Two-sample Wilcoxon Rank-sum Test Research Articles

Early pregnancy associations with Gestational Diabetes: methods and cohort results of the Hoosier Moms Cohort

Background Gestational Diabetes (GDM) raises the risk of adverse perinatal outcomes and long-term risk of type 2 diabetes. There is currently a lack of comprehensive GDM prediction models based on more than simple clinical features. Objective The objective of this study was to collect a comprehensive set of clinical, sociodemographic, biobehavioral, and genomic features in a prospective high-risk cohort for GDM, to discover novel predictive and therapeutic targets for GDM during early pregnancy. Study design The Hoosier Moms Cohort was a prospective observational study of pregnant individuals, with a singleton gestation <20 weeks. The study protocol included 2 visits during pregnancy and one at delivery. Psychosocial, dietary, social, and demographic characteristics were collected in addition to maternal and newborn samples. Developing GDM was the primary outcome. Univariate associations with GDM for continuous variables were analyzed using either two-sample t-test or Wilcoxon Rank Sum test, and categorical variables using either chi-square or Fishers exact test. Multiple logistic regression was performed for independent associations with GDM. Results A total of 411 participants were recruited, with complete data available for 391. Patients were on average 30 years of age, had a mean body mass index (BMI) of 28, and 17% were of Hispanic ethnicity. Additionally, 54% reported a family history of diabetes, with 4% reporting a personal prior history of GDM. A total of 39 participants (10.0%) developed GDM. Compared to those that did not, participants who developed GDM had a significantly higher baseline BMI (31.6 vs 27.2, p=0.003), HbA1c (5.24 vs 5.07, p<0.001), triglycerides (156.8 vs 134.2, p=0.022), and random blood glucose (85.90 vs 79.96, p=0.025) at the initial visit. Those with GDM were more likely to have a prior history of gestational diabetes (28.21% vs 1.96%, p<0.001), and current chronic hypertension (12.82% vs 1.9%, p=0.003). Additionally, they scored higher on a validated insomnia questionnaire (9.62 vs 7.80, p=0.028). A significant association was found between GDM and 3 previously reported genetic markers (p<0.01). Individuals with high polygenic risk scores for type 2 diabetes were not more likely to have a GDM diagnosis. Through stepwise logistic regression, prior history of GDM, current diagnosis of hypertension, insomnia, and BMI were independently associated with GDM (odds ratio, 95% confidence intervals: 14.98, 4.49-50.02; 10.94, 2.32-51.69; 1.11, 1.01-1.22; 1.09, 1.03-1.16, respectively). Conclusion The Hoosier Moms Cohort identified that participants with a previous GDM diagnosis, chronic hypertension, elevated BMI, and insomnia have significantly increased odds of developing GDM in a diverse cohort of participants. These factors will be integrated into a machine learning model with multi-omics data to develop a comprehensive predictor for GDM.

Comparison of anticoagulation control and outcomes between usual medical care and pharmacist-led anticoagulation service in ambulatory patients taking warfarin at tertiary hospital in Ethiopia: a quasi-experimental study

BackgroundWe aimed to compare anticoagulation control and outcomes between usual medical care (UMC) and pharmacist-led anticoagulation services (PLAS) in patients receiving warfarin at the Tikur Anbessa Specialized Hospital (TASH), Addis Ababa, Ethiopia.MethodsA quasi-experimental study was conducted, including 350 (66.7%) and 175 (33.3%) patients from the UMC and PLAS groups, respectively, from 525 patients. The time in therapeutic range (TTR) was determined using the Rosendaal method, with a TTR ≥ 65% set as the cut-off for optimal anticoagulation. The two-sample Wilcoxon rank-sum (Mann–Whitney U) test was used to compare continuous variables between groups. Categorical variables were compared between groups using Pearson’s chi-square test or Fisher’s exact test. Logistic regression and negative binomial regression analyses were conducted to identify the factors associated with suboptimal TTR and secondary outcomes, respectively, at the p values < 0.05, and 95% confidence interval (CI).ResultsCompared with the UMC group, the patients in the PLAC group showed a significantly higher median (IQR) TTR [60.89% (43.5–74.69%) vs. 53.65% (33.92–69.14%), p < 0.001]. A significantly higher optimal TTR (≥ 65%) was achieved in the PLAC group (41.7% vs. 31.7%) than in the UMC group (p = 0.002). The odds of having a poor TTR were reduced by 43% (AOR = 0.57, 95% CI = 0.36–0.88, p = 0.01) among patients in the PLAC group compared to those in the UMC group. There were no statistically significant differences in the secondary outcomes between the groups, except for all-cause emergency visits (p = 0.003). The incidence of bleeding events decreased by 3% (IRR = 0.97, 95% CI = 0.96–0.99, p < 0.001) for every increase in INR monitoring frequency. The incidence of thromboembolic events increased by a factor of 15.13 (IRR = 15.13, 95% CI = 1.47–155.52, p = 0.02) among patients with a high-risk CHA2DS2-VASc score compared with those with a moderate score.ConclusionPatients in the PLAC group had a significantly higher median TTR than those in the UMC group did. There were no statistically significant differences in the secondary outcomes between the groups, except for fewer all-cause emergency department visits in the PLAC group.

Changes in Transient Elastography with Glucagon-Like Peptide-1 Receptor Agonist Use in Metabolic Dysfunction-Associated Steatotic Liver Disease: A Real-World Retrospective Analysis.

