Discrepant Results Research Articles

The effects of compassionate care on oral health outcomes: A scoping review.

To access and synthesize the existing literature about the effects of compassionate care on oral health outcomes. A scoping review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify articles from six electronic databases: MEDLINE via the PubMed interface, Embase, Age-Line, Scopus, CINAHL, and Cochrane. Among 30 studies reporting on compassion in dental treatment, only two reported on the effects of compassionate care on oral health outcomes. One study is cross-sectional and evaluated oral health outcomes in children, while the other is a cohort study evaluating oral health outcomes in older adults. Each study used different tools to assess oral health outcomes. However, both studies used the Jefferson Scale of Physician Empathy (JSPE) to assess empathy among dental students, dentists, or dental hygienists. The retrieved studies used different methodologies and had discrepant results. More clinical studies investigating the effects of compassionate care on the outcomes of dental treatment are necessary.

Identifying Compton-thick AGNs in the COSMOS. I. Among X-ray AGNs with low photon counts

Compton-thick active galactic nuclei (CT-AGNs), characterized by a significant absorption with column densities of mathrm N_H ⩾ 1.5 cm emit feeble X-ray radiation and are even undetectable by X-ray instruments, making them difficult to identify. X-ray radiation from AGNs is the predominant source of the cosmic X-ray background (CXB). Based on AGN synthesis models for the CXB, the fraction of CT-AGNs should constitute a substantial portion of AGN population, approximately 30% or more. The fraction of CT-AGNs discovered in the Cosmological Evolution Survey (COSMOS) is significantly lower than this value. This means that many CT-AGNs may be hidden in AGNs that exhibit low photon counts or that have not been detected by X-ray instruments. This work focuses on identifying CT-AGNs hidden in AGNs with low photon counts. Firstly, we selected 440 AGNs with abundant multiwavelength data as our sample. Secondly, we analyzed multiwavelength data, extracting crucial physical parameters required for the CT-AGN diagnosis. Finally, we used multiwavelength approaches to identify CT-AGNs. We have successfully identified 18 CT-AGNs in our sample. Among the CT-AGNs, four AGNs show discrepant results across different diagnostic methods. We discuss the potential reasons behind these diagnostic discrepancies. We explore the impact of estimating O III λ 5007 luminosities based on O II λ 3727 luminosities for the CT-AGN diagnosis. We have also found that the properties of host galaxies for CT-AGNs and non-CT-AGNs do not show significant discrepancies.

P-1593. Experience with a Rapid Diagnostic Blood Culture Identification Panel in Patients with Neutropenic Fever

Abstract Background Rapid identification of organisms in bloodstream infections can expedite selection of appropriate antimicrobials. This can significantly impact patient care, especially in immunocompromised hosts. Our retrospective study evaluates a single-center experience with a rapid diagnostic blood culture panel (BCID) in patients with neutropenic fever. Methods Between January 2020 and October 2023, all adult patients with neutropenic fever for whom blood cultures were obtained were reviewed. As standard protocol, a reflex BCID was performed with the FilmArray© panel for all blood cultures with microbial growth. We evaluated concordance between cultures and BCID data, and clinical implication of discrepant results. Patient demographics, cause of neutropenia, and 90-day mortality was documented. Results Of 6382 blood cultures in 1604 episodes for neutropenic fever, 253 unique blood cultures in 189 patients met criteria (Figure 1). Median age was 59 (SD±14.9) years, with 95 (50.3%) being female. A central venous catheter (CVC) was present in 75 patients (39.7%). The most common etiology for neutropenic fever was malignancy or chemotherapy in 124/189 (65.6%), followed by shock in 10/189 (5.3%). BCID identified resistance genes in 86/253 (34.0%) of samples, with mecA (64, 25.3%) and CTX-M (11, 4.3%) most commonly reported. BCID and routine susceptibility testing showed similar results in 219/253 (86.6%) specimens (Table 1). Of the discordant results, 9/31 BCID results missed presence of an on-target multi-drug resistant organism (Table 2). A change in therapy occurred based on BCID results from 143 (56.5%) of cultures in 94 (49.7%) of patients. There was no significant difference in 90-day mortality among patients where BCID led to an antibiotic change (37.2% vs 36.8%, p-value=0.96), and no difference in 90-day mortality among patients with discordant data (28.9% vs 37.5%, p-value=0.26). Conclusion In 239 episodes of neutropenic fever, BCID results correlated with routine results in 87% of blood cultures. BCID results resulted in quicker change to culture-appropriate antimicrobials in nearly half of the patients, however this was not associated with a mortality benefit. Disclosures All Authors: No reported disclosures

