Difference In Mean Rate Research Articles

Sustainable improvement in upstream and downstream outcomes for intubated patients three years after an airway-based educational intervention in a low-resource pediatric intensive care unit

ObjectiveTo determine whether implementation of an education-based intervention can sustainably improve upstream and downstream outcomes in intubated patients in a pediatric intensive care unit (PICU) in a low-resource country. DesignQuality improvement study comparing airway-related morbidity in two previously studied patient cohorts pre-intervention (Epoch 1) and immediately post-intervention (Epoch 2) with a third cohort thirty-six months post-intervention (Epoch 3). SettingPICU of the largest public children's hospital in El Salvador. Patients147 patients under 18 years requiring intubation and mechanical ventilation (MV) met inclusion criteria in the long-term follow-up period and were consecutively sampled without exclusion (Epoch 3) (compared to 98 previously studied patients in the short-term follow-up period (Epoch 2)). InterventionA low-cost, education-based intervention to close knowledge gaps, improve communication among PICU doctors, nurses, and respiratory therapists, and optimize patient outcomes. Measurements and main resultsThe primary outcome measure was change in unplanned extubation (UE) between Epochs 2 and 3. Other outcomes included use of cuffed endotracheal tubes (ETT), rate of elective ETT change and days of MV. The 17 % decrease in UE previously reported for Epoch 2 was sustained in Epoch 3. There was a statistically significant increase in use of cuffed ETT from 35.7 % in Epoch 2–55.1 % in Epoch 3 (p = 0.003, z-score −2.99). There was also a statistically significant mean difference in rate of elective ETT change per 100 MV days from Epoch 2 to Epoch 3 of 1.7 (p = 0.007; 95 % CI 0.15–0.84). There was no change in MV days from Epoch 2 to Epoch 3 (p-value 0.764; 95 % CI -1.48–2.02). Beyond these quantifiable results, many unanticipated practice changes were observed three years after the initial intervention. ConclusionsSustained improvement in upstream and downstream outcomes (UE, cuffed ETT use, elective ETT change) for intubated patients in a low-resource PICU were observed three years after a low-cost, low-touch, education-based intervention.

Visual Field Outcomes in the Primary Tube Versus Trabeculectomy Study

PurposeTo describe visual field outcomes in the Primary Tube Versus Trabeculectomy (PTVT) Study. DesignCohort analysis of a prospective multicenter randomized clinical trial. SubjectsA total of 155 eyes from 155 subjects randomly assigned to treatment with tube shunt surgery (n=84) or trabeculectomy with mitomycin C (n=71). MethodsThe PTVT Study was a multicenter randomized clinical trial comparing the safety and efficacy of trabeculectomy and tube shunt surgery in eyes without prior intraocular surgery. Subjects underwent standard automated perimetry (SAP) at baseline and annually for five years. SAP tests were deemed reliable if the false positive rate was ≤15%. Tests were excluded if visual acuity was ≤20/400 or loss of ≥2 Snellen lines from baseline were attributed to a non-glaucomatous etiology. Linear mixed-effects models were used to compare rates of change in SAP mean deviation (MD) between the two treatment groups. Intraocular pressure (IOP) control was assessed by percentage of visits with IOP <18 mmHg and mean IOP. Outcome MeasuresRate of change in SAP MD during follow-up. ResultsA total of 730 SAP tests were evaluated, with an average of 4.7 tests per eye. The average SAP MD at baseline was -12.8±8.3 dB in the tube group and -12.0±8.4 dB in the trabeculectomy group (p=0.57). The mean rate of change in SAP MD was -0.32±0.39 dB/year in the trabeculectomy group and -0.47±0.43 dB/year in the tube group (p=0.23). Eyes with mean IOP 14-17.5 mmHg had significantly faster rates of SAP MD loss compared to eyes with mean IOP <14 mmHg (-0.59±0.13 vs. -0.27±0.08 dB/year, p=0.012) and eyes with only 50-75% of visits with IOP <18 mmHg had faster rates than those with 100% of visits with IOP <18 mmHg (-0.90±0.16 vs. -0.29±0.08 dB/year, p<0.001). Multivariable analysis identified older age and worse IOP control as risk factors for faster progression in both treatment groups. ConclusionsNo statistically significant difference in mean rates of visual field change was observed between trabeculectomy and tube shunt surgery in the PTVT Study. Worse IOP control was significantly associated with faster rates of SAP MD loss during follow-up. Older patients were also at risk for faster progression.

