One-year Data Research Articles

1016-P: Prescribing SGLT2 and GLP-1 for Patients with Type 2 Diabetes at Time of Discharge after MI Increases Their Likelihood of Having Active Prescriptions at One Year

Intro: SGLT2 inhibitors (SGLT2) and GLP1 agonists (GLP1) both reduce major adverse cardiovascular events (MACE) in patients with T2D and MI. We characterize the pattern of prescriptions for these medications in an urban safety net teaching hospital which provided these medications to low income patients at nominal cost. Methods: Using the hospital EHR, we reviewed medication lists for patients with T2D who were hospitalized with type 1 MI between 2018-2019. Results: There were 178 patients with one-year follow-up data, of which 75 (42.1%) were uninsured. We summarized the distribution of diabetes therapies in Table 1. SGLT2 and GLP1 were prescribed in 39% and 8% of patients at 1-year, respectively. Likelihood of having an active SGLT2 prescription at 1-year was higher for patients prescribed it at discharge compared to those who were not (RR 2.6; 95% CI 1.9-3.4). Likelihood of having an active GLP1 prescription at 1-year was higher for patients prescribed it at discharge compared to those who were not (RR 10.9; 95% CI 4.9-24.5). Conclusions: Rates of prescription of MACE-reducing therapies (SGLT2 and GLP1) after MI are low compared to metformin and insulin, which have no proven MACE benefit. Prescribing SGLT2 and GLP1 at index discharge can significantly increase the likelihood that patients will be prescribed these medications one year later. Disclosure N.Sumarsono: None. S.Das: None. C.L.Malladi: None. A.A.Dweik: None. P.L.Della-penna: None. K.Geurink: None. C.Mathew: None. E.Moss: None. K.Peykova: None. L.Mack-boyd: None.

1027-P: Lower Admission HbA1c Is Associated with Lower Likelihood of SGLT-2 Inhibitor or GLP-1 Agonist Prescription in Patients with Type 2 Diabetes after Myocardial Infarction

Introduction: SGLT2 inhibitors (SGLT2) and GLP1 agonists (GLP1) reduce major adverse cardiovascular events (MACE) in patients with T2D and MI. We examined prescription rates of these medications stratified by hemoglobin A1c at time of index MI admission in a large urban safety net teaching hospital which provided these medications to low income patients at nominal cost. Methods: Using the hospital EHR, we reviewed medication lists one year after discharge for all patients with T2D who were hospitalized with type 1 MI between 2018-2019. Results: There were 178 patients with one-year follow-up data, of which 75 (42%) were uninsured. As shown in Figure 1, proportions of patients prescribed SGLT2 and GLP1 at one year increased with higher admission A1c (p = 0.009 and p = 0.07, respectively). Median A1c at time of index MI was higher in those prescribed SGLT2 (9.3 vs 8.0, p = 0.03) and GLP1 (10.1 vs 8.1, p = 0.07) at one year versus those were not. Conclusion: Patients with higher A1c at the time of MI were statistically significantly more likely to be prescribed SGLT2 and numerically more likely to be prescribed GLP1 one year after MI. These results suggest that a focus on glycemic control may be contributing to suboptimal use of these MACE-reducing medications in patients who would be expected to benefit from them. Disclosure C.L.Malladi: None. S.Das: None. N.Sumarsono: None. P.L.Della-penna: None. A.A.Dweik: None. K.Geurink: None. C.Mathew: None. E.Moss: None. K.Peykova: None. L.Mack-boyd: None.

Predicting railway wheel wear by calibrating existing wear models: Principle and application

The accuracy of physics-based wheel wear prediction approaches depends not only on the vehicle-track dynamics model but more importantly on the wear model. The currently available wear models, however, were developed for specific wheel/rail materials and under fixed operational conditions, and they need to be calibrated when used in new operational conditions. In this paper we introduce a data-driven approach into the physics-based approach to automatically calibrate the existing wear model so that it can be extended to a new operational scenario. Specifically, based on a one-year follow-up measurement data on the wheel profile evolution of a metro train commuting on a Guangdong metro line, we introduce radial basis function (RBF) and particle swarm optimization (PSO) to determine the boundary of each wear regime and the wear coefficient for each wear regime in the Archard-local model. Finally, we present a calibrated Archard-local model and then apply it to two cases. One application case shows that the calibrated model can be used for long-term wear prediction and another case shows that the calibrated model can be used to roughly estimate the wear evolution over the tread region of vehicles operating on other China metro lines.

