Minute Delay Research Articles

Effect of Pre-Analytical Line Settings on Artefactually Elevated Anion Gap Results

Abstract Introduction When the core lab at a large tertiary care hospital introduced an automated laboratory system from a major manufacturer, the automated line aliquoted patient serum into open cups for all chemistry testing. It was subsequently discovered that if sample testing was delayed, electrolyte abnormalities could be introduced from evaporation, resulting in an increased anion gap (presumably due to a loss of bicarbonate with evaporation of carbon dioxide). To address this issue, the core lab changed the sample processing protocol in April 2023 from an open cup system to testing primary tubes on the analyzers. The purpose of this study was to evaluate the impact of switching to a primary tube testing system on artefactually elevated anion gap results. Methods Equivalent ten-week blocks of anion gap, creatinine and sample turnaround time (from receipt on the line to analyzer perform time) results from pre- to post-primary tube conversion were collected from the laboratory information system. Data from weekend testing and from repeat samples from the same patient were excluded. Data was cleaned and analyzed using R. Results Multivariable linear regression showed that when adjusted for the turnaround time and creatinine result, the open cup system was significantly associated (p<0.0001) with a 0.95 [95% CI 0.69-1.21] increase in anion gap. There was a positive relationship between turnaround time and anion gap, with a slope of 0.017 (i.e., a 0.017 increase in anion gap per minute delay; p<0.0001). Overall, the proportion of abnormal results (defined as anion gap >=16) decreased from 26% to 10% after switching to a primary tube testing system. Furthermore, there was an association between the times of day in which the lines were overloaded with specimens, turnaround time, and an increase in abnormal anion gap results. Overall, the mean anion gap decreased by 1 with a turnaround time of one hour and 2 after two hours by switching to the primary tube system. This trend in anion gap was largely driven by a corresponding decrease in bicarbonate. Sodium and chloride levels did not show any relationship with turnaround time. Conclusions Using an open cup system for electrolyte testing can cause spuriously elevated anion gap levels, especially with testing delays. Switching to a primary tube testing system largely resolved the issue; however, the data still showed a weakly positive relationship between turnaround time and anion gap for the primary tube testing system, so additional work is needed to identify potential causes of this relationship.

Clinical Impact of 3- versus 5-Minute Delay and 30- versus 60-Second Intervals on Unattended Automated Office Blood Pressure Measurements.

Guidelines advise automated office blood pressure (AOBP) with an initial 5-minute delay and multiple measurements at least 60 seconds apart. Recent studies suggest that AOBP may be accurate with shorter delays or intervals, but evidence in clinical settings is limited. Patients referred to one hypertension (HTN) center underwent 24-hour ambulatory blood pressure monitoring (ABPM) and one of four non-randomized, unattended AOBP protocols: a 3- or 5-minute delay with a 30 or 60-second interval, i.e., 3min/30sec/30sec, 3/60/60, 5/30/30 and 5/60/60 protocols. HTN was defined as systolic blood pressure ≥140 or diastolic blood pressure ≥90 mmHg. We compared differences in mean blood pressure and HTN classification between average AOBP and awake-time ABPM by t-tests and Fisher's exact test. Among 212 participants (mean 58.9 years, 61% women, 25% Black), there was substantial overlap in the probability distributions of awake-time ABPM and each of the three AOBP measures. Systolic blood pressure means were similar between the 5/60/60 and 3/30/30 protocols and 5/30/30 and 3/60/60 protocols. The 5/30/30 was associated with a higher proportion of systolic HTN, while the 3/60/60 protocol was associated with a higher proportion of diastolic HTN. There were no significant differences in systolic or diastolic HTN between 5/60/60 and 3/30/30 protocols with respect to awake-time ABPM. In this quality improvement study, the shortest AOBP protocol did not differ significantly from the longest protocol. The time savings of shorter protocols may improve AOBP adoption in clinical practice without meaningfully compromising accuracy.

