Incomplete Testing Research Articles

Targeted next-generation sequencing of Mycobacterium tuberculosis from patient samples: lessons learned from high drug-resistant burden clinical settings in Bangladesh

ABSTRACT Lack of appropriate early diagnostic tools for drug-resistant tuberculosis (DR-TB) and their incomplete drug susceptibility testing (DST) profiling is concerning for TB disease control. Existing methods, such as phenotypic DST (pDST), are time-consuming, while Xpert MTB/RIF (Xpert) and line probe assay (LPA) are limited to detecting resistance to few drugs. Targeted next-generation sequencing (tNGS) has been recently approved by WHO as an alternative approach for rapid and comprehensive DST. We aimed to investigate the performance and feasibility of tNGS for detecting DR-TB directly from clinical samples in Bangladesh. pDST, LPA and tNGS were performed among 264 sputum samples, either rifampicin-resistant (RR) or rifampicin-sensitive (RS) TB cases confirmed by Xpert assay. Resistotypes of tNGS were compared with pDST, LPA and composite reference standard (CRS, resistant if either pDST or LPA showed a resistant result). tNGS results revealed higher sensitivities for rifampicin (RIF) (99.3%), isoniazid (INH) (96.3%), fluoroquinolones (FQs) (94.4%), and aminoglycosides (AMGs) (100%) but comparatively lower for ethambutol (76.6%), streptomycin (68.7%), ethionamide (56.0%) and pyrazinamide (50.7%) when compared with pDST. The sensitivities of tNGS for INH, RIF, FQs and AMGs were 93.0%, 96.6%, 90.9%, and 100%, respectively and the specificities ranged from 91.3 to 100% when compared with CRS. This proof of concept study, conducted in a high-burden setting demonstrated that tNGS is a valuable tool for identifying DR-TB directly from the clinical specimens. Its feasibility in our laboratory suggests potential implementation and moving tNGS from research settings into clinical settings.

Identification of CNTN2 as a genetic modifier of PIGA-CDG through pedigree analysis of a family with incomplete penetrance and functional testing in Drosophila.

Loss of function mutations in the X-linked PIGA gene lead to PIGA-CDG, an ultra-rare congenital disorder of glycosylation (CDG), typically presenting with seizures, hypotonia, and neurodevelopmental delay. We identified two brothers (probands) with PIGA-CDG, presenting with epilepsy and mild developmental delay. Both probands carry PIGA S132C , an ultra-rare variant predicted to be damaging. Strikingly, the maternal grandfather and a great-uncle also carry PIGA S132C , but neither presents with symptoms associated with PIGA-CDG. We hypothesized genetic modifiers may contribute to this reduced penetrance. Using whole genome sequencing and pedigree analysis, we identified possible susceptibility variants found in the probands and not in carriers and possible protective variants found in the carriers and not in the probands. Candidate variants included heterozygous, damaging variants in three genes also involved directly in GPI-anchor biosynthesis and a few genes involved in other glycosylation pathways or encoding GPI-anchored proteins. We functionally tested the predicted modifiers using a Drosophila eye-based model of PIGA-CDG. We found that loss of CNTN2 , a predicted protective modifier, rescues loss of PIGA in Drosophila eye-based model, like what we predict in the family. Further testing found that loss of CNTN2 also rescues patient-relevant phenotypes, including seizures and climbing defects in Drosophila neurological models of PIGA-CDG. By using pedigree information, genome sequencing, and in vivo testing, we identified CNTN2 as a strong candidate modifier that could explain the incomplete penetrance in this family. Identifying and studying rare disease modifier genes in human pedigrees may lead to pathways and targets that may be developed into therapies.

Results of a quality improvement program to increase complete lung cancer biomarker testing rates by focusing on system, physician, and other factors associated with adverse health outcomes.

