Primary Variable Research Articles

Travel distance does not affect overall survival in patients with appendiceal adenocarcinoma undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

IntroductionCytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is a potentially curative approach for appendiceal cancer (AC) with peritoneal dissemination and is most often employed at tertiary referral centers. Regionalization may provide geographic barriers to care for vulnerable patients. The aim of this study was to examine the effect of travel distance on oncologic outcomes of patients with AC treated with CRS-HIPEC. MethodsThe National Cancer Database (NCDB) was reviewed from 2006 through 2020 for patients with AC who underwent CRS-HIPEC. The primary comparison variable was distance (<50 miles vs ≥ 50 miles from the CRS-HIPEC facility). Demographic and tumor characteristics were analyzed. Primary outcome was overall survival (OS). Secondary outcomes were 30-day and 90-day mortality, readmission, and length of stay (LOS). ResultsDuring the study period, 1703 patients met inclusion criteria, with 1000 patients travelling < 50 miles for CRS-HIPEC (59 %) and 703 travelling ≥ 50 miles (41 %). Patients who traveled ≥ 50 miles were more likely to be non-Hispanic White (p < 0.001), have annual income less than $74,062, be treated at an academic center and live in the South-Atlantic region of the United States. There was no significant difference in OS between groups (Figure 1). There were no significant differences in 30-day postoperative survival, 90-day survival, or 30-day readmission. Post-operative LOS was 8.0 versus 9.0 days (p < 0.001). ConclusionsTravel distance ≥ 50 miles was not significantly associated with decreased OS or increased postoperative mortality, suggesting that regionalization of care does not worsen oncologic outcomes for patients with AC undergoing CRS-HIPEC.

How the Ionosphere Responds Dynamically to Magnetospheric Forcing

AbstractGround magnetic field variations have been used to investigate ionospheric dynamics for more than a century. They are usually explained in terms of an electric circuit in the ionosphere driven by an electric field, but this is insufficient to explain how magnetic field disturbances are dynamically established. Here we explain and simulate how the ionosphere dynamically responds to magnetospheric forcing and how it leads to magnetic field deformation via Faraday's law. Our approach underscores the causal relationships, treating the magnetic field and velocity as primary variables (the B, v paradigm), whereas the electric field and current are derived, in contrast to the E, j paradigm commonly used in ionospheric physics. The simulation approach presented here could be used as an alternative to existing circuit‐based numerical models of magnetosphere‐ionosphere coupling.

Racial resentment, sexism, and evaluations of Kamala Harris in the 2020 U.S. presidential election

AbstractObjectiveThis article examines the effect of racial attitudes and sexism on evaluations of Kamala Harris. It also compares the effect of these variables on evaluations of other Democratic politicians: Joe Biden, Barack Obama, and Hillary Clinton.MethodsData are taken from the 2020 American National Election Studies, using feeling thermometers for Harris, Biden, and Obama, and from the 2016 American National Election Studies for Clinton. Our primary independent variables are racial resentment and three measures of sexism: modern, hostile, and traditional sexism.ResultsRacial resentment, modern sexism, and traditional sexism exerted an effect on evaluations of Kamala Harris above and beyond other explanatory variables, including party identification and ideology. However, these effects did not differ considerably from those found for Biden, Obama, and Clinton.ConclusionsRacial resentment and sexism appear to be related to evaluations of any Democratic presidential or vice presidential nominee, reflecting how they have become salient in defining party identities. We speculate, however, that their effects might be even more visible for black women at the top of a presidential ticket, and provide major headwinds into which Kamala Harris may have to run when contemplating any future presidential candidacy of her own.

Evaluation of China's double-carbon energy policy based on the policy modeling consistency index

The clean energy transition is crucial for achieving China's double-carbon goal. With the promulgation of a series of policies, analyzing the energy policies in this policy framework is essential. This paper identifies 32 current effective and representative energy policies through collection and screening. After establishing a Policy Modeling Consistency (PMC) index, this paper designs the corresponding text-mining dictionary through the TF-IDF algorithm and uses regular expressions to retrieve, filter, and match policy texts. The results show that the average PMC score of all policies selected in this paper is 5.23, and the overall PMC surface is relatively smooth. The scores of primary variables are relatively balanced. For the future, it is essential to focus on optimizing utility level (P3), policy type (P5), policy receptors (P8), and policy areas (P9) in energy policy formulation. Most importantly, the social network density of energy policy issuers is low now; thus, diversity and close cooperation need to be strengthened.

