Unstandardized Regression Coefficient Research Articles

Comparing Accuracy of Thermoplastic Mask versus Commercial Bra for the Immobilization of Pendulous Breast During Radiation Therapy Treatment: A Retrospective Cohort Study

PurposeThis study aimed to compare thermoplastic mask with bra in terms of setup reproducibility and immobilization of pendulous breasts during radiation therapy (RT). Methods and materialsForty-two female patients with breast cancer treated with either intensity modulated RT or 3-dimensional conformal RT were retrospectively reviewed. Of these, 21 benefited from thermoplastic mask immobilization and 21 used a bra. Setup accuracy was evaluated using consecutive cone beam computed tomography/electronic portal imaging device sessions over the first 3 days before treatment (systematic setting), followed by weekly cone beam computed tomography/electronic portal imaging device (random settings), and compared with the reference image to calculate the corresponding translational shift (setup error) in the 3 planes. Average absolute shift values in both systematic and random settings were compared between the 2 groups. Accuracy was analyzed by comparing the percentage of pooled settings within ±0.05 and ±0.1 cm of the reference image. ResultsCompared with a bra, use of the mask was associated with a smaller longitudinal shift in systematic settings (difference in mean: 0.27 cm; P = .027; Mann-Whitney U test) and a lesser lateral shift in random setting (difference in mean: 0.19 cm; P = .005; Mann-Whitney U test). In the pooled systematic settings, the mask performed relatively better than the bra in the lateral and longitudinal planes, with no statistical significance. In pooled random settings, mask showed greater accuracy than bra in the lateral plane with 86.0% versus 58.9% accuracy at ±0.5 cm (P < .001) and 48.8% versus 21.7% accuracy at ±0.1 cm (P < .001), respectively. There was no significant difference in the incidence of radiodermatitis between the 2 groups. However, a hypofractionation regimen was associated with a lower incidence of radiodermatitis, and the severity of skin reactions was positively correlated with treatment dose (unstandardized regression coefficient: B = .001; correlation coefficient: r = .571; P < .001). ConclusionsMasks provide superior reproducibility compared with commercially available bras.

Different impacts of COVID-19-related information sources on public worry: An online survey through social media

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic spread rapidly, as did COVID-19-related information on diverse media platforms. Excessive COVID-19-related information caused substantial mental distress among the public. Although most studies focused on the impact of information on individuals during the pandemic, they usually focused on information from internet sources, and few studies compared the impacts between different information sources. We examine the sociodemographic profiles of participants receiving different information sources and the impact of various COVID-19-related information sources on public worry. MethodsA cross-sectional online survey with a total of 2007 participants aged 20 years and above recruited anonymously was conducted during the COVID-19 pandemic. The sociodemographic data, frequencies at which participants received COVID-19-related information, the information sources (e.g., traditional media, interpersonal information exchange, and academic courses), and the levels of past, current, and anticipated worry about COVID-19 were assessed. ResultsThe most common sources of COVID-19-related information were internet media (80.52%), traditional media (52.62%), family members (24.36%), coworkers (23.57%), friends (21.08%), academic courses (20.18%), and medical staff (19.03%). We found that the COVID-19-related information from traditional media, internet media, and friends was associated with higher current worry (the unstandardized regression coefficient, B, ranged from 0.27 to 0.30), and the information from friends was associated with higher past worry (B was 0.18). In contrast, participants who received information from academic courses had lower past worry and anticipated worry (B ranged from −0.15 to −0.17). ConclusionsAcademic courses may play a protective role in public worry during the pandemic. Therefore, academic courses and the information they provide may help facilitate public education and reduce public worry in cases of infectious disease outbreaks.

