1178 Predictors Of Being Seen By A Board-certified Sleep Medicine Provider

Introduction

Although several studies have evaluated the impact of board-certification in sleep medicine regarding obstructive sleep apnea treatment outcomes, no studies to date have identified predictive factors to determine which patients are evaluated by board-certified sleep medicine providers (BCSMP) in the clinical practice. Thus, the purpose of this study was to identify predictors of being seen by a BCSMP, relative to non-sleep specialist providers.

Methods

Our data source was a random 5% sample of Medicare administrative claims data from 2006-2013. Sleep disorder diagnoses such as insomnia, obstructive sleep apnea, restless legs syndrome, hypersomnias, and parasomnias, as well as medical comorbidities including cardiovascular, cerebrovascular, mood, pulmonary, and neurological disorders, were operationalized using International Classification of Diseases, Ninth Revision, Clinical Modification codes. Demographic data were obtained from the claims. BCSMP were identified using a novel cross-matching approach based on National Provider Identifier (NPI).

Results

A total of 57,209 Medicare beneficiaries received a sleep disorder diagnosis between 2006-2013, but only 1,279 (2.2%) of these individuals were ever seen by a BCSMP. Within a multivariate logistic regression model, male gender, asthma, and heart failure were significantly associated with being seen by a BCSMP. Additionally, BCSMP were more likely to evaluate patients with two or more sleep diagnoses.

Conclusion

Complexity of sleep disorders and cardiovascular and lung comorbidities were predictive of being seen by a BCSMP. These results demonstrate the importance of BCSMPs in caring for complex sleep medicine patients.

Support

This research was supported by an AASM Strategic Research Award from the AASM Foundation to the University of Maryland, Baltimore (PI: EMW).

Measurement of differential cross sections and charge ratios for t-channel single top quark production in proton-proton collisions at s = 13 Te

A measurement is presented of differential cross sections for t-channel single top quark and antiquark production in proton-proton collisions at a centre-of-mass energy of 13Te by the CMS experiment at the LHC. From a data set corresponding to an integrated luminosity of 35.9fb - 1 , events containing one muon or electron and two or three jets are analysed. The cross section is measured as a function of the top quark transverse momentum ( p T ), rapidity, and polarisation angle, the charged lepton p T and rapidity, and the p T of the W  boson from the top quark decay. In addition, the charge ratio is measured differentially as a function of the top quark, charged lepton, and W  boson kinematic observables. The results are found to be in agreement with standard model predictions using various next-to-leading-order event generators and sets of parton distribution functions. Additionally, the spin asymmetry, sensitive to the top quark polarisation, is determined from the differential distribution of the polarisation angle at parton level to be 0.440 ± 0.070 , in agreement with the standard model prediction.

Patient deprivation and perceived scan burden negatively impact the quality of whole-body MRI

AIM

To evaluate the association between the image quality of cancer staging whole-body magnetic resonance imaging (WB-MRI) and patient demographics, distress, and perceived scan burden.

MATERIALS AND METHODS

A sample of patients recruited prospectively to multicentre trials comparing WB-MRI with standard scans for staging lung and colorectal cancer were invited to complete two questionnaires. The baseline questionnaire, administered at recruitment, collated data on demographics, distress and co-morbidity. The follow-up questionnaire, completed after staging investigations, measured perceived WB-MRI scan burden (scored 1 low to 7 high). WB-MRI anatomical coverage, and technical quality was graded by a radiographic technician and grading combined to categorise the scan as "optimal", "sub-optimal" or "degraded". A radiologist categorised 30 scans to test interobserver agreement. Data were analysed using the chi-square, Fisher's exact, t-tests, and multinomial regression.

RESULTS

One hundred and fourteen patients were included in the study (53 lung, 61 colorectal; average age 65.3 years, SD=11.8; 66 men [57.9%]). Overall, 45.6% (n=52), scans were classified as "optimal" quality, 39.5% (n=45) "sub-optimal", and 14.9% (n=17) as "degraded". In adjusted analyses, greater deprivation level and higher patient-reported scan burden were both associated with a higher likelihood of having a sub-optimal versus an optimal scan (odds ratio [OR]: 4.465, 95% confidence interval [CI]: 1.454 to 13.709, p=0.009; OR: 1.987, CI: 1.153 to 3.425, p=0.013, respectively). None of the variables predicted the likelihood of having a degraded scan.

