High Level Of Utilization Research Articles

Severe Hypoglycemia and the Use of Glucagon Rescue Agents: An Observational Survey in Adults With Type 1 Diabetes.

Severe hypoglycemia (SH) is the most frequent and potentially serious complication affecting individuals with type 1 diabetes and can have major clinical and psychosocial consequences. Glucagon is the only approved treatment for SH that can be administered by non-health care professionals (HCPs); however, reports on the experiences and emotions of people with type 1 diabetes associated with SH and glucagon rescue use are limited. This survey study demonstrated that an increasing number of individuals with type 1 diabetes have current and filled prescriptions for glucagon and have been educated about glucagon rescue use by an HCP. Despite this positive trend, challenges with SH remain, including a high level of health care resource utilization, considerable out-of-pocket expenses for glucagon kits, a high prevalence of hypoglycemia unawareness, and a negative emotional impact on individuals with diabetes. Nocturnal and exercise-related hypoglycemia were concerns for most survey participants.

Abstract P6-05-45: Providing Educational Resources during the Pandemic for Advanced Breast Cancer Patients

Abstract Significance and Background: Metastatic Breast Cancer (MBC) or Advanced Breast Cancer (ABC) is multifaceted and requires high levels of support and resource utilization. The ABC Program at MD Anderson Cancer Center began in 2014 with a goal to increase the quantity and quality of life for patients living with MBC. It offers emotional support, personalized visits with a nurse practitioner navigator, access to clinical trials, specialty clinics, tailored patient education and innovative care projects. Prior to COVID-19, the ABC Program held a 90-minute quarterly town hall series featuring 2-3 presenters and topics of patient interest. In response to COVID-19, it pivoted to a weekly virtual 60-minute educational series called “ABCs of Healthy Living in Challenging Times” that is for patients with breast cancer, caregivers, faculty, staff, community members and advocates. Purpose: To address COVID-19 social-distancing related isolation and changes to healthcare, build community, empower patients, and educate on diverse topics including patient services, treatment, symptom management and quality of life. Interventions and Evaluation: The series was facilitated by a nurse practitioner navigator via Zoom. A distribution list created from town hall meetings was the basis for the series’ notices and has grown by referrals, word of mouth and marketing opportunities; it began with less than 150 people and has grown to more than 550 people. The facilitator offered a format where the attendees and speakers could interact visually and verbally with each other. From 4/2020 to 6/2022, 104 webinars were held for 2,546 attendees for an average of 24 attendees each week. Topics covered were side effect management/quality of life/healthy lifestyle (26%), patient education/empowerment (18%), treatment (19%), clinical trials/research (11%), quality of life related to COVID-19 (8%), COVID-19 (7%), innovation projects (4%), palliative/end of life care (7%), and financial/disability concerns (3%). The series was evaluated using the Qualtrics survey software (n=53). Respondents said that the series has positively influenced their interactions with healthcare providers (65%), how patients with MBC think about their cancer experiences (65%) and provided an opportunity to connect with others like themselves (65%). Respondents stated actions taken based on the series: shared the information with family/friends (77%), joined or remained in a support group (34%), spoke with a provider for information and services (32%), requested an appointment with the ABC Program or other specialty clinics (26%), started a new healthy behavior (21%), joined a clinical trial (11%), or started using a patient reported outcome tool (9%). The series served mostly patients living with MBC (70%), established patients at MD Anderson (38%) or patients at MD Anderson as well as a community cancer center (17%). Most respondents indicated that they attended about half of the time, usually or always (60%) and are very or completely satisfied with the series (92%). Demographics of the respondents were White (77%), Black (13%), Asian (4%) and Hispanic (16%). Discussion: The ABC Program pivoted to COVID-19 by offering services virtually. The virtual series has allowed for more digestible patient education, varied presentations, and participation for those living outside of Houston, TX. Peer support and continuing education are imperative dynamics for patients to use their voice to impact their overall quality of life. The series has impacted attendees with a change in behavior when speaking with their clinical team, awareness and utilization of support resources, and starting healthy behaviors. While the series was created in response to demands of COVID-19, it effectively addressed psychosocial and educational needs and overall quality of life of MBC patients. The series was an easy intervention to initiate with lasting changes relative to the effort and resources required. Citation Format: Ginny T. Kirklin, Abbey Kaler, Debu Tripathy. Providing Educational Resources during the Pandemic for Advanced Breast Cancer Patients [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 P6-05-45.

Burden of illness seen in hereditary angioedema in Japanese patients: Results from a patient reported outcome survey.

