Pairwise Wilcoxon Rank Sum Tests Research Articles

The Impact of Air Pollutants on a Chicagoland Cohort of Patients with Acute Myeloid Leukemia

Background Outcomes in acute myeloid leukemia (AML) can be impacted by cytogenetic/molecular features along with environmental factors such as previous exposure to cytotoxic therapy and county-level income. Our group previously identified structural racism, defined as systemic disadvantage experienced by certain groups of people, as a mediator of disparities within a cohort of 822 patients (pts) diagnosed with AML in the Chicagoland area even when accounting for genetic features of disease (Abraham et al, Blood 2022). Air pollution disproportionately impacts racial-ethnic minorities and has been demonstrated to impact DNA methylation patterns in pts which in turn influence disease biology (Tessum et al, Sci Advances 2021; Rider et al, Clin Epigenetics 2019). With that in mind we aimed to investigate the impact of air pollutant exposures that have been associated with both leukemia development/mortality and with air pollution disparities in historically redlined cities. Methods Adult AML (non-APL) pts diagnosed between 2012 and 2018 at six academic cancer centers in the Chicago area were included. Pts' census tracts were joined with measures of pollution obtained from the Center for Disease Control National Environmental Public Health Tracking Network and the 2014 National Air Toxics Assessment: 1,3-butadiene, benzene, diesel particulate matter (PM), polycyclic aromatic hydrocarbons and polycyclic organic matter (PAHPOM), and PM 2.5 µm (2014 averaged daily census tract measures). Pollutant exposures by racial/ethnic groups were determined using a Kruskall-Wallis rank sum test and pairwise Wilcoxon rank sum tests. Univariate logistic regressions for each pollutant were performed for 2010 European Leukemia Net (ELN) AML criteria and TP53 mutation status. Survival among pts in the most and least polluted census block quartiles for each pollutant was compared using Kaplan-Meier survival analysis. Results Our multi-center database contained 789 pts with AML with census tract data, allowing for air pollutant data collection. Median age of diagnosis was 62 years old. In addition, 59.9% of pts were non-Hispanic White (NHW), 15.3% were non-Hispanic Black (NHB), and 15% of pts were Hispanic. Additional characteristics are summarized in Table 1. There was significantly higher median exposure to 1,3-butadiene, benzene, diesel PM, PAHPOM, and PM2.5 in NHB and Hispanic pts when compared to NHW pts. Hispanic pts had significantly median higher exposure to 1,3-butadiene and benzene when compared to NHB pts while NHB pts had significantly higher median exposure to PM2.5 ( Table 2). With univariate analysis, no pollutant exposure was found to be significantly associated with ELN 2010 risk category or with TP53 mutation status. We also compared median OS (mOS) from AML diagnosis between the quartile with the lowest exposure (Q1) and quartile with the highest exposure (Q4). For 1,3-butadiene mOS was 2.52 years (Q1) vs. 2.96 years (Q4) (p=0.75), for benzene it was 2.65 years vs 3.0 years (p=0.38), for diesel PM it was 2.56 years vs 2.96 years (p=0.56), for PAHPOM it was 2.76 years vs. 2.96 years (p=0.31), and for PM2.5 it was 2.92 years vs. 2.70 years (p=0.32). Conclusions We analyzed the impact of 1,3-butadiene, benzene, diesel PM, PAHPOM, and PM2.5 on outcomes in pts with AML in the Chicagoland area. While there were significant differences in median exposure to pollutants by race/ethnicity, there was no significant association between pollutant exposure and ELN 2010 risk category or TP53 mutation analysis. We also analyzed overall survival between Q1 and Q4 of exposure for each pollutant and found no significant difference. While pollutant exposure disproportionately impacts racial-ethnic minorities, individual pollutants did not appear to be a major driver of outcomes in AML. Limitations include the source of our air pollutant data, where misclassification of pollutants may exist and impact the ability to detect true associations.

Poster 238: Early Postoperative Increase of IL-1a in Synovial Fluid Correlates with Worse Short-Term Patient-Reported Outcomes after Cartilage Transplantation in the Knee

