Wald Chi Research Articles

A Generalized Linear Model of HIV/AIDS Patients in Kenya: A Case Study of Nyeri County Referral Hospital

With millions of new cases and deaths reported every year, HIV/AIDS is a significant worldwide health concern. Creating successful public health policies and interventions requires an understanding of the dynamics of HIV transmission and progression. WHO predicted that by the end of 2022 roughly 39 million individuals worldwide would be living with HIV, out of which 37.5 million are adults, whereas 1.5 million are children. Despite outstanding global gains in HIV/AIDS prevention, treatment and care, Kenya continues to struggle to effectively handle the HIV epidemic, particularly in areas like Nyeri County. Nyeri County Referral Hospital is a critical healthcare institution for HIV/AIDS patients in the region. However, there is still a lack of understanding about the epidemiological characteristics of HIV/AIDS in this particular population. This study’s aim was to use a GLM on HIV/AIDS data in Nyeri County Referral Hospital in Kenya. To determine the significance of model parameters, Likelihood Ratio Test was used whereas significance of regression coefficients was determined using Wald Chi- Square Test. Deviance was utilized to test for the goodness of fit. R software version 4.4.1 was utilized. This project may help health policymakers in developing or refining HIV/AIDS care programs. Findings from the study can help healthcare planners and policymakers allocate resources more efficiently to meet the requirements of HIV/AIDS patients. The fitted model showed that, only ART use was significant (p-value = 2.684562 × 10<sup>−13</sup>). Because some covariates were not significant, each of them was analyzed separately. Age was a significant predictor (p-value = 0.0001536103). The other variables were not significant. This finding is consistent with previous evidence, which stresses the relevance of ART in lowering viral load, enhancing immunological function, and extending the lives of people living with HIV. To build upon the current findings, future research should explore additional variables that may influence HIV status, for example cultural beliefs, and access to healthcare services. Again, future studies may involve the use of survival analysis through GLM in analyzing similar data.

Admission levels of serum biomarkers have additive and cumulative prognostic value in traumatic brain injury

Elevated levels of CNS-derived serum proteins are associated with poor outcome in traumatic brain injury (TBI), but the value of adding acute serum biomarker levels to common clinical outcome predictors lacks evaluation. We analyzed admission serum samples for Total-Tau (T-Tau), Neurofilament light chain (Nfl), Glial fibrillary acidic protein (GFAP), and Ubiquitin C-terminal hydrolase L1 (UCHL1) in a cohort of 396 trauma patients including 240 patients with TBI. We assessed the independent association of biomarkers with 1-year mortality and 6–12 months Glasgow Outcome Scale Extended (GOSE) score, as well as the additive and cumulative value of biomarkers on Glasgow Coma Scale (GCS) and Marshall Score for outcome prediction. Nfl and T-Tau levels were independently associated with outcome (OR: Nfl = 1.65, p = 0.01; T-Tau = 1.99, p < 0.01). Nfl or T-Tau improved outcome prediction by GCS (Wald Chi, Nfl = 6.8–8.8, p < 0.01; T-Tau 7.2–11.3, p < 0.01) and the Marshall score (Wald Chi, Nfl = 16.2–17.5, p < 0.01; T-Tau 8.7–12.4, p < 0.01). Adding T-Tau atop Nfl further improved outcome prediction in majority of tested models (Wald Chi range 3.8–9.4, p ≤ 0.05). Our data suggest that acute levels of serum biomarkers are independently associated with outcome after TBI and add outcome predictive value to commonly used clinical scores.

12‐month cognitive outcome after acute geriatric TBI not associated with U.S. Military Veteran status

AbstractBackgroundTraumatic brain injury (TBI) increases risk for cognitive decline and Alzheimer’s disease/related dementias (ADRD), and Veterans may be at increased risk of both TBI and cognitive decline due to combat/training related exposures and other risk factors. However, it is unknown whether older Veterans are more likely to experience a poor cognitive outcome after acute TBI compared to civilians.MethodWe examined 112 male Veterans and 320 male civilians (55+) who experienced an acute TBI and enrolled in Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK‐TBI). Data were collected at baseline (i.e., emergency room visit) on demographic and injury characteristics. Cognitive and TBI recovery data (i.e., Rivermead Postconcussive Questionnaire, Brief Symptom Inventory, Satisfaction with Life Scale, and Glascow Outcome Scale‐Extended) were collected at 2 weeks, 6 months, and 12 months. We calculated descriptive statistics and compared across Veterans and civilians. 12‐month cognitive outcome was defined as performance &lt;9th percentile on 2+ cognitive tests, and/or decline from 2‐week or 6‐month score &gt;90% reliable change index on two+ tests. We used propensity weighting to address missing cognitive outcome data and conducted a logistic regression analysis to examine association of Veteran status with classification of cognitive outcome.ResultVeterans were older and less likely to be Hispanic compared to civilians but did not differ on race, education, history of head injury, or injury severity. At 12 months post‐TBI, Veterans endorsed worse mood and satisfaction with life (p’s = 0.05), but these results were attenuated by adjustment for prior TBI and injury severity. In adjusted models Veterans did not differ from civilians on a measure of overall TBI outcome (p = 0.45) or postconcussive symptoms (p = 0.32). Moreover, there was no association between Veteran status and cognitive outcome (Wald chi square = 2.66, p = 0.45).ConclusionRisk of poor cognitive outcome following TBI does not differ between older male Veterans and civilians, and mood and life satisfaction outcomes were worse for Veterans but impacted by injury severity and prior head injury. These findings have implications for understanding risk for cognitive decline and ADRD among older men who experience an acute TBI as well as tailoring care, including provision of psychosocial support, for these patients.

