Poor Disposition Research Articles

Pre-procedural nursing home length of stay and outcomes of transcatheter aortic valve replacement.

Older adults with severe aortic stenosis (AS) may receive care in a nursing home (NH) prior to undergoing transcatheter aortic valve replacement (TAVR). NH level of care can be used to stabilize medical conditions, to provide rehabilitation services, or for long-term care services. Our primary objective is to determine whether NH utilization pre-TAVR can be used to stratify patients at risk for higher mortality and poor disposition outcomes at 30 and 365 days post-TAVR. We conducted a retrospective cohort study among Medicare beneficiaries who spent ≥1 day in an NH 6 months before TAVR (2011-2019). The intensity of NH utilization was categorized as low users (1-30 days), medium users (31-89 days), long-stay NH residents (≥ 100 days, with no more than a 10-day gap in care), and high post-acute rehabilitation patients (≥90 days, with more than a 10-day gap in care). The probabilities of death and disposition were estimated using multinomial logistic regression, adjusting for age, sex, and race. Among 15,581 patients, 9908 (63.6%) were low users, 4312 (27.7%) were medium users, 663 (4.3%) were high post-acute care rehab users, and 698 (4.4%) were long-stay NH residents before TAVR. High post-acute care rehabilitation patients were more likely to have dementia, weight loss, falls, and extensive dependence of activities of daily living (ADLs) as compared with low NH users. Mortality was the greatest in high post-acute care rehab users: 5.5% at 30 days, and 36.4% at 365 days. In contrast, low NH users had similar mortality rates compared with long-stay NH residents: 4.8% versus 4.8% at 30 days, and 24.9% versus 27.0% at 365 days. Frequent bouts of post-acute rehabilitation before TAVR were associated with adverse outcomes, yet this metric may be helpful to determine which patients with severe AS could benefit from palliative and geriatric services.

Reform of government policy on the acquisition of functional literacy, numeracy and cognitive skills through the reading curriculum of primary schools

As part of the ongoing efforts to ensure the acquisition of functional literacy and communicative competence among primary school leavers, the present study examined the implementation of the reading component of the primary school English curriculum under the UBE scheme. The study was a descriptive survey and recruited six head teachers and sixty classroom teachers as the study sample. Five research questions were posed to guide the study and research data were collected using questionnaires and an observation checklist. Data were analysed using frequency counts and percentages. The findings of the study shed light on the status of the implementation of the reading curriculum in primary schools in Nigeria. In particular, it was found that the majority of the teachers do not always use the phonics instructional method while teaching reading, lack the required competency to use the phonics instructional method and show poor disposition towards the phonics method. It was also found that teaching materials are available, but very few of them are used by teachers in teaching reading. These findings suggest that the implementation of the reading curriculum under the present UBE scheme is faced with many challenges.

Abstract 5381: Combinatory effect of EZH2 inhibitor and dopamine D1 receptor agonist enhance inhibition of triple negative breast cancer cell growth

Abstract Treatment for Triple Negative Breast Cancer remains a challenge due to its aggressive behavior; poor clinical outcome and disposition to therapeutic resistance. The diverse clinical and molecular characteristics drives high level of heterogeneity in breast cancer. Overall change in the epigenome triggers oncogenic activity of enhancer of zeste homolog 2 (EZH2) causing changes in gene expression that leads to cancer progression. EZH2 is the catalytic member of the Polycomb group protein complex that provides the active site for covalent methylation reactions. High expression of EZH2 is strongly associated with aggressive TNBC phenotypes, compared to other non-TNBCs. Development of resistance to EZH2 inhibitors limit their therapeutic use. Studies have shown that dopamine receptor (DR) agonists and antagonists alter TNBC cell growth in both in vitro and in vivo models. Our objective was to investigate if a combination of a D1R agonist with an EZH2 inhibitor was effective to attenuate TNBC cell proliferation. Docking studies were performed using Schrodinger software and visualization software to determine the affinity of GSK126 and SKF38393 towards EZH2. TNBC cells were treated individually and combined with EZH2 inhibitor, GSK126, and D1 agonist SKF38393 for cell viability and immunoprecipitation. Insilco analysis using docking studies revealed that SKF38393 actively interacts in the same region where GSK126 binds to EZH2 i.e. the catalytic site. Combination treatment of TNBC cells with GSK126 and SKF38393 caused synergistic inhibition of cell viability, suppressed the H3K27 trimethylation activity, and inhibited invasion of TNBC cells. Immunoprecipitation of EZH2 in the presence of GSK126 and SKF38393 dissociated the association between EZH2, EED, and SUZ12 in MDA-MB-231 cells. We report that combination of GSK126 and SKF38393 may have an enhanced efficacy in inhibiting the catalytic function of EZH2. The combined treatment of TNBC cells with GSK126 and SKF38393 inhibit TNBC proliferation by disrupting EZH2 functions. (This work is supported by DOD: W81XWH2010065, for Eswar Shankar) Citation Format: Prem Prakash Kushwaha, Shiv Verma, Gautham Sarathy, Anmol Kumar, Sanjay Gupta, Bhuvaneswari Ramaswamy, Sarmila Majumder, Eswar Shankar. Combinatory effect of EZH2 inhibitor and dopamine D1 receptor agonist enhance inhibition of triple negative breast cancer cell growth [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5381.