e23249 Background: Complete biomarker testing (CBT) is an underutilized standard of care for patients with advanced lung adenocarcinoma, but limited tissue samples may lead to incomplete testing. Especially if quantity is not sufficient (QNS) requiring additional samples, a prolonged time-to-initiation of treatment (TTT) has been shown to negatively impact clinical outcomes. Bon Secours Mercy Health (BSMH) Youngstown, Ohio reviewed biomarker testing data and found: 1) only 41% of patients received CBT, and 2) in the case of QNS when liquid biopsies were utilized, the time from diagnosis to results took an average of 42 days. BSMH worked in collaboration with OncoLens and Q Synthesis to address these issues and reduce the TTT. To our knowledge, there is also no data on interventions that can increase CBT across large health systems and simultaneously tackle both physician and other factors associated with known health disparities. Methods: A multidisciplinary team developed a new workflow for patients diagnosed with advanced NSCLC. The pilot involved collecting both tissue and blood at the time of needle biopsy and working with a single reference lab for testing. Physicians and nurses in radiology and pulmonology were in-serviced on the new workflow. As patients were being prepared for a biopsy procedure, nurses collected two tubes of blood for liquid biopsy. After the procedure, both the tissue and blood were sent to pathology and if pathology confirmed an advanced NSCLC diagnosis, both samples were sent to the reference lab for testing. The lab developed a new process to hold blood and test it only when the tissue was QNS. If QNS, tissue testing for PD- L1 was prioritized, and additional biomarker tests were completed with the blood sample. If tissue quantity was sufficient, unused blood was discarded. The lab charged for a single test regardless of whether the test was performed on tissue and/or blood. Results: The QI project ran from Sept 2021 - Dec 2022 and achieved four improvements: 1) a 39.6% increase in CBT in patients with advanced NSCLC (80.6% post-intervention), 2) a decrease of 15.7 days from diagnosis to complete liquid biopsy test results (27.2 days post-intervention, 3) increased CBT rates across all but one physician by an average of 55% (-5% to 220%), and 4) increased CBT by 8% in females and patients with Medicare, Medicaid or other noncommercial/underinsured/uninsured payors. Conclusions: This QI project demonstrated that CBT of advanced NSCLC can be improved by programs that are tailored to large health systems and individual physicians. Gains are also seen in patient populations at risk of adverse outcomes.

A Deep-Sea Environment Simulated Test System for Subsea Control Modules, Part A: Prototype and Test

This paper proposes a version of the deep-sea environment simulated test system for subsea control modules to solve the problem of incomplete testing systems for electro-hydraulic subsea control modules. Based on the subsea control module test requirements specified in APISTD17F, the test system in this paper is a highly integrated system, including a test hydraulic power unit, a control module test bench, a signal simulator, an electronic test unit, an umbilical simulator, a high-pressure chamber, and an incubator. Firstly, the design indicators of the test system were determined by analyzing the various functions of the subsea control module and its working environment. Secondly, the design scheme for the test system was proposed, and a detailed design was carried out. Finally, a hydro-electrical subsea control module for the Bohai Sea was fully tested with this system, with tests including the qualification test and the factory acceptance test. The test results show that all parts of the test system coordinated well and have achieved the design indicators, and the test system can simulate the working environment and complete a land test. The effectiveness and feasibility of the test system have been verified through the test. By adopting this system, the risk of subsea control module failure can be minimized, laying the foundations for future research and improvement of subsea control module testing equipment.

78 Examining the Association Between a Patient's Diagnosis and Occurrence of The First Error on Trails B

Objective:Clinical and experimental neuropsychology patients are not always able to complete a given test due to limitations in their functioning and it can lead to frustration and time wasted, leading researchers to examine the value of metrics that can be derived earlier in a test so as to ascertain and salvage useful information. The Trail Making Test (TMT) is an oft-utilized test of executive function and has been the focus of such exploration (e.g., first error vs. time to complete Trails B which can be lengthy in dementia cases and lead to discontinuation and loss of scorable data; Christidi et al., 2013; Correia et al., 2015). The present retrospective study utilized archival chart review to examine the association between a patient's diagnosis and occurrence of the first error on Trails B (TB1err).Participants and Methods:De-identified data was culled from adult private practice records (n=137) in the northeastern United States (the study was conducted in compliance with local IRB review). Trails A and B times, as well as Digit Span scores (for checking construct validity) were pulled from reports, and Trails B record forms were scored to extract the enumerated stimulus where any first error was observed in the patient's rendering of the trail connecting alternating numbers and letters. Paired t-tests compared the average TB1err of normative individuals (no diagnosis) with patients with a primary diagnosis of mood disorder, traumatic brain injury (TBI), mild cognitive impairment (MCI), or dementia. Additionally, Pearson's correlations were computed comparing TB1err with Trails B time, and another test of executive function (Digit Span backwards).Results:The order of diagnoses according to the average occurrence of the first error on Trails B (from later, to sooner occurrence) was as follows: normative (no diagnosis), mood disorder, TBI, MCI, and finally dementia. There was a significant difference on this first error metric (TB1err) when comparing normative and dementia patients (p = .03; 8.3 vs 4.2 for the average enumeration of 1st error on Trails B). Furthermore, significant correlations were found between this derived TB1err metric and Digit Span backwards (r = .31; p <.001) as well as overall TrailsB performance (r = -.39; p < .001).Conclusions:The present study adds to a growing literature on the utility of deriving test metrics to maximize useful data for clinical and experimental neuropsychology. Results from this retrospective chart review indicate additional validity data to support the use of extracting the first error on Trails B as a way to salvage useful data even when a patient may not be able to complete the full TMT as designed. In this preliminary sample there was a significant difference found for normative vs. dementia patients on this derived TB1err metric and suggests it is worthy of additional research to see if it can reliably differentiate various diagnoses. We expect this finding will also be useful in experimental designs wherein time is often limited and loss of data due to incomplete testing might be avoided by extracting the first error on TrailsB.

