Early Time Period Research Articles

Multi-Asset Value Payoff: Is Recent Underperformance Cyclical?

Recent value factor underperformance has called into question whether the value factor payoff is cyclically low, or if there are more structural challenges. We use a new approach to explore a link between the well-known macroeconomic exposures of traditional asset classes and those of value premia in a multi-asset context, focusing on country equities, bonds, and currencies in developed markets. Taking advantage of the cross-country inflation and growth expectations implicit in every value portfolio, we derive the net inflation and real growth characteristics embedded in each asset class carry portfolio at each point in time. Our analysis provides several insights: (1) Multi-asset value payoff is only weakly related to the global business cycle. (2) However, we find that the payoff to value portfolios is strongly linked to relative growth and inflation expectations across countries. (3) Over the last decade, we find that cheaper assets have had much lower net relative macro exposures compared to earlier time periods. This characteristic coincides with the period of unconventional central bank policies designed to lift global growth after the Global Financial Crisis (GFC).

Porttipahta end moraine in Finnish Lapland is constrained to Early Weichselian (MIS 5d, Herning stadial)

Litho- and chronostratigraphy of the Early Weichselian time period, or Marine Isotope Stages (MIS) 5e-5a, is insufficiently established in Northern Fennoscandia and still more ambiguous is the regional-scale distribution of the corresponding end moraines. We applied Light Detection And Ranging Digital Elevation Models (LiDAR DEMs), electromagnetic (EM) sedimentary anisotropy (orientation) and ground penetrating radar (GPR) to reveal till-covered landforms diagnostic to the Early Weichselian phase(s) in Finnish Lapland. Morphometric and geophysical data revealed that sands and gravels of the Porttipahta end moraine were deposited from the north-northwest and are overlain by one diamicton (till) unit deposited from the southwest and most likely being correlative to the Late Weichselian (MIS 2). Sub-till OSL-ages yielded 91 ± 19, 96 ± 14, 100 ± 16 and 120 ± 26 ka, thus correlative with the MIS 5c interstadial (Brørup). The Porttipahta end moraine deposited during the deglaciation of the Early Weichselian 5d stadial (Herning).The NW-SE oriented till-covered eskers and rock drumlins in the area suggest Late Saalian (MIS 6) phase. Southwest of the Porttipahta area the end moraine complex is deformed by earthquake(s) attributable to glacial isostatic adjustment (GIA) probably during the MIS 5d phase. The morphological appearance is similar to Veiki moraine in Norrbotten, Sweden, and high-resolution LiDAR DEMs emphasize that both landforms exhibit a minute erosion by the later stadials. It remains unresolved, if the Porttipahta end moraine represents the maximum extent of the MIS 5d or if it represents a recessional stage.

Management and outcome across the spectrum of high-risk patients with myocardial infarction according to the thrmobolysis in myocardial infarction (TIMI) risk-score for secondary prevention.

BackgroundPatients with myocardial infarction (MI) are at increased risk for recurrent cardiovascular events, yet some patients, such as the elderly and those with prior comorbidities, are particularly at the highest risk. Whether these patients benefit from contemporary management is not fully elucidated.MethodsIncluded were consecutive patients with MI who underwent percutaneous coronary intervention (PCI) in a large tertiary medical center. Patients were stratified according to the thrombolysis in myocardial infarction (TIMI) risk score for secondary prevention (TRS2°P) to high (TRS2°P = 3), very high (TRS2°P = 4), or extremely high‐risk (TRS2°P = 5–9). Excluded were low and intermediate‐risk patients (TRS2°P < 3). Outcomes included 30‐day/1‐year major adverse cardiac events (MACE) and 1‐year mortality. Temporal trends were examined in the early (2004–2010) and late (2011–2016) time‐periods.ResultsAmong 2053 patients, 50% were high‐risk, 30% very high‐risk and 20% extremely high‐risk. Extremely high‐risk patients were older (age 74 ± 10 year) and had significant comorbidities (chronic kidney disease 68%, prior CABG 40%, heart failure 78%, peripheral artery disease 29%). Drug‐eluting stents and potent antiplatelets were more commonly used over time in all risk‐strata. Over time, 30‐day MACE rates have decreased, mainly attributed to the very high (11.3% to 5.1%, p = .006) and extremely high‐risk groups (15.9% to 8.0%, p = .016), but not the high‐risk group, with similar quantitative results for 1‐year MACE. The rates of 1‐year mortality remained unchanged in either group.ConclusionWithin a particularly high‐risk cohort of MI patients who underwent PCI, the implementation of guideline‐recommended therapies has improved over time, with the highest‐risk groups demonstrating the greatest benefit in outcomes.