P-2081. Prototype Assay for Detection of Carbapenem-Resistant Acinetobacter baumannii Complex (CRABC)

Abstract Background Carbapenem-resistant Acinetobacter baumannii complex (CRABC) is recognized as an urgent/critical antimicrobial resistance (AMR) threat, causing hospital-acquired and ventilator-associated pneumonia (HAP/VAP) and bacteremia. Due to limited treatment options, there is an urgent need for novel targeted antibiotics against CRABC. As these drugs become available, their timely and appropriate use will require the rapid identification of patients with CRABC infection. We evaluated the performance of a prototype assay for the rapid detection of CRABC directly from bronchoalveolar lavage (BAL), sputum/endotracheal aspirate (S/ETA), and positive blood culture (PBC) samples. Methods A prototype assay was designed for the qualitative detection of A. baumannii complex (ABC) harboring the most prevalent associated carbapenemase genes (blaOXA-23, blaOXA-24, blaOXA-58, and/or blaNDM). The prototype assay was developed for use on the high-throughput cobas® 5800/6800/8800 Systems with a defined oligo pool and positive control. A total of 452 BAL, 681 S/ETA, and 392 PBC samples (including prospective, archived, and contrived specimens) were tested by the prototype assay and compared with routine microbiology for ABC detection and the Unyvero Hospitalized Pneumonia or BCU panel for carbapenemase detection. Discrepant resolution was performed using the BioFire® FilmArray® Pneumonia or BCID Panel and/or the Streck ARM-D® Kit, OXA assay, depending on the type of discrepancy. Results After resolution of discrepant results, the overall percentage agreement, positive percent agreement, and negative percent agreement between the prototype assay and the comparator methods (culture/nucleic acid amplification tests [NAATs]) was 97.1%, 98.5%, and 96.5%, respectively, for BAL; 99.3%, 100%, and 99.1%, respectively, for S/ETA; and 99.2%, 100%, and 99.1%, respectively, for PBC. Conclusion This prototype assay exhibited a high percentage agreement for the detection of CRABC in BAL, S/ETA, and PBC samples when compared to culture/NAATs. A future assay based on this prototype could be evaluated in a clinical trial to establish its utility in facilitating timely and appropriate antibiotic selection for patients with HAP/VAP or bacteremia caused by CRABC. Disclosures Brian Lee, MD, GE Healthcare: Stocks/Bonds (Public Company)|Invitae: Stocks/Bonds (Public Company)|Merck: Stocks/Bonds (Public Company)|OPKO Health: Stocks/Bonds (Public Company)|Roche Diagnostics Solutions: Employment|Roche Diagnostics Solutions: Stocks/Bonds (Public Company)|Spero Therapeutics: Stocks/Bonds (Public Company) Natacha Martins Sorenson, PhD, Roche Diagnostics Solutions: Employment|Roche Diagnostics Solutions: Stocks/Bonds (Public Company) Hai Nguyen, n/a, Roche Diagnostics Solutions: Employment Arrash Moghaddasi, n/a, Roche Diagnostics Solutions: Employment Aishwarya Sathish, n/a, Roche Diagnostics Solutions: Employment Patrick Lin, n/a, Roche Diagnostics Solutions: Employment Kyle C. Cady, PhD, Roche Diagnostics Solutions: Employment|Roche Diagnostics Solutions: Stocks/Bonds (Public Company)

Cryofibrinogenemia as a cause of ABO forward/reverse discrepancy and positive antibody screen result.

Cryofibrinogenemia as a cause of ABO forward/reverse discrepancy and positive antibody screen result.

