Equal Periods Research Articles

Effects of the COVID-19 Pandemic on Primary Health Care for Chronic Conditions in Canada: Protocol for a Retrospective Pre-Post Study Using National Practice-Based Research Network Data.

Since the COVID-19 pandemic began, there have been concerns that interruptions to the health care system may have led to changes in primary care, especially for care of chronic conditions such as diabetes and heart failure. Such changes may have longer term implications for population health. This study aims to describe the impacts of the COVID-19 pandemic on indicators of primary care access, comprehensiveness, and appropriateness among adult patients, as well as on specific indictors of chronic conditions. Additionally, this study aims to determine whether any identified changes were associated with patient sociodemographic characteristics and multimorbidity. This is a retrospective, single-arm, pre-post study using Canadian Primary Care Sentinel Surveillance Network (CPCSSN) data. CPCSSN is a research network supported by a primary care electronic medical record database, comprising over 1500 physicians and nearly 2 million patients. We are examining changes in care (eg, frequency of contacts, laboratory tests and investigations, referrals, medications prescribed, etc) among adults. We will also examine indicators specific to evidence-based recommendations for care in patients with diabetes and those with heart failure. We will compare rates of outcomes during key periods of the pandemic between March 13, 2020, and December 31, 2022, with equal time periods before the pandemic. Differences will be examined among specific subgroups of adults, including by decade of age, number of comorbidities, and socioeconomic status. Regression models appropriate to outcome distributions will be used to estimate changes, adjusting for potential confounders. This analysis is part of a mixed-methods study with a qualitative component investigating how patients with diabetes with or without concurrent heart failure perceived the impact of the pandemic on access to primary care and health care-related decisions. This study was approved by the Hamilton Integrated Research Ethics Board (14782-C). The start date of this study was October 5, 2022, and the prospective end date is January 31, 2024. As of May 2023, the study cohort (n=875,934) is defined, data cleaning is complete, and exploratory analyses have begun. Extended analyses using 2022 data are planned once the new data becomes available. We will disseminate results through peer-reviewed publications and academic conference, as well as creating evidence briefs, infographics, and a video for policy maker and patient audiences. This study will investigate whether the COVID-19 pandemic has resulted in changes in the provision of primary care in Canada and whether these potential changes have led to gaps in care. This study will also identify patient-level characteristics associated with changes in care patterns across the COVID-19 pandemic. Indicators specific to chronic conditions, namely diabetes and heart failure, will also be explored to determine whether there were changes in care of these conditions. ClinicalTrials.gov NCT05813652; https://clinicaltrials.gov/ct2/show/NCT05813652. RR1-10.2196/49131.

Accumulated Cyclone Energy-Based Tropical Cyclone Return Periods in Florida

This article introduces an accumulated cyclone energy (ACE) approach for estimating the return period of tropical cyclone (TC) wind risk in Florida. As opposed to calculating return periods directly from maximum sustained wind speed, the ACE-based approach also describes the duration of the strong winds, giving an additional dimension to the assessment of TC wind risks. Because Florida is a peninsula, TCs can move across the state within six hours of landfall, causing an underestimation of the inland wind footprint if only the six-hour reanalysis track points are employed as an input data source. This study uses four different scenarios and an inland exponential decay function to interpolate the wind speed between the six-hour reanalysis track points to feed the ACE-based return period calculation based on a 121-year record from 1900 to 2020. South Florida has the shortest return period (five to ten years) of TCs with an ACE equivalent to one hour of hurricane intensity (≥ 64 kt; 1 kt ∼ 0.51 m s−1) caused by intense historical hurricane strikes, and Polk County in inland central Florida has an equal return period due to frequent and long-duration TC occurrences, acting as an intersection for landfalling TCs in the Florida peninsula.