Introduction: Current guidelines recommend the use of glucagon-like peptide-1 receptor agonists (GLP-1RAs) in the treatment of metabolic dysfunction-associated steatotic liver disease (MASLD), especially in patients with comorbid diabetes and obesity. This study investigated the effects of GLP-1RAs on hepatic steatosis and fibrosis in patients with MASLD, as measured by changes in vibration-controlled transient elastography (VCTE) and other clinical parameters in a real-world clinical setting. Methods: We conducted a single-center, retrospective analysis of 96 patients with MASLD from a multidisciplinary care clinic who completed VCTE at baseline and follow-up within 6-24 months to compare changes in controlled attenuation parameter (CAP) and liver stiffness measurement (LSM), as well as other metabolic markers, between GLP-1RA users and nonusers using two-sample t-tests and Wilcoxon rank-sum tests. We also assessed whether improvements in hepatic steatosis, defined as a change in CAP >38 dB/m as previously described in the literature, were associated with improvement in fibrosis. Results: GLP-1RA use resulted in significant improvements in weight (-8.1 kg vs. -3.5 kg, P = 0.009), body mass index (BMI) (-2.9 kg/m2 vs. -1.3 kg/m2, P = 0.012), alanine aminotransferase (-15.0 IU/L vs. -4.0 IU/L, P = 0.017), aspartate aminotransferase (-5.0 IU/L vs. -1.0 IU/L, P = 0.021), glycated hemoglobin (HbA1c) (-0.7% vs. 0.1%, P = 0.019), and CAP (-59.9 dB/m vs. -29.1 dB/m, P = 0.016). Responders also had significant improvements in weight (-9.2 kg vs. -1.9 kg, P < 0.001), BMI (-3.3 kg/m2 vs. -0.7 kg/m2, P < 0.001), diastolic blood pressure (-6.1 mmHg vs. -0.7 mmHg, P = 0.028), HbA1c (-0.8% vs. 0.3%, P < 0.001), and LSM (-1.5 kPa vs. 0.1 kPa, P < 0.001). Conclusions: Patients with MASLD treated with GLP-1RAs showed significant improvements in hepatic steatosis and multiple other metabolic parameters, with weight loss as the proposed mechanism for this liver improvement. In addition, change in CAP >38 dB/m was associated with improvements in LSM and other metabolic parameters, suggesting the clinical utility of VCTE in the surveillance of MASLD.

Impact of an internet-based insomnia intervention on suicidal ideation and associated correlates in veterans at elevated suicide risk.

Improving public health approaches to suicide prevention requires scalable evidence-based interventions that can be easily disseminated. Given empirical data supporting the association between insomnia and suicide risk, internet-delivered insomnia interventions are promising candidates to meet this need. The purpose of this study was to examine whether an unguided internet-delivered cognitive-behavioral therapy for insomnia (iCBT-I) improved insomnia severity, suicidal ideation (SI), and suicide risk correlates (depression, post-traumatic stress disorder, anxiety, hostility, belongingness, hopelessness, agitation, irritability, concentration) in a sample of veterans. Secondary data analysis of Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn veterans (n = 50) with clinically significant insomnia and elevated SI drawn from a larger randomized controlled trial (RCT) of an iCBT-I, Sleep Healthy Using the Internet (SHUTi). Two-sample t-tests or Wilcoxon rank sum tests were used to evaluate between-group differences (SHUTi vs. Insomnia Education Website control) in symptom improvement from baseline to post-intervention. SHUTi participants experienced a significant improvement in insomnia severity (P < .001; d = -1.08) and a non-significant with small (subthreshold medium) effect size reduction of SI (P = .17, d = 0.40), compared to control participants. Significant improvement in hopelessness was observed (medium effect size), with non-significant small to medium effect size reductions in most remaining suicide risk correlates. Self-administered iCBT-I was associated with improvements in insomnia severity in veterans at elevated risk for suicide. These preliminary findings suggest that SI and suicide risk correlates may improve following an iCBT-I intervention, demonstrating the need for future well-powered iCBT-I RCTs targeted for populations at elevated suicide risk.

Novel cryotherapy technique for pulpotomy in mature permanent teeth with symptomatic irreversible pulpitis- a randomized controlled trial.

To assess the effect of cryotherapy on haemostasis, post-operative pain, and the outcome of full pulpotomy performed in mature permanent teeth with symptomatic irreversible pulpitis. The study included sixty mature permanent mandibular molar teeth with symptomatic irreversible pulpitis and no periapical rarefaction. After coronal pulp tissue amputation, teeth were randomly allocated to one of two groups (n = 30 each). In group I (conventional pulpotomy), a sterile cotton pellet moistened with 2.5% NaOCl was used for haemostasis. In group II (cryotherapy), the pulp chamber was continuously lavaged with 2.50C normal saline solution for haemostasis using an indigenous portable cryotherapy irrigation unit. Following haemostasis, the pulp was capped with mineral trioxide aggregate and the tooth was restored with resin composite. The time taken to achieve haemostasis was recorded. Preoperative and 24, 48 and 72h postoperative pain was measured using the Numerical Rating Scale. The pulpotomy outcome was assessed at the 12-month follow-up. Data were analyzed using Fischer's exact test, two-sample t-test, two-sample Wilcoxon rank-sum test, Friedman Test, and Wilcoxon Signed Rank Test. The cryotherapy group achieved haemostasis in less time (p < 0.05). There was a significant pain reduction at 24 and 48h in the cryotherapy group when compared with the conventional pulpotomy group (P < 0.005). The overall success rate of pulpotomy after 12 months was 88% (n = 22) in both study groups(p < 0.05). Cryotherapy application reduces postoperative pain and has no adverse effect on the outcome of pulpotomy in permanent teeth with symptomatic irreversible pulpitis. The cryotherapy can be incorporated in pulpotomy protocol as an adjunct to minimize post-operative pain.