Phase 2 Trial Evaluating Minocycline for Geographic Atrophy in Age-Related Macular Degeneration

Existing therapies to slow geographic atrophy (GA) enlargement in age-related macular degeneration (AMD) have relatively modest anatomic efficacy, require intravitreal administration, and increase the risk of neovascular AMD. Additional therapeutic approaches are desirable. To evaluate the safety and possible anatomic efficacy of oral minocycline, a microglial inhibitor, for the treatment of GA in AMD. This was a phase 2, prospective, single-arm, 45-month, nonrandomized controlled trial conducted from December 2016 to April 2023. Patients with GA from AMD in 1 or both eyes were recruited from the National Institutes of Health (Bethesda, Maryland) and Bristol Eye Hospital (Bristol, UK). Study data were analyzed from September 2022 to May 2023. After a 9-month run-in phase, participants began oral minocycline, 100 mg, twice daily for 3 years. The primary outcome measure was the difference in rate of change of square root GA area on fundus autofluorescence between the 24-month treatment phase and 9-month run-in phase. Of the 37 participants enrolled (mean [SD] age, 74.3 [7.6] years; 21 female [57%]), 36 initiated the treatment phase. Of these participants, 21 (58%) completed at least 33 months, whereas 15 discontinued treatment (8 by request, 6 for adverse events/illness, and 1 death). Mean (SE) square root GA enlargement rate in study eyes was 0.31 (0.03) mm per year during the run-in phase and 0.28 (0.02) mm per year during the treatment phase. The primary outcome measure of mean (SE) difference in enlargement rates between the 2 phases was -0.03 (0.03) mm per year (P = .39). Similarly, secondary outcome measures of GA enlargement rate showed no differences between the 2 phases. The secondary outcome measures of mean difference in rate of change between 2 phases were 0.2 letter score per month (95% CI, -0.4 to 0.9; P = .44) for visual acuity and 0.7 μm per month (-0.4 to 1.8; P = .20) for subfoveal retinal thickness. Of the 129 treatment-emergent adverse events among 32 participants, 49 (38%) were related to minocycline (with no severe or ocular events), including elevated thyrotropin level (15 participants) and skin hyperpigmentation/discoloration (8 participants). In this phase 2 nonrandomized controlled trial, oral minocycline was not associated with a decrease in GA enlargement over 24 months, compared with the run-in phase. This observation was consistent across primary and secondary outcome measures. Oral minocycline at this dose is likely not associated with slower rate of enlargement of GA in AMD.

The effect of gradually lifting the two-child policy on demographic changes in China.

Low-fertility rate has been a common problem in many industrialized countries. To reverse the declining trend of new births, Chinese government gradually lifted its restrictions on the number of births per family, allowing for a household to have no more than two children. Little is known about the additional births or population increase contributed by the gradual relaxation of birth restrictions. To fill this gap, this quasi-experimental design study including data from 124 regions used the synthetic control method and controlled interrupted time series analysis to evaluate the differences in birth rates and rates of natural population increase between China and its synthetic control following implementation of the two-child policy from 2011 to 2020. A total of 123 regions were included in the control pool. Data collected during 1990-2010 were used to identify the synthetic China for each study outcome. The mean rate differences of birth rates and rates of natural increase between China and synthetic China after two-child policy implementation were 1.16 per 1000 population and 1.02 per 1000, respectively. These rate differences were distinguished from variation due to chance (one-sided pseudo-P-values: P for birth rates = 0.047, P for rates of natural increase = 0.020). However, there were statistically significant annual reductions in the pre-post trend of birth rates and rates of natural increase compared with those of controls of <0.340 per 1000 population per year [P = 0.007, 95% CI = (-0.584, -0.096)] and <0.274 per 1000 per year [P = 0.028, 95% CI = (-0.518, -0.031)]. The results suggested that lifting birth restrictions had a short-term effect on the increase in birth rates and rates of natural population increase. However, birth policy with lifting birth restrictions alone may not have sustained impact on population growth in the long run.

RE-AIM implementation outcomes and service outcomes: what’s the connection? results of a cross-sectional survey

