Wilcoxon Matched-pairs Signed-rank Test Research Articles

Biomechanical comparison of standard-of-care endoprosthesis limb-sparing technique to a gap group with stainless steel plates and no endoprostheses in the distal radial site of dogs.

To compare the biomechanical properties of standard-of-care limb salvage stainless steel plates with metal endoprosthesis constructs to constructs without endoprosthesis. This was a cadaveric biomechanical study including 5 pairs of normal canine thoracic limbs randomly allocated into 2 groups: limbs with a second-generation, 11.5-mm Veterinary Orthopedic Implants stainless steel plate and a 122-mm stainless steel with endoprosthesis (SS-E) and limbs without endoprostheses or stainless steel with a gap (SS-G). Standard limb-spare surgery was performed and reconstructed with or without endoprostheses (ie, gap). Limbs were tested in axial loading until failure, and load-deformation curves were used to determine the biomechanical properties of the constructs, compared using a Wilcoxon matched-pairs signed-rank test. Failure modes were compared descriptively. Yield load (644 ± 523 N and 288 ± 153 N), yield energy absorbed (1,126 ± 1,695 N/mm and 239 ± 251 N/mm), and ultimate energy absorbed (39,732 ± 11,679 N/mm and 5,175 ± 878 N/mm) were significantly different between the SS-E and SS-G groups, respectively. Stiffness (360 ± 64 N/mm and 180 ± 50 N/mm) and ultimate load (3,385 ± 512 N and 747 ± 98 N) were not. The mode of failure varied between groups, with 2 SS-E constructs failing by humeral fracture and 3 by plate bending at the most distal radial or radiocarpal screw holes, whereas all SS-G constructs failed by plate bending midgap. Limbs incorporating endoprosthesis were biomechanically superior to limbs reconstructed with a gap. Limbs reconstructed with locking 11.5-mm Veterinary Orthopedic Implants plates without endoprosthesis may fail at physiological forces during trot or run.

Summer Research Internship Curriculum to Promote Self-Efficacy, Researcher Identity, and Peer-to-Peer Learning: Retrospective Cohort Study.

Common barriers to students' persistence in research include experiencing feelings of exclusion and a lack of belonging, difficulties developing a robust researcher identity, perceptions of racial and social stigma directed toward them, and perceived gaps in research skills, which are particularly pronounced among trainees from groups traditionally underrepresented in research. To address these known barriers, summer research programs have been shown to increase the participation and retention of undergraduate students in research. However, previous programs have focused predominantly on technical knowledge and skills, without integrating an academic enrichment curriculum that promotes professional development by improving students' academic and research communication skills. This retrospective pre-then-post study aimed to evaluate changes in self-reported ratings of research abilities among a cohort of undergraduate students who participated in a summer research program. The Human BioMolecular Atlas Program (HuBMAP) piloted the implementation of a web-based academic enrichment curriculum for the Summer 2023 Research Internship cohort, which was comprised of students from groups underrepresented in biomedical artificial intelligence research. HuBMAP, a 400-member research consortium funded by the Common Fund at the National Institutes of Health, offered a 10-week summer research internship that included an academic enrichment curriculum delivered synchronously via the web to all students across multiple sites. The curriculum is intended to support intern self-efficacy, researcher identity development, and peer-to-peer learning. At the end of the internship, students were invited to participate in a web-based survey in which they were asked to rate their academic and research abilities before the internship and as a result of the internship using a modified Entering Research Learning Assessment instrument. Wilcoxon matched-pairs signed rank test was performed to assess the difference in the mean scores per respondent before and after participating in the internship. A total of 14 of the 22 undergraduate students who participated in the internship responded to the survey. The results of the retrospective pre-then-post survey indicated that there was a significant increase in students' self-rated research abilities, evidenced by a significant improvement in the mean scores of the respondents when comparing reported skills self-assessment before and after the internship (improvement: median 1.09, IQR 0.88-1.65; W=52.5, P<.001). After participating in the HuBMAP web-based academic enrichment curriculum, students' self-reported research abilities, including their confidence, their communication and collaboration skills, their self-efficacy in research, and their abilities to set research career goals, increased. Summer internship programs can incorporate an academic enrichment curriculum with small-group peer learning in addition to a laboratory-based experience to facilitate increased student engagement, self-efficacy, and a sense of belonging in the research community. Future research should investigate the impact of academic enrichment curricula and peer mentoring on the long-term retention of students in biomedical research careers, particularly retention of students underrepresented in biomedical fields.

