Two-tailed Test Of Significance Research Articles

AI-enabled automated cardiac chambers volumetry in non-contrast ECG-gated cardiac scans vs. non-contrast non-gated lung scans

Abstract Introduction We have developed an AI-enabled automated volume measurement of cardiac chambers (AutoChamber) that works on ECG-gated coronary artery calcium scans and correlates well with contrast enhanced coronary CT angiography scans. We have recently reported that increased left atrial volume measured by AutoChamber is a strong predictor of new onset atrial fibrillation (AF) in asymptomatic individuals of Multi-Ethnic Study of Atherosclerosis (MESA). In this study, we compare the volumetry results in ECG- gated CAC scans with those of non-gated full-chest lung cancer screening scans in the same individuals. Methods We have studied 169 cases of paired ECG-gated cardiac CT scans and non-gated lung scans obtained from Harbor UCLA. Mean±SD for age was 62.1±10.0 years with 52% female participants. All cases were asymptomatic and were scanned for preventive health assessment. AutoChamber was run on all cases by an independent operator who was not involved in data analysis. P value was calculated using a two-tailed test of significance with α=0.05. Results AutoChamber in cardiac scans vs lung scans reported volume (Mean±SD) for left atrium (LA) was 63.8 ± 18.5 vs. 65.5 ± 19.4, left ventricle (LV) 102.8 ± 25.3 vs. 105.5 ± 25.2, right atrium (RA) 81.9 ± 20.5 vs. 85.7 ± 21.9 right ventricle (RV), 140.7 ± 34.2 vs. 134.2 ± 33.7, left ventricle wall (LVW) 113.0 ± 26.6 vs. 109.7 ± 27.0 respectively (P < 0.0001). Strong correlation was shown between cardiac and lung scans for each cardiac chamber: LA (R = 0.92), LV (R = 0.93), RA (R = 0.91), RV (R = 0.92), and left ventricular wall (LVW) R = 0.95. Conclusions AutoChamber volumetry results are similar in ECG-gated cardiac scans vs non-gated full-chest lung scans. This AI-enabled automated tool is promising as it can provide added value to patients undergoing coronary calcium and lung cancer screening scans flagging enlarged cardiac chambers at risk of AF and heart failure.

Mental health and resilience of students with a refugee background in Greece.RaRE project findings

Abstract Background Research highlights the mental health challenges faced by children and adolescents from refugee backgrounds due to various risk factors encountered during migration, including exposure to violence, family disruptions, insecure legal status, and educational interruptions. These factors increase the risk of psychological issues and academic difficulties. This study investigates the relationship between mental health and resilience in refugee adolescents in Greece. Methods The study focuses on refugee adolescents aged 12-18 from Syria, Iraq, Afghanistan, Somalia, and Ukraine, the countries with the highest numbers of school-age refugees in Greece. Data were collected from 37 refugee children, 37 teachers, 4 parents, and 19 guardians using Poisson sampling. Results are based on responses to the Strengths and Difficulties Questionnaire (SDQ) and the Child Youth Resilience Measure (CYRM), with triangulation of self-completed questionnaires from students, parents/legal guardians, and teachers. Pearson correlation coefficient was employed for analysis. Results We present the pairwise Pearson correlation coefficients of students’ responses to psychometric tests in relation to those of teachers, along with the corresponding p-values for a two-tailed test of significance. Specifically, cor(SDQst,SDQt)=0.443 (p-value=0.006), cor(SDQst,CYRMt)=-0.341 (p-value=0.039), cor(CYRMst,SDQt)=-0.333, (p-value=0.006), cor(CYRMst,CYRMt)=0.323 (p-value=0.051). All p-values are below 0.05 or very close to it, so we reject (or we are close to) the null hypothesis of no association at 5% significance level for every case. On the contrary, we note that the corresponding coefficients between students and parents/legal guardians are all statistically non-different from 0 at 5% significance level. Conclusions Educators exhibit a solid understanding of students’ challenges and resilience compared to parents and guardians. These promising findings support further research.

Contraceptive use, unmet need and its determinants among tribal married reproductive women: A community based observational study in a district of West Bengal

ABSTRACT Context: Reported literatures revealed the problems of access and misconceptions, low contraceptive usage and high unmet need for family planning among the tribes. Aims: Our aim was to find out the prevalence of contraceptive usage, unmet need and their determinants among tribal married reproductive women. Settings and Design: A community-based, observational, analytical research using cross-sectional design was conducted among 290 tribal women of the Nadia district of West Bengal. Subjects and Methods: After obtaining ethical clearance, an interviewer-administered pre-designed, structured proforma was used to collect information on socio-demographic attributes, marital history, contraceptives and fertility status, unmet needs and the reasons for not using contraceptives. Statistical Analysis Used: Bi-variate analysis was used to know the differences and a two-tailed significance test with a P value of 0.05 or less was considered statistically significant. Results: The present study revealed a high prevalence of teenage marriage (60.7%) and pregnancy (27.6%). Every one in six tribal women was illiterate. The contraceptive prevalence rate was 43.8%. Tubectomy (38.6%) was the most common method (38.6%) and unfelt need (19.6%) was the most common reason for non-use. Age, occupation of women, social class, living status, marital duration, number of living children and desire to have a future child were found to be associated with the current contraceptive use. Social class, number of living children, contraceptive awareness, source and place of availability, abortion history, opposition from family and husband, and husband participation all were significantly associated with the unmet need for family planning. Conclusion: In-depth counselling focusing on achieving a satisfactory level of awareness and acceptance of family planning methods may help to achieve reproductive health by reducing unmet needs.

