Deep-potential enabled multiscale simulation of gallium nitride devices on boron arsenide cooling substrates

High-efficient heat dissipation plays critical role for high-power-density electronics. Experimental synthesis of ultrahigh thermal conductivity boron arsenide (BAs, 1300 W m-1K-1) cooling substrates into the wide-bandgap semiconductor of gallium nitride (GaN) devices has been realized. However, the lack of systematic analysis on the heat transfer across the GaN-BAs interface hampers the practical applications. In this study, by constructing the accurate and high-efficient machine learning interatomic potentials, we perform multiscale simulations of the GaN-BAs heterostructures. Ultrahigh interfacial thermal conductance of 260 MW m-2K-1 is achieved, which lies in the well-matched lattice vibrations of BAs and GaN. The strong temperature dependence of interfacial thermal conductance is found between 300 to 450 K. Moreover, the competition between grain size and boundary resistance is revealed with size increasing from 1 nm to 1000 μm. Such deep-potential equipped multiscale simulations not only promote the practical applications of BAs cooling substrates in electronics, but also offer approach for designing advanced thermal management systems.

Generative artificial intelligence, human creativity, and art

Recent artificial intelligence (AI) tools have demonstrated the ability to produce outputs traditionally considered creative. One such system is text-to-image generative AI (e.g. Midjourney, Stable Diffusion, DALL-E), which automates humans' artistic execution to generate digital artworks. Utilizing a dataset of over 4 million artworks from more than 50,000 unique users, our research shows that over time, text-to-image AI significantly enhances human creative productivity by 25% and increases the value as measured by the likelihood of receiving a favorite per view by 50%. While peak artwork Content Novelty, defined as focal subject matter and relations, increases over time, average Content Novelty declines, suggesting an expanding but inefficient idea space. Additionally, there is a consistent reduction in both peak and average Visual Novelty, captured by pixel-level stylistic elements. Importantly, AI-assisted artists who can successfully explore more novel ideas, regardless of their prior originality, may produce artworks that their peers evaluate more favorably. Lastly, AI adoption decreased value capture (favorites earned) concentration among adopters. The results suggest that ideation and filtering are likely necessary skills in the text-to-image process, thus giving rise to "generative synesthesia"-the harmonious blending of human exploration and AI exploitation to discover new creative workflows.

Integrating artificial intelligence into the modernization of traditional Chinese medicine industry: a review

Traditional Chinese medicine (TCM) is the practical experience and summary of the Chinese nation for thousands of years. It shows great potential in treating various chronic diseases, complex diseases and major infectious diseases, and has gradually attracted the attention of people all over the world. However, due to the complexity of prescription and action mechanism of TCM, the development of TCM industry is still in a relatively conservative stage. With the rise of artificial intelligence technology in various fields, many scholars began to apply artificial intelligence technology to traditional Chinese medicine industry and made remarkable progress. This paper comprehensively summarizes the important role of artificial intelligence in the development of traditional Chinese medicine industry from various aspects, including new drug discovery, data mining, quality standardization and industry technology of traditional Chinese medicine. The limitations of artificial intelligence in these applications are also emphasized, including the lack of pharmacological research, database quality problems and the challenges brought by human-computer interaction. Nevertheless, the development of artificial intelligence has brought new opportunities and innovations to the modernization of traditional Chinese medicine. Integrating artificial intelligence technology into the comprehensive application of Chinese medicine industry is expected to overcome the major problems faced by traditional Chinese medicine industry and further promote the modernization of the whole traditional Chinese medicine industry.

BioKG: a comprehensive, large-scale biomedical knowledge graph for AI-powered, data-driven biomedical research

To cope with the rapid growth of scientific publications and data in biomedical research, knowledge graphs (KGs) have emerged as a powerful data structure for integrating large volumes of heterogeneous data to facilitate accurate and efficient information retrieval and automated knowledge discovery (AKD). However, transforming unstructured content from scientific literature into KGs has remained a significant challenge, with previous methods unable to achieve human-level accuracy. In this study, we utilized an information extraction pipeline that won first place in the LitCoin NLP Challenge to construct a largescale KG using all PubMed abstracts. The quality of the large-scale information extraction rivals that of human expert annotations, signaling a new era of automatic, high-quality database construction from literature. Our extracted information markedly surpasses the amount of content in manually curated public databases. To enhance the KG's comprehensiveness, we integrated relation data from 40 public databases and relation information inferred from high-throughput genomics data. The comprehensive KG enabled rigorous performance evaluation of AKD, which was infeasible in previous studies. We designed an interpretable, probabilistic-based inference method to identify indirect causal relations and achieved unprecedented results for drug target identification and drug repurposing. Taking lung cancer as an example, we found that 40% of drug targets reported in literature could have been predicted by our algorithm about 15 years ago in a retrospective study, demonstrating that substantial acceleration in scientific discovery could be achieved through automated hypotheses generation and timely dissemination. A cloud-based platform (https://www.biokde.com) was developed for academic users to freely access this rich structured data and associated tools.

BioThings Explorer: a query engine for a federated knowledge graph of biomedical APIs

SUMMARY

Knowledge graphs are an increasingly common data structure for representing biomedical information. These knowledge graphs can easily represent heterogeneous types of information, and many algorithms and tools exist for querying and analyzing graphs. Biomedical knowledge graphs have been used in a variety of applications, including drug repurposing, identification of drug targets, prediction of drug side effects, and clinical decision support. Typically, knowledge graphs are constructed by centralization and integration of data from multiple disparate sources. Here, we describe BioThings Explorer, an application that can query a virtual, federated knowledge graph derived from the aggregated information in a network of biomedical web services. BioThings Explorer leverages semantically precise annotations of the inputs and outputs for each resource, and automates the chaining of web service calls to execute multi-step graph queries. Because there is no large, centralized knowledge graph to maintain, BioThings Explorer is distributed as a lightweight application that dynamically retrieves information at query time.

AVAILABILITY AND IMPLEMENTATION

More information can be found at https://explorer.biothings.io and code is available at https://github.com/biothings/biothings_explorer.

Trends over 20 years of antimicrobial prophylaxis for artificial urinary sphincter surgery

INTRODUCTION AND OBJECTIVE

Perioperative antimicrobial prophylaxis is crucial for prevention of prosthesis and patient morbidity after artificial urinary sphincter (AUS) placement. While antibiotic guidelines exist for many urologic procedures, adoption patterns for AUS surgery are unclear. We aimed to assess trends in antibiotic prophylaxis for AUS and outcomes relative to American Urological Association (AUA) Best Practice guidelines.

METHODS

The Premier Healthcare Database was queried from 2000 to 2020. Encounters involving AUS insertion, revision/removal, and associated complications were identified via ICD and CPT codes. Premier charge codes were used to identify antibiotics used during the insertion encounter. AUS-related complication events were found using patient hospital identifiers. Univariable analysis between hospital/patient characteristics and use of guideline-adherent antibiotics was done via chi-squared and Kruskal-Wallis tests. A multivariable logistic mixed effects model was used to assess factors related to the odds of complication, specifically the use of guideline-adherent versus nonadherent regimens.

