Yr Olds Research Articles

Digital Rectal Examination Is Not a Useful Screening Test for Prostate Cancer

BackgroundAnnual digital rectal examination (DRE) is recommended as a stand-alone screening test for prostate cancer (PCa) in Germany for 45+ yr olds. DRE diagnostic performance in men as young as 45 yr old has not been proved by a screening trial. ObjectiveTo determine DRE diagnostic performance in a screening trial. Design, setting, and participantsThis analysis was conducted within the multicentric, randomized PROBASE trial, which enrolled >46 000 men at age 45 to test risk-adapted prostate-specific antigen (PSA) screening for PCa. Intervention(1) DRE was analyzed as a one-time, stand-alone screening offer at age 45 in 6537 men in one arm of the trial and (2) PCa detection by DRE was evaluated at the time of PSA-screen–driven biopsies (N = 578). Outcome measurements and statistical analysis(1) True-/false-positive detection rates of DRE as compared with PSA screening and (2) DRE outcome at the time of a prostate biopsy were evaluated. Results and limitations(1) A prospective analysis of 57 men with suspicious DRE at age 45 revealed three PCa. Detection rate by DRE was 0.05% (three of 6537) as compared with a four-fold higher rate by PSA screening (48 of 23 301, 0.21%). The true-positive detection rate by DRE relative to screening by PSA was 0.22 (95% confidence interval [CI] = [0.07–0.72]) and the false-positive detection rate by DRE was 2.2 (95% CI = [1.50–3.17]). (2) Among PSA-screen–detected PCa cases, 86% had unsuspicious DRE (sensitivity relative to PSA was 14%), with the majority of these tumors (86%) located in the potentially accessible zones of the prostate as seen by magnetic resonance imaging. ConclusionsThe performance of stand-alone DRE to screen for PCa is poor. DRE should not be recommended as a PCa screening test in young men. Furthermore, DRE does not improve the detection of PSA-screen–detected PCa. Patient summaryOur report demonstrated the poor diagnostic performance of digital rectal examination in the screening for prostate cancer in young men.

1264-P: Trends in Incidence and Prevalence of CFRD from the U.S. Cystic Fibrosis Foundation Patient Registry (CFFPR)

Intro: The US CFFPR includes data from ~30,000 individuals with cystic fibrosis (CF). We aimed to examine trends in incidence and prevalence alongside screening rates of cystic fibrosis related diabetes (CFRD) from 2003-2018. Methods: Prevalence of CFRD was defined as the percent of patients with CFRD in the registry in a given year. Annual incidence of CFRD was calculated as the number of new diagnoses per 1,000 person-years. Annual screening rates were defined as the percent of individuals without CFRD who underwent an oral glucose tolerance test (OGTT). Individuals <10 years were excluded, and data were grouped by age decade. Results: (Table 1) CFRD screening rates increased from 2003-2018, particularly in 10-18 yr olds. Although screening rates increased in adults as well, overall rates remain low. In 10-18 yr olds, the incidence of CFRD did not increase, and incident cases in adults decreased. The prevalence of CFRD is gradually increasing in adults. Conclusions: Despite increased screening, the incidence of CFRD is stable or declining. CFRD prevalence is steadily rising in older adults. Screening rates and trends in CFRD incidence support a need for revised and potentially targeted screening algorithms. With increasing longevity in people with CF and rising prevalence of CFRD, there is great need for more specialists trained to care for a growing population of adults with CFRD. Disclosure C.L.Kohler: None. T.B.Vigers: None. C.Sakamoto: None. A.Moran: Advisory Panel; Abata Therapeutics, Dompé, Other Relationship; Novo Nordisk, Research Support; Abbott Diabetes. S.Sagel: None. C.L.Chan: None.

