Secondary Risk Factors Research Articles

16S Metagenomics Reveals Dysbiosis of Nasal Core Microbiota in Children With Chronic Nasal Inflammation: Role of Adenoid Hypertrophy and Allergic Rhinitis.

Allergic rhinitis (AR) and adenoid hypertrophy (AH) are, in children, the main cause of partial or complete upper airway obstruction and reduction in airflow. However, limited data exist about the impact of the increased resistance to airflow, on the nasal microbial composition of children with AR end AH. Allergic rhinitis (AR) as well as adenoid hypertrophy (AH), represent extremely common pathologies in this population. Their known inflammatory obstruction is amplified when both pathologies coexist. In our study, the microbiota of anterior nares of 75 pediatric subjects with AR, AH or both conditions, was explored by 16S rRNA-based metagenomic approach. Our data show for the first time, that in children, the inflammatory state is associated to similar changes in the microbiota composition of AR and AH subjects respect to the healthy condition. Together with such alterations, we observed a reduced variability in the between-subject biodiversity on the other hand, these same alterations resulted amplified by the nasal obstruction that could constitute a secondary risk factor for dysbiosis. Significant differences in the relative abundance of specific microbial groups were found between diseased phenotypes and the controls. Most of these taxa belonged to a stable and quantitatively dominating component of the nasal microbiota and showed marked potentials in discriminating the controls from diseased subjects. A pauperization of the nasal microbial network was observed in diseased status in respect to the number of involved taxa and connectivity. Finally, while stable co-occurrence relationships were observed within both control- and diseases-associated microbial groups, only negative correlations were present between them, suggesting that microbial subgroups potentially act as maintainer of the eubiosis state in the nasal ecosystem. In the nasal ecosystem, inflammation-associated shifts seem to impact the more intimate component of the microbiota rather than representing the mere loss of microbial diversity. The discriminatory potential showed by differentially abundant taxa provide a starting point for future research with the potential to improve patient outcomes. Overall, our results underline the association of AH and AR with the impairment of the microbial interplay leading to unbalanced ecosystems.

Risk factors for malnutrition among hospitalized gastroenterological patients

Background/Aim. Risk factors for malnutrition of patients during hospitalization have not been precisely deter-mined. The aim of the study was to determine these factors in hospitalized gastroenterological patients. Methods. Nutritional status (NS) of 650 gastroenterological patients was assessed at the hospital admission and at discharge by the six parameters: unintentional weight loss, lymphocyte count, serum albumin concentration, body mass index, triceps skinfold thickness, and mid-upper arm muscle circumference. The influence on NS at discharge was tested for ten factors: gender, age, affected organ, the nature, severity, and complications of the disease, the length of hospitalization, mobility worsening during hospitalization, Karnofsky score, and NS on admission. Primary and secondary risk factors were defined among the factors significantly influencing malnutrition. Results. Seven factors were found to be the independent predictors for malnutrition in hospitalized gastroenterological patients. NS at admission was considered as a primary risk factor (Forward: Wald multivariate logistic regression analysis, p < 0.001 for five applied assessment parameters). The other six factors, obtained in the evaluation according to 1-3 assessment parameters, were considered as secondary risk factors: severe disease activity, malignancy, the existence of complications, male gender, hospitalization > 14 days, and mobility worsening during the hospitalization (Forward: Wald multivariate logistic regression analysis, p from 0.001 to 0.027). Conclusion. There are seven risk factors for malnutrition among gastroenterological patients during hospitalization. Timely nutritional support in these patients can prevent the development of intrahospital malnutrition and its negative influence on the clinical outcome.

Fracture risk assessment in celiac disease: a registry-based cohort study.