სოციალურ-ეკონომიკური ფაქტორების გავლენა შობადობის თანამედროევე ტენდენციებზე

სოციალურ-ეკონომიკური ფაქტორების გავლენა შობადობის თანამედროევე ტენდენციებზე

Protein crystallization with DNA templates

Protein crystallization plays a significant role in three-dimensional structural analysis and protein purification. It is important to increase the crystallization efficiency, which is possible by adding heterogeneous templates in crystallization systems. DNA is biologically compatible and artificially designable polymer, which is easy to extract. In this study, single- and double-stranded DNA of precise sequences were designed and used as templates to promote protein crystallization of lysozyme and catalase. Influence of DNA, single-stranded DNA with 10, 20, 40 bases and double-stranded DNA with 10, 20, 40 base pairs, were investigated. The success rate of obtaining crystals of lysozyme and catalase in equal period was significantly improved with the addition of DNA comparing without templates added. Double-stranded DNA led to higher nucleation rate than that with single-stranded DNA. The promotion of nucleation was more obvious at low concentration of protein solution and with longer chain DNA templates. Crystal number and crystallization rate was enhanced with addition of long double-stranded DNA templates. All the results confirm that DNA is an effective polymer additive to enhance protein crystallization, especially for the application of the scarce protein crystallization.

Effects of surge and roll motion on a floating tidal turbine using the actuator-line method

This paper employs a dynamic and sliding mesh in the simulation of both uncoupled and coupled surge and roll motions of a tidal stream turbine, utilizing a modified actuator-line method. The modification involves the relocation of blade elements in relation to the grid. Detailed analyses are conducted on the Cp and Cz variations in surge, roll, and coupled motions at various frequencies and amplitudes. It is observed that changing the amplitude and frequency of surge and roll motions both impacts the amplitude of Cp and Cz. Interestingly, the Cp and Cz variations in surge motion are inversely proportional to velocity variations, while they are directly proportional in roll motion. The influence of the surge motion on Cp Cz plays a major role, while the addition of the roll motion increases the mean values of Cp and Cz. Due to the combination of the wake characteristics of both surge and roll, the coupled motion wake exhibits a contraction–expansion oscillation pattern. In a coupled motion with equal periods, the ring and strip tail vortex characteristics of both motions are apparent. A surge period increment diminishes the surge's tail vortex characteristic, whereas an increase in the roll period gradually erodes the roll's tail vortex characteristic. The coefficient variation of the tangential and normal forces (cn, ct) in combined motion mirror that of surge motion, presenting a convex table per surge cycle with depressions at the 1/2T and 1T points. The peak of cn and ct in surge motion are approximately 0.28 and 0.03, respectively, while in roll motion, they are around 0.261 and 0.025. The exploration of cyclic stress impacts on the turbine, and the potential instability on the platform could be valuable directions for future research.

Exploring the relationship of working memory to the temporal distribution of pausing and revision behaviors during L2 writing

AbstractThis study examined the extent to which L2 writers with varied working memory display differential pausing and revision behaviors at different periods during writing. The participants were 30 advanced Chinese L2 users of English, who wrote an argumentative essay. While composing, participants’ keystrokes and eye-gaze movements were recorded to capture their pausing, revision, and eye-gaze behaviors. The working memory battery included tests of phonological and visual short-term memory and executive functions. We divided the writing process into five equal periods. The results revealed that participants’ pausing and revision patterns were consistent with previous findings that planning, linguistic encoding, and monitoring processes dominate the initial, middle, and later composing periods, respectively. Various working memory components had differential effects on pausing depending on period, largely reflecting the predictions of Kellogg’s (1996, 2001) model. However, we identified no differences in the temporal distribution of revision behaviors contingent on working memory.

Accidental poison exposure among children in a regional hospital in northern KwaZulu-Natal before and during the COVID-19 pandemic

Background. Poisoning has been reported as the fifth most common cause of injury-related deaths in children younger than five years worldwide. Little is known about accidental poison exposure among children at regional hospital level. Regional hospitals generally provide more specialised support to primary care facilities over a larger area. During the COVID-19 pandemic, lockdown measures may have increased home-based unintentional poisoning. Objectives. To determine the frequency, outcome and type of accidental poison exposure in children admitted to a regional hospital and compare cases before and during the COVID-19 pandemic. Methods. A review of admissions to Queen Nandi Regional Hospital in Empangeni was performed to document cases of accidental poison exposure over two years. Equal periods during 2019 and 2020 (April to December) were then compared. Children <13 years of age were included. Age, sex, date of admission, death or survival and type of poisoning were collected. Results. Cases of accidental poison exposure made up a small proportion of the total admissions over two years (n=252/5 071, 4.97%) with a low case fatality rate (0.40%). Boys made up the majority (n=132/252, 52.38%). Most were <five years old (n=220/252, 87.30%). Medicines (n=114/252, 45.24%), hydrocarbons (n=59/252, 23.41%) and pesticides (n=26/252, 10.32%) were the main types of poison. Domestic cleaner-, sanitiser- and disinfectant-related admissions were significantly increased during the pandemic (p=0.020). Conclusion. Accidental poison exposure occurs commonly in younger children. Medicines, hydrocarbons and pesticides made up the majority of cases. Domestic cleaner, hand sanitiser and disinfectant ingestion increased in the pandemic. Future research should involve primary care facilities, and risk factors as well as clinical severity should be investigated.

