Moderate Outcomes Research Articles

Inclusive, sustainable economic transformation: an analysis of trends and trade-offs

This article presents a typology to capture varying degrees of inclusive, sustainable economic transformation in low- and middle-income countries. We perform a cluster analysis of these pillars – poverty and inequality, environmental sustainability, and economic transformation – proxied by a set of quantitative indicators with data pooled between 2000 and 2018. This is supported by descriptive analysis of correlations in change over time between indicators as well as an exploration of the contextual risk and governance profiles underpinning these changes. From this analysis, we identify five clusters of countries with a range of outcomes across the three pillars. Countries consistently performing well across the three dimensions are not readily evident, though some countries are able to achieve moderate outcomes. Policy implications point to the need to get the basics right around pro-poor infrastructure development and making certain sectors greener in an effort to advance tripartite gains.

Predictors of EX/RP alone versus EX/RP with medication for adults with OCD: Does medication status moderate outcomes?

Exposure and response prevention (EX/RP) can be delivered as monotherapy or to augment serotonin reuptake inhibitors (SRIs). While both options are considered effective OCD treatments, responses are heterogenous. Substantial work has investigated EX/RP predictors to account for this variability, with mixed findings. Little research has studied whether EX/RP predictors may differ in medicated versus non-medicated samples (i.e., medication status as a moderator). We pooled data from two clinical trials conducted concurrently in the same specialty OCD clinic. One enrolled patients who were on stable SRI doses (EX/RP as SRI augmentation, n = 58) while the other enrolled non-medicated patients (EX/RP monotherapy, n = 38). Both trials used the same manualized EX/RP protocol and blinded independent evaluators. LASSO regression derived predictors and moderators of outcome. Improvement did not significantly differ between the EX/RP alone group and the SRI + EX/RP group. In both groups, higher baseline OCD severity and worse quality of life predicted poorer outcome. OCPD traits moderated results: Patients with more severe OCPD traits had better outcomes from EX/RP monotherapy than those receiving EX/RP with SRIs. Patient adherence to EX/RP homework mediated the associations between the baseline variables and outcome. The effect of OCPD traits on outcome warrants future study to improve care.

O.4.3-4 Associations between screen-time media use, physical activity, and positive and negative mental health outcomes among adolescents in Ireland: a cross-sectional study

Abstract Purpose Understanding the individual and joint associations of positive and negative mental health with screen-time and physical activity (PA) among adolescents is essential to develop enhanced guidance for prevention strategies and appropriate interventions. Methods Participants (n=879, n = 463 female, mean age 14.71 (SD = 1.51) years) from second-level schools in Ireland completed a battery of well-validated questionnaires assessing hours of daily screen-time use (TV, computer, and phone), PA levels (PACE+) (low (0–2 day/week), moderate (3–4 day/week), or high (5+day/week), and mental health outcomes (anxiety (STAI-Y2) and depressive symptoms (QIDS) and positive mental health (MHC-SF)). Multiple linear regressions examined associations between screen-time, PA and mental health and one-way ANOVA’s examined differences in mental health outcomes between screen-time mode and use categories (none (0 hours), low (0.5-1.5 hours), moderate (2-4.5 hours), and high (5+ hours)). Cohen’s d effect size and 95% confidence intervals quantified the magnitude of the difference. Results Higher computer (β=0.112, p≤0.001) and phone use (β=0.138, p≤0.001) were associated with higher depressive symptoms. Higher TV use (β=-0.111, p≤0.002) and PA levels (β=-0.123, p≤0.001) were associated with lower anxiety symptoms. Higher phone use (β=0.113, p≤0.002) and PA levels (β=0.116, p≤0.001) were associated with higher positive mental health. The magnitude of differences in depressive and anxiety symptoms across screen-time use categories were largely small-to-moderate (d = 0.02 to 0.67) and in positive mental health, ranged from small to large (d = 0.03 to 0.88). The sample was then stratified by PA level to assess the potential moderating influence of PA on the screen-time-mental health association, with mixed results. Conclusions Results are among the first findings regarding the relationship between screen-time mode and PA levels with mental health, particularly positive mental health among adolescents in Ireland. Associations of screen-time and PA with mental health outcomes varied according to PA level and screen-time mode. The variation in these findings suggest the need to investigate the context of screen-time use and the screen-time activity engaged with. These results suggest that not all screen-time is detrimental and some, in moderation, may be beneficial for mental health. Future research should investigate longitudinal associations between screen-time, PA, and mental health. Support/Funding Source N/A

