Single Chart Research Articles

P-205. Investigating PCR (Polymerase Chain Reaction) Cycle Threshold’s Utility in Diagnosing and Treating Clostridioides difficile Infections

Abstract Background Clostridioides difficile (C diff) is a pathobiont bacteria in the human gastrointestinal tract that can cause morbidity and mortality and has public health implications. Guidelines suggest two-step testing to diagnose C diff infection (CDI). However, since polymerase chain reaction (PCR) tests can be positive in persons with colonization and no active disease, management of discordant results is challenging. Usage of facility-onset CDI as a quality metric further raises the need to accurately differentiate infection from colonization. We hypothesize PCR cycle threshold (Ct) values may be useful for quantifying C diff disease burden and differentiation of infection from colonization. However, Cts are currently unvalidated and are not currently approved for use for clinical decision making. Sample and results data for C diff infection and C diff PCR CT correlation This table provides an overview of our data investigating the usage of C diff PCR CT to better diagnose CDI Methods We performed a retrospective, single center chart review of patients who tested positive for C diff, and analyzed clinical and laboratory data in 2022. We excluded minors, outpatients, and repeat C diff episodes, and performed multi variable analyses. Results 70 patients met inclusion criteria. This cohort consisted of 37 (52.86%) male and 33 (47%) female patients. The mean and median ages were 70 and 73 years old respectively. Approximately 30 percent of our cohort was immunocompromised, and 90 percent of our patients were on antibiotics within 30 days of CDI testing. Using a Ct of 26.35, a cutoff used in previous studies to indicate infection, 30 patients (42.9%) had a positive Ct, and of these, 16 (53%), had a positive confirmatory enzyme immunoassay (EIA) . Ct of less than cutoff had a positive predictive value of 53%, and negative predictive value of 85%, for positive EIA. All patients analyzed underwent C diff treatment, with a mean length of treatment of 10 days. Mean time to recovery, classified as less than three documented bowel movements, or hospital discharge, was 4.6 days. Nine patients (13%) in our cohort died within 30 days of C diff testing. Conclusion This data show that C diff PCR Ct value threshold of < 26.35 combined with EIA positivity may be a helpful parameter for evaluating possible C diff. The demonstrated high negative predictive value may show a utility for high Ct values in ruling out active disease. Disclosures Roderick Go, DO, Aptose Biosciences: Stocks/Bonds (Private Company)|Bristol Meyers Squibb: Stocks/Bonds (Private Company)|Cytodyn Inc.: Stocks/Bonds (Private Company)|Scynexis: Grant/Research Support|Shionogi, Inc: Grant/Research Support

P-1336. Building Connections: Rise in Construction Projects correlated with New Cluster of Infantile Botulism in North Texas

Abstract Background Regional clustering of infantile botulism is well documented in throughout the United States. We report a new cluster of cases in Northeast Texas. Methods We performed a single center retrospective chart review of all patients with suspected and confirmed infant botulism admitted to Children’s Medical Center Dallas from January 1, 2010 through December 31, 2023. Environmental conditions near each patient’s home prior to hospitalization were analyzed. County level data on annual birth, population, and death rates was collected from The United States Census Bureau. Construction permit data from Tyler, Texas was analyzed. Results 46 infants with suspected infant botulism presented to care and received botulism immune globulin from 2010-2023. 3 infants were excluded due to alternative neurologic diagnosis. Features of cohort (N=43) without alternative diagnosis included in Table 1. 39 infants without honey exposure were included in environmental analysis: Group 1: 2010-2016 (N=8 infants), and Group 2: 2017-2023 (N=31 infants). The mean number of yearly residential construction permits issued (235.0 vs 352.7, p=0.01) and projects finalized (208.6 vs 333.5, p=0.01) increased from 2010-2016 to 2017-2022. The mean number of yearly commercial construction permits issued (40.1.0 vs 14.5, p=< 0.01) and projects finalized (36.9 vs 17.5, p=0.01) decreased between 2010-2016 as compared to 2017-2022. A sudden cessation of infantile botulism cases occurred during the COVID-19 pandemic that appears to coincide with delays in construction projects being complete. There were no significant differences between the 2 cohorts in environmental changes near the patient’s home address: temperature, precipitation, wind speed or direction, soil moisture, or drought index (Table 2). Specific humidity was significantly higher (p=0.01) in the 30-60 days before admission for patients presenting 2017-2023 as compared to 2010-2016 (-0.53 g/kg vs 0.70 g/kg). Conclusion Changes in local construction patterns are associated with a notable increase in infantile botulism cases in Northeast Texas over the past 14 years. Changes in environmental conditions do not appear to play a large role in this increasing case count. Disclosures All Authors: No reported disclosures

