Discontinuity Factors Research Articles

Hybrid finite-element-based numerical solution of the SP3 equations – SP3 solution of two- and three-dimensional VVER reactor problems

As a follow-up to the paper previously published by the authors detailing the hybrid finite element (HYBFEM) solution of the SP3 equations, in this paper, besides a semi-analytical solver verification with an analysis on the applied source fitting polynomial order, three-dimensional VVER-440, and VVER-1000 benchmarks are reproduced with the continuous Galerkin (CGFEM) and HYBFEM SP3 modules of the SPNDYN code. The effect of the applied axial nodalisation and radial element order on the calculation results is discussed. The HYBFEM solver extended with a discontinuity factor (DCF) calculation module based on Serpent 2 output parameters is verified on a two-dimensional VVER-1000 benchmark. The SPNDYN CGFEM and HYBFEM results show very good agreement. We also verify that by introducing DCFs in SP3 calculations, the reference transport solution can be reproduced with high accuracy. We highlight the effect of using scalar flux weighted linearly anisotropic scattering matrices in higher-order transport calculations.

Development and application of the improved multicell method for the PWR fuel assemblies adjacent to reflector

The conventional “two-step” scheme based on assembly homogenization is widely applied in the modeling and simulation for PWRs. In the “two-step” scheme, the reflective boundary condition is applied in the two-dimensional calculation of fuel assembly, providing the few-group constants and ADFs (Assembly Discontinuity Factors) for the three-dimensional core calculation. However, the neutron-leakage phenomenon would occur to the fuel assemblies adjacent to the reflector, in which case the approximation of the reflective boundary condition applied to the single fuel assembly would no longer be suitable. In order to consider the neutron-leakage phenomenon, the multicell method originally developed for CANDU reactor has been improved and applied to PWRs for the fuel assemblies adjacent to reflector in this paper. Through the heterogeneous simulation of the multicell case, which are composed of fuel and reflector assemblies to characterize the neutron leakage from the fuel assembly, the multicell correction factors for the few-group constants and ADFs can be determined and applied to the core calculation. Applying the improved multicell method, our home-developed Bamboo-C code has been improved. For the method verifications, the baffle-reflector PWR and heavy-reflector PWR have been modeled with the improved Bamboo-C code, and the keff and power distributions are compared with reference values provided by the Monte-Carlo code. The numerical results show that the improved multicell method can reduce the power-distribution differences notably, which indicate the effectivity of this method for the fuel assemblies adjacent to both the baffle-reflector PWR and heavy-reflector PWR.

Discontinuation of adjuvant endocrine therapy and impact on quality of life and functional status in older patients with breast cancer

PurposeSide effects are the main reason for discontinuation of adjuvant endocrine therapy in older adults. The aim of this study was to examine geriatric predictors of treatment discontinuation of adjuvant endocrine therapy within the first 2 years after initiation, and to study the association between early discontinuation and functional status and quality of life (QoL).MethodsPatients aged ≥ 70 years with stage I–III breast cancer who received adjuvant endocrine therapy were included. The primary endpoint was discontinuation of endocrine therapy within 2 years. Risk factors for discontinuation were assessed using univariate logistic regression models. Linear mixed models were used to assess QoL and functional status over time.ResultsOverall, 258 patients were included, of whom 36% discontinued therapy within 2 years after initiation. No geriatric predictive factors for treatment discontinuation were found. Tumour stage was inversely associated with early discontinuation. Patients who discontinued had a worse breast cancer-specific QoL (b = − 4.37; 95% CI − 7.96 to − 0.78; p = 0.017) over the first 2 years, in particular on the future perspective subscale (b = − 11.10; 95% CI − 18.80 to − 3.40; p = 0.005), which did not recover after discontinuation. Treatment discontinuation was not associated with functional improvement.ConclusionA large proportion of older patients discontinue adjuvant endocrine treatment within 2 years after initiation, but geriatric characteristics are not predictive of early discontinuation of treatment. Discontinuation of adjuvant endocrine therapy did not positively affect QoL and functional status, which implies that the observed poorer QoL in this group is probably not caused by adverse effects of endocrine therapy.

