Non-response Rate Research Articles

Son Preference among Infertile Couples at the Fertility Clinic of Two Tertiary Hospitals in Enugu, Nigeria.

Son preference is known to be prevalent in developing countries and has dire consequences for the family, particularly girls and women. It is speculated that the prevalence of son preference may be high among fertility clinic attendees, and that son preference may be the reason for seeking fertility care in Nigeria. To determine the prevalence and risk factors for son preference among fertility seekers in Enugu, Nigeria. Questionnaire-based cross-sectional study of fertility clinic attendees from the University of Nigeria Teaching Hospital Ituku-Ozalla Enugu and the Pink Petals Fertility Clinic Enugu from April 1 to September 30, 2023. Eligible and consenting participants were interviewed. Data collection was with a pretested interviewer-administered questionnaire, which contained three sections: biodata, obstetrics and gynecological data and 3-point son preference questions. The proportion of those who scored 3 (son preference) was documented. The analysis was both descriptive and inferential using IBM SPSS statistics for Windows, version 22.0 Armonk, NY, USA: IBM Corp. Of the 422 participants interviewed, 416 (98.6%) completed the study with a nonresponse rate of 6 (1.4%). The overall prevalence of son preference was 10.1% (42/416) and all 42 (10.1%) were in the clinic to have a male baby. The risk factors for son preference were less than tertiary education (P < 0.001, adjusted odds ratio [AOR] = 6.46, confidence interval [CI] 2.79-14.98) and family pressure to have a male baby (P = 0.03, AOR = 3.41, CI 1.72-7.13). One in 10 couples who attend an infertility clinic in Enugu, Nigeria, has a preference for son, and having a male child is the sole purpose of such a visit. Being under family pressure and not having tertiary education were the predictive risk factors for son preference in the study population.

IJCM_107A: A study on healthcare seeking behaviour among the geriatric population residing in southeast Delhi: A community based cross sectional study

Background: Health-seeking behaviour is defined as ‘any activity undertaken by individuals who perceive themselves to have a health problem or to be ill for the purpose of finding an appropriate remedy. The severity of the disease among elderly is influenced by one important factor which is health seeking behaviour. To regain their lost health status the elderly must seek the treatment. The way people conceptualize the cause of their health problem and their perception of symptoms plays an important role in seeking healthcare. Health seeking behaviour is influenced by few factors like illiteracy, misconception, income, family composition, social isolation and dependency. Objective: To assess the healthcare seeking behaviour among the geriatric population residing in the field practise area of a Medical College in South East Delhi. Methodology: Community-based cross-sectional study conducted in South East Delhi. • The sample size was calculated as 350 considering a relative error of 3% at 95% level of significance and 10% non-response rate. Stratified random sampling with probability proportional to size was applied to the population registered at UHTC &amp; RHTC area of a medical college in southeast Delhi. Households were selected by systematic random sampling. Persons aged &gt; 60 years from the households were selected for the study. A self-designed, pre-tested, validated, structured questionnaire was used to collect the data. Results In our study it was found that the majority of the participants take treatment when they fall sick ie 99.5%. Of those who take treatment 54% go forconsultation whereas 48% take over the counter medication and 33% do home remedies. Out of the 54% who consult, 78.7% visit Private health facility and 21.3% visit Public health facility. Out of the 78.7% who visit private health facility 65.9% visit Non registered medical practitioner and 7.1% don’t even know whether their doctor is registered or not. Majority of the participants ie 86% preferred health facility within 1kms of their house &amp; it was also a major reason for choosing a health facility for consultation. 98% of the participants visit only in case of illness. 52% were accompanied by their children or daughter in law and 26% visited alone. Conclusion: The participants favoured more private than public healthcare institutions. Nearby medical facilities were favoured, and non-registered medical professionals comprised the majority of them. Almost all senior people received therapy of some kind rather than dismissing it as an issue unique to ageing.

Practices in Data-Quality Evaluation: A Large-Scale Review of Online Survey Studies Published in 2022

In this study, I examine data-quality evaluation methods in online surveys and their frequency of use. Drawing from survey-methodology literature, I identified 11 distinct assessment categories and analyzed their prevalence across 3,298 articles published in 2022 from 200 psychology journals in the Web of Science Master Journal List. These English-language articles employed original data from self-administered online questionnaires. Strikingly, 55% of articles opted not to employ any data-quality evaluation, and 24% employed only one method despite the wide repertoire of methods available. The most common data-quality indicators were attention-control items (22%) and nonresponse rates (13%). Strict and unjustified nonresponse-based data-exclusion criteria were often observed. The results highlight a trend of inadequate quality control in online survey research, leaving results vulnerable to biases from automated response bots or respondents’ carelessness and fatigue. More thorough data-quality assurance is currently needed for online surveys.

