Disruption Rate Research Articles

Functional and clinical outcome of minimally invasive anterior bridge platting in humerus shaft fractures

Introduction: To assess the functional and radiological outcomes of minimally invasive anterior bridge plating (ABP) for mid-shaft humerus fractures. This study is done to evaluated the clinical, radiological, and functional outcome of mid shaft humerus fractures in 30 patients, all of which were managed with MIPPO. over an average follow up period of 12 months.Materials and Method: 30 patients fulfilling inclusion criteria were treated with ABP by using a 4.5-mm dynamic/locking compression plate and followed for a period of 12 month. Functional outcome was assessed using the UCLA & Mayo elbow scores. Range of motion (ROM), subjective strength, and radiographic union were assessed.Results: Out of the 30 patients in the study, 24 were males and 6 were females. The mean age was 36 years (range 26 to 65 years). 22 out of 30 patients (73%) had the dominant side fractured. Mean surgical time in minutes was 60 min (range: 35-80 min).The mean fracture union (radiological) time was 10.6 weeks (range: 08–16 weeks). However Shoulder function was excellent to good in 28 cases (93.3%) and fair in 2 case (6.7%) on the UCLA score and excellent in 28 cases(93.3%) and fair in 2 cases (6.7%) on mayo elbow score.The majority of patients (28 patients, 93.3%) who fell in the excellent or very good category according to our questionnaire were extremely satisfied. There were 2 cases (6.7%) of non-union.Conclusion: ABP is fundamentally different from traditional open posterior plating or conventional intramedullary nailing. It works on the principal of relative stability with union taking place by callus formation, and a longer plate on the tensile surface ensures that the humerus can withstand greater amount of rotational and bending stresses. The minimally invasive nature preserves the soft tissue envelope and, if done correctly, causes no damage to the vital structures in proximity. ABP for mid-shaft humerus fractures is a safe and effective treatment modality yielding high rates of union, excellent functional recovery, minimal biological disruption, better cosmesis, and superior satisfaction rates.

Moderate Binding between Two SARS-CoV-2 Protein Segments and α-Synuclein Alters Its Toxic Oligomerization Propensity Differently.

The neurological symptoms of long COVID and viral neuroinvasion have raised concerns about the potential interactions between SARS-CoV-2 protein segments and neuronal proteins, which might confer a risk of post-infection neurodegeneration, but the underlying mechanisms remain unclear. Here, we reported that the receptor-binding domain (RBD) of the spike protein and the nine-residue segment (SK9) of the envelope protein could bind to α-synuclein (αSyn) with Kd values of 503 ± 24 nM and 12.7 ± 1.6 μM, respectively. RBD could inhibit αSyn fibrillization by blocking the non-amyloid-β component region and mediating its antiparallel β-sheet structural conversions. Omicron-RBD (BA.5) was shown to have a slightly stronger affinity for αSyn (Kd = 235 ± 10 nM), which implies similar effects, whereas SK9 may bind to the C-terminus which accelerates the formation of parallel β-sheet-containing oligomers and abruptly increases the rate of membrane disruption by 213%. Our results provide plausible molecular insights into the impact of SARS-CoV-2 post-infection and the oligomerization propensity of αSyn that is associated with Parkinson's disease.

Informal Caregiving Among American Indians and Alaska Natives in the Pacific Northwest.

Unpaid or informal caregivers are people who provide assistance without compensation to adults and children who require care beyond typical needs. Although often rewarding, informal caregiving can be associated with high rates of depression, stress, anxiety, sleep and endocrine system disruption, immunosuppression, and general morbidity and mortality. Few recent studies of informal caregivers have included data from American Indians and Alaska Natives (AI/AN). Given this noteworthy gap in the literature, we surveyed a total of 225 AI/ANs attending two cultural, community functions in the Pacific Northwest to gain a general understanding of frequency of caregiving, caregiver and recipient characteristics, caregiving duties, support needs, and financial, emotional, and physical strains as a consequence of caregiving. Of the 225 participants who completed the survey, 90 (40%) indicated that they had been an unpaid caregiver for a month or more and 28 (12%) were current unpaid caregivers. Consistent with prior research, most caregivers (84%) reported satisfaction from providing help, but 84% of caregivers reported experiencing "increased stress," 40% reported financial strain, and 34% reported decreased health "because of involvement with providing care." Our data also suggested a disproportionate impact on AI/AN women given higher rates of being a caregiver compared to other populations and less support from others in their communities. Our data suggest similarities for AI/AN caregivers with other groups of caregivers but also emphasize the importance of including AI/AN populations in future research in order to understand ways to best serve their unique needs.