P1175 Handheld ultrasound devices are an accurate alternative to cart-based ultrasound for IBD disease activity assessment

Abstract Background Intestinal ultrasound has revolutionised inflammatory bowel disease (IBD) care, as a quick, cost-effective, accurate and reliable tool for assessing IBD activity. Recently high-quality handheld ultrasound devices (HHUS) have emerged, representing a more accessible, cheaper alternative to expensive and cumbersome cart-based ultrasounds (CBUS), however their accuracy for IUS has not been studied. We aimed to assess the accuracy of HHUS compared to CBUS in a real-world IBD population. Methods We prospectively recruited patients attending outpatient IBD clinics in a tertiary centre from 18 July to 1 October 2024. Patients were first scanned by IUS trainees or clinicians certified by the Gastroenterological Network of Intestinal Ultrasound using 1-2 HHUS (Clarius™ L15 HD3 (CL) and/or GE™ Vscan Air CL (GE) using linear and convex probes as needed) and then CBUS. We collected baseline demographics, standard ultrasound parameters, disease activity classification, concordance with CBUS, and the predicted impact on clinical management. Qualitative statistical analyses and diagnostic accuracy calculations were performed. Results We performed IUS on 101 patients (49% ulcerative colitis, 52% Crohn’s disease, 46% male, median age 39 years, median BMI 23.4 kg/m2), using CL in 69 (total segments 260) and GE in 57 (total segments 220). The demographics and scan results are detailed in Table 1. Overall concordance for disease activity status (classified as "active" or "inactive") with CBUS was 93% for CL and 91% for GE, and 100% and 95% respectively for patients with a BMI >25 kg/m2. There were 5 discordant scans each for CL (7%) and GE (9%) mostly related to discrepancies in bowel wall thickness in either the sigmoid colon or terminal ileum (there was a discrepant Doppler result in 1 case), in which 4 cases for both GE and CL reported high clinician confidence with the results. It was anticipated that the discordant result would negatively impact management in 4 (5.8%) cases for CL and 3 (5.2%) cases for GE. Overall sensitivity and specificity were high in both CL (85% and 100%) and GE (76% and 100%) and remained reasonably high for all segments (see Figure 1). Conclusion Both CL and GE HHUS represent viable alternatives to CBUS, with high diagnostic accuracy for IUS in IBD patients with normal and high BMIs. Given significantly lower costs, use of HHUS could improve access to IUS in IBD care internationally. There is a small risk that rare discordant results could negatively impact management, however this risk could be mitigated by interpreting IUS findings in the context of other disease activity markers and considering a repeat IUS using CBUS where there is uncertainty regarding findings.

Incomplete reporting of adverse events in duloxetine trials: a meta-research survey of randomized controlled trials versus placebo.

Relying on published data alone might be insufficient for meta-analyses to be reliable and trustworthy since selective outcome reporting is common, especially for adverse events. We investigated the existence of selective reporting and its potential for bias in a case study exploring adverse events of duloxetine in adults. We systematically searched all previous meta-analyses/pooled analyses on duloxetine published on PubMed for 7 indications approved by the American and European health authorities. We included all randomized controlled trials (RCT) versus placebo. For each RCT, we extracted the number of serious adverse events (SAE), adverse events (AE), drop-outs (DO) and drop-outs for safety reasons (DOSR) using 4 information sources: published articles, clinical study registries, clinical study reports and data available in meta-analyses/pooled analyses. To assess the range of differences resulting from these 4 extraction strategies, we performed 4 meta-analyses using random effect models as well as a complete meta-analysis combining all sources. 70 RCTs (including 24,330 patients) were included. Of those, SAEs were identified for 42 studies (61%) in published articles, 58 (84%) in study reports (8 study reports were not retrieved), 24 (34.7%) in registries, and 21 (30.4%) in meta-analyses/pooled analyses.For 2 (2.9%), 2 (2.9%), 2 (2.9%) and 1 (1.4%) studies, we found respectively no data on SAEs, AEs, DOs and DOSRs in any sources. Discrepant results across sources were found in 24 (34.5%), 20 (28.5%), 13 (18.6%) and 9 (12.8%) studies, respectively for SAEs, AEs, DOs and DOSRs. Despite variations in point estimates and their 95% confidence intervals, we did not find different results in the conclusions of meta-analyses depending on the different information sources used, except for DOs, for which no effect was found using results published in registries, in contrast to other information sources. None of the four information sources provided complete retrieval of safety results for duloxetine in adults across various indications. However, we did not find strong evidence that this under-reporting leads to different conclusions in meta-analyses. Nonetheless, this finding remains uncertain, as we were unable to obtain complete information for all studies despite extensive searches.

