Results Of First Year Research Articles

Feasibility of a Customized Assistive Technology Service in Outpatient Rehabilitation

Abstract Date Presented 03/23/24 A university-based assistive technology (AT) makerspace housed in an OT department created custom assistive devices requested by outpatient OTs and physical therapists. This poster details the service and provides first-year feasibility results. Primary Author and Speaker: Kial-Ann M. Rasmussen Additional Authors and Speakers: William E. Janes

Observations and emission constraints of trichlorofluoromethane (CFC-11) in southeastern China: first-year results from a new AGAGE station

The recovery of the ozone layer relies on decreasing atmospheric mixing ratios of ozone-depleting substances (ODSs), including chlorofluorocarbons (CFCs). A significant decline in the mixing ratio of trichlorofluoromethane (CFC-11 or CCl3F ), the second most abundant CFC, has been observed since the mid-1990s. However, a slowdown in the decline after 2012 indicates a rise in emissions, particularly in Eastern Asia. Ground-based observations are lacking in southeastern China, limiting a thorough evaluation of CFC-11 levels and emissions in this region. A new Advanced Global Atmospheric Gases Experiment background station was established at Xichong (XCG), Shenzhen, China, to provide high-frequency continuous in situ observations. The annual mean CFC-11 mixing ratio, recorded from May 2022 to April 2023, is 221.64 ± 2.29 ppt. When compared with a monthly (MHD) or daily (MLO) observation, this value is found to be 0.45% to 5.36% higher than the northern hemispheric background. With the inverse modeling and interspecies correlation method, we estimate CFC-11 emissions in southeastern China between 1.23 ± 0.25 Gg yr−1 and 1.58 ± 0.21 Gg yr−1, in line with the bottom-up estimation of 1.50 Gg yr−1. Results indicate that CFC-11 emissions in the Pearl River Delta region have returned to levels before 2010, aligning with regional and global trends. Observations from XCG would compensate for the deficiency of CFC-11 measurements in southeastern China, paving the road for ODS studies in this region and beyond.

Telemedicine-Enhanced Lung Cancer Screening Using Mobile Computed Tomography Unit with Remote Artificial Intelligence Assistance in Underserved Communities: Initial Results of a Population Cohort Study in Western China.

Introduction: Lung cancer is a leading cause of cancer deaths globally. Despite favorable recommendations, low-dose computed tomography (LDCT) lung screening adoption remains low in China. Barriers such as limited infrastructure, costs, distance, and personnel shortages restrict screening access in disadvantaged regions. We initiated a telemedicine-enabled lung cancer screening (LCS) program in a medical consortium to serve people at risk in underserved communities. The objective of this study was to describe the implementation and initial results of the program. Methods: From 2020 to 2021, individuals aged 40-80 years were invited to take LCS by mobile computed tomography (CT) units in three underserved areas in Western China. Numerous CT scans were remotely reported by radiologists aided by artificial intelligence (AI) diagnostic systems. Abnormal cases were tracked through an integrated hospital network for follow-up. A retrospective cohort study documented participant demographics, health history, LDCT results, and outcomes. Descriptive analysis was conducted to report baseline characteristics and first-year follow-up results. Results: Of the 28,728 individuals registered in the program, 19,517 (67.94%) participated in the screening. The study identified 2.68% of participants with high-risk pulmonary nodules and diagnosed 0.55% with lung cancer after a 1-year follow-up. The majority of high-risk participants received timely treatment in hospitals. Conclusions: This study demonstrated mobile CT units with remote AI assistance improved access to LCS in underserved areas, with high participation and early detection rates. Our implementation supports the feasibility of deploying telemedicine-enabled LCS to increase access to a large scale of basic radiology and diagnostic services in resource-limited settings. Clinical Trial Registration Number: ChiCTR1900024623.

