Pearson X2 Research Articles

Trends and outcomes of different mechanical circulatory support modalities for acute myocardial infarction associated cardiogenic shock in patients undergoing early revascularization

BackgroundThe use of Mechanical Circulatory Support (MCS) devices in cardiogenic shock (CS) is growing. However, the recent trends in using different MCS modalities and their outcomes in acute myocardial infarction associated CS (AMI-CS) are unknown. MethodsThe national readmission database (2016–2020) was used to identify AMI-CS requiring MCS. Cohorts were stratified as ECMO compared to Impella. Propensity score matching (PSM) was used to remove confounding factors. Pearson's x2 test was applied to matched cohorts to compare outcomes. We used multivariate regression and reported predictive margins for adjusted trend analysis. ResultsAmong 20,950 AMI-CS hospitalizations requiring MCS, 19,628 (93.7 %) received Impella vs 1322 (6.3 %) were placed only on ECMO. ECMO group was younger (median age: 61 vs. 68 years, p < 0.001) and had a lower comorbidity burden. On propensity-matched cohorts (N 742), the ECMO cohort had higher adverse events, including mortality (51.6 % vs. 41.5 %), sudden cardiac arrest (SCA) (40.9 % vs. 31.8 %), acute stroke (9.2 % vs. 4.6 %) and major bleeding (16 % vs 12.2 %) [p < 0.05]. However, comparing ECPELLA (ECMO + Impella) to Impella alone, mortality (46.2 % vs. 39.4 %) and SCA (44 % vs. 36.4 %) rates were similar, though major bleeding was higher (18.2 % vs. 9.8 %). From 2016 to 2020, mortality trends for AMI-CS in the U.S. showed no significant change (p-trend: 0.071). ConclusionDespite advances in MCS modalities, the overall mortality rate for AMI-CS remains unchanged. ECMO use without LV unloading showed higher mortality and adverse events compared to Impella. Prospective studies are needed to verify these findings.

375. ROLE OF RECURRENTIAL LYMPHADENECTOMY BY MINIMALLY INVASIVE APPROACH IN THE SURGICAL TREATMENT OF ESOPHAGEAL CANCER

Abstract Background Esophageal cancer is an aggressive tumor, which is normally diagnosed in more advanced stages. The anatomical characteristics of the esophagus allow rapid spread to neighboring structures, and the extensive lymphatic drainage network facilitates tumor spread even in early stages. Lymphatic spread is the single most important prognostic factor and is a good predictor of disease-free survival. The objective of this study is to present the esophageal neoplasms operated in our center in which we have performed a recurrent lymphadenectomy, describing the postoperative complications, the presence of lymph node metastases and their influence on the evolutionary course of the disease. Methods Retrospective, observational, descriptive and analytical study in which all patients operated on for esophageal neoplasia from January 2019 to January 2024 are included. All patients have been operated on by the same surgical team specialized in esophagogastric surgery. Quantitative variables are described as mean and standard deviation, and qualitative variables are described as absolute number and percentage. The univariate methods used are Pearson's X2 or Student's t for independent samples. A logistic regression has also been performed to study factors that influence in survival. The IBM SPSS Statistics 22 program was used to analyze the data. Results 89 patients have been operated on, 70 three-stage esophagectomies and 16 two-stage. In 60,6% cases it was adenocarcinoma and 33,7% squamous cell histology. Recurrent lymphadenectomy was performed in all of them, 31 expanded and 58 total. 6 patients with recurrent lymph nodes affected, 2 on the right side, 3 on the left and 1 bilateral. 15% patients with tumors &amp;gt;T2 presented recurrent affected lymph nodes, increasing to 20% in adenocarcinomas. 20 recurrent nerve injuries, all of them transient except 3. Statistically significant relationship has been found between the number of affected lymph nodes and disease-free survival time (p = 0.045). Conclusion Mediastinal and recurrent lymphadenectomy in esophageal cancer influences in the number of positive nodes obtained after surgery. This could determine a more advanced staging of the disease, which allows adaptation of the adjuvant treatment, influencing in the time free of disease. Most injuries caused by this type of lymphadenectomy can be managed with conservative treatment.

Resistance Pattern of Klebsiella pneumoniae in Aseer Region, Saudi Arabia: A Ten-Year Hospital-Based Study.