RESULTS

Of 9775 patients with primary AUS surgery, 4310 (44.1%) received guideline-adherent antibiotics. The odds of guideline-adherent regimen use increased 7.7% per year with 53.0% (830/1565) receiving guideline-adherent antibiotics by the end of the study period. Patients with guideline-adherent regimens had a decreased risk of any complication (odds ratio [OR]: 0.83, 95% confidence interval [CI]: 0.74-0.93) and surgical revision (OR: 0.85, 95% CI: 0.74-0.96) within 3 months; however, no significant difference in infection within was noted (OR: 0.89, 95% CI: 0.68-1.17) within 3 months.

CONCLUSIONS

Adherence to AUA antimicrobial guidelines for AUS surgery appears to have increased over the last two decades. While guideline-adherent regimens were associated with decreased risk of any complication and surgical intervention, no significant association was found with risk of infection. Surgeons appear to be increasingly following AUA recommendations for antimicrobial prophylaxis for AUS surgery, however, further level 1 evidence should be obtained to demonstrate conclusive benefit of these regimens.

BioThings Explorer: a query engine for a federated knowledge graph of biomedical APIs

Knowledge graphs are an increasingly common data structure for representing biomedical information. These knowledge graphs can easily represent heterogeneous types of information, and many algorithms and tools exist for querying and analyzing graphs. Biomedical knowledge graphs have been used in a variety of applications, including drug repurposing, identification of drug targets, prediction of drug side effects, and clinical decision support. Typically, knowledge graphs are constructed by centralization and integration of data from multiple disparate sources. Here, we describe BioThings Explorer, an application that can query a virtual, federated knowledge graph derived from the aggregated information in a network of biomedical web services. BioThings Explorer leverages semantically precise annotations of the inputs and outputs for each resource, and automates the chaining of web service calls to execute multi-step graph queries. Because there is no large, centralized knowledge graph to maintain, BioThing Explorer is distributed as a lightweight application that dynamically retrieves information at query time. More information can be found at https://explorer.biothings.io, and code is available at https://github.com/biothings/biothings_explorer.

Bleeding and Ketorolac Use in Pediatric Circumcision

BACKGROUND

Circumcision is a common surgical procedure performed among pediatric male patients. Ketorolac is an effective adjunct in multimodal regimens for postoperative pain control. However, many urologists and anesthesiologists refrain from administering ketorolac due to concern for postoperative bleeding.

AIMS

Compare the risk of clinically significant bleeding after circumcision with and without intraoperative ketorolac administration.

METHODS

A single center, retrospective cohort study was conducted of pediatric patients 1-18 years of age who underwent isolated circumcision by one urologist from 2016 to 2020. Clinically significant bleeding was defined as bleeding requiring intervention within the first 24 hours of circumcision. Interventions included use of absorbable hemostats, placement of sutures, or return to the operating room.

RESULTS

Of 743 patients, 314 (42.3%) did not receive ketorolac and 429 (57.7%) received intraoperative ketorolac 0.5 mg/kg. Postoperative bleeding requiring intervention occurred in one patient (0.32%) in the non-ketorolac group versus four patients (0.93%) in the ketorolac group (Difference 0.6%, 95% CI (-0.8%, 2.0%), p=0.403).

CONCLUSIONS

There was one patient (0.32%) with postoperative bleeding requiring intervention in the non-ketorolac group versus four patients (0.93%) in the ketorolac group (Difference 0.6%, 95% CI (-0.8%, 2.0%), p=0.403). As bleeding was a rare outcome, this study was not powered to detect a statistically significant difference between the two groups. Future studies regarding the association between ketorolac and postoperative bleeding are needed.

733. Letermovir treatment for refractory or resistant cytomegalovirus infection or disease with concurrent organ dysfunction: an interim analysis of a Phase 2 open label study

Background

Cytomegalovirus (CMV) disease is associated with increased morbidity and mortality following solid organ and hematopoietic cell transplantation. Currently, standard of care CMV treatments often have significant myelosuppressive or renal toxicities. Given letermovir’s favorable safety profile when used prophylactically, it may be a safe and efficacious alternative agent for CMV treatment.

Methods

A proof-of-concept, open-label trial was conducted in patients who lacked effective therapeutic options or presented with baseline organ dysfunction. Participants were eligible for enrollment if they were ≥12 years old and had documented CMV infection refractory to treatment defined as failure to achieve >1 log reduction in CMV viral load (VL) (when VL > 500 IU/mL) or lack of clinical improvement for CMV end-organ disease after ≥14 days of standard CMV treatment. Alternatively, patients with severe myelosuppression and renal dysfunction at baseline or genotypic antiviral resistance were also eligible. Participants were excluded if their current CMV infection developed while receiving letermovir for CMV prophylaxis. Letermovir was administered daily (480 mg PO/IV) for up to 12 weeks, with optional additional 12 weeks of treatment for secondary prophylaxis if clinically indicated.

Results

Ten patients met eligibility criteria and were enrolled. Reasons for enrollment included ganciclovir resistance (1/10), refractory CMV infection (6/10), renal dysfunction (7/10), and myelosuppression (7/10). The median baseline CMV VL was 1272 IU/ml [interquartile range (IQR); 925, 2546]. Six patients completed the study, three died due to complications of primary disease, and one discontinued due to diarrhea. Five patients (50%) had documented CMV viremia clearance, with a median time to first unquantifiable/undetectable CMV VL of 13 days [IQR; 9,18] and a median treatment duration of 53 days [IQR; 15,84]. Infections and GI disorders were the most common adverse events (AE), none considered related to study drug. No unexpected AE were observed during letermovir treatment.

Conclusion

Letermovir may be a safe and tolerable alternative for patients with treatment refractory CMV infection or for patients with severe baseline myelosuppression and renal dysfunction.

Disclosures

Matthew Cheng, MD, AstraZeneca: Honoraria|Cidara Therapeutics: Grant/Research Support|Scynexis Inc.: Grant/Research Support Sandra Burchett, MD, MSc, merck: Grant/Research Support Sarah P. Hammond, MD, F2G: Advisor/Consultant|F2G: Grant/Research Support|GSK: Grant/Research Support|Merck: Grant/Research Support|pfizer: Advisor/Consultant|Scynexis: Grant/Research Support Nicolas C. Issa, MD, AiCuris: Grant/Research Support|Merck: Grant/Research Support Francisco M. Marty, MD, SM, AlloVir: Advisor/Consultant|Amplyx: Advisor/Consultant|Amplyx: Grant/Research Support|Ansun: Grant/Research Support|Avir: Advisor/Consultant|Chimerix: Grant/Research Support|Cidara: Grant/Research Support|F2G: Advisor/Consultant|F2G: Grant/Research Support|Gilead: Grant/Research Support|Janssen: Advisor/Consultant|Kyorin: Advisor/Consultant|Merck: Advisor/Consultant|Merck: Grant/Research Support|Regeneron: Advisor/Consultant|Regeneron: Grant/Research Support|ReViral: Advisor/Consultant|Scynexis: Grant/Research Support|Symbio: Advisor/Consultant|Takeda: Grant/Research Support|United Medical: Advisor/Consultant|WHISCO: Grant/Research Support.

