Greater Percentage Of Males Research Articles

Perspectives of osteopathic medical students on preclinical urology exposure: a single institution cross-sectional survey.

There is an increasing number of medical school graduates opting for surgical specialties, and the osteopathic applicant match rate for urology is lower than that of allopathic applicants. Factors influencing this may include alack of interest, perceived challenges in matching into urology, insufficient urology mentorship, limited research opportunities, and inadequate osteopathic representation in urology. The objective of this survey is to assess osteopathic medical students' perspectives on pursuing urology and enhancing preclinical exposure to and knowledge of urology. A 20-question survey addressing experiences andthe factors influencing osteopathic medical students' specialty selection and their interest in and perception of urology was designed by the investigators on Research Electronic Data Capture (REDCap) software. This survey was distributed via email listserv to all current osteopathic medical students attending Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine over 2months. Responses were collected and analyzed utilizing Fisher's exact test. Among 150 respondents, 91 % found mentors crucial in selecting a medical specialty, 95 % emphasized the importance of early exposure, and 68 % lacked familiarity with urology, with more M1 students unfamiliar with urology compared to M2 (70.4 % vs. 59 %). A larger proportion of combined M1 and M2 (preclinical) students are considering urology as a specialty compared to M3 and M4 (clinical) students who are actively on rotations (56.5 % vs. 28.6 %; p=0.0064). Also, a greater percentage of males are considering urology compared to females (64.2 % vs. 42.7 %; p=0.0164). Among those considering urology (n=75), 57.3 % lack awareness of urology's scope, and 84 % report no preclinical discussions with urologists. Those students who report that they are considering urology value early exposure significantly more than others (98.7 % vs. 78.7 %; p=0.0001). They also express greater interest in having acore urology course (73.3 % vs. 38.7 %; p<0.0001). More urology-considering students are interested in extracurricular urology-related workshops, seminars, or conferences (61.3 % vs. 17.3 %; p<0.0001). Students who are considering urology as a specialty show greater interest in having a mentorship program (85.3 % vs. 28 %; p<0.0001). Results suggested that increased urology exposure during the preclinical years is important. Urology elective offerings and urology mentorship are of high interest among those considering urology. However, additional investigation is needed to determine the impact ofpreclinical urology curricula implementation on urology match outcomes.

Continuation of Learning During COVID-19 Situation in Nepal

This study explored the obstacles and ways of continuation for learning faced by school teachers during and after the COVID-19 situation. The quantitative cross-sectional survey research design was adopted. All the school teachers of Nepal were the population for this study and the sample size was 226. The online survey method was adopted for the data collection tools. A set of closed and open-ended questionnaires were distributed to respondents and data was collected using Google Forms. The study seeks the relationship between the independent variables (age, experience of teaching, school location, teacher’s residence, access to the internet, access to digital devices, knowledge about ICTs interest in online teaching) and dependent variables (continuation of online teaching). It was found that the community teaching and homework/ assignment methods were applicable to the rural areas. Continuing online teaching would be inconvenient for the students who had no internet access. According to the teacher's response, it was found that about 90% of students had no access to the internet. Although online teaching was suitable for the COVID-19 situation, it was biased for the maximum number of students. The teacher's interest and the obstacles in the online class and continuation of learning are significantly co-related (0.003 and 0.000 respectively). There was no significant difference between male and female teachers in continuation for online learning but a greater percentage of males are involved in online classes than females. The experienced teachers equally continued their learning of digital skills. There was a problem with the internet/ wifi/ 3G/ 4G network in rural areas. Teacher adjusted their teaching and learning activities even if they had no access to a laptop. The study concludes that teachers are ready for online classes and they regularly update their digital skills with changing times but digital divides created a serious problem with conducting online classes. So, the Government of Nepal should pay attention to teacher training, integration of digital skills in the curriculum, and proper allocation of budget for infrastructure development.

Patients poorly recognize lesions of concern that are malignant melanomas: is self-screening the correct advice?