Magnitude and associated factors of early Implanon discontinuation among rural women in public health facilities of central Ethiopia: a community-based cross-sectional study

BackgroundAdvocating for and promoting contraception use is critical in reducing mother and child morbidity and mortality. Early Implanon discontinuation may result in unwanted pregnancies and induced abortions. Although there has been research in Ethiopia on long-acting reversible contraceptives, there has been none on early Implanon removal among rural women who have used and removed it. Hence, this study aimed to investigate the magnitude of Implanon discontinuation and related characteristics among women who had the Implanon removed in central Ethiopian public health facilities.MethodsA community-based cross-sectional study was conducted among all women of the reproductive age group who had removed Implanon after using it. A simple random sampling technique was used to select 373 women after proportional allocation to each health facility. Data were collected using a pretested semi-structured interviewer-administered questionnaire adapted from previous studies. Data were entered using EpiInfo and exported to SPSS version 21 for analysis. A binary logistic regression model was used to determine the association between the outcome variable and independent variables. A p-value less than 0.25 was used as a cutoff point to select candidate variables for the final model. Then, a p value less than 0.05, AOR, and a 95% confidence level were used to declare statistical significance.ResultA total of 360 participants responded to the questionnaires, making a response rate of 96.5%. In this study, the early discontinuation rate was 42% (95% CI 36.9–47.7). No formal education (AOR = 0.53 [95% CI 0.3–0.94], having medium monthly income (AOR = 3.02 [95% CI 1.38–6.6]), inadequate pre-insertion counseling (AOR = 0.55 [95% CI 0.31–0.98]), lack of appointment for follow up (AOR = 0.16 [95% CI 0.05–0.54]), didn`t satisfy with service provided (AOR = 0.067 [95% CI 0.015–0.29] and developed side effect (AOR) = 4.45 [95% CI 2.37–8.36] were significantly associated with Implanon discontinuation.ConclusionThe discontinuation rate of Implanon among those who removed it after using it in this study was high. Lack of formal education, having a medium-income, inadequate pre-insertion counseling, lack of appointments for the follow-up, poor satisfaction, and problems with side effects were the factors associated with early discontinuation rate. Hence, quality family planning service provision is essential to reduce the discontinuation rate.

Triangular Polynomial Expansion Nodal Method for VVER Core Analysis

Due to the low computational cost, nodal diffusion methods are still commonly used to simulate full-core reactor problems. This work represents the developmental effort to build an accurate nodal kernel to treat hexagonal geometry in the core simulator code PARCS. An innovative method called TriPEN-9 has been developed by splitting a hexagonal assembly into six triangular nodes and solved using cubic polynomial expansion for the scalar flux with nine-term expansion coefficients. The nodal diffusion calculation is further accelerated with the multilevel coarse-mesh finite difference method. The verification of the TriPEN-9 method on the VVER full-core problem is provided with the model based on the NURESIM (Nuclear Reactor Simulator)-SP1 V1000-2D-C1-tr benchmark problem. The Serpent Monte Carlo code is used as a reference solution for verification and to generate homogenized group-constants data for PARCS. Exact discontinuity factors were generated in GenPMAXS, a cross-section processing code, using a similar expansion method as the TriPEN-9 core solver method with the utilization of heterogeneous solutions from Serpent. Implementing the TriPEN-9 method in PARCS, this approach can exactly reproduce the solutions from the high-fidelity Serpent calculations.

Risk factors for discontinuation of exclusive breast feeding within 1month: a retrospective cohort study in Japan

BackgroundWhile breastfeeding provides benefits for infants and the mother, many women either do not breastfeed or terminate breastfeeding earlier than recommended. The aim of this analysis was to identify factors associated with early discontinuation of breastfeeding in Japanese women.MethodsThis study used data from medical records of women delivering a singleton live birth between March 2017 and August 2019 in Iwase General Hospital, Fukushima Prefecture, Japan to assess cessation of breastfeeding by the 1-month postpartum appointment. Demographic (age at birth, and employment status), medical (parity, and physical and mental condition of the mother; and infant medical factors, such as sex, Apgar score, and jaundice, among other), and family factors (husband/partner, family members living at the same house, among others) in 734 women who had initiated breastfeeding during their delivery hospital stay were examined, and multiple logistic regression was used to determine significant predictors of early cessation of exclusive breastfeeding.ResultsBivariate analysis revealed that women who were primipara, unmarried, exposed to secondhand smoke, and employed; those who smoked before pregnancy; and those who had asthma were more likely to discontinue exclusive breastfeeding than other women. Infant factors associated with discontinuation were lower birthweight, earlier gestational age, neonatal intensive care unit admission, treatment for jaundice, or lower weight gain. Multivariable analysis revealed that primiparity, passive smoking before pregnancy, maternal employment, and neonatal jaundice therapy were associated with discontinuation of breastfeeding.ConclusionsIn particular, women whose partners smoked before pregnancy may need to be targeted for additional support for breastfeeding.

