364. Individualized Prognostics in COVID-19 Facilitated by Computer Recognition of Blood Leukocyte Subsets

Abstract Background To determine whether CBC differentials of COVID+ inpatients can predict, at admission, both maximum oxygen requirements (MOR) and 30-day mortality. Methods Based on an approved IRB protocol, CBC differentials from the first 3 days of hospitalization of 12 SARS CoV-2 infected patients were retrospectively extracted from hospital records and analyzed with a privately owned Pattern Recognition Software (PRS, US Patent 10,429,389 B2) previously validated in sepsis, HIV, and hantavirus infections. PRS partitions the data into subsets immunologically dissimilar from one another, although internally similar. Results Regardless of the angle considered, the classic analysis −which measured the percentages of lymphocytes, monocytes, and neutrophils− did not distinguish outcomes (A). In contrast, non-overlapping patterns generated by the PRS differentiated 3 (left, vertical, and right) groups of patients (B). One subset was only composed of survivors (B). The remaining subsets included the highest oxygenation requirements (B). At least two immunologically interpretable, multi-cellular indicators distinguished the 3 data subsets with statistically significant differences (C, p≤ 0.05). Survivors (the left subset) showed lower N/L and/or higher M/L ratios than non-survivors (the vertical subset, C).Therefore, PRS partitioned the data into subsets that displayed both biological and significant differences. Because it offers visually explicit information, clinicians do not require a specialized training to interpret PRS-generated results. CBCs vs. outcomes - Software-analyzed CBCs vs. outcomes Conclusion (1) Analysis of blood leukocyte data predicts MOR and 30-d mortality. (2) Real time PRS analysis facilitates personalized medical decisions. (3) PRS measures two dimensions rarely assessed: multi-cellularity and dynamics. (4) Even with very small datasets, PRS may achieve statistical significance. (5) Larger COVID+ infected cohort is being analyzed for potential commercialization. Disclosures Claudia R. Libertin, MD, Gilead (Grant/Research Support)

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FRI0510 THE FREQUENCY OF CONTRACEPTION DOCUMENTATION IN WOMEN ON AND OFF TERATOGENIC ANTI-RHEUMATIC MEDICATIONS IN THE RISE REGISTRY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.5762 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 853.2-854

Author(s):

M. Clowse ◽

J. LI ◽

M. Birru Talabi ◽

A. Eudy ◽

G. Schmajuk

Keyword(s):