Identifying the critical road combination in urban roads network under multiple disruption scenarios

The promising approach to ensure the robustness of the road network is to identify the critical roads. Previous researches mainly focus on the identification of single critical road. Nevertheless, the impact of one road seems to be limited, and the more practical problem is to figure out the critical road combination wherein multiple roads failures may lead to the serious collapse of a road network. This paper develops a rigorous, extensible, mathematical model to identify the critical combination of roads in urban road networks for multiple disruption scenarios. Specifically, we propose a bi-level mixed-integer nonlinear problem (MINLP) model, which is challenging to solve due to its NP-hard characters. Then the transformation and linearization of constraints help simplify the formula into a single-level mixed-integer linear problem (MILP) formula. Finally, the Nguyen and Sioux Falls networks are sufficiently tested under multiple scenarios with different levels of disruption rate and travel demand. The results confirmed the validity and superiority of the proposed model. From the numerical results, it is more practical to measure the robustness of the road network than topological analysis. Besides, the most critical combination with multiple-link failures is not simply the combination of most critical roads with single-link failure, and these roads are not necessarily connected or in the neighborhood of each other. The results also correctly evaluate the impact of disconnection, which could provide advice for managers with preferences for accessibility and travel time.

Early life sleep disruption potentiates lasting sex-specific changes in behavior in genetically vulnerable Shank3 heterozygous autism model mice

BackgroundPatients with autism spectrum disorder (ASD) experience high rates of sleep disruption beginning early in life; however, the developmental consequences of this disruption are not understood. We examined sleep behavior and the consequences of sleep disruption in developing mice bearing C-terminal truncation mutation in the high-confidence ASD risk gene SHANK3 (Shank3ΔC). We hypothesized that sleep disruption may be an early sign of developmental divergence, and that clinically relevant Shank3WT/ΔC mice may be at increased risk of lasting deleterious outcomes following early life sleep disruption.MethodsWe recorded sleep behavior in developing Shank3ΔC/ΔC, Shank3WT/ΔC, and wild-type siblings of both sexes using a noninvasive home-cage monitoring system. Separately, litters of Shank3WT/ΔC and wild-type littermates were exposed to automated mechanical sleep disruption for 7 days prior to weaning (early life sleep disruption: ELSD) or post-adolescence (PASD) or undisturbed control (CON) conditions. All groups underwent standard behavioral testing as adults.ResultsMale and female Shank3ΔC/ΔC mice slept significantly less than wild-type and Shank3WT/ΔC siblings shortly after weaning, with increasing sleep fragmentation in adolescence, indicating that sleep disruption has a developmental onset in this ASD model. ELSD treatment interacted with genetic vulnerability in Shank3WT/ΔC mice, resulting in lasting, sex-specific changes in behavior, whereas wild-type siblings were largely resilient to these effects. Male ELSD Shank3WT/ΔC subjects demonstrated significant changes in sociability, sensory processing, and locomotion, while female ELSD Shank3WT/ΔC subjects had a significant reduction in risk aversion. CON Shank3WT/ΔC mice, PASD mice, and all wild-type mice demonstrated typical behavioral responses in most tests.LimitationsThis study tested the interaction between developmental sleep disruption and genetic vulnerability using a single ASD mouse model: Shank3ΔC (deletion of exon 21). The broader implications of this work should be supported by additional studies using ASD model mice with distinct genetic vulnerabilities.ConclusionOur study shows that sleep disruption during sensitive periods of early life interacts with underlying genetic vulnerability to drive lasting and sex-specific changes in behavior. As individuals progress through maturation, they gain resilience to the lasting effects of sleep disruption. This work highlights developmental sleep disruption as an important vulnerability in ASD susceptibility.

