Predictors Of Likelihood Research Articles

Sensitivities of Porous Beds and Plates to Ignition by Firebrands

The increasing occurrence of severe wildfires, coupled with the expansion of the wildland urban interface has increased the number of structures in danger of being destroyed by wildfires. Ignition by firebrands is a significant avenue for fire spread and structure loss; thus, understanding processes and parameters that control the ignition of fuel beds by firebrands is important for reducing these losses. In this study the effect of fuel bed characteristics (i.e., particle size and porous or solid fuel bed) on ignition behavior was considered. Modelling and analysis was conducted to better understand parameters that are dominant in controlling ignition. The fuel beds, made from Douglas-fir shavings, Douglas-fir plates, or cardboard plates, were heated with a cartridge heater (i.e., surrogate firebrand) to observe ignition. Smaller particles were observed to ignite more readily in porous beds than larger particles when heat transfer from the heater is primarily through conduction. This occurs in large part due to differences in contact area between the fuel bed and the heater coupled with thermal properties of the fuel bed. As particle sizes increased, ignition was more likely to occur at extended times (>100 s) due to the increased importance of radiation heat transfer. Douglas-fir plates were primarily observed to ignite at times where conduction was the dominant mode of heat transfer (<10 s). Heat flux delivered to the fuel bed was observed to be a more accurate predictor of ignition likelihood and ignition time than heater temperatures. The characteristic ratio of transport and chemical timescales can be used, in conjunction with the measured heat flux and thermal diffusivity of the fuel beds, as a first approximation to predict ignition for the porous fuel beds. This suggests that future work focusing on these parameters may produce a general characterization of fuel bed ignition probability across fuel beds materials and morphologies.

Abstract 13609: Predictors of Treatment of Hospitalized Patients With Atrial Fibrillation in the US

Introduction: While a few studies have been conducted that evaluated anticoagulant (AC) treatment of patients with atrial fibrillation (AF) in the outpatient setting, little is known regarding inpatient AC treatment practices. Objective: To identify predictors of AC treatment among patients hospitalized with AF in the US Methods: Patients (≥18 years of age) who had a primary or secondary discharge diagnosis code of AF during a hospitalization (without a diagnosis of venous thromboembolism) were selected from the Premier Hospital database (1/1/2016-9/30/2017). Patients were grouped into 2 study cohorts: 1) Patients who received oral AC (OAC) therapy during hospitalization and 2) Patients who did not receive any AC therapy. Demographics, patient clinical characteristics, and hospital characteristics were examined. A multivariable logistic regression analysis was carried out to evaluate potential predictors of not receiving any AC therapy vs. receiving OACs. Results: Of the patients hospitalized with an AF diagnosis, 65.7% (n=205,438; mean age: 74.4 years; 47.1% female) received OAC therapy and 34.3% (n=107,076; mean age: 75.9 years; 46% female) did not receive any AC therapy. The most common OACs received were warfarin (39.4%) and apixaban (34.2%). Key predictors of a greater likelihood of not receiving any AC therapy vs. receiving OACs were greater comorbidity (Charlson Comorbidity Index [CCI] ≥5 vs. 0 odds ratio [OR]: 1.72; 3-4 vs. 0: 1.32; 1-2 vs. 0: 1.11, all p<0.001) and having had prior bleeding (OR: 1.59, p<0.001). Key predictors of receiving OACs, relative to not receiving any AC therapy, were having a AF diagnosis in the first vs. second position on insurance claims (OR: 0.24, p<0.001), chronic (OR: 0.76, p<0.001) or persistent (OR: 0.61, p<0.001) AF vs. paroxysmal, higher stroke risk (CHA 2 DS 2 -VASc=5 vs. 0 OR: 0.48; 3-4 vs. 0: 0.51; 1-2 vs. 0: 0.58, all p<0.001), and a prior stroke (OR: 0.87, p<0.001). Conclusions: A substantial portion of hospitalized AF patients in the study did not receive any AC therapy, particularly those patients with an AF diagnosis in the second position on insurance claims. The predictors of AC treatment that were identified may be helpful in the clinical decision-making process for patients who are hospitalized with AF.