The PocketPerio application significantly increases the accuracy of diagnosing periodontal conditions in didactic and chairside settings

The study aimed to determine the accuracy of diagnosing periodontal conditions using the developed web-based PocketPerio application and evaluate the user’s perspective on the use of PocketPerio. First, 22 third-year dental students (DS3) diagnosed ten cases without PocketPerio (control) and with PocketPerio (test) during a mock examination. Then, 105 DS3, 13 fourth-year dental students (DS4), and 32 senior second-year International Standing Program students (ISP2) used PocketPerio chairside. Statistical analysis was performed using a non-parametric paired two-tailed test of significance with the Wilcoxon matched-pairs signed rank test. The null hypothesis that PocketPerio did not increase the accuracy of periodontal diagnoses was rejected at α < 0.01. Periodontal diagnoses made using PocketPerio correlated with those made by periodontics faculty (“gold standard") in all cases. During the mock examination, PocketPerio significantly increased the accuracy of periodontal diagnoses compared to the control (52.73 vs. 13.18%, respectively). Chairside, PocketPerio significantly increased the accuracy of primary (100 vs. 40.0%) and secondary (100 vs. 14.25%) periodontal diagnoses compared to the respective controls. Students regardless of their training year felt more confident in diagnosing periodontal conditions using PocketPerio than their current tools, provided positive feedback on its features, and suggested avenues for its further development.

Burden and predictors of distress among persons with type 2 diabetes mellitus: Excerpts of an observational study from Eastern India.

Diabetes distress (DD) is a common psychological condition distinct from depression. This is a unique, hidden emotional burden and worry that the patient experiences under ongoing treatment. To assess the prevalence and predictors of DD among adult diabetics attending a tertiary healthcare facility. This hospital-based observational, analytical, cross-sectional study recruited 152 adult patients with type 2 diabetes. The sociodemographic and diabetes-related information was collected with the help of a predesigned, structured proforma. Clinical and anthropometric examinations were conducted. Distress was determined by the standardized Diabetic Distress Scale (DDS). Statistical Analysis Used: The mean (SE) value was calculated for quantitative variables. The mean item score in DDS of ≥2 is taken as the presence of distress. Fisher's exact Chi-square test was done to check for association. Two-tailed significance test with a P value of < 0.05 was considered statistically significant. Majority of study participants were literate, married, and from the lower middle socioeconomic class. High blood pressure was the most common co-morbidity and tobacco use was the most prevalent addiction. The prevalence of diabetes distress was 77.0%. Emotional DD was found to be more common than regimen, interpersonal, and physician-related DD. The major determinants that emerged were young age, low socioeconomic class, physical inactivity, longer time duration to reach the hospital, associated known co-morbidities, and poor glycaemic control. A target-specific and routine counseling sessions merged with pronged strategic services are essential to improve the mental health of respondents.

A Study on the Relationship between Psychological Needs, Entrepreneurial Motivation and Entrepreneurial Performance of College Students’ Entrepreneurship in the Context of Digitization

Abstract Promoting entrepreneurship of high quality in the context of digitization is an important support for the in-depth implementation of the innovation-driven development strategy, and it is a necessary way to achieve fuller employment and employment quality. In this paper, starting from the hypothesis of correlation, we analyzed the reliability and validity of the design of the questionnaire. The fuzzy DEMATEL-SEM model was constructed by combining structural equation modeling and fuzzy decision-making experimental method, which can be utilized to realize the exploration of the correlation between entrepreneurial psychological needs, entrepreneurial motivation and entrepreneurial performance. The quantitative validation of the data is carried out through linear analysis, correlation analysis, regression analysis, and model analysis. The results show that the two-tailed significance test result of the importance of entrepreneurial psychological needs and entrepreneurial motivation is less than 0.01, the mean value of R2 of the model between entrepreneurial psychological needs and entrepreneurial performance of college students is 0.6355, and the direct effect of entrepreneurial motivation on entrepreneurial performance is 0.766. There is a clear positive correlation between entrepreneurial psychological needs, entrepreneurial motivation and entrepreneurial performance, and universities and colleges need to fully carry out entrepreneurship education activities to enhance students’ entrepreneurial awareness.

Abstract 19109: AI-Enabled Automated Cardiac Chambers Volumetry in ECG-Gated Coronary Calcium Scans vs. Non-Gated Lung Cancer Screening Scans

