Percentile Points Research Articles

From Private Practice to Public Service: A Preliminary Investigation of the Fit LiteTM Model With At-Risk Students.

Like many Title 1 schools in the United States, the host site for this study in rural South Carolina represents a widespread literacy crisis in our public education system. In this particular school, only 20% of 3rd graders demonstrated proficient reading skills. Although extremely effective precision teaching-based literacy intervention programs have been developed in the private sector, such as the Fit Learning™ model, the extensive time and related costs of training classroom teachers in those methods prohibit struggling schools on tight budgets. As such, the current study sought to develop and test the feasibility of a truncated version of the Fit Learning™ model, dubbed Fit Lite™. Fourteen students identified by the school as "high risk" for literacy struggles were instructed in the Fit Lite™ model in their after-school program. With expert oversight and only 1 week of training, a group of 4 implementers with no prior experience using precision teaching or implementing Fit Lite™ produced promising reading improvements. Over the course of approximately 12 weeks, the 14 students improved by an average of 16 percentile points against the national average on standardized progress-monitoring tools. Details of the Fit Lite™ model, results achieved in this study, and considerations for future replications are described.

Fetal cerebral Doppler changes and outcome in late preterm fetal growth restriction: prospective cohort study

To explore the association between fetal umbilical and middle cerebral artery (MCA) Doppler abnormalities and outcome in late preterm pregnancies at risk of fetal growth restriction. This was a prospective cohort study of singleton pregnancies at risk of fetal growth restriction at 32 + 0 to 36 + 6 weeks of gestation, enrolled in 33 European centers between 2017 and 2018, in which umbilical and fetal MCA Doppler velocimetry was performed. Pregnancies were considered at risk of fetal growth restriction if they had estimated fetal weight and/or abdominal circumference (AC) < 10th percentile, abnormal arterial Doppler and/or a fall in AC growth velocity of more than 40 percentile points from the 20-week scan. Composite adverse outcome comprised both immediate adverse birth outcome and major neonatal morbidity. Using a range of cut-off values, the association of MCA pulsatility index and umbilicocerebral ratio (UCR) with composite adverse outcome was explored. The study population comprised 856 women. There were two (0.2%) intrauterine deaths. Median gestational age at delivery was 38 (interquartile range (IQR), 37-39) weeks and birth weight was 2478 (IQR, 2140-2790) g. Compared with infants with normal outcome, those with composite adverse outcome (n = 93; 11%) were delivered at an earlier gestational age (36 vs 38 weeks) and had a lower birth weight (1900 vs 2540 g). The first Doppler observation of MCA pulsatility index < 5th percentile and UCR Z-score above gestational-age-specific thresholds (1.5 at 32-33 weeks and 1.0 at 34-36 weeks) had the highest relative risks (RR) for composite adverse outcome (RR 2.2 (95% CI, 1.5-3.2) and RR 2.0 (95% CI, 1.4-3.0), respectively). After adjustment for confounders, the association between UCR Z-score and composite adverse outcome remained significant, although gestational age at delivery and birth-weight Z-score had a stronger association. In this prospective multicenter study, signs of cerebral blood flow redistribution were found to be associated with adverse outcome in late preterm singleton pregnancies at risk of fetal growth restriction. Whether cerebral redistribution is a marker describing the severity of fetal growth restriction or an independent risk factor for adverse outcome remains unclear, and whether it is useful for clinical management can be answered only in a randomized trial. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.

The importance of physical activity to preserve hippocampal volume in people with multiple sclerosis: a structural MRI study.