Characterising the variability in ocean data using fractal and correlation dimension analysis

Understanding the variability of ocean data is essential for predicting its behaviour in time domain. This study aims to examine the usability of several nonlinear time series analysis techniques for diagnosing the complexity of the underlying dynamics of various ocean data. For such purpose, one-year data from an offshore platform and two-year data from a weather buoy were collected and analysed. The results indicate that all the ocean data considered here are chaotic in nature, reflected by the unfolded structure in the reconstructed phase space. In general, the surface currents speed possess the largest fractal dimension (or lowest Hurst exponent) and correlation dimension, while the significant wave height has the lowest values. This implies that the dynamics associated with surface currents speed tend to be the most complex, which can lead to more random and unpredictable temporal behaviour. The fractal analysis shows that the fluctuation of these ocean data are mostly persistent, and the dependence of fractal properties on window length appears to vary amongst different ocean data. Overall, the results derived from various analysis techniques are consistent, which confirms the potential of using chaotic time series analysis technique for characterizing ocean data variability.

Optimizing ship speed depending on cargo and wind-sea conditions for sustainable blue growth and climate change mitigation.

The impact of fuel consumption on merchant ships is categorized in both economic and environmental ways in terms of sustainable blue growth. Apart from the economic benefits of reducing fuel consumption, attention should be paid to related environmental concerns with ship fuels. As a result of global regulations and agreements concerning mitigating greenhouse gases on board, such as the International Maritime Organization and Paris Agreement, ships have to take a step to reduce fuel consumption to adopt these regulations. The present study aims to determine optimal speed diversity depending on ships' cargo amounts and wind-sea states to reduce fuel consumption. Within this context, one-year voyage data from two model sister Ro-Ro cargo ships were used, including daily ship speed, daily fuel consumption, ballast water consumption, total ship cargo consumption, sea state, and wind state. The genetic algorithm method was used to determine the optimal diversity rate. In conclusion, after speed optimization, optimum speed result values are calculated between 16.59 and 17.29 knots; thus, approximately 18% of exhaust gas emissions were also reduced.

PATIENT-REPORTED OUTCOMES (PROMS) IN SECOND OF STAGED TOTAL HIP ARTHROPLASTY PROCEDURES: DOES A GOOD OUTCOME FROM THE FIRST PREDICT THE SECOND?

It is anecdotally thought that a good outcome from the first of staged total hip arthroplasties (THAs) is predictive of benefit on the contralateral side. The objective was to determine whether outcome from the first THA could be used to predict outcome from the second, contralateral THA.A retrospective cohort study of consecutive patients undergoing staged THAs at a UK arthroplasty centre over 25-years (1995–2020). A control THA group was identified and matched for age, gender, BMI, implant and diagnosis. One-year patient-reported outcome data was available for 91% 1543/1700.1700 patients who underwent staged THA were compared to 1700 matched controls. Preoperative status was comparable for pain, function, and modified Harris hip score (mHHS, mean 41 SD 13 for both groups).At one year, there was a 2% dissatisfaction rate in all groups (first of staged THAs, second of staged THAs and controls). Groups were similar in terms of pain, function and mHHS (mean 88 SD 11 for all groups). For every 100 patients undergoing staged THAs, 87 had a bilateral good outcome (mHHS >70 both), 11 had unilateral poor outcome (mHHS >70 one, <70 other) and 2 had bilateral poor outcome (mHHS <70 both).If the first THA had a good outcome, the relative risk of a bad outcome was 20% less than for controls (RR 0.8 95% CI 0.6–1.1). If the first THA had a poor outcome, the risk of a second poor outcome was 4.5 times higher (RR 4.5 95% CI 3.2–6.4), increasing from 6% to 29% (absolute risk).Patients undergoing staged THAs with a good outcome from the first THA were less likely to have a bad outcome with the second. Risk of a poor outcome after a previous successful THA was 6% but rose to almost 30% with a previous poor outcome. This remained after correcting for patient variables including gender, age, BMI and diagnosis, indicating a potentially novel independent risk factor for poor outcome from staged THA.