Misperception of Norms About Intimate Partner Violence as a Driver of Personal IPV Attitudes and Perpetration: A Population-Based Study of Men in Rural Uganda.

Intimate partner violence (IPV) against women is a global public health problem. Conceptual frameworks suggest misperceived norms around IPV might drive perpetration of violence against women in southern and eastern Africa. We conducted a cross-sectional, population-based survey of all men residing in a rural parish in southwest Uganda, eliciting their endorsement of IPV in five hypothetical scenarios and their reported frequency of perpetration of violence against their wife/main partner. They also reported their perceptions about the extent to which most other men in their villages endorsed and/or perpetrated IPV, which we compared against the population data to measure the primary explanatory variable of interest: whether individuals misperceived norms around IPV. We fitted multivariable Poisson regression models specifying personal IPV endorsement and IPV perpetration as the outcomes. Overall, 765 men participated in the study (90% response rate): 182 (24%) personally endorsed IPV, and 78 of 456 partnered men (17%) reported perpetrating one or more acts of IPV at least once per month. Although most men neither endorsed nor reported perpetrating IPV, 342 (45%) men mistakenly thought that most other men in their villages endorsed IPV and 365 (48%) men mistakenly thought that most other men perpetrate IPV at least monthly. In multivariable regression models, men who misperceived most men to endorse IPV were more likely to endorse IPV themselves (adjusted relative risk [aRR] = 2.44; 95% CI [1.66, 3.59]; p < .001). Among partnered men, those who misperceived IPV perpetration to be normative were more likely to perpetrate IPV themselves (aRR = 4.38; [2.53, 7.59]; p < .001). Interventions to correct misperceived norms about IPV may be a promising method for reducing violence against women in rural Uganda.

Research on the Influence of Temperature on the Assessment of Coal and Gas Outburst Dynamic Risk in Deep Mining

To ensure the sustainable development of energy supply, there is a continuous increase in demand for deep coal mining, making safe and efficient extraction a crucial area of research. However, with the increasing depth, rising ground temperatures pose new challenges for safe and sustainable mining operations. Among these challenges, coal and gas outburst dynamic hazards stand out as significant issues. Therefore, it is necessary to assess the impact of temperature variations on coal and gas outburst disaster prevention and control. To investigate this effect, we conducted an analysis based on outburst-triggering mechanisms and adsorption–desorption processes. Temperature was considered as the primary controlled variable, while gas expansion energy served as the criterion for assessing outburst hazards. Kilometer-deep coal samples were selected for measurement, focusing on indicators such as Langmuir adsorption constants (a,b), gas content (Q), gas pressure (P) and drilling cutting desorption indices (K1, Δh2). The results indicate that, under the same gas pressure, there is a slight decreasing trend in gas expansion energy with increasing temperature, although the overall change is minimal. Hence, the sole influence of temperature on the gas’s ability to perform work during outbursts is limited. Temperature exerts varying degrees of influence on gas parameters such as gas content and drill cutting desorption indices. The fluctuation amplitudes of these indicators range from large to small in the following order: Δh2 &gt; ΔP &gt; Q &gt; K1 &gt; P. Additionally, their correlation with gas expansion energy decreases in the following order: P &gt; Q &gt; Δh2 &gt; K1 &gt; ΔP. Thus, the influence of temperature on the indicators used in various prediction methods exhibits inconsistency, emphasizing the importance of considering temperature effects on predicted values. Gas pressure emerges as the optimal indicator for outburst determination, while gas content and drill cutting desorption indices are preferable as predictive indicators. These results will provide valuable references for the sustainable and safe development, risk assessment and prediction of deep coal mining.

Analisis Faktor-faktor yang Mempengaruhi Ketimpangan Wilayah di Provinsi DKI Jakarta dan Provinsi Kalimantan Timur Tahun 2010-2020

Regional inequality is a development problem experienced by Indonesia. DKI Jakarta Province as the capital city of Indonesia and East Kalimantan Province which is designated as a candidate for the new capital city of Indonesia has a high inequality. This study aims to analyze the effect of investment, agglomeration, unemployment rate, primary sector GRDP distribution and road length on regional inequality in DKI Jakarta Province and East Kalimantan Province in 2010‒2020.This study uses the Ordinary Least Square (OLS) regression analysis method and uses a data processing tool in the form of the Eviews 10 application. The data used in this analysis is time series data in 2010-2020 obtained from the BPS, BPS DKI Jakarta and BPS Kalimantan Timur.The study indicates that in the Province of DKI Jakarta the investment variable has a positive and significant influence on regional inequality. The agglomeration variable, the unemployment rate has a negative and significant effect on regional inequality, while the primary sector GRDP distribution and road length variables have no significant effect on regional inequality. Meanwhile, in East Kalimantan Province, the variables of agglomeration, unemployment rate and distribution of GRDP in the primary sector have a positive and significant effect on regional inequality, while the investment variables and road length have no significant effect on regional inequality. Investment variables, agglomeration, unemployment rate, primary sector GRDP distribution and road length together have a positive and significant impact on regional inequality in DKI Jakarta Province and East Kalimantan Province in 2010-2020.