Australia is known for its outdoor culture, with a large percentage of its population engaging in outdoor recreational activities, aquatic, non-aquatic and outdoor occupational activities. However, these outdoor enthusiasts face increased exposure to ultraviolet radiation (UVR), leading to a higher risk of skin cancer, including malignant melanoma (MM). Over the past 40 years, there has been a significant rise in skin cancer rates in Australia, with two out of three Australians expected to develop some form of skin cancer by age 70. Currently, skin cancer examinations are not endorsed in asymptomatic or low-risk individuals in Australia, with only high-risk individuals recommended to undergo regular skin examinations. Notably, the Melanoma Institute Australia suggests that one-half of patients identify MMs themselves, although this claim appears to be based on limited Australian data which may not reflect contemporary practice. Therefore this study sought to determine the percentage of patients who were able to self-identify MMs as lesions of concern when presenting for a skin cancer examination. Multi-site, cross-sectional study design incorporating a descriptive survey and total body skin cancer screening, including artificial intelligence by a skin cancer doctor. A total of 260 participants with suspect MM lesions were biopsied, with 83 (31.9%) found to be melanomas. Of the true positive MMs only a small percentage of participants (21.7% specificity) correctly had concerns about the suspect lesion being a MM. These MMs were located primarily on the back (44.4%), shoulder (11.1%) and upper leg (11.1%). There was no significant difference in the size between those participants aware of a MM versus those who were not (P=0.824, 24.6 vs 23.4 mm2). Significantly more males identified lesions of concern that were MMs as compared to females (P=0.008, 61.1% vs 38.9%, respectively). With regard to true negatives males and females were similar (52.1% vs 47.9%, respectively). With regard to false negatives (n=65), a greater percentage of males than females did not recognize the MM as a lesion of concern (66.2% vs 33.8%, respectively). Participants were more likely to correctly identify an invasive MM as opposed to an in situ MM (27.3% versus 21.3%). Only a small percentage of participants in this study were able to self-identify either in situ or invasive MM as a lesion of concern with a tendency to identify the more advanced, thicker MMs. Given that MM is associated with a high mortality and cost of treatment, particularly when invasive, the inability of lay persons to identify these cancerous lesions will likely lead to delayed treatment and a possible adverse outcome. We believe the current melanoma screening practices in Australian general practice should be revisited to improve patient outcomes with regard to MM. Additionally, prevention campaigns should include images and primary risk factors for MM.

506 Methamphetamine Intoxication and Inpatient Outcomes for Burn Patients

Abstract Introduction Methamphetamine intoxication frequently complicates inpatient burn admissions. While single-institution studies describe adverse outcomes during resuscitation, less is known about the associated inpatient complications and perioperative management in users. This analysis aims to identify these trends on a national level. Methods The US National Trauma Data Bank was queried to identify burn patients between 2017-2021. Methamphetamine intoxication was identified on admission and compared to those who screen negative. Primary outcomes included death, stroke, and myocardial infarction (MI). Secondary outcomes included organ failure, timing of surgery, admission vitals, length of stay (LOS), and days in the intensive care unit (ICU). Multivariable regressions modeled the effects on outcomes adjusting for available covariates including demographics, total body surface area (TBSA) burned, and inhalation injury. Bonferroni adjustments were applied. Results 326,614 burn encounters were identified, and 5,380 (1.7%) had positive methamphetamine drug screens upon admission. Users were significantly older (35.2 versus 31.9 years, p &amp;lt; .001), had a greater percentage of males (85.3 vs. 82.0, p &amp;lt; .001), were more likely to have inhalation injury and overall had larger %TBSA burns (16% vs. 13%, (p &amp;lt; .001). Users had significantly higher but clinically insignificant ED systolic blood pressures (132.1 vs. 129.9, p &amp;lt; .001). There was no significant difference between the two groups regarding pulse rate &amp;gt;120 (1.7% vs. 1.6%, p=.611). Users were not more likely to die, sustain an MI, or stroke during admission. In contrast, users were significantly more likely to have alcohol withdrawal (0.8% vs. 0.5%, p=.019), drug withdrawal (0.3% vs. 0.2%, p=.003), a pulmonary embolism (PE) (0.9% vs. 0.7%, p=.039), and delirium (1.2% vs. 0.4%, p=.003). Users had longer times to surgery adjusting for burn severity and demographics (1.6 vs. 1.4 days, p=.033). There were no significant differences in the average number of wound coverage procedures (1.50 vs. 1.45, p=.947). Users had significantly longer hospitalization (8.7 vs. 6.2 days, p &amp;lt; .001); however, there was no significant difference between days in the ICU (6.7 vs. 6.4 days, p=.072). Conclusions While not associated with mortality, methamphetamine intoxication was associated with an increased risk of many complications including PE, drug withdrawal, and delirium. Methamphetamine use was associated with delays in surgery and hospitalization. Applicability of Research to Practice Recognize the increased risk of complications and the need for tailored perioperative care for methamphetamine users. Additionally, burn centers may consider how to avoid delaying care for users and support interventions for withdrawal.

Inpatient Complications and Outcomes for Burn Patients Admitted With Methamphetamine Intoxication.

