Completion Of Day Research Articles

A pragmatic, single-arm clinical trial of a dose-adjustment algorithm for preventing cytopenia-related delays during FOLFOX chemotherapy.

6608 Background: Unplanned delays are common during FOLFOX chemotherapy, and cytopenias (neutropenia and/or thrombocytopenia) are the most common cause of delays. We evaluated a novel, provider-driven FOLFOX dose-adjustment algorithm designed to reduce unplanned delays while maintaining chemotherapy dose intensity. Methods: We conducted a pragmatic, single-arm clinical trial to evaluate the FOLFOX dose adjustment algorithm (NCT04526886). The algorithm prescribed graded chemotherapy dose reductions without delay on day 1 of cycles 2-6 for patients with an absolute neutrophil count (ANC) of 750 to 1499/microL and/or a platelet count of 50 to 99 K/microL. The algorithm prescribed a delay when ANC was less than 750 or platelet count was less than 50 on day 1 of cycles 2-6. Chemotherapy dose adjustments and delays for reasons other than cytopenias were at the discretion of the treating provider. Patients receiving initial treatment with FOLFOX chemotherapy (with or without concomitant monoclonal antibodies) were eligible. Subjects received standard chemotherapy doses in cycle 1 (bolus 5-FU 400 mg/m2, oxaliplatin 85 mg/m2, and infusional 5-FU 2400 mg/m2/46 hours). Use of granulocyte colony stimulating factor (GCSF) was not permitted, except for patients who had already experienced an unplanned delay. The primary outcome was any unplanned delay prior to completion of day 1 of cycle 6 of chemotherapy (with an interval of >18 days between cycles.) We tested whether the incidence of any unplanned delay was less than the historical rate of 43%, using a one-sample test of proportions. Chemotherapy relative dose intensity (RDI) over cycles 1-6 was a key secondary outcome. Results: 48 of 54 enrolled subjects were evaluable. The median age was 66, and 50% were female. The most common primary cancer sites were colorectal (n = 31) and gastroesophageal (n = 12). Metastatic cancer was present in 67%, and 35% received a concurrent monoclonal antibody. Sixteen of 48 subjects had any unplanned delay before completing cycle 6 (33%, 95% CI 0.22-0.47, p = 0.08 for comparison with historical proportion of 43%), and 7 subjects had any cytopenia-related delay (15%, CI 0.07-0.27). Twenty-one subjects (44%) had one or more algorithm-driven chemotherapy dose reductions without a delay, and 8 cycles were delivered without delay with an ANC of 750-999 (without GCSF). The mean (median) chemotherapy RDIs were: bolus 5-FU, 65% (67%); oxaliplatin, 85% (90%); and infusional 5-FU, 92% (97%). Conclusions: The 33% observed incidence of any unplanned chemotherapy delay was nominally but not significantly lower than the historical rate of 43%. The incidence of any cytopenia-related delay was 15%, lower than the historical rate of >30%. Further refinement and evaluation of the FOLFOX dose adjustment algorithm may help to reduce unplanned delays and their attendant disruptions and costs for patients and providers. Clinical trial information: NCT04526886 .

E-Wallet- Factors Affecting Its Intention to Use

The purpose of this research paper is to determine the influence of factors on intention to use E-Wallet, Bangkok, Thailand. The five factors which are selected for the study are perceived usefulness, perceived ease of use, security/privacy confidence, social influence and trustworthiness. In this study, the research is based on data collected through electronic questionnaires which were filled by 384 respondents who belong to service class of Bangkok, Thailand. The data were collected by using judgement quota and convenience sampling of non-probability sampling method. The data so collected was analyzed by using Pearson Product Moment Coefficient Correlation (Bivariate) in order to find out the level of significance and relationship between independent and dependent variables. The result of analysis revealed that all the independent variables have a significant relationship with intention to use E-Wallet, with one of the variables, namely trustworthiness showing a strong relationship with intention to use E-Wallet whereas social influence showing lowest impact on intention to use E-Wallet. The results and findings of the study throw light on factors that the companies can emphasize and work upon to design their product related as well as marketing related strategies. The companies will be in a better position to attract new and existing customers towards E-Wallet usage. The use of E-Wallet is becoming popular not only in developed economies, but also in developing economies owing to the ease, safety and fast completion of day to day financial activities of the users. Moreover, the digitalization of monetary transactions throughout the world is a major factor which necessitates the use of E-Wallets by the users, thereby increasing the number of such users in the days to come.

Evaluation of biochemical and haematological changes in dengue fever and dengue hemorrhagic fever in Sri Lankan children: a prospective follow up study

