Early Days Research Articles

The Polk COVID-19 and Flu Response clinical trial: COVID-19 antibody positivity higher in Black EMS workers

This study reports on a countywide assessment of COVID-19 positivity among emergency medical services workers. Participants completed a short survey of demographic factors and co-morbidities prior to obtaining COVID-19 and influenza testing to analyze the prevalence of these two respiratory viruses that EMS workers, being the first on the scene, are at special risk for, especially in the early days of the pandemic. A total of 7% had a positive COVID-19 antibody test. Although Black EMS personnel only comprised 9% of the cohort, they were significantly more likely to test positive for COVID-19 (P=0.0012). Black race remained a statistically significant predictor in a multivariate model that included the age, sex, BMI, number of hours of direct patient contact, whether the medic was symptomatic, presence of co-morbidities and whether or not the medic had received a flu shot prior (P=0.0008, 95% CI 0.0621-0.2354). This clinical trial (NCT04682132) ) was registered at clinicaltrials.gov, a resource provided by the U.S. National Library of Medicine.

The economic impact of CGIAR-related crop technologies on agricultural productivity in developing countries, 1961–2020

The international agricultural research centers that comprise the CGIAR got their start in the 1960s. They soon made major contributions to crop improvement in developing countries, particular in rice and wheat in Asia. Today, farmers can acquire new technologies from many sources, and evidence of whether the CGIAR continues to play an important role in crop improvement has become dated. This paper brings together an expanded set of evidence on the diffusion and productivity impact of CGIAR crop research through 2020, and breaks out these impacts by crop, region, and over time. By 2016–2020, CGIAR-related crop technologies had been adopted on at least 221 million hectares across Asia, Africa and Latin America, generating economic welfare gains of $47 billion annually. In the 2010s, technology adoption and welfare impacts were increasing by about $600 million annually, almost as much as in the 1990s. In the early days of the “Green Revolution,” these welfare impacts were largely confined to rice and wheat in Asia, but in recent decades have grown to include a larger range of crops and geographies, notably cassava and maize in Sub-Saharan Africa. Although improved crop varieties have been the main technology through which CGIAR crop centers have achieved these impacts, CGIAR-related integrated pest management and natural resource management technologies have also made significant contributions to crop productivity. In addition to raising farm income, productivity gains in staple crops have lowered food prices, thereby benefitting the whole population. This is a key reason why agricultural productivity growth, and food crop productivity growth in particular, has had greater impacts on poverty reduction in low-income countries than comparable productivity growth in other sectors.

Palliative care, COVID-19, and the suffering quotient.

The COVID-19 pandemic presented many challenges for patients with palliative care needs and their care providers. During the early days of the pandemic, visitors were restricted on our palliative care units. These restrictions separated patients from their families and caregivers and led to considerable suffering for patients, families, and health-care providers. Using clinical vignettes that illustrate the suffering caused by visiting restrictions during the pandemic, the introduction of a new concept to help predict when health-care providers might be moved to advocate for their patients is introduced. We report 3 cases of patients admitted to a palliative care unit during the COVID-19 pandemic and discuss the visiting restrictions placed on their families. In reviewing the cases, we coined a new concept, the "Suffering Quotient" (SQ), to help understand why clinical staff might be motivated to advocate for an exemption to the visiting restrictions in one situation and not another. This paper uses 3 cases to illustrate a new concept that we have coined the Suffering Quotient. The Suffering Quotient (SQ)=Perceived Individual (or small group) Suffering/Perceived Population Suffering. This paper also explores factors that influence perceived individual suffering (the numerator) and perceived population suffering (the denominator) from the perspective of the health-care provider. The SQ provides a means of weighing perceived patient and family suffering against perceived contextual population suffering. It reflects the threshold beyond which health-care providers, or other outside observers, are moved to advocate for the patient and ultimately how far they might be prepared to go. The SQ offers a potential means of predicting observer responses when they are exposed to multiple suffering scenarios, such as those that occurred during the COVID-19 pandemic.

The past, present and future of neuroscience data sharing: a perspective on the state of practices and infrastructure for FAIR.