Methamphetamine intoxication frequently complicates inpatient burn admissions. While single-institution studies describe adverse outcomes during resuscitation, little is known about the risks of amphetamine intoxication on inpatient complications and perioperative management. The US National Trauma Data Bank was queried for burn encounters between 2017 and 2021. Amphetamine intoxication was identified on admission. Primary outcomes included death, stroke, and myocardial infarction (MI). Secondary outcomes included organ failure and surgical management. Multivariable regressions modeled outcomes adjusting for available covariates including demographics, TBSA burned, and inhalation injury. Bonferroni adjustments were applied. Our study identified a total of 73,968 primary burn encounters with toxicology screens. Among these, 800 cases (1.1%) were found to have positive methamphetamine drug screens upon admission. Methamphetamine users were significantly older (41.7 vs 34.9 years, P < .001), had a greater percentage of males (69.6 vs 65.4, P = .045), were more likely to have inhalation injury (P < .001), and had larger %TBSA burns (16% vs 13%, P < .001). Methamphetamine users were no more likely to die, experience MI, or experience stroke during admission. In contrast, methamphetamine users were significantly more likely to have alcohol withdrawal (P = .019), acute kidney injury (AKI) (P < .001), deep vein thrombosis (P = .001), pulmonary embolism (PE) (P = .039), sepsis (P = .026), and longer intensive care unit (ICU) stays (P < .001). Methamphetamine use was associated with a longer number of days to the first procedure (P = .005). Of all patients who required surgery (15.0%), methamphetamine users required significantly more total debridements and reconstructive procedures (P < .001). While not associated with mortality, methamphetamine intoxication was associated with an increased risk of many complications including PE, deep vein thrombosis, AKI, sepsis, and longer ICU stays. Methamphetamine intoxication was associated with delays in surgical care.

The American Woodcock Singing Ground Survey largely conforms to the phenology of male woodcock migration

AbstractAmerican woodcock (Scolopax minor; woodcock) are monitored, in part, by counts of displaying male woodcock collected via the American Woodcock Singing Ground Survey (SGS), which suggests long‐term, range‐wide declines in woodcock populations. Data from the SGS have been used extensively to develop conservation plans, direct management actions, and understand causes of decline. To avoid bias, the SGS should be timed to avoid spring migration, and the distribution of survey routes should coincide with woodcock breeding distribution. Our objectives for this research were to evaluate SGS timing with the phenology of male woodcock migration, relate the spatial coverage of the SGS to male woodcock breeding distributions, and explore other sources of variation in woodcock migration timing. We marked 133 male woodcock captured throughout eastern North America with global positioning system (GPS) transmitters during 2019–2022, and compared the timing of their spring migration with the spatiotemporal stratification of the SGS. Most woodcock (74%) completed migration prior to the onset of the SGS. In the northernmost SGS zone, a greater percentage of males (34%) continued migration during the survey window; however, the influence of this mismatch is offset because SGS routes were run more frequently during the second half of the window. Young woodcock completing their first spring migration took 8.6 days longer to do so, on average, compared to adults, and so were more likely to migrate during the SGS window. We found little evidence that timing of migration varied among years. Existing SGS routes cover the majority of male woodcock post‐migratory breeding distribution, with 90% of male woodcock establishing final breeding sites within the spatial coverage of the SGS. Our results confirm the SGS includes some migrating males, with the proportion relative to resident breeding males increasing in more northern survey strata. Our data suggests these errors are unlikely to bias trend estimates at large scales (e.g., within woodcock management regions), but there may be potential for bias at more local scales (e.g., state or provincial population indices).

Metabolic associated fatty liver disease better identifying patients at risk of liver and cardiovascular complications.

A nomenclature of "metabolic associated fatty liver disease" (MAFLD) with a new definition was proposed in 2020 instead of the previous "non-alcoholic fatty liver disease" (NAFLD). Whether it better coheres with the clinical demand remains controversial. The participants with fatty liver on ultrasonography inTaiwan bio-bank cohorts were included. MAFLD is defined as the presence of fatty liver, plus any of the following three conditions: overweight/obesity, type 2 diabetes mellitus (DM), or metabolic dysfunction. The severity of liver fibrosis was determined using fibrosis-4 (FIB-4) index and NAFLD fibrosis score (NFS). The risk of atherosclerotic cardiovascular disease was assessed using intima-media thickness (IMT) or plaques of carotid duplex ultrasound. A total of 9,719 subjects (ages 55.9 ± 10.8; males 42.6%) were distributed among 4 groups: "overlapping group", "MAFLD only", "NAFLD only", and "neither fatty liver disease (FLD)" with the percentages of 79.7, 12, 7.1, and 1.2%, respectively. Compared with NAFLD patients, MAFLD patients had a greater percentage of males, higher levels of BMI, waist circumference, HbA1c, and triglyceride. In addition, they had higher levels of serum ALT, AST, GGT, fatty liver index (FLI), NFS, and IMT, but no difference in FIB-4 index and the percentage of carotid plaques. To note, "MAFLD only group" had greater levels of AST, ALT, GGT, FLI, FIB-4, NFS, IMT and a higher percentage of carotid plaques than the "NAFLD only group". The grand, population-based study showed MAFLD with new diagnostic criteria to aid in identifying a greater number of high-risk patients of metabolic, liver, and cardiovascular complications, suggesting MAFLD may be a better nomenclature than NAFLD in clinical practice.