Boosting visible-light photocatalytic degradation of polystyrene nanoplastics with immobilized CuxO obtained by anodization

Plastics composed mainly of polystyrene polymer have become widely used materials in different industries. The poor disposition of these products and their interaction with the environment has caused their fragmentation into particles that reach a nanometric scale (≤1 µm), called nanoplastics (NPs), considered pollutants due to their effects on human health and capacity to absorb toxic-bioaccumulative substances. Currently, advanced oxidation processes have shown efficiency in removing emerging pollutants, making them promising alternatives to treat NPs. This study proposes photocatalytic degradation with visible light irradiation to mitigate the contamination produced by polystyrene nanoplastics (PS-NPs). Therefore, PS particles of ~ 350 nm were degraded using immobilized copper oxide semiconductors grown by the anodizing process for the first time. The anodization process considered two growth media (NH4F and NaOH), obtaining immobilized Cu2O/CuO semiconductors with different morphologies and a bandgap between 1.6 and 2 eV. The degradation of the nanoplastics was examined using several analytical methods such as TOC, ATR-FTIR, turbidity, and gas chromatography showing the presence of intermediates compounds with the carbonyl group, confirming the degradation of PS-NPs. The results showed that photocatalysis in visible light with copper oxide semiconductors promotes polymer chain scissions and reduces the concentration of PS-NPs up to 23%, representing six times more than the reductions achieved by photolysis. In addition, mineralization of up to 15% was achieved. Although contamination by nanoplastics involves many challenges, this study provides the basis for an alternative process that allows the mitigation of these nanoplastics using visible light.

Addressing behavioural safety concerns on Qatari Mega projects

This study explores the behavioural safety measures for addressing accidents on Qatar mega projects which are infamous for their high rates of accidents and fatality. Using extant literature and brainstorming as sources of preliminary information, questionnaire was used for collecting quantitative data, which was analysed using reliability analysis and exploratory factor analysis.The finding suggests that there is a low level of behavioural safety awareness among the construction workers due to their lack of adequate safety knowledge, with the rate of accident exacerbated by use of improper safety gears or improper use of such gears. Putting production ahead of safety, due to urgency and timeliness of the projects, engenders poor disposition to safety among site workers. To turn the tides on the high rates of accidents and fatality, more proactive approaches to safety management is essential for engendering behavioural safety among the operatives. Such measures include enhanced communication and feedback on safety practices, increased use of safety signs to raise awareness, education and regular observation and appraisal of the employees. A key requisite for achieving a positive behavioural safety outcome is an increased commitment of the management team and the site supervisors who are expected to implement a robust safety policy as well as the carrot and stick approach for engendering positive safety behaviour.With behavioural safety management recognised as an effective approach for mitigating health and safety concerns on construction sites, this study suggests measures for mitigating unsafe behaviours, thereby reducing accidents and fatalities on the Qatari Mega projects.

Increased Pulse Pressure Variability Within the First 24 Hours Leads to Poor Disposition in Subarachnoid Hemorrhage Patients.