Contribution of Indicators to the Analysis of Projects in Historic Sites: Case of Mill São João

Objective: The objective of this study is to analyze the economic and financial viability of the Engenho São João Cultural and Ecological Reference Center. Theoretical Framework: The study presented the characterization of the area of ​​the research object, addressing the relevant historical facts and demonstrating the project's masterplan. Method: The research was conducted in two stages: surveying the costs, revenues and results of the mill's first year of operation, followed by a critical assessment focusing on cost-benefit and distributional impact. A qualitative approach was used, with document analysis and interviews with relevant stakeholders. Results and Discussion: The results indicate viability in the social, patrimonial and distributive impact aspects of the mill, but point to the economic and financial unfeasibility of the project. The discussion contextualizes these results in light of the theoretical framework, highlighting the need to explore new scenarios, such as obtaining financing and developing entertainment activities. Research Implications: The practical implications of this study include recommendations for promoting the sustainability of Engenho São João, such as the search for public-private partnerships and the diversification of revenue sources. Theoretically, it contributes to the field of historical-cultural heritage management by highlighting the challenges and possibilities faced by these enterprises. Originality/Value: This study stands out for its integrated approach, combining economic, social and heritage analyses. Its relevance lies in its contribution to the development of sustainable strategies for the preservation and promotion of historical-cultural heritage, providing valuable insights for public and private managers in this field.

Hepatitis C screening in Lithuania: first-year results and scenarios for achieving WHO elimination targets.

The World Health Organization (WHO) has outlined a set of targets to achieve eliminating hepatitis C by 2030. In May 2022, Lithuanian health authorities initiated a hepatitis C virus (HCV) screening program to start working towards elimination. In the program, bonus was given to general practitioners (GPs) to promote and conduct anti-HCV tests for two situations: (1) one time testing for individuals born in 1945-1994 and (2) annual HCV testing for persons who inject drugs or are living with human immunodeficiency virus (HIV) regardless of age. This study aimed to model the current viral hepatitis C epidemiological status in Lithuania and to outline the requirements for WHO elimination targets using the first-year HCV screening results. Individuals were invited to participate in the anti-HCV screening by GPs during routine visits. Patients who tested positive were then referred to a gastroenterologist or infectious disease doctor for further confirmatory testing. If a patient received a positive RNA test and a fibrosis staging result of ≥ F2, the doctor prescribed direct-acting antivirals. Information on the patients screened, diagnosed, and treated was obtained from the National Health Insurance Fund. The Markov disease progression model, developed by the CDA Foundation, was used to evaluate the screening program results and HCV elimination progress in Lithuania. Between May 2022 and April 2023, 790,070 individuals underwent anti-HCV testing, with 11,943 individuals (1.5%) receiving positive results. Anti-HCV seroprevalence was found to be higher among males than females, 1.9% and 1.2%, respectively. Within the risk population tested, 2087 (31.1%) seropositive individuals were identified. When comparing the screening program results to WHO elimination targets through modelling, 2180 patients still need to be treated annually until 2030, along with expanding fibrosis restrictions. If an elimination approach was implemented, 1000 new infections would be prevented, while saving 150 lives and averting 90 decompensated cirrhosis cases and 110 hepatocellular carcinoma cases. During the first year of the Lithuanian screening program, GPs were able to screen 44% of the target population. However, the country will not meet elimination targets as it currently stands without increasing treatment levels and lifting fibrosis restrictions.

Myosteatosis is an independent risk factor for overt hepatic encephalopathy after transjugular intrahepatic portosystemic shunting.

The relationship between skeletal muscle and adipose tissue compositions and risk of overt hepatic encephalopathy (OHE) following transjugular intrahepatic portosystemic shunt (TIPS) treatment needs to be investigated. A total of 282 patients were collected from two medical centres. The median time of follow-up was 48.23 + 1.36 months and the first-year results of all patients after TIPS therapy were collected. The muscle and adipose tissue indices were quantified at the third lumbar vertebra level. Sarcopenia and myosteatosis were defined according to previous researches. Receiver operating characteristic curves, chi-square test, univariate and multivariate logistic regression analyses were employed to investigate the potential association between muscle and adipose indices, sarcopenia, myosteatosis and the risk of developing post-TIPS OHE. All skeletal muscle indices, adipose tissue indices and sarcopenia had limited associations with post-TIPS OHE. Myosteatosis (148 cases, 52.5%, 55 with OHE, 37.2%) was identified as an independent risk factor for post-TIPS OHE. with P < 0.001 in Chi-square test, P < 0.001, odds ratio (OR): 2.854, 95% confidence interval (CI): 1.632-4.993 in univariate logistic regression analyses, and P = 0.007, OR: 2.372, 95% CI: 1.268-4.438 in multivariate logistic regression analyses, respectively. Our results showed that myosteatosis was proven as an independent risk factor for the development of post-TIPS OHE.