40 Duration of Neonatal Oxygen Supplementation Associated with Higher Hemoglobin and Higher Blood Pressure in Young Adults Born Preterm

Abstract Introduction/Background Although erythropoiesis is impaired and anemia frequent in neonates born preterm, hematopoiesis in adults born preterm has not been previously studied. We hypothesize that adverse neonatal events durably affect erythropoiesis regulation, leading to a difference in hemoglobin levels in young adults born preterm compared to those born term. Objectives We thus aimed to evaluate hemoglobin and erythropoietin levels in young adults born preterm, to identify neonatal events associated with erythropoiesis in adulthood and to examine the relationships of hemoglobin levels with respiratory function and blood pressure. Design/Methods This study included 101 young adults (ages 18-29 years) born preterm (≤29 weeks of gestation) and 105 full-term controls. We measured office blood pressure using automated oscillometric device, complete blood count, serum erythropoietin levels (ELISA) and pulmonary function test. Group comparisons were performed using Student’s t or Mann-Whitney U tests. Correlations were assessed using Pearson’s coefficient and test. We performed a mediation analysis to assess the relationship between blood pressure, hemoglobin levels and preterm birth. Results Tobacco use and sex adjusted hemoglobin levels were 5.3 (95% CI: 2.9, 7.7) g/L higher in preterm-born individuals compared to controls (Table). We did not observe a difference in erythropoietin levels (7.3±3.4 and 8.12±3.40 U/L in the term and the preterm groups, respectively, p=0.102). Duration of oxygen supplementation in the neonatal period was independently associated with higher hemoglobin levels in the preterm group. In adults born preterm with bronchopulmonary dysplasia, airflow limitation was associated with higher hemoglobin levels. Both systolic (SBP) and diastolic (DBP) blood pressure were increased in individuals born preterm (p=0.042 and p=0.0008, respectively). Higher hemoglobin levels were associated with higher SBP and DBP, independently of term or preterm status. Mediation analysis (Figure) suggests that hemoglobin increase contributes to 37% and 32% of the effect of preterm birth on SBP and DBP, respectively. Conclusion While erythropoietin levels are similar between groups, hemoglobin levels are higher in young adults born preterm, especially in cases of bronchopulmonary dysplasia and airflow limitation. Hemoglobin increase is associated with elevated blood pressure in this population. Understanding mechanisms of impaired erythropoiesis regulation in adults born preterm will be important in designing antihypertensive approaches specific to this population. Results shown as mean ± SD or medians (25%-75%) and comparisons were performed using Student’s t test or Mann-Whitney U test, when appropriate. Systolic blood pressure (SBP). B. Diastolic blood pressure (DBP). Hb: hemoglobin. ACME: Average Causal Mediation Effect. B: unstandardized regression coefficient. All estimations are adjusted for sex.

Association between morphological characteristics of the optic disc and other anatomical features of the fundus in highly myopic eyes

To investigate associated factors with optic disc characteristics in high myopia patients. According to the meta-analysis of pathologic myopia study, patients were divided into groups from categories 1 (C1) to C4. The diameters, tilt ratio, and rotation degree of optic disc, and the diameters of parapapillary atrophy were measured among other morphometric variables. Totally 147 eyes (84 patients) were included. Longer horizontal optic disc diameter was associated with smaller tilt ratio (p < 0.001, unstandardized regression coefficient B: -0.59), greater rotation degree (p < 0.001, B: 0.01), and longer horizontal delta zone diameter (p < 0.001, B: 0.09). Longer vertical optic disc diameter was associated with smaller rotation degree (p < 0.001, B: 0.01), longer vertical delta zone diameter (p < 0.001, B: 0.16), and longer disc-fovea distance (DFD; p < 0.024, B: 0.14). Generally, the horizontal optic disc diameter of C3 and C4 groups was smaller than C1 and C2, while vertical diameter and tilt ratio was greater than in C1 and C2. After setting axial length (AL) as an independent variable, horizontal diameters and tilt ratio still showed significant differences, while vertical diameters did not show significant differences. Axial elongation was associated with an increase of vertical optic disc diameter that was correlated with an reduction of optic disc rotation degree. By contrast, horizontal optic disc diameter elongation was correlated with an reduction of optic disc tilt ratio and an increase of optic disc rotation degree, which was independent of axial elongation.

Efficacy of quadruple treatment on different types of pre-operative anaemia: secondary analysis of a randomised controlled trial.

