Probability Of Outcome Research Articles

The impact of SARS-CoV-2 immunization on COVID-19 disease course in people with myasthenia gravis.

There is limited knowledge regarding the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines οn coronavirus disease 2019 (COVID-19) disease course in people with myasthenia gravis. In this study, we aimed to investigate whether SARS-CoV-2 vaccination influences hospitalization and mortality due to COVID-19 in this population. This is a retrospective analysis of administrative data extracted from the Greek nationwide database that holds the COVID-19 disease and vaccination registry, as well as all medical prescription records. The study period extended from the onset of the pandemic (February 2020) until the 10th of January 2022. We identified 278 people with myasthenia gravis (mean age 58.1± 17.2, 47.5% males) who tested positive for SARS-CoV-2. Of those, 139 (50%) were not vaccinated at the time of infection. Multivariable binary logistic regression analysis showed that the probability of hospitalization increased with age (odds ratio [OR]: 1.058; 95% confidence interval [CI], 1.036-1.080; p< .001) and immunosuppressive treatment (OR: 2.872; 95% CI 1.412-5.839; p= .004), and decreased with vaccination (OR: 0.244; 95% CI 0.132-0.453; p< .001). The probability of a fatal outcome increased with age (OR: 1.085; 95% CI 1.043-1.129; p< .001) and decreased with vaccination (OR: 0.315; 95% CI 0.125-0.791; p= .014). SARS-CoV-2 vaccination significantly reduces hospitalization and mortality due to COVID-19 in people with myasthenia gravis. This study regarding the efficacy of these vaccines, together with previous studies regarding their safety, provide evidence to support their use in people with myasthenia gravis.

Usutu virus: a Flavivirus on the rise amid COVID-19 and monkeypox

Usutu virus: a Flavivirus on the rise amid COVID-19 and monkeypox

Полиморфные варианты генов ферментов системы детоксикации ксенобиотиков CYP2E1, GSTM1, GSTT1, EPHX1 как биомаркеры чувствительности к экспозиции побочными продуктами водоподготовки (на примере хлороформа)

Chloroform accumulation in the body and the increase in its steady-state concentrations in blood of exposed people have been established to be associated with polymorphisms of enzyme genes in a genotype involved in metabolism of water disinfection byproducts (A415G of EPHX1 gene, C1091T of CYP2E1 gene, zero mutations of GSTT1 and GSTM1 genes) (р &lt; 0.000001). These polymorphisms in a genotype correlate with higher chloroform levels in blood of people consuming chlorinated drinking water: by 43.8 % and higher for GSTM1 gene polymorphism; by 68.2 % and higher for GSTT1; by 80.4 % and higher for EPHX1 (р &lt; 0.01). EPHX1 genetic polymorphism makes chloroform accumulation much more probable (levels in blood ≥ Р75), which is the most pronounced when combined with GSTТ1 genetic polymorphism. The study results allow us to consider hetero- and homozygous polymorphic genotypes AG/GG for the EPHX1 gene, CT/TT for the CYP2E1 gene, and the null allele in the GSTT1 and GSTM1 genes as genetic predisposition factors for chloroform accumulation in the body. This increases the probability of health outcomes associated with chronic exposure to this disinfection byproduct. The A415G polymorphism of the EPHX1 gene and null alleles of GSTT1 gene, their combinations including the combination with the null allele of the GSTM1 gene and/or the C1091T polymorphism of the CYP2E1 gene can be used as the most informative biomarkers of sensitivity when assessing risks associated with exposure to trihalomethanes (chloroform) at levels not exceeding MPC in water.

Abstract Number ‐ 207: Modeling Optimal Patient Transport in a Stroke Network Capable of Remote Telerobotic Endovascular Therapy

