Five-year Period Research Articles

Factors Influencing Athletic Training Services in California Secondary Schools: A Five- Year Update.

California is the only state that does not regulate the athletic training profession, allowing unqualified personnel to be hired and call themselves athletic trainers. The benefits of employing a certified athletic trainer in the secondary school setting are numerous but efforts to push regulation legislation continue to fail in California. To describe the availability of certified athletic trainers in California secondary schools and explore factors influencing athletic trainer employment. Cross-Sectional Study. Online survey. Participants from 1538 California Secondary Schools. Officials from member schools completed the 2022-2023 California Interscholastic Federation Participation Census. Participants provided information specific to enrollment, sport participation, access to AEDs, and whether the school had athletic trainers on staff. The athletic trainer's certification status was independently verified. Enrollment data specific to ethnicity, race, and percentage of students eligible for free meals was obtained through the California Department of Education Statistics. More than half (51.6%) of California secondary schools did not employ a certified athletic trainer and 8.3% employed unqualified personnel as athletic trainers. Nearly half (43%) of student athlete participants were enrolled at schools with no certified athletic trainer. Schools that employed certified athletic trainers had a lower proportion of students eligible to receive free and reduced-price meals. The average percentage of Hispanic or Latino students was greater in schools with no certified athletic trainer and schools that employed unqualified personnel as athletic trainers than schools that employed certified athletic trainers. Data indicates that in a five-year period, access to athletic training services in California secondary schools has not improved. There are large gaps in access to athletic training services and there are clear socioeconomic and racial and ethnic disparities. Efforts to educate stakeholders on the importance of athletic training regulation in California should continue.

Clinical Experience With Lacosamide as an Adjunct Treatment for Neonatal Seizures: A Retrospective Single-Center Study

BackgroundLacosamide (LCM) is a third-generation antiseizure medication (ASM) currently approved for the treatment of focal seizures in children aged greater than one month. There are limited data on its efficacy in the neonatal age group. We describe our experience with LCM as an adjunct ASM for the treatment of neonatal seizures. MethodsA retrospective chart review over a five-year period (2018 to 2022) was conducted at Le Bonheur Children's Hospital to identify neonates with electroencephalography (EEG)-proven seizures who were treated with LCM. Data were collected on electroclinical seizure characteristics, underlying etiology, ASMs, treatment response, and any adverse effects. ResultsA total of 15 neonates with EEG-confirmed seizures who were treated with LCM were included. Ten neonates achieved seizure cessation after LCM was added to their ASM regimen consisting of phenobarbital, levetiracetam, or both. No new treatment-related adverse effects were noted. ConclusionsLCM is effective as an adjunct treatment for neonatal seizures. Randomized controlled studies are needed to establish its effectiveness and adequate dosing regimen in this population.

Assessment of Wind Energy Potential at Three Prime Locations in Saudi Arabia: Analysis of Sharma, Qurayyat and Sakaka Sites

Purpose: The research aims to assess the wind energy potential at three chosen sites in Saudi Arabia Sharma, Al Qurayyat, and Sakaka over a five-year period from 2019 to 2023. The main goal is to determine the most favorable locations for wind farm development based on wind speed characteristics, Weibull distribution parameters, and wind power density (WPD). Materials and Methods: The wind speed data for the chosen locations was obtained from NASA's wind website and analyzed using the Weibull distribution to determine the shape (k) and scale (c) parameters, which are indicative of wind speed distribution. Critical metrics such as mean wind speed, WPD, and the most probable wind speed were computed to evaluate the wind energy potential. The Vestas V150-4.2 MW turbine was utilized to estimate potential energy output, considering the variability and reliability of wind resources at the specified locations. The study utilized tables, figures, and wind rose diagrams to highlight important wind parameters like mean wind speed, Weibull parameters, WPD, and Vmax for each location. Flowcharts were also used to summarize the methodology and conclusions, ensuring a clear and comprehensive presentation of the data. Findings: The analysis showed that Qurayyat consistently had the highest mean wind speed and WPD, indicating excellent wind energy potential. Sharma and Sakaka also displayed significant wind resources, with high mean wind speeds and substantial WPD values. The Weibull parameters indicated that all three sites have favorable wind characteristics for energy production. The estimated energy output using the Vestas V150-4.2 MW turbine ranged from 12,809 to 17,807 MWh/yr at Site 18, 14,095 to 15,170 MWh/yr at Site 24, and 14,013 to 15,832 MWh/yr at Site 31. Implications to Theory, Practice and Policy: The study presents a thorough evaluation of the wind energy potential in the Al-Jawf and Tabuk regions of Saudi Arabia. It contributes to a deeper understanding of wind resource distribution and its significance for the development of renewable energy. The study provides valuable insights for wind farm developers and policymakers by identifying the most promising locations for investment in wind energy infrastructure. Furthermore, it emphasizes the need for detailed site-specific analyses to optimize wind energy deployment, aligning with Saudi Arabia's broader renewable energy objectives.

