Differences Research Articles

Trends of Diphtheria–Tetanus–Pertussis and Measles Vaccine Coverage Preceding and during the COVID-19 Pandemic: An Analysis of the WHO European Region from 2000 to 2022

Available data highlights the significant impact of the COVID-19 pandemic on global vaccination trends. Despite this, comprehensive evaluations of these changes at the European level are still scarce. This study examines coverage for diphtheria, tetanus, and pertussis (DTP) and measles-containing vaccines (MCV) in the WHO European Region from 2000 to 2022. Vaccination coverage data, defined as the percentage of surviving infants who received the first and third doses of DTP (DTP1 and DTP3) and the first and second doses of MCV (MCV1 and MCV2), were extracted from UNICEF databases. Joinpoint regression analysis was employed to identify joinpoints in the time series and to estimate Annual Percent Changes (APCs) and Average Annual Percent Changes (AAPCs) over predefined timeframes. The coverages for DTP1 and MCV1 exhibit a similar trend, overall characterized by four joinpoints, one of which is in 2019. In contrast, the coverage for DTP3 does not show a significant temporal trend and lacks joinpoints, while the vaccination coverage for MCV2 shows a steadily increasing trend, with three identified joinpoints. A comparative analysis with the pre-pandemic period reveals a significant increase in the number of countries characterized by a decreasing trend during the pandemic period for all considered vaccination coverages, as indicated by the negative AAPC values. These results highlight the effect of the pandemic on childhood vaccination coverage. Compared to a mere descriptive analysis, the temporal analysis of trends using joinpoint regression provides significant opportunities to identify variations in vaccination coverages and pinpoint areas for intervention in future vaccination strategies.

Trends and socio-demographic determinants of suicide-related mortality in Türkiye: An epidemiological study from 2009 to 2022.

Suicide is a leading cause of death, particularly among the young age group, in Türkiye, a country with a high population of young people. The aim of this study is determine the suicide related mortality trend and some associated socio-demographic factors in Türkiye between 2009 and 2022. The study includes an epidemiological trend on suicide. The Turkish Statistical Institute's data portal was used. The study population is 46,691 people (Male/female ratios = 74.6%/ 25.4%). Changes in mortality trends were evaluated using the Joinpoint Regression method with Annual Percentage Change (APC) and Average Percentage Change (AAPC) analysis. Over the past 14 years in Türkiye, there has been a statistically significant increase in the standardized mortality rate among males (2009-2022 APC = .76, p = .012) and a statistically non-significant decrease among females (2009-2022 APC = -1.62, p = .083). According to the Nomenclature of Territorial Units for Statistics (NUTS-1) classification, the highest increase is observed in the Central Anatolia region followed by the Western Black Sea region (APC = 3.0 and 2.7, respectively; p < .005). While the percentage of primary school and below has decreasing trends (2009-2022 APC = -7.11, p < .005), there is a significant increase in the percentage of university graduates (2009-2016 APC = 10.87, p < .001). Regarding the marital status, there is a significant decrease in the percentage of those who are married (2009-2013 APC = -3.36, p < .001; 2013-2016 APC = 2.42, p = .037; 2016-2022 APC = -2.31, p = .003) and a significant increase in those who have never been married (2009-2013 APC = 2.63, p < .001; 2013-2016 APC = -1.36, p = .002). Although suicide related mortality is below the global average, there has been an increasing trend in turkey in the last 14 years. Analytical and intervention studies on the socio-demographic determinants supporting the increasing trend are needed.

Effects of Acute and One-Week Supplementation with Montmorency Tart Cherry Powder on Food-Induced Uremic Response and Markers of Health: A Proof-of-Concept Study

Metabolic conditions, such as gout, can result from elevated uric acid (UA) levels. Consuming high-purine meals increases UA levels. Therefore, people with hyperuricemia typically must avoid ingesting such foods. Polyphenols have been shown to reduce uric acid levels and tart cherries (TCs) are a rich source of phenolic and anthocyanin compounds. This proof-of-concept study evaluated whether ingesting TCs with a purine-rich meal affects the uricemic response. Methods: A total of 25 adults (15 males and 10 females, 85.0 ± 17 kg, 40.6 ± 9 years, 29.1 ± 4.9 kg/m2) with elevated fasting UA levels (5.8 ± 1.3 mg/dL) donated a fasting blood sample. In a randomized, double-blind, crossover, placebo-controlled, counterbalanced manner, participants ingested capsules containing 960 mg of a placebo (PLA) or concentrated TC powder containing 20.7 mg of proanthocyanins with a serving of hot soup (10 g of carbohydrate, 2 g protein, and 1 g fat) containing 3 g of purines (1 g of adenosine 5′-monophosphate, 1 g of disodium 5′-guanylate, and 1 g of disodium 5′-inosinate). Blood samples were obtained at 0, 60, 120, 180, and 240 min after ingestion to assess changes in uric acid levels and pharmacokinetic profiles. Cell blood counts, a comprehensive metabolic panel, cytokines, inflammatory markers, and subjective side effects ratings were analyzed on baseline (0 min) and post-treatment (240 min) samples. Participants continued consuming two capsules/day of the assigned treatment for one week and then repeated the experiment. Participants observed a 14-day washout and then repeated the experiment while ingesting the alternate treatment. Data were analyzed using general linear model (GLM) statistics with repeated measures, pairwise comparisons, and percentage change from baseline with 95% confidence intervals (CIs). Results: No statistically significant interaction effects or differences between treatments were seen in uric acid levels or PK profiles. Analysis of percent changes from baseline revealed that TC ingestion reduced the blood glucose levels following the ingestion of the high-purine meal (−4.2% [−7.7, −0.7], p = 0017). Additionally, there was some evidence that TC ingestion attenuated the increase from baseline in IL-1β and IL-10 and increased INF-γ. No significant differences were seen in the remaining health markers or subjective side effects ratings. Conclusions: Acute and one-week TC supplementation did not affect the uricemic response to ingesting a high-purine meal in individuals with mildly elevated UA levels. However, there was some evidence that TC supplementation may blunt the glycemic response to ingesting a meal and influence some inflammatory cytokines. Registered clinical trial NCT04837274.

