Longer Delay Research Articles

Delayed initiation of anti-osteoporosis medications increases subsequent hip and vertebral fractures in patients on long-term glucocorticoid therapy: A nationwide health insurance claims database study in Japan.

Early initiation of anti-osteoporosis medications (AOMs) is recommended for patients on long-term glucocorticoid (GC) therapy. This study aimed to examine whether physicians prescribe AOMs as soon as GC therapy is initiated, and whether a delay in AOM initiation affects hip and vertebral fracture incidence, using the nationwide health insurance claims database of Japan (NDBJ). Patients aged ≥50years who were prescribed GC (≥5mg/day prednisolone or equivalent) for ≥90days and who were followed for AOM use and hip and vertebral fracture events for the subsequent 1080days in 2012-2018 were selected from NDBJ. Delay in AOM initiation was defined as the number of days without AOMs following GC therapy initiation. Associations between delay in AOM initiation and hip and vertebral fracture risk were evaluated by Cox proportional hazards regression. In total, 92,143 women and 94,772 men were included in the analysis, of which only 39.3% of women and 28.5% of men received AOMs within 90days from GC therapy initiation. Approximately, 15% of hip fractures and 30% of vertebral fractures occurred before AOM initiation in patients with delayed AOM initiation. HRs of both fractures were significantly greater in patients with a longer delay in AOM initiation (p value for trend<0.001). After excluding patients who had fractures before AOM initiation, the magnitude of HRs significantly decreased, and HR trends for hip fracture became insignificant. Delayed initiation of AOMs may result in increased fracture events, which may be reduced by early initiation of AOMs.

Multivariate analysis of speech envelope tracking reveals coupling beyond auditory cortex

The systematic alignment of low-frequency brain oscillations with the acoustic speech envelope signal is well established and has been proposed to be crucial for actively perceiving speech. Previous studies investigating speech-brain coupling in source space are restricted to univariate pairwise approaches between brain and speech signals, and therefore speech tracking information in frequency-specific communication channels might be lacking. To address this, we propose a novel multivariate framework for estimating speech-brain coupling where neural variability from source-derived activity is taken into account along with the rate of envelope's amplitude change (derivative). We applied it in magnetoencephalographic (MEG) recordings while human participants (male and female) listened to one hour of continuous naturalistic speech, showing that a multivariate approach outperforms the corresponding univariate method in low- and high frequencies across frontal, motor, and temporal areas. Systematic comparisons revealed that the gain in low frequencies (0.6 - 0.8 Hz) was related to the envelope's rate of change whereas in higher frequencies (from 0.8 to 10 Hz) it was mostly related to the increased neural variability from source-derived cortical areas. Furthermore, following a non-negative matrix factorization approach we found distinct speech-brain components across time and cortical space related to speech processing. We confirm that speech envelope tracking operates mainly in two timescales (δ and θ frequency bands) and we extend those findings showing shorter coupling delays in auditory-related components and longer delays in higher-association frontal and motor components, indicating temporal differences of speech tracking and providing implications for hierarchical stimulus-driven speech processing.

Integration and Optimization of British and American Literature Information Resources in the Distributed Cloud Computing Environment.

One of the most effective approaches to improve resource usage efficiency and degree of resource collecting is to integrate resources. Many studies on the integration of information resources are also available. The search engines are the most well-known. At the same time, this article intends to optimize the integration of British and American literature information resources by employing distributed cloud computing, based on the needs of British and American literature. This research develops a model for the dispersed nature of cloud computing. It optimizes the method by fitting the mathematical model of transmission cost and latency. This article analyzes the weaknesses of the current British and American literature information resource integration and optimizes them for the integration of British and American literature resources. The Random algorithm has the longest delay, according to the results of this paper's experiments (maximum user weighted distance). The algorithms NPA-PDP and BWF have longer delays than the algorithm Opt. The percentage decline varies between 0.17 percent and 1.11 percent for different algorithms. It demonstrates that the algorithm presented in this work can be used to integrate and maximize information resources from English and American literature.