Introduction: We have developed an AI-enabled automated volume measurement of cardiac chambers (AutoChamber) that works on ECG-gated non-contrast coronary artery calcium scans and correlates well with contrast enhanced coronary CT angiography scans. Automated LA and LV volumes have shown to predict atrial fibrillation (Afib) and congestive heart failure. Hypothesis: In this study, we hypothesize that AutoChamber volumetry results in ECG-gated CAC scans correlated well with those of non-gated full-chest lung cancer screening scans in the same individuals. Methods: We have studied 169 cases of paired ECG-gated cardiac CT scans and non-gated lung scans. Mean±SD for age was 62±10 with 52% female. All caseswere asymptomatic and were scanned for preventive health assessment. AutoChamber was run on all cases by an independent operator who was not involvedin data analysis. P value was calculated using a two-tailed test of significance with α=0.05. Results: AutoChamber in cardiac scans vs lung scans reported volume (Mean±SD) for left atrium (LA) as 67.2 and 70.1, left ventricle (LV) 102.8 and 105.5 right atrium (RA) 81.9 and 85.7 right ventricle (RV) 140.7 and 134.2 left ventricle wall (LVW) 113.0 and 109.7 respectively (P &lt; 0.0001). Correlations between cardiac and lung scans for each cardiac chamber: LA (R2= 0.85), LV (R 2= 0.93), RA (R2= 0.91), RV (R2= 0.92), and left ventricular wall (LVW) R2= 0.95. (P &lt;0.0001 for all). Conclusions: AutoChamber volumetry results are similar in ECG-gated cardiac scans vs non-gated full-chest lung scans. This AI-enabled automated tool is promising as it can provide added value to patients undergoing coronary calcium and lung cancer screening scans flagging enlarged cardiac chambers at risk of future Afib and heart failure.

Monitoring salinity in bare soil based on Sentinel-1/2 image fusion and machine learning

In the application of satellite remote sensing data to salinity inversion in bare soil, multispectral satellites enjoy richer wavelength bands compared with synthetic aperture radar (SAR), but their vulnerability to cloudy weather limits the inversion accuracy. In contrast, SAR has stronger penetration, is less affected by cloudy weather, and can work around the clock. Therefore, in order to monitor soil salinity over a longer period of time and under various climatic conditions, and to further improve the accuracy of salinity inversion, we fused Sentinel-1 and Sentinel-2 images and investigated the feasibility of SAR and multispectral satellite image fusion in salinity inversion in this paper. And we conducted experiments in Hetao Irrigation Area, Inner Mongolia, China. Gram-Schmidt(GS) was used to fuse Sentinel-1 and Sentinel-2 images at the same time, and maximum-normalization was carried out on the DN value of the fused image. Then some remote indices conducted with the normalized DN, together with high relevant fused single bands were input into Back Propagation(BP), Support Vector Machine(SVM), Random Forest(RF) as independent variables after two-tailed significance test and Variable importance in projection(VIP) selection, for soil salinity inversion model construction. Finally, the inversion results of the study area were evaluated with R2, RMSE, RPD, RSS, and RPIQ. The results of this study showed that the bare soil salinity inversion based on the fusion of VV(Sentinel-1) and Sentinel-2 had a higher accuracy than that on the fusion of VH (Sentinel-1) and Sentinel-2 image and that without the fusion. Among the three machine learning models, random forest (RF) achieved the most satisfying results (R2 = 0.801, RMSE = 0.686), followed by SVM(R2 = 0.624, RMSE = 0.875) and BP(R2 = 0.613, RMSE = 0.918). This study demonstrated the feasibility of fusing Sentinel-1 radar images with Sentinel-2 multispectral images to improve the accuracy of soil salinity inversion, and constructed the soil salinity inversion model based on machine learning and GS fusion.

Implicit Mindsets of Intelligence, Achievement Goals, Self-Handicapping, and Confidence

The present study seeks to further understand the relationship between implicit mindsets about the malleability of intelligence with achievement goal orientations, academic self-handicapping behaviors, and confidence in one’s intelligence among undergraduate students. A sample of 142 undergraduate students at two small, private liberal arts universities participated in this study. Using a Pearson correlation coefficient and a two-tailed test of significance, results confirmed hypotheses that having a growth mindset positively correlated with mastery-approach and mastery-avoidance achievement goals, as well as having a high confidence in intelligence. However, a growth mindset is negatively correlated with those who do not engage in self-handicapping behaviors, which refutes the first hypothesis in this study. Moreover, having a fixed mindset is positively correlated with performance-avoidance achievement goals, and having low confidence in one's intelligence, which supports the second hypothesis in this study. Yet, having a fixed mindset is negatively correlated with performance-approach achievement goals and self-handicapping behaviors; both of which refute the second hypothesis in this study. Overall, the study helps further understand the complex relationship between implicit mindsets and non-cognitive factors among undergraduate students. Using the findings in this study, college educators and professors will be better equipped to aid students who have differing mindsets and learning strategies.

How Internet use patterns affect scholastic performance of Moroccan high school students: a correlational study

ABSTRACT The aim of the current study is to explore the effects of Internet use patterns on the scholastic performance of Moroccan high school students. To answer its research questions, the study used a random-sample sampling method to select its subjects. 373 participants have been recruited and were asked to answer a questionnaire about their Internet use habits. Analyzing the obtained data, the study runs four Spearman's Rank Correlation tests to measure the strength and direction of the relationship between the variables using a two-tailed test of significance. The findings reveal a negative correlation between academic performance and time duration online. In terms of specific online activities, a negative correlation was found between academic performance and time spent on social networking websites, listening to music and playing games. However, a positive correlation was detected between using the Internet for academic purposes and good academic performance. This study has important implications for policymakers.

