Study Time Period Research Articles

Growth in Newborn Circumcisions Performed by Pediatric Urologists and Advanced Practice Providers Between 2010 and 2021 in the United States

To characterize changes in the proportion of newborn circumcisions performed by pediatric urologists and advanced practiced providers (APPs) in the United States over the last decade. The Merative MarketScan Commercial Database was queried for newborn circumcision private health insurance claims (Common Procedural Terminology 54150) between 2010 and 2021. Setting (inpatient/outpatient), US Census Bureau region, clinician specialty, and patient age (days) were determined for the full study time period, and by study year. Simple linear regression assessed growth in proportion of newborn circumcisions performed by pediatric urologists and APPs (nurse practitioner/physician assistant/midwife), over time. In total, 1,006,748 newborn circumcisions (59% inpatient) were identified; while most were performed by obstetricians (45%) or pediatricians (33%); APPs performed 0.9%, and pediatric urologists performed 0.7%. From 2010-2021, the proportion of newborn circumcisions performed by pediatric urologists increased from 0.3% to 2.0% and by APPs in from 0.5% to 2.9% (P<.001 for both). Growth for both pediatric urologists and APPs occurred APPs predominantly from 2016 to 2021. Trends in proportion of newborn circumcision performed by pediatricians was stable [31.5% (2010) and 32.5% (2021)], but decreased for obstetricians [48.8% (2014) and 38.1% (2021)]. The proportion of newborn circumcisions performed by pediatric urologists and APPs increased more than 6-fold between 2010 and 2021, though both specialties still perform a minority of newborn circumcisions. These data provide important baseline information for newborn circumcision workforce planning, including evaluating collaborative care models where pediatric urologists train APPs to perform circumcision.

Application of the BLUP Animal Model method in assessing the breeding value of the breeding stock of Ayrshire cattle

The aim of the study is to assess the breeding value of the breeding stock of Ayrshire cattle from 13 breeding farms in various regions of the Russian Federation using the BLUP Animal Model method.Materials and methods. The analyzed sample included data on 14,450 cows with a first calving date of 1987 – 2021, which were analyzed for identification errors and discrepancies in the dates of birth of parents and offspring. The forecast of the breeding value of cows based on milk productivity traits for 1 lactation was made using the best linear unbiased forecast method BLUP Animal Model using the RStudio program.Results. The dynamics of milk yield EBV values during the studied time period with different numbers of first calving cows was studied. EBV estimates varied not only depending on the level of absolute milk yield of first-calving cows, but also under the influence of factors such as reproduction, the number of herds being assessed, as well as management, by which herds differed.Conclusion. The assessment of breeding value using the BLUP AM method made it possible to reliably evaluate the studied array of animals of the Ayrshire breed breeding stock on farms in the Russian Federation. The best and worst producers in terms of milk yield were identified, taking into account the effects of various factors.

Amphibious Airplane Accidents: An Exploratory Analysis

Causes and contributing factors of amphibious airplane accidents are examined by comparing the proportion of fatal accidents for different causes of accidents, with a focus on landings on water and low-level flying maneuvers. A set of 183 accidents involving amphibious planes from 2005 to 2020 was extracted from the National Transportation Safety Board’s online database. Amphibious airplane accidents are reported to be fatal in 34% of cases, which is higher than the average of 20% for general aviation. Logistic regression analysis shows that the maneuvering flight phase and decision-making factors are significantly more often associated with fatal accidents than other flight phases and causes. In addition, the number of accidents associated with decision-making factors significantly increased during the studied time period. Amphibious airplanes benefit from accident analysis despite the absence of denominator data and the limitations of most general aviation accident reports. Intentional low-level flying is shown to be a central area of concern that may be addressed at the operational as well as the training level. Landing accidents could be avoided by introducing additional warning systems and training regarding (retractable) landing gear as well as general awareness training of decision-making during landings on water.

