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At least 829 records · Page 46

Visual Analytics of Heterogeneous Data Using Hypergraph Learning

For real-world learning tasks (e.g., classification), graph-based models are commonly used to fuse the information distributed in diverse data sources, which can be heterogeneous, redundant, and incomplete. Thesemodels represent the relations in different datasets as pairwise links. However, these links cannot deal with high-order relations which connect multiple objects (e.g., in public health datasets, more than two patient groups admitted by the same hospital in 2014). In this article, we propose a visual analytics approach forthe classification on heterogeneous datasets using the hypergraph model. The hypergraph is an extension to traditional graphs in which a hyperedge connects multiple vertices instead of just two. We model various high-order relations in heterogeneous datasets as hyperedges and fuse different datasets with a unified hypergraph structure. We use the hypergraph learning algorithm for predicting missing labels in the datasets.To allow users to inject their domain knowledge into the model-learning process, we augment the traditional learning algorithm in a number of ways. In addition, we also propose a set of visualizations which enable the user to construct the hypergraph structure and the parameters of the learning model interactively during the analysis. Here, we demonstrate the capability of our approach via two real-world cases.

97 MATHEMATICS AND COMPUTING↗

LoTToR: An Algorithm for Missing-Wedge Correction of the Low-Tilt Tomographic 3D Reconstruction of a Single-Molecule Structure (LoTToR) v1.0

The low-tilt tomographic reconstruction (LoTToR) method is a post-processing method to correct the missing-wedge artifact, which contains a model-free iteration process under a set of constraints in real and reciprocal spaces. A proof of concept is conducted by using the LoTToR on a phantom, i.e., a simulated 3D reconstruction from a low-tilt series of images, including that within a tilt range of ±15°. The method is validated by using both negative-staining (NS) and cryo-electron tomography (cryo-ET) experimental data. A significantly reduced missing-wedge artifact verifies the capability of LoTToR, suggesting a new tool to support the future study of macromolecular dynamics, fluctuation and chemical activity from the viewpoint of single-molecule 3D structure determination. Moreover, the software can be used for hospital computer tomography (CT) to reduce the radiation damage to patients without reducing the CT image quality.

Ren, Gang↗

Computational epidemiological tools for pandemic analysis, understanding, and response

This suite of software tools is being developed to enhance and analyze computational epidemiological models that incorporate realistic disease dynamics and human behavior, with the goal of supporting epidemic and pandemic response. Specifically, the tools enable data analysis, feature extraction, data synthesis, machine learning model development, and prediction of key public health outcomes, such as cases, hospitalizations, deaths, and behavioral responses, for airborne infectious diseases like COVID-19 and influenza.

Butts, David↗

The Pacific Northwest Heat Wave of 25–30 June 2021: Synoptic/Mesoscale Conditions and Climate Perspective

Abstract An unprecedented heat wave occurred over the Pacific Northwest and southwest Canada on 25–30 June 2021, resulting in all-time temperature records that greatly exceeded previous record maximum temperatures. The impacts were substantial, including several hundred deaths, thousands of hospitalizations, a major wildfire in Lytton, British Columbia, Canada, and severe damage to regional vegetation. Several factors came together to produce this extreme event: a record-breaking midtropospheric ridge over British Columbia in the optimal location, record-breaking midtropospheric temperatures, strong subsidence in the lower atmosphere, low-level easterly flow that produced downslope warming on regional terrain and the removal of cooler marine air, an approaching low-level trough that enhanced downslope flow, the occurrence at a time of maximum insolation, and drier-than-normal soil moisture. It is shown that all-time-record temperatures have not become more frequent and that annual high temperatures only increased at the rate of baseline global warming. Although anthropogenic warming may have contributed as much as 1°C to the event, there is little evidence of further amplification from increasing greenhouse gases. Weather forecasts were excellent for this event, with highly accurate predictions of the extreme temperatures. Significance Statement This paper describes the atmospheric evolution that produced an extreme heat wave over the Pacific Northwest during June 2021 and puts this event into historical perspective.