Metabolomics of Extracellular Vesicles: A Future Promise of Multiple Clinical Applications

Extracellular vesicles (EVs) can contain DNA, RNA, proteins and metabolic molecules from primary origins; they are coated with a phospholipid bilayer membrane and released by cells into the extracellular matrix. EVs can be obtained from various body liquids, including the blood, saliva, cerebrospinal fluid, and urine. As has been proved, EVs-mediated transfer of biologically active molecules is crucial for various physiological and pathological processes. Extensive investigations have already begun to explore the diagnosis and prognosis potentials for EVs. Furthermore, research has continued to recognize the critical role of nucleic acids and proteins in EVs. However, our understanding of the comprehensive effects of metabolites in these nanoparticles is currently limited and in its infancy. Therefore, we have attempted to summarize the recent research into the metabolomics of EVs in relation to potential clinical applications and discuss the problems and challenges that have occurred, to provide more guidance for the future development in this field.

Identification of a novel gene signature of lung adenocarcinoma based on epidermal growth factor receptor-tyrosine kinase inhibitor resistance

INTRODUCTION

Tyrosine kinase inhibitors (TKIs) that target epidermal growth factor receptor (EGFR) mutations are commonly administered to EGFR-positive lung cancer patients. However, resistance to EGFR-TKIs (mostly gefitinib and erlotinib) is presently a significant problem. Limited studies have focused on an EGFR-TKI resistance-related gene signature (ERS) in lung adenocarcinoma (LUAD).

METHODS

Gefitinib and erlotinib resistance-related genes were obtained through the differential analyses of three Gene Expression Omnibus datasets. These genes were investigated further in LUAD patients from The Cancer Genome Atlas (TCGA). Patients in the TCGA-LUAD cohort were split into two groups: one for training and one for testing. The training cohort was used to build the ERS, and the testing cohort was used to test it. GO and KEGG analyses were explored for the enriched pathways between the high-risk and low-risk groups. Various software, mainly CIBERSORT and ssGSEA, were used for immune infiltration profiles. Somatic mutation and drug sensitivity analyses were also explored.

RESULTS

An ERS based on five genes (FGD3, PCDH7, DEPDC1B, SATB2, and S100P) was constructed and validated using the TCGA-LUAD cohort, resulting in the significant stratification of LUAD patients into high-risk and low-risk groups. Multivariable Cox analyses confirmed that ERS had an independent prognostic value in LUAD. The pathway enrichment analyses showed that most of the genes that were different between the two risk groups were related to the immune system. Further immune infiltration results revealed that a lower immune infiltration score was observed in high-risk patients, and that various leukocytes were significantly related to the ERS. Importantly, samples from the high-risk group showed lower levels of PD-1, PD-L1, and CTLA-4, which are important biomarkers for immunotherapy responses. Patients in the high-risk group also had more gene mutation changes and were more sensitive to chemotherapy drugs like docetaxel and sorafenib. The ERS was also validated in the GSE30219, GSE11969 and GSE72094, and showed a favorable prognostic value for LUAD patients.

DISCUSSION

The ERS established during this study was able to predict a poor prognosis for LUAD patients and had great potential for predicting drug responses.

Analysis of the Failure of Removal of the Urinary Catheter for Patients With Intracerebral Hemorrhage Postoperatively

BACKGROUND

We conducted this study to assess the value of clinically relevant data for predicting the failure of removing urinary catheters among patients with intracerebral hemorrhage postoperatively.

MATERIALS AND METHODS

We retrospectively analyzed the medical records of all patients with intracerebral hemorrhage who underwent surgery for removal of intracerebral hematoma between January 2014 and December 2019, all of whom retained their urinary catheter. The patients were classified into 2 groups. Group A included patients who underwent successful removal of the catheter while group B included patients who underwent a failed removal. Univariate analysis was performed to determine the relationship between the failure of catheter removal and the patients' preoperative clinical characteristics. Independent prognostic predictors were identified using multivariate analyses.

RESULTS

The site of intracerebral hematoma ( P =0.004), volume of hematoma ( P <0.001), intraventricular hemorrhage ( P <0.001), admitted Glasgow Coma Scale (GCS) ( P <0.001), GCS before urinary catheter removal ( P <0.001), smoking ( P =0.011), herniation ( P <0.001), urine protein ( P =0.013), creatinine ( P =0.037), and timing of urinary catheter removal ( P <0.001) were significantly different among the 2 groups. Multiple logistical regression analysis indicated that GCS before urinary catheter removal (odds ratio=1.171; 95% confidence interval=1.050-1.306; P =0.005) and timing for urinary catheter removal (odds ratio=0.962; 95% confidence interval=0.944-0.981; P <0.001) were associated with failure of urinary catheter removal.

CONCLUSIONS

This study demonstrated that GCS before urinary catheter removal and the timing of urinary catheter removal are independent factors associated with failure of urinary catheter removal among patients with intracerebral hemorrhage.

Exploration of a Novel Circadian miRNA Pair Signature for Predicting Prognosis of Lung Adenocarcinoma

Lung adenocarcinoma (LUAD) is the primary histological subtype of lung cancer with a markedly heterogeneous prognosis. Therefore, there is an urgent need to identify optimal prognostic biomarkers. We aimed to explore the value of the circadian miRNA (cmiRNA) pair in predicting prognosis and guiding the treatment of LUAD. We first retrieved circadian genes (Cgenes) from the CGDB database, based on which cmiRNAs were predicted using the miRDB and mirDIP databases. The sequencing data of Cgenes and cmiRNAs were retrieved from TCGA and GEO databases. Two random cmiRNAs were matched to a single cmiRNA pair. Finally, univariate Cox proportional hazard analysis, LASSO regression, and multivariate Cox proportional hazard analysis were performed to develop a prognostic signature consisting of seven cmiRNA pairs. The signature exhibited good performance in predicting the overall and progression-free survival. Patients in the high-risk group also showed lower IC50 values for several common chemotherapy and targeted medicines. In addition, we constructed a cmiRNA–Cgenes network and performed a corresponding Gene Ontology and Gene Set enrichment analysis. In conclusion, the novel circadian-related miRNA pair signature could provide a precise prognostic evaluation with the potential capacity to guide individualized treatment regimens for LUAD.

Electrically-driven robust tuning of lattice thermal conductivity

The two-dimensional (2D) materials, represented by graphene, stand out in the electrical industry applications of the future and have been widely studied. As commonly existing in electronic devices, the electric field has been extensively utilized to modulate the performance. However, how the electric field regulates thermal transport is rarely studied. Herein, we investigate the modulation of thermal transport properties by applying an external electric field ranging from 0 to 0.4 V Å^-1, with bilayer graphene, monolayer silicene, and germanene as study cases. The monotonically decreasing trend of thermal conductivity in all three materials is revealed. A significant effect on the scattering rate is found to be responsible for the decreased thermal conductivity driven by the electric field. Further evidence shows that the reconstruction of internal electric field and generation of induced charges lead to increased scattering rate from strong phonon anharmonicity. Thus, the ultralow thermal conductivity emerges with the application of external electric fields. Applying an external electric field to regulate thermal conductivity illustrates a constructive idea for highly efficient thermal management.