Introduction Endovascular therapy (EVT) is the standard‐of‐care for large vessel occlusion stroke; however, timely access to treatment is still limited for a large proportion of the population. Telerobotic EVT has the potential to decrease time to treatment and expand existing networks of care to more rural populations. It is currently unclear how its implementation would impact existing stroke networks. Methods Conditional probability models were generated to predict the probability of excellent outcome (modified Rankin Scale 0–1 at 90 days post stroke) for patients with suspected large vessel occlusion (LVO). A baseline stroke network was created for California using existing intravenous thrombolysis (IVT) centers and comprehensive stroke centers (CSCs) capable of IVT and EVT. Optimal transport decisions and catchment areas were generated for the baseline model and three hypothetical scenarios through conversion of IVT centers at various distances from a CSC into centers capable of Telerobotic EVT [i.e. hospitals ≥ 15 and &lt; 50 miles from a CSC were converted (Scenario 1), ≥ 50 and &lt; 100 miles (Scenario 2), and ≥ 100 miles (Scenario 3)]. Catchment areas were calculated for each scenario using varied robotic procedural delay times and success rates. Results In the baseline model, 51 hospitals were designated as CSCs and 142 hospitals were designated IVT centers. Conversion of IVT centers into Telerobotic EVT centers decreased median travel time for LVO patients in all three scenarios. The estimated number of robotically treated LVOs per year in Scenarios 1, 2, and 3 were 2172, 740, and 212, respectively. Scenario 1 (15‐50 miles) was the most sensitive to robotic time delay and success rate, but all three scenarios were more sensitive to decreases in procedural success rate compared to time delay. Conclusions Telerobotic EVT has the potential to improve care for stroke patients outside of major urban centers. Compared to procedural time delays in robotic EVT, a decrease in procedural success rate would not be well tolerated. This modeling analysis can inform system planning for the potential advent of remote EVT care.

Polymorphisms of xenobiotic metabolism enzyme genes cyp2e1, gstm1, gstt1, ephx1 as biomarkers of sensitivity to exposure to water disinfection byproducts (using chloroform as an example)

Chloroform accumulation in the body and the increase in its steady-state concentrations in blood of exposed people have been established to be associated with polymorphisms of enzyme genes in a genotype involved in metabolism of water disinfection byproducts (A415G of EPHX1 gene, C1091T of CYP2E1 gene, zero mutations of GSTT1 and GSTM1 genes) (р &lt; 0.000001). These polymorphisms in a genotype correlate with higher chloroform levels in blood of people consuming chlorinated drinking water: by 43.8 % and higher for GSTM1 gene polymorphism; by 68.2 % and higher for GSTT1; by 80.4 % and higher for EPHX1 (р &lt; 0.01). EPHX1 genetic polymorphism makes chloroform accumulation much more probable (levels in blood ≥ Р75), which is the most pronounced when combined with GSTТ1 genetic polymorphism. The study results allow us to consider hetero- and homozygous polymorphic genotypes AG/GG for the EPHX1 gene, CT/TT for the CYP2E1 gene, and the null allele in the GSTT1 and GSTM1 genes as genetic predisposition factors for chloroform accumulation in the body. This increases the probability of health outcomes associated with chronic exposure to this disinfection byproduct. The A415G polymorphism of the EPHX1 gene and null alleles of GSTT1 gene, their combinations including the combination with the null allele of the GSTM1 gene and/or the C1091T polymorphism of the CYP2E1 gene can be used as the most informative biomarkers of sensitivity when assessing risks associated with exposure to trihalomethanes (chloroform) at levels not exceeding MPC in water.

Utility of triage shock index in predicting patient outcome in calcium channel blocker poisoning

Introduction:Shock index is defined as heart rate divided by systolic blood pressure. It is reported as a predictor of morbidity and mortality in trauma and acute myocardial infarction in previous studies. It may be valuable in evaluation of calcium channel blocker poisoning. The objective of this study is to examine the probability of serious outcome based on first measured shock index in patients who presented to emergency department with calcium channel blocker poisoning.Methods:A retrospective chart review was conducted on calcium channel blocker poisoning cases in Hong Kong Poison Information Centre from 1 July 2008 to 30 June 2017. Shock index was calculated with blood pressure and pulse measurement at emergency department triage. Odds ratios of various variables for major outcome, mortality, intensive care unit admission, length of stay in acute hospital were calculated by multivariate analysis or negative binomial regression where appropriate. The performance of shock index in predicting major outcome was evaluated with receiver operating characteristic curve.Results:A total of 390 cases were identified, of whom 25.1% developed major outcome and 5.6% died. Shock index showed significant association with major outcome (odds ratio: 17.017, 95% confidence interval: 5.521–52.455). The area under the receiver operating characteristic curve for shock index in predicting major outcome was 0.7008 (95% confidence interval: 0.64–0.76).Conclusion:Higher shock index is associated with worse patient outcome in calcium channel blocker poisoning. However, shock index alone is not reliable in predicting patient outcome. Further research is needed before shock index can be incorporated for use in patient management in poisoning with calcium channel blocker or other anti‐hypertensives.