ANALISIS HASIL BELAJAR MATEMATIKA SISWA KELAS VIII PADA MATERI BANGUN RUANG SISI DATAR

Student learning outcomes are a reference for educators to determine the success or failure of students in carrying out the learning process in class. This study aims to determine the factors that influence mathematics learning outcomes in the material of flat-sided geometric shapes at SMP Negeri 4 Gunungsitoli Idanoi. The subjects of this study were class VIII students with 26 students. The instruments used in the study were a test of 5 questions and interviews. The data analysis method used in this study is a quantitative descriptive method. Based on the data exposure, the researchers concluded that the average student learning achievement was 73.00. From the data on student learning outcomes test scores above, a standard deviation of 11.1 was obtained from 26 respondents. Students with moderate learning outcomes are 53.85%, with high learning outcomes are 26.92%, and students with very high learning outcomes are 3.85%, with a completeness percentage of 65.38%. Low learning outcomes can be seen from interviews with students that 69.23% of students need help understanding the material the teacher explains during the learning process. In addition, from the results of interviews with subject teachers, it was obtained that aspects that often affect student learning outcomes are internal aspects, including lack of student interest in learning, lack of ability to understand the material, lack of student memory, lack of student skills in arithmetic and aspects of External factors include the lack of attention and support from the family to return to the lessons given by the teacher at home.

Effect of endovascular treatment on patients with basilar artery occlusion presenting with different pathologic mechanisms: a systematic review and meta-analysis.

This study aimed to summarize the clinical outcomes of endovascular treatment in patients with basilar artery occlusion (BAO) with different pathologic mechanisms. Two independent reviewers searched PubMed/MEDLINE, Embase and Cochrane Library database up to December 2022, patients with different BAO pathological mechanisms (BAO with in situ atherosclerosis vs. embolism alone without vertebral artery steno-occlusion vs. embolism from tandem vertebral artery steno-occlusion) were collected and analyzed. We calculated the odds ratios (ORs) and 95% confidence intervals (CIs) to assess the associations between clinical outcomes and BAO pathological mechanisms. A total of 1163 participants from 12 studies were identified. Compared with embolism alone, patients with in situ atherosclerotic BAO had a lower favorable outcome rate (modified Rankin score [mRS] 0-2: 34.5% vs. 41.2%; OR 0.83, 95% CI 0.70-0.98; P = 0.03) and moderate outcome rate (mRS 0-3: 45.8% vs. 55.4%; OR 0.65, 95% CI 0.47-0.90; P = 0.01) at 3 months and a higher risk of mortality (29.9% vs. 27.2%; OR 1.31, 95% CI 0.96-1.79, P = 0.09; adjusted OR 1.46, 95% CI 1.08-1.96). Tandem BAO had a comparable mortality risk to that of in situ atherosclerotic BAO (OR 1.37, 95% CI 0.84-2.22; P = 0.48) or embolism alone (OR 1.44, 95% CI 0.65-3.21; P = 0.43), and there were no significant differences in favorable or moderate outcomes between tandem BAO and each of the other two BAO mechanisms. Among BAO patients with endovascular treatment, embolism mechanism had better clinical outcomes than in situ atherosclerosis, and atherosclerotic mechanism was associated with a higher mortality at 3 months. RCTs are needed to further confirm clinical outcomes of BAO by different mechanisms.

The Effects of Hospitalisation on the Serum Metabolome in COVID-19 Patients.

COVID-19, a systemic multi-organ disease resulting from infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is known to result in a wide array of disease outcomes, ranging from asymptomatic to fatal. Despite persistent progress, there is a continued need for more accurate determinants of disease outcomes, including post-acute symptoms after COVID-19. In this study, we characterised the serum metabolomic changes due to hospitalisation and COVID-19 disease progression by mapping the serum metabolomic trajectories of 71 newly hospitalised moderate and severe patients in their first week after hospitalisation. These 71 patients were spread out over three hospitals in Switzerland, enabling us to meta-analyse the metabolomic trajectories and filter consistently changing metabolites. Additionally, we investigated differential metabolite-metabolite trajectories between fatal, severe, and moderate disease outcomes to find prognostic markers of disease severity. We found drastic changes in serum metabolite concentrations for 448 out of the 901 metabolites. These results included markers of hospitalisation, such as environmental exposures, dietary changes, and altered drug administration, but also possible markers of physiological functioning, including carboxyethyl-GABA and fibrinopeptides, which might be prognostic for worsening lung injury. Possible markers of disease progression included altered urea cycle metabolites and metabolites of the tricarboxylic acid (TCA) cycle, indicating a SARS-CoV-2-induced reprogramming of the host metabolism. Glycerophosphorylcholine was identified as a potential marker of disease severity. Taken together, this study describes the metabolome-wide changes due to hospitalisation and COVID-19 disease progression. Moreover, we propose a wide range of novel potential biomarkers for monitoring COVID-19 disease course, both dependent and independent of the severity.