Impact of delayed processing of positive blood cultures on organism detection: a prospective multi-centre study

BackgroundBlood cultures remain the gold standard investigation for the diagnosis of bloodstream infections. In many locations, quality-assured processing of positive blood cultures is not possible. One solution is to incubate blood cultures locally, and then transport bottles that flag positive to a central reference laboratory for organism identification and antimicrobial susceptibility testing. However, the impact of delay between the bottle flagging positive and subsequent sub-culture on the viability of the isolate has received little attention.MethodsThis study evaluated the impact of delays to sub-culture (22 h to seven days) in three different temperature conditions (2–8 °C, 22–27 °C and 35 ± 2 °C) for bottles that had flagged positive in automated detection systems using a mixture of spiked and routine clinical specimens. Ninety spiked samples for five common bacterial causes of sepsis (Escherichia coli, Haemophilus influenzae, Staphylococcus aureus, Streptococcus agalactiae and Streptococcus pneumoniae) and 125 consecutive positive clinical blood cultures were evaluated at four laboratories located in Cambodia, Lao PDR and Thailand. In addition, the utility of transport swabs for preserving organism viability was investigated.ResultsAll organisms were recoverable from all sub-cultures in all temperature conditions with the exception of S. pneumoniae, which was less likely to be recoverable after longer delays (> 46–50 h), when stored in hotter temperatures (35 °C), and from BacT/ALERT when compared with BACTEC blood culture bottles. Storage of positive blood culture bottles in cooler temperatures (22–27 °C or below) and the use of Amies bacterial transport swabs helped preserve viability of S. pneumoniae.ConclusionsThese results have practical implications for the optimal workflow for blood culture bottles that have flagged positive in automated detection systems located remotely from a central processing laboratory, particularly in tropical resource-constrained contexts.

OTHR-06. Knowledge gap among health care providers in childhood central nervous system tumors: Result from an international multicenter survey

BACKGROUND: Central nervous system (CNS) tumors in children are associated with a longer delay in diagnosis. One of the contributing factors is the lack of awareness regarding childhood CNS tumors presentation among health care providers. To evaluate the knowledge gap among health care providers, we conducted a cross-sectional survey that was distributed globally. METHODS: The survey was disseminated to health care practitioners via electronic mail in November 2018 and it was closed in March 2020. The participants were asked to complete a pre-test survey, requested to view a CNS tumor education seminar, and subsequently complete a post-test survey. The survey had nine questions focusing on CNS tumor symptoms, pre-diagnosis symptom interval (PSI), and imaging indication. The knowledge gap was evaluated with pre-test and post-test scores. RESULTS: 889 pre-test and 392 post-test responses were received. The majority of the respondents were from Asia, with a percentage of 73.1% and 87.5% in pre-test and post-test respectively. For the pre-test, the median score for accurate answers was 40.0% (range:13.1-92.9%). Interestingly, a high rate of correctness was achieved in the post-test with a median score of 77.1% (14.9-98.2%). In the pre-test, only 18.7% of the participants responded precisely that Cushing’s triad is a less common symptom and just 15.0% recognized that older children >10 years old are at risk for late diagnosis. Surprisingly, 21.9% falsely reported that patients with malignant tumors experience the longest PSI, and 54.5% of the respondents wrongly selected medulloblastoma as the commonest CNS tumor. Overall, the pre-test scores among pediatricians and professionals with >10 years of experience did not demonstrate improved knowledge when compared to other specialties. CONCLUSIONS: The survey analysis showed a significant knowledge gap regarding childhood CNS tumors among health care providers. Therefore, raising professional awareness is very important and can be achieved through targeted educational strategies.

Assessment of executive functions and physical activity in girls and boys with normal weight, overweight and obesity.

