Previous Visit Research Articles

Dental Experience, Anxiety and Oral health in Low Income Chennai Children

Background: Dental problems are more common in children nowadays due to the change in food habits. Various treatment modalities are available including fillings, root canal treatment, and crown. The ambience in the dental clinic and the noise created by the compressor, suction apparatus make the child apprehensive, low-income children have more exposure to noises and their fear threshold are more compared with high-income children. This study was to evaluate the prevalence of dental anxiety and the factors influencing dental anxiety and poor oral health among low-income children in Chennai.
 Materials and Methods: One hundred and fifty children were examined who reported to Pedodontic Department in Saveetha Dental College, Chennai. The oral health status of male and female patients was assessed based on the decayed, filled teeth index, simplified oral hygiene index (OHI), and Streptococcus mutans score. The assessment excluded the patient who had facial deformities, and mentally retardant, suffering from congenital diseases. Dental anxiety was assessed using the facial image scale and Frankl scale. Early dental experience was classified as: no previous dental visits; preventive control; restorative treatment; and emergency visit.
 Results: Dental caries is the key factor for the child to visit the dental clinic. The dental setup and its factors are one of the triggering agents to child’s anxiety and previous dental experiences. Patients with systemic problems have a high rate of dental caries.
 Conclusion: In low-income children, prior dental experiences of six-year-old children were directly related to their dental caries experience. Children who had preventive visits and those who had never seen a dentist before had low rates of dental caries. Patients have a low percentage of dental visits for their preventive treatment due to the unawareness of their parents. Simplified OHI and dental anxiety levels showed no statistically significant differences among the types of previous dental experiences

Assessment of Oral Mucosal Lesions (OML), Periodontal Health Conditions, and Unmet Dental Treatment Needs in the Rural Adult Population of Jharkhand, North India.

Background Dental diseases like caries, periodontal diseases, and oral mucosal lesions (OML) are common findings in rural adult populations that greatly impact their quality of life. Aim To assess OML, periodontal health conditions, and unmet dental treatment needs in the rural adult population in Jharkhand. Methodology A total of 700 permanent residents of Bero Block, Jharkhand, North India, in the age group of 35-44 years, participated in this cross-sectional study. Both men and women were equally represented. Their socio-demographic characteristics and previous dental visits were collected using standardized proforma. An assessment of periodontal health conditions, OML, and unmet dental treatment needs was done using the World Health Organization (WHO) Oral Health Assessment Proforma of 1997. Results It was found that over half (54.3%) of the studypopulation had the adverse habit of smoking and chewingpaan. Males were more likely to experience leukoplakia (18.87%), whereas females were more likely to experience abscesses (9.43%). The majority of males and females had a community periodontal index (CPI) score and loss of attachment (LOA) score greater than two, which indicated poor periodontal health as assessed by the periodontal index. Both males and females needed extraction of the diseased teethas their primary treatment. Conclusion The rural adult population residing in the Bero block of Jharkhand showed poor periodontal health and high unmet dental treatment needs. These people need effective oral health promotion policies and dental health education to improve their oral health.

Emergency Department Usage Patterns Among Pediatric Victims of Gun Violence and Physical Assault.

Violent injuries are a common reason for pediatric emergency department (ED) visits, with gun violence being the leading cause of violent death among children. The objective of this study was to assess for patterns of pediatric ED usage that are associated with future ED visits for violent injuries. This case-control study included youths aged 6 to 19 years who presented to a pediatric ED over a 3-year period due to a physical assault (PA) or their first known gunshot wound (GSW). We compared them with age-, race-, and sex-matched youths presenting for nonviolent medical complaints. All previous ED visits were coded as (1) injuries due to a previous PA, (2) mental/behavioral health visits, (3) sexual/reproductive health visits, (4) sexual assault, or (5) concerns for child abuse. We used multivariate logistic regression to identify patterns of previous ED usage associated with future ED visits for injuries related to PA and/or GSW. The PA and GSW groups used the ED for previous PAs, mental/behavioral health, sexual/reproductive health, sexual assault, and/or child abuse concerns on average 4 to 8 times as often as the control group. Previous ED visits for mental/behavioral health (odds ratio [OR] 5), sexual/reproductive health (OR 3), sexual assault (OR 9), and prior PA (OR 8) were predictive of a future ED visit for PA. Male sex (OR 6) and previous ED visits for PA (OR 5) were predictive of a future ED visit for GSW. Two percent of the PA group and 9% of the GSW group returned to the ED with a subsequent GSW in the following 16 to 40 months. Emergency department visits due to interpersonal violence, mental/behavioral health, sexual/reproductive health, and sexual assault are associated with recurrent ED visits for violent injuries. Awareness of patterns of ED usage may aid in identifying patients at high risk for violence and increase opportunities for preventative interventions.

