Wilcoxon Matched-pairs Signed-rank Test Research Articles

Reliability and reproducibility of measurements in para-sagittal planes on sub-axial cervical vertebral bodies: a morphometric study of endplates in three-dimensional models

BackgroundDimensional measurements have been implemented on a variety of entities in morphological studies of the sub-axial cervical vertebral endplate. Despite great progress, little information between the mid-sagittal plane and bilateral uncinate processes has been acquired due to the lack of a reliable method to determine the para-sagittal planes. Also, few studies of this region are available. We proposed a new approach to defining the para-sagittal planes on a 3D cervical vertebral body model; in this approach, dimensions can be measured in a specific plane. The aim of this study was to assess the inter-observer and intra-observer reliability of the measurements in different sagittal planes on sub-axial cervical vertebral endplates of 3D models.MethodsWe established mid-sagittal and bilateral quarter para-sagittal planes on the 3D model of a sub-axial cervical vertebral body based on landmarks labeled on the surface. By intersecting the vertebral body with the planes, three curves located at the three para-sagittal planes were generated. Linear dimensions were measured on every curve by two observers separately, and in total, 24 sub-axial cervical spines were included in the study. The first observer (O1) performed the procedure twice with an interval of 2 weeks. The paired t test, Wilcoxon matched-pairs signed-rank test and the interclass correlation coefficient (ICC) were employed to evaluate the inter- and intra-observer reliability of the proposed method.ResultsThere were no significant differences in most intra- and inter-observer comparisons, and higher non-significant proportions were found in the intra-observer comparisons than in comparisons between different observers. The interclass correlation coefficients (ICCs) in the measurements were excellent (> 0.75) in most circumstances, and the values in intra-observer comparisons were higher than those in inter-observer comparisons.ConclusionsIn this study, we proposed an approach to determine the bilateral quarter para-sagittal planes in a 3D cervical vertebral body model; the results demonstrated that the method is reproducible with high intra- and inter-observer agreement.

168. Minimally invasive hydrogel nucleoplasty in a goat model of moderate severity disc degeneration

<h3>BACKGROUND CONTEXT</h3> Intervertebral disc (IVD) degeneration (IVDD) is implicated as a cause of low back pain. The earliest degenerative changes typically occur in the central nucleus pulposus (NP), where progressive loss of proteoglycans and associated hydration compromise tissue mechanical function. <h3>PURPOSE</h3> We developed a noncrosslinked injectable hydrogel for NP replacement and augmentation together with its percutaneous delivery method and instrument assembly. We then evaluated the short- and long-term performance of this hydrogel in a goat model of moderate IVDD. <h3>Methods</h3> Six goats underwent two percutaneous procedures: one to induce degeneration in 3 lumbar IVDs via injection of 1U C-ABC and, 2 weeks later, a second procedure for the delivery of hydrogel at 2 levels with the third remaining untreated. Animals were euthanized at 6 weeks (n=2) and 12 weeks (n=1); three animals are currently enrolled for long-term survival. Disc height index (DHI) was measured from monthly lateral radiographs in the standing animal. Postmortem, motion segments were imaged using microcomputed tomography (µCT) to assess hydrogel distribution and bone volume fraction values (BV/TV) for cranial and caudal endplates. Volumetric analysis and compression testing were performed on explanted gels. Samples were dried to determine polymer and water content. Explant characteristics were compared to nonimplanted gels. Histology was performed to assess glycosaminoglycans and collagen content, cellularity, and disc morphology. Significant changes in DHI were established using Wilcoxon matched-pairs signed ranks tests and differences in histological grades were established using Kruskal-Wallis test with post-hoc Dunn's tests (p<0.05). <h3>Results</h3> Animals recovered uneventfully from surgical procedures. Extrusion of hydrogel into the spinal canal during delivery occurred in two animals without major clinical repercussions. At 2 weeks after C-ABC injection, DHI was ∼80% of pre-C-ABC levels. For IVDs treated with hydrogel, DHI improved while untreated IVDs continued to degenerate. The hydrogel presents radiographically unremarkable for up to 2 years post nucleoplasty. µCT imaging demonstrated that the majority of hydrogel was localized to the central NP. BV/TV ratio of treated levels at 6-week and 12-week endpoint were similar to controls. Explant analyses showed higher elastic moduli and polymer content compared to nonimplanted gels. Treated IVDs exhibited an overall improved histological grade compared to positive controls. <h3>Conclusions</h3> The results of this work illustrate the practical utility of an injectable hydrogel being effective in normalizing the mechanical function of the degenerating IVD in a clinically relevant animal model. The implant showed successful retention without extrusion following delivery. A critical benchmark for the success of any injectable implant to treat IVDD is the normalization of mechanical properties. We demonstrate through long-term in vivo follow up studies that hydrogel injected into degenerating goat discs can preserve the spine motion segment. There is a critical need for new therapies for patients with symptomatic disc degeneration that preserve joint mobility. A minimally invasive injectable therapy mitigates anulus fibrosus trauma during nucleoplasty and may restore the biomechanics of the motion segment. Moreover, successful biomechanical restoration of the affected motion segment may slow or prevent further IVDD. Motion preservation therapies may also help mitigate adjacent level IVDD in these patient cohorts. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Multiple diagnostic tests demonstrate an increased risk of canine heartworm disease in northern Queensland, Australia