Antipsychotic utilization trajectories three years after initiating or reinitiating treatment of schizophrenia: A state sequence analysis approach.

This study aims to describe the utilization patterns of antipsychotic (AP) medication in patients with schizophrenia (SCZ), three years after initiating or reinitiating a given AP. Based on medico-administrative information on patients living in Quebec (Canada), this retrospective cohort study included 6444 patients with a previous diagnosis of SCZ initiating or reinitiating AP medication between January 1, 2012, and December 31, 2014, with continuous coverage by public drug insurance. For each day of follow-up (1092days), patient was either exposed to one of the chosen categories of APs, or to none. This patient's sequence of AP exposure overtime has been referred to as the "antipsychotic utilization trajectory". These trajectories were analyzed using a State Sequence Analysis, an innovative approach which provides useful visual information on the continuation and discontinuation patterns of use over time. Clozapine and long-acting injectable second-generation APs had the best continuation and discontinuation patterns over 3years among all other groups, including less switching of APs, while oral first-generation APs had the poorest patterns. These findings were comparable among incident and non-incident cohorts. Oral second-generation antipsychotics, excluding clozapine, had a poorer continuation and discontinuation pattern than long-acting injectable antipsychotics. State Sequence Analysis provides a clear representation of treatment adherence in comparison with dichotomous indicators of adherence or discontinuation. Consequently, this innovative method has shed light on the impact of the AP chosen to initiate or reinitiate treatment in SCZ, which has been identified as a key factor for long-term treatment continuation and discontinuation.

Magnitude and factors for method discontinuation and switching among long acting reversible contraceptive users in health facilities of Southern Ethiopia

BackgroundLong Acting Reversible Contraceptives (LARCs) are contraceptives that prevent unplanned pregnancy in a more safer and effective way than other modern short acting methods. However, method discontinuation and switching are still challenges for utilization of LARCs in resource limited countries for several reasons. Thus, the aim of this study was to determine magnitude and factors for method discontinuation and switching among LARCs users in health facilities of Southern Ethiopia.MethodsA Facility based record review was used to collect data from May to June 2019. Three hospitals were randomly selected from five hospitals found in southern Ethiopia. A total of 1050 records were included in the study from long acting family planning registers between 2018 and 2019. Data were entered to Epi-info 3.5.4 and exported to SPSS for windows version 20 for analysis. A descriptive statistics was performed to describe factors and reasons for LARCs discontinuation and switching off. Logistic regression technique with a 95% confidence level was used to determine the association between factors and magnitude of method discontinuation and switching.ResultsOf the 1050, 69.8% of women discontinued long acting reversible family planning method before the recommended duration of use and 30.2% of them switched from long acting family planning methods to any other modern contraceptive methods. Women who shifted from any LARCs to short-acting family planning methods accounted for 38.8% of those who shifted to any other modern methods. Desire to get pregnant and method specific side effect were most common reasons for both method discontinuation and switching. Women with only one child were 1.61 times more likely to discontinue than women who had greater than five number of children.ConclusionDiscontinuation and switching of long acting reversible family planning method was high. Primiparous women were more likely to discontinue use of long acting reversible family planning methods. Re-evaluating family planning services focusing on effective counseling about side effects of LARCs methods is required. Training should also be given for family planning providers including community healthcare workers.

Jacobian-free Newton Krylov two-node coarse mesh finite difference based on nodal expansion method