An analysis of paediatric clinical presentations in Northwest Syria and the effect of forced displacement, 2018–2022

BackgroundOne in six children worldwide lives in a region exposed to armed conflict. In conflicts, children are among the most vulnerable, and at risk of adverse health outcomes. We sought to describe trends in child and adolescent morbidity in northwest Syria (NWS) and understand how forced displacement affects clinical utilisation during the Syrian conflict. MethodsRetrospective data between January 2018 and December 2022 were obtained from the Syrian American Medical Society (SAMS), a non-governmental organisation that operates health facilities in NWS. After initial descriptive analyses were completed, we performed a seasonal-trend decomposition to estimate the seasonality of clinical presentations. We subsequently employed a multivariate regression model incorporating age, gender, residency status, season, and a random district-level intercept to measure the association between the odds of clinical consultation and forced displacement. FindingsAcross 51 reporting SAMS facilities, 2,687,807 clinical consultations were studied over a five-year period. Seasonality was demonstrated for every clinical consultation category. Higher levels of forced displacement were associated with increased odds of consultations for nutrition, trauma, NCDs and mental health and decreased odds of consultation for communicable diseases. Aside from traumatic injury, internally displaced persons (IDPs) had higher AORs of clinical consultations compared to host populations. InterpretationForced displacement differentially impacts clinical utilisation among children in northwest Syria, and the effects of displacement persist for at least six months. Clinical needs vary by host/IDP status, sex, age, and season. This study can assist policymakers in forecasting the health needs of children in northwest Syria.

The roles of entrepreneurial university and regional conditions for graduate entrepreneurship: a configurational approach

ABSTRACT This study conceptualizes graduate entrepreneurship as a spatial phenomenon. Specifically, we explore how combinations of university-related (knowledge exchange intensity and entrepreneurship support) as well as regional conditions (economic prosperity and entrepreneurial culture) might explain the presence or absence of high graduate entrepreneurship as possible (or likely) explanations based on a configurational approach. We applied fuzzy-set qualitative comparative analysis (fsQCA) to a dataset using HE-BCIS (Higher Education-Business Community Interaction Survey) survey and the UK’s ONS (Office for National Statistics) data for England covering a five-year period, combined with map-based analysis to identify distinct pathways that explain the presence or absence of graduate entrepreneurship across different regions. Findings demonstrate that university-related and regional conditions can complement each other in different ways to explain high levels of graduate entrepreneurship, but absence of one can also suppress the effect of the other, resulting in the absence of high graduate entrepreneurship.