P-1692. Evaluation of Antibiotic Appropriateness at Discharge in a Community Teaching Hospital

Abstract Background Antimicrobial therapy is prescribed for approximately 20% of patients upon hospital discharge. The CDC and Joint Commission emphasize antimicrobial stewardship as a standard of care. While inpatient programs have processes in place to monitor and optimize antimicrobial therapy, monitoring and intervention during transitions of care is an unmet need for many hospital-based antimicrobial stewardship programs. We sought to evaluate antibiotic use at discharge at our institution to help develop potential strategies for monitoring and intervention. Figure 1 Appropriateness of overall discharge antimicrobial therapy and breakdown by specific domains Methods This retrospective single center chart review evaluated adult patients discharged on oral antibiotics and diagnosed with pneumonia, skin and soft tissue infection, urinary tract infection, intra-abdominal infection, or bacteremia secondary to these infections. Exclusion criteria included pharmacist intervention on discharge orders, discharge parenteral antibiotics, and immunocompromised patients. The primary outcome was antibiotic appropriateness defined as right drug, dose, duration, and antibiotic-appropriate indication. Secondary outcomes included total duration of antibiotics, 30-day mortality, infection recurrence, and Clostridium difficile occurrence. Descriptive statistics were used for demographics and primary and secondary endpoints, and comparative statistics were used to evaluate the relationship between secondary outcomes and appropriateness. Results A total of 150 patients were included, of which 43/150 (28.7%) were prescribed appropriate antimicrobial therapy on discharge. Cefpodoxime was the most commonly prescribed antibiotic (45/150, 30%). The most common cause of inappropriate therapy was excess duration. The average excess duration of therapy was 4.4 days. The most common antibiotic indication was urinary tract infection, of which 33/52 (63.5%) cases were asymptomatic. Of note, the inappropriate use group had a statistically significant higher rate of 30-day readmission (12/107 versus 0/43, p = 0.022). Conclusion Inappropriate discharge antibiotics were common and associated with increased 30-day readmission rates, indicating a need for increased antimicrobial stewardship monitoring and intervention on hospital discharge. Disclosures Hinal Patel, PharmD, BCPS, BCIDP, Abbvie: Stocks/Bonds (Public Company)

Gender Inequality in Spain’s Official Music Charts: Neither Representation nor Success for Female Artists (2008–2020)

This study seeks to investigate gender inequality in the Spanish’s official music charts from 2008 to 2020, using a quantitative methodology. The dataset comprises 1300 entries sourced from Promusicae’s official charts, evenly divided between albums and singles. Firstly, this analysis evaluates the frequency of artist representation; secondly, it assesses the success achieved by gender; and finally, it examines disparities in featured collaborations. The findings indicate that male artists appear almost three times more frequently than their female counterparts on both charts, achieve a higher amount of points, and dominate the role of featuring collaborations. Notably, Spanish female artists are predominantly absent from the top positions in the singles chart. Moreover, there is an absence of female bands in the top 50. The observed outcomes align with previous research concerning gender inequality in the United States and the United Kingdom, highlighting a persistent structural gender inequality within Spain’s music industry throughout the reviewed period, which systematically undermines the creativity of female artists.

On the one-chart schemes for joint monitoring of the two parameters of a zero-inflated Poisson (ZIP) process

One-chart scheme for joint monitoring of two parameters allows the practitioners to focus on a single chart and thus, it offers significant operational advantages. Recently, four one-chart schemes are reported in literature for joint monitoring of the two parameters (Φ, λ) of a zero-inflated Poisson (ZIP) process. One of these schemes, namely - Gamma chart, is developed assuming samples of large size will be inspected and other three charts, namely DS-chart, Max-chart and LR chart, are developed assuming samples of small size will be inspected after every certain interval. The plotting statistics of these three charts are computed using the estimated ZIP parameters. However, unless the sample size (n) is sufficiently large, the excessive number of zeros in the ZIP process may offer a sample of zeros only. Therefore, these three schemes require estimation of ZIP parameters and subsequent computation of the plotting statistic based on the accumulated samples till the sampling stage. Because of the accumulation of samples, these schemes suffer from several limitations. In this paper, these one-chart schemes are modified for large sample size to make them free from their limitations. Subsequently, the performances of the four one-chart schemes are evaluated extensively using simulation studies. The results reveal that among the three modified charts likelihood ratio (LR) chart is the most preferable with respect to in-control and out-of-control average run length (ARL) performances. However, all these three modified charts give false alarms when the process parameter(s) shift towards desirable direction(s) implying process improvement. On the other hand, the Gamma chart is slightly inferior with respect to out-of-control ARL performances. But it does not give false alarm when there is a process improvement. Further, since Gamma chart directly monitors the average number of defects, it offers significant advantages in terms of implementation and interpretations.