Gender Egalitarianism and Attitudes Toward Parental Leave

This paper examines the relationship between gender ideology and attitudes toward parental leave. We use data from two original survey experiments with a total analytic sample of 3332 respondents. Using an experimental design where participants evaluate a new parent’s decision about taking parental leave in light of the employer’s leave policies, and answer attitudinal questions about leave and gender ideology, we assess the associations between gender ideology and (a) desired weeks of parental leave for mothers and fathers, as well as (b) perceptions of whether the new parent described in the experiment took too little or too much leave. We find that participants think fathers should receive 10.5 weeks of paid paternity leave, whereas mothers should receive 16 weeks of paid maternity leave. In general, those with egalitarian gender ideals support longer paternity leave and more equal periods of leave for mothers and fathers—and are more likely to think that men workers take too little leave. However, those who support mothers as financial providers are more likely to think that women workers take too much leave, demonstrating the complexities between dimensions of gender ideology, the gender of the parent taking leave, and views of parental leave.

Energy Management in a Standalone Microgrid: A Split-Horizon Dual-Stage Dispatch Strategy

Microgrid technology has recently gained global attention over increasing demands for the inclusion of renewable energy resources in power grids, requiring constant research and development in aspects such as control, protection, reliability, and management. With an ever-increasing scope for maximizing renewable energy output, there is also a need to reduce the curtailment of power on both the generation and demand sides by increasing forecasting accuracies and using resources more effectively. This paper proposes a dual-stage dispatch employing a novel “split-horizon” strategy, in a bid to enhance energy management in a standalone microgrid. The split-horizon is essentially the considered time horizon split into equal operational periods of the dual-stage dispatch. The proposed strategy utilizes a custom-designed novel variant of the inertia-weight-based particle swarm optimization (PSO), termed customized PSO, to perform the optimal schedule and dispatch operation by benefitting from the simplicity of PSO and customization as per the considered objectives. A modified IEEE 34-node test system is derived into a standalone microgrid with added distributed energy resources to test the proposed strategy, while another standalone microgrid, a modified IEEE 69-node test feeder, is also considered for scalability. Furthermore, the validation of the strategy is performed appropriately with a case study while also validating the proposed optimization algorithm. It is observed that the proposed energy management strategy provides approximatelya 7% reduction in costs.

Co-exposure of iron oxide nanoparticles with glyphosate herbicides in Poecilia reticulata: Fish liver damages is reversible during iron accumulation and elimination period

Iron oxide nanoparticles (IONPs) are advanced materials for water remediation technologies. It is therefore relevant to evaluate the cellular and tissue behavior of fishes in response to IONPs and their associations with agrochemicals such as glyphosate (GLY) and glyphosate-based herbicides (GBHs). Iron accumulation, tissue integrity and lipid distribution in the hepatocytes of Poecilia reticulata (guppy) were investigated in a control group and in groups exposed to soluble iron ions, namely IFe (0.3 mgFe/L), IONPs (0.3 mgFe/L), and IONPs, associated with GLY (0.65 mg/L), GBHs 0.65 mgGLY/L (IONPs + GBH1), and 1.30 mgGLY/L (IONPs + GBH2), for 7, 14, and 21 days, followed by an equal period of postexposure in clean reconstituted water. The results showed that the accumulation of iron was greater in the subjects in the IONP treatment group when compared to that in the Ife group. In addition, the subjects in the mixtures with GBHs had a greater accumulation of iron than those in the IONP + GLY treatment group. Tissue integrity assessments demonstrated an intense accumulation of lipids, formation of necrotic zones and leukocyte infiltrates in all the treated groups, with a greater quantity of lipids in the animals treated with IONP + GLY and IFe. During postexposure, the results indicated an elimination of iron in all treated groups, reaching the same level as the control group, throughout the 21 days postexposure. Thus, the damage caused to animal livers by IONP mixtures is reversible, providing promising results for the development of safe environmental remediation practices using nanoparticles.