Demonstration of quantum correlations that are incompatible with absoluteness of measurement

Exploiting the tension between the two dynamics of quantum theory (QT) in the Wigner's Friend thought experiment, we point out that the standard QT leads to inconsistency in observed probabilities of measurement outcomes between two superobservers: Wigner and his Student. To avoid such inconsistent predictions of QT, we hypothesize two distinct perspectives. The first one is ``absoluteness of measurement (AoM),'' that is, any measurement process is an absolute event irrespective of other observers and yields a single outcome. The other is ``nonabsoluteness of measurement (NoM)'' as the negation of AoM. We introduce an operational approach, first with one friend and then with two spatially separated friends, to test the validity of these two perceptions in quantum theory without assuming the details of the experiment. First, we show that the set of probabilities obtainable for NoM is strictly larger than the set obtainable for AoM. We provide the simplest scenario so far, involving a single quantum preparation and one unitary operation by a superobserver that can demonstrate correlations incompatible with AoM. Remarkably, in the scenario with spatially separated observers, we present a strict hierarchy among the sets of probabilities observed in the following three theories: classical or local realist, quantum theory with AoM, and quantum theory with NoM.

The nonalcoholic fatty liver risk in prediction of unfavorable outcome after stroke: A nationwide registry analysis

Few researches have looked at the relationship between nonalcoholic fatty liver disease (NAFLD) at the time of admission and the long-term outcomes of patients suffering from acute ischemic stroke (AIS). We aimed to probe the relationship between NAFLD risk evaluated by NAFLD indices and long-term endpoints, along with the prognostic value of merging NAFLD indices with established risk markers for the prognosis of AIS patients. The fatty liver index (FLI) and the Hepatic steatosis index (HSI) were used to evaluate NAFLD risk in the Third China National Stroke Registry (CNSR-III), a large, prospective, national, multicenter cohort registry study. NAFLD was defined as FLI ≥35 for males and FLI ≥ 20 for females, as well as HSI>36. Death or major disability (modified Rankin Scale score ≥3) were the primary outcomes following the beginning of a stroke. On patient outcomes, the prognostic performance of two objective NAFLD parameters was evaluated. NAFLD was detected in 32.10-51.90% of AIS patients. After 1-year, 14.5% of the participants had died or suffered a severe outcome. After controlling for known risk factors, NAFLD was associated with a modest probability of adverse outcome (odds ratio,0.72[95% CI, 0.61-0.86] for FLI; odds ratio,0.68[95% CI, 0.55-0.85] for HSI). The inclusion of the two NAFLD indicators in the conventional prediction model was justified by the integrated discrimination index, continuing to increase the model's overall predictive value for long-term adverse outcomes. NAFLD risk was linked to a lower risk of long-term death or major disability in people with AIS. The predictive value of objective NAFLD after AIS was demonstrated in our study.

Managing human activity and marine mammals: A biologically based, relativistic risk assessment framework

Presented here is a broadly applicable, transparent, repeatable analytical framework for assessing relative risk of anthropogenic disturbances on marine vertebrates, with the emphasis on the sound generating aspects of the activity. The objectives are to provide managers and action-proponents tools with which to objectively evaluate drivers of potential biological risk, to identify data gaps that limit assessment, and to identify actionable measures to reduce risk. Current regulatory assessments of how human activities (particularly those that produce sound) influence the likelihood of marine mammal behavioral responses and potential injury, rely principally on generalized characterizations of exposure and effect using simple, threshold-based criteria. While this is relatively straightforward in regulatory applications, this approach fails to adequately address realistic site and seasonal scenarios, other potential stressors, and scalable outcome probabilities. The risk assessment presented here is primarily based on a common and broad understanding of the spatial-temporal-spectral intersections of animals and anthropogenic activities, and specific examples of its application to hypothetical offshore wind farms are given. The resulting species- and activity-specific framework parses risk into two discrete factors: a population’s innate ‘vulnerability’ (potential degree of susceptibility to disturbance) and an ‘exposure index’ (magnitude-duration severity resulting from exposure to an activity). The classic intersection of these factors and their multi-dimensional components provides a relativistic risk assessment process for realistic evaluation of specified activity contexts, sites, and schedules, convolved with species-specific seasonal presence, behavioral-ecological context, and natural history. This process is inherently scalable, allowing a relativistic means of assessing potential disturbance scenarios, tunable to animal distribution, region, context, and degrees of spatial-temporal-spectral resolution.

