Characterization of Clinical, Systemic, and Socioeconomic Factors That May Affect the Timing of Initial Management of Patients with Posterior Urethral Valves
Bibliographic record
Abstract
Background: To characterize clinical, system, and socioeconomic factors as potential barriers to healthcare access, measured by timing of posterior urethral valve (PUV) management. Methods: We retrospectively reviewed PUV patients managed at our institution from 2000-2019. Primary outcomes were time to first imaging (renal ultrasound and/or voiding cystourethrogram) and surgery. Univariate analyses assessed associations with clinical (antenatal suspicion, prematurity), system (NICU admission, transfer status, hospital distance), and socioeconomic factors. Socioeconomic status was assessed using the Canadian Index of Multiple Deprivation (CIMD) scores and quintiles, which include situational vulnerability, residential instability, economic dependency, and ethnocultural composition. Results: 62 PUV patients were included. Median age at imaging was 5 days and at surgery was 14 days. Antenatal suspicion of PUV was present in 53.3% (32/60), prematurity in 27.6% (16/58), NICU admission in 57.7% (30/52), and transfer from another hospital in 51.7% (30/58) of patients. Median distance from hospital was 69.8 km. Median CIMD scores were: situational vulnerability –0.25, residential instability –0.21, economic dependency –0.36, and ethnocultural composition –0.39. Antenatal suspicion of PUV was associated with earlier imaging (p < 0.001) and surgery (p < 0.001). Prematurity was also associated with earlier imaging (p = 0.048) and surgery (p = 0.028). Neonatal intensive care unit (NICU) admission was associated with both earlier imaging (p = 0.002) and surgery (p = 0.02). Higher ethnocultural composition scores were associated with a longer time to surgery (p = 0.05). Imaging and surgery timing were not significantly associated with transfer status, distance from hospital, or other CIMD dimensions. Conclusion: Patients with antenatally suspected PUV, prematurity, and NICU admission had earlier imaging and surgery. Most socioeconomic factors were not barriers to PUV management, but higher ethnocultural composition scores were associated with longer time to surgery. Clinical and system factors appear to primarily drive timely PUV management, though disparities related to ethnocultural composition may merit further study.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".