Transcriptomic network analysis reveals key drivers of response to anti-TNF biologics in patients with rheumatoid arthritis.

Anti-TNF biologics have been widely used to ameliorate disease activity in patients with RA. However, a large fraction of patients show a poor response to these agents. Moreover, no clinically applicable predictive biomarkers have been established. This study aimed to identify response-associated biomarkers using longitudinal transcriptomic data in two independent RA cohorts. RNA sequencing data from peripheral blood cell samples of Korean and Caucasian RA cohorts before and after initial treatment with anti-TNF biologics were analysed to assess treatment-induced expression changes that differed between highly reliable excellent responders and null responders. Weighted correlation network, immune cell composition, and key driver analyses were performed to understand response-associated transcriptomic networks and cell types and their correlation with disease activity indices. In total, 305 response-associated genes showed significantly different treatment-induced expression changes between excellent and null responders. Co-expression network construction and subsequent key driver analysis revealed that 41 response-associated genes played a crucial role as key drivers of transcriptomic alteration in four response-associated networks involved in various immune pathways: type I IFN signalling, myeloid leucocyte activation, B cell activation, and NK cell/lymphocyte-mediated cytotoxicity. Transcriptomic response scores that we developed to estimate the individual-level degree of expression changes in the response-associated key driver genes were significantly correlated with the changes in clinical indices in independent patients with moderate or ambiguous response outcomes. This study provides response-specific treatment-induced transcriptomic signatures by comparing the transcriptomic landscape between patients with excellent and null responses to anti-TNF drugs at both gene and network levels.

Bone Marrow Stimulation for Osteochondral Lesions of the Tibial Plafond Yields Good Patient-Reported Outcomes in Daily Living but Moderate Outcomes in Sports Activities at 2- to 22–Years Follow-Up

To assess the patient-reported outcomes, as well as the revision and complication rates, of patients who underwent arthroscopic bone marrow stimulation (BMS) for an osteochondral lesion of the tibial plafond (OLTP). Patients with an OLTP treated with arthroscopic BMS at a minimum follow-up of 2-years were cross-sectionally included from a historical database. The primary outcome was the Numeric Rating Scale (NRS) during walking. Secondary outcomes included the NRS in rest and during running, and the Foot and Ankle Outcome Score. Additionally, the association of baseline patient and lesion demographics with follow-up patient-reported outcome measures (PROMs) was assessed with the Spearman rank correlation test. A subanalysis was performed for PROMs in patients with or without a coexisting talar (i.e., bipolar) lesion. Finally, the revision surgery (i.e., repeat surgery for the OLTP) and complication rates were assessed. Fifty-one patients were included at a mean 8.8 (standard deviation [SD]= 5.7, range, 2-22) years follow-up. Seventy-three percent of patients had a solitary OLTP, and 27% had a coexisting talar (bipolar) lesion. Males had a significantly higher rate of bipolar lesions compared to females (P ≤ .01), and patients with a bipolar lesion had a significantly larger OLTP lesion diameter (P= .02) and volume (P= .04). At final follow-up, the mean NRS during walking was 1.9 (SD= 2.3) out of 10. Anterior-posterior OLTP size (r= 0.36; P ≤ .01) was significantly associated with a higher NRS pain score during walking, although the presence of bipolar lesions did not result in inferior clinical outcomes. At final follow-up, 6% of patients underwent revision surgery. Minor complications were observed in 12% of patients. Arthroscopic BMS for OLTP results in favorable patient-reported outcomes at mid- to long-term follow-up, although moderate outcomes were observed in sports activities. Lesion size was associated with increased pain scores, although bipolar lesions did not result in inferior patient-reported outcomes. Six percent of patients required revision surgery, and 12% of patients had minor complications after surgery. Level III, retrospective cohort study.

