 GPa. Meanwhile, this sample crystallized for 4 h demonstrates excellent thermal stability and frequency stability. These results show that these GCs could be highly competitive as lead-free materials for energy storage capacitors.