#4146 LIMITATIONS AND UNCERTAINTIES OF ASSESSING AND MANAGING OLDER PATIENTS WITH ANCA ASSOCIATED VASCULITIS

Abstract Background and Aims ANCA associated vasculitis (AAV) has a peak incidence in 65 -74 yr olds. As a result, it affects an ageing population who are vulnerable to co-morbidities, polypharmacy and frailty. Due to the high burden of morbidity and mortality in these patients, it is increasingly recognised that individualised management is needed. Whilst current immunotherapies are effective, there remains caution in treating older patients due to the potential risks. Yet despite AAV being a condition that predominantly affects older people, few studies have looked specifically at the benefit of treating AAV in such age groups, or at frailty assessments tools to guide treatment. Method We aimed to evaluate treatment outcomes in older AAV patients, as well as frailty assessment tools to aid prognostication and management. A cohort study evaluating outcomes of induction immunosuppression in patients ≥75yrs was constructed from 2 centres, with subsequent meta-analysis of published data [1]. In addition, studies identifying frail patients, who may be at risk of adverse outcomes, were carried out using the quantitative tools; Hospital Frailty Risk Score (HFRS) [2] and the Clinical Frailty Scale (CFS). Primary outcomes were mortality and end stage kidney disease (ESKD). The HFRS was calculated using hospital coding data from any hospital admissions between a patient's AAV diagnosis to 2yr follow up. Patients were categorized into low, intermediate and high HFRS groups. CFS scores at presentation were documented prospectively and then repeated a minimum of 6 weeks from diagnosis. A CFS score of ≥5 was used to categorise frailty. Differences in the scores were assessed and compared to clinical outcomes. Results Retrospective analysis of our AAV cohort aged ≥75 yrs demonstrated that induction immunosuppression was associated with a significant reduction in the 2yr mortality risk [HR 0.29 (95% CI 0.09–0.93)]. Following systematic review, with a study population of 290 patients, the pooled HR by meta-analysis confirmed a significant reduction in the risk of death with induction treatment [HR 0.31 (95% CI 0.16 - 0.57)]. Treated patients had a lower rate of ESKD, but this was not statistically significant [HR 0.71 (95% CI 0.15 – 3.35)]. Looking separately at frailty assessments, mortality and ESKD were assessed according to HFRS and CFS. Thirty-four patients with AAV aged ≥75 yrs were assessed using HFRS and categorised into the low (n = 18), intermediate (n = 13) and high (n = 3) HFRS groups. All patients in the high HFRS groups had ≥1 episodes of hospitalization after diagnosis of AAV. However, there was no difference in mortality or duration of hospitalisation between the 3 categories. Forty-one patients with AAV aged ≥65yrs were assessed using the CFS. The median CFS at diagnosis and follow-up was 4. There was no significant interval change in CFS (P = 0.16) suggesting that patients did not become frailer. Instead, there was a tendency towards improved frailty scores at reassessment (n = 17, 43%), with some patients going from a CFS of 6 (moderately frail) to 3 (managing well). There was no significant difference in ESKD between those categorised as frail and non-frail (P = 1.0), although crude mortality was higher among those initially categorised as frail (P = 0.03). Conclusion Our research shows that older patients with AAV benefit from standard remission-induction therapy and those treated had favourable mortality outcomes compared to those who were not. Furthermore, frailty assessment tools do not correlate clearly with clinical outcomes. Whilst there is evidence to support the use of HFRS and CFS in a many diseases, its utility in determining frailty and potential susceptibility to adverse effects of therapy in patients with multifaceted, autoimmune inflammatory disease remains limited. Patients may present ‘frail’ as a result of significant disease burden, which has the potential to improve with appropriate treatment. We suggest that age alone and frailty at assessment should not be a limiting factor when considering treatment and prospective studies of this population are needed.

Sound sensitivity of the giant scallop (Placopecten magelanicus) is life stage, intensity, and frequency dependent.

There is increasing concern that anthropogenic sounds have a significant impact on marine animals, but there remains insufficient data on sound sensitivities for most invertebrates, despite their ecological and economic importance. We quantified auditory thresholds (in particle acceleration levels) and bandwidth of the giant scallop (Placopecten magellanicus) and subsequently sought to discern sensitivity among two different life stages: juveniles (1 yr olds) and subadults (3 yr olds). We also leveraged a novel valvometry technique to quantify the amplitude of scallop valve gape reductions when exposed to different sound amplitudes and frequencies. Behavioral responses were obtained for lower frequencies below 500 Hz, with best sensitivity at 100 Hz. There were significant differences between the auditory thresholds of juveniles and subadults, with juveniles being more sensitive, suggesting ontogenetic differences in hearing sensitivity. Scallops showed intensity and frequency dependent responses to sounds, with higher valve closures to lower frequencies and higher sound levels. To our knowledge, these are the first data highlighting life stage, intensity, and frequency responses to sound in a marine benthic invertebrate. These results demonstrate clear sound sensitivity and underscore that the potential impacts of anthropogenic sound in valuable ecological resources, such as scallops, may be dependent on sound characteristics.

First demographic parameter estimates for the Mediterranean monk seal population at Madeira, Portugal

We provide the first comprehensive demographic assessment of the Endangered Mediterranean monk seal Monachus monachus population residing in the Madeira Archipelago to identify factors that may impede population growth. Encounter data was obtained for this small, elusive population from 2012 to 2021 using a variety of non-invasive methods. From birth to age 2 mo, when pups molt, survival averaged 0.57. From birth to 1 yr and from 1-2 yr, estimated survival rates were 0.47 and 0.85, respectively. Beyond 2 yr, survival estimates differed by sex: 0.98 for females and 0.90 for males. These survival rates are similar to published estimates from the Cabo Blanco (Western Sahara/Mauritania) population. This is remarkable given that Cabo Blanco is situated adjacent to the extremely productive Canary Current system, whereas the marine environment of Madeira is far less productive. Instead of reducing survival, low marine productivity in Madeira appears to manifest in strikingly depressed reproductive rates. We estimated a mean gross reproductive rate of just 0.31; less than half the value (0.71) reported for Cabo Blanco. The youngest parturient females in Madeira were 6 yr old, whereas 3 yr olds give birth at Cabo Blanco. Despite low fecundity, the monk seal population in Madeira has been recovering, aided by a series of conservation measures implemented since 1988. Our results document that abundance increased from 19 seals in 2013 to 27 in 2021. Despite this undeniable success, the monk seals of Madeira remain vulnerable and require continued monitoring and protection in order to persist.