Data Mining: Will First-Year Results Predict the Likelihood of Completing Subsequent Units in Accounting Programs?

Data Mining: Will First-Year Results Predict the Likelihood of Completing Subsequent Units in Accounting Programs?

STRONGHOLD first-year results of biomechanically calculated abdominal wall repair: a propensity score matching

PurposeEvery year around 70,000 people in Germany suffer from an abdominal incisional hernia that requires surgical treatment. Five years after reconstruction about 25% reoccur. Incisional hernias are usually closed with mesh using various reconstruction techniques, summarized here as standard reconstruction (SR). To improve hernia repair, we established a concept for biomechanically calculated reconstructions (BCR). In the BCR, two formulas enable customized patient care through standardized biomechanical measures. This study aims to compare the clinical outcomes of SR and BCR of incisional hernias after 1 year of follow-up based on the Herniamed registry.MethodsSR includes open retromuscular mesh augmented incisional hernia repair according to clinical guidelines. BCR determines the required strength (Critical Resistance to Impacts related to Pressure = CRIP) preoperatively depending on the hernia size. It supports the surgeon in reliably determining the Gained Resistance, based on the mesh-defect-area-ratio, further mesh and suture factors, and the tissue stability. To compare SR and BCR repair outcomes in incisional hernias at 1 year, propensity score matching was performed on 15 variables. Included were 301 patients with BCR surgery and 23,220 with standard repair.ResultsBCR surgeries show a significant reduction in recurrences (1.7% vs. 5.2%, p = 0.0041), pain requiring treatment (4.1% vs. 12.0%, p = 0.001), and pain at rest (6.9% vs. 12.7%, p = 0.033) when comparing matched pairs. Complication rates, complication-related reoperations, and stress-related pain showed no systematic difference.ConclusionBiomechanically calculated repairs improve patient care. BCR shows a significant reduction in recurrence rates, pain at rest, and pain requiring treatment at 1-year follow-up compared to SR.

Transurethral resection of the prostate (TURP) versus transperineal laser ablation (TPLA) due to benign prostatic hyperplasia (BPH): prospective and comparative study.

We aimed to compare the first-year results of Transurethral resection of the prostate (TURP), the gold standard method, and Transperineal laser ablation (TPLA) techniques. This study was designed as a prospective, randomized, controlled, and single-center and was conducted between November 2021 andFebruary 2023. TURP candidates were included in the study. Demographic data and perioperative data were recorded. Preoperative and first-year International Prostate Symptom Score (IPSS), International Erectile Function Index (IIEF-5), Male Sexual Health Questionnaire-Ejaculatory Dysfunction (MSHQ-EjD), QoL, peak urinary flow rate (Qmax), prostate volume (PV) and postvoid residual (PVR) data were recorded. Fifty patients were included in the study and were assigned to equal numbers of groups. TPLA group had a higher ASA score (p = 0.03). There was improvement in IPSS, Qmax, and PVR parameters compared to baseline values in both groups at 1year (p < 0.01). The improvement in Qmax was better in the TURP group (p < 0.01). IIEF-5 score was similar between groups (p = 0.83 and p = 0.12, respectively). The MSHQ scores in the first year did not change according to their baseline values in the TPLA group (p = 0.54 and p = 0.34, respectively). According to the first-year results of TPLA, the symptomatic improvement effect without sacrificing ejaculatory functions is comparable to TURP. We think that this method will can be an alternative, especially for patients who want to avoid ejaculatory dysfunction, who have a high risk of anesthesia, and whose anticoagulant/antiplatelet therapy cannot be discontinued.