Early childhood intervention and children's health development : Exemplary findings and methodological challenges in the use of the school entry examination

Early childhood intervention is intended to systematically network and customise support services, particularly for socio-economically disadvantaged families. The programmes are universal or selective, but the evidence on their effectiveness is limited. The aims of this study were to exemplary analyse whether participants in early childhood intervention services had better development than non-participants using the school entry examination (SEE) as well as to discuss to what extent the SEE can be used to assess the impact of early childhood intervention services. We analysed three typical offers of early childhood intervention services (family education; Zukunft für Kinder (ZfK); Kita-U) in relation to full vaccination coverage and age-appropriate development at U9. Data from 4579 Düsseldorf first graders were included. Propensity score matching was used to calculate percentage differences (average treatment effect on the treated; ATT) in terms of immunisation coverage and development between comparable intervention and control groups. All programmes are associated with aslightly increased probability of full vaccination protection (ATT2.1 for family education; 2.5 for ZfK; 5.3 for Kita-U). Family education is also associated with aslightly higher probability of age-appropriate development (ATT 1.6), while the probability of age-appropriate development is lower for participants in ZfK (-10.1) and Kita‑U (-4.5). The evaluation of early childhood intervention, especially selective services, is amethodological challenge due to confounding and suitable comparison groups. However, the SEE could be aframework for impact analyses under specific conditions.

Bedside 3D ultrasound fistula maturation assessment by non-expert sonographers provides equivalent accuracy to formal duplex sonography: A prospective clinical trial.

EchoSure is an automated point-of-care 3D ultrasound (3DUS) designed to be used by dialysis technicians without advanced ultrasound training. The EchoMark/EchoSure System is a two-part system comprised of a bioresorbable implant, EchoMark, and a diagnostic ultrasound imaging platform, EchoSure. EchoSure was designed to enable any healthcare personnel in a dialysis clinic setting to obtain non-invasive, direct measurements of flow and vessel parameters that are critical quantifications used in the assessment of AVF maturation and readiness for hemodialysis cannulation. In this pilot feasibility study, we sought to explore whether use of an automated 3DUS could enable fistula assessment by non-experts and obtain measurement accuracy comparable to expert sonographer Duplex. This was a 20 subject prospective multicenter trial conducted at four sites in the United States. All subjects had an EchoMark implanted under their AVF during the fistula creation procedure. Subjects were evaluated at 2-weeks post-op with EchoSure and Duplex, followed by monthly assessments until either the 4-month visit or until radiographic maturation was achieved, whichever was longer. Beyond monthly ultrasound assessments, clinical follow-up continued every 6 months between months 6 and 24. Technical success of EchoMark implantation was demonstrated in 100% of subjects. Technical success of EchoSure was 99% across all scans. The mean percent difference in flow rate measurements between EchoSure and Duplex was -9.2% with a standard deviation of 38.1% compared to a mean percent difference of -15.7% with a standard deviation of 35.5% between Duplex measurements taken at the cannulation zone and brachial artery. Pearson correlation between EchoSure and Duplex was 0.708 versus 0.716 for the two Duplex measurements. Radiographic maturation was achieved in 70% of study subjects by 30 days and continued to rise to 90% through 90 days and 95% through 180 days after baseline. This study demonstrates the feasibility and accuracy of an automated 3D ultrasound system for assessment of maturation at the dialysis bedside by non sonographers.

The Diabetes Technology Society Error Grid and Trend Accuracy Matrix for Glucose Monitors.

An error grid compares measured versus reference glucose concentrations to assign clinical risk values to observed errors. Widely used error grids for blood glucose monitors (BGMs) have limited value because they do not also reflect clinical accuracy of continuous glucose monitors (CGMs). Diabetes Technology Society (DTS) convened 89 international experts in glucose monitoring to (1) smooth the borders of the Surveillance Error Grid (SEG) zones and create a user-friendly tool-the DTS Error Grid; (2) define five risk zones of clinical point accuracy (A-E) to be identical for BGMs and CGMs; (3) determine a relationship between DTS Error Grid percent in Zone A and mean absolute relative difference (MARD) from analyzing 22 BGM and nine CGM accuracy studies; and (4) create trend risk categories (1-5) for CGM trend accuracy. The DTS Error Grid for point accuracy contains five risk zones (A-E) with straight-line borders that can be applied to both BGM and CGM accuracy data. In a data set combining point accuracy data from 18 BGMs, 2.6% of total data pairs equally moved from Zones A to B and vice versa (SEG compared with DTS Error Grid). For every 1% increase in percent data in Zone A, the MARD decreased by approximately 0.33%. We also created a DTS Trend Accuracy Matrix with five trend risk categories (1-5) for CGM-reported trend indicators compared with reference trends calculated from reference glucose. The DTS Error Grid combines contemporary clinician input regarding clinical point accuracy for BGMs and CGMs. The DTS Trend Accuracy Matrix assesses accuracy of CGM trend indicators.