A Jacobian-Free Newton Krylov Two-Nodal Coarse Mesh Finite Difference algorithm based on Nodal Expansion Method (NEM_TNCMFD_JFNK) is successfully developed and proposed to solve the three-dimensional (3D) and multi-group reactor physics models. In the NEM_TNCMFD_JFNK method, the efficient JFNK method with the Modified Incomplete LU (MILU) preconditioner is integrated and applied into the discrete systems of the NEM-based two-node CMFD method by constructing the residual functions of only the nodal average fluxes and the eigenvalue. All the nonlinear corrective nodal coupling coefficients are updated on the basis of two-nodal NEM formulation including the discontinuity factor in every few newton steps. All the expansion coefficients and interface currents of the two-node NEM need not be chosen as the solution variables to evaluate the residual functions of the NEM_TNCMFD_JFNK method, therefore, the NEM_TNCMFD_JFNK method can greatly reduce the number of solution variables and the computational cost compared with the JFNK based on the conventional NEM. Finally the NEM_TNCMFD_JFNK code is developed and then analyzed by simulating the representative PWR MOX/UO2 core benchmark, the popular NEACRP 3D core benchmark and the complicated full-core pin-by-pin homogenous core model. Numerical solutions show that the proposed NEM_TNCMFD_JFNK method with the MILU preconditioner has the good numerical accuracy and can obtain higher computational efficiency than the NEM-based two-node CMFD algorithm with the power method in the outer iteration and the Krylov method using the MILU preconditioner in the inner iteration, which indicates the NEM_TNCMFD_JFNK method can serve as a potential and efficient numerical tool for reactor neutron diffusion analysis module in the JFNK-based multiphysics coupling application.

An improved homogenization method for the treatment of strong absorbers in pebble-bed HTGR

In pebble-bed high temperature gas-cooled reactors (HTGRs), strong absorbers including control rods and absorber balls are placed in the reflector. The strong absorber regions need to be homogenized for the convenience of downstream whole-core neutronics diffusion calculation. Previously, a homogenization method based on the generalized equivalence theory (GET) was studied. This paper proposes an improved homogenization method by employing a more rigorous discontinuity factor (DF) model, for more accurate treatment of the strong absorbers in the HTGR reflector. The proposed method has been implemented in the PANGU code developed by Institute of Nuclear and New Energy Technology (INET), Tsinghua University. Numerical results suggest that the newly proposed homogenization method achieves good agreement with the heterogeneous Monte Carlo transport solution and experimental result.

Real-world effectiveness and safety of golimumab in rheumatoid arthritis treatment: A two-center study in Taiwan.

The real-world outcomes of golimumab (GLM) use have been rarely studied in Asian patients with rheumatoid arthritis (RA). This study assessed the real-world effectiveness and safety of GLM in a Taiwanese cohort. One hundred and eight GLM-treated RA patients were enrolled. Predictors of a good European League Against Rheumatism (EULAR) response at 24 months and drug retention were identified through multivariate analyses. After 24 months of GLM treatment, the mean Disease Activity Score using 28 joint counts with the erythrocyte sedimentation rate (DAS28-ESR) decreased from 6.7 to 3.1 (p < 0.001). Up to 58.9% of patients achieved a good EULAR response at 24 months. Multivariate logistic regression analysis revealed that after adjustment for other variables, a higher baseline C-reactive protein was an independent negative predictor of good EULAR responses (odds ratio, 0.82; 95% confidence interval [CI], 0.67-0.99; p = 0.043). During the mean follow-up period of 38.3 months, 15 (13.9%) patients discontinued GLM due to treatment failure. In multivariate analysis, high baseline ESR level, high DAS28-ESR, and the experience of biologic therapy were independent risk factors for GLM discontinuation (adjusted hazard ratio [HR], 1.03; 95% CI, 1.01-1.05; p = 0.003; adjusted HR, 2.93; 95% CI, 1.42-6.08; p = 0.004; and adjusted HR, 5.00; 95% CI, 1.75-14.26; p = 0.003, respectively). In receiver operator characteristic curve analysis, the optimal cutoff values of baseline ESR and DAS28-ESR for predicting drug survival were 52 mm/h (sensitivity: 60.0% and specificity: 77.4%) and 7.7 (sensitivity: 46.7% and specificity: 94.3%), respectively. During the follow-up period, 22 patients (20.4%) developed adverse events. The safety profile of GLM in this study was comparable with that in previous clinical trials. GLM was effective and safe for the real-life management of Taiwanese RA patients and showed a high retention rate in biologic-naive patients compared with biologic-experienced patients.