Study on Instant Delivery Service Riders' Safety and Health by the Effects of Labour Intensity in China: A Mediation Analysis

The Instant Delivery Service (IDS) riders' overwork by “self-pressurisation” will not only reduce the level of their physical and mental health but also lose their lives in safety accidents caused by their fatigue riding. The purpose of this article is to examine whether there is overwork among IDS riders in big and medium cities in China? What's going on with them? Based on the Cobb-Douglas production function in the input-output theory, this study characterised the factors on IDS riders' safety and health associated with labour intensity. A mediating model with moderating effect was adopted to describe the mediation path for the 2,742 IDS riders who were surveyed. The results of moderating regression demonstrated that (1) 0.4655 is the total effect of labour intensity on the safety and health of IDS riders. (2) 0.3124 is the moderating effect that working hours make a greater impact on labour intensity. (3) The mediating effect of work pressure is the principal means of mediation both upstream and downstream.

Testing delivery of components of cognitive behavioral therapy for insomnia to breast cancer survivors by smart speaker: a study protocol

BACKGROUND

Insomnia is common in breast cancer survivors (BCS), affecting an estimated 30-50% of the 3.8 million BCS in the US. Insomnia is associated with health consequences for cardiometabolic and immune systems, neurobehavioral function, depression, fatigue, and quality of life and may put BCS at particular risk. While pharmacotherapy for insomnia may address symptoms in the short-term, cognitive behavioral therapy for insomnia (CBT-I) is considered the gold standard insomnia treatment. We describe our protocol to determine the efficacy of voice-activated delivery of CBT-I components on insomnia symptoms compared to a sleep education control among BCS.

METHODS

We will conduct a 6-week, randomized controlled trial with two arms. Intervention arm participants will receive a smart speaker device and will be asked to engage with the program daily, using a voice-activated speaker with an accompanying smart-phone app. Control participants will have access to a website with basic information about CBT-I, sleep, and breast cancer survivorship and will be asked to engage with the website as desired.

DISCUSSION

Our primary outcome is the Insomnia Severity Index total score. Secondary outcomes include sleep diary outcomes (sleep efficiency, wake after sleep onset, sleep onset latency, total sleep time, and sleep quality). This study will provide evidence on a promising modality to deliver elements of CBT-I for BCS experiencing insomnia. Trial Registration ClinicalTrials.gov NCT05233800 Released 3/25/2022.

Biolink Model: A universal schema for knowledge graphs in clinical, biomedical, and translational science

Within clinical, biomedical, and translational science, an increasing number of projects are adopting graphs for knowledge representation. Graph‐based data models elucidate the interconnectedness among core biomedical concepts, enable data structures to be easily updated, and support intuitive queries, visualizations, and inference algorithms. However, knowledge discovery across these “knowledge graphs” (KGs) has remained difficult. Data set heterogeneity and complexity; the proliferation of ad hoc data formats; poor compliance with guidelines on findability, accessibility, interoperability, and reusability; and, in particular, the lack of a universally accepted, open‐access model for standardization across biomedical KGs has left the task of reconciling data sources to downstream consumers. Biolink Model is an open‐source data model that can be used to formalize the relationships between data structures in translational science. It incorporates object‐oriented classification and graph‐oriented features. The core of the model is a set of hierarchical, interconnected classes (or categories) and relationships between them (or predicates) representing biomedical entities such as gene, disease, chemical, anatomic structure, and phenotype. The model provides class and edge attributes and associations that guide how entities should relate to one another. Here, we highlight the need for a standardized data model for KGs, describe Biolink Model, and compare it with other models. We demonstrate the utility of Biolink Model in various initiatives, including the Biomedical Data Translator Consortium and the Monarch Initiative, and show how it has supported easier integration and interoperability of biomedical KGs, bringing together knowledge from multiple sources and helping to realize the goals of translational science.

0416 The Impact of Idiopathic Hypersomnia on Social and Romantic Relationships of Young Adults

Introduction

Idiopathic hypersomnia (IH) is a rare and debilitating neurologic disorder characterized by hypersomnolence, often beginning in adolescence. As IH has significant impacts on quality of life and may have greater social impact than narcolepsy, we studied how IH impacts social, romantic, and sexual relationships in young adults.

Methods

Young adults (18-39 years; N=106) with a self-reported IH diagnosis were recruited through national patient organizations. Participants completed an online survey to evaluate social, romantic, and sexual relationships, and communication with medical providers.

Results

Participants (mean=29.6 years; SD=5.2) were primarily female (90%), White/Caucasian (90%) and employed (80%). Almost all participants indicated that IH made social life or entering relationships more difficult (98% and 92%, respectively). Eighty-nine percent of participants indicated that IH had affected their sex life (“Too tired to engage in sexual activities or to feel aroused. …I want to sleep if I am in bed …”). IH symptoms impacted relationships in majority of participants (84%) and contributed to the breakup of a romantic relationship for almost 1 in 3 (32%). Rates of cohabitation and marriage were comparable to nationally representative samples. On the Multidimensional Scale of Perceived Social Support, participants reported receiving significantly more support from their significant others (mean=4.3; SD=1.8) compared to their family (mean=3.9; SD=1.6; p&lt;.05) or friends (mean=4.0; SD=1.6; p&lt;.05). There was no difference between the level of support received from family or friends (V = 2154; p =.77). Medical providers rarely asked about the social (34%) or sex lives (9%) of participants. In contrast, many participants wanted clinicians to ask about the impact of IH symptoms on social life (70%) and sex life (35%).

Conclusion

IH substantially impacts social and romantic health in young adults. Similar to findings in narcolepsy, individuals with IH appear to prioritize romantic partnerships over other personal relationships. Many participants were interested in discussing their social and sexual relationships with their medical providers. However, only a small proportion of clinicians ask about these relationships. To provide effective treatment for the whole patient, clinicians should be prepared to evaluate and provide further support for the social health of young adults with IH.

Support (If Any)

Jazz Pharmaceuticals.

0374 A sleep health educational module for social work students is associated with improvements in sleep knowledge and sleep quality

Introduction

Insufficient sleep is highly prevalent, particularly among underserved groups. Social workers often work with underserved populations who are at risk for sleep deprivation and are well-positioned to promote healthy sleep behaviors. However, sleep health training is rarely integrated into social work curriculums. To address this gap, we developed and tested a 2-hour online sleep health educational intervention, designed to improve sleep-related knowledge among social work students.

Methods

We recruited 106 social work students via a departmental listserve to participate in a 1-hour sleep education module. Pre-post module changes in knowledge and beliefs were assessed using the Sleep Beliefs Scale (SBS) and the Sleep Practices and Attitudes Questionnaire (SPAQ). We also assessed changes in self-reported sleep quality using the Pittsburgh Sleep Quality Index (PQSI). Wilcoxon Signed-Rank tests were used to assess pre- to post-module scores. We conducted qualitative research (open-ended questions and focus groups) to assess acceptability and to inform future module refinement.

Results

Of the 106 students participating in the module, mean age was 28.3±8.8 yrs, 92.5% were female, 4.7% male, and 2.8% other. The sample was racially/ethnically diverse with 37.7% identifying as non-Hispanic White, 34.0% African American/Black, 22.6% Hispanic/Latino, 0.9% Asian, and 4.7% other. Ninety (84.9%) participants completed the questionnaires. Demographics did not differ between students who completed the training and those who did not. Students participating in the module reported improvements in the Sleep Beliefs Scale (Median=2.0, range: -4, 10 [positive change=increased knowledge]), the SPAQ (Median=-10, range: -37, 95 [negative change=increased importance of sleep]), and the Global PQSI Score (Median=-1, range: -7, 4 [negative change = improved sleep quality]). Qualitative data supported the module’s acceptability and utility (e.g., “Not only will I adapt these healthy sleep habits, I will always ask my clients how they are sleeping!”). Suggestions for improvement included adding additional topics (e.g., over-the-counter sleep aids) and shortening the training duration.