8548 Breast Development in Infant Girls: Does Endogenous Estrogen Production During Minipuberty Play a Role?

Abstract Disclosure: M. Goldberg: None. S. Zhao: None. A. Kelly: None. V.A. Stallings: None. D.M. Umbach: None. W.J. Rogan: None. N. Shaw: None. D.P. Sandler: None. Background: Breast tissue, present at birth in most term infants, regresses during infancy but persists longer in girls than boys. In girls, this persistence is thought to be due in part to stimulation by estradiol (E2) produced during minipuberty, the postnatal activation of the hypothalamic-pituitary-gonadal axis. Empirical data are sparse, however. Because E2 concentrations in infant girls fluctuate, repeated E2 measures may be necessary to adequately characterize production across minipuberty and to detect effects on estrogen-sensitive breast tissue. Hypothesis: Higher average exposure to E2 during minipuberty is associated with larger breast bud diameter in late infancy in term females. Methods: We leveraged data from 136 girls from the Infant Feeding and Early Development (IFED) Study, a prospective cohort of reproductive development in term infants enrolled during 2010-2013 from the Philadelphia area. We measured E2 in serum samples collected at study visits every 2-4 weeks from age 2-32 weeks. We assessed breast bud diameter via ultrasound at the 32-week visit. For data analysis, we log2-transformed both E2 and breast bud diameter. For E2 concentrations below the limit of detection (2.99 pg/mL, 35% of samples), we applied multiple imputation. We first calculated the intraclass correlation coefficient (ICC) of repeated E2 to understand the relative magnitude of total variation from within subjects. We then calculated subject-specific mean of E2 across time and estimated associations with breast bud diameter at the 32-week visit using both age- and multivariable-adjusted linear regression models. We present results as percent change in breast bud diameter per doubling in average E2 concentration ([2β-1] x 100%). Results: Most infants were Black (71%) and formula-fed (76%). The median number of E2 measures per girl was 9 (range: 5-10). Most of the variation in E2 concentrations was due to within-individual variation (ICC=0.27). The geometric mean E2 concentration from 2-32 weeks of age was 5.1 pg/mL (95% confidence interval [CI]: 4.7-5.4). The median breast bud diameter at the 32-week visit was 13.7mm (range: 4.4-30.5). A doubling in average E2 concentration across minipuberty was associated with a 26% larger breast bud diameter (95% CI 10-43%). This association was similar after adjustment for feeding method, race, gestational age, neonatal weight, and breast bud diameter at the neonatal visit (percent change: 28%, 95% CI: 12-46%). Conclusions: Our results suggest that endogenous estrogen production in females during minipuberty stimulates the infant breast bud. More research is needed to investigate the potential biologic relevance of this hormonal stimulation of infant breast tissue to later breast development and risk of malignant and benign breast disorders. Presentation: 6/1/2024

6986 Efficacy and Safety of Weekly Liquid Alendronate Sodium Trihydrate in Korean Postmenopausal Women with Osteoporosis: A 12-Month, Multi-Center, Randomized Trial

Abstract Disclosure: Y. Rhee: None. S. Ahn: None. N. Hong: None. D. Seo: None. S. Hong: None. Background: Although alendronate is the most prescribed oral bisphosphonate for osteoporosis treatment, it can lead to gastrointestinal problems, impacting treatment compliance and efficacy. This study aimed to assess the efficacy and safety of once-weekly alendronate sodium trihydrate (ALN-S), an oral solution, compared to once-weekly alendronate sodium (ALN-T), an oral tablet, in Korean postmenopausal women with osteoporosis. Methods: Conducted as a 12-month, multi-center, prospective, randomized, open-labeled, parallel trial at two hospitals in Korea, 170 postmenopausal women were randomized to ALN-S (N=85) or ALN-T (N=85). Bone mineral density (BMD) at the lumbar spine (LS), femoral neck (FN), and total hip (TH) was measured at baseline and after 12 months. Bone turnover markers, including C-telopeptide (CTX) and procollagen type 1 amino-terminal propeptide (P1NP), were assessed at baseline, 6 months, and 12 months. The primary outcome was the percentage change in LS BMD, evaluated for non-inferiority. Results: After 12 months, both ALN-S and ALN-T groups exhibited a significant increase in LS, FN, and TH BMD, with no significant intergroup differences (ALN-S: LS 5.0 ± 0.6%, FN 1.8 ± 0.6%, TH 2.2 ± 0.5%; ALN-T: LS 5.2 ± 0.6%, FN 1.6 ± 0.6%, TH 1.8 ± 0.5%). ALN-S was found to be non-inferior to ALN-T for BMD change at LS (treatment difference: -0.22%, 95% CI: -1.84 to 1.40%), excluding the predefined non-inferiority margin of -2.29%. Changes in both CTX and P1NP over time did not significantly differ between the groups. There was no significant difference in the frequency of adverse events between the groups. Conclusion: Weekly liquid alendronate sodium trihydrate demonstrated non-inferiority to weekly tablet alendronate sodium in increasing LS BMD in Korean postmenopausal women with osteoporosis. Presentation: 6/2/2024

6926 Subgroup Analysis by Gender and Body Mass Index (BMI) in People Living With Overweight/Obesity in the Survodutide, a Glucagon/GLP-1 Receptor Dual Agonist, Phase II Trial