Results of a quality improvement program to increase complete lung cancer biomarker testing rates.

57 Background: Biomarker testing is the standard of care for patients with advanced lung adenocarcinoma, but limited tissue samples may lead to incomplete testing. Especially if quantity is not sufficient (QNS) requiring additional samples, a prolonged time-to-initiation of treatment (TTT) has been shown to negatively impact clinical outcomes. Bon Secours Mercy Health (BSMH) Youngstown, Ohio reviewed biomarker testing data and found: 1) only 41% of patients received complete biomarker testing, and 2) in the case of QNS when liquid biopsies were utilized, the time from diagnosis to results took an average of 42 days. BSMH worked in collaboration with OncoLens and Q Synthesis to address these issues and reduce the TTT. Methods: A multidisciplinary team developed a new workflow for patients diagnosed with advanced NSCLC. The pilot involved collecting both tissue and blood at the time of needle biopsy and working with a single reference lab for testing. Physicians and nurses in radiology and pulmonology were in-serviced on the new workflow. As patients were being prepared for a biopsy procedure, nurses collected two tubes of blood for liquid biopsy. After the procedure, both the tissue and blood were sent to pathology and if pathology confirmed an advanced lung adenocarcinoma diagnosis, both samples were sent to the reference lab for testing. The lab developed a new process to hold blood and test it only when the tissue was QNS. If QNS, tissue testing for PD- L1 was prioritized and additional biomarker tests were completed with the blood sample. If tissue quantity was sufficient, unused blood was discarded. The lab charged for a single test regardless of whether the test was performed on tissue and/or blood. Results: The QI project ran from Sept 2021 - Dec 2022 and achieved two improvements: 1) a 39.6% increase in complete biomarker testing in patients with advanced lung adenocarcinoma (80.6% post-intervention) and 2) a decrease of 15.7 days from diagnosis to complete liquid biopsy test results (27.2 days post-intervention). Conclusions: This QI project demonstrated a significant improvement in overall biomarker testing rates and a nearly 50% reduction in the time to completion of testing. It also demonstrated how hospitals and reference labs may coordinate efforts to streamline biomarker testing with the aim of improving clinical outcomes through reductions of TTT.

Development of a Testing System for High-efficiency Power Recovery Bag Accumulators

Currently, most of the bladder-type accumulator test benches used have problems such as large installed capacity, severe energy loss, and incomplete testing functions. This article focuses on the research of the testing requirements and power recovery issues of bladder-type accumulators. A new type of hydraulic schematic and electrical control system for power recovery bladder type accumulator testing based on mechanical compensation with dual output shaft motor transmission, differential charging and discharging of dual accumulators, and parallel addition of oil replenishing accumulators has been designed. A measurement and control software based on the LabVIEW platform has been developed. The experimental results show that the system’s power recovery efficiency can reach 60.5% by adopting a scheme of mechanical compensation type power recovery, differential charging and discharging of energy accumulator group, and parallel addition of oil replenishing energy accumulator. The testing system can accurately, efficiently, and conveniently complete various performance tests of hydraulic bladder accumulators.

Assessment of the effectiveness of a new neonatal screening algorithm for cystic fibrosis