Poor objective sleep quality is associated with worse cognition cross‐sectionally and longitudinally in cognitively unimpaired adults

AbstractBackgroundSleep disturbances are prevalent in Alzheimer’s disease (AD), with sleep quality being impaired already in the preclinical stages. Specifically, reduced sleep efficiency and sleep fragmentation have been cross‐sectionally associated with poor cognition in healthy older adults. However, there is limited knowledge of how objectively measured sleep features relate to cognitive change. We aimed to investigate the relationships of actigraphy‐measured sleep with both cross‐sectional and longitudinal cognition in a cohort of cognitively unimpaired (CU) adults at increased risk of AD.MethodThis study included 123 CU adults from the ALFASleep project (mean age 63.9 years, 60.2% females, 50.4% APOE‐ε4 carriers) without sleep medication use (Table 1). Correlates of sleep quality were measured using actigraphy (Actiwatch2®, Philips Respironics) for two weeks. We used separate multivariate linear regressions to assess the association between actigraphy‐derived sleep parameters: total sleep time (TST), sleep efficiency, sleep latency, wake after sleep onset (WASO), and cognitive composite outcomes: Preclinical Alzheimer’s Cognitive Composite (PACC), and executive, memory and attention composites. We corrected all models for age, sex, APOE‐ε4, status, education and the time difference between cognitive and sleep assessments. Furthermore, we performed analyses on cognitive change from a previous visit (performed on average 3 years before) additionally adjusting by the time difference between two cognitive assessments.ResultsIn cross‐sectional analyses, shorter TST was associated with lower PACC (p = 0.049) and executive composite (p = 0.039) scores. Also, lower sleep efficiency and higher WASO (indicating more nocturnal awakenings) were associated with lower performance on executive tasks (p = 0.015; p = 0.026) (Table 2). In longitudinal analyses, shorter TST was associated with poorer longitudinal performance in PACC and executive composite scores (p = 0.020).ConclusionsObjectively measured indicators of poorer sleep quality are associated with poorer cognitive outcomes, both cross‐sectionally and longitudinally, in middle‐aged CU adults. Importantly, the executive function seems to be the most vulnerable to sleep impairment. Further research to unravel the underlying mechanisms using multi‐modal neuroimaging and CSF biomarkers of AD pathology is undergoing.