Meteorology & Atmospheric Sciences↗

A population data-driven workflow for COVID-19 modeling and learning

CityCOVID is a detailed agent-based model that represents the behaviors and social interactions of 2.7 million residents of Chicago as they move between and colocate in 1.2 million distinct places, including households, schools, workplaces, and hospitals, as determined by individual hourly activity schedules and dynamic behaviors such as isolating because of symptom onset. Disease progression dynamics incorporated within each agent track transitions between possible COVID-19 disease states, based on heterogeneous agent attributes, exposure through colocation, and effects of protective behaviors of individuals on viral transmissibility. Throughout the COVID-19 epidemic, CityCOVID model outputs have been provided to city, county, and state stakeholders in response to evolving decision-making priorities, while incorporating emerging information on SARS-CoV-2 epidemiology. Here we demonstrate our efforts in integrating our high-performance epidemiological simulation model with large-scale machine learning to develop a generalizable, flexible, and performant analytical platform for planning and crisis response.

97 MATHEMATICS AND COMPUTING↗

Bacterial community structure and functional contributions to emergence of health or necrotizing enterocolitis in preterm infants

Background: Preterm infants represent a unique patient population that is born functionally immature and must accomplish development under the influence of a hospital environment. Neonatal necrotizing enterocolitis (NEC) is an inflammatory intestinal disorder affecting preterm infants. The purpose of this study was to evaluate the progression of intestinal microbiota community development between preterm infants who remained healthy compared to preterm infants who developed NEC. Results: Weekly fecal samples from ten preterm infants, five with NEC and five matched healthy controls were obtained. Bacterial DNA from individual fecal samples was subjected to sequencing of 16S rRNA-based inventories using the 454 GS-FLX platform. Fecal samples from control infants demonstrated a temporal pattern in their microbiota, which converged toward that of a healthy full term breast-fed infant. Microbiota development in NEC patients diverged from controls beginning three weeks prior to diagnosis. Shotgun metagenomic sequencing was performed to identify functional differences in the respective microbiota of fecal samples from a set of twins in which one twin developed NEC and one did not. The majority of the differentially abundant genes in the NEC patient were associated with carbohydrate metabolism and mapped to members of the family Enterobacteriaceae. This may indicate an adaptation of the community to an altered profile of substrate availability for specific members as a first step towards the development of NEC. We propose that the microbial communities as a whole may metabolize milk differently, resulting in differential substrate availability for specific microbial groups. Additional differentially represented gene sets of interest were related to antibiotic resistance and vitamin biosynthesis. Conclusions: Our results suggest that there is a temporal component to microbiome development in healthy preterm infants. Thus, bacteriotherapy for the treatment or prevention of NEC must consider this temporal component of the microbial community in addition to its taxonomic composition and functional content.

59 BASIC BIOLOGICAL SCIENCES↗

Crystal structure and DNA binding activity of a PadR family transcription regulator from hypervirulent Clostridium difficile R20291

Background: Clostridium difficile is a spore-forming obligate anaerobe that can remain viable for extended periods, even in the presence of antibiotics, which contributes to the persistence of this bacterium as a human pathogen during host-to-host transmission and in hospital environments. We examined the structure and function of a gene product with the locus tag CDR20291_0991 (cdPadR1) as part of our broader goal aimed at elucidating transcription regulatory mechanisms involved in virulence and antibiotic resistance of the recently emergent hypervirulent C. difficile strain R20291. cdPadR1 is genomically positioned near genes that are involved in stress response and virulence. In addition, it was previously reported that cdPadR1 and a homologue from the historical C. difficile strain 630 (CD630_1154) were differentially expressed when exposed to stressors, including antibiotics. Results: The crystal structure of cdPadR1 was determined to 1.9 Å resolution, which revealed that it belongs to the PadR-s2 subfamily of PadR transcriptional regulators. cdPadR1 binds its own promoter and other promoter regions from within the C. difficile R20291 genome. DNA binding experiments demonstrated that cdPadR1 binds a region comprised of inverted repeats and an AT-rich core with the predicted specific binding motif, GTACTAT(N2)ATTATA(N) AGTA, within its own promoter that is also present in 200 other regions in the C. difficile R20291 genome. Mutation of the highly conserved W in α4 of the effector binding/oligomerization domain, which is predicted to be involved in multi-drug recognition and dimerization in other PadR-s2 proteins, resulted in alterations of cdPadR1 binding to the predicted binding motif, potentially due to loss of higher order oligomerization. Conclusions: Our results indicate that cdPadR1 binds a region within its own promoter consisting of the binding motif GTACTAT(N2)ATTATA(N)AGTA and seems to associate non-specifically with longer DNA fragments in vitro, which may facilitate promoter and motif searching. This suggests that cdPadR1 acts as a transcriptional auto-regulator, binding specific sites within its own promoter, and is part of a broad gene regulatory network involved, in part, with environmental stress response, antibiotic resistance and virulence.