Relevance All over the world, neonatal screening protocols are being improved in order to reduce the time of diagnosis, simplify the examination procedure, and reduce the number of false positive and false negative results of neonatal screening. In most European countries, the best neonatal screening algorithm is molecular genetic testing. Objective: Evaluate the effectiveness of the new cystic fibrosis screening protocol algorithm, which, in the first step, determines the immunoreactive trypsin (IRT) level from one dry spot and performs DNA diagnostics (36 most frequent mutations) in patients with increased IRT. Compare the economic costs of screening by two algorithms (existing and alternative). Materials and methods: two parallel algorithms were used for neonatal screening. Which was performed on 56,534 infants in the Moscow Region from March to November 2022. The current three-stage algorithm was used, which involves re-blood sampling from newborns at risk 3-4 weeks after the first blood sampling and a sweat test. In the new algorithm, newborns with an elevated IRT 1 level at the 1st week of life underwent a molecular genetic study (search for frequent mutations in the CFTR-36 variants gene, sequencing of individual locus of the CFTR gene for control purposes) in the same dry blood spot used for screening. Results: out of 56,534 test forms received, 607 (1.07%) newborns with a positive test for IRT were identified for neonatal screening in a laboratory from the Moscow region, of which 501 (82.5%) samples were selected, where the level of RTI1 exceeded the cut-off level (65 ng / ml), which were sent for molecular genetic research in order to search for pathogenic variants in the CFTR gene. 106 (17.5%) newborns did not complete the examination. Positive results of confirmatory diagnosis were obtained in 6 infants, which accounted for 0.01% of the number of children who underwent screening and 1.2% of the number of children with neonatal hypertrypsinogenemia. Conclusion: the positive effects of the new algorithm are to reduce psychological tension in families during examination by reducing the time of diagnosis, no need for repeated blood sampling on the 21st-28th day of life, reduction of the time of diagnosis, prevention of nutritional deficiencies in children during the first months of life and life-threatening complications. Reducing the number of children with incomplete testing for cystic fibrosis, economic benefit. The negative effects of the new algorithm are that it is possible to miss a patient with cystic fibrosis who does not have any of the common pathogenic variants in the CFTR gene.

Opportunities for Enhanced Prevention and Control of Hepatitis C Through Improved Screening and Testing Efforts.

An estimated 2.4 million people in the United States are living with hepatitis C virus (HCV) infection. In 2020, the Centers for Disease Control and Prevention updated hepatitis C screening recommendations to test adults aged ≥18 years at least once in a lifetime and pregnant persons during each pregnancy. For those with ongoing exposure to HCV, periodic testing is recommended. The recommended testing sequence is to obtain an HCV antibody test and, when positive, perform an HCV RNA test. Examination of HCV care cascades has found that incomplete HCV testing occurs when a separate visit is required to obtain the HCV RNA test. Hepatitis C core antigen testing has been shown to be a useful tool for diagnosing current HCV infection in some settings. Hepatitis C testing that is completed, accurate, and efficient is necessary to achieve hepatitis C elimination goals.

Inappropriate Multi-Target Stool DNA Use for Colorectal Cancer Screening: Risks, Compliance, and Outcomes.

Background Inappropriate or "off-label" use of multi-target stool DNA (mt-sDNA) tests refers to their use in patients for whom colonoscopy or no testing at all is warranted. Examples include a positive family history of colorectal cancer, a history of inflammatory bowel disease, or medical issues necessitating diagnostic colonoscopy, among others. Current understanding of off-label mt-sDNA use for colorectal cancer screening, its associated risks, and outcomes is lacking. We examined off-label mt-sDNA prescription and compliance with testing in an outpatient setting in southeast Michigan. Aims The primary aims of the study were determining the extent of off-label mt-sDNA testing and compliance, and results of all testing, as well as demographic factors associated with off-label prescriptions. The secondary aims were to examine explanations for incomplete testing and factors contributing to successful completion. Methods Using a retrospective design, we identified mt-sDNA orders from outpatient internal medicine clinics between January 1, 2018, to July 31, 2019, to evaluate the proportion of off-label mt-sDNA, results of testing, and follow-up colonoscopies up to one year after order placement. Patients were categorized as "off-label" if any inappropriate criteria were met. Statistical analysis was performed for primary and secondary outcomes. Results From 679 mt-sDNA orders within the study period, 81 (12.1%) had at least one off-label criterion for testing. In total, 404/679 (59.5%) patients completed testing. Lack of follow-up comprised the majority of incompletions (216/275; 78.6%). Only 52 (70.3%) out of 74 positive results were followed by diagnostic colonoscopy. Retired employment status (OR = 1.87; 95%CI, 1.17-2.98; P = 0.008) and age of 76 years or older (OR = 2.28; 95%CI, 0.99-5.21; P = 0.044) were significantly associated with increased risk of off-label mt-sDNA prescription. Increasing age range was associated with higher test completion (χ2 (5) = 12.085, p = 0.034). Multinomial logistic regression revealed an increasing age range (OR = 1.29; 95% CI, 1.09-1.54; P = 0.004), predictive of a positive mt-sDNA result for both groups. There was no significant difference between off-label or on-label groups in the mean number of resected polyps or pathology scores on follow-up colonoscopy. Conclusions Off-label mt-sDNA use remains a concern in the outpatient setting. Compliance for test completion and follow-up colonoscopy for positive results require further improvement. Our findings shed new light on the factors associated with off-label testing while reiterating its burden. We also describe common reasons for incomplete tests in an attempt to augment future colorectal cancer (CRC) screening initiatives.