Transfusion Requirements in Hospitalized Patients with Sickle Cell Disease Taking Either Voxelotor or Hydroxyurea

Background Sickle Cell Disease is a cause of anemia frequently requiring blood transfusions. Current treatments for Sickle Cell Anemia include Hydroxyurea, or the recently approved medication in 2019, Voxelotor. Although recent research, such as the HOPE study, has shown that Voxelotor increases hemoglobin levels when compared to Hydroxyurea, there is limited data regarding the requirement of blood transfusions in patients with Sickle Cell Disease when comparing the two medications. We conducted a retrospective cohort study to determine the requirement of blood transfusions in hospitalized patients with Sickle Cell Disease who were on either taking Voxelotor or Hydroxyurea. Methods This retrospective cohort study identified 8,815 patients across several facilities diagnosed with Sickle Cell Disease who were taking outpatient Voxelotor or Hydroxyurea. Patients who had CKD Stage 4 or 5, ESRD, pregnancy, major surgery, normal hemoglobin levels, and elevated liver enzymes were excluded with a final sample of 6,240. Patients were stratified into two groups based on the treatment they were on, a group taking Voxelotor (243 patients 3.92%) and a group taking Hydroxyurea (5961 96.08%) outpatient. We assessed patient's characteristics such as age, sex, race, smoking status and events during hospitalization. The primary outcome was the number of blood transfusions required with either treatment. Zero-inflated Poisson regression was used to determine the quantity and prediction of blood transfusions required according to different characteristics. Results Of the 6,240 with Sickle Cell Disease who were either on Voxelotor or Hydroxyurea the mean age was 31.32 years, 58.11% were female and 41.89% were male, 94.63% were African-American and 5.37% were non-African-Americans. The medication group was not significantly associated with the log count of transfusions (ie. increased number of transfusions), when controlling for other variables (χ 2 = 0.81, p = 0.367). The odds ratio is 0.425, indicating that patients on Voxelotor are 0.4247 times as likely to be in the “certain zero” group as those on Hydroxyurea - in other words, patients taking Hydroxyurea are 2.354 (1/0.425) times as likely to be in the “certain zero” group (i.e., patients on Hydroxyurea are 2.354 times as likely to not need a transfusion compared to patients taking Voxelotor). Conclusion Hospitalized patients with Sickle Cell Disease taking Voxelotor or Hydroxyurea outpatient have similar blood transfusions requirements when controlling for other variables. In the case of Voxelotor, it is known to increase hemoglobin levels more than Hydroxyurea in patients with Sickle Cell Disease, but there is limited data regarding the end requirements of blood transfusions when comparing the two medications. Our study is the first to identify that there was no increased requirement in the quantity of blood transfusions (Wald Chi Square 26.36, p&amp;lt;.0001, CI 0.3063~ 0.5890) when comparing each medication group. However, the limitation is having a relatively small sample size, and possible confounders from the patients and the disease itself. Further research is required to investigate this.

Risk Factors for Early Mechanical Failure and Revision in Modern Total Ankle Replacements