Association between ambient air pollution prior to initiation of in vitro fertilization and fertilization rates, pregnancy, and live birth

BACKGROUND AND AIM: There is a growing body of evidence that pre-pregnancy exposure to ambient air pollution is associated with fecundity and pregnancy, however much existing evidence depends on poorly quantified exposure measures. This study uses highly resolved exposure predictions for ambient air pollution in biologically critical pre-pregnancy windows in a population undergoing in vitro fertilization (IVF) to estimate if air pollutants are associated with adverse IVF outcomes. METHODS: This study includes individuals initiating a first IVF cycle from 2012-2013 at one of four clinics. Participant characteristics and cycle outcomes were extracted from medical records. PM2.5, NO2, and NOx were estimated using a highly resolved city-specific spatiotemporal prediction models. Exposures were estimated for 2 and 8-week periods prior to cycle initiation representing biologically critical time periods. Outcomes evaluated included percent oocytes fertilized, embryo grade, clinical pregnancy, and live birth. Poisson and linear regression were used to evaluate binary and continuous outcomes, respectively. RESULTS:There were 4,756 eligible participants with a mean age of 35. Mean 2-week exposures were 9.5 µg/m3 for PM2.5, 9.6 ppb for NO2, and 14.5 ppb for NOx. We did not detect associations between any exposure and embryo quality, pregnancy, and live birth. Across pollutants, exposure was associated with a small but consistently lower fertilization rate. We found 0.13% (95% CI: -0.24, -0.02), 0.04% (95% CI: -0.07, -0.01), and 0.01% (95% CI: -0.02, -0.01) lower percent oocytes fertilized with a 2 µg/m3 PM2.5, 6ppb NO2, and 11ppb NOX 2-week average exposure, respectively. Results for an 8-week exposure were similar. CONCLUSIONS:These findings support recent studies which indicate a link between air pollution, fertility, and fecundity. The results of this study indicate that recent exposure to ambient air pollution may be related fecundity, though the effects seen here are not clinically relevant. Further work in characterizing this early time period is necessary. KEYWORDS: fecundity, fertility, pregnancy, air pollution

117. Minimally invasive transforaminal lumbar interbody fusion increases late-term rates of pseudarthrosis versus open approach

<h3>BACKGROUND CONTEXT</h3> Lumbar fusion has developed into an effective surgical treatment option for patients with various lumbar pathologies including discogenic pain, stenosis and spinal instability. Popular minimally-invasive (MI) fusion techniques, such as transforaminal lumbar interbody fusion (TLIF) have been increasingly utilized by spinal surgeons, offering similar clinical outcomes to traditional open approaches and often reporting decreased blood loss and complications in the long term. Despite a number of reports comparing open versus MI-TLIF, literature stratifying return to OR (RTO) complications between the two approaches by time after surgery is limited. Therefore, the purpose of this study was to determine the differences in early, late and long-term revision rates between open and MI-TLIF. <h3>PURPOSE</h3> To determine differences in early, late and long-term revision rates between MI and open TLIF. <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort study. <h3>PATIENT SAMPLE</h3> This study included 423 consecutive patients from 2012-2018 with a minimum follow-up of 2 years. Of the total, 127 underwent open TLIF and 296 underwent MI-TLIF. <h3>OUTCOME MEASURES</h3> (1) Return to OR revision rate, (2) pseudarthrosis proportion, (3) ASD proportion. <h3>Methods</h3> A retrospective review was performed to identify all patients between 2012-2018 who underwent 1- or 2-level open or MI-TLIF with a minimum follow-up of 2 years. Demographic data were compared between groups. RTO complications were noted and grouped according to categories related to infection, neurologic, fusion status, hardware and global alignment. These complications were then stratified by early (<6 months), late (6 months-2 years), and long-term (>2 years) time periods. Standard binominal and categorical comparative analyses were performed. <h3>Results</h3> A total of 423 consecutive patients were included; 127 in the open TLIF cohort and 296 in the MI-TLIF cohort. There were 67 males and 60 females in the open TLIF group compared to 177 males and 119 females in the MI-TLIF group (p= 0.180). Mean age was 54.1 years (21.9-79.2). Mean follow-up for the open TLIF and MI-TLIF groups were 67.9 and 69.6 months, respectively (p= 0.633). The overall RTO rate was 10.8% in the MI-TLIF cohort and 11.8% in the open TLIF cohort (p= 0.764). The open TLIF cohort had a significantly lower incidence of pseudarthrosis requiring RTO at the late-term time point (p= 0.042). There were no significant differences with respect to rates of adjacent segment disease (ASD) or any other particular complication requiring RTO. RTO rates at respective time points were 2.4%, 5.7%, and 2.7% for the MI-TLIF group and 5.5%, 0.8%, and 5.5% for the open TLIF group. Subgroup analysis of single-level operations only (75 open TLIF vs 255 MI-TLIF) demonstrated a significantly lower incidence of pseudarthrosis and ASD at both the late- and long-term time points (p= <0.001) in the open TLIF cohort, with no significant differences between overall RTO rates or any other complication (p= 0.333). <h3>Conclusions</h3> Open and MI-TLIF have both been shown to provide equivalent long-term clinical outcomes. In this study, patients undergoing open TLIF had significantly lower rates of pseudarthrosis compared to MI-TLIF. Open TLIF should be considered in patients with risk factors for nonunion; however, larger cohort studies are required to corroborate these findings. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Representation of women in vascular surgery science and societies