Background and Objectives: The frequency of multidrug-resistant Klebsiella pneumoniae (MDRKP) has dramatically increased worldwide in recent decades, posing an urgent threat to public health. The aim of this study was to assess the extent of K. pneumoniae in the Aseer region and explore the corresponding antimicrobial resistance profile over the last ten years. Materials and Methods: A record-based retrospective study was conducted in a tertiary hospital during the period of 2013 to 2022. The study targeted laboratory samples taken from patients admitted to the hospital and sent for K. pneumoniae culturing. We included only samples taken from the patient and confirmed by the lab. Data were extracted using a pre-structured data extraction sheet to avoid data-collection bias and confirm the inter-rater precision. Statistical Package for Social Sciences (SPSS) version 26 was employed for statistical analysis. All relationships were tested using Pearson X2 test for categorical data or chi-square for linear trend for resistance rate over years. Results: We obtained 3921 samples of isolated K. pneumoniae out of 28,420 bacterial samples. The isolation rate began at 11.3% in 2013, decreased to 6.1% in 2016, and then increased to a peak of 16.3% in 2021, before slightly decreasing to 12.8% in 2022. In total, 23.7% of K. pneumoniae samples were identified in urine samples, 19% in sputum samples, 14% in wound samples, and 11.7% in blood samples. The overall antibiotic resistance rate of K. pneumoniae from 2013 to 2022 showed a significant increase, particularly during 2020 and 2021, before decreasing again in 2022. The resistance rate decreased from 22.2% in 2013 to 18.6% in 2016 and increased to 54.6% and 56.4% during 2020 and 2021, respectively (p = 0.039). Conclusions: We observed a significant shift in K. pneumoniae resistance for some antibiotics during the study period, highlighting the urgent need for enhanced antimicrobial stewardship and infection-control measures.

Treatment options for impacted maxillary canines and occurrence of ankylotic and resorptive processes: a 20-year retrospective study

BackgroundThis 20-year retrospective study aimed to evaluate the treatment methods used in patients with impacted maxillary permanent canines and to determine the occurrence of ankylotic and resorptive processes and their association with potential risk factors.MethodsThe cohort consisted of 351 consecutive Caucasian patients (120 males and 231 females, mean age 18.4 and 19.9 years, respectively) with 420 impacted maxillary permanent canines. CT and CBCT findings were subsequently confirmed during surgery. Statistical analyses were performed by the generalized linear models, Pearson x2 and Fisher exact tests using the statistical programs R and Statistica v. 14.ResultsA total of 273 (65.0%) impacted canines were aligned in the dental arch by orthodontic traction after surgical exposure, this treatment was predominant in patients under 20 years of age. Surgical extraction was performed in 115 (27.2%) impacted canines and was more common in older patients. Ankylotic changes were recorded in 61 (14.5%) impacted canines. The probability of ankylosis increased with age, particularly after the patient’s 20th year of life (p < 0.001). Patients were 1.2% likely to develop ankylosis at age 15 years, 4.3% at age 20 years, 14.1% at age 25 years, and 96.8% at age 45 years. Invasive cervical root resorption (ICRR) was found in 8 (1.9%) canines. In 4 canines (1.0%), root ankylosis in addition to ICRR was observed. In contrast to ankylosis, whose frequency of occurrence increased with age, the occurrence of ICRR resulting from PDL damage during surgery was more typical in younger patients. Canines in a high position above the root apices of the adjacent teeth, with a horizontal inclination of the longitudinal axis, with the crown located deep in the center of the alveolar bone and with labiopalatal position, should be considered critically impacted canines with a high risk to failure of orthodontic traction.ConclusionIn conclusion, the treatment of impacted canines depends mainly on the age of the patient, and the position and inclination of the longitudinal axis of the impacted tooth. To select an adequate treatment method, we recommend CBCT examination, which allows a precise analysis of the position of impacted canines.

Knowledge of mothers of children under 5 years of age about vaccination schedule

Determine the level of knowledge of mothers of children under 5 years of age about vaccination schedule. Cross-sectional, observational, descriptive, and analytical study, carried out in the Family Medicine Unit 1 of Orizaba, Veracruz, in which two questionnaires were applied to mothers of children under 5 years of age, one prepared by PAHO that qualifies attitudes. of parents about vaccines, and another that evaluates knowledge of immunizations. Absolute frequencies and percentages were estimated; and the association with Pearson's X2 was determined. A total of 138 women were registered, with age limits of 18 to 48 years. The level of knowledge was high (70.3%) and was related to the age, education (p = 0.00) and occupation (p = 0.03) of the mothers. The highest frequencies were for housewives (47.1%), professionals (3.5%), married (60.2%) and of the Catholic religion (81.2%). This study confirms the null hypothesis, which indicates that 70.3% have high knowledge about vaccination, and it is associated with the age, education, and occupation of the mothers.