59 BASIC BIOLOGICAL SCIENCES↗

The association between high birth weight and the risks of childhood CNS tumors and leukemia: an analysis of a US case-control study in an epidemiological database

Background: High birth weight (BW), 4000 g or larger, is an established risk factor for childhood leukemia. However, its association with central nervous system (CNS) tumor risk is yet unclear. The present study examined it, analyzing data obtained from a case-control study conducted among three states from the US. The association with childhood leukemia risk was also further examined. Methods: In this study, a data set provided by the Comprehensive Epidemiologic Data Resource was analyzed with an official permission. The original case-control study was conducted to examine the association between paternal preconception exposure to ionizing radiation and childhood cancer risk. Cases with childhood cancer were mainly ascertained from local hospitals, and controls were selected, matched with birth year (1-year category), county of residence, sex, ethnicity and maternal age (+/-2 years). Since the ID numbers were unavailable, conventional logistic analyses were conducted adjusting for those matching variables except for the county of residence. In addition to those variables, gestational age, age at diagnosis and study sites as covariables were included in the logistic models. Results: Analyzed subjects were 72 CNS tumor cases, 124 leukemia cases and 822 controls born from 1945 to 1989. The odds ratios (ORs) of CNS tumor risk for children with low BWs (<2500 g) and high BWs (>4000 g) were 2.0 (95% confidence interval [CI]) = 0.7, 5.9) and 2.5 (95%CI = 1.2, 5.2)], respectively. When high-BW children were restricted to those who were large for gestational age (LGA), the OR for high-BW children remained similar (OR = 2.7; 95%CI = 1.1, 6.2). On the other hand, the ORs of leukemia risk for children with low and high BWs were 0.8 (95%CI = 0.2, 3.0) and 1.4 (95%CI = 0.7, 2.6), respectively. In the normal range of BW (2500–4000 g), higher BW was positively associated with CNS tumor risk (beta = 0.0011, p for trend = 0.012). However, the association with leukemia risk was not significant (beta = -0.0002, p for trend = 0.475). Conclusion: High-BW and LGA children had an elevated childhood CNS tumor risk. In the normal BW range, the BW itself was positively related to CNS tumor risk. No significant association between BW and childhood leukemia risk was observed in this study.

60 APPLIED LIFE SCIENCES↗

When to vaccinate for seasonal influenza: check the peak forecast

Background Seasonal influenza infects 5-20% of people every year in the United States, resulting in hospitalizations, deaths, and adverse economic impacts. To mitigate these impacts, influenza vaccines are developed and distributed annually; however, growing evidence suggests that vaccine effectiveness (VE) wanes over the course of a flu season. Delaying influenza vaccination for older adults has attracted attention as a potential public health strategy. However, given the uncertainties in seasonal peak, vaccine effectiveness, and waning rates, postponing vaccination could also lead to increased morbidity, motivating an evaluation of a range of potential scenarios. The aim of this study was to investigate favorable age group-specific vaccination schedules that could lead to the greatest disease burden reduction. Methods We systematically investigated a broad range of vaccination start times for five age groups under six combinations of initial effectiveness and waning rates, based on influenza cases and vaccine uptake data from 10 influenza seasons. We defined the most favorable vaccination schedule as the one that resulted in the greatest reduction in disease burden. Results In scenarios with fast waning, all age groups benefit from delaying vaccination regardless of initial VE and peak timing. In scenarios with slower waning, results are mixed. For the ≥65 group, high initial VE and slow waning suggests that in early-peaking seasons, early vaccination most effectively reduces disease burden, while in late-peaking seasons delaying vaccination is most effective. For the ≥65 group in medium and low initial VE, and slow waning scenarios, delaying vaccination appears to prevent the greatest number of cases, regardless of whether the season peaks early or late. Conclusion The most favorable vaccination schedule is sensitive to changes in initial VE, waning rate, and peak timing. Given estimates of these quantities from statistical and immunological models and observations, our methods can inform vaccination recommendations in order to most effectively reduce the annual disease burden caused by seasonal influenza. Specifically, accurate peak timing forecasts for the upcoming season have the potential to guide decisions on when to vaccinate.