There is scarce data as to the association between physical activity and the volumes of subcortical brain regions in people with multiple sclerosis (PwMS). To compare the volumetric measures of subcortical brain structures in physically active and insufficiently active PwMS. This cross-sectional study comprised 153 PwMS (39.3 ± 12.0years, 68.0% female) who had undergone a complete neurological examination, computerized cognitive evaluation and brain MRI (using a high-resolution scanner). MRI volumetric analysis was based on the FreeSurfer image analysis suite. Regions of interest included the hippocampus, amygdala, brain stem, basal ganglia, thalamus, accumbens nucleus, putamen, caudate and pallidum. Two MRI metrics, total volume (mm3) and estimated percentile of the subcortical region according to adjusted normative population, were calculated for each individual and brain region. Based on scores obtained from the Godin Leisure-Time Exercise Questionnaire, the cohort was subsequently divided into two groups, physically active (n = 77) and insufficiently active (n = 76). The left hippocampus estimated percentile point significantly differentiated between active and insufficiently active PwMS (48.5 (S.D. = 32.2) vs. 36.4 (S.D. = 29.8); p = 0.004), even after controlling for disability (p = 0.011) and cognition (p = 0.021). The right hippocampal estimated percentile point was also significantly different between groups (46.7 (S.D. = 30.6) vs. 34.6 (S.D. = 30.8); p = 0.004). Subcortical volume of the right hippocampus explained 19.4% of the variance between the groups (p = 0.008), even after controlling for disability (p = 0.013) and cognition (p = 0.020). Our results provide evidence that PwMS who regularly participate in leisure-time physical activities maintain their hippocampal volume, regardless of their disability and cognitive capabilities.

Comparison of Early Life Obesity-Related Risk and Protective Factors in Non-Hispanic Black Subgroups.

Previous obesity prevention studies in preschool-age children have included non-Hispanic Black (NHB) children, but few have investigated between-subgroup differences even though there may be cultural risk and protective practice differences, challenging the generalizability of findings. The purpose of this study was to examine differences in early childhood obesity-related factors in NHB subgroups (Haitian, other Caribbean Islander and African-American [AA]) children. Baseline data from two randomized controlled trials in 52 childcare centers of which 35 had data to test a preschool-based obesity prevention intervention was analyzed. The sub-sample included 370 caregiver-child dyads; 209 self-identified as AA, 120 as Haitian and 41 as Caribbean Islander/West Indian or mixed race. Multilevel regression models generated outcome estimates for group differences in body mass index (BMI) percentile, birthweight, breastfeeding initiation and duration, bottle feeding duration and age when solid foods were introduced. Mean BMI percentile was similar for AA, Haitian and Caribbean Islander/West Indian/Multiracial (60.1th percentile, 60.8th percentile, 62.8th percentile, respectively) as was birthweight (6.3, 6.8, and 6.6lb, respectively). Children of US-born caregivers had significantly lower BMI percentiles (9.13 percentile points) versus foreign-born caregivers. Haitian women were significantly more likely to initiate breastfeeding (64.9%) versus AA (47.6%) and Caribbean Islander/West Indian/Multiracial (62.2%) (p < .01). No significant group differences were found in breastfeeding or bottle feeding duration or age solid foods were introduced. Findings here suggest that NHB race classification can identify important subgroup behavioral similarities which in turn may inform culturally sensitive strategies to promote early childhood healthy weight. Foreign-born caregivers may benefit from healthy weight promotion information, and as early as possible in their child's development.

Assessment of lead exposure controls on bridge painting projects using worker blood lead levels

A retrospective analysis of worker blood lead levels (BLL) was conducted using blood lead data collected by four bridge painting contractors before and after lead exposure. The objective of the study was to evaluate the effectiveness of exposure controls in preventing elevated blood lead levels (>25 μg/dl) during bridge painting projects. The contractors selected for the study submitted BLL data for 289 workers representing ten work tasks and 11 bridge painting projects. In total, 713 blood lead levels results were evaluated.The mean blood lead level for all work classifications combined was 10.9 μg/dl at baseline compared with 14.9 μg/dl after two months of exposure and 15.0 μg/dl after four months of exposure. Two months after initial exposure, 29% of the painters and 35% of the laborers had a 10 μg/dl incremental increase or greater in blood lead level. Likewise, 18% of the painters and 26% of the laborers had a blood lead level greater than 25 μg/dl during the same time. The blood lead levels that exceeded the 25 μg/dL threshold ranged from 30μg/dL-63 μg/dL for painters and 26 μg–56 μg/dL for laborers.All work tasks with high-intensity exposure (abrasive blaster/painter, abrasive blaster, painter & laborer) experienced an average blood lead level increase that ranged from 0.2 μg/dl to 8.9 μg/dl two months after initial exposure. Blood lead testing conducted after modified exposure controls (two months after the initial follow-up blood testing) were implemented showed a decrease in average blood lead levels (range −0.14 μg/dl to −2.7 μg/dl) for two high-intensity exposure work tasks. In comparison, the other two high-intensity work tasks had moderate increases (range 1 μg/dl to 2.4 μg/dl). The modified exposure controls included an increase in the air velocity inside of the work containment and an administrative control in the form of additional worker training on lead exposure prevention. The reduction in the 95th percentile (point estimate) BLL exposure profile for each exposure group at the 4-month follow-up blood testing period is associated with modified exposure controls.Ineffective exposure controls were identified through the analysis of worker BLLs. We found two exposure groups (laborer and painter) whose 95th percentile (point estimate) exposure profile was greater than the OSHA construction lead standard's targeted BLL goal (25 μg/dl) during the first two months of exposure. Our research findings provide support for monthly blood lead testing after baseline until blood lead levels are controlled to an acceptable concentration.