To evaluate the association between body mass index (BMI) and performance of executive functions (EFs) in girls and boys with 9- and 10-year-old schoolchildren with moderate- to vigorous-intensity physical activity (MVPA) and sedentary behaviour. A total of 120 schoolchildren (61 girls and 59 boys) were evaluated anthropometrically. The MVPA was evaluated with a self-report questionnaire. EFs were measured using a neuropsychological battery of Executive Functions and Frontal Lobes-2 (BANFE-2). A high BMI was associated with longer delay in completing inhibitory control tests (p=0.00, rp =0.32) and working memory (p=0.00, rp =0.26). We observed correlations in time (p=0.00, rp =-0.43) and hits (p=0.04, rp =-0.27) of self-directed signalling test in boys; and girls in alphabetical words order (p=0.00, rp =-0.39). Active normal weight schoolchildren (ANw) performed better by successfully completed the working memory tasks (H=26.97, p=0.00) than sedentary schoolchildren with overweight and obesity. In addition, overweight-active schoolchildren (AOw) showed better performance on working memory tests in time (p=0.00) and hits (p=0.01) than their sedentary peers. Multiple linear regression analysis revealed a significant association between BMI and EFs scores (F=2.41, df=98, p=0.001). EFs are affected by a high BMI and sedentary behaviour in school children. Boys and girls reflected differences to solve the same challenges. The MVPA has a positive effect on executive control skills mainly in overweight children.

Long-term evolution and prognostic factors of epilepsy in limbic encephalitis with LGI1 antibodies.

To characterize the evolution of epilepsy in patients with leucine-rich glioma inactivated 1 antibody-associated (LGI1ab) limbic encephalitis, including factors associated with drug-resistant epilepsy (DRE). Retrospective analysis of patients with LGI1 encephalitis managed at two tertiary epilepsy centers between 2005 and 2019 and whose samples were confirmed by the French Reference Center of Paraneoplastic Neurological Syndromes. Raw clinical, biological, EEG, and MRI data were reviewed. Two endpoints were defined: (i) Epilepsy remission: patients seizure free and in whom anti-seizure medications (ASM) have been stopped for at least 1year at the last follow-up visit (ii) DRE: patients with persistent seizures at the last follow-up despite at least two ASM used at efficacious daily dose. 39 patients with LGI1 encephalitis were included with a median follow-up duration of 42months (range 13-169). All of them reported seizures at the acute phase, with faciobrachial dystonic seizures (FBDS) in 23 (59%) and other focal seizures in 38 (97%), including 4 patients (10%) with de novo status epilepticus. At the last follow-up visit, 11 patients (28%) achieved epilepsy remission. Among the 28 patients with persistent epilepsy, eight (29%) fulfilled criteria of DRE. The only factor significantly associated with epilepsy remission was the time from clinical onset of the encephalitis to initiation of the first immunomodulatory treatment, with longer delay in patients with persistent epilepsy (7.5 ± 8.9 vs 2.4 ± 1.7months, p = 0.006). Evolution to DRE was only driven by MRI evolution. Eight of the 15 patients (53%) who developed hippocampal atrophy (p = 0.007) also suffered from drug-resistant seizures at the last follow-up. In patients with LGI1 encephalitis, rapid initiation of immunomodulatory treatment favors long-term epilepsy remission. Evolution to DRE might primarily reflect the anatomical lesion of limbic structures. Determining what modalities of immune treatment may alter these outcomes requires prospective studies with long-term follow-up.

Delay in diagnosis of pulmonary tuberculosis: a survey in the Lazio region, Italy

&#x0D; OBJECTIVE: To estimate patient and health care delays in the diagnosis of PTB and to evaluate associated factors.&#x0D; METHODS: PTB incident cases ≥18 years diagnosed between September 2010 and September 2011 in the Lazio region; information on symptoms and date of onset, health professionals contacts, diagnostic exams performed, and drugs prescribed before diagnosis were collected through a standardized questionnaire. The total delay (TD) was divided into patient delay (PD: from symptoms onset to first contact with healthcare services) and health system delay (HSD: from first contact to diagnosis).&#x0D; RESULTS: 278 cases were evaluated. Median PD,HSD, and TD, were 31, 15, and 77.5 days, respectively. The median PD, HSD, and TD were significantly lower in foreign born patients (26, 10.5, 63.5, vs. 45, 36, 100 days, respectively). Other factors independently associated with longer delay were: absence of fever and presence of weight loss for PD; prior unspecific treatment, absence of cough, consult with a general practitioner, visit to an outpatient clinic, and a PD &lt;30 days for HSD.&#x0D; CONCLUSIONS: In Italy, the delay in TB diagnosis is similar to that estimated in other European countries. Results indicate that actions aimed to reduce diagnostic delay should be primarily addressed to Italian patients.