MP28-01 CYTOREDUCTIVE NEPHRECTOMY PERIOPERATIVE OUTCOMES HAVE SIGNIFICANTLY IMPROVED IN RECENT YEARS

You have accessJournal of UrologyCME1 Apr 2023MP28-01 CYTOREDUCTIVE NEPHRECTOMY PERIOPERATIVE OUTCOMES HAVE SIGNIFICANTLY IMPROVED IN RECENT YEARS Arighno Das, Daniel Shapiro, Jose Karam, Viraj Master, Philippe Spiess, Jay Raman, Ashanda Esdaille, Logan Zemp, Pranav Sharma, Wade Sexton, Datta Patil, Glenn Allen, Surena Matin, and E. Jason Abel Arighno DasArighno Das More articles by this author , Daniel ShapiroDaniel Shapiro More articles by this author , Jose KaramJose Karam More articles by this author , Viraj MasterViraj Master More articles by this author , Philippe SpiessPhilippe Spiess More articles by this author , Jay RamanJay Raman More articles by this author , Ashanda EsdailleAshanda Esdaille More articles by this author , Logan ZempLogan Zemp More articles by this author , Pranav SharmaPranav Sharma More articles by this author , Wade SextonWade Sexton More articles by this author , Datta PatilDatta Patil More articles by this author , Glenn AllenGlenn Allen More articles by this author , Surena MatinSurena Matin More articles by this author , and E. Jason AbelE. Jason Abel More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003256.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Few data are available describing perioperative outcomes for cytoreductive nephrectomy (CN) or how changes in patient selection may have impacted modern cohorts. This study investigated factors associated with perioperative outcomes in a multi-institutional cohort of patients treated with CN. METHODS: Data was analyzed for metastatic renal cell carcinoma patients treated with CN at 6 tertiary centers from 2005-2019. Outcomes included: Clavien-Dindo complications, mortality, length of hospitalization, and 30-day readmission rate. Multivariable logistic regression was used to evaluate variables associated with perioperative outcomes. Patients were stratified into 3 equal time periods to evaluate changes in outcomes over time. RESULTS: A total of 1,272 patients were treated with CN at 6 centers including 369 (29%) from 2005-2009, 557 (44%) from 2010-2014, and 346 (27%) from 2015-2019. Patients treated in 2015-2019 vs 2005-2009 were less likely to have received pre-surgical systemic therapy (19% vs 26%, p=0.02). Perioperative outcomes are shown in Table. Mortality at 90 days was lower for patients treated in 2015-2019 vs 2005-2009 (5% vs 10%, p=0.02). Patients treated in 2015-2019 vs 2005-2009 had lower overall (22% vs 39%, p<0.001) and major (Clavien-Dindo ≥ 3) complications from surgery (10% vs 16%, p=0.02). Median hospital stay was shorter for patients treated 2015-2019 vs 2005-2009 (4 days vs 5 days, p<0.001) but 30-day readmission rate was also higher (12% vs 7%, p=0.02). On multivariable analysis, patients undergoing CN in 2015-2019 had significantly lower odds of major complications (OR 0.57, 95%CI 0.36-0.90) and 90-day mortality (OR 0.49, 95%CI 0.27-0.89) compared to undergoing CN in 2005-2009. Receipt of presurgical systemic therapy was not associated with increased odds of high-grade complications (OR 0.79, 95%CI 0.52-1.19). CONCLUSIONS: In this large multi-institutional study, perioperative complications have significantly decreased over time. Prospective studies should investigate how to further improve outcomes and select patients. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e369 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Arighno Das More articles by this author Daniel Shapiro More articles by this author Jose Karam More articles by this author Viraj Master More articles by this author Philippe Spiess More articles by this author Jay Raman More articles by this author Ashanda Esdaille More articles by this author Logan Zemp More articles by this author Pranav Sharma More articles by this author Wade Sexton More articles by this author Datta Patil More articles by this author Glenn Allen More articles by this author Surena Matin More articles by this author E. Jason Abel More articles by this author Expand All Advertisement PDF downloadLoading ...