59 BASIC BIOLOGICAL SCIENCES↗

Demographic factors associated with dietary supplement prescriptions filled by United States Military Service Members 2005–2013

Background: Dietary supplements (DSs) can be purchased over-the-counter but may also be prescribed by medical personnel for specific therapeutic reasons. Few studies have examined this latter source of DSs despite the fact that 79% of physicians and 82% of nurses have recommended DSs to their patients. This investigation examined demographic factors associated with temporal trends in oral DS prescriptions filled by all United States (US) service members (SMs) from 2005 to 2013 (n = 1,427,080 ± 22,139, mean ± standard deviation per year). Methods: The Food and Drug Administration National Drug Code database and the formularies of the US Defense Health Agency’s Pharmacoeconomic Center were queried to identify DSs available to SMs. The number of these DS prescriptions filled by all SMs from 2005 through 2013 was then obtained from the US Department of Defense Pharmacy Data Transaction System. Data were grouped by American Hospital Formulary System (AHFS) pharmacologic-therapeutic classifications and examined over time. Denominators (number of SMs each year) were obtained from the Defense Health Agency. Results: Major findings included 1) generally greater prevalence of prescriptions filled by women and older SMs for most AHFS categories; 2) a temporal decline in total prescriptions filled by Marine Corps personnel accounted for by a decline in the prevalence of zinc preparations filled by younger male Marines; 3) a temporal decline in the prevalence of iron preparations filled by women; 4) a temporal increase in the prevalence of prescriptions for replacement preparations filled by women accounted for largely by more prescriptions for calcium compounds; and 5) a temporal decline in the prevalence of prescriptions filled for cathartics/laxatives in older SMs accounted for largely by a decline in prescriptions for sodium/potassium compounds. Conclusions: These temporal trends may be associated with the greater health care utilization of women and older SMs as well as the perceptions of prescribers and/or patients on appropriate roles of these substances in medicine and public health.

60 APPLIED LIFE SCIENCES↗

Retrospective analysis of pulse oximeter alarm settings in an intensive care unit patient population

Background: The cacophony of alerts and alarms in a hospital produced by medical devices results in alarm fatigue. The pulse oximeter is one of the most common sources of alarms. One of the ways to reduce alarm rates is to adjust alarm settings at the bedside. This study is aimed to retrospectively examine individual pulse oximeter alarm settings on alarm rates and inter- and intra- patient variability. Methods: Nine hundred sixty-two previously collected intensive care unit (ICU) patient records were obtained from the Multiparameter Intelligent Monitoring in Intensive Care II Database (Beth Israel Deaconess Medical Center, Boston, MA). Inclusion criteria included patient records that contained SpO 2 trend data sampled at 1 Hz for at least 1 h and a matching clinical record. SpO 2 alarm rates were simulated by applying a range of thresholds (84, 86, 88, and 90 %) and delay times (10 to 60 s) to the SpO 2 data. Patient records with at least 12 h of SpO 2 data were examined for the variability in alarm rate over time. Results: Decreasing SpO 2 thresholds and increasing delay times resulted in decreased alarm rates. A limited number of patient records accounted for most alarms, and this number increased as alarm settings loosened (the top 10 % of patient records were responsible for 57.4 % of all alarms at an SpO 2 threshold of 90 % and 15 s delay and 81.6 % at an SpO 2 threshold of 84 % and 45 s delay). Alarm rates were not consistent over time for individual patients with periods of high and low alarms for all alarm settings. Conclusion: Pulse oximeter SpO 2 alarm rates are variable between patients and over time, and the alarm rate and the extent of inter- and intra-patient variability can be affected by the alarm settings. Personalized alarm settings for a patient’s current status may help to reduce alarm fatigue for nurses.