What a second booster dose of mRNA COVID-19 vaccines tells us

What a second booster dose of mRNA COVID-19 vaccines tells us

Multi-Agent Reinforcement Learning-Based Distributed Channel Access for Next Generation Wireless Networks

In the next generation wireless networks, more applications will emerge, covering virtual reality movies, augmented reality, holographic three-dimensional telepresence, haptic telemedicine and so on, which require the provisioning of high bandwidth efficiency and low latency services. In order to better support the aforementioned applications and services, novel distributed channel access (DCA) schemes are necessary. Therefore, we propose a new MAC protocol, QMIX-advanced Listen-Before-Talk (QLBT), based on the cutting-edge multi-agent reinforcement learning (MARL) algorithm. It employs a centralized training with decentralized execution (CTDE) framework to exploit the overall information of all agents during training, and ensure that each agent can independently infer the optimal channel access behavior based on its local observation. We enhance QMIX, a well-known MARL algorithm, by introducing an extra individual Q-value for each agent in the mixing network apart from the original total Q-value, which makes QLBT more stable. Moreover, delay to last successful transmission (D2LT) is first introduced in this work as a part of the observations of each QLBT agent, which facilitates agents to reach a cooperative policy that prioritizes the agent with the longest delay. Finally, extensive simulation experiments are provided to show that the proposed QLBT algorithm: 1) outperforms CSMA/CA and even its theoretical performance bound in various scenarios including saturated traffic, unsaturated traffic and delay-sensitive traffic; 2) is robust in dynamic environment; and 3) is able to friendly coexist with &#x201C;legacy&#x201D; CSMA/CA stations.

African American and Caucasian patients with Sézary syndrome have no differences in outcomes at an ethnically diverse urban medical center

Sézary syndrome (SS) is an aggressive cutaneous T-cell lymphoma with poor survival. We performed a retrospective review of SS patients at Emory University from 1990 to 2020. We collected data on race, clinical characteristics, therapy, and social determinants of health. Clinical endpoints were overall survival (OS) and time to next treatment (TTNT). Univariate association and multivariable analyses were assessed by Cox proportional hazards models. Among 62 patients, 45.2% were AA. The median OS and TTNT were 3.1 years and 6.3 months, respectively, with no difference by race. AA patients had a higher median baseline LDH (360 vs. 232, p = 0.002) and a longer delay in initiation of systemic therapy compared to CC patients (3.17 vs. 2.14 months, p = 0.039), but a shorter commute (<10 miles) and no difference in insurance coverage (p = 0.260). AA patients at an academic center had unique clinical features and treatment patterns, but similar survival to CC SS patients.

Hyperspectral and Laser Speckle Contrast Imaging for Monitoring the Effect of Epinephrine in Local Anesthetics in Oculoplastic Surgery.

Purpose:Epinephrine is used in local anesthetics to induce vasoconstriction and thus reduce bleeding and prolong the anesthetic effect. Finding the optimal delay between the administration of the anesthetic and skin incision to ensure vasoconstriction and minimize bleeding is important and has recently become the subject of debate. This is the first study to assess blood perfusion and oxygen saturation (sO2) simultaneously in response to a local anesthetic containing epinephrine in human oculoplastic surgery.Methods:A local anesthetic consisting of lidocaine and epinephrine (20 mg/ml + 12.5 μg/ml) was injected in the eyelids of 9 subjects undergoing blepharoplasty. The perfusion and sO2 of the eyelids were monitored using laser speckle contrast imaging and hyperspectral imaging, respectively.Results:Laser speckle contrast imaging monitoring showed a decrease in perfusion over time centrally at the site of injection. Half-maximum effect was reached after 34 seconds, and full effect after 115 seconds, determined by exponential fitting. The drop in perfusion decreased gradually further away from the injection site and hypoperfusion was less prominent 4 mm from the injection site, with a spatially dependent half-maximum effect of 231 seconds. Hyperspectral imaging showed only a slight decrease in sO2 of 11 % at the injection site.Conclusions:The optimal time delay for skin incision in oculoplastic surgery is approximately 2 minutes after the injection of lidocaine with epinephrine. Longer delay does not lead to a further decrease in perfusion. As sO2 was only slightly reduced after injection, the results indicate that the use of epinephrine is safe in the periocular region.