Searching for ultra-light bosons and constraining black hole spin distributions with stellar tidal disruption events

Stars that pass close to the supermassive black holes located in the center of galaxies can be disrupted by tidal forces, leading to flares that are observed as bright transient events in sky surveys. The rate for these events to occur depends on the black hole spins, which in turn can be affected by ultra-light bosons due to superradiance. We perform a detailed analysis of these effects and show that searches for stellar tidal disruptions have the potential to uncover the existence of ultra-light bosons. In particular, we find that upcoming stellar tidal disruption rate measurements by the Vera Rubin Observatory’s Legacy Survey of Space and Time can be used to either discover or rule out bosons with masses ranging from 10−20 to 10−18 eV. Our analysis also indicates that these measurements may be used to constrain a variety of supermassive black hole spin distributions and determine if close-to maximal spins are preferred.

Learning Amid Technological Disruption: Evidencefrom U.S. Inventors, 1836-1999

How do inventors in disruptive technological environments accumulate knowledge? When disruption erodes the value of inventors’ knowledge, their time becomes one of their most precious resources. Inventors can learn by accumulating experience over time, but inventors operating in highly disruptive environments require faster alternatives. One alternative is collaboration, which allows inventors to aggregate knowledge quickly. To assess how disruption affects inventors' strategies for knowledge aggregation, we study how the benefits inventors received from experience and from collaboration in teams of co-inventors changed across historical periods and technological fields with different disruption rates. Our analysis uses novel datasets that track the careers and record the impact of the inventions of U.S.-based patent inventors that started their careers between 1836 and 1999. Our results show that the importance of prior patenting experience for the creation of high-impact inventions decreased in the early 20th century, while the importance of collaborating in large teams increased. Both shifts were greater for inventors that patented in more disruptive technological fields, indicating that technological disruption induced inventors to collaborate. Our results generate critical insights for individuals, teams, and organizations that compete in the disruptive contemporary knowledge economy.

Ultrasound assessment after a subscapularis-sparing approach to total shoulder arthroplasty.

Although anatomic total shoulder arthroplasty (ATSA) has favorable outcomes, nearly all techniques involve subscapularis tendon release for shoulder joint access. Such takedown of the subscapularis may be associated with decreased function, instability, and pain. Subscapularis-sparing approaches have the theoretical benefits of improved function, decreased failure of the tendon reattachment site, and early range of motion and rehabilitation. The primary purpose of this study was to use ultrasound to assess the postoperative integrity of the subscapularis tendon and surrounding soft tissues after ATSA with a subscapularis-sparing technique through an extensile anterosuperior skin incision. Our hypothesis was that this subscapularis-sparing approach would have low rates of subscapularis disruption. A consecutive cohort of patients who underwent subscapularis-sparing ATSA between 2014 and 2017 were included. Ultrasound was used to evaluate the rotator cuff tendons and deltoid postoperatively, and these were classified as intact, disrupted, or unable to be adequately visualized. Clinical outcome scores, range of motion, and strength measurements were also collected at 1-3 years postoperatively. Thirty-seven subscapularis tendons and 40 supraspinatus and infraspinatus muscles were adequately visualized and included for analysis. Of the subscapularis muscles, 32 (86%) were intact; 38 of the visualized supraspinatus muscles (95%) and 39 of the infraspinatus muscles (98%) were intact. No dehiscence or loss of integrity of the deltoid was noted. Clinical comparison between patients with disrupted subscapularis muscles and patients without such disruption demonstrated no difference in clinical outcome scores and postoperative range of motion but showed less strength in forward flexion, abduction, and external rotation. The rate of subscapularis disruption using a subscapularis-sparing approach for ATSA was low (14%), but the potential for tendon disruption was not eradicated. Favorable clinical outcomes support this surgical approach as a potential technique for ATSA.

Star Cluster Formation and Evolution in M101: An Investigation with the Legacy Extragalactic UV Survey