P-2066. Impact of XXB 1.5 Monovalent Booster Vaccination on Mucosal and Systemic Immune Responses in Healthy Adults

Abstract Background The FDA recently approved the first monovalent XBB1.5 booster vaccine. However, the mechanism by which this vaccine stimulates mucosal and systemic immune responses has been understudied.Figure 1.Impact of XBB 1.5 vaccination on viral neutralization titers using pseudo virus assay (left panel) and ACE2 inhibition assay (right panel).Each dot (white) represents a single serum sample tested in parallel with a post-vaccination sample (colored dot) for each of the 28 participants. The mean fold increase in neutralization titers pre- and post-vaccination are shown for Wuhan, XBB 1.5, and BA5 variants. All increases in neutralization titers are significant to P&amp;lt;0.0001 by employing Wilcoxon matched-pairs signed rank test. Methods We examined 28 participants' serum and saliva one week before and two to three weeks after the XBB1.5 mRNA vaccination for neutralizing and binding antibodies to Wuhan and XBB1.5 S protein.Figure 2:Inhibition of ACE2 binding to different S variants by saliva samples pre- and post-vaccination with XBB1.5 monovalent booster.Paired samples represent the percent ACE2 binding inhibition in participants before and after vaccination. Vaccination induced a 1.7-fold increase in ACE2 neutralization in saliva to XBB1.5 (p&amp;lt;0.0001) and 1.2-fold increase in ACE2 neutralization to Wuhan (p=0.03). Significance tested between pre and post-vaccination by Wilcoxon matched-paired sign rank test. *** p&amp;lt;0.001, **** p&amp;lt;0.0001. Results We observed a 2.9 to 2.6-fold and 5.0 to 7.8-fold increase in Wuhan and XBB1.5 serum neutralization titers following mRNA vaccination using pseudovirus and ACE2 neutralization assays respectively, that closely correlated with a rise in binding antibodies to S protein. Vaccination induced a 1.7-fold increase in ACE2 neutralization in saliva to XBB1.5 (p&amp;lt; 0.0001) and 1.2-fold increase in ACE2 neutralization to Wuhan (p=0.03). This increase in neutralization Ab levels in saliva failed to correlate with the number and time of prior COVID-19 infections, vaccination status, type of vaccine, or concomitant rise in S-specific IgA or IgG in saliva or serum. Depletion of IgA or IgG in saliva following vaccination demonstrated that IgA was primarily responsible for the increase in ACE2 blocking activity (mean reduction in blocking activity with IgA depletion=68%, range, 58-81%) compared to IgG (mean reduction=27%, range 0-71%).Figure 3.Role of IgA on percent reduction in ACE2 inhibition in saliva. Depletion of IgA or IgG in saliva following vaccination demonstrated that IgA was primarily responsible for the increase in ACE2 blocking activity (mean reduction in blocking activity with IgA depletion=68%, range, 58-81%) compared to IgG (mean reduction=27%, range 0-71%). Statistical analysis done using unpaired t test. Conclusion The XBB1.5 monovalent vaccine boosts systemic and mucosal viral neutralization antibody levels, primarily to the XBB1.5 variant. Most people have hybrid immunity to SARS-CoV2 now, so mRNA vaccines boost mucosal immune response better than observed earlier in the pandemic. Increased oral mucosal immunity may reduce the risk of COVID-19 progressing to pneumonia and more severe disease. Disclosures All Authors: No reported disclosures

93. Biomarkers of Amphotericin-Induced Complement Activation and Associated Clinical Manifestations

Abstract Background Therapeutic liposomes and lipid excipient medications are frequent causes of infusion reactions. Liposomal amphotericin B (L-AmB) is well-known to induce hypersensitivity reactions upon initial infusion. Animal models have suggested this phenomenon as secondary to a primitive immune response mediated by complements (complement activation-related pseudoallergy (CARPA). We performed a prospective study investigating the biologic response to L-AmB infusion to explore the pathophysiologic mechanism(s) responsible for infusion related adverse events.Figure 1.Day 0 C3a Concentrations C3a concentrations were elevated 5 minutes after amphotericin infusion. C3a concentrations were measured by ELISA. Statistics performed by Wilcoxon matched-pairs signed rank test, comparing samples to baseline pre-infusion measurements, p = 0.0061. Methods This is a single-center, prospective, observational, blood draw only study that includes patients 12 years of age and older who were admitted to a large academic medical center receiving initial L-AmB infusions. Excluded were those less than 12 years of age, those who had previous treatment history with L-AmB formulations, pregnant and incarcerated patients. Lab draws occurred prior to amphotericin infusion (time 0), 5 minutes after the start of infusion, and 30 minutes post-infusion. The samples were batched, transported to the lab for analysis (ELISA), and data output analyzed. The primary outcome of this study is the change in complement levels during and after amphotericin infusion.Figure 2.Day 0 SC5b-9 ConcentrationsSC5b-9 concentrations were elevated 5 minutes after amphotericin infusion and 30 minutes post infusion. SC5b-9 concentrations were measured by ELISA. Statistics performed by Wilcoxon matched-pairs signed rank test, comparing samples to baseline measurements. Pre-infusion to 5 minutes into the infusion p = 0.0061. 5 minutes into the infusion to 30 minutes post infusion p = 0.0005. Results Thirteen patients were enrolled: mean age was 54.62 (± 16.99) and 10/13 (76.92%) had a comorbidity of malignancy. Following L-AmB infusion there was a clear increase in C3a at 5 min (P = 0.0061) and 30 minutes post infusion compared to time 0. Additionally, evaluation of SC5b-9 concentrations were also significantly higher 5 min into infusion (P = 0.0398) and 30 minutes post infusion (P = 0.0005). Among enrolled patients 5/13 received pre-medication with diphenhydramine and acetaminophen 30 minutes before their infusion and correlated with complement response. Conclusion Clinical data confirms the likely mechanism of CARPA as responsible for L-AmB infusion reactions given the clear increase in C3a and SC5b-9 from baseline following infusion. These increases confirm prior findings in animal models found responsible for lipid-associated infusion reactions, and will assist in the development of future antifungal agents. Disclosures George R. Thompson, III, MD, Astellas: Advisor/Consultant|Cidara: Advisor/Consultant|Cidara: Grant/Research Support|F2G: Advisor/Consultant|F2G: Grant/Research Support|Melinta: Advisor/Consultant|Melinta: Grant/Research Support|Mundipharma: Advisor/Consultant|Mundipharma: Grant/Research Support|Pfizer: Advisor/Consultant