Factors associated with delays in diagnosis of pediatric, adolescent and young adult patients with central nervous system tumors.

e13532 Background: Central Nervous System (CNS) tumors are the most common solid tumor in children and have the highest mortality. Delays in diagnosis (Dx) may lead to reduced survival. We identify factors associated with delays in Dx in pediatric, adolescent and young adult (AYA) patients with CNS tumors. Methods: A retrospective cohort from the OptumLabs Data Warehouse, which includes claims data for privately insured enrollees in a large US health plan, was identified. Patients diagnosed with CNS tumors between 2001-17 continuously enrolled 6 months prior to diagnosis (Dx) were included. The onset of cancer symptoms was identified by the date of the first encounter associated with cancer symptoms. Time to Dx was calculated as the days between cancer symptom onset and Dx date. The likelihood of presenting with symptoms and the time to Dx (among those with symptoms) was modeled using logistic regression and included sociodemographic and clinical factors. A delay in Dx was defined as > 3 months after a symptom. Results: We identified 6,627 eligible patients, 5,637 (85%) of whom presented with symptoms prior to Dx. Likelihood of a delay appears greatest in those first presenting to a specialist (OR 1.28 vs PCP; P = .24 ) but lowest in those presenting to Urgent care/ER (OR .56 vs PCP; P < 0.001) and was greatest among children < 5 years of age were more likely to present with a symptom (table). However, among those with a symptom, children < 5 had the longest time to Dx (Median 122 days). Males were less likely to present with a symptom prior to Dx (OR .80, P = 0.040) and when experiencing a symptom they experienced shorter time to Dx compared to females (Median 85 vs 110 days). Race, income, and census region were not significant predictors of either likelihood of presenting with symptoms or delay in time to Dx. Conclusions: This study indicates that young children < 5 years had a longer delay in diagnosis compared to older patients. [Table: see text]

Predictors of the Self-Reported Likelihood of Seeking Social Worker Help among People with Physical Disabilities

ABSTRACTThe current study assesses the association between demographic factors, attitudes toward social workers, the stigma attached to seeking social worker help, perceived social support, and psychological distress—and the self-reported likelihood of seeking social worker help, among people with physical disabilities in Israel. Data collection utilized structured questionnaires, administered to a sample of 435 people with physical disabilities. The findings suggest that women, older respondents, people with more positive attitudes toward social workers, with higher levels of psychological distress and of social support, and with a lower level of stigma, reported a greater likelihood of seeking social workers help. The study’s conclusion is that there are certain avoidance factors among people with physical disabilities that might discourage them from seeking social workers’ help. Therefore, it is important that social workers identify these factors and develop interventions aimed at encouraging people with physical disabilities to seek social workers help in case of need, and also develop practices adjusted to the unique needs of people with physical disabilities.

Adolescent Callous-Unemotional Traits and Parental Knowledge as Predictors of Unprotected Sex Among Youth

Risky sexual behavior among adolescents is common and results in many negative consequences. The present study investigated longitudinal predictors of adolescents' likelihood of engaging in unprotected sexual intercourse. Parental knowledge, or the extent to which parents know about their children's activities, whereabouts, and friendships, is a robust predictor of youth risk behavior, including risky sexual behavior. However, parenting practices are typically less potent as predictors of subsequent behavior among youth with high levels of callous-unemotional (CU) traits. We conducted three logistic regression models, each of which examined parental knowledge in a different way (through child report, parent report, and a discrepancy score), allowing us to examine parental knowledge, CU traits, and their interaction as predictors of adolescents' subsequent engagement in sex without a condom. Results indicated that adolescents who perceived their parents to possess greater knowledge were less likely to engage in unprotected sex. Higher parent report of parental knowledge was also related to decreased likelihood of engaging in unprotected sex, but only for adolescents with high levels of CU traits. In addition, greater discrepancy between parent and adolescent reports of parental knowledge was related to increased likelihood of engaging in unprotected sex, but only for adolescents with low levels of CU traits. Results highlight the importance of considering both parent and adolescent perceptions of parental knowledge and have important implications for prevention and intervention efforts.

