Early Dropout Research Articles

Same-day vs. delayed buprenorphine prescribing and patient retention in an office-based buprenorphine treatment program

BackgroundBuprenorphine is a safe and effective treatment for opioid use disorder (OUD), yet a small fraction of people with OUD receive it, and rates of retention in treatment are suboptimal. Dropout most commonly occurs within 30 days of treatment initiation. Therefore, research needs to investigate modifiable factors contributing to early dropout. Requiring multiple visits for evaluation prior to providing an initial buprenorphine prescription (delayed prescription) may lead to more early dropout when compared with prescribing at the first medical visit (same-day prescription). Our objective was to determine whether same-day (vs. delayed) buprenorphine prescription was associated with 30-day retention in treatment. MethodsWe conducted a retrospective cohort study of 237 patients who initiated buprenorphine treatment at an urban federally qualified community health center (FQHC) between June 1, 2015, and December 31, 2017. We measured prescription delays by determining the time between patients' first request for buprenorphine treatment (by calling, presenting to the FQHC in-person, or requesting treatment during a visit) and when providers wrote buprenorphine prescriptions. We included only patients with prescription delays less than or equal to 30 days in the analysis. We defined same-day prescription as the patient experiencing no delays in starting treatment and receiving a prescription during the first medical visit. We examined whether patients who received same-day prescriptions had different sociodemographic and clinical characteristics than patients who received delayed prescriptions. We also evaluated whether there was an association between the initial provider who made the decision about same-day vs. delayed buprenorphine prescribing and same-day prescription. We built a multivariable logistic regression model to evaluate the independent association between same-day vs. delayed prescription receipt and odds of 30-day retention in treatment. ResultsOf the 237 patients who initiated buprenorphine treatment from June 1, 2015, to December 31, 2017, 222 had delays less than or equal to 30 days and we included them in the analysis. Of the 222 patients, the mean age was 46 (SD 10.4), the majority were Hispanic (n = 160, 72%), male (n = 175, 79%), and publicly insured (n = 165, 74%). The majority of patients experienced delayed buprenorphine prescription receipt (n = 133, 60%). The median time to buprenorphine prescription was 5 days (IQR 0–11). Of those who experienced a delay (n = 133), the median delay time was 8 days (IQR 5–20). Compared to those with same-day prescription receipt, more patients with delayed prescription receipt were non-Hispanic white (11% vs. 2%, p = 0.01), had a history of alcohol use (43% vs. 21%, p < 0.01) or benzodiazepine use (22% vs. 9%, p = 0.01), and had the buprenorphine coordinator as their initial provider (57 vs. 13%, p < 0.01). Same-day prescription receipt was not significantly associated with 30-day treatment retention in the adjusted analysis (AOR 1.92, 95% CI 0.81–4.56). ConclusionPatients who received buprenorphine prescriptions on the same day as their initial evaluation differed from those who received delayed prescriptions. After adjustment for these differences, same-day prescription was not significantly associated with higher 30-day treatment retention. Providers may be delaying treatment when there is concern about alcohol and/or benzodiazepine use; however, providers could institute enhanced monitoring based on clinical concern for sedation or overdose risk without delaying buprenorphine prescription. Prospective studies of same-day vs. delayed buprenorphine receipt would elucidate the association between delays and retention more definitively.

Development of a Simple Clinical Tool for Predicting Early Dropout in Cardiac Rehabilitation: A SINGLE-CENTER RISK MODEL.