Factors Associated with High Prevalence of Multibacillary Leprosy in West Bengal: A Case-Control Study.

High proportion of multibacillary (MB) among newly diagnosed leprosy cases poses a public health challenge. This study aimed to find out the factors associated with the high burden of MB leprosy in West Bengal. This case-control study was conducted from August 2020 to December 2022 in three high-endemic districts (annual new case detection rate ≥10/lakh) of West Bengal. MB cases registered under the National Leprosy Eradication Programme were considered as case and paucibacillary (PB) cases were considered as control. Weighted sample sizes for cases and controls in each of the three districts were selected using simple random sampling from the list of registered leprosy patients. Requisite data were collected through structured interview with a validated questionnaire in Bengali. R, version 4.1.1 (R Foundation for Statistical Computing, 2021, Vienna, Austria) was used for data analysis. A binary logistic regression model was prepared with the type of leprosy as a dependent variable. Three hundred and ninety-eight individuals, 204 MB and 194 PB, participated in this study with 1.97% nonresponse rate. Gender, marital status, and diagnostic delay (adjusted odds ratio = 2.75 [1.66,4.65]) were associated with developing MB. Not perceiving the symptoms seriously (90, 56% [PB], 97, 51% [MB]), lack of knowledge about the disease and its complications (47, 29% [PB], 53, 28% [MB]), delayed referral by the private practitioners (11, 7% [PB], 22, 12% [MB]) were the major reasons of delay. This study identified a vulnerable group - married and migrated males. Changing from annual screening to quarterly screening along with capacity building and awareness generation of the targeted population is the need of the hour for eradicating the disease.

IJCM_24A: Determinants of unintended pregnancy among women attending Antenatal clinic at AIIMS Patna – a cross-sectional study

Background: Every day 67,385 babies are born in India, that’s around one- sixth of the world’s childbirths. Every minute one of these new-borns dies, with an annual birth rate of 25 million which accounts for nearly one-fifth of the world’s annual childbirth. Objectives: 1. To find out the proportion of unintended pregnancy among women of reproductive age group attending ANC Clinic of AIIMS Patna USING LUMP SCALE. 2. To determine the Factors contributing to unintended pregnancy. Methodology: This was a hospital based cross-sectional study done for 6months (March 2022 to September 2022) conducted in Department of Obstetrics and Gynaecology OPD, AIIMS Patna and included all the pregnant ladies who visited the ANC clinic. Consecutive sampling was done and a sample size of 237 was taken rounding off to 250 with 5% absolute precision, 95% confidence and 10% non-response rate. A predesigned, semi-structured questionnaire was used and the information collected was downloaded from Epicollect5/Google forms in an MS Excel sheet and analysis was done using the IBM SPSS version20. Results: Out of 255 participants who were more than 20 years of age 31% (79) participants had unplanned pregnancies compared to 50% (17) out of 34 participants whose age was less than 20. This association was statistically significant with a p-value of 0.027. Out of 289 participants attending the ANC clinic, 32.87% (95) participants had a history of abortion among which only 23.2% (22) participants had an unplanned pregnancy. This association was statistically significant with a p-value of 0.011. Conclusion: In our study we found the prevalence of unintended pregnancy to be 33.2% which is comparable with 33% prevalence of unintended pregnancy in African continent study.

IJCM_194A: Diabetes distress and associated factors among adult patients residing in an urban resettlement colony in Delhi

Background: Diabetes distress “refers to the negative emotional or affective experiences resulting from the challenge of living with the demands of diabetes.” The American Diabetes Association recommends routinely screening for distress. Presently, this does not take place and distress remains undiagnosed. Objectives: This study aimed to determine the prevalence of diabetes distress, its associated factors and the relationship between glycemic control and distress. Methodology: This community-based, cross-sectional study was conducted in a resettlement colony in Delhi. The participants were selected using simple random sampling and included adults diagnosed with DM. The sample size calculated was 433 (prevalence: 42%, absolute precision: 5%, non-response rate: 10%). The questionnaire included Diabetes Distress Scale 17 and Diabetes Self-Management Questionnaire. Fasting blood sugar (FBS) was tested for all the participants. Logistic regression was used to determine the factors associated with distress as well as the association between glycemic control status and the presence of distress. Results: 412 adults were included in the study, of which 35.4% had clinically significant distress. The factors found to be associated with diabetes distress on multivariable logistic regression were: female sex, belonging to the lower socio-economic status, having self-reported comorbidities, being diagnosed with diabetes 10 or more years ago, being on treatment from a private or government hospital as compared to not being on treatment and having an unmet need for social support. There was a positive association between physician contact and distress. Those with poor glycemic control had higher odds of distress, regimen related distress and emotional burden, as compared to those who had adequate glycemic control. Conclusion: In this study, distress was prevalent among 35.4% of adults with diabetes. The factors determined to be associated with distress may provide a targeted approach to address distress, which ought to be screened for in routine clinical settings and be addressed, to help improve disease control.