CONCLUSIONS

Deprivation and patients' perceived experience of the WB-MRI are related to image quality. Tailored protocols and individualised patient management before and during WB-MRI may improve image quality.

A multi-dimensional search for new heavy resonances decaying to boosted W W , W Z , or Z Z boson pairs in the dijet final state at 13 Te

A search in an all-jet final state for new massive resonances decaying to W W , W Z , or Z Z boson pairs using a novel analysis method is presented. The analysis is performed on data corresponding to an integrated luminosity of 77.3 fb - 1 recorded with the CMS experiment at the LHC at a centre-of-mass energy of 13  Te . The search is focussed on potential narrow-width resonances with masses above 1.2  Te , where the decay products of each W or Z boson are expected to be collimated into a single, large-radius jet. The signal is extracted using a three-dimensional maximum likelihood fit of the two jet masses and the dijet invariant mass, yielding an improvement in sensitivity of up to 30% relative to previous search methods. No excess is observed above the estimated standard model background. In a heavy vector triplet model, spin-1 Z ' and W ' resonances with masses below 3.5 and 3.8   Te , respectively, are excluded at 95% confidence level. In a bulk graviton model, upper limits on cross sections are set between 27 and 0.2 fb for resonance masses between 1.2 and 5.2   Te , respectively. The limits presented in this paper are the best to date in the dijet final state.

Search for direct pair production of supersymmetric partners to the τ lepton in proton-proton collisions at s = 13 TeV

A search is presented for τ slepton pairs produced in proton-proton collisions at a center-of-mass energy of 13TeV . The search is carried out in events containing two τ leptons in the final state, on the assumption that each τ slepton decays primarily to a τ lepton and a neutralino. Events are considered in which each τ lepton decays to one or more hadrons and a neutrino, or in which one of the τ leptons decays instead to an electron or a muon and two neutrinos. The data, collected with the CMS detector in 2016 and 2017, correspond to an integrated luminosity of 77.2fb - 1 . The observed data are consistent with the standard model background expectation. The results are used to set 95% confidence level upper limits on the cross section for τ slepton pair production in various models for τ slepton masses between 90 and 200GeV and neutralino masses of 1, 10, and 20GeV . In the case of purely left-handed τ slepton production and decay to a τ lepton and a neutralino with a mass of 1GeV , the strongest limit is obtained for a τ slepton mass of 125GeV at a factor of 1.14 larger than the theoretical cross section.

High Pressure Liquid Chromatographic Determination of Bacitracin in Premix Feeds and Finished Feeds: Collaborative Study

A liquid chromatographic technique for the determination of bacitracin in finished feeds and premix feeds consists of an isocratic reverse phase, ion-suppressed technique. The chromatography can be completed in less than 25 min. In a collaborative study involving 9 laboratories and 3 samples of bacitracin methylene disalicylic acid and 3 samples of bacitracin zinc premixes covering the range of 10-50 g/lb, the repeatability standard deviation was 0.55, and the reproducibility standard deviation was 1.35. The average recovery of the bacitracin was 102.0%. The method has been adopted official first action for bacitracin in premix feeds.

Greenhouse gas, water, and land footprint per unit of production of the California dairy industry over 50 years

Food production including dairy has been associated with environmental impacts and resource use that has been steadily improving when adjusted per unit of product. The objective of this study was to conduct a cradle-to-farm gate environmental impact analysis and resource inventory of the California dairy production system to estimate the change in greenhouse gas emissions and water and land use over the 50-yr period between 1964 and 2014. Using a life cycle assessment according to international standards and the Food and Agriculture Organization of the United Nations guidelines, we analyzed contributions from dairy production in California to global environmental change. Production of 1 kg of energy- and protein-corrected milk (ECM) in California emitted 1.12 to 1.16 kg of CO₂ equivalents (CO₂e) in 2014 compared with 2.11 kg of CO₂e in 1964, a reduction of 45.0 to 46.9% over the last 50 yr, depending on the model used. Greater reductions in enteric methane intensity (i.e., methane production per kilogram of ECM) were observed (reduction of 54.1 to 55.7%) compared with manure GHG (reduction of 8.73 to 11.9%) in 2014 compared with 1964. This was mainly because manure management in the state relies on lagoons for storage, which has a greater methane conversion factor than solid manure storage. Water use intensity was reduced by 88.1 to 89.9%, with water reductions of 88.7 to 90.5% in crop production, 55.3 to 59.2% in housing and milking, and 52.4 to 54% in free water intake. Improved crop genetics and management have contributed to large efficiencies in water utilization. Land requirements for crop production were reduced by 89.4 to 89.7% in 2014 compared with 1964. This was mainly due to dramatic increases in crop yields in the last 50 yr. The increases in milk production per cow through genetic improvements and better nutrition and animal care have contributed to reductions in greenhouse gas emissions and land and water usage when calculated per unit of production (intensity) basis.