114 Burn Specific VTE Prophylaxis: Higher Enoxaparin Dose and Anti-Xa Adjustments Is Safe and Potentially Beneficial

Abstract Introduction Burn and trauma patients are at high risk of venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolus (PE). VTE prophylaxis guidelines for trauma patients recommends a higher standard dose of enoxaparin and anti-Xa level adjustments in select patients; however, no guidelines specific to burn patients exist. We hypothesize that higher standard doses of enoxaparin and anti-Xa level adjustments will be safe and effective at reducing VTE complications in burn patients. Methods This retrospective review included patients admitted to a regional burn center six months prior to and after the initiation of a VTE prophylaxis quality improvement protocol. The protocol doubled the standard dose of enoxaparin, 40 mg daily to 40 mg twice a day, for all burn patients who were &amp;gt; 50 kg and had creatinine clearance &amp;gt; 60mg/dl. Peak anti-Xa level monitoring was indicated if a high-risk factor (TBSA ≥20%, inhalation injury, burn shock, BMI ≥40) was present. Patients on therapeutic anticoagulation or anti-platelet therapy, had a history of chronic kidney disease, decompensated cirrhosis, coagulation disorder, heparin induced thrombocytopenia (HIT), or were admitted for polytrauma were excluded. Efficacy was evaluated by rates of VTE within 31 days of discharge. Safety was evaluated by bleeding complications, including estimated blood loss (EBL), number of transfusions and gastrointestinal (GI) bleeding events. Differences between groups were compared using a two-sample t-test or Wilcoxon rank-sum test. A p-value of &amp;lt; 0.05 signified statistical significance. Results The pre-protocol group included 217 patients and the post-protocol group included 207 patients. There were no significant differences in age (45 vs 44 years), BMI (27 vs 26.4 kg/m2), TBSA (5.9 vs 5.3%), IHI (4.6 vs 7%), number of procedures (3 vs 3), mortality (4.1 vs 3%), or ICU length of stay (1.9 vs 1.6 days) between groups. No significant difference in EBL (50 vs 25 cc), number of transfusions (3.3 vs 2.4 units), or GI bleeding events (1 vs 1) was noted between groups, and no patient developed thrombocytopenia or HIT. There were 5 patients (2.3%) with a VTE within 31 days of discharge in the pre-protocol group compared to 1 patient (0.4%) in the post-protocol group (p=0.19). There was not enough power to determine statistically significant VTE prevention. Conclusions A lack of VTE prophylaxis recommendations for burn patients leads to variability in protocols among burn centers. These protocols are infrequently studied. This protocol, which doubled the standard dose of enoxaparin and adjusted based on anti-Xa levels for high-risk patients, was safe. Efficacy and applicability to other centers needs further elucidation. Applicability of Research to Practice Enoxaparin 40mg twice a day with anti-Xa level adjustments is safe and a promising strategy to reduce the rates of VTE in the burn population without increasing bleeding complications.

117 Applying the Competency Index for Clinical Research Professionals (CICRP) for Educational Program Evaluation

OBJECTIVES/GOALS: To demonstrate the value of the Competency Index for Clinical Research Professional (CICRP) as a tool in program evaluation using a pre- and post- design to evaluate student perceived self-efficacy in clinical trial competencies at program entry and at program completion. METHODS/STUDY POPULATION: Using a separate-sample pre-post study design, we administered the CICRP questionnaire to students in the entry and exit courses of the Master of Clinical Research (MCR) Program during the 2021-2022 academic year, using QualtricsTM (Provo, Utah) survey instrument for use on desktop or mobile device. We included the 20 CICRP competency items asking students to rate their self-efficacy in performing each item using a Likert Scale (from 0-10) (0=not at all confident; 10= extremely confident). Links to the survey were included in the courses for the foundational entry course and for the final culminating project course. RESULTS/ANTICIPATED RESULTS: Overall, 54 students took the CICRP during the entry course and 56 during the exit. Cronbach’s alpha for each assessment ranged from 0.93 to 0.98. Both the Welch’s two-sample t-test and Wilcoxon rank-sum test show very significant differences between the group of students entering the program and leaving the program (p value &lt; 0.001). A significant increase in mean CICRP total score is seen at each experience level between program entry and program exit (p&lt;0.001) A linear regression, adjusting for available covariates, individuals taking the exit course have a mean CICRP total score 92.690 (p value &lt; 0.001) higher than individuals taking the entry course. DISCUSSION/SIGNIFICANCE: Competency indices have been used to measure self-efficacy in translational research scientists, thus the use of CICRP to measure self-efficacy can be useful in assessing whether our competency-based program is meeting the JTF Competency needs of students.