Conclusion

Participation in an online educational module was associated with not only improvements in sleep knowledge but also self-reported sleep among social work students, suggesting feasible ways to expand providers promoting sleep health.

Support (If Any)

American Academy of Sleep Medicine Foundation

0441 Treating Insomnia Disorder in Black Women: Results from an Internet-Based, Randomized Clinical Trial of a Culturally Tailored Intervention

Introduction

Black women are at high risk for insomnia. Despite considerable interest in addressing sleep health disparities, there is very limited research investigating the efficacy of gold standard treatment (cognitive-behavioral therapy for insomnia; CBT-I) among this minority population. Further, we are not aware of any data studying whether a culturally tailored intervention would improve treatment efficacy and/or engagement among Black women.

Methods

We conducted a randomized clinical trial within a national, longitudinal cohort study (Black Women’s Health Study; BWHS). BWHS participants with elevated insomnia symptoms were randomized to receive: (1) automated Internet-delivered CBT-I (Sleep Healthy Using the Internet; SHUTi); (2) a stakeholder-informed, tailored version of SHUTi for Black women (SHUTi-BWHS); or (3) patient education about sleep (PE). Primary outcomes were insomnia severity (Insomnia Severity Index; ISI) and treatment engagement (completion of the intervention). We hypothesized that both SHUTi and SHUTi-BWHS would lead to significantly decreased insomnia severity compared to PE, and that SHUTi-BWHS participants would be more likely to complete the intervention.

Results

Three-hundred and thirty-three Black women (mean age=59.3 years) were enrolled in the trial. Those randomized to receive either SHUTi or SHUTi-BWHS had greater reductions in ISI scores at 6-month follow-up (-10.0 and -9.3 points, respectively) compared to PE (-3.6 points). More participants randomized to SHUTi-BWHS completed the intervention compared to those randomized to SHUTi (78.2% vs 64.8%; p&lt;.01). Participants who completed either SHUTi or SHUTi-BWHS showed greater reductions in insomnia severity compared to non-completers (-10.4 vs -6.2 points; p&lt;.01).

Conclusion

Both SHUTi and SHUTi-BWHS improved sleep outcomes more than an active control. The culturally tailored SHUTi-BWHS program was more effective at engaging participants with the program as a greater proportion completed the full intervention, which was associated with greater improvements in sleep outcomes. These compelling data demonstrate that offering a culturally adapted program is a possible path in efforts to address the sleep health disparities facing Black Americans.

Support (If Any)

This trial was funded by Patient-Centered Outcomes Research Institute grant AD-2017C1-6314. National Cancer Institute grant U01 CA164974 supports the BWHS infrastructure.

0023 Screen Time and Insomnia Symptoms in University Students

Introduction

Prior research has demonstrated a relationship between screen time and sleep health, but more work is needed to understand the potential impact of reason for screen time and timing (i.e., weekend vs. weekday). This study aimed to determine whether screen time, and reason for use, was associated with insomnia symptoms in a sample of university students during the school term. Further, we sought to determine whether effects differed by weekend/weekday.

Methods

Participants were 767 enrolled students from two universities (age x̄=20.94 [SD=5.25]; 74% women). Insomnia symptoms were assessed with the Insomnia Severity Index (ISI); screen time was a self-report of average daily screen time for a variety of purposes (productivity, social media, streaming media, browsing the internet, or video games) on weekdays/workdays and weekends/off days.

Results

A total of 16.4% of the sample had insomnia symptoms in the clinical range (ISI x̄=9.1 [SD=5.3]). Participants reported 10.0 hours (SD=4.5) of screen time per day on weekdays and 10.8 hours (SD=5.2) per day on weekends. During the week, the most screen time (44%; x̄=4.4 [SD=2.6] hours/day) was spent on productivity (work or school). On weekends, the most screen time (30%; x̄=3.3 [SD=2.1] hours/day) was spent on streaming media. More screen time on the weekends was associated with greater insomnia symptoms (r=.10, p=.004), but not during the week (r=.05, p=.185). Regression analyses indicated weekend screen time accounted for 2% of the variance in insomnia symptoms, and this relationship was driven by screen time for productivity (beta=.09, p=.017) and video games (beta=.09, p=.019).

Conclusion

Among university students, self-reported screen time during the week was not associated with elevated insomnia symptoms. Weekend screen time, particularly for the purpose of productivity and video games, was associated with elevated insomnia symptoms though the effect was small. Although screen time is often highlighted as a key contributor to poor sleep health, this impact was minimal in the current study. Future work should continue to examine whether different motivations for screen time is associated with various facets of sleep health, and delineate these associations by weekend vs. weekday.

Support (If Any)

None

Accessing negative Poisson's ratio of graphene by machine learning interatomic potentials

The negative Poisson's ratio (NPR) is a novel property of materials, which enhances the mechanical feature and creates a wide range of application prospects in lots of fields, such as aerospace, electronics, medicine, etc. Fundamental understanding on the mechanism underlying NPR plays an important role in designing advanced mechanical functional materials. However, with different methods used, the origin of NPR is found different and conflicting with each other, for instance, in the representative graphene. In this study, based on machine learning technique, we constructed a moment tensor potential for molecular dynamics (MD) simulations of graphene. By analyzing the evolution of key geometries, the increase of bond angle is found to be responsible for the NPR of graphene instead of bond length. The results on the origin of NPR are well consistent with the start-of-art first-principles, which amend the results from MD simulations using classic empirical potentials. Our study facilitates the understanding on the origin of NPR of graphene and paves the way to improve the accuracy of MD simulations being comparable to first-principle calculations. Our study would also promote the applications of machine learning interatomic potentials in multiscale simulations of functional materials.

Targeting Cancer Cell Ferroptosis to Reverse Immune Checkpoint Inhibitor Therapy Resistance

In recent years, cancer therapies using immune checkpoint inhibitors (ICIs) have achieved meaningful success, with patients with advanced tumors presenting longer survival times and better quality of life. However, several patients still do not exhibit good clinical outcomes for ICI therapy due to low sensitivity. To solve this, researchers have focused on identifying the cellular and molecular mechanisms underlying resistance to ICI therapy. ICI therapy induces apoptosis, which is the most frequent regulated cell death (RCD) but lacks immunogenicity and is regarded as an “immune silent” cell death. Ferroptosis, a unique type of non-apoptotic-RCD, has been preliminarily identified as an immunogenic cell death (ICD), stimulating tumor-antigen-specific immune responses and augmenting anti-tumor immune effects. However, ferroptosis has rarely been used in clinical practice. Present evidence strongly supports that the interferon-γ signaling pathway is at the crossroads of ICI therapy and ferroptosis. TYRO3, a receptor tyrosine kinase, is highly expressed in tumors and can induce anti-programmed cell death (PD)-ligand 1/PD-1 therapy resistance by limiting tumoral ferroptosis. Therefore, in this review, we summarize the clinical practice and effects of ICI therapy in various cancers. We also provide an overview of ferroptosis and report the molecular connections between cancer cell ferroptosis and ICI therapy, and discuss the possibility to reverse ICI therapy resistance by inducing cancer cell ferroptosis.