ObjectiveMedical schools and surgical residencies have seen an increase in the proportion of female matriculants, with 30% of current vascular surgery trainees being women over the past decade. There is widespread focus on increasing diversity in medicine and surgery in an effort to provide optimal quality of patient care and the advancement of science. The presence of gender diversity and opportunities to identify with women in leadership positions positively correlates with women choosing to enter traditionally male-dominated fields. The purpose of this study was to evaluate the representation of women in regional and national vascular surgical societies over the last 20 years. MethodsA retrospective review of the meeting programs of vascular surgery societies was performed. Data were collected on abstract presenters, moderators, committee members and chairs, and officers (president, president-elect, vice president, secretary, and treasurer). The data were divided into early (1999-2009) and late (2010-2019) time periods. ResultsFive regional and five national societies' data were analyzed, including 139 meetings. The mean percentage of female abstract presenters increased significantly from 10.9% in the early period to 20.6% in the late period (P < .001). Female senior authors increased slightly from 8.7% to 11.5%, but this change was not statistically significant (P = .22). Female meeting moderators increased significantly from 7.8% to 17.2% (P < .001), as well as female committee members increased from 10.9% to 20.3% (P = .003). Female committee chairs increased slightly from 10.9% to 16.9%, but this difference was not statistically significant (P = .13). Female society officers increased considerably from 6.4% to 14.8%. (P = .002). Significant variation was noted between societies, with five societies (three regional and two national) having less than 10% women at the officer level in 2019. There was a wide variation noted between societies in the percentage of female abstract presenters (range, 7.6%-34.9%), senior authors (3.9%-17.9%), and meeting moderators (5.4%-40.7%). ConclusionsOver the past two decades, there has been a significant increase in the representation of women in vascular surgery societies among those presenting scientific work, serving as meeting moderators, and serving as committee members. However, the representation of women among committee chairs, senior authors, and society leadership has not kept up pace with the increase noted at other levels. Efforts to recruit women into the field of vascular surgery as well as to support the professional development of female vascular surgeons are facilitated by the presence of women in leadership roles. Increasing the representation of women in vascular society leadership positions may be a key strategy in promoting gender diversity in the vascular surgery field.

The Challenge of Identifying Pediatric Abusive Head Trauma During the COVID-19 Pandemic.

The Challenge of Identifying Pediatric Abusive Head Trauma During the COVID-19 Pandemic.

Widening Survival Disparities between AYA with ALL Treated in Pediatric Vs. Adult Centers: A Population-Based Study Using the IMPACT Cohort

Background: Survival outcomes in adolescents and young adults (AYA) with cancer have not improved at the same rates as those in children. Studies in AYA with acute lymphoblastic leukemia (ALL) have shown that pediatric-based treatment protocols result in better survival compared to adult protocols. Consequently, many adult centers have begun to treat AYA ALL with pediatric protocols. Whether this change in practice has diminished survival disparities between pediatric and adult centers has not been established.Methods: The IMPACT Cohort comprises all Ontario, Canada AYA 15-21 years old diagnosed with one of six common cancers (including ALL) between 1992 and 2011. Detailed demographic, disease, treatment, and outcome data were collected through chart abstraction and validated by content experts. Locus of cancer care (pediatric vs. adult center) was determined based on where the majority of chemotherapy was delivered in the first three months after diagnosis. Linkage to population-based health administrative data identified cancer events (relapse, death) that were not detected through chart abstraction. Various predictors of locus of care were examined, including age (continuous variable), gender, time period (1992-1998 vs. 1999-2005 vs. 2006-2011), rural residence, and socioeconomic status using logistic regression. The impact of the above predictors and of locus of care on event-free (EFS) and overall survival (OS) was determined using Cox proportional hazard models. Events included disease progression, relapse, death, and second malignancies.Results: The cohort included 271 patients with ALL, 152 (56%) of whom received therapy at an adult center. In multivariable analysis, older patients [odds ratio (OR) 11.9 per year; 95th confidence interval (CI) 6.1-25.0] and those in the earliest time period (1992-1998 vs. 2006-2011, OR 3.5; 95CI 1.1-10.7) were more likely to be treated in an adult center. The 5-year EFS of patients treated at a pediatric center was 69.8%±4.2% vs. 50.7%±4.0% at adult centers (p=0.0006). 5-year OS was 78.0%±3.9% vs. 58.7%±5.5% (p=0.0006). For the entire cohort, there was no significant improvement in EFS over time. In multivariable analysis, only locus of care was significantly associated with EFS [adult vs. pediatric hazard ratio (HR) 4.0; 95CI 1.4-11.9]; age and time period were not predictive. The disparity in both EFS and OS between pediatric and adult cancer centers widened over time (Table 1). In the earliest time period (1992-1998) there was no significant different in OS between adult vs. pediatric centers (HR 1.8; 95CI 0.8-4.3). The HR increased and became statistically significant in the middle time period (1999-2005; HR 2.4; 95CI 0.9-5.6) and widened further in the most recent time period (2006-2011; HR 4.3; 95CI 1.4-13.8).Conclusions: Despite studies showing improved survival outcomes in AYA with ALL treated on pediatric-based protocols, and the increased use of such protocols at adult centers, outcomes in Ontario did not improve over the 20-year study period. Contrary to expectations, disparities in survival between pediatric and adult centers widened, with the largest disparities seen in the most recent time period. These results suggest that at a population-level, the use of pediatric protocols may not be sufficient to abolish locus of care-based outcome disparities. Future analyses will look at the impact of protocol adherence, delays in therapy, toxicity, and hospital volume on survival. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Real-World Outcomes of Chemoimmunotherapy in Chronic Lymphocytic Leukemia (CLL) Clinical Practice: Results from a Decade of Practice in Helsinki 2005-2015