The Impact on Student Achievement of Replacing Principals in District of Columbia Public Schools

The 2007 Public Education Reform Amendment Act led to 39 percent of the principals in District of Columbia Public Schools (DCPS) being dismissed before the start of the 2008–09 school year, and additional principal exits over the next few years. We measure the impact of replacing these principals on schoolwide student achievement by measuring the changes in achievement that occurred when principals were replaced, and comparing these changes to achievement in comparison schools within DCPS that kept the same principal. We find that after a new principal's third year in a school, average schoolwide achievement increased by 4 percentile points (0.09 standard deviations) compared with how students in the school would have achieved had DCPS not replaced the previous principal. For students in grades 6 to 8, the gains were larger and statistically significant in both math and reading.

Optimised cushioning in diabetic footwear can significantly enhance their capacity to reduce plantar pressure

BackgroundPlantar pressure reduction with the use of cushioning materials play an important role in the clinical management of the diabetic foot. Previous studies in people without diabetes have shown that appropriate selection of the stiffness of such materials can significantly enhance their capacity to reduce pressure. However the significance of optimised cushioning has not been yet assessed for people with diabetic foot syndrome.Research question: What is the potential benefit of using footwear with optimised cushioning, with regards to plantar pressure reduction, in people with diabetes and peripheral neuropathy? MethodsPlantar pressure distribution was measured during walking for fifteen people with diabetic foot syndrome in a cohort observational study. The participants were asked to walk in the same type of footwear that was fitted with 3D-printed footbeds. These footbeds were used to change the stiffness of the entire sole-complex of the shoe; from very soft to very stiff. The stiffness that achieved the highest pressure reduction relative to a no-footbed condition was identified as the patient-specific optimum one. ResultsThe use of the patient-specific optimum stiffness reduced, on average, peak pressure by 46% (±14%). Using the same stiffness across all participants lowered the footwears' capacity for pressure reduction by at least nine percentile points (37% ± 17%); a statistically significant difference (paired samples t-test, t(13) = −3.733, p = 0.003, d = 0.997). Pearson correlation analysis indicated that patient-specific optimum stiffness was significantly correlated with the participants’ body mass index (BMI), with stiffer materials needed for people with higher BMI (rs(14) = 0.609, p = 0.021). SignificanceThis study offers the first quantitative evidence in support of optimising cushioning in diabetic footwear as part of standard clinical practice. Further research is needed to develop a clinically applicable method to help professionals working with diabetic feet identify the optimum cushioning stiffness on a patient-specific basis.

Assessing the true association between hypertension status and stature of individuals in Bangladesh: propensity score analysis.

Inconsistent evidence is found in the literature regarding the association between individuals' stature and hypertension status. In this study, an attempt has been made to investigate the true association between height and occurrence of hypertension. For analysis purpose, this study considers Bangladesh Demographic and Health Survey (BDHS) 2011 data obtained from an observational study. By dividing height (tall/normal/short) based on 25th and 75th percentile points separately for females and males, a binary logistic regression model was fitted to the weighted data, where weights were calculated from propensity scores (PS). From the PS-based weighted data, we did not find any significant association between height and hypertension (p > 0.05). Besides the respondent's height, logistic regression analyses of a balanced data set have revolved around some well-known factors that are associated with the occurrence of hypertension: gender of the respondent, higher wealth index status, as well as overweight. This study also found higher odds of occurring hypertension among the residents of Khulna and Rangpur divisions, whereas lower likelihood of hypertension is reported for the individual living in Chittagong and Sylhet districts. The findings of this paper indicate that human stature is not a risk factor for hypertension. Apart from height, this study uncovers some important risk factors for developing hypertension. By considering these factors, awareness should be raised among male, wealthier, and overweighted individuals in Bangladesh. However, why the prevalence of hypertension is higher in Khulna and Rangpur, as well as lower in Chittagong and Sylhet, demands further research.