Approximating decision trees with priority hypotheses

This paper addresses the problem of creating decision trees for identifying hypotheses, also known as entities, in a setting where the cost of an action is dependent on the true hypothesis. Specifically, we consider the scenario where n hypotheses are divided into m groups based on their priority levels. Taking an action on a higher priority hypothesis incurs a higher cost. This is relevant to many real-world applications where cost-sensitive decisions need to be made. For example, in a medical diagnosis task, the goal is to take a series of actions (such as medical tests) to identify a cause. Each action in this process requires conducting a test on the patient and observing the outcome, which can take anywhere from a few minutes to several weeks depending on the test. In this case, the cost (the result of waiting for the outcome) is higher if the true hypothesis is more time-sensitive. For example, if the true hypothesis is toxic chemical exposure (as opposed to a chronic disease such as diabetes), a delay of a few minutes could significantly increase the patient's risk of mortality. We propose a group greedy algorithm to solve this problem. We demonstrate that under worst-case scenarios, our algorithm has an approximation ratio of O(mlog⁡n). Importantly, when m=1, meaning there is only one group of hypotheses, our result is consistent with the logarithmic approximation bound for the traditional optimal decision tree problem.

A - 11 Organizational Strategies and Delayed Recall in Older Adults: Insights from the Rey-Osterrieth Complex Figure Test

Abstract Objective The objective of this study was to investigate the factors that influence older adults’ ability to recall complex figure in the Rey-Osterrieth Complex Figure (ROCF) test. Method 172 participants (50% female; M = 74.64) between the ages of 60 and 100 were recruited through the Israel Interior Ministry. Participants were asked to complete the Rey-Osterrieth Complex Figure Test (ROCF), which involved two tasks: A) participants were first instructed to replicate the complex figure exactly as shown (copy task). Subsequently, they were asked to B) recall and redraw the figure after a 30-minute delay (delayed recall task). The evaluations were conducted at the participants’ homes. The participants were evaluated on three criteria: accuracy, continuation, and the symmetry. To analyze the relationship between participants’ scores on the accuracy, continuation, and symmetry, a linear regression analysis was performed. Results A linear regression model predicting delayed recall score was significant F(3,48) = 9.61, p < 0.001. Among the predictors, continuation (b = 0.75, p = 0.01) and copy scores (b = 0.39, p 0.02) displayed a significant positive relationship with delayed recall score. Conclusion(s) The ROCF test serves as a comprehensive measure of cognitive functions, such as visuospatial memory, executive and organizational abilities, and retrieval. The significant influence of organizational score underscores the important link between planning abilities and declarative memory. This supports previous findings that organizing ROCF into meaningful clusters of units during the copy task improves performance in delayed recall task.

Positive and negative touch differentially modulate metacognitive memory judgements for emotional stimuli.

Touch plays a crucial role in providing humans with information from the external environment and can be perceived by humans as positively or negatively valenced. It is well documented that touch can differentially influence social functions, but very little is known about how touch can modulate (meta)cognition. Utilizing a within-subject design, participants were exposed to (a) positive, (b) negative, and (c) no touch, alongside encoding of emotionally valenced (positive and negative) images. After a 20-minute delay, participants completed a Yes/No recognition task to investigate how touch influenced memory-related decision components (e.g. criterion, confidence). Results showed that, compared to the control condition, both positive and negative touch were associated with overall lower confidence ratings, a less liberal response bias and slower response times. Interestingly, for correct recognitions, only negative touch (vs. no touch) led to inappropriately lower confidence and slower response times while both confidence and response time remained unaltered in positive touch. Our findings provide the first evidence that positive and negative touch differentially interact with metacognitive memory-related decisions. Altered metacognitive judgements after being touched could have significant consequences in applied settings, such as situations of eyewitness testimony.

Mitigating Risks in Cone Beam Computed Tomography Guided Online Adaptive Radiation Therapy: A Preventative Reference Planning Review Approach