Adolescent Pregnancy Outcomes and Risk Factors.

One of the major social and public health problems in the world is adolescent pregnancy. Adolescent pregnancy is strongly associated to less favorable results for both the mother and the newborn. We conducted this research to ascertain the impact of teenage age on neonatal outcomes and also observed the lifestyles of pregnant teenage girls. We conducted a study of 2434 mothers aged ≤19 years (n = 294) or 20-34 years (n = 2140) who gave birth in 2019-2020 at the Department of Gynaecology and Obstetrics of Louis Pasteur University Hospital in Košice. The data on mothers and newborn infants have been reported from the reports on mothers at childbirth. Women between the ages of 20 and 34 served as the reference group. The teenage mothers were more likely to become pregnant if they were unmarried (OR = 14.2; 95% CI = 9.3-21.6; p < 0.001) and had a basic education or lack of education (OR = 16.8; 95% CI = 11.5-24.6; p < 0.001). Additionally, they were more likely to smoke when pregnant (OR = 5.0; 95% CI = 3.8-6.6; p < 0.001). Low birth weight was more common in newborns born to adolescent mothers than in those born to adult mothers (p < 0.001). Our findings showed that infants of teenage mothers often had lower birth weights (-332.6 g, p < 0.001). Adolescent mothers were associated with lower Apgar scores at the first minute (p = 0.003). As compared with the control group, pregnant teenage girls had a greater prevalence of preterm deliveries in our research (p = 0.004). This study finds significant age-related disparities in neonatal outcomes between mothers. These results might be used to identify vulnerable groups who need special assistance and actions to reduce the probability of negative outcomes for such groups.

Independent value of PMOI on hCG day in predicting pregnancy outcomes in IVF/ICSI cycles.

The aim of this study was to determine whether, on the day of human chorionic gonadotropin (hCG) injection, the progesterone to number of mature oocytes index (PMOI) can be used alone or together with other parameters in a fresh embryo transfer in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycle to predict pregnancy outcome. This was a retrospective cohort study of all couples who underwent a clinical pregnancy and received a fresh IVE/ICSI cycle at a single large reproductive medical center between June 2019 and March 2022. The study involved a total of 1239 cycles. To analyze risk factors associated with pregnancy outcomes on the day of HCG injection, univariate and multivariate logistic regression analyses were used. The area under the curve (AUC) was determined, and PMOI and other factors were compared using receiver operating characteristic (ROC) curves. The clinical pregnancy rate was significantly higher in group A (60.76%) than in the other groups (Group B: 52.92% and Group C:47.88%, respectively, p =0.0306). Univariate and multivariate logistic regression revealed that PMOI levels were significantly correlated with the probability of pregnancy outcome, independent of other risk factors. More importantly, PMOI levels independently predict the occurrence of pregnancy outcome, comparable to the model combining age. The optimal serum PMOI cutoff value for pregnancy outcome was 0.063 ug/L. Our results suggest that PMOI levels have an independent predictive value for pregnancy outcome in fresh IVF/ICSI cycles.

Gender differences in "optimistic" information processing in uncertain decisions.