Effect of Rapid Prototyped Complete Denture on Electromyographic Activity

Purpose: This study was directed to evaluate the electromyographic activity(EMG) of patients with rapid prototyped (RP) complete denture. Subjects andmethods: A total of ten completely edentulous subjects aged between 45-50 years wereselected following specific inclusion criteria from the outpatient clinic of RemovableProsthodontics Department, Faculty of Dental Medicine for Girls, AL-Azhar University.All Patients had received two complete dentures; one constructed by rapid prototypedtechnology and the other constructed by conventional heat compressed method.Patients were classified into two groups, five patients in each. First Group received theRP complete denture first then the conventional complete denture (CCD) while, secondgroup received the (CCD) first then RP complete denture. All patients were instructedto wear their denture for equal periods and recalled after 1- week, 1- month and 3-months to measure the (EMG). After an interval of 2- weeks, as a wash out period,patients received their other dentures. Results: Conventional complete denture showedsignificant higher EMG than RP denture at different testing periods and with differenttested foods. Also, the EMG of both masseter and anterior temporalis muscles improvedwith time for each tested denture. Conclusion: Conventional complete dentures still thebest rehabilitation choice for completely edentulous patients. Rapid prototyped denturecould be suitable alternative for completely edentulous patients.

Effect of Rapid Prototyped Complete Denture on Electromyographic Activity

Purpose: This study was directed to evaluate the electromyographic activity(EMG) of patients with rapid prototyped (RP) complete denture. Subjects andmethods: A total of ten completely edentulous subjects aged between 45-50 years wereselected following specific inclusion criteria from the outpatient clinic of RemovableProsthodontics Department, Faculty of Dental Medicine for Girls, AL-Azhar University.All Patients had received two complete dentures; one constructed by rapid prototypedtechnology and the other constructed by conventional heat compressed method.Patients were classified into two groups, five patients in each. First Group received theRP complete denture first then the conventional complete denture (CCD) while, secondgroup received the (CCD) first then RP complete denture. All patients were instructedto wear their denture for equal periods and recalled after 1- week, 1- month and 3-months to measure the (EMG). After an interval of 2- weeks, as a wash out period,patients received their other dentures. Results: Conventional complete denture showedsignificant higher EMG than RP denture at different testing periods and with differenttested foods. Also, the EMG of both masseter and anterior temporalis muscles improvedwith time for each tested denture. Conclusion: Conventional complete dentures still thebest rehabilitation choice for completely edentulous patients. Rapid prototyped denturecould be suitable alternative for completely edentulous patients.

The Masticatory Activity Interference in Quantitative Estimation of CA1, CA3 and Dentate Gyrus Hippocampal Astrocytes of Aged Murine Models and under Environmental Stimulation.

Studies indicating the influence of masticatory dysfunction, due to a soft diet or lack of molars, on impairing spatial memory and learning have led to research about neuronal connections between areas and cell populations possibly affected. In this sense, with scarce detailed data on the subfields of hippocampus in dementia neurodegeneration, there is no information about astrocytic responses in its different layers. Thus, considering this context, the present study evaluated the effects of deprivation and rehabilitation of masticatory activity, aging, and environmental enrichment on the stereological quantification of hippocampal astrocytes from layers CA1, CA3, and DG. For this purpose, we examined mature (6-month-old; 6M), and aged (18-month-old; 18M) mice, subjected to distinct masticatory regimens and environments. Three different regimens of masticatory activity were applied: continuous normal mastication with hard pellets (HD); normal mastication followed by deprived mastication with equal periods of pellets followed by soft powder (HD/SD); or rehabilitated masticatory activity with equal periods of HD, followed by powder, followed by pellets (HD/SD/HD). Under each specific regimen, half of the animals were raised in standard cages (impoverished environment (IE)) and the other half in enriched cages (enriched environment (EE)), mimicking sedentary or active lifestyles. Microscopic stereological, systematic, and random sampling approaches with an optical dissector of GFAP-immunolabeled astrocytes were done, allowing for an astrocyte numerical estimate. Stratum moleculare and hilus, from the dentate gyrus (DG) and Strata Lacunosum-Moleculare, Oriens, and Radiatum, similarly to the dentate gyrus, showed no significant change in any of the investigated variables (age, diet, or environment) in these layers. However, in Stratum radiatum, it was possible to observe significant differences associated with diet regimens and age. Therefore, diet-related differences were found when the HD 18M IE group was compared to the HD/SD/HD 18-month-old group in the same environment (IE) (p = 0.007). In the present study, we present modulatory factors (masticatory function, environmental enrichment, and aging) for the differentiated quantitative laminar response in the hippocampal regions, suggesting other studies to read the plasticity and responsiveness of astrocytes, including the molecular background.

