WHO Algorithm Research Articles

Wild Horse Optimizer and Support Vector Machine (SVM) Classifier Predicts The Heart Disease Converging Nature-Motivated Optimization and Machine Learning

Background: As one of the leading causes of morbidity and mortality worldwide, the diagnosis of acute cardiovascular disease (acute CVD) in emergency settings remains a significant challenge. Machine learning (ML) is artificial intelligence that allows computer programs to learn from and analyze large data sets without human intervention. As a diagnostic tool, ML presents numerous advantages, such as convenience, speed, and affordability. Methods: This research utilized a new model for predicting heart disease for feature selection(Wild Horse Optimizer, WHO) and another classification model (Support Vector Machine, SVM). In the WHO algorithm, like envisioning social behaviors of wild horses, we observe that wild horses display diverse behaviors like leading, grazing, moving, mating and chase. One odd behavior about wild horses is that young foals will break away from the herd to avoid the breed in its related herd before reaching maturity. It defines the decencies of the horses. Discussion: Multiple ML techniques were employed to train classifiers using the Cleveland heart disease dataset after conducting feature selection using WHO algorithm. The performance of these models was evaluated based on different parameters like Sensitivity, Accuracy, Specificity, and AUC. The SVM classifier model trained using the WHO approach proved better than the existing methods. In the research, we proposed a Wild Horse Optimization algorithm to optimize the features for Heart Disease prediction. After feature optimization, the optimized dataset is then given to Support Vector machine classification, which performs the classification of heart disease. After evaluating different experimental results, authors conclude that combining this feature selection algorithm and SVM as a classifier for forecasting heart disease is very effective. With the help of this approach, we can improve the early detection of heart disease and effectively manage severe heart disease. The experimental result graph shows an increased accuracy rate of the spectra feature subject.

220 External Validation and Comparison of NIRUDAK Models and WHO Algorithm for Assessing Dehydration in Patients With Acute Diarrhea

220 External Validation and Comparison of NIRUDAK Models and WHO Algorithm for Assessing Dehydration in Patients With Acute Diarrhea

A comparison of the NIRUDAK models and WHO algorithm for dehydration assessment in older children and adults with acute diarrhoea: a prospective, observational study

Despite the importance of accurate and rapid assessment of hydration status in patients with acute diarrhoea, no validated tools exist to help clinicians assess dehydration severity in older children and adults. The aim of this study is to validate a clinical decision support tool (CDST) and a simplified score for dehydration severity in older children and adults with acute diarrhoea (both developed during the NIRUDAK study) and compare their accuracy and reliability with current WHO guidelines. A random sample of patients aged 5 years or older presenting with diarrhoea to the icddr,b Dhaka Hospital in Bangladesh between Jan 30 and Dec 13, 2022 were included in this prospective cohort study. Patients with fewer than three loose stools per day, more than 7 days of symptoms, previous enrolment in the study, or a diagnosis other than acute gastroenteritis were excluded. Patients were weighed on arrival and assessed separately by two nurses using both our novel clinical tools and WHO guidelines. Patients were weighed every 4 h to determine their percent weight change with rehydration, our criterion standard for dehydration. Accuracy for the diagnosis of dehydration category (none, some, or severe) was assessed using the ordinal c-index (ORC). Reliability was assessed by comparing the prediction of severe dehydration from each nurse's independent assessment using the intraclass correlation coefficient (ICC). 1580 patients were included in our primary analysis, of whom 921 (58·3%) were female and 659 (41·7%) male. The ORC was 0·74 (95% CI 0·71-0·77) for the CDST, 0·75 (0·71-0·78) for the simplified score, and 0·64 (0·61-0·67) for the WHO guidelines. The ICC was 0·98 (95% CI 0·97-0·98) for the CDST, 0·94 (0·93-0·95) for the simplified score, and 0·56 (0·52-0·60) for the WHO guidelines. Use of our CDST or simplified score by clinicians could reduce undertreatment and overtreatment of older children and adults with acute diarrhoea, potentially reducing morbidity and mortality for this common disease. US National Institutes of Health. For the Bangla translation of the abstract see Supplementary Materials section.