Increases in Household Food Waste in Canada as a Result of COVID-19: An Exploratory Study

The era of the COVID-19 pandemic has resulted in a variety of individual lifestyle and behavioural changes, and could, therefore, potentially involve a shift towards more sustainable food systems. This research was conducted through an online survey of cross-sectional design. We surveyed 8272 Canadians in August of 2020. Participants answered questions about socio-demographic food waste amounts in kilograms, and food-waste-management behaviours. In this exploratory study, we assessed the relationships between socio-demographic variables, and self-reported food-waste behaviours through two-tailed significance testing. Results indicated that Canadian households self-reported an insignificant decrease in food waste during the pandemic. Respondents reported allowing food to expire, not utilizing leftovers, and not finishing meals. Understanding food-waste behaviour changes is key to designing effective mitigation strategies to reduce household food waste and to minimize the environmental consequences with which food waste is associated.

Alcohol Screening and Brief Intervention: Office-Based Primary Care Physicians, U.S., 2015–2016

In 2013, the U.S. Preventive Services Task Force again recommended alcohol misuse screening and provision of brief behavioral counseling interventions to those engaged in risky drinking for all adults aged ≥18 years in primary care. This report presents national estimates of the provision of alcohol screening and brief intervention by U.S. primary care physicians, the screening methods, and the resources they identified as helpful in implementing alcohol/substance screening and intervention in primary care settings. Data included 876 self-identified primary care physicians from the Physician Induction Interview portion of the 2015-2016 National Ambulatory Medical Care Survey, an annual nationally representative sample survey of nonfederal, office-based physicians in the U.S., encompassing all the 50 states and the District of Columbia. Descriptive estimates (annualized percentages) of alcohol misuse screening were generated for selected primary care physician characteristics. Estimates of how primary care physicians reported screening, the frequency of brief intervention, and resources identified as helpful in the implementation of screening/intervention procedures were also generated. Two-tailed significance tests were used to determine the differences between the compared groups. Data analyses were conducted in 2019-2021. In total, 71.7% of office-based primary care physicians reported screening patients for alcohol misuse. Statistically significant differences in screening were observed geographically and by provider specialty. Less than 40% of primary care physicians who screened patients for alcohol misuse reported always intervening with patients who screened positive for risky alcohol use. Collection of data on resources that primary care physicians report as being helpful for alcohol/substance screening and intervention implementation may be useful in continuous improvement efforts.

Clinical and Economic Impact of Red Blood Cell Antigen Alloimmunization on Patients with Hereditary Hemorrhagic Telangiectasia

Hereditary Hemorrhagic Telangiectasia (HHT) is a rare autosomal dominant disorder characterized by the presence of arteriovenous malformations which lead to repeated bleeding episodes for which Red Blood Cell (RBC) transfusions may be required. Previous research has shown that this patient population presents with high rates of alloimmunization against RBC antigens (15.29%) (Zheng Transfusion. 2018;58(3):775-780). However, the impact of such complications on clinical and economic outcomes has not been assessed previously. The present study aims to quantify the impact of alloimmunization on clinical outcomes and healthcare costs among HHT patients in a hospital setting.A cross-sectional study of alloimmunized and non-alloimmunized patients using the Premier Hospital chargemaster dataset from January 2015 to June 2019 was performed. Alloimmunization was defined based on the presence of antiglobulin crossmatch and RBC antibody identification laboratory codes in patient medical records. In order to assess the accuracy of this method of identification, the alloimmunization rates among discharges for patients diagnosed with HHT and myelodysplastic syndrome (MDS) for 2018 were extrapolated to the whole country and compared to reports in the literature (Zheng Transfusion. 2018;58(3):775-780, Singhal Haematologica. 2017;102(12):2021-2029). Consistent results were shown, 16.8% vs 15.3% and 11.5% vs. 11% for the HHT and MDS discharges, respectively.Alloimmunized and non-alloimmunized groups were matched for sex, age, admission date, and visit type (outpatient vs. inpatient). Diagnosis of HHT was defined using ICD-10 code I78.0. Cost per discharge for outpatient and inpatient visits, hospital and intensive care unit (ICU) length of stays (LoS), and inpatient mortality were both cases and controls. Bivariate comparisons were performed assuming a two-tailed test of significance and α level of 0.05 and multivariable regression models adjusting for diagnosis-related groups (incidence ≥1%) were performed.A total of 783 alloimmunized HHT cases were matched to 6,744 non-alloimmunized controls. Mean (SD) age was 65.7 (10.9) years for the alloimmunized (cases) and 59.4 (16.3) for the non-alloimmunized (controls), and slightly more than half of the population included in both groups were females (53.0% and 54.0% for the alloimmunized and non-alloimmunized groups, respectively).Outpatient visits were more common than inpatient admissions in both groups (52.6% and 71.4% of cases and controls, respectively albeit inpatient admissions were less common in both control groups (47.4% vs. 28.6%). Most common diagnoses leading to inpatient admission in both groups were disorders of the circulatory system (16.1% and 8.0%, respectively), followed by blood disorders for the alloimmunized group (9.8%) and disorders of the digestive system for the non-alloimmunized group (3.6%).Alloimmunized HHT patients presented with 22% longer hospitalizations (6.1 vs 7.3 days; p=0.0001) and 54% longer ICU stays (4.7 vs 7.2 days; p=0.0146), as well as a 40% increased likelihood of being admitted to the ICU. Inpatient mortality was higher among the alloimmunized population although it did not reach statistical significance (Odds Ratio: 1.53 [0.79; 2.96]; p=0.2092). Overall 12 (3.23%) and 59 (3.1%) deaths were reported for the alloimmunized and non-alloimmunized patient population, respectively. Median costs per discharge were significantly higher both for inpatient ($1,461; p=0.0202) and outpatient ($377; p<0.0001) visits within the alloimmunized population (Table 1).Presence of alloantibodies was associated with significantly worse clinical outcomes, increased healthcare resource use and higher costs within HHT patients. The increased prevalence of alloimmunization within the HHT population is not yet fully understood, and this study was not designed to determine whether prophylactic antigen matching would prevent alloimmunization in the HHT population. Further studies assessing the use of preventive strategies such as prophylactic antigen matching to prevent alloimmunization and its clinical and economic consequences could help determine whether antigen negative RBC units should be preferentially distributed to HHT patients. [Display omitted] DisclosuresGehrie: Grifols SSNA: Consultancy, Honoraria. Viayna: Grifols S.A.: Current Employment. Blanchette: Grifols SSNA: Consultancy; Novo Nordisk Inc.: Current Employment. Meny: Grifols SSNA: Current Employment. Noumsi: Grifols SSNA: Current Employment. Huber: Grifols SSNA: Current Employment. Runken: Grifols SSNA: Current Employment.