Nonadherence to cardiac rehabilitation (CR) is common despite the benefits of completing a full program. Adherence might be improved if patients at risk of early dropout were identified and received an intervention. Using records from patients who completed ≥1 CR session in 2016 (derivation cohort), we employed multivariable logistic regression to identify independent patient-level characteristics associated with attending <12 sessions of CR in a predictive model. We then evaluated model discrimination and validity among patients who enrolled in 2017 (validation cohort). Of the 657 patients in our derivation cohort, 318 (48%) completed <12 sessions. Independent risk factors for not attending ≥12 sessions were age <55 yr (OR = 0.23, P < .001), age 55 to 64 yr (OR = 0.35, P < .001), age ≥75 yr (OR = 0.64, P = .06), smoker within 30 d of CR enrollment (OR = 0.40, P = .001), low risk for exercise adverse events (OR = 0.54, P = .03), and nonsurgical referral diagnosis (OR = 0.66, P = .02). Our model predicted nonadherence risk from 23-90%, had acceptable discrimination and calibration (C-statistics = 0.70, Harrell's E50 and E90 2.0 and 3.6, respectively) but had fair validity among 542 patients in the validation cohort (C-statistic = 0.62, Harrell's E50 and E90 2.1 and 11.3, respectively). We developed and evaluated a single-center simple risk model to predict nonadherence to CR. Although the model has limitations, this tool may help clinicians identify patients at risk of early dropout and guide intervention efforts to improve adherence so that the full benefits of CR can be realized for all patients.

GIS location-allocation models in improving accessibility to primary schools in Mansura city-Egypt

Egypt governmental reports shows non-optimal geographical distribution of educational facilities and the difficulty in reaching school locations leads to high rates of early school drop-out. Reports showed that 2.75% of school dropout in Mansura city-Egypt (the case study) was due to spatial factors related to the difficulty of reaching school. Urban Planning Authority's report endorse that, the primary school location and the residential building must range between 500–750 m. However, such recommendations failed to take into attention or abided by a developing country like Egypt. The study goes through two Scenarios: (i) Scenario No. 1. Evaluating current school locations and (ii) Scenario No. 2. Analyzing proposed school locations and assess accessibility effectiveness after the process of schools’ geographical redistribution, it was carried out using GIS environment. The study objectives are about examined the role of spatial modeling and location analysis for improving the accessibility to public primary schools in Egypt: The specific aim of the study (i) Showing geographic distribution of public primary Schools in Mansura city. (ii) Examining the accessibility to Public Primary Schools in Mansura city and (iii) Using GIS tools to propose optimum locations where future public primary schools ought to be located. The study manipulated location-allocation models in GIS being one of the location analyses tools. It supports the process of spatial decision-making through several models and various scenarios. These provides varied options and great flexibility during planning. For analyzing the current situation of primary schools' distribution, GIS spatial analysis tools were used such as: Average Nearest Neighbor, Hotspot analysis and Grouping analysis. Study results concluded that number of demand points exceeds the distance of arrival at the optimal standard was about 54.96%. Schools concentration ratio in the city was 71.74% fell to 19.77% after the process of geographical redistribution of school locations. The proposed map of primary school locations in Mansura city can give a clear view for the decision maker on what location-allocation models can contribute for improving accessibility to educational facilities through applying the reliable standards.

The association between occupational physical activity, psychosocial factors and perceived work ability among nurses.

To examine the relationship between physical and psychosocial work-related risk factors and perceived work ability (PWA) among nurses. The work of nurses is challenging due to its high physical and mental workload. This might reduce PWA. A sustainable level of PWA is crucial to maintain well-being at work and to prevent early dropout. As a consequence, gaining a better understanding of which factors play a role in determining PWA is essential for health care organisations. The associations between work-related risk factors and PWA were investigated among 114 nurses from Ghent University Hospital, Belgium. PWA and psychosocial factors were subjectively assessed. Occupational physical activity (OPA) was objectively measured over a period of 2-5days using two accelerometers. No association between OPA and PWA was found. Multiple linear regression models revealed that job demands were negatively associated with PWA, whereas job control showed a positive association with PWA. The results highlight the importance of psychosocial factors for more research on the PWA of nurses. Further investigation into the specific physical work demands of nurses is called for. Giving attention to psychosocial factors is crucial to enhance the PWA and well-being of nurses.