The fracture risk assessment tool (FRAX®) uses clinical factors and bone mineral density (BMD) measurement to predict 10-year major osteoporotic (MOF) fracture probability. The study aim was to determine whether celiac disease affects MOF risk independent of FRAX score. The Manitoba BMD Registry includes clinical data, BMD measurements, 10-year probability of MOF calculated for each individual using the Canadian FRAX tool and diagnosed celiac disease. Using linkage to population-based healthcare databases, we identified incident MOF diagnoses over the next 10years for celiac disease and general population cohorts. Celiac disease (N = 693) was associated with increased fracture risk adjusted for FRAX score computed without secondary osteoporosis or BMD (adjusted hazard ratio [HR] 1.43, 95% confidence interval [CI] 1.11-1.86). Celiac disease was no longer a significant risk factor for fracture when secondary osteoporosis or BMD were included in the FRAX calculation (p > 0.1). In subjects with celiac disease, each SD increase in FRAX score (calculated with and without secondary osteoporosis or BMD) was associated with higher risk of incident MOF (adjusted HR 1.66 to 1.80), similar to the general population (p-interaction > 0.2). Including celiac disease as secondary osteoporosis or including BMD in FRAX 10-year MOF probability calculations (10.1% and 8.6% respectively) approximated the observed cumulative 10-year MOF probability (10.8%, 95% CI 7.8-13.9%). Celiac disease is associated with an increased risk of major osteoporotic fractures. When celiac disease is considered as a secondary osteoporosis risk factor or BMD is included in FRAX assessment, FRAX accurately predicts fracture risk.

A Feature-Driven Decision Support System for Heart Disease Prediction Based on Fisher's Discriminant Ratio and Backpropagation Algorithm

Coronary heart disease included a group of cardiovascular, and it is a leading cause of death in low and middle-income countries. Risk factors for coronary heart disease are divided into two, namely primary and secondary risk factors. The need to identify characteristics or risk factors in heart disease patients by making the classification model. The modeling of heart disease classification to know how the system can able to reach the best prediction accuracy. Fisher's Discriminant Ratio is one of the methods for feature selection, which is used to get high discriminant features. While Backpropagation is one of the classification models to recognize patterns in heart disease patients. The experiment results showed that the accuracy of the classification model using 13 original features reached 92%. By reducing the features based on the score of the feature selection, then the lowest feature was removed from original features and left there were 12 features involved in the classification model which the accuracy increased to 93%. Furthermore, the results of determining the threshold (accuracy does not decrease continuously) and consider the effect of eliminating the lowest features that are considered quite fluctuating on accuracy. The accuracy reached 90% by eliminating the five lowest features and left eight existing features.

Genetic, clinical, molecular, and pathogenic aspects of the South Asian-specific polymorphic MYBPC3Δ25bp variant.

Hypertrophic cardiomyopathy (HCM) is a cardiac genetic disease characterized by ventricular enlargement, diastolic dysfunction, and increased risk for sudden cardiac death. Sarcomeric genetic defects are the predominant known cause of HCM. In particular, mutations in the myosin-binding protein C gene (MYBPC3) are associated with ~ 40% of all HCM cases in which a genetic basis has been established. A decade ago, our group reported a 25-base pair deletion in intron 32 of MYBPC3 (MYBPC3Δ25bp) that is uniquely prevalent in South Asians and is associated with autosomal dominant cardiomyopathy. Although our studies suggest that this deletion results in left ventricular dysfunction, cardiomyopathies, and heart failure, the precise mechanism by which this variant predisposes to heart disease remains unclear. Increasingly appreciated, however, is the contribution of secondary risk factors, additional mutations, and lifestyle choices in augmenting or modifying the HCM phenotype in MYBPC3Δ25bp carriers. Therefore, the goal of this review article is to summarize the current research dedicated to understanding the molecular pathophysiology of HCM in South Asians with the MYBPC3Δ25bp variant. An emphasis is to review the latest techniques currently applied to explore the MYBPC3Δ25bp pathogenesis and to provide a foundation for developing new diagnostic strategies and advances in therapeutics.