Men and Women Respond Equally Well to Spinal Cord and Dorsal Root Ganglion Stimulation

ObjectivesThe influence of gender on outcomes in individuals undergoing treatment for chronic pain is unclear. This retrospective, single-site study explored the impact of gender on pain, quality of life (QoL), revisions, and explants in patients with failed back surgery syndrome or visceral pain, who received a fully implanted 10 kHz spinal cord stimulation (SCS), burst SCS, or dorsal root ganglion (DRG) stimulation system. Materials and MethodsThe following data were collected from paper and electronic records: gender, age, chronic pain diagnosis, system, baseline and follow-up scores (average pain [visual analog scale, VAS], worst pain [VAS], QoL [EQ-5D-3L]), revisions, and explants. Data were statistically analyzed by one-way ANCOVAs controlling for age, chi-square tests of independence, and logistic regression. ResultsThe final sample comprised 387 patients (176 males and 211 females). Males were significantly older compared to females (mean difference: 2.33 years, p = 0.044). Controlling for age, baseline average pain was significantly lower in males than females (mean difference: −0.32, p = 0.049). Males and females responded equally well to 10 kHz SCS and burst SCS as well as DRG stimulation. A greater percentage of males (5%) than females (1%) had revisions due to lead fractures. Additionally, more females (13%) than males (6%) had an explant due to insufficient pain relief. Female gender and older age were associated with greater likelihood of having an explant compared to male gender and younger age. ConclusionGender may play an influential role in pain severity at baseline but have little effect at follow-up. To help identify which patients may undergo a revision or explant, gender and age could be important factors and should be further scrutinized. Even though men and women responded equally well to SCS and DRG stimulation, more men had a revision due to lead fractures, and more women were explanted due to insufficient pain relief.

Socioeconomic factors associated with a late-stage pancreatic cancer diagnosis: An analysis of the national cancer database.

4135 Background: Pancreatic cancer is an aggressive, lethal cancer that is the 4th leading cause of cancer death in the United States. It is often asymptomatic until later stages, thus it is critical to assess the socioeconomic factors associated with diagnosis at early vs. late stages. Using the National Cancer Database, we aim to identify associations between socioeconomic factors of patients that present with early stage (0-I) pancreatic cancer in comparison to late-stage disease (stage IV) at diagnosis. Methods: In this study, 256,822 patients from the National Cancer Database who were diagnosed with NCDB Analytic Stage Group stage 0-I and stage IV pancreatic cancer were analyzed based on age, race, sex, ethnicity, insurance type, income, geographic location, education and Charlson-Deyo score. Demographic factors of patients that presented with early and late-stage disease were analyzed using chi square and multivariate analysis. All patients included in the study were diagnosed with pancreatic cancer between 2004 and 2018. Results: We identified significant ( P &lt;0.05) associations between race, sex, insurance status, education, income, and geographic location with diagnosis of advanced-stage disease. A greater percentage of males were diagnosed with late-stage cancer than early-stage (52.8% vs 47.9%). Females were more likely to have an earlier-stage diagnosis and were 15% less likely to have late-stage diagnosis than males (p &lt; 0.001 and 95% CI = 0.839-0.875). African Americans were 10% more likely to have a late-stage diagnosis than Caucasians (p &lt; 0.001 and 95% CI = 1.069-1.144). For insurance status, private and Medicaid insurance had higher percentages of late-stage diagnosis than early-stages, and all types of insurance had lower rates of late-stage diagnosis than patients without insurance (p &lt; 0.001). Patients from a zip-code associated with &lt; $38,000 median household income and zip-codes with lower levels of high school diplomas had higher rates of late-stage diagnosis (p &lt; 0.025). Conclusions: Factors associated with increased likelihood of pancreatic cancer presentation at advanced stage compared to early stage include race, sex, insurance status, education, median income, comorbidity score, and geographic location.

Influence of Socio Economic Variables on Output of Honey in Ikwuano Local Government Area of Abia State, Nigeria

This research portrays the influence of socio economic variables on the output of honey in Ikwuano Local Government Area (LGA) of Abia State, Nigeria. Specific analytical techniques employed were descriptive statistics, Likert rating scale and multiple regression analysis involving the linear, Cobb Douglass, semi log and exponential functional forms. Result from the socio economic characteristics shows that greater percentage of males (76.67%) were involved in bee keeping than their female counterpart (23.33%). Mainstream of the Apiculturist adopted the modern techniques of honey production. The significant socio economic variables influencing the output of honey in Ikwuano LGA were access to credit, Bee farmer’s experiences in Apiculture, gender of the Apiculturist, farm assets, family labour and baiting materials. Lack of access to credit facilities ranked the topmost constraints bee farmers encounter in their enterprises. It is recommended that Bee farmers be encouraged to expand their production by increasing their number of hives; this will reduce their aggregate cost of production and increase their total accruable revenue. Additionally, the government and ministry of agriculture, as well as other agencies should provide credit facilities to Bee farmers in order to increase their scale of production.