Kawasaki Disease in the Time of COVID-19 and MIS-C: The International Kawasaki Disease Registry

BackgroundPatients with multisystem inflammatory syndrome in children (MIS-C) and Kawasaki disease (KD) have overlapping clinical features. We compared demographics, clinical presentation, management, and outcomes of patients according to evidence of previous SARS-CoV-2 infection. MethodsThe International Kawasaki Disease Registry (IKDR) enrolled KD and MIS-C patients from sites in North, Central, and South America, Europe, Asia, and the Middle East. Evidence of previous infection was defined as: Positive (household contact or positive polymerase chain reaction [PCR]/serology), Possible (suggestive clinical features of MIS-C and/or KD with negative PCR or serology but not both), Negative (negative PCR and serology and no known exposure), and Unknown (incomplete testing and no known exposure). ResultsOf 2345 enrolled patients SARS-CoV-2 status was Positive for 1541 (66%) patients, Possible for 89 (4%), Negative for 404 (17%) and Unknown for 311 (13%). Clinical outcomes varied significantly among the groups, with more patients in the Positive/Possible groups presenting with shock, having admission to intensive care, receiving inotropic support, and having longer hospital stays. Regarding cardiac abnormalities, patients in the Positive/Possible groups had a higher prevalence of left ventricular dysfunction, and patients in the Negative and Unknown groups had more severe coronary artery abnormalities. ConclusionsThere appears to be a spectrum of clinical features from MIS-C to KD with a great deal of heterogeneity, and one primary differentiating factor is evidence for previous acute SARS-CoV-2 infection/exposure. SARS-CoV-2 Positive/Possible patients had more severe presentations and required more intensive management, with a greater likelihood of ventricular dysfunction but less severe coronary artery adverse outcomes, in keeping with MIS-C.

Incomplete Testing of SOC

Incomplete Testing of SOC

Profile of partners who completed HIV testing and received a new HIV diagnosis in Ukraine’s HIV index testing program: a retrospective cohort study to inform program improvement

BackgroundApproximately one-third of people living with HIV in Ukraine are unaware of their HIV status. Index testing (IT) is an evidence-based HIV testing strategy that supports voluntary notification of partners with HIV risk, so they can receive HIV testing, prevention, and treatment services.MethodsUkraine scaled up IT services in 2019. This observational study of Ukraine’s IT program covered 39 health facilities located in 11 regions with high HIV burden. The study used routine program data from January—December 2020 to describe the profile of named partners and explore index client (IC) and partner factors associated with two outcomes: 1) completing testing; and 2) HIV case finding. Analysis used descriptive statistics and multilevel linear mixed regression models.ResultsThe study included 8,448 named partners, of whom 6,959 had unknown HIV status. Among them,72.2% completed HIV testing and 19.4% of those tested were newly diagnosed with HIV. Two-thirds of all new cases were among partners of ICs who were recently diagnosed and enrolled in care (< 6 months), while one third were among partners of established ICs. In adjusted analysis, partners of ICs with unsuppressed HIV viral load (VL) were less likely to complete HIV testing (adjusted odds ratio [aOR] = 0.11, p < 0.001), but more likely to receive a new HIV diagnosis (aOR = 1.92, p < 0.001). Partners of ICs who cited injection drug use or having a known HIV + partner as their own reason for testing were more likely to receive a new HIV diagnosis (aOR = 1.32, p = 0.04 and aOR = 1.71, p < 0.001 respectively). Involving providers in the partner notification process was associated with completed testing (aOR = 1.76, p = 0.001) and HIV case finding (aOR = 1.64, p < 0.01), compared with notification by ICs.ConclusionHIV case detection was highest among partners of recently diagnosed ICs, but IT participation among established ICs still yielded an important share of all newly-identified HIV cases. Areas for improvement in Ukraine’s IT program include completing testing for partners of ICs with unsuppressed HIV VL, with history of injection drug use or discordant partnerships. Using intensified follow-up for the sub-groups at risk of incomplete testing may be practical. Greater use of provider-assisted notification could also accelerate HIV case finding.

Observations from the Field Concerning the Use of 1 mEq/L Potassium Dialysate, Equipment Monitoring, Staffing, and Total Chlorine Testing

Patient safety and survey readiness should be top priorities for dialysis facilities. Hemodialysis is a complex process that redisposes staff and patients to possible errors and patient harm. Some observations seen by surveyors in dialysis facilities include an increased use in 1 mEq/L potassium dialysate, incomplete testing of hemodialysis machines, incorrect total chlorine testing, and staffing shortages. This article discusses the implications for the nephrology nurse in each of these situations.