Do transfusion requirements increase after the diagnosis of vasospasm in patients with aneurysmal subarachnoid haemorrhage?

Abstract Background: Many patients experience impaired cerebral oxygen delivery secondary to vasospasm and delayed cerebral ischemia following aneurysmal subarachnoid haemorrhage (SAH). Anaemia is common after SAH affecting up to 50% patients, which may decrease cerebral oxygen delivery and is associated with worse clinical outcomes. Transfusion of allogeneic red cells increases the oxygen content of the blood but it not consistently associated with improved physiologic markers of clinical outcomes. The threshold for transfusion is not clear in patients with SAH. A recent survey found that most physicians would alter their transfusion threshold in SAH patients who develop delayed ischemia. The objective of our study is to identify the predictors of transfusion and to determine if the diagnosis of delayed ischemia increases the transfusion rates in patients with aneurysmal subarachnoid haemorrhage. Materials and Methods: We retrospectively reviewed the charts of 100 consecutive patients with SAH who were admitted to ICU for mechanical ventilation, and collected demographic and clinical data. Data were analyzed for the association between clinical factors and transfusion the differences in transfusion between the patients with and without vasospasm. Statistical methods included the t-test, univariate analysis and multivariate analysis. Results: Data from 96 patients were included in the analysis. Incidence of anaemia haemoglobin (Hb) < 100 gm/l and vasospasm were 67% (64/96) and 39% (38/96) respectively. Of 64 patients with anaemia, 27 patients received transfusion, while 38 patients did not receive a transfusion. The transfusion rates were similar between those who had vasospasm and who did not. However, out of the 14 patients with vasospasm who received a transfusion, 11 patients had been transfused after experiencing vasospasm, while only 3 were transfused before. On multivariate analysis only female sex, starting Hb levels and lowest Hb levels were found to be predictors of transfusion. Presence or absence of vasospasm was not found to be a predictor. Conclusions: From our retrospective review, we conclude that the incidence of anaemia is higher in patients with vasospasm. Sex and starting and lowest Hb levels were the only predictors of transfusion likelihood in aneurysmal subarachnoid haemorrhage while presence of vasospasm was not.

Synovial White Cell Count in the Diagnosis of Septic Arthritis: Are Current Diagnostic Practices Appropriate?

Introduction & aims: Septic arthritis is an emergency, potentially causing irreversible joint destruction and disability. Synovial WCC and polymorphonuclear cell percentage are the best predictors of septic arthritis likelihood. Yet, synovial white cell and differential count are not routinely assessed. We aim to investigate the incidence of failure to perform these tests, and to develop correct synovial fluid analysis practices. Method: This is a retrospective analysis of native joints having undergone arthrocentesis for suspicion of septic arthritis at Box Hill Hospital (BHH) during September 2011 and September 2013 inclusive. Recruitment was from the Eastern Health Decision Support Service (DSS), a database compiled from all systems within Eastern Health, of which BHH is a member. The study was limited to large joints, including hip, knee and shoulder. All prosthetic joints were excluded from the patient population. All patient histories were examined for suspicion of septic arthritis and subsequent arthrocentesis. Pathology records were accessed to determine incidence of cell count and differential. Results: One hundred and thirty-six cases of joint aspirations were identified within the time frame, of which sixty-seven fitted our criteria for evaluation. All but two cases were delivered using the DSS, which was limited to data compiled only until June 2013. The two remaining cases were identified with a manual search of the radiology and pathology databases from June to September 2013. 22 of the 67 joint aspirates studied did not have a cell count carried out. Four of these 22 cases had a diagnosis of septic arthritis. In five aspirates, there was a failure to confirm a definite diagnosis and they were thus conservatively treated as a septic joint. The remaining acute joints in which no cell count was done were gout (7 cases), pseudogout (5 cases) and rheumatoid arthritis (1 case). Cell counts were not routinely detected for a variety of reasons. Eleven aspirates were deemed too viscous, and in eight cases the sample had clotted prior to pathologist assessment. Two cases had insufficient volume, and one sample was too bloodstained to calculate a cell count and differential; likely due to traumatic aspiration. Conclusions: 33% of acute monoarthritis’ evaluated over the study period failed to have a synovial fluid WCC and differential. This may be due to inadequate samples, or lack of appropriate collection tube. Better education is required for appropriate collection and test requesting wherein a diagnosis of septic arthritis is in question.