Edoxaban treatment in atrial fibrillation in routine clinical care: One-year outcomes of the prospective observational ETNA-AF study in South Korean patients.

The real-world outcomes of edoxaban treatment in patients with atrial fibrillation (AF) were analyzed in the ETNA-AF (Edoxaban Treatment in Routine Clinical Practice) study involving data from multiple regional registries. This report addresses effectiveness and safety of edoxaban in the Korean ETNA-AF population. One-year data from 1887 Korean ETNA-AF participants were analyzed according to edoxaban dose and patient age and compared with results of other ETNA-AF registries. Approximately 70% of patients received the recommended doses of edoxaban (60 mg/30 mg); non-recommended 60 mg and 30 mg doses were prescribed to 9.6% and 19.8% of the patients, respectively. The proportions of reference age (<65 years), youngest-old (65-74 years) and middle-old/oldest-old (≥75 years) groups were 21.4%, 40.2%, and 38.4%, respectively. Incidence of major or clinically relevant nonmajor bleeding was similar within dose (0.57%-1.71%) and age subgroups (1.26%-1.63%). Incidence of net clinical outcome, a composite of stroke, systemic embolic event, major bleeding, and all-cause mortality, was also comparable among dose subgroups (1.14%-3.10%) and age subgroups (2.28%-2.78%). The percentage of Korean patients receiving non-recommended 30 mg (19.8%) was over twice that of the European population (8.4%). However, the clinical outcomes were generally similar among different populations included in the ETNA-AF study. The outcomes in the Korean ETNA-AF population are like those in the global ETNA-AF population, with overall low event rates of stroke, major bleeding and all-cause mortality across age and dose subgroups. Edoxaban can be used effectively and safely in specific populations of Korean AF patients, including the elderly.

Analysis of profitability of Pay-As-You-Speed scheme

Objective Implementing usage-based insurance (UBI) schemes captured the attention and has found a better practical foundation, thanks to the presence of probes for recording the driving and traveling data. The UBI is believed to provide an incentive measure through premium discounts for correcting driving and traveling behavior. However, the success of UBI implementation is dependent on different factors including the presence of alternative insurance plans, the level of privacy concerns among society, and the amount of trust within the society. Therefore, designing proper discount schemes which affect UBI acceptance by drivers and its profitability for government and insurance companies differs across countries and different scenarios. We aim to investigate the profitability of UBI Pay-As-You-Speed in Iran with a focus on the government and insurance companies. This study will be beneficial for policymakers seeking to understand the potential impact of UBI Pay-As-You-Speed in Iran. Methods The research is conducted on a synthesized population with acceptance and accident frequency models based on a self-reported survey. We assumed six UBI schemes based on previous research. The acceptance model is a logit discrete choice model and the accident frequency is based on Poisson regression. Costs of crashes are estimated based on one-year data of the Central Insurance company in Iran. After models’ estimation, the simulated population is used to estimate the resultant profit of private insurance companies and government. Results It is found that the scheme with no premium discount and no rental prices for the required monitoring device, results in the highest revenue for the government. Moreover, with an increase in the probe penetration rate, the profitability of the government increases with a greater reduction in crashes. However, this trend is not observed for insurance companies because the cost of the monitoring device and premium discounts offset the profits gained from prevented crashes. Conclusion The presence of the government as a main actor in facilitating the implementation of UBI schemes is essential or private insurance companies would be reluctant to provide these schemes to customers.