Aneurysmal subarachnoid hemorrhage (SAH) continues to be associated with significant morbidity and mortality despite treatment advancements. Although high blood pressure (BP) remains a significant risk factor in aneurysmal SAH and rerupture, the role of BP parameters and fluctuation in prognostication remains unclear. We sought to define how BP parameters and variability within 24 hours of hospitalization in acute-onset SAH affects patient discharge outcomes. We retrospectively analyzed a prospectively collected cohort of SAH patients. Hourly BP parameters, including systolic BP (SBP), diastolic BP, pulse pressure (PP), and their corresponding variability (delineated by SD), were collected to investigate associations with the primary endpoint of discharge disposition. One hundred and seventy-four SAH patients were included in the study. On bivariate analysis, Hunt-Hess (HH) score, Fisher grade, intraventricular hemorrhage, external ventricular drain placement, and SBP and PP variability were significantly associated with a poor disposition. Poor disposition was significantly associated with age, HH score, intraventricular hemorrhage, and PP variability on multivariate analysis. PP variability remained an independent predictor for poor disposition (odds ratio 1.11, 95% confidence interval, 1.02-1.21, P = 0.02) when adjusting for potential confounders. Increased BP and PP variability within the first 24 hours of admission portends a poor discharge disposition for aneurysmal SAH patients.

Falls and fear of falling among older adults in an assisted-living facility: A qualitative and foundational study for intervention development in a developing country

BackgroundFalls and fear of falling (FOF) have serious adverse effects for older adults. Culturally-specific and environmentally-tailored interventions may help address the problems of falls and FOF. No such interventions are however available for use in the African context. ObjectiveTo explore falls and FOF among older adults in an assisted-living facility, as a foundation for developing interventions to address falls and FOF. MethodsThis qualitative study involved purposefully recruiting nine older adults and four caregivers at an assisted-living facility in Southeast Nigeria. Focus group discussions were conducted separately for older adults and the caregivers. Data were analysed using an Inductive Approach. ResultsFour themes emerged: incidence of falls and fear of falling; factors associated with falls and fear of falling; health implications of falls and fear of falling; and coping strategies to deal with falls and fear of falling. Older adults were experiencing a high prevalence of falls and FOF perceived to be caused by both cultural/environmental/institutional-related factors (poorly lit environment at night; poor ambulatory surfaces; unwillingness to accept age-related changes in physical capacity; poor disposition towards walking aids; poor treatment of injuries; misconceptions; poor physical activity participation; and external perturbation) and intrinsic factors (psychological/emotional, concentration/attention, socio-demographic and morbidity-related). ConclusionThe older adults were experiencing a high prevalence of falls and FOF which has a multifactorial origin of common and cultural/societal/institutional/environmental-related factors. The need for a multicomponent and culturally and environmentally-specific interventions to address falls and FOF in this sample is thus highlighted.

WOMEN LEADERS, VICTIMS OF DOMESTIC VIOLENCE:A PHENOMENOLOGY

The purpose of this phenomenological qualitative study was to give light to the experiences of working women and women leaders who are also victims of domestic violence. This study may inspire women from all walks of life and to give voice to the abused women to stand for their rights in advancing gender equality and development. Five informants from Matanao, Davao del Sur were selected through purposive sampling on February 18, 2017, for an in-depth interview. The research design employed in this study was phenomenology as it explained well the experiences and perspectives of women leaders on domestic violence. The results of the interview were transcribed, translated, and coded to produce themes. Several issues escalated as regards to the narratives of working women leaders who are abused at home, the following were the themes: anxiety and signs of depression, prejudice, low self-esteem, and poor disposition, and resilience. As to their insights that they can share with other women and to the academe: disputing chauvinism, the optimistic outlook in life, faith in God, tenets on leadership, and gender distinctions.

Phenotypic heterogeneity by site of infection in surgical sepsis: a prospective longitudinal study