PurposeOnline adaptive radiotherapy (oART) treatment planning requires evaluating the temporal robustness of reference plans, anticipating the potential changes during treatment courses that may even lead to risks unique to the adaptive workflow. This study conducted a risk analysis of the CBCT-guided adaptive workflow and is the first to assess an adaptive specific reference planning review that mitigates risk in the planning process to prevent events and treatment deficiencies during adaptation. Methods and MaterialsA quality management team of medical physicists, residents, physicians, and radiation therapists performed a fault tree analysis, and failure mode and effects analysis (FMEA). Fault trees were created for under/overdosing targets, treatment deficiencies, as well as assisted in identifying failure modes for the FMEA. Treatment deficiency was defined to include a non-ideal oART plan resulting in treatment with a lower quality plan (either oART or scheduled plan), treatment delay, or cancelling treatment for the day. A reference planning checklist was created to catch failure modes before reaching the patient. Risk priority numbers (RPN=Severity*Detectability*Occurrence) were scored with and without the reference planning checklist to quantify risk mitigation. A root cause analysis was conducted for an event where an adaptive plan failed to generate. ResultsThe reference planning checklist (with items covering patient background, contouring/planning robustness for anatomy variability, and machine limitations) reduced the RPN for all failure modes. Only 1 failure mode with a risk priority number >150 occurred with the reference planning checklist compared to 29 failure modes without, including 14 adaptive specific failure modes. Contouring, planning, setup, scheduling, and documentation errors were identified during the fault tree analysis. 29/70 errors were adaptive specific. The reference planning checklist could address 23/33 for over/under dosing and 28/37 errors for treatment deficiency. The root cause analysis highlighted the need for checking setup prior to adaptive plan delivery, and time-out checklist. ConclusionsThe reference planning checklist improved detection of the failure modes and improves the quality and robustness of the plans produced for oART. It is ideally performed before physician plan review to prevent last minute re-plan (before or after first adaptive treatment) and delay of patient start. The checklist presented can be modified based on failures specific to individual clinics and utilized at various planning steps based on available resources.

A Nurse-Driven Plan to Diminish First-Case Operating Room Delays.

The purpose of this study was to examine the use of a nurse-driven plan to describe factors associated with delays in the 1st case on time start within the operating room. A posttest-only quasi-experiment was conducted to examine the effect of designating specific time periods for steps in the preoperative process on 1st case operating delays. Rationale for delays was also examined. Using an audit form, data on target time, time met, delay in minutes, and reasons for delay were collected by an observer. Thirty-one percent (n = 31) of patient/participants (N = 99) were late to the operating room. Controllable factors, such as caregivers being late, and uncontrollable factors, such as patients' needing to use the restroom just prior to surgery, were identified. Results of this study support the identification and examination of steps in the preoperative process to prevent delays by adjusting activities as needed. Identifying controllable and uncontrollable factors can help in preparing to prevent delays.

Mechanical properties of dual-polymerizing resin-core material, dual-polymerizing resin cement, and bulk-fill composite resin used for restoring endodontically treated teeth

How resin-based material and a light-activation protocol influence the mechanical properties of materials used to cement glass fiber post-and-cores in endodontically treated teeth is unclear. The purpose of this in vitro study was to evaluate the influence of immediate or 5-minute delayed light activation on the mechanical properties of dual-polymerizing resin cements and dual-polymerizing resin-core materials compared with bulk-fill composite resins. Nine resin-based materials were tested: 4 dual-polymerizing resin-core materials, (Allcem Core; FGM, LuxaCore Z; DMG, Rebilda DC; VOCO, and (Clearfil DC Core Plus; KURARAY), 3 dual-polymerizing resin cements, (RelyX Universal; 3M ESPE, RelyX U200; 3M ESPE, and Allcem Dual; FGM), and 2 bulk-fill composite resins, (Opus Bulk Fill APS; FGM, and Filtek One Bulk Fill; 3M ESPE). The dual-polymerizing materials were light activated using both protocols. The postgel shrinkage (Shr), flexural strength (FS), elastic modulus (E), Knoop hardness (KH), degree of conversion (DC), and depth of polymerization (DoP) were measured (n=10). The data for Shr, FS, E, and DoP were analyzed using 2-way ANOVA, and for KH and DC using 2-way repeated measurement ANOVA and the Tukey HSD test (α=.05). A 5-minute delay before light-activation significantly reduced Shr for all materials (P<.001). Increasing the depth significantly reduced the KH for all materials (P<.001). Bulk-fill composite resins and dual-polymerizing resin-core had higher KH values than dual-polymerizing resin cements (P<.001). Delayed 5-minute light-activation reduced postgel shrinkage and had no negative effect on mechanical properties. Dual-polymerizing resin-core materials exhibited higher KH values than dual-polymerizing resin cement and mechanical properties similar to those of bulk-fill composite resin.