Low-Molecular-Weight Heparin vs Warfarin for Thromboprophylaxis in Children With Coronary Artery Aneurysms After Kawasaki Disease: A Pragmatic Registry Trial

BackgroundThe substantial risk of thrombosis in large coronary artery aneurysms (CAAs) (maximum z-score ≥ 10) after Kawasaki disease (KD) mandates effective thromboprophylaxis. We sought to determine the effectiveness of anticoagulation (low-molecular-weight heparin [LMWH] or warfarin) for thromboprophylaxis in large CAAs. MethodsData from 383 patients enrolled in the International KD Registry (IKDR) were used. Time-to-event analysis was used to account for differences in treatment duration and follow-up. ResultsFrom diagnosis onward (96% received acetylsalicylic acid concomitantly), 114 patients received LMWH (median duration 6.2 months, interquartile range [IQR] 2.5-12.7), 80 warfarin (median duration 2.2 years, IQR 0.9-7.1), and 189 no anticoagulation. Cumulative incidence of coronary artery thrombosis with LMWH was 5.7 ± 3.0%, with warfarin 6.7 ± 3.7%, and with no anticoagulation 20.6 ± 3.0% (P < 0.001) at 2.5 years after the start of thromboprophylaxis (LMWH vs warfarin HR 1.5, 95% confidence interval [CI] 0.4-5.1; P = 0.56). A total of 51/63 patients with coronary artery thrombosis received secondary thromboprophylaxis (ie, thromboprophylaxis after a previous thrombus): 27 LMWH, 24 warfarin. There were no differences in incidence of further coronary artery thrombosis between strategies (HR 2.9, 95% CI 0.6-13.5; P = 0.19). Severe bleeding complications were generally rare (1.6 events per 100 patient-years) and were noted equally for patients on LMWH and warfarin (HR 2.3, 95% CI 0.6-8.9; P = 0.25). ConclusionsLMWH and warfarin appear to have equivalent effectiveness for preventing thrombosis in large CAAs after KD, although event rates for secondary thromboprophylaxis and safety outcomes were low. Based on our findings, all patients with CAA z-score ≥ 10 should receive anticoagulation, but the choice of agent might be informed by secondary risk factors and patient preferences.

Road To Zero Percent Low Back Pain At Work - 23-years Progress

BACKGROUND AND OBJECTIVE: Low back pain is approximately 80% of cause of job-related disability in Japan. Risk factors for developing low back pain have been well documented, which include occupational risk factors, types of job requiring heavy lifting, pushing, pulling, one’s fitness levels, and mental health factors. In this long-term project, we have focused on these secondary risk factors of low back pain. We have designed and implemented dynamic, comprehensive low back pain workshop. The objective of this study was to examine how the company-based workshop has offered and reached to 0% low back pain at work. METHODS: The project period was from 1982 to 2004. In 1982, about 1,100 male workers at a soft-drink company participated in the project. Their mean age at the starting of the project was 29 ± 5.3 years. All healthy participants took the modified Kraus-Weber test measuring their strength and flexibility of key postural core muscles. The test was graded for each movement. Also, the participants took questionnaire survey on low back pain. The dynamic, comprehensive low back pain workshop included endurance exercise, strength training, stretching, safe work-related movement practices, lectures on low back pain, good posture, and implementing preventive work-place events. RESULTS: The total number of participants in this project was 24,289. The mean age of participants in 2004 was 42.6 ± 9.7 years. The results of the questionnaire survey revealed that low back pain which hinders work, decreased from 44.6% in 1982 to 0.2% in 2004. The number of absenteeism due to low back pain decreased from 480days to 0 day a year. The perfect score of Kraus-Weber increased from 35.4% to 83.7%. A negative correlation was observed between low back pain and the Kraus-Weber test. CONCLUSIONS: This study demonstrated that company-based dynamic, comprehensive low back pain workshop improved physical fitness and work movements over a long-term. The workshop was effective reducing low back pain at work. Further research is required to be assessed whether the reduction in low back pain at work is related to a range of key health and work-related outcomes, and how the dynamic, comprehensive low back pain workshop can be further improved.

Risk factors for intensive care admission in children with severe acute asthma in the Netherlands: a prospective multicentre study.