First stage of labour duration and associated risk of adverse neonatal outcomes

Prior evidence evaluating the benefits and harms of expectant labour duration during active first stage is inconclusive regarding potential consequences for the neonate. Population-based cohort study in Stockholm-Gotland region, Sweden, including 46,040 women (Robson 1), between October 1st, 2008 and June 15th, 2020. Modified Poisson regression was used for the association between active first stage of labour duration and adverse neonatal outcomes. 94.2% experienced a delivery with normal neonatal outcomes. Absolute risk for severe outcomes increased from 1.9 to 3.0%, moderate outcomes increased from 2.8 to 6.2% (> 10.1 h). Compared to the reference, (< 5.1 h; median), the adjusted relative risk (aRR) of severe neonatal outcome significantly increased beyond 10.1 h (> 90th percentile) (aRR 1.53, 95% CI 1.26, 1.87), for moderate neonatal outcome the aRR began to slowly increase beyond 5.1 h (≥ 50 percentile; aRR 1.40, 95% CI 1.24, 1.58). Mediation analysis indicate that most of the association was due to a longer active first stage of labour, 13% (severe neonatal outcomes) and 20% (moderate neonatal outcomes) of the risk was mediated (indirect effect) by longer second stage of labour duration. We report an association between increasing active first stage duration and increased risk of adverse neonatal outcomes. We did not observe a clear labour duration risk threshold.

Transcatheter aortic valve replacement with the self-expanding ACURATE Neo2 in patients with horizontal aorta: Insights from the ITAL-neo registry

BackgroundHorizontal aorta (HA), defined by an aortic angulation (AA) ≥48°, is associated with worse outcomes particularly after self-expanding (SE) trans-catheter heart valve (THV) implantation. Although the SE ACURATE Neo THV demonstrated favorable procedural success rates in patients with HA, it remains associated with a non-negligible rate of moderate or greater paravalvular leak (PVL). ObjectivesAim of the study was to assess the performance of ACURATE Neo2 in the setting of HA. MethodsWe performed a multicenter cohort analysis on patients with severe aortic valve stenosis and HA undergoing transcatheter aortic valve replacement (TAVR) with the Neo or Neo2 THV enrolled in the ITAL-neo registry. The primary endpoint was a composite of early safety and clinical efficacy at 30 days according to the Valve Academic Research Consortium-3 (VARC-3). Secondary endpoints included the occurrence of moderate or severe PVL and 90-day clinical outcomes. ResultsAmong 900 patients included in the ITAL-neo registry, 407 exhibited HA; of these, 300 received a Neo THV and 107 a Neo2 THV. HA, irrespective of the THV implanted, emerged as an independent risk factor for developing ≥ moderate PVL. Technical and device success at 30-day follow-up was comparable between groups. However, Neo2 was associated with a significantly lower rate of ≥moderate PVL vs. Neo: (5% vs. 15%; p < 0.001), which was confirmed also at 90-day follow-up. Additionally, no correlation was found between ≥moderate PVL and AA in the Neo2 group, while PVL degree increased proportionally to the AA in the Neo cohort. ConclusionIn patients with HA, the new generation Acurate Neo2 THV was associated with a comparable device success rate and a significantly lower rate of ≥moderate PVL, when compared with its predecessor.

Decreased liver density as a potential predictor of severe COVID-19: a retrospective cohort study

Background. To stratify the risk in patients with COVID-19, it is important to understand the parameters that predispose to a severe course. Following risk factors were described: age over 60 years, overweight, male gender, chronic diseases: hypertension, diabetes mellitus. Low liver density on computed tomography (CT) is also considered as a potential risk factor.&#x0D; Aim. To evaluation whether low liver density can be used as a predictor of severe COVID-19.&#x0D; Materials and methods. Retrospective single-center cohort study. Patients with COVID-19 treated in a hospital setting, who underwent two CT scans of the thoracic organs in dynamics, were included. The patients were divided into groups according to the severity of the course (groups of moderate course, severe course and lethal outcome). Relation of the investigated factors was estimated using regression analysis.&#x0D; Results. 99 patients were enrolled; 3 comparison groups were formed (moderate-severe course n=37, severe course n=52, lethal outcome n=8). All groups significantly differed in C-reactive protein levels. According to multivariate regression analysis, COVID-19 severity was influenced by the liver to spleen density ratio as measured by CT scan on admission [odds ratio 12.18 (95% confidence interval 1.6789.07); p=0.008].&#x0D; Conclusion. Reduced liver density on CT scan in a patient with COVID-19 may be a predictor of severe course of novel coronavirus infection.