When Every Minute Counts: REBOA Before Surgery Is Independently Associated With a 15-Minute Delay in Time to Definitive Hemorrhage Control.

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a temporizing hemorrhage control intervention, but its inevitable effect on time to operating room (OR) has not been assessed. The aim of our study is to assess the impact of undergoing REBOA before surgery (RBS) on time to definitive hemorrhage control surgery. In this retrospective analysis of 2017-2021 ACS-TQIP database, all adult (≥18 years) patients who underwent emergency hemorrhage control laparotomy (≤4 hours of admission) and received early blood products (≤4 hours) were included, and patients with severe head injury (Head-abbreviated injury score > 2) were excluded. Patients were stratified into those who did (RBS) vs those who did not undergo REBOA before surgery (No-RBS). Primary outcome was time to laparotomy. Secondary outcomes were complications and mortality. Multivariable linear and binary logistic regression analyses were performed to identify the independent associations between RBS and outcomes. A total of 32,683 patients who underwent emergency laparotomy were identified (RBS: 342; No-RBS: 32,341). The mean age was 39 (16) years, 78% were male, mean SBP was 107 (34) mmHg, and the median injury severity score was 21 [14-29]. The median time to emergency hemorrhage control surgery was 50 [32-85] minutes. Overall complication rate was 16% and mortality was 19%. On univariate analysis, RBS group had longer time to surgery (RBS 56 [41-89] vs No-RBS 50 [32-85] minutes, P < 0.001). On multivariable analysis, RBS was independently associated with a longer time to hemorrhage control surgery (β + 14.5 [95%CI 7.8-21.3], P < 0.001), higher odds of complications (aOR = 1.72, 95%CI = 1.27-2.34, P < 0.001), and mortality (aOR = 3.42, 95%CI = 2.57-4.55, P < 0.001). REBOA is independently associated with longer time to OR for hemorrhaging trauma patients with an average delay of 15 minutes. Further research evaluating center-specific REBOA volume and utilization practices, and other pertinent system factors, may help improve both time to REBOA as well as time to definitive hemorrhage control across US trauma centers. III. Epidemiologic.

Door-to-Needle Time for Extracorporeal Cardiopulmonary Resuscitation and Neurological Outcomes in Out-of-Hospital Cardiac Arrest: A Nationwide Study.

Extracorporeal cardiopulmonary resuscitation (ECPR) is an option for refractory cardiac arrest, and immediate initiation after indication is recommended. However, the practical goals of ECPR preparation (such as the door-to-needle time) remain unclear. This study aimed to elucidate the association between the door-to-needle time and neurological outcomes of out-of-hospital cardiac arrest. This is a post hoc analysis of a nationwide multicenter study on out-of-hospital cardiac arrest treated with ECPR at 36 institutions between 2013 and 2018 (SAVE-J [Study of Advanced Cardiac Life Support for Ventricular Fibrillation with Extracorporeal Circulation in Japan] II study). Adult patients without hypothermia (≥32 °C) in whom circulation was not returned at ECPR initiation were included. The probability of favorable neurological function at 30 days (defined as Cerebral Performance Category ≤2) was estimated using a generalized estimating equations model, in which institutional, patient, and treatment characteristics were adjusted. Estimated probabilities were then calculated according to the door-to-needle time with 3-minute increments, and a clinical threshold was assumed. Among 1298 patients eligible for this study, 136 (10.6%) had favorable neurological function. The estimated probability of favorable outcomes was highest in patients with 1 to 3 minutes of door-to-needle time (12.9% [11.4%-14.3%]) and remained at 9% to 10% until 27 to 30 minutes. Then, the probability dropped gradually with each 3-minute delay. A 30-minute threshold was assumed, and shorter door-to-extracorporeal membrane oxygenation/low-flow time and fewer adverse events related to cannulation were observed in patients with door-to-needle time <30 minutes. The probability of favorable functions after out-of-hospital cardiac arrest decreased as the door-to-needle time for ECPR was prolonged, with a rapid decline after 27 to 30 minutes. URL: https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000041577; Unique identifier: UMIN000036490.