Prognostic significance of programmed cell death 1 expression on CD8+T cells in various cancers: a systematic review and meta-analysis.

Increased PD-1 expression on CD8+ T cells is considered as a hallmark for T-cell exhaustion, and is thought to be related to the prognosis of cancer patients. However, discrepant results have made it difficult to apply PD-1+CD8+T cells and tumor prognosis to clinical practice. Therefore, we conducted a meta-analysis to evaluate its prognostic value in human cancers. PRISMA reporting guidelines were strictly followed for conducting the current meta-analysis. The PubMed, Web of Science, Embase databases were searched from inception to November 2024. The pooled Hazard Ratio (HR) along with 95% confidence intervals (CIs) of each article were combined for the associations of PD-1+CD8+ T cells with overall survival (OS), progression- free survival (PFS) and disease-free survival(DFS). Subgroup analyses were performed for area, specimen type, cancer type, treatment, detected method and cancer stage. A total of 20 studies (23 cohorts, 3086 cancer patients) were included in our study. The expression PD-1+CD8+ T cells in cancer patients tended to predict poor overall survival (OS) (HR: 1.379, 95%CI: 1.084-1.753, p= 0.009), and unfavorable disease-free survival(DFS) (HR: 1.468, 95%CI: 0.931-2.316, p=0.099), though it did not reach statistical significance. Begg's and Egger's test demonstrated that no obvious publication bias was exist. High PD-1 expression on CD8+ T cells is associated with worse survival outcomes, which can be potentially used as a prognostic marker of malignant tumor.

Solid-phase red cell adherence versus gel column agglutination: Is there any difference for the detection of alloantibodies associated with the JK system?

Detection of alloantibodies associated with the JK system may be tricky. They are nevertheless associated with transfusion reactions and their detection is crucial. Retrospectively and over a period of 7 years, we compared the results obtained using two different assays for antibody detection. We performed antibody detection testing with solid-phase red cell adherence (SPRCA). If positive, the antibody identification was carried out with the SPRCA and confirmed with the gel method in Coombs medium. In case of discrepant results occurring in recently transfused patients, we investigated these patients during the post-transfusion period. Fifty-five patients with anti-JK1 or anti-JK2 were identified out of which 41 were further analyzed. Both techniques clearly identified 10 alloantibodies. In 22 cases, the alloantibody identified by SPRCA was not observed with the gel method because of negative detection tests. In one case, none of the techniques identified the alloantibody and in 8 cases, the final result was inconclusive (1/41 with the SPRCA and 8/41 with the gel method). Two patients having a highly probable delayed hemolytic transfusion reaction (DHTR) were identified among the discrepant results. For both cases, anti-JK2 was clearly identified by the SPRCA but showed inconclusive reactions with the gel method. This study shows that in 29 out of 41 cases, the anti-JK1 or anti-JK2 identified with the SPRCA method were not with the gel method in Coombs medium. Eleven cases (11/29) were clinically significant and among them, 4 likely DHTRs and 2 highly probable DHTRs occurred.