IJCM_294A: COVID-19 vaccination status and willingness for booster dose among staff and students of tertiary care institute

Background: Exposure to new COVID-19 variants and decline in herd immunity may result in new or repeat infection. The booster dose may face certain challenges that result in low uptake. The aim of the study was to assess the COVID-19 vaccination status and willingness of medical staff and students to receive further booster doses. Objectives: 1. To assess the willingness of staff and students regarding booster dose of any COVID-19 vaccine. 2. Explore reason behind the willingness of booster dose and nasal route. Methodology: A cross sectional study was conducted among the staff and students of a tertiary care institute. With 5% margin of error, 95% confidence interval, intention to receive booster vaccine as 55.3% and 10% non-response rate, the sample size was calculated as 312. The participants received a web based semi-structured questionnaire through email and WhatsApp. The data was analyzed using SPSS version 24. Descriptive analysis was performed in the form of frequency and proportions for categorical variables. Results: About 302 participants responded to the survey. About 51.3% of them were females and 61.2% belonged to 18-29 year age group. The health workers, ancillary staff and students were 37.7%, 40% and 22.2% respectively. About 49.3% received a precaution dose while 49% had received 2 doses of any COVID-19 vaccine. About 72.1% of the participants were willing to receive another booster dose. Perception of vaccine as an immunity booster was the top reason for the willingness. About 34.2% (25/73) of them preferred nasal route for the booster with 66.3% (21/33) perceiving it convenient to administer. Conclusion: Knowledge about the acceptance of COVID-19 vaccine and perceptions regarding the booster dose may help to increase the readiness of medical community to uptake the booster. Alternative routes of administration and reasons for willingness may reduce the skepticism for booster dose.

IJCM_92A: Pregnancy outcomes associated with antenatal care service utilization &amp; barriers and enablers affecting the utilization of antenatal care services in South-East Delhi: A community-based cross-sectional study

Background: Antenatal care provides preventive health care, through which women can learn from skilled health personnel. Women who don’t consume Iron Folic Acid Supplements as prescribed would experience iron and folic acid (IFA) deficiency anemia. Iron deficiency has negative effects on mothers and newborns while folic acid deficiency in pregnancy causes pre-eclampsia, preterm delivery, neural tube defects, fetal malformation, type 2 diabetes, and obesity in the newborn. Comprehensive antenatal care is early registration of pregnancy (within 12 weeks), at least four ANC visits at a health facility, two doses of tetanus toxoid, and at least 100 days of IFAS consumption. Objectives: 1-To assess pregnancy outcomes associated with antenatal care service utilization in participants aged 18-49 years residing in the field practice areas of a Medical College in South-East Delhi. 2-To determine the barriers and enablers affecting the utilization of antenatal care services in the given population. Methodology: It is a community-based cross-sectional study conducted in South-East Delhi. The sample size was calculated as 300 considering a 5% absolute error for a 95% confidence interval and 10% non-response rate. Out of 300, the current data of 200 participants will be depicted here. Stratified systematic random sampling with the Probability Proportional to Size technique was applied to the population registered at RHTC &amp; UHTC. Households were selected by systematic random sampling. Pregnant women aged between 18-49 years were selected from the household. A self-designed, pre-tested, validated structured questionnaire was used. Results: Out of the total number of participants, 66.0% had knowledge regarding early registration of pregnancy. 80.0 % had permission to attend a health facility, 70.5 % had an accompanying person, 62.5 % of participants had been residing more than 6 km away from the health facility. 58.0 % of participants could meet the expenses of health care services. Out of all newborns, 90.0 % had normal birth weights, 10% had low birth weights, 81.0% participants had NVDs, and 19% were caesarean sections. Conclusion: Enablers are knowledge regarding early registration, presence of accompanying person. Permission for health visits, expenses for health care services &amp; distance to health facility were barriers.

Defining predictors of responsiveness to advanced therapies in Crohn’s disease and ulcerative colitis: protocol for the IBD-RESPONSE and nested CD-metaRESPONSE prospective, multicentre, observational cohort study in precision medicine

IntroductionCharacterised by chronic inflammation of the gastrointestinal tract, inflammatory bowel disease (IBD) symptoms including diarrhoea, abdominal pain and fatigue can significantly impact patient’s quality of life. Therapeutic developments in the...