Continuous Glucose Monitoring Attrition in Youth With Type 1 Diabetes.

The purpose of the study was to identify the most common reasons for and timing of continuous glucose monitoring (CGM) attrition in youth with type 1 diabetes (T1DM). This single center retrospective chart review included youth with T1DM <22 years seen between November 1, 2021, and October 31, 2022. Data were gathered from CGM cloud-based software and the electronic medical record. Among 2663 youth, 88.3% (n = 2351) actively used CGM, and 5.9% (n = 311) had CGM attrition. Those who discontinued CGM were older (17.0 vs 14.9 years, P = .0001), had a longer T1DM duration (7.4 vs 5.1 years), higher A1C (9% vs 7.4%), and were non-Hispanic Black (NHB; 34.0% vs 11.5%). The odds of CGM attrition were 5.0 and 2.8 times higher in NHB and Latine youth, respectively, compared to non-Hispanic White youth. Median time to CGM discontinuation was 4 months, 21 days after initiation; 57% of youth who discontinued did so in the first 6 months of use. The most common reasons for CGM attrition were problems with device adhesion (18.4%), dislike device on the body (10.8%), insurance problems (9.5%), pain with device use (8.3%), and system mistrust due to inaccurate readings (8.2%). NHB and Latine youth were more likely to discontinue CGM due to insurance problems (3.2% vs 15.1% vs 16.7%). To support equitable, uninterrupted CGM use, education at CGM initiation should address practical approaches to improve adhesion and wearability and provide a clear pathway to obtaining supplies. Interventions to support sustained CGM use should occur within the first 6 months of initiation.

BRAF inhibitor monotherapy in BRAFV600E-mutated pediatric low-grade glioma: a single center's experience.

Pediatric low-grade gliomas (pLGGs) have an overall survival of over 90%; however, patients harboring a BRAFV600E alteration may have worse outcomes, particularly when treated with classic chemotherapy. Combined BRAF/MEK inhibition following incomplete resection demonstrated improved outcome in BRAFV600E altered pLGG compared to combined carboplatin/vincristine chemotherapy and is now considered the standard FDA-approved treatment for this group of tumors. The aim herein was to investigate the efficacy and tolerability of single agent BRAF inhibitor treatment in BRAFV600E altered pLGG. A single institution retrospective chart review analysis was performed on patients, 0 to 21 years of age, with newly diagnosed and/or progressive BRAFV600E mutated pLGGs (WHO Grade 1 or 2) at Children's Healthcare of Atlanta treated off-study with BRAF inhibitor monotherapy between 2013-2023. 2-year progression free survival (PFS) and objective tumor response was evaluated. All toxicities possibly associated with BRAF inhibition therapy were evaluated and described according to Common Terminology Criteria for Adverse Events version 5 (CTCAEv5). MRI brain imaging data at baseline and best response wasevaluated to identify patterns that may predict response to BRAF inhibition monotherapy. Fifteen patients diagnosed with BRAFV600E mutated pLGG, treated with monotherapy BRAF inhibition, were identified. Median age of diagnosis: 3.8 years (0.2 -18.1). Histologic diagnosis: pilocytic astrocytoma (PA) (N=4); ganglioglioma (GGL) (N=3); GGL, atypical (N=3); pleomorphic xanthroastrocytoma (PXA) (N=2); low-grade neuroepithelial tumor (N=1); infiltrating glioma (N=1); and LGG (NOS) (N=1). Tumor locations included: hypothalamus/optic chiasm (N=6); brainstem (N=4); third ventricle/thalamus (N=2); parietal/temporal lobe (N=2); and spinal cord (N=1). Mean duration of BRAF inhibitor monotherapy: 38.41 months (range 3.9-83.7). Median follow-up: 32.6 months (16 - 78.1). Two-year PFS for patients on BRAFi monotherapy for at least 10 months: 90% (95% CI: 73.2%-100%). Objective Response (OR) for 15 evaluable patients on BRAF inhibitor (BRAFi) therapy: 73% (0/15 CR + 6/15 PR + 5/15 MR) with Overall Response Rate (ORR=CR+PR): 40%. Overall, patients tolerated treatment well with Grade 1 rash being the most common toxicity. Two of 15 patients (13%) discontinued therapy due to toxicities, and 2 other patients switched within drug class from vemurafenib to dabrafenib due to toxicities. In this small cohort of incompletely resected BRAFV600E mutated pLGGs, BRAFi monotherapy was effective and well tolerated with an ORR comparable to published prospective outcomes of dual MEK/BRAF inhibitor therapy. This promising monotherapy treatment should be considered when choosing treatment for incompletely resected BRAFV600E-altered pLGGs.