Geospatial analysis of cardiovascular mortality before and during the COVID-19 pandemic in Peru: analysis of the national death registry to support emergency management in Peru.

COVID-19 has led to significant global mortality, with Peru being among the countries most affected. While pre-existing comorbidities have been linked to most cases, the exact distribution of fatalities within the country remains unclear. We aimed to assess deaths attributed to cardiovascular diseases (CVD) before and during the COVID-19 pandemic across various regions and provinces in Peru. An observational georeferencing study was designed. Peru faced four waves of COVID-19 over three years, with variable impacts across its three regions (Coast, Highlands, and Jungle). Deaths related to cardiovascular diseases, such as heart failure (HF), arrhythmia, acute myocardial infarction (AMI), strokes, and acute coronary syndrome, were examined as primary variables. The study period spanned pre-pandemic years (2017-2019) and pandemic years (2020-2021), utilizing death data from the National Death Information System (SINADEF). The georeferencing analysis was conducted using ArcGIS v10.3. A total of 28,197 deaths were recorded during the study period, with significant increases during the pandemic (2020-2021). Cardiovascular deaths were disproportionately higher during the pandemic, totaling 19,376 compared to 8,821 in the pre-pandemic period (p < 0.001). AMI and HF were the leading causes of mortality, showing significant increases from the pre-pandemic (5,573 and 2,584 deaths) to the pandemic period (12,579 and 5,628 deaths), respectively. Deaths due to CVD predominantly affected individuals aged over 60, with significant increases between the two study periods (7,245 vs. 16,497 deaths, p = 0.002). Geospatial analysis revealed regional disparities in CVD mortality, highlighting provinces like Lima and Callao as COVID-19 critical areas. The substantial increase in cardiovascular deaths during the COVID-19 pandemic in Peru showed distinctive patterns across regions and provinces. Geospatial analysis identified higher-risk areas and can guide specific interventions to mitigate the impact of future health crises. Understanding the dynamic relationship between pandemics and cardiovascular health is crucial for effective public health strategies.

Describing use of muscle-building supplements among adolescents and young adults in Canada

BackgroundGiven the high prevalence of use of muscle-building supplements, such as whey protein and creatine monohydrate, there remains a need for more research to understand use among adolescents and young adults. This study aimed to describe the influences of muscle-building supplement use, the amount of time researching muscle-building supplements, common places of purchase, information sources, symptoms during use, medical attention sought, and perceptions of problematic use. MethodsData from the Canadian Study of Adolescent Health Behaviors (N = 912) were analyzed. Descriptive statistics were used to describe the primary variables and chi-square tests and one-way ANOVAs were used to identify gender differences. Regression analyses were conducted to determine the sociodemographic associations with reported symptoms during use, not seeking medical attention for symptoms, and perceived problematic use. ResultsProtein bars (58.9 %) and whey protein powders or protein shakes (52.2 %) were the most reported muscle-building supplements used. Nearly half (43.7 %) of participants reported social media influencers as a primary influence of use, while over two-thirds (69.3 %) reported seeking information from online websites. Participants spent the most time researching the risks and benefits of creatine monohydrate. Nearly two-thirds of participants reported at least one symptom while using muscle-building supplements, despite 87.8 % of those participants not seeking medical attention. Only 9.8 % of participants perceived their use as problematic, with distinct sociodemographic factors linked to symptoms and perceptions of problematic use. ConclusionsFindings provide important information about the use of muscle-building supplements among adolescents and young adults that can guide harm reduction and intervention efforts among healthcare, public health, and policymaking professionals.

Intention to Quit Tobacco due to Media Advertisements in India: Findings from Global Adult Tobacco Survey 2016-17.