BackgroundThe role of site of infection in sepsis has been poorly characterized. Additionally, sepsis epidemiology has evolved. Early mortality has decreased, but many survivors now progress into chronic critical illness (CCI). This study sought to determine if there were significant differences in the host response and current epidemiology of surgical sepsis categorized by site of infection.Study designThis is a longitudinal study of surgical sepsis patients characterized by baseline predisposition, insult characteristics, serial biomarkers, hospital outcomes, and long-term outcomes. Patients were categorized into five anatomic sites of infection.ResultsThe 316 study patients were predominantly Caucasian; half were male, with a mean age of 62 years, high comorbidity burden, and low 30-day mortality (10%). The primary sites were abdominal (44%), pulmonary (19%), skin/soft tissue (S/ST, 17%), genitourinary (GU, 12%), and vascular (7%). Most abdominal infections were present on admission and required source control. Comparatively, they had more prolonged proinflammation, immunosuppression, and persistent organ dysfunction. Their long-term outcome was poor with 37% CCI (defined as > 14 in ICU with organ dysfunction), 49% poor discharge dispositions, and 30% 1-year mortality. Most pulmonary infections were hospital-acquired pneumonia. They had similar protracted proinflammation and organ dysfunction, but immunosuppression normalized. Long-term outcomes are similarly poor (54% CCI, 47% poor disposition, 32% 1-year mortality). S/ST and GU infections occurred in younger patients with fewer comorbidities, less perturbed immune responses, and faster resolution of organ dysfunction. Comparatively, S/ST had better long-term outcomes (23% CCI, 39% poor disposition, 13% 1-year mortality) and GU had the best (10% CCI, 20% poor disposition, 10% 1-year mortality). Vascular sepsis patients were older males, with more comorbidities. Proinflammation was blunted with baseline immunosuppression and organ dysfunction that persisted. They had the worst long-term outcomes (38% CCI, 67% poor disposition, 57% 1-year mortality).ConclusionThere are notable differences in baseline predisposition, host responses, and clinical outcomes by site of infection in surgical sepsis. While previous studies have focused on differences in hospital mortality, this study provides unique insights into the host response and long-term outcomes associated with different sites of infection.

Prognostication via early computed tomography head in patients treated with targeted temperature management after cardiac arrest

BackgroundWe evaluated computed tomography head (CTH) imaging obtained prior to targeted temperature management (TTM) in patients after cardiac arrest, and its role in prognostication. MethodsIn this retrospective cohort study in a tertiary-care hospital, 341 adults presenting with out-of-hospital cardiac arrest received a CTH prior to TTM. Associations between outcomes and neuroimaging variables were evaluated with Chi-square analysis for significant associations that yielded a composite neuroimaging score—Tennessee Early Neuroimaging Score (TENS). Univariable and multivariable logistic regression analysis including TENS as an independent variable and the four outcome dependent variables were analyzed. ResultsFour of the neuroimaging variables—sulcal effacement, partial gray-white matter effacement, total gray-white matter effacement, deep nuclei effacement—had significant associations with each of the four outcome variables and yielded TENS. In multivariable logistic regression models adjusted for potential confounders, TENS was associated with poor discharge CPC (OR 2.15, 95%CI 1.16–3.98, p = .015), poor disposition (OR 2.62, 95%CI 1.37–5.02, p = .004), in-hospital mortality (OR 1.99, 95%CI 1.09–3.62, p = .024), and ICU mortality (OR 1.89, 95%CI 1.12–3.20, p = .018). ConclusionImaging prior to TTM may help identify post-cardiac arrest patients with severe anoxic brain injury and poor outcomes.

Does race matter in universal healthcare? Stroke cost and outcomes in US military health care

ABSTRACT Introduction: It is well documented in the US civilian healthcare system that race is correlated with different outcomes for ischemic stroke patients. That healthcare system has wide variations in access to and quality of care. In contrast, the US military healthcare system (MHS) a universal healthcare system where every member has access to the same healthcare benefits. Do racial disparities evident in the civilian healthcare system transfer to the MHS? Methods: Data was collected from the MHS Military Mart (M2) database from calendar years 2010 through 2015. All adult patients with a primary diagnosis of ischemic stroke upon discharge were reviewed. Race was compared across primary outcomes of: (1) IV tPA administration and (2) Disposition destination ‘poor disposition destination or in-hospital mortality’. And secondary outcomes of: (1) Total cost of hospitalization and (2) Length of hospital stay. Relevant demographic and co-morbidities were adjusted with regression analysis. Results: A total of 3623 patients met this study’s parameters. Race was identified in 2661 (73.5%) admissions. Racial composition of this patient sample was: White 1767 (48.8%), African Americans 619 (17.1%), Asian 275 (7.6%), Other or Unknown 962 (26.5%). There was no correlation between race and administration of IV tPA, poor disposition destination or in-hospital mortality. There was a correlation between African Americans and increased cost of hospitalization. This finding was correlated with costs for radiological studies but was not correlated with any increase in the length of stay. Conclusion: Racial disparities evident in the civilian healthcare system do not appear to transfer the universal healthcare system represented by the MHS. Universal healthcare mitigates racial disparities in ischemic stroke admissions.

