Demographic Differences Research Articles

Role of gastric bypass surgery in control of blood sugar in obese uncontrolled type 2 diabetic patients

Background and goalThe pandemic of the twenty-first century is diabetes. Both type 2 diabetes mellitus and obesity pose severe problems for public health. Despite significant improvements in diagnosing and managing both conditions, diabetes mellitus remains poorly controlled, and diabetic complications are more common than ever. Internists have discovered over the past 20 years that obese people with type 2 diabetes who have gastric bypass surgery to shed weight have improved glycemic control. Thus, interventional diabetology has a growing significance in patients’ ability to reverse type 2 diabetes mellitus. We want to evaluate the impact of gastric bypass on blood sugar regulation and look for potential causes.Patients and methodsBetween 2018 and 2020, a prospective interventional study was carried out. Ninety patients in total were enrolled in the trial. The two patient groups (A and B) contained 45 obese T2DM patients with a body mass index (BMI) of over 35 kg/m2. Group B received its antidiabetic medications, either oral hypoglycemic or insulin, while Group A underwent gastric bypass surgery. Each patient underwent a comprehensive history review and clinical assessment. Both groups had their HA1c and blood sugar levels measured; group A had their insulin, GLP-1, and HOMA-IR (Homeostasis Model Assessment for Insulin Resistance) levels calculated at time O and one year later.ResultsThe demographic differences between the two study groups were negligible. After a one-year follow-up, group A had significantly lower anthropometric measurement data for BMI and waist circumference (cm), lipid profile data for triglycerides, total cholesterol, and LDL levels, and systolic and diastolic blood pressure. Fasting plasma glucose and HbA1c, two metrics of glucose metabolism, significantly decreased in group A. Regarding indicators of glucose metabolism, there was a drop in fasting insulin level and HOMA-IR and an increase in GLP1 level in the gastric bypass group.ConclusionAs a result of improving all indicators, gastric bypass is an effective treatment for patients with uncontrolled T2DM. Future research that is confirmed is needed.

Safety and Efficacy of Outpatient Anterior Cervical Disk Replacement (ACDR) in an Ambulatory Surgery Center Versus Hospital Setting: A 2-year Retrospective Analysis.

Retrospective cohort analysis. To compare clinical outcomes of outpatient anterior cervical disk replacements (ACDR) performed in free-standing private ambulatory surgery centers versus tertiary hospital centers. ACDR is an increasingly popular technique for treating various degenerative pathologies of the cervical spine. There has been an increase in the utilization of ambulatory surgery centers (ASCs) for outpatient cervical procedures due to economic and convenience benefits; however, a paucity of literature exists in evaluating long-term safety and efficacy of ACDRs performed in ASCs versus outpatient hospital centers. A retrospective cohort review of all patients undergoing 1- or 2-level ACDRs at 2 outpatient ASCs and 4 tertiary care medical centers from 2012 to 2020, with a minimum follow-up of 24 months, was performed. Approval by each patient's insurance and patient preference determined distribution into an ASC or non-ASC. Demographics, perioperative data, length of follow-up, complications, and revision rates were analyzed. Functional outcomes were assessed using VAS and NDI at follow-up visits. One hundred seventeen patients were included (65 non-ASC and 52 ASC). There were no significant differences in demographics or length of follow-up between the cohorts. ASC patients had significantly lower operative times (ASC: 89.5 minutes vs. non-ASC: 110.5 minutes, P <0.001) and mean blood loss (ASC: 17.5mL vs. non-ASC: 25.3mL, P <0.001). No significant differences were observed in rates of dysphagia (ASC: 21.2% vs. non-ASC: 15.6%, P <0.001), infection (ASC: 0.0% vs. non-ASC: 1.6%, P =0.202), ASD (ASC: 1.9% vs. non-ASC: 1.6%, P =0.202), or revision (ASC: 1.9% vs. non-ASC: 0.0%, P =0.262). Both groups demonstrated significant improvements in VAS and NDI scores ( P <0.001), but no significant differences in the degree of improvement were observed. Our 2-year results demonstrate that ACDRs performed in ASCs may offer the advantages of reduced operative time and blood loss without an increased risk of postoperative complications.

Exploring visual communication in corporate sustainability reporting: Using image recognition with deep learning

AbstractPhotographs and images in sustainability reports can affect readers' impressions of a company. This study conducts an exploratory analysis to investigate the impact of visual content on sustainability reporting and identify corporate reporting strategies. Using image recognition with deep learning technology, we analyse how 1025 global companies, publishing reports in English, incorporate images into their sustainability reports. The study also identifies factors influencing image selection and utilisation, assessing the images based on these factors' impact. Our findings highlight that economic development, cultural preferences and industry type contribute to variations in image usage. Moreover, these influences differ according to disclosure medium (i.e., integrated or sustainability reports), revealing industry‐specific image trends and providing insights into workforce characteristics. Leveraging deep learning, the study delves into facial expressions and demographic differences in the images, providing a comprehensive understanding of corporate communication strategies.