Abstract Disclosure: C.W. Le Roux: Consulting Fee; Self; Boehringer Ingelheim, Novo Nordisk, GI Dynamics, Herbalife, Johnson &amp; Johnson, Eli Lilly, Keyron. O. Steen: Consulting Fee; Self; Eli Lilly &amp; Company, Novo Nordisk, Sanofi. Grant Recipient; Self; Alnylam, Anji, AstraZeneca, Boehringer Ingelheim, Eli Lilly &amp; Company, Janssen, Genzyme Corporation, Medacorp, Novo Nordisk, Medicago, Moderna, Novavax, Pfizer, Sanofi, Zucara Therapeutics, Gilead, ViaCyte, CRISPR Therapeutics, Kowa. Speaker; Self; Amgen Inc, AstraZeneca, Bausch Health, Janssen, LMC, Novo Nordisk. K.J. Lucas: None. E. Startseva: Employee; Self; Boehringer Ingelheim. A. Unseld: Employee; Self; Boehringer Ingelheim. A.M. Hennige: Employee; Self; Boehringer Ingelheim. Aim: To explore the effect of gender and BMI on weight loss and adverse events with survodutide in people living with overweight/obesity. Methods: In this double-blind, placebo (PBO)-controlled Phase II trial (NCT04667377), 387 adults with BMI ≥27 kg/m2 without diabetes were randomized 1:1:1:1:1 to weekly subcutaneous survodutide (0.6, 2.4, 3.6, 4.8 mg) or PBO over 46 weeks. Percentage change in body weight (primary endpoint), absolute change in body weight and waist circumference (secondary endpoints), and adverse events (AEs) were assessed in subgroups based on gender and BMI at baseline (BL). Data were analyzed descriptively for all participants who received ≥1 dose of study drug and had data for ≥1 efficacy endpoint (full analysis set [FAS]; planned treatment: n=384). Results: Of 384 participants, 68.2% (262) were female. At BL, 9.9% (38), 30.5% (117), 31.8% (122), and 27.9% (107) had a BMI of &amp;lt;30, 30-&amp;lt;35, 35-&amp;lt;40, and ≥40 kg/m2, respectively. Demographics and clinical characteristics at BL were similar between males and females and across BMI subgroups. At Week 46, mean percentage change in body weight from BL with survodutide 4.8 mg vs PBO was -11.9% vs -3.3% in males and -17.0% vs -3.2% in females, and -19.1% vs -1.7%, -15.8% vs -3.1%, -15.4% vs -5.8%, and -13.4% vs -0.8% across BL BMI categories. Mean absolute body weight loss from BL (survodutide 4.8 mg vs PBO) was -15.9 vs -4.2 kg in males and -22.0 vs -3.0 kg in females. Reductions in absolute body weight with survodutide 4.8 mg vs PBO were similar across BMI subgroups: -21.3 vs 1.4 kg, -16.2 vs -3.3 kg, -22.2 vs -7.5 kg, and -19.9 vs -1.6 kg. Mean absolute change in waist circumference from BL (survodutide 4.8 mg vs PBO) was -12.8 vs -1.7 cm in males and -17.9 vs -4.9 cm in females, and -8.4 vs -2.6 cm, -14.3 vs -6.4 cm, -17.5 vs -5.0 cm, and -17.2 vs 3.3 cm across BL BMI categories. A higher proportion of participants lost ≥15% of BL body weight with survodutide 4.8 mg vs PBO: 31.8% vs 9.5% in males and 66.7% vs 3.0% in females, and 75.0% vs 14.3%, 57.9% vs 4.5%, 52.0% vs 6.7%, and 50.0% vs 0.0% across BL BMI categories; respectively. All survodutide doses (pooled) were tolerated as expected across gender and BL BMI subgroups. In males vs females, respectively, rates of any AE (87.9% vs 92.4%), serious AEs (4.0% vs 4.3%), and discontinuations due to AEs (25.3% and 24.3%) were comparable. Gastrointestinal (GI) AEs with all survodutide doses were experienced by fewer males (65.7%) than females (79.5%); mild to moderate nausea was the most frequently reported GI AE in both subgroups. Conclusion: After 46 weeks of survodutide treatment, females appeared to lose more body weight and waist circumference than males. Participants with a lower vs higher BL BMI generally lost more proportional body weight, with an opposite trend observed for waist circumference. Presentation: 6/2/2024

12411 Trends In Metabolic Dysfunction-associated Steatotic Liver Disease(MASLD) By Race/ethnicity: Data From NHANES 1988 To 2018

Abstract Disclosure: M. Shaheen: None. K. Schrode: None. D. Pan: None. S.M. Najjar: None. T.C. Friedman: None. Societies of the liver recommended replacing the term non-alcoholic fatty liver disease (NAFLD) with metabolic dysfunction-associated steatotic liver disease (MASLD). This study aimed to investigate the trends in the MASLD prevalence by racial/ethnic among the U.S. adult population overtime. We analyzed data from 32,726 adults in National Health and Nutrition Examination Survey 1988-2018. Hepatic steatosis (HS) was diagnosed using the U.S. Fatty Liver Index. MASLD was diagnosed in individuals with both HS and at least one of the following: overweight/obesity, diabetes mellitus, hypertension, high triglyceride or HDL-Cholesterol or in treatment. Logistic regression was used to test for trends over time for the overall sample and for each racial/ethnic group accounting for design and sample weights. Prevalence estimates were age-adjusted using the direct standardization based on census data. We also estimated the percent change in the adjusted prevalence (change in the adjusted prevalence/baseline adjusted prevalence)*100. The study showed that over the study period, the age-adjusted prevalence of MASLD significantly increased from 16% in 1988 to 38% in 2018, representing a 138% percent increase. Concurrently, the age-adjusted prevalence of obesity increased from 23% in 1988 to 40% in 2018 reflecting a 74% increase (p&amp;lt;0.05). Among Mexican Americans, the age-adjusted MASLD prevalence consistently exceeded that of the overall population and other racial/ethnic groups. Significant increase in the percent change of the age-adjusted prevalence of MASLD was observed across all racial/ethnic groups (Mexican Americans=69%; Blacks=117%; Whites=140%) except Other Hispanics (no change). The age adjusted prevalence of obesity also increased significantly in all racial/ethnic groups (% change: Mexican Americans=58%; Other Hispanics=18%; Blacks=59%; Whites=77%) (p&amp;lt;0.05). Our findings indicated an increase in the age-adjusted prevalence of MASLD over time that surpassing the increase in obesity prevalence. These disparities warrant further investigation and targeted interventions to address MASLD effectively. Grants: R01MD012579, R24DA017298, U54MD007598, S21MD000103, UL1TR001881 Presentation: 6/2/2024