RationaleSevere acute asthma (SAA) can be fatal, but is often preventable. We previously observed in a retrospective cohort study, a three-fold increase in SAA paediatric intensive care (PICU) admissions between 2003 and 2013 in the Netherlands, with a significant increase during those years of numbers of children without treatment of inhaled corticosteroids (ICS).ObjectivesTo determine whether steroid-naïve children are at higher risk of PICU admission among those hospitalised for SAA. Furthermore, we included the secondary risk factors tobacco smoke exposure, allergic sensitisation, previous admissions and viral infections.MethodsA prospective, nationwide multicentre study of children with SAA (2–18 years) admitted to all Dutch PICUs and four general wards between 2016 and 2018. Potential risk factors for PICU admission were assessed using logistic regression analyses.Measurements and main results110 PICU and 111 general ward patients were included. The proportion of steroid-naïve children did not differ significantly between PICU and ward patients. PICU children were significantly older and more exposed to tobacco smoke, with symptoms >1 week prior to admission. Viral susceptibility was not a significant risk factor for PICU admission.ConclusionsChildren with SAA admitted to a PICU were comparable to those admitted to a general ward with respect to ICS treatment prior to admission. Preventable risk factors for PICU admission were >7 days of symptoms without adjustment of therapy and exposure to tobacco smoke. Physicians who treat children with asthma must be aware of these risk factors.

The Role of Physical Therapy in Multiple Risk Factor Management Poststroke: A Scoping Review.

Individuals after stroke often have multiple chronic conditions, such as hypertension, diabetes, dyslipidemia, obesity, and tobacco use. These comorbidities not only are commonly found in individuals with stroke, but also negatively affect functional outcomes and increase risk for hospital readmission and overall mortality. It is important for physical therapists to address the whole person during treatment after stroke, including comorbidities, not just the problems resulting from the stroke itself. However, it is unclear how common it is for physical therapists to address multiple diagnoses at once using a wellness model. Therefore, the purpose of this scoping review was to examine current evidence regarding the role of physical therapy in addressing modifiable risk factors for individuals after stroke, to identify gaps in research associated with physical therapy management of related comorbid diagnoses during treatment for stroke. A scoping review methodology was utilized searching PubMed and CINAHL databases to identify interventional research studies specifically addressing multiple modifiable risk factors utilizing physical therapy for individuals after stroke. The initial search yielded 5358 articles and 12 articles met full inclusion criteria. Only 2 studies included participants with significant mobility impairments, and none included individuals with communication impairments. Only 4 of the 12 studies provided education in their design. Eight studies did not include any patient-reported outcome measures. Only 3 studies included long-term follow-up assessments. Secondary stroke risk factors can be positively addressed using physical therapy interventions; however, more research is needed regarding individuals with moderate to severe mobility or communication deficits. Opportunities for physical therapy research to address stroke risk factors in this complex population include expanding follow-up periods, improving educational interventions, and including caregivers in study design. This review highlights the need for better integration of clinical considerations into stroke rehabilitation research as a whole, along with the need for additional research regarding the role physical therapy can play in addressing multimorbidity in individuals with stroke.

Severe Acute Respiratory Syndrome Coronavirus 2 is Penetrating to Dementia Research.

Severe Acute Respiratory Syndrome Coronavirus 2 is Penetrating to Dementia Research.