229. IDSA FEATURED ORAL ABSTRACT: MVA-BN Induces a Low Avidity, Non-Durable Humoral Response Against Mpox Virus

Abstract Background The 2022 global outbreak of clade IIb mpox, the first significant occurrence outside Africa, led to vaccination campaigns using the third-generation orthopoxvirus vaccine modified vaccinia Ankara, Bavarian Nordic (MVA-BN or JYENNEOS vaccine). In the US, a one-fifth dose of an intradermal regimen of the MVA-BN was authorized as a dose-sparing alternative to the two-dose subcutaneous regimen licensed in 2019. During the vaccination campaign, we launched the New York City Observational Study of Mpox Immunity (NYC OSMI) which enrolled participants who received the MVA-BN vaccine during the outbreak in NYC. Here we report the antibody data at one-year post vaccination. Methods We initiated the New York City Observational Study of Mpox Immunity (NYC OSMI), a longitudinal study involving 171 MVA-BN vaccinees, some with prior smallpox vaccination and mpox convalescents. Study participants had blood drawn prior to vaccination, after one dose, and after two doses. We performed Immunofluorescence-based Mpox virus (MPXV) clade IIb microneutralization assays, Multiplexed immunoassay for binding antibodies and avidity, and Anti-MPXV H3 Enzyme-Linked Immunosorbent Assay (ELISA). Paired measurements in figures were analyzed by Wilcoxon matched-pairs signed rank test. Comparisons of multiple sample groups in figures were conducted by Kruskal-Wallis test with Dunn’s method for multiple comparisons. Linear mixed-effects regressions (LMER) were used to model neutralizing titer durability with repeated measurements. Results Our findings indicate that neutralizing titers in naïve individuals return to baseline in less than a year, while those with prior smallpox vaccination maintain elevated titers. Both groups generate robust IgG responses against MPXV H3 and A35, but the response in naïve vaccinees, characterized by lower avidity, is short-lived. Conclusion These results highlight the necessity for further investigation into MVA-BN's long-term protection, potential need for booster doses, and the development of next-generation orthopoxvirus vaccines. Disclosures Mark J. Mulligan, M.D., HilleVax: Advisor/Consultant|Meissa Vaccines: Advisor/Consultant|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support|Sanofi: Grant/Research Support

Falling Rates of Public Orthopaedic Surgery Reimbursements and Utilization, 2016 to 2024.

Declining reimbursement rates can lead to decreased access and utilization of common orthopaedic surgeries for patients on Medicare, which is a particularly vulnerable population for musculoskeletal injuries. Using the Centers for Medicare & Medicaid Services Physician Fee Schedule Look-Up Tool from 2016 to 2024 and utilization data for Medicare and part B beneficiaries from 2016 to 2022, we analyzed reimbursement and utilization trends. Simple linear regressions were executed to measure the annual trends, and Wilcoxon matched-pairs signed rank test were used to analyze the statistical significance of price and utilization changes. Between 2016 and 2024, mean reimbursements for all evaluated orthopaedic surgeries decreased 26.2% with a -3.34% compound annual growth rate, from $1,558 to $1,150 (P < 0.0001). Comparatively, reimbursement rates for evaluation and management (E/M) services fell by 15.82% or a -1.91% compound annual growth rate, from $102.3 to $86.12 (P < 0.0021). The federal utilization of all orthopaedic surgeries fell from 2016 to 2022 (P < 0.0001), although no significant changes were seen for E/M services (P = 0.9102). We observe that Medicare reimbursement rates for orthopaedic surgeries from 2016 to 2024 have fallen consistently with a large drop in utilization, especially during the Covid-19 pandemic. Reimbursements for E/M services have fallen at attenuated rates with minimal changes in utilization. This demonstrates the supportive role that declining reimbursement rates may play in utilization and accessibility of orthopaedic surgery.