Association of physical functional activity impairment with severity of sarcopenic obesity: findings from National Health and Nutrition Examination Survey

We aim to clarify the relationship between low skeletal muscle mass and varying levels of adiposity and to identify the types of physical function impairments associated with sarcopenic obesity (SO). This study examined cross-sectional data from the National Health and Nutrition Examination Survey with whole-body dual-energy X-ray absorptiometry (DXA) scans. The data included age, gender, DXA-assessed body composition, and physical functional activity with performing daily tasks by questionnaire. We subdivided the data by body composition into a non-SO group and a SO group (ASMI 0–49.99% and FMI of 50–100%), after which the SO data were subdivided into three classes. A higher class indicated higher adiposity and lower muscle mass. The physical function impairment of the two groups was compared. Our study examined 7161 individuals, of which 4907 did not have SO and 2254 had SO, and their data were further divided into three classes (i.e., class I, 826 individuals; class II, 1300 individuals; and class III, 128 individuals). Significant differences in demographics and DXA parameters were identified between the non-SO and SO groups (P < 0.001); the individuals with SO were older, included more women, and exhibited high adiposity and less lean muscle mass. The individuals with class III SO exhibited greater differences and reported more difficulty in performing daily activities. The individuals with class III SO exhibited the most severe physical function impairment. Our study highlights the considerable difficulties encountered by individuals with SO in performing daily activities. Given this finding, customized rehabilitation strategies should be implemented to improve the quality of life of individuals with SO.

Perceval sutureless bioprosthesis versus Perimount sutured bioprosthesis for aortic valve replacement in patients with aortic stenosis: a retrospective, propensity-matched study

BackgroundRapid-deployment aortic valve replacement (RDAVR) is an alternative to conventional AVR (cAVR) for aortic stenosis. Benefits include a reduction in operative times, facilitation of minimal access surgery and superior haemodynamics compared to conventional valves. However, further evidence is required to inform guidelines, preferably in the form of propensity-matched studies that include mid-term follow-up data.MethodsThis was a single-centre, retrospective, propensity-matched cohort study comparing the Perceval and conventional Perimount Magna Ease valve for short- and mid-term clinical parameters and size-matched mid-term echocardiographic parameters (n = 102 in both groups) from 2014 to 2020. Data were extracted from a nationally managed dataset.ResultsThere were no demographic differences between the matched groups. The Perceval group had shorter cross-clamp time (Perceval 62 [49–81] minutes; Perimount 79 [63–102] minutes, P < 0.001), shorter bypass time (Perceval 89 [74–114] minutes; Perimount 104 [84–137] minutes, P < 0.001), and more frequent minimally-invasive approaches (Perceval 28%; Perimount 5%, P < 0.001). Size-matched haemodynamics showed initially higher gradients in the Perceval group, but haemodynamics equalised at 12 + months. The Perceval group had a more favourable % change in the left ventricular posterior wall dimension at 2 + years (Perceval − 4.8 ± 18; Perimount 17 ± 2).ConclusionsThe Perceval facilitated shorter operations, which may benefit intermediate-high-risk, elderly patients with comorbidities requiring concomitant procedures. It also facilitated minimally invasive surgery. Size-matched haemodynamic performance was similar at mid-term follow-up, with the Perceval possibly better facilitating regression of left ventricular hypertrophy.

Turtle Economic Value: The non-use value of marine turtles in the Asia-Pacific region

Marine turtle species in the Asia-Pacific region face loss of habitat, population decline and serious risk of extinction. Understanding the associated loss in human welfare can motivate conservation finance, policy reforms and other actions to protect and restore marine turtle populations. This paper estimates non-use values for marine turtles in the Asia-Pacific region using a large-sample (n = 7765) global household survey. The survey focused on six countries in the region (China, Fiji, Indonesia, Malaysia, the Philippines and Vietnam) but received responses from over 80 countries in total. A discrete choice experiment was used to elicit willingness-to-pay (WTP) for marine turtles, defined in terms of population trends (increasing, stable or declining) and species diversity (avoided extinctions). We find that a high proportion of households (82%) expressed a positive WTP for turtle conservation, and that the donation amounts are substantial. The median WTP for ensuring stable marine turtle populations, adjusted for demographic differences between the survey sample and the general population, is estimated at US $79 per household per year. A scenario analysis is used to estimate the economic welfare changes that would result from policy inaction (in which turtle populations continue to decline and two species become extinct) versus strong policy action (resulting in increasing turtle populations and no extinctions). The welfare loss that results from not acting is estimated to be US $40 billion per year, whereas the potential welfare gain from taking policy action to conserve, manage and protect marine turtles is estimated at US $55 billion per year. These results present a strong economic justification for governments across the region to align their environmental policies and budgets with Asia-Pacific peoples' stated WTP for turtle conservation.