Are open‐book tests still as effective as closed‐book tests even after a delay of 2 weeks?

AbstractThe present work was conducted to re‐examine the findings of Agarwal et al. (Applied Cognitive Psychology, 22(7), 861–876, 2008), which showed that both closed‐book tests (with feedback) and open‐book tests increased learning outcomes after 1 week compared to simple re‐study of the same materials. However, contrary to often found benefits of retrieval practice—which should be more pronounced in closed‐book tests—both test conditions proved to be similarly effective. As retrieval practice benefits increase with retention interval, this pattern may change with a longer delay. Hence, we conducted a laboratory study and applied three within‐participant learning conditions (re‐study, open‐book test, closed‐book test with feedback) with a 2 weeks instead of 1 week delay between studying and the final test. Notably, our results mirrored the findings of Agarwal et al. (Applied Cognitive Psychology, 22(7), 861–876, 2008) showing that open‐book and closed‐book tests outperform re‐study but are similarly effective—even using a slightly changed procedure, new materials, a different sample, and a longer delay.

Delayed Auditory Feedback Elicits Specific Patterns of Serial Order Errors in a Paced Syllable Sequence Production Task.

Delayed auditory feedback (DAF) interferes with speech output. DAF causes distorted and disfluent productions and errors in the serial order of produced sounds. Although DAF has been studied extensively, the specific patterns of elicited speech errors are somewhat obscured by relatively small speech samples, differences across studies, and uncontrolled variables. The goal of this study was to characterize the types of serial order errors that increase under DAF in a systematic syllable sequence production task, which used a closed set of sounds and controlled for speech rate. Sixteen adult speakers repeatedly produced CVCVCV (C = consonant, V = vowel) sequences, paced to a "visual metronome," while hearing self-generated feedback with delays of 0-250 ms. Listeners transcribed recordings, and speech errors were classified based on the literature surrounding naturally occurring slips of the tongue. A series of mixed-effects models were used to assess the effects of delay for different error types, for error arrival time, and for speaking rate. DAF had a significant effect on the overall error rate for delays of 100 ms or greater. Statistical models revealed significant effects (relative to zero delay) for vowel and syllable repetitions, vowel exchanges, vowel omissions, onset disfluencies, and distortions. Serial order errors were especially dominated by vowel and syllable repetitions. Errors occurred earlier on average within a trial for longer feedback delays. Although longer delays caused slower speech, this effect was mediated by the run number (time in the experiment) and small compared with those in previous studies. DAF drives a specific pattern of serial order errors. The dominant pattern of vowel and syllable repetition errors suggests possible mechanisms whereby DAF drives changes to the activity in speech planning representations, yielding errors. These mechanisms are outlined with reference to the GODIVA (Gradient Order Directions Into Velocities of Articulators) model of speech planning and production. https://doi.org/10.23641/asha.19601785.

Time Intervals from the First Symptom to Surgery of Ovarian Malignancies in a Tertiary Government Hospital

Objective. This is a cross-sectional study aimed to determine the time intervals from the first symptom to surgery of 37 patients with ovarian malignancies who underwent surgery at a tertiary government hospital from June to October 2019.&#x0D; Methods. Structured interviews of patients and chart reviews were conducted to identify the intervals and the reasons behind such. The data were analyzed using Stata/SE 14.1, with the time intervals presented as medians and the reasons as frequencies. Multinomial logistic regression analysis established the association of time intervals with the extent of surgery and final stage of ovarian malignancies.&#x0D; Results. The median Total Time Interval from the first symptom to surgery was 214 days. The longest delay was the Total System Interval (from the first visit at the tertiary hospital to surgery) with a median of 70 days. This was followed closely by Patient Interval (from the first symptom to consult with the initial physician) with a median of 64 days. A distant third was the Initial Physician Interval (from the consult with the initial physician to the first visit at the tertiary hospital) with a median of 29 days. Most common reasons for the delays were the patients not acknowledging the gravity of their condition for the Patient Interval; choice to go to other hospitals, distance and laboratory works or diagnostics for the Initial Physician Interval; waiting for laboratory work-ups for the First System Interval; and waiting for other departments’ clearance for the Second System Interval. The most common first symptom was abdominal enlargement. The length of interval and the final stage (p=0.056 for Stage III and p=0.162 for Stage IV)) as well as extent of surgery (p=0.093) did not show significant association.&#x0D; Conclusion. The time interval from first symptom to surgery showed a median of 214 days. The greatest delay is contributed by Total System Interval followed by Patient Interval due to varying reasons. Length of time intervals, however, was not found to be significantly associated with the extent of surgery and final stage