Optimal Management of HCV Genotype 4

The optimal treatment for HCV genotype 4 (HCV-G4)-infected patients is still evolving. Pegylated interferon (PEG)-ribavirin (RBV) therapy was the standard of care but provides moderate response rates and adverse events. Sofosbuvir (SOF) and simeprevir (SIM) allow for shorter duration and higher cure rates when added to PEG-RBV. The recommended treatment depends on interferon eligibility and previous treatment status. Currently, the optimal therapy for HCV-G4 interferon-eligible is a 12-week course of SOF plus PEG-RBV or SIM plus PEG-RBV. The combination of PEG-RBV may still be appropriate where no other treatment option is available, especially for treatment-naive patients with baseline predictors of a high likelihood of response. For interferon-ineligible patients, the optimal regimen is a 24-week course of SOF plus RBV or a 12-week course of SOF-SIM combination with or without RBV. These recommendations will be very short-lived. The combination of ABT-450/r plus ombitasvir and the SOF-ledipasvir combination for 12 weeks may become an optimal therapy when approved. Next generation therapies that allow high cure rates with shorter duration of treatment with will shortly become available.

Early predictors of remission in newly diagnosed epilepsy: a systematic approach to reviewing prognostic factor studies

Background: It is necessary to select a range of consistently identified prognostic factors from exploratory studies to include in multivariate models of confirmatory studies. We illustrate a systematic approach to selecting consistently identified prognostic factors using the example of predictors of remission in newly diagnosed epilepsy.Methods: Medline and Embase were searched for reports of cohort studies enrolling at least 100 people with epilepsy within 1 year of diagnosis, and followed up for at least 1 year. We included studies that identified predictors of remission after adjusting for confounders using multivariate regression analysis. To identify consistent predictors a chart was designed to list the variables considered for inclusion in each model and those retained in more than one model from different cohorts were deemed to be consistent.Results: Remission off medication was less likely if there was more than one seizure between 6 and 12 months on medication and if there was comorbid intellectual disability in childhood onset epilepsy. The likelihood of remission on or off medication reduces with mixed seizure types at onset, intellectual disability, symptomatic aetiology, and also with increasing number of seizures before diagnosis or in the first 6 months after diagnosis.Conclusion: A greater number of seizures before diagnosis and early in treatment, intellectual disability, and symptomatic aetiology are consistent predictors of less likelihood of remission. This suggests that early identification, diagnosis of epilepsy, and seizure control should be the primary aim of medical intervention, and that these predictors should be included in future confirmatory studies of prognostic factors of remission in newly diagnosed epilepsy.

Use of stem cell transplantation (SCT) as initial therapy in multiple myeloma (MM) and impact of sociodemographic factors in the era of novel agents: Analysis of 137,409 patients using the National Cancer Data Base (NCDB).