We present Hubble Space Telescope WFC3/UVIS (F275W, F336W) and ACS/WFC optical (F435W, F555W, and F814W) observations of the nearby grand-design spiral galaxy M101 as part of the Legacy Extragalactic UV Survey (LEGUS). Compact sources detected in at least four bands were classified by both human experts and the convolutional neural network StarcNet. Human experts classified the 2351 brightest sources, retrieving N c = 965 star clusters. StarcNet, trained on LEGUS data not including M101, classified all 4725 sources detected in four bands, retrieving N c = 2270 star clusters. The combined catalog represents the most complete census to date of compact star clusters in M101. We find that for the 2351 sources with both a visual- and machine-learning classification StarcNet is able to reproduce the human classifications at high levels of accuracy (∼80%–90%), which is equivalent to the level of agreement between human classifiers in LEGUS. The derived cluster age distribution implies a disruption rate of over 107 < τ < 108.5 yr for cluster masses ≥103.55 M ⊙ for the central region of M101 and for cluster masses ≥103.38 M ⊙ in the northwest region of the galaxy. The trends we recover are weaker than those of other nearby spirals (e.g., M51) and starbursts, consistent with the M101 environment having a lower-density interstellar medium, and providing evidence in favor of environmentally dependent cluster disruption in the central, southeast, and northwest regions of M101.

Trends in the Prevalence and Postoperative Surgical Complications for Smokers Who Underwent a Total Knee Arthroplasty from 2011 to 2019: An Analysis of 406,553 Patients.

Smoking is a modifiable risk factor for complications following total knee arthroplasty (TKA). It is unclear if the declining prevalence of tobacco use in the U.S. population is reflected in patients undergoing elective TKA. This study aims to investigate (1) the incidence of 30-day complications following TKA in smokers and (2) trends in preoperative smoking status among TKA patients. In this study, patients undergoing primary elective TKA in the United States from 2011 to 2019 were identified in the American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP) database. Our cohort included 406,553 cases, 8.13% of which had smoked cigarettes within 1 year of undergoing TKA. Smokers were propensity score-matched to a group of nonsmokers, with each n = 32,533. The incidences of 30-day complications, readmission, and non-home discharge were compared between groups. The rate of preoperative smoking among elective primary TKA patients remained stagnant from 2011 to 2019. Smokers had higher rates of superficial surgical site infections (SSIs; 1.1 vs. 0.5%, p < 0.001), deep SSI (0.3 vs. 0.2%, p = 0.012), wound disruption (0.4 vs. 0.2%, p < 0.001), pneumonia (0.5 vs. 0.3%, p < 0.001), and 30-day readmission (3.6 vs. 2.7%, p < 0.001) compared with nonsmokers. No significant trends in 30-day complications were noted between 2011 and 2019. This study supports the success of national efforts to reduce the prevalence of smoking and reports a modest effect within the TKA population. However, almost 1 in 10 patients undergoing elective TKA continues to smoke and maintains a higher risk of postoperative complications.

Life table simulations of a univoltine codling moth, Cydia pomonella, population 3. Impact of immigration on the effectiveness of mating disruption

ABSTRACT The potential for immigration of female codling moth, Cydia pomonella (L.), to affect the efficacy of control by mating disruption was simulated by incorporating different rates of disruption and immigration into previously published life tables for a univoltine codling moth population on unsprayed apple trees in Nelson, New Zealand. Eight-year simulations were conducted using an initial codling moth density of 1.22 adults per tree at 330 trees per ha, as in the original life tables. Life table simulations without mating disruption served as controls for comparison with simulations that included various rates of disruption, and then various rates of immigration by virgin or mated female moths into trees subjected to 85% or 98% disruption. Model outputs were evaluated principally in relation to a nominal low export tolerance of fresh codling moth damage on harvested fruit of one per million. The simulations suggested that 85% disruption reduced the codling moth population too slowly for such export production, and that this rate of disruption was highly susceptible to immigration of virgin or mated female moths. Mating disruption of 98% provided rapid reduction of codling moth to extremely low population density, even in the presence of virgin female immigration up to ∼30 females per ha. However, although this efficacy should allow export by reducing simulated damage to less than one per million fruit, this was undermined by immigration of mated females as low as ∼0.7 per ha, or one per ∼3500 trees, in modern high-density orchards at 2400 trees per ha.