In patients with pre-operative anaemia undergoing cardiac surgery, combination treatment with intravenous iron, subcutaneous erythropoietin alpha, vitamin B12 and oral folic acid reduces allogeneic blood product transfusions. It is unclear if certain types of anaemia particularly benefit from this treatment. We performed a post-hoc analysis of anaemic patients from a randomised trial on the 'Effect of ultra-short-term treatment of patients with iron deficiency or anaemia undergoing cardiac surgery'. We used linear regression analyses to examine the efficacy of a combination anaemia treatment compared with placebo on the following deficiencies, each representing a part of the combination treatment: ferritin and transferrin saturation; endogenous erythropoietin; holotranscobalamine; and folic acid in erythrocytes. Efficacy was defined as change in reticulocyte count from baseline to the first, third and fifth postoperative days and represented erythropoietic activity in the immediate peri-operative recovery phase. In all 253 anaemic patients, iron deficiency was the most common cause of anaemia. Treatment significantly increased reticulocyte count in all regression analyses on postoperative days 1, 3 and 5 (all p<0.001). Baseline ferritin and endogenous erythropoietin were negatively associated with change in reticulocyte count on postoperative day 5, with an unstandardised regression coefficient B of -0.08 (95%CI -0.14 to -0.02) and -0.14 (95%CI -0.23 to -0.06), respectively. Quadruple anaemia treatment was effective regardless of the cause of anaemia and its effect manifested early in the peri-operative recovery phase. The more pronounced a deficiency was, the stronger the subsequent boost to erythropoiesis may have been.

Temporal Trends in the Association between Participation in Physical Education and Physical Activity among U.S. High School Students, 2011-2017.

The purpose of this study was to assess trends in physical education and physical activity among U.S. high school students from 2011 to 2017, respectively, and to evaluate temporal trends in the relationship between physical education class participation and physical activity levels. Data from a total of 51,616 high school students who participated in the Youth Risk Behavior Surveillance System (YRBSS) from 2011 to 2017 were analyzed for this study. Physical education was measured as follows: In an average week when you are in school, on how many days do you go to physical education classes? Physical activity was measured as follows: During the past 7 days, on how many days were you physically active for a total of at least 60 min per day? Meeting physical activity guideline was defined as engaging in 7 days per week of at least 60 min per day. Across the 2011–2017 YRBSS, there were no linear (p = 0.44)/quadratic trends (p = 0.37) in physical education and linear (p = 0.27)/quadratic trends (p = 0.25) in physical activity, respectively. Regarding the trends in the association between physical education and physical activity, there were no statistically significant linear (unstandardized regression coefficient (b) = 0.013, p = 0.43) or quadratic (p = 0.75) trends; however, at the sample level, there was a slight increase in the odds ratio effect sizes from 2011 to 2017 (ES = 1.80–1.98). The pooled association between physical education participation and physical activity was statistically significant, OR = 1.88, 95% CI = 1.75–2.03, p < 0.001. That is, on average across the four YRBSS cycles, students who participated in physical education had 1.88 times higher odds of meeting physical activity guideline when compared to students who did not participate in physical education. The trends of physical education and physical activity did not change between 2011 and 2017. Overall, we observed a significant relationship between participation in physical education and physical activity. There was a non-significant yet stable trend of association between participation in physical education and physical activity over time.

Timing of Recanalization and Functional Recovery in Acute Ischemic Stroke

Background and PurposeAlthough onset-to-treatment time is associated with early clinical recovery in acute ischemic stroke (AIS) patients treated with intravenous tissue plasminogen activator (tPA), the effect of the timing of tPA-induced recanalization on functional outcomes remains debatable. MethodsWe conducted a multicenter, prospective observational cohort study to determine whether early (within 1-hour from tPA-bolus) complete or partial recanalization assessed during 2-hour real-time transcranial Doppler monitoring is associated with improved outcomes in patients with proximal occlusions. Outcome events included dramatic clinical recovery (DCR) within 2 and 24-hours from tPA-bolus, 3-month mortality, favorable functional outcome (FFO) and functional independence (FI) defined as modified Rankin Scale (mRS) scores of 0–1 and 0–2 respectively. ResultsWe enrolled 480 AIS patients (mean age 66±15 years, 60% men, baseline National Institutes of Health Stroke Scale score 15). Patients with early recanalization (53%) had significantly (jos-2019-01648P<0.001) higher rates of DCR at 2-hour (54% vs. 10%) and 24-hour (63% vs. 22%), 3-month FFO (67% vs. 28%) and FI (81% vs. 39%). Three-month mortality rates (6% vs. 17%) and distribution of 3-month mRS scores were significantly lower in the early recanalization group. After adjusting for potential confounders, early recanalization was independently associated with higher odds of 3-month FFO (odds ratio [OR], 6.19; 95% confidence interval [CI], 3.88 to 9.88) and lower likelihood of 3-month mortality (OR, 0.34; 95% CI, 0.17 to 0.67). Onset to treatment time correlated to the elapsed time between tPA-bolus and recanalization (unstandardized linear regression coefficient, 0.13; 95% CI, 0.06 to 0.19). ConclusionsEarlier tPA treatment after stroke onset is associated with faster tPA-induced recanalization. Earlier onset-to-recanalization time results in improved functional recovery and survival in AIS patients with proximal intracranial occlusions.