Physical Activity And Barriers To Participation Among Middle School Students In Howard County, Maryland

PURPOSE: To identify pre-COVID-19 levels of physical activity, health behaviors related to physical activity and barriers to participation among middle school youth in Howard County, Maryland. METHODS: Cross-sectional data from the 2018 Maryland Middle School (6th through 8th grade) Youth Risk Behavior Survey (YRBS) for Howard County, Maryland (n = 1584) was assessed to characterize associations between physical activity, health behaviors and barriers. Meeting physical activity guidelines was defined as engaging in 7 days of physical activity per week at least 60 minutes per day. Social determinants included access to food, access to sports teams and social support; health behaviors included screen time (e.g., television, computers, video games, etc.). Prevalence estimates and confidence intervals were computed for all outcomes. RESULTS: Overall, 30.3% of children are meeting the criteria for physical activity. A greater percentage of males (36.5%, 95% CI = 32.7-40.5) were meeting these guidelines than females (23.7%, 95% CI = 19.3-28.8). Among black students, significantly fewer females (13.7%, 95% CI = 7.0-25.1) met the requirements than males (35.9%, 95% CI = 29.0-43.6). More white students (74.7%, 95% CI = 67.0-81.1) participated on at least one sports team compared to black (53.7%, 95% CI = 48.2-59.1) and Hispanic/Latino (51.9%, 95% CI = 42.1-61.5) students. Lack of access to food due to finances was reported more frequently for black students (19.7%, 95%CI = 15.3 - 25.2) than white students (7.7%, 95%CI = 4.9 - 12.0). Fewer white students (6.2%, 95%CI = 4.1 - 9.2) were concerned about their quantity of food than black (21.1%, 95%CI = 15.4 - 28.1) or Hispanic students (19.4%, 95%CI = 11.6 - 30.8). In 2018, the overall proportion of students playing video or computer games (3+ hours per day) was 38.9% (95%CI 32.8-45.4), compared to 16.5% (95%CI = 13.8-19.5) watching television. There were no statistically significant differences between gender and race. CONCLUSIONS: Overall, less than one third of middle school students are meeting national physical activity guidelines. There are significant differences in physical activity participation between gender and races, with minorities reporting greater exposure to food and financial hardships.

Influence of the Mediterranean Diet on 25-Hydroxyvitamin D Levels in Adults

The Mediterranean diet (MD) is a dietary pattern effective in terms of prevention of obesity-related diseases, and represents the gold standard in preventive medicine, due to the synergistic action of many nutrients with antioxidant and anti-inflammatory properties. In addition, excess body weight significantly increases the risk of hypovitaminosis D, a well-recognized common feature of individuals with obesity. It is well-known that there is a clear gender difference in the adherence to the MD. The aim of this study was to investigate the association between adherence to the MD and 25-hydroxyvitamin D (25OHD) levels in adults, according to gender. Study population consisted of 617 participants; 296 were males and 321 were females, matched by age and body mass index (BMI). A validated 14-item questionnaire PREDIMED (Prevención con dieta Mediterránea) was used for the assessment of adherence to the MD. The 25OHD levels were determined by a direct competitive chemiluminescence immunoassay. Females have a higher PREDIMED score than males (7.4 ± 2.8 vs. 6.7 ± 3.1 score, p = 0.001), and according to PREDIMED categories, a greater percentage of males had low adherence to the MD compared to their female counterparts (40.2% vs. 37.1%; χ2 = 8.94, p = 0.003). The 25OHD levels were higher in males than in females (18.3 ± 7.3 vs. 16.8 ± 7.8 ng/mL, p = 0.01), and a higher percentage of males had sufficient 25OHD levels (>30 ng/mL) than their female counterparts (10.5% vs. 3.4%, χ2 = 10.96, p < 0.001). Stratifying the sample population according to 25OHD categories, BMI decreased and PREDIMED score increased significantly along with the increased 25OHD levels, in both males and females, respectively (p < 0.001). Looking at the bivariate correlations, PREDIMED score was positively correlated with 25OHD levels after adjusting for age and BMI, in both males (r = 0.21, p < 0.001) and females (r = 0.30, p < 0.001). At the bivariate proportional odds ratio (OR) model, 25OHD levels presented the highest OR values in the category low adherence vs. high adherence to the MD, in both genders (OR 1.21 and OR 1.31, in males and females, respectively). Receiver operator characteristic (ROC) analysis was performed to determine the cut-off values of PREDIMED scores predictive of 25OHD levels: PREDIMED score >5 in males (p < 0.001) and >7 in females (p < 0.001) could serve as thresholds for 25OHD levels above the median. The results of our study highlighted a novel positive association between adherence to the MD and 25OHD levels in both genders. Although 25OHD levels were higher in males than females, 69.7% were deficient. To the best of our knowledge, this is the first study to show that high adherence to the MD is associated with low BMI and high 25OHD levels in both genders, probably through the anti-inflammatory and anti-oxidant effects that are synergistically exerted by either MD or vitamin D on body weight.