BackgroundImplementation science and health services outcomes research each focus on many constructs that are likely interrelated. Both fields would be informed by increased understanding of these relationships. However, there has been little to no investigation of the relationships between implementation outcomes and service outcomes, despite general acknowledgement that both types of outcomes are important in the pathway to individual and population health outcomes. Given the lack of objective data about the links between implementation and service outcomes, an initial step in elucidating these relationships is to assess perceptions of these relationships among researchers and practitioners in relevant fields. The purpose of this paper is to assess perceived relationships between Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework outcomes and service outcomes, testing five a priori hypotheses about which perceived relationships may be strongest.MethodsA cross-sectional online survey was administered to a convenience sample of implementation scientists, health services researchers, and public health and medical practitioners from a variety of settings. Respondents provided information on their discipline, training, practice and research settings, and levels of experience in health service outcomes research, implementation science, and the RE-AIM framework. Next, they rated perceived relationships between RE-AIM and service outcomes. Repeated measures analysis of variance were used to test a priori hypotheses. Exploratory analyses assessed potential differences in mean ratings across groups of respondents categorized by discipline, setting, and levels of implementation science, health services, and RE-AIM experience.ResultsSurveys were completed by 259 respondents, most of whom were employed in academic and medical settings. The majority were doctoral-level researchers and educators or physicians. Reported levels of experience with implementation research, health services research, and the RE-AIM framework varied. The strongest perceived relationships overall were between Implementation/Fidelity and Effectiveness (as a service outcome); Maintenance and Efficiency; Reach and Equity; Adoption and Equity; Implementation/Adaptation and Patient-Centeredness; Adoption and Patient-Centeredness; and Implementation/Fidelity and Safety. All but one of the a priori hypotheses were supported. No significant differences in ratings of perceived relationships were observed among subgroups of respondents.ConclusionsThis study is an initial step in developing conceptual understanding of the links between implementation outcomes, health services outcomes, and health outcomes. Our findings on perceived relationships between RE-AIM and services outcomes suggest some areas of focus and identify several areas for future research to advance both implementation science and health services research toward common goals of improving health outcomes.

Efficacy and safety of sodium-glucose cotransporter-2 inhibitors in patients with chronic kidney disease: a systematic review and meta-analysis.

Owing to the pharmacological mechanism, sodium-glucose cotransporter 2 inhibitors (SGLT2is) may be less effective in patients with reduced renal functions, but no systematic review or meta-analysis addressed chronic kidney disease (CKD) patients specifically. We aimed to assess the efficacy and safety of SGLT2is in CKD patients. We conducted a systematic review and meta-analysis of randomized controlled trials. Mean difference (MD) were pooled for the decline of glomerular filtration rate (eGFR) and change in urine albumin-to-creatinine ratio (uACR). Hazard ratio (HR) and rate ratio (RR) were pooled for composite of renal outcomes and adverse effects. Thirty articles were identified. Overall MD in rate of eGFR decline was 0.02 (P = 0.05), with a borderline significant difference favoring SGLT2is, while the change in uACR from baseline was - 141.34mg/g and hazard ratio of composite renal outcomes was 0.64 significantly favoring SGLT2is. Subgroup analyses showed that the long-term renal function, participants with baseline macroalbuminuria, and stage 4 CKD patients had significantly slower eGFR decline rate in SGLT2is compared to the placebo group. Risks of genital mycotic infection and ketoacidosis were significantly higher among the SGLT2is group than placebo. For CKD patients, no matter diabetic or non-diabetic, our study showed potential renoprotective effects favoring SGLT2is in overall and long-term phase, and in patients with macroalbuminuria or stage 4 CKD. However, only slight increased risk of adverse effects among the SGLT2is group is observed. Therefore, we concluded that in CKD patients, prescribing SGLT2is was safe and had renal benefits.

0934 An Analysis of 5,212 Sleep Medicine Providers’ Online Patient Reviews

Abstract Introduction Online provider rating websites are an increasingly popular medium for patients to provide reviews &amp; feedback and obtain information about varying healthcare providers. There have yet to be studies on what factors significantly impact sleep medicine provider ratings. Healthgrades is a popular healthcare provider rating database with over 11 million patient reviews. This study analyzes various dimensions to determine what factors correlate with average sleep medicine provider ratings to improve patient satisfaction. Methods Data were collected on 5,212 sleep medicine providers’ online profiles using web data extraction software. Factors such as medical degree, gender, age, and ethnicity were compared to online ratings using Pearson correlation and ANOVA analysis via statistics software. Results Variables with positive correlation in provider rating include the presence of a headshot (pc=0.106, p&amp;lt; 0.01), designation of trustworthiness (pc=0.152, p&amp;lt; 0.01), and presence of care philosophy statement (pc=0.105, p&amp;lt; 0.01). The only variable with a negative correlation in provider rating was increasing age (p=-0.109, p&amp;lt; 0.01). A one-way ANOVA revealed that there was a statistically significant difference in mean rating between different healthcare degrees (F(122.271, 5062.570)=[17.955], p=&amp;lt;.001). Tukey’s HSD Test for multiple comparisons found that the mean value of ratings was significantly different between allopathic physicians and sleep medicine dentists (p=0.000, 95% C.I.=[-0.943,0.070]), physician assistants (p=0.000, 95% C.I.=[-1.268,-0.239]), and nurse practitioners (p=0.000, 95% C.I.=[-0.941,-0.188]). There was no statistically significant difference in mean online rating between allopathic physicians and osteopathic physicians (p=0.505), sleep psychologists (p=0.344), or foreign medical graduates (p=0.998), respectively. Conclusion This study suggests patients perceive sleep medicine providers’ online profiles with headshots, care philosophy statements, and designation of trustworthiness as contributing factors when rating. Additionally, degree type and age matter when rating online. Patients do not value factors such as ethnicity or gender strongly when rating their sleep medicine provider. Further study is needed to determine factors influencing non-physician providers’ higher ratings when compared to U.S. medical graduates. This study demonstrates the importance of building an online presence for sleep medicine practices and identifying characteristics patients value. The expectation is that this information can be used to improve the quality of care delivered in the field of sleep medicine. Support (if any)