External validation of triage tools for adults with suspected COVID-19 in a middle-income setting: an observational cohort study

BackgroundTools proposed to triage ED acuity in suspected COVID-19 were derived and validated in higher income settings during early waves of the pandemic. We estimated the accuracy of seven risk-stratification...

Prognostic Impact of Pathologic Features in Molecular Subgroups of Endometrial Carcinoma.

The molecular characterization of endometrial carcinoma (EC) has recently been included in the ESGO/ESTRO/ESP guidelines. The study aims to evaluate the impact of integrated molecular and pathologic risk stratification in the clinical practice and the relevance of pathologic parameters in predicting prognosis in each EC molecular subgroup. ECs were classified using immunohistochemistry and next-generation sequencing into the four molecular classes: POLE mutant (POLE), mismatch repair deficient (MMRd), p53 mutant (p53abn), and no specific molecular profile (NSMP). According to the WHO algorithm, 219 ECs were subdivided into the following molecular subgroups: 7.8% POLE, 31% MMRd, 21% p53abn, 40.2% NSMP. Molecular classes as well as ESGO/ESTRO/ESP 2020 risk groups were statistically correlated with disease-free survival. Considering the impact of histopathologic features in each molecular class, stage was found to be the strongest prognostic factor in MMRd ECs, whereas in the p53abn subgroup, only lymph node status was associated with recurrent disease. Interestingly, in the NSMP tumor, several histopathologic features were correlated with recurrence: histotype, grade, stage, tumor necrosis, and substantial lymphovascular space invasion. Considering early-stage NSMP ECs, substantial lymphovascular space invasion was the only independent prognostic factor. Our study supports the prognostic importance of EC molecular classification and demonstrated the essential role of histopathologic assessment in patients' management.

The safety of pneumococcal vaccines at the time of sequential schedule: data from surveillance of adverse events following 13-valent conjugated pneumococcal and 23-valent polysaccharidic pneumococcal vaccines in newborns and the elderly, in Puglia (Italy), 2013-2020.

Nowadays, two types of anti-pneumococcal vaccine are available: pneumococcal 13-valent conjugate vaccine (PCV13), first licensed in the United States (US) in 2013, and pneumococcal 23-valent polysaccaridic vaccine (PPSV23), first licensed in the US in 1999. These vaccines are recommended in Italy for the immunization of newborns and of the elderly, using a combined sequential schedule for the latter. This report aims to describe the PCV13- and PPSV23-related AEFIs notified in Puglia in 2013-2020, in order to design these products' safety profile in a real-life scenario, three years after the official recommendation about the sequential schedule for people over 60 years of age. This is a retrospective observational study. Data were gathered from the list of AEFIs notified following PCV13 and PPSV23 administration in Puglia in 2013-2020. The number of administered vaccine doses was obtained from the regional immunization database. AEFIs were classified according to WHO's algorithm, and causality assessment was carried out in case of serious AEFIs. From January 2013 to December 2020, 764,183 doses of PCV13 and 40,382 doses of PPSV23 were administered in Puglia. In the same period, 71 PCV13 AEFIs (Reporting Rate: 9.29 x100,000 doses) and 5 PPSV23 AEFIs (Reporting Rate: 12.4 x100,000 doses) were reported. The overall male/female ratio in AEFIs was 0.85. The majority of AEFIs occurred in subjects aged less than 2 (64/76, 84.2%), while 10 out of 76 (13.2%) occurred in patients aged 60 or older. 22 AEFIs were classified as serious and for 12 (54.5%) causality assessment showed a consistent relationship with immunization. The most commonly reported symptoms were fever (Reporting Rate: 4.72 x100,000 doses) and neurological symptoms (Reporting Rate: 3.23 x100,000 doses). Only one death was notified, classified as non-vaccine-related. The benefit of pneumococcal vaccination appears to be greater than the risk of AEFIs for both PCV13 and PPSV23. In fact, AEFIs occur in less than 0.1‰ of patients and the majority of AEFIs are mild and self-limiting.