Effectiveness and safety of therapeutic plasma exchange in neurological disorders; measuring the response to treatment using Modified Rankin Scale – A single-center study

Abstract INTRODUCTION: Therapeutic plasma exchange (TPE) is commonly used as a treatment modality in varying neurological disorders. Response to TPE in neurological disorders is usually noted in “subjective” terms. We, measured response to treatment, objectively, using Modified Rankin Scale (MRS). MATERIALS AND METHODS: This was an observational prospective study in patients diagnosed with autoimmune neurological disorders (AND) who underwent TPE, in addition to intravenous immunoglobulin, and/or prednisolone. This study was carried out at a tertiary care center. Demographic data, procedure details including adverse reactions, and clinical responses were collated. Clinical response was assessed by applying MRS, in different neurological disorders, before (pre-TPE) and after TPE (post-TPE). Pre- and post-TPE clinical conditions were compared using the Wilcoxon matched-pairs signed-ranks test. RESULTS: Fifty-three patients were included, with 15 females and 38 males, who had a median age of 48 years. Seven different AND were; myasthenia gravis (n = 11), Guillain–Barre syndrome (n = 18), neuromyelitis Optica spectrum disorders (n = 6); chronic inflammatory demyelinating polyneuropathy (n = 5); autoimmune encephalitis (n = 6); transverse myelitis (n = 6); and multiple sclerosis (n = 1). Patients received a median of 5 cycles of TPE and a mean 1.5 plasma volume was exchanged. The improvement in the MRS scale was significant when post-TPE scores were compared with pre-TPE scores. The most common adverse reaction was shivering (n = 5; 1.85%), which was managed conservatively. CONCLUSION: TPE was shown to be an effective and safe treatment modality in providing relief to patients with neurological disorders.

Maxillomandibular Advancement with the Use of Virtual Surgical Planning and the CAD/CAM Technology in OSA Surgery: Volumetric Analysis of the Posterior Airway Space

Background and Objectives: Obstructive sleep apnea is an extremely diffuse pathology that, if left untreated, can lead to very serious cardiovascular consequences. The primary goal of treatment is to maintain airflow in the upper airway tract, which can be obtained thanks to orthognathic surgery such as maxillo-mandibular advancement (MMA). This procedure increases the volume of the posterior airway space (PAS)—a parameter considered fundamental in OSA physiology. However, the correlation between the degree of advancement, the volume increase, and the clinical improvement in OSA is not yet clear, even in patients who undergo virtual surgical planning. Aiming to test the correlation of these parameters and the role of PAS volume changes, we present our pre- and post-operative volumetric analysis of the PAS using cone beam computed tomography (CBCT) following CAD/CAM-assisted maxillomandibular advancement. Materials and Methods: We collected information from patients who underwent MMA for moderate or severe OSA, planned virtually with custom-made devices, between 2020 and 2022 at the Maxillofacial Surgery and Odontostomatology Unit of the Policlinico Hospital in Milan. The degree of mandibular advancement (pogonion antero-posterior advancement) was noted. All patients underwent pre- and post-operative CBCT and pre- and post-operative polysomnography to measure the Apnea–Hypopnea Index (AHI) parameters. Both exams were performed within six months before and after surgery. The surgeries were planned virtually along with the production of custom-made devices (cutting guides and mandibular osteosynthesis plates). Volumetric analysis of the PAS was performed pre- and post-CBCT images using medical segmentation software (Mimics, Materialise, Mimcs 26.0). Results: Ten patients (nine men and one woman) with a mean age of 51 years were included in this study. The mean pogonion advancement was 14.5 mm, ranging from 13.8 to 15.6. The mean pre-surgical AHI was 52.31 events/h, while the mean post-surgical AHI was 5.94 events/h (SD 5.34). The improvement in AHI was statistically significant (Wilcoxon matched-pairs signed-rank test, p value 0.004). The mean pre-surgical PAS volume was 8933 mm3, while the mean post-surgical volume was 10,609 mm3. In 8 out of 10 patients, the volume increased, with a mean increase of 2640 mm3 (max. 5183, min. 951), corresponding to a percentage increase variation ranging from 78% to 6%. In two patients, the volume decreased by 1591 (−16%) and 2767 mm3 (−31%), respectively. The difference between pre- and post-operative results was not statistically significant (paired t-test, p value 0.033). Conclusions: The results obtained confirm the efficacy of virtually planned MMA performed with custom-made devices in OSA therapy. However, they also show that PAS volume should not be used as a comprehensive parameter for OSA treatment evaluation because it does not always have a positive correlation with advancement and AHI.