Category: Ankle Arthritis; Ankle Introduction/Purpose: Total ankle replacements (TAR) have rapidly advanced in terms of volume, technique, design, and indications. However, they are still at risk for failure and need for revision, even early in the postoperative period. Although recently there has been extensive research on TAR, many studies are limited in their power and sample size to assess risk factors for failure/revision. Using a large multi-surgeon retrospective database, we sought to describe the incidence and etiology of mechanical failure across modern implants. We also aimed to identify risk factors for early mechanical failure. We hypothesized that greater body mass index (BMI) and ipsilateral hindfoot fusion would be predictors of mechanical failure, and that implants with greater extent of tibial fixation (stems and keels) would be protective against mechanical failure. Methods: This is a single-center retrospective review of TAR patients in a prospective database. Adults undergoing primary TAR using any implant (Cadence, Inbone, Infinity, Invision, Salto, STAR, Vantage, Zimmer) who were minimum 2 years post-surgery were included. Exclusion criteria included revision TAR or patients undergoing ankle fusion takedown and conversion to TAR. Five surgeons contributed patients. Demographics, etiology of arthritis, operative data, and postoperative complications, reoperations, and revisions were collected. Revisions and reoperations were classified by standard criteria. Cause of revision was recorded. There were 560 TARs eligible for 2-year follow-up (mean 3.9 +- 1.1 years postoperative), with mean follow-up of 2.2 +- 1.4 years (range 1-71 months). The cohort had mean age 63.8 +- 9.1 years, BMI 29.4 +- 5.2 kg/m2, and 57% were male. Kaplan- Meier survival plots were created. Risk factors for revision due to mechanical failure were analyzed using multivariable logistic regression with partial Wald chi square statistics. Results: Most implants were low-profile (n=444, 79.3%), with 28 implants having tibial keels (5%) and 88 with tibial/talar stems (15.7%). There were 25 (4.5%) revisions of tibial and/or talar components at mean 1.6 years after index surgery (Figure). Preoperative coronal deformity did not impact revision rates (p=0.433). Patients who underwent revision for mechanical failure had significantly higher rates of concomitant hindfoot fusion (20% vs. 8.4%, p=0.047) and greater BMI (31.4 kg/m2 vs. 29.3 kg/m2, p=0.04). In multivariable logistic regression, hindfoot fusion was just short of statistical significance (odds ratio [OR] 2.96, p=0.056), and BMI was not significant (OR 1.05, p=0.417). Stemmed or keeled implants did not significantly decrease revision rates compared to low-profile implants, although the revision rate of stemmed implants was substantially low (1/88, 1.1%). Conclusion: Among 560 modern TAR implants, short-term survivorship was 95% at 2-year follow-up, which is consistent with existing studies. Patients who underwent revision for early mechanical failure had significantly higher BMI and rates of hindfoot arthrodesis. However, these variables fell short of statistical significance in multivariable regression, suggesting that there are either additional factors contributing to revision, or a larger cohort is needed. In addition, these results are likely biased by surgeons' tendencies to use stemmed implants in patients with hindfoot fusions. Further research is warranted to determine if stemmed implants provide a protective effect in these high-risk patients.

Effects of an opioid stewardship program on opioid consumption and related outcomes after multilevel lumbar spine fusion: a pre- and postimplementation analysis of 268 patients.

Opioid stewardship programs combine clinical, regulatory, and educational interventions to minimize inappropriate opioid use and prescribing for orthopedic and spine surgery. Most evaluations of stewardship programs quantify effects on prescriber behavior, whereas patient-relevant outcomes have been relatively neglected. The authors evaluated the impact of an opioid stewardship program on perioperative opioid consumption, prescribing, and related clinical outcomes after multilevel lumbar fusion. The study was based on a retrospective, quasi-experimental, pretest-posttest design in 268 adult patients who underwent multilevel lumbar fusion in 2016 (preimplementation, n = 141) or 2019 (postimplementation, n = 127). The primary outcome was in-hospital opioid consumption (morphine equivalent dose [MED], mg). Secondary outcomes included numeric rating scale pain scores (0-10), length of stay (LOS), incidence of opioid-induced side effects (gastrointestinal, nausea/vomiting, respiratory, sedation, cognitive), and preoperative and discharge prescribing. Outcomes were measured continuously during the hospital admission. Differences in outcomes between the epochs were assessed in bivariable (Wilcoxon signed-rank or Fisher's exact tests) and multivariable (Wald's chi-square test) analyses. In bivariable analyses, there were significant decreases in preoperative opioid use (46% vs 28% of patients, p = 0.002), preoperative opioid prescribing (MED 30 mg [IQR 20-60 mg] vs 20 mg [IQR 11-39 mg], p = 0.003), in-hospital opioid consumption (MED 329 mg [IQR 188-575 mg] vs 199 mg [100-372 mg], p < 0.001), the incidence of any opioid-related side effect (62% vs 50%, p = 0.03), and discharge opioid prescribing (MED 90 mg [IQR 60-135 mg] vs 60 mg [IQR 45-80 mg], p < 0.0001) between 2016 and 2019. There were no significant differences in postanesthesia care unit pain scores (4 [IQR 3-6] vs 5 [IQR 3-6], p = 0.33), nursing floor pain scores (4 [IQR 3-5] vs 4 [IQR 3-5], p = 0.93), or total LOS (118 hours [IQR 81-173 hours] vs 103 hours [IQR 81-132 hours], p = 0.21). On multivariable analysis, the opioid stewardship program was significantly associated with decreased discharge prescribing (Wald's chi square = 9.45, effect size -52.4, 95% confidence interval [CI] -86 to -19.0, p = 0.002). The number of lumbar levels fused had the strongest effect on total opioid consumption during the hospital stay (Wald's chi square = 16.53, effect size = 539, 95% CI 279.1 to 799, p < 0.001), followed by preoperative opioid use (Wald's chi square = 44.04, effect size = 5, 95% CI 4 to 7, p < 0.001). A significant decrease in perioperative opioid prescribing, consumption, and opioid-related side effects was found after implementation of an opioid stewardship program. These gains were achieved without adverse effects on pain scores or LOS. These results suggest the major impact of opioid stewardship programs for spine surgery may be on changing prescriber behavior.