Penalized smoothing splines resolve the curvature identifiability problem in age‐period‐cohort models with unequal intervals

Age-period-cohort (APC) models are frequently used in a variety of health and demographic-related outcomes. Fitting and interpreting APC models to data in equal intervals (equal age and period widths) is nontrivial due to the structural link between the three temporal effects (given two, the third can always be found) causing the well-known identification problem. The usual method for resolving the structural link identification problem is to base a model on identifiable quantities. It is common to find health and demographic data in unequal intervals, this creates further identification problems on top of the structural link. We highlight the new issues by showing that curvatures which were identifiable for equal intervals are no longer identifiable for unequal data. Furthermore, through extensive simulation studies, we show how previous methods for unequal APC models are not always appropriate due to their sensitivity to the choice of functions used to approximate the true temporal functions. We propose a new method for modeling unequal APC data using penalized smoothing splines. Our proposal effectively resolves the curvature identification issue that arises and is robust to the choice of the approximating function. To demonstrate the effectiveness of our proposal, we conclude with an application to UK all-cause mortality data from the Human mortality database.

Distribution of Births of Bafra Sheep Reared in the Mediterranean Region during the Day

In this study, the distribution of birth data during the day (24 hours) of 651 lambs born in 2019-2022 of Bafra sheep reared in a private sheep farm in Kızıllı village of Antalya province was investigated. In the study, the effects on the distribution of births during the day and the characteristics of lambs such as birth type, sex, difficult and normal births, and dam’s lactation number were investigated. The 24 hours were divided into four equal periods such as 06:01-12:00 = 1, 12:01-18:00 = 2, 18:01-00:00 = 3, and 00:01- 06:00 = 4 to evaluate the distribution within the day. χ2 (Chi-square) test analysis was used to determine whether the characteristics such as, birth type, sex, difficult and normal births, and dam’s lactation number affected the distribution of births during the day. As a result of the analysis, the distribution of a total of 651 lamb births during the day was observed as 260 heads (39.9%) at 06:01-12:00, 199 heads (30.6%) at 12:01-18:00, 109 heads (16.7%) at 18:01- 00:00, and 83 heads (12.7%) at 00:01-06:00, respectively. In the first and second time periods between 06:01 and 18:00, 70.5% (459 heads) of lamb births occurred. The ratio and number of lambs in sex distribution were determined as 45.8% male (298 head) and 54.2% female (353 head), respectively. The number and rate of lamb births of ewes in the first lactation comprised 366 heads and 56.2%, respectively. According to the χ2 test of the time periods of the births, the effect of the lamb's birth type (P

Abstract P4-03-29: Impact of the COVID-19 pandemic on breast cancer incidence and tumor stage in the Netherlands and Norway