Objectives: The purpose of this study was to determine the longitudinal concentrations of several synovial fluid biomarkers after cartilage transplantation and potential correlations with patient reported outcomes. Methods: After institutional IRB approval, patients undergoing osteochondral allograft (OCA) transplantation or autochondrocyte implantation (ACI) were consented and enrolled into a prospective study involving intraoperative synovial fluid aspiration of the operative knee, as well as postoperative aspirations of the operative knee at standardized clinic follow-up timepoints: 2 weeks, 6 weeks, 6 months, and 1 year postoperatively. For this analysis, patients undergoing cartilage transplantation (OCA or ACI) with preoperative aspiration and at least one successful postoperative aspiration were included. Exclusion criteria for aspirations from the analysis included subsequent surgical procedure or articular injections on the index knee within 1 year of the transplant. The synovial fluid samples were analyzed for the following inflammatory biomarkers with Multiplex ELISA: CCL5, MMP-1, EGF, VEGF, IL1a, FGF2, CCL2, BMP2, and Aggrecan (ACAN). The samples were digested 1:1 with 3mg/mL hyaluronidase prior to execution of the assay in accordance with the manufacturer’s protocol. A minimum of 3uL was required for analysis. Patients prospectively completed Knee Injury and Osteoarthritis Outcome Score (KOOS), including Activities of Daily Living (ADL), Pain, Quality of Life (QoL), Sports, Symptoms, and Joint Replacement (JR) subscores, preoperatively and at 6 months and 1 year postoperatively. All statistical analyses were performed on RStudio and STATA. Non-parametric tests were utilized to avoid assumptions of normality. Skillings-Mack tests were utilized as a non-parametric alternative for a repeated-measures ANOVA in the setting of sporadic missing values (i.e., dry aspirations). Post-hoc pairwise Wilcoxon ranksum tests with Bonferroni corrections for multiple comparisons were performed for significant tests. Univariate linear regressions were performed to determine correlations between cytokine changes and patient-reported outcomes. A minimum of 10 observations per predictor was considered sufficient for the analysis. All testing was two-sided, and significance was set at p<0.05. Results: A total of 63 aspirations from 19 patients were evaluated. Postoperatively, successful aspirations were able to be performed on 13 patients at 2 weeks (68%), 17 patients at 6 weeks (89%), 9 patients at 6 months (47%), and 5 patients at 1 year (26%) (Table 1). One patient underwent a subsequent procedure on the index knee (lysis of adhesions) 10 weeks after cartilage transplantation, thereby excluding their 6 month and 1-year aspirations from analysis. Across all timepoints, there were significant differences in MMP-1 (p=0.003), ACAN (p<0.001), and FGF2 (p=0.026). Specifically, ACAN was significantly elevated at 2 (p<0.001) and 6 weeks (p<0.001), and MMP- 1 was the greatest at 6 weeks relative to transplant (p<0.001), 6 months (p=0.01), and 1 year (p=0.04). In contrast, FGF2 was significantly lower at 2 weeks compared to transplant levels (p=0.02). There were no significant differences across timepoints for CCL5 (p=0.88), VEGF (p=0.068), CCL2 (p=0.071), BMP2 (p=0.067), IL-1a (p=0.13), or EGF (p=0.01, p>0.05 for all pairwise comparisons after Bonferroni correction) (Figure 1). A subanalysis was performed for cytokines which demonstrated at least 5 “pro-inflammatory” responses (positive fold-change) and at least 5 “anti-inflammatory” responses (negative fold-change), with a minimum of 10 observations with associated patient-reported outcomes at 6 and/or 12 months postoperatively. From the 2-week aspiration samples, CCL5 (5 increase/7 decrease), IL-1a (5/7), and CCL2 (6/7) met the inclusion criteria. Increase in IL-1a demonstrated significant linear associations with worse postoperative KOOS ADL (p=0.048), Pain (p=0.01), Quality of Life (p=0.01), and Symptoms (p=0.01) scores at 6 months (Table 2, Figure 2). Similarly, an increase in CCL-2 postoperatively was associated with worse KOOS ADL (p=0.04) and Pain (p=0.04) scores at 6 months. No significant linear associations between cytokine changes at 6 weeks and later PROMs were identified. Conclusions: Following cartilage transplantation of the knee, the synovial fluid profile may demonstrate early postoperative increases in MMP-1 and ACAN and a decrease in FGF-2. An early pro-inflammatory response with IL-1a within the first two postoperative weeks may be linearly associated with worse short-term patient-reported outcomes compared to an early decrease. [Table: see text] [Table: see text]

Immune landscape of patients with metastatic non-clear cell renal cell carcinoma (nccRCC) treated with atezolizumab plus bevacizumab.