African American Women ◽

White Women ◽

Contraceptive Use ◽

Statistical Significance ◽

Hormonal Contraceptives ◽

Research Support ◽

Informatics System ◽

Contraceptive Effectiveness ◽

Highly Effective ◽

Effective Contraception

Background:Several of the most commonly prescribed medications for women with rheumatic disease are teratogens, posing a risk for pregnancy loss and birth defects if taken in pregnancy. To prevent these life-altering complications, it is important that all women taking teratogenic medications avoid pregnancy through abstinence or contraception.Objectives:We sought to understand the accessibility to contraceptive data within the RISE Registry and to test whether, compared to other women, those prescribed a teratogen would be more likely to have documentation of contraceptive.Methods:Data were derived from Rheumatology Informatics System for Effectiveness (RISE), a national EHR-enabled rheumatology registry that passively collects data on all patients seen by participating practices. As of 2018, RISE held validated data from 1,113 clinicians in 226 practices, representing an estimated 32% of the U.S. clinical rheumatology workforce. Female patients between the ages 18-45 with an anti-rheumatic medication prescribed within the RISE system in 2018 were stratified into one of 3 groups: 1) Any teratogen (methotrexate, mycophenolate, mycophenolic acid, cyclophosphamide, leflunomide, thalidomide, lenalidomide); 2) Only pregnancy-compatible medications (hydroxychloroquine, azathioprine, or a TNF-α inhibitors [TNFi]); and 3) Any medication with unknown teratogenicity (non-TNF biologics and new small molecule medications). We identified the most recent contraceptive medication or device reported in 2018 using structured fields in the EHR. Contraceptive effectiveness was classified as ‘highly effective’ (IUD, Nexplanon, and surgical) and ‘effective’ (oral contraceptives, depo-provera, patch, ring), and unknown (type not reported). Statistical significance was assessed using Stata SE 15.1.Results:In 2018, 110,359 women between the ages of 18-45 were prescribed an anti-rheumatic medication within the RISE Registry. Of these, 11,569 (10.5%) had a contraceptive documented at the last visit. The frequency of contraception documentation varied between practices, ranging from 0% to 28.7% (median 9.2%).Contraception was documented slightly less often in women receiving teratogens (9.8%) compared to women receiving only pregnancy-compatible medications (10.4%, p=0.04) and medications with unknown pregnancy risks (10.0%, p=0.67).The frequency of contraceptive documentation in women prescribed a teratogen varied significantly by race with white women having the highest rate (11.0%) compared to African-American women (7.4%, p<0.001), Hispanic women (5.5%, p<0.001), and Asian women (8.4%, p=0.08).The type of contraceptive documented did not vary significantly between medication group. Highly effective contraception was rarely documented (1.4-1.6%) and moderately-effective hormonal contraceptives were more frequently documented (6.3-8.2%).Conclusion:This study is limited to the analysis of structured fields within the RISE Registry, thereby missing contraceptive documentation within the clinician notes. Increased uniformity in documentation and/or analysis of visit notes will be essential to use the RISE Registry to study the implementation of published contraceptive guidelines. While the documentation of contraception identified in this analysis of the RISE Registry likely under-estimates actual contraceptive use, it reveals important gaps in care. Contrary to what was expected, women prescribed a teratogen were not more likely than other women to have a documented contraceptive. Additionally, important racial disparities in contraception documentation suggest that rheumatologists may not addressing reproductive health needs equally across patient populations.Acknowledgments Disclaimer:This data was supported by the ACR’s RISE Registry. However, the views expressed represent those of the authors, not necessarily those of the ACRDisclosure of Interests:Megan Clowse Grant/research support from: GSK, Pfizer, Consultant of: UCB, Astra-Zeneca, Speakers bureau: UCB, Jing Li: None declared, Mehret Birru Talabi: None declared, Amanda Eudy: None declared, Gabriela Schmajuk Grant/research support from: Pfizer

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THU0652-HPR ONLINE EDUCATION YIELDS SIGNIFICANT GAINS IN RHEUMATOLOGISTS’ KNOWLEDGE OF BIOLOGICS AND BIOSIMILARS BUT A SUBSTANTIAL GAP REMAINS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.6048 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 570.2-571

Author(s):

A. Stan ◽

E. Bell ◽

P. Schoonheim ◽

E. Mysler

Keyword(s):