Survival Analysis Approach for Early Prediction of Student Dropout Using Enrollment Student Data and Ensemble Models

The Universal Access to Quality Tertiary Education Act is a law in the Philippines that provides college students with free tuition and other fees in Philippine state universities and local universities. People's tax is used to finance this law and the government should ensure that student retention or persistence is attained throughout the duration of their stay. To effectively decrease student dropout, it is necessary to understand which students are at risk of dropping out. In addition, this study proposed a model that detects and predicts student success in tertiary education through the right selection of the suitable program utilizing the enrollment data that may have a significant on the study outcome of the students. This study experimented single classifier and added ensemble approach classifiers to propose a predictive model to detect early dropout of first-year college students. The study utilized tree algorithms and then applied the ensemble algorithm to identify student attributes that distinguish potential dropouts from college. The result reveals a very interesting prediction that if their average grade is less than 85, there is a high tendency of dropping any program they enrolled in. Evaluation results in the final stage of the model construction process reveal that applying bagging ensemble into j-48 tree attained the highest accuracy as matched with other tree algorithms, however, forest tree algorithm achieved the highest value in terms of dropout precision and graduated recall. The result also shows that applying ensemble approaches have a marginal increase in classification performance.

Double-Blind Placebo-Controlled Randomized Clinical Trial of Neurofeedback for Attention-Deficit/Hyperactivity Disorder With 13-Month Follow-up

To determine whether theta/beta-ratio (TBR) electroencephalographic biofeedback (neurofeedback [NF]) has a specific effect on attention-deficit/hyperactivity disorder (ADHD) beyond nonspecific benefit. In a 2-site double-blind randomized clinical trial, 144 children aged 7 to 10 years with rigorously diagnosed moderate/severe ADHD and theta/beta-ratio (TBR)≥4.5 were randomized 3:2 to deliberate TBR downtraining versus a control of equal duration, intensity, and appearance. Two early dropouts left 142 children for modified intent-to-treat analysis. The control used prerecorded electroencephalograms with the participant's artifacts superimposed. Treatment was programmed via Internet by an off-site statistician-guided co-investigator. Fidelity was 98.7% by trainers/therapists and 93.2% by NF expert monitor. The primary outcome was parent- and teacher-rated inattention; analysis was mixed-effects regression. Because the expense and effort of NF can be justified only by enduring benefit, follow-ups were integrated. Blinding was excellent. Although both groups showed significant improvement (p< .001, d= 1.5) in parent/teacher-rated inattention from baseline to treatment end and 13-month follow-up, NF was not significantly superior to the control condition at either time point on this primary outcome (d= 0.01, p= .965 at treatment end; d= 0.23, p= .412 at 13-month follow-up). Responders (Clinical Global Impression-Improvement [CGI-I]= 1-2) were 61% of NF and 54% of controls (p= .36). Adverse events were distributed proportionally between treatments. The 13-month follow-up found nonsignificant improvement from treatment end for NF (d= 0.1), with mild deterioration for controls (d=-0.07). NF required significantly less medication at follow-up (p= .012). This study does not support a specific effect of deliberate TBR NF at either treatment end or 13-month follow-up. Participants will be reassessed at 25-month follow-up. Double-Blind 2-Site Randomized Clinical Trial of Neurofeedback for ADHD; https://clinicaltrials.gov/; NCT02251743.

Predictors of attrition from a weight loss program. A study of adult patients with obesity in a community setting

PurposeObesity unit attrition is frequent and contributes to treatment failure. Many studies evaluating attrition predictors were part of randomized trials, and different terminology and criteria were used in the engagement field. We aimed to investigate the factors potentially implicated in early (< 12 weeks) and late (> 12 weeks) attrition from an obesity unit in a community settingMethodsThis was a retrospective cohort study of 250 patients with obesity who were followed-up at our obesity unit. Our program included at least 6 meetings in 12 months. Sociodemographic and anthropometric data, and psychometric questionnaires were collected from all participants.ResultsOne-hundred thirty-four (53.6%) participants dropped out. Those individuals showed lower BMI, lower overall health status, and increased depression scores. In a multiple regression model, BMI (inversely; OR = 0.90; 95%CI 0.84–0.96) and depression score (directly, OR = 1.05; 1.00–1.10) were associated with attrition risk. Early dropouts (n = 47) had lower weights, smaller waist circumferences and worse mental health scores than late dropouts (n = 87) and more frequently lived alone. When compared to completers, early dropouts had lower weights, BMIs, waist circumferences, overall health and mental status scores, increased depression scores and percentage of individuals living alone. In a multiple regression, lower BMI (OR = 0.83; 0.75–0.92), lower mental status score (OR = 3.17; 1.17–8.59) and living alone (OR = 2.25; 1.02–4.97) were associated with early attrition risk.ConclusionLower BMI and increased depression score were associated with attrition. Early attrition was associated with lower weight, decreased mental well-being, and living alone. Individuals with these characteristics might need tailored approaches to enhance their engagement.Level of evidenceLevel V, retrospective descriptive study.