Optimization of intraoperative lumpectomy specimen labeling

BackgroundAccurate lumpectomy specimen orientation is critical as incorrect orientation may result in excision of the wrong lumpectomy margin. Our goal was to determine if specimen orientation achieved by labeling three surfaces is superior to two. MethodsThis was a prospective single-institution study including 22 breast surgical oncologists. Intraoperative labeling of either two or three surfaces of the lumpectomy specimen was based on surgeon preference. The specimen was delivered to Pathology where it was oriented by the pathology team and the surgeon then determined if the specimen was correctly oriented or if re-orientation was required. Surgeons subsequently recorded orientation technique and if re-orientation was required. Specimen weight, patient age, and BMI were recorded. Fisher’s exact test and two-sample Wilcoxon rank-sum test were used to determine p-values. ResultsOf 268 specimens, 40 (14.9%) required re-orientation. Labeling specimens on three surfaces was superior to two (22 of 195 (11.2%) versus 18 of 73 (24.6%), p = 0.01). Specimens requiring re-orientation were more likely to be heavier (36 g vs. 24 g, p = 0.02). In multivariable analysis, labeling specimens on three surfaces resulted in a 70% reduction in discordance rates between the surgeon and pathology team (OR 0.3, p = 0.001). Using mean weight of lumpectomy specimens, specimens >33 g were more likely to require reorientation (OR 2.8, p = 0.004). Age and BMI did not impact the need for re-orientation. ConclusionLumpectomy specimen labeling using three surfaces was superior to two. Surgeons should routinely orient their specimens on three or more surfaces to decrease discordance rates.

Abstract 143: Electronic Consultation for Outpatient Stroke/TIA Care: Are Recommendations Followed?

Background: Including electronic consultations (e-consults) in addition to video visits in a teleneurology program can improve patient access and allow early recommendations (recs) to be communicated to referrers of patients with prior stroke/TIA. We sought to compare how attention to recs differed by type of teleneurology care. Methods: We evaluated outpatient video and e-consults for Veterans with stroke/TIA receiving care in the VA National TeleNeurology Program from 12/2022-4/2023. E-consults were completed if relevant records were available in the electronic health record (EHR). Video consults were scheduled as part of the NTNP. Clinical information, recs (categorized by type), and subsequent orders were assessed with EHR data and chart review. Rec attention was defined as ordered or completed within 60 days of a completed consult. We used two-sided two-sample t-tests, two-sample Wilcoxon rank sum tests and chi-square tests to compare demographics and rec attention rates between e-consult and video groups. Results: Of 391 consults requested for a stroke/TIA diagnosis, 214 (55%) had a neurologist stroke/TIA diagnosis and at least one rec; 57 (27%) of these were e-consults. Patients were similar in both groups (Table); e-consults were completed faster (mean 3.9 days vs. 60.3 days). E-consults had a similar number of recs (mean 2.2 recs vs 1.9 per consult, p = 0.17) but slightly more imaging recs (0.89 vs 0.62 per consult, p = 0.04). Overall, e-consult recs were less likely to receive attention: 55% in e-consult vs 69%, p = 0.05; this gap was worst for attention to lab recs (40% vs 70%, p = 0.03). Conclusion: E-consults for outpatient stroke/TIA questions can improve the timeliness of care, but recs are less likely to be followed than if care is directly provided via telehealth video visits. Consideration for care models that improve communication between the neurologist and the referrer may be necessary to improve attention to consult recommendations.

Does a centralized written final examination in mathematics indeed improve pupils’ subject-related study ability?

Since 2015/16, a standardized written final examination in mathematics or applied mathematics has been compulsory for nearly all pupils at the upper secondary level in Austria. While this standardized competence-oriented maturity examination is intended to increase pupils’ subject-related study ability, empirical research in this regard is scarce. Therefore, the subject-related study ability for six partially different control and experimental groups containing between 11 and 17 first-year STEM students is compared using a one-tailed two-sample Wilcoxon rank sum test. No significant differences in the subject-related study ability are detected between the control groups, comprising first-year Austrian STEM students who did not participate in the standardized written final examination in mathematics, and the experimental groups, comprising first-year Austrian STEM students who did participate in the standardized written final examination in mathematics. However, post hoc power analyses show that the sample sizes for each of the six sample cases would have to be much larger to prove significant results with a power of at least 80%. Additionally, no evidence for teaching-to-the test practices could be found in the experimental groups.

Deep Learning Based Blood Abnormalities Detection As a Tool for Vexas Syndrome Screening

Introduction The VEXAS syndrome (vacuoles, E1 enzyme, X-linked, auto-inflammatory, somatic) described in 2020 caused by mutations of the UBA1 gene, displayed a large pleomorphic array of clinical and biological features. Nevertheless, these criteria do not allow to discriminate VEXAS from other myeloid malignancies on complete blood count + differential, notably due to the absence of peripheral blood characterization of the disease. This study aimed at singling out dysplastic features indicative of VEXAS among peripheral blood (PB) polymorphonuclears (PMN) from VEXAS patients compared to healthy patients and myelodysplastic (MDS) patients. As such task is tedious and subject to operator bias, a multicentric dataset has been used to design a deep learning algorithm for automatic detection of these features, finally tested on an external validation cohort. Patient, material and methods Patients written consents were obtained and five academic centers (number from 1 to 5) were involved in this 3 steps study. Firstly, 3 academic centers (number 1 to 3) enrolled 20 patients distributed as follow: 9 patients with UBA1 mut and 6 patients UBA1 wt with no other genetic mutation as well as 5 samples from MDS patients. A total of 25 PB smears and especially PMN images were gathered and screened for various abnormalities. Two independent morphologists blindly quantified PMN predefined characteristics. This dataset of 2,824 multilabelled PMN was evaluated and tested by a two-sample Wilcoxon Rank Sum test for statistical significance between UBA1 mut and the others. Secondly, in order to automate the detection of these significant features on PMN images, a convolutional neural network (CNN) was trained using a multicentric image dataset gathered from 4 academic centers (number 2 to 5). Patients were selected based on clinical and biological symptoms suggesting VEXAS syndrome, namely fever, skin lesions, chondrites, vasculitis and/or anemia. After evaluation of the UBA1 mutation status, this multicentric cohort was separated into confirmed VEXAS (n = 19) and UBA1 WT (n=20). A total of 6,615 annotated PMN images were collected from DI systems (Cellavision ®, Lund, Sweden) with 1 to 12 PB smears per patient, yielding a 48 UBA1 mut and 33 UBA1 wt smears. All patients were males, the median age was 74 year-old (IQR 67-77) and that of control patients 72 year- old (61-79). Finally, the CNN was evaluated on an external cohort from another academic hospital (center 1), including inflammatory patients, and patients screened for VEXAS syndrome for a total cohort of 15 patients and 1,887 images. Results Four specific abnomalities were observed in PMNs from VEXAS patients as compared with healthy or myelodysplastic controls. The automatic recognition of anomalies was then cast in a multilabel classification task, where each PMN image could be assigned to one or more labels during interference. In order to take into account this specificity, a CNN was trained, composed of different layers of convolutions and pooling (Figure1). The model was set-up to output an independent binary prediction for the presence or absence of each of the four anomalies of interest. Automatic detection of these 4 anomalies by the proposed model yielded area under the curve (AUC) of 0.827; 0.837; 0.927 and 0.947 (Figure 2). Regarding the general performance on the external validation cohort, the CNN achieved a Hamming loss of 0.141, and macro and micro F1 scores of 0.588 and 0.668 respectively. Discussion This study suggests that computer-assisted analysis of PB smears, focusing on suspected VEXAS cases, could provide valuable insights to determine which patients should undergo molecular testing. A deep-learning approach leveraging previously identified peripheral blood indicators and automatic analyzers is thus presented, which can help hematologists orient their suspicion before initiating further analysis.