Evaluation of plasma cell sorting methods in multiple myeloma patients: flow cytometry versus magnetic beads

BackgroundThe prognosis of a plasma cell neoplasm (PCN) varies depending on the presence of genetic abnormalities. However, detecting sensitive genetic mutations poses challenges due to the heterogeneous nature of the cell population in bone marrow aspiration. The established gold standard for cell sorting is fluorescence-activated cell sorting (FACS), which is associated with lengthy processing times, substantial cell quantities, and expensive equipment. Magnetic-activated cell sorting (MACS) can be performed without the need for FACS equipment and allows for rapid sorting of many cells, making it a practical alternative. Our objective is to conduct a comparative analysis of these two sorting techniques to assess whether MACS can viably replace FACS in clinical applications.MethodsPlasma cell purity, fluorescence in situ hybridization (FISH), and next-generation sequencing analyses were performed on FACS- and MACS-sorted bone marrow samples from 31 PCN patients.ResultsThe MACS-sorted samples yielded a higher percentage of plasma cells than FACS-sorted samples under microscopy (p = 0.0156) and flow cytometry (p = 0.0313). FISH performed by two methods in 10 samples showed the same results, and the proportion of abnormal cells was significantly higher in MACS than in FACS (p = 0.001). Wilcoxon matched-pairs signed rank test analysis showed that the median of differences of variant allele frequency (VAF) of two methods (VAF of MACS minus VAF of FACS) in the DNMT3A, TET2, and ASXL1 (DTA) group was − 0.006555 (p = 0.0020), while that in the non-DTA group was 0.002805 (p = 0.0019). Ten copy number variants (CNVs) were found in both FACS- and MACS-sorted samples, eight were identified only in MACS-sorted samples, and one was detected only in FACS-sorted samples.ConclusionOur study demonstrates that MACS is a viable alternative for plasma cell sorting in bone marrow samples of patients with PCN.

Immunogenicity of bivalent versus monovalent mRNA booster vaccination among adult paramedics in Canada who had received three prior mRNA wild-type doses.

Introduction. Comparative immunogenicity from different mRNA booster vaccines (directed at WT, BA.1 or BA.4/5 antigens) remains unclear. Methods. We included blood samples from adult paramedics who received three mRNA WT-directed vaccines plus a fourth dose of the following: (1) WT monovalent, (2) Moderna BA.1-WT bivalent or (3) Pfizer BA.4/5 WT bivalent vaccine. The primary outcome was angiotensin-converting enzyme 2 (ACE2) inhibition to BA.4/5 antigen. We used optimal pair matching (using age, sex-at-birth, preceding SARS-CoV-2 infection and fourth vaccine-to-blood collection interval) to create balanced groups to individually compare each vaccine type to each other vaccine (overall, within subgroups defined by SARS-CoV-2 infection and after combining BA.1 and BA.4/5 cases). We compared outcomes with the Wilcoxon matched-pairs signed rank test. Results. Overall, 158 paramedics (mean age 45 years) were included. ACE2 inhibition was higher for BA.1 compared to WT (P=0.002); however, no difference was detected between BA.4/5 vs. WT or BA.1 vs. BA.4/5. Among cases with preceding SARS-CoV-2, there were no detected between-group differences. Among cases without preceding SARS-CoV-2, the only detected difference was BA.1>WT (P=0.003). BA.1 and BA.4/5 cases combined had higher ACE2 inhibition than WT (P=0.003). Conclusion. Omicron-directed vaccines appear to improve Omicron-specific immunogenicity; however, this appears limited to SARS-CoV-2-naive individuals.

Effect of acetate- and lactate-containing intravenous fluid on acid-base status, electrolytes and plasma lactate concentration in dehydrated cats.

Acetate (ACE) and lactate (LAC)-containing balanced resuscitation fluids are commonly used for fluid therapy in cats. These fluids can influence acid-base and electrolyte status. This prospective randomised study compared two balanced crystalloid solutions regarding their effect on acid-base status, electrolytes and LAC concentrations in dehydrated cats after intravenous fluid therapy. A total of 100 client-owned cats presenting to the emergency service with dehydration ⩾5% due to diarrhoea, vomiting or anorexia were included in this study. They were randomised to receive either ACE- (Sterofundin ISO; B Braun Vet Care) or LAC-containing (Ringer-Laktat nach Hartmann; B. Braun Vet Care) fluids for rehydration. Exclusion criteria were age <6 months, severe electrolyte abnormalities, severely increased creatinine or bolus therapy, and decompensated heart disease and liver diseases. Vital parameters were assessed and venous blood gas analysis was performed before and after fluid therapy. Data were analysed using the Mann-Whitney U-test and the Wilcoxon matched-pairs signed-rank test. The significance level was set at P ⩽0.05. Post-rehydration pH normalised, and bicarbonate and base excess increased in both groups. Anion gap and LAC and potassium concentrations decreased in both groups. No difference in electrolyte, acid-base status and LAC was observed between cats receiving ACE and cats receiving LAC. Both fluids have similar effects on dehydrated cats' acid-base status and electrolyte and LAC concentrations. No significant differences in values were found between ACE- and LAC-containing resuscitation fluids. Blood LAC concentration decreased in both groups.