4535 Background: The treatment of metastatic nccRCC remains an area of unmet clinical need. A multicenter phase II trial of atezolizumab/bevacizumab in patients with advanced nccRCC or any RCC type with ≥ 20% sarcomatoid differentiation (NCT02724878) demonstrated clinical activity of these agents, with objective response rates of 50% in patients with sarcomatoid clear-cell RCC (sccRCC) and 26% in patients with nccRCC. We aim to understand the intratumoral and circulating factors that impact immunotherapy response in this population. Methods: We collected blood samples prior to therapy and on-treatment (following 2 cycles of therapy) and quantified levels of plasma soluble factors (cytokines and growth factors) using a fluorescent bead array platform. We used high dimensional flow cytometry on peripheral blood mononuclear cells to analyze the composition and phenotype of peripheral immune cells. Immunohistochemistry and immunofluorescence were performed on available formalin-fixed, paraffin-embedded tumor tissue samples (archival or on-study biopsy) collected prior to the start of therapy. We assessed relationships between biomarkers and outcomes using pairwise Wilcoxon rank-sum test and log-rank tests, and univariate Cox regression models. Results: We collected blood samples from 60 patients with paired tumor samples from 38 patients. Baseline circulating inflammatory cytokines MIP-1b, IL-1, MCP-1, IL-6, and IL-13 were highly correlated with one another, forming an “inflammatory module” that was increased in IMDC-poor risk patients and associated with worse progression-free survival (PFS) (p = 0.028). At baseline, elevated circulating VEGF-A was associated with a lack of response (p=0.03) and worse PFS (p=0.021). Whereas a larger increase in on-treatment levels of circulating VEGF-A was associated with clinical benefit as defined by Braun et al. (Nat Med. 2020) (p=0.01) and improved overall survival (p=0.006). Among peripheral immune cell populations, an on-treatment decrease in circulating PD-L1+ T cells was associated with improved outcomes: reductions in CD4+ PD-L1+ (HR:0.62[0.49-0.91], p=0.016) and CD8+ PD-L1+ T cells (HR:0.59[0.39-0.87], p=0.009) correlated with improved PFS. Within the tumor, a higher percentage of terminally exhausted (PD-1+, TIM-3+ and/or LAG-3+) CD8+ T cells at baseline was associated with worse PFS (p=0.028). Conclusions: Among patients with advanced nccRCC or sccRCC, a baseline high systemic inflammatory state and high circulating VEGF-A are associated with worse outcomes after treatment with atezolizumab and bevacizumab. High levels of intratumor terminally exhausted CD8+ T cells were associated with worse PFS. These results highlight the importance of an integrative approach to explore biomarkers of response in advanced variant histology RCC which may inform future therapeutic approaches.

Application of Real-time Augmented Reality-guided Osteotomy and Apex Location in Endodontic Microsurgery: A Surgical Simulation Study Based on 3D-printed Alveolar Bone Model

IntroductionAugmented reality (AR) is a novel visualization technique in which pregenerated virtual 3D content is superimposed on surgical sites. This study aimed to validate the viability of AR-guided endodontic microsurgery (ARG) and compare the changes in objective and subjective outcomes of surgical simulation using ARG and freehand (FH) endodontic microsurgery on customized 3D-printed models. MethodsWe created and printed a customized 3D alveolar bone model with artificial periapical lesions (APLs) based on cone-beam computed tomography. Eight models with 96 APLs were equally divided into ARG and FH groups. We planned surgical trajectories on rescanned printed models. Four inexperienced residents (IRs) performed ARG and FH on the models and completed pre and intraoperative confidence questionnaires for the subjective outcome. Postoperative cone-beam computed tomography scans of the models were reconstructed and analyzed, and all procedures were timed. We used pairwise Wilcoxon rank sum tests to compare objective outcomes. Kruskal–Wallis tests and post hoc pairwise Wilcoxon rank sum tests were used to compare subjective outcomes. ResultsCompared to the FH group, the ARG group significantly reduced deviation of the volume of bone removal, root-end resection, and deviation of bevel angle, with improved confidence of the IRs (P < .05); it also significantly increased surgical time and volume of unremoved APL (P < .05). ConclusionsWe customized an APL model through 3D printing and developed and validated a low-cost AR application framework, based on free AR software, for endodontic microsurgery. ARG allowed IRs to perform more conservative and precise surgical procedures with enhanced confidence.

Cross-Country Differences in Return and Volatility Metrics of World Equity Indices

Abstract This research seeks to determine whether the cross-country differences in return and volatility metrics in various country equity indices can be explained by differences in economic development. We base the study on the MSCI IMI net income indices on two samples: a 51-country sample from the period 31 May 2002 to 28 February 2022, and a 75-country sample from the period 30 November 2010 to 28 February 2022. In this study, countries are grouped into four categories: frontier, emerging, early-developed, and developed, based on gross domestic product (GDP) per capita. The Kruskal–Wallis rank sum test is used to find cross-group differences, and the results are further analyzed with the pairwise Wilcoxon rank sum test with the Holm–Bonferroni p value adjustment method. The results are relatively unintuitive and show that there is no significant cross-group difference in daily and monthly returns. There is evidence of a considerable difference in volatility metrics, especially in the case of the emerging market group, which is significantly different from the three other groups. The results are slightly sensitive to time period change and very sensitive to changes in income categories of some countries.

Fungal Metabarcoding Data for Two Grapevine Varieties (Regent and Vitis vinifera ‘Cabernet-Sauvignon’) Inoculated with Powdery Mildew (Erysiphe necator) Under Drought Conditions

Fungal Metabarcoding Data for Two Grapevine Varieties (Regent and <i>Vitis vinifera</i> ‘Cabernet-Sauvignon’) Inoculated with Powdery Mildew (<i>Erysiphe necator</i>) Under Drought Conditions

NDVI Values Suggest Immediate Responses to Fire in an Uneven-Aged Mixed Forest Stand