Clarithromycin-Rifampin-Based Treatment for Nontuberculous Mycobacteria Infections in Immunocompromised Patients who Require Concomitant CYP-Metabolized Medications

Clarithromycin (CYP inhibitor) can be used instead of azithromycin for nontuberculous mycobacteria therapy in patients requiring CYP substrates to mitigate rifampin's CYP induction. We found no differences in adverse events (10/13 vs 14/17; P = .73), drug intolerability (1/5 vs 4/11; P = 1), or 90-day mortality (0/13 vs 1/17; P = 1) in patients receiving clarithromycin vs azithromycin.

Unique Arrangement of Atoms Leads to Low Thermal Conductivity: A Comparative Study of Monolayer Mg2C

Two-dimensional Mg₂C, one of the typical representative MXene materials, is attracting lots of attention due to its outstanding properties. In this study, we find the thermal conductivity of monolayer Mg₂C is more than 2 orders of magnitude lower than graphene and is even lower than MoS₂ despite the relatively lighter atoms of Mg and C. Based on the comparative analysis with graphene, silicene, and MoS₂, the underlying mechanism is found lying in the unique arrangement of atoms (lighter atoms in the middle plane) and large electronegativity difference in Mg₂C. The phonon anharmonicity is strong due to the resonant bonding. In addition, dual band gaps emerge in the phonon dispersion of Mg₂C, which limit the phonon-phonon scattering and reduce the phonon relaxation time. This study reveals a new mechanism responsible for low thermal conductivity, which would be helpful for designing thermal functional materials and pave the way for applications in thermoelectrics.

Shared Cultural Values Influence Mental Health Help-Seeking Behaviors in Asian and Latinx College Students

The current study sought to understand the influence of cultural values on mental health attitudes and help-seeking behaviors in college students of diverse ethnic backgrounds. Asian and Latinx college students (N = 159) completed an online survey in which they reported on their adherence to cultural values as measured by ethnicity-specific cultural values and general attitudes towards mental health. Factor analysis revealed two common factors of cultural values irrespective of ethnicity: Interdependent Orientation (IO) and Cultural Obligation (CO). Regardless of ethnicity, the more students endorsed IO values, the less likely they were to perceive a need for mental health treatment. IO value adherence was also predictive of more negative attitudes towards mental health. CO values were not predictive of perceived need or help-seeking behaviors. Findings highlight the importance of understanding shared cultural values across ethnic-racial groups and considering how the multidimensionality of culture may help explain shared mental health behaviors crossing lines of ethnic group membership.

A novel tau-based rhesus monkey model of Alzheimer's pathogenesis

INTRODUCTION

Alzheimer's disease (AD) is a devastating condition with no effective treatments, with promising findings in rodents failing to translate into successful therapies for patients.

METHODS

Targeting the vulnerable entorhinal cortex (ERC), rhesus monkeys received two injections of an adeno-associated virus expressing a double tau mutation (AAV-P301L/S320F) in the left hemisphere, and control AAV-green fluorescent protein in the right ERC. Noninjected aged-matched monkeys served as additional controls.

RESULTS

Within 3 months we observed evidence of misfolded tau propagation, similar to what is hypothesized to occur in humans. Viral delivery of human 4R-tau also coaptates monkey 3R-tau via permissive templating. Tau spreading is accompanied by robust neuroinflammatory response driven by TREM2+ microglia, with biomarkers of inflammation and neuronal loss in the cerebrospinal fluid and plasma.

DISCUSSION

These results highlight the initial stages of tau seeding and propagation in a primate model, a more powerful translational approach for the development of new therapies for AD.

498 It Makes Relationships Harder: The Role of Narcolepsy in Social and Romantic Relationships in Young Adults

Introduction

Narcolepsy typically begins during adolescence/young adulthood – a crucial period for developing relationships. As symptoms would be expected to impact social interactions, we studied how narcolepsy impacts social, romantic, and sexual relationships in young adults.

Methods

Young adults (18–39 years; N=262) with a self-confirmed narcolepsy diagnosis were recruited through national narcolepsy patient organizations. Participants completed an online survey, including open-ended questions, to evaluate their social, romantic, and sexual relationships and communication with medical providers.

Results

Participants (mean=28.5 years old; SD=5.6) were primarily female (87%), White/Caucasian (92%), employed (75%), and had Narcolepsy Type I (56%). All participants indicated that narcolepsy made social life or entering relationships somewhat or a lot more difficult. Rates of cohabitation and marriage were comparable to nationally representative samples. On the Couples Satisfaction Index, most participants reported feeling satisfied with their romantic relationships (mean=15.8; SD=4.3). On the Multidimensional Scale of Perceived Social Support, participants reported receiving greater support from their significant others (mean=4.5; SD=1.4) compared to both family (mean=3.7; SD=1.5; p&lt;.05) and friends (mean=3.9; SD=1.4; p&lt;.05). There was no difference between family and friends (p&gt;.05). Eighty-percent of participants indicated that narcolepsy impacted their sex life, including experiencing cataplexy or falling asleep during sex. Few participants indicated that their providers asked about their social (31%) and sex life (10%). In contrast, 73% of participants wanted providers to ask about social life and 45% wanted providers to ask about sex life.

Conclusion

Narcolepsy substantially impacts social functioning in young adults. They often prioritize the development of a single, meaningful romantic relationship as their disorder makes sustaining more social relationships challenging (“I do not go out and socialize at all, but spend all my time at home nurturing my romantic relationship because it’s the most important to me”). At a time of sexual development, there are considerable implications of narcolepsy symptoms on their sexual experiences. Though many participants were interested in discussing their social, romantic, and sexual relationships with medical providers, only a small proportion of providers inquire. Effective treatment of narcolepsy in young adults should include support for the impact of the disorder on relationship health.

Support (if any)

Jazz Pharmaceuticals.

319 Validation of the Insomnia Severity Index Short-Form for Identifying Insomnia Disorder in Young Adult Cancer Survivors

Introduction

Insomnia is a common and impairing late effect experienced by many young adult cancer survivors (YACS). Although routine evaluation of sleep disorders in cancer survivors is recommended, lack of consensus on appropriate screening measures contributes to under-identification and under-treatment of these disorders in YACS. As screening measures are ideally as brief as possible while maintaining validity, we sought to validate the recently published three-item Insomnia Severity Index Short-Form (ISI-SF) in YACS.

Methods

250 YACS completed the ISI and the Structured Clinical Interview for the DSM-5 (SCID-5). The ISI-SF was created by summing three ISI items: distress (item #6), interference (item #7), and satisfaction (item #4). In receiver operating characteristic (ROC) analyses, area under the curve (AUC) was calculated to compare discrimination on the ISI-SF to two criteria: the full-scale ISI using a cutoff of ≥8 recently validated in this sample, and the SCID-5 insomnia module. Consistent with previous research, we specified a priori that a cut-off score on the ISI-SF with sensitivity ≥.85 and specificity ≥.75 would be acceptable.