КРАЖИ С БАНКОВСКОГО СЧЕТА, А РАВНО В ОТНОШЕНИИ ЭЛЕКТРОННЫХ ДЕНЕЖНЫХ СРЕДСТВ: ПРОБЛЕМЫ РАСКРЫТИЯ

Introduction: the authors consider features of bank accounts fraud, as well as online banking fraud; crime detection methods taken by internal affairs bodies; recommendations to improve police action in this field. Materials and Methods: sociological method and interviewing law enforcement officers, as well as criminal cases study and regulatory acts regulating law enforcement activity of the Russian Federation were used when investigating bank accounts fraud, as well as online banking fraud. The authors used content-analysis of scientific articles and Results: the authors suggest proposals to improve the work of law enforcement in the area of combating bank accounts fraud and online banking fraud. Discussion and Conclusions: the authors suggest authorize the local internal affairs bodies at district level (they are the ones who face the challenge of solving of crime at the initial stage) to direct appeal to financial institutions and network operators in investigations and obtain information about the users in real-time. Nowadays it is important to create a single interdepartmental platform to obtain information about all transactions in “a single chart”. Such a platform can be implemented in the Financial Sector Computer Emergency Response Team of the Bank of Russia.

Determination of technological schemes for extraction of gold from ores of the Gyzylbulag deposit and their practical importance

This article is devoted to the study and determination of optimal process flow charts for gold extraction from the Gyzylbulag deposit ores, as well as to the analysis of their practical significance in the context of modern mining production. In the context of growing demand for gold and resource limitations, it is important to develop effective methods that not only increase the extraction rate, but also minimize the environmental impact and economic costs.The article considers the features of the ore composition of the Gyzylbulag deposit, their mineral and chemical composition, which play a key role in choosing the appropriate extraction technology. The authors analyze in detail the efficiency of traditional methods, such as gravity concentration, for processing these ores, considering each of them in terms of extraction rate. Particular attention is paid to the integration of various methods into a single process flow chart, which allows to increase the overall gold extraction rate and reduce losses of the precious metal at all stages of processing. The practical significance of the results lies in the proposal of processing schemes that can be applied not only at the Gyzylbulag deposit, but also in other regions with similar geological conditions. These schemes are aimed at optimizing gold extraction while reducing production costs and environmental impact, which meets the objectives of sustainable development in the mining industry. The article is addressed to specialists in the field of mineral processing, researchers and practitioners involved in the development of effective methods for processing gold-bearing ores. Keywords: native gold; gravity; gold dimensions; flotation.

Radiographic Variants Associated With Allergic Fungal Rhinosinusitis: Key Differences for Pre-Operative Planning.

Allergic fungal rhinosinusitis (AFRS) often results in expansion of disease beyond the paranasal sinuses, which may put important structures, such as the anterior ethmoid artery (AEA) or lateral lamella of the cribiform, at risk of injury during endoscopic sinus surgery (ESS). This study aims to compare the AEA to skull base (AEA-SB) length in patients with AFRS versus chronic rhinosinusitis with nasal polyps (CRSwNP), as well as additional anatomic variants. A single institutional retrospective chart review of patients undergoing ESS for AFRS and CRSwNP was performed. AEA-SB length were compared between the 2 groups. Other anatomic variants, including Keros measurement and presence of supraorbital ethmoid air cells (SOEC), concha bullosa (CB), sphenoethmoidal, and infraorbital ethmoid cells were measured and compared between the 2 groups. Twenty-one patients were included in each cohort. The AFRS group was younger in age (P = .015) and had a significantly longer AEA-SB length (P = .014) compared to the CRSwNP group. No significant differences were observed between the 2 groups regarding Keros measurement, presence of concha bullosa, infraorbital ethmoid, sphenoethmoidal, or SOEC. No association was seen between AEA-SB length and Keros class in either group. AFRS harbors anatomical differences when compared to CRSwNP, with the former associated with a longer AEA-SB length. This key difference should be considered in preoperative planning to prevent injury to the AEA in patients undergoing ESS for AFRS.