Evaluation of the better operative outcome software tool to predict cataract surgical outcome in the early postoperative follow-up

BackgroundCataracts are the world’s leading cause of avoidable blindness. In low-income countries, there are high rates of poor follow-up, which makes it very difficult to monitor surgical outcomes. To address this issue, the Better Operative Outcome Software Tool (BOOST Cataract app) predicts outcome on the first postoperative day and provides specific advice to improve outcomes. The aim of the study is to evaluate the ability of the BOOST Cataract app to categorise surgical outcomes and to analyse the possible factors that contribute to its performance. This was a prospective observational study performed at the General Hospital of Hospitalet of Llobregat.ResultsA total of 126 cataracts were included. Patients had a mean [SD] age of 75.8 [12.19] years, and 52% were females. Manual small-incision cataract surgery was involved in 57% and phacoemulsification in 43%. Thirty-eight percent of eyes presented significant corneal oedema on day 1. The BOOST Cataract app succeeded in categorising the final outcome in 65.6% of the eyes and in 93,4% of the eyes with good outcome.The agreement between the BOOST and UDVA outcomes was 0.353 (p< .000). The level of agreement improved to 0.619 (p< .000) in eyes with clear corneas. Success obtained by BOOST for both types of surgery was not statistically different. Eyes that obtained a good outcome on day one after surgery and eyes with clear cornea had 37 times higher odds (95% CI 6.66, 212.83) and 12 times higher odds (95% CI 3.13, 47.66) of being correctly categorised by the BOOST Cataract app than eyes that obtained a suboptimal (moderate and poor) outcome and eyes with corneal oedema on day 1.ConclusionsThe BOOST Cataract app is an e-Health tool designed to address issues of measuring quality in low- and middle-income settings. Although its reliability is limited to eyes that obtain a good outcome and with clear corneas on day 1, the use of the tool on a regular basis facilitates monitoring and reporting outcomes when clinical data collection is challenging due to low postoperative follow-up rates.

Negative multicultural experiences can increase intergroup bias

Multicultural experiences – such as living, traveling, or working abroad – can have many psychological benefits, including decreasing intergroup bias. However, unlike the intergroup contact literature, research on multicultural experiences has yet to examine whether the valence of these experiences may moderate such outcomes. So, could multicultural experiences actually increase intergroup bias? Five studies reveal that multicultural experiences increase (rather than decrease) intergroup bias when those experiences are negative (rather than positive). Across multiple methods (recall priming; virtual reality simulation), and experiences across multiple countries, negative multicultural experiences increased intergroup bias (stereotyping; prejudice) – both to groups associated, and stigmatized groups not associated, with the specific multicultural experience. This increased bias did not extend to ingroup members or non-human targets. The impact of negative multicultural experiences on increased bias was mediated by changes in intergroup ideologies/worldviews – specifically social dominance orientation. These findings reveal how multicultural experiences can be a double-edged sword in our increasingly globalized world.

P-154 Is there an impact of oocyte vitrification on embryological and clinical outcomes in PGT-A cycles? A propensity score matching-based study