Wild Horse Optimization with Deep Learning-Driven Short-Term Load Forecasting Scheme for Smart Grids

Energy is a major driver of human activity. Demand response is of the utmost importance to maintain the efficient and reliable operation of smart grid systems. The short-term load forecasting (STLF) method is particularly significant for electric fields in the trade of energy. This model has several applications to everyday operations of electric utilities, namely load switching, energy-generation planning, contract evaluation, energy purchasing, and infrastructure maintenance. A considerable number of STLF algorithms have introduced a tradeoff between convergence rate and forecast accuracy. This study presents a new wild horse optimization method with a deep learning-based STLF scheme (WHODL-STLFS) for SGs. The presented WHODL-STLFS technique was initially used for the design of a WHO algorithm for the optimal selection of features from the electricity data. In addition, attention-based long short-term memory (ALSTM) was exploited for learning the energy consumption behaviors to forecast the load. Finally, an artificial algae optimization (AAO) algorithm was applied as the hyperparameter optimizer of the ALSTM model. The experimental validation process was carried out on an FE grid and a Dayton grid and the obtained results indicated that the WHODL-STLFS technique achieved accurate load-prediction performance in SGs.

Evaluation of mortality attributable to SARS-CoV-2 vaccine administration using national level data from Qatar

Accurate determination of mortality attributable to SARS-CoV-2 vaccination is critical in allaying concerns about their safety. We reviewed every death in Qatar that occurred within 30 days of any SARS-CoV-2 vaccine administration between January 1, 2021 and June 12, 2022. Probability of association with SARS-CoV-2 vaccination was determined by four independent trained reviewers using a modified WHO algorithm. Among 6,928,359 doses administered, 138 deaths occurred within 30 days of vaccination; eight had a high probability (1.15/1,000,000 doses), 15 had intermediate probability (2.38/1,000,000 doses), and 112 had low probability or no association with vaccination. The death rate among those with high probability of relationship to SARS-CoV-2 vaccination was 0.34/100,000 unique vaccine recipients, while death rate among those with either high or intermediate probability of relationship to SARS-CoV-2 vaccination was 0.98/100,000 unique vaccine recipients. In conclusion, deaths attributable to SARS-CoV-2 vaccination are extremely rare and lower than the overall crude mortality rate in Qatar.

Special issue on International Conference on Computing and Communication Networks

Special issue on International Conference on Computing and Communication Networks

Quasi‐oppositional wild horse optimization based multi‐agent path finding scheme for real time IoT systems

AbstractMulti‐Agent System (MAS) gained significant interest amongst researchers since it provides multiple benefits through several application areas. MAS involves a network of socially‐cooperative smart agents that is conscious about the drastic modifications that occur in the platform at the time of task execution. On the other hand, energy efficiency is a major issue in real‐time IoT systems, since most of the sensor nodes experience energy constraints. Though several works have been conducted earlier, there is a need exists to design an effective solution for simultaneous processing in real‐time environments using multiple agents. The aim of Multi‐Agent Pathfinding (MAPF) process is to provide collision‐free routes so as to divert the agents from original path to the destination. In this view, the current study designs a Quasi‐Oppositional Wild Horse Optimization‐based Multi‐Agent Path Finding (QOWHO‐MAPF) scheme for real‐time IoT systems. The aim of the proposed QOWHO‐MAPF scheme is to determine the optimal set of paths to reach the destination in real‐time IoT networks. QOWHO algorithm is created by integrating the concepts of Quasi‐Oppositional Based Learning (QOBL) and conventional WHO algorithm. In addition, the proposed QOWHO‐MAPF model derives a fitness function that involves two input parameters such as residual energy and distance‐to‐destination. The proposed QOWHO‐MAPF model was experimentally analysed and the results were inspected under several aspects. The simulation results established that QOWHO‐MAPF model is a superior model compared to other state‐of‐the‐art models.