Adolescent-specific memory effects: evidence from working memory, immediate and long-term recognition memory performance in 8-30 yr olds.

Working memory and recognition memory develop across adolescence, but the relationship between them is not fully understood. We investigated associations between n-back task performance and subsequent recognition memory in a community sample (8-30 yr, n = 150) using tasks from the Adolescent Brain Cognitive Development Study (ABCD Study) to cross-sectionally assess memory in an age range that will be sampled longitudinally. We added a 24-h delay condition to assess long-term recognition. Overall working memory, immediate and long-term recognition performance peaked in adolescence. Age effects in recognition memory varied by items (old targets, old distractors, and new items) and delay (0 and 24 h). For immediate recognition, accuracy was higher for targets and new items than for distractors, with accuracy for targets peaking in adulthood and accuracy for new items peaking during adolescence. For long-term recognition, adolescents' accuracy was higher for targets than distractors, while adults showed similarly high accuracy for targets and distractors and children showed low accuracy for both. This pattern appeared to be specific to recognition of items from the high working memory load condition. The results suggest that working memory may facilitate long-term recognition of task-relevant over irrelevant items and may benefit the detection of new information during adolescence.

Seroprevalence of CMV in Women with Bad Obstetric History in Babil/Iraq

Placental dysfunction and or fetal central nervous system infestation caused by Human cytomegalovirus (HCMV) is the leading cause of congenital non-genetic neuro-developmental problems of the newborn, worldwide. Although the highest rates of congenital infection and CMV seroprevalence occurs in developing countries like Iraq, there remains a paucity of data from that part of the world. This descriptive case control study was undertaken in Babylon/ Iraq to determine the local seroprevalence of CMV in women of child bearing age, and to identify the socio-demographic factors associated with it. This study found a seropositivity peak amongst the 26-35 yr olds which declined in the 36 – 45 yr olds. However, the evidence of current infection was stable at 25% among the 26-35 yr olds and the 36 – 45 yr old women. Overall seropositivity was at 77.32%, a susceptibility rate was at 22.68%, and seropositivity for IgG was highest among the educated, those living in overcrowded settings, and those with poor obstetric histories. Our study concludes that CMV screening of women in the Al Hamza district in Babylon/Iraq and the availability of advice on how to prevent the infection can be beneficial for health outcomes. 

Changes in paediatric respiratory infections at a UK teaching hospital 2016–2021; impact of the SARS-CoV-2 pandemic

Objective To describe the impact of the SARS-CoV-2 pandemic on the incidence of paediatric viral respiratory tract infection in Oxfordshire, UK.Methods Data on paediatric Emergency Department (ED) attendances (0–15 years inclusive), respiratory virus testing, vital signs and mortality at Oxford University Hospitals were summarised using descriptive statistics.Results Between 1-March-2016 and 30-July-2021, 155,056 ED attendances occurred and 7,195 respiratory virus PCRs were performed. Detection of all pathogens was suppressed during the first national lockdown. Rhinovirus and adenovirus rates increased when schools reopened September-December 2020, then fell, before rising in March-May 2021. The usual winter RSV peak did not occur in 2020/21, with an inter-seasonal rise (32/1,000 attendances in 0–3 yr olds) in July 2021. Influenza remained suppressed throughout. A higher paediatric early warning score (PEWS) was seen for attendees with adenovirus during the pandemic compared to pre-pandemic (p = 0.04, Mann-Witney U test), no other differences in PEWS were seen.Conclusions SARS-CoV-2 caused major changes in the incidence of paediatric respiratory viral infection in Oxfordshire, with implications for clinical service demand, testing strategies, timing of palivizumab RSV prophylaxis, and highlighting the need to understand which public health interventions are most effective for preventing respiratory virus infections.