Neuroscience has made significant strides over the past decade in moving from a largely closed science characterized by anemic data sharing, to a largely open science where the amount of publicly available neuroscience data has increased dramatically. While this increase is driven in significant part by large prospective data sharing studies, we are starting to see increased sharing in the long tail of neuroscience data, driven no doubt by journal requirements and funder mandates. Concomitant with this shift to open is the increasing support of the FAIR data principles by neuroscience practices and infrastructure. FAIR is particularly critical for neuroscience with its multiplicity of data types, scales and model systems and the infrastructure that serves them. As envisioned from the early days of neuroinformatics, neuroscience is currently served by a globally distributed ecosystem of neuroscience-centric data repositories, largely specialized around data types. To make neuroscience data findable, accessible, interoperable, and reusable requires the coordination across different stakeholders, including the researchers who produce the data, data repositories who make it available, the aggregators and indexers who field search engines across the data, and community organizations who help to coordinate efforts and develop the community standards critical to FAIR. The International Neuroinformatics Coordinating Facility has led efforts to move neuroscience toward FAIR, fielding several resources to help researchers and repositories achieve FAIR. In this perspective, I provide an overview of the components and practices required to achieve FAIR in neuroscience and provide thoughts on the past, present and future of FAIR infrastructure for neuroscience, from the laboratory to the search engine.

Makna Konsep Uang dan Permasalahan Riba serta Bunga Dalam Kacamata Makroekonomi Islam

In the early days, before the creation of money, economic activities or business transactions were carried out through barter or commonly called barter trade. In the exchange process, goods and services were exchanged directly with other goods and services that were mutually needed by the parties involved. At the macro level itself, the parties involved in the production of goods and services can easily and smoothly exchange goods and services by using money as an intermediary. Meanwhile, the domestic sector that receives income in the form of money uses the money to buy goods and services produced by the commercial and manufacturing sectors. It is the changes in these cash flows that cause changes in prices and/or production quantities, for example. It also affects saving behavior, investment and the business cycle. The method in this study is to use a type of qualitative descriptive research. The purpose of this study is to understand and explore the concept of money in Islamic macroeconomics that does not contradict Islamic law.

Understanding how COVID-19 affected black pregnant women early in the pandemic: A cross-sectional survey

ObjectivePrevious research has shown that the COVID-19 pandemic significantly increased anxiety among pregnant women, and at the same time, COVID-19 has disproportionately affected communities of color in the United States. We sought to understand how self-identied Black pregnant women in the United States were affected in the early days of the COVID-19 pandemic. DesignCross-sectional, online survey distributed via social media SettingOnline ParticipantsNon-probability, convenience sample of self-identified Black pregnant women in the United States between April 3 and 24, 2020 who responded to an online inquiry seeking women who were pregnant at the outset of the COVID-19 pandemic. Measurements and findingsAn anonymous, self-administered, online survey of pregnant women was conducted, including both quantitative assessment of demographics, COVID-related anxiety, and pregnancy-related anxiety as well as open-ended prompts for qualitative assessment of the impact of COVID on prenatal care, birth plans, anxiety and overall experience of pregnancy. Quantitative data were analyzed using Stata 15.0, qualitative data were thematically analyzed using NVivo12.1. Results were compared using joint display methodology. Of 87 self-identified Black or African-American women who responded, the most common concerns related to fear of getting infected with COVID (89.7 %, N = 78) and concerns related to loss of job/income (67.8 %, N = 59). More than half (55.2 %, N = 48) reported either themselves or their family members working in essential services. Findings indicate that uncertainty, lack of support, perceived quality of care, and heightened anxiety worked together to define Black women's experiences of pregnancy in the early days of the COVID-19 pandemic in the U.S. While quantitative data did not explicitly capture reports of discrimination as impacting perceived quality of care, the qualitative data suggest a link between fears of discrimination, the need for self-advocacy, and heightened anxiety. Key conclusionsDespite being a relatively well-educated sample of Black women from around the United States, many respondents spoke of the fears of discrimination, the need for self-advocacy, and heightened anxiety, reinforcing that discrimination and fear of discrimation for Black women in healthcare settings are pervasive, regardless of a woman's level of education or other socioeconomic status indicators. Implications for practiceThese findings suggest that in times of uncertainty, such as the early days of the COVID-19 pandemic, it is more important than ever to provide thoughtful, supportive care to pregnant women of color who are primed for negative experiences in the healthcare settting.