Gastrointestinal endoscopy 30-day-associated bacteremia: Nonoutbreak 5-year review in an inner-city, tertiary-care hospital

Gastrointestinal endoscopic procedures (GIEP's) are an essential part of patient care both diagnostically and therapeutically. Post-GIEP infections may be higher than previously reported and may not have been accurately captured in the past. The aim of this study was to determine the incidence and associated factors of bacteremia associated with GIEP's. This is retrospective study of GIEPs performed over a five-year period (2018-2022) at an academic medical center. Electronic health records (EHR) identified GIEPs and positive blood cultures within 30 days of procedure. Statistical analysis was performed using non-parametric testing to compare variables due to the small number of positive blood cultures. EHR identified 18,986 GIEP's and 52 true and unique bacteremia out of 17,093 blood cultures during the five-year study period. The highest rate of positive blood culture of 2.84% (18/ 634) was associated with ERCP and the lowest 0.08% (7/ 9029) was associated with colonoscopy. Our study showed a reflection of the endemic rate of bacteremia post GIEP's. Our study cannot differentiate endogenous infection versus contaminated (exogenous) endoscopes. ERCP procedures are disproportionately associated with higher incidence of bacteremia. Clinical surveillance in non-outbreak settings is essential for estimating GIEP related infections. It should be combined with endoscopic reprocessing audits for appropriate prevention of GIEP associated infections.

A narrative review and update on drain-related outbreaks

Outbreaks linked to hospital drainage systems are well reported, and continue to present challenges to incident management teams. Such outbreaks can be protracted and complex, with multi-modal strategies being required for remediation. To summarize recent drain-related outbreaks, investigate whether multi-modal control measures are being implemented, and determine any antecedent factors. Databases were searched for drain-related outbreaks over a 5-year period. Search terms employed included 'healthcare drainage outbreaks', 'drain outbreaks', 'drainage system outbreaks', 'sink outbreaks' and 'shower outbreaks'. Information was collected on country of origin, pathogens involved, unit affected, drain types, patient numbers, drainage system interventions, type of drain disinfectant, infection control interventions, typing method, outcomes and any antecedent factors. Nineteen drain-related outbreak studies were reviewed. The majority of incidents were due to carbapenemase-producing Enterobacterales, and were from critical care settings. Most (16/19) studies recognized the need for a multi-modal approach. Information on the success of interventions was not documented for all incidents, but 13/19 studies reported no further cases after control measures. Variation in the choice of agent and frequency of application exists with regards to drain disinfection. Seven studies discussed antecedent factors. Despite drain-related outbreaks being reported for the last 24 years and review articles on the subject, outbreaks continue to pose significant challenges. There is currently no UK guidance on the management of drain-related outbreaks or the design of new buildings to mitigate the risk. Addressing the challenges from hospital drainage systems should be considered a priority by agencies and guidance developers.

Impact of multidisciplinary tumor boards on clinical decision making in a genitourinary oncology clinic in Mexico city.

e23217 Background: Effective management of genitourinary neoplasms demands a comprehensive approach due to the diverse treatment options and the need for multiple specialists. Multidisciplinary tumor board (MDTB) meetings are a platform for experts to collectively assess and discuss the latest evidence and provide their expertise to tailor treatment plans for patients. Methods: Cases discussed during uro-oncology MDTB meetings at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán in Mexico City over a five-year period (01/2018 to 12/2022) were included. We analyzed the type of neoplasm, reason for case discussion, specialties involved and whether the final decision led to a modification of the original plan. Descriptive statistics were used for analysis. Chi-squared test was used to determinate differences and p value < 0.05 was considered statistically significant. A logistic regression analysis was performed for multivariate analysis. Results: Over the study period, 500 discussions involving 399 patients were included. 87% were men. Prostate, kidney, testicular, upper tract urothelial and bladder carcinoma, represented: 223 (44.6%), 117 (23.4%), 84 (16.8%), 37 (7.4%), 32 (6.4%) of cases, respectively. The majority were presented by urology (319 cases; 63.6%). The primary reason for presentation was surgical decisions in 54.6%. Regarding final conclusions, 55.8% underwent modifications in the treatment plan, 33.2% had no changes and 11% remained inconclusive, requiring further assessment. Individuals with metastatic disease had a higher likelihood of treatment plan changes in 61.6% vs 52.3% (OR 1.46 95%CI 1.01-2.12; p = 0.042). The 163 cases (32.6%) presented during the COVID-19 pandemic were more prone to have treatment modifications 62.6% vs 52.5% (OR 1.51 95%CI 1.03-2.22; p = 0.034); cases presented for surgical reasons during this period were more likely to have a change in treatment modality 74% vs 52.3% (OR 2.6 95%CI 1.34-5.04; p = 0.004). Implementation of results was successful in most cases (72%), with a median time of 3.6 weeks. Reasons for not implementing the plan included: patient decision, treating physician decision, comorbidities, death, and lack of resources. Factors associated with implementation in the multivariate analysis included: male gender (OR 2.81), cases presented during pandemic (OR 2.0), and by urology service (OR 1.92). Conclusions: Among patients presented in our uro-oncology MDTB meetings, more than half will have a change in the original treatment plan, and this agreed strategy is successfully implemented in most individuals. These sessions remained key for patient management during the COVID-19 pandemic.