Risk factors for severe bronchiolitis among children in the emergency department at Sultan Qaboos University Hospital

Background and Aim: Bronchiolitis is an acute viral lower respiratory tract infection. It is a common disease among children below 2 years old, resulting in frequent presentation to the emergency department and occasionally admission1 . For proper management of such patients, studying the disease spectrum and the risk factors is important2 . The aim of this study was to investigate the demographics and risk factors for severe bronchiolitis in children (0–2 years old), in the emergency department (ED) at Sultan Qaboos University Hospital (SQUH). Methods: We conducted a retrospective cohort study, including children ( < 2 years old), who came to the ED with a presentation suggestive of bronchiolitis. We reviewed the charts for a two-year period (January 2015–December 2016). Demographic and baseline characteristics were gathered from electronic medical records and then analyzed. We categorized patients into severe and non-severe bronchiolitis according to the guidelines set by the New South Wales (NSW) Ministry of Health in Australia in 2012 for the “Acute Management of Bronchiolitis in Infants and Children”3 . Therefore, in our study children who were considered to have severe bronchiolitis had one of the following: unwell appearance, apneas, severe tachypnea (>70 breaths/min), bradypnea ( < 30 breaths/min), moderate to severe grunting, cyanosis, pallor, oxygen saturation < 90% in air (or < 92% in O2), tachycardia (>180 beats/min) and difficulty in feeding (taking less than 50% of normal feed).We investigated the following risk factors to predict severe bronchiolitis: maternal age, birth weight, prematurity ( < 37 weeks of gestational age), age < 12 weeks, congenital heart defects, congenital respiratory diseases, immunodeficiency, and global developmental delay. We described the cohort using descriptive statistics and performed a logistic regression analysis to determine the risk factors for severe bronchiolitis. Results: Of the 235 children with bronchiolitis, 133 had severe bronchiolitis while 102 had the non-severe form of the disease, with a greater percentage of males than females in both groups. The majority of children with severe bronchiolitis were in the age < 3 months group (32%), while the least was in the ≥ 12 months age group (10%). There was a trend toward statistically significant results for the following factors: chronological age < 12 weeks (OR = 2.67, 95% CI = 0.89–2.67), congenital cardiac diseases (OR = 2.12, 95% CI = 0.85–5.30) and congenital respiratory diseases (OR = 1.86, 95% CI = 0.80–4.27).The following factors were associated with severe bronchiolitis using stepwise logistic regression: increased heart rate (OR = 1.046, 95% CI = 1.026 – 1.066), decreased SpO2 (OR = 0.890, 95% CI = 0.827 - 0.957), male gender (OR = 2.248, 95% CI = 1.105 – 4.573), irritability (OR = 2.209, 95% CI = 1.024 – 4.769) and global developmental delay (OR = 3.5, 95% CI = 1.0 – 12.537). Conclusion: Multiple factors were associated with severe bronchiolitis and three were trending toward significant association including the younger age group, presence of congenital heart and respiratory diseases4. Low saturation, tachycardia and irritability were both part of the diagnostic criteria for severity and risk factors which confirms the clinical importance of these factors. Further investigations with a prospective study and a bigger sample size are required to confirm our findings and find other associated factors.

Abstract TP435: Hospital of Origin Does Not Influence Outcome in Patients Treated With Decompressive Hemicraniectomy After Malignant Middle Cerebral Artery Infarction