Alternative Endpoints and Models for AD Prevention Trials

AbstractBackgroundThere are several challenges for AD prevention trials. First, the subtle cognitive change in asymptomatic disease stages requires large sample sizes, e.g. 400‐500/arm for two phase 3 confirmatory trials, or 800‐900/arm for a single phase 3 confirmatory trial, using the traditional MMRM. Second, large, international trials may necessitate the use of different tracers for imaging biomarker assessment due to global availability issues, however, statistical models that harmonize tracer differences within clinical trials are still lacking. Third, primary prevention trials using time to event endpoint demands even larger sample sizes, e.g., 1650/arm for TRAILBLAZER‐ALZ 3 with time‐to‐first‐conversion from CDR global 0 to >0 as the outcome. The percentage slowing relative to placebo decline (e.g., lecanemab led to 27% slowing at 18 months) is a popular concept to describe treatment effect. Instead of estimating the absolute difference using MMRM, we proposed to model this percentage treatment effect directly using the percentage or proportional MMRM (pMMRM). pMMRM can harmonize assessments from different tracers by converting the absolute difference into a shared proportional treatment effect across tracers. When using time‐to‐conversion as the primary outcome, instead of using a single event, Cox proportional hazards models for recurrent events can capture the treatment effect after the first event, where a recurrent event is defined as any increment over the previous visit in CDR global.MethodWe first demonstrated that disease modifying treatment effects are essentially proportional retreatment effects. Then, we evaluated the power advantage of pMMRM over MMRM and Cox recurrent events model over single event model through simulations. Finally, we demonstrated how to harmonize data from different tracers using pMMRM.ResultFigure 1 demonstrates that disease modifying treatment effects are like proportional treatment effects, leading to diverged disease progression trajectories and increased absolute differences. Figure 2 shows the power comparison between MMRM and pMMRM. pMMRM led to a power increase up to 30% over MMRM.ConclusionAlternative models such as pMMRM or Cox recurrent event models can yield greater power and pMMRM can harmonize assessment from different tracers, which may help enable global prevention trials in AD with disease modifying drug effects.

Gestational Hypertension and Midlife Cognition: The CARDIA Study

AbstractBackgroundGestational hypertension (GH) increases the risk of cardiovascular diseases, which may contribute to worse cognitive outcomes, and yet little is known about the long‐term impact of GH on cognition. We investigated the association of GH with midlife cognitive performance and decline in the Coronary Artery Risk Development in Young Adults (CARDIA) Study.MethodsWe studied 1,273 parous Black and White women (106 with GH and 1167 without GH) aged 18‐30 years at baseline (1985‐86) who were followed up to Year 30 (mean age 55.2±3.6 years) when five cognitive tests measuring global cognition, memory, processing speed, executive function, and verbal fluency were administered. Accelerated decline over five years was defined as a decline ≥1.5 standard deviations from the mean change on each of the three tests available at year 25, measuring processing speed, memory, and executive function. GH, defined as having new onset hypertension in pregnancy without proteinuria, was self‐reported for each pregnancy since the previous visit up to 30 years. We conducted linear and logistic regression to assess the association of GH with cognitive performance and decline.ResultsCompared with women who did not develop GH during pregnancy, those with GH were more likely to be Black (62% vs 50%) and have obesity (22% vs 11%), and lower diet quality (CARDIA A Priori Diet Quality Scores) at baseline. After adjusting for age, race, education, number of pregnancies, and baseline cardiovascular and behavior risk factors (diabetes, obesity, smoking, alcohol use, physical activity, and diet quality), having GH was significantly associated with lower cognitive performance (z‐standardized) at year 30 in global cognition (‐0.27, 95% CI ‐0.44 to ‐0.11), processing speed (‐0.25, 95% CI ‐0.44 to ‐0.07), and verbal fluency (‐0.20, 95% CI ‐0.38 to ‐0.02). Additional adjustment for hypertension, diabetes, and obesity up to Year 30 did not change the results. GH was also associated with higher odds of experiencing an accelerated decline in processing speed over 5 years (9.2% vs. 4.5%, odds ratio 2.48, 95% CI 1.07 to 5.74), after adjustment for all covariates.ConclusionGH is independently associated with worse cognitive performance and accelerated decline in midlife.

Association of Sociodemographic Characteristics with Pediatric Vision Screening and Eye Care: An Analysis of the 2021 National Survey of Children's Health