Racial differences in intracerebral haemorrhage outcomes in patients with obesity.

SummaryObjectiveThis study was conducted to determine the role of obesity and race in intracerebral haemorrhage (ICH) outcomes.MethodsThe Get with the guideline‐Stroke database was queried for all admitted patients with spontaneous ICH. Secondary causes of ICH were excluded. Body mass index (BMI) was classified using the Center for Disease Control guidelines. Race was classified as White or non‐White. Demographics, clinical, imaging data were retrieved. Outcome measures were hematoma expansion at 24 h and discharge disposition.ResultsA total of 428 patients were included in our analysis. Female gender, past history of congestive heart failure, diabetes mellitus, HbA1c, blood pressure, ICH volume, ICH location, intraventricular haemorrhage and hospital length of stay deferred across BMI categories. On multivariate analysis, along with obese categories, age, ICH location and ICH volume were independent predictors of poor outcomes (hematoma expansion and poor discharge disposition). After adjusting for these variables, obesity remained a predictor of poor disposition outcome compared with normal and overweight subjects; Normal vs. Obese OR 0.26 CI 0.115–0.593 p = 0.0014; Obese vs. Overweight OR 3.79 CI 1.68–8.52 p = 0.0013. Nonetheless, obesity did not influence hematoma expansion. Overall, BMI‐race classification did not influence outcomes. However, among non‐Whites, the obese category had higher odds of a poor disposition outcome than normal (OR 6.84 CI 2.12–22.22 p = 0.0013) or overweight (OR 8.45 CI 2.6–27.49 p = 0.0004) categories.ConclusionAn obesity paradox in ICH was not observed in our cohort. In the non‐White population, patients with obesity were likely to be associated with poor disposition outcome. Similar findings were not observed in White population.

Didactic Strategies to Improve the Competencies in Analytical Reading and Academical Writing of Future Teachers and Teachers in Service

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Fathers’ personality dispositions and conduct-disordered children's perception of their fathers

IntroductionIndividual's personality profile is one of the major determinants of one's behavior. Thus, poor personality disposition of fathers and the child's perception of father have been reported to be powerful predictors of subsequent delinquency and criminal offences. The externalizers resemble the dimensions of conduct disorder as prescribed in diagnostic statistical manual IV. The essential feature is their repetitive behavioral pattern wherein the basic right of others or major age appropriate societal norms are violated.ObjectiveThis study finds out the relationship between the fathers’ personality-disposition, having male children with conduct disorder (CDC, n = 30, experimental group), dysthymic disorder (DDC, n = 30, control group), and normal (NC, n = 30, control group), by applying the new five factor inventory, and children's perception of their fathers on the parent–child relationship scale.MethodThe children were matched on age, sex, socio-economic status and other relevant variables. The CD and DD were selected on the DSM-IV criteria for the diagnosis of conduct disorder and dysthymic disorder. The fathers of each group of children were administered the aforesaid questionnaires.ResultThe CDF showed only significantly poor agreeableness compared to the NF. The CDC's perceived their fathers most negatively compared to the DDC and NC. The CDF's conscientiousness was significantly correlated to a number of variables of the children's perception of them as observed on the PCRS.ConclusionThe CDF showed lower agreeableness than the NF. The CDC perceived their fathers most negatively, hence, setting the model for the child to observe and learn socially inappropriate behavior.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

Abstract W P335: The Impact of Electrolyte Abnormalities in Primary Intracerebral Hemorrhage