QI/PI: POSNA Safe Surgery Program (PSSP)—First-Year Results Implementing Quality Metrics

Background: Ranking of orthopaedic programs by external organizations is expanding to pediatric orthopaedics. These external organizations rarely consult pediatric orthopaedists themselves; therefore, POSNA members strongly supported the creation of a new performance evaluation. As a result, POSNA developed a member-driven process for driving quality improvements in pediatric orthopaedics: the POSNA Safe Surgery Program (PSSP). The PSSP aims to develop key quality metrics that members believe improve outcomes in pediatric orthopaedics. This paper aims to summarize the first year of implementing the PSSP quality metrics.Methods: The POSNA Quality, Safety, and Value Initiative (QSVI) Council developed 20 PSSP quality metrics for five domains: sports medicine, trauma, spine, hip/lower extremity (LE), and hand/upper extremity (UE). The quality metrics were integrated into five online surveys (one per domain) and distributed to POSNA member orthopaedic centers across North America.Results: Thirty-three POSNA member orthopaedic centers responded to at least one domain-specific survey. Spine had the highest response rate (88%), while hand/UE and hip/LE had the lowest (70% and 73%, respectively). Centers meeting each quality metric ranged from 65% to 92% in sports medicine, 62% to 100% in trauma, 79% to 100% in spine, 83% to 96% in hip/LE, and 83% to 100% in hand/UE. Large and very large centers, as well as specialized children's hospitals, provided more detailed protocols and procedures, likely due to greater resources and specialization. There was nearly 100% agreement between centers on protocols with well-known, easy-to-follow checklists for fulfilling a quality metric.Conclusions: The primary goal of the PSSP is to create internally developed, surgeon-driven quality metrics that determine high-quality care. By using these quality metrics and reports, we hope surgeons can gain institutional resources to drive improvements in their centers. In its first year, the PSSP demonstrated that these quality metrics can be successfully distributed and reviewed by POSNA members. Our future work will focus on expanding the PSSP to more pediatric orthopaedic centers, iteratively evaluating and modifying the metrics, and adding metrics for additional domains.Level of Evidence: Level IVKey Concepts•Ranking of orthopaedic programs by external organizations is expanding to pediatric orthopaedics which will have important clinical and financial implications.•Pediatric orthopaedists are rarely consulted in quality evaluations by external organizations; therefore, POSNA created a member-driven performance evaluation system—the POSNA Safe Surgery Program (PSSP)—to develop surgeon-driven quality metrics to improve high-quality care.•Twenty PSSP quality metrics were developed by the POSNA Quality, Safety, and Value Initiative (QSVI) Council across five domains: sports medicine, trauma, spine, hip/lower extremity (LE), and hand/upper extremity (UE).•Our first year distributing the PSSP quality metrics to POSNA member centers revealed (1) high engagement rates and (2) diverse ranges of quality metric fulfillment by centers.•In the future, we will expand the PSSP to more pediatric orthopaedic centers, iteratively evaluate and modify the PSSP quality metrics, and develop metrics for additional domains.

Feasibility and first results of the ‘Trials-within-Cohorts’ (TwiCs) design in patients undergoing radiotherapy for lung cancer

Background: ‘Trials-within-Cohorts’ (TwiCs), previously known as ‘cohort multiple randomized controlled trials’ is a pragmatic trial design, supporting an efficient and representative recruitment of patients for (future) trials. To our knowledge, the ‘COhort for Lung cancer Outcome Reporting and trial inclusion’ (COLOR) is the first TwiCs in lung cancer patients. In this study we aimed to assess the feasibility and first year results of COLOR.Material and Methods: All patients diagnosed with lung cancer referred to the Radiotherapy department were eligible to participate in the ongoing prospective COLOR study. At inclusion, written informed consent was requested for use of patient data, participation in patient-reported outcomes (PROs), and willingness to participate in (future) trials. Feasibility was studied by assessing participation and comparing baseline PROs to EORTC reference values. First-year results of PROs at baseline and 3 months after inclusion were evaluated separately for stereotactic body radiotherapy (SBRT) and conventional radiotherapy patients.Results: Of the 338 eligible patients between July 2020 and July 2021, 169 (50%) participated. Among these, 127 (75%) gave informed consent to PROs participation and 110 (65%) were willing to participate in (future) trials. The inclusion percentage dropped from 77% to 33% when the information procedure was switched from in-person to by phone (due to COVID-19 pandemic measures). Baseline PROs for physical and cognitive functioning were comparable in COLOR patients compared to the EORTC reference values. No significant changes in PROs were observed 3 months after inclusion, except for a slight increase in pain scores in the SBRT group (n = 97).Conclusions: The TwiCs-design appears feasible in lung cancer patients with fair participation rates (although negatively impacted by the COVID-19 pandemic). With a planned expansion to other centers, the COLOR-study is expected to enable multiple (randomized) evaluations of experimental interventions with important advantages for recruitment, generalizability, and long-term outcome data collection.