Minimizing tearing during vaginal delivery with a perineal protection device: a randomized controlled trial

There is a growing body of evidence indicating that second-degree tears cause both short- and long-term consequences. Very few preventative measures have been found to reduce the incidence of these tears. This study aimed to investigate whether the use of a perineal protection device during vaginal birth reduces severe perineal tearing (grade ≥2 tear) in primiparous women compared with routine manual perineal support. A single-center randomized controlled trial was conducted in Sweden from 2019 to 2021. Primiparous women at term were randomly allocated to the intervention group (n=43), where a perineal protection device was used, or to the routine care group (n=49). The primary outcome was grade of perineal tear. The secondary outcomes were vaginal and labial tearing. Continuous data were analyzed using the Student t test or Mann-Whitney U test. Dichotomous data were analyzed using the Pearson X2 test, Fisher exact test, and ordinal logistic regression. Women in the intervention group had a significantly lower risk of sustaining more extensive perineal tearing than those in the control group. The use of the perineal protection device decreased the risk of grade ≥2 tears in relation to grade 0 to 1 tears (odds ratio, 0.40; 95% confidence interval, 0.17-0.94). Ordinal logistic regression analyses revealed an odds ratio of 0.36 (95% confidence interval, 0.16-0.81) per incremetn of grade injury using the perineal protection device vs routine care (P=.013). The number needed to treat using the perineal protection device was 4.3 to avoid 1 grade ≥2 tear. Women in the treatment group showed less labial tearing (P=.016). No adverse effect was detected. The use of a perineal protection device reduced the risk of grade ≥2 perineal tearing by 60% and labial tearing. El resumen está disponible en Español al final del artículo.

Tachyarrhythmias burden in hospitalized patients with cancer: A nationwide propensity matched analysis.

e24032 Background: Remarkable progress has been made in the management of cancer with the advent of new therapies. However, significant concern exists over the cardiotoxic effects of chemotherapy and radiation therapy. We aim to evaluate the different cardiac tachyarrhythmias in hospitalized cancer patients. Methods: The national readmission database (2016-2020) was queried to identify all-cause admissions for patients with active malignancy of any origin. Multivariate regression model was used to obtain adjusted odds ratio (aOR). Univariate screening was utilized for regression building model. Multicollinearity among different variables were determined by variation inflation factor (VIF). VIF &gt; 5 was taken as cut off for significant collinearity. Cohorts were stratified based on the presence of tachyarrhythmias. A propensity score matching (PSM) model, implementing complete Mahalanobis Distance Matching within the Propensity Score caliper (set at 0.2), matched cancer patients with and without tachyarrhythmias. Inverse Probability weighting(IPW) was utilized, and Pearson's x2 test was applied to the PSM matched cohorts to compare outcomes. Results: Among 10.6 million all-cause hospitalizations of cancer patients, about 1.7 million (16%) developed tachyarrhythmia. On a propensity-matched cohort, patients with active malignancy had the highest rates of atrial fibrillation (AF) (14.1%), followed by supraventricular tachycardia (SVT) (1.1%), ventricular tachycardia (VT) (0.8%) and atrial flutter (AFL) (0.4%) [p &lt; 0.001]. Cancer patients with tachyarrhythmias had increased in-hospital mortality. The mortality was highest for VT (aOR 3.9, CI 3.7 - 4.01, P &lt; 0.001), followed by SVT (aOR 2.6,CI 2.51 - 2.67, p &lt; 0.001), AFL (aOR 2.5, CI 2.38 - 2.59, p &lt; 0.001 ) and AF (aOR 1.54, CI 1.52 -1.56, p &lt; 0.001). Readmissions among patients who developed tachyarrhythmias during index hospitalization showed that 18.7% and 34.3 % had recurrent AF, 17.4% and 33% had recurrent SVT, 17.3% and 32.1% had recurrent AFL, and 15.4% and 31.1% developed recurrent VT at 30 and 90- day readmissions respectively. Resource utilization was also higher in the cohort complicated by tachyarrhythmias, with the highest length of stay (LOS)(7 vs 4 days) and total cost ($31,718 vs $17,659) in hospitalization complicated by VT (p &lt; 0.001). A similar increase in LOS and total inpatient cost was also seen in cancer patients whose hospitalization was complicated with SVT, AFT and AF compared to patients without arrhythmias (p &lt; 0.01). Conclusions: Hospitalizations in cancer patients complicated by tachyarrhythmias were associated with higher in-hospital mortality, LOS, and adjusted cost. VT is associated with the highest mortality; however, AF appears to be most prevalent during index admission and readmissions. This study signifies the importance of close cardiac monitoring in hospitalized cancer patients to prevent adverse outcomes.