International Portfolio Diversification Benefits: An Empirical Investigation of the 28 European Stock Markets During the Period 2014–2024

Abstract This study investigates the benefits of international diversification in the stock markets of the 28 European countries (the EU and the UK) over two five-year periods: a stable period from 2014 to 2019 and a turbulent period from 2019 to 2024. The analysis draws on the Markowitz mean-variance, Sharpe reward-to-variability, and naive diversification models, based on which different investment strategies were developed and implemented. We find that actively managed portfolios perform significantly better than naively diversified portfolios. The analyzed markets exhibit positive short-term associations, with an average correlation coefficient of 0.29 in the first period and 0.46 in the second period. However, these markets do not show long-term cointegration. Recent crises have reduced diversification benefits, yet significant opportunities for diversification remain. Diversification benefits are almost halved in the second period: average single-market standard deviation can be reduced by 60.5% with investments in 20-indices portfolios in the stable period, and only by 33.7% with the same portfolio size in the turbulent period.

Epizootological and epidemiological situation of anthrax in Siberia and the Far East (1985–2023)

Anthrax remains relevant in the world and in the Russian Federation. In Siberia and the Far East, epizootological, epidemiological, environmental and microbiological monitoring of anthrax is constantly carried out. To analyze the epizootological and epidemiological situation of anthrax, we used the information from veterinary institutions and Rospotrebnadzor for 24 regions, as well as reference and archive materials. On the territory of Siberia and the Far East for the period from 1985 to 2023, pronounced epizootological and epidemiological problems of anthrax are observed in the Yamalo-Nenets Autonomous Okrug, the Republic of Buryatia, Omsk Region and the Altai Territory. Over the last five-year observation period, high epizootic activity has been observed in the west of the Republic of Tyva. A total of 3,375 livestock animals and 128 people fell ill. The anthrax database contains information on 7,491 stationary anthrax-infected points in 22 subjects and 562 anthrax burials and cattle burials in 17 subjects of Siberia and the Far East. B. anthracis strains have slight variability in biological properties and belong to two global genetic lines – A and B. In order to prevent anthrax, it is necessary to ensure surveillance of soil foci of anthrax (anthrax burials and cattle burials, “plague fields”), a high level of livestock animals registration and their specific vaccination coverage; to control the implementation of veterinary and sanitary requirements for pre-mortem inspection and emergency slaughter of livestock, the sale of meat and meat products, and biological waste disposal; to carry out explanatory work among the population.