Fire modifies vegetation dynamics in terrestrial ecosystems. Abundant literature has studied the post-fire effects with satellite sensors; however, relatively fewer studies have used unmanned aerial vehicles (UAVs) to assess the dynamics of greenness prior to and immediately following prescribed fires. Using multispectral sensors mounted on UAVs, we documented the results of the normalized difference vegetation index (NDVI) as a proxy for pre- and post-fire greenness in a natural forest stand in northern Mexico. Using spectral reflectance techniques and the statistical analyses of Kruskal–Wallis and pairwise Wilcoxon rank-sum tests, statistically significant differences were found in the NDVI values, measured before and after controlled burning (p &lt; 0.05). The results showed an increase in post-fire “greenness” from 0.57 to 0.65. This was interpreted as an immediate change in vegetation activity in the canopy, which could be attributable as a stimulus to heat stress. Complementary spectral indices also reinforce our findings; we recognize that further research is required, for instance, to address the timing of image capture. Our findings demonstrate the potential and some of the challenges associated with the use of UAVs to monitor prescribed fires, while also suggesting the need for more detailed physiological and phenological studies. High spatial and spectral resolution maps of greenness represent a valuable starting point for subsequent temporal monitoring and contribute to the knowledge of fire effects at fine spatial resolutions.

Assessing Cowpea-Wheat Double Cropping Strategies in the Southern United States Using the DSSAT Crop Model

Information is limited on the potential of cowpea-wheat double cropping in the southern United States to enhance soil health and increase net returns. Using the Decision Support System for Agrotechnology Transfer (DSSAT) crop model and weather data spanning 80 years, we assessed the effects of soil type (Darco: Grossarenic Paleudults and Lilbert: Arenic Plinthic Paleudults), N application rate (0, 100, and 200 kg•ha−1), and El Niño-Southern Oscillation (ENSO) on the grain yields of double-cropped cowpea (Vigna unguiculata L.) and wheat (Triticum aestivum L.) in this region. Yield differences were tested using the pairwise Wilcoxon rank sum test. Results showed that yields of wheat that followed cowpea (cwheat) were greater than those that followed fallow (fwheat). The soil type effects on cwheat and fwheat yields decreased with an increase in N rate. The soil type effect on cowpea yields was greater during La Niña. The ENSO impact on cowpea yields was greater on the less fertile soil Darco. Yields of cwheat and fwheat increased with an increase in N rate up to 100 and 200 kg•ha−1, respectively. The yield response of cwheat to N rate was less than that of fwheat. The N rate effects on cwheat and fwheat yields were greater on Darco and under El Niño. Yields of cowpea were greatest under El Niño, whereas those of wheat were greatest under La Niña. The ENSO effect on cowpea yields was greater on Darco. With an increase in N rate, the effect of ENSO was diminished.

Survival strategies of producers involved in short food supply chains following the outbreak of COVID-19 pandemic: A Hungarian case-study.

Survival strategies of producers involved in short food supply chains following the outbreak of COVID-19 pandemic: A Hungarian case-study.

Epidemiology, etiology, and diagnosis of health care acquired pneumonia including ventilator-associated pneumonia in Nepal.

Epidemiologic data regarding health care acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) from Nepal are negligible. We conducted a prospective observational cohort study in the intensive care unit (ICU) of a major tertiary hospital in Nepal between April 2016 and March 2018, to calculate the incidence of VAP, and to describe clinical variables, microbiological etiology, and outcomes. Four hundred and thirty-eight patients were enrolled in the study. Demographic data, medical history, antimicrobial administration record, chest X-ray, biochemical, microbiological and haematological results, acute physiology and chronic health evaluation II score and the sequential organ failure assessment scores were recorded. Categorical variables were expressed as count and percentage and analyzed using the Fisher's exact test. Continuous variables were expressed as median and interquartile range and analyzed using Kruskal-Wallis rank sum test and the pairwise Wilcoxon rank-sum test. 46.8% (205/438) of the patients required intubation. Pneumonia was common in both intubated (94.14%; 193/205) and non-intubated (52.36%; 122/233) patients. Pneumonia developed among intubated patients in the ICU had longer days of stay in the ICU (median of 10, IQR 5-15, P< 0.001) when compared to non-intubated patients with pneumonia (median of 4, IQR 3-6, P< 0.001). The incidence rate of VAP was 20% (41/205) and incidence density was 16.45 cases per 1,000ventilator days. Mortality was significantly higher in patients with pneumonia requiring intubation (44.6%, 86/193) than patients with pneumonia not requiring intubation (10.7%, 13/122, p<0.001, Fisher's exact test). Gram negative bacteria such as Klebsiella and Acinetobacter species were the dominant organisms from both VAP and non-VAP categories. Multi-drug resistance was highly prevalent in bacterial isolates associated with VAP (90%; 99/110) and non-VAP categories (81.5%; 106/130). HAP including VAP remains to be the most prevalent hospital-acquired infections (HAIs) at Patan hospital. A local study of etiological agents and outcomes of HAP and VAP are required for setting more appropriate guidelines for management of such diseases.