Introduction: Decompressive hemicraniectomy has been shown to reduce mortality in malignant middle cerebral artery (MCA) infarction. This procedure has been done for malignant MCA infarction at our institution, a tertiary referral centre, since 2011. We aimed to review the outcomes of patients receiving this procedure based on hospital of origin. Hypothesis: Patients originating outside of a tertiary centre would have worse outcomes and delays in obtaining decompressive hemicraniectomy for malignant MCA infarction. Methods: We retrospectively reviewed the medical records of all patients who underwent decompressive hemicraniectomy for malignant MCA infarction from March 2011 until March 2014. We compared 30-day mortality as well as time to surgery between patients presenting to the tertiary referral centre and patients presenting to peripheral hospitals. We compared 30-day mortality between those patients receiving surgery within 48 hours and those receiving surgery over 48 hours. We also compared the clinical characteristics of the patients in our cohort to data from published trials. Results: Eighteen patients underwent decompressive hemicraniectomy during this period of time. The 30-day mortality rate was 10/18 (55.6%). There was no difference in mortality between those presenting to the tertiary referral centre and those presenting to peripheral centres (3/6 [50%] vs 7/12 [58.3%], p=0.99). There was no difference in time to surgery between those presenting to the tertiary referral centre and those presenting to peripheral hospitals (median 44.2 vs 30.5 h, p=0.3933). There was weak evidence of reduced mortality for those undergoing the procedure within 48 hours of onset (6/14 [42.9%] vs 4/4 [100%], p=0.092). The patients in our cohort had no statistically significant difference in mortality compared to those in the hemicraniectomy trials but did have a longer time to surgery and a greater percentage of males. Conclusions: Mortality rates and time to surgery were comparable regardless of hospital of origin for decompressive hemicraniectomy after malignant MCA infarction.

PHYSICAL ACTIVITY LEVEL AMONG UNIVERSITY STUDENTS: A CROSS SECTIONAL SURVEY

Background and Objective: Physical inactivity is the fourth leading risk factor for global mortality. Physical inactivity levels are rising in developing countries and Malaysia is of no exception. Malaysian Adult Nutrition Survey 2003 reported that the prevalence of physical inactivity was 39.7% and the prevalence was higher for women (42.6%) than men (36.7%). In Malaysia, the National Health and Morbidity Survey 2006 reported that 43.7% (5.5 million) of Malaysian adults were physically inactive. These statistics show that physically inactive is an important public health concern in Malaysia. College students have been found to have poor physical activity habits. The objective of this study was to identify the physical activity level among students of Asia Metropolitan University (AMU) in Malaysia. Materials and Methods: The study design was a cross sectional survey. A total of 100 participants comprising of 50 male and 50 female students were selected for the study by means of convenience sampling. International Physical Activity Questionnaire (IPAQ) short form was used to identify the physical activity level. Results: A greater percentage of males (56%) showed high physical activity level than females (24%). In contrast, females showed high percentage of low physical activity level. Students in the age range of 22-25 years depicted more percentage (43.5%) of high physical activity level. When comparison of physical activity levels were done among different races, Indian students showed greater percentage (61.8%) of high physical activity level. Furthermore, students who were underweight and overweight had 50% and 46.7% of high physical activity levels respectively which are greater than the values observed in normal body weight students. Conclusion: The physical activity level among students was found satisfactory although the percentage of low level of physical activity was found higher in female students.

Phenotypic differences in individuals with autism spectrum disorder born preterm and at term gestation.

The objective of the study was to characterize the phenotype of males and females with autism spectrum disorder born preterm versus those born at term. Descriptive statistical analyses identified differences between male and female autism spectrum disorder subjects born preterm compared to term for several phenotypic characteristics and comorbidities. Of the 115 (13.0% of 883) born preterm, a greater percentage of males had sleep apnea (13.8% vs. 2.5%, p < 0.0001), seizure disorders (17.0% vs. 8.5%, p = 0.01), and attention-deficit/hyperactivity disorder (14.9% vs. 6.6%, p = 0.005). Females born preterm were more likely to be nonverbal (22.2% vs. 4.6%, p = 0.001). In summary, phenotypic differences were observed, especially among males. The results may have implications for understanding the underpinnings of a subset of individuals with autism spectrum disorder and contribute to the development of focused treatments for autism spectrum disorder among children born preterm.

A province-wide retrospective comparison of pathologic response and progression-free survival in locally advanced esophagus cancer patients treated with either cisplatin-5FU (CF) or carboplatin-paclitaxel (CP) concurrent with radiation (XRT) with or without surgery.