Cardiorespiratory consequences of attenuated fentanyl and augmented rocuronium dosing during protocolised prehospital emergency anaesthesia at a regional air ambulance service: a retrospective study

BackgroundPre-Hospital Emergency Anaesthesia (PHEA) has undergone significant developments since its inception. However, optimal drug dosing remains a challenge for both medical and trauma patients. Many prehospital teams have adopted a drug regimen of 3 mcg/kg fentanyl, 2 mg/kg ketamine and 1 mg/kg rocuronium (‘3:2:1’). At Essex and Herts Air Ambulance Trust (EHAAT) a new standard dosing regimen was introduced in August 2021: 1 mcg/kg fentanyl, 2 mg/kg ketamine and 2 mg/kg rocuronium (up to a maximum dose of 150 mg) (‘1:2:2’). The aim of this study was to evaluate the cardiorespiratory consequences of a new attenuated fentanyl and augmented rocuronium dosing regimen.MethodsA retrospective study was conducted at EHAAT as a service evaluation. Anonymized records were reviewed from an electronic database to compare the original (‘3:2:1’) drug dosing regimen (December 2019-July 2021) and the new (‘1:2:2’) dosing regimen (September 2021-May 2023). The primary outcome was the incidence of absolute hypotension within ten minutes of induction. Secondary outcomes included immediate hypertension, immediate hypoxia and first pass success (FPS) rates.ResultsFollowing exclusions (n = 121), 720 PHEA cases were analysed (360 new vs. 360 original, no statistically significant difference in demographics). There was no difference in the rate of absolute hypotension (24.4% ‘1:2:2’ v 23.8% ‘3:2:1’, p = 0.93). In trauma patients, there was an increased first pass success (FPS) rate with the new regimen (95.1% v 86.5%, p = 0.01) and a reduced incidence of immediate hypoxia (7.9% v 14.8%, p = 0.05). There was no increase in immediate hypertensive episodes (22.7% vs. 24.2%, p = 0.73). No safety concerns were identified.ConclusionAn attenuated fentanyl and augmented rocuronium dosing regimen showed no difference in absolute hypotensive episodes in a mixed cohort of medical and trauma patients. In trauma patients, the new regimen was associated with an increased FPS rate and reduced episodes of immediate hypoxia. Further research is required to understand the impact of such drug dosing in the most critically ill and injured subpopulation.

Relationship between shoulder and elbow range of motion and ultrasonographic structural abnormalities in the elbow of Taiwanese high school baseball players

BackgroundUltrasonographic structural abnormalities are regarded as one of the risk factors of elbow injuries. Elbow injuries are commonly associated with decreased shoulder/elbow range of motion (ROM). The purpose of this study is to determine the relationship between shoulder/elbow ROM and elbow ultrasonographic structural abnormalities in Taiwan high school baseball players.MethodsA total of 533 Taiwan high school baseball players were enrolled. Physical examinations including measurements on shoulder/elbow ROM and elbow sonographic examinations were performed and recorded by professional physicians. The analyses were conducted in three subgroups according to their defensive position because the training programs were different. All players pooled, pitchers-only, and fielders-only, due to several demographic differences among these subgroups. In all the subgroups, univariate analyses were conducted separately for participants with and those without elbow ultrasonographic structural abnormalities, and then multivariate analyses were conducted to identify factors significantly related. The odds ratios (ORs) were used to estimate the risk of elbow ultrasonographic structural abnormalities.ResultsDemographic data showed that pitchers had taller body height (P < 0.001) and greater elbow flexion/extension ROM (P < 0.001). When all players were pooled, significant risk factors included started playing baseball at an younger age (OR = 1.202; 95% CI = 1.064–1.357; P = 0.003), longer experience of official baseball (OR = 1.154; 95% CI = 1.038–1.283; P = 0.008), lower total shoulder rotation angle (OR = 1.007; 95% CI = 1.000–1.014; P = 0.050), and less total elbow arm angle (OR = 1.052; 95% CI = 1.017–1.088; P = 0.003) For pitchers, significant risk factors included longer experience of official baseball (OR = 1.342; 95% CI = 1.098–1.640; P = 0.004), lower total shoulder rotation angle (OR = 1.016; 95% CI = 1.004–1.027; P = 0.006), and lower total elbow arm angle (OR = 1.075; 95% CI = 1.024–1.129; P = 0.004) (Table 5). There were no significant risk factors for elbow structural abnormalities in fielders.ConclusionFor Taiwan high school pitchers, longer official baseball experience, decreased shoulder total rotational angle, and decreased elbow total flexion/extension angle, were related to ultrasonographic structural abnormalities in elbows.