Study on Optimum IUPAC Adsorption Isotherm Models Employing Sensitivity of Parameters for Rigorous Adsorption System Performance Evaluation

Adsorption cooling technologies driven by low-grade thermal or solar power are used as an energy-efficient alternative to conventional refrigeration and air conditioning systems. Explicit understanding of the adsorption cycles requires precise determination of the performance parameters, replication of the experimental data, and the rigorous study of the adsorption heat transformation method. Hence, the optimum adsorption isotherms model must be identified. Scientists often face difficulties in selecting the suitable isotherm model as there are many models for a particular form of adsorption isotherm. The present study introduces a novel approach for choosing the optimal models for each type of International Union of Pure and Applied Chemistry (IUPAC) classified adsorption isotherm using robust statistical methods. First, the box-and-whisker plots of error identification are employed. Tóth for Type-I(a) and Type-I(b), modified BET for Type-II, GAB for Type-III, Universal for Type-IV(a), and Type-IV(b), Sun Chakrabarty for Type-V, and Yahia et al. for Type-VI were found lower than the other candidate models in box-and-whisker plot. The optimality of our selected models was further verified using analysis of variance (ANOVA), pairwise Tukey honest significant difference (HSD) test, Kruskal–Wallis rank-sum test, and pairwise Wilcoxon rank-sum test. In short, rigorous statistical analysis was performed to identify the best model for each type of isotherm by minimizing error. Moreover, specific cooling effect (SCE) of Maxsorb III/ethanol and silica gel/water pairs were determined. Results showed that Tóth is the optimal isotherm model for the studied pairs, and the SCE values obtained from the model agree well with experimental data. The optimum isotherm model is indispensable for the precise designing of the next generation adsorption cooling cycles.

Ecosystem service coproduction across the zones of biosphere reserves in Europe

ABSTRACT Biosphere reserves (BR) balance biodiversity protection and sustainable use through different management restrictions in three zones: core areas, buffer zones, and transition areas. Information about the links between zoning and ecosystem services (ES) is lacking, particularly in terms of the relative roles of natural contributions (ecosystem properties and functions) and anthropogenic contributions (human inputs such as technology and infrastructure) in coproducing ES. This study aimed to: (1) analyse how coproduction of four ES (crop production, grazing, timber production, recreation) differs across the three zones of BRs; and (2) understand which predictors (zoning, natural and anthropogenic contributions, other environmental characteristics) best explain ES provision within BRs. To do this, we collected spatial data on 137 terrestrial BRs in the European Union and on 16 indicators of ES coproduction. We used non-parametric pairwise Wilcoxon rank sum tests to calculate differences in indicators between zones. We used model selection and multiple linear regression to identify predictors of ES provision patterns. Anthropogenic contributions showed most differences between zones, with contributions generally increasing from buffer zones to transition areas. Natural contributions did not, on average, differ between zones, however, for recreation and crop production they decreased from buffer zones to transition areas. ES provision differed between zones only for crop production and grazing, which increased from buffer zones to transition areas. Regression analysis showed that natural contributions are the best predictors of ES provision for all four services. Our results indicate that zoning of BRs has implications for ES coproduction.

Mycoplasma pneumoniae Genotypes and Clinical Outcome in Children.

Factors leading to the wide range of manifestations associated with Mycoplasma pneumoniae infection are unclear. We investigated whether M. pneumoniae genotypes are associated with specific clinical outcomes. We compared M. pneumoniae loads and genotypes of children with mucocutaneous disease to those of children with pneumonia, family members with upper respiratory tract infection (URTI), and carriers from a prospective cohort study (n = 47; 2016 to 2017) and to those of other children with mucocutaneous disease from a case series (n = 7; 2017 to 2020). Genotyping was performed using macrolide resistance determination, P1 subtyping, multilocus variable-number tandem-repeat analysis (MLVA), and multilocus sequence typing (MLST). Comparisons were performed with a pairwise Wilcoxon rank sum test and a Fisher exact test with corrections for multiple testing, as appropriate. M. pneumoniae loads did not statistically differ between patients with mucocutaneous disease and those with pneumonia or carriers. Macrolide resistance was detected in 1 (1.9%) patient with mucocutaneous disease. MLVA types from 2016 to 2017 included 3-5-6-2 (n = 21 [46.7%]), 3-6-6-2 (n = 2 [4.4%]), 4-5-7-2 (n = 14 [31.1%]), and 4-5-7-3 (n = 8 [17.8%]), and they correlated with P1 subtypes and MLST types. MLVA types were not associated with specific outcomes such as mucocutaneous disease, pneumonia, URTI, or carriage. They were almost identical within families but varied over geographic location. MLVA types in patients with mucocutaneous disease differed between 2016 to 2017 (3-5-6-2, n = 5 [62.5%]) and 2017 to 2020 (4-5-7-2, n = 5 [71.4%]) (P = 0.02). Our results suggest that M. pneumoniae genotypes may not determine specific clinical outcomes.