An Assessment of Knowledge of Health Workers in Hospitals of Southern Province of Zambia, Towards Marketing of Breastmilk Substitutes Regulations

Background: Optimal breastfeeding practices have been undermined by unregulated marketing of breastmilk substitutes worldwide, resulting in about 820, 000 preventable deaths per year among children under five years globally. The International Code (thereafter called the Code) of Marketing Breastmilk Substitutes was developed by the World Health Organization, the United Nations Children's Emergency Fund and stakeholders to protect, promote and support breastfeeding. Member states are expected to domesticate the Code. Zambia enacted Statutory Instrument No. 48 of 2006, Regulations on marketing of breastmilk substitutes. Successful implementation calls for a good level of knowledge among health workers. However, we found no study, in Zambia on the marketing of breastmilk substitutes Regulations. Objective: To assess the level of knowledge of health workers on Zambia’s Regulations on marketing breastmilk substitutes. Study design and methods: A mixed-method cross-sectional study. Data was collected online and in person. Probability proportional to size calculation yielded an estimated sample size of 384. A sample size of 410 after adjusting upwards assumed non-response rate, 401 participants responded. Quantitative data were analyzed using the Social Statistical Package for Social Sciences. Knowledge results were described by frequencies and percentages. Tests were conducted using univariable linear and multivariable regression analysis. A p-value of &lt;0.05 was considered statistically significant. Thematic analysis was used for qualitative data analysis. Results: The mean overall level of good knowledge of health workers was 0.339 or 34% [SE: 0.0221; 95%CI: (0.2959, 0.3828)]. Conclusion: The level of knowledge among health workers in hospitals of Southern Province, Zambia was poor.

Performance of GPT-4V in Answering the Japanese Otolaryngology Board Certification Examination Questions: Evaluation Study.

Artificial intelligence models can learn from medical literature and clinical cases and generate answers that rival human experts. However, challenges remain in the analysis of complex data containing images and diagrams. This study aims to assess the answering capabilities and accuracy of ChatGPT-4 Vision (GPT-4V) for a set of 100 questions, including image-based questions, from the 2023 otolaryngology board certification examination. Answers to 100 questions from the 2023 otolaryngology board certification examination, including image-based questions, were generated using GPT-4V. The accuracy rate was evaluated using different prompts, and the presence of images, clinical area of the questions, and variations in the answer content were examined. The accuracy rate for text-only input was, on average, 24.7% but improved to 47.3% with the addition of English translation and prompts (P<.001). The average nonresponse rate for text-only input was 46.3%; this decreased to 2.7% with the addition of English translation and prompts (P<.001). The accuracy rate was lower for image-based questions than for text-only questions across all types of input, with a relatively high nonresponse rate. General questions and questions from the fields of head and neck allergies and nasal allergies had relatively high accuracy rates, which increased with the addition of translation and prompts. In terms of content, questions related to anatomy had the highest accuracy rate. For all content types, the addition of translation and prompts increased the accuracy rate. As for the performance based on image-based questions, the average of correct answer rate with text-only input was 30.4%, and that with text-plus-image input was 41.3% (P=.02). Examination of artificial intelligence's answering capabilities for the otolaryngology board certification examination improves our understanding of its potential and limitations in this field. Although the improvement was noted with the addition of translation and prompts, the accuracy rate for image-based questions was lower than that for text-based questions, suggesting room for improvement in GPT-4V at this stage. Furthermore, text-plus-image input answers a higher rate in image-based questions. Our findings imply the usefulness and potential of GPT-4V in medicine; however, future consideration of safe use methods is needed.

Awareness of Urgent Care Services Among Primary Healthcare Center Patients in Al-Ahsa, Saudi Arabia.

Background Urgent care clinics (UCCs) provide services for patients without the need to book an appointment in advance to treat acute diseases and injuries that do not need ED service and provide care for chronic conditions. This study aimed to assess the patients's level of awareness regarding UCCs in the Al-Ahsa region and provide information contributing to decision-makers' support about the urgent care services and their patterns of use within primary healthcare. Methods A descriptive cross-sectional study was conducted in the Al-Ahsa region from August 2023 to December 2023. A validated questionnaire was used. Cluster sampling was used to select three primary healthcare centers from four health sectors (southern cluster, middle cluster, northern cluster, and eastern cluster), and then simple random sampling was used to select participants. sample size calculated by Cochran'ssample size formula, which estimated 377 participants. However, to accommodate a non-response rate of 10.0% and stronger statistical power and effect size, the final sample size was 469 participants. Data were analyzed by SPSS Statistics version 28 (IBM Corp. Released 2021. IBM SPSS Statistics for Windows, Version 28.0. Armonk, NY: IBM Corp.). Both descriptive and inferential statistics were used. A p-value ≤0.05 is considered statistically significant. Results Of the 469 participants in the study, more than half (54.8%) were aged between 18 and 38 years old, and more than half (54.8%) were male. More than half (67.4%) reported having no chronic diseases, whereas the most common chronic diseases reported were diabetes mellitus (11.9%) and hypertension (14.3%). Most of the participants (84.9%) weren't aware of UCCs. Among the participants who were aware of UCCs (n=71), 53.5% of them had visited a UCC in the last three months. The most common reasons for their visits were the common cold (40.8%), headaches (5.6%), and abdominal pain (5.6%). More than one-third of participants (38.6%) believed that UCCs provide services like those of the emergency center. According to patients' sex, there was a significant (0.031) difference in the awareness level; the highest was among females at 20.1% vs. 12.6%. Conclusion The study revealed that the majority of the participants were unaware of UCCs. Increasing patients' awareness of UCCs is necessary through different media to improve access to healthcare services and reduce overcrowding in the ED that is caused by non-urgent problems.