Mucosal melanoma treatment patterns and outcomes in real clinical practice: Single institution experience.

e21571 Background: Mucosal melanoma (MM) is a challenging malignancy to diagnose and treat, even with the advent of modern drug therapies. There is a lack of established surgical, radiological, or pharmacological treatment approaches for locally advanced or metastatic mucosal melanoma. This study analyzes the treatment practices and clinical outcomes at a single institution over a five-year period to understand real-world clinical practices. Methods: A сomprehensive, continuous, retrospective study analyzed medical records of adults with histologically confirmed MM at the N.N. Blokhin Russian Cancer Research Center from January 2018 to December 2023. Data was digitized into an electronic questionnaire, with patient follow-up conducted via telephone. Results: A total of 87 patients were identified, comprising 72 females (82.8%) from 31 regions of Russia. The median age was 67.8 years (ranging from 29.5 to 90.1 years). The patient breakdown was as follows: 6 with head&neck MM (6.9%), 41 with vulvovaginal MM (47.1%), 5 with penile MM (5.7%), 27 with anorectal MM (31.0%), and 8 with gastrointestinal MM (9.2%). A significant portion of the patients presented with locally advanced (22.9%) or metastatic disease (67.8%), while 9.2% of the patients had undergone surgery and were being considered for adjuvant treatment. The most common sites of metastasis were regional lymph nodes (23%), liver (14%), and lungs (11.5%), with one patient having CNS metastasis. Mutational status was determined for 48 of the 87 patients, revealing driver mutations in 12 patients (Table). The majority of patients were initially treated with immunotherapy. The most frequently used therapies included monotherapy with anti-PD-1 agents (nivolumab or pembrolizumab, accounting for 41.6%) and a combination of ipilimumab and nivolumab (33.3%). After a median follow-up of 17.7 months, the median overall survival (OS) for the entire cohort was 18.1 months (with a 95% confidence interval ranging from 6.8 to 23.2 months), showing no significant statistical differences in outcomes based on the location of the mucosal melanoma or the type of treatment received. Conclusions: Mucosal melanoma remains an under-researched malignancy. There is a critical need for prospective, randomized trials to explore more effective treatment options for patients with this condition. [Table: see text]

Carbonation and corrosion of steel in fly ash concrete, concluding investigation of five-year-old laboratory specimens and preliminary field data

Carbonation development and reinforcement corrosion were investigated on concretes exposed for a five-year period at 90% RH, 20 ℃, and 5% CO2, and for a six-year period at natural carbonation. Portland cement-based binders with 0%, 18%, and 30% fly ash were investigated. The fly ash blends showed lower carbonation resistance compared to PC both at laboratory and field exposure, a large difference in carbonation performance was observed between the laboratory exposed specimens. The carbonation rate was fastest on the laboratory specimens and showed square-root time dependency the first 2.5 years, but reduced rate at later age. Deeper carbonation depths were in general observed in the vicinity of the reinforcement compared to the unreinforced laboratory exposed specimens. Not all specimens were fully carbonated at the steel-concrete interface. The correlation between degree of carbonation of the steel-mortar interface, the open circuit potential, and the observed corrosion of the steel bars varied between binders and bar position (top or bottom). The measured corrosion rate in the laboratory exposed (90% RH, 20 ℃, and 5% CO2) carbonated concrete was on average 0.2 μA/cm2, with an upper value of 0.6 μA/cm2. The highest corrosion rate was measured in the fly ash concrete. No corrosion rate data are yet available for the field exposed concretes.

Analysing patterns of blood component transfusions over a five-year period at Sawai Man Singh Medical College Jaipur: a cross sectional study

Analysing patterns of blood component transfusions over a five-year period at Sawai Man Singh Medical College Jaipur: a cross sectional study

An application of Rumor Propagation In Google trends

Daley and Kendle’s pioneering mathematical basis for modelling rumor propagation around 1965 has paved a strong platform for researchers to come up with new generalizations for practical scenarios of rumor spreading in social networks. In this study, we use a generalization of original DK model, Ignorant-Spreader-Stifler (ISS) model to analyze the cricket related searches in Sri Lanka on Google.The secondary data used for the study were obtained from Google trends for a five-year period from 2012 to 2017, targeting the three t20 matches held during the period. We introduce two algorithms on Maple mathematical software to estimate the parameters of the ISS model numerically. We observe that the way people search on web about cricket is roughly analogous to spreading a rumour and forecasting is better when modelling with most recent data than considering more data back in time and we also find that the predicting accuracy is significantly equal of the two models built considering the data in 2012 and 2014.