Conversion arthroplasty after failed extracapsular hip fracture fixation is associated with high complication rates

Background/Aim: There is no standard treatment of choice that addresses all extracapsular fractures, which account for approximately half of the elderly hip fractures. Arthroplasty is mostly favored secondary to unsuccessful fixation or unstable primary fractures. However, conversion arthroplasty complication rates are high in the literature. This study compares arthroplasty performed after unsuccessful fixation and primary arthroplasty for unstable extracapsular hip fractures. Methods: In this retrospective study, we compared the first-year results of the groups that underwent conversion arthroplasty (cHA) and the primary arthroplasties (pHA) for extracapsular hip fractures. In the cHA group, patients were indicated for operation if there was a failure of fixation after extracapsular hip fractures (n=44). In the pHA group, patients were for unstable extracapsular hip fractures (n=44). In the cHA group, failure of fixation causes were cut-out of lag screws (54.5%), cut-through of lag screws (9.1%), non-union of fractures (27.3%), and osteonecrosis of femoral heads (9.1%). While total hip replacement was applied to all patients in the cHA group, total hip replacement was applied to ten patients in the pHA group and hemiarthroplasty to 34 patients. In comparing groups, duration of operation, amount of bleeding, intraoperative complications, post-operative complications, mobilization capacities, functional status, and mortality rates were used. Results: There were 44 patients in both groups. The surgical time (134.3 [34.5)] vs. 66 [16], [P&lt;0.001]), the amount of bleeding (1000 ml [400] vs. 300ml [200], [P&lt;0.001]), the need for red blood cell transfusion in the operations (80% vs. 32%, [P&lt;0.001]), and the frequency of intraoperative femur fracture (30% vs. 0%, [P&lt;0.001]) were larger or longer in the cHA group compared to pHA group (P&lt;0.001). While 14 complications requiring surgical intervention were observed in 12 of 44 patients in the CHA group in the post-operative 1st year, four complications were observed in four of 44 patients in the pHA group. There was no difference in mortality rates (3 vs. 3, [P =1]), mobilization capacities (5.9 [2.1] vs. 5.7 [2.0], [P=0.597]), and functional status (12.5 [3.3] vs. 13.0 [2.7], [P=0.434]) between the groups. Conclusion: Arthroplasty performed as conversion surgery after unsuccessful fixation has a higher risk of intraoperative and post-operative complications than primary arthroplasty performed after extracapsular hip fractures. We believe the cases prone to implant failure, non-union, or restricted mobilization because of the patient and fracture-type reasons should be treated with primary arthroplasty.

Change in First-year Intravascular Ultrasound Results Predicts Adverse Events in Heart Transplant Recipients: Implications for Clinical Trial Endpoints.

Heart transplantation (HTx) is an established therapeutic option for patients with advanced heart failure who are refractory to conventional guideline-directed treatments. This study aimed to reassess whether intravascular ultrasound variables could predict adverse events after HTx in the modern era. One hundred primary HTx recipients with available serial intravascular ultrasound examination results of the left anterior descending artery 4-8 wk and 1 y after HTx were enrolled, with an average follow-up duration of 5.7 y. The primary endpoint was a composite of all-cause death, nonfatal major adverse cardiac events, and angiographic cardiac allograft vasculopathy. Forty-three patients developed primary endpoints. The baseline maximal intimal thickness was independently associated with the primary endpoint (hazard ratio, 8.24; 95% confidential interval [CI], 3.21-21.21; P < 0.001), and the optimal cutoff value was 0.64 mm. A change in the plaque atheroma volume in a proximal 20-mm segment from the left anterior descending artery bifurcation >1.05 mm 3 /mm (hazard ratio, 2.75; 95% CI, 1.28-5.89; P = 0.009) and a change in the first-year maximal intimal thickness >0.27 mm (hazard ratio, 2.63; 95% CI, 1.05-6.56; P = 0.04) were independent predictors of the primary endpoint 1 y after intravascular ultrasonography. The aforementioned important clinical implications of intravascular ultrasound parameters are useful predictors of outcomes, which may be considered endpoints in modern clinical HTx trials.