Effects of build orientation on adaptation of casting patterns for three-unit partial fixed dental prostheses fabricated by using digital light projection

Statement of problemThe lost-wax technique is commonly used for fabricating partial fixed dental prostheses. The casting patterns can be fabricated by using vat photopolymerization (a type of additive manufacturing), but the adaptation of these casting patterns has not been elucidated. PurposeThe purpose of this in vitro study was to evaluate the effect of build orientation on the adaptation of casting patterns fabricated by digital light projection (DLP). Material and methodsA 3-unit partial fixed dental prosthesis with mandibular left second premolar and second molar abutment teeth was scanned and virtually designed with a computer-aided design software program. The cement space was designed to be 30 μm. Specimens were fabricated with 3 build orientations: 0 degrees (with the occlusal surface parallel to the platform), 30 degrees, and 45 degrees (by rotating the file along the long axis). The casting patterns were fabricated by using DLP (Cara Print 4.0) with a photopolymerizable monomer (dima Print Cast Q). Photopolymerization, cleaning, and postpolymerization processes were performed according to the manufacturer’s instructions. The adaptation of the specimens was examined by using a silicone replica method. The vertical marginal discrepancy and axial wall, occlusal, and marginal gaps were measured by using a digital measuring microscope. The effect of build orientation at each cross-sectional area was statistically analyzed by using the Kruskal-Wallis test followed by the pairwise Wilcoxon rank sum test with Bonferroni correction (α=.05). ResultsExcess polymerized resin was observed along the intaglio buccal wall at build orientations of 30 degrees and 45 degrees. Vertical marginal discrepancies in the buccolingual section ranged from −50 to 248 μm, while those in the mesiodistal section ranged from −25 to 182 μm. The gaps in the buccolingual section ranged from 0 to 236 μm, while those in the mesiodistal section ranged from 0 to 177 μm. According to the observation of vertical marginal discrepancies and gaps, the 30-degree specimens inclined during insertion, and the 45-degree specimens were not completely seated. However, the marginal gaps of the 0- and 30-degree specimens were within the clinically acceptable limit of 120 μm. ConclusionsThe limited data indicated that the build orientation influenced the adaptation of casting patterns for 3-unit partial fixed dental prostheses fabricated by using DLP. A build orientation of 0 degrees is recommended for fabricating casting patterns for 3-unit partial fixed dental prostheses because no excess polymerization of the intaglio buccal wall was observed.

Variation in Hospitalist-Specific Antibiotic Prescribing at Four Hospitals: A Novel Tool for Antibiotic Stewardship

Background: Hospitalists play a critical role in antimicrobial stewardship as the primary antibiotic prescriber for many inpatients. We sought to describe antibiotic prescribing variation among hospitalists within a healthcare system. Methods: We created a novel metric of hospitalist-specific antibiotic prescribing by linking hospitalist billing data to hospital medication administration records in 4 hospitals (two 500-bed academic (AMC1 and AMC2), one 400-bed community (CH1), and one 100-bed community (CH2)) from January 2016 to December 2018. We attributed dates that a hospitalist electronically billed for a given patient as billed patient days (bPD) and mapped an antibiotic day of therapy (DOT) to a bPD. Each DOT was classified according to National Healthcare Safety Network antibiotic categories: broad-spectrum hospital-onset (BS-HO), broad-spectrum community-onset (BS-CO), anti-MRSA, and highest risk for Clostridioides difficile infection (CDI). DOT and bPD were pooled to calculate hospitalist-specific DOT per 1,000 bPD. Best subsets regression was performed to assess model fit and generate hospital and antibiotic category-specific models adjusting for patient-level factors (eg, age ≥65, ICD-10 codes for comorbidities and infections). The models were used to calculate predicted hospitalist-specific DOT and observed-to-expected ratios (O:E) for each antibiotic category. Kruskal-Wallis tests and pairwise Wilcoxon rank-sum tests were used to determine significant differences between median DOT per 1,000 bPD and O:E between hospitals for each antibiotic category. Results: During the study period, 116 hospitalists across 4 hospitals contributed a total of 437,303 bPD. Median DOT per 1,000 bPD varied between hospitals (BS-HO range, 46.7–84.2; BS-CO range, 63.3–100; anti-MRSA range, 48.4–65.4; CDI range, 82.0–129.4). CH2 had a significantly higher median DOT per 1,000 bPD compared to the academic hospitals (all antibiotic categories P &lt; .001) and CH1 (BS-HO, P = .01; anti-MRSA, P = .02) (Fig. 1A). The 4 antibiotic groups at 4 hospitals resulted in 16 models, with good model fit for CH2 (R2 &gt; 0.55 for all models), modest model fit for AMC2 (R2 = 0.46–0.55), fair model fit for CH1 (R2 = 0.19–0.35), and poor model fit for AMC1 (R2 &lt; 0.12 for all models). Variation in hospitalist-specific O:E was moderate (IQR, 0.9–1.1). AMC1 showed greater variation than other hospitals, but we detected no significant differences in median O:E between hospitals (all antibiotic categories P &gt; .10) (Fig. 1B). Conclusions: Adjusting for patient-level factors significantly reduced much of the variation in hospitalist-specific DOT per 1,000 bPD in some but not all hospitals, suggesting that unmeasured factors may drive antibiotic prescribing. This metric may represent a target for stewardship intervention, such as hospitalist-specific feedback of antibiotic prescribing practices.Funding: NoneDisclosures: Scott Fridkin, consulting fee - vaccine industry (various) (spouse)

Daily Pad Usage Versus the International Consultation on Incontinence Questionnaire Short Form for Continence Assessment Following Radical Prostatectomy.