Age (≤75 years) and Not Choice of First-Line Therapy Improves Overall Survival in Transplant Ineligible NDMM Patients: Results from a Large UK Real-World Dataset

BackgroundUK standard of care for transplant-ineligible (TNE) newly diagnosed multiple myeloma (NDMM) patients is fixed duration therapy (FDT) for the first two lines of treatment, which usually consists of 6-8 cycles of either a bortezomib (BOR) or thalidomide (THAL) based regimen. Treatment objective for this patient group is disease control whilst maintaining quality of life (QoL), which translates into improved survival. QoL is often reported to be better during treatment free intervals (TFI). TNE MM patients are under-represented in clinical trials owing to a combination of personal choice, poor performance status (PS), and co-morbidities. We performed a retrospective analysis in TNE NDMM patients to evaluate the influence of age and choice of upfront therapy on clinical outcomes. We quantified treatment free interval (TFI), in real world practice where FDT is used.Methods218 TNE NDMM patients treated between 2009-2017 within Thames Valley Cancer Network (UK) were eligible for inclusion. Data was collected from the chemotherapy database and patient records. Primary outcome was overall survival (OS) and the secondary outcomes were progression-free survival (PFS), time to next treatment (TTNT), TFI and response rates for the total cohort. Subgroup analyses were performed based on first line treatment: thalidomide-based (THAL) vs. proteasome inhibitor-based (PI), and age at presentation: ≤75 yrs vs. >75 yrs. Differences between subgroups were tested using an unstratified log-rank test. Medians and Cox hazard ratios (HR), with 95% confidence intervals (CIs) were calculated and Kaplan-Meier survival estimates are presented. Response rates were recorded as per IMWG consensus criteria.ResultsAt start of first line therapy, median age was 75.2 years (IQR: 68-81), ≤75: n=106, >75: n=112, male 60%, and ISS stage (I: 17%, II: 16%, III: 48%, unknown: 19%), serum creatinine ≥ 140micromol/L was recorded in 30% of patients. Upfront therapy was THAL: 58%, PI: 22%, alkylator-based: 12%, lenalidomide-based: 8%. Treatment was delivered as a triplet regimen in 62.4% of the total cohort of patients, and as a doublet in 37.6%. Patient numbers within treatment subgroups were: THAL: n=126, PI: n=49. Median follow-up for the total cohort was 23months (IQR 10.8-44.4). Median length of upfront FDT was 4.6 months (IQR: 2.7-5.7). Overall response rate (ORR) for first-line therapy in all patients was 69%, with responses categorised as CR: 24%, VGPR: 14%, PR: 31%, SD: 12%, PD: 8% and unknown 11%. No difference in OS and PFS was noted between sexes. Both gender distribution and therapy proportions (doublet, triplet) were comparable across the 2 age groups: ≤75 (61% M, 39% F, doublet 34%, triplet 65%), >75 (59% M, 41% F, doublet 35%, triplet 65%). THAL group (58% M, 42% F), PI group (55% M, 45% F). ORR between subgroups was as follows: (THAL: 75% vs. PI: 80%) and (≤75: 76% vs. >75: 63%). Patients aged ≤75 showed a statistically significant improvement in OS and PFS compared to those >75: OS (49.0 vs. 22.5 months, p<0.0001, HR: 2.19, 95% CI: 1.53-3.14), PFS (10.8 vs. 7.6 months, p<0.001, HR: 1.66, 95% CI: 1.23-2.24). Survival rates at 1 year and 2 years between ≤75 and >75 were (80.9% vs. 77.4%) and (66.8% vs. 44.6%) respectively. Differences in OS and PFS were not statistically significant between the THAL and PI subgroups: OS (33.0 vs. 31.3 months, p=0.957, HR 1.01, 95% CI: 0.66-1.56), PFS (9.2 vs. 8.7 months, p=0.366, HR 1.18, 95% CI: 0.82-1.70). Difference in TTNT was not statistically significant between ≤75 vs. >75 (18.6 vs. 18.3 months, HR: 1.29, 95% CI: 0.91-1.82) and between THAL vs. PI (18.6 vs. 20.2 months, HR 0.91, 95% CI: 0.61-1.38). The longest TFI during FDT was following first-line therapy with a median of 6.9 months (IQR: 1.4-18.0, n=141), reducing after second line therapy to 2.3 (IQR: 0.7-6.6, n=71), and after third line therapy to 0.7 (IQR: 0.2-2.1, n=26).ConclusionThis large real-world data study showed significantly improved OS and PFS for patients aged ≤75 compared to those >75 yrs, whilst choice of therapy (THAL or PI) had limited impact, when evaluated as individual factors. Survival benefit in <75 yr olds emerges after the first year suggesting that relapse related morbidity/mortality has an impact on survival. Clinically meaningful TFI was only recorded after first line FDT. This data suggests that a continuous therapeutic approach with manageable toxicities may be more appropriate in TNE myeloma patients. [Display omitted] DisclosuresDjebbari:Takeda: Honoraria; Celgene: Honoraria, Other: Educational Grant.. Sharpley:Celgene: Other: Educational Grant . Ferguson:Takeda: Honoraria; Celgene: Honoraria, Other: Educational Grant. McLain-Smith:pH Associates: Other: employee of pH Associates; carried out data analysis and provided medical writing support. Ramasamy:Celgene: Honoraria, Other: Research Grant; Janssen: Honoraria, Other: Research Grant.