Abstract Study question Does oocyte vitrification affect euploid blastocyst rate (EBR) per cohort of inseminated oocytes and/or clinical outcomes per euploid blastocyst transfer? Summary answer Vitrified-warmed oocytes are subject to ≈90% cryo-survival and lower blastulation rates than fresh cohorts, but similar euploidy and clinical outcomes per euploid blastocyst transfer. What is known already Cryopreservation was a game-changer in IVF. It is an essential step of the IVF journey with a plethora of clinical (e.g., reduction of OHSS while fully-exploiting the ovarian reserve, implementation of chromosomal/genetic testing, cumulative perspective in defining IVF success), logistic (e.g., higher flexibility), and social (e.g., fertility preservation) advantages. Vitrification represents the gold-standard protocol. Studies in sibling oocytes showed that vitrification may slightly reduce blastocyst development without impact on embryo chromosomal constitution. Here we aimed at measuring the impact (if any) of oocyte vitrification on EBR per cohort of inseminated oocytes and clinical outcomes per euploid blastocyst transfer. Study design, size, duration We gathered a dataset of first PGT-A cycles with vitrified-warmed (N = 54) or fresh (N = 3916) inseminated MII-oocytes (April-2013 to July-2022). Patients were matched 1:1 for maternal age at retrieval (37.2 ± 3.4 versus 37.1 ± 3.4 years) and MII-oocytes used (8.7 ± 4.1 versus 9.0 ± 5.1) through propensity-score-matching resulting in 49 cycles per arm. The primary outcome was EBR per cohort of inseminated MII-oocytes. The secondary outcomes were all embryological and clinical outcomes, including cumulative-live-birth-rate (CLBR) per concluded warming/fresh cycle. Participants/materials, setting, methods ICSI of all (cryo-survived) MII-oocytes, trophectoderm biopsy without day3 zona-drilling, and comprehensive-chromosome-testing to assess full-chromosome non-mosaic aneuploidies were performed. Cryopreservation was performed via vitrification. Only euploid blastocyst transfers were conducted. The groups were comparable also for BMI and sperm factor. The reasons for oocyte vitrification were supernumerary oocytes (N = 22, 45%; days between vitrification and warming: 573.7 ± 503.9), postponement of sperm collection (N = 7, 14%; 69.3 ± 113.4 days) and fertility preservation (N = 20, 41%; 1160 ± 779.7 days). Main results and the role of chance 8.7 ± 4.1 oocytes were warmed and 7.9 ± 3.7 survived (survival rate: 90.3 ± 14.7%). The zygotes were 5.4 ± 2.9 and 6.5 ± 4.0 in the vitrified-warmed and fresh groups, respectively (p = 0.2; fertilization-rates: 69.7 ± 22.3% versus 73.6 ± 18.4%, p = 0.5). The blastocysts were 2.1 ± 1.8 and 3.0 ± 1.9 (p = 0.01; blastulation-rates per zygotes: 34.9 ± 26.2% versus 49.4 ± 26.7%, p = 0.02). The euploid blastocysts were 1 ± 1.2 and 1.4 ± 1.6 (p = 0.2; euploidy-rates per biopsied blastocysts: 49.7 ± 34.3% versus 45.7 ± 36.3%, p = 0.5). The EBR per inseminated oocytes were 12.7 ± 13.3% and 17.5 ± 18.1% (p = 0.3). AA-blastocyst rates were also similar (N = 48/101, 47.5% versus N = 77/149, 51.7%, p = 0.6), while the day5-blastocysts rate was lower among vitrified-warmed cohorts (N = 12/101, 11.9% versus N = 51/149, 34.2%, P &amp;lt; 0.01). Nonetheless, the clinical outcomes per euploid transfer (LBR: N = 15/34, 44.1% versus N = 16/38, 42.1%, p = 0.99; miscarriage-rate per clinical pregnancy: N = 1/16, 6.3% versus N = 4/20, 20%, p = 0.4), gestational age (37.8 ± 1.5 versus 38.4 ± 1.4 weeks, p = 0.32) and birthweight (3471.7 ± 575 versus 3153.8 ± 449.3 g, p = 0.1) were comparable. 85.7% (N = 42/49) and 77.6% (N = 38/49) of the warming/fresh cycles were concluded with similar CLBR: 33.3% (N = 14/42) versus 39.5% (N = 15/38; p = 0.6). Among the 22 cohorts of vitrified-warmed oocytes because supernumerary, the EBR per inseminated oocytes was similar to their sibling fresh cohorts (11.7 ± 13.4% versus 13.8 ± 11.1%; p = 0.6). Also, 68.1% warming cycles were concluded (N = 15/22) eliciting 20% CLBR (N = 3/15), comparable to their sibling fresh cohorts (N = 4/22, 18.2%). Limitations, reasons for caution Retrospective design with limited sample size. About half of the patients in the vitrified-warmed group cryopreserved oocytes because supernumerary. These women were characterized by better ovarian reserve markers and response to ovarian stimulation than controls. Nonetheless, these parameters do not affect our primary outcome. Wider implications of the findings Oocyte vitrification is crucial in IVF. It involves higher flexibility with clinical (full ovarian reserve exploitation, oocyte accumulation), social (fertility preservation), and ethical (cryo-storage of supernumerary oocytes) benefits. Beyond a moderate impact (degeneration after warming, lower blastulation-rates), euploidy-rates and clinical outcomes are not affected by this procedure. Trial registration number not applicable

The Chinese herbal KangXianYiAi formula inhibits hepatocellular carcinoma by reducing glutathione and inducing ferroptosis