Serum calcium improves the relationship between fluoride exposure and hypothalamic-pituitary-testicular axis hormones levels in males—a cross-sectional study on farmers in the lower reaches of the Yellow River

Numerous studies have reported the toxicity of fluoride to the male reproductive system, but epidemiological evidence is limited. We conducted a cross-sectional study in Kaifeng City, Henan Province in 2011 to explore the association between fluoride exposure and hypothalamic-pituitary-testicular (HPT) axis hormones in men. Morning urinary fluoride (UF), serum HPT axis hormones and serum calcium (SC) concentrations were detected. Percent changes and 95% confidence intervals in HPT axis hormones associated with UF were estimated using adjusted linear regression models, and performed subgroup analysis based on SC levels. The restricted cubic spline model was used to fit nonlinear relationships. For every 10% increase in UF, the concentrations of serum GnRH, T, SHBG and TSI decreased by 2.13%, 2.39%, 2.19% and 1.96%, while E2 and FEI increased by 1.11% and 3.33%. Subgroup analysis showed that for every 10% increase in UF, the levels of GnRH, T, TSI and FTI decreased by approximately 3.15%, 5.49%, 4.47% and 5.14%, while the E2 level increased by 2.92% in low-serum-calcium group (LCG). The levels of GnRH and T decreased by approximately 2.97% and 1.82% in medium-serum-calcium group (MCG). In high-serum-calcium group (HCG), serum SHBG levels decreased by 4.70%, while FTI and FEI levels increased by 4.93% and 4.20% as UF concentration increased (P < 0.05, respectively). The non-linear relationship between serum GnRH and UF concentrations presented an approximately inverted U-shaped curve, with a turning point UF concentration of 1.164 mg/L (P < 0.001), and their nonlinear relationship in LCG and MCG were similar to that in the overall subjects. In conclusion, excessive exposure to fluoride can interfere with male serum HPT axis hormones, and a moderate increase in SC alleviates the effect of fluoride. Prospective cohort studies are essential to confirm the causality.

Influence of printing orientation on power-law hardening and ductile damage parameters for 3D-printed SS316L steel: experimental and FEA approach

In the present investigation, the selective laser melting (SLM) technique has been utilized for the 3-dimensional printing (tensile test specimens) of SS316L steel powder at 00 (horizontal) and 900 (vertical) angles. Further, an experimental and finite element analysis approach has been made to analyse the effect of printed orientation or direction on the Hollomon power law parameters (strain hardening exponent (n) and strength coefficient (K)) and ductile damage parameters (fracture strain (εf), stress triaxiality (η) and strain rate ( ε ̇ )). The influence of printing orientation on plastic deformation behavior has also been analysed. The results revealed that 00 angle 3D-printed specimens exhibited 11.05%, 21.97% and 9.50% more yield strength, tensile strength and elongation than 900 angle 3D-printed tensile test specimens. Further, the strain hardening exponent (n) and strength coefficient (K) (Hollomon power law hardening model parameters) for 00 angle 3D-printed specimens are 35.80% and 32.47% more than the 900 angle 3D-printed tensile test specimens respectively. The fracture strain for 00 angle 3D-printed specimens is 37.82% less than the 900 angle 3D-printed tensile test specimens. The percentage difference between FEA and experimental results is less than 5% which shows the good prediction capability of estimated Hollomon power law parameters and ductile damage model parameters with developed FEA model for 00 and 900 3D printed specimens.

Removal of Nitrogen, Phosphates, and Chemical Oxygen Demand from Community Wastewater by Using Treatment Wetlands Planted with Ornamental Plants in Different Mineral Filter Media

This study aimed to explore the impact of various ornamental plants (Heliconia psittacorum, Etlingera elatior, Spatyphilum walisii) grown in different filter media (porous river rock (PR) and tepezyl (TZ)) on the removal of pollutants in vertical-subsurface-microcosm treatment wetlands (TWs). This study also sought to assess the adaptability of these plant species to TW conditions. Twenty-four microcosm systems were utilized, with twelve containing PR and twelve containing TZ as the filter media. Each porous media type had three units planted with each species, and three were left unplanted. Rural community wastewater was treated in the TWs. The results showed no significant differences in the effects of the porous media on pollutant removal performance (p &gt; 0.05). However, it was noted that while both porous media were efficient, TZ, a residue of construction materials, is recommended for sites facing economic constraints. Additionally, the removal efficiency was found to be independent of the type of ornamental plant used (p &gt; 0.05); however, the measured parameters varied with plant spp. The adaptation of the plants varied depending on the species. H. psittacorum grew faster and produced a larger number of flowers compared to the other species (20–22 cm). S. wallisii typically produced 7–8 flowers. E. elatior did not produce flowers, and some plants showed signs of slight disease and pests, with the leaves turning yellow. In terms of plant biomass, the type of porous media used did not have a significant effect on the production of above (p = 0.111) or below-ground biomass (p = 0.092). The removal percentages for COD in the presence and absence of plants were in the ranges of 64–77% and 27–27.7%, respectively. For TN, the numbers were 52–65% and 30–31.8%, and for N-NO3, they were 54–60% and 12–18%. N-NH4 saw removal rates of 67–71% and 28–33%, while P-PO4 saw removal rates of 60–72% and 22–25%. The difference in removal percentages between microcosms with and without plants ranged from 30 to 50%, underscoring the importance of plants in the bio-removal processes (phytoremediation). These results reveal that incorporating ornamental plants in TWs with TZ for wastewater in rural areas holds great promise for enhancing the visual appeal of these systems and ultimately gaining public approval. Our findings also enable us to offer recommendations for selecting suitable plants and substrates, as well as designing combinations for TWs.