Diminished Blood Pressure Profiles in Children With Down Syndrome.

This study sought to analyze blood pressure trends in children with Down syndrome at multiple centers. A multicenter, retrospective, cross-sectional study was performed. All patients were <18 years and had a diagnosis of Down syndrome. Existing comorbidities were nonexclusionary. For each patient, 3 blood pressure recordings were obtained from routine clinic visits. In total, 887 patients with 2661 total blood pressure recordings were included in this study. The average blood pressure percentile for patients was 38.87 with a median percentile of 31.5. Age, sex, and race were not predictive of blood pressure percentile. Compared with established data from the National Heart Lung and Blood Institute and National Health and Nutrition Examination Survey cohort (ages 8-18 years), blood pressure in our Down syndrome population was statistically lower by 6.1 percentile points (P<0.001), with the greatest difference at higher blood pressure percentiles (P<0.001). Only 10% of all Down syndrome cohort blood pressure recordings were greater than the National Heart Lung and Blood Institute/National Health and Nutrition Examination Survey 70th percentile, with no patients meeting criteria for prehypertension or hypertension. Additional comparisons against American Academy of Pediatrics data were similar and statistically significant. In children with Down syndrome, there is a 12 percentile point reduction in baseline blood pressure compared with age- and height-matched controls reported in the National Heart Lung and Blood Institute/National Health and Nutrition Examination Survey and American Academy of Pediatrics cohorts. This data can potentially be utilized in the evaluation and care of persons with Down syndrome in their pediatric medical homes.

Receipt of Corrective Lenses and Academic Performance of Low-Income Students.

Untreated vision problems are associated with poor school performance. Whether providing glasses alone improves performance, however, remains unknown. We sought to test whether receiving glasses was associated with improved school performance for low-income minority students in Los Angeles. From 2017 to 2018, we analyzed achievement marks in mathematics and language arts from 406 first to fifth grade students attending 24 public elementary schools who received glasses through a free school-based vision program between February and May 2014, and 23,393 of their nonparticipating same-school, same-grade peers. We calculated students' percentile rank during each grading period in 1 year before and 2 years since they received glasses. Multilevel linear regressions tested whether percentile rank differed from baseline at each subsequent grading period. Models accounted for clustering at the school level and controlled for gender, grade level, and baseline class rank. Interaction terms tested whether associations differed by gender and class rank. Students increased 4.5 percentile points (P=.02) in language arts in the second year after receiving glasses. There was no change in math achievement overall; however, those with baseline performance in the bottom tercile had an immediate and sustained improvement of 10 to 24 percentile points from baseline (interaction term P < .001). Class rank for behavior marks decreased during the fourth grading period after receiving glasses but subsequently returned to baseline. There were no significant changes in work habits and no variation in results by gender. Ensuring access to vision care may be a simple, scalable strategy to improve language arts performance for low-income minority children.

A Comparative Analysis of Robust Dispersion Control Charts with Application Related to Health Care Data

Abstract One of the most efficient tools of statistical process control is the control chart. The efficiency and effectiveness of control charts depend on its in-control robustness, i.e., how the control chart reacts against the violation of the designed model of the chart. The current study evaluates the in-control robustness properties of a chart that is based on the mixture of the statistics of cumulative sum and exponentially weighted moving averages (CS-EWMA) control charts for monitoring the process dispersion under normal, nonnormal, and contaminated normal environments. The in-control robustness performance of the CS-EWMA chart is compared with some existing control charts. Moreover, the appropriate values of the design coefficients for selected charts are also determined. In-control robustness is evaluated in terms of different properties of run length distribution, such as average run length, standard deviation of the run length, and various percentile points. In addition, a real-life application of all the selected charts based on the colonoscopy procedure is considered for practical implementation. It is found that the CS-EWMA chart has a better in-control robustness performance as compared with its counterparts.