PurposeContinence assessment is an essential component of follow-up after radical prostatectomy (RP). Several methods exist to assess the severity of urinary incontinence (UI). Our study examined the relationship and degree of agreement between International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) scores and the number of pads used in a 24-hour period in the assessment of UI following RP.MethodsContinence was prospectively assessed in 746 men from a Spanish urology clinic 12 months after RP using the ICIQ-SF and pad usage. The relationship between ICIQ-SF scores and pad usage was assessed using Spearman rank correlation coefficients. The Jonckheere-Terpstra trend test was used to determine whether the ICIQ-SF score and the component question scores increased with increasing pad usage. The Bonferroni-corrected pairwise Wilcoxon rank-sum test was used to determine which pairs of pad usage levels differed. The weighted kappa was used to evaluate the agreement between pad usage levels and ICIQ-SF questions.ResultsThe continence rate was 82% using the “no pad usage” definition of continence versus 78% using the definition of an ICIQ-SF score of 0 (P<0.001). Strong positive correlations were observed between the number of pads and the ICIQ-SF total and component question scores (rs>0.85, P<0.001). The ICIQ-SF total and component question scores increased significantly with increasing pad usage (P<0.001). The ICIQ-SF scores (P<0.018) for all pairs of pad usage levels (0, 1, 2, or 3 or more) differed significantly. The agreement between the ICIQ-SF leakage amount question and pad usage was very good (rs=0.861, P<0.001).ConclusionsAt 12 months post-RP, 24-hour pad usage was closely correlated with ICIQ-SF, although the continence rate differed depending on the definition used. Higher levels of pad usage were associated with higher questionnaire scores, more leakage, and poor quality of life (interference with everyday life).

Dose-Dependent Effects of EPA Supplementation on Plasma Specialized Pro-Resolving Mediators in Major Depressive Disorder Patients with Chronic Inflammation

Abstract Objectives The immunomodulatory effects of eicosapentaenoic acid (EPA) support it as an effective treatment for major depressive disorder (MDD) associated with chronic inflammation. Increased production of specialized pro-resolving mediators (SPM) during EPA supplementation may help reduce inflammation. We compared the effects of different EPA doses on plasma fatty acids and SPM in MDD patients. Methods MDD patients with baseline inflammation (N = 61, IDS-C score &amp;gt;25; BMI &amp;gt; 25 kg/m2; serum CRP &amp;gt; 3 mg/L) were enrolled in a 2-site, 12-wk randomized trial comparing EPA 1, 2 and 4 g/d to placebo (soybean oil). Plasma fatty acids (mol%) and SPM (pg/mL) were measured at baseline and 12 wks (n = 8 [10], 12 [11], 11 and 10 in the placebo, EPA 1, 2 and 4 g/d arms, respectively). Dose effects were tested using the Kruskal-Wallis followed by pairwise Wilcoxon rank-sum tests with Benjamini-Hochberg correction. Results In the placebo arm, plasma EPA and EPA derivatives did not change at 12 wks, relative to baseline. EPA supplementation significantly increased plasma EPA dose-dependently (3-, 3- and 9-fold in the 1, 2 and 4 g/d arms). Similar significant dose-dependent increases in EPA derivatives were observed in the EPA arms, including 18-hydroxy-EPA (18-HEPE, 8-, 7- and 14-fold) and 15-HEPE (4-, 6- and 10-fold). The increase in 18-HEPE, a precursor of EPA-series resolvins (RvE), by 4 g/d EPA was significantly greater than with lower doses. While RvE1 remained undetected in all treatment arms, RvE2 was detected in some subjects at baseline and 12 wks with a dose-dependent median increase (+3, +6 and +8 pg/mL). RvE3, undetectable at baseline, became detectable in more subjects dose-dependently (n = 1, 2, 3 and 6). The reduction in plasma arachidonic acid (AA) by EPA supplementation significantly differed from placebo only at 2 and 4 g/d but not between the two doses. AA derivatives were not affected, except for the pro-resolving lipoxin B4, which was rarely detected at baseline, but became detectable in most subjects after EPA supplementation (median: 46, 59 and 94 pg/mL). Conclusions Our results show a robust dose-effect of EPA in increasing plasma EPA and EPA-derived 18-HEPE, which may result in improved conversion to RvE2 and RvE3. Its associations with reduced inflammation and improved IDS-C scores will be further analyzed. Funding Sources NCCIH.