P373 Real world evidence of tofacinitib in ulcerative colitis: short and long-term effectiveness, impact of extraintestinal manifestations and immunomediated diseases and safety

Abstract Background Main aim: To assess the retention rate of tofacitinib treatment in patients with ulcerative colitis (UC). Secondary aims: To assess the short-term effectiveness and the durability of response; to evaluate the evolution of extraintestinal manifestations (EIMs) and immunomediated inflammatory diseases (IMIDs); to assess the tolerability of tofacitinib in clinical practice. Methods Retrospective, multicenter study. UC patients who had received the first tofacitinib dose at least, 8 weeks before the start date of recruitment. Patients were followed-up from the first tofacitinib dose to treatment discontinuation or last visit, whichever came first. Only patients with active disease [Partial Mayo Score (PMS)&amp;gt;2] were considered in the short-term effectiveness analysis. Clinical response was based on the PMS. Variables associated with short-term remission were identified by logistic regression analysis. Kaplan-Meier curves and Cox-regression analysis were used to evaluate the long-term effectiveness and durability of tofacitinib treatment. Results 335 patients have been included so far (recruitment still ongoing) (Table 1). A total of, 70 patients (21%) would have met the criteria for entering A3921133 trial. A total of, 155 patients interrupted tofacitinib during follow-up (Figure 1a), mainly due to primary non-response (46%) and loss of response (25%); predictive factors of tofacitinib discontinuation are shown in figure 1b. Short-term effectiveness and predictive factors of remission are shown on figure 2;, 16% of non-responders and, 35% with partial response at week, 4 reached remission at week, 8, and, 19% of non-responders and, 37% of partial responders at week, 8 reached remission at week, 16. Of, 151 patients in remission at week, 8, 68 (45%) lost response (Figure 3); tofacitinib dose was increased in, 27%, and, 71% of them reached remission again. Obvious blood with stool most of the time or blood alone passed at baseline was the only variable associated with losing response over time. There were, 86 adverse events related to tofacitinib treatment (Table 2). Fifty-seven patients (17%) had EIMs or IMIDs non-active at tofacitinib start; only, 2 out of, 12 patients with peripheral arthropathy worsened., 53 patients (16%) had active EIMs or IMIDs at the start of tofacitinib and some of them improved. A total of, 17 EIMs or IMIDs occurred after starting tofacitinib but only, 1 (vasculitis) caused tofacitinib withdrawal. Conclusion Tofacitinib is effective in inducing remission even in highly refractory UC patients. A relevant proportion of patients discontinue the treatment, mainly during the first months due to primary failure. The safety profile is similar to that previously reported for tofacitinib

Durability of single tablet regimen for patients with HIV infection in Southern Taiwan: data from a real-world setting

BackgroundA single-tablet regimen (STR) has been associated with better drug adherence. However, the durability of different STRs was unknown in the real-world settings. Our aim was to investigate the durability of different initial STR regimens in antiretroviral-naive patients starting STR in southern Taiwan.MethodThis was a retrospective study of antiretroviral-naive patients that initiated first-line antiretroviral regimens with STRs between May 2016 and December 2017. The primary endpoint was time to virological failure. Secondary endpoints were STR discontinuation due to toxicity/intolerance. Durability was defined as time from the initiation until discontinuation/modification. Kaplan- Meier curves were plotted assessing time to virological suppression, treatment failure and discontinuation for the three STRs and Cox proportional hazards model was used to analyze the factors associated with time to viral suppression, treatment failure or discontinuation.ResultsTwo hundred and twenty-three patients were included: The median follow-up duration (IQR) was 73.9 (48–101.6) weeks, 25 patients (11%) experienced virological failure; the 48 weeks probability of treatment failure was 22.9% (16/70) for Efavirenz/Emtricitabine/Tenofovir Disoproxil Fumarate (EFV/FTC/TDF), 24.1% (13/54) for Emtricitabine/Rilpivirine/Tenofovir Disoproxil Fumarate (FTC/RPV/TDF) and 24.2% (24/99) for Abacavir/Dolutegravir/Lamivudine (ABC/DTG/3TC) (p=0.16). Fifty-six patients (25%) discontinued their STRs owing to toxicity/intolerance. When compared to EFV/FTC/TDF, treatment with FTC/RPV/TDF (aHR 8.39, CI 1.98–35.58, p = 0.004) and ABC/DTG/3TC (aHR 8.40, CI 2.39–29.54, p=0.001) were more likely to have treatment failure. The predictors for treatment failure included age ≦ 30 years old (aHR 3.73, CI 1.25–11.17, p = 0.018), switch between different STR (aHR 2.3, CI 1.18–4.50, p = 0.001) and free of active syphilis infection (aHR 0.24, CI 0.08–0.73, p = 0.012). The risk factor for treatment discontinuation included younger age ≦ 30 years old (aHR 3.82, CI 1.21–12.37, p = 0.023), treatment with EFV/FTC/TDF (aHR 8.65, CI 2.64–28.39, p < 0.001) and free of active syphilis infection (aHR 0.16, CI 0.04–0.62, p = 0.006).ConclusionYounger age was associated with treatment failure and drug discontinuation. Active syphilis infection s/p treatment was associated with free from treatment failure and discontinuation. This probably driven by the more frequently sexual health education and counseling when patients had syphilis infection. Treatment with ABC/DTG/3TC was associated with higher risk of treatment failure. The STR durability was dependent on the drug toxicity/intolerance, age and syphilis infection.