Did People Really “Leave It Blank”? A Tale of What Became of the Census Citizenship Question and Allocation Trends Through Time

Abstract The 2020 Decennial Census garnered unprecedented attention due to the proposed reintroduction of the citizenship question by the Trump Administration. The legal imperative to respond to the Census and the sensitive nature of the citizenship question led to tensions and public outrage. This paper discusses the controversy surrounding the addition of the citizenship question and its implications on vulnerable communities, particularly undocumented immigrants and communities of color. Although the citizenship question was ultimately not added to the 2020 Decennial Census, it continued to be asked on the American Community Survey (ACS). We examine how negative public sentiment during this time, in tandem with historical mistrust of government data collection, may have manifested as item non-response within the ACS, specifically on questions relating to citizenship status and, more broadly, the Origin and Language subgroup of questions. The analyses in this paper explore trends in non-response rates from the American Community Survey from 2014 to 2022. Item allocation rates are used as a proxy for non-response to questions relating to citizenship. A variety of data visualization tools, supported by statistical methods, are employed to weave connections between allocation trends and the proposed addition of the citizenship question to the Decennial Census. We aim to bring transparency to this issue to educate and encourage response within vulnerable communities by emphasizing the importance of accurate data collection and positive perceptions of government-issued surveys, which are used to make key legislative decisions and create a more democratic nation.

Abstract 6694: Gut microbial drivers of response to bladder-sparing therapy in human muscle-invasive bladder cancer enhance immunotherapy efficacy and limit immunosuppression following fecal microbiome transplantation in vivo

Abstract BACKGROUND: Radiation therapy (RT) is a bladder-sparing option for Muscle-Invasive Bladder Cancer (MIBC), yet encounters a 30% non-response rate, with half of the patients succumbing to metastasis. Preclinical models demonstrate enhanced antitumor responses with RT combined with PD-1/PD-L1 blockade but give limited insight into the determinants of success for such combination therapies (CT). The gut microbiome, pivotal in conditioning local and peripheral immunity, influences PD-1-based immunotherapy efficacy in various cancers. Immune profiling indicates heightened systemic and antitumor immunity in responders with a favorable gut microbiome, enriched in Akkermansia muciniphila, Bifidobacterium, and Faecalibacterium. Oral gavage of immunogenic bacteria further enhances combined RT and anti-PD-L1 therapy. We thus aim to 1) elucidate the role of patients’ microbiome in shaping anti-tumor immune responses to CT, and 2) use its composition as a predictive factor for CT success. METHODS: We performed shotgun metagenomics on microbial DNA from fecal materials of MIBC RT responders (R, n=26) and non-responders (NR, n=11). Fecal homogenates from donors were gavaged into germ-free (GF) mice. Three weeks post-gavage, MB49 tumor cells were subcutaneously delivered to mice, randomized into four groups: control, anti-PD-L1, RT, and RT + anti-PD-L1. Tumors were harvested seven days post-treatment for single-cell RNA-seq and TCR sequencing (10X Genomics), while stool samples were collected weekly for 16S sequencing. RESULTS: Significant gut microbial disparities were observed between R and NR MIBC patients, with particular enrichment in known promoters of anti-PD-L1 response, such as Phocaeicola dorei in R. Transplantation of R microbiome into GF mice resulted in significant increases in predicted survival, tumor growth delay, and counts of effector CD4+ T cell infiltration in the RT+PD-L1 arm. Conversely, NR microbiome transplantation correlated with increased neutrophil and Treg infiltration, abrogating the survival tumor growth delay benefits of the combination arm. Spatial tissue analyses revealed higher neutrophil densities around CD8+ T cells in all NR arms. Single-cell RNA-seq of tumor-infiltrating immune cells unveiled skewed CD4 and CD8 polarization between R and NR in vivo batches. SIGNIFICANCE: To our knowledge, this is the first study to use FMT as a modulator of response in the context of radiation therapy combinations in MIBC. Our results highlight that the gut microbiome alone may condition a favorable immune terrain for combinatorial therapies involving radiation. This offers strong predictive value for personalized therapeutic approaches in selecting patients who will benefit the most from bladder-sparing therapies. Citation Format: Eva Michaud, Sabina Fehric, Cynthia Faubert, Bertrand Routy, Irah King, José Joao Mansure, Wassim Kassouf. Gut microbial drivers of response to bladder-sparing therapy in human muscle-invasive bladder cancer enhance immunotherapy efficacy and limit immunosuppression following fecal microbiome transplantation in vivo [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 6694.