Development and Beta Testing of Serious Game-Based Auditory Training Application to Enhance Perceptual Learning of Speech in Cochlear Implant Recipients.

Computer-based applications became a popular option for auditory training, but their efficacy can be compromised by lack of users' compliance. Serious games are a new emerging field that promotes the use of games for purposes other than entertainment. The purpose of this clinical focus article was to describe the design and development of a new serious game-based auditory training application that aims at enhancing perceptual learning of speech in cochlear implant (CI) recipients. Using a participatory action research protocol, three phases were used in the process of development of this application to ensure its appropriateness for the target population. There were eight participants in Phase I, 16 participants in Phase II, and 51 participants in Phase III. In Phase III, participants were required to provide feedback using an online questionnaire after a 1-week trial period. Participants' feedback and reflection from each phase were used to enhance the design and functionality of the final application. Results from Phase III demonstrated that greater than 90% of participants in both groups rated their satisfaction with several features of the games 4 or more on a 5-point Likert scale, with 1 being very dissatisfied and 5 being very satisfied. Differences in mean ratings for some features were significantly different between the two groups, perhaps reflecting differences in their auditory abilities. Results demonstrated that participants were highly satisfied with several features of the application, suggesting its potential to offer CI users a unique training opportunity by presenting repetitive and structured listening exercises using serious games.

Applicants to a Special Education Advocacy Training Program: "Insiders" in the Disability Advocacy World.

Although social groups have "insiders," this construct has not been measured within the disability advocacy community. Examining 405 individuals who applied for an advocacy training program, this study examined the nature of insiderness within the disability advocacy community and ties to individual roles. Participants showed differences in mean ratings across 10 insider items. A principal components analysis revealed two distinct factors: Organizational Involvement and Social Connectedness. Non-school providers scored highest on Organizational Involvement; family members/self-advocates highest on Social Connectedness. Themes from open-ended responses supported the factors and showed differences in motivation and information sources across insiderness levels and roles. Qualitative analysis revealed two additional aspects of insiderness not addressed in the scale. Implications are discussed for future practice and research.

Statistical analysis plan for the motor neuron disease systematic multi-arm adaptive randomised trial (MND-SMART)

BackgroundMND-SMART is a platform, multi-arm, multi-stage, multi-centre, randomised controlled trial recruiting people with motor neuron disease. Initially, the treatments memantine and trazodone will each be compared against placebo, but other investigational treatments will be introduced into the trial later. The co-primary outcomes are the Amyotrophic Lateral Sclerosis Functional Rating Scale Revised (ALS-FRS-R) functional outcome, which is assessed longitudinally, and overall survival.MethodsInitially in MND-SMART, participants are randomised 1:1:1 via a minimisation algorithm to receive placebo or one of the two investigational treatments with up to 531 to be randomised in total. The comparisons between each research arm and placebo will be conducted in four stages, with the opportunity to cease further randomisations to poorly performing research arms at the end of stages 1 or 2. The final ALS-FRS-R analysis will be at the end of stage 3 and final survival analysis at the end of stage 4. The estimands for the co-primary outcomes are described in detail. The primary analysis of ALS-FRS-R at the end of stages 1 to 3 will involve fitting a normal linear mixed model to the data to calculate a mean difference in rate of ALS-FRS-R change between each research treatment and placebo. The pairwise type 1 error rate will be controlled, because each treatment comparison will generate its own distinct and separate interpretation. This publication is based on a formal statistical analysis plan document that was finalised and signed on 18 May 2022.DiscussionIn developing the statistical analysis plan, we had to carefully consider several issues such as multiple testing, estimand specification, interim analyses, and statistical analysis of the repeated measurements of ALS-FRS-R. This analysis plan attempts to balance multiple factors, including minimisation of bias, maximising power and precision, and deriving clinically interpretable summaries of treatment effects.Trial registrationEudraCT Number, 2019–000099-41. Registered 2 October 2019, https://www.clinicaltrialsregister.eu/ctr-search/search?query=mnd-smartClinicalTrials.gov, NCT04302870. Registered 10 March 2020.