Discrepancies Between Sex Prediction and Fetal Sex After Prenatal Noninvasive Cell-Free DNA Screening

Abstract In the last 10 years the field of prenatal diagnosis has been significantly reshaped followed by the implementation of noninvasive prenatal cell-free DNA (cfDNA) testing methodologies in clinical practice. Based on a superior performance and higher sensitivity and specificity than the former practice of biochemical markers screening, the American College of Obstetricians and Gynecologists and American College of Medical Genetics and Genomics recommend noninvasive prenatal cfDNA screening for trisomy 21, 18, 13, and sex chromosome aneuploidy to all pregnant people. While cfDNA screening is helpful in risk assessment for the most common autosomal trisomies, cfDNA also provides information about fetal sex chromosomes. Prediction of fetal sex is highly desired by the parents and also useful to healthcare providers for management of pregnancies that are at-risk for X-linked conditions. In fact, utilization of cfDNA screening has resulted in a significant number of referrals to evaluate discordant results for cfDNA sex prediction and appearance of fetal genitalia by prenatal ultrasound scan or at birth raising concerns about the fetus/infant atypical sex development known as a difference in sex development (DSD). In this mini-review, we outline principles and limitations of cfDNA technology, summarize recent findings related to cfDNA test performance in prediction of sex chromosome abnormalities and DSD conditions, define the technical and biological causes of discrepant results, provide recommendations to consolidate efforts by prenatal and clinical management teams in challenging situations, and discuss ethical considerations associated with fetal sex prediction and prenatal DSD diagnosis.

Analysis of lipid profile before and after a simulated Brazilian jiu-jitsu para-sport fight: Multiple case analysis.

Analysis of energy pathways is useful in helping to understand adaptations to specific sports practices, which vary according to the type of effort and individual characteristics of the athletes. In this sense, this study aimed to describe the physiological changes related to lipid markers in amputee athletes who practice para-sport jiu-jitsu. This is an observational study, which included three male amputee athletes, aged between 41 and 46 years old and with more than 24 months of experience at a professional level. The collection procedures included the verification of anthropometric measurements (body mass and height), handgrip strength, body fat and lipid profile, before and after a simulated para-sport jiu-jitsu fight. The main results of the study refer to elevations in the values of total lipids (13.2%); total cholesterol (11.8%); and phospholipids (7.7%) in the three participants. The findings of other indices had more discrepant results, ranging from 14% (very low density lipoprotein and triacylglycerol) to 65% (high density lipoprotein). In addition, a high percentage of body fat was observed among the participants. The data presented require attention, since understanding metabolic demands is crucial to provide favorable conditions for sports practice at safe levels and expected sports performance.

Clinical and preclinical evidence of psilocybin as antidepressant. A narrative review.

In the rapidly growing field of psychedelic research, psilocybin (and active metabolite psilocin) has been proposed as a promising candidate in the search for novel treatments for neuropsychiatric disorders. Clinical trials have revealed that psilocybin has a large, rapid, and persistent effect in the improvement of symptoms of depression and anxiety. The safety profile is considered favourable, with low toxicity and good tolerance. Several preclinical studies have also been carried out to determine the long-term mechanism of action of this drug. In this sense, preclinical studies in naïve animals as well as in animal models of disease have shown somewhat discrepant results in conventional tests for assessment of depression- and anxiety-like phenotype in response to psilocybin, but overall suggest positive outcomes. Additionally, several valuable assays in rodent models have been developed over the years to elucidate the neurochemical correlates of serotonin 2A receptor (5HT2AR) activation in the brain, primary molecular target of psilocin. This review aims to provide a general overview of the current and most recent literature in the therapeutic potential of psilocybin through a description of clinical trials of psilocybin-assisted psychotherapy, and to showcase the scene in the up-to-date preclinical research. A detailed description of preclinical rodent models and experimental approaches that have been used to study the neurobiological and behavioural actions of psilocybin is provided, and potential therapeutic mechanisms of action are discussed.