BackgroundCanine heartworm (Dirofilaria immitis) is a life-threatening infection of dogs with a global distribution. Information on the prevalence of D. immitis and associated risk factors for canine heartworm antigen positivity—and thus disease—in Australia is scarce or outdated. The current reference method for D. immitis diagnosis in dogs is via the detection of heartworm antigen in blood using commercially available microwell-based enzyme-linked immunosorbent assays (ELISAs). Heat treatment of canine plasma prior to testing has been suggested to increase test sensitivity. The aim of the current study was to estimate the prevalence of D. immitis in dogs confined to shelters in Queensland, Australia. The impact of heat treatment on antigen test results was also assessed.MethodsBlood samples (n = 166) were collected directly from dogs in seven shelters across Queensland (latitudinal span of approx. 1700 km) into EDTA blood collection tubes. A commercially available ELISA (DiroCHEK®) was used to detect canine heartworm antigen in untreated and heat-treated plasma. Whole blood was concurrently tested for the presence of microfilariae and D. immitis DNA using a modified Knott’s test and real-time PCR, respectively. Risk factors (age, gender, source, location) associated with the odds of positivity for canine heartworm were assessed using binary logistic regression models.ResultsA total of 16 dogs (9.6%; 95% confidence interval [CI]: 5.9–15.2%) were positive for canine heartworm based on combined test results. Heat treatment did not impact on the positivity of D. immitis antigen within samples (Cohen’s kappa = 0.98), but the optical density was significantly increased in paired plasma samples for D. immitis antigen-positive samples (Wilcoxon matched-pairs signed rank test, two-tailed P < 0.01). Location of the dog in a shelter in northern Queensland was the only risk factor significantly associated with the odds of a dog being more likely to be D. immitis antigen positive (odds ratio: 4.39; 95% CI: 1.26–13.51). All samples positive for the modified Knott’s test were also positive for D. immitis DNA by PCR.ConclusionsThis study demonstrated the presence of heartworm-positive dogs in shelters in Queensland, with positive animals significantly more likely to occur in northern Queensland than southern Queensland. Sustained testing for the presence of D. immitis microfilariae and antigen remain important diagnostic tools in areas with known and re-emerging canine heartworm activity.Graphical

Changed inflammatory markers after application of 4DryField PH for adhesion prevention in gynecological surgery

IntroductionThe development of peritoneal adhesions and the effects of different antiadhesion agents on such mechanisms are not fully understood. Temporary rises of the C-reactive protein (CRP) level have been reported after antiadhesion agent application. We present the changes of inflammation markers observed after use of a starch-based polysaccharide certified for adhesion prevention and hemostasis 4DF (4DryField® PH).MethodRetrospective comparative analysis of inflammation markers in 40 patients undergoing laparoscopic adhesiolysis with or without adhesion prophylaxis was conducted. Statistical comparisons were performed by means of paired or unpaired t tests (for normally distributed continuous data), Wilcoxon matched pairs signed-rank tests or Mann–Whitney tests (for not-normally distributed continuous data), Mantel–Cox tests (for continuous data describing time intervals), and Fisher’s exact tests (for discrete data).ResultsThe maximum post-operative CRP level was significantly elevated in the 4DF group (87 vs. 29%; p < 0.001), whereas leukocyte concentration and body temperature did not differ between groups. No signs of infection were detected in any of the patients and CRP levels spontaneously dropped to normal values within few days. No side effects or complications were observed in both groups. In second-look surgeries performed for other diagnoses 1–56 weeks after the first interventions, no remnants of 4DF or any peritoneal inflammatory reactions were observed.ConclusionThe starch-based polysaccharide 4DF can be considered safe and does not induce inflammatory reactions of clinical significance. Further studies regarding 4DF degradation are recommended and, apart from macrophage migration, could also examine corresponding markers such as IL-6 and PCT.