Applying for external funding of research

External project funds are essential for conducting research and establishing an academic career, and the funding application process itself can have numerous benefits for researchers. However, applying for external funding is a pervasive and time-consuming process affecting researchers’ capacity and workload. Further, the success rates of funding applications are low, ranging from 8% to 11% at the largest funding organs. Despite this, or arguably because of this, half of the researchers in higher education report experiencing higher institutional expectations and pressure to acquire external funds, rather than to generate high-quality research. There are also notable gender differences in the rates of external funding applications accepted by RCN, as around 63% of all accepted funding applications are for projects led by men. This gender distribution almost perfectly mirrors the gender distribution in submitted funding applications, as around 65% of all submitted applications are for projects led by men. Due to both this gender difference and the overall increasing relevance of external funding, it is important to investigate factors that might impact researchers’ motivation to apply for external funding and their capacity to do so, both overall, and by gender. Thus, this report from the Prestige Project aimed to investigate UiT employees’ attitudes regarding applying for external project funds and any potential gender differences. To do this, we conducted a survey that explored UiT employees’ attitudes around applying for external funding, as well as factors that may impact this. Specifically, we investigated researchers’ motivation for and against applying for further research, their capacity to do so, their perceived institutional support, and how much of their work versus personal time was spent working on external funding applications. We aimed to answer three main research questions: What are the main factors motivating researchers to (not) apply for external funding? 2 Does the motivation to (not) apply for external funding differ by gender? Are there gender differences in employees’ prioritisation and capacity to apply for external funding? Are there gender differences in employees’ perceived institutional support for applying for external funding? The findings indicated that overall, employees reported moderate levels of motivation to apply; motivation to not apply; capacity to apply; and institutional support to apply for external funding. There were found no gender differences in mean rates of reported motivation or capacity, but women reported slightly lower institutional support than men. However, when examining all statements from the survey separately, a tentative pattern emerged. As a slight tendency, women reported a higher level of agreement with some statements relating to facing greater adversity, and lower capacity and institutional support for external funding applications than men did. Moreover, men indicated a significantly higher agreement with some statements relating to having a higher capacity to apply for external funding than women. To help illustrate potential gender differences in employee responses to different statements, all survey statements were presented together with response distribution (ranging from Strongly agree to Strongly disagree) by gender. Maybe most saliently, the current findings also found that both men and women reported that around 40% of their work related to external funding applications is done in their personal time. The findings are discussed, and the report concludes by summarizing and highlighting the most notable findings.

P125 The effect of glucocorticoids on rate of lung function decline in Duchenne Muscular Dystrophy patients receiving Non-Invasive Ventilation

Abstract Background Duchenne Muscular Dystrophy (DMD) causes progressive muscle weakness as a result of a mutation in the X-linked gene dystrophin. Recently glucocorticoid treatment has delayed deterioration in muscle strength prolonging survival. When respiratory failure develops, Non-invasive ventilation (NIV) is used to improve symptoms and prolong life. Recent research suggests the use of glucocorticoids with concomitant NIV may be associated with accelerated lung function decline. Methods To evaluate this we conducted a retrospective analysis of serial lung function data in patients with DMD across two healthcare campuses in Melbourne, Australia. A database of all patients with a coded diagnosis of DMD was collated from 1980-2010. Patient records were examined to collect data on age, lung function (FEV1/FVC/FER), glucocorticoid use (y/n), daily glucocorticoid dose, date of NIV initiation, FVC at NIV commencement, date of death (where applicable) and concomitant diagnosis of scoliosis or cardiomyopathy. This data was analysed to see if a trend for accelerated lung function decline with the use of NIV was observed. Progress to date A total of 356 patients were identified of which 36 had transitioned to the Austin Hospital adult Ventilation Service with available serial lung function data. There was no statistical difference in mean rate of decline in lung function post NIV initation (n=26, p=0.527) with glucocorticoid treatment. Intended outcome and impact Our inital results are in line with the previously observed rates of decline in lung function from other studies and do not indicate a negative synergistic effect on NIV with glucorticoid therapy.