8702 Age-Sex Differences in Global Burden of Ischemic Heart Disease Attributable to High LDL in the Last 3 Decades:Global, Regional, National Variations, Age Dynamics, and Implications for Global Health

Abstract Disclosure: V. Adedara: None. K. Maddineni: None. A. Dekhne: None. M. Chinthapalli: None. G. Potluri: None. A. Parisapogu: None. K. Markandu: None. H. Desai: None. Background: Ischemic Heart Disease (IHD) stands as the foremost cause of mortality globally, contributing to 9.6 million deaths. Elevated levels of low-density lipoprotein cholesterol (LDL-C) consistently feature among the risk factors associated with IHD. Methods: Employing the Global Burden of Disease framework, we computed mortality and DALYs linked to IHD attributable to LDL-C, stratified by age-sex, year, and covering 204 countries and territories during the period from 1990 to 2019. Non-fatal health outcomes were estimated using DISMOD MR 2.1, Bayesian meta-regression tool for epidemiological modelling. Results were expressed in absolute counts and age-standardized rates (ASR) per 100,000 person-years. Results: The total number of deaths attributed to IHD due to elevated LDL-C increased from 2.5 million (95% Uncertainty Interval: 2-3.1 million) in 1990 to 3.7 million (95% UI: 2.8-4.8 million) in 2019. Concurrently, DALYs increased from 60.4 million (95% UI: 50.4-70.7 million) in 1990 to 84.9 million (95% UI: 69.5-101.3 million) in 2019. In terms of ASR, the annual percentage change (APC) in death rates decreased by 36%, and DALY rates decreased by 32% from 1990 to 2019. Regionally, East Asia exhibited the highest increase in APC in death counts by 191%, followed by Commonwealth Low-Income countries at 164%, and Oceania at 160% during the same period. Conversely, the Commonwealth High-Income region experienced the highest decrease at 41%. Males displayed higher APC in death (48% vs. 44%) and DALYs (42% vs. 38%) compared to females over the last three decades. In terms of ASR, males observed a higher decrease compared to females. In 2019, the age group 80-84 years had the highest number of deaths at 534,079 (264,177-813,898), while DALYs were most pronounced in the 55-59 year age group, reaching 10.6 million (8.9-12.3 million). Conclusion: IHD remains a significant global health challenge, with high LDL-C levels being a crucial modifiable risk factor. Age-sex disparities in the burden of IHD are evident, driven by variations in LDL-C metabolism, hormonal changes, and lifestyle factors. Recognizing and addressing these disparities is essential for developing effective prevention and treatment strategies tailored to different populations and age groups. Presentation: 6/2/2024

Transiently worse postural effects after vestibulo-ocular reflex gain-down adaptation in healthy adults.

Suffering an acute asymmetry in vestibular function (i.e., vestibular neuritis) causes increased sway. Non-causal studies report associations between lateral semicircular canal function and balance ability, but direct links remain controversial. We investigate the immediate effect on body sway after unilateral vestibulo-ocular reflex (VOR) gain down adaptation simulating acute peripheral vestibular hypofunction. Eighteen healthy adults, mean age 27.4 (± 12.4), stood wearing an inertial measurement device with their eyes closed on foam before and after incremental VOR gain down adaptation to simulate mild unilateral vestibular neuritis. Active head impulse VOR gain was measured before and after the adaptation to ensure VOR gain adaptation. Percentage change for VOR gain was determined. Sway area was compared before and after VOR adaptation. VOR gain decreased unilaterally exceeding meaningful change values. Sway area was significantly greater immediately after VOR gain down adaptation, but quickly returned to baseline. In a subset of subjects VOR gain was re-assessed and found to remain adapted despite sway normalization. These results indicate that oculomotor adaptation targeting the lateral semicircular canal VOR pathway has an immediate, albeit transient increase in body sway. Rapid return of body sway to baseline levels suggests dynamic sensory reweighting between vestibular and somatosensory inputs to resolve the undesirable increased body sway.

Exploring the gap between notified and diagnosed cases of Food-borne Diseases: evidence from a time-trend analysis in Italy.