Online Education ◽

Statistical Significance ◽

Treatment Options ◽

Educational Activity ◽

Round Table Discussion ◽

Knowledge Gain ◽

Regulatory Requirements ◽

Research Support ◽

Significance Level ◽

Post Assessment

Background:Biologics are complex proteins which have revolutionized the treatment of many serious diseases. Due to their complexity and manufacturing which involves living organisms, it is not possible to create identical versions of reference biologics, but it is possible to create biosimilar drugs. Biosimilars have the potential to yield high cost savings and expand treatment options to meet the growing demand for biological therapies.Objectives:This study assessed whether the online CME-accredited round-table-discussion titled “Understanding Biologics: from protein to clinical practice” improved physicians’ understanding of the inherent variability of biologics and what similarity means in the context of biologics as well as the analytical assessment of quality that applies to both biologics and biosimilars.Methods:Rheumatologists participated in an online CME activity (www.medscape.org/viewarticle/900121) consisting of a 30-minute video discussion between 4 experts with accompanying slides. Educational effect was assessed using a 4-question repeated pairs, pre-/post-assessment. A chi-square test was used to determine if a statistically significant improvement (P<.05 significance level) existed in the number of pre-/post-test correct responses. Cramer’s V was used to estimate the level of impact of the education. The CME activity launched on 22 Aug 2018, and the data were collected through 9 Oct 2018.Results:A total of 622 rheumatologists participated in the educational activity, and 87 completed the pre- and postassessment. Overall the activity had a signficiant impact (P<.001) on rheumatologists’ understanding of the inherent variability of biologics and the regulatory requirements for approval of a biosimilar. The Cramer’s V value of 0.186 indicates a considerable effect of the education. The average perecentage of correct responses rose from 33% pre-activity to 51% post-activity. A linked learning assessment (individual responses matched pre- and post-education) showed that 25% of learners improved their knowledge and 26% reinforced their knowledge. The change in percentage of correct responses from pre- to post-assessment achieved statistical significance (P<.05) in 2 of the 3 questions presented: (i) understanding the type of studies needed to demonstrate comparability of a biosimilar to an originator (11% at baseline; 45% post activity), (ii) understanding the type of variability considered acceptable for a biologic (46% at baseline; 63% post activity). However, no knowledge gain was observed regarding basic analytic attributes evaluated to ensure batch to batch consistency (37% at baseline; 38% post activity). Almost 45% of rheumatologists gained confidence in their ability to describe the regulatory requirements for approval of a biosimilar.Conclusion:This online CME activity significantly improved rheumatologists’ understanding of the inherent variability of complex biologic medicines and the role of analytical studies in the regulatory approval of biosimilars. However, there is room for further improving physicians’ knowledge, especially of basic analytics of biologics and biosimilars.Acknowledgments:This CME-certified activity was supported by independent funding from Sandoz.Disclosure of Interests:Adriana Stan Grant/research support from: The CME-certified activity was supported by anindependent educational grant from Sandoz., Elaine Bell: None declared, Peter Schoonheim Grant/research support from: This CME-certified activity was supported by independent funding from Sandoz., Eduardo Mysler Grant/research support from: AbbVie, Lilly, Pfizer, Roche, BMS, Sandoz, Amgen, and Janssen., Consultant of: AbbVie, Lilly, Pfizer, Roche, BMS, Sandoz, Amgen, and Janssen.

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ANALYSIS OF RELATIONSHIPS BETWEEN INTELLECTUAL CAPITAL AND MEASUREMENT PERFORMANCE INDICATORS OF THE PHARMACEUTICAL COMPANIES IN TEHRAN STOCK EXCHANGE

Ciência e Natura ◽

10.5902/2179460x19440 ◽

2015 ◽

Vol 37 ◽

pp. 58

Author(s):

Hadi Kord Javadi ◽

Zahra Kohandel ◽

Khadije Fardi

Keyword(s):

Performance Measurement ◽

Intellectual Capital ◽

Stock Exchange ◽

Statistical Significance ◽

Value Added ◽

Two Dimensions ◽

Pharmaceutical Companies ◽

Statistical Population ◽

And Performance ◽

Spearman Test

http://dx.doi.org/10.5902/2179460X19440Intellectual Capital is the most precious possession of companies in modern economy; therefore, Intellectual Capital of industrial centers is ever-increasingly changing to become the chief indicators both in company operations and in improving its ability to manage the organization capitals. In the main, the current study aims to investigate the relationship between the Intellectual Capital and performance measurement. In this research, the independent variable is the intellectual capital having three dimensions of human, structure and physical capitals, and the dependent variable is the organization operation with two dimensions of economical and accounting which are going to be assessed in this study. The Statistical population is the pharmaceutical companies admitted in the Tehran Stock Exchange from 1387 to 1391 amounting to 30 companies in total. This research investigates the time span from the beginning of 1387 up to the end of year, 1391. Data relevant to variables has been collected by the software of the Stock Exchange. The collection of data has been carried out by means of SPSS. In this study, the researcher used the descriptive and inferential statistics (Spearman test) and the results show that the hypotheses are a s follows 1. There is statistical significance between intellectual capital and performance measurement, 2. There is no statistical significance between the intellectual capital and ROR of the owners’ salary, 3. There is no statistical significance between the intellectual capital and the ROR of the properties, 4. There is statistical significance between the intellectual capital and the value added of the market, 5. There statistical significance between the intellectual capital and economic value added.