Perceived Ease of Access and Age Attenuate the Association Between Marijuana Ad Exposure and Marijuana Use in Adolescents.

This study theorizes and tests moderators (perceived availability of marijuana and age-group) of the association between adolescents' frequency of marijuana ad exposure and past-year marijuana use. To test this model, I analyzed national survey data from 9,024 American adolescents with hierarchical regression techniques. Results showed that being a male (95% confidence interval [CI] for unstandardized regression coefficient [0.06, 0.16]) and peer pressure (95% CI [0.04, 0.14]) were positively associated with past-year marijuana use, and father education (95% CI [-0.11, -0.06]) was negatively associated with it. Perceived ease of access (95% CI [0.18, 0.22]), ad exposure (95% CI [0.03, 0.14]), and age (95% CI [0.16, 0.27]) were positively associated with past-year marijuana use. Importantly, the associations of perceived ease of access and age with past-year marijuana use were significantly larger than that of ad exposure. Age (95% CI [0.00, 0.15]) and perceived ease of access (95% CI [0.01, 0.07]) independently strengthened the ad exposure to use association. There was a significant three-way interaction (95% CI [0.01, 0.12]) showing that age increases the positive influence of perceived ease of access on the marijuana ad exposure to past-year marijuana use association. An exploratory analysis further revealed that male adolescents are more strongly influenced by perceived ease of access compared to females. Based on the findings, I suggest that approaches for reducing perceived marijuana availability and for implementing age-specific interventions are promising avenues for prevention programs aimed at decreasing marijuana use in adolescents.

377 Pretreatment Estradiol Does Not Predict Improvement in Serum Testosterone in Men Receiving Clomiphene Citrate

Since clomiphene citrate is a an estrogen receptor modulator and dosage in women is determined based on baseline estradiol level. We hypothesized that pre-treatment estradiol level in men is associated with greater total testosterone response to treatment with clomiphene citrate. Following IRB approval, a retrospective chart review was performed at two large academic centers for all men prescribed clomiphene citrate (25 mg every other day) between January 1, 2015 and December 31, 2018. Age, body mass index (BMI), and prescription date were recorded for all patients. Pre- and post-treatment estradiol (E), total testosterone (TT), follicle-stimulating hormone (FSH), and luteinizing hormone (LH) levels were recorded for all patients as well. Only men with pretreatment TT < 300 ng/dL were included in the analysis. Using SPSS, univariate linear regression analysis was performed to determinate the independent variables (i.e., age, BMI, pre and post treatment E, FSH, and LH serum levels) that may predict percent change in TT change following clomiphene citrate treatment. The unstandardized regression coefficient (B) and coefficient of determination (R2) were calculated for each independent variable.

Association Between Objectively Measured Sleep Duration and Symptoms of Psychiatric Disorders in Middle Childhood