Evaluation of outcome measures for myasthenia gravis subgroups

IntroductionDisease evaluation and long-term follow-up of myasthenia gravis (MG) patients rely on disease-specific measures. We evaluated four widely used MG-specific assessments, and compared the response to disease change in different MG subgroups. MethodsWe used the Cronbach's α coefficient to test reliability, Pearson correlation coefficients to test construct validity, as well as one-way ANOVA and independent-sample t-tests to access discriminant validity. Analyses of similar items between QMG and MG-ADL included paired-sample t-tests and mean score comparisons. Pearson correlation coefficients were used to describe the correlation between changes of QMG, MG-ADL, MG-QOL15r and MGC. The Wilcoxon matched-pairs signed-ranks test was performed to compare the outcomes. Results872 MG patients were enrolled. QMG, MG-ADL, MG-QOL15r, and MGC all exhibited high reliability. All four scales displayed good discriminant validity according to the MGFA classification and MGC score. MG-ADL showed significant differences between patients grouped by age and gender, and MG-QOL15r showed significant differences between patients grouped by age. Analyses of similar items showed that MG-ADL achieved higher scores in bulbar items, whereas QMG produced higher scores in limb items. For patients in remission or minimal manifestation status, QMG exhibited significantly greater improvement than MG-QOL15r. In patients of MGFA I, II, III, and IV, QMG showed significantly greater improvement than MG-ADL. ConclusionsPatient-reported scale is an important supplement for a given period. MG-ADL has a better response to severe disease, and MG-QOL15r is more comprehensive for patients in remission or minimal manifestation status.

Provision and utilisation of health and nutrition services during COVID-19 pandemic in urban Bangladesh.

The COVID‐19 pandemic is expected to have profound effects on healthcare systems, but little evidence exists on service provision, utilisation, or adaptations. This study aimed to (1) examine the changes to health and nutrition service delivery and utilisation in urban Bangladesh during and after enforcement of COVID‐19 restrictions and (2) identify adaptations and potential solutions to strengthen delivery and uptake. We conducted longitudinal surveys with health care providers (n = 45), pregnant women (n = 40), and mothers of children <2 years (n = 387) in February 2020 (in‐person) and September 2020 (by phone). We used Wilcoxon matched‐pairs signed‐rank tests to compare the changes before and during the pandemic. Services delivery for women and children which require proximity were severely affected; weight and height measurements fell by 20–29 percentage points (pp) for pregnant women and 37–57 pp for children, and child immunisations fell by 38 pp. Declines in service utilisation were large, including drops in facility visitations (35 pp among pregnant women and 67 pp among mothers), health and nutrition counselling (up to 73 pp), child weight measurements (50 pp), and immunisations (61 pp). The primary method of adaptation was provision of services over phone (37% for antenatal care services, 44%–49% for counselling). Despite adaptations to service provision, continued availability of routine maternal and child health services did not translate into service utilisation. Further investments are needed to provide timely and accurate information on COVID‐19 to the general public, improve COVID‐19 training and provide incentives for health care providers and ensure availability of personal protective equipment for providers and beneficiaries.

Endoscopic Resection and Mucosal Reconstitution With Epidermal Grafting: A Pilot Study in Idiopathic Subglottic Stenosis.

To describe technical aspects and surgical outcomes of endoscopic resection and mucosal reconstitution with epidermal grafting (ie, the Maddern procedure) in the treatment of idiopathic subglottic stenosis. Medical record abstraction. Johns Hopkins Hospital. Retrospective series of 9 adults with idiopathic subglottic stenosis who underwent the Maddern procedure by a single surgeon over a 5-year period. Prespecified outcomes included (1) perioperative outcomes (Clavien-Dindo grade 4/5 complications, need for staged tracheostomy, hospital length of stay), (2) postoperative outcomes (peak expiratory flow rate [PEFR], need for subsequent airway surgery, tracheostomy at follow-up), and (3) patient-reported quality-of-life outcomes (Clinical COPD Questionnaire, Voice Handicap Index-10, Eating Assessment Tool-10, and 12-Item Short Form Version 2). Wilcoxon matched-pairs signed rank test and Kaplan-Meier analysis were performed. There were no Clavien-Dindo grade 4/5 complications; 2 patients required unplanned staged tracheostomy; and the median length of stay was 3 days. Following endoscopic resection and stent removal, a median of 2 laser resurfacing procedures were required. Two patients developed recurrent stenosis requiring cricotracheal resection (CTR). There were significant improvements in PEFR, Clinical COPD Questionnaire, and Voice Handicap Index-10, without significant difference in Eating Assessment Tool-10. The 12-Item Short Form Version 2 approximated the population norm. Kaplan-Meier analysis demonstrated significant improvement in time to surgery after the final laser resurfacing. The Maddern procedure has a low complication rate and offers durable physiologic improvement in PEFR, limiting need for additional procedures. Risks included need for CTR salvage, temporary tracheostomy, phlegm accumulation, and laryngospasm. It is a surgical option for patients with short dilation intervals who prefer to avoid the risks of CTR.

The Effects of Date Fruit Consumption on Breast Milk Quantity and Nutritional Status of Infants.