Outcomes of Vaso-Occlusive Episode Management in Adults Vs. Pediatrics in the Emergency Department

Introduction: Vaso-occlusive episodes (VOEs) contribute to significant morbidity and mortality in patients with sickle cell disease (SCD) and require timely treatment. Prompt intravenous fluids (IVF) and analgesics are key mainstays of care that may influence outcomes such as the increased disease burden from VOE-associated tissue infarction and the development of chronic pain. VOEs often lead to uncontrolled pain, requiring frequent ED (emergency department) visits and hospitalizations. Timely acute care management is crucial for curbing the significant polymerization of hemoglobin (Hgb) S and dehydration, which increases sickling of Hgb and can precipitate VOEs. In this study, we investigate the relationship between variables such as time to first IVF and IV pain medications in the ED for adult and pediatric patients with SCD presenting with VOEs and rates of admission. Methods: A retrospective study was conducted to analyze outcomes of adult and pediatric patients with SCD at Loma Linda University Medical Center ED and Children's Hospital ED. Patients with HgbSS, HgbSC, and HgbS/beta-thalassemia genotypes with at least two encounters at our institution for VOEs were included. Endpoints collected were time to first IVF in the ED, time to first IV pain medication, and rate of admission. Two-sample Wilcoxon rank-sum (Mann-Whitney) test was utilized to compare time to first IVF or pain medication in adult vs pediatric patients and the rates of admission. In these models, age, gender, and genotype were adjusted for. Results: 110 patients, 56 adult and 54 pediatric, with a total of 298 patient encounters were analyzed. In the adult population, 55% were male and 45% were female, with a median age of 30. In the pediatric population, 56% were male and 44% were female, with a median age of 10. Of the patients, 47 adult and 43 pediatric patients had severe genotypes (HgbSS or HgbS/beta-thalassemia). Compared to the adult population, the pediatric group had lower odds of receiving IVF and IV pain medications in &amp;lt; 90 minutes (min) of presentation to the ED (odds ratio (OR): 0.13, p=0.01 &amp; OR: 0.114, p=0.02, respectively), controlling for age, gender, and genotype. There was no significant difference in the median time to first IVF or IV pain medication in adults compared to pediatric patients (p=0.22 and p=0.42, respectively) (Table 1). When comparing adult and pediatric patients who received IVF and IV pain medications in &amp;lt; 90 min vs ≥ 90 min, the rates of admission were lower in the &amp;lt; 90 min groups (rates of admission by time to IVF: 56.9% for ≥ 90 min vs 51.8% for &amp;lt; 90 min in adults &amp; 62.4% for ≥ 90 min vs. 50.1% for &amp;lt; 90 min in pediatric patients; rates of admission by time to IV pain medications: 60.9% for ≥ 90 min vs 12.5% for &amp;lt; 90 min in adults &amp; 60.8% for ≥ 90 min vs 50.5% for &amp;lt; 90 min in pediatric patients) (Table 2). Conclusion: Overall, shorter time to IVF and IV pain medications in the ED led to decreased rates of admission for both adult and pediatric patients, regardless of age, gender, or genotype. Despite higher odds of adults receiving IVF and IV pain medications in &amp;lt; 90 min compared to pediatric patients, there was no difference in median time to IVF or IV pain medications. Thus, developing protocols to decrease the time to IVF and pain medications in the adult and pediatric ED setting may subsequently lead to improved outcomes for patients with SCD. The study calls for larger studies to further elucidate the significance of time to initial IVF and IV pain medications in the acute management of VOEs.