The long-term association between sleep duration and mental health in children is currently unknown. To investigate the prospective associations between sleep duration and symptoms of emotional and behavioral disorders at ages 6, 8, 10, and 12 years. This population-based cohort study obtained data from the Trondheim Early Secure Study in Trondheim, Norway. A representative, stratified random sample of children born between January 1, 2003, and December 31, 2004, were invited to participate. Participants were followed up biennially from age 4 years (2007-2008) to 12 years (2013-2014). Data analysis was conducted from January 2, 2019, to May 28, 2019. Sleep duration was assessed with 1 week of continuous use of a triaxial accelerometer. Symptoms of emotional (anxiety and depression) and behavioral (oppositional defiant, conduct, and attention-deficit/hyperactivity) disorders were measured by semistructured clinical interviews (using the Preschool Age Psychiatric Assessment and the Child and Adolescent Psychiatric Assessment) with parents (at all ages) and children (from age 8 years). The analytical sample comprised 799 children (mean [SD] age at time point 2, 6.0 [0.2] years; 405 [50.7%] boys; and 771 [96.5%] Norwegian). Shorter sleep duration at age 6 years (β [unstandardized regression coefficient] = -0.44; 95% CI, -0.80 to -0.08; P = .02) and 8 years (β = -0.47; 95% CI, -0.83 to -0.11; P = .01) forecasted symptoms of emotional disorders 2 years later. Comparatively short sleep duration at age 8 years (β = -0.65; 95% CI, -1.22 to -0.08; P = .03) and 10 years (β = -0.58; 95% CI, -1.07 to -0.08; P = .02) was associated with symptoms of behavioral disorders 2 years later among boys but not among girls at age 8 years (β = -0.14; 95% CI,- 0.52 to 0.24; P = .48) or 10 years (β = -0.05; 95% CI, = -0.49 to 0.40; P = .84). These associations were statistically significant among boys compared with girls at age 8 years (Δχ21 = 13.26; P < .001) and 10 years (Δχ21 = 10.25; P = .001). Symptoms of psychiatric disorders did not forecast sleep duration at any age. This study found an association between short sleep duration and increased risk of future occurrence of emotional disorder symptoms in both boys and girls and between reduced sleep and behavioral disorder symptoms in boys. These results suggest that improving sleep in children may help protect against the development of symptoms of common psychiatric disorders and may be advantageous in the treatment of such disorders.

Measurement and verification of energy conservation measures using whole-building electricity data from four identical office towers

Reliable measurement and verification (M&V) of the energy savings associated with energy conservation measures (ECMs) is critical for financial settlement of utility incentives and energy performance contracts. With the proliferation of advanced metering infrastructure, there is increasing interest in using whole-building data for M&V, as a cost-effective alternative to sub-metering or installing equipment-specific data loggers. Commonly observed protocols provide a framework for regression-based M&V analysis of whole-building data. This paper leverages seven years of whole-building electricity data from four geometrically-identical multi-storey multi-tenant co-located office towers, which underwent a series of very similar ECMs, to explore the application and validity of straightforward, regression-based models. Results showed the models met the criteria for goodness of fit and statistical uncertainty (R2 above 0.75; coefficient of variation of the root-mean-square error, CV(RMSE) below 25%; normalized mean bias error, NMBE below 0.005%; standard error in the unstandardized regression coefficient estimating an ECM effect less than 50% of the regression coefficient itself). Further, these regression models were (in the large majority of cases) able to differentiate between multiple ECMs applied sequentially, and that, in some cases, effects as low as 5% were reported. Effect estimates of similar ECMs were similar across the buildings, but were generally substantially larger than the pre-retrofit engineering predictions of savings. ECM effect estimates using monthly and hourly data with equivalent regression formulations gave very similar estimates, differences in coefficients ranged between approximately 0–15%, with a mean of 7%. Estimates of ECM effects made using the full timespan of data were more sensitive, and generally larger, than estimates using only a single year of pre- and post-ECM data. However, visually identifying ECM effects in time-series data was challenging, which highlights the many sources of error in such an analysis.

Physical activity, sedentary time and their associations with clustered metabolic risk among people with type 2 diabetes in Jiangsu province: a cross-sectional study

ObjectiveInvestigating the association between total physical activity, physical activity in different domains and sedentary time with clustered metabolic risk in patients with type 2 diabetes from Jiangsu province, China.DesignInterview-based cross-sectional...

Factors associated with depression in people with inflammatory bowel disease: The relationship between active disease and biases in neurocognitive processing.