International Public Sector Accounting Standards and Organisational Characteristics as Determinants of Timeliness of Financial Reporting in Nigerian Public Sector Institutions

The timeliness of financial reporting is crucial for transparency and accountability in public sector organisations. This study aimed to examine the effect of International Public Sector Accounting Standards (IPSAS) adoption and organisational factors on the timeliness of financial reporting of Nigerian public institutions. Data were sourced from the audited financial statements of ninety public institutions for 2017 and 2018. Panel regression analysis was adopted. The findings revealed a poor quality of timeliness in public sector financial reporting is poor in Nigeria. IPSAS adoption and organisational characteristics jointly did not demonstrate a significant effect on timeliness (Adj R 2 = 0.0190, Wald chi 2 (4) = 7.75, p &gt; 0.05). The study concluded that the quality of timeliness in financial reporting in the Nigerian public sector is poor and is affected by other unmeasured factors rather than IPSAS adoption and organisational characteristics. Regulators need to enforce statutory timeframes for submission of financial reports by public institutions. There is also a need for further research to identify the determinants of timeliness in public sector financial reporting in Nigeria.

Paranormal Experiences and Understanding of God for Innovative Community Development: Interrogating the Akurinu Believers in Kenya.

The study’s objective was to examine the relationship between Akurinu Believers’ understandings of God and their use of paranormal experiences with an emphasis on innovative community development in Nairobi County, Kenya. The research was guided by Divine Command Theory and Diffusion of Innovations Theory. Descriptive and correlation designs were used. The study was conducted among 2618 Akurinu believers who formed Akurinu congregations registered with the General Conference of Akurinu Churches Assembly in Nairobi County. Data were analysed on Software Package for Social Sciences computer system to generate frequency distributions, and the Chi-square test was used on qualitative data to test agreement between variables. Wald Chi to test for predictive probability in quantitative data. A logistic binary regression model was used to test the hypothesis on quantitative data. Qualitative data were presented in frequency tables, and percentages and inferential data were presented in SPSS software tables. Based on α=0.05 level, the hypothesis is statistically significant with a predictive probability of odds ratio of 0.259 of change on the dependent variable. P-value was less than α=0.05. The study concluded that sustainable innovations in Akurinu spirituality, education and economics existed. They were understanding God through the Bible and relying on the Holy Spirit. Although Akurinu believers and leaders claimed that they derived their understandings of God through paranormal experiences, the probability was less than 50 per cent (0.259 odds ratio). The study recommended that the Akurinu leaders use theological principles, here called understandings of God, to train Akurinu believers to understand God better.

Age-adjusted risk factors are independently associated with an increased risk of ischaemic stroke, transient ischaemic stroke and systemic embolism in the ETNA-AF-Europe registry

Abstract Background Oral anticoagulation is highly effective in preventing ischaemic stroke in patients with atrial fibrillation, but 1–2% of the patients suffer an ischaemic stroke upon anticoagulation. Outcomes are further influenced by various factors, and recent research has focussed on identifying risk factors that could be helpful in predicting stroke outcomes in anticoagulated patients. This could further assist clinicians in timely identification and management of high-risk patients. Purpose The present analysis aims to assess the age-adjusted risk predictors of ischaemic stroke and systemic embolic events (SEE) (including transient ischaemic attack [TIA]) during two-year follow-up of unselected European patients with AF in the ETNA-AF-Europe registry. Methods ETNA-AF-Europe is a prospective, multi-centre, post-authorisation, observational study conducted in 825 centres enrolling patients treated with edoxaban once daily in 10 European countries. Wald Chi square tested the association between risk predictors and stroke and SEE after adjusting for age, given that age is a well-known, strong predictor of stroke. Results A total of 13,417 patients with AF (edoxaban 60 mg: n=10,248; edoxaban 30 mg: n=3169) completed the two-year follow-up. The mean age was 73.6±9.5 years, with ∼84% of the patients aged over 65 years. The mean weight was 81.0±17.3 kg, estimated glomerular filtration rate was 74.4±30.5 ml/min/1.73m2 and males were 56.6%. The mean CHA2DS2-VASc and HAS-BLED scores were 3.2 and 2.5, respectively. Univariate analysis demonstrated that history of TIA at baseline was the strongest age-adjusted predictor of stroke and SEE (Wald Chi-square: 77.69; p&amp;lt;0.0001) (Figure 1), followed by CHA2DS2-VASc score (41.09; p&amp;lt;0.0001) (Figure 2), history of ischaemic stroke (29.47; p&amp;lt;0.0001), history of any stroke (all strokes combined including stroke of unknown/unspecified type) (29.18; p&amp;lt;0.0001), subjective frailty as assessed by physician (20.60; p&amp;lt;0.0001), and HAS-BLED score (17.22; p&amp;lt;0.0001). Conclusion History of TIA, CHA2DS2-VASc score, history of stroke, frailty and HAS-BLED score are independently associated with an increased age-adjusted risk of ischaemic stroke, TIA and SEE in anticoagulated patients with AF. These findings highlight the importance of optimising anticoagulation therapy in secondary prevention of TIA and in patients with high CHA2DS2-VASc scores, ensuring the correct use of NOACs - adherence and correct dosing - in this high-risk population. These findings also suggest that additional therapies could be needed to prevent stroke in this population. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Daiichi Sankyo Europe GmbH Figure 1. History of TIA as a predictorFigure 2. CHA2DS2-VASc score as a predictor

Age-adjusted risk factors are independently associated with an increased risk of major bleeding during the two-year follow-up of the ETNA-AF-Europe registry