STUDY ON IMPACT OF INTEREST RATES ON THE STOCK MARKET

This study set out to investigate and focus on the effect of interest rates on stock markets, namely the National Stock Exchange (NSE) and the Bombay Stock Exchange (BSE), with the aim of increasing knowledge. All of the secondary data included in this study came from reliable exchanges and was collected over a five-year period between 2019 and 2023. The Reserve Bank of India [RBI], which collects daily and monthly prices of several stock indexes, was another source of interest data. The Unit Root test, Johansen’s Co-integration test, and ARCH models were examined using the statistical program EViews 12, were employed to calculate the outcomes and determine whether there was a long-term positive or negative association between the variables. For this study, interest rates such as bank rate, repo rate, and reverse repo rate are measured as independent variables, and stock prices such as BSE Bank, and NSE Bank are measured as dependent variables. This study will be useful to investors, financial managers, and other experts in the field of finance.

A STUDY ON THE ROLE OF TECHNICAL ANALYSIS IN PREDICTING SHORT-TERM PRICE MOVEMENTS IN THE STOCK MARKET

This research explores the efficacy of technical analysis in predicting short-term stock market movements. The study investigates various technical analysis tools, including support and resistance levels, Fibonacci retracement, and swing highs and lows, applied to a selection of stocks from Bank Nifty. The primary objective is to evaluate the effectiveness of these tools in forecasting price trends and providing actionable trading insights. Data was analyzed over a five-year period, utilizing a blend of qualitative and quantitative research methods. Findings indicate that while technical analysis provides significant insights into market behavior, its effectiveness can vary widely depending on market conditions and the specific tools used. The research contributes to academic discourse on market efficiency and offers practical implications for traders and financial analysts by enhancing the understanding of technical analysis as a robust component of trading strategy development in the volatile environment of stock trading. Keywords : Short term Price Movements, Support and Resistance Level, Fibonacci Retracement, Swing highs and lows, Technical Analysis, Stock Market, Bank Nifty.

How does pre-service teachers’ general pedagogical knowledge develop during university teacher education? Examining the impact of learning opportunities and entry characteristics over five time points using longitudinal models

ABSTRACT General pedagogical knowledge (GPK) is regarded as a central component of the competence that teachers acquire during university teacher education. However, existing research on GPK typically uses only one or two measurement points to assess development and identify influencing factors. The present study draws on an annual survey of pre-service teachers’ GPK over 5 measurement points during the course of university teacher education (i.e. over the standard five-year study period). Latent growth curve models were used to assess knowledge development and explore potential influences. Knowledge development was best described as an increasing trend that flattens out over time. While students’ initial knowledge levels differed, their knowledge increase showed little interindividual variance. Initial knowledge level was related to the use of learning opportunities at the beginning of the study programme, but no significant association was identified between knowledge growth and increased learning opportunities over time. Moreover, initial knowledge level was predicted by the grade point average achieved in secondary school examinations but not by intrinsic motivation. Overall, the findings indicate that university teacher education effectively promotes GPK, with the entry phase being of particular significance.

Surgical treatment for obstructive sleep apnea prevents arrhythmic events: a nationwide population-based study