Background: Date fruit is a popular natural galactagogue among breastfeeding Muslim mothers. However, there is no evidence to support the effectiveness of date fruit in increasing the quantity of breast milk. Objective: This research aimed to study the effect of date fruit consumption on breast milk quantity and nutritional status of infants. Materials and Methods: This was a parallel randomized controlled trial. Forty-eight pairs of breastfeeding mothers and infants aged 1-3 months were included. The intervention group (n = 25) was asked to consume their normal dietary intake with 10 date fruits/day for 4 weeks. The control group (n = 23) was asked to consume their normal dietary intake without date fruit. Breast milk quantity was measured by using an electric breast pump and recorded for 2 days at baseline, week 2 and 4. The nutritional status of infants was assessed by calculating infant weight-for-age at baseline and week 4. Dietary data were collected at baseline, week 2, and 4, using a 2-day food record. Data were analyzed using Chi-square, t-test Mann-Whitney U test, and Wilcoxon matched-pairs signed-ranks test by SPSS version 18.0. Results: Breastfeeding mothers who received 10 date fruits/day had an 11% increase in breast milk quantity from baseline to week 2, and a 23% increase from baseline to week 4, (both p < 0.05). The breast milk quantity of the breastfeeding mothers who received date fruits was significantly higher than that of the control group (p < 0.05). However, there were no differences in infant nutritional status. Conclusions: Date fruit consumption appears to be useful for promoting and increasing breast milk quantity in breastfeeding mothers. Date fruits may be an alternative galactagogue.

Evaluation of the effect comorbid Parkinson syndrome on normal pressure hydrocephalus assessment

ObjectiveThe primary aim of the study was to assess the effect comorbid Parkinson syndromes have on results of CSF tap test (TT) and shunt outcomes for patients presenting with Normal Pressure Hydrocephalus (NPH). We hypothesized that patients with possible NPH and comorbid Parkinson syndromes with Positive DaT scans will not respond to CSF TT at the same rate as patients without comorbid Parkinson syndromes. Additionally, we followed a small number of patients with positive DaT scans who were shunted to assess long term outcome of comorbid Parkinson syndromes. MethodsMedical records and neurological exams of 251 patients were reviewed. In our analysis 101 patients with no parkinsonian symptoms and no DaT scans were included as a control group, there were 52 patients with DaT scans, 31 patients were positive (DaT-P). Gait measures were assessed before and after CSF TT using the Wilcoxon matched-pairs signed-rank test or paired t-tests were used. To compare the effect of DaT-P and Control, we used an ANCOVA controlling for age, sex, assistive device used, and past medical history effecting gait. ResultsThere was not a significant difference in response between Control and DaT-P group. The Control group improved on timed up and go (TUG) by 14.82%, DualTUG 16.35%, 10-meter Walk Test (10MWT) 18.13%, MiniBEST 15.91%, and 6-minute Walk Test (6MWT) 13.96%, while the DaT-P group improved on TUG by 14.93%, DualTUG 17.24%, 10MWT 22.68%, MiniBEST 18.07%, and 6MWT 16.06%. ConclusionOur findings suggest that patients with possible NPH and suspected comorbid movement disorder, showed similar improvement after diagnostic CSF TT compared to participants with no parkinsonian symptoms present on exam. Data availability statementData relevant to the study will be made available from the corresponding author upon a reasonable request.

Laboratory parameters related to severe disease and death in SARS-CoV-2 pneumonia: Retrospective analysis.

The clinical evolution of coronavirus disease 2019 (COVID‐19) is highly variable and hospitalized patients can rapidly develop conditions requiring oxygen support, intensive care unit (ICU) or high dependency unit (HDU) care. Early identification of high‐risk patients is mandatory. We retrospectively collected the medical history, symptoms, radiological, and laboratory findings of COVID‐19 patients hospitalized between February and April 2020. Laboratory data were collected at the first, last, and middle times of hospitalization. We used arterial oxygen partial pressure and fractional inspired oxygen ratio (P/F) to evaluate respiratory status. Outcomes considered were death and ICU/HDU admission. We used the χ 2 or Fisher's exact test to examine differences between categorical variables. Continuous variables were analyzed using the Wilcoxon matched pairs signed‐ranks test and Mann–Whitney test sample test. Of 71 patients admitted, 92% had interstitial pneumonia, and 17% an unfavorable outcome. Negative predictors were age, cerebrovascular disease, obesity, and chronic obstructive pulmonary disease. Baseline P/F was strongly associated with all outcomes. Markers linked to immunological dysregulation like elevated neutrophil‐to‐lymphocyte ratio exhibited prognostic significance over time. A validated prognostic score comprehensive of all these conditions for early staging and management of COVID‐19 patients is urgently needed. Further studies are desirable to evaluate whether laboratory tests can target early treatment in high‐risk patients.

Diameter-Based Volumetric Models May Inadequately Calculate Jugular Paraganglioma Volume Following Sub-Total Resection.