Comparable long-term retention rates and effects on bone mineral density of denosumab treatment in patients with osteoporosis with or without autoimmune inflammatory rheumatic diseases: real-life data.

Objectives:To investigate whether concomitant autoimmune inflammatory rheumatic diseases (AIIRDs) represent a risk factor for denosumab discontinuation and to explore other possible predictors.Design:This is a real-life retrospective study conducted at our centre on consecutive patients who started treatment with denosumab from January 2014 to October 2021.Methods:Data on patients’ characteristics, denosumab prescriptions and reason for discontinuation were collected from their medical electronic records. A log-rank test was run to assess differences in the denosumab retention rate between the not AIIRD and AIIRD patients. A backward stepwise logistic regression was used to identify possible predictors of denosumab discontinuation. When available, BMD data of the lumbar spine and total hip were collected.Results:Three hundred and sixty-three patients were included (265 not AIIRD and 98 AIIRD; median follow-up, 44 months). Sixty-nine patients discontinued denosumab at any time point (4 due to patient’s decision, 3 due to medical decision, 62 were lost in follow-up). The log-rank test did not find a statistically significant difference for denosumab persistence between the two subgroups. In the binary logistic regression analysis, only older age at initiation and lower baseline serum 25-hydroxy vitamin D were confirmed as predictors for discontinuation. BMD significantly increased from baseline to the last prescription visit at both the lumbar spine and the total hip, without statistically significant differences in the not AIIRD and AIIRD patients.Conclusion:The present data seem to suggest that AIIRDs do not represent a risk factor for denosumab discontinuation. Furthermore, the presence of AIIRDs does not seem to impair its effectiveness in terms of BMD.

Reasons and Associated Factors of Early Discontinuation of Implanon: A Follow-up Study from Lahore, Pakistan

Background: Family planning is needed at this time when the world population is rapidly increasing. Etonogestrel sub-dermal implant is a highly effective long-acting and reversible sub-dermal contraceptive implant. Despite its success and enhancement in usage, it is stopped by a proportion of users prior to its expiration date. Objective: To ascertain the frequency of discontinuation of Implanon during one year period and uncover its reasons and associated factors among women consulting obstetrics and gynecological clinics for contraception methods and opting for Implanon among the available options. Methodology: This prospective observational study was conducted in Services Hospital, Lahore. All of the women who underwent Implanon insertion from July to December 2020 were enrolled in the study. The outcome variable is early discontinuation of the inserted implant within one year of its insertion. Results: 350 women receiving sub-dermal Implanon for contraception purposes were included in this study. Their median age and BMI were 28(IQR= 25.8-31) years and 24.3 (IQR=23.6-25) Kg/m2 respectively. The early discontinuation rate was 49.1%. Reasons for removal were menstrual problems (100%), headache (19%), weight gain (12%), pain in the arm (5%), desire to conceive (1.7%) and spouse death (0.3%). Younger age, increasing body mass index, rural residence and shorter marriage duration were found to be significantly associated with early removal. Conclusion: This study found a high early discontinuation rate. Premature removal was most commonly caused by menstrual issues. Early removal was independently predicted by an early age, length of the marriage, rising BMI, and residence in a rural location. An awareness campaign should be created specifically for rural areas to address their concerns and reduce the early discontinuation rate. Further research should be conducted to understand the menstrual problems in women undergoing implanon insertion.