CT-guided Left Stellate Ganglion Cryoneurolysis for Refractory Ventricular Arrhythmias.

Background Ventricular arrhythmias (VAs), including ventricular tachycardia and ventricular fibrillation, present substantial therapeutic challenges due to their high morbidity, mortality, and increasing prevalence. Current treatments often prove infeasible or inadequate in patients with refractory VAs. Purpose To evaluate the safety and effectiveness of CT-guided left stellate ganglion cryoneurolysis (SGC) in the treatment of refractory VAs. Materials and Methods This retrospective study reviewed all consecutive patients with refractory VAs who underwent SGC between June 2020 and December 2023 at two tertiary care centers. Patients with refractory VAs who underwent CT-guided left SGC were included. No patients were excluded. Data on preprocedural clinical status, procedural approach, procedural outcomes, and adverse events were analyzed. The pre- and postprocedural number of defibrillations were compared using the Wilcoxon matched-pairs signed rank test. Results A total of 17 patients (mean age, 60.4 years ± 2.7 [standard error of the mean]; 14 male) were included; seven patients (41%) were receiving β-adrenergic blocking agents. The mean number of antiarrhythmic medications per patient was 2.2 ± 0.2. CT-guided left SGC led to a significant reduction in defibrillations, from a median of 3 (IQR, 3-15) to 0 (IRQ, 0-0) in the 24 hours before and after the procedure, respectively (P < .001). Clinical success, defined as freedom from defibrillation within the preceding 24-hour period, was achieved in 14 of 17 patients (82%) 24 hours after and 15 of 17 patients (88%) 72 hours after the procedure. Of 17 patients, 12 (71%) proceeded to additional procedural management after SGC. At a mean follow-up of 469.2 days ± 90.8, 14 of 17 patients (82%) were alive. No moderate or high-grade adverse events were observed; mild adverse events included left upper extremity neurapraxia (n = 1) and transient Horner syndrome (n = 3). Conclusion CT-guided left SGC demonstrated promising effectiveness and safety in treating patients with refractory VAs. Thus, SGC warrants consideration for inclusion in a multidisciplinary treatment algorithm for VAs. © RSNA, 2024 See also the editorial by Cadour and Scemama in this issue.

Basic ENT training for enhanced healthcare worker knowledge, attitudes and practices in a resource-limited setting: a pre-post and post-post cross-sectional study

IntroductionDiagnostic errors in ear, nose and throat (ENT) diseases are prevalent among healthcare workers (HCWs) in resource-limited settings, yet comprehensive data that describe HCW knowledge, attitudes and practices (KAP) regarding...

Digital Coaching to Address Health, Wellness, and Burnout Among Healthcare Workers: Pilot Study Results.

Healthcare worker (HCW) well-being is essential for safe, high-quality patient care, but clinicians and front-line staff continue to experience alarming rates of burnout. This pilot study evaluated a novel 6-week program of remote wellness coaching supported by daily digital messaging to reduce burnout and increase well-being among HCWs. In spring 2023, staff from a large community health center in California were invited to participate in this single-group pretest-posttest study in an academic-practice partnership. Thirty-four participants who were mostly female (91%), Latina (77%), 36 years old on average (range = 20-61), and represented all major job categories provided informed consent and completed the baseline survey. Of these, 17 completed 6 weekly 20-minute coaching sessions; received daily messages about stress management, self-care, workplace well-being, social connections, and lifestyle and health behaviors, and completed follow-up data collection. The Wilcoxon matched pair signed-rank tests assessed changes from baseline to 2-months follow-up. Self-reported burnout decreased from 59% at baseline to 35% at follow-up. Work exhaustion (p < .05), stress (p < .05) and sleep problems (p < .01) reduced significantly, and wellness practices (p < .05), moderate physical activity (p < .01), and healthy daily eating (p < .05) improved. Our pilot study suggests that a brief digital wellness program may address burnout and increase health and well-being among front-line staff and clinicians. Healthcare settings should consider this type of program for their workers, especially given the added burden of COVID-19 on the healthcare system.

Validation of a web-based dietary assessment program against 24-h recalls in adults with type 1 diabetes.