774-P: Fully Integrated Medical and Psychological Intervention for T1D Self-Management in Adolescents: Trial Design and Baseline Characteristics

There is an urgent need to address medical and psychosocial needs of adolescents with T1D. Baseline sample characteristics and study progress data are presented from a combined in-person/telehealth RCT using multiphasic optimization strategy (2x2 factorial design) to improve A1C in 10-17 yr olds (≥1 A1C 9-12% in prior yr). During Phase 1, 88 adolescents (target N=100) with T1D (Mage=14.5 yrs; 50% female; 79.5% White, 10.2% Hispanic; 76.1% insulin pump) were randomized to Enhanced Standard Care (Medical visit only every 6 weeks) or Integrated Medical/Psychology (Enhanced Standard Care+Personalized Adherence Feedback Report). During Phase 2 (6-mo visit; N completed=75) all adolescents are re-randomized to another 6 months of intervention every 6 weeks: Enhanced Standard Care or Integrated Medical/Psychology (Enhanced Standard Care+Problem-Solving). During Phase 3 (12-mo visit; N complete=50), psychology support is withdrawn; participants are randomized to Enhanced Standard Care (Medical visit only every 6 weeks) or Standard Care (Medical visit only every 3 months) for 6 months). Adolescents and caregivers download devices and complete psychosocial questionnaires at visits (Table; no statistically significant group differences). N=25 completed the study (18-month visit) and 5 withdrew (94% retention to date); data collection is ongoing. Disclosure H. ODonnell: None. G.T. Alonso: None. T. Gomer: None. S. Majidi: Advisory Panel; Self; Companion Medical. J.K. Snell-Bergeon: Stock/Shareholder; Self; GlaxoSmithKline plc. T. Reznick-Lipina: None. R. Wadwa: Advisory Panel; Self; Eli Lilly and Company, Medtronic. Research Support; Self; Dexcom, Inc., Eli Lilly and Company, MannKind Corporation, Medtronic, Novo Nordisk Inc., Tandem Diabetes Care. K.A. Driscoll: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (DP3DK113363)

Modeling Nutrient Intakes for Current and Revised Daily Values of Children and Teens (4–18 Years) in the United States Population

Abstract Objectives In 2016, the United States (US) Food and Drug Administration updated the Daily Values (DVs) on the Nutrition Facts Label for packaged foods and beverages. Implementation of these changes is required by manufacturers in 2020–2021. This study modeled the possible impact of these changes on nutrient intake of children and teens from intrinsic and fortified food sources. Methods We used data from the 2009–2012 National Health and Nutrition Examination Survey (NHANES) with the International Life Sciences Institute, North America Fortification Database, which identifies intrinsic, enriched, and fortified sources of nutrients in foods and beverages. In our sample of 5155 children and teens aged 4–18 yrs, we determined the usual intake (UI), % UI &amp;lt; the Estimated Average Requirement (% &amp;lt;EAR), and % ≥the Tolerable Upper Limit (% ≥ UL) based on the current DVs. We modeled estimated UI, % &amp;lt;EAR and % ≥ UL using the updated DVs for 10 micronutrients with the assumption that fortified food products will be reformatted to maintain current % DV claims. UI was based on two 24-hr recalls. Results Comparison of models of the current versus updated DVs overall, demonstrated increases in the UI for vitamins C, D and calcium; a decrease for vitamins A and B12; slight decreases for niacin, zinc and vitamin B6; and little change for thiamin and riboflavin. Conversely, the % &amp;lt;EAR increased for vitamins A, B6, B12 and zinc; slightly increased for thiamin, riboflavin and niacin; and decreased for calcium, vitamins C and D. The % ≥ UL decreased for zinc (20%), niacin (38%) and vitamin A (65%) and remained unchanged for other nutrients studied. Modeling of the % &amp;lt;EAR indicated that teens 14–18 yrs could be severely deficient in vitamins A, C and D. The updated DV helped mitigate this deficiency for vitamins C and D, but worsened it for vitamin A. Younger children (4–8 yrs) had the greatest impact in UI from the revised DV for vitamin C. Conclusions In 4–18 yr olds, our modeling predicts reductions in overall vitamin A intake, a recognized “shortfall nutrient”, with an especially large increase in % &amp;lt;EAR for teens 14–18 yrs. Teens at greatest risk are those currently dependent upon vitamin A fortified foods. Funding Sources This work was supported by the International Life Sciences Institute (ILSI) North America Fortification Committee. ILSI North America is a public, nonprofit science foundation.

Modeling arterial pulse waves in healthy aging: a database for in silico evaluation of hemodynamics and pulse wave indexes.