Tobacco has been among the most important causes of morbidity and mortality worldwide. In reducing tobacco consumption, media campaigns are crucial in raising awareness and encouraging individuals to quit. The present study aimed to profile participants of GATS-2, including tobacco usage patterns and media exposure, and explore the factors associated with quitting in the presence of media exposure. Secondary data analysis of Global Adult Tobacco Survey-India (2016-17) data was done among current daily cigarette smokers and smokeless tobacco users. The primary independent variable was an intention to quit, while media exposure was the primary independent variable. Respondents were profiled as per various socio-demographic variables, and exposure to media advertisements and intention to quit were assessed using weighted bivariate analysis and multivariate log regression analysis. Males, and respondents aged 15 to 45, had more exposure to media and advertisements than female respondents. Cigarette smokers with moderate consumption, better awareness, those who had made any quit attempts in the last 12 months, and moderate to high media exposure depicted better intention to quit. In SLT users, intention to quit depicted significant odds per education level quit attempts and exposure to media and advertisements. We report a high intention to quit among those exposed to advertisements. Media campaigns play an important role in promoting tobacco control. There is a need to assess the impact of such advertisements on behavioral aspects. At the same time, comprehensive tobacco control policies should go hand in hand in reducing smoking rates.

What Affects Healing Rates in Patients Treated for Medication-Related Osteonecrosis of the Jaw? The Role of Operative Therapy and Other Clinical Factors

BackgroundIn the therapy of medication-related osteonecrosis of the jaw (MRONJ), the healing rate, effectiveness of operative therapy, and factors associated with healing remain unclear. PurposeThis study aimed to estimate MRONJ therapy healing rates and identify associated prognostic factors. Study design, setting, sampleA 25-center prospective cohort study was conducted on 291 patients with MRONJ treated with a common therapeutic protocol during 2013–2016. Patients unable to continue examinations or treatment were excluded. Predictor variableThe primary predictor variable was MRONJ therapy grouped into two categories: operative and nonoperative. Secondarily, the prognostic factors categorized as demographic, medical, clinical, and perioperative were evaluated. Main outcome variablesThe primary outcome variable was treatment duration, defined as the time (in months) between the initiation of therapy and when the site was healed or the date of the final visit or loss to follow-up. CovariatesNot applicable. AnalysesDescriptive statistics and 3-year cumulative healing rates were calculated. The association between clinical factors and time to healing were analyzed using bivariate and multivariate analyses and propensity score analysis. P < .05 was considered significant. ResultsWe analyzed data from 291 subjects with 76 (26.1%) and 215 (73.9%) subjects in the operative and nonoperative therapy groups, respectively. The healing rates for operative and nonoperative therapies were 95.8% and 70.7%, respectively (hazard ratio [HR] = 1.6, 95% confidence interval [CI] = 1.1–2.2, P-value [P] < .01). The healing rates in patients for whom anti-resorptive agent (ARA) treatment was discontinued and continued were 87.2% and 37.4%, respectively (HR = 1.8, 95% CI = 1.1–3.0, P = .02). In a multiple regression analysis using ARA indication, the therapy method showed a significant association in the MRONJ malignancy group (HR = 2.75, 95% CI = 1.46–5.17, P < .01). Conclusions and RelevanceOperative therapy and ARA discontinuation were associated with better healing rates in MRONJ therapy. However, the choice of therapy for MRONJ should be based on a comprehensive consideration of the patient’s condition. ARA discontinuation should be considered an adjunctive measure because of the possibility of adverse events such as fragility fractures and skeletal related events.

Epidemiological profile of Ophir Loyola Cancer Hospital: A snapshot of the incidence of solid neoplasms in the eastern Amazon.

e22515 Background: The geographical distribution of cancer is a major concern in global public health, associated with this reality, the susceptibility of a population is closely linked to risk factors and carcinogenic profiles in different groups, which explain the heterogeneous prevalence and incidences among countries. In Brazil the region delimited by the Legal Amazon has a distinct epidemiological profile with a high prevalence of breast cancer and a low survival rate compared to countries with the highest human development index. Furthermore, the North and The Northeast has more than half of the country's penile cancer cases. In Pará, Ophir Loyola Cancer Hospital(OLCH) accounts for 71.11% of hospital visits in the state. The results of this study indicate the importance of OLCH as the reference center in Pará for the care and treatment of cancer patients. Methods: This was an ecological, exploratory, and mixed descriptive studythat investigated the epidemiological profile of patients with cancer treated at OLCH from January to December 2020. Sociodemographic data at admission were the primary variables, which were analyzed according to spatial distribution. Results: In this study, the data of 2952 patients were analyzed, with the majority being between the ages of 50 and 79 years (62.47%), and diagnosed but without previous treatment (87.30%). The most common cancers were breast (16.50%), cervical (13.40%), stomach (8.98%), and prostate (7.72%). The spatial distribution of the total number of cases, by the location of the primary solid tumor, was heterogeneous with regard to the number of cases per municipality. In Tucuruí Lake and Carajás, thyroid cancer was the second most frequent neoplasms, and in the Lower Amazon, it was the third most frequent . Previous studies have indicated the high mining activity in Carajás and the Lower Amazon with a strong relationship between methyl mercury and Mercury contamination in the Tapajós River and the adjacent gold extraction territory and and fish contamination. In some regions of Pará, cervical cancer is more prevalent than breast câncer in womans, which is different from the national data where it ranks second or third in the female population. Within the relationship between females and males, there was a higher proportion of cases of stomach cancer among men, representing the second more prevalent tumor in men, indicating a high incidence of gastric cancer in the region. Conclusions: The care profile at OLCH showed a high incidence of solid malignancies compared to other regions of Brazil, such as gastric cancer, cervical and thyroid cancer, indicating environmental and sociocultural influences on the carcinogenic profile present in the Eastern Amazon. Just as a heterogeneous incidence of tumors was seen in the regions of Pará.