Nutrition Data is a web-based program for nutrition analysis and registration of diet and exercise. It may aid dietary assessment and carbohydrate counting in people with type 1 diabetes (T1D) but requires validation. To assess relative validity of Nutrition Data in measuring energy, carbohydrate and other macronutrient intake and evaluate the program's user acceptability, in adults with T1D. In this validation study, we analyzed data from 42 participants (median age 46.5 years, 45% women) from the DANCE study, a randomized controlled trial comprising of individuals with T1D in Sweden. Mean intakes of energy, carbohydrates, fat, protein, alcohol, fiber, sugars and saturated fat from 2 days registered in Nutrition Data were compared against the respective intakes acquired by unannounced 24-h-recalls of the same days. Paired sample t-tests and Wilcoxon matched-pairs signed rank tests were used to compare mean intakes between the two methods, and Spearman's rank correlation and Bland Altman plots were used to assess agreement between the methods. Usability and user acceptability of Nutrition Data were assessed with a questionnaire. There were no significant differences in mean dietary intakes between the two methods. Spearman's correlation coefficients ranged from r = 0.79 for energy intake to r = 0.94 for carbohydrate intake (% total energy intake) (p < 0.001 for all outcomes). The Bland-Altman plots showed no clear patterns of bias, though limits of agreement were relatively wide. Most participants found Nutrition Data easy to use (70%), helpful for carbohydrate counting (88%) and would recommend it to others (73%). The web-based program Nutrition Data showed good validity in assessing intake of energy and macronutrients compared to 24-h recalls and high user acceptability in Swedish men and women with T1D, and could, therefore, be used to facilitate diet registration and carbohydrate counting.

Abstract Su802: Feasibility of detecting CPR compression frequency using machine-learning software in video footage of CPR

Background: Several studies have demonstrated that video assisted cardiopulmonary resuscitation (V-CPR) is efficient in improving cardiopulmonary resuscitation (CPR) quality and patient outcome. However, currently the technique depends on 911 dispatchers who evaluate the video footage and may thus be subject to inter-operator variations. Research Question: We hypothesized that using an open-source machine learning supported software (“artificial intelligence” – AI) would be able to provide real-time feedback on CPR frequency in a video of CPR. Aims: To evaluate the feasibility and accuracy of a selected AI software to correctly detect the actual compression frequency in video footage of CPR performed in a CPR manikin. Methods: MediaPipe Pose Landmark Detection (Google LLC, Mountain View, CA, USA), an open-source AI software using machine-learning models to detect human body postures in images and videos, was programmed to assess compression frequency of nine videos showing CPR on a manikin, each with a different fixed compression frequency and compression depth. Camera angle and distance were standardized. Frequency was assessed from compression to compression with AI software and the manikin’s internal software (QCPR, Laerdal, Stavanger, Norway). After testing for Gaussian distribution, means were compared using Wilcoxon matched-pairs signed rank test. Results: There were high levels of agreement between compression frequencies derived from AI and manikin’s software (Statistic comparisons are presented in Figure 1, correlations of measurements are presented in Figure 2 ). Conclusions: In this pilot study, an open-source landmark detection AI software was able to assess CPR compression frequency with high agreement to actual frequency derived from a CPR manikin. Since the software used is currently not intended for medical use, further development is necessary before the technology can be evaluated for real-life CPR.

Feasibility of real-time compression frequency and compression depth assessment in CPR using a “machine-learning” artificial intelligence tool

BackgroundVideo assisted cardiopulmonary resuscitation (V-CPR) has demonstrated to be efficient in improving CPR quality and patient outcomes, as Emergency Medical Service (EMS) dispatchers can use the video stream of a caller for diagnostic purposes and give instructions in a CPR scenario. However, the new challenges faced by EMS dispatchers during video-guided CPR (V-CPR)—such as analyzing the video stream, providing feedback to the caller, and managing stress—demand innovative solutions. This study explores the feasibility of incorporating an open-source “machine-learning” tool (artificial intelligence – AI), to evaluate the feasibility and accuracy in correctly detecting the actual compression frequency and compression depth in video footage of a simulated CPR. DesignMediaPipe Pose Landmark Detection (Google LLC, Mountain View, CA, USA), an open-source AI software using “machine-learning” models to detect human bodies in images and videos, was programmed to assess compression frequency an depth in nine videos, showing CPR on a resuscitation manikin. Compression frequency and depth were assessed from compression to compression with AI software and were compared to the manikin’s internal software (QCPR, Laerdal, Stavanger, Norway). After testing for Gaussian distribution, means of non-gaussian data were compared using Wilcoxon matched-pairs signed rank test and the Bland Altman method. Main resultsMediaPipe Pose Landmark Detection successfully identified and tracked the person performing CPR in all nine video sequences. There were high levels of agreement between compression frequencies derived from AI and manikin’s software. However, the precision of compression depth showed major inaccuracies and was overall not accurate. ConclusionsThis feasibility study demonstrates the potential of open-source “machine-learning” tools in providing real-time feedback on V-CPR video sequences. In this pilot study, an open-source landmark detection AI software was able to assess CPR compression frequency with high agreement to actual frequency derived from the CPR manikin. For compression depth, its performance was not accurate, suggesting the need for adjustment. Since the software used is currently not intended for medical use, further development is necessary before the technology can be evaluated in real CPR.