Mass segregation and dynamics of primordial binaries in star clusters with a radially anisotropic velocity distribution

ABSTRACT This paper is the third in a series investigating, by means of N-body simulations, the implications of an initial radially anisotropic velocity distribution on the dynamics of star clusters. Such a velocity distribution may be imprinted during a cluster’s early evolutionary stages and several observational studies have found examples of old globular clusters in which radial anisotropy is still present in the current velocity distribution. Here we focus on its influence on mass segregation and the dynamics of primordial binary stars (disruptions, ejections, and component exchanges). The larger fraction of stars on radial/highly eccentric orbits in the outer regions of anisotropic clusters lead to an enhancement in the dynamical interactions between inner and outer stars that affects both the process of mass segregation and the evolution of primordial binaries. The results of our simulations show that the time-scale of mass segregation of the initially anisotropic cluster is longer in the core and shorter in the outer regions, when compared to the initially isotropic system. The evolution of primordial binaries is also significantly affected by the initial velocity distribution and we find that the rate of disruptions, ejections, and exchange events affecting the primordial binaries in the anisotropic clusters is higher than in the isotropic ones.

706-P: CGM Disruption: A Common Phenomenon

Background: Advances in diabetes technology have led to reliance on continuous glucose monitors (CGM) for glycemic management. Insufficient wear time due to device malfunction, insertion problems, displacement or removal for imaging, medical procedures or hospitalization is common. Prescription practices that provide an exact number of sensors without redundancy fail to account for the realities of CGM use. The aim of this study is to characterize CGM disruption rates and consequences. Methods: A RedCap survey was completed by adults from a university based diabetes center with T1D or T2D who utilize CGM. Results: Of 262 surveys sent, 76 were completed. Participants had mean age 54, T1D 69%, female 72%, White 97%, and mean duration of diabetes 28 years. 100% used CGM (85.1% Dexcom, 9.5% Freestyle Libre, 5.4% Medtronic) , 61% insulin pump, and 41% HCL systems. The percent of participants reporting ≥1 CGM disruption events in 1 year: device malfunction (85.1%) , insertion problems (63.0%) , displacement (56.8%) ; removal for imaging (44.6%) , surgery/procedures (13.7%) and hospitalization (4.1%) . Adverse glycemic events attributed to disruption of CGM including hyperglycemia and hypoglycemia occurred ≥1 time in 55.4% and 45.9% of the participants respectively (Figure) . Conclusion: Loss of CGM use prior to the anticipated change date is common. Lack of redundancy of CGM supplies contributes to disruptions in care and adverse glycemic events. Disclosure A.Cedeno: None. P.Krutilova: None. A.Markov: None. J.B.Mcgill: Advisory Panel; Gilead Sciences, Inc., Lilly Diabetes, MannKind Corporation, Novo Nordisk A/S, Provention Bio, Inc., Salix Pharmaceuticals, Consultant; Bayer AG, Boehringer Ingelheim International GmbH, Research Support; Dexcom, Inc., Novo Nordisk. A.M.Mckee: Consultant; Medtronic.

Pharmaceutical supply chain reliability and effects on drug shortages

Drug shortages occur frequently and are often caused by supply chain disruptions. For improvements to occur, it is necessary to be able to estimate the vulnerability of pharmaceutical supply chains. In this work, we present the first model of pharmaceutical supply chain reliability. We consider three key approaches that companies may use to improve reliability: configuration, risk of disruptions, and speed of recovery. Key metrics include expected drug shortages, average time-to-shortage, and average time-to-recovery. We parametrize the model using data from major drug shortage databases and a case example of a generic injectable oncology drug. With a lean supply chain configuration, we observe that expected shortages at status quo conditions are 10%. By either doubling the speed of recovery or halving the disruption rate, expected shortages could drop to 5%. The most influential single change would be to add a back-up supplier to a lean configuration, leading to expected shortages of 4%. We also consider profitability and present the breakeven prices for different configurations. The results from our analyses could lead to immediate policy impact, providing evidence of the benefits of redundancy and improving facility quality.