Red Cell Alloimmunization Is Associated with Higher Treatment Costs and Poor Health Outcomes Among Hemoglobin S-Beta Thalassemia Patients

Hemoglobin S (HbS) beta thalassemias (thal) are types of sickle cell disease (SCD) that result from the inheritance of one HbS gene and one β thalassemia gene. Red Blood Cell (RBC) alloimmunization is believed to be a major complication of transfusion therapy for HbS-thal patients. Indeed, among SCD patients generally, alloimmunization not only complicates the procurement of blood, but can also lead to life threatening delayed hemolytic transfusion reactions, and can be associated with a host of negative health outcomes including a higher risk of death. It is generally accepted that some alloimmunization events can be prevented via donor-recipient antigen matching, although this strategy is associated with higher costs and utilization of scarce resources (i.e.. antigen negative RBC units). The present study aimed to assess the clinical and economic implications of alloimmunization in HbS-thal patients.The Premier Hospital chargemaster dataset was used to perform a cross-sectional study matching alloimmunized and non-alloimmunized patients based on sex, age, date of admission, and type of visit (outpatient vs. inpatient). All outpatient and inpatient discharges from Jan 2015 to Jun 2019 were included in the study. Because there is not a specific laboratory code to designate alloimmunization, presence of both “antiglobulin crossmatch” and “RBC antibody identification” codes in a record was used as a surrogate for alloimmunization. Accuracy of this approach was validated by comparing the frequency of these codes among the hereditary hemorrhagic telangiectasia (HHT) and myelodysplastic syndromes (MDS) populations within the Premier dataset to the reported rates of alloimmunization for these entities in the medical literature (Zheng Transfusion. 2018;58(3):775-780, Singhal Haematologica. 2017;102(12):2021-2029). This comparison predicted a 16.8% alloimmunization rate in the HHT population (similar to the 15.3% reported in the literature) and an 11.5% alloimmunization prevalence in the MDS population (similar to the 11% reported in the literature).HbS-thal patients were identified based on diagnostic coding (ICD-10 code D57.4). Demographic, clinical and billing characteristics were retrieved. Cost per outpatient and inpatient discharge, hospital and intensive care unit (ICU) length of stay (LoS) and inpatient mortality were assessed for both alloimmunized and non-alloimmunized HbS-thal patients. Bivariate comparisons were performed, assuming a two-tailed test of significance and an α level of 0.05. Multivariable regression models adjusting for diagnosis-related groups with ≥1% incidence were performed.This approach permitted a total of 999 discharges corresponding to alloimmunized HbS-thal patients (cases) to be matched to 550 HbS-thal controls. Mean (SD) age was 35.1 (18.8) and 30.1 (18.6) for cases and controls, respectively. The percentage of females was slightly higher within the alloimmunized group (63.66% vs. 57.45%), and higher rates of inpatient visits were observed for the alloimmunized population compared to controls (67.9% vs. 33.1%).The multivariate models showed that alloimmunized HbS-thal patients presented significantly worse economic and clinical outcomes compared to their non-alloimmunized controls through all variables assessed. Median cost per discharge was $5,313 (p<0.0001) higher for alloimmunized inpatients and $1,014 (p<0.0001) higher for alloimmunized outpatients, compared to non-alloimmunized controls. Alloimmunized HbS-thal patients also experienced a 63% increase in hospital LoS (4.5 vs 7.4 days;; p<0.0001) and nearly over a 2.5-fold increase in ICU LoS (4.2 vs 10.0 days; p=0.0257). Alloimmunization in this population was also associated with a 3-fold increased risk of admission to intensive care (p=0.0032), longer stays in the ICU (p-0.0257), and a 3-fold increase in inpatient death (p<0.0001) (Table 1).The present study reveals that alloimmunization is associated with significantly longer hospitalizations and ICU stays, higher risk of ICU admission, greater inpatient death, and higher healthcare costs among patients with ICD-10 diagnosis of HbS-thal. These data seem to support the incremental costs and resource allocation decisions required to provide prophylactic antigen matching to HbS-thal patients, in an effort to diminish the risk of alloimmunization. [Display omitted] DisclosuresGehrie: Grifols SSNA: Consultancy, Honoraria. Viayna: Grifols S.A.: Current Employment. Blanchette: Grifols SSNA: Consultancy; Novo Nordisk Inc.: Current Employment. Meny: Grifols SSNA: Current Employment. Noumsi: Grifols SSNA: Current Employment. Huber: Grifols SSNA: Current Employment. Runken: Grifols SSNA: Current Employment.