Pulmonary vein capture is a predictor for long-term success of stand-alone pulmonary vein isolation with cryoballoon ablation in patients with persistent atrial fibrillation.

The mechanisms of AF development and progression are still not completely understood. Despite the relative efficacy of ablation, the risk of AF recurrence is substantial, particularly in patients with persistent AF (perAF). At present we do not have any reliable intra-procedural electrophysiologic predictors of long-term success of AF ablation other than pulmonary vein isolation. We evaluated selected intraprocedural pulmonary vein characteristics that may be helpful in future guidance of persistent AF ablation. 390 consecutive procedures using cryoballoon for initial AF ablation were divided by clinical presentation (paroxysmal or persistent AF), and by pulmonary vein (PV) response to pacing after completion of ablation (discrete electrogram elicited with pacing-"PV capture" or not-"Control"). Patients were followed (median 20 months) for recurrent atrial arrhythmias as the primary end point of the study. PV capture was identified in 20.3% and 17.1% and patients with paroxysmal and persistent AF respectively (ns). In patients with persistent AF presence of PV capture was associated with significantly better outcomes compared to patients without PV capture (p < 0.001). In the group "persistent AF and PV capture", an initial strategy of PV isolation and reisolation of the PVs (without additional lesions) for patients with recurrent atrial arrhythmias resulted in 20/23 (87%) patients in sinus rhythm off antiarrhythmic medications at study completion. In patients with paroxysmal AF, PV capture was not associated with outcome benefits. Specific electrophysiologic characteristics of PV (PV capture cycle length: PVCCL) did not have an impact on AF recurrence, although 25% shortening of PVCCL was observed after 60 s periods of pacing at short cycle lengths. No background demographic patient characteristic differences were identified between patients with vs. without PV capture. The presence of PV capture was associated with better outcomes in patients with persistent AF. PV capture may identify those patients with persistent AF in whom cryoballoon PV isolation alone is sufficient as an initial ablation procedure and as the primary ablation strategy for recurrent AF.

Disparities in Demographics in Hip Arthroplasty Between U.S. Active Duty Military and the ACS-NSQIP Clinical Registry.

Patient demographics, such as sex and age, are known risk factors for undergoing revision following primary total hip arthroplasty (THA). The military population is unique because of the increased rates of primary and secondary osteoarthritis of the hip. Treatment options are limited for returning patients to their line of duty; however, THA has been shown to be an effective option. The primary purpose of this study was to evaluate and contrast the demographic differences of patients undergoing primary THA between the U.S. active duty military population and the general population. The secondary goal was to identify the proportion of primary THA performed at the MTF within the military health system (MHS). This was an exempt study determined by the local institutional review board. A retrospective analysis of the MHS Data Repository (MDR) and the National Surgical Quality Improvement Program (NSQIP) was performed. The databases were used to identify the patients who underwent THA from January 1, 2015 to December 31, 2020. The MDR was used to identify demographics such as sex, age, setting of surgery, geographic location, previous military deployments, history of deployment-related injuries, branch of service, and rank. The NSQIP database was queried for sex and age. The median age of the population was compared using the Mann-Whitney U test and gender was compared using the Chi-square test. The MDR was used to evaluate 2,734 patients, whereas the NSQIP database was used to evaluate 223,832 patients. In the military population, patients who underwent THA were 87.7% male with an average age of 45 years, whereas in the general population as measured via the NSQIP database, 45.2% patients were male with an average age of 66.0 years. Comparing the two groups, we demonstrated that the military patients were significantly more likely to be younger (P < .001) and males (P < .001). Only 29.6% of primary THAs were performed within the MTF. Patients in the MHS are undergoing THA at a younger age and are more likely to be male compared to the general population. A significant portion of primary THAs in the MHS are also being performed at civilian institutions. These demographics may result in increased risk of revision; however, long-term studies are warranted to evaluate survivorship in this unique population.