Impact of anxiety on dropping out of treatment for major depressive disorder at an intensive partial hospitalization program.

Premature treatment discontinuation (dropout) is a common problem among patients seeking treatment for major depressive disorder (MDD). To prevent treatment dropout, it is important to identify its associated risk factors. The impact anxiety has on treatment dropout for MDD is especially critical to investigate due to the high rates of comorbidity between anxiety and depressive disorders. Evidence for the degree to which anxiety reliably predicts treatment dropout for MDD remains inconclusive and has yet to be investigated at an adult partial hospitalization program. Examining this can help elucidate which factors predict dropout among patients who need intensive treatment for their depression. Participants were patients seeking treatment for MDD at an adult partial hospitalization program (N = 461). A series of Chi-square tests and t tests were conducted to assess for any differences in frequencies of anxiety disorder comorbidities or mean scores of dimensional anxiety among patients who dropped out of treatment and those who did not. No significant associations between high baseline anxiety and early dropout were found (all P > .05). Findings suggest that no specific actions need to be taken to prevent individuals with high baseline levels of anxiety from prematurely dropping out of a partial hospitalization program.

O Sistema Alerta Precoce para o Insucesso Escolar – SAPIE

De acordo com legislação relativa à educação inclusiva, as políticas de combate ao insucesso e abandono escolar devem centrar-se essencialmente no trabalho preventivo, cientificamente sustentado, precocemente implementado e empiricamente validado por sistemas eficientes de sinalização precoce, monitorização e avaliação do impacto. Com este objetivo em mente, desenvolveu-se o Sistema de Alerta Precoce para o Insucesso Escolar – SAPIE, uma ferramenta inovadora de combate ao insucesso escolar que identifica o risco de retenção ou abandono escolar precoce, monitoriza o progresso dos alunos nos indicadores de risco e analisa o impacto da intervenção inclusiva ao longo do tempo. Neste artigo, apresenta-se o SAPIE, descrevendo a sua ancoragem científica no seio da investigação realizada no âmbito dos modelos de risco, especificando o seu desenvolvimento e procedimento de implementação, com referência aos seus objetivos, funcionalidades e os resultados esperados. Esta apresentação é feita com base na consulta de bibliografias disponíveis em diversas fontes (base de dados, relatórios, decretos lei, entre outros). Discutem-se as vantagens e limitações do SAPIE, concluindo-se pela sua relevância no combate ao insucesso escolar, no quadro da política de educação inclusiva e dos projetos de autonomia e flexibilidade curricular.

Adaptação acadêmica de estudantes do 1º ano

O presente artigo tem como objetivo desenvolver uma reflexão teórica a partir da compreensão dos fenômenos multifacetados que estão presentes no ingresso do estudante no ensino superior. Este constructo contemplou as expectativas que este novo contexto provoca nos estudantes e o impacto das primeiras vivências adaptativas no êxito e permanência do estudante na universidade. A transição e adaptação ao ensino superior constituem verdadeiros desafios e são descritas através de diferentes dimensões adaptativas em relação à instituição, aos estudos, aos seus pares, às exigências de autonomia pessoal e emocional, ou ao planejamento da carreira. Propõem-se alternativas de prevenção ao abandono universitário precoce, aqui entendido como o direito que o estudante possui de iniciar e concluir seus estudos com qualidade, com o devido suporte acadêmico, social e político, disponível nas instituições de ensino superior. Busca-se, portanto, uma reflexão sobre novas práticas formativas nesse nível de ensino diante dos alunos, os quais, potencialmente, estão mais vulneráveis em termos de desenvolvimento de competências. Abrange-se a necessidade de apoio social, psicológico e educativo, destinado a apoiar o êxito universitário dos estudantes e, consequentemente, a conclusão dos seus cursos, fazendo diminuir as taxas de abandono, tendencialmente mais elevadas entre os estudantes do 1º ano.