ObjectiveVision screening and regular eye care can help to detect and treat potentially irreversible vision impairment. This study aims to investigate the associations between sociodemographic and health characteristics and the receipt of eye care among children aged 17 and under in the United States. DesignThis cross-sectional study used data from the National Survey of Children's Health, a nationally representative and population-based survey of randomly sampled households. ParticipantsParticipants were children aged 0 to 17 years old, residing in all 50 states and the District of Columbia, whose caregivers or parents answered an address-based survey by mail or online. MethodsWeighted prevalence calculations were applied to analyze the data, and logistic regression was performed to explore associations between reported eye care and demographic, health, and parent-related variables. Main outcomes and measuresCaregiver-reported vision screenings, referral to an eye doctor after vision screening, eye doctor visits, and prescription of corrective lenses. ResultsCaregivers reported that 53.2% of children had a vision screening at least once (if child ≤ 5 years) or within the past 2 years (if child > 5 years). Of those screened, 26.9% were referred to an eye doctor. Overall, 38.6% of all children had a previous eye doctor visit, and among them, 55.4% were prescribed corrective lenses during the visit. Factors associated with decreased odds of vision screening included younger age, lack of health care visits, no insurance coverage, parent education ≤ high school, and lower household income. Non-White ethnicities, households with a non-English primary language, and lower incomes were more likely to be referred to an eye doctor after vision screening. Lower rates of eye doctor visits were associated with younger age, lack of insurance coverage, and primary household languages other than English. ConclusionsChildren from disadvantaged backgrounds are less likely to receive vision screening and eye care. Targeted strategies are needed to increase vision screening and access to eye care services in these vulnerable groups.

The impact of brand trust on consumers' behavior toward agricultural products' regional public brand.

The importance of agricultural products' regional public brands, owned by relevant organizations and jointly used by several agricultural production and operation entities, is increasing in contemporary marketing research. Based on a survey of 544 consumers, this study investigates the influence of brand trust, attitude, subjective norms, and perceived behavioral control on their purchase intention and behavior toward agricultural products' regional public brand. Through SEM, we find that brand trust toward agricultural products' regional public brand positively influences consumer attitude, purchase intention, and purchase behavior. In addition, attitude and purchase intention mediate the relationship between brand trust and purchase behavior. While attitude and perceived behavioral control positively affect purchase intention, no similar effect is found for subjective norms. Moreover, multigroup invariance tests demonstrate that consumer behavior can be influenced by factors such as gender, age, monthly income, marital status, previous visits to the region, and purchase purpose. We therefore recommend that to bolster competitiveness, regional public brand stakeholders maintain agricultural product quality, ensure reliable purchasing and transportation channels, and enhance brand trust.

TransformEHR: transformer-based encoder-decoder generative model to enhance prediction of disease outcomes using electronic health records

Deep learning transformer-based models using longitudinal electronic health records (EHRs) have shown a great success in prediction of clinical diseases or outcomes. Pretraining on a large dataset can help such models map the input space better and boost their performance on relevant tasks through finetuning with limited data. In this study, we present TransformEHR, a generative encoder-decoder model with transformer that is pretrained using a new pretraining objective—predicting all diseases and outcomes of a patient at a future visit from previous visits. TransformEHR’s encoder-decoder framework, paired with the novel pretraining objective, helps it achieve the new state-of-the-art performance on multiple clinical prediction tasks. Comparing with the previous model, TransformEHR improves area under the precision–recall curve by 2% (p < 0.001) for pancreatic cancer onset and by 24% (p = 0.007) for intentional self-harm in patients with post-traumatic stress disorder. The high performance in predicting intentional self-harm shows the potential of TransformEHR in building effective clinical intervention systems. TransformEHR is also generalizable and can be easily finetuned for clinical prediction tasks with limited data.

Brain MRI and EEG overemployment in patients with vasovagal syncope: results from a tertiary syncope unit