Molecular surveillance of Plasmodium falciparum histidine-rich protein 2/3 gene deletions in Mozambique, 2023

BackgroundRapid diagnostic tests (RDTs) based on the detection of Plasmodium falciparum histidine rich protein 2 (PfHRP2) are widely used for the diagnostic of P. falciparum in Africa. However, deletions of the pfhrp2 and pfhrp3 genes can lead to false negative test results and compromise appropriate case management. Due to the high burden of malaria in Mozambique, it is crucial to monitor the potential emergence of parasites with pfhrp2/3 gene deletions in the country.MethodsThe presence of pfhrp2/3 deletions was assessed during the 2023 high transmission season in 34 health facilities from 9 districts across 6 provinces in Mozambique. Children between 2 and 10 years of age attending the health facility with fever were tested by both the routine HRP2-RDT and a P. falciparum lactate dehydrogenase (PfLDH)-RDT, and dried blood spots (DBS) were collected from those testing positive by one or both RDTs. DBS from children with a negative HRP2-RDT but positive PfLDH-RDT were tested for the presence of pfhrp2/3 deletions by multiplex real time quantitative polymerase chain reaction (qPCR).Results3208 children attended the health facilities during the study. 81.6% (2612/3208) participants were positive for at least one malaria RDT and, among them, 0.8% (210/2612) had discrepant RDT results (22 HRP2 − but LDH + and 188 HRP2 + but LDH −). The overall prevalence of suspected false-negative HRP2-RDT results in Mozambique was 0.91% (95% CI 0.58–1.39; 22/2424). pfhrp2/3 gene deletions were confirmed in 4 cases (1 in Nampula and 3 in Inhambane). Therefore, the prevalence of P. falciparum confirmed cases with pfhrp2/3 gene deletions in the six provinces sampled was 0.16% (95% CI 0.15–2.57; 4/2424), being 0.27% (95% CI 0.01–1.75; 1/367) in Nampula and 0.59% (95% CI 0.15–1.88; 3/503) in Inhambane.Conclusionpfhrp2/3 gene deletions were detected in 2 out of 6 provinces surveyed in Mozambique, but at a prevalence far below the 5% threshold recommended for a change in HRP2-based-RDT.

Paraprotein-induced Discordance Between Direct and Total Bilirubin Levels in Patients with Myeloma: a Case Study Series

This study represents a preliminary investigation into the clinical implications of discordance between total and direct bilirubin levels in patients with multiple myeloma. Four cases are presented to highlight the variability in paraprotein concentrations and the discordance of total and direct bilirubin levels, emphasizing the importance of the timing of these measurements. The results of the bilirubin level discrepancy were observed either before the official diagnosis of multiple myeloma, or immediately after diagnosis, meaning before the initiation of chemotherapy for multiple myeloma.

Evaluation of the Vitros® Anti-T. cruzi Assay for its incorporation into the Trypanosoma cruzi Infection Diagnostic Algorithm

Background and objectiveSerological screening for Chagas disease (CD) in Latin American adults living in Europe is a cost-effective strategy for transmission prevention. The World Health Organization recommends two different serological tests including native and recombinant antigens for IgG detection. In Spain, most commercialized native tests require manual processing. We aimed to evaluate the sensitivity and specificity of the automated Vitros® Anti-T. cruzi native antigen-based test. MethodsA total of 556 serum samples were tested using two different tests: 1) our reference assay, a chemiluminescence immunoassay employing a recombinant multi-antigen protein (Liaison® XL Murex Chagas); 2) a chemiluminescence immunoassay with native antigen (Vitros® Anti-T. cruzi assay). Additionally, 180 samples were also processed by a manual indirect immunofluorescent assay (Chagas IFA). Sensibility, specificity and kappa index were calculated. ResultsVitros® showed a kappa index of 0.94 (IC 95%: 0.86-1.03) compared to Liaison® XL with a sensitivity of 93.6% and specificity of 99.5%. Compared to IFA, Vitros® showed a kappa index of 0.61 (IC 95%: 0.47-0.76), sensitivity of 97.5% and specificity of 70.37%. Discrepant results were obtained mainly in treated patients. ConclusionsThe Vitros® Anti-T. cruzi assay showed potential for implementation as an automated serological screening test, enhancing the diagnostic process in high-throughput microbiology laboratories.