Decision-makers often are faced with uncertain situations in which they have incomplete information. While risky decisions include the probabilities of the possible outcomes, ambiguous decisions involve both unknown probabilities and unknown outcomes. Prior research has suggested that there are differences in how men and women evaluate risk, but evidence related to gender and ambiguity is mixed. The present work approaches this problem from a novel angle, focusing on the use of information that is present rather than the impact of information that is absent. It examines how individuals assign value in uncertain decisions based on the partial information they do have. While a main effect of gender on value is not observed, there is an enhanced "optimism bias" in how both favorable and unfavorable information influences the subjective value of ambiguous financial prospects for male compared to female participants. Unpacking these effects suggests multiple mechanisms, including a significant contribution of risk processing. Specifically, favorable and unfavorable information are over- and underweighted respectively in male participants' estimated likelihood of a winning outcome, and unfavorable information is underweighted in estimating certainty. There also is an interaction of gender and risk preferences, such that value increases more for male participants as the subjectively estimated likelihood of winning increases. A second experiment demonstrates this risk interaction effect is alsoobserved for objective probabilities of winning, suggesting that the relationship between value and risk uses similar mechanisms across layers of uncertainty.

Towards a Low-Cost Comprehensive Process for On-Farm Precision Experimentation and Analysis

Few mechanisms turn field-specific ecological data into management recommendations for crop production with appropriate uncertainty. Precision agriculture is mainly deployed for machine efficiencies and soil-based zonal management, and the traditional paradigm of small plot research fails to unite agronomic research and effective management under farmers’ unique field constraints. This work assesses the use of on-farm experiments applied with precision agriculture technologies and open-source data to gain local knowledge of the spatiotemporal variability in agroeconomic performance on the subfield scale to accelerate learning and overcome the bias inherent in traditional research approaches. The on-farm precision experimentation methodology is an approach to improve farmers’ abilities to make site-specific agronomic input decisions by simulating a distribution of economic outcomes for the producer using field-specific crop response models that account for spatiotemporal uncertainty in crop responses. The methodology is the basis of a decision support system that includes a six-step cyclical process that engages precision agriculture technology to apply experiments, gather field-specific data, incorporate modern data management and analytical approaches, and generate management recommendations as probabilities of outcomes. The quantification of variability in crop response to inputs and drawing on historic knowledge about the field and economic constraints up to the time a decision is required allows for probabilistic inference that a future management scenario will outcompete another in terms of production, economics, and sustainability. The proposed methodology represents advancement over other approaches by comparing management strategies and providing the probability that each will increase producer profits over their previous input management on the field scale.

People prefer to predict middle, most likely quantitative outcomes (not extreme ones), but they still over-estimate their likelihood.

Past work showed a tendency to associate verbal probabilities (e.g., possible, unlikely) with extreme quantitative outcomes, and to over-estimate the outcomes' probability of occurrence. In the first four experiments (Experiment 1, Experiments 2a-c), we tested whether this "extremity effect" reflects a general preference for extreme (vs central or less extreme) values of a distribution. Participants made predictions based on a frequency distribution in two scenarios. We did not find a preference for extreme outcomes. Instead, most of the participants made a prediction about the middle, most frequent outcome of the distribution (i.e., the modal outcome), but still over-estimated the outcomes' probabilities. In Experiment 3, we tested whether the over-estimation could be better explained by an "at least"/"at most" reading of the predictions. We found that only a minority of participants interpreted predictions as the lower/upper bounds of an open interval and that these interpretations were not associated with heightened probability estimates. In the final three experiments (Experiments 4a-c), we tested whether participants perceived extreme outcome predictions as more correct, useful and interesting than modal outcome predictions. We found that extreme and modal predictions were considered equally correct, but modal predictions were judged most useful, whereas extreme predictions were judged to be more interesting. Overall, our results indicate that the preference for extreme outcomes is limited to specific verbal probability expressions, whereas the over-estimation of the probability of quantitative outcomes may be more general than anticipated and applies to non-extreme values as well.

The Effects of Orthoptic Therapy on the Surgical Outcome in Children with Intermittent Exotropia: Randomised Controlled Clinical Trial