The arterial pulse wave (PW) is a rich source of information on cardiovascular (CV) health. It is widely measured by both consumer and clinical devices. However, the physical determinants of the PW are not yet fully understood, and the development of PW analysis algorithms is limited by a lack of PW data sets containing reference CV measurements. Our aim was to create a database of PWs simulated by a computer to span a range of CV conditions, representative of a sample of healthy adults. The typical CV properties of 25–75 yr olds were identified through a literature review. These were used as inputs to a computational model to simulate PWs for subjects of each age decade. Pressure, flow velocity, luminal area, and photoplethysmographic PWs were simulated at common measurement sites, and PW indexes were extracted. The database, containing PWs from 4,374 virtual subjects, was verified by comparing the simulated PWs and derived indexes with corresponding in vivo data. Good agreement was observed, with well-reproduced age-related changes in hemodynamic parameters and PW morphology. The utility of the database was demonstrated through case studies providing novel hemodynamic insights, in silico assessment of PW algorithms, and pilot data to inform the design of clinical PW algorithm assessments. In conclusion, the publicly available PW database is a valuable resource for understanding CV determinants of PWs and for the development and preclinical assessment of PW analysis algorithms. It is particularly useful because the exact CV properties that generated each PW are known.NEW & NOTEWORTHY First, a comprehensive literature review of changes in cardiovascular properties with age was performed. Second, an approach for simulating pulse waves (PWs) at different ages was designed and verified against in vivo data. Third, a PW database was created, and its utility was illustrated through three case studies investigating the determinants of PW indexes. Fourth, the database and tools for creating the database, analyzing PWs, and replicating the case studies are freely available.

Trends in Management of Cerebrospinal Fluid Leaks Among Pediatric Head Trauma Patients With Skull Base Fractures

Abstract INTRODUCTION Cerebrospinal fluid (CSF) leaks occur in association with skull base fractures (SBF) among head-trauma patients. Using a national database, management trends of CSF-leaks associated with SBF in pediatric patients were examined. METHODS Weighted data were analyzed from the Nationwide Inpatient Sample 2000-2014 and all pediatric head-trauma patients having a diagnosis of SBF identified. Injury severity was mapped using the Abbreviated Injury Severity (AIS) scale and categorized as mild: AIS &lt; 3, moderate: AIS = 3, and severe: AIS &gt;3. Trends over time and across 5-yr age groups were examined at a significance level of P &lt; .05. RESULTS A total of 699 173 SBF cases were diagnosed, representing 23.25% of all pediatric head-trauma cases. The majority were closed-SBF (93.14%) and involved male patients (68.60%), and mean patient age was 11.25 yr (SD = 6.49). The median AIS-injury score was 3.0. Severe TBI was more common among 15 to 19 yr olds (P &lt; .001). Overall, CSF-leaks occurred in 2.10%, were more common in older children versus under-5 yr olds (P &lt; .05), and were mostly managed conservatively with fewer patients requiring duraplasty (8.48%) and/or lumbar-drain placement (9.54%). The requirement for nonconservative management, including duraplasty (OR = 5.53; 95% CI = 1.58–19.37; P &lt; .001) and lumbar-drain placement (OR = 2.64; 95% CI = 1.06–6.60; P = .03), was higher among 15 to 19 versus under-5 yr olds. The risk of bacterial meningitis in patients with CSF-leaks was slightly increased among under-5 yr olds compared to older children (P &lt; .05). In-patient mortality associated with SBF was 4.68%, was higher among 15 to 19 versus under-5 yr olds (6.55% vs 3.44%, P &lt; .001) and in open versus closed SBF (16.07% vs 3.84%, P &lt; .001), and decreased significantly across time from 5.09% in 2000 to 3.75% in 2014 (P &lt; .001). The decline in mortality seen across all age groups was significant only in under-5 and in 15 to 19 yr olds (P = .02 and .03, respectively). There was no increased mortality associated with CSF-leaks (P = .65). CONCLUSION CSF-leaks occurring among pediatric head-trauma patients are mostly managed conservatively. Younger children may be at an increased risk of meningitis following CSF-leaks.

Outcomes and Risks With Age in Spondylolisthesis: A Comparison of the Elderly From the Quality Outcomes Database

Abstract INTRODUCTION Degenerative lumbar spondylolisthesis affects 3% to 20% of the population with an increasing incidence of up to 30% in the elderly. The impact of age on surgical complication and patient reported outcomes (PRO) have yet to be evaluated in a modern, multicenter study. METHODS The Quality Outcomes Database (QOD) multicenter, prospective registry was used to evaluate patients from 12 US centers, including academic and private institutions, between July 2014 and June 2016 who underwent surgical treatment for grade 1 lumbar spondylolisthesis. All patients received at least 12 mo of follow-up RESULTS A total of 608 patients were divided into &lt; 60 (n = 239), 60 to 70 (n = 209), 71 to 80 (n = 128), and &gt; 80 (n = 32) categories. Older patients showed lower body mass index (BMI) (P = .00001), increased diabetes (P = .007), coronary artery disease (P = .0001), and osteoporosis (P = .005). A lower likelihood for home disposition was seen with the elderly (89.1% in &lt; 60 yr olds vs 75% in &gt; 80 yr olds), with more elderly patients discharged to skilled nursing facilities or rehabilitation (P = .002). No baseline differences in PROs (Oswestry Disability Index [ODI], EQ-5D [EuroQol healthy survey], Numeric Rating Scale for leg pain [NRS-LP] and back pain [NRS-BP]) were seen among age categories. A significant improvement for all QOLs was seen regardless of age (P &lt; .05). Minimal clinically important differences (MCID) in QOLs were seen after surgery for all age groups. No differences in hospital readmissions (30-d, 3-mo) or reoperations (30-d, 1-yr, 2-yr, and 3-yr) were seen among age groups (P &lt; .05). CONCLUSION Despite increased presurgical comorbidities and risk, well-selected elderly patients undergoing surgical treatment of grade 1 spondylolisthesis can achieve meaningful outcomes without increases in complications or readmission. However, PRO do not improve to the same degree in the elderly as in younger adults. This modern, multicenter US study reflects the current use and limitation of spondylolisthesis treatment in the elderly, which may be informative to patients and providers.