T81. MULTIPLE DRUG USE IN SCHIZOPHRENIA - THE ROLE OF EARLY ENVIRONMENTAL RISK ACCUMULATION AND GENETIC PREDISPOSITION

BackgroundDrug (ab)use and substance use disorders are frequently observed in patients with psychiatric illness, but the underlying causes remain widely unknown. A number of environmental risk factors have been proposed to affect the use of one or multiple drugs in the general population and adolescents. Whereas most previous studies focused on the influence of single risk factors on the use of one or a few selected drugs, the effect of accumulated environmental risk in early life on multiple drug use remains to be studied. Similarly, evidence on genetic susceptibility to the (ab)use of a single drug, e.g. nicotine, alcohol, cocaine, is abundant, while the role of genetic predisposition for multiple drug use - in particular during early life - is yet to be explored. Thus, the current work aims to study the role of environmental as well as genetic risk factors for multiple drug abuse (‘polytoxicomania’) in a large sample of schizophrenic/schizoaffective patients.MethodsInformation from ~2000 schizophrenia/schizoaffective patients on (preadult) multiple drug use (> 2 drugs) and environmental risk factors was extracted from the Göttingen Research Association for Schizophrenia (GRAS) data collection – currently the largest data base of deeply phenotyped patients with schizophrenia/schizoaffective disorder or other neuropsychiatric diseases. In addition, genetic data from these patients and 2111 healthy blood donors were used in a novel genetic approach that employs multiple genome-wide association studies (GWAS) to identify genetic associations with preadult multiple drug use. Genotyping was performed on a semi-custom Axiom MyDesign Genotyping Array (Affymetrix, Santa Clara, CA, USA), based on a CEU (Caucasian residents of European ancestry from UT, USA) marker backbone.ResultsThe accumulation of environmental risk factors, i.e. sexual abuse, physical abuse, migration, urbanicity, together with alcohol and cannabis consumption as secondary risk factors, in early life (< 18 years) were strongly associated with lifetime multiple drug use (p = 3.48 x 10^-44, extreme group comparison odds ratio (OR) = 31.8). When the sample was split into preadult and adult multiple drug users, there was a remarkable association of the number of preadult environmental risk factors with preadult multiple drug use (p = 1.12 x 10^-25, OR = 243.6). Furthermore, preadult environmental risk accumulation strongly predicted onset of multiple drug use in adulthood (> 18 years; p = 6.27 x 10^-18, OR = 19.4). The application of the novel genetic approach yielded 35 single-nucleotide variants (SNPs) that potentially confer susceptibility to preadult multiple drug use. Out of these, 14 were located in gene-coding regions. Interestingly, 9 of these genes are implicated in neuronal development/function or metabolite transport/transformation. Additional gene-based analyses identified another 4 genes relevant for metabolite transport/transformation as well as 4 genes that play a role in hypoxia signaling.DiscussionThe present results show that an accumulation of environmental risk factors during early life (< 18 years) is a strong predictor of multiple drug use during adolescence and later life. These findings suggest that exposure to accumulated environmental risk during early life is not only associated with violent aggression – as previously reported by our lab – but is also an important predictor of multiple drug use. Moreover, we present first evidence of a genetic susceptibility to preadult multiple drug use, which will benefit from future replication in suitable samples of patients with mental illness or the general population.

Abstract 376: Adverse Pregnancy Outcomes and Cardiovascular Risks Multi-disciplinary Awareness Project

Background: Cardiovascular disease (CVD) remains the number one cause of death amongst women. There has been much effort put forth over the past decade in reducing both the incidence and prevalence of this disease burden through screening and treating the traditional risk factors. Recent guidelines have shown that adverse pregnancy outcomes (APOs), including pre-eclampsia (PEC), gestational diabetes mellitus (GDM) and pre-term birth (PTB) have been associated with future maternal CVD risk. Much of the current literature focuses almost exclusively on PEC. Our investigation is more comprehensive, covering not only these other APOs but assessing whether providers of multiple specialties in our community are aware of the APO to CVD risk association. The primary objective of this study was to investigate if there exist any knowledge gaps regarding the progression from APO to CVD and if this knowledge varies by specialty. Methods: An anonymous voluntary survey through REDCap© was sent to providers in the fields of Internal medicine (IM, 21%), Family medicine (FM, 26%), Obstetrics-Gynecology (Ob-Gyn, 23%) and Cardiology (30%) who have been in practice for greater than five years in our local Gainesville community. This project was registered as a QI project and descriptive analysis was used to examine the responses. Results: A total of 53 providers responded to the survey. Despite having the majority of patients being women, Ob-Gyn was the least likely amongst all specialties to routinely screen for CV risk factors. However, when addressed, they were the most likely to ask about APOs. Cardiologists, despite declaring to be aware of the association between APOs and CV risk, were least likely to ask about APOs. All specialties recognized PEC and GDM as APOs linked to long-term maternal CV risk but failed to associate PTB as an APO. The majority of providers amongst IM, FM, and Cardiology did not ask about APOs and lacked the knowledge of how often to appropriately screen for secondary risk factors associated with APOs. Additionally, these providers outright admitted that they are not familiar with the current AHA and/or ACOG guidelines for screening and follow-up. Conclusion: Descriptive statistical analysis of our data suggests that there exists a notable knowledge gap between all four specialties investigated in our survey. Education concerning the link between APOs and future maternal CV risk is needed amongst all specialties, especially amongst the providers in Cardiology, IM, and FM. Targeted efforts at our institution to improve awareness of all APOs, their associated secondary risk factors, and appropriate screening is required in all specialties to help reduce CVD morbidity and mortality.