Professional wellbeing and turnover intention among child therapists: a comparison between therapists trained and untrained in Trauma-Focused Cognitive Behavioral Therapy

BackgroundPoor professional wellbeing and job turnover is challenging for child mental health clinics and despite an increasing interest in implementing evidence-based practices (EBPs) in mental health services, little is known about if and how using EBPs may influence therapists’ professional wellbeing and turnover intention. To investigate this, we compare the average level of compassion satisfaction, burnout, secondary traumatic stress, and turnover intention between therapists trained in an EBP (Trauma-Focused Cognitive Behavioral Therapy – TF-CBT) and untrained therapists. We also explore the prevalence of and the associations between these personal and organizational outcomes.MethodIn this cross-sectional study, the data is collected from a national sample of 373 therapists 5 years after an implementation program began (i.e., in the sustainment phase). The variables were measured by the Professional Quality of Life and the Turnover Intention Scales. The Evidence-Based Practice Attitude Scale was also used to measure therapists’ attitudes toward EBPs.ResultsOver 70% of the respondents reported medium to high levels of burnout, secondary traumatic stress symptoms, and compassion satisfaction, whereas one-third of the respondents reported a high level of intention to leave their job in the current or near future. Higher ratings on burnout and secondary traumatic stress were significantly associated with lower compassion satisfaction and higher turnover intention. Finally, we found significantly lower degree of burnout and turnover intention along with higher compassion satisfaction among TF-CBT therapists (n = 96), compared to other therapists who were not trained in TF-CBT (n = 231). These differences could not be explained by between-group differences in age, job tenure, educational background, or therapists’ attitudes towards EBPs. However, mean differences in ratings on secondary traumatic stress symptoms were not statistically significant.ConclusionAlthough the prevalence findings are in general alarming, the present study provides the first empirical evidence for a potential positive effect of being trained in TF-CBT on therapists’ wellbeing and turnover intention. We discuss these findings in the light of self-efficacy theory and the job demands-resources model.

High-volume hemodiafiltration decreases the pre-dialysis concentrations of indoxyl sulfate and p-cresyl sulfate compared to hemodialysis: a post-hoc analysis from the HDFit randomized controlled trial.

Although high-volume online hemodiafiltration has been associated with higher clearance and lower pre-dialysis concentration of middle molecular weight toxins compared to hemodialysis, its effect on protein-bound uremic toxins has shown inconclusive results. In this study, we investigated whether hemodiafiltration impacts pre-dialysis plasma levels of the toxins indoxyl sulfate, p-cresyl sulfate, and indole-3-acetic acid compared to high-flux hemodialysis. This is a post-hoc analysis of the multicenter, randomized controlled trial HDFit (ClinicalTrials.gov: NCT02787161). Uremic toxins were determined by high performance liquid chromatography at baseline, 3, and 6months. Mean differences in monthly changes of pre-dialysis uremic toxin concentrations between hemodiafiltration and high-flux hemodialysis were analyzed using linear mixed-effect models. One hundred ninety-three patients (mean age 53years old, 71% males) were analyzed. There were no differences between groups regarding clinical and biochemical characteristics at baseline or duration of dialysis session and blood flows throughout the follow-up. Mean differences in rates of change (μM/month, [confidence interval CI]) in high-flux hemodialysis vs. hemodiafiltration were 2.4 [0.3 to 4.56], 3.94 [- 1.54 to 9.41] and 0.06 [- 0.6 to 0.5] for indoxyl sulfate, p-cresyl sulfate and indole-3-acetic acid, respectively. In the exploratory analysis, these differences in high-flux hemodialysis vs. hemodiafiltration subgroup with convective volume > 27.5L were 2.86 [0.43 to 5.28], 7.43 [0.7 to 14.16] and - 0.19 [- 0.88 to 0.50]. These exploratory findings suggest that hemodiafiltration is more effective in reducing indoxyl sulfate as compared to standard high-flux hemodialysis, and also that this effect was extended to p-cresyl sulfate in patients achieving higher convective volumes.

P051 NATIONAL TRENDS IN VOLUME, COSTS, AND PATIENT RISK PROFILE OF INPATIENTS UNDERGOING INCISIONAL HERNIA REPAIR IN RELATION TO ABDOMINAL SURGERY

Abstract Aim We describe trends in inpatient burden by volume, cost, and patient risk profiles of incisional hernia repair (IHR) as compared to other abdominal surgery (AS) procedures in the United States. Material and Methods Patients undergoing AS were identified using the National Inpatient Sample (2008-2018) by ICD-9/ICD-10 codes. National weighted procedure rates and hospital costs were ascertained and plotted using sampling weights and normalized per 1,000,000 people. Regression models allowed identification of statistical significance of trends and prediction of mean differences in rates, costs and patient characteristics. Results Over 38,000,000 AS discharges were identified, averaging 3.5 million annually, with over 1,200,000 discharges following IHR (3.1% of all AS). The difference between AS and IHR significantly decreased over time from 12,702 procedures per million (PPM) to 9,039 PPM. Open and laparoscopic AS down-trended (46.2% and 20.8%, respectively), whereas robotic AS up-trended (95.2% [all p &amp;lt; 0.01]). Open IHR down-trended (60.9%) and laparoscopic IHR up-trended (83.6%, [both p &amp;lt; 0.01]). Robotic IHR increased by 99.5% (p = 0.17). Average annual national charges for AS and IHR were $183.8 and $6.6 billion, respectively. Costs increased by 20.3% for AS and 25.6% for IHR. Patients undergoing IHR were 45-64 years old (46%), female (63.1%), White (68.1%), publicly insured (55.1%), with moderate loss of function (43.2%) and ≥2 comorbidities (43.3%). Conclusions IH continues to carry a significant societal and healthcare burden. With AS decreasing and IHR remaining stable from 2008 to 2018, the percentage of patients developing IH after AS has increased, as well as cost per IHR, critically underscoring the need to adopt and implement risk reduction and hernia prevention.