0499 Predictors of Session Attendance in a RCT for CBT-I for Perinatal Insomnia

Abstract Introduction Cognitive behavioral therapy for insomnia (CBT-I) is recommended as the first-line treatment for chronic insomnia disorder. However, early treatment dropout can negatively impact the success of treatment. In order to design effective strategies to reduce attrition we need to understand predictors of dropout. In this work, we focus on predictors of treatment session attendance among pregnant women in a randomized controlled trial of CBT-I. Methods Participants were 87 pregnant women with insomnia disorder (mean age=32.5, SD=5.1 years) who were enrolled in a randomized controlled trial of CBT-I and were randomized to the CBT-I arm (5 sessions). We did not include women who did not complete treatment due to early labor. The Insomnia Severity Index (ISI) and Edinburgh Postnatal Depression Scale (EPDS) and demographic questionnaires (age, income, and educational background) were administered at screening. Results Logistic regression analyses were conducted to identify predictors of number of CBT-I sessions attended during pregnancy. A logistic regression model that included clinical predictors found that the ISI and EPDS were not significant predictors of session attendance. A logistic regression model that included demographic predictors (income, education, and age) was significant (F(3,76)=6.49, p&amp;lt;0.001) with an R² of .204. Independently, income was not a significant predictor (β =.15, p=.32), but education (β =-.21, p&amp;lt;.05) and age (β =-.48, p&amp;lt;.01) were significant predictors of fewer sessions attended. Dropping income from the model, there was a significant age by education effect (β =1.39, p&amp;lt;.05). Among participants with less than a college degree, those who were younger had attended fewer sessions during pregnancy. Among those who completed a college education and above, number of sessions attended did not differ by age. Conclusion Pregnant women with insomnia who were randomized to receive CBT-I were more likely to withdraw early from treatment if they were younger and had less than a college education. Further research that focuses on increasing attendance in CBT-I treatment among pregnant women needs to develop strategies to increase retention in this vulnerable population. Support NR013662

When is Psychotherapy Brief? Considering Sociodemographic Factors, Problem Complexity, and Problem Type in U.S. Adolescents

ABSTRACT Objective: When psychotherapy is brief (1–2 sessions), “early dropout” – defined as premature treatment discontinuation due to financial or structural barriers – is a commonly assumed cause. However, there are several possible reasons why treatment may be brief, including youth-level factors such as psychopathology complexity or problem type. Better characterizing whether factors beyond financial and structural barriers predict adolescents’ receipt of briefer (versus longer-term) treatment may guide efforts to retain specific youth in longer-term services – and disseminate intentionally brief interventions to youth potentially positioned to benefit. Method: Using data from the 2017 SAMHSA National Survey on Drug Use and Health, we examined whether sociodemographic disadvantage (minority race, low-income, government assistance), perceived problem type, and psychopathology complexity (1 versus multiple problem types) related to psychotherapy length (1–2 versus 3-24+ sessions) among adolescents receiving outpatient psychotherapy (N = 1,601; ages 12–17; 60.59% white; 64.50% female). Results: Among adolescents beginning outpatient psychotherapy, 23.36% ended treatment after 1–2 sessions. Psychopathology complexity predicted greater likelihood of receiving >2 sessions, after adjusting for specific problem type (χ2 = 75.14, p < .001, OR = 1.80). Further, although certain problem types (e.g., depression, anxiety, and anger control) were associated with increased likelihood of greater treatment length, these findings did not hold after accounting for psychopathology complexity. No sociodemographic factors significantly predicted treatment length. Conclusions: Structural and financial barriers alone may not explain when and why youth psychotherapy is brief. Additional factors, such as psychopathology complexity, may be important and potentially primary contributors to treatment duration among youth who access outpatient services. Future research may examine whether youth with less comorbidity differentially benefit from intentionally brief interventions, along with strategies for retaining youth who might benefit from longer-term care – such as those with multiple co-occurring problems – in treatment.