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Autonomy and Objectivity as Political Operators in the Medical World: Twenty Years of Public Controversy about AIDS Treatments in France

Science in Context ◽

10.1017/s0269889708001841 ◽

2008 ◽

Vol 21 (3) ◽

pp. 403-434 ◽

Cited By ~ 9

Author(s):

Nicolas Dodier ◽

Janine Barbot

Keyword(s):

Conceptual Framework ◽

Patient Autonomy ◽

Two Dimensions ◽

Medical Decisions ◽

Public Controversy ◽

Meeting Point ◽

Way Of Thinking ◽

Contemporary Medicine ◽

The Way

ArgumentThe article is based on the controversies relating to conducting experiments and licensing AIDS treatments in France in the 1980s and 1990s. We have identified two political operators, i.e. two issues around which tensions have grown between the different generations of actors involved in these controversies: 1) the way of thinking about patient autonomy, and 2) the way in which objectivity regarding medical decisions is built. The article shows that there are several regimes of objectivity and autonomy, and that it is at the meeting point of the two dimensions that very different political forms of medicine have developed. In the case of AIDS, the article identifies four of these forms (liberal and conservative clinical traditions and therapeutic modernity – enclosed, then participative) and analyzes the dynamics of their emergence and opposition. We discuss an “objectivity/autonomy” diagram as a conceptual framework which enables us (above and beyond AIDS) to think about changes in contemporary medicine.

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Mesoscale Simulation of Grain Growth

Materials Science Forum ◽

10.4028/www.scientific.net/msf.467-470.1057 ◽

2004 ◽

Vol 467-470 ◽

pp. 1057-1062 ◽

Cited By ~ 7

Author(s):

D. Kinderlehrer ◽

Jee Hyun Lee ◽

Irene Livshits ◽

Anthony D. Rollett ◽

Shlomo Ta'asan

Keyword(s):

Grain Growth ◽

Evolution Equations ◽

Materials Science ◽

Statistical Significance ◽

Dissipative System ◽

Two Dimensions ◽

Nonlinear Evolution Equations ◽

Three Dimensions ◽

Mesoscale Simulation ◽

Large Systems

Simulation is becoming an increasingly important tool, not only in materials science in a general way, but in the study of grain growth in particular. Here we exhibit a consistent variational approach to the mesoscale simulation of large systems of grain boundaries subject to Mullins Equation of curvature driven growth. Simulations must be accurate and at a scale large enough to have statistical significance. Moreover, they must be sufficiently flexible to use very general energies and mobilities. We introduce this theory and its discretization as a dissipative system in two and three dimensions. The approach has several interesting features. It consists in solving very large systems of nonlinear evolution equations with nonlinear boundary conditions at triple points or on triple lines. Critical events, the disappearance of grains and and the disappearance or exhange of edges, must be accomodated. The data structure is curves in two dimensions and surfaces in three dimensions. We discuss some consequences and challenges, including some ideas about coarse graining the simulation.

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297. Infectious Complications Associated with Tocilizumab Use in Patients Infected with SARS-CoV-2 at a Mid-Atlantic Hospital Consortium

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.499 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S256-S256

Author(s):

Kristen R Kent ◽

Nellie Darling ◽

Xue Geng ◽

Gavin Clark ◽

Marybeth Kazanas ◽

...

Keyword(s):