Active immunotherapy for C5a-mediated inflammation using adjuvant-free self-assembled peptide nanofibers

The terminal protein in the complement cascade C5a is a potent inflammatory molecule and chemoattractant that is involved in the pathology of multiple inflammatory diseases including sepsis and arthritis, making it a promising protein to target with immunotherapies. Active immunotherapies, in which patients are immunized against problematic self-molecules and generate therapeutic antibodies as a result, have received increasing interest as an alternative to traditional monoclonal antibody treatments. In previous work, we have designed supramolecular self-assembling peptide nanofibers as active immunotherapies with defined combinations of B- and T-cell epitopes. Herein, the self-assembling peptide Q11 platform was employed to generate a C5a-targeting active immunotherapy. Two of three predicted B-cell epitope peptides from C5a were found to be immunogenic when displayed within Q11 nanofibers, and the nanofibers were capable of reducing C5a serum concentrations following immunization. Contrastingly, C5a's precursor protein C5 maintained its original concentration, promising to minimize side effects heretofore associated with C5-targeted therapies. Immunization protected mice against an LPS-challenge model of sepsis, and it reduced clinical severity in a model of collagen-antibody induced arthritis. Together, this work indicates the potential for targeting terminal complement proteins with active immunotherapies by leveraging the immunogenicity of self-assembled peptide nanomaterials. Statement of significanceChronic inflammatory diseases such as rheumatoid arthritis, psoriasis, and inflammatory bowel disease are currently treated primarily with monoclonal antibodies against key inflammatory mediators. While helpful for many patients, they have high non-response rates, are costly, and commonly fail as anti-drug antibodies are raised by the patient. The approach we describe here explores a fundamentally different treatment paradigm: raising therapeutic antibody responses with an active immunotherapy.We employ innovative supramolecular peptide nanomaterials to elicit neutralizing antibody responses against complement component C5a and demonstrate therapeutic efficacy in preclinical mouse models of sepsis and rheumatoid arthritis. The strategy reported may represent a potential alternative to monoclonal antibody therapies.

Factors associated with immunological non-response after ART initiation: a retrospective observational cohort study

BackgroundAmong people living with HIV (PLHIV) on antiretroviral therapy (ART), the mortality of immunological non-responders (INRs) is higher than that of immunological responders (IRs). However, factors associated with immunological non-response following ART are not well documented.MethodsWe obtained data for HIV patients from the National Free Antiretroviral Treatment Program database in China. Patients were grouped into IRs (CD4 cell count ≥ 350 cells/μl after 24 months’ treatment), immunological incomplete responders (ICRs) (200–350 cells/μl) and INRs (< 200 cells/μl). Multivariable logistic regression was used to assess factors associated with immunological non-response.ResultsA total of 3900 PLHIV were included, among whom 2309 (59.2%) were IRs, 1206 (30.9%) ICRs and 385 (9.9%) INRs. In multivariable analysis, immunological non-response was associated with being male (2.07, 1.39–3.09), older age [40–49 years (vs. 18–29 years): 2.05, 1.29–3.25; 50–59 years: 4.04, 2.33-7.00; ≥ 60 years: 5.51, 2.84–10.67], HBV co-infection (1.63, 1.14–2.34), HCV co-infection (2.01, 1.01–4.02), lower CD4 + T cell count [50–200 cells/μl (vs. 200–350 cells/μl): 40.20, 16.83–96.01; < 50 cells/μl: 215.67, 85.62-543.26] and lower CD4/CD8 ratio (2.93, 1.98–4.34) at baseline. Compared with patients treated with non-nucleoside reverse transcriptase inhibitors (NNRTIs) based regimens, those receiving protease inhibitors (PIs) based regimens were less likely to be INRs (0.47, 0.26–0.82).ConclusionsWe found a sizable immunological non-response rate among HIV-infected patients. Being male, older age, coinfection with HBV and HCV, lower CD4 + T cell count and lower CD4/CD8 ratio are risk factors of immunological non-response, whereas PIs-based regimens is a protective factor.