The Impact of Brand Awareness, and Product Attributes to Increase Purchase Intention (Study Case: Transvision)

In the dynamic landscape of the Indonesian television industry, the rise of over-the-top (OTT) services poses a major challenge to traditional pay-TV providers such as Transvision. Intense competition from emerging OTT providers in Indonesia requires innovative strategies to secure customer acquisition. Indonesia is one of the fastest growing pay-TV markets, with a predicted CAGR of 5% and revenue projections of $633 million by 2025. The demographic differences between OTT and pay TV users, highlight the need for a customized marketing approach. In detail, Transvision, which offers pay TV services through Android TV box devices, faces hurdles in terms of market penetration and brand recognition. This study aims to propose an effective transvision marketing strategy while considering the complex dynamics of the evolving television landscape in Indonesia. Using a quantitative approach, the research conducted an examination of customers and hypothesis testing, administering surveys to android TV box users in the Jabodetabek area. The data, processed through SEM-PLS, indicated that social media marketing and electronic word of mouth positively impact brand awareness. Furthermore, significant product attributes, including variety of content and additional features, subscription package price, and payment method options, were found to influence purchase intention. The study concludes that both brand awareness and product attributes play pivotal roles in shaping purchase intention.

Radioembolization plus Immune Checkpoint Inhibitor Therapy Compared with Radioembolization plus Tyrosine Kinase Inhibitor Therapy for the Treatment of Hepatocellular Carcinoma

PurposeTo investigate if combination therapy with immune checkpoint inhibitor (ICI) and yttrium-90 (90Y) radioembolization results in superior outcomes than those yielded by tyrosine kinase inhibitor (TKI) therapy and 90Y for the treatment of intermediate- to advanced-stage hepatocellular carcinoma (HCC). MethodsA retrospective review of patients presented at an institutional multidisciplinary liver tumor board between January 1, 2012 and August 1, 2023 was conducted. In total, 44 patients with HCC who underwent 90Y 4 weeks within initiation of ICI or TKI therapy were included. Propensity score matching was conducted to account for baseline demographic differences. Kaplan–Meier analysis was used to compare median progression-free survival (PFS) and overall survival (OS), and univariate statistics identified disease response and control rate differences. Duration of imaging response was defined as number of months between the first scan after therapy and the first scan showing progression as defined by modified Response Evaluation Criteria in Solid Tumors (mRECIST) or immune Response Evaluation Criteria in Solid Tumors (iRECIST). Adverse events were analyzed per Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. ResultsPatients in the 90Y+ICI therapy group had better objective response rates (ORRs) (89.5% vs 36.8%; P < .001) and disease control rates (DCRs) (94.7% vs 63.2%; P < .001) by mRECIST and iRECIST (ORR: 78.9% vs 36.8%; P < .001; DCR: 94.7% vs 63.2%; P < .001). Median PFS (8.3 vs 4.1 months; P = .37) and OS (15.8 vs 14.3 months; P = .52) were not statistically different. Twelve patients (63.1%) in the 90Y+TKI group did not complete systemic therapy owing to adverse effects compared with 1 patient (5.3%) in the 90Y+ICI group (P < .001). Grade 3/4 adverse events were not statistically different (90Y+TKI: 21.1%; 90Y+ICI: 5.3%; P = .150). ConclusionsPatients with HCC who received 90Y+ICI had better imaging response and fewer regimen-altering adverse events than those who received 90Y+TKI. No significant combination therapy adverse events were attributable to radioembolization.

Respiratory Syncytial Virus Infection and Apnea Risk As Criteria for Hospitalization in Full Term Healthy Infants.

Introduction Apnea is recognized as a serious and potentially life-threatening complication associated with Respiratory Syncope Virus (RSV). The literature reports a wide range of apnea rates for infants with comorbid factors. Prematurity and young chronological age have been historically associated with the risk of apnea in hospitalized infants. Few studies have specifically examined the risk of apnea in healthy infants presenting to the emergency department. Methods This is a retrospective review of infants diagnosed with RSV using a PCR assay. Patients were divided into "mild" and "severe" cohorts based on symptoms at presentation. This study occurred in the NYU Langone Long Island (NYULI) pediatric emergency department (ED), a midsize academic hospital in the Northeast United States. The study included infants <6 months of age, born full term without comorbid conditions such as chronic lung or cardiac conditions, seen in NYULI ED over three consecutive RSV seasons (2017-2020). The primary outcome was the risk of apneic events. Secondary outcomes included hospital admission, ICU admission, length of stay, and supplemental oxygen support. Results The risk of apnea was <2%, regardless of disease severity. There were no significant differences in demographics between mild and severe disease. Cohorts differed significantly in the number of hospitalizations (41 milds vs. 132 severe), ICU admissions (2 milds vs. 27 severe), need for oxygen support (17 milds vs. 92 severe), hospital readmissions (2 milds vs. 42 severe), and length of stay (2 days milds vs. 3 days severe). Conclusions Apnea does not pose a significant risk for healthy full-term infants with RSV disease of any severity. The decision to admit this population to the hospital should be based on clinical presentation and not solely on the perceived risk of apnea.