Longer Hospitalizations, Increased Inpatient Mortality and Costs Are Associated with Alloimmunization Among Patients with Myelodysplastic Syndromes

Red Blood Cell (RBC) transfusions remain an important part of the management of anemia caused by myelodysplastic syndromes (MDS). Almost 90% of patients diagnosed with MDS require at least one RBC transfusion and 30%-45% require chronic transfusions (Singhal Haematologica. 2017;102(12):2021-2029). Importantly, it is estimated that 11% of MDS patients form alloantibodies as a result of RBC transfusions. Despite this relatively high alloimmunization rate, MDS patients are almost never prophylactically transfused with RBCs from antigen-matched donors, a strategy which has been shown to reduce the incidence of alloimmunization among patients with sickle cell disease, but which also increases costs and utilizes a limited resource (antigen negative RBCs). Herein, we present the economic and clinical burden of RBC alloimmunization in MDS patients, in order to better inform decision making regarding prophylactic RBC antigen matching.A cross-sectional study using the Premier Hospital chargemaster dataset was performed. All outpatient and inpatient discharges from January 2015 to June 2019 were included. MDS was defined using ICD-10 code D.46. Because there is no diagnosis code for alloimmunization, alloimmunized patients were identified based on the presence of antiglobulin crossmatch (CXM) and RBC antibody identification (RAI) codes in Premier records. This approach was validated by comparing the published rate of alloimmunization observed in patients diagnosed with MDS as well as hereditary hemorrhagic telangiectasia (HHT; another population with a relatively high alloimmunization rate) to the prevalence of both CXM and RAI codes in the Premier dataset during 2018. The comparison showed that our approach successfully modeled the published alloimmunization rates in HHT (16.8% vs 15.3%) and MDS (11.5% vs 11%) (Zheng Transfusion. 2018;58(3):775-780, Singhal Haematologica. 2017;102(12):2021-2029).Demographic, clinical, and billing characteristics were gathered. Total cost per discharge, hospital and intensive care unit (ICU) length of stay, and inpatient mortality, were calculated for both study groups and compared. Bivariate comparisons were performed, assuming a two-tailed test of significance and an α level of 0.05. Multivariable regression models adjusting for sex, age, admission date, visit type (outpatient vs. inpatient) type of MDS based on the World Health Organization (WHO) classification and diagnosis-related groups (DRG) with an incidence ≥1% of inpatient visits were performed.Overall, 179,819 MDS patient encounters were identified. Of these, 11,948 were alloimmunized and 167,871 were not alloimmunized (Table 1). When assessing incremental economic and clinical outcomes for the alloimmunized MDS population, multivariate models showed that alloimmunization led to significantly worse economic and clinical outcomes through all variables assessed (Table 2). The incremental median cost per inpatient and outpatient visit for the alloimmunized population were $2,829 (p<0.0001) and $630 (p<0.0001) higher, respectively. Alloimmunized patients had significantly longer inpatient hospitalizations (7.2 vs 8.2 days; p<0.0001) as well as longer ICU stays (4.4 vs 6.8 days; p<0.0001). Alloimmunized)A patients also encountered a 38% increased risk of being admitted to intensive care, and a 30% higher risk of inpatient mortality.This analysis discloses that alloimmunization is associated with higher healthcare costs and worsened clinical outcomes in the MDS population. Further work is needed to clarify whether alloimmunization is causally related to these outcomes, or whether alloimmunization is incidentally more common among patients with worse disease. The present study was not designed to assess the effectiveness of prophylactic antigen matching in the prevention of alloimmunization in the transfused MDS population, and further work is needed to confirm the findings presented herein. However, decisions regarding provision of antigen-matched RBCs to MDS patients should consider the potential for downstream consequences of alloimmunization. [Display omitted] DisclosuresGehrie: Grifols SSNA: Consultancy, Honoraria. Viayna: Grifols S.A.: Current Employment. Blanchette: Grifols SSNA: Consultancy; Novo Nordisk Inc.: Current Employment. Meny: Grifols SSNA: Current Employment. Noumsi: Grifols SSNA: Current Employment. Huber: Grifols SSNA: Current Employment. Runken: Grifols SSNA: Current Employment.