Change in Sexual Behaviour Among Men Who have Sex with Men During the COVID-19 Pandemic in the Czechia

Introduction: The study sought to identify changes in sexual activity during the COVID-19 pandemic among men who have sex with men. Methods: The descriptive cross-sectional study used a questionnaire survey distributed on social networks using the snowball method in the Czech Republic. Statistical procedures were performed in SPSS and MS Excel. After descriptive statistics, association analysis was performed using the Pearson x2 test. Cramer’s V and the Contingency Coefficient were used to verify the strength of the association. Pearson’s adjusted standardized residuals were analyzed to interpret the associations.

Associations of Changes in Bone Turnover Markers with Change in Bone Mineral Density in Kidney Transplant Patients.

Bone loss after kidney transplantation is highly variable. We investigated whether changes in bone turnover markers associate with bone loss during the first post-transplant year. Bone mineral density (BMD) was measured at 0 and 12 months, with biointact parathyroid hormone, bone-specific alkaline phosphatase (BALP), intact procollagen type I N -terminal propeptide (PINP), and tartrate-resistant acid phosphatase isoform 5b (TRAP5b) measured at 0, 3, and 12 months post-transplant ( N =209). Paired transiliac bone biopsies were available in a subset ( n =49). Between-group differences were evaluated by Student's t test, Wilcoxon signed-rank test, or Pearson's chi-squared test. Changes in BMD varied from -22% to +17%/yr. Compared with patients with no change (±2.5%/yr), patients who gained BMD had higher levels of parathyroid hormone (236 versus 136 pg/ml), BALP (31.7 versus 18.8 μ g/L), and Intact PINP (121.9 versus 70.4 μ g/L) at time of transplantation; a greater decrease in BALP (-40% versus -21%) and Intact PINP (-43% versus -13%) by 3 months; and lower levels of Intact PINP (36.3 versus 60.0 μ g/L) at 12 months post-transplant. Patients who lost BMD had a less marked decrease, or even increase, in Intact PINP (+22% versus -13%) and TRAP5b (-27% versus -43%) at 3 months and higher Intact PINP (83.7 versus 60.0 μ g/L) and TRAP5b (3.89 versus 3.16 U/L) at 12 months compared with patients with no change. If none of the biomarkers decreased by the least significant change at 3 months, an almost two-fold (69% versus 36%) higher occurrence of bone loss was seen at 12 months post-transplant. Bone loss after kidney transplantation was highly variable. Resolution of high bone turnover, as reflected by decreasing bone turnover markers, associated with BMD gain, while increasing bone turnover markers associated with bone loss.

Teachers’ appraisal of classroom physical environment on students’ academic performance in Kenya certificate of secondary education in Laikipia county

The Universal Declaration of Human Rights has declared that education is fundamental human rights to the well-being of any society. Therefore, the study was motivated by the need to improve students’ academic performance in Kenya Certificate of Secondary Education examination, a case in Laikipia County, Kenya. The study was guided by one objective. To determine the extent to which appraisal of teachers on classroom physical environment influences students’ performance in Kenya Certificate of Secondary Education in Laikipia County. The study targeted 94 public secondary schools which comprises of 94 principals and 1100 teachers in Laikipia County. Purposive sampling was used to select 45 principals while simple random sampling was used to select 300 teachers. Questionnaires were used to collect data from principals and teachers. The findings of the null hypothesis there is no significant relationship between teacher appraisal on classroom physical environment and students’ performance using Chi square test was (df=16, Pearson X2=233.083, p=0.005 at 0.05 significance level). The null hypothesis was rejected hence there is a significant relationship between teacher appraisal on classroom physical environment and students’ performance to both principals and teachers to enhance establishment of effective appraisal process and Teachers Service Commission to have a well-placed sound policy and include all stakeholders, well-defined criterion on how to appraise, promote and appoint competent and experienced principals because a number of them lack competency in appraisal process.

Competing Forecast Verification: Using the Power-Divergence Statistic for Testing the Frequency of “Better”

Abstract When testing hypotheses about which of two competing models is better, say A and B, the difference is often not significant. An alternative, complementary approach, is to measure how often model A is better than model B regardless of how slight or large the difference. The hypothesis concerns whether or not the percentage of time that model A is better than model B is larger than 50%. One generalized test statistic that can be used is the power-divergence test, which encompasses many familiar goodness-of-fit test statistics, such as the loglikelihood-ratio and Pearson X2 tests. Theoretical results justify using the distribution for the entire family of test statistics, where k is the number of categories. However, these results assume that the underlying data are independent and identically distributed, which is often violated. Empirical results demonstrate that the reduction to two categories (i.e., model A is better than model B versus model B is better than A) results in a test that is reasonably robust to even severe departures from temporal independence, as well as contemporaneous correlation. The test is demonstrated on two different example verification sets: 6-h forecasts of eddy dissipation rate (m2/3 s−1) from two versions of the Graphical Turbulence Guidance model and for 12-h forecasts of 2-m temperature (°C) and 10-m wind speed (m s−1) from two versions of the High-Resolution Rapid Refresh model. The novelty of this paper is in demonstrating the utility of the power-divergence statistic in the face of temporally dependent data, as well as the emphasis on testing for the “frequency-of-better” alongside more traditional measures.