68 Urinary Catheterisation in Trauma and Orthopaedic Patients

Background

The use of urinary catheterisation in neck of femur fracture patients is often debated as common best practice to manage and appropriate fluid assessment. Routine catheterisation increases the risk bacteraemia, genitourinary injury, worsening mobility, risk of pressure sores and predisposition to delirium and falls. There is a need for increased awareness of urinary catheterisation management in conjunction with healthcare-associated infections. NHS improvement has issued a letter aiming to half healthcare-associated Gram-negative bacteraemia, the majority of which is catheter-related. This project aims to identify barriers to safe catheter care in the orthopaedic population; by determining if management of urinary catheters is complaint with NICE quality standards (QS61).

Introduction

Appropriate perioperative care can help manage the associated risk of neck of femur fractures. The British Hip Society and British Orthopaedic Association have provided little guidance on postoperative care and risk management. Appropriate catheter care will improve overall patient care but reducing mortality and associated morbidity, by shortening stay by early mobilisation and management of complications.

Methods

All catheterised trauma and orthopaedic patients in a district general hospital over one month (February) were included 67% of which had sustained neck of femur fractures. Data from nursing and doctors’ records on the following parameters were collected: demographics, the reason of admission, indication/location for catheterisation and responsible clinician; the number of days catheterised, the reason for the retention of catheterisation and management of suspected/confirmed catheter-related infection. Data were collected in April following the implementation.

Intervention

A urinary care pathway was launched based on the HOUDINI algorithm and educational seminars for medical and nursing staff were conducted.

Results

Mean age of patients was 78. Initial data was suggestive of poor documentation and prolonged, inappropriate retention of urinary catheterisation and not in accordance with current guidance. Data was recollected in April after the launch of the pathway; data was indicative of marginal improvement of catheter care management, reduced time of catheter retention, improved documentation likelihood of review.

Conclusions

Incorporating a catheter care pathway in managing orthopaedic patients has shown improvement in the overall documentation and management of urinary catheterisation. Despite this improvement demonstrated, implementation of the pathway is still substandard. This pathway will be incorporated into an innovative integrated neck of femur pathway in June.

Search for production of four top quarks in final states with same-sign or multiple leptons in proton-proton collisions at s = 13 TeV

The standard model (SM) production of four top quarks ( t t ¯ t t ¯ ) in proton-proton collisions is studied by the CMS Collaboration. The data sample, collected during the 2016-2018 data taking of the LHC, corresponds to an integrated luminosity of 137fb - 1 at a center-of-mass energy of 13TeV . The events are required to contain two same-sign charged leptons (electrons or muons) or at least three leptons, and jets. The observed and expected significances for the t t ¯ t t ¯ signal are respectively 2.6 and 2.7 standard deviations, and the t t ¯ t t ¯ cross section is measured to be 12 . 6 - 5.2 + 5.8 fb . The results are used to constrain the Yukawa coupling of the top quark to the Higgs boson, y t , yielding a limit of| y t / y t SM | < 1.7 at 95 % confidence level, where y t SM is the SM value of y t . They are also used to constrain the oblique parameter of the Higgs boson in an effective field theory framework,H ^ < 0.12 . Limits are set on the production of a heavy scalar or pseudoscalar boson in Type-II two-Higgs-doublet and simplified dark matter models, with exclusion limits reaching 350-470GeV and 350-550GeV for scalar and pseudoscalar bosons, respectively. Upper bounds are also set on couplings of the top quark to new light particles.