Real world, open label experience with lacosamide against acute painful oxaliplatin-induced peripheral neurotoxicity.

We report the outcome of a pilot, open-label study that tested the potential of lacosamide (200 mg/bi.d) as an effective and safe symptomatic treatment against acute painful oxaliplatin-induced peripheral neurotoxicity (OXAIPN). Lacosamide was introduced in 18 colorectal cancer patients with evidence of clinically significant acute, painful OXAIPN after infusion of the third course (T1) of oxaliplatin-based chemotherapy (FOLFOX4) and was maintained until completion of all 12 courses (T4). The OXA-Neuropathy Questionnaire (OXA-NQ) was used to record the severity of acute OXAIPN; the PI-NRS estimated the severity of neuropathic pain, while the chronic OXAIPN was graded with TNSc. The EuroQOL (EQ-5D) instrument was also applied. The Patient Global Impression of Change (PGIC) scale measured the lacosamide-attributed perception of change. LCM-responders were considered those with ≥50% reduction in PI-NRS and OXA-NQ scores at T4, compared to T1. Patients experienced on T1 a median number of acute OXAIPN symptoms of 4 and had a median neuropathic pain severity score of 6, which was strongly related to lower quality of life, according to EQ-VAS (P < .001). At T4, 12 patients (66.7%) were classified as responders. A significant clinical improvement was documented in the severity of acute OXAIPN and neuropathic pain in relation to lacosamide (P < .001) at T4 compared to T1, which was associated with improved EQ-VAS scores (P < .001). Twelve patients scored PGIC ≥5 (lacosamide-attributed) at T4. There were no incidences of early drop-outs for safety reasons. Lacosamide appears to be an effective and well-tolerated symptomatic treatment against acute, painful OXAIPN.

Former Road Cyclists Still Involved in Cycling Report Lower Burnout Levels Than Those Who Abandoned This Sport.

Despite the numerous benefits associated with sport practice, many children and adolescents end up quitting it year after year, with a stable dropout rate between 10 and 19 years of age. Among the causes of sport abandonment, the scientific literature highlights the presence of burnout as a fundamental factor. In this regard, the aim of the present study was to investigate the levels of the three components of sport burnout–emotional and physical exhaustion, reduced sense of accomplishment, and sport devaluation–reported by a sample of young (former) athletes, depending on whether their sport abandonment was relative (i.e., change to another sport modality) or definitive. In particular, participants were former agonist road cyclists, who have been divided into three groups on the basis of what they did after abandoning road bicycle racing, namely: (a) those still involved in cycling, either in a different specialty (e.g., mountain bike) or with a different role (e.g., coach for kids); (b) those who started practicing a different sport; and (c) those who definitively abandoned sports. The general hypothesis was that, with respect to those who changed sport and those who definitively abandoned it, those still involved in cycling would report experiencing lower levels of the three burnout components during the last year practicing it. To test this hypothesis, the Athlete Burnout Questionnaire (ABQ; Raedeke and Smith, 2001) was administered to 85 young former road cyclists. The results seem to support the hypothesis for two out of the three components, namely, emotional and physical exhaustion and sport devaluation; on the other hand, for reduced sense of accomplishment, no difference among the three groups emerged. Further research is needed to deepen the understanding of such processes, also in relation with other relevant constructs; yet, the results of the present study should already raise the awareness of sport organizations on the need to deal with this and related phenomena by adopting appropriate strategies to ensure the well-being of young athletes, thus trying to reduce early dropout.

SAT-223 ARE CURRENT REIMBURSEMENT SCHEMES PREVENTING MORE PATIENTS GOING HOME?