Are variations in ventricular catheter placement related to design of the catheter? A single-center cohort study.

The use of intracranial catheters is a common procedure used for neurosurgical patients with a variety of pathologies. Despite its frequency of use, shunt failure and revision have been reported to be a common problem. Given that depth of insertion can significantly affect the catheter tip position, a single institution retrospective chart review was performed to examine the accuracy of shunt and external ventricular drain (EVD) placement. Computed tomography (CT) images of the head following shunt or ventriculostomy insertion were analyzed to determine the delta between the final length of the intracranial catheter and the intended depth described in the operative notes. We found that there was a statistically significant difference in the accuracy of placement when comparing EVDs to shunts. The most used EVDs at our institution are marked with a solid black line in increments spaced 2 cm apart. The most used ventricular shunt catheter has a marking at 5 cm and 10 cm from the tip of the catheter. We believe that the visual confirmation that is afforded by metric unit markings on the EVD allows for better final placement of the catheter at the outer table of the calvarium. The addition of regular millimeter metric unit markings by the manufacturer is imperative in decreasing the chances of error in the insertion of ventricular catheters and preventing potential neurovascular injury to the surrounding structures.

On-line recognition of mixture control chart patterns using hybrid CNN and LSTM for auto-correlated processes

Statistical process control (SPC), designed to detect and identify process disturbances, is an effective quality control method for ensuring process stability. Owing to the growing automation of the industry, the manufacturing process can be autocorrelated. Engineer process control (EPC) is typically used to address autocorrelation. However, process disturbances can be offset by feedback compensation, making control chart patterns (CCPs) difficult to identify. Most studies on control chart pattern recognition (CCPR) techniques are based on a single abnormal control chart pattern (CCP). However, a mixture of CCPs can occur during real-world manufacturing processes. With the development of intelligent manufacturing systems, early detection of abnormal concurrent CCPs has become an important issue. In this study, a hybrid model combining a convolutional neural network (CNN) and long short-term memory (LSTM) in an online detection system was used to recognize the concurrent CCPR problem in SPC-EPC processes. The results showed that the average accuracy of the deep learning CNN-LSTM method was 99.83%, which was significantly better than that of the machine learning method. In addition, the running time of the CNN-LSTM model was shortened. In a comparison of online monitoring between the deep learning method and the machine learning method, the CNN-LSTM model for an online monitoring system identified abnormal concurrent patterns faster. Therefore, the proposed CNN-LSTM online monitoring scheme can be applied confidently and successfully to identify mixture CCPs in an SPC-EPC process.

The correlation between intracranial pressure and venous sinus pressures changes after venous sinus stenting

BackgroundThe pathophysiology of idiopathic intracranial hypertension (IIH) and other cerebral venous outflow disorders (CVD) has largely been unexplored. While a correlation between venous sinus pressure and opening pressure (OP) has...

Sum of defects (SOD) chart for joint monitoring of the two parameters of a zero-inflated Poisson process

Rapid technological advancements and automation in today's world have led to many high quality manufacturing processes, where most of the products are free from defects. The defects data from high quality processes are commonly modeled by twoparameter zero- inflated Poisson (ZIP) distribution. Most of the existing control charting procedures for ZIP processes are developed assuming that all the manufactured units are inspected one by one, and most often separate control charts are proposed for monitoring the two parameters of a ZIP process. However, joint monitoring of the two parameters in a single chart can offer significant operational advantages because one needs to focus on a sole chart and a single charting statistic. Again, in many manufacturing set ups 100% inspection may not always be feasible. Recently, a few one-chart schemes with group inspection of small samples are reported in literature, and all these schemes require estimation of the two parameters based on accumulated samples till the current sampling stage for computation of the monitoring statistics. This accumulation of samples introduces several limitations in these schemes. In this paper, probability mass function and the cumulative distribution function (cdf) of the sum of defects (SOD) in a sample of size are defined, and a control chart for SOD is proposed. Both the parameters of a ZIP process can be jointly monitored using the SOD chart. Again, since no accumulation of the samples is required for application of the SOD chart, it is free from all limitations of the existing one-chart schemes with group inspection. Two case studies based on past data are presented. The performance of the SOD chart is found to be very encouraging.