59 BASIC BIOLOGICAL SCIENCES↗

NSAID use and clinical outcomes in COVID-19 patients: a 38-center retrospective cohort study

Abstract Background Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to reduce pain, fever, and inflammation but have been associated with complications in community-acquired pneumonia. Observations shortly after the start of the COVID-19 pandemic in 2020 suggested that ibuprofen was associated with an increased risk of adverse events in COVID-19 patients, but subsequent observational studies failed to demonstrate increased risk and in one case showed reduced risk associated with NSAID use. Methods A 38-center retrospective cohort study was performed that leveraged the harmonized, high-granularity electronic health record data of the National COVID Cohort Collaborative. A propensity-matched cohort of 19,746 COVID-19 inpatients was constructed by matching cases (treated with NSAIDs at the time of admission) and 19,746 controls (not treated) from 857,061 patients with COVID-19 available for analysis. The primary outcome of interest was COVID-19 severity in hospitalized patients, which was classified as: moderate, severe, or mortality/hospice. Secondary outcomes were acute kidney injury (AKI), extracorporeal membrane oxygenation (ECMO), invasive ventilation, and all-cause mortality at any time following COVID-19 diagnosis. Results Logistic regression showed that NSAID use was not associated with increased COVID-19 severity (OR: 0.57 95% CI: 0.53–0.61). Analysis of secondary outcomes using logistic regression showed that NSAID use was not associated with increased risk of all-cause mortality (OR 0.51 95% CI: 0.47–0.56), invasive ventilation (OR: 0.59 95% CI: 0.55–0.64), AKI (OR: 0.67 95% CI: 0.63–0.72), or ECMO (OR: 0.51 95% CI: 0.36–0.7). In contrast, the odds ratios indicate reduced risk of these outcomes, but our quantitative bias analysis showed E-values of between 1.9 and 3.3 for these associations, indicating that comparatively weak or moderate confounder associations could explain away the observed associations. Conclusions Study interpretation is limited by the observational design. Recording of NSAID use may have been incomplete. Our study demonstrates that NSAID use is not associated with increased COVID-19 severity, all-cause mortality, invasive ventilation, AKI, or ECMO in COVID-19 inpatients. A conservative interpretation in light of the quantitative bias analysis is that there is no evidence that NSAID use is associated with risk of increased severity or the other measured outcomes. Our results confirm and extend analogous findings in previous observational studies using a large cohort of patients drawn from 38 centers in a nationally representative multicenter database.

60 APPLIED LIFE SCIENCES↗

Dichotomous development of the gut microbiome in preterm infants

Preterm infants are at risk of developing intestinal dysbiosis with an increased proportion of Gammaproteobacteria. In this study, we sought the clinical determinants of the relative abundance of feces-associated Gammaproteobacteria in very low birth weight (VLBW) infants. Fecal microbiome was characterized at ≤ 2 weeks and during the 3rd and 4th weeks after birth, by 16S rRNA amplicon sequencing. Maternal and infant clinical characteristics were extracted from electronic medical records. Data were analyzed by linear mixed modeling and linear regression. Clinical data and fecal microbiome profiles of 45 VLBW infants (gestational age 27.9 ± 2.2 weeks; birth weight 1126 ± 208 g) were studied. Three stool samples were analyzed for each infant at mean postnatal ages of 9.9 ± 3, 20.7 ± 4.1, and 29.4 ± 4.9 days. The average relative abundance of Gammaproteobacteria was 42.5% (0–90%) at ≤ 2 weeks, 69.7% (29.9–86.9%) in the 3rd, and 75.5% (54.5–86%) in the 4th week (p < 0.001). Hierarchical and K-means clustering identified two distinct subgroups: cluster 1 started with comparatively low abundance that increased with time, whereas cluster 2 began with a greater abundance at ≤ 2 weeks (p < 0.001) that decreased over time. Both groups resembled each other by the 3rd week. Single variants of Klebsiella and Staphylococcus described variance in community structure between clusters and were shared between all infants, suggesting a common, hospital-derived source. Fecal Gammaproteobacteria was positively associated with vaginal delivery and antenatal steroids. We detected a dichotomy in gut microbiome assembly in preterm infants: some preterm infants started with low relative gammaproteobacterial abundance in stool that increased as a function of postnatal age, whereas others began with and maintained high abundance. Vaginal birth and antenatal steroids were identified as predictors of Gammaproteobacteria abundance in the early (≤ 2 weeks) and later (3rd and 4th weeks) stool samples, respectively. These findings are important in understanding the development of the gut microbiome in premature infants.