As gross total resection of jugular paragangliomas (JPs) may result in cranial nerve deficits, JPs are increasingly managed with subtotal resection (STR) with postoperative radiological monitoring. However, the validity of commonly used diameter-based models that calculate postoperative volume to determine residual tumor growth is dubious. The purpose of this study was to assess the accuracy of these models compared to manual volumetric slice-by-slice segmentation. A senior neuroradiologist measured volumes via slice-by-slice segmentation of JPs pre- and postoperatively from patients who underwent STR from 2007 to 2019. Volumes from three linear-based models were calculated. Models with absolute percent error (APE) > 20% were considered unsatisfactory based on a common volumetric definition for residual growth. Bland-Altman plots were used to evaluate reproducibility, and Wilcoxon matched-pairs signed rank test evaluated model bias. Twenty-one patients were included. Median postoperative APE exceeded the established 20% threshold for each of the volumetric models as cuboidal, ellipsoidal, and spherical model APE were 63%, 28%, and 27%, respectively. The postoperative cuboidal model had significant systematic bias overestimating volume (p = 0.002) whereas the postoperative ellipsoidal and spherical models lacked systematic bias (p = 0.11 and p = 0.82). Cuboidal, ellipsoidal, and spherical models do not provide accurate assessments of postoperative JP tumor volume and may result in salvage therapies that are unnecessary or inappropriately withheld due to inaccurate assessment of residual tumor growth. While more time-consuming, slice-by-slice segmentation by an experienced neuroradiologist provides a substantially more accurate and precise measurement of tumor volume that may optimize clinical management.

Pre-contrast T1-weighted imaging of the spinal cord may be unnecessary in patients with multiple sclerosis

ObjectivesMultiple sclerosis (MS) is an inflammatory disease frequently involving the spinal cord, which can be assessed by magnetic resonance imaging (MRI). Here, we hypothesize that pre-contrast T1-w imaging does not add diagnostic value to routine spinal MRI for the follow-up of patients with MS.Methods3-T MRI scans including pre- and post-contrast T1-w as well as T2-w images of 265 consecutive patients (mean age: 40 ± 13 years, 169 women) with (suspected) MS were analyzed retrospectively. Images were assessed in two separate reading sessions, first excluding and second including pre-contrast T1-w images. Two independent neuroradiologists rated the number of contrast-enhancing (ce) lesions as well as diagnostic confidence (1 = unlikely to 5 = very high), overall image quality, and artifacts. Results were compared using Wilcoxon matched-pairs signed-rank tests and weighted Cohen’s kappa (κ).ResultsFifty-six ce lesions were found in 43 patients. There were no significant differences in diagnostic confidence between both readings for both readers (reader 1: p = 0.058; reader 2: p = 0.317). Inter-rater concordance was both moderate regarding artifacts (κ = 0.418) and overall image quality (κ = 0.504). Thirty-one black holes were found in 25 patients with high diagnostic confidence (reader 1: 4.04 ± 0.81; reader 2: 3.80 ± 0.92) and substantial inter-rater concordance (κ = 0.700).ConclusionsAvailability of pre-contrast T1-w images did not significantly increase diagnostic confidence or detection rate of ce lesions in the spinal cord in patients with MS. Thus, pre-contrast T1-w sequences might be omitted in routine spinal MRI for follow-up exams, however not in special unclear clinical situations in which certainty on contrast enhancement is required.Key PointsAvailability of pre-contrast T1-w images does not increase diagnostic confidence or detection rate of contrast-enhancing lesions in the spinal cord of MS patients.Excluding pre-contrast T1-w sequences reduces scan time, thus providing more time for other sequences or increasing the patients’ compliance.

Speech Outcomes Following Orticochea Pharyngoplasty in Patients With History of Cleft Palate and Noncleft Velopharyngeal Dysfunction.

To report speech outcomes following Orticochea pharyngoplasty in 43 patients with cleft palate and noncleft velopharyngeal dysfunction. A retrospective surgical audit of patients undergoing Orticochea pharyngoplasty between 2004 and 2012, with speech as a primary outcome measure. Patients known to a regional UK cleft center. Forty-three patients underwent Orticochea pharyngoplasty by a single surgeon in a UK regional cleft center. Twenty-one patients had undergone a prior procedure for velopharyngeal dysfunction. Pre- and postoperative speech samples were assessed blindly using the Cleft Audit Protocol for Speech-Augmented by a specialist cleft speech and language therapist, external to the team. Speech samples were rated on the following parameters: hypernasality, hyponasality, audible nasal emission, nasal, turbulence, and passive cleft speech characteristics. Statistical differences in pre- and postoperative speech scores were tested using the Wilcoxon matched-pairs signed-ranks test. Inter- and intrareliability scores were calculated using weighted Cohen κ. Whole group: A statistically significant difference in pre- and postoperative scores for hypernasality (P < .001), hyponasality (P < .05), nasal emission (P < .01), and passive cleft speech characteristics (P < .01) were reported. Patients with cleft diagnoses: A statistically significant difference in scores for hypernasality (P < .001), nasal emission (P < .01), and passive cleft speech characteristics (P < .01) were reported for this group of patients. Patients with noncleft diagnoses: The only parameter to demonstrate a statistically significant difference was hypernasality (P < .01) in this group. Orticochea pharyngoplasty is a successful surgical procedure in treating velopharyngeal dysfunction in both the cleft and noncleft populations.