0591 The Significance of Body Mass Index in Varying Sleep Apnea Levels for Men and Women

Abstract Introduction A BMI increase, in men and women, is associated with an increased severity and progression of OSA. This study will examine the impact of BMI on varying levels of OSA severity and progression. Methods Participants, divided by sex, included 2728 (47%) men and 3076 (53%) women over the age of 40 that were in the Sleep Heart Health Study (SHHS). Participants were separated into 1 of 10 groups based on initial OSA levels at SHHS time point 1 (SHHS1) and ending OSA levels at SHHS time point 2 (SHHS2) as measured by RDI. A Kruskall-Wallis test examined the BMI median differences in the groups. Post-hoc tests, including pairwise comparisons and Wilcoxon rank sum test with Holm adjustment, were conducted to further examine results. Results Significant differences existed between certain groups (Men: Chi-Square=146.87, p&amp;lt;.001, df=9; Women: Chi-Square=128.59, p&amp;lt;.001, df=9). For men and women, those in the group with normal OSA levels at SHHS1 and SHHS2 had significant BMI differences compared to those in all 9 other groups where mild, moderate, or severe OSA levels exist at SHHS1 or SHHS2. Additionally, in men, BMI is significantly different for those with normal or mild OSA levels at SHHS2 compared to those with moderate or severe OSA levels at SHHS2. Also, a significant BMI difference exists in men maintaining mild OSA levels throughout SHHS compared to those maintaining severe OSA levels. Conclusion Although BMI is a known influential factor in OSA progression, this study demonstrated that those maintaining normal OSA levels over time have a significant BMI difference compared to those reaching even mild OSA levels over time. Additional implications were also found for men. These findings may coincide with recent research suggesting that one needs to progress only to moderate OSA levels to reach a tipping point of significantly increasing and impacting many health risks. Support Robert Wood Johnson Foundation Future of Nursing Scholars Program

Comparative study of nature-inspired algorithms to design (1+α) and (2+α)-order filters using a frequency-domain approach

A precise control in the stopband attenuation characteristics can be achieved by using the fractional-step filters instead of the traditional integer-order filters. In this paper, nine nature-inspired optimization algorithms, such as five advanced variants of differential evolution (DE), three advanced variants of particle swarm optimization (PSO), and an efficient evolutionary strategy method (CMA-ES-RIS) are employed to design the fractional-step low pass Butterworth filter (FLBF). The proposed ( 1 + α ) and ( 2 + α ) order models, where α ∈ ( 0 , ​ 1 ) , are optimally approximated as an integer-order transfer function by using the magnitude-frequency information of the ideal FLBF. Comparisons regarding the solution quality and robustness reveal an improved accuracy for the DE variants and CMA-ES-RIS over all the PSO variants. Results from the pair-wise Wilcoxon rank-sum test demonstrate the superiority of enhanced fitness-adaptive differential evolution (EFADE) algorithm as the most efficient optimization tool for solving this problem. Comparisons with the state-of-the-art approaches also confirm the superior modelling accuracy of the proposed FLBFs. The canonical structure circuit realization of the FLBFs using current feedback operational amplifiers is presented. Simulations carried out in OrCAD PSPICE platform suggest proximity in the magnitude responses between the proposed and the theoretical models. The optimal design of stable, minimum-phase ( 2 + α ) order FLBFs is also presented for the first time without employing the cascading concept involving the integer-order Butterworth polynomials.

An Efficient JAYA Algorithm with Lévy Flight for Non-linear Channel Equalization

Neural network (NN) based equalizers are known to outperform the linear equalizers based on finite impulse response (FIR) adaptive filter for highly dispersive and non-linear channels. To overcome the limitations of the back-propagation (BP) algorithm, metaheuristic algorithms are emerging as promising alternatives for training the NN based equalizers. JAYA is a simple and efficient metaheuristic algorithm. Hence, its application to channel equalization problem is worth investigating. Despite its simplicity and efficiency, the JAYA algorithm has problems such as being trapped in local minima due to insufficient diversity of population and weak exploration capability. To alleviate these issues, in this paper the concept of Lévy flight (LF) and greedy selection scheme has been incorporated into the basic JAYA algorithm. The LF concept enhances the population diversity and thus avoids the state of stagnation. The greedy selection scheme is employed to improve the exploitation ability without loss of population diversity. Furthermore, in order to maintain the balance between the exploration and exploitation capabilities of the algorithm, an adaptive Lévy index is proposed based on a linear control parameter strategy. An extensive simulation-based sensitivity analysis of proposed method called JAYA algorithm with Lévy flight (JAYALF) with respect to key parameters is carried out to select the optimized values for these parameters. In order to validate the local optima avoidance ability, exploitation and convergence rate of the proposed JAYALF algorithm, it is tested on seventeen well-known unimodal and multimodal benchmark functions and to verify the effectiveness of the JAYALF for non-linear channel equalization problem, three wireless communication channels with two different nonlinearities have been considered for simulation. In addition, the non-parametric pairwise Wilcoxon rank-sum test has been employed to test the statistical validity of the results obtained from JAYALF. The results of experiments and statistical test demonstrate that the proposed algorithm significantly outperforms JAYA, variants of JAYA, state-of-the-art algorithms and BP algorithm in terms of solution quality, convergence speed, and robustness. Furthermore, the results of experimental analyses conducted indicate that proposed JAYALF algorithm has a better exploration ability and converges quickly without getting trapped into local optima.