Achievement of overburden stripping production targets based on the calculation of cut-and-fill volume and truck count at Pit Middle West PT Cipta Bersama Sukses job site Tungkal Jaya

Abstract PT Cipta Bersama Sukses (PT CBS) calculates the volume of excavated materials using the mine progress survey method or truck count method. The common obstacle in the calculation is the discrepant results between survey production volume and truck count production volume. In November 2023, PT CBS set the production target of 291,790 BCM in overburden stripping production. It prompted this study to identify the causes of the discrepancy between the cut-and-fill calculation volume and the truck count volume, as well as the causes of the difference in target volume and actual production volume. We expect to provide references to the company in improving the performance quality the following month. This quantitative study gathered data from survey activities in the field and analyzed the data using Surpac 6.5.1 software. The total volume of overburden removal results in November 2023 using the cut-and-fill method was 331,446.883 BCM, and the truck count volume was 313,237.500 BCM, indicating a 5.494% difference with a standard deviation of 6.37%. It prompted the evaluation of data collection and calculation review. This research has achieved the overburden production target of 114% cut and fill volume and 107% truck count volume.

GRAViTy-V2: a grounded viral taxonomy application.

Taxonomic classification of viruses is essential for understanding their evolution. Genomic classification of viruses at higher taxonomic ranks, such as order or phylum, is typically based on alignment and comparison of amino acid sequence motifs in conserved genes. Classification at lower taxonomic ranks, such as genus or species, is usually based on nucleotide sequence identities between genomic sequences. Building on our whole-genome analytical classification framework, we here describe Genome Relationships Applied to Viral Taxonomy Version 2 (GRAViTy-V2), which encompasses a greatly expanded range of features and numerous optimisations, packaged as an application that may be used as a general-purpose virus classification tool. Using 28 datasets derived from the ICTV 2022 taxonomy proposals, GRAViTy-V2 output was compared against human expert-curated classifications used for assignments in the 2023 round of ICTV taxonomy changes. GRAViTy-V2 produced taxonomies equivalent to manually-curated versions down to the family level and in almost all cases, to genus and species levels. The majority of discrepant results arose from errors in coding sequence annotations in INDSC records, or from inclusion of incomplete genome sequences in the analysis. Analysis times ranged from 1-506min (median 3.59) on datasets with 17-1004 genomes and mean genome length of 3000-1 000 000 bases.

Positive impact of a diagnostic stewardship intervention on syndromic panel ordering practices and inappropriate C. difficile treatment.

Multiplex polymerase chain reaction (PCR) panels for stool testing may be used to diagnose Clostridioides difficile, which can circumvent more appropriate targeted C. difficile testing, resulting in treatment of incidentally detected colonization. We sought to reduce C. difficile diagnosis via a gastrointestinal pathogen panel (GIPP). Quasi-experimental, pre/post, retrospective cohort study from January 1, 2022, to January 31, 2024. Mayo Clinic Arizona-a single academic medical center and associated clinics. Adult patients receiving C. difficile testing and/or treatment. Preferred C. difficile testing consisted of glutamate dehydrogenase and toxin antigen immunoassay, followed by toxin gene testing for discrepant results. The GIPP contained 22 targets during the baseline period with C. difficile removed during the postintervention period. Surveys were provided to provider and nursing groups, separately, to identify C. difficile ordering practices and knowledge gaps. At baseline, from January 1, 2022, to January 31, 2023, 2,772 GIPPs were completed for 2,307 unique patients (∼7 per day), primarily for outpatients (1,805 of 2,772, 65%). The most common positive target was C. difficile (517 of 1,018, 51%), which resulted in treatment for C. difficile infection in 94.9% (337 of 355) of cases. Following GIPP C. difficile target removal, GIPP orders decreased from 3.23 to 2.7 per 1,000 patient visits (P < .001). Prescribing of C. difficile treatments decreased in the postintervention period in inpatient and outpatient settings. There were no cases of delayed C. difficile diagnosis during the postintervention period. Removing C. difficile from the GIPP resulted in effective diagnostic and antimicrobial stewardship without resulting in delayed diagnoses.