0078 Assessing Sleep Health in Children Recently Adopted from Foster Care

Abstract Introduction An estimated 450,000 children were in the U.S. foster care system in 2019. Early adversity including maltreatment and/or neglect renders this vulnerable population at high risk for negative outcomes, both physical and psychological. Burgeoning evidence suggests that children in foster care develop high rates of sleep disruption. Sleep disruption is associated with negative life outcomes including heart disease, diabetes, and psychiatric disorders. However, there is still a lack of knowledge examining sleep health in children adopted from foster care. Methods Sleep quality and problems were examined among a sample of children adopted from foster care (n = 234) within the past two years, ages 4 to 11 years (M = 5.94, SD = 1.97). Caregivers across the US were invited to complete an anonymous Qualtrics survey via private Facebook groups for foster families. The Child Sleep Habits Questionnaire (CSHQ) was completed by foster parents to assess child sleep problems (e.g., nightmares, bedwetting, snoring, etc.) and overall sleep quality. Caregivers endorsed sleep problems and frequency using responses “Never,” “Sometimes,” and “Usually; sleep quality was rated using a Likert scale from 1 = Very Poor to 10 = Excellent. Results Paired-samples t-test compared first month (i.e., when first arrived in the home) and current child sleep quality based on caregiver-report. Sleep quality showed significant improvement since arrival in the foster home; t(233) = 12.98, p &amp;lt; .001, d = 0.85. However, on the CSHQ, 99% of the sample scored above the clinical cutoff for this measure indicating elevated sleep problems. Conclusion Children adopted from foster care show some improvement in sleep quality after achieving permanency. However, these data suggest this population continues to experience clinical levels of sleep problems even after being adopted. Our results suggest a need for specialized intervention services targeting sleep health among children recently adopted from foster care. Support (If Any) None

0323 Gender-Specific Differences in Self-Reported Factors Attributed to Sleep Disruption

Abstract Introduction Women are more likely to report sleep difficulties. There are many ways for sleep to be disrupted (social influences, external sensory stimuli, somatic cues) but limited data exists on the relative burden of these disruptors. The purpose of the present analysis was to compare the occurrence of disruptors between males and females of equal ages. Methods We used self-reported data from the PSG-validated SleepScore mobile app to analyze the relative occurrence of a variety of sleep disruptors in an age- and gender-balanced sample of users (39,560 male and 39,560 female, median age=41, SD=15). Fisher's exact test was used to examine whether gender was a significant factor in the likelihood of reporting each disruptor. Disruptors were categorized as follows: somatic cues included hot flashes/thermal discomfort, chronic pain, bathroom visits, and heartburn; external sensory stimuli included temperature, light, and noise; social influences included: bed partner, pet, and children. All p &amp;lt; 0.00001 results are reported. Results Women were significantly more likely than males to report at least one sleep disruptor (Odds ratio (OR): 2.29, prevalence: 90% vs 80%) and were more likely to report sleep disruption attributed to external stimuli (OR: 1.61, prevalence: 54% vs 42%), somatic cues (OR: 1.66, prevalence: 68% vs 56%), and social influences (OR: 1.95, prevalence: 50% vs 34%). Among somatic cues, women were more likely than males to report hot flashes/thermal discomfort (OR: 3.42), chronic pain (OR: 2.32), bathroom visits (OR: 1.24), and heartburn (OR: 1.14). Among external sensory stimuli, women were more likely than males to report sleep disruption attributed to sound (OR: 1.58), light (OR: 1.54), and temperature (OR: 1.54). Among social influences related disruptive factors, women were more likely than males to report sleep disruption attributed to pets (OR: 2.31), bed partners (OR: 1.65), and children (OR: 1.62). Conclusion The present analysis found that women reported higher rates of regular disruption for every cause. These findings highlight the role of gender in sleep-health reporting behavior and mirror other findings showing lower symptom reporting and healthcare utilization among males. Support (If Any)