Every minute matters: Improving outcomes for penetrating trauma through prehospital advanced resuscitative care.

Prehospital resuscitation with blood products is gaining popularity for patients with traumatic hemorrhage. The MEDEVAC trial demonstrated a survival benefit exclusively among patients who received blood or plasma within 15 minutes of air medical evacuation. In fast-paced urban EMS systems with a high incidence of penetrating trauma, mortality data based on the timing to first blood administration is scarce. We hypothesize a survival benefit in patients with severe hemorrhage when blood is administered within the first 15 minutes of EMS patient contact. This was a retrospective analysis of a prospective database of prehospital blood (PHB) administration between 2021 and 2023 in an urban EMS system facing increasing rates of gun violence. PHB patients were compared to trauma registry controls from an era before prehospital blood utilization (2016-2019). Included were patients with penetrating injury and SBP ≤ 90 mmHg at initial EMS evaluation that received at least one unit of blood product after injury. Excluded were isolated head trauma or prehospital cardiac arrest. Time to initiation of blood administration before and after PHB implementation and in-hospital mortality were the primary variables of interest. A total of 143 patients (PHB = 61, controls = 82) were included for analysis. Median age was 34 years with no difference in demographics. Median scene and transport intervals were longer in the PHB cohort, with a 5-minute increase in total prehospital time. Time to administration of first unit of blood was significantly lower in the PHB vs. control group (8 min vs 27 min; p < 0.01). In-hospital mortality was lower in the PHB vs. control group (7% vs 29%; p < 0.01). When controlling for patient age, NISS, tachycardia on EMS evaluation, and total prehospital time interval, multivariate regression revealed an independent increase in mortality by 11% with each minute delay to blood administration following injury (OR 1.11, 95%CI 1.04-1.19). Compared to patients with penetrating trauma and hypotension who first received blood after hospital arrival, resuscitation with blood products was started 19 minutes earlier after initiation of a PHB program despite a 5-minute increase in prehospital time. A survival for early PHB use was demonstrated, with an 11% mortality increase for each minute delay to blood administration. Interventions such as PHB may improve patient outcomes by helping capture opportunities to improve trauma resuscitation closer to the point of injury. Prospective, Level IV.

Workflow and Outcome of Thrombectomy in Late Time Window: A Pooled Multicenter Analysis.

We investigated the impact of workflow times on the outcomes of patients treated with endovascular thrombectomy (EVT) in the late time window. Individual patients' data who underwent EVT in the late time window (onset to imaging >6 hours) were pooled from seven registries and randomized clinical trials. Multiple time intervals were analyzed. Mixed-effects logistic regression was used to estimate the likelihood of functional independence at 90 days (modified Rankin Scale 0-2). Mixed-effects negative binomial regression was used to evaluate the relationship between patient characteristics and workflow time intervals. 608 patients were included. The median age was 70 years (IQR: 58-71), 307 (50.5%) were female, and 310 (53.2%) had wake-up strokes. Successful reperfusion was achieved in 493 (81.2%) patients, and 262 (44.9%) achieved 90-day mRS 0-2. The estimated odds of functional independence decreased by 13% for every 30 minute delay from emergency department (ED) arrival to imaging time and by 7% from ED arrival to the end of EVT in the entire cohort. Also, the estimated odds of functional independence decreased by 33% for every 30 minute delay in the interval from arterial puncture to end of EVT, 16% in the interval from arrival in ED to end of EVT and 6% in the interval from stroke onset to end of EVT among patients who had a wake-up stroke. Faster workflow from ED arrival to end of EVT is associated with improved functional independence among stroke patients treated in the late window.

Memory for space and time in 2-year-olds

Although the capacity to remember spatial and temporal information may develop at different rates throughout childhood, its early development has rarely been examined within the same participants, using the same task, and across different time delays elucidating retention of different aspects of early episodic memories. We used a novel tablet game to investigate memory for objects’ spatial locations and temporal order in a sample of toddlers ranging in age from 2 years to 2;8 years (M = 2;4 years, SD = 2 months; N = 73). We examined performance both immediately after an initial and an additional demonstration, following a 20-minute delay, and 1 week after learning; performance was also assessed following a new demonstration after the 1-week delay test. Using a linear mixed model, we found that toddlers remembered spatial locations better than temporal order, and temporal memory decayed more quickly and did not benefit from reminders compared to spatial memory, underscoring that early memory fragility may depend on the type of information being retained.