60 APPLIED LIFE SCIENCES↗

Air quality and health impacts of the 2020 wildfires in California

Abstract Background Wildfires in 2020 ravaged California to set the annual record of area burned to date. Clusters of wildfires in Northern California surrounded the Bay Area covering the skies with smoke and raising the air pollutant concentrations to hazardous levels. This study uses the Fire Inventory from the National Center for Atmospheric Research database and the Community Multiscale Air Quality model to estimate the effects of wildfire emissions on air quality during the period from August 16 to October 28 of 2020. In addition, low-cost sensor data for fine particulate matter (PM 2.5 ) from the PurpleAir network is used to enhance modeled PM 2.5 concentrations. The resulting impacts on ozone and PM 2.5 are used to quantify the health impacts caused by wildfires using the Benefits Mapping and Analysis Program – Community Edition. Results Wildfire activity significantly increased direct PM 2.5 emissions and emissions of PM 2.5 and ozone precursors. Direct PM 2.5 emissions surged up to 38 times compared to an average day. Modeling results indicated that wildfires alone led to a rise in ozone daily maximum 8-h average by up to 10 ppb and exceeded PM 2.5 air quality standards in numerous locations by up to 10 times. While modeled PM 2.5 concentrations were lower than measurements, correcting these with PurpleAir data improved the accuracy. The correction using PurpleAir data increased estimates of wildfire-induced mortality due to PM 2.5 exposure by up to 16%. Conclusions The increased hospital admissions and premature mortality attributed to wildfires were found to be comparable to the health impacts avoided by strategies aimed at meeting ozone and PM2.5 air quality standards. This suggests that widespread wildfire emissions can negate years of efforts dedicated to controlling air pollution. The integration of low-cost sensor data proved invaluable in refining the estimates of health impacts from PM2.5 resulting from wildfires.

54 ENVIRONMENTAL SCIENCES↗

Forecasting seasonal influenza with a state-space SIR model

Seasonal influenza is a serious public health and societal problem due to its consequences resulting from absenteeism, hospitalizations, and deaths. The overall burden of influenza is captured by the Centers for Disease Control and Prevention’s influenza-like illness network, which provides invaluable information about the current incidence. This information is used to provide decision support regarding prevention and response efforts. Despite the relatively rich surveillance data and the recurrent nature of seasonal influenza, forecasting the timing and intensity of seasonal influenza in the U.S. remains challenging because the form of the disease transmission process is uncertain, the disease dynamics are only partially observed, and the public health observations are noisy. Fitting a probabilistic state-space model motivated by a deterministic mathematical model [a susceptible-infectious-recovered (SIR) model] is a promising approach for forecasting seasonal influenza while simultaneously accounting for multiple sources of uncertainty. A significant finding of this work is the importance of thoughtfully specifying the prior, as results critically depend on its specification. Our conditionally specified prior allows us to exploit known relationships between latent SIR initial conditions and parameters and functions of surveillance data. We demonstrate advantages of our approach relative to alternatives via a forecasting comparison using several forecast accuracy metrics.

60 APPLIED LIFE SCIENCES↗

Laparoscopic Hyperthermic Intraperitoneal Chemotherapy is Safe for Patients with Peritoneal Metastases from Gastric Cancer and May Lead to Gastrectomy

Background: Laparoscopic hyperthermic intraperitoneal chemotherapy (LS-HIPEC) is a novel strategy for patients with gastric adenocarcinoma (GA) metastatic to the peritoneum. We evaluated the safety profile of LS-HIPEC for patients with positive peritoneal cytology (PPC) or carcinomatosis from GA. Methods: Outcomes were reviewed of patients with stage IV GA with peritoneal involvement who received LS-HIPEC from June 2014 to January 2017. LS-HIPEC included a 60-minute perfusion of mitomycin-C (30 mg) and cisplatin (200 mg) with inflow temperatures of 41–42 °C and outflow temperatures of 39–40 °C. Results: A total of 71 LS-HIPEC procedures were performed in 44 patients. At diagnosis, 68% (n = 30) had carcinomatosis and 32% (n = 14) had isolated PPC. Three patients (7%) underwent LS-HIPEC for intractable ascites. All patients initially received systemic chemotherapy, and 20 patients (45%) received pre-procedural chemoradiotherapy. The median number of LS-HIPEC procedures performed per patient was one (range 1–5 procedures). There were no conversions to laparotomy, two outflow catheter obstructions, and one major (Clavien-Dindo grade III) surgical complication within 30 days. A total of seven postoperative adverse hematologic events (> CTCAE 2) were observed in five patients (11%), without any major renal or gastrointestinal adverse events within 30 days. The median overall length of hospital stay after LS-HIPEC was 2 (range 2–11) days. Eleven patients (25%) underwent secondary gastrectomy following resolution of peritoneal cytology. Conclusions: Laparoscopic HIPEC is a safe procedure and may be repeated in patients with peritoneal metastases from gastric cancer. Future studies are required to determine the optimal HIPEC regimen and timing relative to systemic therapy to best minimize morbidity.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Determining the Safety and Efficacy of Enhanced Recovery Protocols in Major Oncologic Surgery: An Institutional NSQIP Analysis