Home Haemodialysis (HHD) is a renal replacement therapy (RRT) performed at a patient's home. Research has shown that both conventional HHD (cHHD, 3x4 hours a week) and intensive HHD (iHHD, > 3x4 hours a week) may reduce mortality, improve patients’ quality of life and be a cost-effective treatment if offered to the right patients at the right time. Despite these benefits, uptake of HHD in Europe is low (1.6 percent). The main reasons are perceived barriers by patients, caregivers and providers. This study evaluates potential financial hurdles for the provider by mapping relevant cost components and assessing gaps in existing reimbursement schemes. A systematic literature review (SLR) was conducted on economic publications in the field of HHD. To gain further insights on applicable cost items, expert interviews with healthcare professionals (N = 10) were undertaken. These interviews were transcribed and analysed. The identified 41 cost items were assigned to one of six categories (training, installation, consumables, medication, personnel, other costs) resulting in a detailed cost item list. Dialysis providers have great (financial) responsibility when setting up a HHD program; however the results of the SLR showed that published literature is usually incomplete and does not depict total cost of ownership. Identified relevant cost items (SLR & interviews) are illustrated in Table 1. Our research shows that the cost structure is not homogenous over time as installation and training cost items are primarily applicable in the first year of the HHD program and a patient’s HHD journey. Furthermore, it was found that while iHHD’s and cHHD’s cost items are identical, the financial impact might differ due to increased therapy frequency of iHHD and dialysis system used. When selecting the right patient, HHD results in better patient outcome and reduces costs for the health system (e.g. transportation, unplanned hospitalization, medication). However, it may be more expensive for the provider in comparison to offering in-center treatment. Therefore, it seems justified that the higher care provision costs are compensated by some of the health system savings. To enable patient-centered care, health systems need to establish a reimbursement structure that allows flexibility to offer all HHD modalities to fit individual patient needs along their RRT journey. In most European countries the reimbursement set-up does not reflect the heterogenous cost distribution of and within HHD programs due to one-time costs and different frequency of treatment. To reduce the hurdles of HHD uptake, reimbursement schemes should account for provider's financial investments in the first year and resulting fear of sunk costs due to potential early patient drop-out. Thus, payers need to be aware of applicable cost components and responsibilities of HHD providers and consider them when defining an appropriate tariff for the appropriate treatment regime prescribed to a patient.

Prediction of students’ early dropout based on their interaction logs in online learning environment

ABSTRACTOnline learning has become more popular in higher education since it adds convenience and flexibility to students’ schedule. But, it has faced difficulties in the retention of the continuity of students and ensure continual growth in course. Dropout is a concerning factor in online course continuity. Therefore, it has sparked great interest among educators and researchers to offer many models and strategies to reduce online course students’ dropout by analyzing students’ behavior and their individual and academic information. However, online education platforms still face challenges of high dropout rate and the difficulty of accurate prediction to reduce it. The key aim of the present study is to construct a predictive model to early predict students who are at-risk of dropout. This model is useful to the course instructors to make effective and timely interventions. We have noticed that dropout prediction is basically a sequence labeling or time series prediction problem. For these reasons, we proposed two models; the Logistic Regression by adding a regularization term and the Input-Output Hidden Markov Model (IOHMM). Results showed that the proposed models achieved an accuracy of 84% compared to the baseline of Machine Learning Models for prediction of the students at-risk of dropping out.

Predictors for the Early Termination of a Psychological Intervention During Treatment with Assisted Reproductive Technologies.

Introduction Assisted reproductive technologies are typically perceived by couples as being an emotional burden. The objective of the study “Positive Ausrichtung bei unerfülltem Kinderwunsch” [Positive adjustment in infertility] (PACI) is to examine the efficacy and acceptance of a smartphone-supported psychosocial intervention during infertility treatment. In this investigation, the early drop-out of study subjects from the study is of primary interest. The objective of the investigation was to find predictors for ending a psychological intervention prematurely. Materials and Methods There are data available from an eight-month randomised, controlled study in which 141 patients and their partners participated. Sociodemographic and fertility-related data were collected at the start of the study. The couples received the ScreenIVF questionnaire at two points in time. As part of a post-evaluation, a survey was conducted on the efficacy of the psychological online intervention. To analyse the data, a dyadic data structure was used in order to determine connections within the study subject couples between the selected stress indicators and the drop-out. In addition, a “risk score” as a possible predictor for the drop-out was tested. Results The descriptive observation of the sample indicates in this interim assessment that the study subjects recruited are less stressed patient couples. Actor–partner interdependence models indicate statistically significant connections between the stress indicators of anxiety, little social support and helplessness and an early drop-out. Conclusions The statistically significant effects found in this study with regard to the stress indicators in connection with drop-outs from psychosocial intervention studies indicate that it is advisable to continue to seek measures for people undergoing stressful medical treatments in order to motivate and support them and thus optimally utilise the opportunities of a medical treatment. The number of patients who endure their ART treatment may also increase as a result, which could lead in turn to increased patient satisfaction over the long term (and thus possibly to higher pregnancy rates).