Recovery of enteroviruses and poliovirus in Harare sewage using the bag-mediated filtration system at the introduction of the inactivated polio vaccine in Zimbabwe

Environmental surveillance is a sensitive method for detecting circulating virus in the absence of clinical cases and is important for monitoring progress for poliovirus (PV) eradication. This study used the bag-mediated filtration system (BMFS) to determine PV and enterovirus (EV) prevalence in sewage at the transition from oral polio vaccine type 2 (OPV2) use to inactivated polio vaccine (IPV) use in Zimbabwe, and examined the correlation between environmental surveillance results and vaccination coverage of OPV. A total of 18 BMFS samples from 6 sampling sites were analysed for the presence of EV and PV via direct RT-qPCR, direct ITD (intratypic differentiation), and the WHO algorithm. EV prevalence in Harare wastewater was 88.9% (16/18) using direct RT-PCR, 61.1% (11/18) using direct ITD, and 77.8% (14/18) using the WHO algorithm. Of the 18 samples analysed using the WHO algorithm, 10 samples (55.6%) were positive for Sabin-like PV type 3 (SL3). Of these 10 samples, 2 were also positive for non-polio enteroviruses (NPEV), resulting in a total of 6 (33.3%) samples positive for NPEV and 4 negative. The sensitivity of isolation in detecting EVs in sewage was 92.9% when comparing direct RT-qPCR results to the WHO algorithm. Using direct ITD, two high-density, low-income sampling sites were negative for SL3 and one low-density, high-income sampling point was negative for SL3 using the WHO algorithm. There was a strong association between relative EV concentration and the number of OPV3 vaccine recipients (r = 0.8590; p = 0.0284) in sampled areas. This study demonstrated the ability of BMFS to detect PVs circulating in Harare wastewater at the beginning of the OPV–IPV switch and can be used to monitor potential reintroduction of wild PV or vaccine-derived PVs from endemic areas.

Tuberculosis screening among HIV-positive inpatients: a systematic review and individual participant data meta-analysis.

SummaryBackgroundSince 2011, WHO has recommended that HIV-positive inpatients be routinely screened for tuberculosis with the WHO four-symptom screen (W4SS) and, if screened positive, receive a molecular WHO-recommended rapid diagnostic test (eg, Xpert MTB/RIF [Xpert] assay). To inform updated WHO tuberculosis screening guidelines, we conducted a systematic review and individual participant data meta-analysis to assess the performance of W4SS and alternative screening tests to guide Xpert testing and compare the diagnostic accuracy of the WHO Xpert algorithm (ie, W4SS followed by Xpert) with Xpert for all HIV-positive inpatients.MethodsWe searched MEDLINE, Embase, and Cochrane Library from Jan 1, 2011, to March 1, 2020, for studies of adult and adolescent HIV-positive inpatients enrolled regardless of tuberculosis signs and symptoms. The separate reference standards were culture and Xpert. Xpert was selected since it is most likely to be the confirmatory test used in practice. We assessed the proportion of inpatients eligible for Xpert testing using the WHO algorithm; assessed the accuracy of W4SS and alternative screening tests or strategies to guide diagnostic testing; and compared the accuracy of the WHO Xpert algorithm (W4SS followed by Xpert) with Xpert for all. We obtained pooled proportion estimates with a random-effects model, assessed diagnostic accuracy by fitting random-effects bivariate models, and assessed diagnostic yield descriptively. This systematic review has been registered on PROSPERO (CRD42020155895).FindingsOf 6162 potentially eligible publications, six were eligible and we obtained data for all of the six publications (n=3660 participants). The pooled proportion of inpatients eligible for an Xpert was 90% (95% CI 89–91; n=3658). Among screening tests to guide diagnostic testing, W4SS and C-reactive protein (≥5 mg/L) had highest sensitivities (≥96%) but low specificities (≤12%); cough (≥2 weeks), haemoglobin concentration (<8 g/dL), body-mass index (<18·5 kg/m2), and lymphadenopathy had higher specificities (61–90%) but suboptimal sensitivities (12–57%). The WHO Xpert algorithm (W4SS followed by Xpert) had a sensitivity of 76% (95% CI 67–84) and specificity of 93% (88–96; n=637). Xpert for all had similar accuracy to the WHO Xpert algorithm: sensitivity was 78% (95% CI 69–85) and specificity was 93% (87–96; n=639). In two cohorts that had sputum and non-sputum samples collected for culture or Xpert, diagnostic yield of sputum Xpert was 41–70% and 61–64% for urine Xpert.InterpretationThe W4SS and other potential screening tests to guide Xpert testing have suboptimal accuracy in HIV-positive inpatients. On the basis of these findings, WHO now strongly recommends molecular rapid diagnostic testing in all medical HIV-positive inpatients in settings where tuberculosis prevalence is higher than 10%.FundingWorld Health Organization.