Results

The ISI-SF had excellent discrimination when compared to the full-scale ISI (AUC = .97) and a cut-off score of ≥4 met criteria with a sensitivity of 97% and specificity of 86%. The ISI-SF had good discrimination when compared to the SCID-5 (AUC = .88), but none of the cut-off scores met a priori criteria for sensitivity and specificity. A cut-off score of ≥4 came closest with a sensitivity of 94% and specificity of 70%.

Conclusion

Although the ISI-SF did not meet sensitivity and specificity criteria for a stand-alone screening measure when compared to a diagnostic interview, it demonstrated utility as the first step in a two-step screening procedure. Specifically, the high sensitivity of the ≥4 ISI-F cut-off score is well-suited to accurately screening out YACS who do not need insomnia services; as a second screen, the SCID-5 insomnia module could be administered only to those elevated on the ISI-SF in order to identify false positives cases before making referrals for insomnia specialists.

Support (if any)

National Cancer Institute (1R21CA223832), Swim Across America

Abstract P649: Extracranial Hemorrhage in the Setting of Gastrointestinal Or Genitourinary Cancer is Associated With Increased Risk of Ischemic Stroke in Patients With Atrial Fibrillation

Background and Purpose: Anticoagulation therapy reduces the risk for ischemic stroke in atrial fibrillation (AF) but also predisposes patients to hemorrhagic complications. Patients with GI or GU cancer and AF are at higher risk of bleeding complications with anticoagulation therapy. There is limited knowledge on the risk of first-ever ischemic stroke in AF patients after extracranial hemorrhage (ECH) in patients with gastrointestinal or genitourinary (GI/GU) cancer.

Methods: We conducted a retrospective study using the California State Inpatient Database (SID) including all non-federal hospital admissions in California from 2005-2011. The exposure variable was hospitalization with a diagnosis of ECH with a previous diagnosis of AF. The outcome variable was a subsequent hospitalization with acute ischemic stroke. We excluded patients with stroke prior to or at the time of ECH diagnosis. We calculated adjusted hazard ratios (HRs) for ischemic stroke during follow up and at 6-month intervals using Cox regression models adjusted for pertinent demographics and co-morbidities and stratifying patients with ECH based on the presence/absence of a GI/GU cancer.

Results: We identified 764,257 AF patients (mean age 75 years, 49% women) without a documented history of stroke. Of these, 98,647 (13%) had an ECH-associated hospitalization, and 22,748 patients (3%) developed an ischemic stroke during a mean follow up. Compared to non-ECH patients, patients with ECH in the setting of a GI/GU cancer had a significantly higher risk of incident ischemic stroke (adjusted HR 1.40, 95% CI 1.20-1.64).Whereas there was only a modest increase in ischemic stroke risk in those without GI/GU cancer (adjusted HR 1.09 95% CI 1.05-1.13).

Conclusion: AF patients hospitalized with ECH in the setting of GI/GU cancer have a particularly high risk of incident ischemic stroke. Particular consideration should be given to the optimal balance between the benefits and risks of anticoagulation therapy and the use of non-anticoagulant alternatives such as left atrial appendage closure in this vulnerable population.

Is oseltamivir suitable for fighting against COVID-19: In silico assessment, in vitro and retrospective study

BACKGROUND

Oseltamivir is a first-line antiviral drug, especially in primary hospitals. During the ongoing outbreak of coronavirus disease 2019 (COVID-19), most patients with COVID-19 who are symptomatic have used oseltamivir. Considering its popular and important role as an antiviral drug, it is necessary to evaluate oseltamivir in the treatment of COVID-19.

OBJECTIVE

To evaluate the effect of oseltamivir against COVID-19.

METHODS

Swiss-model was used to construct the structure of the N-terminal RNA-binding domain (NRBD) of the nucleoprotein (NC), papain-like protease (PLpro), and RNA-directed RNA polymerase (RdRp) of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). TM-align program was performed to compare the structure of the viral proteins with the structure of the neuraminidase of influenza A. Molecular docking was used to analyze the theoretical possibility of effective binding of oseltamivir with the active centers of the viral proteins. In vitro study was used to evaluate the antiviral efficiency of oseltamivir against SARS-CoV-2. By clinical case analysis, we statistically evaluated whether the history of oseltamivir use influenced the progression of the disease.

RESULTS

The structures of NRBD, PLpro, and RdRp were built successfully. The results from TM-align suggested that the S protein, NRBD, 3C-like protease (3CLpro), PLPrO, and RdRp were structurally similar to the influenza A neuraminidase, with TM-scores of 0.30077, 0.19254, 0.28766, 0.30666, and 0.34047, respectively. Interestingly, the active center of 3CL pro was found to be similar to the active center from the neuraminidase of influenza A. Through an analysis of molecular docking, we discovered that oseltamivir carboxylic acid was more favorable to bind to the active site of 3CLpro effectively, but its inhibitory effect was not strong compared with the positive group. Finally, we used in vitro study and retrospective case analysis to verify our speculations. We found that oseltamivir is ineffective against SARS-CoV-2 in vitro study and the clinical use of oseltamivir did not improve the patients' symptoms and signs and did not slow the disease progression.

CONCLUSIONS

We consider that oseltamivir isn't suitable for the treatment of COVID-19. During the outbreak of novel coronavirus, when oseltamivir is not effective for the patients after they take it, health workers should be highly vigilant about the possibility of COVID-19.

Risk of Ischemic Stroke in Patients With Atrial Fibrillation After Extracranial Hemorrhage

BACKGROUND AND PURPOSE

Anticoagulation therapy not only reduces the risk of ischemic stroke in atrial fibrillation (AF) but also predisposes patients to hemorrhagic complications. There is limited knowledge on the risk of first-ever ischemic stroke in patients with AF after extracranial hemorrhage (ECH).

METHODS

We conducted a retrospective study using the California State Inpatient Database including all nonfederal hospital admissions in California from 2005 to 2011. The exposure variable was hospitalization with a diagnosis of ECH with a previous diagnosis of AF. The outcome variable was a subsequent hospitalization with acute ischemic stroke. We excluded patients with stroke before or at the time of ECH diagnosis. We calculated adjusted hazard ratios for ischemic stroke during follow-up and at 6-month intervals using Cox regression models adjusted for pertinent demographics and comorbidities. In subgroup analyses, subjects were stratified by primary ECH diagnosis, severity/type of ECH, age, CHA₂DS₂-VASc score, or the presence/absence of a gastrointestinal or genitourinary cancer.

RESULTS

We identified 764 257 patients with AF (mean age 75 years, 49% women) without a documented history of stroke. Of these, 98 647 (13%) had an ECH-associated hospitalization, and 22 748 patients (3%) developed an ischemic stroke during the study period. Compared to patients without ECH, subjects with ECH had ≈15% higher rate of ischemic stroke (overall adjusted hazard ratio, 1.15 [95% CI, 1.11-1.19]). The risk appeared to remain elevated for at least 18 months after the index ECH. In subgroup analyses, the risk was highest in subjects with a primary admission diagnosis of ECH, severe ECH, gastrointestinal-type ECH, with gastrointestinal or genitourinary cancer, and age ≥60 years.

CONCLUSIONS

Patients with AF hospitalized with ECH may have a slightly elevated risk for future ischemic stroke. Particular consideration should be given to the optimal balance between the benefits and risks of anticoagulation therapy and the use of nonanticoagulant alternatives, such as left atrial appendage closure in this vulnerable population.