Abstract Background/Introduction Obstructive sleep apnoea (OSA) is a well-established risk factor for the development and exacerbation of cardiac arrhythmias. Continuous positive airway pressure therapy is recommended as the primary non-invasive treatment for OSA. However, suboptimal patient compliance remains a common challenge. Purpose This study explores the benefits of surgery in reducing the occurrence of arrhythmias associated with OSA. The study aims to investigate the impact of surgery in managing OSA-associated arrhythmias. Methods Data from the Korean Health Insurance, from January 2009 to December 2020, were retrospectively compiled and analysed to investigate the clinical outcomes of 359,851 individuals with OSA. Propensity score matching (PSM) at a 1:4 ratio was employed to compare patients who underwent surgery with those who did not. A final cohort of 117,665 participants (85.4% men, aged 60 years old or younger: 94.2%) was established, with 23,533 having undergone surgery for OSA and 94,132 receiving non-surgical management. Over a five-year follow-up period, the occurrence rates of atrial fibrillation (AF), premature beats (premature atrial contractions or premature ventricular contractions), ventricular arrhythmias, sudden cardiac arrest, atrioventricular block, and sinus node dysfunction were evaluated. Results Across the six types of arrhythmias, the cohort that underwent surgery for OSA consistently exhibited a lower incidence of arrhythmias than the non-surgical cohort. In the PSM analysis, a statistically significant reduction in the incidence of AF, premature beats, and sudden cardiac arrest was observed in groups of patients who underwent surgery for OSA. Among those who developed AF, the group that underwent surgery for OSA had a fivefold higher incidence than the non-surgical group (hazard ratio [HR] 5.384, 95% confidence interval [CI] 3.459-8.381). The incidence of premature beats was more than four times higher in the non-surgical group (HR 4.284, 95% CI 2.96-6.177, p<0.0001), and sudden arrest was more than 24x higher in the non-surgical group (HR 24.089, 95% CI 3.348-173.312). Conclusion This study suggests a potential causative relationship between OSA and arrhythmias. Additionally, surgical intervention for OSA may be considered an effective strategy for preventing arrhythmias in young patients. Further clinical research is warranted to validate and refine these observations.Figure 1Figure 2

#1381 Economic evaluation of an integrated care program versus conventional care for chronic kidney disease patients in rural communities of Thailand

Abstract Background and Aims This study evaluates an integrated care program for chronic kidney disease (CKD), which has demonstrated effectiveness in delaying kidney function decline in the rural population of Thailand. Efficacy of the program was initially established through the ESCORT-1 study, a cluster-randomized controlled trial (doi: 10.1186/s12882-016-0414-4), and further demonstrated the effectiveness by the larger-scale prospective cohort study, ESCORT-2 (doi: 10.1111/nep.13849). The aim of this study is to assess the cost-effectiveness of incorporating this program into Thailand's public health benefit package, with the goal of establishing it as a model for similar rural areas in resource-limited settings. Method Following the Thailand's guideline for health technology assessment, a cost-utility analysis utilizing data from the ESCORT studies, local databases, and literatures. The integrated care program was tailored to primary healthcare system by using preexisting workforces. It involved a collaboration between Multi-Disciplinary Care Teams (MDCT) at district hospitals and Community Care Network (CCN) teams at Sub-District Health Centers (SDHC). The MDCT, comprising general practitioners, CKD nurse managers, pharmacists, a nutritionist, and a physical therapist, provided key patient education on diet, medication adherence, exercise, and avoiding certain medications and herbal remedies. The CCN teams, including community nurses and village health volunteers, conducted home visits for health monitoring and lifestyle guidance. Both MDCT and CCN personnel received training in CKD care based on the NKF-K/DOQI and KDIGO Clinical Practice Guidelines. A decision-analytic Markov model and Monte-Carlo simulation were applied to quantify and compare the lifetime costs and quality-adjusted life years (QALY) outcomes of the intervention and conventional-care from a societal perspective considering both direct and indirect costs. The analysis included extensive sensitivity analyses, incorporating a probabilistic model and scenario-analyses based on patient ages, CKD stages, and varying program efficacy. Additionally, a budget impact analysis from the payer's perspective assessed the financial impact and affordability over a five-year period. Results The integrated care program was found to dominate conventional care. The results indicated an incremental cost-effectiveness of (-)278,000 Thai Baht (∼7,267 EUR) per QALY for the base case analysis. Probabilistic analysis demonstrated consistent outcomes, with the integrated care program being cost-effective at almost 100% of the time during analysis at the 160,000 Thai Baht (∼4,182 EUR) willingness-to-pay threshold (Fig. 1). These results are driven by significant cost savings due to reduced time and overall costs in dialysis before death. The program is most cost-effective when provided early to patients, in terms of both age and CKD stages (Fig. 2). The budget impact analysis showed that introducing the intervention could save the payer 184 billion Thai Baht (4.76 billion EUR) over five years. (The exchange rate; 1 Thai Baht = 38.26 EUR) Conclusion The integrated care program for patients with stage 3-4 CKD is cost-effective and suitable for inclusion in Thailand's health benefit package, mainly due to its significant cost savings and enhanced health outcomes. The program's design, focusing on sustainability and feasibility by utilizing existing workforces, positions it as a viable model for similar economic and healthcare contexts, especially in resource-limited countries.