8580 Background: Novel agents for MM became available in the past decade. Our study aim was to determine whether the rate of SCT utilization as part of initial therapy in patients with MM had changed in the US after the introduction of novel agents. We also determined the impact of various sociodemographic factors. Methods: De-identified patient level data were obtained from the NCDB bParticipant User File. NCDB is a nationwide oncology outcomes database, which comprises approximately 70% of all newly diagnosed cancer cases in the United States. Results: A total of 137,409 MM patients were included in the study. The median age was 68 years (range, 18-90+). The population was predominantly male (54%), white (79%), non-Hispanic (87%), and living in a metro (78%), low- or middle-income (annual income < $46,000; 63%), and low- or moderate-education (> 14% without high school diploma; 66%) areas. Most patients had minimal or no co-morbidities (Charlson-Deyo score of 0-1; 93%) and treated in the community setting (62%). The rate of SCT use as initial therapy consistently increased annually from 5% in 1998 to 12% in 2010. This was true for all socio-demographic subgroups except for those who were age > 75 years, treated in the Northeast, and the medically uninsured. Multivariate logistic regression showed that the following characteristics were significant main predictors of lower likelihood of SCT use (odds ratio): age > 65 years (0.18), non-white race (0.57), Hispanic ethnicity (0.68), lack of high education (0.89), annual income < $30,000 (0.76), diagnosed before the era of novel agents (1998-2003) (0.70), covered by a non-managed care insurance (0.57), treatment in a non-academic facility (0.28), residence at a non-metro area (0.88), and treatment facility located outside of the Midwest or West (0.62). In contrast, sex was not significant. Conclusions: Even after the introduction of novel agents, the rate of SCT as initial therapy in MM continues to increase annually in the US. Significant disparity exists in the rate of SCT use by demographic, social, and geographic factors as well as the type of treatment facility.

Data-Driven Interdisciplinary Interventions to Improve Inpatient Pain Management

Pain during hospitalization and dissatisfaction with pain management are common. This project consisted of 4 phases: identifying a pain numeric rating scale (NRS) metric associated with patient satisfaction, identifying independent predictors of maximum NRS, implementing interventions, and evaluating trends in NRS and satisfaction. Maximum NRS was inversely associated with favorable pain satisfaction for both efficacy (n = 4062, χ(2) = 66.2, P < .001) and staff efforts (n = 4067, χ(2) = 30.3, P < .001). Independent predictors of moderate-to-severe maximum NRS were younger age, female sex, longer hospital stay, admitting department, psychoactive medications, and 10 diagnostic codes. After interventions, moderate-to-severe maximum NRS declined by 3.6% per quarter in 2010 compared with 2009. Satisfaction data demonstrated improvements in nursing units meeting goals (5.3% per quarter, r (2) = 0.67) and favorable satisfaction answers (0.36% per quarter, r (2) = 0.31). Moderate-to-severe maximum NRS was an independent predictor of lower likelihood of hospital discharge (likelihood ratio = 0.62; 95% confidence interval = 0.61-0.64). Targeted interventions were associated with improved inpatient pain management.

Latino Political Connectedness and Electoral Participation

This study examines the political attitudinal profile of Latinos in the contemporary United States and the implications of Latinos' political connectedness for their electoral participation. Relying on data from The Washington Post/Henry J. Kaiser Foundation/Harvard University National Survey on Latinos in America (1999), it considers Latinos' levels of efficacy, trust in government, civic duty, attention to politics, and strength of partisanship and whether these differ from those of Anglos. The study also assesses what factors structure these political attitudes and the impact of these attitudes on voter registration and turnout among the registered. Controlling for social location and circumstances, Latinos are distinctive in their political attitudinal profile. Hispanic Americans are more trusting of the federal government and more externally efficacious than are Anglos but also are associated with lower levels of internal efficacy and civic duty and pay less attention to politics. Attachment to a political party is a powerful predictor of Latinos' likelihood of registering and turning out to vote. On balance, Hispanic Americans do not suffer from a marked political resource deficit as a consequence of their attitudinal profile.