Risk of pseudoaneurysm and bleeding complications after partial nephrectomy: comparison of tumor enucleation to standard margin technique.

Partial nephrectomy (PN) is the gold standard for the resection of amenable small renal masses. Some surgeons have adopted tumor enucleation (TE) over the standard margin PN (SPN) technique based on preservation of healthy renal parenchyma by following the tumor pseudocapsule. However, TE may also confer additional advantages due to avoidance of sharp incision including reduction in perioperative and bleeding complications. Therefore, we evaluated the rate of pseudoaneurysms and other complications following TE vs. SPN. A retrospective cohort study of patients undergoing PN (TE and SPN) between 2008 and 2020 was conducted. Baseline characteristics were compared between the TE and SPN cohorts with univariable and multivariable logistic regression models. A total of 534 patients were included, 195 (36.5%) receiving TE and 339 (63.5%) SPN. There were no differences in baseline patient demographics. There was no difference in RENAL nephrometry scores between the two groups (p=0.47). TE had lower rates of postoperative complications (11.3 vs. 21.5%, p=0.002). TE had less bleeding complications (2.1 vs. 8.0%, p=0.002) with no pseudoaneurysm events following TE compared to 12 following SPN (0.0 vs. 3.5%, p=0.008). Need for interventional radiology largely reflected pseudoaneurysm differences (0 (0.0%) TE vs. 13 (3.8%) SPN, p=0.006. Readmission occurred less often after TE vs. SPN (4.1 vs. 8.3%, p=0.07). Patients receiving TE experienced no clinically significant pseudoaneurysm formation and were less likely to have any bleeding complication or major complication postoperatively. TE may be preferred when minimizing morbidity aligns with patient selection and preferences.

Synthetic data in cancer and cerebrovascular disease research: A novel approach to big data.

Synthetic datasets are artificially manufactured based on real health systems data but do not contain real patient information. We sought to validate the use of synthetic data in stroke and cancer research by conducting a comparison study of cancer patients with ischemic stroke to non-cancer patients with ischemic stroke. retrospective cohort study. We used synthetic data generated by MDClone and compared it to its original source data (i.e. real patient data from the Ottawa Hospital Data Warehouse). We compared key differences in demographics, treatment characteristics, length of stay, and costs between cancer patients with ischemic stroke and non-cancer patients with ischemic stroke. We used a binary, multivariable logistic regression model to identify risk factors for recurrent stroke in the cancer population. Using synthetic data, we found cancer patients with ischemic stroke had a lower prevalence of hypertension (52.0% in the cancer cohort vs 57.7% in the non-cancer cohort, p<0.0001), and a higher prevalence of chronic obstructive pulmonary disease (COPD: 8.5% vs 4.7%, p<0.0001), prior ischemic stroke (1.7% vs 0.1%, p<0.001), and prior venous thromboembolism (VTE: 8.2% vs 1.5%, p<0.0001). They also had a longer length of stay (8 days [IQR 3-16] vs 6 days [IQR 3-13], p = 0.011), and higher costs associated with their stroke encounters: $11,498 (IQR $4,440 -$20,668) in the cancer cohort vs $8,084 (IQR $3,947 -$16,706) in the non-cancer cohort (p = 0.0061). A multivariable logistic regression model identified 5 predictors for recurrent ischemic stroke in the cancer cohort using synthetic data; 3 of the same predictors identified using real patient data with similar effect measures. Summary statistics between synthetic and original datasets did not significantly differ, other than slight differences in the distributions of frequencies for numeric data. We demonstrated the utility of synthetic data in stroke and cancer research and provided key differences between cancer and non-cancer patients with ischemic stroke. Synthetic data is a powerful tool that can allow researchers to easily explore hypothesis generation, enable data sharing without privacy breaches, and ensure broad access to big data in a rapid, safe, and reliable fashion.

Development of a measure for assessing malingered incompetency in criminal proceedings: Denney competency related test (D-CRT)