Background and Purpose: Electrolyte abnormalities are common in patients with hemorrhagic stroke. In subarachnoid hemorrhage for instance, hyponatremia is common and is independently associated with adverse outcomes. For patients with primary ICH, however, there is limited about electrolyte abnormalities. This study aims to examine the relationship between electrolyte abnormalities and outcomes in ICH patients. Methods: We retrospectively reviewed consecutive ICH patients in a single center stroke registry between 2008-2013. Patient demographics, clinical information including stroke severity (NIHSS) and ICH score, laboratory values and neuroimaging were collected. Admission electrolyte abnormalities for serum sodium, potassium and chloride were defined as any value outside the hospital’s reference range. Outcomes of interest included hematoma expansion, discharge mRS, length of stay (LOS) and poor discharge disposition (i.e., not to home or inpatient rehabilitation). Results: A total of 384 patients were included in this analysis. Serum sodium was abnormal in 47 patients (12.2%), potassium was abnormal in 46 patients (11.9%) and chloride was abnormal in 76 patients (19.8%). Hyponatremia was the most common sodium abnormality (46/47, 98%). Potassium and chloride abnormities were not associated with worse outcomes. Serum sodium abnormalities were associated with longer length of stay (11 vs 5 days, p=0.002), higher discharge mRS (5 vs 4, p=0.04) and poor disposition (60% vs 43%, p=0.03). There was no association with hematoma expansion. Although not significant for all hemorrhage severities, in patients with an ICH score ≤2, abnormal sodium was associated with a discharge mRS 4-6 (OR 2.49, 95% CI 1.16-5.39, p=0.02) and poor disposition (OR 2.55, 95% CI 1.29-5.02, p=0.01). Conclusions: Electrolyte abnormalities were not uncommon in our sample of ICH patients and hyponatremia was a frequent cause of abnormal serum sodium. Although potassium and chloride abnormalities were not associated with poor outcomes, serum sodium abnormalities were associated with worse functional outcomes, particularly in patients with milder hemorrhage severity. Further research is needed to determine if sodium correction can improve these outcomes.

Abstract T P326: The Utility of Charlson Comorbidity Index in Predicting Short-term Outcomes in Patients with Primary Intracerebral Hemorrhage

Background and Purpose: The Charlson Comorbidity Index (CCI) is used to evaluate a patient's risk of in-hospital, 1-year and 10-year mortality, and has been validated in acute ischemic stroke. Previous studies have shown that CCI influences functional outcomes. We sought to evaluate the association between CCI and outcomes in patients with primary ICH presenting to our center. Methods: Patients with primary ICH admitted to our center from 2008-2013 were included. Demographic and clinical data were collected. Primary outcomes were a discharge mRS (dmRS) of 4-6, death and poor discharge disposition (any disposition other than home or inpatient rehabilitation). Crude and adjusted logistic regressions were used to evaluate the association between CCI and outcomes. Results: A total of 383 patients were identified. There were 37 (9.7%) patients with a CCI of 0 or 1, 242 (63.2%) patients with a CCI of 2-5, and 104 (27.2%) with a CCI of 6 or greater (Figure). While the continuous CCI was not significantly associated with a dmRS of 4-6 (OR 1.08, 95% CI 0.99-1.19, p=0.09), it was associated with disposition. The odds of poor disposition increased 18% with each increase in CCI (OR 1.18, 95% CI 1.08-1.28, p=0.0003). The odds of death increased 12% with each point increase in CCI (OR 1.12, 95% CI 1.02-1.23, p=0.021). After adjusting for baseline ICH score, CCI remained significantly associated with poor disposition (OR 1.13, 95% CI 1.00-1.27, p=0.042), however the association between CCI and death was not statistically significant (OR 1.05, 95% CI 0.91-1.21, p=0.52). Conclusions: In contrast to previous studies, the CCI was not associated with poor short-term functional outcome or in-hospital mortality. However, it was significantly associated with poor discharge disposition. This suggests that cumulative comorbidities only predict disposition in ICH, because the ICH score strongly impacts poor functional outcome and in-hospital mortality.

The Nutrition Profession in Africa: Meeting the Current and Future Challenges

The relevance of nutrition to national development is very strategic; even though many sub-Saharan African countries do not consider nutritional challenges as critical. Poor disposition to nutrition in many African countries are aggravated by the quality of nutrition professionals in the region. There is lack of reliable information regarding the number of people working as nutrition professionals and the quality of the training received. Majority of countries in Africa cannot boast of world-class nutrition training institutes and linkages with standard foreign institutes are few. The dearth of highly qualified nutrition professionals has resulted into poor nutrition programme planning, implementation and evaluation. In some cases, the outcome of many nutrition intervention programmes is at variance with the set goals due to faulty programme planning and design. It is obvious that urgent consideration should be given to capacity building of nutrition professionals in developing countries, especially in those countries where the problem of malnutrition has remained unabated for many years. Developmental assistance from donor countries and other global bodies should have nutrition components. Capacity building in nutrition stands as one of the most cost-effective veritable tools to enhance national progress. However, the UNICEF’s Conceptual Framework on the Causes of Malnutrition may need to include lack of capacity building for nutrition professionals as part of the strategies to tackle the underlying causes of malnutrition in developing countries. Availability of competent professionals in the field of nutrition may be the beginning of profitable journey to solving many problems confronting the continent of Africa.