Introduction: Around 350 new CLL cases are diagnosed annually in Finland, with approximately 1800 individuals living with the disease. However, no comprehensive disease outcome studies from clinical practice have been conducted to-date. In the absence of direct head-to-head trials, robust historical control data have become requisite to complement available clinical trial data and estimate the potential effects of novel therapies in local practice. In addition, patients (pts) in routine clinical care are far more heterogeneous than those included in clinical trials. The Finnish Hematology Registry (FHR) was created to collect real-world practice outcomes in CLL and other hematological malignancies, with Finland's centralized nationwide healthcare system allowing reliable pt identification and complete follow-up. The objective of this registry study is to describe treatment and survival outcomes for CLL pts from routine practice settings.Methods: A non-interventional, retrospective study design was used to collect routine clinical practice data from the FHR. Eligible pts aged ≥18 years diagnosed with CLL and receiving 1 or more treatment lines during 2005-2015 were identified from the FHR, with groupings of pts into those treated in the early (2005-2007), middle (2008-2010) and late (2011-2015) cohort time periods. As the registry had limited CLL pt data at study start, clinical investigators accessed medical records to retrieve and validate data. We report interim results on 66 pts from the Helsinki University Hospital, Helsinki, Finland, a hospital region accounting for 30% of the total national CLL incidence. The completion and validation of the Helsinki cohort (~130 pts) is ongoing and results from the whole dataset will be presented at ASH.Results: Median age at diagnosis was 67 years and 23% had Binet stage C. Longitudinal follow-up was available from 1st to 7th or higher treatment lines. Across all treatment lines, fludarabine-cyclophosphamide-rituximab (FCR) (52%), bendamustine-rituximab (BR) (48%), fludarabine-cyclophosphamide (FC) (27%), and chlorambucil (chl) -based therapies (24%) were the most frequently used treatments. FCR (48%) and FC (27%) were frequently used in the 1st line, whereas BR (34%) was the primary choice in the 2nd line. In later lines a wide array of treatment regimens were used. Only 2 pts received the novel agent ibrutinib as part of a named patient program; no other novel agents were used in this cohort during this period.FC and FCR were initiated in equal yet constantly decreasing proportions through 2008, when FCR became most common (0% FC vs. 40% FCR). A year later in 2009, BR was introduced into clinical practice and its use increased steadily from 14% to 30% through 2014 when its use then declined. The peak year of chl monotherapy or chl-based combinations was in 2006 with 38% of pts receiving chl-based treatment. Since then chl use has decreased dramatically, to 0% in 2015.Median overall survival (OS) from the start of any given 1st line treatment was 81 months (m). Pts receiving FC (p=0,009) and FCR (p<0,001) had significantly longer median OS (79 m and 82 m respectively) compared to bendamustine/BR (62 m) when given in the 1st line. FC and FCR resulted in longer, though not statistically different, time-to-next-treatment (TTNT) compared to bendamustine/BR (77 m vs 44 m). Despite the observed practice changes over the years, there were no detectable outcome differences in 1st and 2nd line median OS between those treated in early, middle and late time periods, possibly due to limited follow-up in the later period (data not shown).Conclusions: We describe real-world treatment trends and outcomes from a decade of practice in the Helsinki region. Our results show that chemoimmunotherapies have been vigorously implemented in clinical practice. However, interim results do not show detectable improvements for OS and TTNT during this decade of treatment in the Helsinki hospital region. In the Nordics, real-world evidence has become essential when introducing novel targeted therapies into clinical practice settings, with comprehensive disease registries expanding to allow for more detailed follow-up. [Display omitted] DisclosuresJarvinen:Janssen-Cilag Oy: Employment. Mehtälä:EPID Research: Employment, Other: EPID Research is a contract research organization that performs commissioned pharmacoepidemiological studies and thus its employees have been and currently are working in collaboration with several pharmaceutical companies.. Khanfir:EPID Research: Employment, Other: EPID Research is a contract research organization that performs commissioned pharmacoepidemiological studies and thus its employees have been and currently are working in collaboration with several pharmaceutical companies.. Juuti:EPID Research: Employment, Other: EPID Research is a contract research organization that performs commissioned pharmacoepidemiological studies and thus its employees have been and currently are working in collaboration with several pharmaceutical companies.. Leval:Janssen-Cilag Ab: Employment.