Depression is common among people with inflammatory bowel disease (IBD), though the causes remain unclear. We conducted a cross-sectional study to investigate the role of emotional processing biases in contributing to depression among people with IBD. One hundred and twenty outpatients with IBD were recruited and: (a) completed questionnaires to record: age, sex, social support, socioeconomic status, anxiety and depression (n=104), (b) underwent assessments of biases in emotional recognition (n=112), emotional memory and reinforcement learning (c) had recorded from clinical records: type of IBD, duration of IBD, IBD activity and (d) provided blood for high-sensitivity C-reactive protein levels (n=99). Sixty-eight participants had Crohn's disease and 49 had ulcerative colitis. Of these, 35 had active disease and 26 had depression. Those with depression were more likely to be female, lack social support, have active disease, be taking corticosteroids but not TNF-alpha inhibitors and exhibit less positive emotional recognition bias. On multivariable regression analysis, depression was associated independently with lack of social support (unstandardized regression coefficient (B)=-1.40, P=0.02) and increased disease activity (B=1.29, P=0.03). Causal steps analysis was consistent with less positive emotional recognition bias partially mediating the effects of disease activity on depression. This is the first study to demonstrate links between disease activity and less positive biases in emotional recognition that could explain higher rates of depression among people with active IBD. Future prospective studies are required to confirm the effects of emotional processing biases in depression and allow stronger causal inferences to be drawn.

Community intervention to prevent adolescent health behavior problems: Evaluation of communities that care in Australia.

A major challenge for health psychologists is to ensure the implementation of evidence-based interventions to improve population health. To reduce high rates of adolescent alcohol use and related health problems, trials of the Communities That Care (CTC) prevention process were implemented in Australia beginning in 2001. The process assists communities to strategically plan and monitor implementation of evidence-based preventative interventions. This article reports an evaluation of the effects in the first four Australian communities that completed the process. Trends were examined based on self-report surveys completed by 41,328 adolescents (average age 13.5 years, 51.7% female) across 109 municipal localities between 1999 and 2015. Multilevel modeling compared the 5 localities where the 4 coalitions completed the CTC process with the remaining 104 localities for trends in adolescent reports of lifetime alcohol, tobacco, and cannabis use and past year antisocial behavior. Relative to Australian trends, adolescents in CTC localities reported significantly steeper annual reductions in any lifetime alcohol (Adjusted odds ratio [AOR] = 0.94, 95% confidence intervals [CI] = [0.93, 0.95]), tobacco (AOR = 0.97, CI [0.96, 0.99]), cannabis use (AOR = 0.96, CI [0.93, 0.98]) and antisocial behavior (unstandardized regression coefficient [B] = -0.001, CI [-0.002, 0.000]). Implementation of the CTC process in Australia was associated with more rapid community reductions in adolescent health behavior problems. Supporting community coalitions to adopt evidence-based interventions appears a feasible means for health psychologists to improve the health of large adolescent populations and prevent related chronic health problems in later life. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Impact of pretreatment with intravenous thrombolysis on reperfusion status in acute strokes treated with mechanical thrombectomy

IntroductionWe sought to evaluate the impact of pretreatment with intravenous thrombolysis (IVT) on the rate and speed of successful reperfusion (SR) in patients with emergent large vessel occlusion (ELVO) treated...

Incidence, characteristics and outcomes in patients with embolic stroke of undetermined source: A population-based study

Embolic stroke of undetermined source (ESUS) represents a subgroup of cryptogenic ischemic stroke (CS) distinguished by high probability of an underlying embolic mechanism. There are scarce population-based data regarding the incidence, characteristics and outcomes of ESUS. Consecutive patients included with first-ever ischemic stroke of undetermined cause in the previously published population-based Evros Stroke Registry were further subdivided into ESUS and non-ESUS CS. Crude and adjusted [according to the European Standard Population (ESP), WHO and Segi population] incidence rates (IR) for ESUS and non-ESUS CS were calculated. Baseline characteristics, admission stroke severity (assessed using NIHSS-score), stroke recurrence and functional outcomes [determined by modified Rankin Scale (mRS) scores], were recorded during the 1-year follow-up period. We identified 21 and 242 cases with ESUS (8% of CS) and non-ESUS CS. The crude and ESP-adjusted IR for ESUS were 17.5 (95%CI: 10–25) and 16.6 (95%CI: 10–24) per 100,000 person-years. Patients with ESUS were younger (p < .001) and had lower median admission NIHSS-scores (p < .001). Functional outcomes were more favorable in ESUS at 28, 90 and 365 days. ESUS was independently (p = .033) associated with lower admission NIHSS-scores (unstandardized linear regression coefficient: -13.34;95%CI: -23.34, −3.35) on multiple linear regression models. ESUS was not related to 1-year stroke recurrence, mortality and functional improvement on multivariable analyses. In conclusion we found that ESUS cases represented 8% of CS patients in this population-based study. Despite the fact that ESUS was independently related to lower admission stroke severity, there was no association of ESUS with long-term outcomes.