Abstract Introduction. The SARS-CoV-2 infection rate and the COVID-19 death rate were relatively high in the Netherlands during the first wave of the COVID-19 pandemic (2.7 and 7.2 times higher than in Norway, respectively). Moreover, social measures differed between the two countries. This study aimed to compare the effect of the pandemic on breast cancer incidence and stage between the Netherlands and Norway. Methods. Women diagnosed with DCIS or invasive breast cancer between January 2017 and December 2021 were selected from the Netherlands Cancer Registry and from the Cancer Registry of Norway. The COVID-19 period was divided in three approximately equal periods: March-September 2020 (first wave), October 2020-April 2021 (second wave), May-December 2021 (post-second wave). Breast cancer incidence during the COVID-19 periods was compared with averaged data of the corresponding reference period: March-September 2017, 2018, 2019 (first wave_ref), October-April 2017, 2018, 2019 (second wave_ref), May-December 2017, 2018, 2019 (post-second wave_ref). Incidences were compared by age group, clinical tumor stage, and method of detection. Results. The number of breast cancer diagnosis and the breast cancer incidence are shown in Table 1. Compared to the reference period, breast cancer incidence was lower during the first wave in the Netherlands and Norway (IRR: 0.72; 95%CI: 0.70-0.75; IRR: 0.83, 95%CI 0.78-0.88, respectively), and was higher post-second wave in Norway (IRR: 1.10, 95%CI: 1.04-1.16) (Table 1). During the first wave, breast cancer incidence was lower in all age groups in the Netherlands (age &amp;lt; 50 IRR: 0.85, 95%CI: 0.79-0.91; 50-69 IRR: 0.64, 95%CIL 0.61-0.67; 70-74 IRR: 0.61, 95%CI: 0.56-0.67; &amp;gt;74 IRR: 0.86, 95%CI: 0.80-0.93, respectively). During the first wave, incidence was lower in women aged 50-69 in Norway (i.e., women eligible for screening; IRR: 0.68, 95%CI: 0.62-0.74). Post-second wave incidence was higher in women aged 50-69 and &amp;gt;74 in Norway (IRR: 1.09, 95%CI: 1.01-1.17; IRR: 1.13, 95%CI: 1.00-1.28, respectively). In the first wave the incidence of DCIS, stage I tumors, and screen-detected tumors was lower in the Netherlands (IRR: 0.55, 95%CI: 0.50-0.61; IRR: 0.62, 95%CI: 0.59-0.65, IRR: 0.36, 95%CI: 0.33-0.38, respectively) as well as Norway (IRR: 0.66, 95%CI: 0.54-0.79; IRR: 0.73, 95%CI: 0.66-0.81, IRR: 0.46; 95%CI: 0.40-0.52, respectively). Conclusion. The current study showed that the incidence of early-stage tumors mainly decreased. Moreover, during the first wave of the pandemic breast cancer incidence decreased in all age groups in the Netherlands but only in women aged 50-69 in Norway. The relatively high infection and death rate in the Netherlands might have increased the fear of patients to visit the general practitioner (GP) and/or to overburden the healthcare system at the start-up of the pandemic. In addition, it might have reduced the capacity at the GP. As a result, appointments with the GP might have been postponed, resulting in a decrease in the number of breast cancer diagnoses in all age groups. A catch-up in breast cancer diagnoses was seen post-second wave in Norway, but not in the Netherlands. Incidence rates should therefore be monitored in the coming period. Table 1: Number of breast cancer diagnoses (breast cancer incidence) during the COVID-19 pandemic and during the corresponding reference period (incidence is expressed per 100.000 women living in the Netherlands or Norway during the period of interest) Citation Format: Anouk Eijkelboom, Linda de Munck, Marthe Larsen, Jan Nygård, Solveig Hofvind, Sabine Siesling. Impact of the COVID-19 pandemic on breast cancer incidence and tumor stage in the Netherlands and Norway [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-03-29.

Stable lifetime of compact, evenly spaced planetary systems with non-equal masses

ABSTRACT Compact planetary systems with more than two planets can undergo orbital crossings from planet–planet perturbations. The time for which the system remains stable without orbital crossings has an exponential dependence on the initial orbital separations in units of mutual Hill radii. However, when a multiplanet system has period ratios near mean-motion resonances, its stability time differs from the time determined by planet separation. This difference can be up to an order of magnitude when systems are set-up with chains of equal period ratios. We use numerical simulations to describe the stability time relationship in non-resonant systems with equal separations but non-equal masses which breaks the chains of equal period ratios. We find a deviation of 30 per cent in the masses of Earth-mass planets that creates a large enough deviation in the period ratios where the average stability time of a given spacing can be predicted by the stability time relationship. The mass deviation where structure from equal period ratios is erased increases with planet mass but does not depend on planet multiplicity. With a large enough mass deviation, the distribution of stability time at a given spacing is much wider than in equal-mass systems where the distribution narrows due to period commensurabilities. We find the stability time distribution is heteroscedastic with spacing – the deviation in stability time for a given spacing increases with said spacing.

Pathological and clinical outcomes of adrenalectomy: A multi-center experience in Saudi Arabia