The Impact of COVID-19 on Speech-Language Pathologists Engaged in Clinical Practices With Elevated Coronavirus Transmission Risk.

Purpose This study assessed and described potential clinical practice changes secondary to COVID-19 that emerged as an early response to the pandemic for speech-language pathologists (SLPs) engaged in voice, alaryngeal, and swallowing activities that may increase the risk of virus transmission. Method SLPs from the United States and Canada (n = 665) who were engaged in clinical activities that might elevate the risk of COVID-19 exposure completed an online survey regarding their clinical practices. Topics assessed included potential clinical service modifications, COVID-19 testing and health, and potential financial impacts in the early time period of the pandemic. Results The percentage of SLPs completing the most endoscopic procedures prepandemic (≥ 10/week) was reduced from 39% of respondents to 3% due to the pandemic. Those who completed the most tracheoesophageal puncture voice prosthesis changes (≥ 5/week) reported a reduction in frequency from 24% to 6%. Twenty-five percent of SLPs reported that they were tested for COVID-19, and 6% reported a positive result. Descriptive statistics suggest that COVID-19 testing rates of SLPs, the percentage of SLPs experiencing a financial impact, and the percentage who were furloughed varied across SLP work setting. Conclusions These findings provide the first data characterizing the impact on COVID-19 on clinical practice for SLPs engaged in procedures such as endoscopy and laryngectomy care. The results indicate that, as frontline workers, SLPs were directly impacted in their practice patterns, personal health, safety, and financial security, and that these reported impacts occurred differently across SLP work settings.

Carotid Endarterectomy Following Intravenous Thrombolysis in the UK

The aim of this study was to evaluate the effect of pre-operative intravenous thrombolytic therapy (ivTT) on short term outcomes after carotid endarterectomy (CEA) among patients who presented with ischaemic stroke. A retrospective study using a large population based dataset from the National Vascular Registry in the United Kingdom (UK-NVR). The cohort included adult patients who underwent CEA for ischaemic stroke between 1 January 2014 and 31 December 2019. NVR records provided information on patient demographics, Rankin score, medication, time from onset of symptoms to surgery and whether the patient received ivTT prior to surgery. Logistic regression was used to evaluate the relationship between ivTT and rates of any stroke at 30 days after CEA and in hospital complication rates for neck haematoma. Secondary outcomes included in hospital cardiac and respiratory complications, and cranial nerve injury. Between 2014 and 2019, 9 030 patients presented with a stroke and underwent CEA, of whom 1 055 (11.7%) had received pre-operative ivTT. Those receiving ivTT were younger (mean 70.6 vs. 72.0 years, p < .001). The median (IQR) time from symptom to CEA was 10 days (6 - 17) for ivTT patients and 11 days (7 - 20) for CEA patients not receiving ivTT. Post-operative rates of 30 day stroke were similar between the no ivTT (2.1%) and ivTT (1.8%) cohorts (p= .48). In hospital neck haematomas were statistically significantly more common in CEA patients receiving ivTT (3.7%) vs. no ivTT (2.3%) (p= .006). There was no statistically significant association between 30 day stroke and neck haematoma complications when stratified for delays from symptom onset to CEA, but the overall cohort contained few adverse events for analysis during the very early time period. The use of ivTT before CEA in stroke patients was not associated with an increased risk of 30 day stroke, but there was an increase in the risk of neck haematoma.