A Single-Center Retrospective Study to Identify Causes of Sex Differences in the Living Kidney Donor Evaluation Process.

Multiple studies have shown that females are living donors for kidney transplantation at higher rates than males. However, the underlying reasons for this observation are not well-understood. We examined the living donor evaluation process to determine the point at which sex imbalance arises. Based on a previous study, we hypothesized that both sexes are equally likely to become approved as living donors, but females are more likely to follow through with donation. Single institution retrospective chart review of self-referrals for living donor evaluation between 1/2009 - 12/2022. Self-referrals identified using the Organ Transplant Tracking Record database and cross referenced with billing data. Exclusion at each stage of evaluation was recorded and compared between sexes using log binomial regression; unadjusted and adjusted (for donor age, race, ethnicity, relationship to recipient, and recipient sex) risk ratios (RRs) with 95% confidence interval (CI) were determined. 1,861 self-referrals were reviewed, including 1,214 (65.2%) females and 647 (34.8%) males, resulting in 146 approvals and 125 donations (76/125, 60.8% females, 49/125 39.2% males). Adjusted RRs indicated no significant differences between sexes in completing medical and/or psychosocial workup, having medical and/or psychosocial contraindications, being approved for donation, and proceeding with donation. The top medical contraindications for both sexes were obesity, hypertension, and nephrolithiasis. Female overrepresentation among living donors is likely due to the 1.9 times higher rate of self-referral for evaluation. After this point, both sexes were equally likely to complete workup, be approved, and follow through with donation. Increased efforts to engage males at the initial self-referral stage has the potential to expand access to living donor kidney transplantation.

Down, and Under Pressure: The Decline of Local and Non-Anglo Best-Selling Recording Artists in Australia 2000–2023: Submitted to the International Journal of Music Business Research 14.06.24.

Abstract The global consolidation and platformitisation of recorded music have attracted attention to changes in local artist representation in national sales charts and, more broadly, to the diversity of nationalities within recorded music markets. Global platform distribution has been perceived to aid local music economies and the diversity of cultural production. This article quantitatively analyses the annual Australian top 100 single and album charts 2000–2023 to determine Australian artist representation, Indigenous artist representation and diversity of nationality over the period. The data reveals, contrary to propositions of glocalisation and internationalisation, that Australian and non-Anglo artist representation has declined significantly, while North American and British artists have increased their presence in the Australian charts. It also finds that Indigenous chart representation over the period is low, stable and in line with population ratios. The data raises issues for artists, companies, policy makers and consumers in the Australian music industries.

Hemodynamic Collapse After Intubation in Critical Care Transport

Objectives The aim of this study was to describe the incidence of and modifiable risk factors for post intubation hemodynamic collapse in prehospital and interfacility critical care transport. Methods Single center retrospective chart review of adult patients (≥18 years) intubated by a critical care transport team between January 2017 and May 2023. The primary outcome was incidence of hemodynamic collapse (systolic blood pressure <90 mmHg for greater than 30 min, new vasopressor requirement, vasopressor dose increase, fluid bolus of >15 mL/kg, systolic blood pressure <65 mmHg at least once, or cardiac arrest). Secondary outcomes included post intubation hypoxia, as well as association of hemodynamic collapse with potentially modifiable risk factors including pre intubation shock index, pre intubation heart rate, pre intubation systolic blood pressure, and induction agent. Results Three hundred and thirty-three patients were included. Ninety-seven (29.1%) patients experienced hemodynamic collapse and 36 (10.8%) of patients experienced life threatening hemodynamic collapse. Pre intubation shock index >1 (OR 3.18, 95% CI 1.15–8.74) was associated with post intubation hemodynamic collapse. Choice of induction agent, fluid bolus prior to intubation, location of intubation, presence of traumatic injury, and age were not correlated with risk of hemodynamic collapse. The number of intubation attempts and methods of intubation were similar between groups. Conclusions Hemodynamic collapse and life-threatening hemodynamic collapse after intubation occurred frequently in this critical care transport cohort. Shock index greater than one was associated with significantly higher risk of hemodynamic collapse and life-threatening hemodynamic collapse.