Comparison of RT-dPCR and RT-qPCR and the effects of freeze–thaw cycle and glycine release buffer for wastewater SARS-CoV-2 analysis

Public health efforts to control the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic rely on accurate information on the spread of the disease in the community. Acute and surveillance testing has been primarily used to characterize the extent of the disease. However, obtaining a representative sample of the human population is challenging because of limited testing capacity and incomplete testing compliance. Wastewater-based epidemiology is an agnostic alternative to surveillance testing that provides an average sample from the population served by the treatment facility. We compare the performance of reverse transcription quantitative PCR (RT-qPCR) and reverse transcription digital droplet PCR (RT-dPCR) for analysis of SARS-CoV-2 RNA in a regional wastewater treatment facility in northern Indiana, USA from the earliest stages of the pandemic. 1-L grab samples of wastewater were clarified and concentrated. Nucleic acids were extracted from aliquots and analyzed in parallel using the two methods. Synthetic viral nucleic acids were used for method development and generation of add-in standard-curves. Both methods were highly sensitive in detecting SARS-CoV-2 in wastewater, with detection limits as low as 1 copy per 500 mL wastewater. RT-qPCR and RT-dPCR provided essentially identical coefficients of variation (s/overline{mathrm{x} } = 0.15) for triplicate measurements made on wastewater samples taken on 16 days. We also observed a sevenfold decrease in viral load from a grab sample that was frozen at – 80 °C for 92 days compared to results obtained without freezing. Freezing samples before analysis should be discouraged. Finally, we found that treatment with a glycine release buffer resulted in a fourfold inhibition in RT-qPCR signal; treatment with a glycine release buffer also should be discouraged. Despite their prevalence and convenience in wastewater analysis, glycine release and freezing samples severely and additively (~ tenfold) degraded recovery and detection of SARS-CoV-2.

Thrombophilia Testing Patterns, Result Interpretation, and Clinical Outcomes in a Retrospective Cohort of Patients with Retinal Vascular Occlusion

Background Low quality evidence exists to support an association between retinal vascular occlusion and thrombophilia. However, testing may be complicated by the impact of anticoagulants, hormone use and other factors on the results. Even when test results are interpretable, the implications for clinical decision-making are not established. We performed a retrospective chart review to assess patterns of test selection, result interpretation, and clinical outcomes in a cohort of patients who received thrombophilia testing after presenting to a tertiary care center for retinal vascular occlusion. Methods Eligible patients were >18 years with retinal vein occlusion (RVO) or retinal artery occlusion (RAO) and referred for thrombophilia testing by an ophthalmologist between 3/16/2011 and 3/22/2021 at the University of Washington. Electronic medical records were extracted for relevant clinical characteristics, test results, use of antithrombotic therapy, and recurrent arterial or venous events. Continuous variables are summarized by means and standard deviations or medians and range, as applicable. Categorical variables are described by proportions. Differences between groups were assessed using Student's t-tests and Fisher's exact tests for continuous and categorical variables, respectively. Analyses were conducted in R. Results A cohort of 57 patients were identified, with median age of 44 years at diagnosis (Table 1). 38 (66.7%) presented with RVO and 23 (40.4%) presented with RAO, including 4 patients with concurrent RVO and RAO at diagnosis. Baseline characteristics were not significantly different between patients presenting RAO versus RVO, apart from a trend toward higher prevalence of stroke history in the RAO group (4/23 vs 1/38, p = 0.06). Thrombophilia test selection varied: protein C activity was most commonly tested (80.7%) while activated protein C resistance (40.4%) was least commonly ordered (Figure 1). Among the 50 patients who received some combination of antiphospholipid antibody (aPL) testing, only 44% had all Sydney criteria aPL assays performed. The underlying prevalence of thrombophilia was 3.5% (2/57). One patient was found to be homozygous for the factor V Leiden mutation (FVL) after presenting with a central RVO and 1 was diagnosed with antiphospholipid syndrome (APS) in the context of a branch RAO plus persistent positivity of anti-beta-2 glycoprotein I (IgM) and anticardiolipin (IgM) antibodies. Another 5 patients had abnormal test results that were not diagnostic of an underlying thrombophilia (1 heterozygous FVL, 1 heterozygous prothrombin gene mutation, and 3 positive aPL). In total, 15 patients were initiated on low-dose aspirin following diagnosis, including the patient diagnosed with APS. Four patients were treated with anticoagulation, including the heterozygous FVL and heterozygous prothrombin gene mutation patients, who were placed on indefinite anticoagulation. The patient found to be homozygous for FVL briefly received prophylactic dosing of rivaroxaban before switching to low-dose aspirin due to side effects. After a median follow-up of 3.1 years, 3 patients had recurrent events (1 RVO, 2 strokes). One developed recurrent stroke while taking rivaroxaban for atrial fibrillation, while the other 2 were not receiving antithrombotic therapy at the time of thrombosis recurrence. Conclusion A low prevalence of thrombophilia was observed in a young cohort of patients presenting with retinal vascular occlusion. Incomplete testing was common, including for antiphospholipid syndrome, which is associated with 2-fold increased risk of retinal vascular occlusion. Thrombophilia testing did not clearly aid in clinical decision making; the tests ordered and the actions taken based on the test result were inconsistent. Both patients identified to have underlying thrombophilia lacked other history of venous or arterial thromboembolism and ultimately opted against long-term anticoagulation. An additional 14 patients opted for antithrombotic therapy with low-dose aspirin after an entirely negative thrombophilia workup. Misinterpretation of test results likely led to inappropriate recommendations for indefinite anticoagulation in at least 2 patients. The utility of thrombophilia testing in retinal vascular occlusion is poorly studied. In this cohort, we found no evidence that such testing should influence clinical decision-making. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