Comparison Shows that Multiplex Polymerase Chain Reaction Identifies Infection-associated Urinary Biomarker–positive Urinary Tract Infections That Are Missed by Standard Urine Culture

BackgroundMultiplex polymerase chain reaction (M-PCR) has increased sensitivity for microbial detection compared with standard urine culture (SUC) in cases diagnosed as urinary tract infections (UTIs), leading to questions whether detected microbes are likely causative of UTIs or are incidental findings. ObjectiveTo compare infection-associated biomarker levels against M-PCR and SUC results in symptomatic cases with a presumptive diagnosis of a UTI by a urologist. Design, setting, and participantsParticipants were ≥60 yr old and presented to urology clinics between January and April 2023 with symptoms of UTIs (n = 583). Urine microbial detection was by M-PCR and SUC. Three infection-associated biomarkers (neutrophil gelatinase-associated lipocalin, interleukin-8, and interleukin-1β) were measured by enzyme-linked immunosorbent assay. Symptomatic cases with elevated biomarkers, detection of uropathogens, and a specialist clinical diagnosis of a UTI were considered definitive UTI cases. Outcome measurements and statistical analysisDistributions were compared using two-sample Wilcoxon rank sum test, with two-tailed p values of <0.05 considered statistically significant. Results and limitationsIn cases with M-PCR–positive/SUC-negative results (n = 80), all median biomarker levels were significantly higher (p < 0.0001) than in cases with M-PCR–negative/SUC-negative results (n = 107). Two or more biomarkers were positive in 76% of M-PCR–positive/SUC-negative specimens. Limitation was an inability to examine associations between each individual organism and inflammation. ConclusionsA significant number of M-PCR–positive/SUC-negative cases had elevated levels of infection-related urinary biomarkers, especially when infection was caused by organisms other than Escherichia coli. This is a strong indication that microbes detected by M-PCR, which would be missed by SUC, are associated with UTIs. Patient summaryWe compared infection-associated biomarkers in patients diagnosed with urinary tract infections (UTIs) against the detection of microorganisms by standard urine culture (SUC) and multiplex polymerase chain reaction (M-PCR). We found that most patients with microorganisms detected by M-PCR, which were missed by SUC, had elevated markers of inflammation, indicating that these organisms were likely causative of UTIs.

Examining the link between impulse control disorder and antidepressant use in Parkinson's disease

IntroductionImpulse control disorders (ICD) in Parkinson's disease (PD) and hypomanic episodes of bipolar disorder show overlapping symptoms, suggesting a shared neurobiology. To explore this, the following hypotheses are tested: (1) larger changes in affective symptoms from OFF to ON medication states will be associated with ICD, (2) antidepressant exposure will be associated with larger OFF to ON affective symptom changes, and (3) antidepressant exposure will be associated with ICD. Methods200 participants (mean age 65, 61 % male) were evaluated in “off” and “on” dopamine states. Affective symptoms were captured using the Hamilton Anxiety and Depression Rating Scales. Differences in clinical outcomes were compared using two-sample Wilcoxon rank-sum tests and Pearson χ2 tests. We performed multivariable logistic regression to assess the association of antidepressant exposure on ICD. ResultsParticipants with an ICD had higher anxiety and depressive scores in “on” and “off” states and larger changes in depressive symptoms from OFF to ON states compared to those without an ICD. Participants on antidepressants had higher anxiety scores in “on” and “off” states, higher depressive scores in the “off” state, and larger changes in anxiety symptoms from OFF to ON states than those not on an antidepressant. Antidepressant use was associated with a higher odds of an ICD (OR 2.3, CI [1.0–4.5], p-value 0.04). ConclusionsAffective symptom severity in “on” and “off” dopamine states is associated with ICD. Antidepressant therapy may be associated with ICD. Future prospective studies clarifying temporal associations between antidepressant initiation and ICD emergence are needed.

Statistical Shape Modeling Enables Identification of Subtalar Contact Stress Differences Following Tibiotalar Arthrodesis and Total Ankle Replacement

Category: Hindfoot; Ankle Arthritis Introduction/Purpose: Clinical studies have shown 32% of patients with a TAR progress to subtalar OA within 5 years, whereas 78% of patients with a tibiotalar arthrodesis presented with subtalar OA by 7.5 years. Higher rates of subtalar OA after arthrodesis may be explained by a transfer of ankle forces and stress through the adjacent subtalar joint while TAR may mitigate these changes. The objective of this study was to compare subtalar joint contact stresses between patients treated with tibiotalar arthrodesis and total ankle replacement (TAR) during an overground walking activity using correspondence particles to enable regional analysis. Methods: With IRB approval, ten individuals with unilateral tibiotalar arthrodesis and six individuals with unilateral TAR were imaged with biplane fluoroscopy during overground walking. Discrete element analysis (DEA) was performed to estimate subtalar joint contact stress using the tracked bone models. Cartilage was modeled using linear-elastic material properties (E=12 MPa, v=0.42) and uniformly extruded compressible surfaces from rigid subchondral bone (0.98 mm talar side, 0.75 mm calcaneal side1). A calcaneal statistical shape model (SSM) was created and resulting correspondence particles served as registered locations for comparison of cumulative stress across three phases of normalized stance (loading-response 0-24%, mid 25-54%, and terminal 55- 87%). Two-sample t-tests or Wilcoxon rank-sum tests were used to evaluate differences (p &lt; 0.05) in cumulative contact stresses at each correspondence particle within the 3 phases based upon Shapiro-Wilk findings of normality. Results: There were significant differences in contact stress exposure across all three phases of gait. Differences were identified along the superior-medial aspect of the posterior facet and within the anterior facet (Figure 1). Higher cumulative stresses were observed along the border of the posterior facet and in the medial facet. This model is limited by a lack of validation, uniform cartilage thickness assumptions applied across groups, and that DEA only estimates contact stress without consideration of shear. Conclusion: This study was the first to localize regional differences in subtalar joint stress for patients having undergone TAR and tibiotalar arthrodesis. Interestingly, TAR patients experienced higher stress in this study compared to those with arthrodeses. These ostensibly counterintuitive findings of higher TAR stress may relate to the pre-existence of subtalar OA which is a common indication of TAR versus fusion.