Retrofitting of heat-damaged fiber-reinforced concrete cylinders using welded wire mesh configurations

Abstract Fire damage poses a significant risk to reinforced concrete structures throughout their lifespan. Fire exposure influences the stress-strain properties and durability of concrete, despite its non-flammability. Therefore, the strengthening approach is an economic option for lengthening their lifespan. This paper aims to conduct an experimental investigation into retrofitting heat-damaged fiber-reinforced concrete cylinders using welded wire mesh (WWM) configurations. Four concrete mixes were investigated. In total, 48 concrete cylinders were tested under axial compression until failure. The primary variables considered in the testing program consisted of (i) the influence of various fiber types (steel fiber (SF), polypropylene (PP), and hybrid fibers (SF+PP)); (ii) exposure temperature (26°C and 600°C); and (iii) WWM strengthening. Exposure to a temperature of 600°C led to a significant reduction in the compressive strength, ranging from 23.7% to 53.3%, while the inclusion of fibers has a substantial effect on the compressive strength of concrete, regardless of fiber type, with an increased ratio reaching up to 34.7%. The finding also clearly shows that the strengthening of heat-damaged specimens with WWM jacketing resulted in a 38.8%, 4.9%, and 9.4% increase in compressive strength for SF, PP, and SF+PPF specimens, respectively, compared to unheated control specimens. The suggested approaches to strengthening, which involve the use of WWM jacketing with two layers, successfully restored and surpassed the initial concrete compressive strength of the specimens that were damaged due to exposure to high temperatures.

Safety and efficacy of extracorporeal shockwave therapy on chronic prostatitis/chronic pelvic pain syndrome: a prospective, randomized, double-blind, placebo-controlled study

PurposeThis study aimed to investigate the efficacy and safety of extracorporeal shock wave therapy (ESWT) over an 8-week period in individuals diagnosed with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) compared to a control group. Materials and methodsThis prospective, double-blind, placebo-controlled study enrolled 46 participants diagnosed with CP/CPPS, who were randomly assigned to either the treatment group or the control group in a 2:1 ratio. In the treatment group, ESWT was administered at the perineum once a week for 8 weeks. CP/CPPS-related symptoms were assessed using the National Institutes of Health-Chronic Prostatitis Symptom Index (NIH–CPSI). Pain and erectile function were measured using the Visual Analogue Scale (VAS) and the International Index of Erectile Function-Erectile Function (IIEF-EF). ResultsThe primary efficacy assessment variable, the change in NIH–CPSI total score at 4 weeks after the end of the 8-week treatment compared to baseline, was significantly improved (P = 0.0225) in the treatment group (−11.27 ± 8.39) compared to the control group (−5.44 ± 5.73). Regarding the secondary efficacy assessment variables, the treatment group showed significant decreases compared to the control group in change in NIH–CPSI total score (P = 0.0055) at the end of the 8-week treatment compared to baseline, along with significant decreases in pain and quality of life scores, as well as VAS assessments at the end of the 8-week treatment and 4 weeks after the end of treatment (P < 0.05). Moreover, in the evaluation conducted to assess improvement in sexual function, the treatment group showed a significant increase compared to baseline than the control group in the IIEF total score at 4 weeks after the end of the treatment (P = 0.0364). No patients experienced severe side effects related to ESWT during the therapeutic period or the follow-up duration. ConclusionsThe efficacy assessment in this clinical trial indicates that extracorporeal shock wave therapy is expected to have a symptomic improvement effect on CP/CPPS.