LED Technology and Smart City, their Role and Impact on Man and the Environment

This chapter explores the evolution of public lighting, tracing its historical development from the early days of illumination to contemporary times. It highlights the contemporary significance of public lighting in meeting regulatory standards for illumination, emphasizing the fundamental role of LED technology. LED technology not only ensures compliance with lighting regulations but also significantly reduces network power consumption, thereby mitigating environmental pollution compared to traditional discharge lamps. Furthermore, this chapter underscores the transformative shift in the role of modern lighting systems, which have evolved into multifunctional hubs for the integration of value-added services. These services encompass a wide range of applications, including surveillance cameras, smart parking systems, and electric vehicle charging stations, thereby enhancing the overall functionality and sustainability of urban environments.

Letter to Humanity

ABSTRACT In this brief piece, I appeal to the world for recognition of the plight of the Afghan people following the Taliban takeover of the country in August 2021, after the United States’ fast exit after years of promise and presence. Thousands were left frightened, dislocated, unprotected, and forgotten, at a loss for country or hope. Much has occurred in my own journey since those early days. This essay records some of my initial thoughts and reactions following the precipitous events in the final days of August 2021.

Fractures overseen: soviet medical experts splitting from the international epistemic community during the interwar period

ABSTRACT Soviet medical science went through a deep and systematic transformation. Initiated in the very early days of the Communist regime, a moment of disrupting and isolating impact uprooted it from its former organizational and epistemic foundations and re-adjusted the expert output and modus operandi to state needs. Professional identities, paradigmatic approaches and everyday practices resulting from these were transformed and forcibly aligned with the expectations of the new powerholders, aligned with the newly formulated party-bound loyalties and secured by the broad array of severe sanctions. This article systematically approaches the dark side of the Soviet interwar transformation in medicine with a special focus on a sample of psychiatric experts. The paper analyses the entanglement between domestic pressures exercised upon scholars by the emerging totalitarianism, forcing them to detach and considerably re-adjust their international ties, while nonetheless trying to remain a part of this cross-border epistemic community. While international contacts did not cease entirely, their expanse, intensity and the very mode of cooperation had to change dramatically so as to fit the new regime´s vision upon medicine. International networks were re-appropriated for the sake of promoting the success of the Communist state, with scholars functioning as involuntary ambassadors of the regime. Though perfectly compatible with the practices and outputs of their fellow experts elsewhere across the globe while exposed to the permanent pressure of political terror at home, Soviet public health and its experts became deeply transformed and detached in manifold ways from their peers and their medical science. Largely overlooked, the early fractures of the interwar period carry on into the Cold War-influenced second half of the twentieth century.

Performance of parthenocarpic cucumber genotypes under protected cultivation for yield and horticultural traits

An investigation was conducted to identify the most desirable genotypes of parthenocarpic cucumber under protected cultivation. Experimental material consists of 23 genotypes of parthenocarpic cucumber including 1 check (KPCH-1) and the experiment was laid out in three replications with support of Randomized Block Design. ANOVA revealed significant differences among the genotypes for 17 traits. Based on the genotypes' mean performance for all traits investigated, m earliest days to first flower (26.80) and minimum inter-nodal length (7.22 cm) was observed in genotype BRPCU-1×BRPCU-8, whereas maximum number of flowers per node (2.20), number fruits per vine (31.47) and yield per vine (3.96 kg) was observed in genotype BRPCU1×BRPCU-8. The lowest node to the first flower (3.27) was observed in genotype BRPCU-2×BRPCU-7. Earliest days to first picking (39.80 days) whereas highest TSS (3.87 °Brix) and longest span of harvesting (58.67 days) was noted in genotype in BRPCU-2×BRPCU-5. The highest average fruit weight was recorded in genotype BRPCU-2×BRPCU-8 (143.07 g), while the highest fruit length was observed in genotype BRPCU-5 (20.73 cm). Genotype BRPCU-3×BRPCU-8 (3.90 cm) had maximum fruit diameter. Maximum vine length was recorded in BRPCU-6×BRPCU-7 (3.15 m). The best top-performing genotypes identified in the present study were BRPCU1×BRPCU-8, BRPCU-2×BRPCU-5, and BRPCU-3×BRPCU-8 were superior for most of the fruit yield components and quality traits.

3D Cell Culture: Techniques For and Beyond Organoid Applications.