Hereditary angioedema (HAE) is a potentially life-threatening rare disease, which is mainly caused by the deficiency or dysfunction of C1-esterase inhibitor, and characterized by spontaneous, recurrent episodes of edema in various parts of the body including internal organs and the laryngeal area. Delayed diagnosis and treatment increase the burdens and risks of this condition. The current study aimed to understand the burden of illness for HAE patients in Japan before and after diagnosis through a patient reported outcome survey. A survey instrument was distributed to 121 adult patients with HAE by a patient organization via HAE treating physicians between July and November in 2016. Seventy patients (57.9%) returned the questionnaire. Patients reported high levels of medical resource utilization, including emergency procedures and services. Episodes of receiving laparotomy were somewhat less after diagnosis with HAE than before, but no apparent difference in episodes of tracheotomy between before and after the diagnosis. The economic burden, including direct and indirect medical costs, was highest before diagnosis, but still perceived as substantial after diagnosis. Patients reported disruption of work and school life, with 40% reporting that they miss 10 or more days from work or education per year. Sixty percent of patients reported that HAE affected their daily activities. We concluded that HAE is associated with considerable physical, social, economic and psycho-social burdens even after diagnosis, and that higher attack frequency is associated with a heavy disease burden for patients in Japan.

Evaluating hospital performance with plant capacity utilization and machine learning

This study extends the measurement of plant capacity utilization by incorporating undesirable outputs. We select indicators through feature selection in machine learning and also introduce an undesirable output for assessment in these models. By defining and applying four plant capacity concepts, we analyze plant capacity utilization in health institutions in 31 provinces in China over the last 11 years (2009 to 2019). This paper has two main contributions. First, we propose a refined by-production hospital technology by introducing the mortality rate into the performance evaluation of public hospitals. Second, we expand the measures of plant capacity utilization with undesirable outputs. The preliminary results show that after the introduction of the death rate, the long-run output-oriented plant capacity utilization of medical institutions is significantly impacted. Furthermore, we find a high level of long-run input-oriented plant capacity utilization tends to increase mortality.

Physical health of Post-9/11 U.S. Military veterans in the context of Healthy People 2020 targeted topic areas: Results from the Comparative Health Assessment Interview Research Study

Large-scale epidemiological studies suggest that veterans may have poorer physical health than nonveterans, but this has been largely unexamined in post-9/11 veterans despite research indicating their high levels of disability and healthcare utilization. Additionally, little investigation has been conducted on sex-based differences and interactions by veteran status. Notably, few studies have explored veteran physical health in relation to national health guidelines. Self-reported, weighted data were analyzed on post-9/11 U.S. veterans and nonveterans (n = 19,693; 6,992 women, 12,701 men; 15,160 veterans, 4,533 nonveterans). Prevalence was estimated for 24 physical health conditions classified by Healthy People 2020 targeted topic areas. Associations between physical health outcomes and veteran status were evaluated using bivariable and multivariable analyses. Back/neck pain was most reported by veterans (49.3 %), twice that of nonveterans (22.8 %)(p < 0.001). Adjusted odds ratios (AORs) for musculoskeletal and hearing disorders, traumatic brain injury, and chronic fatigue syndrome (CFS) were 3–6 times higher in veterans versus nonveterans (p < 0.001). Women versus men had the greatest adjusted odds for bladder infections (males:females, AOR = 0.08, 95 % CI:0.04–0.18)(p < 0.001), and greater odds than men for multiple sclerosis, CFS, cancer, irritable bowel syndrome/colitis, respiratory disease, some musculoskeletal disorders, and vision loss (p < 0.05). Cardiovascular-related conditions were most prominent for men (p < 0.001). Veteran status by sex interactions were found for obesity (p < 0.03; greater for male veterans) and migraine (p < 0.01; greater for females). Healthy People 2020 targeted topic areas exclude some important physical health conditions that are associated with being a veteran. National health guidelines for Americans should provide greater consideration of veterans in their design.

Performance factors for filtration of air using cellulosic fiber-based media: A review

The filtration of air has attracted increasing attention during recent waves of viral infection. This review considers published literature regarding the usage of cellulose-based materials in air filtration devices, including face masks. Theoretical aspects are reviewed, leading to models that can be used to predict the relationship between structural features of air filter media and the collection efficiency for different particle size classes of airborne particulates. Collection of particles can be understood in terms of an interception mechanism, which is especially important for particles smaller than about 300 nm, and a set of deterministic mechanisms, which become important for larger particles. The effective usage of cellulosic material in air filtration requires the application of technologies including pulp refining and chemical treatments with such additives as wet-strength agents and hydrophobic sizing agents. By utilization of high levels of refining, in combination with freeze drying and related approaches, there are opportunities to achieve high levels of interception of fine particles. A bulky layer incorporating nanofibrillated cellulose can be used in combination with a coarser ply to achieve needed strength in a filter medium. Results of recent research show a wide range of development opportunities for diverse air filter devices containing cellulose.

Impact of a dedicated center for atrial fibrillation on resource utilization and costs.