0638 Circadian rhythms among youth with craniopharyngioma

Abstract Introduction Craniopharyngioma is an intracranial tumor located in the hypothalamic and pituitary region. Despite high survival rates for youth with craniopharyngioma, quality of life is substantially affected. Morbidity includes high rates of sleep disruption, particularly disorders of hypersomnolence. Circadian rhythms may also be affected due to the proximity of the tumor and subsequent treatment to the hypothalamic-pituitary-adrenal axis, though the role of circadian rhythms has been less studied in this patient population. To evaluate circadian rhythms among youth with craniopharyngioma, dim light melatonin onset (DLMO), an established marker of the circadian system, was estimated. Methods Fifty-five patients between the ages of 7 and 20 years participated in this study. Data were collected prior to completion of proton therapy (if indicated). Participants provided hourly saliva samples, in their homes, starting 3 hours prior to habitual bedtime until 1 hour following in dim light conditions (&amp;lt;30 lux). DLMO was calculated based on a threshold of 4 pg/ml. Participants also wore actigraphs to measure sleep patterns. We derived bedtime and waketime from actigraphy and calculated phase angles to bedtime and waketime. DLMO timing and phase angles were compared to published norms for healthy youth ages 9 to 17 years. Results DLMO could not be estimated for almost half of the sample (n=25), most often due to a melatonin value above the threshold at the first collection time point. Higher grade of hypothalamic involvement and the presence of diabetes insipidus predicted inability to capture DLMO. Subsample analyses of participants with DLMO (n=30) showed later DLMO timing and shorter phase interval to bedtime than the healthy reference sample. Conclusion With standard practice for DLMO estimation, we only obtained estimates for slightly more than half our sample. This may reflect circadian rhythm disturbances or advanced circadian phase. Relative to published norms, those with captured DLMO had later DLMO timing and shorter phase angles to bedtime, indicating sleep at an earlier circadian phase. These findings suggest possible circadian rhythm disruption in pediatric craniopharyngioma. Methodological differences among samples may also contribute to findings. Further examination of circadian rhythm disruption and relations with other sleep disturbances is needed. Support (If Any) This work was supported by the Cancer Center Support Grant (CA21765) from the National Cancer Institute and ALSAC.

0317 Interaction of Sleep and Emotion Across the Menstrual Cycle

Abstract Introduction Women experience increased risk for sleep and affective disorders compared to men, attributed in part to monthly oscillations in sex hormones. Emotional functioning worsens during the perimenstrual phase. There is increasing evidence that sleep continuity also decreases during this phase. Thus, this study examined the interactive effects of sleep and menstrual phase on emotion across two menstrual cycles in healthy women. Methods Participants (N=51, 43% Caucasian) aged 18-35 (m=23.67) completed actigraphy and daily sleep/emotion diaries over two menstrual cycles (m days=51.29). Cycles were identified via date of menses and urinary ovulation detection, and coded into four phases: perimenstrual, mid-follicular, periovulatory, and mid-luteal. The perimenstrual phase was defined the 3 days prior to and the 3 days following menses onset. Variables included diary and actigraphic total wake time (TWT), daily ratings of positive (happy, calm, enthusiastic) and negative (angry, afraid, sad) affect using a 9-point scale. Relationships between phase, sleep, and emotion were estimated using multistep hierarchical linear modeling. Pandemic-related stress and daily US and region-specific COVID-19 case counts were included as covariates in adjusted models. Results Mean menstrual cycle length was 28.61±2.69 days. Menstrual phase was first entered into models as predictors for sleep and emotion variables independently. The perimenstrual phase positively predicted anger (p&amp;lt;.001) but no other emotions. Additionally, the perimenstrual phase predicted higher rates of TWT, such that diary-reported TWT was 8-16 minutes longer during the perimenstrual (m=67.54, SE=3.37) compared to other phases (p&amp;lt;.001). Actigraphic TWT was also increased by 4-7 minutes (m=61.54, SE=3.37) in the perimenstrual phase (p&amp;lt;.001). A second model included the interaction term, TWT*phase to the original model. Positive emotions were .05-.10 points lower (p’s=.006-.02) when TWT was greater in the perimenstrual phase. Conclusion Menstruating women experienced greater rates of anger and sleep disruption during the perimenstrual phase compared to other phases. When poor sleep occurred during the perimenstrual phase, however, women reported reduced positive emotions. Sleep disruptions, particularly occurring during the perimenstrual phase, may be an important intervention target for women at risk for affective disorders. Future studies should be mindful to assess menstrual phases when assessing sleep and circadian rhythm. Support (If Any)

The impact of frailty on postoperative complications in geriatric patients undergoing multi-level lumbar fusion surgery.