Human health risk assessment of selected heavy metals in tanker water: A study from Kudlu, Bengaluru

The current study aims to assess the risk in humans due to six heavy metals, namely zinc, iron, copper, cadmium, arsenic, and lead, present in the tanker water supplied in the rural area of Bangalore called Kudlu village. Water samples were analyzed for a total period of 18 months between September 2021 to February 2023. Physicochemical and microbiological parameters were assessed for the collected water samples that included 04 tanker water and 01 purified water. Chlorine, pH, alkalinity, cyanuric acid, total hardness, conductivity, temperature, sodium, potassium, total dissolved solids, calcium, and magnesium was taken into consideration. Further bacteriological contamination by E.coli was also tested. Water Quality Indices were calculated based on these parameters. Water quality indices of the tanker water samples indicated that the quality of water was not suitable for drinking. The indices like exposure frequency, Hazard coefficient, carcinogenic and non-carcinogenic risks were calculated for both adults and infants for these heavy metals. The results indicated that the heavy metal concentration observed during the studied time period poses no risk to human health.

Abstract 17446: Trends, Disparities, and Outcomes in Patients With Takotsubo Cardiomyopathy Complicated by Cardiogenic Shock

Introduction: Cardiogenic shock (CS), a highly fatal complication, is estimated to be seen in up to 20% of patients with Takotsubo cardiomyopathy (TC). Previous studies have found patients with TC to have similar mortality rates as those with acute myocardial infarction, highlighting the potential importance of therapeutic intervention. However, the existing literature on TC is limited. Hypothesis: Minority patients with TC-CS are associated with increased mortality. Methods: All adult admissions with a diagnosis of Takotsubo Cardiomyopathy and cardiogenic shock (TC-CS) were analyzed using the National Inpatient Sample Database between January 2016 and December 2019. Outcomes included in-hospital mortality, in-hospital complications, and resource use. We used multivariate logistics and Elixhauser co-morbidities to adjust for clinical comorbidities. Results: Our study population included 37,902 patients with a diagnosis of Takotsubo cardiomyopathy. Of the sampled population, 2,455 (6.48%) experienced cardiogenic shock. Over the study time period, there was a significant increase in prevalence with TC-CS (p&lt;0.001). Compared to patients with TC, patients with TC-CS were significantly associated with acute kidney injury (OR: 2.463, p&lt;0.001). Controlling for baseline characteristics and Elixhauser comorbidities, Asians were at significantly higher odds of developing cardiogenic shock (OR: 1.859, p&lt;0.001) and mortality, while Whites were at significantly decreased odds of developing cardiogenic shock (OR: 0.690, p&lt;0.001). In addition, Asians who self-pay were at significantly higher odds (OR: 4.836, p=0.005) of developing cardiogenic shock compared with Asians holding insurance. Conclusions: Our study offers insights into the disparities connected with TC-CS. There is a statistically significant increase in the trend of incidence of CS among patients with TC, and CS is associated with significantly higher odds of mortality. Notably, Asian individuals with TC face significantly higher odds of developing CS. However, there were no significant differences in hospitalization costs between races in patients with TC-CS.

Abstract 17997: Contemporary Trends in Coronary Artery Anomalies

Introduction: Coronary artery anomalies (CAA) are a group of congenital conditions whose prognostic significance is still widely debated. In part, this is due to the limited data on CAA, given its general incidental nature. Data on age, gender, and ethnic disparities is even more scarce. Hypothesis: There is an increase in prevalence of CAA over time with unchanged difference in mortality. Methods: The National Inpatient Sample (NIS) database was queried between 2016-2019 to identify hospitalizations with CAA. The primary outcome was in-hospital mortality. Secondary outcomes included type of hospital, region, age, and complications. Linear regression and Chi-squared were used for analysis. Results: Our study identified 7,821 patients diagnosed with CAA. There was a significant increase in the prevalence of CAA from 1,961 in 2016 to 2,127 in 2019 (p&lt;0.001). However, no significant difference in mortality rate (1.89% to 2.05%) in this time period was identified. The average age of the population diagnosed with CAA was 50.4 years, which was not significantly different between the study time periods. Comparing races, 62.35% of those with coronary anomalies were white, 17.54% were African American, 12.1% were Hispanic, and 3.11% were Asians or Pacific Islanders. Of note, 4.14% of those with CAA were diagnosed in a rural hospital, 14.68% in an urban non-teaching hospital, and 81.18% in a teaching hospital. This is a significant difference compared to the percentage composition of each hospital within the database. Conclusions: With recent advances in imaging technology, CAA has been detected at earlier stages, allowing for early intervention. However, our study suggests that CAA may still be under diagnosed, given that most were diagnosed at resource heavy teaching hospitals. In addition, the number of minorities diagnosed with CAA increased during the study period, suggesting disparities that exist and will continue to be addressed as access to modern medicine improves. Despite having a low mortality rate, the mortality rate did not improve over the study period. This highlights the need for further studies to identify challenges in diagnosis and management of CAA, especially regarding ethnic and racial disparities.