To assess the clinical effectiveness of orthoptic therapy in the postoperative stabilisation and rehabilitation of binocular function in children with intermittent exotropia (IXT) after surgery. This was a prospective, parallel, randomised controlled trial. A total of 136 IXT patients (aged from 7 to 17 years) who had been successfully corrected at 1 month after surgery were enrolled in this study, and 117 patients (58 controls) completed the 12-month follow-up visit. The primary outcome was established as the proportion of patients with suboptimal surgical outcomes, which were defined as: (1) exodeviation ≥10 prism diopters (PD) at distance or near using the simultaneous prism and cover test (SPCT), or (2) constant esotropia ≥6 PD at distance or near using SPCT, or (3) loss of 2 or more octaves of stereopsis from baseline. The secondary outcomes were the exodeviation at distance and near using the prism and alternate cover test (PACT), stereopsis, fusional exotropia control and convergence amplitude. The cumulative probability of suboptimal surgical outcome by 12 months was 20.5% (14/68) in the orthoptic therapy group and 42.6% (29/68) in the control group. There was a significant difference between these two groups (χ2 = 7.402, p = 0.007). Improvements in stereopsis, fusional exotropia control and fusional convergence amplitude were found in the orthoptic therapy group. A smaller exodrift was found in the orthoptic therapy group at near fixation (t = 2.26, p = 0.025). Early postoperative orthoptic therapy can effectively improve the surgical outcome as well as stereopsis and fusional amplitude.

Developing a machine learning algorithm to predict probability of retear and functional outcomes in patients undergoing rotator cuff repair surgery: protocol for a retrospective, multicentre study

IntroductionThe effectiveness of rotator cuff tear repair surgery is influenced by multiple patient-related, pathology-centred and technical factors, which is thought to contribute to the reported retear rates between 17% and...

Abstract WMP62: Stroke Severity Is The Primary Mediator Of Increased Stroke Mortality In The Elderly

Background: The risk of ischemic stroke mortality increases with age, but the impact of stroke severity on this relationship has not been fully examined. Methods: We included adults in the National Inpatient Sample from 2016-2019 who had a primary discharge diagnosis of ischemic stroke (I63*) and a baseline NIH Stroke Scale (NIHSS). The primary outcome was in-hospital death. The exposure of age had left skew, so we transformed it into deciles. We fit a logistic regression model adjusted for sex, race/ethnicity, diabetes, atrial fibrillation, hypertension, thrombolytic therapy, and endovascular therapy. We report the predicted probability of the primary outcome with and without NIHSS and use structural equation modeling (SEM) to estimate the proportion of age’s effect on the primary outcome that is mediated by stroke severity. Results: We included 138,637 individuals, of which 3.5% died in-hospital. The proportion of in-hospital death and an NIHSS violinplot by decile of age are seen in Figure 1, both of which had a positive linear relationship. The AUC of the multivariable model without NIHSS was 0.70 and with NIHSS was 0.86 (p&lt;0.001). The predicted probability of death is seen without and with NIHSS in Figure 2, illustrating the importance of adjusting for NIHSS. In the SEM model, we observed that 57.7% of age’s effect on in-hospital death is mediated by stroke severity. Conclusions: We found that elderly individuals in the United States have more severe stroke and higher stroke mortality, but the effect of age on stroke mortality is primarily mediated by elderly individuals having more severe stroke. Additional research is needed to better understand this novel finding.

Abstract WP12: The Golden 75 Min And Black 120 Min For Acute Basilar Artery Occlusion Intervention: Effect Of Procedure Time On Outcome

Background and Objectives: Previous studies have shown the impact of procedure time (PT) on large vessel occlusion (LVO), however, the relationship for patients with acute basilar artery occlusion (ABAO) was not clear. We aimed to characterize the impact of PT and other procedure-related variables on clinical outcomes among patients with ABAO that underwent mechanical thrombectomy (MT). Methods: Patients with ABAO that underwent MT with a documented PT in the BASILAR study from January 2014 to May 2019 among 47 comprehensive centers in China were included. Multivariable analysis was performed to reveal the association between PT and 90-day modified Rankin Scale score, mortality, complications, and all-cause death at one year. Results: Of the 829 patients from the BASILAR registry, 633 eligible patients were included. A decreased likelihood of favorable outcomes (defined as a modified Rankin Scale score of 0-3 at 90 days) was demonstrated when PT exceeded 60 min (P &lt; 0.001). Additionally, a PT ≤ 75 min independently predicted favorable outcomes (adjusted OR 2.28[95% CI 1.41- 3.68], respectively). The risk of complications and mortality increased by 0.5% and 1.5% with every 10 min increase in PT, respectively (R 2 = 0.64 and R 2 = 0.68, P &lt;0.01). The cumulative rates of favorable outcomes and successful recanalization plateaued after 120 min (2 attempts). Restricted cubic spline regression analysis for the probability of favorable outcomes had an L-shape association (P non-linearity = 0.048) with PT with significant benefit loss before 120 min and then appeared relatively flat. Discussion: For ABAO patients, procedures that exceeded 75 min increased the risk of mortality and decreased the likelihood of a favorable outcome. For procedures exceeding 120 min the benefits and costs of continuing the procedure should be carefully considered. Classification of Evidence: This study provides Class II evidence for ABAO patients undergoing EVT.