#1578 Left ventricular ejection fraction: association with risk of mortality and the incidence of AVF dysfunction

Abstract Background and Aims Ejection fraction (EF) and chronic heart failure (HF) are often considered as criteria for the possibility of arteriovenous fistula (AVF) creation in relation to an increased risk of death, without sufficient evidence for this. There is, however, rare but compelling evidence that low EF increases the risk of AVF dysfunction. Aims: to evaluate the association between EF at the time of AVF creation and the incidence of adverse cardiovascular events, all-cause mortality, as well as AVF dysfunction Method This retrospective cohort study included 962 adult patients who had a first-time created functioning AVF. Only patients with a more than three months period after AVF creation and within a five-year period were included. The mean follow-up period was 34 ± 13 months. Four groups were identified based on EF and the presence of HF at the time of AVF creation (transthoracic echocardiogram): HF with reduced EF (rEF) <40%, with mid-range (mrEF) of 40-49%, or with preserved EF (pEF) ≥50% + HF, and a “no HF” group with EF ≥50% and no HF. Results In the univariate analysis, a reduced EF was associated with an increased risk of mortality, with the hazard ratios (HRs) of 2.706 [95% CI 1.330; 5.507], p = 0.006 for mrEF and 8.250 [95% CI 2.621; 25.97], p < 0.001 for rEF, compared to the “no HF” group (here and thereafter)—Fig. 1. However, after adjusting for age, sex, and Charlson Comorbidity Index (CCI), the EF was not significantly associated with the risk of death. Only the CCI score remained a significant factor (HR = 1.748 [95% CI 1.482; 2.063], p < 0.001). A decreased EF was associated with the incidence of AVF dysfunction both in the univariate analysis and after adjustments. In the univariate analysis, the incidence rate ratios (IRRs) of 6.88 [95% CI 3.88; 12.1], p < 0.001 for mrEF, and 19.9 [95% CI 8. 64; 41.6], p < 0.001 for rEF, were shown. After adjusting for age, sex, and CCI, the IRR for mrEF was 8.96 [95% CI 5.81; 13.7], p < 0.001, and for rEF it was 23.4 [95% CI 13.8; 38.6], p < 0.001. Even in the presence of polycystic kidney disease and diabetes mellitus in the fully adjusted model, the association between EF and the incidence of AVF dysfunction remained statistically significant: the IRR was 8.61 [95% CI 5.61; 13.1], p < 0.001 for mrEF, and 33.4 [95% CI 19.5; 56.2], p < 0.001 for rEF. The findings were confirmed in a sensitivity analysis that included adjustments for unplanned onset of dialysis and competing risks survival analysis (death—outcome of interest, conversion of HD to PD or kidney transplantation and conversion of AVF to CVC—competing events). According to our results patients with EF<40% will inevitably lose AVF function for various reasons within 3.5 years—Fig. 2. Meanwhile, this approach will give the patient additional time of HD via AVF, but not CVC, without increasing the risk of death, subject to Qa monitoring. Conclusion In patients with CKD 5 who are initiating treatment with maintenance hemodialysis, a decreased EF is associated to a greater extent with a higher risk of AVF dysfunction than with an increased risk of mortality. The burden of comorbidities, rather than a standalone assessment of EF, is one of the major risk factors determining patient survival.