Stroke in Sierra Leone. the stroke risk factors for people with HIV: A prospective case-control study

BackgroundHIV infection rates are relatively low in Sierra Leone and in West Africa but the contribution of HIV to the risk factors for stroke and outcomes is unknown. In this study, we examined stroke types, presentation, risk factors and outcome in HIV stroke patients compared with controls. MethodsWe used data from the Stroke in Sierra Leone Study at 2 tertiary hospitals in Freetown, Sierra Leone. A case control design was used to compare stroke type, presentation, risk factors and outcome in sero-positive HIV patients with HIV negative stroke controls. Controls were matched for age and gender and a 1:4 ratio cases to controls was used to optimize power. Analysis was performed using the Pearson x2 for categorical variable, Paired-T test and Mann-Whitney U test for continuous variables. A p-value of less than 0.05 was taken as the level of statistical significance. ResultsOf 511 (51.8%) stroke patients tested for HIV, 36 (7.1%) were positive. Univariate unmatched analysis showed a stroke mean age of 49 years in HIV-positive versus 58 years in HIV-negative population (p = <0.001). In the case-control group, ischaemic stroke is the major type reported in both populations, HIV-negative population: 77 (53.5%) versus HIV-positive: 25 (69.4%) (p = 0.084). Hypertension is the most prevalent risk factor in both groups, HIV-positive: 23 (63.9%) versus HIV-negative: 409 (86.1%) (p = 0.001). Lower CD4+ count is associated in-hospital mortality (p = <0.001). ConclusionThese findings support the current call for timely management of stroke and HIV through integrated care.

Efficacy of inferior alveolar nerve block and intraligamentary anesthesia in the extraction of primary mandibular molars: A randomized controlled clinical trial

ObjectiveThe study aims to compare the effectiveness and quality of intraligamentary anesthesia (ILA) and inferior alveolar nerve block (IANB) for primary mandibular molar extraction. MethodsThis prospective, randomized clinical study included patients aged 5 to 13 years scheduled for primary mandibular molar extraction. A total of 208 participants were randomly allocated into two groups (n = 104 each group), IANB and ILA, who were administered 2% lignocaine with epinephrine 1:100,000. Patients rated their pain during injection and extraction (VAS pain score). Frankl’s behavior rating score, quality of anesthesia as perceived by clinician, and duration of procedure were recorded. Demographic and other variables were analysed using Pearson x2 test, Pearson correlation coefficient, Fisher exact test, or an analysis of variance, as appropriate. ResultsIn patients who received IANB, the clinician reported a slightly better quality of anesthesia (p = 0.19) than those who received ILA (VAS score 1.3 ± 0.7 Vs 1.6 ± 0.4). Mean (±SD) score for pain during extraction were found be 1.7 (±0.6) for the IANB group and 1.8 (±0.5) for the ILA group. The clinician observed 46.2% of patients in the IANB group and 39.4% of patients in the ILA group had no discomfort during extraction. Frankl’s behavior score was negatively correlated with the quality of anesthesia and the time taken to complete the extraction (p = 0.017 and p = 0.053, respectively). ConclusionThe efficacy of conventional ILA was similar to IANB, and thus ILA might be a good alternative to the IANB while extracting primary mandibular molars.