Background: Enhanced-recovery (ER) protocols are increasingly being utilized in surgical practice. Outside of colorectal surgery, however, their feasibility, safety, and efficacy in major oncologic surgery have not been proven. This study compared patient outcomes before and after multispecialty implementation of ER protocols at a large, comprehensive cancer center. Methods: Surgical cases performed from 2011 to 2016 and captured by an institutional NSQIP database were reviewed. Following exclusion of outpatient and emergent surgeries, 2747 cases were included in the analyses. Cases were stratified by presence or absence of ER compliance, defined by preoperative patient education and electronic medical record order set-driven opioid-sparing analgesia, goal-directed fluid therapy, and early postoperative diet advancement and ambulation. Results: Approximately half of patients were treated on ER protocols (46%) and the remaining on traditional postoperative (TP) protocols (54%). Treatment on an ER protocol was associated with decreased overall complication rates (20% vs. 33%, p < 0.0001), severe complication rates (7.4% vs. 10%, p = 0.010), and median hospital length of stay (4 vs. 5 days, p < 0.0001). There was no change in readmission rates (ER vs. TP, 8.6% vs. 9.0%, p = 0.701). Subanalyses of high magnitude cases and specialty-specific outcomes consistently demonstrated improved outcomes with ER protocol adherence, including decreased opioid use. Conclusions: This assessment of a large-scale ER implementation in multispecialty major oncologic surgery indicates its feasibility, safety, and efficacy. Future efforts should be directed toward defining the long-term oncologic benefits of these protocols.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Effect of Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features (NIFTP) on Malignancy Rates in Thyroid Nodules: How to Counsel Patients on Extent of Surgery

Purpose: To investigate the impact of the nomenclature change to “noninvasive follicular thyroid neoplasm with papillary-like nuclear features” (NIFTP) on reported malignancy rates following thyroidectomy. Methods: Retrospective cohort study of patients with thyroid nodules sampled preoperatively with fine-needle aspiration (FNA) and subsequently removed at one tertiary-care hospital from 4/2016 to 2/2017. Surgical procedure, anatomic pathology, thyroid cytopathology classification, and demographic characteristics were recorded. Results: Thyroidectomy was performed in 353 patients. Twenty-six patients (7.3%) had NIFTP on anatomic pathology. Preoperative FNA demonstrated atypia of undetermined significance (AUS/Bethesda III) in 13 (50%), suspicious for malignancy (SUS/Bethesda V) in 6 (23%), suspicious for follicular neoplasm (SFN/Bethesda IV) in 4 (15%), benign/Bethesda I in 2 (8%), and malignant/Bethesda VI in 1 (4%). Invasive malignancy rates across cytologic categories changed as follows: benign (n = 74) from 4 to 1%, AUS (n = 85) from 33 to 18% (p < 0.05), SFN (n = 58) from 29 to 22%, SUS (n = 33) from 91 to 73% (p < 0.05), and malignant (n = 99) from 99 to 98%. Overall decrease in invasive malignancy was 7.3% for the entire population and 13.1% for indeterminate preoperative FNA cytology (Bethesda III–V). Among 26 NIFTP patients, 17 had thyroid lobectomy (TL) and 9 underwent total thyroidectomy (TT). Eight of the nine patients with TT could have been definitively treated with TL, an 89% decrease. Conclusions: The NIFTP nomenclature change led to an overall decrease in the malignancy rate at our institution, especially for Bethesda III–V categories. Patients may be counseled toward more conservative surgical options if NIFTP is in the differential.

62 RADIOLOGY AND NUCLEAR MEDICINE↗