IntroductionHepatocellular carcinoma (HCC) is one of the most common malignant tumors worldwide and has a moderate treatment outcome. The traditional Chinese medicine KangXianYiAi formula (KXYA) has shown a clinically therapeutic effect on liver lesions. Here, we aimed to explore the effect and mechanism of KXYA in treating HCC. MethodsThe rat HCC model induced with diethylnitrosamine was treated with KXYA. After treatment, the rat's serum and the liver tissues were used to detect biochemical indices and perform pathological examinations, second-generation sequencing (RNA-seq), and phosphoproteomics analysis (PPOA). The hepatoma cells were treated with KXYA in vitro and a nude-mice model. The expression levels of genes were detected by quantitative Real-Time Polymerase Chain Reaction (qRT-PCR), Western blotting (WB), and immunohistochemistry approaches. The expression and prognosis data of genes in HCC were obtained from the public database. ResultsCompared to the model, KXYA treatment significantly downregulated the rats’ serum hepatitis index, inflammatory damage, collagen deposition, and malignant proliferation of hepatocytes. And through the RNA-seq and PPOA analysis of rat liver tissues, we obtained the key pathways of KXYA including glutathione metabolism and ferroptosis. The qRT-PCR and WB results suggested that the key targets of UGDH, AKR1B10, and SLC7A11 were abnormally upregulated in HCC and downregulated to normal levels after KXYA treatment. In the public database, UGDH, AKR1B10, and SLC7A11 expression was significantly upregulated in HCC and indicated a poor prognosis. DiscussionOur study showed that KXYA treatment could effectively inhibit the progression of HCC by reducing glutathione and inducing ferroptosis of liver cancer cells.

Prognostic Signals From Moderate Valve Disease in Big Data: An Artefact of Digital Imaging and Communications in Medicine Structured Reporting?

Recent studies have identified an association between moderate AS and outcome. We assessed whether DICOM structured reporting (SR), which captures and inserts echocardiographic measurements and text data directly into radiological reports, may lead to misclassifying patients with severe aortic stenosis (AS) as moderate. Moderate or severe AS cases were filtered from an echocardiography dataset based on aortic valve area (AVA) <1.5 cm2, indexed AVA (AVAi) <0.85 cm2/m2, mean pressure gradient (MPG) >25 mmHg, dimensionless severity index (DSI) <0.5, or peak velocity (Vmax) >3 m/s. Data validation was conducted by verification of each parameter. Each echocardiographic parameter and definitions of AS were compared pre- and post-validation by taking differences in measurements. Misclassification rates were assessed by determining percent of cases that changed AS severity classification and impact on outcomes. Patients were followed over 4.3±1.5 years. Of 2,595 validated echocardiograms with AS, up to 36% of the echocardiographic parameters for AS criteria had >10% difference between DICOM-SR and manual validation, highest with MPG (36%) and lowest with DSI (6.5%). The validation process changed the reported degree of AS in up to 20.6% of echocardiograms with resultant changes in AS severity and its association with mortality or heart failure-related hospitalizations. In contrast to multiple quantitative metrics in DICOM-SR after manual validation, clinicians' evaluation of AS severity was unable to distinguish composite outcomes over 3 years between moderate and severe AS. The risk of composite outcomes was significantly increased when severe AS was evidenced by at least 1 echocardiographic parameter of severe AS (hazard ratio (HR) =1.24 [95% CI: 1.12-1.37], p<0.001). The greatest hazard was based on DSI only (HR=1.26 [95% CI: 1.10-1.44, p<0.001), which was higher after manual validation compared to DICOM-SR. Averaging of repeated echo measures including invalid values contributed most to erroneous data. Non-peak data in DICOM-SR led to incorrect categorization of a high proportion of patients based on AS severity definitions. Standardization of data fields, and curation to ensure that only peak values are imported from DICOM-SR data are essential.

The Value of an Arts Degree: Career Success and Inequality

This study examines the value of a college degree for artists, in addition to racial, sex, and ethnic differences. I use propensity score matching on data from the 2015–2019 American Community Survey to produce causal estimates of the effect of getting an arts degree and a non-arts bachelor’s degree on income, and the probability of unemployment, self-employment, and working in an arts industry. The results illustrate that degrees positively affect artists’ average incomes and, depending on the type of degree, the probability of working in an arts industry. The analyses also illustrate that degrees have differential effects on artists’ employment outcomes based on race, sex, and ethnicity, though not always in the direction we would expect. The results illustrate the often-delicate balance between building a career as an artist and maintaining a livelihood and that individual differences with respect to career aspirations and personal circumstances moderate employment outcomes that are often attributed to common educational trajectories.