Predictors of Likelihood and Intensity of Past-Year Mental Health Service Use in an Active Canadian Military Sample

Predictors of Likelihood and Intensity of Past-Year Mental Health Service Use in an Active Canadian Military Sample

Predictors of Likelihood and Intensity of Past-Year Mental Health Service Use in an Active Canadian Military Sample

This study examined associations between sociodemographic, military, and psychiatric need variables and past-year mental health service use among active Canadian military members. The likelihood and intensity of services were examined across two provider types--mental health providers and medical providers. Data were drawn from the first epidemiological survey of mental health in the Canadian Forces, conducted by Statistics Canada in 2002. Survey instruments included the Composite International Diagnostic Interview, which was used to assess mental health and service use. Of the 8,441 military members who participated in the survey, 14.5% (N=1,220) met criteria for having a mental disorder in the past year. However, of the 8,441 only 9.1% (N=767) contacted a mental health provider in the past year for mental health problems; even fewer (N=539, 6.4%) contacted a medical provider. Across the two provider types, the majority of those seeing a provider reported five or fewer mental health visits in the past year. In univariate and multivariate analyses across the two provider types, psychiatric need variables were consistently associated with both greater service use likelihood and intensity. In multivariate analyses, lower military rank was consistently associated with both greater service use likelihood and intensity. Of the entire military sample, only a small percentage used mental health services. The observed associations between military and psychiatric need variables and mental health service use in this study should be used by military health care providers and administrators to increase mental health service use among those most at risk of not using services.

Abstract 3176: Differerential Impact Of Acute Myocardial Risk Factors And Chronic Comorbidities On Use Of Guideline-recommended Therapies In Patients Presenting With Acute Coronary Syndromes

Background: Prior investigations show that patients presenting with ACS with high-risk features are less likely to receive evidence-based therapies (EBT). Current risk stratification tools combine acute and chronic risk factors (RF); these may contribute differently to receipt of proven therapies. Methods: Using data from a prospective audit of 2600 patients in Australia, the impact of acute myocardial RF (biomarker elevation, ECG changes, cardiac arrest, Killip class ≥ 2), chronic co-morbid RF (prior CHF, chronic lung disease, malignancy, prior CVA, GFR &lt; 60, age &gt; 75), and traditional RF on patient management were examined using logistic regression. Results: the best predictor of receipt of EBT was the number of myocardial RF; the best predictor of a low likelihood of receipt was the number of co-morbid RF (Table ). The presence of three or more myocardial RF conferred an OR of 2.21 for receiving clopidogrel and 4.3 for undergoing angiography, while the presence of four or more co-morbid RF lowered the OR to 0.47 for clopidogrel and 0.09 for angiography (Figure 1a /b ). Conclusions: High-risk patients may be less likely to receive EBT than low-risk patients, but this is driven by comorbid conditions rather than markers of severity of illness. Research is needed to validate these therapies in high-risk patients, and ongoing efforts at quality improvement should focus on high-risk populations. Figure 1a. Odds of receiving clopidogrel during hospitalization Figure 1b. Odds of receiving angiography during hospitalization Application of management recommendations within 24 hours of admission and at discharge, adjusted for cardiovascular risk factors and prior coronary artery bypass grafting.

Experiential values over time – a comparison of measures of satisfaction and emotion

This paper reports on a longitudinal, quantitative study of the effects of satisfaction and emotions on future behavioural intention. A review of the literature identifies growing evidence of the effects of an individual's emotional state on consumption decisions. There is evidence that measures of satisfaction are poor predictors of repeat buying behaviour, and this may be due to their failure to adequately incorporate an affective element. In this study, 352 graduates who attended a graduation ceremony were tracked over a period of six months and their level of satisfaction, and the emotions evoked by the experience of attending their ceremony were recorded. Satisfaction was observed to be a poor predictor of an individual's likelihood of recommending attendance at a future graduation ceremony to a friend. Furthermore, satisfaction had a declining effect over time. However, the level of positive emotions evoked after six months continued to be strongly associated with behavioural intention. This paper informs methodologies for measuring customer satisfaction, which have traditionally been undertaken immediately after a service encounter, but evidence is presented that a survey undertaken closer to the next point of consumption decisions/recommendation may be a more valid and managerially useful measure.