254. THE IMPACT OF D2 VERSUS D1 LYMPHADENECTOMY IN SIEWERT II GASTROESOPHAGEAL JUNCTION (GEJ) CANCER

Abstract Background Though a myriad of multimodal treatment options exist for gastroesophageal junction (GEJ) cancer, surgical resection remains the mainstay for potential cure. Extended nodal dissection with a D2 lymphadenectomy (LAD) beyond the D1 peri-gastric dissection remains controversial for Siewert II GEJ cancer. Though D2 LAD may lead to increased lymph node harvest, its effect on overall survival remains elusive. We hypothesize that additional D2 dissection in Siewert II GEJ cancer does not lead to increased survival. Methods We reviewed Siewert II GEJ cancer patients who received either a D1 or D2 LAD after receiving neoadjuvant chemoradiation or perioperative chemotherapy from 2012 through 2022. Chi-square and Fisher exact tests were used to compare categorical variables and two-sample Wilcoxon rank sum tests for non-normally distributed continuous variables. The main outcomes measured were 1-year mortality from date of diagnosis, number of nodes sampled, and operative time. Results Among the 155 patients identified, 75% of Siewert II underwent a D1 and 25% underwent a D2 LAD. Patients with a D2 LAD more often had &amp;gt;15 lymph nodes harvested than D1 (83% vs 48%, p &amp;lt; 0.001) but had no significant difference in median number of positive nodes (Figure 1). Patients with a D2 LAD had a median operative time approximately 2 hours longer than D1, 362 min vs 244 min (p &amp;lt; 0.001). On multivariable logistic regression adjusting for patient and clinical characteristics, there was no significant difference in 1-year mortality from patients undergoing a D2 vs D1 LAD. Conclusion Despite the associated high mortality associated with gastroesophageal junction (GEJ) cancer, there remains little consensus guidelines regarding the optimal preoperative and operative management. Though D2 LAD may theoretically lead to more lymph node harvest, its role in staging may be unnecessarily excessive as there is no gain in number of positive nodes leading to increased operative morbidity with no significant change in survival.

Serum CD64 as a Marker for Chronic Periprosthetic Joint Infection.

Serum cluster of differentiation 64 (CD64) has emerged as a diagnostic test for musculoskeletal infections. The purpose of this study was to evaluate the utility of serum CD64 in diagnosing periprosthetic joint infections (PJIs) compared to conventional markers like white blood count (WBC), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and interleukin-6 (IL-6). A prospective case-control study on patients undergoing revision hip or knee arthroplasty surgery >6weeks after their index surgery was performed at a single institution. Whole blood samples were drawn within 24 hours prior to revision surgery for white blood count, ESR, CRP, IL-6, and CD64. Intraoperative cultures were obtained during the revision, and PJI was defined using the major criteria from the 2018 Musculoskeletal Infection Society criteria. Two-sample Wilcoxon rank-sum test and Fisher's exact test were used to determine if there were significant differences in serum laboratory values between patients with and without infection. The sensitivity, specificity, positive predictive value (PPV), negative predictive value, and accuracy of each test were calculated. With an average age of 67 years, 39 patients with 15 revision THAs and 24 TKAs, were included. 19 patients (48.7%) were determined to have PJI. Patients with PJI had significantly higher CD64 (P=.036), CRP (P= .016), and ESR (P= .045). CD64 had the highest specificity (100%) and PPV (100%), moderate accuracy (69.2%), but low sensitivity (37.0%) and negative predictive value (62.5%). Given the high specificity, PPV, and accuracy, CD64 may be an excellent confirmatory test to help diagnose PJI.

Associations between canine hookworm infection and dog owners' awareness, perception, and behaviour: A cross-sectional study in Brisbane, Queensland, 2019-2020.

Canine hookworms are found globally, and infections have been recorded in domestic dogs visiting dog parks in Queensland, Australia. Some canine hookworms also present a risk of zoonotic transmission to humans. Potential transmission of hookworms can occur in the household and at public places because of lack of owner awareness and poor coverage of canine deworming. Between April 2019 and March 2020, faecal samples from owned dogs were collected from 39 dog parks in metropolitan Brisbane, Queensland, and tested for the presence of hookworm eggs using faecal floatation technique. Dog owners who provided samples were requested to complete a survey on their awareness, perceptions and behaviour regarding the risks and consequences of canine parasitic infection. Associations between dog owner demographics and responses to the survey were measured using Goodman and Kruskal's gamma. Statistical associations between canine hookworm infection in dogs and their owner's responses were quantified using a two-sample Wilcoxon rank-sum test. A total of five canine faecal samples from 175 respondents were found positive for hookworm eggs, corresponding to a sample- and park-level prevalence of 2.86% and 12.82%, respectively. Female dog owners were found to be more aware of the importance of regular deworming of their dogs (|γ| = 0.405). Our results indicate that hookworm infection was associated with a lower awareness of the importance of deworming (p = 0.007), less diligence in administration of deworming (p = 0.004), lower awareness of the risk of acquiring parasites from raw meat (p = 0.010), less likelihood of cooking meat before feeding it to their dogs (p = 0.028), and less likelihood to properly dispose their dog's faeces (p = 0.027). This study not only indicates a need for improving owner education towards the importance of deworming but also a need for changing owner's behaviours to reduce potential environmental contamination with infective hookworms. The latter in particular indicates a broader public health risk of disease transmission in public places due to improper disposal of dog faeces, especially in areas with higher canine hookworm infections.