Aligner therapy in adolescents: first-year results on the impact of therapy on oral health-related quality of life and oral hygiene

ObjectivesThe aim of this multicenter clinical study was to examine the oral health-related quality of life and oral hygiene in adolescents before and during aligner therapy.Materials and methodsForty subjects (18 ♀, 22 ♂; mean age: 13.6 years) scheduled for aligner therapy (Invisalign® Teen) were given oral health-related quality of life questionnaires, Oral Health Impact Profile (OHIP-G14) and Psychosocial Impact of Dental Aesthetic Questionnaire (PIDAQ), to complete within their treatment (visit 1: 0 start of therapy; visit 2: 0 + 4 weeks; visit 3: 0 + 10 weeks; visit 4: 0 + 6 months; visit 5: 0 + 1 year). To assess oral hygiene, a questionnaire to take home was used, and plaque level was evaluated with the Quigley-Hein Plaque Index (TMQH) modified by Turesky et al.ResultsThe OHIP-G14 mean score before aligner therapy was 3.3 ± 3.2, and 4.9 ± 5.4 after 1 year. The PIDAQ showed a positive psychological change in the well-being, as well as a more effective at-home oral hygiene regime. On average, the TMQH remained at a low level (grade 2 of 0–5). The initial insertion of the aligners caused the most significant changes in all parameters (except TMQH).ConclusionOral health-related quality of life is only slightly affected during the first year of aligner therapy in adolescents. Oral hygiene at home is intensified and there is no increased dental plaque accumulation.Clinical relevanceDentofacial esthetics is a subset of the so-called Oral H-Related Quality of Life (OHRQoL) which should be considered more during orthodontic therapy.

Twenty-Four-Month Efficacy of Ureteroureterostomy Combined With Unilateral Nephrostomy Following Radical Cystectomy

Introduction The purpose of this study was to evaluate the 24-month outcomes of ureteroureterostomy combined with unilateral nephrostomy following radical cystectomy in patients with muscle-invasive bladder cancer (BC). Materials and methods This single-center study with prospectively collected data with retrospective data analysis was carried out between December 2018 and November 2021 and enrolled 36 patients, who underwent radical cystectomy combined with ureteroureterostomy and unilateral nephrostomy. Regular renal function assessment was carried out using serum creatinine and estimated glomerular filtration rate (eGFR), and postoperative complications, endoscopic, ultrasound, and other radiological study findings were evaluated. The follow-up of the patients was carried out over a period of 24 months. Results After completion of the 24-month follow-up, the renal function proved to be slightly improved (mean serum creatinine and eGFR values of 1.38±0.72 mg/dL and 55.9±21.87 mL/min) compared to the first-year results (1.41±0.54 mg/dL and 52.10±19.64 mL/min). However, this improvement is statistically not significant (p=0.44, p=0.30). The 24-month follow-up imaging findings remained stable in 97.22% of patients compared to the first-year results, with preservation of bilateral ureteric dilatation and grade 1 dilatation of the non-drained kidney. No case of acute pyelonephritis was recorded after the completion of the second year of follow-up, in comparison to the eight patients (22.22%) of the 12-month follow-up, who sufferedacute pyelonephritis. After completing of the 24-month follow-up, one patient was excluded from further analysis, due to the placement of a second permanent percutaneous nephrostomy in the non-drained kidney, due to ureteroureterostomy stenosis with consecutive hydronephrosis in the contralateral kidney and acute renal failure. No case of anastomotic leak was observed. Conclusions The function of the ureteroureterostomy combined with unilateral nephrostomy is proven to be a safe method of urinary diversion (UD) at 24 months, with minimal and easily manageable complications. Only one case of stenosis of the ureteroureterostomy with consecutive acute renal failure due to hydronephrosis in the non-drained kidney was observed. The renal function remained stable.

Stress, Anxiety and Depression Prevalence among Greek University Students during COVID-19 Pandemic: A Two-Year Survey.