In the rapidly evolving landscape of cell biology and biomedical research, three-dimensional (3D) cell culture has contributed not only to the diversification of experimental tools available but also to their improvement toward greater physiological relevance. 3D cell culture has emerged as a revolutionary technique that bridges the long-standing gap between traditional two-dimensional (2D) cell culture and the complex microenvironments found in living organisms. By providing conditions for establishing critical features of in vivo environment, such as cell-cell and cell-extracellular matrix interactions, 3D cell culture enables proper tissue-like architecture and differentiated function of cells. Since the early days of 3D cell culture in the 1970s, the field has witnessed remarkable progress, with groundbreaking discoveries, novel methodologies, and transformative applications. One particular 3D cell culture technique has caught the attention of many scientists and has experienced an unprecedented boom and enthusiastic application in both basic and translational research over the past decade - the organoid technology. This book chapter provides an introduction to the fundamental concepts of 3D cell culture including organoids, an overview of 3D cell culture techniques, and an overview of methodological- and protocol-oriented chapters in the book 3D Cell Culture.

Assessing quality in extrusion based additive manufacturing technologies

Quality is a magic word that has fascinated the people since the early days of civilization and today, quality is the only mantra to survive. Quality is the only relevant attribute associated with product and processes that makes any technology in-demand. The quality of the parts produced by Additive Manufacturing (AM) Technologies depends on many factors, like print speed, nozzle temperature etc. The aim of this work is the identification of influence factors that affect the performance measures of extrusion based Additive Manufacturing (AM) technologies, namely, Fused Deposition Modelling (FDM). These processes can be characterized by a set of influence factors, like print speed, infill density, temperature; layer thickness and build orientation are responsible for quality of the product. In this work, Grey relational Analysis (GRA) is employed. GRA is a method which enables determination of the relational degree of every factor in the system. The method can be used for systems that are not completely described and with relatively few available data. Reliable technique of optimization GRA is clubbed with another established technique; called Interrelation ship Diagram (ID), to identify and optimize the influence factors, that yields highest performance characteristics. Manufacturing Combinations are evaluated against performance measures. In the earlier research, the authors have applied same tool, GRA clubbed with 7QC tools, to evaluate extrinsic and intrinsic qualities of the parts produced by FDM, In this research, the entire focus is paid to the intrinsic properties of the parts produced by FDM. This research will have a greater impact on the quality of the parts produced by the FDM.

Assessing public support for expanded police powers in the early days of the COVID-19 pandemic: Testing the limits of Sunshine and Tyler's empowerment hypothesis

PurposeThis study seeks to extend recent research on perceptions of “pandemic policing” by examining public support for the ability of police to surveil, quarantine, detain, and remove individuals from their homes, if suspected of exposure to or manifesting symptoms of the coronavirus. This study draws from extant research on public willingness to empower police, including common normative and instrumental explanations of empowerment. We also assess whether perceptions that governments exploit emergencies influence willingness to empower police. MethodsUsing a nationwide opt-in sample of 600 American adults surveyed in late April 2020, OLS regressions examine the correlates of support for expanding police powers at that time. ResultsThere was greater than 50% support for six out of seven possible expansions of police authority. Regression results indicate that normative orientations (police legitimacy, perceptions that governments exploit national emergencies) and instrumental considerations (fear of COVID-19, perceived severity of its consequences) influence willingness to empower police, though normative orientations appear to have stronger effects. ConclusionLegitimacy is a powerful predictor of empowerment, even in exceptional circumstances. Strategies meant to deal with these circumstances will need to be cognizant of the long-term need to cultivate legitimacy by various institutional actors, including police, and the relevance of instrumental considerations in shaping support for these strategies.

The Early Days of Prof. Deog-Kyoon Jeong’s Lab: Looking back at the 32-year journey with a visionary who reinvented display interfaces

The Early Days of Prof. Deog-Kyoon Jeong’s Lab: Looking back at the 32-year journey with a visionary who reinvented display interfaces