Autonomic Activity in Overweight-Obese Children During the Morning Transition in Cardiac Circadian Regulation (P21-065-19)

ObjectivesRegulation of the autonomic nervous system is disturbed in obese children and adults. This dysregulation—which includes sympathetic nervous system (SNS) over activity and disruption of cardiac circadian rhythms—is of interest because of the negative impact of these effects on cognition, regulation of energy homeostasis, cardiovascular health, and metabolic functions. The present study evaluated heart rate (HR) measures during the first hours following awakening from sleep when circadian cardiac control transitions from an emphasis on parasympathetic nervous system activity (PNS) during sleep to an emphasis on SNS activity during wakefulness. MethodsResting HR recordings (5 min) were obtained from healthy normal weight (NW: BMI < 85th %ile; n = 47; 25 boys) and overweight-obese (OB: BMI > 95th %ile; n = 48; 24 boys) 10 yr olds enrolled in the ACNC’s Brain Food study. The first of two recording sessions (T1) took place 2 hrs after awakening (1 hr after a standardized breakfast), and the second (T2) 1 hr later. Recordings were processed for measures of sympathetic [low frequency (LF)] and parasympathetic [high frequency (HF); vagal tone (VT); root mean square of intervals between adjacent heart beats (RMSSD)] activities. ResultsSeparate ANOVAs (recording session by group by sex) were conducted for each measure. Previous reports of higher HR in girls than boys and in OB than NW groups were confirmed (both P ≤ 0.001) HR slowed significantly from T1 to T2 for OB (P = 0.021), but not NW. These effects were associated with T1 to T2 increases in SNS LF activity for both groups (both P ≤ 0.003), but significant increases in PNS measures (HF, RMSSD, VT; all P < 0.05) for only OB children. Increases in PNS activity across recording sessions for OB children attenuated group HR differences during T2 (T1: OB > NW, P = 0.008; T2: OB > NW, P = .051). Gender differences were consistent with faster HR in girls which was maintained across groups and recording sessions. ConclusionsThe results are the first to show that autonomic dysregulation in obese children modulates the shift in SNS-PNS balance characteristic of the transition from sleep to waking. These findings may inform the development of new early intervention strategies to attenuate obesity that consider the role played by circadian rhythms. Funding SourcesFunded by USDA-ARS Project 6026-51000-010-05S.

Learning from Social Marketing: Living and Eating for Health Segments (LEHS) and Social Media Use (P16-023-19)

ObjectivesBehavior change in young adults (YA) is notoriously difficult. Psycho-behavioral segmentation, used by marketing, may be more effective to foster change than grouping by demographic characteristics alone. The aim was to determine whether previously developed Living and Eating for Health Segments (LEHS) were applicable in a nationally representative sample of 18–24 yr olds. MethodsYA were asked to select one of six LEHS: Lifestyle Mavens (LM), Health Conscious (HC), Aspirational Healthy Eaters (AHE), Balanced All-Rounders (BAR), Contemplating Another Day (CAD), Blissfully Unconcerned (BU) and answer demographic and SM usage questions ResultsApproximately 64% (n = 2019) of YA completed the survey, mean age of 21 (SD ± 2), mostly healthy weight (54.6%), females (51.8%), with 2.0% identifying as non-binary/gender fluid. All LEHS were selected: LM = 15.4% were primarily males (62%); HC = 21.1% slightly more males 54%; AHE = 27.5%, were predominately females (61%); BAR = 21.4% higher prevalence of females (62%); CAD = 11.2% slightly more females (51.8%); BU = 3.4% slightly more males 56.5% with 4.3% identifying as non-binary. All LEHS agreed the internet was ‘helpful to see other people’s health-related experiences’ (61.1% to 91.8%). All segments apart from BU were intending to search online for health/food information over the next month. SM platform usage varied by LEHS: highest users were AHE, with extensive use of Facebook (40.8%), YouTube (45.9%) Instagram (43.2%) Snapchat (34%) and Spotify (35.3%) on Apple devices (48.1%). CAD (48.7%) reported using YouTube extensively and were the highest (17.7%) to report not using Instagram. BAR were most likely to use laptops (44.2%) with extensive use of Facebook (39.2%) but did not use Twitter (56.0%). BU were more likely to report not using Snapchat (29.4%), Spotify (35.3%) and Apple devices (40.6%), but were the most extensive users of Android Smartphones (37.7%). ConclusionsEnabling YA to self-nominate into segments forces researchers to challenge existing stereotypes and assumptions about young adults perceptions and behaviors. Continued analysis will further explore how effective interventions and SM campaigns might be co-designed. Funding SourcesNational Health and Medical Research Council, Australia. Qualtrics LLC recruited participants for the online survey developed by the research team.