Three-Dimensional Evaluation of Changes in Condylar Position After Orthognathic Surgery With Different Types of Jaw Deformities

BackgroundAssessing condyle position post orthognathic surgery is pivotal for optimizing surgical accuracy, sustaining postoperative stability, and ensuring predictable treatment outcomes. PurposeThe aim of this study was to analyze the changes of condyle position after orthognathic surgery with different types of jaw deformity and to analyze whether the changes of condyle position are different. Study design, setting, sampleA retrospective cohort study was designed and conducted, involving adults who underwent orthognathic surgery for jaw deformities at the affiliated Stomatological Hospital of Nanchang University between 2019 and 2022. Patients with incomplete CT data were excluded. Predictor/exposure/independent variableThe primary predictor variable was time (pre-operative and post-operative) and types of jaw deformities (skeletal Class III, skeletal Class II, and mandibular deviation). Main outcome variable(s)The main outcome variables were the 3D linear and rotational positional changes of the condyle. CovariatesEvaluated covariates included sex and age. AnalysesMIMICS 20.0 software measured all data, and SPSS 22.0 software facilitated statistical analyses. Intra- and inter-group correlation analyses employed paired t-tests and independent t-tests, with statistical significance set at P < 0.05. ResultsThe study sample was composed of 32 subjects with a mean age of 22.43±1.6 and 9 were male. The analysis of changes of condylar position from virtual surgical planning to immediate postoperative period showed that the maximum condylar displacement was 1.74 mm and the maximum angular change was 3.92°. The analysis of changes in condylar position from the immediate postoperative period to 1-year postoperatively showed no statistically significant changes for the same type of jaw deformity. But patients with Class II malocclusion exhibited distinct condylar displacement and rotation patterns compared to those with Class III malocclusion and mandibular deformity. Conclusions and RelevanceThe application of virtual surgical planning in orthognathic surgery ensures a high degree of consistency in achieving the desired condylar position. Moreover, no significant change in condylar position was observed after orthognathic surgery for the same type of jaw deformity. However, patients with Class II deformities exhibited a higher susceptibility to rotational displacement of the condyles compared to those with other types of jaw deformities.

Association of Patient-Surgeon and Patient-Physical Therapist Relationships With Return to Sports After ACL Reconstruction: The Untested Dimension in Outcome Assessments.

The Quality of Patient-Surgeon Relationship (QPASREL) is an 11-item questionnaire developed and validated to assess the relationship between practitioners and patients on recovery and return to work after surgery. To evaluate the association of patient-surgeon relationship (PSR) and patient-physical therapist relationship (PPR), as measured by QPASREL, with a patient's return to sports (RTS) after anterior cruciate ligament reconstruction (ACLR). Case-control study; Level of evidence, 3. This study targeted patients who underwent primary ACLR at a specialized sports surgery referral center between January and May 2021. Patients who had revision surgery, multiligamentous knee injury, and sedentary status were excluded from the study. Patients were grouped based on ability to RTS at the preinjury level 1 year postoperatively (RTS group and no-RTS group). The primary outcome was rate of RTS at 1 year postoperatively, and the primary dependent variables were the quality of PSR and PPR as measured by QPASREL scores at 6-month intervals. Secondary outcomes were the correlation and discriminative capacity of the QPASREL compared with the Anterior Cruciate Ligament-Return to Sport After Injury (ACL-RSI) scores (collected at 6-month intervals). The study included 243 patients. Patients in the RTS group exhibited a higher mean PPR QPASREL score (36.6 ± 5.1) compared with no-RTS patients (34.8 ± 5.2; P = .01) as well as a higher mean PSR score (35.7 ± 5.1) compared with no-RTS patients (33.8 ± 5.9; P = .01). Multivariate analysis showed that every 5-point increase in the QPASREL scores for PPR and PSR resulted in a 39% (odds ratio [OR] = 1.39; P = 0.014) and 35% (OR = 1.35, P = 0.021) increased odds of RTS, respectively. A weak yet positive correlation was found between QPASREL and ACL-RSI. The predictive capacity of the QPASREL (area under the curve [AUC] = 0.60 for PPR and 0.61 for PSR), although significant, was less powerful compared with that of the ACL-RSI (AUC = 0.73). The quality of the PPR and PSR, as measured by QPASREL scores, demonstrated a significant association with RTS rates at 1 year after ACLR. A weak yet positive correlation was found between QPASREL and ACL-RSI.