(309) WHAT IS THE RIGHT APPROACH FOR PEYRONIE’S DISEASE SURGERY? COMPARING POSTOPERATIVE WOUND COMPLICATIONS BETWEEN VENTRAL AND SUBCORONAL INCISIONS FOR PATIENTS UNDERGOING PENILE STRAIGHTENING SURGERIES

Abstract Introduction Surgical treatment options for Peyronie’s disease (PD) include penile plication, plaque excision with grafting, and penile prosthesis placement with straightening maneuvers. Choice of surgical incision depends on location and severity of curve, concomitant procedures, and surgeon preference. Objective To assess risk of wound complications after PD surgery stratified by ventral versus subcoronal incision type. Methods A single surgeon retrospective chart review was conducted for all patients undergoing PD tunica albuginea plication (TA) or plaque excision with grafting (PEG) from Aug 2019 to June 2023. Wound complication was classified as any dehiscence or physical examination finding suspicious for infection within 30d of surgery. A Mann–Whitney U Test was used to compare demographic variables and wound complication rate based on ventral and subcoronal approaches. Results Of the 161 patients included, 105 underwent TAP and 56 underwent PEG. All patients who underwent PEG had at least one plication suture performed to correct mild residual curvature after grafting. A ventral midline penile incision was used in 81 patients (50%) and subcoronal in 80 patients (50%). Wound complications within 30d of surgery were found in 10 patients (6%), including 8 (10%) with ventral incisions versus only 2 (3%) subcoronal (OR 4.27; 95% CI 0.87-20.79; p = 0.09). There was no significant difference in wound complications between TAP and PEG cohorts. Wound complications included dehiscence requiring repeat closure (n = 1) and superficial wound infection necessitating antibiotic therapy (n = 9). In a subgroup analysis of patients who underwent TAP only, 8 patients (7.6%) with a ventral approach experienced a 30d wound complication compared with 1 patient (3.4%) with a subcoronal approach. Conclusions Penile straightening surgeries are associated with a low rate of significant wound infections. While not statistically significant, a ventral incision may have a slightly higher risk than subcoronal for wound complications within the first 30d of surgery. Both ventral and subcoronal incisions can offer excellent exposure and may be considered for patients requiring plication and/or grafting approaches. Disclosure No.

The Billboard Melodic Music Dataset (BiMMuDa)

We introduce the Billboard Melodic Music Dataset (BiMMuDa), which contains the lead vocal melodies of the top five songs of each year from 1950 to 2022 according to the Billboard year-end singles charts. In this article, the dataset’s compilation process and attributes are described in detail. The melody from each of the 371 songs was transcribed manually in full to create 371 MIDI (musical instrument digital interface) files, and then melodies from the songs’ different sections (e.g., verses, choruses) were exported into separate files to create an additional 1,133 MIDI files of shorter melodies. Lyrics to the songs are provided separately from the melodic transcriptions. This report includes comprehensive descriptions and graphical representations of the available metadata per song and per melody. Analysis of verse and chorus melodies revealed structural differences between them: chorus melodies have significantly fewer notes and lower note density, but larger melodic intervals on average. Whether added to existing datasets or used as a complete dataset, BiMMuDa can serve as ground truth data for a variety of MIR tasks as well as provide insight into the study of Western pop melody.

Combine Study of Technical Indicator Bollinger Bands and Moving Average Convergence Divergence in Nepal Stock Exchange Limited

Stock price forecasting involves predicting a company's future condition based on time series analysis. Investors need precise forecasts of future indices or stock price changes to address the Buy-Sell-Hold problem effectively. Data were collected for Nepal Stock Exchange Limited, Nepse Alpha, and Chukul. For this study, data were collected over six months (December 2023 to May 2024), utilizing technical trading tools like Bollinger Bands (BB) and Moving Average Convergence Divergence (MACD). Combining BB and MACD on a single chart yields better results than analyzing each indicator separately. This integrated approach provides a more thorough understanding of market dynamics, improves decision-making accuracy, and leads to more profitable outcomes. Integrating the analysis of BB and the MACD on one chart can provide more benefits than using each indicator independently. This method offers market behavior and improves decision-making precision, resulting in more profitable outcomes.