579-P: Behavioral Outcomes of a Digital Health Coaching Program Stratified by Baseline A1C: A Real-World Retrospective Analysis

Background: The 2021 ADA Standards of Medical Care suggest digital health coaching (DHC) programs can be beneficial in treating diabetes. As programs expand, it is increasingly important to understand expected benefits for diverse populations. Studies have shown greater clinical impact for patients with suboptimal baseline health, yet little is known about the influence of health on behavioral outcomes. In this real-world study, we analyzed trends in lifestyle change by baseline A1c following exposure to a T2DM DHC program. Methods: The 12-week DHC program, including patient-centered phone, email and/or text interactions, was delivered to T2DM patients. Retrospective analysis of patient reported data at baseline and program completion was conducted to evaluate impact on engagement in CDC recommended physical activity and healthy meal consumption (defined by USDA MyPlate guidelines). Outcomes were analyzed for 3 cohorts stratified by baseline A1c (&amp;lt;7% 7-9%, &amp;gt;9%) using Wilcoxon matched-pairs signed rank tests and paired proportion tests. Results: Individuals who completed all measures (n=130) were included in the study. A majority (82.30%) reported a baseline A1c ≥ 7%, and 27.69% were high-risk (A1c &amp;gt; 9%). Across all cohorts, there were significant improvements in the percent of participants adherent to CDC guidelines, median weekly activity minutes and number of healthy meals (p&amp;lt;0.01). For subgroup analyses, weekly activity minutes improved the most for the A1c &amp;lt; 7% cohort (50 minutes; p&amp;lt;0.01). Change to weekly healthy meals was greatest for those with an A1c ≥ 7%. Conclusions: Outcomes suggest that DHC can improve lifestyle behaviors among all individuals with T2DM, irrespective of baseline A1c, with those at an elevated glycemic risk reporting the greatest dietary benefit and those with the lowest risk reporting the greatest shift in physical activity. If confirmed, findings may inform DHC referral strategies and individualized behavioral goals. Disclosure M. Martin: Consultant; Self; PACK HEALTH. J. Patterson: None. V. T. Tran: None. B. B. Oconnor: Employee; Self; Pack Health. M. Allison: None. D. Patel: None.

Independent verification of treatment planning system calculations

Abstract Purpose According to the available international recommendations, at least one independent verification of the calculations of number of monitor unit (MU) is required for every patient treated by teleradiotherapy. The aim of this study was to estimate the differences of dose distributions calculated with two treatment planning systems: Eclipse (Varian) and Oncentra MasterPlan (Elekta). Materials and methods The analysis was performed for 280 three-dimensional conformal radiotherapy treatment (3D-CRT) plans with photon beams from Varian accelerators: CL 600C/D X6 MV (109 plans), CL 2300C/D X6 MV (43 plans), and CL 2300C/D X15 MV (128 plans). The mean doses in the planning target volume (PTV) and doses at the isocenter point obtained with Eclipse and Oncentra MasterPlan (OMP) were compared with Wilcoxon matched-pairs signed rank test. Additionally, the treatment planning system (TPS) calculations were compared with dosimetric measurements performed in the inhomogeneous phantom. Results Data were analysed for 6 MV plans and for 15 MV plans separately, independently of the treatment machine. The dose values calculated in Eclipse were significantly (p &lt;0.001) higher compared to calculations of OMP system. The average difference of the mean dose to PTV was (1.4 ± 1.0)% for X6 MV and (2.5 ± 0.6)% for X15 MV. Average dose disparities at the isocenter point were (1.3 ± 1.9)% and (2.1 ± 1.0)% for X6 MV and X15 MV beams, respectively. The largest differences were observed in lungs, air cavities, and bone structures. Moreover the variation in dosimetric measurements was less as compared to Eclipse calculations. Conclusions OMP calculations were introduced as the independent MU verification tool with the first action level range equal to 3.5%.