Conventional and Nanotechnology Based Approaches to Combat Chronic Obstructive Pulmonary Disease: Implications for Chronic Airway Diseases.

Chronic obstructive pulmonary disease (COPD) is the most prevalent obstructive lung disease worldwide characterized by decline in lung function. It is associated with airway obstruction, oxidative stress, chronic inflammation, mucus hypersecretion, and enhanced autophagy and cellular senescence. Cigarette smoke being the major risk factor, other secondary risk factors such as the exposure to air pollutants, occupational exposure to gases and fumes in developing countries, also contribute to the pathogenesis of COPD. Conventional therapeutic strategies of COPD are based on anti-oxidant and anti-inflammatory drugs. However, traditional anti-oxidant pharmacological therapies are commonly used to alleviate the impact of COPD as they have many associated repercussions such as low diffusion rate and inappropriate drug pharmacokinetics. Recent advances in nanotechnology and stem cell research have shed new light on the current treatment of chronic airway disease. This review is focused on some of the anti-oxidant therapies currently used in the treatment and management of COPD with more emphasis on the recent advances in nanotechnology-based therapeutics including stem cell and gene therapy approaches for the treatment of chronic airway disease such as COPD and asthma.

COVID-19 and Stroke Risk: A Double Whammy

AbstractThe emphasis so far during the COVID-19 pandemic has been on the respiratory manifestations with little attention being given to neurological manifestations. Literature has shown multiple cases of stroke being associated with COVID-19. Thus, there is great interest in the role of the virus in stroke pathogenesis. Regarding hyperacute and acute stroke treatment, the routine guidelines for thrombolysis and thrombectomy are to be followed with emphasis on high suspicion of COVID-19 in stroke cases with respiratory symptoms or with contact/travel history. Secondary risk factor treatment for hypertension, diabetes, dyslipidemia is a must. We recommend continuing angiotensin converting enzyme 2 inhibitors/angiotensin II receptor blockers (ARBs) in those who are taking these medications as per evidence available. Mandatory lockdown has led to delay in presentation to the hospital with a decrease in thrombolysis due to ineligibility and a corresponding increase in primary thrombectomies being performed. Telemedicine could be an important tool to triage cases worthy of tertiary referral from other strokes and must be encouraged.

“Sleep Surge”: The impact of sleep onset and offset on epileptiform discharges in idiopathic generalized epilepsies

ObjectiveTo investigate the impact of sleep onset and offset on the rate of epileptiform discharges (ED) in idiopathic generalized epilepsies (IGE). MethodsWe studied the temporal distribution of EDs with mixed-effects Poisson regression modeling in a cohort of patients diagnosed with IGE who underwent 24-hour ambulatory electroencephalography (EEG) recordings. We defined the mean number discharges per hour per subject as the mean ED rate. The association between each hour and the mean ED rate was quantified with incidence rate ratio (IRR) as the metric. We calculated the IRR of each hourly block for the total cohort in relation to sleep onset and offset. Finally, we admitted secondary risk factors into our Poisson regression model and quantified changes in IRR in order to investigate the impact of those variables on the outcome. The secondary risk factors included: epilepsy syndrome, duration of seizure freedom, duration of epilepsy, number of antiepileptic drugs (AED), type of AED, and age. ResultsA total of 39 patients with a mean age of 29.1 y (SD = 10.1) were studied. The distribution of ED rate demonstrated a highly significant abrupt increase in the first hour after sleep onset (IRR = 3.96; p < 0.001). On the contrary, the ED rate significantly dropped in the second hour after the sleep offset compared with the last hour block before sleep offset (IRR = 0.39; p < 0.001). None of the secondary risk factors demonstrated any significant impact on this pattern. ConclusionsSleep onset is a very significant trigger for the generation of EDs in IGE. SignificanceOur results support the hypothesis that there is a “critical zone of vigilance” in the sleep-wake boundary from which generalized EDs are more likely to emerge.