Measurement of electroweak production of a W boson in association with two jets in proton-proton collisions at s = 13 Te

A measurement is presented of electroweak (EW) production of a W boson in association with two jets in proton-proton collisions ats = 13 Te . The data sample was recorded by the CMS Collaboration at the LHC and corresponds to an integrated luminosity of 35.9fb - 1 . The measurement is performed for the ℓ ν jj final state (with ℓ ν indicating a lepton-neutrino pair, and j representing the quarks produced in the hard interaction) in a kinematic region defined by invariant massm jj > 120 Ge and transverse momentap T j > 25 Ge . The cross section of the process is measured in the electron and muon channels yieldingσ EW ( W jj ) = 6.23 ± 0.12 (stat) ± 0.61 (syst) pb per channel, in agreement with leading-order standard model predictions. The additional hadronic activity of events in a signal-enriched region is studied, and the measurements are compared with predictions. The final state is also used to perform a search for anomalous trilinear gauge couplings. Limits on anomalous trilinear gauge couplings associated with dimension-six operators are given in the framework of an effective field theory. The corresponding 95% confidence level intervals are - 2.3 < c W W W / Λ 2 < 2.5 Te - 2 , - 8.8 < c W / Λ 2 < 16 Te - 2 , and - 45 < c B / Λ 2 < 46 Te - 2 . These results are combined with the CMS EW Zjj analysis, yielding the constraint on the c W W W coupling: - 1.8 < c W W W / Λ 2 < 2.0 Te - 2 .

Extraction and validation of a new set of CMS pythia8 tunes from underlying-event measurements

New sets of CMS underlying-event parameters ("tunes") are presented for the pythia8 event generator. These tunes use the NNPDF3.1 parton distribution functions (PDFs) at leading (LO), next-to-leading (NLO), or next-to-next-to-leading (NNLO) orders in perturbative quantum chromodynamics, and the strong coupling evolution at LO or NLO. Measurements of charged-particle multiplicity and transverse momentum densities at various hadron collision energies are fit simultaneously to determine the parameters of the tunes. Comparisons of the predictions of the new tunes are provided for observables sensitive to the event shapes at LEP, global underlying event, soft multiparton interactions, and double-parton scattering contributions. In addition, comparisons are made for observables measured in various specific processes, such as multijet, Drell-Yan, and top quark-antiquark pair production including jet substructure observables. The simulation of the underlying event provided by the new tunes is interfaced to a higher-order matrix-element calculation. For the first time, predictions from pythia8 obtained with tunes based on NLO or NNLO PDFs are shown to reliably describe minimum-bias and underlying-event data with a similar level of agreement to predictions from tunes using LO PDF sets.

Digital tooth reconstruction: An innovative approach in forensic odontology

In mass disasters, accidents and crime investigations, where human remains are decomposed, charred or skeletonized, teeth may dislodge due to post-mortem loss or due to mishandling of evidence during the manipulation of skeletal and dental remains. Thus, the identification process is hampered due to the loss of dental evidence. In these situations, forensic tooth reconstruction may aid in the identification process. Forensic tooth reconstruction (FTR) refers to the process that aims to reconstruct the morphology of the missing tooth from the skeletal remains from the intra-alveolar morphology of the dental socket. The study is an innovative attempt to develop a digital approach to reconstruct three-dimensional (3D) printed tooth models through recording intra-alveolar morphology of empty dental sockets which simulate the teeth which are missing post-mortem. An experimental study was conducted on the human mandible, where using volumetric scanning, 3D scanning and printing techniques the tooth was reconstructed from the intra-alveolar morphology of the socket. Through metric analysis and qualitative congruency testing it was established that there was minimal discrepancy between natural tooth and 3D printed tooth. It was determined that teeth missing post-mortem do not necessarily invalidate the identification process. Digital FTR gives accurate results with minimum error.

Search for Physics beyond the Standard Model in Events with Overlapping Photons and Jets

Results are reported from a search for new particles that decay into a photon and two gluons, in events with jets. Novel jet substructure techniques are developed that allow photons to be identified in an environment densely populated with hadrons. The analyzed proton-proton collision data were collected by the CMS experiment at the LHC, in 2016 at sqrt[s]=13  TeV, and correspond to an integrated luminosity of 35.9  fb^{-1}. The spectra of total transverse hadronic energy of candidate events are examined for deviations from the standard model predictions. No statistically significant excess is observed over the expected background. The first cross section limits on new physics processes resulting in such events are set. The results are interpreted as upper limits on the rate of gluino pair production, utilizing a simplified stealth supersymmetry model. The excluded gluino masses extend up to 1.7 TeV, for a neutralino mass of 200 GeV and exceed previous mass constraints set by analyses targeting events with isolated photons.