Cluster synchronization in finite/fixed time for semi-Markovian switching T-S fuzzy complex dynamical networks with discontinuous dynamic nodes

&lt;abstract&gt;&lt;p&gt;In this paper, cluster synchronization in finite/fixed time for semi-Markovian switching complex dynamical networks (CDNs) with discontinuous dynamic nodes is studied. Firstly, the global fixed-time convergence principle of nonlinear systems with semi-Markovian switching is developed. Secondly, the novel state-feedback controllers, which include discontinuous factors and integral terms, are designed to achieve the global stochastic finite/fixed-time cluster synchronization. In the framework of Filippov stochastic differential inclusion, the Lyapunov-Krasovskii functional approach, Takagi-Sugeno(T-S) fuzzy theory, stochastic analysis theory, and inequality analysis techniques are applied, and the global stochastic finite/fixed time synchronization conditions are proposed in the form of linear matrix inequalities (LMIs). Moreover, the upper bound of the stochastic settling time is explicitly proposed. In addition, the correlations among the obtained results are interpreted analytically. Finally, two numerical examples are given to illustrate the correctness of the theoretical results.&lt;/p&gt;&lt;/abstract&gt;

A questionnaire study of support for adult survivors of childhood cancer.

Childhood cancer survivors (CCSs) entering adulthood experience different problems, including late therapy-related complications. Long-term follow up (LTFU) is important for early intervention and psychosocial support for CCSs with late complications but it is frequently discontinued. This study aimed (i) to identify clearly the factors responsible for LTFU discontinuation, and (ii) to define the support needs of CCSs. From July, 2017 to March, 2019 we conducted a questionnaire survey of 121 CCSs aged ≥ 18 years at the time of the survey to investigate people who have experienced childhood cancer and identify their support needs. This was conducted in cooperation with patient associations throughout Japan. The LTFU levels were determined by CCSs themselves based on their treatment history. Long-term follow-up rates and LTFU discontinuation factors were assessed using the Kaplan-Meier method and the Cox proportional-hazards model. Late complications were the most common problem encountered by CCSs (80%). The most common support need was "explanation of late complications by a physician," reported by 86.9% of respondents. The rate of LTFU continuation decreased over time. The LTFU was discontinued both for physicians' reasons (35.6%) and patients' reasons (64.4%). Not knowing the extent or level of one's LTFU was reported to be an independent factor (P < 0.05) preventing LTFU continuation. As necessary support to continue LTFU, 67.9% of respondents stated the need for "explanation of LTFU by a doctor" and 60.7% stated "convenience of outpatient visit". Childhood cancer survivors require support, especially for late complications. It is necessary to continue LTFU, raising LTFU awareness among physicians and CCSs.

889. Early Discontinuations and Adverse Events Among Treatment-Naïve Patients Initiating Integrase Inhibitors in a Real-world Setting

BackgroundCohort studies suggest higher rates of discontinuations (DCs) and adverse events (AEs) with integrase inhibitors (INSTIs) than is reported in clinical trials. Here, we assess DC of different INSTIs in combination with one of two tenofovir prodrugs in the first year following initiation defined as “early DC” in a real-world cohort of treatment-naïve patients.MethodsThis analysis evaluated treatment-naïve patients at a single center initiating raltegravir (RAL), elvitegravir/cobicistat (EVG/c), dolutegravir (DTG) or bictegravir (BIC) in combination with emtricitabine/tenofovir alafenamide (F/TAF) or emtricitabine/tenofovir disoproxil fumarate (F/TDF) between 10/2007-1/2020. Eligible patients had a minimum follow-up of 1 year. The primary endpoint was incidence of early INSTI DC. Secondary endpoints included AEs and risk factors for early INSTI DC and treatment-related AEs.Results331 patients were included. Median age was 32 years, 89% were male, 43% were non-White, 8% started RAL-based therapy, 46% started EVG/c-based therapy, 22% started DTG-based therapy and 24% started BIC/F/TAF. 36 discontinued INSTI-based therapy early yielding an incidence rate of 0.17 DCs per person-years (PPY) among RAL patients, 0.14 DCs PPY among EVG/c patients, 0.22 DCs PPY among DTG patients, and 0 DCs PPY among BIC patients, p=0.006. Treatment-related AEs occurred in 27% of RAL patients, 42% of EVG/c patients, 50% of DTG patients, and 43% of BIC patients p=0.607; and were responsible for early DC rates of 0.022 in 3 EVG/c patients and 0.075 in 5 DTG patients. No treatment-related early DCs occurred among RAL or BIC patients. No evaluated factor was significantly associated with early INSTI DC, however DTG use was significantly associated with treatment-related AEs (aOR 3.46, 95% confidence interval: [1.20; 10.82]).Table 1. Risk factors for early integrase inhibitor discontinuation and treatment-related adverse events ConclusionIn this cohort, early DCs occurred in 11% initiating INSTI-based therapy, however of these only 2% were treatment-related. These data support use of INSTI-based regimens as preferred options for treatment-naïve patients living with HIV due to their favorable safety and tolerability profiles.Disclosures Charlotte-Paige M. Rolle, MD MPH, Gilead Sciences (Grant/Research Support, Scientific Research Study Investigator, Speaker’s Bureau)Janssen Infectious Disease (Scientific Research Study Investigator, Advisor or Review Panel member)ViiV Healthcare (Grant/Research Support, Scientific Research Study Investigator, Advisor or Review Panel member, Speaker’s Bureau) Kiran Patel, PharmD, Gilead Sciences (Employee) Federico Hinestrosa, MD, AbbVie (Speaker’s Bureau)Gilead Sciences (Advisor or Review Panel member, Speaker’s Bureau)Theratechonologies (Advisor or Review Panel member)ViiV Healthcare (Advisor or Review Panel member, Speaker’s Bureau) Edwin DeJesus, MD, Gilead Sciences (Scientific Research Study Investigator, Advisor or Review Panel member)