Relationship of Mobbing and Burnout in Vascular Surgeons

Burnout is a condition of frustration brought on by unfulfilled commitment to a cause or way of life. It may negatively affect the quality of patient care by raising the likelihood of medical errors and decreasing patient satisfaction. Mobbing is described as harassment that undermines a person's character, integrity, or dignity at least once per week for more than 6 months. It can result in decreased productivity and an environment that is more hazardous for patients. The prevalence of burnout among vascular surgeons has been the subject of multiple research, with estimates ranging from 34% to 41%. The association between burnout and mobbing among vascular surgeons has not yet been investigated. The purpose of this study was to examine whether or not burnout among Mexican vascular surgeons is associated with mobbing. This is a cross-sectional observational study of vascular surgeons currently practicing in Mexico. The protocol was approved by The Ethics Committee of the National Institute of Medical Sciences and Nutrition Salvador Zubiran. The Maslach Burnout Inventory (MBI) was used to assess burnout, and the Modified Leymann Inventory of Psychological Terrorism-60 (LIPT-60), was used to assess mobbing. The study also collected data on other characteristics that may contribute to burnout and mobbing, such as gender, hours worked per week, practice type, and birth generation. REDCap platform was used for both the collection and evaluation of the data, the statistical analysis for this study included the utilization of descriptive statistics, as well as the examination of statistical correlations using X2, Fisher's and Pearson's X2 test. Of the 142 complete surveys assessed, 41% revealed burnout symptoms, with emotional exhaustion being the most prevalent symptom (Tables I and II). Of the population, 32% suffered positive mobbing strategies. The study demonstrated a strong association between burnout and mobbing, with mobbing victims having a greater risk of developing burnout (odds ratio, 3.16; 95% confidence interval, 1.5-6.6). In addition, female gender, belonging to Generation X, working more than three extra 8-hour shifts per week, practicing in the public sector were also related with a greater prevalence of burnout and mobbing. This study discovered a substantial correlation between burnout and mobbing among Mexican vascular surgeons. These findings show that measures to prevent mobbing may lessen the occurrence of burnout among this population. To validate these findings and identify possible strategies for preventing and addressing burnout and mobbing in this group, additional study is required.Table IRisk factors for burnout in Mexican vascular surgeonsBurnout (n = 142)Affected populationOdds ratioP valueGender.03 Female (n = 58)52%1.6 Male (n = 84)33%0.61Generation.06 Baby boomer (n = 22)18%0.25 Generation X (n = 41)44%0.78 Millennial (n = 79)46%0.85Type of practice.05 Public (n = 14)57%1.32 Mixed (n = 56)46%0.85 Private (n = 50)28%0.39Extra shifts per week (8-hour shift).18a 0 (n = 68)37%1.12 1 (n = 26)35%1.06 2 (n = 18)33%1 3 (n = 19)58%1.75 4 (n = 3)33%1 5 (n = 7)75%2.27a>3 shifts vs <3 shifts P = .03. Open table in a new tab Table IIRisk factors for mobbing in Mexican vascular surgeonsMobbing (n = 142)Affected populationOdds ratioP valueGender.04 Female (n = 58)41%1.64 Male (n = 84)25%0.6Generation.02 Baby boomer (n = 22)14%1 Generation X (n = 41)46%3.29 Millennial (n = 79)29%2.07Type of practice.8 Public (n = 14)36%1.29 Mixed (n = 56)33%1.18 Private (n = 50)28%1Extra shifts per week (8-hour shifts).03 0 (n = 68)24%1.09 1 (n = 26)42%1.91 2 (n = 18)22%1 3 (n = 19)42%1.91 4 (n = 3)67%3.04 5 (n = 7)50%2.27 Open table in a new tab

Trends in Gynecologic Carcinosarcoma Based on Analysis of the Surveillance Epidemiology End Result (SEER) Database.

Carcinosarcomas (malignant mixed Mullerian tumors) of a female genital organ are rare tumors associated with a poor survival. The purpose of this study was to identify site-specific differences in the incidence and prognosis in carcinosarcomas originating in the uterus, cervix, or ovary. The data of patients with gynecologic carcinosarcomas were extracted from the Surveillance, Epidemiology, and End Results (SEER) database between 2000 and 2016. The characteristics of gynecologic carcinosarcomas were compared using Pearson X2 and Fisher's exact tests. Kaplan-Meier models were used for cause-specific survival (CSS) analysis. The cohort included 7086 females, including 5731 cases of uterine carcinosarcoma, 161 cervical carcinosarcomas, and 1193 ovarian carcinosarcomas. The age-adjusted incidence rates of uterine, cervical, and ovarian carcinosarcoma were 3.9, 0.1, and 0.6 per 1,000,000, respectively. In the distribution of carcinosarcoma incidence by race, compared with the uterus or cervix, those originating from the ovary were unequally distributed in Caucasians (84.4% versus 69.6%, 67.7%; p < 0.001). The incidence of uterine carcinosarcoma steadily increased over time, from 2.2 in 2000 to 5.5 in 2016 (per 1,000,000), while cervical or ovarian carcinosarcoma showed no significant difference in incidence. The five-year CSS rates based on the site of origin (uterus, cervix, and ovary) were 39.9%, 33.1%, and 25.8%, respectively. The incidence rates of gynecologic carcinosarcoma, especially uterine carcinosarcoma, are gradually increasing. Although uterine carcinosarcoma is associated with a higher incidence than the others, it has a better prognosis compared with ovarian and cervical carcinosarcoma. The survival rates were worst in ovarian carcinosarcoma.