An evaluation of occlusal changes during orthodontic retention

The problem of orthodontic relapse is of fundamental importance for clinicians. In the literature there are few studies concerning the change in position of the teeth after orthodontic treatment. This study analyzes the occlusal changes during the first six months of orthodontic retention and the effectiveness of the Hawley retainer at the upper arch and the canine-to-canine multi-stranded fixed retainer at the lower arch in maintaining the anterior tooth alignment. 48 patients were recruited. PAR index, ABO DI, ABO CRE, Irregularity Index, intercanine, interpremolar and intermolar widths were measured for each patient before (T0) and at the end (T1) of the fixed orthodontic treatment and after 1 (T2), 3 (T3) and 6 (T4) months of retention. Statistics used were paired samples t-test and Wilcoxon matched-pairs signed-ranks test. The p-value was considered statistically significant for P&lt;0.05. During 6 months in retention there was a worsening of PAR index (mean: 1.13±1.08; P&lt;0.001), dental alignment (median: 2.5; P=0.0001) and occlusal relationships (median: 2; P=0.0101); a statistically significant improvement of posterior occlusal contacts (median: 2.54; P=0.0004), marginal ridges (median: 0.5; P=0.0250) and interproximal contacts (median: 0.46; P=0.0305). The stability of the orthodontic results has proved to be similar for the two dental arches, as well as the effectiveness of the two retainers in maintaining the alignment of the anterior teeth. During 6 months in retention the occlusal changes were minimal and didn’t affect the stability of the orthodontic treatment in a clinically significant manner. The effectiveness of the upper Hawley retainer and the lower multi-stranded fixed retainer in maintaining the alignment of the anterior teeth was similar.

Perceptions and Outcomes of Older Adults Following a Cancer Prevention Educational Seminar

Introduction: 19.9 million new cancer cases and 9.7 million cancer deaths occurred globally in 2023. 90-95% of cancers originate from environment and lifestyle choices. Age is a prominent non-modifiable risk factor for cancer development, so it is essential that older adults are informed on lifestyle factors affecting their cancer risk. Physical therapists (PTs) play a major role in educating and advocating for healthy cancer preventive behaviors. The purpose of this study was to describe outcomes of an educational intervention relating to cancer prevention in community-dwelling older adults. Methods: Investigators developed and delivered a cancer prevention educational seminar relevant to exercise, nutrition, sleep, stress management, and skin care. Twelve adults ≥ 65 years of age completed pre and post surveys. Data were analyzed using descriptive statistics. Comparison of variables between the pre and post surveys were performed to determine intervention impact using measures of central tendency. P-values were analyzed using a Wilcoxon matched pairs signed-rank test. Significance was set at ≤ .05. Results: Statistically significant improvements in beliefs, confidence, and/or knowledge regarding prevention were noted in all topic areas. Discussion: The educational seminar demonstrated positive outcomes for older adults’ knowledge, confidence, and attitudes about healthy behaviors to prevent cancer and underscores the necessity for preventive rehabilitative services provided by PTs. Conclusion: A single-episode educational seminar on the prevention of cancer through the implementation of healthy behaviors in the domains of exercise, nutrition, sleep, stress management, and skin care can precipitate positive changes in knowledge, confidence, and perceptions of older, community-dwelling adults.

The modernisation of newborn screening as a pan-European challenge – An international delphi study

Newborn screening is a public health measure to diagnose rare diseases at birth, thereby minimising negative effects of late treatment. Genomic technologies promise an unprecedented expansion of screened diseases at low cost and with transformative potential for newborn screening programmes. However, barriers to the public funding of genomic newborn screening are poorly understood, particularly in light of the heterogenous European newborn screening landscape. This study therefore aims to understand whether international newborn screening experts share a common understanding of the barriers to fund genomic newborn screening. For this purpose, we convened 21 European newborn screening experts across a range of professions and national backgrounds in a Delphi study. Stable consensus, determined via the Wilcoxon matched-pairs signed-ranks test, was found via three consecutive survey rounds for all presented barriers. Experts generally judged the scenario of genomic newborn screening being available to every newborn in seven years to be unlikely, identifying treatability and the absence of counselling and a skilled workforce as the most significant barriers to public funding. We identify value re-definition for rare disease treatments, centralisation of genomic expertise, and international research consortia as avenues for pan-European actions which build on the consensus achieved by our Delphi panel.