Search for Low-Mass Quark-Antiquark Resonances Produced in Association with a Photon at sqrt[s]=13 TeV

A search for narrow low-mass resonances decaying to quark-antiquark pairs is presented. The search is based on proton-proton collision events collected at 13 TeV by the CMS detector at the CERN LHC. The data sample corresponds to an integrated luminosity of 35.9  fb^{-1}, recorded in 2016. The search considers the case where the resonance has high transverse momentum due to initial-state radiation of a hard photon. To study this process, the decay products of the resonance are reconstructed as a single large-radius jet with two-pronged substructure. The signal would be identified as a localized excess in the jet invariant mass spectrum. No evidence for such a resonance is observed in the mass range 10 to 125 GeV. Upper limits at the 95% confidence level are set on the coupling strength of resonances decaying to quark pairs. The results obtained with this photon trigger strategy provide the first direct constraints on quark-antiquark resonance masses below 50 GeV obtained at a hadron collider.

Effect of intra-amniotic fluid pressure from polyhydramnios on cervical length in patients with twin-twin transfusion syndrome undergoing fetoscopic laser surgery

OBJECTIVES

To determine the relationship between intra-amniotic pressure and cervical length (CL) in patients with twin-twin transfusion syndrome (TTTS) undergoing fetoscopic laser photocoagulation (FLP), and to identify pre- or intraoperative factors associated with increased intra-amniotic pressure in this population.

METHODS

This was a prospective cohort study of patients undergoing FLP for TTTS. Exclusion criteria were triplet or higher-order gestation and prior cervical cerclage, amnioreduction or FLP procedure. CL was assessed using preprocedure transvaginal ultrasound. Intra-amniotic pressure measurements were obtained on initial placement of the trocar into the amniotic cavity, using a direct hydrostatic pressure gauge. The relationship between intra-amniotic pressure and CL was assessed using multivariate linear regression analysis, including relevant preoperative and intraoperative variables.

RESULTS

In total, 283 pregnancies met the inclusion criteria. Quintero stage of TTTS was I in 33 pregnancies, II in 88, III in 150 and IV in 12. Mean gestational age (GA) at FLP was 20.7 ± 3 weeks. Mean intra-amniotic pressure was 23.1 ± 9 mmHg. On unadjusted linear regression analysis, there was no significant association between intra-amniotic pressure and preoperative CL (P = 0.24) or GA at delivery (P = 0.22). On multivariate analysis, the factors associated significantly with intra-amniotic pressure were: number of prior term deliveries (P = 0.03), recipient maximum vertical pocket (P < 0.0001), Quintero stage IV (P = 0.01) and type of anesthesia (sedation vs general anesthesia; P = 0.01).

CONCLUSION

In pregnancies with TTTS, intra-amniotic pressure is not associated with CL or GA at delivery. This novel finding suggests that cervical shortening in this population is not mechanically driven. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

Measurements of triple-differential cross sections for inclusive isolated-photon+jet events in p p collisions at s = 8 TeV

Measurements are presented of the triple-differential cross section for inclusive isolated-photon+jet events in p p collisions ats = 8 TeV as a function of photon transverse momentum ( p T γ ), photon pseudorapidity ( η γ ), and jet pseudorapidity ( η jet ). The data correspond to an integrated luminosity of 19.7 fb - 1 that probe a broad range of the available phase space, for| η γ | < 1.44 and1.57 < | η γ | < 2.50 ,| η jet | < 2.5 , 40 < p T γ < 1000 GeV , and jet transverse momentum, p T jet , > 25GeV . The measurements are compared to next-to-leading order perturbative quantum chromodynamics calculations, which reproduce the data within uncertainties.

3M™ Petrifilm™ Staph Express Count Plate Method for the Enumeration of Staphylococcus aureus in Selected Dairy Foods: Collaborative Study

The 3M™ Petrifilm™ Staph Express Count plate method was compared with AOAC Official Method 975.55 for the enumeration of Staphylococcus aureus in selected foods. Five foods—ice cream, raw milk, yogurt, whey powder, and cheese—were analyzed for S. aureus by 12 collaborating laboratories. For each food tested, the collaborators received 8 blind test samples consisting of a control sample, a low inoculation level, a medium inoculation level, and a medium inoculation level with background flora, each in duplicate. The mean log10 counts for the methods were comparable for all 5 foods. The repeatability and reproducibility variances of the 24 h Petrifilm Staph Express Count plate method were similar to those of the 72 h standard method.