Abstract Background Non-vitamin K antagonist oral anticoagulants (NOACs) are a preferred treatment option over warfarin for anticoagulation in patients with atrial fibrillation (AF). Management decisions for thromboprophylaxis in AF need to balance the risk of stroke against the risk of bleeding. Various patient characteristics have been identified as independent risk factors for bleeding. A substantial number of bleeding events might be prevented if independent predictors of bleeding were identified. Purpose The present analysis aims at assessing age-adjusted risk predictors of major bleeding during two-year follow-up of unselected European patients with AF in the ETNA-AF-Europe registry. Methods ETNA-AF-Europe is a prospective, multi-centre, post-authorisation, observational study conducted in 825 centres enrolling patients treated with edoxaban once daily in 10 European countries. Wald Chi square tested the association between risk predictors and major bleeding after adjusting for age, given that age is a well-known, strong predictor of anticoagulation-related bleeding in patients with AF. Results Overall, 13,417 patients with AF (edoxaban 60 mg: n=10,248; edoxaban 30 mg: n=3169) completed the two-year follow-up. The mean age was 73.6±9.5 years, with ∼84% of the patients aged over 65 years. Mean CHA2DS2-VASc and HAS-BLED scores were 3.2 and 2.5, respectively. 438 (3.3%) patients had a history of bleeding events at baseline, of which 138 (1.0%) had a history of major bleeding event. Univariate analysis demonstrated that recalculated glomerular filtration rate (Cockcroft-Gault Equation) (GFR-CG) at baseline was the strongest age-adjusted predictor of major bleeding (Wald Chi-Square: 31.84; p&amp;lt;0.0001) (Figures 1 and 2), followed by history of major or clinically relevant non-major (CRNM) bleeding (24.08; p&amp;lt;0.0001), HAS-BLED score (21.10; p&amp;lt;0.0001), history of heart failure (derived) (16.59; p&amp;lt;0.0001), subjective frailty as assessed by physician (17.35; p=0.0002), history of major bleeding (14.14; p=0.0002), chronic obstructive pulmonary disease (COPD) (12.84; p=0.0003), CHA2DS2-VASc (12.14; p=0.0005), history of myocardial infarction (MI) (7.79; p=0.005), and left ventricular ejection fraction (LVEF) categorised by 40% (5.45; p=0.02). Conclusion Bleeding events on therapy with edoxaban can be predicted by quantifying kidney disease and capturing information on heart failure, frailty, prior bleeding, chronic obstructive lung disease and history of myocardial infarction. These data highlight the need for optimal management of anticoagulation therapy and close follow-up of patients with such risk profiles. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Daiichi Sankyo Europe GmbH Figure 1. GFR-CG as a predictor of major bleedingFigure 2. Predictors of major bleeding

The Importance of Positive Psychological Strengths in Well-Being and Adjustment of Romanian Emerging Adults: A Pattern and Variable-Oriented Approach.

Transition to adulthood in countries that have seen recent historical structural changes in society as well as changes in what it means to be an adult represents important contexts for investigations of ways in which positive development and transition to adulthood are experienced. Situated in such context, this cross-sectional study aimed to (1) describe profiles of positive psychological strengths, as measured by the Five Cs of positive youth development (PYD) and (2) document how identified profiles might differ in relation to other aspects of positive and problematic development. Participants were 272 Romanian emerging adults attending university (76% female; aged 19–29 years old, Mage = 21 years old). Latent class analysis was performed to identify patterns of psychological strengths using the Five Cs theory of positive youth development. Pairwise Wald chi square difference tests were then conducted to determine if the identified Five Cs profiles were associated with significant differences in other key outcomes. Findings indicated that, a two-class model emerged as the best fitting model, and in this model, Class 1 was similar to Class 2 on strengths of competence, confidence, and connection. However, the two classes were distinguishable by caring and character, with Class 2, the numerically more common profile (89%), being elevated on character and caring relative to Class 1 (which was a less frequently occurring profile, 11%). This finding highlights the importance of examining the diversity of positive development, even within the same theoretical framework. Further results indicated that the two identified classes showed similarities in problematic behaviors as well as in purpose in life and psychological complaints. Other group difference tests by profile/class indicated that Class 2 was higher in general and social well-being relative to Class 1, with a trend in the same direction for hope. However, an unexpected finding was that Class 2 was also elevated in somatic complaints relative to Class 1. These are important findings not only because of the contribution to the generalizability of the Five Cs theory and measure but also because of the implications of the findings to research, policy, and practice in the Romanian context and beyond.