BackgroundThe diagnosis of vasovagal syncope (VVS) is mainly based on history-taking and physical examination. However, brain Magnetic Resonance Imaging (MRI) and Electroencephalogram (EEG) are commonly used in the diagnostic course of VVS, despite not being indicated in the guidelines. This study aims to find the possible associated factors with the administration of brain MRI and EEG in patients with VVS.MethodsPatients with a diagnosis of VVS from 2017 to 2022 were included. Several demographic and syncope features were recorded. The association of these was assessed with undergoing MRI, EEG, and either MRI or EEG. Univariate and multivariable logistic regression models were also used to calculate odds ratios (OR) and 95% confidence intervals (CI).ResultsA total of 1882 patients with VVS were analyzed, among which 810 underwent MRI (43.04%), 985 underwent EEG (52.34%), and 1166 underwent MRI or EEG (61.96%). Head trauma (OR 1.38, 95% CI 1.06 to 1.80), previous neurologist visit (OR 6.28, 95% CI 4.24 to 9.64), and gaze disturbance during syncope (OR 1.75, 95% CI 1.13 to 2.78) were all positively associated to the performance of brain MRI/EEG. Similar results were found for urinary incontinence (OR 2.415, 95% CI 1.494 to 4.055), amnesia (OR 1.421, 95% CI 1.053 to 1.930), headache after syncope (OR 1.321, 95% CI 1.046 to 1.672), and tonic-clonic movements in head-up tilt table test (OR 1.501, 95% CI 1.087 to 2.093). However, male sex (OR 0.655, 95% CI 0.535 to 0.800) and chest pain before syncope (OR 0.628, 95% CI 0.459 to 0.860) had significant negative associations with performing brain MRI/EEG.ConclusionBased on our findings, performing MRI or EEG was common among VVS patients while it is not indicated in the majority of cases. This should be taken into consideration to prevent inappropriate MRI/EEG when there is a typical history compatible with VVS.

Dictive Factors of Dental Anxiety in Adult Patients at a Tertiary Dental Hospital in Nigeria

Objective: This study was designed to assess the prevalence and associated factors of dental anxiety among adult patients attending a tertiary dental hospital in Nigeria, while also identifying potential predictors of dental anxiety.&#x0D; Method: A total of 177 adult dental patients completed a self -administered questionnaire comprising socio-demographic information and other information relating to medical conditions, pain, health insurance coverage, previous dental visits and self-perception of oral health. Dental anxiety was assessed with the Modified dental anxiety scale.&#x0D; Result: The prevalence of dental anxiety was 10.73% (MDAS=19-25) with overall severity mean score of 13.36±3.41. Age and sex were associated with the level of dental anxiety (p-values of 0.027 and 0.007 respectively). Moreover, age, sex and level of education were associated with mean anxiety levels (p-values of 0.043, 0.009 and 0.015 respectively). Previous dental visits and self-perception of oral health were associated with dental anxiety (p-values of 0.034 and &lt; 0.001 respectively). Sex, marital status, previous dental visits and self-oral health perception were predictors of high dental anxiety (p-values of 0.028, 0.019, 0.033 and 0.001 respectively).&#x0D; Conclusion: Demographic factors, previous dental visits and self-perception of oral health are associated with dental anxiety. Predictors of high dental anxiety are sex, marital status, previous dental visits and self-oral health perception.

How does tourism memory affect revisit decisions? The mediating role of episodic future thinking

Although scholars have explored how memorable tourism experiences affect tourists' behaviour, little research has considered the role of tourism memory from an autobiographical memory phenomenology perspective—particularly negative tourism memories. By combining the notion of mental time travel with the constructive episodic simulation hypothesis, this research proposes a theoretical framework describing the effects of positive and negative tourism memories on revisit intention through episodic future thinking. A questionnaire survey and two experiments jointly revealed that tourists' revisit intentions were stronger when memories of previous visits were positive. Episodic future thinking partly mediated the association between tourism memory valence and revisit intention. Moreover, positive external information could strengthen the effect of episodic future thinking on this intention. Results offer practical guidance on harnessing tourism memory to improve destinations' competitiveness.

High Influenza Incidence and Disease Severity Among Children and Adolescents Aged