Abstract TP132: Intensive Medical Management and Life-Style Modifications Can Be Successfully Applied in Combination With Indirect Surgical Revascularization for Symptomatic Intracranial Atherosclerotic Disease

Introduction: We present the results of using the strict model of intensive medical management (IMM) and life-style modification of SAMMPRIS in a phase 2 study of EDAS revascularization in patients with symptomatic intracranial atherosclerosis (ERSIAS). Methods: ERSIAS was a mid-development, single surgical arm trial that enrolled patients closely matched to those recruited in SAMMPRIS with the exception of including also individuals with occlusions of the intracranial arteries. In addition to surgery, primary and secondary risk factors were strictly managed and a life-style modification program with monthly phone calls to encourage adherence to medication, diet, physical activity, and smoking cessation was applied. Every 3 months, patients were clinically evaluated and data of adherence to medical regimen was collected. Results: As previously reported, the rate of recurrent stroke in ERSIAS at one year was 7.7%. ERSIAS required patients to have ceased smoking for at least 6 months before enrollment. Of the 52 patients enrolled only 5 had a relapse in their smoking habit (9.6%). At the end of the study four stopped smoking, representing a failure on smoking control of only 2%. Patient’s engagement in vigorous physical activity increased from 43% at baseline to 84% at follow-up (p=0.03). Median LDL values at baseline, 6 months, and 12 months were 83.9 (IQR 65.2), 70.9 (IQR 38.8), and 77 (IQR 78.25), respectively. At an individual level 75.6% of patients had improvement in LDL control. The SBP goal (&lt;160mmHg) was achieved in 91% of patients, and a reduction of SBP was observed in 65.9% at either 6 or 12 months. Median HbA1c values in diabetic (DM2) patients were 6.3% (QR 2.5) at baseline, 5.1% (IQR 2.5) at 6 months, and 5.9% (IQR 2.8) at 12 months, accounting for an improvement in 60% of patients at either 6 or 12 months. Conclusion: A dedicated follow-up program optimized medical adherence and results in ERSIAS. The surgery did not affect the ability of patients to engage in exercise or adhere to medical management. The IMM model of SAMMPRIS was successfully applied in this surgical trial. Strict observance of the improvements in medical management should be integrated in future interventional studies for ICAD.

Abstract TMP107: Impact of a Stroke Transitional Care Navigator at a Comprehensive Stroke Center

Background: The Stroke Transitional Care Navigator (STCN), was implemented at our Comprehensive Stroke Center (CSC) in January 2017 in order to bridge care from the inpatient to outpatient setting. The STCN nurse meets with patients prior to discharge to address secondary stroke risk factors and discuss the follow up plan in an effort to improve patient outcomes. The purpose of this study was to determine whether implementation of a STCN improved compliance with follow up stroke neurology care and reduced unplanned readmissions and Emergency Department (ED) visits. Methods: Retrospective data review, included ischemic stroke or ICH patients, 18 or over, discharged from February 2017 through February 2018. Subarachnoid hemorrhages and hospice discharges were excluded. Patients were grouped into a “Followed’ cohort if they had documented contact with the STCN prior to discharge or within 30 days; otherwise they were categorized as “Not Followed”. Outcomes of interest were percentage of patients compliant with attending an outpatient visit with a stroke provider within 45 or 120 days post-discharge and percentage of unplanned readmission and ED visits 30 days post-discharge. Analyses comparing those with and without STCN contact were performed using Fisher’s Exact test and Pearson’s chi square test. Results: There were 689 patients that met inclusion criteria with 47.2% (n=325) in the Followed and 52.8% (n=364) in the Not-Followed cohorts. The Followed cohort was more likely to comply with attending a follow-up visit within 45-days (67.2% vs. 32.8%, p&lt;.001) as well as 120 days of discharge (61.0% vs 39.0%, p&lt;.001). No differences were found between the Followed and Not Followed cohorts for readmissions (9.5% vs. 11.5%, p=.394) or ED visits (9.5% vs. 10.2%, p=.783). Conclusion: The STCN had a significant positive impact on patients returning to clinic for follow up stroke neurology care. Though follow up care has been shown to reduce readmission rates in some studies, in this study there was no impact on 30-day readmissions or ED visits. Given the unique, individualized care and coordination provided by the STCN, which is very well received by patients and providers, qualitative measures may be more useful in the future to determine the effectiveness of the STCN.