107 Background: The 2012 CROSS trial demonstrated an overall survival (OS) benefit for neoadjuvant, concurrent Carboplatin-Paclitaxel (CP) and radiation versus surgery alone. Based on this trial, the standard chemotherapy treatment for locally advanced esophageal (LAE) cancer in British Columbia (BC) became CP instead of Cisplatin-5FU (CF). This study evaluates the pCR rates and progression free survival (PFS) of those patients treated immediately prior and immediately after the change in provincial standard. Methods: All BC patients with LAE cancer diagnosed between February 2010 and February 2013 who completed at least 40 Gy of neoadjuvant radiation were analyzed. Standard demographics, chemotherapy delivered, radiation dose, surgical pathology and follow-up data were collected. Pathologic response was compared by chi-squared analysis. Patients were followed until death or last follow-up. Survival was compared by log-rank test. Results: Seventy-three patients received CF and 39 received CP. The tumor characteristics of the subgroups were similar: squamous histology was 57% (CF) vs. 49% (CP), node positivity rate on pre-treatment PET scan was 66 vs. 67%, and median tumor length was 5.7 vs. 5.8 cm. Median radiation dose was 50 Gy in both arms. The CP arm was slightly older (Median 66 vs. 61 yo) and had a greater percentage of males (80% vs. 57%). Forty eight and 49% percent of patients were able to undergo resection. The pCR rates were 49% (CF) vs. 16% (CP) (p&lt;0.01) in the surgical subgroups. Median FU was 14.5 (CF) vs. 9.3 (CP) months. Median PFS for all patients was 16.5 (CF) and 14.6 (CP) (p=0.44). Median PFS in surgical patients was 23.4 months (CF) and 14.6 months (CP) (p=0.16. Conclusions: In patients with similar tumor characteristics, XRT with CF resulted in greater pCR rates than with CP. The pCR rate in the CP subgroup is lower than the 29% seen in the trial. With relatively short follow-up, no difference in PFS has yet been identified. [Table: see text]

Inhaler mishandling is very common in patients with chronic airflow obstruction and long-term home nebuliser use

Inhalers and nebulisers are devices used for delivering aerosolised drugs in subjects with Chronic Airflow Obstruction (CAO). This multicentre, cross-sectional observational study was performed in a large population of outpatients with CAO regularly using home aerosol therapy and referring to chest clinics. The aims of the study were to compare the characteristics of the group of subjects with CAO who were using home nebulisers but also experienced with inhalers vs. those only using inhalers and to investigate whether the first group of subjects was particularly prone to inhaler misuse. Information was gained evaluating the responses to a standardised questionnaire on home aerosol therapy and the observations of inhaler technique. We enrolled 1527 patients (58% males; mean±SE; aged 61.1±0.4 years; FEV1% pred 69.9±0.6; 51% and 44% respectively suffering from COPD and asthma) who were only inhaler users (OIU group) and 137 (85% males; aged 67.7±1.3 years; FEV1% pred 62.3±2.9; 60% and 23% respectively suffering from COPD and asthma) who were using both nebulisers and inhalers (NIU group). Nebuliser users were older, had more severe obstruction, related symptoms and health care resources utilisation. Nebulisers users performed more critical inhalers errors than those of the OIU group (49% vs. 36%; p=0.009). We conclude that our patients with CAO and regular nebuliser treatment had advanced age, severe respiratory conditions and common inhaler misuse.

Epidemiological Analysis of Cleft Lip and/or Palate by Cleft Pattern

To analyze gender differences in cleft pattern by the clinical statistical study of Japanese patients with cleft lip and/or cleft palate. Cleft pattern modeling was used to analyze 782 patients with cleft lip and/or cleft palate (417 males and 365 females) who had been examined at the Cleft Lip and Palate Center, Aichi-Gakuin University Hospital, and whose details could be confirmed. Relationships between gender and cleft type were analyzed with chi-squared test. A comparison of gender differences by cleft type revealed that a greater percentage of males had milder cleft lip, cleft lip and palate, or cleft palate, whereas the percentage of females tended to be greater as cleft severity increased. Modeling of cleft patterns enables more detailed classification of cleft lip and palate, and can lead to a greater understanding of pathology.

Prehypertension in Outpatient Obese Children

The aim of the study was to analyze the prevalence of prehypertension (PH) in obese (OB) children and its relation with estimated glomerular filtration rate (eGFR) and left ventricular (LV) function. The study included 447 OB and 131 normal-weight children. PH was defined according to the criteria proposed by the National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. Insulin sensitivity was evaluated by HOMA(IR), and eGFR was calculated by Schwartz's formula. LV function was analyzed by echocardiography in 165 OB children. PH was observed in 79 OB children (17.7%) and in 2 (1.5%) controls. Among OB children, those with PH had greater percentage of males (P < 0.05), higher level of body mass index (BMI) (P < 0.001), waist circumference (WC) (P < 0.005), and HOMA(IR) (P < 0.001), compared to PH- children. The two groups did not differ for eGFR and LV function. At logistic regression analysis, PH was independently associated with male gender (P < 0.025) and HOMA(IR) (P < 0.002). Gender analysis showed that boys with PH presented higher levels of BMI (P < 0.005), WC (P < 0.01), HOMA(IR) (P < 0.001), and triglycerides (P < 0.005) compared to PH- boys. Females with PH were older and in more advanced postpubertal stage, had higher BMI, WC (P < 0.05, for all), and HOMA(IR) (P < 0.025), compared to PH- girls. In a population of outpatient OB children, the prevalence of PH was 17.7% and boys were more likely than girls to have PH. This condition is characterized by insulin resistance in both sexes but no impairment in glomerular and LV function.