Association of characteristics of cancer, patient, and county with telemedicine services use: Impact of the waiver of reimbursement restrictions on telemedicine.

11058 Background: Telemedicine services have great potential to improve access to care of cancer patients who are vulnerable in health status and may experience financial hardship due to the cost of their care. However, very little is known about how the Centers for Medicare and Medicaid Services’ waiver of reimbursement restrictions on telemedicine and characteristics of cancer affected their use of telemedicine services. We examined the changes in frequency of telemedicine use before and after the waiver and, after the waiver, the determinants of telemedicine use across medical provider types. Methods: We used the 5% Surveillance, Epidemiology and End Results registry file linked to Medicare data among patients who had a newly diagnosed cancer in 2019 and were enrolled in Medicare Parts A and B during 2019-2020, and Area Health Resources File. Our outcomes were binary variables of telemedicine services use in outpatient (OP), office-based clinics (OB), and emergency department (ED), respectively, and for detailed provider types in OB. Primary independent variables included the ten most frequently observed cancer sites (reference: all other sites), sequence of cancer, stage of diagnosis, and quarter of diagnosis in 2019. Analysis was by a multilevel mixed effects logistic regression model, adjusting characteristics of cancer, patient and county. Results: Among eligible patients (n = 14,226), telemedicine services use for all provider types increased from 4.3% in pre-waiver period to 40.3% (5.2% in OP, 39.3% in OB, and 0.2% in ED) in post-waiver period. Telemedicine services use varied by primary cancer site, but was higher for those with a cancer recurrence (odds ratio [OR] 1.36, 95% confidence interval [CI] 1.16-1.60) and advanced cancer stage (OR 1.24, 95% CI 1.03-1.48). For visits to oncologists, cancer characteristics such as recurrence (OR 1.67, 95% CI 1.34-2.08), advanced stage (OR 5.52, 95% CI 4.12-7.40) and diagnosis in the last quarter in 2019 (OR 1.39, 95% CI 1.20-1.61) were associated with greater use of telemedicine. Patients of older age and minority race/ethnicity and in non-Northeast regions were less likely to use telemedicine, while women, patients with dual eligibility for Medicaid, and those living in a county with high median household income and high availability of hospital beds were more likely to use telemedicine. Conclusions: Cancer patients used telemedicine services more frequently after the waiver and their cancer characteristics were most strongly associated with that use, implying their greater need for, and benefit from, telemedicine. Disparities in telemedicine use related to individual and county-level socio-demographics and medical supply suggest health policy changes to improve equitable access to telemedicine and efficient cancer care planning.

A domain-oriented approach to characterizing movement-evoked pain.

Movement-evoked pain (MEP) impacts a substantial proportion of US adults living with chronic pain. Evidence suggests that MEP is influenced by numerous biopsychosocial factors and mediated by mechanisms differing from those of spontaneous pain. However, both characteristic and mechanistic knowledge of MEP remain limited, hindering effective diagnosis and treatment. We asked (1) can chronic pain, functional, psychosocial, and behavioral measures be grouped into descriptive domains that characterize MEP? and (2) what relationships exist between biopsychosocial factors across multiple domains of MEP? We formed 6 characteristic domains from 46 MEP-related variables in a secondary analysis of data from 178 individuals (aged 45-85 years) with knee pain. Ratings of pain during 3 functional activities (ie, Balance, Walking, Chair Stand) were used as primary MEP variables. Pearson correlations were calculated to show linear relationships between all individual domain variables. Relationships between variables were further investigated through weighted correlation network analysis. We observed a unique combination of pain characteristics associated with MEP apart from general pain. Notably, minutes doing physical activity were inversely associated with multiple variables within 4 of the 6 domains. Weighted correlation network analysis largely supported our classification of MEP domains. Additional interdomain relationships were observed, with the strongest existing between MEP, Mechanical Pain, and Multiple Pain Characteristics and Symptoms. Additional relationships were observed both within and between other domains of the network. Our analyses bolster fundamental understanding of MEP by identifying relevant mechanistic domains and elucidating biopsychosocial and interdomain relationships.