Pulsed-field- vs. cryo- vs. radiofrequency ablation: one-year recurrence rates after pulmonary vein isolation in patients with paroxysmal atrial fibrillation

Abstract Funding Acknowledgements Type of funding sources: None. Background A multipolar pulsed-field ablation (PFA) catheter has recently been introduced and showed favorable data in terms of safety and procedural efficiency of pulmonary vein isolation (PVI) for atrial fibrillation (AF). Long-term outcome data in comparison to other ablation modalities however is lacking. Purpose To compare procedural and one-year recurrence data of patients with paroxysmal AF (paroxAF) undergoing a first PVI using PFA, cryoballoon ablation (Cryo), or radiofrequency (RFA). Methods Consecutive patients with paroxAF undergoing a first PVI with PFA at our institution from May to December 2021 were included. For comparison, patients with paroxAF undergoing a first PVI with Cryo or RFA between May 2020 and March 2021 were included. A 3-D electro-anatomical mapping system was used in PFA and RFA, but not in Cryo. The following ablation protocols were used to achieve acute PVI: In the PFA group, the standard 32-applications lesion-set and supplementary applications at the discretion of the operator. In the Cryo group, a time-to-effect plus two minutes strategy and in the RFA group following to the CLOSE protocol. Patients were followed with 7d-Holter ECGs 3, 6, and 12 months after ablation. The primary endpoint was recurrence of any atrial arrhythmias following a blanking period of 3 months. Results A total of 202 patients were included (PFA: 32; Cryo: 82; RF: 88). Age, gender, CHA2DS2-VASc score, LVEF and LAVI did not differ among the groups (Table). Median procedure times were shortest with Cryo (76 [interquartile range 60-95] min) followed by PFA (94 [82-110] min) and RFA (157 [126-211] min, p &amp;lt; 0.01). Fluoroscopy dose was lowest with RFA (1.4 [0.6-2.5] Gycm2) followed by PFA (4.8 [3.5-7.9] Gycm2) and Cryo (5.3 [2.8-10.2] Gycm2, p &amp;lt; 0.01). Median follow-up time in patients without recurrence was 12 [10-12] months for the PFA group, 12 [12-13] months for the Cryo group and 13 [12-13] months for the RFA group. There was a trend towards fewer recurrences of atrial arrhythmias with PFA compared to Cryo and RFA (PFA 7%, Cryo: 25%, RFA: 20%, p = 0.13, Figure). Conclusion Recurrences of atrial arrhythmias 12 months after PFA PVI for paroxAF may be lower compared to Cryo and RFA. Larger prospective randomized studies are needed to confirm this initial experience.

Pulsed-field- vs. cryo- vs. radiofrequency ablation: one-year recurrence rates after pulmonary vein isolation in patients with persistent atrial fibrillation

Abstract Funding Acknowledgements Type of funding sources: None. Background A multipolar pulsed-field ablation (PFA) catheter has recently been introduced and showed favorable data in terms of safety and procedural efficiency of pulmonary vein isolation (PVI) for atrial fibrillation (AF). Long-term outcome data in comparison to other ablation modalities however is lacking. Purpose To compare procedural and one-year recurrence data of patients with persistent AF (persAF) undergoing a first PVI using PFA, cryoballoon ablation (Cryo), or radiofrequency (RFA). Methods Consecutive patients with persAF undergoing a first PVI with PFA at our institution from May to December 2021 were included. For comparison, patients with persAF undergoing a first PVI with Cryo or RFA between May 2020 and March 2021 were included. A 3-D electro-anatomical mapping system was used in PFA and RFA, but not in Cryo. The following ablation protocols were used to achieve acute PVI: In the PFA group, the standard 32-applications lesion-set and supplementary applications at the discretion of the operator. In the Cryo group, a time-to-effect plus two minutes strategy and in the RFA group following to the CLOSE protocol. Patients were followed with 7d-Holter ECGs 3, 6, and 12 months after ablation. The primary endpoint was recurrence of any atrial arrhythmia following a blanking period of 3 months. Results A total of 177 patients were included (PFA: 65; Cryo: 63; RF: 49). Age, gender, CHA2DS2-VASc score, LVEF and LAVI did not differ among the groups (Table). Median procedure time was different among the groups (PFA: 109 [interquartile range 88-130] min, Cryo: 81 [62-96] min, RF: 177 [153-200] min, p &amp;lt; 0.01). Fluoroscopy dose was different among groups: RF (1.9 [0.7-4.9] Gycm2), PFA (8.3 [4.3-19.0] Gycm2), and Cryo (9.5 [4.8-19.1] Gycm2, p&amp;lt;0.01). Median follow-up time in patients without recurrence was 13 [11-13] months for the PFA group, 13 [12-13] months for the Cryo group and 12 [11-13] months for RFA group. Recurrence of atrial arrhythmias in the KM-analysis after 12 months was not different in all three groups (PFA 44%, Cryo: 33%, RFA: 51%, Figure). Conclusion In patients with persAF, recurrence of atrial arrhythmias 12 months after PFA-PVI only is high, regardless of ablation modality. Assessment of strategies including ablation of extra-PV targets in some patients with persAF is needed.