Acute exercise increases BDNF serum levels in patients with Parkinson’s disease regardless of depression or fatigue

ABSTRACT Studies have consistently reported a decreased level of brain-derived neurotrophic factor (BDNF) in individuals with Parkinson’s disease (PD). The benefits of exercise on BDNF levels are well-documented in humans, however, the effects of acute exercise are inconclusive in neurological disorders. In addition, there are no studies investigating a precursor molecule – proBDNF – and its comparison to patients with vs. without depression or fatigue. Thirty patients with PD were instructed to walk on a treadmill at light to moderate intensity for 30 min. Generalized Estimating Equation (GEE) showed a significant effect of time (pre- vs. post-exercise) when compared individuals with vs. without depression [Wald Chi Square (4.392), p = 0.036)] and with vs. without fatigue [Wald Chi Square (7.123), p = 0.008)] for mature BDNF (mBDNF) level. There was no effect of group, time, and group x time interaction for proBDNF level when compared individuals with vs. without depression or fatigue. The present study showed that a single bout of light to moderate-intensity exercise increases mBDNF serum levels in patients with PD regardless of depression and fatigue. Our finding is important because it is necessary investigate methods to enhance the gains made by rehabilitation, especially when considering a short period of rehabilitation in different health services. The increase in mBDNF level can lead to an enhancement of neuroplasticity and facilitate the improvement of motor performance. No effect on proBDNF level could be explained, as this precursor molecule is cleaved by intracellular or extracellular enzymes.

Developing and Evaluating a Continuous Education Program for Healthcare Assistants in Macao: A Cluster-Randomized Trial.

The shortage of healthcare human resources is an important challenge for coping with the aging society in Macao. Since little attention has been paid to continuous education of healthcare assistants, this study aims to develop and evaluate a continuous education program, supporting the expansion and optimization of the competence of healthcare assistants. It is a cluster-randomized trial study. All healthcare assistants who were employed in nursing homes in Macao were eligible for this study. Six nursing homes were recruited and randomly assigned either an experimental group (3 nursing homes; 45 healthcare assistants) or a control group (3 nursing homes; 40 healthcare assistants). Healthcare assistants were assessed at baseline and after intervention with the Healthcare Assistants Care Knowledge Test and the Healthcare Assistants Care Competence Self-Assessment. The experimental group received a continuous education program with 10 themes during 2017–2018 while the control groups did not. The results of the generalized estimating equation showed that care knowledge in the experimental group was significantly different from that of the control group (Wald Chi Square = 3.848, p < 0.05) as well as care competence (Wald Chi Square = 13.361, p < 0.001). This study developed a continuous program for health assistants and provided evidence that continuous education programs improve and maintain the level of care knowledge and care competency of healthcare assistants.

High risk for human exposure to Rift Valley fever virus in communities living along livestock movement routes: Across-sectional survey in Kenya.

IntroductionMultiple outbreaks of Rift Valley Fever (RVF) with devastating effects have occurred in East Africa. These outbreaks cause disease in both livestock and humans and affect poor households most severely. Communities living in areas practicing nomadic livestock movement may be at higher risk of infection. This study sought to i) determine the human exposure to Rift Valley fever virus (RVFV) in populations living within nomadic animal movement routes in Kenya; and ii) identify risk factors for RVFV infection in these communities.MethodsA cross-sectional descriptive study design was used. Samples were collected from the year 2014 to 2015 in a community-based sampling exercise involving healthy individuals aged ≥18 years from Isiolo, Tana River, and Garissa counties. In total, 1210 samples were screened by ELISA for the presence of immunoglobulin IgM and IgG antibodies against RVFV. Positive results were confirmed by plaque reduction neutralization test.ResultsOverall, IgM and IgG prevalence for all sites combined was 1.4% (95% CI 0.8–2.3%) and 36.4% (95% CI 33.8–39.2%), respectively. Isiolo County recorded a non-significant higher IgG prevalence of 38.8% than Garissa 35.9% and Tana River 32.2% (Chi square = 2.5, df = 2, p = 0.287). Males were significantly at higher risk of infection by RVFV than females (OR = 1.67, 95% CI 1.17–2.39, p<0.005). Age was significantly associated with RVFV infection (Wald Chi = 94.2, df = 5, p<0.0001). Individuals who had regular contact with cattle (OR = 1.38, 95%CI 1.01–1.89) and donkeys (OR = 1.38, 95%CI 1.14–1.67), or contact with animals through birthing (OR = 1.69, 95%CI 1.14–2.51) were significantly at a greater risk of RVFV infection than those who did not.ConclusionThis study demonstrated that although the Isiolo County has been classified as being at medium risk for RVF, virus infection appeared to be as prevalent in humans as in Tana River and Garissa, which have been classified as being at high risk. Populations in these counties live within nomadic livestock movement routes and therefore at risk of being exposed to the RVFV. Interventions to control RVFV infections therefore, should target communities living along livestock movement pathways.