1659. Association of Rurality and Identifying as Black with Receipt of Specialty Care among Patients Hospitalized with Diabetic Foot Ulcers: a Medicare cohort study

Abstract Background Among those with diabetic foot ulcers, rural patients identifying as Black face at least 10% greater risk of major amputation or death compared to the US as a whole. As specialty care is associated with lower risk of major amputation, this difference could be driven by specialty care access. We hypothesize that rural patients and, particularly, rural patients identifying as Black, receive less inpatient specialty care compared to the overall cohort. Methods We built a cohort of all Medicare patients hospitalized with diabetic foot ulcers (2013–2014). Rurality was measured using Rural Urban Commuting Area codes. Race was categorized using the Research Triangle Institute algorithm. Specialty care was defined as receiving inpatient care from at least 1 of 6 relevant specialties to address diabetes, infection, biomechanics or vascular disease, per National Provider Taxonomy codes: endocrinology, infectious disease, orthopedic surgery, plastic surgery, podiatry, and vascular surgery. We reported observed differences in specialty care, overall and stratified by rurality, identifying as Black, and ulcer severity. Pearson X2 tests were performed on observed frequencies. Results Overall, 32.2% of the cohort received inpatient specialty care. This proportion decreased to 29.6% for rural patients (X2 = 36.2, p ≤ 0.001) and 26.2% for rural patients identifying as Black (X2 = 19.5, p ≤ 0.001). Among those with osteomyelitis, 54.3% of the cohort received specialty care, while only 49.5% of rural patients, 50.8% of patients identifying as Black, and 37.6% of rural patients identifying as Black received specialty care; the disparity for rural patients identifying as Black was greater than the sum of rural and racial disparities (4.8% for rural + 3.5% for Blacks = 8.3% versus a 16.7% observed difference for rural Blacks; Figure 1). Notably, only 2.7% of patients presenting with osteomyelitis were seen by an infectious disease specialist. This proportion decreased to 2.5% for rural patients. Observed Proportions of Patients Receiving Specialty Care Stratified by Rurality, Identifying as Black, and Ulcer Severity Conclusion A smaller proportion of rural patients received specialty care, and rural patients identifying as Black were half as likely to receive specialty care than the overall cohort. Improving specialty access for these high-risk patients may reduce disparities in major amputations. Disclosures All Authors: No reported disclosures.

ROLE OF INVOLVEMENT WITH PROFESSIONAL OCCUPATION OF LIFE-SENSE ORIENTATIONS OF TODAY'S STUDENTS OF PEDAGOGICAL INSTITUTIONS

The article discusses students' personal growth and preparedness for their future professional occupation during their learning in a pedagogical university. The authors address the effects of involvement in professional occupation during their university study on the life-meaning areas. The following methods were used to conduct this study: questionnaire surveys; "Who am I?", a reflective self-assessment test developed by V.S. Mukhina; the life-sense orientation test developed by D.A. Leontiev; the Value Survey by Milton Rokeach; Occupational Motivation Methodology by C. Zamfir updated by A. Rean, and the statistical methods of empirical data processing: Pearson's x2 criterion and cluster analysis. The research covered the students of the pedagogical institute, with 100 students in the 1st through 4th year. The empirical research identified five subject clusters distinguished by their involvement in professional activities and life-sense orientations. The research allows us to view professional involvement during students' higher education periods as a factor of their professional motivation in the context of digital education.

ROLE OF INVOLVEMENT WITH PROFESSIONAL OCCUPATION OF LIFE-SENSE ORIENTATIONS OF TODAY'S STUDENTS OF PEDAGOGICAL INSTITUTIONS

The article discusses students' personal growth and preparedness for their future professional occupation during their learning in a pedagogical university. The authors address the effects of involvement in professional occupation during their university study on the life-meaning areas. The following methods were used to conduct this study: questionnaire surveys; "Who am I?", a reflective self-assessment test developed by V.S. Mukhina; the life-sense orientation test developed by D.A. Leontiev; the Value Survey by Milton Rokeach; Occupational Motivation Methodology by C. Zamfir updated by A. Rean, and the statistical methods of empirical data processing: Pearson's x2 criterion and cluster analysis. The research covered the students of the pedagogical institute, with 100 students in the 1st through 4th year. The empirical research identified five subject clusters distinguished by their involvement in professional activities and life-sense orientations. The research allows us to view professional involvement during students' higher education periods as a factor of their professional motivation in the context of digital education.