393 Cerebral Oximetry Using the USIC Protocol Is a Reliable Tool for Indicating Selective Intraluminal Shunting During Carotid Endarterectomy

INTRODUCTION: Indication to selective shunting during carotid endarterectomy (CEA) is based on monitoring during the procedure. Cerebral oximetry (CO) using near-infrared spectroscopy (NIRS) is one of the monitoring tools but no clear cut off value for an intraluminal shunt insertion has been established. METHODS: 125 patients underwent CEA under LA and were monitored clinically through the whole procedure. The patients also underwent bilateral NIRS monitoring during the surgery. During the monitoring period, we first clamped the external carotid artery (ECA), and after a 1 minute delay followed by clipping the internal carotid artery (ICA). The decrease in the cerebral oximetry values was analyzed separately after selective ICA clipping (ÚstÍ Selective Internal carotid artery Clamping “USIC” protocol). The decision to use a shunt was based solely on clinical symptomatology but the NIRS data were recorded and analyzed. All patients underwent DWI before and after CEA. RESULTS: One hundred and six patients (85%) underwent CEA without clinical deterioration while 19 patients (15%) clinically deteriorated during surgery. The mean drop in the cerebral oximetry after selective ICA clamping in clinically stable patients was 6% while in patients with clinical deterioration the NIRS decreased by 15% (p &lt; 0.05). When we set the cut-off value for selective shunting as a 10% decrease of the ipsilateral cerebral oximetry after selective ICA clamping, the sensitivity of the technique was 100% and the specificity 83%. CONCLUSIONS: Our study showed that a 10% decrease in the ipsilateral brain tissue oximetry after selective cross-clamping the ICA provides a reliable cut-off for selective shunting during CEA. More, bilateral NIRS monitoring allows differentiation between systemic or local events leading to brain hypoxia.

Contact measurement of skin temperature using a wearable two-channel PPG optical sensor supplemented by thermometers

Abstract This paper describes realization, basic properties, testing, and experiments with a special prototype of a wearable two-channel photoplethysmography (PPG) sensor supplemented by contact thermometers that maps the skin temperature at the place where the optical part of the sensor touches a measured hand part (typically a wrist and fingers). Preliminary measurement confirms that proposed I2C thermometers have proper stability and precision, so can be successfully used in the developed PPG sensor. The performed main experiments show that the significant increase of temperature was always observed at the place of the worn PPG sensors during the whole measurement. This rise of temperature affects mainly the PPG signal range, thus it has also influence on the quality of the sensed PPG wave. The conclusion formulates the final recommendation about the necessity of at least 5-minute time delay between the PPG sensor placement on the hand and the start of the PPG signal acquisition. While the current measurements were realized in normal laboratory conditions, the whole wearable PPG sensor consists of non-ferromagnetic materials and all parts are fully shielded by aluminum boxes to enable measurement in a low magnetic field environment which, is our final long term research aim.

Habitual consumption of anthocyanin is associated with improvements in mood and cognitive performance in older people with memory complaints