Mindful Coping Power Effects on Children's Autonomic Nervous System Functioning and Long-Term Behavioral Outcomes.

Mindful Coping Power (MCP) was developed to enhance the effects of the Coping Power (CP) preventive intervention on children's reactive aggression by integrating mindfulness training into CP. In prior pre-post analyses in a randomized trial of 102 children, MCP improved children's self-reported anger modulation, self-regulation, and embodied awareness relative to CP but had fewer comparative effects on parent- and teacher-reported observable behavioral outcomes, including reactive aggression. It was hypothesized that MCP-produced improvements in children's internal awareness and self-regulation, if maintained or strengthened over time with ongoing mindfulness practice, would yield improvements in children's observable prosocial and reactive aggressive behavior at later time points. To appraise this hypothesis, the current study examined teacher-reported child behavioral outcomes at a one-year follow-up. In the current subsample of 80 children with one-year follow-up data, MCP produced a significant improvement in children's social skills and a statistical trend for a reduction in reactive aggression compared with CP. Further, MCP produced improvements in children's autonomic nervous system functioning compared with CP from pre- to post-intervention, with a significant effect on children's skin conductance reactivity during an arousal task. Mediation analyses found that MCP-produced improvements in inhibitory control at post-intervention mediated program effects on reactive aggression at the one-year follow-up. Within-person analyses with the full sample (MCP and CP) found that improvements in respiratory sinus arrhythmia reactivity were associated with improvements in reactive aggression at the one-year follow-up. Together, these findings indicate that MCP is an important new preventive tool to improve embodied awareness, self-regulation, stress physiology, and observable long-term behavioral outcomes in at-risk youth. Further, children's inhibitory control and autonomic nervous system functioning emerged as key targets for preventive intervention.

No decay in outcomes at a mean 8 years following surgical treatment for aseptic fracture nonunion

Purpose: The purpose of this study is to compare medium to long term patient reported outcomes to one-year data for patients treated surgically for an aseptic fracture nonunion. Methods: 305 patients surgically treated for a fracture-nonunion were prospectively followed. Data collected included pain scores measured by the Visual Analog Scale (VAS), clinical outcomes assessed by the Short Musculoskeletal Functional Assessment (SMFA), and range of motion. 75% of patients in this study had lower extremity fracture nonunions and 25% had upper extremity fracture nonunions. Femur fracture nonunions were the most common. Data at latest follow-up was compared to one-year follow-up using the independent t-test. Results: Sixty-two patients were available for follow-up data at an average of eight years. There were no differences in patient reported outcomes between one and eight years according to the standardized total SMFA (p = 0.982), functional index SMFA (p = 0.186), bothersome index SMFA (p = 0.396), activity index SMFA (p = 0.788), emotional index SMFA (p = 0.923), or mobility index SMFA (p = 0.649). There was also no difference in reported pain (p = 0.534). Range of motion data was collected for patients who followed up in clinic for an average of eight years after their surgical treatment. 58% of these patients reported a slight increase in range of motion at an average of eight years. Conclusion: Patient functional outcomes, range of motion, and reported pain all normalize after one year following surgical treatment for fracture nonunion and do not change significantly at an average of eight years. Surgeons can feel confident in counseling patients that their results will last and they do not need to follow up beyond one year, barring pain or other complications. Level of Evidence: Level IV