A pragmatic behavior-based habit index for adherence to nebulized treatments among adults with cystic fibrosis.

BackgroundHabit, a psychological process that automatically generates urges to perform a behavior in associated settings, is potentially an important determinant of medication adherence. Habit is challenging to measure because, as a psychological construct, it cannot be directly observed. We describe a method of using routinely available objective adherence data from electronic data capture (EDC) to generate a behavior-based index of adherence habit and demonstrate how this index can be applied.Methods to generate the habit indexOur proposed habit index is a “frequency in context” measure. It estimates habit as a multiplicative product of behavior frequency (generated from weekly percentage adherence) and context stability (inferred from time of nebulizer use). Although different timescales can be used, we chose to generate weekly habit scores since we believe that this is the most granular level at which context stability can be reasonably calculated.An application of the habit indexA hallmark of habit is to predict future behavior, hence we used time series method to cross-correlate the habit index with nebulizer adherence in the subsequent week among 123 adults with cystic fibrosis (52, 42.3% female; median age 25 years) over a median duration of 153 weeks (IQR 74–198 weeks). The mean cross-correlation coefficient (R) between the habit index and subsequent adherence was 0.40 (95% CI 0.36–0.44). Adjusting for current adherence, the unstandardized regression coefficient (B) for the habit index was 0.30 (95% CI −1.04 to 1.65).ConclusionWe have described a pragmatic method to infer “habit” from adherence data routinely captured with EDC and provided proof-of-principle evidence regarding the feasibility of this concept. The continuous stream of data from EDC allows the habit index to unobtrusively assess “habit” at various time points over prolonged periods, and hence the habit index may be applicable in habit formation studies.

Abstract TP24: Impact of Pretreatment With Intravenous Thrombolysis on Reperfusion Status in Emergent Large Vessel Occlusion (ELVO) Patients Treated With Mechanical Thrombectomy (MT)

Introduction: It currently remains unclear whether pre-treatment with intravenous thrombolysis (IVT) provides any additional benefits to emergent large vessel occlusion (ELVO) patients undergoing mechanical thrombectomy (MT). We sought to evaluate the impact of pretreatment with IVT on the rate and the speed of complete reperfusion (CR) in LVO patients treated with MT in a high-volume tertiary care stroke center. Methods: Consecutive ELVO patients treated with MT during a five-year period were evaluated. Baseline stroke severity was assessed by NIHSS-score. Standard safety [symptomatic Intracranial Hemorrhage (sICH) by SITS-MOST definition] and efficacy outcomes [CR (modified Thrombolysis in Cerebral Infarction IIb/III), 3-month functional independence (FI; modified Rankin Scale scores of 0-2)] were compared between patients who underwent combined IVT and MT (IVT+MT) vs. direct MT (dMT). The elapsed time between groin puncture to beginning of reperfusion (GPTBRT) and the numbers of device passes (DP) required to achieve CR were also documented. Results: A total of 287 and 132 patients were treated with IVT+MT and dMT respectively. The IVT+MT group had higher CR (74% vs. 63%; p=0.023) and FI (52% vs.38%; p=0.008) rates and shorter median GPTBRT (48 vs. 70 min; p&lt;0.001). The two groups did not differ in sICH rates (7% vs. 9%; p=0.368). Among patients who achieved CR, the median number of required DP was lower in the IVT+MT subgroup (1 vs. 2; p&lt;0.001) and the rate of patients requiring ≤2 DP was higher (98% vs. 77%; p&lt;0.001). IVT+MT was independently related to higher odds of CR (OR:1.64; 95%:1.03-2.61; p=0.036) and shorter GPTBRT (unstandardized linear regression coefficient: -20; 95%CI: -12, -27; p&lt;0.001) on multivariable analyses adjusting for potential confounders including demographics, vascular risk factors, collateral status, stroke severity, location of occlusion and onset to groin puncture time. Among patients with CR, IVT+MT was independently associated with higher likelihood of ≤2 DP (OR:14.75; 95%:4.72-46.04; p&lt;0.001). Conclusions: IVT pretreatment increases the rates of CR and shortens the duration of endovascular procedure by requiring fewer DP in ELVO patients treated with MT.