Impact of Angular and Spatial Source Distribution Approximations on Convergence Performance of Nonlinear Acceleration Methods for MOC in Slab Geometry

The convergence performance of nonlinear acceleration methods for the method of characteristics (MOC) with flat source (FS) approximation (FS MOC) or linear source (LS) approximation (LS MOC) is numerically investigated by focusing on the spatial and angular approximations in the acceleration calculations. The convergence of nonlinear acceleration depends on the consistency of the calculation models between the higher-order and lower-order (acceleration) methods. The convergence of four acceleration methods is evaluated to clarify the relationship between model consistency and convergence performance. These methods consist of FS or LS for the spatial source distribution and P1 or discrete angle for the angular distribution, i.e., (1) FS analytic coarse mesh finite difference (ACMFD) acceleration (FS ACMFD), (2) LS ACMFD, (3) FS angular-dependent discontinuity factor MOC (ADMOC) acceleration (FS ADMOC), and (4) LS ADMOC. The ACMFD and ADMOC accelerations are based on P1 and discrete angle approximations, respectively. The FS MOC and LS MOC are considered higher-order methods. The FS MOC and LS MOC with five acceleration methods, i.e., the aforementioned four acceleration methods and the conventional coarse mesh finite difference acceleration method, are used to perform fixed-source calculations in one-group one-dimensional homogeneous slab geometry, and the spectral radii are numerically evaluated. The numerical results indicate that (1) the nonlinear acceleration methods that are unconditionally stable for FS MOC also show similar convergence properties for LS MOC in one-dimensional slab geometry; (2) better convergence is observed when the consistency of higher- and lower-order models is high; and (3) when a coarse mesh is optically thick, the spatial homogenization degrades the convergence performance, even if spatial and angular approximations are consistent between the higher- and lower-order models.

다문화사회 통합을 위한 여가스포츠 활동요인 순위결정

The purpose of this study is to determine and present the Priority Order of leisure sports activity factors for Multicultural Society Integration using Delphi. To achieve the purpose of this study, we will conduct a third Delphi questionnaire for 21 experts including experts of multicultural centers in the Metropolitan City · Province(4 place). And semi-structured open survey of the Delphi investigation was prepared through a pre-examination on the leisure sports policy professors(2) and in-depth interviews with multicultural centers policy expert(1), Metropolitan City · Province center executives(8), and Immigrant Womens(10). The data resulting from the investigation was revised, and opinions were collected using five-point (re-cut) scale. In conclusion, The results of the investigation recommend five policies and twenty pertinent specifics on priority order of leisure sports activity factors for Multicultural Society Integration as described below: First, the current Multicultural leisure sports activity factors is divided into five classes(poicy system, institution discontinuity, social culture, economic, leisure participation leaning), the first importance of the institution discontinuity factor has been recognized.<BR> Second, the first priority order of leisure sports active factor is incentive grant of Multicultural leisure partaker, and time deficit of leisure activity with a member of society is the lowest appeared.