Risk assessment of landslide-induced surge disaster of river type reservoir in mountainous area

The landslide-induced surge of river type reservoir in the mountainous area has become one of the most important disasters affecting the waterborne transportation and the safety of human life and property in the reservoir area. Based on the field observation of landslide and landslide-induced surge in the Three Gorges Reservoir (TGR) area and relevant research results, this paper develops the basic principles for selecting the risk factors of landslide-induced surge, analyses the risk factors of landslide-induced surge, and gives the main and secondary risk factors and their characteristics. According to the characteristics of landslide-induced surge disaster, the hierarchical structure, judgment matrix, and risk calculation model suitable for landslide-induced surge disaster are established by using analytic hierarchy process method, and the classification standard of the action index of each main evaluation factor is determined. This well-developed evaluation method is then applied to evaluate the risk of Hongyanzi landslide-induced surge disaster in the TGR area. The evaluation result is high risk, which is consistent with the actual disaster situation.

Constructing a Risk‐Sharing Framework for Sponge City PPP Projects from the Perspective of the Individual Participant

Construction of sponge city PPP projects is perceived as a feasible measure for achieving the sustainable urbanization. To ensure the success of sponge city PPP projects, reasonable sharing of risks among participants, which has remained scarce and unscientific, is becoming an urgent problem to be solved. In order to enable the individual participant to accurately grasp the situation of his own risks, specifically for the individual participant, this paper constructs a risk‐sharing framework for sponge city PPP projects. Firstly, this paper identifies critical risk factors by the Delphi method. The final risk evaluation index system is established from the perspectives of political risks, economic risks, construction risks, and operational risks, which include 16 secondary risk factors. Then, risk factors’ weights are determined based on a combination weight method (combining the G1 method and the C‐OWA operator). Next, in order to share risks reasonably, the first step is to obtain the risk factors that can be borne by one participant and define the risk factors that need to be shared among participants through the method of combining GCA method and TOPSIS method. The second step is to build a model based on the utility theory to determine the proportion of risks shared among participants. Finally, the sponge city PPP project in Qingshan demonstration area of Wuhan city as an example is employed to verify the feasibility and effectiveness of the constructed risk‐sharing framework. All the aforementioned studies are expected to provide helpful references for reasonable risk sharing in sponge city PPP projects.

Variance Risk Identification and Treatment of Clinical Pathway by Integrated Bayesian Network and Association Rules Mining

With the continuous development of data mining techniques in the medical field, variance analysis in clinical pathways based on data mining approaches have attracted increasing attention from scholars and decision makers. However, studies on variance analysis and treatment of specific kinds of disease are still relatively scarce. In order to reduce the hazard of postpartum hemorrhage after cesarean section, we conducted a detailed analysis on the relevant risk factors and treatment mechanisms, adopting the integrated Bayesian network and association rule mining approaches. By proposing a Bayesian network model based on regression analysis, we calculated the probability of risk factors determining the key factors that result in postpartum hemorrhage after cesarean section. In addition, we mined a few association rules regarding the treatment of postpartum hemorrhage on the basis of different clinical features. We divided the risk factors into primary and secondary risk factors by realizing the classification of different causes of postpartum hemorrhage after cesarean section and sorted the posterior probability to obtain the key factors in the primary and secondary risk factors: uterine atony and prolonged labor. The rules of clinical features associated with the management of postpartum hemorrhage during cesarean section were obtained. Finally, related strategies were proposed for improving medical service quality and enhancing the rescue efficiency of clinical pathways in China.