Establishing High-Frequency Noise Baselines to 100 Hz Based on Millions of Power Spectra from IRIS MUSTANG

ABSTRACTAdvances in seismic instrumentation have enabled data to be recorded at increasing sample rates. This has in turn created a need to establish higher frequency baselines for assessing data quality, as the widely used new high-noise model (NHNM) and new low-noise model (NLNM) of Peterson (1993) do not extend to frequencies above 10 Hz. To provide a baseline for higher frequencies (10–100 Hz), we examine power spectral density probability density functions (PSDPDFs) for high-sample rate stations available from the Incorporated Research Institutions for Seismology Data Services Modular Utility for STAtistical kNowledge Gathering (IRIS MUSTANG) quality control system. We compute high-frequency high- and low-noise baselines by matching the appropriate composite PSDPDF percentile points to NHNM and NLNM power levels at overlapping frequencies (1–10 Hz) and then extending to higher frequencies (10–100 Hz) with piecewise linear fits to the matching PSDPDF percentile.We find that the Peterson NLNM remains an accurate representation of the lower bound of global ambient Earth noise because it is lower than 99.9% of Global Seismographic Network power spectral densities. We present high-frequency high- and low-noise baselines intended primarily for use by temporary networks targeting high-frequency signals (e.g., monitoring of aftershocks or induced seismicity) based on statistics of PSDPDFs from all publicly available high-sample rate data.Most publicly available high-sample rate data are recorded by temporary deployments, and the experiment design and scientific targets of these deployments strongly influence the observed statistical distribution of high-frequency noise. We anticipate that the noise baselines presented here will be useful in automated quality control of high-sample rate seismic data. However, we note that establishing a low-noise model that accurately represents the lowest possible ambient Earth noise at frequencies up to 100 Hz will require additional continuous high-sample rate data from high-quality permanent stations in low-noise environments.

Efficacy of the Alabama Math, Science, Technology Initiative (AMSTI) on Math, Science, and Reading Achievement: A Report of a Quasi-Experiment in Alabama

This report provided the AMSTI team with the school sites we identified as having the most successful AMSTI outcomes for ELL students. Their further investigation of these schools, referred to as model AMSTI ELL schools, should provide key information for tailoring AMSTI training to support all learners. This study replicated the results of the 2012 study by finding a positive impact of AMSTI for students on the ACT Aspire reading assessment equivalent to 2 percentile points. This analysis used students of AMSTI-trained science teachers, as the training purposely integrates reading and writing practices into the science modules. We also investigated the impact of AMSTI on early-career teachers, and found positive impacts of AMSTI for partially-trained math teachers and fully-trained science teachers. The sample of teachers for this analysis was those in their first three years of teaching with varying levels of AMSTI training.

On designing an efficient control chart to monitor fraction nonconforming

AbstractProcess control measures are mostly applied in production and manufacturing industries. The most important tool used in these disciplines is control chart. In manufacturing and production processes, when the quality characteristic of interest cannot be directly measured, it becomes essential to apply attribute control charts. To monitor fraction nonconforming of the output, quality practitioners mostly prefer p‐chart. In this article, a new progressive mean (PM) control chart is being proposed for monitoring drift in proportion of nonconforming products. The design evaluations of the proposed chart are made and compared through different properties of run length distribution, such as average run length (ARL), standard deviation of run length (SDRL), and some percentile points. The performance of the proposed chart is assessed under zero‐state and steady‐state scenarios. The proposed PM chart is compared with p‐chart, moving average (MA) chart, optimal CUSUM chart, modified exponentially weighted moving average (EWMA) chart, and runs rules p‐charts for monitoring fraction nonconforming. The proposed chart spots efficiently sustained disturbances in the process as compared with their existing counterparts. Two illustrative examples are also provided; one from real‐life application of nonconforming bearing and seal assemblies data and the other from simulated data for the implementation of PM chart.

Abstract 311: Trajectory of Risk-Standardized Survival Rates for In-Hospital Cardiac Arrest