Prognostic accuracy of triage tools for adults with suspected COVID-19 in a prehospital setting: an observational cohort study

BackgroundTools proposed to triage patient acuity in COVID-19 infection have only been validated in hospital populations. We estimated the accuracy of five risk-stratification tools recommended to predict severe illness and...

Comparative Study of Horse Swarm Algorithm and Classical Algorithm

At present, optimization algorithms have been widely used in various scientific fields. These optimization algorithms are usually stimulated by the natural behavior of human, animal, plant, physical or chemical reagents. Most of the algorithms proposed in the past decade are inspired by animal behavior. Based on the horse swarm optimization algorithm, a horse swarm algorithm (WHO), which simulates the social life behavior of horses, is proposed in this paper. The new algorithm integrates the golden sinusoidal guiding mechanism as local operators into WHO algorithm, which improves the accuracy and convergence speed of the algorithm; It avoids the early over convergence of the algorithm. On the challenging CEC2019 test set, the WHO algorithm is comprehensively compared with other improved algorithms. Simulation results show that WHO algorithm has better performance in search efficiency, convergence accuracy and avoiding local optimum for both high-dimensional and fixed-dimensional problems. The results show that compared with other algorithms, this algorithm has strong competitiveness.

Role of Clinical Criteria and Oxygen Saturation Monitoring in Diagnosis of Childhood Pneumonia in Children Aged 2 to 59 Months

Current WHO algorithm has retained the signs and symptoms used in the older version for classifying severity of childhood pneumonia. To study the role of clinical features (including that of current WHO criteria), and oxygen saturation (SpO2) in the diagnosis of childhood pneumonia. Multicenter prospective cohort study. Children, 2 to 59 months of age, suffering from acute respiratory infection (ARI). Sensitivity, specificity, and likelihood ratios were calculated for clinical features, and SpO2. Of a total 7026 children with ARI enrolled, 13.4% had pneumonia (37% of them had severe pneumonia), according to WHO criteria. Based on any abnormality on chest x ray (CXR), 46% had pneumonia. The sensitivity and specificity of the existing WHO criteria for diagnosis of pneumonia was 56.5% and 66.2%, respectively, when compared against abnormalities in CXR. Cough and fever, each had sensitivity of >80%. Audible wheeze and breathing difficulty, each had a specificity of >80%. Sensitivity and specificity of tachypnoea were 58.7% and 63.3%, respectively. None of the clinical features alone had a sensitivity and specificity of >80%. Addition of SpO2 of <92% to chest indrawing alone or WHO criteria increased the likelihood of diagnosis of pneumonia. Current WHO criteria based on rapid respiratory rate and/or chest indrawing has modest sensitivity and specificity, considering CXR abnormalities as gold standard for diagnosis of pneumonia. Addition of SpO2 of <92% to chest indrawing alone or WHO criteria increases the probability of pneumonia diagnosis, and is important in the management of a child with pneumonia.