Abstract 13371: Left Bundle Branch Area Pacing: Experiences From the First Two Years Implanting in an Academic Training Program

Background: Left bundle branch area pacing (LBBAP) has emerged as a more durable physiologic pacing strategy to His bundle pacing and a promising alternative to cardiac resynchronization therapy. Integration of this procedural technique within an academic training program has not yet been described. Objective: Highlight the procedural learning curve of implanting LBBAP leads within a fellowship program. Methods: Retrospective analysis of consecutive patients who underwent placement of a Medtronic 3830 lead for LBBAP at our institution from 1/2021-12/2022. Results: A total of 180 patients underwent LBBAP lead placement over the study time period. Overall, total procedure time was 133.7±58.2min, lead placement time 30.7±20.0min, fluoroscopy time 22.5±21.2 min, left bundle branch (LBB) capture rate 70% and paced QRS duration 128.6±19.3 ms. When dividing the study period by 6-month intervals, there was a rise in procedural volume (21, 28, 62 and 59 cases, respectively), a trend towards less fluoroscopy use (20.2±12.2, 16.7±9.1, 16.2±12.6 and 16.6±14.4 min), less total radiation (345.2±323.3, 317.2±630.9, 214.9±271.2 and 171.7±253.9 mGy), decreased LBBAP lead placement time (37.8±24.3, 30.7±16.3, 28.2±21.5, 30.6±18.7 min), decreased delivery system exchanges (19%, 11%, 8% and 2%*, *p≤0.01 from first six months) and improved LBB capture rates (50%, 69%, 83%*, 64%, *p≤0.01 from first six months). Both fellowship classes showed significant improvements in LBB capture rates (40% to 94% and 38% to 84%, p≤0.01 for both) and paced-QRS duration (140.0±27.2ms to 120.2±16.5ms and 136.2±21.8ms to 121.7±17.2ms, p≤0.05 for both) after 12 months of experience. Conclusion: Over the first two years of performing LBBAP in an academic training program, there was a rise in procedural volume with trends towards less fluoroscopy use, decreased LBBAP lead placement time with significantly decreased delivery system exchanges and improved LBB capture rates. Significant improvements in LBB capture rates and paced-QRS duration were seen by fellows after 12 months of experience. LBBAP is an increasingly popular pacing technique that can be effectively integrated within a training program, with early introduction important to accommodate the initial learning curve.

Abstract 15616: Decline in Temporal Trends of Medicare Physician Reimbursement for Cardiovascular Procedures

Introduction: Utilization of cardiac procedures are common among Medicare beneficiaries and projected to increase over time. Temporal trends of physician fee reimbursement for CV procedures have not been studied. Methods: Cross-sectional study was conducted for national payment amounts that were extracted from Centers for Medicare &amp; Medicaid Services (CMS) Physician Fee Schedule Look-Up Tool using Current Procedural Terminology (CPT) codes. Study time period ranged from 2013 through 2023. CPT codes were analyzed for coronary (percutaneous coronary intervention, coronary artery bypass graft), valvular (surgical aortic, mitral, tricuspid repair/replacement), and structural (transcatheter aortic valve replacement, mitral transcatheter edge-to-edge repair, left atrial appendage occlusion) procedures. All prices were adjusted for inflation to January 2023 US dollars. Primary outcomes were unadjusted and adjusted mean percentage changes (annual and total over 10-year period) and compound annual growth rates for each CV procedure. Results: From 2013 to 2023, mean total unadjusted percentage changes ranged from -0.54% to -21.78%; which decreased further after adjusting for inflation, ranging from -21.07% to -39.83%. The decline was seen in all studied CV procedures. Annual rates (mean and compound) were -3% for most procedures after adjusting for inflation. Conclusions: Our findings suggest a declining trend in physician reimbursement for CV procedures by Medicare, which may adversely influence access to procedures, affect commercial insurance pricing/coverage, and inform trainees and practicing CV physicians of current financial situation. Emphasis needs to be placed on value-based payment model for sustainable and efficient CV care.