A-310 18F-FLUOROCHOLINE-PET/CT IS THE BETTER TOOL TO LOCALISE “NEGATIVE” PARATHYROID ADENOMAS – INTRAOPERATIVE CORRELATION AND 12 MONTH POSTOPERATIVE RESULTS

Abstract Background To characterise the diagnostic performance of 18F-Fluorocholine PET/CT (FCH-PET/CT) to localise parathyroid adenomas (PA) in primary hyperparathyroidism (pHPT) when ultrasound (US) and MIBI-Scan (MS) failed - intraoperative correlation and one year follow up. Methods Beginning in 07/2017 FCH-PET/CT was employed in patients with proven pHPT in whom US and MS delivered either incongruent or negative findings. All patients were offered cervical explorations with intraoperative PTH-monitoring (IO-PTH) and followed for 12 months postoperatively. Imaging results were correlated to operative findings and histopathologic reports and to short term biochemical outcome as well as one-year postoperative follow-up data. Results From 07/2017 to 11/2022, 1085 patients were operated for pHPT. In this period, 215 FCH-PET/CT were performed suggesting PA(s) in 176, 6 false positive, and 33 false negative (sensitivity 84.2%, PPV 96.7%). Of the 95 cases were US and MIBI both gave negative results, FCH-PET/CT accurately localised PA(s) to the respective side of the neck in all the 72 FEC-PET-positive cases (global sensitivity of 75.8%); and was negative in 23 (24.2%). In the 12-month postoperative follow up (currently matched by 61/95) there was no biochemical persistent disease. However, 3 patients exhibited PTH or calcium at the upper limit of norme, thus, a recurrence cannot be reliably excluded so far. Conclusion FCH-PET/CT allows for planned unilateral and focused as opposed to bilateral explorations, especially when preoperative parathyroid localisation with US and MiBI fails. We, therefore, suggest FCH-PET/CT as the preferred tool for the localisation of the “negative” PA.

A Nonparametric Bayesian Approach for Bridge Reliability Assessment Using Structural Health Monitoring Data

Integrating structural health monitoring (SHM) data into reliability assessment has increasingly been practiced in the condition evaluation of in-service bridges over the past decade. The selection of probability distribution models for load- and resistance-related random variables is a prerequisite for monitoring-based reliability assessment. However, the underlying probabilistic assumptions of the used models could be restrictive and unverifiable especially when dealing with real-world heterogeneous monitoring data, weakening the confidence on the estimated reliability index. This study aims to develop a nonparametric Bayesian model with the Dirichlet process prior for bridge reliability assessment, where the model order constraint can be released such that the complexity of the model adapts to the observed data. Reliability analysis via the nonparametric Bayesian model allows the aleatory uncertainty and the epistemic uncertainty arising from monitoring data to be concurrently accounted for in the formulated reliability index. A numerical example is presented to verify the effectiveness of the nonparametric Bayesian model for dealing with multimodal data. The feasibility of the proposed approach for reliability assessment is then demonstrated with one-year strain monitoring data acquired from a large-scale bridge instrumented with the SHM system.