Electron collision cross section data in plasma etching modeling

Semiconductor chips are the cornerstone of the information age, which play a vital role in the rapid development of emerging technologies such as big data, machine learning, and artificial intelligence. Driven by the growing demand for computing power, the chip manufacturing industry has been committed to pursuing higher level of integration and smaller device volumes. As a critical step in the chip manufacturing processes, the etching process therefore faces great challenges. Dry etching (or plasma etching) process based on the low-temperature plasma science and technology is the preferred solution for etching the high-precision circuit pattern. In the low-temperature plasma, electrons obtain energy from the external electromagnetic field and transfer the energy to other particles through collision process. After a series of complex physical and chemical reactions, a large number of active particles such as electrons, ions, atoms and molecules in excited states, and radicals are finally generated, providing the material conditions for etching the substrate. Dry etching chamber is a nonlinear system with multiple space-time dimensions, multiple reaction levels and high complexity. Facing such a complex system, only by fully understanding the basic physical and chemical reaction of the etching process can we optimize the process parameters and improve the etching conditions, so as to achieve precision machining of the semiconductor and meet the growing demand of the chip industry for etching rate and yield. In the early days, the process conditions of dry etching were determined through the trial-and-error method, which is characterized by high cost and low yield. However, with the help of plasma simulation, nowadays people have been able to narrow the scope of experiment to a large extent, and find out efficiently the optimal process conditions in a large number of parameters. In this review, we first introduce the basic theory of the mostly used models for plasma simulation including kinetic, fluid dynamic, hybrid and global models, in which the electron collision cross sections are the key input parameters. Since the formation of the low-temperature plasma is driven by the electron-heavy particle collision processes, and the active species for plasma etching are generated in the reactions induced by electron impact, the accuracy and completeness of the cross-section data greatly affect the reliability of the simulation results. Then, the theoretical and experimental methods of obtaining the cross-section data of etching gases are summarized. Finally, the research status of the electron collision cross sections of etching atoms and molecules is summarized, and the future research prospect is discussed.

Long-term impacts of 48-h water and feed deprivation on blood and performance responses of grazing Bos indicus Nellore heifers.

The study investigated the effects of 48-h water and feed deprivation on blood and the performance of grazing Nellore (Bos indicus) heifers. Twenty-four Nellore heifers (initial body weight [BW] = 238 ± 10kg; age = 16 ± 2 mo), were ranked by initial BW and age and randomly assigned to one of the two treatments: (1) grazing animals with free access to pasture, water, and mineral-mix (CON; n = 12), or (2) the same grazing conditions but deprived of pasture, water, and mineral-mix for 48h (DPR; n = 12). The paddocks consisted of Urochloa brizantha cv. Marandu, using a continuous and fixed stocking rate. The experiment lasted 225 d, with the first 14 d considered as the adaptation period (days -14 to -1) and the subsequent 211 d as the evaluation period (days 0 to 211). From days 0 to 2, treatments were applied by keeping the DPR heifers in pens and reintegrating them into the experimental area after a 48-h water and feed deprivation. Individual full BW was recorded on days -14, -13, -1, before (day 0) and after (day 2) treatment application, and on days 6, 11, 12, 41, 42, 210, and 211. Blood samples were collected in the morning on days 0, 2, 6, 12, and 211. A treatment effect was detected (P < 0.001) for shrink BW from days 0 to 2, which was greater (P < 0.001) in DPR vs. CON heifers. Subsequently, DPR animals were lighter (P < 0.001) compared with CON heifers by the end of the deprivation period (day 2). From days 4 to 211, DPR was lighter (P < 0.001) compared with CON heifers after treatment application and for the entire experimental period. In the first 10 d after treatment application (days 2 to 12), DPR heifers showed a partial compensatory average daily gain (ADG; P < 0.001) compared with CON heifers, while no significant differences were observed in ADG between the treatments from days 12 to 42 and 42 to 211 (P > 0.420). Overall ADG (days 2 to 211) was greater (P < 0.001) for DPR vs. CON heifers. All serum variables, except AST, were higher (P < 0.001) in DPR than in CON heifers on day 2 after treatment application. Our study demonstrates that grazing Nellore heifers subjected to 48-h water and feed deprivation experienced significant alterations in their blood metabolites and BW immediately after the stressful event. Although the deprived heifers partially compensated for their BW loss in the early days post-deprivation, they remained 12kg lighter than the non-deprived animals throughout the production cycle.

Early days of Pharmacy First highlight three things we should study

Early days of Pharmacy First highlight three things we should study

The Place of the Military Revolutionary Organizations of the Estonian Region in the Process of Approving the Authorities of the Soviets During the Period of the Russian Revolution