Abstract TP199: Incidence, Characteristics and Outcomes in Patients With Embolic Stroke of Undetermined Source: A Population-based Study

Introduction: Embolic stroke of undetermined source (ESUS) represents a subgroup of cryptogenic ischemic stroke (CS) distinguished by high probability of an underlying embolic mechanism. There are scarce population-based data regarding the incidence, characteristics and outcomes of ESUS. Methods: Consecutive patients included with first-ever ischemic stroke of undetermined cause in the previously published population-based Evros Stroke Registry were further subdivided into ESUS and non-ESUS CS. Crude and adjusted [according to the European Standard Population (ESP), WHO and Segi population] incidence rates (IR) for ESUS and non-ESUS CS were calculated. Baseline characteristics, admission stroke severity (assessed using NIHSS-score), stroke recurrence and functional outcomes [determined by modified Rankin Scale (mRS) scores], were recorded during the 1-year follow-up period. Results: We identified 21 and 242 cases with ESUS (8% of CS) and non-ESUS CS. The crude and ESP-adjusted IR for ESUS were 17.5 (95%CI: 10-25) and 16.6 (95%CI: 10-24) per 100,000 person-years. Patients with ESUS were younger [median age 68 years (IQR:61-75) vs. 79 years (IQR:73-83); p&lt;0.001] and had lower median admission NIHSS-scores [4 points (IQR:2-8) vs. 8 points (IQR:5-16); p&lt;0.001]. Functional outcomes were more favorable in ESUS at 28 [median mRS-score: 2 (IQR:1-3) vs. 4 (IQR:3-6)], 90 [median mRS-score: 1 (IQR:0-2) vs. 4 (IQR:2-6)] and 365 days [median mRS-score: 1 (IQR:0-2) vs. 5 (IQR:2-6)]. ESUS was independently (p=0.033) associated with lower admission NIHSS-scores (unstandardized linear regression coefficient: -13.34;95%CI: -23.34, -3.35) on multiple linear regression models. ESUS was not related to 1-year stroke recurrence (HR: 0.22, 95%CI: 0.01-4.06), mortality (HR: 0.25, 95%CI: 0.02-4.36) and functional improvement (1-point shift in mRS-scores; cOR: 1.47, 95%CI: 0.59-3.70) on multivariable analyses. Conclusions: ESUS cases represented 8% of CS patients in this population-based study. Despite the fact that ESUS was independently related to lower admission stroke severity, there was no association of ESUS with long-term outcomes.

Testing competing mediators of the association between pre-conception maternal depression and child health-related quality of life: the MatCH study.

Maternal depression is a potent risk factor for poor child development across a number of domains but the mechanisms of transmission are poorly understood. This study aimed to test competing mediators of the association between pre-conception maternal depression and child psychosocial functioning. In 2016, mothers in the 1973-1978 cohort of the Australian Longitudinal Study on Women's Health were asked to be part of the Mothers and their Children's Health study and to complete surveys on the health of their three youngest children under 13years. The current study includes children aged 0-12years (N = 5532, M = 6.99years, SD = 3.22years) and their mothers (N = 2917). We used the CESD-10 to measure depression and the PedsQL to measure psychosocial functioning, and used multilevel structural equation modeling to test hypotheses. Pre-conception maternal depression was associated with poorer maternal mental health and parenting after birth. The effect of pre-conception maternal depression was mediated by post-birth maternal depression in children aged 0-4years (unstandardized regression coefficient (B) = - 0.26, 95%CI - 0.38, - 0.13) and children aged 5-12years (B = - 0.25, 95%CI - 0.34, - 0.16), and by post-birth maternal stress (B = - 0.04, 95%CI - 0.08, - 0.01), and parenting (B = - 0.03, 95%CI - 0.04, - 0.02) in children aged 5-12years. Post-birth maternal depression was the strongest mediator. Pre-conception is the optimal time for depression intervention. Post-birth interventions should include a focus on reducing depression and improving negative parenting aspects such as hostility and discipline.