S936 Factors Associated With Fecal Calprotectin Sample Collection Compliance: An IBD Center Quality Improvement Project

Introduction: Regular assessment of objective markers of inflammatory bowel disease (IBD) activity is recommended. Fecal calprotectin (Fcal) is a non-invasive and inexpensive biomarker of disease activity, however, patient compliance with this test is variable and incompletely described. We assessed compliance rates with Fcal tests and identified factors associated with non-compliance. Methods: As a quality improvement project, we conducted a retrospective chart review of IBD patients who had a Fcal test ordered by us between August 2021 and December 2021. Demographic, clinical, disease-related, and test-related (location of lab relative to the patient’s visit in clinic or at home) information were recorded to determine predictors for non-compliance. Simple statistical analysis and multivariable logistic regression was performed. Results: Of 303 patients, 165 (54.4%) had an order for Fcal. Of the Fcal tests ordered, 55 (33.3%) were not completed. Between those with complete versus incomplete tests, IBD remission status (67.8% vs. 83.7%, p = 0.033), history of prior Fcal order completion (93.2% vs. 68.4%, p = 0.001), and test ordered to an external site (62.7% vs. 85.5%, p = 0.004) were significantly different. A multivariable logistic regression with these factors as well as age, gender, telehealth vs. in-person consultation, and patient residence revealed that history of a prior completed Fcal test is independently associated with subsequent test completion (odds ratio (OR) = 8.3, 95% CI 1.9-35.5, p = 0.004). Fcal testing location (institutional or third-party) was marginally significant (OR = 0.27, 95% CI 0.7-1.0, p = 0.051). A multivariable linear regression for days between test order and completion found that tests ordered for external locations are associated with delayed completion (95% CI 5.2-20.6, p = 0.002). Conclusion: In this single center analysis with Fcal testing in patients with IBD, we found that a history of incomplete testing is associated with subsequent non-compliance, and distant location of the lab is associated with delayed completion of the test. These findings suggest that ordering providers should identify additional methods to educate on the importance of disease monitoring with Fcal and when possible, simplify the lab used for testing. Future availability of at home Fcal tests may be helpful in this regard. Table 1. - Linear Regressions for Predictors of Fecal Calprotectin Compliance Logistic Regression for Test Compliance Regression for Delayed Testing Completion Estimate Effect Size (B) Standard Error P - Value 95% Confidence Interval Estimate Effect Size (B) Standard Error P - Value 95% Confidence Interval Age 0.017 0.015 0.248 0.998-1.048 0.148 0.104 0.163 -31.309-7.575 Gender -0.441 0.543 0.417 0.222-1.866 0.877 3.635 0.810 0.062-0.357 IBD Remission -0.949 0.624 0.128 0.114-1.316 -0.331 3.895 0.933 -6.421-8.176 Consultation Type -.0523 0.528 0.322 0.210-1.570 0.102 3.992 0.980 -8.151-7.490 History of Fecal Calprotectin Completion 2.116 0.741 0.004 1.942-35.493 6.628 2.625 0.357 -7.699-20.956 Fecal Calprotectin Testing Location -1.304 0.668 0.51 0.073-1.005 12.875 3.843 0.002 5.160-20.591

Factors Associated With Fecal Calprotectin Sample Collection Compliance: An IBD Center Quality Improvement Project.