Comprehensive analysis of co-expressed genes with TDP-43: prognostic and therapeutic potential in lung adenocarcinoma

BackgroundTransactivating DNA-binding protein 43 (TDP-43) is intimately associated with tumorigenesis and progression by regulating mRNA splicing, transport, stability, and non-coding RNA molecules. The exact role of TDP-43 in lung adenocarcinoma (LUAD) has not yet been fully elucidated, despite extensive research on its function in various cancer types. An imperative aspect of comprehending the underlying biological characteristics associated with TDP-43 involves investigating the genes that are co-expressed with this protein. This study assesses the prognostic significance of these co-expressed genes in LUAD and subsequently explores potential therapeutic strategies based on these findings.MethodsTranscriptomic and clinical data pertaining to LUAD were retrieved from open-access databases to establish an association between mRNA expression profiles and the presence of TDP-43. A risk-prognosis model was developed to compare patient survival rates across various groups, and its accuracy was also assessed. Additionally, differences in tumor stemness, mutational profiles, tumor microenvironment (TME) characteristics, immune checkpoints, and immune cell infiltration were analyzed in the different groups. Moreover, the study entailed predicting the potential response to immunotherapy as well as the sensitivity to commonly employed chemotherapeutic agents and targeted drugs for each distinct group.ResultsThe TDP-43 Co-expressed Gene Risk Score (TCGRS) model was constructed utilizing four genes: Kinesin Family Member 20A (KIF20A), WD Repeat Domain 4 (WDR4), Proline Rich 11 (PRR11), and Glia Maturation Factor Gamma (GMFG). The value of this model in predicting LUAD patient survival is effectively illustrated by both the Kaplan–Meier (K–M) survival curve and the area under the receiver operating characteristic curve (AUC-ROC). The Gene Set Enrichment Analysis (GSEA) revealed that the high TCGRS group was primarily enriched in biological pathways and functions linked to DNA replication and cell cycle; the low TCGRS group showed primary enrichment in immune-related pathways and functions. The high and low TCGRS groups showed differences in tumor stemness, mutational burden, TME, immune infiltration level, and immune checkpoints. The predictions analysis of immunotherapy indicates that the Tumor Immune Dysfunction and Exclusion (TIDE) score (p < 0.001) and non-response rate (74% vs. 51%, p < 0.001) in the high TCGRS group are higher than those in the low TCGRS group. The Immune Phenotype Score (IPS) in the high TCGRS group is lower than in the low TCGRS group (p < 0.001). The drug sensitivity analysis revealed that the half-maximal inhibitory concentration (IC50) values for cisplatin, docetaxel, doxorubicin, etoposide, gemcitabine, paclitaxel, vincristine, erlotinib, and gefitinib (all p < 0.01) in the high TCGRS group are lower than those in the low TCGRS group.ConclusionsThe TCGRS derived from the model exhibits a reliable biomarker for evaluating both prognosis and treatment effectiveness among patients with LUAD. This study is anticipated to offer valuable insights into developing effective treatment strategies for this patient population. It is believed that this study is anticipated to contribute significantly to clinical diagnostics, the development of therapeutic drugs, and the enhancement of patient care.

P537 Analysis of immunological VAriables in ex vivo Tofacitinib-treated human biopsies from Active ulcerative colitis patients to predict clinical Response (the AVATAR study)

Abstract Background Ulcerative colitis (UC) is characterized by chronically relapsing inflammation of the colonic mucosa. Tofacitinib (TOFA) is a paninhibitor of the JAK kinases, a family of intracellular kinases in volved in the signal transduction pathway of multiple inflammatory signals. Despite the efficacy shown by TOFA in inducing and maintaining remission in moderately-to-severely active UC, rates of primary non response remains high. We propose a new method to identify predictors of responsiveness to TOFA based on "ex-vivo" challenge of organ cultures from biopsies collected from candidate patients. Methods Baseline biopsies from inflamed areas of UC patients with active disease and candidate to receive TOFA 10mg b.i.d. for 8 weeks, were used for "ex-vivo" organ culture and stimulated with TOFA 20μM and 200nM or left untreated. After 24 hours, proteomic analysis was performed and quantitative expression of 92 inflammation-related human proteins (Olink® Human Inflammation panel) was correlated with week 8 clinical response defined by Modified Mayo Score (MMS). Intestinal biopsies were also collected at baseline and at 8 weeks for proteomic analysis. To decipher the nature of TOFA's effects, both unsupervised and supervised machine learning (ML) methods were employed (sklearn module, Python). The K-means method was used for unsupervised learning followed by a supervised ML approach to classify week 8 responders and non-responders. Data were transformed in into a second-order polynomial format and logistic regression was used for modelling. Results Between Jannuary 2022 and January 2023, 17 UC patients were enrolled (Table 1). At week 8, 13/17 (76.5%) patients treated with TOFA showed clinical response. Unsupervised ML, utilizing proteomic data from organ cultures stimulated with TOFA 200nM, achieved a 90% success rate in predicting a positive clinical response. This prediction was based on forming two distinct clusters, with significant contributions from key variables such as CASP-8, CCL19, CCL20, CD5, CXCL9, EN-RAGE, GDNF, HGF, IL-18R1, MCP-1, MCP-2, MCP-4, MMP-10, OPG, PD-L1, STAMBP, TNFRSF9, TRANCE, TWEAK, and VEGFA. In our supervised ML approach, logistic regression was employed with 30 shuffle splits to refine the predictive model. We discovered that transforming the dataset into a second-order polynomial format significantly enhanced the model's performance. The most effective logistic regression model achieved a mean precision score of 0.82 (Fig.1). Conclusion Our predictive model demonstrates a high level of precision in identifying positive treatment responses, emphasizing the potential of further dataset expansion and the use of advanced machine-learning to predict response in TOFA-treated UC patients.