OC-109 ONE-YEAR FOLLOW-UP ANALYSIS OF WOUND VS SUTURE LENGTH RATIO AS A PREDICTOR OF INCISIONAL HERNIA - A COHORT STUDY (WISER)

Abstract Background The purpose of the study was to determine if the recommended wound to suture length ratios of 1:4 and 1:6 were followed during midline laparotomy closure with loop PDS and 2–0 PDS, respectively, and whether this affected the development of an incisional hernia three years following the procedure. Methods This prospective study included eighty-six patients operated by the midline incision. The closures were performed as per the surgeon's choice. The length of the incision, types and length of suture used were noted. The one-year follow-up data was analyzed. Results In thirty cases, loop PDS was used for the closure, and in 56 patients, 2-0 PDS was used. Adherence to the recommendation was better with the loop PDS (13/30,43.33%) vs 2-0 PDS (8/56,14.28%). Eighteen patients were excluded(10-death-,5-loss to follow-up,3-reoperation).46.1%(12/26) developed incisional hernia in the loop PDS group vs 7.14%(3/42) with 2-0 PDS; total 22.05%(15/68). If the recommendations were followed or not, there were 20% (2/10) hernias in the loop PDS group compared to 62.5% (10/16); and 28.57% (2/7) compared to 2.8% (1/35) in the 2-0 PDS group. The loop PDS group had more malignancies (40% vs 20%, p=0.04). Conclusion The adherence to the recommendation of wound vs suture length was low. The incidence of incisional hernia was significantly low with 2-0 PDS, at one year, however the results should be interpreted with caution considering many patients closed with loop PDS had malignancies, a risk factor for incisional hernia, and low sample size due to death and loss to follow-up.

Multi-criteria assessment and optimization of ice-energy storage systems in combined heat and cold supply networks of a campus building

Ice energy storage systems (ICES) can be a promising technology for the combined provision of heating and cooling for non-residential buildings by utilizing currently unexploited waste heat without depending on solar assistance. However, detailed studies on the effects of different operating strategies of an ICES in the context of an overall supply system are not available yet, nor are there any design routines for dimensioning and integration. For this purpose, a detailed numerical investigation and evaluation of an ICES in the supply system of a research building is performed in this work, using one-year measurement data of the system containing 500 m3 storage. The considered building, of which about 70% of the floor area is disposed of for laboratories and workplaces, is located in Bayreuth, Germany, where a warm and moderate climate with an annual average temperature of 8.9 °C is prevailing. Thereby, both an optimization of plant operation and dimensioning is carried out, while frameworks of Germany, France and EU27 average are used to elaborate their influence on the optimization process. Compared to conventional heating and cooling, the existing system can reduce CO2 emissions by 37% in optimal operation. Through the technically possible operating modes of the realized system, there is a range in annual costs from 213 to 287 k€ and CO2 emissions from 148 to 235 t/a between the optimal and worst control. By adapting the plant concept and a downhill simplex method for identifying optimal storage dimensioning, the economic efficiency of the process can also be significantly increased. Moreover, the configuration of the optimal ICES realization shows a high dependency on the prevailing boundary conditions. For all considered regions, the use of ICES can lead to an ecological improvement as well as a reduction in demand-related costs, whereby the methodology can also be applicable to other building types in the future.

Outcomes of morbidly obese patients undergoing total hip arthroplasty with the anterior-based muscle-sparing approach.

Obesity is associated with an increased risk of hip osteoarthritis, resulting in an increased number of total hip arthroplasties (THAs) performed annually. This study examines the peri- and postoperative outcomes of morbidly obese (MO) patients (BMI ≥ 40 kg/m2) compared to healthy weight (HW) patients (BMI 18.5 to < 25 kg/m2) who underwent a THA using the anterior-based muscle-sparing (ABMS) approach. This retrospective cohort study observes peri- and postoperative outcomes of MO and HW patients who underwent a primary, unilateral THA with the ABMS approach. Data from surgeries performed by three surgeons at a single institution was collected from January 2013 to August 2020 and analyzed using Microsoft Excel and Stata 17.0. This study compares 341 MO to 1,140 HW patients. Anaesthesia, surgery duration, and length of hospital stay was significantly lower in HW patients compared to MO. There was no difference in incidence of pulmonary embolism, periprosthetic fracture, or dislocation between the two groups. The rate of infection in MO patients (1.47%) was significantly higher than HW patients (0.14%). Preoperative patient-reported outcome measures (PROMs) show a significantly higher pain level in MO patients and a significantly lower score in functional abilities. Overall, six-week and one-year postoperative data show higher levels of pain, lower levels of functional improvement, and lower satisfaction scores in the MO group. The comorbidities of obesity are well studied; however, the implications of THA using the ABMS approach have not been studied. Our peri- and postoperative results demonstrate significant improvements in PROMs in MO patients undergoing THA. However, the incidence of deep infection was significantly higher in this group compared with HW patients.