BackgroundSeries of biochemical and haematological changes occur during the course of dengue infection, which vary depending on the clinical disease. The patterns of change are not well documented and identifying these patterns in children with dengue infection would help to anticipate the progression to different clinical stages thus enabling effective management.MethodsA prospective follow up study was conducted during the period of July 2013 – April 2014 at Professorial Pediatric unit, Lady Ridgeway Hospital for Children, Colombo, Sri Lanka. Children (5–12 years) admitted within the first 84 h of fever, with a clinical diagnosis of dengue infection were recruited. Children who became positive for dengue IgM were included in the final analysis. Blood was collected on admission for complete blood count, Alanine aminotransferase, Aspartate aminotransferase, albumin, cholesterol and corrected calcium. These tests were repeated at 12 hourly intervals during the hospital stay.ResultsData of 130-subjects were analyzed (Dengue fever /Dengue hemorrhagic fever: 100/30). There was a significant difference in the pattern of white cell counts, platelets and haematocrit in the two clinical groups. Both transaminase rose initially in both dengue fever and dengue hemorrhagic fever and a steep rise were seen between 8th and 9th days in hemorrhagic fever. Both albumin and cholesterol decreased significantly at the time of entering into the critical phase. According to Receiver operating characteristic curve analysis, albumin level crossing 37.5g/L (sensitivity 86.7%, specificity 77.8%) and a 0.38 mmol/L reduction in cholesterol level (sensitivity 77.3%, specificity 71.9%) between day 3 and 4 were the best predictors of entering into critical phase. Calcium levels did not show any distinct pattern.ConclusionsThere is a clear difference in the pattern of change of both hematological and biochemical parameters in dengue fever and dengue hemorrhagic fever. Reduction in albumin and cholesterol levels seen between the completion of day 3 and day 4 were highly valid predictors of entering into critical phase in dengue hemorrhagic fever.

Misperception of tiredness in young adults with insomnia.

People with insomnia often exhibit interpretive biases to cues associated with their condition. This study examined whether individuals with insomnia display an interpretive bias, such that they misperceive facial attributes of tiredness in a disorder-consistent manner. The efficacy of providing feedback related to the accuracy of participants' perception on later judgements of tiredness was further examined. Forty participants, 20 with DSM-5-defined insomnia disorder and 20 normal-sleepers, participated. The perception of one's own facial appearance of tiredness was assessed twice over two consecutive days using a visual task whereby participants indicated when a morphing image of their face represented their current level of tiredness. Visual and verbal feedback, related to participants' degree of misperception, was provided on completion of Day 1 testing. Overall, individuals with insomnia perceived their own face as significantly more tired than a baseline neutral photograph was, whereas normal-sleepers perceived themselves as appearing more alert. This pattern of results was only apparent on Day 1. Although no group×day interaction was established, mean scores suggest an improvement in perception on Day 2 amongst individuals with insomnia only. These findings suggest that individuals with insomnia exhibit a misperception of their facial attributes of tiredness, interpreting them in a disorder-consistent manner. This finding adds to the body of literature on cognitive models of insomnia, demonstrating more general cognitive biases in the disorder. Further, the results provide suggestive evidence that this misperception may be reformed.

Effect of sodium intake on fasting and postprandial levels of atrial natriuretic factor in humans

The effect of chronic dietary sodium intake on fasting and postprandial plasma atrial natriuretic factor (ANF) levels was examined in 2 studies of normal humans. In Study I, 3 separate groups of normals (n=8 for each) reeieved diets of either low (L), normal (N) or high (H) daily sodium intake for 7 days. Twenty-four h urines for sodium were obtained on days 6 and 7. Urine sodium excretion for each group was (L) 13.1±3.7, (N) 150.1±19.4 and (H) 271.3±33.6 mEq/day. On the completion of day 7, fasting plasma ANF showed no change with alteration in sodium intake. In contrast, when blood samples were obtained postprandially, significant increased in plasma ANF were observed in the group maintained on high sodium diet. In Study II, a continuous group of normals ( n=8) received the 3 sodium controlled diets for 7 days sequentially (L/N/H). No significant changes in fasting levels of ANF were detected between L/N/H sodium diets. In conclusion, these studies show that the maintenance of sodium balance during chronic changes in sodium intake can occur despite no significant increase in plasma ANF under normal steady state conditions. However, plasma ANF is significantly elevated during chronic high sodium intake, when measured postprandially.

Testosterone 5 alpha-reductase activity as related to proliferative status in mouse accessory sex glands.

Testosterone 5 alpha-reductase activity has been measured during the proliferative response of the seminal vesicle and coagulating gland of the castrated mouse after continuous treatment with tesotsterone. Daily subcutaneous injections were begun either 3 or 14 days after castration. At 3 days after castration, a pre-replicative period of 50-60 h occurred before the onset of DNA synthesis, and a continuous [3H]thymidine labelling procedure revealed that only a minority of epithelial cells were subsequently involved in the transitory proliferative response. At 14 days after castration, cells were able to prepare more quickly for DNA synthesis (20-30 h), and the subsequent proliferative response involved a higher proportion of the epithelial cells present. At 14 days after castration, testosterone treatment resulted in the activity of the enzyme/mg homogenate increasing fourfold in the seminal vesicle and tenfold in the coagulating gland, to values almost double those of control (intact animals. At 3 days after castration, testosterone treatment resulted in much slower increases in enzyme activity, and at the completion of day 5 of treatment, levels were close to control values. It is concluded that a relationship may exist between the initial increase in 5 alpha-reductase activity and the duration of the pre-replicative period before DNA synthesis begins. Although testosterone and its resultant effects upon 5 alpha-reductase activity are clearly implicated in the genesis of the proliferative response, the ultimate control of cell proliferation must be independent of androgenic hormones. When cell division was effectively curtailed at the completion of day 4 of testosterone treatment, abnormally high levels of enzyme activity were still present.