Competencies and Values of Barangay Nutrition Scholars in Eastern Visayas: Basis for Program Development

The study determined the competencies and values of Barangay Nutrition Scholars (BNS) in Eastern Visayas and the relationship between the said variables along the socio demographic variables, which formed as bases in proposing for a capacity training development program for BNS in the local community. The study utilized the quantitative research design in determining the values and competencies of the BNS. Descriptive and inferential statistics were employed to measure and analyze the variables. It was affirmed that there were significant differences in mean ratings for competence in implementing, monitoring and evaluating, and documenting and record keeping, while there are no significant differences in mean ratings for competence in planning, coordinating, and mobilizing resource. In terms of the core values practiced, it was affirmed that the BNS “practiced” the values of integrity, transparency, excellence in work, respect for human rights, and accountability while they only “moderately practiced” values of efficiency and equity on the other hand, MNAOs indicates that the BNSs “practiced” values of integrity, transparency, respect for human rights, and accountability BNSs only “moderately practiced” values of efficiency, equity, and excellence in work. Further, there is significant difference between the BNS and MNAO mean ratings. As a recommendation, it was put forward that the selection criteria for BNS be reviewed and consider factors that could improve nutrition program management including gender mainstreaming criteria. It is imperative to formulate a simplified version and an extensive practical approach to nutrition education training needs to be looked into when designing and modifying the existing programs.

Adjunctive dietary intervention for bipolar disorder: a randomized, controlled, parallel-group, modified double-blinded trial of a high n-3 plus low n-6 diet.

To investigate the preliminary efficacy of a high n-3 plus low n-6 (H3-L6) dietary intervention in improving mood stability in Bipolar Disorder (BD) when compared to dietary intervention with usual U.S. levels of n-6 and n-3 polyunsaturated fatty acid (PUFA) intakes (control diet, CD). This 2-arm, parallel-group, randomized, modified double-blind, controlled 48-week study of 12-week intensive diet intervention in subjects with BD was conducted at a single suburban-rural site in the mid-Atlantic region. Participants with DSM-IV TR BD I or II with hypomanic or depressive symptoms were randomized, stratified on gender (N=82). The intervention included the provision of group-specific study foods and dietary counseling. Variability of mood symptoms was measured by a twice-daily, 12-week ecological momentary analysis (EMA) paradigm, and group differences were analyzed using multilevel models. Circulating n-3 and n-6 fatty acids were measured at baseline and after 4, 8, and 12weeks of diet exposure. All 82 randomized participants were included in biochemical analyses. Seventy participants completed at least 2 EMA surveys and were included in primary EMA analyses. Variability in mood, energy, irritability, and pain as measured using EMA was reduced in the H3-L6group compared to the CD group. No significant differences in mean ratings of mood symptoms, or any other symptom measures, were detected. The dietary intervention effect on target PUFAs significantly differed by the group over time. A dietary intervention adjunctive to usual care showed preliminary efficacy in improving variability in mood symptoms in participants with BD. ClinicalTrials.Gov NCT02272010.

Implementing a Novel Through-Glass Chest Radiography Technique for COVID-19 Patients: Image Quality, Radiation Dose Optimization, and Practical Considerations