Statistical Significance ◽

Post Treatment ◽

Risk Of Infection ◽

Research Support ◽

Candida Spp ◽

Gram Positive ◽

Gram Negative ◽

Material Support ◽

Increased Risk ◽

Significant Difference

Abstract Background The IL-6 inhibitor Tocilizumab (TOCI) has been associated with infections in 5-8% of patients with Rheumatoid Arthritis. TOCI has now been recommended as a treatment option for select patients with COVID-19; however, the risk of infection in this patient population is yet to be determined. Methods We performed a retrospective chart review of patients diagnosed with COVID-19 and admitted to MedStar hospitals within the D.C./Baltimore corridor from 03/01/2020 to 12/31/2020. We identified patients who had positive culture data within 30 days of administration of TOCI-based regimens and analyzed clinical characteristics and outcomes. Univariate analyses (Wilcoxon, T-test, Chi-Square, Fisher’s Exact) were used to compare these outcome variables between patients who had post-treatment infections and those who did not. Results A total of 220 patients received TOCI-based regimens; 16% (N=36) of patients developed positive cultures within 30 days of treatment. Of the 99 cultures, 50% were gram positive (N=49), 38% were gram negative (N=38), 10% were Candida spp. (N=10), and 2% were anaerobic organisms (N=2). Only 9% (8/87) of the gram positive and gram negative organisms were MDROs. Bloodstream infections were the most common and accounted for 58.4% of all infections. Length of stay (LOS) was approximately twice as long in those with post-treatment infections (26 days) compared to those without infections (14 days, p< 0.001). Although the mortality rate was higher in patients with infections after TOCI-based treatment compared to patients with no post-treatment infection (47% vs 31% respectively), this did not reach statistical significance (p=0.09). Moreover, there was no significant difference in the infection rate of patients treated with TOCI alone compared to TOCI and Dexamethasone (16.6% vs. 13.3%, p=0.99). No cases of invasive Aspergillosis were observed. Conclusion Tocilizumab treatment in patients with COVID-19 may predispose patients to an increased risk of infection which is associated with a prolonged LOS and possibly higher mortality. We observed a two-fold increase in infections in COVID-19 patients compared to other patient groups receiving this treatment. Disclosures Princy N. Kumar, MD, AMGEN (Other Financial or Material Support, Honoraria)Eli Lilly (Grant/Research Support)Gilead (Grant/Research Support, Shareholder, Other Financial or Material Support, Honoraria)GSK (Grant/Research Support, Shareholder, Other Financial or Material Support, Honoraria)Merck & Co., Inc. (Grant/Research Support, Shareholder, Other Financial or Material Support, Honoraria)

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Policentryczność regionów miejskich w Polsce = Polycentricity of urban regions in Poland

Przegląd Geograficzny ◽

10.7163/przg.2020.4.1 ◽

2020 ◽

Vol 92 (4) ◽

pp. 455-474

Author(s):

Bartosz Bartosiewicz ◽

Szymon Marcińczak

Keyword(s):

Urban Development ◽

Statistical Significance ◽

Regional Distribution ◽

Two Dimensions ◽

Morphological Development ◽

Urban Structure ◽

Urban Regions ◽

Two Measures ◽

Commuting Patterns ◽

The Relationship

Studies dealing with the issue of polycentric urban development, both functional and morphological, often promote different approaches to the measurement of polycentricity. Relying on data on commuting patterns and the intra-regional distribution of population in Poland in 2011, we apply two measures of polycentricity to shed more light on the functional and morphological development of urban regions in Poland. We also explore the relationship between the two dimensions of polycentricity, using a functional/morphological primacy index and a general functional polycentricity index. The results reveal regions for which the different measures suggest divergent conclusions, while also implying that the measure used can determine the strength and statistical significance of the relationship between the two dimensions to polycentricity. As, in our view, it is the measure advocated by Burger et al. (2011) that best seems to differentiate between the different forms of urban structure, we use this to summarise patterns of polycentric urban development in Poland. The results illustrate: the statistical significance of the relationship between the two (morphological and functional) dimensions to polycentricity in Poland’s urban regions, and the way in which the level of functional polycentricity is higher than the degree of functional polycentricity.

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Compartmentalization of Subtype A17 of Small Ruminant Lentiviruses between Blood and Colostrum in Infected Goats Is Not Exclusively Associated to the env Gene

Viruses ◽

10.3390/v11030270 ◽

2019 ◽

Vol 11 (3) ◽

pp. 270 ◽

Cited By ~ 2

Author(s):

Monika Olech ◽

Jacek Kuźmak

Keyword(s):