The role of flavonoids on cognitive performance in older adults has been intensively studied, with the subclass of anthocyanins showing promising outcomes(1). However, there is conflicting evidence in the case of individuals at high risk of developing dementia, namely those with mild cognitive impairment (MCI). A recent study has suggested that cognitive scores in people with MCI were higher in those who had higher anthocyanin intake (&gt;10 mg)(2). Baseline data from 65 participants of an ongoing clinical trial that had an MIS (Memory Index Score) score ≤ 13 with self-reported subjective memory complaints, (mean age 69.1y ± 6.2) were used to investigate the relationship between dietary anthocyanin intake and indices of mood and cognitive performance. Repeated 24-hour dietary intake was recorded through Intake24 (a computer-based program) for three days (2Xweekday and 1Xweekend day) and anthocyanin intake was quantified using the PhenolExplorer food composition database. The primary outcome of interest was the Buschke and Grober Free and Cued Selective Reminding Test-Immediate Recall (FCSRT+IR) (assesses auditory anterograde memory functioning), while other cognitive functions assessed included: Spot the Word-2 (assessing premorbid estimate); Oral Symbol Digit Test (speed of processing); List Sorting (working memory); Trail Making Test A &amp; B (speed of processing/executive function); and Verbal Fluency (language/semantic memory). Subjective memory complaints were assessed using the Memory Assessment Clinic-Q (MAC-Q) and mood was assessed using the Geriatric Depression Scale (GDS). Independent t-tests were used to compare differences in cognitive tasks and mood scores between high (&gt;10 mg/d) and low consumers of anthocyanins (&lt;10 mg/d). There was a trend for high anthocyanin consumers (n = 35, median = 44.87 (10.01, 177.83)) to score better on FCSRT-Delayed Free Recall scores (16.57 ± 3.74) compared to lower consumers (n = 30, median = 0.01 (0, 9.51)), (15.97 ± 0.18) with a mean difference (SE) of −1.06 (0.58) (p = 0.06) suggesting recall of 1.06 more words after a 20-30 minute delay. Higher consumers had a lower GDS score (1.77 ± 3.73) compared to lower consumers (3.73 ± 1.77), p = 0.01. Spot the word test scores (assesses premorbid verbal abilities using a robust lexical decision task) were higher for high anthocyanin consumers (53.06 ± 4.38) compared to lower consumers (50.40 ± 4.38), mean difference (SE) = −2.66 (1.10), p = 0.01, meaning participants with higher intake of dietary anthocyanin were able to point at 2.7 more real words than low consumers. Dietary consumption of anthocyanin in older adults with MIS is associated with beneficial effects on depressive scores and the ability to retrieve words. Further research is warranted to identify optimal dosage for recommended intake. This cross-sectional study used baseline data from a randomised controlled trial registered with the Australian New Zealand Clinical Trials Registry (ANZCTR):12622000065796.

PERBEDAAN HASIL PENUNDAAN SAMPEL FFP (Fresh Frozen Plasma) 36 JAM DAN 48 JAM TERHADAP PEMERIKSAAN APTT (Activated Partial Thromboplastin Time)

Blood transfusion is the transfer of blood from one person (donor) into the vein of another person (recipient). Blood components include cellular and non-cellular components. The results of the study were conducted to determine the differences in the results of 36-hour and 48-hour FFP (Fresh Frozen Plasma) samples stored at room temperature against APTT (Activated Partial Thromboplastin Time) examination. The sample was FPP (Fress Frozen Plasma) from Dr. Sotomo Hospital Surabaya, which obtained significant results, namely there was a difference in the plasma APTT value with a delay of 36 hours, plasma with a delay of 48 hours with plasma with a delay of 30 minutes or without delay, while the plasma APTT value with a 30-minute delay as a control for the normal APTT value. The Mann-Whitney statistical test showed that there was a significant difference (p&lt;0.05) between 30-minute plasma with 36-hour delay plasma p=0.00 and 48-hour delay plasma with p=0.000. The conclusion in the hematological examination, especially the APTT examination, if there is a delay in the examination, it should be examined no more than two hours. Keywords: Fress Frozen Plasma, Activated Partial Thromboplastin Time

The Expression of Neurodegeneration-Related Genes in the Hippocampus of Hypothyroid Rats Following Long-Term Potentiation.