The dramatic events of the great Russian revolution of 1917, which to a certain extent became the catalyst for major global changes, are one of the turning points of world history that led to the onset of the modern era. The historical upheaval caused by these events influenced the change in many vectors of further development both directly of our country and of the world community as a whole. At the same time, modern domestic historiography often forgets or underestimates the prominent role that Estonian military-revolutionary organizations played in establishing this power at the very beginning of its formation. Meanwhile, the leadership of the Bolshevik Party reasonably considered Estonia as one of the most important bridgeheads of the political coup prepared in October 1917. In this regard, it is important to take into account not only the geographical position, but also the socio-economic and military-strategic importance of the Estonian region for the entire North-West of Russia. On the eve of the 1917 revolution, the Estland province was one of the largest industrial centers of the Russian Empire. At this time, a kind of agglomeration developed between Revel (modern Tallinn) and Petrograd (St. Petersburg), or more precisely conurbation (from Latin con – «together» and urbs – «city»), which included a network of industrial zones, ports, arsenals, military bases, etc. In the conditions of the long First World War, it was also one of the most important bases of the Baltic Fleet and the closest rear area for the troops of the Northern Front, which covered Petrograd from the Kaiser army. On October 23, 1917, revolutionary troops and detachments of the Red Guard captured railway stations, mail, telegraph and other strategic objects in Revel. Commissars of the Estonian Military Commissars were sent to military units, ships and institutions. Thus, the control of the pro-Soviet forces in Tallinn was established even after the beginning of the armed uprising in Petrograd (October 24-25, 1917) and, in fact, was a dress rehearsal for the latter. Thus, the Estonian Military Revolutionary Committee, even a day before the start of the open speech of the Bolsheviks to seize key positions in Petrograd, took control of all the strategically important points of Revel, put revolutionary military units and the fleet on alert. As a result of these actions, Estonian military-revolutionary organizations blocked the path of counter-revolutionary units trying to move in the direction of Petrograd. Without achieving all of their original goals, Estonian military revolutionary organizations made a notable contribution to the Bolshevik power-building in the earliest days of Soviet power in Russia, when its position here was still extremely unsustainable.

Yesterday and the Day Before in Semitic

Abstract In addition to reflexes of Proto-Semitic*timāli, the Semitic languages use a variety of innovative words meaning ‘yesterday’, as well as numerous different words and phrases used to mean ‘the day before yesterday’ and sometimes even earlier days. This article examines these various adverbs or adverbial phrases in the diverse Semitic languages, both ancient and modern, coming from a variety of semantic developments, some of which are typologically unusual.

Outcomes Following Initiation of Triple Therapy with Fluticasone Furoate/Umeclidinium/Vilanterol versus Multiple-Inhaler Triple Therapy Among Medicare Advantage with Part D Beneficiaries and Those Commercially Enrolled for Health Care Insurance in the United States.

Patients with chronic obstructive pulmonary disease (COPD) have been shown to benefit from triple therapy commonly delivered by multiple-inhaler triple therapy (MITT); however, the complexity of MITT regimens may decrease patient adherence. Fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI), a once-daily single-inhaler triple therapy (SITT), became available in the United States (US) in 2017, but real-world data comparing outcomes for SITT versus MITT are currently limited. This study compared outcomes among patients with COPD initiating MITT versus SITT with FF/UMEC/VI who were either Medicare Advantage with Part D (MAPD) beneficiaries or commercial enrollees in the US. Retrospective study using administrative claims data from the Optum Research Database for patients with COPD who initiated FF/UMEC/VI or MITT between September 1, 2017, and March 31, 2019 (index date: first pharmacy claim for FF/UMEC/VI cohort; earliest day of ≥30 consecutive days-long period of overlap in the day's supply of all triple therapy components for MITT cohort). COPD exacerbations, adherence to triple therapy, and all-cause and COPD-related health care resource utilization (HCRU) and costs were compared between FF/UMEC/VI and MITT initiators. In total, 4659 FF/UMEC/VI initiators and 9845 MITT initiators for the MAPD population, and 821 FF/UMEC/VI initiators and 1893 MITT initiators for the commercial population were included in the study. MAPD beneficiaries initiating FF/UMEC/VI had a significantly lower annual rate of severe exacerbations compared to MITT initiators (0.26 vs 0.29; p=0.014). They also had a significantly higher mean adherence (proportion of days covered) (0.51 vs 0.37; p<0.001) and significantly lower all-cause and COPD-related inpatient stays compared to MITT initiators ([32.02% vs 34.27%; p=0.017], [16.09% vs 17.72%; p=0.037]). Trends were similar among the commercial population, but the results were not statistically significant. FF/UMEC/VI initiators had significantly fewer severe exacerbations, higher triple therapy adherence, and lower HCRU costs compared to MITT initiators for MAPD beneficiaries.