Trải nghiệm của người bệnh điều trị nội trú tại bệnh viện Răng Hàm Mặt Trung ương Hà Nội năm 2023

Objective: This study is to describe status of the experience of inpatients at National hospital of odonto - stomatology hospital in 2023 and to analyze some related factors. Methods: A cross-sectional descriptive study was conducted on 256 inpatients, using the CAHPS questionnaire. Study time period was from 11/2022 to 5/2023 at National hospital of odonto - stomatology hospital. Results: The percentage of patients with a overall positive experience was 91,4%. In the aspects of hospital experience, the percentage of patients with a positive experience on Communication with doctors was highest (92,6%). Aspect having lowest positive experience rate of inpatients is “treatment in hospital” with only 65,4%. Since then, the research offered a variety of ways to enhance hospital quality in general and patient experience in particular, such as: Enhance training for medical staff in order to increase professional qualifications and communication, form professional supervision teams, and improve communication and behavior of health workers, sanitation employees, and security guards. Key word: Patient experience, CAHPS, patient, inpatient treatment, hospital

Impact of a modified screening approach during the COVID-19 pandemic on the diagnosis and outcomes of gestational diabetes mellitus: A population-level analysis of 90,518 pregnant women.

To provide real-world evidence on the uptake of and outcomes associated with the modified gestational diabetes mellitus (GDM) screening approach offered during the COVID-19 pandemic compared with the standard screening approach. All pregnancies between 01 January 2020 and 31 December 2021, in Alberta, Canada, were included in the study. We examined GDM screening and diagnosis rates, and large-for-gestational-age (LGA) outcomes. Annual GDM screening rates were > 95% during the study time period. Overall, 84.7%, and 11.6% of the 92,505 pregnancies underwent standard and modified screening for GDM, respectively. The use of modified screening was the highest among deliveries in August 2020 (49.8%) which corresponded to the early first wave of the pandemic. GDM diagnosis rate was lower in the modified screening (7.4%) than in the standard screening (12.3%, p < 0.001) group. The LGA rates in the modified screening with GDM and the standard screening with GDM groups were 24.8% and 12.6%, respectively (p < 0.001). Women in the modified screening with GDM group were at a higher risk of having an LGA infant (adjusted odds ratio: 3.46; 95% confidence interval: 2.93, 4.08) compared to the standard screening with no GDM group. The COVID-19 epidemic had no impact on screening for GDM. Women who underwent modified screening, based on HbA1c/random plasma glucose, had lower rates of GDM cases.

Handling Missing Data in COVID-19 Incidence Estimation: Secondary Data Analysis.

The COVID-19 pandemic has revealed significant challenges in disease forecasting and in developing a public health response, emphasizing the need to manage missing data from various sources in making accurate forecasts. We aimed to show how handling missing data can affect estimates of the COVID-19 incidence rate (CIR) in different pandemic situations. This study used data from the COVID-19/SARS-CoV-2 surveillance system at the National Institute of Hygiene and Epidemiology, Vietnam. We separated the available data set into 3 distinct periods: zero COVID-19, transition, and new normal. We randomly removed 5% to 30% of data that were missing completely at random, with a break of 5% at each time point in the variable daily caseload of COVID-19. We selected 7 analytical methods to assess the effects of handling missing data and calculated statistical and epidemiological indices to measure the effectiveness of each method. Our study examined missing data imputation performance across 3 study time periods: zero COVID-19 (n=3149), transition (n=1290), and new normal (n=9288). Imputation analyses showed that K-nearest neighbor (KNN) had the lowest mean absolute percentage change (APC) in CIR across the range (5% to 30%) of missing data. For instance, with 15% missing data, KNN resulted in 10.6%, 10.6%, and 9.7% average bias across the zero COVID-19, transition, and new normal periods, compared to 39.9%, 51.9%, and 289.7% with the maximum likelihood method. The autoregressive integrated moving average model showed the greatest mean APC in the mean number of confirmed cases of COVID-19 during each COVID-19 containment cycle (CCC) when we imputed the missing data in the zero COVID-19 period, rising from 226.3% at the 5% missing level to 6955.7% at the 30% missing level. Imputing missing data with median imputation methods had the lowest bias in the average number of confirmed cases in each CCC at all levels of missing data. In detail, in the 20% missing scenario, while median imputation had an average bias of 16.3% for confirmed cases in each CCC, which was lower than the KNN figure, maximum likelihood imputation showed a bias on average of 92.4% for confirmed cases in each CCC, which was the highest figure. During the new normal period in the 25% and 30% missing data scenarios, KNN imputation had average biases for CIR and confirmed cases in each CCC ranging from 21% to 32% for both, while maximum likelihood and moving average imputation showed biases on average above 250% for both CIR and confirmed cases in each CCC. Our study emphasizes the importance of understanding that the specific imputation method used by investigators should be tailored to the specific epidemiological context and data collection environment to ensure reliable estimates of the CIR.