Inpatient gastrostomy in Huntington's disease: Nationwide analysis of utilization and outcomes compared to amyotrophic lateral sclerosis

BackgroundHuntington's disease (HD) causes dysphagia and dementia, both of which are risk factors for malnutrition. Gastrostomy is used to sustain enteral intake in neurodegenerative diseases and specifically improves outcomes in ALS, but its indications and outcomes in HD are understudied. ObjectiveTo explore the indications and outcomes for gastrostomy for HD. MethodsWe performed a retrospective cross-sectional analysis of all HD admissions in the National Inpatient Sample. Logistic regression models compared the patient- and hospital-level characteristics associated with gastrostomy placement in HD and the prevalence of associated diagnoses in HD vs. ALS gastrostomy patients. We also examined in-hospital mortality, length of stay (LOS), and discharge status. ResultsBetween 2000 and 2010, 5.12% (n = 1614) of HD admissions included gastrostomy tube placement. Gastrostomy patients were more likely to be Black (adjusted odds ratio [AOR] 1.55, 95% CI: 1.09–2.21) and have Medicare coverage (AOR 1.43, 95% CI: 1.0–2.05). The most common comorbidities were aspiration pneumonia (34.1%), dementia (31.3%), malnutrition (30.3%), and dysphagia (29.5%). Dementia and delirium were associated with discharge type but not LOS. Aspiration pneumonia, sepsis, and Elixhauser comorbidity index were associated with LOS but not discharge type. Compared to 7908 ALS gastrostomy patients, those with HD more frequently had aspiration pneumonia (34.1% vs. 20.5%, p < 0.0001), sepsis (28.1% vs. 13.7%, p < 0.0001), prolonged LOS (OR 1.14, 95% CI: 1.02–1.28), and skilled nursing facility discharge (p < 0.0001, Wald chi square test). ConclusionsGastrostomy is frequently performed in HD patients with dementia and aspiration pneumonia who are at increased risk for negative hospitalization outcomes.

Endogenous-Switching Regression Modeling of Farmers’ Exposure to Climate Hazards and Reforestation in Selected Villages in Africa

Deforestation remains a serious concern for Africa’s economic development and global climatic stability. This paper analyzed the effect of exposure to climate-related hazards on tree planting among smallholder farmers in nine selected African countries. The data were from baseline surveys which were conducted by the CGIAR’s research programme on Climate Change, Agriculture and Food Security (CCAFS). The included countries were Burkina Faso, Ethiopia, Ghana, Kenya, Mali, Niger, Senegal, Tanzania and Uganda. Data were analyzed with Endogenous Switching regression considering the endogeneity potentials of climate-hazard exposure. The results showed that Uganda and Ethiopia had the highest average numbers of tree planting with 1.082 and 1.000 respectively, while Senegal (89.86%), Kenya (87.77%), Burkina Faso (82.86%) and Ethiopia (82.86%) had the highest exposure to climate-related hazards. Endogenous Switching regression results showed that climate hazard exposure was truly endogenous going by statistical significance of the Wald Chi Square test (p<0.05) and it was significantly influenced by female household headship, perception of more droughts, floods and low ground water. The number of tree that were planted increased significantly (p<0.05) with climate hazard exposure, degraded land areas, asset indices and residence in East Africa, while it reduced with female household headship. In addition, Average Treatment Effect (ATE) result indicated that an average household will plant 0.745 trees more when it had been previously exposed to climate shocks while Average Treatment Effect on the Treated (ATET) revealed that an average household that was exposed to climate hazards would plant 0.54 more trees than it would if it had not been exposed to hazards. It was concluded that many farmers had been affected by climate-related shocks and efforts to safeguard future climate through tree planting should be gender sensitive and concentrated among previously affected farmers.

2204Predicting the trajectory of depression following an acute coronary syndrome: the role of resilience

Abstract Background Depression is common in patients following an Acute Coronary Syndrome (ACS) substantially increases the risk of future events and mortality. Post-ACS depression typically resembles one of four longitudinal trajectories: chronic; absent; recovered, or delayed depression. Early identification of a patient's post-ACS depression trajectory will improve risk stratification, treatment implementation and risk management. Purpose To explore whether stable psychosocial traits, such as resilience, predict the trajectory of depression one month and 6 months following an ACS admission. Method Consecutive adult ACS patients (STEMI/NSTEMI) admitted to a large general hospital completed the Cardiac Depression Scale (CDS) and the Sense of Coherence scale during their admission, then one and six months following discharge. Results 132 ACS in-patients (males = 111; mean age = 63.13±13.47) satisfied enrolment criteria. Unconditional linear latent growth modelling identified a 3-class model for the trajectory of depression post-ACS (increasing depression; consistent non-depressed; decreasing non-depressed). For the increasing depression class, resilience at baseline was significant and negative compared to the consistent class, b=−0.06, Wald chi square (1) = 4.42, p=0.036 and the decreasing class, b=−0.09, Wald chi square (1) = 7.20, p=0.007. Conclusions Patients who reported lower levels of resilience during an ACS admission were significantly more likely to experience initially high levels of depressive symptoms (CDS ≥85) that exceeded the clinically relevant cut-off (CDS ≥95) at 6 months post-discharge. This study suggests that screening for resilience and depression will improve risk stratification for persistent and delayed depression post-ACS.

A prognostic score system with lymph node ratio in stage IIIA-N2 NSCLC patients after surgery and adjuvant chemotherapy.