ObjectiveTo determine the nature of adrenal pathology in patients undergoing adrenalectomy in Saudi Arabia over the last decade and compare it with the literature. We compared perioperative outcomes between minimally invasive adrenalectomy (MIA) and open adrenalectomy (OA). MethodsThis retrospective study included patients who underwent adrenalectomy at five tertiary care centers in Saudi Arabia from 2010 to 2020. We collected patients’ baseline and perioperative characteristics and detailed hormonal evaluation of adrenal masses. ResultsAmong 160 patients (mean age 44 ± 14.5 years; mean BMI 29.17 ± 5.96 kg/m2), 84 (51.5 %) were men and 51.5 % had left-sided adrenal masses. The mean tumor size was 6.1 ± 4.2 (1.0–19.5) cm, including 60 (37.5 %) incidentalomas and 65 (40.6 %) functioning masses. Histopathology revealed 74 (46.2 %) adenomas and 24 (15 %) cancers or metastases from other primary organs; 20 %, 8.8 %, and 2.5 % of patients had pheochromocytoma, myelolipoma, and 2.5 % ganglioneuroblastoma, respectively. MIA and OA were performed in 135 (84.4 %) and 21 (15.6 %) patients, respectively. Adrenalectomy was increasingly performed over three equal periods in the last decade (17.5 % vs 34.4 % vs 48.1 %), with increasing numbers of MIAs to replace OAs. OA patients had larger tumors and needed blood transfusion more frequently (47.6 % vs 10.8 %, p< 0.001). MIA was significantly associated with shorter operative time, shorter length of stay, and less blood loss. Postoperative complications occurred in 10 (6.2 %) patients and were significantly higher for OA (24 % vs 3.0 %, p< 0.001). ConclusionsThe majority of adrenal masses are benign. Herein, the observed functional and perioperative outcomes were comparable to those of available meta-analyses.

Trends in the Characteristics, Treatment, and Outcomes of Rectal Adenocarcinoma in the US From 2004 to 2019

Rectal cancer management has significantly evolved over the last 2 decades. This study aimed to evaluate trends in the characteristics, treatment, and outcomes of rectal adenocarcinoma across 16 years. This retrospective, observational case series study used data from the National Cancer Database (NCDB) to evaluate patients diagnosed with rectal adenocarcinoma from 2004 through 2019. Data analysis was performed from March to May 2022. Trends in the treatment and outcomes of rectal adenocarcinoma in the US between 2004 and 2019 were explored. This period was subdivided into 4 equal periods: 2004-2007, 2008-2011, 2012-2015, and 2016-2019. Patient and tumor characteristics, treatments, short-term outcomes, and overall survival. A total of 318 548 patients diagnosed with rectal adenocarcinoma were included in the analysis, 191 369 (60.1%) of whom were males and 127 179 (39.9%%) were females. The mean (SD) age of the patients was 63.5 (13.4) years, and 46 824 patients (14.8%) were younger than 50 years. Among the patients, 10 859 (3.4%) were of Asian race and ethnicity, 28 464 (8.9%) were Black, and 271 236 (85.1%) were White. The percentage of patients younger than 50 years who were diagnosed with rectal cancer increased by 1.5%, from 13.9% in period 1 to 15.4% in period 4. Patients in the last period (2016-2019) presented more often with stages III (36.2% vs 30.2% vs 25.0% vs 23.4%; P < .001) and IV (21.5% vs 19.3% vs 18.1% vs 18.6%; P < .001) disease compared with those in the remaining 3 periods. The use of chemotherapy (36.8% vs 48.1% vs 49.1% vs 47.0%; P < .001) and immunotherapy (0.4% vs 0.2% vs 3.5% vs 6.5%; P < .001) significantly increased across the 4 periods. Although neoadjuvant radiotherapy was used more often across the periods studied (28.6% in period 1 to 34.3% in period 4), the use of adjuvant radiotherapy was reduced by half (12.9% to 6.0%). The median (IQR) time from diagnosis to definitive surgery increased from 95 (15-126) days in period 1 to 128 (47-158) days in period 4. The rate of use of open surgery decreased by half (60.1% in period 2 to 30.1% in period 4), and the use of robotic surgery significantly increased (5.2% in period 2 to 28.4% in period 4). The conversion rate was significantly reduced (11.2% in period 2 to 7.3% in period 4) and the median (IQR) hospital stay decreased by 2 days, from 6 (3-9) days to 4 (2-7) days. The median (IQR) overall survival significantly increased across the periods (from 83.1 months [95% CI, 81.8-84.6 months] in period 1 to 92.1 months [95% CI, 90.2-93.6 months] in period 3; P < .001). The findings of this case series study suggest a treatment trend of increased use of chemotherapy, immunotherapy, sphincter-saving surgery, and minimally invasive surgery. In addition, the time between diagnosis and definitive surgery increased by a median of 33 days. This treatment trend was associated with a significant improvement in the overall survival, reduction in the conversion rate by 3.9%, and a 2-day shorter hospital stay. These findings have major clinical relevance to the management of rectal cancer. The improvements seen in short-term outcomes and survival of patients diagnosed with rectal cancer can probably be attributed to the treatment trends observed. Continued improvement in outcomes warrant further updates in treatments.