Abstract TP9: Examining Predictors Of Functional 90-day Outcome Among Stroke Patients With Active Cancer Receiving Endovascular Therapy

Introduction: Intraarterial therapy (IAT) is the standard of care for all AIS patients, even those with active cancer. However, there is little information on the characteristics that may contribute to a functional 90-day modified Rankin scale (mRS 0-2) score for AIS patients with active cancer undergoing IAT. Methods: This retrospective study included patients (age ≥ 18) admitted from 07/18-10/20 with AIS and were treated by IAT. AIS patients with large artery occlusion who had active cancer were identified. Baseline characteristics and outcomes were evaluated to determine predictors of a functional outcome at 90 days. Outcomes were also compared to those without active cancer during the same period. The receiver operating characteristic area under the curve (AUC) was used to determine optimal admission national institutes of health scores (NIHSS) to obtain a 90-day mRS of 0-2. Results: Of the 453 patients who received IAT, 12% had active cancer. Overall, patients were a majority male (50%), a median of 70 (60-81) years of age and had an admission NIHSS of 14 (7-20). Compared to patients without cancer, patients with cancer experienced significantly more thromboembolic events during their hospital stay (40% vs. 11%, p&lt;0.001), but functional outcomes at 90-days were not different between groups. In active cancer patients, an admission NIHSS cut-off of 8.2 (AUC:0.72 (confidence interval (CI): 0.58-0.86), p=0.001) indicating strong fit, and experiencing less thromboembolic events, were significantly associated with functional independency at 90 days. However, the admission NIHSS cut-off for patients without cancer for predicting a functional outcome was 10.5 (AUC: 0.66 (CI: 0.60-.71), p&lt;0.001), indicating moderate fit. Receiving intravenous tissue type plasminogen activator (IV-tPA) and successful reperfusion were other significant predictors of a functional outcome for non-cancer patients. Conclusions: In our population, using an NIHSS cut-off of 8.2 for patients with active cancer in determining who should receive IAT may increase the probability of a favorable 90-day outcome. An admission NIHSS of 10.5 was moderately associated with functional outcome at 90 days, in addition to successful reperfusion and receiving IV-tPA in non-cancer patients.

Chemomechanical energy regulates time-dependent changes in thin filament activation.

Muscle activation is a reaction that turns on and off as a binary switch, which sharpens the contrast between two proposals for the energy of activation, namely, allosteric or chemomechanical. Binary switching rules out sequential allosteric models. That a segment rather than the entirety of the thin filament switches on and off rules out the concerted allosteric model. By contrast, switching data fit a model in which mechanical energy is combined in the Gibbs-Duhem equation for binary change in probability of M-state. To be consistent with a binary system, the probability of M-state is the extensive conjugate of mechanical energy in modified Gibbs-Duhem (mGD). Time dependent changes of mGD accurately predict that a source of mechanical impulses, such as driven by myosin, shifts the probability of a switch to longer times. From time dependent mGD, we derived a set of probable outcomes (mGD sample space), that can be tested by observing switching behavior of individual segments. Sample space mGD predicts that a segment in M-state moves a single unloaded thin filament at the unregulated actomyosin rate for the time the switch is on. Because load acts specifically on mechanical energy, a load can change the probability of M-state in sample space mGD by a mechanism consistent with the extensive variable, such as forced addition of subunits to a segment in M-state. Continuous sum produces a sample space for the time dependent response of ensemble units. Overlap of myosin S-1 in the sarcomere determines the size of the ensemble. Although sample space mGD does not vary by the number of subunits, changes in ensemble size change the amplitude of the response. Normalizing amplitude to overlap by careful experimentation is required for comparison with sample space mGD.