ABSTRACT Introduction Experts frequently assess competency in criminal settings where the rate of feigning cognitive deficit is demonstrably elevated. We describe the construction and validation of the Denney Competency Related Test (D-CRT) to assess feigned incompetency of defendants in the criminal adjudicative setting. It was expected the D-CRT would prove effective at identifying feigned incompetence based on its two alternative, forced-choice and performance curve characteristics. Method Development and validation of the D-CRT occurred in described phases. Items were developed to measure competency based upon expert review. Item analysis and adjustments were completed with 304 young teenage volunteers to obtain a proper spread of item difficulty in preparation for eventual performance curve analysis (PCA). Test-retest reliability was assessed with 44 adult community volunteers. Validation included an analog simulation design with 101 jail detainees using MacArthur Competency Assessment Test-Criminal Adjudication and Word Memory Test as criterion measures. Effects of racial/ethnic demographic differences were examined in a separate study of 208 undergraduate volunteers. D-CRT specificity was identified with 46 elderly clinic referrals diagnosed with mild cognitive impairment and dementia. Results Item development, adjustment, and repeat analysis resulted in item probabilities evenly spread from .28 to 1.0. Test-retest correlation was good (.83). Internal consistency of items was excellent (KR-20 > .91). D-CRT demonstrated convergent validity in regard to measuring competency related information and as well as malingering. The test successfully differentiated between jail inmates asked to perforfm their best and inmates asked to simulate incompetency (AUC = .945). There were no statistically significant differences found in performance across racial/ethnic backgrounds. D-CRT specificity remained excellent among elderly clinic referrals with significant cognitive compromise at the recommended total score cutoff. Conclusions D-CRT is an effective measure of feigned criminal incompetency in the context of potential cognitive deficiency, and PCA is assistive in the determination. Additional validation using knowns groups designs with various mental health-related conditions are needed.

Resource Use and Clinical Outcomes in Infants with Supraventricular Tachycardia Monitored with the Owlet Smart Sock

ObjectivesTo describe the prevalence of Owlet Smartsock (OSS) use in infants with supraventricular tachycardia (SVT), and associated demographic and clinical characteristics of users, and to analyze the association of OSS use on medical resource utilization and clinical outcomes from emergency department (ED) encounters for SVT. Study designSingle-center, retrospective cohort study of infants with confirmed SVT, from 2015 to 2022. OSS users and non-users were compared across clinical and demographic parameters. Medical resource utilization (phone calls, office visits, ED visits) and outcomes (need for intensive care, length of stay, echocardiographic function, clinical appearance) were compared between OSS users and non-users. ResultsOf 133 infants with SVT, OSS was used by 31/133 (23%), purchased prior to SVT diagnosis in 5/31 (16%) of users. No demographic difference was found between OSS users and non-users. OSS users had more phone notes than non-users, (p =0.002) and more ED visits, (p=0.03) but the number of office visits and medication adjustments did not differ. During ED presentation, OSS users had better preserved left ventricular ejection fraction on echocardiogram (p=0.04) and lower length of hospital stay by a mean 1.7 days (p=0.02). ConclusionOSS is used by a portion of infants with SVT. It is associated with more frequent phone calls and ED visits, but lower length of stay and better-preserved cardiac function upon presentation.

Collaborations between industry and academia for future workforce development: construction practitioners’ perspective

PurposeThere is a growing mismatch between the skill demands of the industry and the offerings of academia. One way of reducing this mismatch is by improving collaborations between practitioners and instructors using web-networking platforms. However, it is important to understand practitioners’ considerations while collaborating with instructors. Therefore, this study identified these considerations in order to infer inputs for the design of the graphical user interface (GUI) of a web-based platform for connecting instructors and practitioners.Design/methodology/approachA mixed method was adopted through a survey and focus group. A survey was used to capture practitioners’ considerations while collaborating with instructors for student development, and a focus group helped uncover an in-depth understanding of the study phenomena. The data were analyzed using descriptive and inferential statistics and thematic analysis.FindingsThe results show the willingness of practitioners to collaborate with instructors for student development, the ways by which practitioners are willing to meet instructors' course-support needs and their considerations in deciding to do so. Slight differences were observed between the results of the survey and the focus group regarding the ranking of the practitioners’ considerations. The study highlighted demographic differences in practitioners’ considerations when deciding on meeting instructors' course-support needs. The results provide a basis to deduce the GUI inputs of web-networking platforms for connecting instructors and practitioners.Originality/valueThis study revealed practitioners’ design needs and GUI inputs to facilitate the design of web-networking platforms for connecting instructors and practitioners. This study also contributes to user interface design principles, theories on individual differences and practitioners’ involvement in student professional development.