Pacing during a cross-country mountain bike mass-participation event according to race performance, experience, age and sex

This study describes pacing strategies adopted in an 86-km mass-participation cross-country marathon mountain bike race (the ‘Birkebeinerrittet’). Absolute (km·h−1) and relative speed (% average race speed) and speed coefficient of variation (%CV) in five race sections (15.1, 31.4, 52.3, 74.4 and 100% of total distance) were calculated for 8182 participants. Data were grouped and analysed according to race performance, age, sex and race experience. The highest average speed was observed in males (21.8 ± 3.7 km/h), 16–24 yr olds (23.0 ± 4.8 km/h) and those that had previously completed >4 Birkebeinerrittet races (22.5 ± 3.4 km/h). Independent of these factors, the fastest performers exhibited faster speeds across all race sections, whilst their relative speed was higher in early and late climbing sections (Cohen's d = 0.45–1.15) and slower in the final descending race section (d = 0.64–0.98). Similar trends were observed in the quicker age, sex and race experience groups, who tended to have a higher average speed in earlier race sections and a lower average speed during the final race section compared to slower groups. In all comparisons, faster groups also had a lower %CV for speed than slower groups (fastest %CV = 24.02%, slowest %CV = 32.03%), indicating a lower variation in speed across the race. Pacing in a cross-country mountain bike marathon is related to performance, age, sex and race experience. Better performance appears to be associated with higher relative speed during climbing sections, resulting in a more consistent overall race speed.

The development of perceptual averaging: Efficiency metrics in children and adults using a multiple-observation sound-localization task.

This study examined the ability of older children to integrate spatial information across sequential observations of bandpass noise. In experiment I, twelve adults and twelve 8-14 yr olds localized 1-5 sounds, all presented at the same location along a 34° speaker array. Rate of gain in response precision (as a function of N observations) was used to measure integration efficiency. Children were no worse at localizing a single sound than adults, and-unexpectedly-were no less efficient at integrating information across observations. Experiment II repeated the task using a Reverse Correlation paradigm. The number of observations was fixed (N = 5), and the location of each sound was independently randomly jittered. Relative weights were computed for each observation interval. Distance from the ideal weight-vector was used to index integration efficiency. The data showed that children were significantly less efficient integrators than adults: only reaching adult-like performance by around 11 yrs. The developmental effect was small, however, relative to the amount of individual variability, with some younger children exhibiting greater efficiency than some adults. This work indicates that sensory integration continues to mature into late childhood, but that this development is relatively gradual.

Effectiveness of Theory of Mind therapy carried out by parents of children with autism – a preliminary study

Tematem artykułu jest program terapii dzieci z autyzmem, ze szczególnym uwzględnieniem dziecięcej teorii umysłu. Terapia koncentruje się na mechanizmach teorii umysłu (The Theory of Mind Mechanism; ToMM), która uczy rozpoznawania głównie stanów mentalnych innych osób, emocji oraz odróżniania prawdziwych lub fałszywych przekonań. W badaniu wzięło udział 12 dzieci (w wieku 8–12 lat) z autyzmem. Podzielono je na 2 grupy 6-osobowe: „grupa leczona” uczestniczyła przez 6 miesięcy w sesjach indywidualnych (rodzice powtarzali sesje zajęć w domu), pozostałych 6 dzieci z „grupy kontrolnej” nie było poddawanych leczeniu. W grupie leczonej zaobserwowano wzrost następujących umiejętności: odróżniania opinii, przyjmowania perspektywy i rozpoznawania emocji. Analiza statystyczna i interpretacja jakościowa potwierdzają skuteczność terapii.

Malaria morbidity among children under 5 years of age: epidemic districts, Northern Uganda, July 2012 to June 2015

Introduction: a malaria epidemic has been confirmed in ten former IRS districts. Given the recent malaria control interventions, a sustained decline in the malaria cases would have been expected. Thus the need for a descriptive analysis on the trends in malaria morbidity in these districts among under 5yr olds for the past 3 financial years to help inform the Ministry of Health and predict future malaria epidemics. The objective of the analysis was to describe annual seasonal trends and peaks in prevalence in malaria morbidity among under 5yr olds over the past three financial years in former IRS districts. Describe the difference in incidence of malaria for the under 5yr olds among all the districts under study for the given period.