The survival of patients with IIIA-N2 non-small cell lung cancer after surgery followed by adjuvant chemotherapy is heterogeneous. The aim of this study is to form a prognostic system and a heat map method to visualize the overall survival rates in those patients. Univariate and multivariate Cox hazards regression models and the associated Wald Chi square coefficient were used to form the prognostic score system. Recursive partitioning analysis was used to determine the cutoff values of lymph node ratio and prognostic score in SEER cohort and validated in FDUSCC cohort. Meanwhile, a heat map method was used to visualize the overall survival probabilities of 3, 5 and 10years for individual patient of both cohorts. Lymph node ratio (with cutoff of 0.36) significantly correlates with overall survival of these patients. In addition, in patients with the same level of N2 disease, lymph node ratio still significantly affects survival. Also, after the multivariate analysis in SEER cohort, six factors were independent prognostic factors including age, sex, type of surgery, size, lymph node ratio and differentiation. A prognostic sore system with these factors (with cutoff of 12) was validated as a predictor for overall survival in FDUSCC cohort. This prognostic score system including lymph node ratio can predict the survival rates of IIIA-N2 patient after surgery and post-operative chemotherapy. Lymph node ratio could be a useful supplementation in TNM stage classification for IIIA-N2 patients. The heat map method can visualize the predicted overall survival of an individual patient.

194 Superovulation response does not affect embryo development of pronuclear microinjected embryos in the goat

Superovulation of donor animals is essential in the production of transgenic founder goats generated through microinjection. There can be a marked variable response to the exogenous hormones used for superovulation. The objective of this study was to examine how the superovulatory response of individual goats affected the ability of the fertilized, microinjected embryos to develop into offspring. The donors were superovulated using a progesterone implant on Day 0, a prostaglandin injection at Day 7, 2 injections ~12h apart of 32 to 36mg of FSH on Day 12 to 15, progesterone implant removal on Day 14, bred by intact bucks several times starting on Day 15 to 16, an injection of 50μg of gonadotropin-releasing hormone, and surgical collection of 1- to 2-cell embryos from retrograde flushing of the oviduct on Day 17 (~24-48 h, 1-2 days after breeding). Surgical collection allows for an accurate ovulation point (OP) count before the oviduct being retrograde flushed and ova collected and counted. Data from donor animals were grouped by superovulatory response based on OP counts of 1-10, 11-20, 21-30, or &amp;gt;30. The number of donors that contributed per group were 130, 280, 175, and 52, respectively. The recovery rate was 76, 72, 68, and 62%, respectively. After collection, ova were viewed under a dissecting microscope and assessed for fertilization by identifying pronuclei, and 1 pronucleus was microinjected. The fertilization rate was 47, 52, 51, and 56%, respectively. The survivability rate after microinjection was 80, 76, 75, and 76%, respectively. Surviving embryos were transferred (3-5) into recipient goats following a 2- to 6-h in vitro culture (as 1- to 2-cell embryos), allowing for a suitable period to assess viability post-injection. Further in vitro development rates were not assessed because of the short timeframe the embryos stayed in culture. The conception rates were 71, 56, 65, and 53%, respectively, and abortion rates were 23, 10, 14, and 9%, respectively. As some recipients received embryos from multiple donors, this data could not be included in the analysis as identifying which offspring were from the corresponding embryo group could not be confirmed. Data were analysed using SAS software (version 9.4, SAS Institute Inc., Cary, NC, USA). The Wald chi square test under linear regression was used to analyse the number of offspring produced per embryo transferred. No significant differences were found between groups (all P-values were&amp;gt;0.05). This analysis indicated that the range of superovulation response does not affect the developmental competence of the pronuclear microinjected embryo or the ability to produce viable offspring. Table 1.Comparison of the donor ovulation counts, number of embryos transferred, offspring produced and overall efficiency

Contrast sensitivity deficits in patients with mutation-proven inherited retinal degenerations

BackgroundPatients with retinal diseases frequently complain of poor visual function even when visual acuity is relatively unaffected. This clinical finding has been attributed to deficits in contrast sensitivity (CS). The purpose of our study was to evaluate the CS in patients with clinical and genetic diagnosis of inherited retinal degeneration (IRD) and relatively preserved visual acuity.MethodsSeventeen patients (30 eyes) with IRD and visual acuity of 20/40 or better, and 18 controls (18 eyes) without any ocular condition underwent slit lamp examination, visual acuity testing via standard Snellen chart testing, CS testing via the Quick Contrast Sensitivity Function (QCSF), and Spectral Domain Optical Coherence Tomography (SD-OCT). CS were measured at 1.0, 1.5, 3.0, 6.0, 12.0, and 18.0 cycles per degree (cpd). T tests with general estimated equations were used to compare CS between groups. Wald chi square followed by pairwise comparisons was used to compare CS between multiple groups.ResultsWe included 12 patients with rod-cone dystrophy (RCD), 3 patients with Stargardt disease (STGD) and 2 patients with Best disease. Patients with IRD had significantly worse CS than controls (p < 0.001) in all spatial frequencies. Patients with STGD had more marked deficits in CS than patients with Best disease (p < 0.001) and RCD (p < 0.001) despite having similar visual acuities.ConclusionPatients with IRD, especially patients with STGD with relatively preserved visual acuity have marked deficits in CS when measured across a range of spatial frequencies. We recommend that clinical trials for STGD incorporate CS measured over a range of spatial frequencies as a secondary clinical endpoint for monitoring visual function. CS may provide an explanation for complaints of visual dysfunction when visual acuity is not significantly altered.