Predictors of Australian consumers’ intentions to consume conventional and novel sources of long-chain omega-3 fatty acids

To elicit predictors of variation in likelihood to purchase foods rich in long-chain omega-3 fatty acids. Responses from a community sample (n = 220) were elicited using a computer-administered questionnaire based on an adaptation of Protection Motivation Theory including measures of perceived risk and vulnerability to coronary heart disease (CHD). Other measures included health status, body mass index (BMI), perceived risk/benefits of novel technologies and sociodemographics. Descriptions of model products were presented, including farmed fish fed fishmeal (FFFF); farmed fish fed genetically modified (GM) oilseed (FFFGM); bread, milk and supplements containing fish oil (SFO) or GM oilseed. It was hypothesised that perceived vulnerability to CHD would enhance acceptance of GM products (H1). Furthermore, information describing the benefits of LCO3FA, limitations to fish supply and potential alternatives was given to a treatment group (50%) and hypothesised to have a positive effect on the acceptance of GM products (H2). No evidence was found to support H1 or H2. FFFF was most likely to be purchased (P < 0.01), followed by SFO and FFFGM. Multivariate regression analysis identified significant (P < 0.05) predictors (standardised beta) for likelihood to purchase FFFF: self-efficacy 0.56; behaviour (product) efficacy 0.19; belief that fishmeal is unnatural -0.14 (R2 = 0.44) and for FFFGM: self-efficacy 0.65; perceived severity of CHD 0.15; BMI -0.13; significant other has/had arthritis 0.11; belief that GM oilseed is unnatural 0.11 (R2 = 0.49). Self-efficacy (confidence to consume) was the most important predictor of likelihood to purchase all products.

Abstract 3629: Socioeconomic and Ethnic Disparities in the Use of Biventricular Pacemakers in Heart Failure Patients with Left Ventricular Systolic Dysfunction

Background : Biventricular pacing (BiV) is an important therapeutic advance for symptomatic heart failure (HF) patients (pts) with reduced left ventricular ejection fraction (EF), but whether socioeconomic and ethnic disparities exist in the use of BiV in HF pts is unknown. Methods : Data were collected on all hospitalized HF pts with an EF ≤ 35% from Pennsylvania hospitals that implanted BiVs from Jan. 2004 to Dec. 2005. These hospitals submitted clinical data from chart abstraction and administrative data to the Pennsylvania Health Care Cost Containment Council. Multiple logistic regression analyses used patient clinical data, insurance and hospital characteristics to identify independent predictors of BiV implantation in symptomatic HF pts with EF≤ 35%. Results : Of the 20,269 HF pts with EF≤ 35%, BiV was implanted in 2,065/15,861 (13%) whites, 182/3107 (5.9%) African-Americans and 175/1301 (13.5%) others. Analysis of 12 clinical variables identified associations of older age, male gender and prior myocardial infarction or bypass surgery with a higher likelihood of BiV implantation (all p&lt;.0001). Pts with diabetes or higher Mediqual Atlas severity score were less likely to have BiV implantation (both p&lt;.01). Pts with lower EF or with intraventricular conduction delay were more likely to have BiV implantation (both p&lt;.0001). After adjusting for these variables, African-American ethnicity (odds ratio (OR) 0.50, [95% confidence interval (CI) 0.42– 0.60], p&lt;.0001) and poverty level (defined as the percentage of residents in a zip code whose household income was below the federal poverty threshold) comparing the poorest quintile to the other quintiles (OR 0.79, [95% CI 0.70 – 0.89], p&lt;.0001), were independently associated with lower likelihood of BiV implantation. Additional independent predictors of a higher likelihood of BiV implantation included commercial and Medicare vs. Medicaid, self-pay or other insurance type, and for-profit hospital status (both p&lt;.05). Conclusion : In a large statewide sample, BiV was implanted less frequently in African-Americans and in lower income pts, independent of clinical, hospital and insurance characteristics, identifying persisting disparities in use of advanced cardiac technology.