Bibliometric Analysis of the Studies Determined By the Monte Carlo Simulation Technique of the Power of the Test

In order to give detailed information about the characteristics of scientific studies related to the power of the test, a bibliometric analysis of studies in which the power of the tests used in statistical data analysis was determined with the aid of Monte Carlo simulation techniques was carried out. The Web of Science (WoS) database's 1309 scientific studies in which the power of the test was determined by using Monte Carlo simulation techniques served as the study's material of data. The analysis includes the number of studies by year, average citation count by year, the number of articles published in scientific journals, countries of responsible authors, and the most relevant words in the studies. It was observed that Communications in Statistics-Simulation and Computation and Journal of Statistical Computation and Simulation are the journals with the highest number of published articles. The United States of America (USA) takes the lead when considering the countries of corresponding authors, while Türkiye is in 8th place. The most used keywords in the ten-year time period of scientific studies were respectively “power”, “test”, “skewness”, “model” and “inference”. As a result, it can be concluded that test power studies can be obtained safely using the Monte Carlo simulation technique.

Does survey mode matter? Comparing in-person and phone agricultural surveys in India

Ubiquitous mobile phone ownership makes phone surveying an attractive method of low-cost data collection. We explore differences between in-person and phone survey measures of agricultural production collected for an impact evaluation in India. Phone responses have greater mean and variance, a difference that persists even within a subset of respondents that answered the same question over both modes. Treatment effect estimation remains stable across survey mode, but estimates are less precise when using phone data. These patterns are informative for cost and sample size considerations in study design and for aggregating evidence across study sites or time periods.

Comfort and Coordination among Interprofessional Care Providers Involved in Intubations in the Pediatric Intensive Care Unit.

Successful execution of invasive procedures in acute care settings, including tracheal intubation, requires careful coordination of an interprofessional team. The stress inherent to the intensive care unit (ICU) environment may threaten the optimal communication and planning necessary for the safe execution of this complex procedure. The objective of this study is to characterize the perceptions of interprofessional team members surrounding tracheal intubations in the pediatric ICU (PICU). This is a single-center survey-based study of staff involved in the intubation of pediatric patients admitted to a tertiary level academic PICU. Physicians, nurses, and respiratory therapists (RT) involved in tracheal intubations were queried via standardized, discipline-specific electronic surveys regarding their involvement in procedural planning and overall awareness of and comfort with the intubation plan. Qualitative variables were assessed by both Likert scales and free-text comments that were grouped and analyzed thematically. One hundred and eleven intubation encounters were included during the study time period, of which 93 (84%) had survey responses from at least 2 professional teams. Among those included in the analysis, the survey was completed 244 times by members of the PICU teams including 86 responses from physicians, 76 from nurses, and 82 from RTs. Survey response rates were >80% from each provider team. There were significant differences in interprofessional team comfort with nurses feeling less well informed and comfortable with the intubation plan and process compared to physicians and RTs (p < 0.001 for both). Qualitative themes including clear communication, adequate planning and preparation prior to procedure initiation, and clear definition of roles emerged among both affirmative and constructive comments. Exploration of provider perceptions and emergence of constructive themes expose opportunities for teamwork improvement strategies involving intubations in the PICU. The use of a preintubation checklist may improve organization and communication amongst team members, increase provider morale, decrease team stress levels, and, ultimately, may improve patient outcomes during this high stakes, coordinated event.