Introduction: Risk-standardized survival rate (RSSR) for in-hospital cardiac arrest (IHCA) has emerged as an important metric to measure and incentivize resuscitation quality at a hospital-level. We examined whether hospital performance on the RSSR metric was generally stable year-over-year. Methods: We used data from 81,795 adult patients with an IHCA from 163 hospitals with continuous participation in Get With The Guidelines-Resuscitation from 2012 to 2017. A two-level hierarchical regression model was used to compute RSSRs for 2 time intervals (baseline: 2012-13; follow-up: 2014-17). Hospitals were classified as top-, middle- and bottom-performing if they ranked in the top 25%, middle 50%, and bottom 25% on the RSSR metric during 2012-2013. We examined the trajectory of top, middle, and bottom-performing hospitals’ RSSR during 2014-2017 (follow-up). Results: During 2012-2013, 41 hospitals were identified as top-performing (median RSSR 31.9%), 81 as middle-performing (median RSSR 24.9%) and 41 as bottom-performing (median RSSR 18.5%). During 2014-2017, more than 3/4 th (75.6%) of top-performing hospitals remained in the top 50% and 53.7% remained in the top 25% (Table). In contrast, most (81.5%) bottom-performing hospitals ranked in the bottom 50%, and 56.1% remained in the bottom 25% during 2014-2017. Performance of middle-performing hospitals on the RSSR metric was variable. Importantly, rankings improved by at least 1 quartile ( &gt; 25 percentile points) at 26.8% and by at least 2 quartiles ( &gt; 50 percentile points) at 12.2% bottom-performing hospitals (Table). Likewise, rankings at 31.7% and 19.5% of top-performing hospitals worsened by at least 25 and 50 percentile points during 2014-2017, respectively. Conclusion: Hospital performance on RSSR during a baseline period was generally consistent with their performance during follow up. However, percentile rankings changed markedly over time at a small proportion of top- and bottom-performing hospitals.

Mathematics Teacher and Curriculum Quality, 2005 and 2016

Efforts to improve teachers’ knowledge and to change the nature of curriculum materials have dominated mathematics reforms since the late 1990s. In this article, we compared middle school teachers’ mathematical knowledge for teaching (MKT) and curriculum use between 2005 and 2016 to assess progress toward these key goals. We found teachers’ MKT increased an amount equal to the average teacher in the 2005 sample improving five percentile points. However, No Child Left Behind’s attempts to encourage mathematics degrees in this population do not explain this increase, as teachers were less likely in 2016 than in 2005 to possess such a degree. Instead, our data are consistent with schools hiring more knowledgeable individuals during the Great Recession. Between surveys, the strength of the association between teacher MKT and student demographic characteristics decreased, although equity gaps still persist. Finally, our data suggest a modest movement toward standards-based curriculum materials over this period.

Characterizing the highly cited articles: A large-scale bibliometric analysis of the top 1% most cited research

We study the bibliometric or formal aspects influencing citations. In particular, we verify the existence or otherwise of bibliometric aspects which displayed significant differences between the group of top 1% most cited articles according to their field and year of publication (highly cited articles) and the remaining articles. This may allow scientific journals to have evidence when writing their submission rules for authors in order to maximize the impact of published articles. We did a large-scale analysis of around 10,000 scientific articles, from the period 2007-2016. A transversal analysis was conducted disaggregating the articles into more than one hundred scientific areas and two groups, each with a random sample of around five thousand documents. The first group comprised a random sample of the top 1% most cited articles in each field and year of publication (highly cited articles), and the second group a random sample of the remaining articles in the Journal Citation Reports (science and social science citation indexes in the Web of Science database). Highly cited articles differ from non-highly cited articles in most of the bibliometric aspects considered. There are significant differences, below the 0.01 level, between the groups of articles in many variables and areas. The highly cited articles are published in journals of higher impact factor (33 percentile points above) and have 25% higher co-authorship. The highly cited articles are also longer in terms of number of pages (10% higher) and bibliographical references (35% more). Finally, highly cited articles have slightly shorter titles (3% lower) but, contrastingly, longer abstracts (10% higher).

Weight Gain After ACL Reconstruction in Pediatric and Adolescent Patients.