Myocardial Dysfunction in Acute Traumatic Brain Injury Relieved by Surgical Decompression

Traumatic brain injury (TBI) is a major public health issue and is a leading cause of death in North America. After a primary TBI, secondary brain insults can predispose patients to a worse outcome. One of the earliest secondary insults encountered during the perioperative period is hypotension, which has been directly linked to both mortality and poor disposition after TBI. Despite this, it has been shown that hypotension commonly occurs during surgery for TBI. We present a case of intraoperative hypotension during surgery for TBI, where the use of transthoracic echocardiography had significant diagnostic and therapeutic implications for the management of our patient. We then discuss the issue of cardiac dysfunction after brain injury and the implications that echocardiography may have in the management of this vulnerable patient population.

Elevated Factor VIII Is Common in the Acute Phase of Ischemic Stroke and Is Associated with African American Race and Poor Outcomes (S43.007)

Objective: We sought to characterize the relationship between factor VIII, patient characteristics, stroke severity, etiology, and early clinical outcomes in patients with acute ischemic stroke. Background Factor VIII drives the formation of fibrin rich clot. Elevation of factor VIII has been associated with higher risk of large vessel arterial occlusions. The relationship of factor VIII with etiology and outcomes in the acute phase of ischemic stroke is poorly understood. Design/Methods: We reviewed factor VIII levels in patients with acute ischemic stroke treated at our stroke center between July 2008 and April 2011. Factor VIII levels were considered elevated if exceeding the laboratory reference range: normal 0-150%. Baseline demographics, laboratory data, clinical course and outcome were compared in patients with normal or elevated levels. Spearman9s correlations were used to assess associations between factor VIII levels and collected variables. Results: Factor VIII level was elevated in 62% of the 73 patients. Significant correlations were found between factor VIII levels and African American race (0.37, p=0.001), hematocrit (-0.340, p=0.003), and platelet count (0.241, p=0.04), treatment with IV tPA (r=-0.24, p=0.041), length of stay (r=.307, p=0.009), discharge NIHSS (r=.338, p=0.004), discharge mRS (r=0.388, p=0.001), and poor discharge disposition (r=0.245, p=0.037). No relationship was found between factor VIII and baseline stroke severity or etiology. After adjusting for IV tPA use, new stroke on MRI, and race, factor VIII was a significant independent predictor of higher discharge NIHSS (p=0.016), higher mRS (p=0.025), and poor disposition (p=0.045). Conclusions: High factor VIII level, found in the majority of patients with acute ischemic stroke, was associated with poor early outcomes. Additional studies are required to determine if factor VIII is causal or a marker of poor outcome in patients with acute ischemic stroke and whether factor VIII contributes to the increased risk of stroke in African American patients. Disclosure: Dr. Chang has nothing to disclose. Dr. Albright has nothing to disclose. Dr. Kruse-Jarres has nothing to disclose. Dr. Leissinger has nothing to disclose. Dr. Martin-Schild has nothing to disclose.

Provider-initiated (Opt-out) HIV testing and counselling in a group of university students in Ile-Ife, Nigeria

ABSTRACTObjectives The Provider Initiated HIV (Opt-out) Testing and Counselling model has rarely been tested in Nigeria. This study assessed its feasibility and uptake among a sample of Nigerian university undergraduate students.Methods Two hundred and fifty-two Nigerian university students were offered rapid ‘opt-out’ HIV tests. The participants were also interviewed using a self-administered questionnaire. Data were analysed using descriptive statistics.Results Two hundred and fifty-one (99.6%) students accepted to be tested and only one (0.4%) refused testing. The commonest reason given for accepting rapid ‘opt-out’ testing was the desire to find out HIV status (93.2%). Only 24 (9.5%) students had previously ever been tested for HIV; among the 228 (90.5%) respondents who had not, the commonest reasons given for not testing were lack of knowledge of where to go to (25%), fear of testing positive (24%), and perception of being unlikely to have been exposed to HIV (18%).Conclusion HIV ‘opt-out’ testing holds the prospect for rapidly increasing the coverage of HIV testing and other preventive interventions among university students in Nigeria. However, waiting time before testing and the poor disposition of medical staff to add on the burden of HIV ‘opt-out’ tests remain potential barriers to its roll-out.