Features of the Course of Lower Urinary Tract Symptoms in Men with Benign Prostate Hyperplasia and COVID-19

Nowadays men’s health remains in priority. It is given no less attention than to the cardiovascular disorders and cancer. Low urinary tract symptoms (LUTS) accompany most urological diseases and thus are among the most significant syndromes in urology. The medico-social significance of the syndrome puts the development of protocols for its effective detection and drug treatment with long-term efficacy in a number of priority tasks, stimulating the pharmaceutical industry to search for promising candidates.. Restrictions of COVID-19 Pandemic prevent routine procedures by urologists, prompting them to provide online counseling. Under these circumstances, recommendations were made on the strategy and tactics of treatment of urological diseases during a pandemic, as well as strategic directions in the urology of the future were identified. There is a worldwide consensus among experts on minimizing invasive treatments for benign prostatic hyperplasia (BPH) to maximize the protection of medical personnel from the potential risk of COVID-19 infection, while direct contact with patients is not always possible to avoid. It is known from scientific sources that, in contrast to 2019, in 2020 there was a tendency of increase the share of hospitalizations for emergency urological conditions as well as the share of critical conditions, requiring the strengthening of anti-epidemic measures. Over the past year the ability of the SARS-CoV-2 virus to increase the severity of LUTS in men with urological pathology was reported. Furthermore the development of severe urogenital symptoms (COVID-19-associated cystitis) with a high content of proinflammatory cytokines not only in blood plasma but also in urine was registered. This allows to include LUTS «de novo» in the complex of symptoms of COVID-19. Physicians should be aware of urogenital manifestations COVID-19 and include verification of bladder dysfunction to diagnostic program. Strict adherence to WHO and EAU anti-epidemic recommendations and algorithms is extremely important, so we provide online counseling to patients with symptomatic BPH, ensuring the continuity of the specialized treatment process and minimizing direct contact. The proposed method of treatment of moderate to severe BPH associated LUTS involves tamsulosin monotherapy or in combination with finasteride. The results of the use of tamsulosin hydrochloride in cases of LUTS in BPH indicate that the percentage of acute urinary retention in patients receiving monotherapy is almost similar to that when using combination therapy (tamsulosin + finasteride) and is about 7.0% per year. The obtained data suggest that the observation of patients at a distance can be justified only temporarily, but requires strict adherence to an individually designed treatment plan, which should be based on the guidelines of the Ministry of Health of Ukraine and WHO standards. The problem of BPH is a very important issue in modern medicine and requires clear treatment algorithms, with different contexts of modern realities, such as the latest data on certain links in the pathogenesis of urinary tract obstruction caused by BPH on the background of COVID-19.

Analytical Evaluation of Dried Blood Spot and Rapid Diagnostic Test as a New Strategy for Serological Community Screening for Chronic Chagas Disease.

BackgroundChagas disease is a public health problem not only in Latin America, but also in other regions, including Spain, due to migration movements. Conventional serological diagnosis requires an invasive sample (plasma or serum) and a well-equipped laboratory. To circumvent those limitations, blood samples dried on filter paper (DBS) or Rapid Diagnostic Test (RDT) could be a practical alternative to reference protocol for serological screening in epidemiological studies. We evaluated the usefulness of dried blood sampling and a rapid diagnostic test (Trypanosoma Detect™) for the detection of antibodies against T. cruzi for their use in community-based screening.Methodology/Principal FindingsA total of 162 stored paired whole-blood and serum samples from Latin American migrants and 25 negative-control blood samples were included. Diagnosis of chronic Chagas disease was performed in serum according to WHO algorithms. Blood samples were retrospectively collected as dried spots and then analyzed using two different serological techniques, enzyme-linked immunosorbent assay (ELISA) and electrochemiluminescence immunoassay (E-CLIA). Whole-blood samples were also used to evaluate a rapid diagnostic test based on immunochromatography. A better correlation with conventional serum was observed in dried blood elutes using E-CLIA than ELISA (97% vs. 77% sensitivity, respectively). Both assays reported 100% specificity. The median cut-off index values of E-CLIA for dried blood were significantly lower than those for serum (138.1 vs. 243.3, P<0.05). The Trypanosoma Detect™ test presented a sensitivity and specificity of 89.6% and 100%, respectively.ConclusionsThe detection of antibodies against T. cruzi in dried blood samples shows a higher sensitivity when using E-CLIA compared with ELISA. Trypanosoma Detect™ is easier to use but has a lower sensitivity. Hence, we propose a sequential strategy based on performing the rapid test first, and a negative result will be confirmed by DBS-ECLIA for use in community Chagas disease screening programs.