Abstract Su703: Racial/Ethnic Disparities in Bystander Cardiopulmonary Resuscitation after Witnessed Out-of-Hospital Cardiac Arrest: A NEMSIS Database Study

Introduction: Out of hospital cardiac arrest (OHCA) is a leading cause of death in the United States, with upwards of 360,000 OHCAs annually. Receiving bystander cardiopulmonary resuscitation (CPR) almost doubles an individual’s odds of survival compared to those who don’t receive bystander CPR. Unfortunately, in the US, bystander application of CPR only occurs in 40% of OHCA. Improving the rate of bystander CPR and AED use will improve survival rates for OHCA. Minoritized populations experience worse outcomes from OHCA. Compared to non-Hispanic whites, they are less likely to survive to hospital discharge. A cross-sectional study of witnessed OHCA patients found that Black and Hispanic patients had lower rates of bystander CPR. Less is known about disparities in care for Asian American persons who experience OHCA. Studies using the Resuscitation Outcomes Consortium Epidemiologic Registry (ROC) and the Cardiac Arrest Registry to Enhance Survival (CARES) have concluded discrepant results, with ROC finding that Asian Americans were less likely to receive bystander CPR and CARES finding that they were just as likely to receive bystander CPR compared to non-Hispanic Whites. To that end, we sought to evaluate the association between bystander CPR and Asian race after witnessed OHCA. Objective: To evaluate the association between race/ethnicity and the odds of receiving bystander cardiopulmonary resuscitation (bCPR) after witnessed out-of-hospital cardiac arrest (OHCA). Methods: Data were obtained from the National Emergency Medical Services Information System (NEMSIS) database for adults (≥18 years) with a witnessed non-traumatic OHCA in the year 2022. Patients were separated into two groups: Non-Hispanic White and Asians. The primary outcome was the odds of receiving bCPR. Exclusions included traumatic etiology, do-not-resuscitate orders, and arrests witnessed by healthcare providers. Pearson’s chi-square test was used to test significance. Results: A total of 73,215 witnessed OHCA activations were included in this study. Overall, bystander CPR rates were lower for the Asian group (59.8%) compared to the Non-Hispanic White group (65.0%). Pearson’s chi-square test showed a statistically significant difference between the bCPR rates of the Asian group and Non-Hispanic White group, with a p-value of less than 0.001. Conclusion: Racial/ethnic disparities exist for Asian individuals in the odds of receiving bCPR after a witnessed non-traumatic OHCA.

The influence in clinical results of lower limb length discrepancy following distal femoral osteotomy

BackgroundDistal femoral osteotomy (DFO) improves valgus limb alignment. However, it might affect lower limb length discrepancy (LLD) and influence functional scores. This study aims to evaluate functional scores and radiographic parameters associated with LLD after DFO. HypothesisIt was hypothesized that the presence of LLD after DFO affects functional scores and associated with femoral length. Patients and methodsA total of 50 patients who underwent DFO, including 24 closed wedge (CW) DFO and 26 open wedge (OW) DFO, were included. Patients were divided into three groups according to the presence of LLD after DFO: LLD-Absent group, LLD-CW group and LLD-OW group. Patient demographics, functional scores (Knee injury and Osteoarthritis Outcome Score (KOOS)), and radiographic parameters were evaluated and compared between the three groups. Multivariable logistic regression analysis was used to assess the radiographic parameter associated with the presence of post-operative LLD. ResultsThere were no significant differences between the three groups in demographic data, correction angles, complications including hinge fractures, time to osteotomy union, and functional scores. However, the return to sports (RTS) was significantly different between three groups. By further analysis between CWDFO and OWDFO, RTS in CWDFO was faster than those in OWDFO. There were significant differences in post-operative mLDFA and Δ femur length. Additionally, post-operative mLDFA was significantly associated with the presence of LLD (Odds ratio 0.11, 95% confidence interval 0.01 to 0.49, p = 0.03). ConclusionFunctional scores and postoperative outcomes following DFO are not affected by the presence of LLD. RTS is independent of LLD, but rather dependent on the surgical procedure and RTS in CWDFO was faster than those in OWDFO. Postoperative mLDFA is the radiographic parameter associated with the presence of LLD. These findings are clinically relevant and should be accounted for in preoperative planning of DFO. Level of evidence IIIRetrospective with comparative study