During the 2022-23 influenza season, early increases in influenza activity, co-circulation of influenza with other respiratory viruses, and high influenza-associated hospitalization rates, particularly among children and adolescents, were observed. This report describes the 2022-23 influenza season among children and adolescents aged <18 years, including the seasonal severity assessment; estimates of U.S. influenza-associated medical visits, hospitalizations, and deaths; and characteristics of influenza-associated hospitalizations. The 2022-23 influenza season had high severity among children and adolescents compared with thresholds based on previous seasons' influenza-associated outpatient visits, hospitalization rates, and deaths. Nationally, the incidences of influenza-associated outpatient visits and hospitalization for the 2022-23 season were similar for children aged <5 years and higher for children and adolescents aged 5-17 years compared with previous seasons. Peak influenza-associated outpatient and hospitalization activity occurred in late November and early December. Among children and adolescents hospitalized with influenza during the 2022-23 season in hospitals participating in the Influenza Hospitalization Surveillance Network, a lower proportion were vaccinated (18.3%) compared with previous seasons (35.8%-41.8%). Early influenza circulation, before many children and adolescents had been vaccinated, might have contributed to the high hospitalization rates during the 2022-23 season. Among symptomatic hospitalized patients, receipt of influenza antiviral treatment (64.9%) was lower than during pre-COVID-19 pandemic seasons (80.8%-87.1%). CDC recommends that all persons aged ≥6 months without contraindications should receive the annual influenza vaccine, ideally by the end of October.

Intelligent Destination Recommender and Community Builder

Recommendation engines make use of machine learning techniques and generally deal with ranking and rating of products/users. With the help of this system we aim to suggest different destinations to users based on their interest and previous visits. Along with recommendations we also aspire to enable users to build travel communities for people sharing similar interests .This shall help travelers with planning ,meeting like-minded people,safety and enthralling experience.&#x0D; As per the analysis done on pre-existing systems we discerned that enabling users to build a community of travelers visiting the same destination is an eccentric attribute proposed.&#x0D; This distinctive attribute of building communities shall be implemented using the basics of clustering algorithms in Machine learning.

Impact of empty flowers on foraging choice and movement within floral patches by the honey bee, Apis mellifera

Floral displays often signal the presence of nectar, but nectar may not always be present due to previous visits by nectarivores or temporal changes in nectar availability. But how does the presence of empty flowers impact the preferences of foraging honey bees for the available flowers? We aimed to test if previously rewarding flowers changed the preference relationship between neighboring flowers, and if empty flowers impacted overall visitation, in the honey bee Apis mellifera. Using artificial flowers, we showed that although empty flowers did not influence foraging choices in A. mellifera workers, empty flowers did increase movement between flowers in the patch. The presence of empty flowers also resulted in increased rates of patch abandonment. Our results suggest that while empty flowers may not directly impact foraging preferences in bees, they can have an impact on visitation within patches and in the surrounding area, with possible knock-on effects for the pollination of both the emptied flower and neighboring plants.

Insights for successful recruitment of people who actively use heroin to a pharmacotherapy trial: a case study

ABSTRACT Background This paper reports on recruiting strategies in a study which aimed to examine the mechanism of intranasal oxytocin on cue-induced opiate craving and attentional bias in males using heroin in addition to substitute opiates from four UK community drug treatment services. Methods Recruitment took place during and post-COVID-19 periods of social distancing and lockdowns. Caseworkers obtained consent to contact from interested service users before an initial telephone screen. People were then scheduled for in-person screens, typically within seven days of the initial telephone call. Subsequent visits took place within 30 days of the previous visit. Each visit lasted one hour and participants received one £20 voucher per completed visit. Results Thirty participants were randomized from 113 referrals. We were unable to contact 36% (n = 41) of people. Of those eligible to start the study (n = 44), 68% (n = 30) agreed to start the study, retaining 82% (n = 24) to completion. Factors which positively influenced recruitment were having a research presence on site, the cultivation of relationships and demonstrating respect and gratitude toward the participants. Conclusions These results support the feasibility of recruiting males currently using heroin in addition to substitute opiates utilizing a person-first approach with service users and staff.

Understanding the antecedents of patients’ missed appointments: the perspective of attribution theory

The occurrence of missed appointments from online outpatient bookings significantly hinders the operational efficiency of outpatient services. This study aimed to investigate various factors influencing patients’ missed appointments from online outpatient bookings. Drawing on attribution theory, an empirical analysis was conducted using 382,004 authentic online outpatient appointments. The empirical findings revealed that appointment lead-time, appointment time, weekday appointments, online doctor rating, appointment doctor’s expertise, patient distance, and previous outpatient visit experience significantly influenced patients’ missed appointment behaviors from online outpatient bookings. Importantly, previous outpatient experience positively moderated the relationship between the appointment doctor’s expertise and patients’ missed-appointment behavior. This study provides insights into the factors influencing patients’ missed-appointment behavior from online outpatient bookings. It further offers a theoretical foundation for medical institutions in China to mitigate the likelihood and adverse effects of patients’ missed-appointment behavior from online outpatient bookings.