P54 ORAL ANTIVIRALS RITONAVIR-NIRMATRELVIR AND MOLNUPIRAVIR ARE HIGHLY EFFECTIVE IN PATIENTS WITH MULTIPLE MYELOMA AND COVID-19; A SINGLE-CENTER, PROSPECTIVE STUDY

P54 ORAL ANTIVIRALS RITONAVIR-NIRMATRELVIR AND MOLNUPIRAVIR ARE HIGHLY EFFECTIVE IN PATIENTS WITH MULTIPLE MYELOMA AND COVID-19; A SINGLE-CENTER, PROSPECTIVE STUDY

Outcomes in infants with unprovoked venous thromboembolism: A retrospective cohort study

BackgroundAlthough children aged <1 year have a relatively high rate of venous thromboembolism (VTE) compared to older children, most have additional prothrombotic risk factors. Unprovoked VTE is rare, and little is known about this population, particularly the risk of recurrent VTE. ObjectivesWe aimed to determine the rate of recurrent VTE in infants with prior unprovoked VTE and evaluate long-term, end-organ outcomes for infants with renal and intracranial vein thrombosis. MethodsInfants <1 year of age with an unprovoked VTE between 2003 and 2021 at a single institution were included. Time to recurrent event and anticoagulation duration were summarized using the Kaplan-Meier estimator. Neurologic outcomes were summarized with the pediatric stroke outcome measure for infants with cerebral sinovenous, medullary, or cortical vein thrombosis. Kidney outcomes were summarized with estimated glomerular filtration rates for infants with renal vein thrombosis. Anticoagulation was summarized. ResultsForty infants with intracranial, renal, portal, and extremity VTE met the inclusion criteria and were followed for a median of 4.7 years (IQR, 2.1-8.5). Most VTE events occurred during the first month of life. There was 1 recurrent event in 237 person-years of follow-up (incidence rate, 4 per 1000 [95% CI, 0.6-29.9] person-years). In outpatient follow-up, 40% of infants with intracranial thrombosis met criteria for moderate or severe neurologic outcomes and two-thirds of infants with a prior renal vein thrombosis had abnormal kidney function (estimated glomerular filtration rate < 90 mL/min/1.73 m2). ConclusionThere is a low rate of recurrent VTE but significant end-organ morbidity in infants with unprovoked VTE.

358 Using autism symptom profiles at intervention baseline to predict social cognitive outcomes

OBJECTIVES/GOALS: 1) Investigate the utility of pragmatic communication profiles in a sample of children with autism at baseline to predict response to treatment in a randomized clinical trial (RCT) of oxytocin augmentation and social cognitive skills training at week 12. 2) Determine if levels of anxiety or hyperactivity moderate child outcome performance. METHODS/STUDY POPULATION: 40 children (37M, 3F), aged 8-11(M=9.25, SD=1.10), with confirmed autism spectrum disorder (ASD), enrolled in an RCT(NCT02918864) were evaluated at baseline on: an assessment of ASD (Autism Diagnosis Observation Schedule, ADOS-2), a task of perspective taking, Theory of Mind ToM, (Reading the Mind from the Eyes Task), pragmatic communication (Pragmatic Rating Scale-School Aged; PRS-SA), IQ (WAIS_I, WISC-V) and anxiety and hyperactivity (Behavior Assessment Scales for Children-3; BASC-3). A Tobii T60 XL was used for eye-tracking visual patterns and attention during the RMET. The PRS-SA was coded by trained, reliable clinicians. Parent ratings indicated over half of the participants’ had At Risk levels or higher on anxiety and hyperactivity on the BASC-3. Week 12 measures included all but the PRS-SA and ADOS-2. RESULTS/ANTICIPATED RESULTS: Baseline preliminary analysis indicated the participants spent more time looking at words (.41ms) than eye images on the RMET(.15ms, p DISCUSSION/SIGNIFICANCE: Findings at baseline suggest pragmatic communication skills are more related to ToM than gaze and attention on the RMET. This relationship will be further investigated over the time of the trial. Mental health indicators need to be considered further in this population. Child profiles at baseline may inform appropriate triage and treatment targets.