Background: The negative effect of COVID-19 pandemic on college students’ mental health is well-demonstrated. The aim of this study is to assess the impact of the pandemic on the students of Aristotle University of Thessaloniki (Northern Greece), in terms of stress, anxiety, and depression, and to analyze the probable correlation of various social and phycological factors. Methods: The survey was conducted in the form of a questionnaire, which was first distributed in November 2020 and then re-launched in November 2021. The evaluation was carried out through the DASS21 screening tool. Associations regarding participants’ characteristics and the three variables (stress, anxiety, and depression) were investigated with Pearson’s chi-squared (Χ2) test. Results: The first-year results (November 2020) revealed severe prevalence of stress, anxiety, and depression (37.4%, 27.2% and 47% respectively). The second-year results (November 2021) revealed a significant augmentation in all three variables, mainly for the extreme severe scales (47.3%, 41.1% and 55% respectively). Participants who were receiving psychiatric treatment exhibited higher levels of stress, anxiety, and depression, especially during the second year of the pandemic (p-Value < 0.00001). Female students’ mental health was at higher risk, as elevated prevalence of negative symptoms was observed (p-Value < 0.00001). Conclusions: The community of Aristotle University of Thessaloniki has been greatly affected during the last 2 years. The inherent risks of the confinement measures on students’ well-being and mental health are undeniable. Recurrent annual psychological evaluation in universities and colleges is strongly advised.

The new educational project Televascular Games during the Coronavirus Disease 2019 pandemic.

ObjectiveTo report methodology and first-year results of a new educational project called “Televascular Games”, which took place during COVID-19 pandemic.MethodsComplex aneurysmal aortic disease was discussed during a 2-hour competition webinar, according to three modalities. 1) Planning case competition (PCC): 2-4 pre-operative Computed Tomography Angiography (CTA) scans of an already performed selected case were submitted for the competition. CTA-scans were anonymously uploaded, without any reference to the center or the surgeon who performed the case. The competitor had to prepare a presentation of how he/she would have diagnosed, sized, planned, treated and followed up the case, of the medical therapy and of the bail-out maneuvers. 2) Challenging case competition (CCC): the competitor elaborates a presentation of an already treated case concerning an aortic topic and discusses sizing, planning, treatment, possible bail-out maneuvers and obtained results. For the CCC and PCC, the competitors with the best score were pre-selected to present and discuss their plan during the webinars. 3) Quiz competition (QZ): 2-6 angio-CTA scans of already performed selected aortic cases were submitted for the competition. A quiz with multiple-choice questions was answered by the competitors. The top four competitors were selected for the webinars and then they discussed the cases during the webinar. Finally, at the end of the case-discussion, the effective case resolution and follow-up were shown. A final winner was voted via televoting, based on six pre-established criteria. The project was endorsed by different National and International Societies.ResultsBetween October-2020 and December-2021, there were 12 Italian and 1 international webinars with overall 1695 participants (mean 130, range:86-177). Competitors were 54 (mean age 27, range 22-38 years). Two editions were CCCs, two QZs, and nine PCCs. The reliability of the inter-observer sizing of competitors was k=.43 and k=.62 for the proximal and distal sealing measurements respectively and very good (k =.88-.95) in the evaluation of orientation of the vessels, presence of angulations, calcifications and thrombus. The sizing discrepancy resulted in a significant variability of the planning (k=.45). The project ranked 9.6 in a “10-point” rating scale by all the participants and competitorsConclusionsThe formula of gaming and collegial discussion of aortic cases herein reported has proved valid and attractive during COVID-19 pandemic period. The variability of the results on sizing and planning suggested to confer with a second opinion especially for less experienced surgeons.

Medicare's Specialty-Oriented Accountable Care Organization: First-Year Results For People With End-Stage Renal Disease.