Recent trends in cardiovascular disease deaths: a state specific perspective

BackgroundThe rate of decline in cardiovascular disease (CVD) mortality has lessened nationally. How these findings apply to specific states or causes of CVD deaths is not known. Examining these trends at the state level is important to plan local interventions.MethodsWe analyzed CVD mortality trends in Minnesota (MN) using the U.S. Centers for Disease Control and Prevention (CDC) Wide-ranging ONline Data for Epidemiologic Research (WONDER). Trends were analyzed by age, sex, type of CVD and location of death.ResultsCVD mortality rates in MN declined in 2000–2009 and then leveled off in 2010–2018, paralleling national rates. Age- and sex-adjusted CVD mortality decreased by 3.7% per year in 2000–2009 (average annual percent changes [AAPC]: -3.7; 95% CI: − 4.8, − 2.6) with no change observed in 2010–2018. Those aged 65–84 years had the most rapid early decline in CVD mortality (AAPC: -5.9, 95% CI: − 6.2, − 5.7) and had less improvement in 2010–2018 (AAPC: -1.8, 95% CI: − 2.2, − 1.5), and the younger age group (25–64 years) now experiences the most adverse trends (AAPC: 1.2, 95% CI: 0.7–1.8). Coronary heart disease (CHD) and cerebrovascular disease had the largest relative decreases in mortality in 2000–2009 (CHD AAPC: -5.2; 95% CI: − 6.5,-3.9; cerebrovascular disease AAPC: -4.4, 95% CI: − 5.2, − 3.6) with no change 2010–2018. Heart failure (HF)/cardiomyopathy followed similar trends with a 2.5% decrease (AAPC 95% CI: − 3.5, − 1.5) per year in 2000–2009 and no change in 2010–2018. Deaths from other CVD also decreased in the early time period (AAPC: -1.6, 95% CI: − 2.7, − 0.5) but increased in 2010–2018 (AAPC: 1.9, 95% CI: 0.5, 3.3). In- and out-of-hospital death rates improved in 2000–2009 with a slowing in improvement for in-hospital death and no further improvement for out-of-hospital death in 2010–2018.ConclusionConcerning CVD mortality trends occurred in MN. In the most recent decade (2010–2018) mortality from all CVD subtypes plateaued or even increased. CVD mortality among the younger age groups increased as well. These data are congruent with adverse national trends supporting their generalizability. These adverse trends underscore the urgent need for CVD prevention and treatment, as well as continued surveillance to assess progress at the state and national level.

Preoperative Patient-Reported Outcomes Measurement Information System Global Health Scores Predict Patients Achieving the Minimal Clinically Important Difference in the Early Postoperative Time Period After Total Knee Arthroplasty.

The patient-specific factors influencing postoperative improvement after total knee arthroplasty (TKA) are important considerations for the surgeon and patient. The primary purpose of this study was to determine which patient demographic factors influence the postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health (GH) scores. In addition, we aimed to compare the prognostic utility of preoperative PROMIS-GH scores and the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS-JR) in predicting postoperative improvement. This retrospective cohort study of a consecutive series of patients who underwent primary, unilateral TKA analyzed prospectively collected KOOS-JR and PROMIS-GH surveys. PROMIS-GH includes physical health (PH) and mental health scores. Patient demographic and presurgical characteristics were evaluated for prognostic capability in predicting postoperative improvement in the PROMIS scores and achievement of the minimal clinically important difference (MCID). Receiver operating characteristic curves were used to understand the prognostic thresholds of the preoperative PROMIS score and KOOS-JR for predicting MCID achievement. A total of 872 patients were included. Although unadjusted analyses showed associations between patient demographic factors and PROMIS-PH scores, multivariable regression analysis for predictors of MCID achievement demonstrated that PROMIS-PH was the only significant preoperative variable. Receiver operating characteristic analysis revealed that the area under the curve of PROMIS-PH (0.70; 95% CI, 0.67 to 0.74) was less than that of the KOOS-JR (0.77; 95% CI, 0.73 to 0.81; P = 0.032). Sensitivity and specificity for achieving the MCID were maximized for preoperative PROMIS-PH scores of ≤ 38 (59% and 70%) and for preoperative KOOS-JR ≤ 51 (71% and 69%). Preoperative KOOS-JR and PROMIS-PH scores predict clinically meaningful improvement after TKA. The KOOS-JR has greater prognostic utility in the early postoperative period. Level III, Prognostic Study.

A simplified approach to describe the mean skin temperature variations during prolonged running exercise.

Skin blood flow and skin temperature play a fundamental role in the thermoregulatory processes and are expected to largely change in response to a prolonged running exercise. The skin temperature changes have been documented in the literature, mainly through infrared thermographic measurements performed before, after, and, in a limited number of studies, during the exercise. After an initial reduction probably ascribed to skin vasoconstriction, the further skin temperature modifications with time, measured in reference papers during a steady and prolonged run, do not show a common behaviour, probably due to different exercise intensities and environmental conditions reported in these studies. This research aimed to develop a simplified method for describing the skin temperature changes during running exercise through the theoretical solutions of the dynamic energy balance of the human body in the early and late time periods, i.e., close to the onset and the end of exercise. These two asymptotic solutions for the skin temperature, having a largely dissimilar trend, collide at a time instant likely associated with the switch from skin vasoconstriction to vasodilation. Examples of application of the proposed method, based on the intersection of asymptotes, were provided. It was also demonstrated its capability to interpret the experimental skin temperature variations with time for constant-load running exercises reported in the literature under different levels of exercise intensity and environmental conditions.