Adult Hemophagocytic Lymphohistiocytosis-a Quality Improvement Initiative

Introduction: Hemophagocytic lymphohistiocytosis (HLH) is a frequently fatal severe inflammatory syndrome. HLH evaluations are conducted by multiple inpatient services due to the protean manifestations of the disease in adults. We observed difficulty identifying HLH precipitating conditions, hemorrhage, and erroneous testing as impediments to optimal care. We embarked on a HLH quality improvement project to examine strategies of precipitant identification, quantify hemorrhagic complications, and decrease erroneous test ordering.Methods: The Johns Hopkins Institutional Review Board approved this single-institution retrospective review. Patients were identified from billing and laboratory databases at The Johns Hopkins Hospital. Patients were included if they were evaluated for HLH during an inpatient hospitalization by their treating clinicians between January 1, 2009 and July 30, 2016. Patients <18 years of age at the time of evaluation were excluded. Clinical, laboratory, and imaging findings were obtained by chart review (SAM). HLH was defined as patients meeting at least 5 of 8 HLH-2004 criteria (Henter et al 2007); Hscore during the first inpatient week was also computed (Fardet et al 2014).Interventions occurred in 2015 and consisted of: 1) a review of HLH diagnostic testing, 2) presentation of findings to hematology staff, 3) development of an evidence-based HLH consult template, and 4) consultation on suspected HLH cases. Ordering interleukin-2 levels (IL2) or quantitative natural killer cell (NK) flow cytometry, instead of soluble interleukin-2 receptor (sIL2R) or NK functional assays were defined as erroneous testing in HLH evaluations. Test costs were obtained from Quest Diagnostics. Test ordering between 2014-2016 were compared before and after the interventions.Practices identifying the HLH precipitant were determined by chart review. Major hemorrhage was defined as bleeding 1) into a critical site, 2) requiring modification of blood product support, 3) requiring procedural intervention, or 4) leading to death. Coagulation parameters were examined in the 24hrs before hemorrhage was clinically evident. Overall survival was defined as date of hospital admission until death. Descriptive statistics were computed with percentages and frequencies. Survival analysis was performed with STATA14. Quality metrics were evaluated with either Fisher's exact test or unpaired t-test; statistical analysis used two-tailed significance testing and P<0.05.Results: During the study period, 86 patients were evaluated for HLH, and 63 fulfilled HLH-2004 diagnostic criteria (Table 1). Most patients (64%) were initially admitted to a non-hematology/oncology service. Serologic testing and bone marrow biopsy were most likely to identify the HLH-precipitating illness in 27% and 17.5% of cases, respectively. Major hemorrhage occurred in 41.3% of patients and occurred at the time of at least two coagulation abnormalities. HLH median survival ranged from 45 days with malignancy to not reached with autoimmune diseases and non-EBV infections (Figures 1 & 2).The interventions significantly decreased the occurrence of erroneous testing from 74.3% to 23.5% of patients (P=0.0008), and decreased costs of erroneous testing from $338 to $34 per patient during the evaluation period (Table 2). The interventions also significantly reduced the time to fulfillment of HLH criteria (38 vs 5.7 days, P<.0001), and reduced the delay in obtaining sIL2R testing after initial erroneous ordering (10.3 vs 0 days, P=0.0005). There were no significant differences in time to steroid administration, time to definitive HLH treatment, or in patient number without treatment.Conclusions: Adults with HLH initially present to non-hematology/oncology inpatient services. Diagnostic uncertainty, hemorrhage, and erroneous testing impair patient care. We observed that serological testing and bone marrow biopsy were most likely to identify the HLH precipitant. Major hemorrhage was common and occurred when multiple coagulation abnormalities were evident. Our quality improvement project significantly decreased erroneous testing and improved time to diagnosis. With these data, we are developing an internal HLH decision support tool to facilitate identification of HLH precipitant illness, curtail erroneous testing, and minimize morbidity from major hemorrhage. [Display omitted] DisclosuresMerrill:True North Therapeutics: Consultancy. Streiff:Roche: Research Funding; Portola: Research Funding; Janssen Scientific Affairs, LLC: Consultancy, Research Funding; CSL Behring: Consultancy, Research Funding. Lanzkron:HRSA: Research Funding; Bayer: Research Funding; Global Blood Therapeutics: Research Funding; Pfizer: Research Funding; PCORI: Research Funding; Prolong: Research Funding. Brodsky:Alexion Pharmaceuticals, Inc.: Membership on an entity's Board of Directors or advisory committees, Other: Grant Funding.

Correlates of perceived caring behaviour of formal caregivers in long‐term care facilities: A cross‐sectional survey

Researchers have identified several factors that correlate with the caring behaviours of formal caregivers in long-term care facilities (LTCFs). However, a limited range of socio-demographic factors has been discussed, and no studies have discussed the combined effects of the institutional characteristics of the LTCF and the personal characteristics (i.e. bio-psycho-socio-spiritual attributes) of the formal caregiver on the caring behaviour. The aim of this study was to examine caring behaviours of formal caregivers for older residents of LTCFs and to explore factors that explain and predict the caring behaviours of them. A valid sample of 224 formal caregivers (nurses and nurse aids) employed at 56 LTCFs (21 nursing homes and 35 assisted living facilities) was analysed. Hierarchical regression analysis with two-tailed significance test was used to investigate whether the caring behaviours of the caregivers were independently associated with the characteristics of the caregivers or the institutions. Caring behaviours of the formal caregivers had significant positive associations with their job satisfaction (β=0.152, p<0.05) and with their perceived satisfaction of LTCF residents (β =0.214, p<0.001).The organisational-level analysis revealed that caring behaviours had positive associations with accreditation level (β=0.163, p<0.01) and with nurse-aid staffing level (β=0.126, p<0.05). Additionally, the caring behaviour had positive associations with their attitude towards older adults (β =0.193, p<0.01) and with their self-transcendence (β =0.184, p<0.01). These two factors explained 42.2% of the variance in the caring behaviours of caregivers. Caring behaviours were related to both personal characteristics (attributes, mindset) and organisational characteristics. By clarifying factors in the caring behaviours of caregivers, this study provides information that LTCFs can use to develop strategies for managing their caregivers and that policymakers can use to establish and implement healthcare policies for older populations.

Epidemiological Study and Clinico-Electrodiagnostic Correlation in Carpal Tunnel Syndrome.