The Impact of COVID-19 on Household Food Insecurity and Interlinkages With Child Feeding Practices and Coping Strategies in Uttar Pradesh, India

ObjectivesThe Coronavirus (COVID-19) pandemic has profound negative impacts on people's lives, but little is known on the effect of COVID-19 on household food insecurity (HFI) in poor setting resources. This study aimed to assess the changes in HFI during the pandemic and examine the interlinkages between HFI with child feeding practices and coping strategies in Uttar Pradesh, India.MethodsWe conducted a longitudinal quantitative survey with 569 mothers with children <2y in December 2019 (in-person) and August 2020 (by phone). We measured HFI by using the Household Food Insecurity Access Scale and examined the changes in HFI during the pandemic using the Wilcoxon matched-pairs signed-rank tests. Wethen assessed child feeding practices and coping strategies by HFI status using multivariable regression models.ResultsHFI increased sharply from 21% to 80% before and during COVID-19, with 62% households changing the status from food security to insecurity and 17% remaining food insecure. Children belonging to newly and consistently food-insecure households were less likely to consume a diversified diet (adjusted odds ratio, AOR: 0.56, P = 0.03 and AOR: 0.45, P = 0.04, respectively) compared to those in food-secure households. Households with food insecurity were more likely to engage in coping strategies for obtaining foods including reducing other essential non-food expenditures (AOR: 1.7–2.2), borrowing money to buy food (AOR: 3.6–4.3), selling jewelry (AOR: 3.0–5.0), and spending savings or selling other assets (AOR∼2.0), all P < 0.05.ConclusionsCOVID-19 had a significant negative impact on HFI, which in turn had implications for child feeding practices and coping strategies. Our findings highlighted the need for further investment in targeted social protection strategies and safety nets as part of multisectoral solutions to improve HFI during and post-COVID-19.Funding SourcesBill & Melinda Gates Foundation through POSHAN, led by International Food Policy Research Institute; and Alive & Thrive, led by FHI Solutions.

Impacts of COVID-19 on Provision and Utilization of Health and Nutrition Services in Uttar Pradesh, India: Insights From Phone Surveys and Administrative Data

ObjectivesThe COVID-19 pandemic has significant potential implications for health systems, but little primary evidence is available on effects on health and nutrition services. We aimed to examine changes in service provision and utilization during the pandemic in Uttar Pradesh, India and identify positive adaptations to service delivery. MethodsWe conducted longitudinal surveys with frontline workers (FLW, n = 313) and mothers of children < 2 years (n = 659) in December 2019 (in-person) and July 2020 (by phone). We also interviewed block-level managers and obtained administrative data. We examined changes in service provision and utilization using Wilcoxon matched-pairs signed-rank tests. ResultsCompared to pre-pandemic, service provision reduced substantially during lockdown (83–98 percentage points, pp), except for home visits and take-home-rations (∼30%). Most FLWs (68–90%) resumed service provision in July 2020, except for immunization and hot-cooked meals (< 10%). Administrative data showed similar patterns of disruption and resumption. FLW fears, increased workload, inadequate personal protective equipment (PPE), and manpower shortages challenged service delivery. Key adaptations made to provide services included: delivering services to beneficiary homes (∼40–90%), social distancing (80%), using PPE (40–50%), and telephones for communication (∼20%). On the demand side, service utilization also reduced substantially (40–80pp) during the lockdown, but about half of mothers received home visits and food supplementation. Utilization for most services did not improve after the lockdown, bearing challenges of limited travel (30%), non-availability of services (26%), fear of catching virus when leaving the house (22%) or meeting service providers (14%). ConclusionsCOVID-19 affected the provision and use of health and nutrition services despite efforts at service restoration and adaptations. Strengthening logistics support, capacity enhancement, performance management, and demand creation are needed to improve service provision and utilization during and post-COVID-19. Funding SourcesBill & Melinda Gates Foundation through POSHAN, led by International Food Policy Research Institute; and Alive & Thrive, led by FHI Solutions.

59-OR: The Diabetes Garage: Using Automotive Maintenance Analogies to Engage Mexican-American Men to Participate in a Diabetes Self-Management and Education Program