Comparison of Transabdominal and Transvaginal Sonograms in Evaluation of Cervical Length During Pregnancy

Objective: A short cervix during pregnancy indicates a higher risk of preterm delivery. Transvaginal sonography is widely used for the detection of a short cervix. The literature indicates that 21–24 weeks is the most sensitive gestational age to assess transvaginal cervical length (TV CL) of ≤2.5 cm for potential preterm delivery. Pregnancies between 18 and 20 weeks’ gestation are generally performed transabdominally; thus, it could be beneficial to have a recognized correlation between the transabdominal cervical length (TA CL) measurement and the TV CL measurement at this earlier time period. Materials and Methods: An online database search produced 13 research articles to be reviewed. Inclusion criteria consisted of TA CL and TV CL assessment of singleton pregnancies with intact membranes. Results: Findings indicate high diagnostic yield when a TA CL of &lt;2.9 cm or TV CL of &lt;2.5 cm is used for defining a shortened cervix when measured between 18 and 20 weeks’ gestation. Conclusion: This review of the literature indicates a correlation between average TA CL and average TV CL measurements, although the relationship widens as CLs become shorter.

How did the COVID crisis affect use of neoadjuvant therapy for patients with breast cancer?

e18708 Background: The COVID-19 pandemic has caused shifts in terms of cancer management, but the impact of this has not been well-elucidated in a contemporary cohort of patients in clinical practice in the US. We hypothesized that closure of operating rooms would increase the use of neoadjuvant therapy (NT) during the early pandemic period. Methods: The nationwide Flatiron Health database is a longitudinal electronic health record (EHR)-derived database, comprising de-identified, patient-level structured and unstructured data, curated via technology-enabled abstraction. These data originated from approximately 280 cancer clinics. We compared patients diagnosed with non-metastatic breast cancer during the early pandemic period (March 1 – June 30, 2020; group 1) with those diagnosed in the four month period prior (November 1, 2019 – February 29, 2020; group 2) and those diagnosed during the same period one year earlier (March 1 – June 30, 2019; group 3). Results: There were 174 patients in group 1, 277 in group 2, and 348 in group 3. Overall, 591 (74.1%) were ER/PR+HER2-, 100 (12.6%) were HER2+, and 106 (13.3%) were triple negative (TN). Patients in the three groups were equally likely to be ER/PR+HER2- (75.3% vs. 72.2% vs. 74.9%, p = 0.68), HER2+ (12.1% vs. 14.9% vs. 11%, p = 0.33), TN (12.6% vs. 12.7% vs. 14.2%, p = 0.83) and to be high risk by genomic testing (either Oncotype Dx or Mammaprint; p = 0.72). While there was no difference in the clinical stage (p = 0.36) nor patient age at diagnosis (p = 0.76) across the three groups, patients diagnosed during the early pandemic (group 1) were more likely to receive NT compared to those diagnosed one year earlier (group 3); 28.7% vs 16.4%, p &lt; 0.01 (see table). The use of NT differed between the three groups in the ER/PR+her2- (p &lt; 0.01) and her2+ patients (p = 0.05), but not in the TN patients (p = 0.61). There was no difference in the use of NT overall during the pandemic by geographic state (p = 0.32) nor practice setting (p = 0.23); NT was also similar by geographic state and practice setting when considering the ER/PR+HER2-, HER2+, and TNBC subsets. Conclusions: Despite similar clinicopathologic features as earlier time periods, there was an increased use of NT during the early pandemic when compared to the same period in the prior year. This was seen particularly in the ER/PR+HER2- group, suggesting an increased use of neoadjuvant endocrine therapy.[Table: see text]

Histological evaluation of periprosthetic infection using HOES scale and CD15 expression analysis at the stage of the hip revision arthroplasty