Hand-hygiene compliance: The importance of WHO's “moment 1” in prevention of healthcare-associated infections

BackgroundHand hygiene is the single most effective strategy for preventing healthcare associated infections (HCAI) but compliance is usually low and effective improvement strategies are needed. We assessed hand hygiene (HH) compliance with the World Health Organization (WHO) prescribed five moments of hand hygiene among health-care workers (HCW). MethodsA retrospective analysis of one-year data on hand hygiene was done. WHO single observer direct observation technique was used and HH compliance was noted among HCWS. ResultsA total of 16,552 opportunities were recorded. Overall compliance as per WHO Guidelines was 69.2%. Sanitation worker had an adherence rate of 73.1% (95% confidence interval [CI]:70.6–75.4) followed by the nurses 71.2% (95% CI: 70.4–72.1). Physicians and technicians had a compliance rate of 64.9% (95% CI: 63.1–66.6) and 64% (95% CI: 60.1–67.9) respectively. Physiotherapists had a compliance rate of 62.2 (95% CI: 50.1–73.2) and the compliance of Phlebotomists was observed to be 23.1% (95% CI: 9.0–43.6). HCW stood best for WHO moment 5 and worst for moment 1 with compliance of 79.1% (95% CI:77.4–80.7) and 55.8% (95% CI:54.5–57.1) respectively. DiscussionThe moment 1 of the WHO's five moments is the most important for preventing the transmission of resistant pathogens between patients. Missed opportunities in moment 1 need to be focused on while planning new strategies to promote hand hygiene.

One-year Data from ENDEAVOR, a Phase 1b Trial of Delandistrogene Moxeparvovec (SRP-9001) in Patients with Duchenne Muscular Dystrophy (DMD) (S48.003)

One-year Data from ENDEAVOR, a Phase 1b Trial of Delandistrogene Moxeparvovec (SRP-9001) in Patients with Duchenne Muscular Dystrophy (DMD) (S48.003)

Forecasting Uncertainty Parameters of Virtual Power Plants Using Decision Tree Algorithm

Renewable energy sources (RESs) are increasingly used to meet the world’s growing electrical needs, especially for the economic benefits and environmental problems associated with fossil fuel use. Small-scale renewable energy sources, controllable loads, energy storage devices, and other nonrenewable sources are effectively integrated to form a virtual power plant (VPP). Uncertainty in forecasting renewable energy generation due to the intermittent nature of renewable energy sources is one of the biggest challenges in VPPs. Power generation by RESs changes with the day of the week, season, location, climate, and resource availability. Also, load demand and utility price vary with time and need to be forecasted for proper energy management of VPPs. However, the dispatching and planning of VPPs are significantly impacted by the volatile nature of RESs, load demand, and utility price. Predicting these uncertainties with high accuracy is essential to balance the electrical power generation and the load demand. In this article, a decision tree (DT) algorithm is proposed, to predict the uncertainty parameters, such as the day-ahead power from the RES, load demand, and utility prices of VPPs. The efficiency of the proposed model and the predicted results are compared with other complex models, such as the artificial neural network (ANN) and auto-regressive integrated moving average (ARIMA) algorithms. Root-mean square error (RMSE), mean square error (MSE), coefficient of determination (R 2), and mean absolute error (MAE) are the statistical metrics used to evaluate the accuracy of the prediction. One-year meteorological data of the Chennai zone in India is considered for predicting the uncertainty parameters. IEEE 16-bus and 33-bus test systems are used to validate the forecasting model. It is evident from the results that the proposed DT algorithm can predict the uncertainty parameters more accurately and use lesser time than the ANN and ARIMA algorithms.