Foodborne diseases are a major global public health concern, causing significant morbidity and mortality worldwide. The COVID-19 pandemic has had widespread effects on various aspects of life, including the food supply chain, potentially impacting the incidence of foodborne diseases. This study aims to analyze the differences between notified and diagnosed cases and investigate the potential impact of the COVID-19 pandemic on foodborne diseases in the metropolitan area of Bologna, Italy. A retrospective time trend analysis from two databases was conducted. The Local Health Authority of Bologna collected data re/Emilia-Romagna Region on the infectious disease reporting system over a six-year period (2017-2022), which included three years of the COVID-19 pandemic. This data was compared with information collected during the same period at the microbiology laboratory serving the entire metropolitan area of Bologna. Statistical methods included percent change calculations, binomial tests, annual averages, gender and age stratification, and trend analysis with regression. An increase (+34.4%, P-value ≤ 0.01) in notified cases during the pandemic - compared to the pre-pandemic period - was found. However, no differences were observed in diagnosed cases when comparing the two periods. The year 2021 saw a significant increase in reported cases of foodborne diseases among schoolers (+300.0%) and workers (+133.3%) compared to 2020. On the other hand, diagnosed cases decreased significantly in 2020 (-19.1%, P<0.01) and increased in 2021 (+21.9%, P<0.01). In absolute terms, a stark difference was observed between notified and diagnosed cases across all the study years (2017-2022). This study highlights the discrepancy between notified and diagnosed cases of foodborne diseases and how the COVID-19 pandemic has increased reporting without affecting transmission. These findings contribute to the ongoing discussion on improving foodborne disease reporting systems.

7838 Improvement of Cognition and Memory Scores in Transgender Individuals Within One Year of Initiating Gender-Affirming Hormone Therapy

Abstract Disclosure: C.M. Godar: None. S.C. De La Torre: None. O. Bonsu: None. M.K. Shakir: None. T.D. Hoang: None. Introduction: The use of gender-affirming hormone therapy (GAHT) in transgender individuals is known to provide many beneficial health effects to reduce gender dysphoria, reduce depressive symptoms, and increase overall quality of life. Cognitive function and memory ability are known to be influenced by sex hormone levels in studies of hormone replacement therapy in post-menopausal women, but studies of GAHT’s effects on cognition and memory in transgender patients have been scarcely reported. We discuss a study of cognitive testing in transgender individuals before and after 12 months of gender-affirming feminizing or masculinizing hormone therapy using a validated cognitive assessment tool. Methods: A prospective study of 32 transgender patients aged 18-45 years was approved by IRB at an academic medical center. The Wechsler Memory Scale 4th edition (WMS®-IV, Pearson) was administered to 19 transgender females and 13 transgender males prior to initiation of GAHT and again after one year of GAHT use. Mean scores were analyzed and reported for five categories of cognitive and memory function: auditory memory (AMI), visual memory (VMI), visual working memory (VWMI), immediate memory (IMI), and delayed memory (DMI). Mean scores for baseline and 12-month data were analyzed for total population and male and female subgroups. Results: Baseline mean WMS-IV values for the total study population were: AMI 105 points, VMI 78 points, VWMI 107 points, IMI 88 points, DMI 91 points. Mean values after 12 months of GAHT were: AMI 120 points, VMI 81 points, VWMI 110 points, IMI 99 points, DMI 102 points. Mean percent change from baseline to 12 months was as follows: AMI 13.4%, VMI 8.9%, VWMI 2.6%, IMI 12.8%, DMI 13%. Similar patterns were noted for both gender subgroups. Discussion: It is well-known that transgender individuals are subject to higher rates of depression, anxiety, and suicidality compared to the general population. Decreased cognitive function and memory are known effects of untreated depression. Our study demonstrated that treatment of gender dysphoria with GAHT provided a tangible cognitive and memory benefit. The long-term impact of GAHT on cognition and memory is not known and deserves additional study. Limitations of this study included the absence of a cis-gender control group and inability to stratify data based on age, which may provide additional significance. Presentation: 6/2/2024

7838 Improvement of Cognition and Memory Scores in Transgender Individuals Within One Year of Initiating Gender-Affirming Hormone Therapy

Abstract Disclosure: C.M. Godar: None. S.C. De La Torre: None. O. Bonsu: None. M.K. Shakir: None. T.D. Hoang: None. Introduction: The use of gender-affirming hormone therapy (GAHT) in transgender individuals is known to provide many beneficial health effects to reduce gender dysphoria, reduce depressive symptoms, and increase overall quality of life. Cognitive function and memory ability are known to be influenced by sex hormone levels in studies of hormone replacement therapy in post-menopausal women, but studies of GAHT’s effects on cognition and memory in transgender patients have been scarcely reported. We discuss a study of cognitive testing in transgender individuals before and after 12 months of gender-affirming feminizing or masculinizing hormone therapy using a validated cognitive assessment tool. Methods: A prospective study of 32 transgender patients aged 18-45 years was approved by IRB at an academic medical center. The Wechsler Memory Scale 4th edition (WMS®-IV, Pearson) was administered to 19 transgender females and 13 transgender males prior to initiation of GAHT and again after one year of GAHT use. Mean scores were analyzed and reported for five categories of cognitive and memory function: auditory memory (AMI), visual memory (VMI), visual working memory (VWMI), immediate memory (IMI), and delayed memory (DMI). Mean scores for baseline and 12-month data were analyzed for total population and male and female subgroups. Results: Baseline mean WMS-IV values for the total study population were: AMI 105 points, VMI 78 points, VWMI 107 points, IMI 88 points, DMI 91 points. Mean values after 12 months of GAHT were: AMI 120 points, VMI 81 points, VWMI 110 points, IMI 99 points, DMI 102 points. Mean percent change from baseline to 12 months was as follows: AMI 13.4%, VMI 8.9%, VWMI 2.6%, IMI 12.8%, DMI 13%. Similar patterns were noted for both gender subgroups. Discussion: It is well-known that transgender individuals are subject to higher rates of depression, anxiety, and suicidality compared to the general population. Decreased cognitive function and memory are known effects of untreated depression. Our study demonstrated that treatment of gender dysphoria with GAHT provided a tangible cognitive and memory benefit. The long-term impact of GAHT on cognition and memory is not known and deserves additional study. Limitations of this study included the absence of a cis-gender control group and inability to stratify data based on age, which may provide additional significance. Presentation: 6/2/2024