Retrospective Cohort Study. This study evaluates the impact of patient frailty status on postoperative complications in those undergoing multi-level lumbar fusion surgery. The Nationwide Readmission Database (NRD) was retrospectively queried between 2016 and 2017 for patients receiving multi-level lumbar fusion surgery. Demographics, frailty status, and relevant complications were queried at index admission and readmission intervals. Primary outcome measures included perioperative complications and 30-, 90-, and 180-day complication and readmission rates. Perioperative complications of interest were infection, urinary tract infection (UTI), and posthemorrhagic anemia. Secondary outcome measures included inpatient length of stay (LOS), adjusted all-payer costs, and discharge disposition. Nearest-neighbor propensity score matching for demographics was implemented to identify non-frail patients with similar diagnoses and procedures. Subgroup analysis of minimally invasive surgery (MIS) versus open surgery within frail and non-frail cohorts was conducted to evaluate differences in surgical and medical complication rates. The analysis used nonparametric Mann-Whitney U testing and odds ratios. Frail patients encountered higher rates perioperative complications including posthemorrhagic anemia (OR: 1.73, 95%CI 1.50-2.00, p < 0.0001), infection (OR: 2.94, 95%CI 2.04-4.36, p < 0.0001), UTI (OR: 2.57, 95%CI 2.04-3.26, p < 0.0001), and higher rates of non-routine discharge (OR: 2.07, 95%CI 1.80-2.38, p < 0.0001). Frail patients had significantly greater LOS and total all-payer inpatient costs compared to non-frail patients (p < 0.0001). Frailty was associated with significantly higher rates of 90- (OR: 1.43, 95%CI 1.18-1.74, p = 0.0003) and 180-day (OR: 1.28, 95%CI 1.03-1.60, p = 0.02) readmissions along with higher rates of wound dehiscence (OR: 2.21, 95%CI 1.17-4.44, p = 0.02) at 90days. Subgroup analysis revealed that frail patients were at significantly higher risk for surgical complications with open surgery (16%) compared to MIS (0%, p < 0.0001). No significant differences were found between surgical approaches with respect to medical complications in both cohorts, nor surgical complications in non-frail patients. Frailty was associated with higher odds of all perioperative complications, LOS, and all-payer costs following multi-level lumbar fusion. Frail patients had significantly higher rates of 90 and 180-day readmission and higher rates of wound disruption at 90-days. On subgroup analysis, MIS was associated with significantly reduced rates of surgical complications specifically in frail patients. Our results suggest frailty status to be an important predictor of perioperative complications and long-term readmissions in geriatric patients receiving multi-level lumbar fusions. Frail patients should undergo surgery utilizing minimally invasive techniques to minimize risk of surgical complications. Future studies should explore the utility of implementing frailty in risk stratification assessments for patients undergoing spine surgery.

The response of dual-species bacterial biofilm to 2% and 5% NaOCl mixed with etidronic acid: A laboratory real-time evaluation using optical coherence tomography.

AimThe addition of etidronic acid (HEDP) to sodium hypochlorite (NaOCl) could increase the antibiofilm potency of the irrigant, whilst maintaining the benefits of continuous chelation. Studies conducted so far have shown that mixing HEDP with NaOCl solutions of relatively low concentration does not compromise the antibiofilm efficacy of the irrigant. However, the working lifespan of NaOCl may decrease resulting in a reduction of its antibiofilm efficacy over time (efficiency). In this regard, continuous irrigant replenishment needs to be examined. This study investigated the response of a dual‐species biofilm when challenged with 2% and 5% NaOCl mixed with HEDP for a prolonged timespan and under steady laminar flow.MethodologyDual‐species biofilms comprised of Streptococcus oralis J22 and Actinomyces naeslundii T14V‐J1 were grown on human dentine discs in a constant depth film fermenter (CDFF) for 96 h. Biofilms were treated with 2% and 5% NaOCl, alone or mixed with HEDP. Irrigants were applied under steady laminar flow for 8 min. Biofilm response was evaluated by means of optical coherence tomography (OCT). Biofilm removal, biofilm disruption, rate of biofilm loss and disruption as well as bubble formation were assessed. One‐way anova, Wilcoxon's signed‐rank test and Kruskal–Wallis H test were performed for statistical analysis of the data. The level of significance was set at a ≤.05.ResultsIncreasing NaOCl concentration resulted in increased biofilm removal and disruption, higher rate of biofilm loss and disruption and increased bubble formation. Mixing HEDP with NaOCl caused a delay in the antibiofilm action of the latter, without compromising its antibiofilm efficacy.ConclusionsNaOCl concentration dictates the biofilm response irrespective of the presence of HEDP. The addition of HEDP resulted in a delay in the antibiofilm action of NaOCl. This delay affects the efficiency, but not the efficacy of the irrigant over time.