Small Ruminant ◽

Permutation Test ◽

Statistical Significance ◽

Virus Transmission ◽

Peripheral Blood Leukocyte ◽

Gene Encoding ◽

Reliable Determination ◽

Small Ruminant Lentiviruses ◽

Blood Leukocyte

The compartmentalization of small ruminant lentiviruses (SRLVs) subtype A17 was analyzed in colostrum and peripheral blood leukocyte cells of three naturally infected goats. This study aimed to analyze heterogeneity of the SRLV env (V4V5) gene, which encodes neutralizing epitopes of SU glycoprotein, the gag gene encoding capsid protein (CA), and LTR, a noncoding region, responsible for determination of cell tropism. Compartmentalization was assessed using six established tree or distance-based methods, including permutation test to determine statistical significance. We found statistical evidence of compartmentalization between blood and colostrum in all infected goats although phylogenetic evidence of such compartmentalization was not obvious. Our study demonstrated that compartmentalization is not exclusively specific to the env gene, as we revealed that gag and LTR sequences are also compartmentalized between blood and colostrum. The work also confirms the combined use of different methods as essential for reliable determination of intrahost viral compartmentalization. Identifying and characterizing distinct viral subpopulations and the genetic evolution of SRLV in specific anatomical sites enhances our overall understanding of SRLV pathogenesis, immune control, and particularly virus transmission.

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Surveillance, Security, and Intelligence-Led Policing in Chicago

10.5406/illinois/9780252040597.003.0012 ◽

2017 ◽

Author(s):

Rajiv Shah ◽

Brendan Mcquade

Keyword(s):

Civil Rights ◽

Crime Prevention ◽

Fusion Center ◽

License Plate ◽

License Plate Recognition ◽

Camera Systems ◽

Use Of Technology ◽

Chicago Police ◽

Recognition Software ◽

Privately Owned

This chapter summarizes the Chicago Police Department’s adoption of Intelligence-Led Policing (ILP) since the early-2000s as a crime prevention and deterrence strategy. It reviews the use of technology such as police observation devices (cameras), the centralization of the Police Department’s data operations at the Crime Prevention and Information Center, a sophisticated data analytics “fusion center,” and examines changing technologies of surveillance used by the police. The authors discuss the integration of police surveillance with privately-owned and operated camera systems, and explore how systems like facial and license plate recognition software and gunshot prediction technologies are reshaping security and policing in Chicago. The chapter also assesses concerns about privacy and eroded civil rights provoked by the expanding use of ILP techniques and data.

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The preferred leadership and followership styles of employees in state- and privately-owned organizations in Serbia and Macedonia

Journal of East European Management Studies ◽

10.5771/0949-6181-2019-2-305 ◽

2019 ◽

Vol 24 (2) ◽

pp. 305-323

Author(s):

Kalina Sotiroska Ivanoska ◽

Zorica Markovic ◽

Elisaveta Sardzoska

Keyword(s):

Leadership Styles ◽

Leadership Style ◽

Statistical Significance ◽

Transition Countries ◽

The Other ◽

Business Organization ◽

Business Organizations ◽

The Individual ◽

Privately Owned ◽

Personal Questionnaire

The aim of the study is to determine the preferred leadership and followership styles, as well as the statistical significance of differences between those preferences among individuals employed in both state and privately owned companies in Serbia and Macedonia. Leadership and followership are important for the efficient functioning of all organizations. Leadership and followership issues are particularly important in transition countries, such as Serbia and Macedonia, where directors general of organizations are no longer appointed politically but are leaders selected according to their capacities. Nationality and type of the organization ownership, the relation between gender and position occupied by an individual within a business organization (a manager, an employee), as well as the preferred style of leadership and followership, have been analyzed. The study was carried out on the sample of 172 participants from Serbia and Macedonia. The data were collected by means of the Personal Questionnaire for Followership Styles designed by Robert E. Kelley (1998), and Fiedler’s LPC scale (Least Preferred Coworker, 1984) which was used to evaluate the preferred leadership style. The results indicate that there is no difference in the preferred leadership styles in relation to gender, nationality or positions occupied by the company employees, but there is a difference between the employees who are in the state- or in the privately-owned companies. The participants working in state owned companies prefer a permissive leadership style, i.e. relationship-oriented. The results show that most of the employees in both state- and privately-owned business organizations prefer an active followership, with statistically significant differences compared to the other followership styles. No relationship was found between gender, nationality, type of organization ownership and position occupied by the individual within a business organization, for the preferred followership style.

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