12620 Developing Hospital Protocols For Managing Patients With Hypertriglyceridemia-induced Acute Pancreatitis In Diabetic Ketoacidosis Hospitalizations

Abstract Disclosure: U. Agbedia-ejughemre: None. Methods: We queried the combined 2017-2020 nationwide inpatient sample database for all adult hospitalizations for DKA with and without HTG-AP using the ICD-10 revision codes. Baseline characteristics were compared between DKA hospitalizations with and without HTG-AP using Pearson’s χ2 tests and Student’s t-test for categorical and continuous variables. Study endpoints were the incidence, predictors, and outcomes of HTG-AP, including mortality, hospitalization duration, mean hospital costs, and acute in-hospital complications (sepsis, ARDS, and acute renal failure). Predictors of HTG-AP were assessed using stepwise multivariable logistic regression analysis. Illness severity, baseline risk of mortality, and comorbidity burden were adjusted using APR-DRG metrics and CCI. Prolonged hospitalization was defined as the length of hospital stay in the top decile of hospital stay for all hospitalizations in the study. Results: We analyzed 630,435 hospitalizations for DKA. The study cohort was 51.4% male, 57.6% white Americans and 26.1% Blacks, with a mean age of 40 (SD, 16.2) years. Incidence of HTG-AP was 2.1% (13,445). Hospitalizations with HTG-AP were older (mean age: 44 vs. 40 years; P&amp;lt;0.001) and had greater comorbidity (CCI score of 2: 38.7 vs. 33.8; P&amp;lt;0.001) compared with DKA hospitalizations without HTG-AP. While DKA hospitalizations showed an uptrend, increasing from 105,769 to 199,429 hospitalizations (Average annual percent change [AAPC]: 27.04%; P=0.029), the incidence of HTG-AP showed a downtrend from 2650 (2.5%) to 4085 (2.0%) (P=0.006). Predictors of HTG-AP included Hispanic (aOR: 2.45; 95% CI: 1.95-3.07; P&amp;lt;0.001) or Asian race (aOR: 2.48; 95% CI: 1.37-4.48; P=0.003), private insurance (aOR: 1.57; 95% CI: 1.10-2.25; P=0.013), self-pay (aOR: 2.2; 95% CI: 1.49-3.27; P&amp;lt;0.001), APR-DRG moderate risk of mortality (aOR: 1.52; 1.21-1.92; P&amp;lt;0.001), APR-DRG major loss of function (aOR: 1.46; 95% CI: 1.31-1.69; P&amp;lt;0.001), dyslipidemia (aOR: 1.87; 95% CI: 1.47-2.38; P&amp;lt;0.001), hypertension (aOR: 1.39; 95% CI: 1.13-1.72; P=0.002), obesity (aOR: 3.09; 95% CI: 2.42-3.96; P&amp;lt;0.001), obstructive sleep apnea (aOR: 2.05; 95% CI: 1.35-3.10; P=0.001), chronic liver disease (aOR: 9.44; 95% CI: 6.61-13.48; P&amp;lt;0.001), old MI (aOR: 2.11; 95% CI: 1.02-4.38; P=0.045), and COPD (aOR: 2.31; 95% CI: 1.47-3.64; P&amp;lt;0.001). DKA hospitalizations with HTG-AP were correlated with higher risk of septicemia (aOR: 1.20; 95% CI: 1.05-1.69; P=0.029), ARDS (aOR: 1.24; 95% CI; 1.04-2.07; P=0.004), and resource use, including prolonged hospitalization (26.3% vs. 11.1%; P&amp;lt;0.001), and higher mean hospital costs ($57,773 vs. $32,692; P&amp;lt;0.001). Conclusion: HTG-AP was linked to worse outcomes, excluding mortality, in hospital admissions for DKA. There is a need for enhanced diagnostic guidelines and protocols targeting this subgroup of patients could improve outcomes. Presentation: 6/2/2024

Neonatal birthweight prediction using two- and three-dimensional estimated fetal weight among borderline small fetuses.

This study aimed (1) to determine the degree of correlation between 2D and 3D estimated fetal weight (EFW) and neonatal birth weight (BW) among borderline small fetuses and (2) to compare the accuracy and precision of 2D and 3D EFW in BW prediction. A retrospective cohort study evaluated fetuses who had an ultrasound performed between January 2017 and September 2021 at a tertiary maternal center. All singleton pregnancies with 3D EFW within 4 weeks of delivery were included. Fetuses with known structural or genetic abnormalities were excluded. Pearson's correlation coefficients were determined for both 2D and 3D EFW to BW then compared using Williams' test and Fisher r to z transformation, where applicable. Mean percent difference and standard deviation were used to assess the accuracy and precision, respectively, of 2D and 3D EFWs in BW prediction. Two hundred forty-eight pregnancies were included. Ultrasound studies were performed with a median interval of 2 weeks (IQR 1, 3) between ultrasound and delivery. Both 2D and 3D estimated fetal weights showed a significant correlation with birth weight (r = 0.74 and r = 0.73, respectively), indicating similar accuracy between the two techniques. Two-dimensional and three-dimensional EFWs performed similarly in the prediction of BW in borderline small fetuses.