The Comprehensive End-Stage Renal Disease (ESRD) Care (CEC) Model was the first Medicare specialty-oriented accountable care organization (ACO) model. We examined whether this model provided better results for beneficiaries with ESRD than primary care-based ACO models. We found significant decreases in Medicare payments ($126 per beneficiary per month), hospitalizations (5percent), and likelihood of readmissions (8percent) among beneficiaries with ESRD during the first year of alignment with the CEC Model and no impacts on these measures among beneficiaries with ESRD who were aligned with primary care-based ACOs, relative to fee-for-service Medicare beneficiaries. Neither the CEC nor primary care-based ACO models significantly reduced the likelihood of catheter use, but fistula use increased for CEC Model beneficiaries to levels just above statistical significance. Other populations with chronic conditions may benefit from the testing of a specialty-oriented ACO model. In addition, primary care-based ACOs may benefit from applying CEC Model strategies to high-need subpopulations. Last, the strategies that enabled ESRD Seamless Care Organizations to achieve reductions in hospitalizations and readmissions even without hospital participation as owners could inform physician-led ACOs' efforts to coordinate with hospitals in their areas.

Training teachers to teach PISA-like reading: A case in Indonesia

This paper presents partial results of the first year of a multi-year joint study, involving three universities in Indonesia, aiming to develop a program to train English and Indonesian teachers to teach PISA-like reading (24 teachers in junior and senior high schools in West Java, Indonesia). The study aimed to identify whether the program can help the teachers enhance their PISA-like reading ability, create PISA-like reading materials for reading practices, and teach them to their students. The program drew on principles of effective teacher professional development (Ajani, 2018; Borko, 2004; Borko et al., 2010; Darling-Hammond et al., 2017), PISA reading (OECD, 2009, 2016, 2017, 2019, 2021), text-based instruction (Macken-Horarik et al., 2017), Reading to Learn Program (Rose, 2020a,b), and online teaching (Ragan, 2015). The study uses a program evaluation with the data collected from four sources, including a phase of training, pre- and post-tests, collection of PISA-like reading materials, and questionnaires distributed before and after the training program. The focus of the first year was on enhancement of teachers’ understanding and skills in different PISA-related aspects. Enhancement of their teaching capacity has not been explored, except for that prior to the training program, and this has been reported in Rahmadina and Emilia (2022). The first-year results reveal that the training program could help enhance the teachers’ ability to read, to use appropriate texts, and to construct PISA-like reading tasks. This was confirmed by the teachers’ positive responses to the program, in accordance with previous research on effective teacher professional development (TPD). It is recommended that the training program be conducted in different contexts, involving more teachers to help students learn to read and succeed in PISA reading.

Integration of the Renal Angina Index and Urine Neutrophil Gelatinase-Associated Lipocalin Improves Severe Acute Kidney Injury Prediction in Critically Ill Children and Young Adults

IntroductionAcute kidney injury (AKI) occurs in one-fourth of children and young adults admitted to pediatric intensive care unit (PICU). Severe AKI (sAKI; Kidney Disease: Improving Global Outcomes stage 2 or 3) is associated with morbidity and mortality. An AKI risk stratification system, the Renal Angina Index (RAI) calculated at 12 hours of admission, exhibits excellent performance to rule out sAKI at 72 hours of admission. We found that integration of urine neutrophil gelatinase-associated lipocalin (NGAL) with RAI improves prediction of sAKI. We now report the first-year results after implementation of our prospective automated RAI-NGAL clinical decision support (CDS) program.MethodsPatients 3 months to 25 years of age were eligible. Admission order sets have a conditional order for urine NGAL released when a 12-hour RAI ≥8. The primary outcome was sAKI any time at days 2 to 4 of admission. We assessed performance of the RAI and RAI+/NGAL to predict the primary outcome.ResultsA total of 1427 unique patients accounted for 1575 admissions. In 147 admissions, RAI was ≥8. RAI <8 had negative predictive value (NPV) of 0.98 (95% CI 0.97–0.99); RAI ≥ 8 had positive predictive value (PPV) of 0.37 (95% CI 0.30–0.46) to predict days 2 to 4 sAKI (area under the receiver operating characteristic curve [AUC-ROC] 0.88 [95% CI 0.84–0.92]). Of 147 RAI+ patients, 89 had NGAL available. RAI/NGAL combination improved PPV (0.64, 95% CI 0.50–0.79) without decrement in NPV (0.98, 95% CI 0.97–0.98).ConclusionAKI biomarker assessment directed by risk stratification improves prediction of sAKI in critically ill children and young adults. This CDS process has potential to enrich the population for interventional study, although improvement to adherence to CDS is needed.