In our research, we examined how the induction of long-term potentiation (LTP) in the hippocampus of hypothyroid rats afects the mRNA levels of several proteins involved with neurodegeneration, including Gsk3, Cdk5, Akt1, Mapt, P35 (Anxa), Capn1, Bace1, and Psen2. Wistar-albino rats, consisting of 12 males, were used in the research, and they were separated into 2 groups: control (n=6) and hypothyroidism (n=6). To induce hypothyroidism, propylthiouracil was added to drinking water at a dosage of 20 mg/kg/day. The test stimulus intensity was calculated, basal recordings were acquired, and LTP was induced by administering 100 Hz high-frequency stimulation (HFS) for 1 second with a 5-minute delay when the rats were aged 60 days. The population spike (PS) amplitude and excitatory postsynaptic potential (EPSP) slope were measured in the granule cell layer of the dentate gyrus. Using reverse transcription polymerase chain reaction, the mRNA levels of neurodegenerative genes were assessed in induced hippocampal tissues after the LTP protocol. The free T4 levels in plasma were measured using a plate reader with the commercial ELISA kit. Following HFS, LTP was solely induced in the EPSP slope and PS amplitude in the control group. The impaired LTP response of the hypothyroidism group was accompanied by an increase in Akt1-mRNA expression and a decrease in Gsk3ß expression, whereas the value genes' mRNA expression levels did not difer significantly from those of the control group. The hypothyroidism-related LTP impairment could be caused by a reduction in PI3K/AKT signaling. Further investigation of this path is required to elucidate the pathophysiology of impaired synaptic plasticity in hypothyroidism.

A national survey on the effect of the COVID-19 pandemic on school travel in the US. – Parents perspective

The Coronavirus Disease 2019 (COVID-19) pandemic has considerably influenced school transportation in the United States (US), with conventional bus use declining and private vehicle use growing. It has increased traffic congestion, reliance on private autos, and detrimental air quality and sustainability effects. This study investigates the shift in transport mode preferences among parents during school reopening in 2021, focusing on elementary, middle, and high schools. An online questionnaire was distributed to parents in the U.S. The findings indicate a significant shift in parental transportation choices, with reduced reliance on school buses and increased automobile usage. Elementary school parents' bus percentage declined from 39.7% to 36.4% in Spring 2021, while middle and high school parents showed similar trends. School closures led to a shift to online learning platforms which affected academic achievement, with 15.9%, 15.5%, and 17.0% of students performing below average. In Spring 2021, 50.5% of students on the school bus encountered a delay of 0 to 15 min, while 32.4% suffered a wait of 15 to 30 min. In Fall 2021, 51.7% saw a 0 to 15-minute delay, while 31.2% suffered a 15-to-30-minute delay. Understanding the COVID-19 pandemic's effects on school travel patterns will allow policymakers and transportation planners to develop post-pandemic solutions prioritizing safety, justice, and environmental sustainability for similar events in the future.

Abstract WP68: National Database Demonstrates Substantial Delays Between Non-Contrast CT and CT Angiography in Suspected Stroke Patients in 2023

Background: Prompt identification of large vessel occlusions (LVOs) leads to shorter door to thrombectomy times and better outcomes. In most stroke centers, both a non-contrast CT (CT) and CT angiography (CTA) are ordered simultaneously in patients suspected to have acute stroke. In some centers, a CT is performed first, and CTA is subsequently obtained if vessel imaging is deemed necessary. Methods : Data on 23,925 patients from 717 hospitals who underwent both CT and CTA imaging processed with Rapid software in the United States from Jan 1, 2023 to June 30, 2023 were queried to determine the time delay between CT and CTA. Rapid software is typically used to evaluate suspected stroke patients for occlusions of major brain arteries and salvageable tissue. Results : A delay greater than 15 minutes between CT and CTA occurred in 4,365 patients (18%). Among the 717 hospitals, 595 (83%) had a median delay of less than 15 minutes, 77 (11%) had 15-30 minute delays and 45 (6%) had greater than 30 minute median delays. Among the 595 high performing hospitals, 57% had greater than 15 minute delays in 10% or fewer patients, 33% of the hospitals had 11-33% of their patients with greater than 15 minute delays, and 10% had 34-50% of patients with greater than 15 minute delays. Conclusion : Nearly 20% of patients have a delay greater than 15 minutes between CT and CTA. Seventeen percent of hospitals had a median delay of greater than 15 minutes and 6% had more than a 30 minute median delay. Even among high performing hospitals, a substantial number of patients had more than 15 minutes delay suggesting these patients were moved off the scanner between scans. Education on reducing CT to CTA time in suspected stroke patients should be targeted to hospitals with substantial delays. Software to identify LVOs on non-contrast CT could significantly reduce the door to diagnosis time for LVOs.