Population growth and competition models with decay and competition consistent delay.

We derive an alternative expression for a delayed logistic equation in which the rate of change in the population involves a growth rate that depends on the population density during an earlier time period. In our formulation, the delay in the growth term is consistent with the rate of instantaneous decline in the population given by the model. Our formulation is a modification of Arino et al. (J Theor Biol 241(1):109-119, 2006) by taking the intraspecific competition between the adults and juveniles into account. We provide a complete global analysis showing that no sustained oscillations are possible. A threshold giving the interface between extinction and survival is determined in terms of the parameters in the model. The theory of chain transitive sets and the comparison theorem for cooperative delay differential equations are used to determine the global dynamics of the model. We extend our delayed logistic equation to a system modeling the competition between two species. For the competition model, we provide results on local stability, bifurcation diagrams, and adaptive dynamics. Assuming that the species with shorter delay produces fewer offspring at a time than the species with longer delay, we show that there is a critical value, [Formula: see text], such that the evolutionary trend is for the delay to approach [Formula: see text].

Implementation of Two-Way Voice and Text Communication System Using Fiber Optic Media

In this technology age, people's need for communication systems is growing. In various places and conditions, communication must be maintained to meet various needs. One of the solutions required in these circumstances is an optical fiber communication system. Fiber optic cable is a light-based data transmission technique. The advantages of optical transmission include the fact that the light spectrum does not spread like radio frequencies, making it impossible to intercept, the fact that it propagates at a very high speed, allowing it to go very large distances, and the ease with which it may be installed. To tackle this problem, we proposed to innovate by realizing and developing a two-way voice and text communication system using fiber optic cable media. The voice and text communication system created and deployed in this study is based on an Android application. This communication system does not require a server and internet network. Only Android smartphones, access points, fiber media converters, and fiber optic cables are required. The greatest throughput value measured by the system is 2708 bytes/second, while the lowest is 1020 bytes/second. The longest delay is 2.314 seconds, while the shortest is 1.99 seconds. In terms of packet loss, the value is 0%.

STROKE IN WOMEN: TIME TO ACKNOWLEDGE SEX DIFFERENCES

Historically, the stroke incidence, prevalence and mortality have been reported to be higher in men compared to women. But this gap seems to be narrowing over time. Recent data from high income countries suggests that the incidence of stroke varies with age, and older women beyond 75 years of age, may have a higher stroke incidence compared to men.1 Additionally, women below 40 years in some South East Asian countries showed an increase in ischemic stroke incidence over time.2 Moreover, Middle East and North Africa have reported higher stroke mortality amongst females compared to males. Keeping in view this changing epidemiology, it is imperative to have a better understanding of stroke in women. When evaluating conventional risk factors for stroke, there are certain sex differences that need special mention. Hypertension has an overall lower prevalence in women compared to men, however, its prevalence as well as its association with ischemic stroke increases in older women. Diabetes is a stronger risk factor for stroke in women compared to men, and atrial fibrillation and migraine are both more prevalent and more strongly associated with ischemic stroke in women.3 Women are in addition exposed to sex-specific risk factors which do not receive much attention. Pregnant and post-partum women have been found to be at three times higher risk of stroke compared to other young adults and this is related to a number of changes associated with these states.4 Hypertensive disorders of pregnancy not only raise the risk during pregnancy but a recent study on the Framingham cohort concluded that a history of pre-eclampsia confers a three-fold higher risk of experiencing a stroke in later life.5 Besides pregnancy, other hormonal changes also increase a woman’s stroke risk. An early menopause and a shorter reproductive lifespan have both been identified as increasing stroke risk in women.6,7 Similarly exogenous oestrogen, be it in the form of oral contraceptive pills or hormone replacement therapy, has also been shown to increase stroke risk in several studies.8,9 Stroke presentations are also more variable in women. Whereas men tend to present with the classic focal neurological deficits, women tend to present with more non-traditional symptoms like fatigue, light headedness, altered mental status etc.10 They also tend to present more often with stroke mimics. These and other reasons explain why women have longer delays in getting proper stroke care and several studies have reported worse outcomes for women.11,12 Very limited data is available on stroke in women from low and middle income countries. It is reasonable to believe that the social determinants of health would further compound the risk and outcomes for women in these areas. Lack of proper nutrition, poor pregnancy management and outcomes, multiparity and poor access to healthcare both for acute and secondary stroke prevention are important factors that are expected to affect stroke in women. Future research should focus on risk factors unique to women in these countries. In addition, awareness should be created amongst physicians so as to screen women early for potential risk factors and address them in a timely manner.