Predicting pediatric severe asthma exacerbations: an administrative claims-based predictive model

Objective Previous machine learning approaches fail to consider race and ethnicity and social determinants of health (SDOH) to predict childhood asthma exacerbations. A predictive model for asthma exacerbations in children is developed to explore the importance of race and ethnicity, rural-urban commuting area (RUCA) codes, the Child Opportunity Index (COI), and other ICD-10 SDOH in predicting asthma outcomes. Methods Insurance and coverage claims data from the Arkansas All-Payer Claims Database were used to capture risk factors. We identified a cohort of 22,631 children with asthma aged 5–18 years with 2 years of continuous Medicaid enrollment and at least one asthma diagnosis in 2018. The goal was to predict asthma-related hospitalizations and asthma-related emergency department (ED) visits in 2019. The analytic sample was 59% age 5–11 years, 39% White, 33% Black, and 6% Hispanic. Conditional random forest models were used to train the model. Results The model yielded an area under the curve (AUC) of 72%, sensitivity of 55% and specificity of 78% in the OOB samples and AUC of 73%, sensitivity of 58% and specificity of 77% in the training samples. Consistent with previous literature, asthma-related hospitalization or ED visits in the previous year (2018) were the two most important variables in predicting hospital or ED use in the following year (2019), followed by the total number of reliever and controller medications. Conclusions Predictive models for asthma-related exacerbation achieved moderate accuracy, but race and ethnicity, ICD-10 SDOH, RUCA codes, and COI measures were not important in improving model accuracy.

Modeling Coil-Globule-Helix Transition in Polymers by Self-Interacting Random Walks.

Random walks (RWs) have been important in statistical physics and can describe the statistical properties of various processes in physical, chemical, and biological systems. In this study, we have proposed a self-interacting random walk model in a continuous three-dimensional space, where the walker and its previous visits interact according to a realistic Lennard-Jones (LJ) potential uLJr=εr0/r12-2r0/r6. It is revealed that the model shows a novel globule-to-helix transition in addition to the well-known coil-to-globule collapse in its trajectory when the temperature decreases. The dependence of the structural transitions on the equilibrium distance r0 of the LJ potential and the temperature T were extensively investigated. The system showed many different structural properties, including globule-coil, helix-globule-coil, and line-coil transitions depending on the equilibrium distance r0 when the temperature T increases from low to high. We also obtained a correlation form of kBTc = λε for the relationship between the transition temperature Tc and the well depth ε, which is consistent with our numerical simulations. The implications of the random walk model on protein folding are also discussed. The present model provides a new way towards understanding the mechanism of helix formation in polymers like proteins.

Abstract P350: Longitudinal And Summary Blood Pressure Measures And Clinical Decision-making Around Antihypertensive Therapeutic Intensification

Background: The rate of treatment intensification (TI) emerges as the most important factor impacting BP control. BP has been consistently reported as the most potent clinical factor in deciding to intensify pharmacotherapy for hypertension. This study aims to quantify the relationship between measured BP and variance in therapeutic intensification (TI). Methods: Data for defining and modeling antihypertensive TI comes from ambulatory primary care clinics at five distinct health care organizations. Mixed-effects logistic regression was used to model longitudinal BP related information and antihypertensive TI at visits with uncontrolled BP (≥140/≥90 mmHg). Results: TI increased as a function of progressively higher SBP (Table 1) and DBP for both current and previous visit BP values. Yet, current and prior visit BP accounted for only 2.8% and 0.8%, respectively, of the variance in TI. Conclusion: Current and historical BP values impact TI. While BP is the most important factor influencing TI, its impact is limited. Highly efficient point-of-care access to previous BP might improve the rate of TI. Yet, there are potent factors limiting TI which require attention.