Adolescent athletes who sustain an anterior cruciate ligament (ACL) tear have significantly reduced activity levels during recovery. Activity level is linked to body mass index (BMI); however, it is unclear how recovery from an ACL reconstruction (ACLR) affects relative BMI and whether these changes persist after return to activity. Patients' BMI percentile will significantly increase after ACLR, but will trend toward baseline after return to activity. Cross-sectional study. Level 3. A retrospective review of 666 pediatric and adolescent patients who underwent ACLR was performed. Body mass was assessed by evaluating change in BMI percentile at 8 standard-of-care time windows relative to BMI percentile at time of surgery. Linear regression and bivariate and multivariate analyses were used to assess the effect of time window and other demographic factors on the change in BMI percentile. These analyses were rerun after dividing patients by clinical obesity categorization (underweight, normal, overweight, or obese) at time of surgery to assess the effect of preinjury body mass levels. BMI percentile of all BMI categories tended to increase postoperatively, peaking 6 to 9 months after surgery, with a median increase of 1.83 percentile points. After this peak, BMI approached baseline but remained elevated at 0.95 percentile points 2 years postoperatively. Beginning 3 months after surgery, the normal-weight group had significantly larger changes in BMI percentile at each time window, peaking at 4.15 points above baseline at 9 months. This BMI increase among normal-weight patients persisted in the second postoperative year, with a median percentile increase of 2.63 points. Pediatric and adolescent patients, especially those with a normal BMI, undergo significant changes to their BMI during recovery from ACLR. Patients' failure to return to their presurgical BMI percentile 2 years postoperatively suggests that ACLR may have long-reaching and often unappreciated effects on body mass.

S5A-05 SESSION 5A: GENERALITIES IN CRANIOSYNOSTOSIS – PART II LARGE SINGLE INSTITUTION SERIES OF ENDOSCOPICALLY TREATED INFANTS WITH CRANIOSYNOSTOSIS

Introduction: Endoscopic strip craniectomy (ESC) followed by helmeting for the treatment of craniosynostosis has gained increasing popularity since its introduction in the 1990s. Efficacy and safety remains to be determined. Methods: 500 consecutive infants who underwent ESC for craniosynostosis at a single institution from 2004 to 2018 by a single neurosurgeon were identified from a prospective database. Patient demographics, operative and postoperative variables were analyzed. Results: 500 infants (69% male) of median (IQR) age 3.0 (1.1–16.7) months and weight 5.9 (IQR 5.6–6.7) kg underwent ESC over the 15 year period. Median operative and anesthesia times were 47 and 140 minutes, respectively. Median length of hospital stay was 1 (IQR 1-1) day (3.2% admitted to ICU). The transfusion rate was 6.6% (95% CI: 5–9%) and postoperative complication rate was 1.4% (95% CI: 1–3%). Risk factors for blood transfusion were identified by multivariable logistic regression and included syndromic craniosynostosis (P=.01) and multiple fused sutures (P=.02). Complications included surgical site infections (n=4), skull defect (n=2), and CSF leak (n=1). 14 patients (2.8%; 95% CI: 2–5%) ultimately required an open procedure for correction of their craniosynostosis due to suture (re-)fusion (n=12) or inadequate cosmetic result (n=2). Infants with sagittal, coronal, and multi-suture craniosynostosis showed normalization of head circumference postoperatively at 12 months of age relative to World Health Organization normal head growth data (all P<.001, paired t-test). Head circumference remained within ±25 percentile points of baseline (WHO percentile) in 81% (95% CI: 77–84%) of infants by 12 months of age, decreasing by >25 in 7% (95%CI: 5–10%) and increasing by >25 in 12% (95% CI: 10–15%). Follow-up data demonstrated compliance with the recommended helmet therapy in 91.4% of patients (5.4% unknown); prior data from this cohort showed an average of 7 months of helmet therapy to achieve satisfactory correction. Conclusion: ESC is a safe, effective, and durable procedure for the correction of craniosynostosis in infants. ESC offers a short length of stay, low complication and transfusion rates, and excellent clinical outcomes including age-appropriate normalization of postoperative head growth in >90% of infants.

A Multifaceted Approach to Improve Physician Communication Scores.

Improving patient satisfaction scores has become a key focus of health-care organizations nationwide but can be a struggle for community hospitals with constrained resources, and particularly challenging for hospitalist programs due to provider variance and turnover. Using the framework of appreciative inquiry, we implemented a multipronged intervention including a rounding model whereby hospitalist leaders rounded on patients and relayed commentary back to their hospitalist providers. We communicated positive feedback preferentially over negative feedback to the entire hospitalist group through regular communication. Providers were encouraged to employ best practices including sitting with the patient, reviewing recommendations using teach back, and providing business cards. Scores improved in the physician communication category by approximately 1% annually from fiscal year 2015 through 2018, with our percentile rank improving 35 percentile points during that time. These findings indicate that a multifaceted approach including best practices is associated with improved patient experience regarding communication with physicians.