Self-Monitoring as a Personality Variable in Tinto’s Theory of Integration

One weakness of Tinto’s (1993) model is its inability to identify early dropouts (Webb, 1988), which may be due to the theory’s inattention to personality traits. Self-monitoring (Snyder, 1974) may be an important trait related to dropout. This study hypothesized low self-monitors, compared to high self-monitors would be more likely to (1) have higher initial commitment levels, (2) achieve higher academic integration, (3) accomplish greater social integration, and (4) persist in college. Path analysis confirmed all hypotheses. Self-Monitoring was demonstrated to be an important personal characteristic in Tinto's Theory. Application of theses findings are discussed.

A randomized, crossover trial comparing the efficacy and safety of fesoterodine and extended-release oxybutynin in children with overactive bladder with 12-month extension on fesoterodine: The FOXY study.

We sought to assess and compare safety and efficacy of fesoterodine and oxybutynin extended-release in the treatment of pediatric overactive bladder (OAB). We conducted a non-inferiority, randomized, double-blind, crossover trial comparing fesoterodine 4-8 mg and oxybutynin 10-20 mg once daily (QD) in children with OAB aged 5-14 years (2015-2018). Every child received the first medication for eight weeks, followed by crossover to the second antimuscarinic after a three-days washout. Dose up-titration was possible at mid-course. Patients could enter a fesoterodine 12-month extension. Endpoints were assessed through changes on voiding diaries, Patient's Perception of Bladder Condition score (PPBC), adverse events, vital signs, electrocardiogram, post-void residual, urinalysis, and blood tests. The Wilcoxon rank sum and Wilcoxon signed rank tests were used for statistical analysis. A total of 62 patients were randomized (two early dropouts). Expected class effects (dry mouth/constipation) were present but no significant difference was observed. There was a 10.1 beats/minute increase in heart rate with fesoterodine (p<0.01) (oxybutynin-1.9 beats/min; p=non-significant [ns]). No life-threatening or serious adverse events occurred. Efficacy was similar for both drugs. Bladder capacity improved over the 16 months of the study; baseline capacity of 125 mL (44.5% expected bladder capacity for age [%EBC]) to 171 mL (53.9 %EBC) at the end of the extension phase. No clinical or statistical difference was shown between efficacy measures for fesoterodine or oxybutynin. The use of fesoterodine or oxybutynin appear safe and effective for the treatment of OAB in children. Based on our study, long-term treatment to achieve the ultimate goal of urinary continence is needed in this population.

Predictors for continued participation of employees in structured outpatient obesity intervention programmes.

BackgroundOverweight, obesity and the conditions resulting from them have become one of the major challenges for health systems all over the world. High dropout rates are particularly common among the participants in outpatient obesity intervention programmes (OIP). Limited research has examined retention in OIP.MethodsBased on the data of a 24-month Bundeswehr outpatient OIP with a total of 630 participants, predisposing factors (n = 30) for continued participation beyond an early stage (0–3 months) and beyond a later stage (0–6 months) were analysed by means of a logistic regression analysis. In order to correct for multiple-comparison, the p-value was adjusted (p* < 0.0017).ResultsThree hundred out of 630 participants continued to participate beyond an early stage and 205 beyond a later stage. Besides an age between 40 and 50 at the beginning of the outpatient OIP, it was possible to show that knowledge of one’s blood pressure and a positive lifestyle prior to participation in the programme (higher level of sporting activity) were predisposing factors for early dropout (>3 months) in the intervention programme.DiscussionThe possible predisposing factors examined accounted for about 35% of the variance in a rough estimate. In order to improve long-term participation in workplace outpatient OIP, the study focused on how the motivation of older people and employees with an unfavourable cardiovascular risk profile could be improved.