1 Youth Experiencing Homelessness Presenting to an Urban Paediatric Emergency Department: A Descriptive Study

Abstract Background Youth experiencing homelessness (YEH) have high rates of both mental and physical health concerns. This population faces multiple barriers in accessing care, resulting in unaddressed needs and reliance on Emergency Departments (ED). In Canada, the use of the paediatric ED by YEH has not been well described, and there is no data exploring the effects of the COVID-19 pandemic lockdown on ED attendance by this population. Objectives This study aims: 1) To review the frequency/nature of the presentations to the paediatric ED by YEH; 2) To compare pre- and post-COVID-19 data. Design/Methods Medical records were searched for ED encounters where a patient identified a youth shelter as their address and/or had terms documented such as “homeless”, during two time periods: pre-COVID-19 (May 1, 2018–March 15, 2020) and post-COVID-19 lockdown (March 16, 2021–Jan 31, 2022). Pertinent details of the encounters were documented, including chief complaint (CC). Descriptive statistics were used, as well as comparative analysis of the two time periods. Results A total of 1103 encounters were included. Over the total 45-month study time period, CCs were split between mental health-related (n=562, 50.9%) and physical health-related presentations (n=541, 49%). Of the mental health CCs, 396 (70.4%) were documented as “depression/overdose/suicidal/self-harm”. The most common CCs related to physical health were injuries (n=127, 23.4%), and pain (n=126, 23.2%). YEH most commonly attended the paediatric ED between 17:00-00:00 (n=504, 45%), and were triaged as CTAS 3/urgent (n = 676, 61.2%). Of those who completed an Ask Suicide-Screening Questionnaire (ASQ) (n=303), 45.8% (n=139) had an acute positive screen/imminent risk identified. The most common principal diagnoses documented at disposition were related to injuries/assault/pain (n= 224, 20%), and suicide attempt/self-harm (n=196, 17.7%). Of the 166 outpatient referrals made at discharge from ED, 105 (63%) were to mental health/psychiatry. While overall there were fewer ED encounters for this population “post COVID-lockdown” (n=465) as compared to “pre-COVID” (n=638) (p-value &amp;lt;0.05), there was a significant reduction in mental health-related CCs (pre-COVID n=365, post-COVID n=197; p-value &amp;lt;0.05), with no significant reduction in physical-related CCs after the pandemic lockdown (pre-COVID, n=273, n=268). Conclusion YEH utilize the paediatric ED for both their mental and physical healthcare and frequently report suicide risk. The findings that lower attendance to the paediatric ED for mental health-related concerns followed the pandemic lockdown, while physical health encounters remained steady, may reflect increased barriers to care or novel methods of mental health care delivery post-pandemic.

Gentrification, neighborhood socioeconomic factors and urban vegetation inequities: A study of greenspace and tree canopy increases in Montreal, Canada

This study investigates the relationship between increasing urban vegetation and census tract-level green inequities, as well as the role of social indicators in this relationship. We analyzed the augmentation of greenspace and tree canopy in Montreal, Canada, between 2011 and 2017, and its effect on green inequities based on material deprivation, the percentage of visible minorities, and gentrification status using Poisson spatial random effect models. Our analyses showed an increase in greenspace from 57.4% to 65.8% and tree canopy from 21.1% to 22.3% between 2011 and 2017. Census tracts (CTs) with higher levels of material deprivation or a higher percentage of visible minority population had less greenspace and tree canopy at baseline in 2011. Additionally, CTs that were not gentrified had less greenspace and tree canopy than ineligible for gentrification CTs. Furthermore, CTs with more visible minorities, higher levels of material deprivation, or those that did not gentrify had smaller increases in greenspace and tree canopy between 2011 and 2017. Among CTs with more visible minorities or higher levels of material deprivation, those with greater greenspace and tree canopy at baseline also experienced greater increases during the study time period. Conversely, among ineligible for gentrification CTs, those with less greenspace/tree canopy at baseline experienced greater increase in greenspace/tree canopy. Our analysis revealed that despite an increase in urban vegetation, inequities in urban vegetation persists. To reduce green inequities and promote social equity in this particular study area, urban planning policies should prioritize CTs with higher levels of material deprivation, more visible minorities, or those that did not gentrify, and focus on increasing urban vegetation.