Rationale and objectives: The novel coronavirus (COVID-19) pandemic has presented many logistical challenges, including unprecedented shortages of personal protective equipment (PPE). A technique of obtaining portable chest radiographs (pCXR) through glass doors or windows to minimize technologist-patient contact and conserve PPE has gained popularity, but remains incompletely evaluated in the literature. Our goal was to quickly implement this technique and evaluate image quality and radiation dose. Materials and methods: An infographic and video were developed to educate nurses and technologists on the through-glass pCXR technique. Imaging parameters were optimized using a phantom and scatter radiation was measured. Three reviewers independently evaluated 100 conventionally obtained and 100 through-glass pCXRs from March 13, 2020 to April 30, 2020 on patients with suspected COVID-19, using criteria for positioning and sharpness/contrast on a 1 (confident criteria not met) to 5 (confident criteria met) scale. Imaging parameters, including deviation index (DI) were recorded for all radiographs. Results: The through-glass method was rapidly adopted and conserved one isolation gown per interaction. Although there was a statistically significant difference in the positioning (P value 0.018) and sharpness/contrast (P value 0.016), the difference in mean ratings was small: 4.82 vs 4.65 for positioning and 4.67 vs 4.50 (conventional vs modified) for sharpness/contrast. Scatter radiation was measured using a thorax phantom and found to be acceptable for the patient and nearby personnel. Standard deviation was higher for the DI for the through-glass technique (2.8) compared to the conventional technique (1.8), although the means were similar. Conclusion: The through-glass technique was quickly implemented, producing diagnostic quality chest radiographs while conserving PPE and reducing risks to radiology staff. There was more variability with imaging technique and DI using the through-glass technique, likely due to technologist uncertainty regarding technical modifications. Further work to reduce this variation is necessary to optimize quality and dose.

Teacher efficacy and attributes on the implementation of tiered instructional frameworks

United States federal mandates and reforms to address the needs of at-risk students have resulted in many states being required to implement evidence-based practices (EBP) and tiered systems of support (TSS). We examined the relationships between successful implementation of EBP and tiered frameworks, specifically Positive Behavior Interventions and Support (PBIS) and the constructs of teacher self-efficacy, collective efficacy, and teacher attributions. Data were collected using the School-wide Evaluation Tool (SET), Teacher Self-Efficacy Scale (TSES), the Collective Efficacy Scale (CES), and Teachers’ Attributions for Student Behavior Measure (TASBM). Significant correlations were found between PBIS implementation level and 1) Instructional Strategies subscale of the TSES; 2) Collective Efficacy Scale and both of its subscales; and 3) TASBM and its Stable and Blame subscales. Significant differences in mean ratings were found between high implementing schools and low implementing schools on the Instructional Strategies subscale of the TSES, on the CES, and both of its subscale. Results showed a decrease in mean ratings on the Blame subscale of the TASBM in schools that had higher implementation scores on the SET.

Trajectories of Child Emotional and Behavioural Difficulties Before and During the COVID-19 Pandemic in a Longitudinal UK Cohort

Background: There are concerns that the COVID-19 pandemic and its associated public health mitigation measures will have detrimental effects on emotional and behavioural problems in children. However, longitudinal studies with pre-pandemic data are scarce. In a UK cohort, we quantify the impact of the COVID-19 pandemic on trajectories of children’s emotional and behavioural difficulties measured before and during the pandemic.Methods: Data were from 708 children (Mean age = 3·45 years, SD = 3·13) part of the third generation of a birth cohort study, the Avon Longitudinal Study of Parents and Children (ALSPAC). Study sample comprised children whose parents provided previous pre-pandemic surveys and a survey between 26 May and 5 July 2020 that focused on the impact of the COVID-19 pandemic as restrictions in the UK were eased. The children had up to seven measurements of emotional and behavioural difficulties from infancy to late childhood (including the most recent measures during the pandemic). We employed multi-level mixed effects modelling with random intercepts and slopes to examine whether children’s trajectories of emotional and behavioural difficulties (a combined “total difficulties score”) during the pandemic differ from expected pre-pandemic trajectories. Findings: We found that children’s emotional and behavioural difficulties increased during infancy, peaked around the age of 2, and then declined throughout the rest of childhood. Pre-pandemic, the decline in difficulties scores after age 2 was 0·6 points per month; but was approximately one third of that in post-pandemic trajectories (there was a difference in mean rate of decline after age 2 of 0·2 points per month in pre vs during pandemic trajectories [95 % CI: 0·1 to 0·3, p Interpretation: The COVID-19 pandemic may be associated with greater persistence of emotional and behavioural difficulties after the age 2. Further evidence and monitoring of emotional and behavioural difficulties are required to fully understand the impact of the pandemic on this population, given ongoing and likely further periods of restrictions.Funding: This work was supported by the UK Medical Research Council and Wellcome (Grants 217065/Z/19/Z and 102215), the European Research Commission grant (Grant Ref: 758813 MHINT), the Elizabeth Blackwell Institute, University of Bristol, with funding from QR SPF (Quality-Related Strategic Priorities Fund), and UKRI Research England the Faculty Research Director’s discretionary fund and the University of Bristol. A comprehensive list of grants funding is available on the ALSPAC website (http://www.bristol.ac.uk/alspac/external/documents/grant-acknowledgements.pdf).Declaration of Interests: All authors declare no conflicts of interest.Ethics Approval Statement: Ethical approval for the study was obtained from the ALSPAC Ethics and Law Committee and the Local Research Ethics Committees. All participants provided fully informed consent and the study is GDPR compliant.