Intercontinental collaborative experience with abdominal, retroperitoneal and pelvic schwannomas

Background

Schwannomas are rare tumours that pose a significant management challenge in the abdomen, retroperitoneum and pelvis. No data are available to inform management strategy.

Methods

A collaborative international cohort study, across specialist sarcoma units, was conducted to include adults presenting between 2000 and 2017 with histopathologically confirmed schwannomas within the abdomen, retroperitoneum or pelvis.

Results

Of 485 patients across 12 centres, 38 (7·8 per cent) were discharged without follow-up, 199 (41·0 per cent) underwent early resection and 248 (51·1 per cent) had radiological monitoring. Of these 248 patients, 96 (38·7 per cent) eventually had surgery, giving an overall resection rate of 60·8 per cent (295 of 485). At baseline, median tumour volume was 90·1 (i.q.r. 26·5–262·0) cm3. The estimated growth rate was 10·5 (95 per cent c.i. 9·4 to 11·6) per cent per year, and was consistent in the short term (within 2 years of diagnosis) and long term (beyond 2 years) (ρ = 0·405, P = 0·021). A decision to operate was more common in symptomatic patients (P &lt; 0·001) and for rapidly growing tumours (growth rate more than 20 per cent per year) (P = 0·025). R0/R1 resection was achieved in 91·6 per cent of patients (263 of 287). Kaplan–Meier long-term recurrence rates after R0/R1 resection were 2·3 and 6·7 per cent at 3 and 5 years respectively.

Conclusion

Specific recommendations include: indications for early surgery, prediction of growth from radiological monitoring, promotion of selective submacroscopic resection and cessation of postoperative imaging surveillance.

Measurement of the average very forward energy as a function of the track multiplicity at central pseudorapidities in proton-proton collisions at s = 13 TeV

The average total energy as well as its hadronic and electromagnetic components are measured with the CMS detector at pseudorapidities - 6.6 < η < - 5.2 in proton-proton collisions at a centre-of-mass energys = 13 TeV . The results are presented as a function of the charged particle multiplicity in the region | η | < 2 . This measurement is sensitive to correlations induced by the underlying event structure over a very wide pseudorapidity region. The predictions of Monte Carlo event generators commonly used in collider experiments and ultra-high energy cosmic ray physics are compared to the data. All generators considered overestimate the fraction of energy going into hadrons.

The Nursing Doctorate: One Size Does Not Fit All

The demand for Advanced Practice Registered Nurses, nursing faculty, and nursing leaders is driving the increase in nurses seeking doctoral degrees (Bednash, Brelin, Kirschling, & Rosseter, 2014). A variety of programs have emerged to prepare nurses for careers in health administration, research, and advanced clinical practice. Prospective graduate level nursing students can choose from doctoral programs focused on research or practice. Potential doctoral students now have several different degrees to choose from, and deciding which one is right for them can be a daunting task.

Search for new physics in top quark production in dilepton final states in proton-proton collisions at s = 13 TeV

A search for new physics in top quark production is performed in proton-proton collisions at 13 TeV . The data set corresponds to an integrated luminosity of 35.9 fb - 1 collected in 2016 with the CMS detector. Events with two opposite-sign isolated leptons (electrons or muons), and b quark jets in the final state are selected. The search is sensitive to new physics in top quark pair production and in single top quark production in association with a W boson. No significant deviation from the standard model expectation is observed. Results are interpreted in the framework of effective field theory and constraints on the relevant effective couplings are set, one at a time, using a dedicated multivariate analysis. This analysis differs from previous searches for new physics in the top quark sector by explicitly separating t W from t t ¯  events and exploiting the specific sensitivity of the t W process to new physics.

Search for Neutrinoless Double-β Decay with the Complete EXO-200 Dataset

A search for neutrinoless double-β decay (0νββ) in ^{136}Xe is performed with the full EXO-200 dataset using a deep neural network to discriminate between 0νββ and background events. Relative to previous analyses, the signal detection efficiency has been raised from 80.8% to 96.4±3.0%, and the energy resolution of the detector at the Q value of ^{136}Xe 0νββ has been improved from σ/E=1.23% to 1.15±0.02% with the upgraded detector. Accounting for the new data, the median 90% confidence level 0νββ half-life sensitivity for this analysis is 5.0×10^{25}  yr with a total ^{136}Xe exposure of 234.1 kg yr. No statistically significant evidence for 0νββ is observed, leading to a lower limit on the 0νββ half-life of 3.5×10^{25}  yr at the 90% confidence level.