Background.The effectiveness improvement and standardization of the methods of histological diagnosing periprosthetic infection (PPI) is an urgent task in the treatment of complications after large joint arthroplasty. Purpose of the study— Histopathological evaluation of the infection involvement of periprosthetic tissues at the stage of revision arthroplasty for deep infection of the hip using HOES scale and immunohistochemical analysis of CD15 expression.Materials and Methods.A single-center prospective study was performed on the clinical intraoperative material obtained at the stage of revision arthroplasty of the hip in 27 patients at the age of 65 (55÷69) years. The group of examination included patients with acute and chronic forms of deep periprosthetic infection. Light-optical microscopic investigation of the samples of periprosthetic connective-tissue membrane and bone tissue from the foci of infectious involvement was made on paraffin sections stained with hematoxylin and eosin; with the immunohistochemical reaction to determine the expression of CD15 neutrophil granulocyte markers. HOES Scale for pathohistological assessment was used in order to objectify osteomyelitis signs in periprosthetic bone tissue.Results. The signs of acute and chronic stages of periprosthetic osteomyelitis were observed in 9/16 patients with PPI chronic course within 1–30 months of postoperative period, from one to 18 months after manifestation of the symptoms. The signs of subsided osteomyelitis were determined in 12/27 patients with PPI of acute and chronic forms. Infected periprosthetic membranes were found in 19/27 clinical cases in the early and longterm time periods after arthroplasty surgery. A direct significant correlation was revealed between histopathological signs of infecting the periprosthetic bone and the connective-tissue periprosthetic membrane, especially strong one in patients with acute and chronic PPI osteomyelitis.Conclusion. The use of HOES Scale and the analysis of CD15 expression ensure the objectivity of PPI histological diagnosing. The results obtained indicate an increased risk of osteomyelitis development in patients with chronic periprosthetic infection after the hip arthroplasty.

Measuring the social impact of contemporary dysphagia research: an altmetric analysis

ABSTRACT This study aimed to (a) identify characteristics of dysphagia research receiving online attention; (b) determine associations between altmetric scores and traditional research metrics; (c) establish differences in altmetric scores between open access and closed access research and funded and non-funded research. Altmetric Explorer was searched on 7th October 2019 to identify contemporary (January 2014 to January 2019) articles with the keyword ‘dysphagia’. Data from 100 articles with the highest Altmetric Attention Score (AAS) were exported for analysis. Data extracted included journal name; first author profession; country; study design; population studied; publication year; journal impact factor; citations; downloads; funding and access status. Most of the 100 articles (AAS 19–317) focused on adult populations (95%). Nearly half of study designs were systematic reviews (27%) or randomized control trials (18%). The Dysphagia journal published the most articles (34%) and nearly one-third of first authors (31%) were based in USA. The most studied population was neurological (30%). There was no association between altmetric scores and traditional metrics. A significant difference in altmetric scores (U = 650.50, p = 0.045, p < 0.05) was found between the earlier time-period (2014–2016) (median AAS = 29) and later time-period (2016–2019) (median AAS=36). A significant difference in altmetric scores was identified between open (median = 33) and non-open access research (median = 29) (U = 1030.50, p = 0.048). Altmetric scores provide an innovative article level metric capturing public interest in dysphagia research. As altmetric scores do not correlate with traditional metrics, improved understanding of the type of dysphagia research that has social impact is imperative to guide researchers and clinicians.

Commentary to ‘Osteotomy in the newborn classic bladder exstrophy patient: A comparative study’

The use of pelvic osteotomies during bladder exstrophy closure has a long history and is widely accepted, except during the very early newborn time period (<72 h), when osteotomies may not be needed due to the malleability of the bones in early life. For those, however, with a pubic diastasis >4 cm, or lack of mobility on exam under anesthesia, osteotomies may be desired even within the first 3 days of life. The goal of this study was to demonstrate that osteotomies may be safely performed in the newborn time period (here defined as <28 days), as well as in the setting of delayed closures (>28 days).

A comparison of three different surgery approaches and methods for neurologically intact thoracolumbar fractures: a retrospective study

ObjectivesThe purpose of this study was to evaluate and compare the feasibility, safety, and efficacy of conventional open pedicle screw fixation (COPSF), percutaneous pedicle screw fixation (PPSF), and paraspinal posterior open approach pedicle screw fixation (POPSF) for treating neurologically intact thoracolumbar fractures.MethodsWe retrospectively reviewed 108 patients who were posteriorly stabilized without graft fusion. Among them, 36 patients underwent COPSF, 38 patients underwent PPSF, and 34 patients underwent POPSF. The clinical outcomes, relative operation indexes, and radiological findings were assessed and compared among the 3 groups.ResultsAll of the patients were followed up for a mean time of 20 months. The PPSF group and POPSF group had shorter operation times, lower amounts of intraoperative blood loss, and shorter postoperative hospital stays than the COPSF group (P < 0.05). The radiation times and hospitalization costs were highest in the PPSF group (P < 0.05). Every group exhibited significant improvements in the Cobb angle (CA) and the vertebral body angle (VBA) correction (all P < 0.05). The COPSF group and the POPSF group had better improvements than the PPSF group at 3 days postoperation and the POPSF group had the best improvements in the last follow-up (P < 0.05).ConclusionBoth PPSF and POPSF achieved similar effects as COPSF while also resulting in lower incidences of injury. PPSF is more advantageous in the early rehabilitation time period, compared with COPSF, but POPSF is a better option when considering the long-term effects, the costs of treatment, and the radiation times.