Real-world multi-target stool DNA longitudinal adherence for colorectal cancer re-screening in a large, national population.

e15633 Background: Colorectal cancer (CRC) is the fourth most diagnosed cancer, as well as the second leading cause of cancer death in the United States – with an estimated 152,810 diagnoses and 53,010 fatal cases in 2024. Regular screening and early detection can reduce CRC incidence and improve overall survival; however, recent national survey data (2021) demonstrate that only 59% of the US screen-eligible population (≥ age 45) is up to date. Home-based, non-invasive CRC screening test options, such as the multi-target stool DNA (mt-sDNA) test, have the potential to improve patient outcomes and overcome CRC screening adherence barriers at multiple levels. Given that the recommended interval for mt-sDNA is three years, a better understanding of use in repeat users is warranted. We evaluated the effective rescreen rate of previous mt-sDNA test users. Methods: In this retrospective cohort study, we included patients between the ages of 45 and 75 years who were shipped an mt-sDNA test kit between January 1st – December 31st, 2023, and had previously completed mt-sDNA screening with a negative result &gt; 2.5 years prior. Our primary variable of interest was mt-sDNA completion rate on repeat testing, defined as kit receipt with a valid result within 120 days of the shipment date. Regression analysis was performed to determine baseline characteristics associated with repeat test completion rate. Results: During the analysis period, a total of 481,748 patients who met the inclusion criteria received an mt-sDNA kit. The majority of the cohort was female (61.4%) and between the ages of 65-75 years (50.9%). Overall repeat test completion rate was 83.6%, with the average time to kit return being 18.9 days. Completion rates were similar between males (83.8%) and females (83.6%), and patients receiving included navigation support via mobile phones demonstrated the shortest average time to kit return (18.7 days). Completion rates increased concordantly with patient age: 81.6%, (45-49 years), 82.2% (50-64 years), and 85% (65-75 years). For first-time rescreen participants (2nd lifetime mt-sDNA test), the completion rate was 83.1%. For second-time rescreen participants (3rd lifetime mt-sDNA test), the completion rate was even higher at 93.6%. Logistic regression analyses revealed that patients re-screening for a second-time were three times more likely to return the mt-sDNA kit for CRC screening (OR = 3.118; p &lt; 0.001). Conclusions: Data from this large, retrospective cohort study revealed that repeat CRC screening with the mt-sDNA test is associated with high adherence to triennial follow-up among participants. suggesting a high-level of perceived patient confidence in repeat performance of the mt-sDNA test. These novel data provide relevant insights regarding strong patient willingness to continue with home-based, non-invasive mt-sDNA testing over multiple cycles of average-risk CRC screening.

Real-world multi-target stool DNA adherence in an underserved and vulnerable prison patient population.

e15632 Background: In 2024, colorectal cancer (CRC) is estimated to be the fourth most diagnosed cancer, as well as the second leading cause of cancer death in the United States. While adherence to regular CRC screening has been suboptimal in the general population, this holds to be especially true in populations that are medically underserved. Non-invasive tests, such as the guideline recommended multi-target stool DNA (mt-sDNA) test, offer a more accessible option to increase screening participation in difficult to reach populations. Herein, we evaluated adherence to CRC screening in a cohort of prisoners who received the mt-sDNA test at a Nebraska Department of Corrections facility in Nebraska. Methods: This was a retrospective cohort study in a small prison population. Participants included both males and females between the ages of 45 and 75 years who underwent CRC screening evaluation at the prison’s medical center between June 1st – December 31st, 2023 and were offered multiple CRC screening options, including the mt-sDNA test. No inducements were provided for completion of the mt-sDNA test. Baseline demographics were collected for cohort description. The primary variable of interest was mt-sDNA test return rate (adherence), defined as completion of the mt-sDNA test within 60 days of kit receipt. We also evaluated mt-sDNA test results in secondary analyses. Results: Once inclusion criteria were applied, the resulting analysis cohort included 129 patients who were first time mt-sDNA screeners. The cohort was largely male (96.9%) and between the ages of 50-64 years (78.3%). Overall mt-sDNA test adherence was 95.3%, with the average time to test completion being 20 days. No significant difference was seen in test completion among males and females (95.2% vs 100%, respectively). Completion rates increased with patient age, at 90.9% (45-49 years), 95% (50-64 years), and 100% (65-75 years). The shortest time to completion in the population was observed amongst patients who were females (18.8 days), and those between the ages of 45-49 years (17.1 days). Negative and positive mt-sDNA test results were observed in 82.9% and 17.1% of the cohort, respectively. Conclusions: CRC screening with the mt-sDNA test in this single-center study of incarcerated participants yielded exceptionally high adherence rates within 60 days of kit receipt. Assessment of follow up colonoscopy rates for test-positive participants is ongoing. While based on a relatively small sample size in this initial study, the mt-sDNA test exhibited favorable completion rates in a difficult to reach population, supporting further efforts to characterize patient, provider, and system-level benefits that may be obtained through broader adoption of this highly accessible screening approach in this challenging healthcare setting.