P703 Comparison of infliximab and adalimumab therapies Persistence in patients with Ulcerative Colitis: Results from a Single Tertiary Turkish IBD Center Cohort

Abstract Background In the last 25 years, the introduction of biological therapies has been a significant milestone in the management of inflammatory bowel diseases. Despite the recent emergence of new biological therapies and small molecules, Anti-TNF agents still play a crucial role in treatment. In a number of countries, anti-TNF agents are still reimbursed as a first line treatment following either a failure or intolerance to conventional therapies such as thiopurines and aminosalycilates. Many studies have been conducted previously to compare the efficacy of these drugs, but a clear conclusion could not be reached. In this study, we aimed to compare the persistence of infliximab (IFX) to adalimumab (ADA) in the treatment of ulcerative colitis at a tertiary IBD center in Turkey. Methods This was a retrospective cohort analysis of patients with ulcerative colitis either received adalimumab or infliximab as a first line biologic treatment. A total of 234 patients were included to this analysis. Demographic information such as gender, age, montreal classification, smoking and prior medications were noted from patients electronic medical records. Weighted Kaplan-Meier and Cox models were used to assess the outcomes. Results Out of the 234 patients included in the study, 116 had used infliximab, and 118 had used adalimumab as a first-line treatment. Age and gender of the patients in both groups did not differ from each other statistically. 88% of the patients treated with adalimumab and 84% of the patients treated with infliximab were thiopurine experienced. Montreal classification did not differ between two groups (in IFX group, 73% of the patients had Montreal E3 involvement where as in ADA group, 66% of the patients had Montreal E3 involvement, p&amp;gt;0.05). Primary non-response rates were not different between IFX and ADA group, 13.6% vs 13.4% respectively. In addition, clinical response rates after first year were 60% and 53% respectively. Drug persistency rates of adalimumab and infliximab in moderate to severe ulcerative colitis patients were not statistically different from each other (Figure 1). Conclusion Neither clinical efficacy rates nor drug persistency rates of adalimumab and infliximab in ulcerative colitis treatment were not different from each other. Factors such as age, gender, location of involvement, concomitant therapies, and smoking did not alter the outcome.

Infection prevention and control practices in the Pediatrics and Child Health Department of Tikur Anbessa Specialized Hospital, Ethiopia.

Infection prevention and control (IPC) is a set of practices that are designed to minimize the risk of healthcare-associated infections (HAIs) spreading among patients, healthcare workers, and visitors. Implementation of IPC is essential for reducing infection incidences, preventing antibiotic use, and minimizing antimicrobial resistance (AMR). The aim of the study was to assess IPC practices and associated factors in Pediatrics and Child Health at Tikur Anbessa Specialized Hospital. In this study, we used a cross-sectional study design with a simple random sampling method. We determined the sample size using a single population proportion formula with the assumption of a 55% good IPC practice, a 5% accepted margin of error, and a 15% non-response rate and adjusted with the correction formula. The final sample size was 284 healthcare workers. The binary logistic regression model was used for analysis. The World Health Organization (WHO) Infection Prevention and Control Assessment Framework (IPCAF) tool was used to assess IPC core components. A total of 272 healthcare workers participated in the study, with a response rate of 96%. Of the total participants, 65.8% were female and 75.7% were nurses. The overall composite score showed that the prevalence of good IPC practices among healthcare workers was 50.4% (95% CI: 44.3-56.5). The final model revealed that nursing professionals and healthcare workers who received IPC training had AORs of 2.84 (95% CI: 1.34-6.05) and 2.48 (95% CI: 1.36-4.52), respectively. The final average total IPCAF score for the IPC level was 247.5 out of 800 points. The prevalence of good IPC practice was suboptimal. The study participants, who were nursing professionals and healthcare workers who received IPC training, showed a statistically significant association with the IPC practice level. The facility-level IPCAF result showed a "Basic" level of practice based on the WHO categorization. These evidences can inform healthcare workers and decision-makers to identify areas for improvement in IPC practice at all levels. Training of healthcare workers and effective implementation of the eight IPC core components should be strengthened to improve suboptimal practices.