Development and validation of a risk factor-based system to predict short-term survival in adult hospitalized patients with COVID-19: a multicenter, retrospective, cohort study

BACKGROUND

Coronavirus disease 2019 (COVID-19) has become a public health emergency of global concern. We aimed to explore the risk factors of 14-day and 28-day mortality and develop a model for predicting 14-day and 28-day survival probability among adult hospitalized patients with COVID-19.

METHODS

In this multicenter, retrospective, cohort study, we examined 828 hospitalized patients with confirmed COVID-19 hospitalized in Wuhan Union Hospital and Central Hospital of Wuhan between January 12 and February 9, 2020. Among the 828 patients, 516 and 186 consecutive patients admitted in Wuhan Union Hospital were enrolled in the training cohort and the validation cohort, respectively. A total of 126 patients hospitalized in Central Hospital of Wuhan were enrolled in a second external validation cohort. Demographic, clinical, radiographic, and laboratory measures; treatment; proximate causes of death; and 14-day and 28-day mortality are described. Patients' data were collected by reviewing the medical records, and their 14-day and 28-day outcomes were followed up.

RESULTS

Of the 828 patients, 146 deaths were recorded until May 18, 2020. In the training set, multivariate Cox regression indicated that older age, lactate dehydrogenase level over 360 U/L, neutrophil-to-lymphocyte ratio higher than 8.0, and direct bilirubin higher than 5.0 μmol/L were independent predictors of 28-day mortality. Nomogram scoring systems for predicting the 14-day and 28-day survival probability of patients with COVID-19 were developed and exhibited strong discrimination and calibration power in the two external validation cohorts (C-index, 0.878 and 0.839).

CONCLUSION

Older age, high lactate dehydrogenase level, evaluated neutrophil-to-lymphocyte ratio, and high direct bilirubin level were independent predictors of 28-day mortality in adult hospitalized patients with confirmed COVID-19. The nomogram system based on the four factors revealed good discrimination and calibration, suggesting good clinical utility.

Usual Care for Emergency Department Patients Who Present with Suicide Risk: A Survey of Hospital Procedures in Washington State

Hospital emergency departments (EDs) are important settings for the implementation of effective suicide-specific care. Usual care for suicidal patients who present to EDs remains understudied. This study surveyed EDs in Washington State to assess the adoption of written procedures for recommended standards of care for treating suicidality. Most (N = 79, 84.9%) of the 93 EDs in Washington State participated. Most (n = 58, 73.4%) hospitals had a written protocol for suicide risk assessment, but half (n = 42, 53.2%) did not include documentation of access to lethal means. There was evidence of an association between patient volume and the adoption of suicide-specific protocols and procedures. Our findings suggest the need to enhance the adoption and implementation of recommended standard care in this setting.

1041 Sleep Quality Mediates The Relationship Between Fear Of Cancer Recurrence And Psychological Distress In Young Adults With Cancer

Introduction

Fear of cancer recurrence is common in young adults with cancer and also related to poorer psychological outcomes. Sleep may be disrupted by anxious thoughts about cancer, causing long-term psychological distress. Thus, the current study tests sleep as a putative mediator of the association between fear of cancer recurrence and overall psychological distress in young adult cancer survivors.

Methods

In a national cross-sectional survey of Canadians, 436 young adults diagnosed with cancer between the ages of 15-39 (current age range 20-39, m=32.39, SD=4.70; 88% female) completed the Pittsburgh Sleep Quality Index, the Fear of Cancer Recurrence Inventory—Short Form, and the Kessler 10 Distress Inventory. Mediation was estimated using PROCESS. Age, sex, and on/off treatment status were entered into models as covariates.

Results

In the current sample, average fear of cancer recurrence was above the clinical cut-point (m=22.92, SD=6.84), psychological distress was high (m=25.18, SD=7.81), and sleep quality was poor (m=9.11, SD=3.95). Females reported significantly higher fear of cancer recurrence than males [F(1, 435)=15.49, p &lt;.001]. Patients on treatment reported significantly higher fear of cancer recurrence [F(1,435)=11.43, p=.001], poorer sleep quality [F(1,435)=6.48, p=.011], and greater psychological distress [F(1,435)=4.73, p &lt;.001] than patients off treatment. Using a bootstrapping model with covariates, higher fear of cancer recurrence was related to poorer sleep quality and, in turn, higher psychological distress as indicated by the indirect effect’s confidence interval not containing 0 (indirect effect=.13; 95%CI=0.081, 0.189).

Conclusion

Sleep quality may play an important role in connecting the common experience of fear of cancer recurrence to psychological distress in young adult cancer survivors. Future longitudinal research is needed to examine this possible mediator of young adult cancer patients’ psychological distress outcomes over time.

Support

This research was supported by a grant from the Newfoundland and Labrador Support for People and Patient-Oriented Research and Trials (NL-SUPPORT) Unit. Sheila Garland is supported by a Scotiabank New Investigator Award from the Beatrice Hunter Cancer Research Institute (BHCRI).

Value of serum tumor markers for predicting EGFR mutations and positive ALK expression in 1089 Chinese non-small-cell lung cancer patients: A retrospective analysis

PURPOSE

The role of serum tumor markers (STMs) in the modern management of epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) mutations in lung cancer remains poorly described. In this study, we investigated whether STMs could be a valuable noninvasive tool to predict EGFR mutations and ALK positivity in non-small-cell lung cancer (NSCLC) patients.

EXPERIMENTAL DESIGN

We retrospectively reviewed and included 1089 NSCLC patients who underwent EGFR or ALK mutation testing and STMs measurement prior to treatment. The differences in several clinical characteristics and STMs between the subgroups were analyzed. Multivariate logistic regression analysis was performed to identify predictors of EGFR mutations and ALK positivity.

RESULTS

EGFR mutations were found more frequently in females (63.11%), never-smokers (59.69%), and those with lung adenocarcinoma (ADC) (53.87%). Negative carbohydrate antigen (CA) 125, ferritin (FERR), squamous cell carcinoma antigen (SCC), and soluble fragment of cytokeratin 19 (CYFRA 21-1) levels were significantly associated with EGFR mutations (p < 0.05). Multivariate analysis demonstrated that ADC, never-smoker status, and negative CA 125 and SCC results were predictors of EGFR mutations (p < 0.05). The receiver operating characteristic (ROC) curve yielded an area under the curve (AUC) of 0.715 (95% confidence interval [CI]: 0.673-0.758) for the combination of the four factors. Positive ALK expression was found more frequently in younger patients (median age: 49 years), females (8.40%), never-smokers (8.82%), and those negative for carcinoembryonic antigen (CEA) (8.02%). Multivariate analysis demonstrated that younger age and never-smoker status were the only independent predictors of ALK positivity (p < 0.05). The ROC curve yielded an AUC of 0.760 (95% CI: 0.677-0.844) for the combination of these two factors.

CONCLUSION

STMs are associated with mutant EGFR status and could be integrated with other clinical factors to enhance the ability to distinguish EGFR mutation status among NSCLC patients. For ALK-positive patients, younger age and never-smoker status could predict the mutation status, whereas STMs could not.