S445 Severity of Reflux Predicts Number of Days Abnormal on Ambulatory Reflux Testing: Discovery and External Validation Cohort Study

Introduction: Ambulatory reflux monitoring off PPI has become a leading option for the diagnosis of GERD. Even with adoption of the Lyon Consensus, there remains controversy on ambulatory reflux parameters for the prediction of abnormal reflux. The aim of our study was to evaluate if severity of reflux alone predicted the number of days of abnormal acid exposure. Methods: Our discovery cohort included single center data from patients with GERD symptoms despite PPI evaluated by pH testing (“Medical”). The Medical group was compared to an external validation cohort from the clinical RCT trial of TIF 2.0 (“RESPECT”) during parallel time-periods over 10 years. RESPECT patients had symptoms and were being evaluated to undergo TIF 2.0. 48 Hour wireless pH testing was performed at least 7 days off PPI therapy in all subjects. Percent total time pH< 4 was considered abnormal if greater than 6% (Lyon Classification). The probability of having abnormal reflux was measured based on severity and frequency of reflux events. Wilcoxon and Pearson X2 tests were used for comparison of continuous and categorical variables, respectively. Results: Our cohorts included the RESPECT group (n=129, 49% male) compared to Medical group (n=119, 30% male). Frequency of abnormal days on pH monitoring was highly dependent on severity of reflux events with a 91-93% likelihood of both days being abnormal if reflux AET was 12% or greater (Figure). Using 6.0% AET on the worst day, the prediction for the 2nd day to also be abnormal was driven by severity of reflux event (Medical= 78% at a pH of 6.0, 88% at pH of 10, and 91% at pH of 12). This was similar for the validation cohort (RESPECT = 72% at a pH of 6.0, 80% at pH of 10, and 93% at pH of 12) (p-value for non-linear effects < .0001) (Figure). This finding was consistent between the discovery and validation cohorts irrespective of esophagitis status. Conclusion: Severity of reflux (defined by abnormal acid exposure time) is highly predictive of number of days abnormal. Utilizing the severity of reflux on ambulatory testing potentially obviates the need for extended ambulatory monitoring beyond 48 hours. As severity of reflux worsens, the predictive power for number of abnormal days is strengthened (from current Lyon of 6.0% to moderate-severe ranges of 10-12). When using ambulatory reflux testing, increased focus on the severity of reflux has higher predictive power in guiding patient diagnosis.Figure 1.: Severity of Reflux (x-axis) Compared to Proportion Abnormal Reflux Parameters on Day 1 vs Day 2 (y-axis) in Our Cohorts

REGRESSION ANALYSIS IN DEVELOPMENT OF PROCEDURE FOR ISOLATION AND QUANTITATIVE DETER-MINATION OF WATER-SOLUBLE POLYSACCHARIDES FROM DANDELION ROOTS OF MEDICINAL

The roots of the dandelion drug (Taraxacum officinale F.H. Wigg) are rich in chemical composition and contain water-soluble polysaccharides based on inulin. The aim of the study is to select optimal parameters of ultrasonic extraction of water-soluble polysaccharides from dandelion roots based on regression analysis. For the experiment, raw materials purchased from one of the pharmacies in the city of Voronezh were used. A sample of raw materials (1.0 g) was placed in an ultrasonic bath "Grad 40-35," which allows maintaining the necessary temperature and frequency of ultrasound with a given duration of time. one-year old, as well as in industrial production of water-soluble polysaccharides from this kind of raw material. Then, 10 (15 or 20) ml of purified water purified from impurities at a temperature of 60 °C to 80 °C was measured with a measuring flask and extracted from 10 to 20 min with a multiplicity of 1 to 3, and after each of the multiple studies, the same raw material was further filtered with a new solvent. The initial conditions and the data obtained during the experiments made it possible to present the regression model in the form of a linear multiple regression equation, which can be used with sufficient accuracy in prediction and analysis. The adequacy of the model was confirmed by testing hypotheses against Pearson's x2 criterion. The correlation coefficient derived from the values of the regression coefficient and the mean square deviation was used in determining the tightness of the overall relationship between the source and the obtained data. In addition, a detailed study of a sample of those variables whose priority was not clearly expressed was carried out by processing when fixing their values. The most important conditions for extraction of dandelion roots for obtaining the most stable performance should be considered: extraction temperature – 80 °C; extraction multiplicity – 3, ultrasound frequency – 35 kHz, extraction time – 40 min, ratio of raw material and extractant – 1 g per 10 ml, at the same time, grinding of raw material can vary from 0.2 mm to 0.5 mm.