SEX-SPECIFIC DIFFERENCES IN STROKE EPIDEMIOLOGY IN LUSAKA, ZAMBIA

<h3>Introduction</h3> Sex-specific characteristics of stroke and access to post-stroke care data remain limited in sub-Saharan Africa. <h3>Objective</h3> Evaluate sex-specific stroke risk factors and characteristics of stroke care among adults with stroke in Zambia. <h3>Methods</h3> We retrospectively collected demographic, clinical, laboratory and imaging results, and in-hospital mortality for consecutive adults admitted with stroke to University Teaching Hospital in Lusaka, Zambia between October 2018 – April 2019. Strokes were classified as ischemic or hemorrhagic based on CT appearance, and as unknown if neuroimaging was unavailable. Descriptive statistics were compared by sex among adults with stroke using t-tests for continuous variables and chi-squared analysis for categorical variables. <h3>Results</h3> Women constituted 62% (n=200) of the cohort, were older (61±19 years vs 57±16 years, p=0.06) and had lower rates of hemorrhagic stroke (22% vs 37%, p=0.001). Hypertension (84% vs 74%, p=0.04) and diabetes (19% vs 13%, p=0.04) were more frequent in women. Several delays exist between stroke onset and care for women, including lack of CT imaging during hospitalization (82% vs 94% men, p=0.002), and, among those with neuroimaging, a trend towards longer delays in obtaining imaging with 69% of women having ≥1 day delay between admission and CT imaging compared to 53% of men (p=0.10). <h3>Discussion</h3> Females with stroke have fewer hemorrhagic strokes and higher prevalence of stroke risk factors. Women experience delays in acquiring post-stroke care, including in obtaining CT imaging, compared to men. Our data necessitates further study of social and socioeconomic factors that may result in women having reduced access to quality acute stroke and preventative care.

Increasing Access to CBT for Psychosis: Development, Feasibility, and Acceptability of a Specialized Outpatient Service.

Despite the increasing demand for cognitive behavioural therapy for psychosis (CBTp), the existing literature is lacking in terms of models for sustainable implementation. The aims of this study were to: (a) describe the development of a specialized CBTp Service; (b) report demographic characteristics and referral patterns over 1year to examine feasibility; and (c) review feedback from participants in group-based CBTp to examine acceptability. Data were analyzed from 126 referrals (M = 35.52, SD = 13.06, 59.5% men) to an outpatient CBTp Service at the Centre for Addiction and Mental Health (Toronto, Ontario) between January 2019 to January 2020. Anonymous feedback was obtained from 54 individuals who completed group-based CBTp. Positive symptoms and distressing emotions were the main reasons for referral. Over half of eligible referrals scheduled an intake assessment and 70% of individuals who completed this assessment attended further treatment. Primary reasons for service refusal were scheduling conflicts and illness-related barriers. The total service wait-time was two months, with the longest delay between dates of referral and initial contact. Satisfaction with the quality of CBTp and its components was rated high among group members. Although variable wait-times and engagement levels were identified across stages of the referral process, the CBTp Service demonstrates preliminary feasibility and acceptability, and provides a model of service delivery to incorporate within future CBTp implementation efforts in Canada.