Analysis of the international trade networks of COVID-19 medical products

This research aimed to gain a deeper understanding of how and for what reasons the world trade networks of medical products were reorganized during the novel coronavirus (COVID-19) pandemic. To do this, first, the trade data of eight COVID-19-related product categories (such as medical test kits and protective garments) were collected for the years 2019 and 2020. Then it was examined which countries’ exports and imports changed the most between the studied time period in each product category. In addition, gravity models containing additional economic, geographic, and COVID-19-related variables were used to analyze the impact of the pandemic on the investigated trade networks. Based on the results, China achieved the highest cumulative export growth, surpassing the second-highest value by approximately 14.66. Hungary, with a population of only 9.7 million, stood out as a major importer of ventilators. Additionally, a higher incidence of COVID-19 among importers typically led to reduced traded values, while European Union membership and innovation capacity had the opposite effect.

Telemedicine and HIV Care Quality Measures During the COVID-19 Pandemic.

During the COVID-19 pandemic, telemedicine was adopted to ensure continuity of HIV care. We examined how introducing televisits affected technical quality of care for people with HIV (PWH) during this time. PWH receiving HIV care at Howard Brown Health Centers and Northwestern University in Chicago, Illinois were included. HIV care quality indicators were calculated using data extracted from electronic medical records during 4 timepoints every 6 months from March, March 1, 2020 to September 1, 2021. Generalized linear mixed models estimated differences in indicators across timepoints within each site while controlling for multiple observations of individuals. Generalized linear mixed models were also used to compare differences in outcomes among PWH who attended all versus a combination of in-person and televisits versus no televisits across the study time periods. 6447 PWH were included in the analysis. Compared with prepandemic levels, there were significant declines in care utilization and processes of care measures. Measures of HIV virologic suppression, blood pressure control, and HbA1C <7% (in both people with and without diabetes) were stable with no significant differences noted across the study timepoints. Similar trends were observed across all age, race, and sex subgroups. In multivariable models, televisits were not associated with decreased HIV viral suppression. During the COVID-19 pandemic and rapid implementation of televisits, indicators of care utilization and processes of care decreased compared with prepandemic levels. Among PWH who remained in care, televisits were not associated with worse virologic, blood pressure, and glycemic control in PWH.

The Impact of Number of Medications on Falls in Aging Persons with Human Immunodeficiency Virus.

We aimed to evaluate the impact of polypharmacy on the risk of having a fall in older persons with HIV (PWH). PWH at least 50 years of age who were seen at our institution from September 2012 to August 2017 were included. Unique participants were selected for either a case or control cohort depending on the presence of a documented fall during the study time period. Demographics, HIV-related measures, VACS score, number of medications, as well as the impact of taking benzodiazepines and opioids were compared between the two cohorts. Fall was documented for 637 patients compared to 1534 without a fall during the same time period. Multivariable logistic regression revealed that the total number of medications, having a higher VACS score, taking an opioid, being female sex assigned at birth, and having a lower nadir CD4 count were significantly associated with higher odds of having a fall. In this cohort of older PWH, taking a higher number of non-ARV medications significantly increased the odds of having a fall. In addition, taking an opioid resulted in the highest odds of having a fall. These results suggest the importance of deprescribing and addressing opioid use in reducing the risk of having a fall in older PWH.

17. OUTCOMES OF ESOPHAGEAL CANCER FROM SINGAPORE’S NATIONAL REGISTRY

Abstract Background The results of the CROSS trial has increased the impetus towards using neoadjuvant chemoradiation followed by surgery (trimodal) treatment for resectable stage II/III esophageal cancer. We sought to see what the Singaporean results have been based on data kept by the Singapore Cancer Registry. Methods Singapore Cancer Registry data pertaining to patients diagnosed with esophageal cancer from January 2010 to December 2017 were analysed in terms of trimodal treatment with curative intent. Results There were 840 patients in the registry with esophageal cancer over the study time period. 171 patients elected to have no active treatment and had a median survival of 2.4 months. Of the remainder, there were 59 patients who underwent trimodal treatment with curative intent. Overall median survival was 4.5 years in this group. There were 11 adenocarcinomas and 48 squamous cell carcinomas. Five-year survival rate was 44%. Conclusions Based on our national registry data, patients selected for neoadjuvant chemoradiation, and who actually follow-through with surgery, have a similar survival time when compared to the findings reported in the CROSS study.