Fecal calprotectin (Fcal) is a noninvasive, inexpensive biomarker of disease activity. However, patient compliance with this test is variable and incompletely described. We assessed compliance rates with Fcal tests and identified factors associated with noncompliance. A retrospective chart review of patients with inflammatory bowel disease (IBD) who had a Fcal test ordered through our center between August 2021 and December 2021 was conducted. Demographic, clinical, disease, and test-related information were recorded. Patients with incomplete Fcal orders were sent a survey to better understand their reasons for noncompliance. Simple statistical analysis and and multivariable logistic regression modeling were performed. Of 303 patients, 165 (54.4%) had an order for Fcal. Of the Fcal tests ordered, 55 (33.3%) were not completed. Remission of IBD, no prior Fcal completion, and tests ordered at a distant site were all associated with test noncompletion. A multivariable logistic regression revealed that history of a prior completed Fcal test is associated with subsequent test completion (odds ratio = 2.1, 95% confidence interval 1.9-35.5, P = .004). Patients who did not complete the test described the pandemic and third-party testing center issues as the most common reasons for noncompliance. In this single center experience with Fcal testing in patients with IBD, we identified that a history of incomplete Fcal testing and distant location of lab testing were significantly associated with noncompletion of the test. We provide practical guidance for future utilization and compliance, including the impact of home-based testing.

Effect of Competence and Work Environment on Employee Performance (Case Study on Village Apparatus in Telukjambe Timur District, Karawang Regency)

This study means to decide the impact of skill and workplace on worker execution in town authorities in Teluk Jambe Timur sub-region, both somewhat and all the while. the technique utilized is confirmation with a quantitative methodology where the information is handled utilizing SPSS programming. The example utilized in this study was 110 examples utilizing immersed examining procedure. The information investigation utilized is way examination with incomplete and concurrent speculation testing. The consequences of this study are that there is a connection among skill and workplace of 0.114, and that truly intends that there is an extremely frail relationship. There is a halfway impact of skill on worker execution. There is a fractional impact of workplace on representative execution. There is a concurrent impact of skill and workplace on execution of 30.1%. This shows that skill and workplace have a commitment of 30.1% while the excess sum is the commitment of different factors not analyzed in this review.

Paper 27: Return to Sport and Testing following Hip Arthroscopy For FAI in High School and Collegiate Athletes

Objectives:Femoroacetabular impingement (FAI) is a known cause of hip pain and dysfunction in young, active patients and can be successfully managed with hip preservation surgery. For athletes with FAI, however, there is inconsistent data regarding the ability to return to competitive sport after surgery and how performance level is impacted. The purpose of this study is to evaluate patient factors contributing to return to sport after hip preservation surgery.Methods:Study Design: Retrospective cohort We retrospectively reviewed patients aged 14 to 44 who underwent hip preservation surgery between December 2018 and May 2021 and who participated in a competitive or recreational sport pre-operatively. All patients underwent formal return-to-sport (RTS) testing between 4 and 6 months after surgery. Patient-reported outcomes (PROs) were obtained at initial RTS testing using the International Knee (Hip) Documentation Committee (IKDC) questionnaire, Hip Outcome Score – Sports Specific Subscale (HOS-SSS), and Hip Return to Sport After Injury (Hip-RSI) scale. Regression analysis was performed to evaluate the relationship between RTS tests, PRO’s, BMI, pre- and post-operative alpha angles, and degree of correction. Degree of correction was the difference between pre- and post-operative alpha angles measured on Dunn view hip x-rays.Results:We identified 40 patients, 47 operative hips (34 females, 85%). Three patients (4 hips) were excluded for incomplete testing data. Mean age was 17.73 ± 2.7 years. All patients underwent hip arthroscopy for FAI including one case of single-stage bilateral hip arthroscopy. The most common primary sports were dance (7), softball (6), and basketball (5). Mean alpha angles were 67.15 ± 10.9° pre-operatively and 41.37 ± 4.5° post-operatively. Average time from surgery to first RTS testing was 26.79 ± 6.5 weeks (median 25.1 weeks). Mean HOS-SSS score at initial testing was 85.98 ± 11. Posteromedial (PM) and posterolateral (PL) reach on Y-balance test were significantly associated with HOS-SSS score at initial testing (PM: r=0.54, p<0.001; PL: 0.53, p<0.01). Composite Y-balance score was also significantly associated with HOS-SSS score (r=0.6, p<0.01). All other comparisons between PROs and RTS tests were not significantly associated. Similarly, there were no significant associations between time to initial RTS testing and BMI, pre-operative alpha angle, or degree of correction.Conclusions:Higher Y-balance scores at initial RTS testing are associated with improved PROs and perceived readiness to return to sport. This test can be easily incorporated into an assessment for safe return after FAI surgery; further prospective studies are warranted.