Aim: This study analyzes the epidemiological distribution and the clinical-electric co-relation in carpal tunnel syndrome (CTS).&#x0D; Methods:100 consecutive patients referred to our out-patient service for carpal tunnel syndrome were included in this study. The clinical examination of the stage of CTS and electrophysiological study (EPS) was conducted and the BCTQ questionnaire was administered with an average of 15 minutes for each. The link between the electrical stage and the total points of the questionnaire was analyzed by the Bivariate Correlation analysis by finding the Pearson coefficient and the level of significance according to the Two-Tailed test of significance.&#x0D; Results: It was found that the female-male ratio was 3.5 to 1 with the predominance of the age 51-60 -year-old. 35% were overweight and 17% were obese. The first predominant symptoms were paresthesia, tingling sensation in their fingertips and pain, which prevailed at night. It was seen that the highest percentage was in those with not more than secondary education. There was no significant relation with family history and CTS. The most common comorbidities were arterial hypertension and rheumatoid arthritis. 43% were referred to the neurologist by the family doctor. In the bivariate analysis a statistically significant link was found with p&lt;0.01 with positive correlation r=0.311for the right hand and p &lt;0.01, r = 0.345 for the left hand.&#x0D; Conclusions: There is still a considerable number of patients diagnosed at an advanced stage, with faded opportunity for maximal benefit from timely treatment. This syndrome is more frequent in women with BMI&gt; 25 and in certain professions that request repetitive flexion of the grip. Family doctor should be more alert on diagnosing this common syndrome in an early stage.

Childhood Obesity and Breastfeeding Rates in Pennsylvania Counties-Spatial Analysis of the Lactation Support Landscape.

Childhood obesity is a global public health issue. As the prevalence of childhood obesity continues to rise, identification of potential interventions by public health policy makers, and health care providers is imperative. Breastfeeding, the most optimal method of infant feeding, has been demonstrated to protect against childhood obesity. Lactation support providers (LSPs) play a key role in providing education, care, and support to families considering a feeding choice. Access to professional lactation care increases breastfeeding initiation, exclusivity, and duration rates, regardless of the credential that the LSP holds. The aims of the current study were to examine the relationship between childhood obesity and breastfeeding rates in Pennsylvania (PA) counties; to examine the relationship between geographic access to professional LSPs in PA counties and breastfeeding rates; and to examine the relationship between geographic access to professional LSPs and childhood obesity in PA counties. Data were collected on 617 professional LSPs in 67 PA counties. There are 608 Certified Lactation Counselors (CLCs) and 144 International Board Certified Lactation Consultants (IBCLCs) in PA. County-level breastfeeding rates, childhood obesity rates, and the number of CLCs and IBCLCs were tested for significance at the p < 0.01 level using a two-tailed significance test and bivariate Pearson's correlation. The results show a significant, inverse relationship between breastfeeding rates and childhood obesity prevalence at the county level, p < 0.01. There is also a significant, inverse relationship between the number of CLCs and the number of all professional LSPs and childhood obesity rates at the county level, p < 0.01. Thus, the availability of breastfeeding support is significantly related to breastfeeding rates and inversely related to childhood obesity rates across Pennsylvania.

1174. The Impact of Multidisciplinary Central Line Stewardship Program to Decrease CLABSI Rates and Central Line Utilization Rates in an Academic Urban Medical Center

BackgroundCentral Line-Associated Blood Stream Infections (CLABSI) is a major healthcare dilemma, contributing to increased morbidity, mortality, and costs. We sought to reduce rates of CLABSI and device utilization by implementing a multidisciplinary Central Line Stewardship Program (CLSP).MethodsIn July 2017, the CLSP, multidisciplinary quality improvement project, was implemented at an academic medical center to ensure proper indication for all CVCs in the hospital and removal when no longer indicated. A CLSP team of executive leaders and infection preventionists performed daily rounds on all CVCs to review indications and maintenance. Nursing staff reported all CVCs daily. Information Technology modified the electronic health record to require daily physician documentation of CVC placement and indications, and to suggest alternatives to CVC when possible. In the event of a CLABSI, a root cause analysis was conducted within 72 hours, and feedback was shared with the clinical staff. A retrospective review was conducted 18 months before and after CLSP implementation. As a facility in a state with mandatory reporting of hospital-acquired infections, institutional data were readily available through the National Healthcare Safety Network (NHSN). To compare rates of CLABSI and device utilization pre- and post-CLSP, we reviewed the Incidence Density Rate (IDR), the standardized infection ratio (SIR), and standardized utilization ratio (SUR). Data from the NHSN website were analyzed using statistical tools provided by the NHSN analysis module. Two-tailed significance tests were conducted with α set at 0.05.ResultsPost-CLSP, there was a statistically significant decrease in SIR from 1.99 to 0.885, with risk reduction by 44.3% (P = 0.013, 95% CI 0.226 -0.831). CLABSI IDR per 1000 CVC days declined from 1.84 to 0.886 (P = 0.0213). CVC utilization per 1000 patient-days reduced from 155.08 to 142.35 (P < 0.001). There was also a trend toward fewer PICC line infections post-intervention (17 to 5).ConclusionWith this novel CLSP, we achieved a significant reduction in rates of CLABSI and device utilization, suggesting that a multidisciplinary approach can promote sustainable prevention of line-associated infections through dedicated surveillance of CVC indications and maintenance. Disclosures All authors: No reported disclosures.