0456 Association of MOCA scores in individuals with Mild Cognitive Impairment-Alzheimer Disease and Obstructive Sleep Apnea

Abstract Introduction Mild cognitive impairment (MCI) is considered a transitional stage between normal aging and dementia. Studies have demonstrated an association with rate of progression of MCI and dementia in individuals with OSA compared to those without OSA. The varying degree of hypoxia, sleep fragmentation and poor quality of sleep in OSA patients has been associated with increased risk of stroke, memory impairment, cardiac arrhythmias, dyslipidemia, hypertension, obesity and glucose intolerance. Identifying different variables in sleep study that can be linked with MCI and AD is helpful. We compared patients' MOCA score at the time of sleep study and compared it with multiple macro and micro variables tested on the sleep study. Methods Data was presented as mean ± (SD) or median [25th, 75th percentiles] for continuous variables and N (%) for categorical variables. Comparisons were performed between baseline MOCA groups (0-17 vs. 18-30) using two-sample T-test or Wilcoxon rank sum test for continuous variables based on distribution, and chi-square test or Fisher’s exact test for categorical variables. Linear regression was used to assess the relationship between baseline MOCA and sleep measures before and after adjustment for covariates. Covariates included age, gender, race, and BMI. Results Patients with smaller MOCA score were older (71.4 ± 8.7 vs. 68.1 ± 9.4, p=0.002), predominantly black (17.8% vs. 10.8%, p=0.013), weigh lower (median [IQR]: 80.5 [69.2, 94.0] vs. 86.2 [74.0, 99.0], p=0.023) and had less prevalence in ADHD, anxiety, depression, GERD and headache (p=0.034,0.024,0.013,0.016,0.040, respectively). After covariates adjustment (age, sex, race and BMI), when percent sleep time with SaO2&amp;lt; 90% increase 10%, MOCA would decrease 0.24 (coefficient -0.21, 95%CI [-0.41,-0.01], p=0.043); when SaO2 nadir increased 10%, MOCA would increase 0.68 (coefficient 0.68, 95%CI [0.05,1.32], p=0.035); when sleep stage %N1 increased 1%, MOCA would decrease 0.04 (coefficient -0.04, 95%CI [-0.08,-0.01], p=0.011). Conclusion Changes in oxygen levels during sleep showed direct correlation between MOCA score in individuals with MCI and AD, at the time of sleep study. Decline in MOCA scores were directly associated with degree of hypoxia observed during the sleep studies. The study showed association of worsening MCI and AD with lower oxygen levels in patients with OSA. Support (if any)

Skill Retention of Light-Curing Technique Using Only Verbal Instructions versus Using an Instructional Video: A 2-Year Follow-Up Study of Dental Students.

To evaluate the retention of light-curing skills among dental students after two years of clinical experience and determine if there are any differences in the skills retention between students who received verbal instructions or those who had received an instructional video. The students' satisfaction with past learning, self-confidence, and general knowledge about light-curing were also evaluated. This study is a 2-year evaluation of previous work. Students had previously been divided into two groups: those who received only verbal instructions, and those who received only an instructional video about the correct light curing technique to use clinically. Each student had light-cured simulated restorations (anterior and posterior) for 10 sec using the Managing Accurate Resin Curing-Patient Simulator (MARC-PS) (BlueLight Analytics, Halifax, Nova Scotia, Canada) and a multiple-emission peak light-emitting-diode (Bluephase N, Ivoclar Vivadent, Schaan, Liechtenstein) curing light. Students then received instructions according to their assigned group and light-cured the simulated cavities again. Two years later, students from both groups light-cured the same simulated cavities. Then, they completed a modified version of the National League of Nursing (NLN) satisfaction and self-confidence questionnaire and answered light-curing knowledge questions. Statistical analysis: The mean radiant exposure values delivered before receiving specific instructions on light curing, immediately after, and two years after instruction for both teaching methods (Friedman test followed by Wilcoxon signed-rank post hoc test), and the difference between both teaching methods was assessed (two-sample Wilcoxon rank-sum test). The satisfaction and self-confidence scores were compared between teaching method groups (Wilcoxon rank-sum test) (p<0.05). The mean and median irradiance values ranged between 194-1777 and 1223-1302 mW/cm2 before instructions, 320-1689 and 1254-1394 mW/cm2 immediately after instructions, and 95-1945 and 1260-1331 mW/cm2 two years later regardless of the simulated restoration or the teaching method. The mean and median radiant exposure values ranged between 2-23 and 12.5-13.6.4 J/cm2 before instructions, 3-28 and 12.8-14.3 mW/cm2 immediately after instructions, and 0.7-20 and 12.8-13.6 mW/cm2 two years later regardless of the simulated tooth being light cured and the teaching method. Students retained their light-curing skills after two years of clinical experience, with no significant differences between both groups. The instructional video group delivered significantly higher radiant exposure values (p=0.021) when light-curing the anterior tooth than the posterior. Students were satisfied with their past learning and confident in their light-curing skills (p=0.020). There were statistical differences in how well the two groups remembered what they had been taught about light-curing. Only 5.7% of students answered all knowledge questions correctly. Students retained their light-curing skills after two years of clinical experience, with no significant difference between verbal instructions or instructional video teaching methods. However, their knowledge about light curing remained very poor. Nevertheless, the students were satisfied with how they had been taught and had confidence in both teaching methods.