Gender as a Predictor of Hearing Preservation Outcome in Acoustic Neuroma Surgery

Introduction: The correlation between gender and likelihood of preservation of serviceable postoperative hearing in acoustic neuroma surgery has seldom been reported. The limited available data suggest that, when preoperative tumor size and hearing are comparable, males have a greater likelihood of preservation of some postoperative hearing (p < 0.05 at best). Methods: A consecutive series of 184 retrosigmoid procedures for removal of unilateral acoustic neuromas (AN), in the period ending June 30, 2005, were subjected retrospectively to linear regression analysis for factors predictive of successful postoperative preservation of Gardner and Robertson Class 1 and 2 hearing (HP). These cases were selected on the basis of size (mean extracanalicular diameter < 20 mm) and preoperative hearing, and form part of a larger series of 810 consecutive cases of unilateral AN. Variables examined included age, gender, side and size of tumor, preoperative hearing, and intraoperative cochlear nerve compound action potential (CAP) threshold shift. Results: Overall HP rate was 34.4% (53.8% for intracanalicular AN). Size (p < 0.001), intraoperative CAP threshold shift (p < 0.0001), and female gender (p = 0.01) were predictors of HP. Male-female ratio for the series was 47/53. Age (p = 0.37) and tumor size (p = 0.20) did not differ between males and females. Postoperative HP occurred in 25.4% of males and 44.2 % of females, respectively (p = 0.01). Conclusions: Though female gender has not previously been identified as a predictor of greater likelihood of preservation of serviceable postoperative hearing in AN surgery, the present study strongly suggests that this is the case. Gender difference should probably be taken into account in preoperative discussion of outcome, at least in our hands, and may have other implications as well.

Level and predictors of agreement between patients and their dentists concerning need for replacement of teeth at the time of extraction

The aims were to determine the level of agreement between patient and dentist about the need for a replacement of teeth at the time of extraction, and to identify and assess the effect of predictor variables on the level of agreement. Data were obtained from questionnaires. A systematic random sample of 1,500 Norwegian general dental practitioners were contacted, 67% of them responded and 75% of their patients. The final sample consisted of 427 patients (16-92 years old) and 224 dentists. Overall agreement was 62% of the cases and agreement about replacement 26%. Multiple logistic regression analysis with overall agreement as dependent variable identified tooth type (OR = 2.7 for anterior teeth versus molars, 95% CI: 1.3; 5.6 and OR = 1.9 for molars versus premolars, 95% CI: 1.2; 3.2), service sector, dentist's age and patient gender as significant predictors. Tooth type (OR = 36.0 for anterior teeth versus molars, 95% CI: 12.5; 104.0 and OR = 5.8 for premolars versus molars, 95% CI: 2.7; 12.3), service sector (OR = 7.0, 95% CI: 2.3; 21.1), the number of teeth extracted and the number of remaining natural teeth affected the likelihood of agreement about the need for replacement of extracted teeth. Predictors of no need for replacement were tooth type (OR = 6.7 for molars versus premolars, 95% CI: 3.3; 13.7) and the dentist's age (OR = 2.1, 95% CI: 1.2; 3.6). Clinical factors were the most important predictors of patients' and dentists' likelihood to agree about replacement, but service sector, dentist's age and patient's gender had also a significant impact on the level of agreement.