(091) The Association Between Hypogonadism, Frailty, and Postoperative Outcomes Among Men Undergoing Radical Cystectomy

Abstract Introduction Hypogonadism is associated with frailty, lower health-related quality of life, decreased muscle mass, and premature mortality, which may predispose patients to poor postoperative outcomes. However, the prevalence and importance of hypogonadism and frailty among men undergoing radical cystectomy (RC) remains unknown. Objective We aimed to determine the prevalence of hypogonadism in men undergoing RC and whether hypogonadism and frailty are associated with adverse postoperative outcomes in this population. Methods We utilized the IBM Marketscan database, which contains information on inpatient admissions, outpatient encounters, and outpatient prescriptions from Commercial and Medicare plans. Inpatient admissions were used to identify men who underwent RC between 2012-2021. Frailty was coded using diagnosis codes available in the year prior to RC and categorized as low-, intermediate-, or high-risk using published Hospital Frailty Risk Score (HFRS) ranges. Patients were considered to have hypogonadism if they had a diagnosis in the 5 years prior to RC. Demographics and surgical outcomes including length of stay (LOS), complications, and rate of 90-day ED visits and 90-day inpatient readmissions were collected. Sub-group analysis was also performed among men with hypogonadism to determine the effect of testosterone replacement therapy (TRT) on clinical outcomes. Differences in baseline characteristics between hypogonadism and control cohorts were assessed via Kruskal Wallis and Chi-squared tests, as appropriate. Multivariable Cox proportional hazards models were used to assess the association between hypogonadism and frailty and the rate of ED visits or inpatient readmissions following RC. To focus on post-RC events, patients without an ED visit or readmission were censored at 90 days. Significance was determined using p&amp;lt;0.05. Results Among 3,729 men who underwent RC, 228 (6.1%) had a diagnosis of hypogonadism within 5 years prior to RC. Overall, 564 (15.1%) men were categorized as low-risk frailty, 2,216 (59.4%) were intermediate-risk frailty, and 949 (25.4%) were high-risk frailty. Men with hypogonadism were significantly more frail compared to men without hypogonadism (p=0.001). There was no significant difference in age, LOS, postoperative complications, ED visits, or rate of inpatient readmissions between cohorts (p&amp;gt;0.05). However, high-risk frailty was independently associated with an increased risk of ED visit (HR 1.29, 95% CI [1.09-1.52], p=0.003) and inpatient readmissions (HR 1.55, 95% CI [1.27-1.89], p&amp;lt;0.001) following RC. On sub-group analysis of men with hypogonadism, 48 (21.1%) had a prescription for TRT within 5 years prior to RC. There was no difference in demographics, frailty, LOS, complications, or 90-day ED visits or 90-day inpatient readmissions between groups. Among men with hypogonadism, high-risk frailty was also associated with increased risk of inpatient readmission (HR 1.45, 95% CI [1.03-2.04], p=0.03). Conclusions Hypogonadism was associated with worse preoperative frailty, but was not independently associated with poor postoperative outcomes among men undergoing RC. However, high-risk frailty was associated with increased odds of postoperative ED visits and inpatient readmission. While prospective data is required to validate our results, these findings suggest that both hypogonadism and preoperative frailty should be evaluated prior to undergoing RC. Disclosure No.

(085) Long-Term Outcomes of Testosterone Replacement Therapy Delaying Biochemical Recurrence Post-RARP: Frequency-Matched Case-Control Study

Abstract Introduction Testosterone Replacement Therapy (TRT) is known to improve functional and sexual outcomes in hypogonadal men. TRT historically has been contraindicated for the management of hypogonadism in men with prostate cancer (PC). Objective In 2020, we demonstrated in a cohort of 850 men that TRT reduced biochemical recurrence (BCR) by 50% (median follow-up 3.5 yrs.). The present study extends the follow up to 5.25 years Methods A retrospective review of prospectively collected data between December 2009 and June 2018 undergoing robotic radical prostatectomy by a single surgeon was conducted. 152 patients were administered TRT post-RP with a calculated free testosterone (cFT; below the 25%) and were frequency matched to 420 patients not receiving TRT with respect to pathological stage (p-stage) and Gleason Grade Group (GGG). Biochemical recurrence (BCR) was defined as two consecutive prostate specific antigen (PSA) blood tests &amp;gt;0.2 ng/mL. An adjusted Kaplan-Meier (KM) graph was used to analyze rate and time to BCR. Results Baseline differences in demographics were observed in BMI (p = 0.006) and follow up time (p = 0.0023), and cFT (p = 0.0156). While overall BCR was not significantly different between the two groups, a difference was observed in time to recurrence. In adjusted KM analysis, patients with a higher calculated free testosterone were less likely to have a BCR (p = 0.05). In the same analysis, patients with a higher GGG, p-stage, and preoperative PSA (p &amp;lt;0.01) were more likely to have a BCR. Patients receiving TRT had similar rates of BCR (p = 0.676). However, if they recurred, there was an average delay of 1.4 years. Conclusions TRT was observed to have a continuing protective effect in preventing and delaying BCR in patients post-RARP when compared to patients who did not receive TRT. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Advisory board and speaker for Coloplast; consultant for Cynosure; advisory board and speaker for Halozyme; intellectual property with Masimo; advisory board for Promescent; consultant for Sprout; advisory board for Xialla.