Mexican-American (MA) men are three times more likely to have diabetes compared to non-Hispanic whites. Despite the availability of diabetes management programs, MA men are underrepresented. The CDC reports that woman (75%) disproportionately participate in diabetes programs compared to men (25%). MA men in particular, have less diabetes knowledge, are less likely to visit a diabetes specialist or adhere to treatments, and are more likely to have complications. Purpose: The Diabetes Garage (DG) is designed to engage MA men in self-management behaviors, improve glycemic and physical health outcomes. Methods: The DG was implemented 2 hours weekly/4 weeks and co-taught by CDCES and automotive technicians. Pre-posttests of self-management behaviors and physical indicators were collected at workshop 1 and at the end of workshop 4. Wilcoxon matched-pairs signed-rank tests were conducted to assess pre-post test differences in behavior (food portion/carbohydrate intake, physical activity) and paired t-tests were conducted to examine differences in health outcomes (i.e., A1c, BP, weight, waist). Results: Data from 2018-2020 (N=74) indicate 77% retention rate. Statistically significant improvements were found in self-reported food portion (Z= -2.030, p &amp;lt;.05) and carbohydrate intake (Z= -2.787, p &amp;lt;.01). Statistically significant improvements were found in systolic BP (t=2.91, mean diff=9.47, p=.01) and improvements in diastolic BP (t=1.41, mean diff=8.18, p =.176). Satisfaction surveys show that men enjoyed the workshops: “The information, the presenters, the diabetes education was totally empowering ⋯ I am looking forward to better managing my diabetes and driving my human-mobile for a long-time...with good quality of life.” Conclusion: Use of automotive maintenance analogies is a feasible approach for engaging men in diabetes management programs, self-management behaviors, and improving health indicators. Disclosure J. B. Concha: None. G. Schober: None. D. N. Portillo: None. R. F. Ruiz: None. R. Ramos: None. R. L. Romero: None. A. Lopez: None. P. Winkler: None. Funding Texas Department of State Health Services

Provision and Utilization of Health and Nutrition Services During the COVID-19 Pandemic in Urban Bangladesh

ObjectivesThe COVID-19 pandemic is expected to have extensive effects on healthcare systems. The Government of Bangladesh has concerns about diminished coverage and quality of maternal and child health services, but little published information exists on service provision, utilization, and adaptations. We examined changes to maternal and child health and nutrition service delivery and utilization in urban Bangladesh during and after the enforcement of COVID-19 restrictions and identified adaptations and potential solutions to strengthen service delivery and uptake. MethodsWe conducted longitudinal surveys with health care providers (n = 45), pregnant women (n = 40), and mothers of children < 2 years (n = 387) in February 2020 (in-person) and September 2020 (by phone). We used Wilcoxon matched-pairs signed-rank tests to compare the changes before and during the pandemic. ResultsMost services for pregnant women remained available during COVID-19 restrictions, with the provision of antenatal care (ANC) services falling by 6.6 percentage points (pp). Services for women and children which require proximity, however, were more severely affected; weight and height measurements fell by 20–29pp for pregnant women and 37–57pp for children, and child immunizations fell by 38pp. Declines in service utilization were large, including drops in facility visitations (35pp among pregnant women and 67pp among mothers), health and nutrition counseling (up to 73pp), child weight measurements (50pp), and immunizations (61pp). The primary method of adaptation was provision of services over phone (37% for ANC services and 44–49% for counselling of pregnant women or mothers with young children). ConclusionsDespite adaptations to service provisions, continued availability of routine maternal and child health services did not translate into service utilization. Further investments are needed to provide timely and accurate information on COVID-19 to the public, improve COVID-19 training and provide incentives for health care providers, and ensure availability of personal protective equipment for both providers and beneficiaries. Funding SourcesBill & Melinda Gates Foundation through POSHAN, led by International Food Policy Research Institute; and Bill & Melinda Gates Foundation, through Alive & Thrive, managed by FHI Solutions.

Effects of a Nurse’s Support for the Adolescent-led HIV/AIDS Sexual Transmission Prevention Program using Social Media

In 2019, 1.1 to 2.4 million adolescents between the ages of 10 and 19 were living with HIV worldwide. In Thailand, there were approximately 5,400 new HIV cases among children and adolescents between the ages of 10 to 19 as a result of unprotected sex. This study, using 2-group pretest-posttest and repeated measures quasi-experimental design, examined the effects of the nurse’s support for the adolescents-led HIV/AIDS sexual transmission prevention program using social media on behavioral intention and perceived effectiveness of HIV/AIDS preventive behaviors among adolescents with HIV/AIDS. The study was conducted from April 2016 to July 2017. Purposive sampling was performed to recruit 70 adolescents with HIV/AIDS. The data were collected before day 1 and after receiving the program on days 15 and 30. The program and questionnaires were validated by 3 experts. The reliabilities of the behavioral intentions and perceived effectiveness of HIV/AIDS preventive behaviors questionnaires were examined, yielding Cronbach’s alpha coefficients of 0.80 and 0.96 respectively. Data were analyzed using a Friedman-test, a Wilcoxon matched-pairs signed-rank test, and a Mann-Whitney U-test. Results revealed that there were significant differences in the overall mean ranks of behavioral intention and perceived effectiveness of HIV/AIDS preventive behaviors at the baseline, on days 15 and 30 in the experimental group (p &lt; 0.001) whereas there were no significant differences in the control group (p &gt; 0.05). There were significant differences in the mean ranks of behavioral intention and perceived effectiveness of HIV/AIDS preventive behaviors measured on days 15 and 30 between the control and experimental groups (p &lt; 0.001). Thus, nurses implementing a social media program for adolescents with HIV/AIDS may have a significantly positive impact on sexual transmission prevention.