961Absolute cardiovascular disease risk scores and medication use in rural India

Abstract Background Low-to-middle-income countries (LMICs) have limited resources to tackle the burden of cardiovascular disease (CVD). Most screening guidelines recommend the use of absolute risk scoring to determine treatment, but there is uncertainty among policy makers and clinicians about which risk algorithm to choose. We aimed to compare laboratory-based absolute CVD risk algorithms in a LMIC setting. Methods The study was conducted in the Rishi Valley, Andhra Pradesh, India. Over 8,000 participants were surveyed between 2012-2015. The 10-year absolute risk was computed and compared using the Framingham, WHO, and Australian absolute risk CVD algorithms. Results In participants aged 35-74 years, 151 (3%) had prior CVD. In all algorithms, absolute CVD risk increased with age and was greater in men than women. Using the WHO algorithm 4% were characterized as high-risk while &amp;gt;29% were at high-risk using the Australian risk tool. Agreement of risk classification among men ranged from a high of 84% (Spearman’s rho (rs) =0.92) between Australian and Framingham algorithms to 43% (rs=0.6) between the Australian and WHO risk scores. Among the high-risk population, only 15% were on lipid-lowering or antihypertensive therapy. Conclusions The Framingham and Australian risk scores enable some discrimination between high- and low-risk groups. However, the WHO algorithm underestimates these high-risk groups. Even though one third of the participants were at high-risk, most of them were not receiving recommended treatment. Key messages Lab-based CVD risk assessment tools have the potential in identifying high-risk populations in LMICs but the WHO risk scoring tool should be used with caution.

970Comparison of lab-and non-lab based absolute cardiovascular disease risk scores in rural India

Abstract Background Over 75% of global cardiovascular (CVD) deaths occur in low-to-middle-income countries (LMICs). In limited resource settings non-lab-based CVD risk algorithms could be as effective as lab-based algorithms in identifying high-risk groups. We aimed to compare the concordance between lab-and non-lab-based absolute CVD risk algorithms in a LMIC setting. Methods The study was conducted in the Rishi Valley, Andhra Pradesh, India. Over 8,000 participants were surveyed between 2012-2015. The 10-year absolute CVD risk score was computed and compared using lab-and-non-lab based Framingham and WHO algorithms. Results In participants aged 35-74 years, absolute CVD risk score increased with age, and was greater in men than women, for all risk assessment tools. Using the Framingham lab-based algorithm, 15.6% were categorized as high-risk while 14.5% were at high-risk using the non-lab-based algorithm. The non-lab-based Framingham risk score had close agreement and strong correlation with the lab-based Framingham risk score in women (90%, Spearman’s rho (rs)=0.81) and men (83%, rs=0.89). Similarly, the non-lab-based WHO risk score had close agreement and strong correlation with the lab-based WHO risk score in women (95%, rs=0.83) and men (92% rs=0.84). In both cases, agreement was better in women than men (P &amp;lt; 0.05 for a two-sample test of proportions). Conclusions The effectiveness of non-lab-based Framingham and WHO algorithms are comparable to that of lab-based algorithms in discriminating high-and low-risk groups. However, the performance of non-lab-based risk score is better among women than men. Key messages Non-lab-based CVD risk algorithms could be effective and resource-efficient in LMIC settings, particularly among women.

Prognostic accuracy of emergency department triage tools for adults with suspected COVID-19: the PRIEST observational cohort study

BackgroundThe WHO and National Institute for Health and Care Excellence recommend various triage tools to assist decision-making for patients with suspected COVID-19. We aimed to compare the accuracy of triage...