Atrial fibrillation (AF) affects millions of Americans each year and can lead to high levels of resource utilization through emergency department (ED) visits and inpatient stays. We hypothesized that referral of patients to a dedicated Center for AF from the ED would reduce costs of care. The University of Pittsburgh Center for AF serves as a rapid referral center for patients with AF to avoid unnecessary inpatient admissions and provide specialized care. Patients that presented to the ED with AF and met prespecified criteria were directed to rapid outpatient follow-up instead of inpatient admission. The primary outcome of interest was 30-day total costs. Secondary outcomes included outpatient costs, inpatient costs, 90-day costs, and inpatient stay characteristics. We identified 96 patients (median age 65, 38% women) referred to the center for AF for a new diagnosis of AFbetween October 2017 and December 2019 and matched 96 control patients. After 30 days of follow-up, patients referred to the center for AF had a lower average cost ($619 vs. $1252, p < 0.001) compared to controls, driven by lower costs of ED care tempered by slightly higher outpatient costs. Thirty-day admissions and lengths of stay were also lower. These differences were persistent at 90 days. Directing patients with AF that present to the ED to follow-up at a dedicated Center for AF significantly reduced overall costs, while reducing subsequent inpatient admissions and total lengths of stay in the hospital.

Key issues of Development and Utilization of New Energy in China under Carbon Peaking and Carbon Neutrality

High-quality development of new energy cannot be achieved without high-level utilization. Utilization rate has become a barometer to measure the effectiveness of new energy management. Through the joint efforts of government departments, power generation enterprises, power grid enterprises, and industry insiders and outsiders, new energy utilization rate has remained above 95% for many years, achieving high-level utilization during large-scale development. In the future, with the continuous increase in the penetration rate of new energy, maintaining high utilization rates presents significant challenges in terms of technology and cost. This paper utilizes the NEOS software independently developed by the State Grid Energy Research Institute to analyse the utilization of new energy in the future and proposes relevant policy recommendations for reasonable utilization rates.

Blockchain adoption and security management of large scale industrial renewable-based systems: Knowledge-based approach

Smart networks, e.g., smart grids (SGs) as complex interconnected systems have become more complex and require greater processing and communication capabilities due to the growing use of renewable energy (RE). In addition to being a reliable method for collecting and managing information, wireless networks (WNs) are capable of enhancing the performance of RE management. As a result of wireless data transfer risks and centralized power trades, SGs using WNs are unable to provide the security of the electricity market or ensure a high level of RE utilization. Blockchains (BCs), which are new technologies that enable data sharing, are gaining popularity, and it is thought to be able to address these issues. A BC-based, reliable power-exchange scheme is presented for SGs using WNs in this study. Using the BC for recording power data obtained from the WNs allows the smart contract for making appropriate trades according to the information. Energy trading and RE consumption are more efficient in a dual-chain architecture that consists of local energy trade BCs and RE trade BCs. A BC-based RE incentive framework is designed to have greater stability and scale among RE producers. Overall, the proposed technique not only can provide higher security and reliability to the system but also can mitigate fraud, as well as providing less operation cost for the system. Ultimately, the 56-bus test feeder layout is used to validate the framework.

Digital literacy skills &amp; electronic resources utilization by undergraduates in public university libraries in Lagos, Nigeria

The study examines the influence of digital literacy skills on electronic resource utilization by undergraduates in public university libraries in Lagos, Nigeria. The study adopted a survey research design which utilized a self-structured questionnaire titled: “Digital literacy skills &amp; electronic resources utilization by undergraduates” as instrument for data collection and measured on a four-point Likert-type scale. The population for the study was 49,165 undergraduates and sample size of 394 was selected from the 200-500 level. Data were obtained from undergraduates on the level of e-resources utilization and the level of digital literacy skills. A response rate of 351 representing 89.1% was achieved and data were analyzed using descriptive and inferential statistics. The finding revealed that undergraduates possessed a high level of e-resources utilization with a score of x=3.36 and a high level of digital skills with a grand of x=3.28. The finding further reveal that digital skill (β=0.434, t = 8.564, p&lt;0.05) have a significant influence on electronic resource utilization. The study concludes that undergraduates in public universities in Lagos State have high digital literacy skills that significantly influence the use of electronic resources in libraries. The study recommends that management should improve in providing more digital literacy skills training programs that can help the undergraduates to sustain and acquire more skills in selected universities in Lagos State.

PUNCTUATED EQUILIBRIA: AN ANALYSIS OF HEALTHCARE UTILIZATION PATTERNS FOR OLDER ADULTS WITH CHRONIC DISEASE

Abstract The growing population of older adults requires healthcare delivery models that are both cost effective and directed toward the higher rates of chronic conditions, frailty and functional impairment often present as one ages. Analyzing healthcare utilization patterns of older adults—especially those over the age of 75—will better inform how to re-design care delivery processes.While the presence of chronic conditions requires consistent treatment, the intensity of health services required on a day-to-day basis is highly variable. Many individuals with at-risk health status are remarkably stable, exhibiting high levels of function and low utilization of care over extended periods of time. Periodically, however, these phases are punctuated by catastrophic episodes that can lead to greater health decline, morbidity, and mortality. During cycles of health decline, a cascade of other challenges stemming from an individual’s underlying risks, predispositions, and complexities can arise. This punctuated equilibrium of utilization for older adults offers insight to assess ways to improve care and lower costs. In this paper, we analyze and quantify both these states of punctuated equilibria as well as the extensive periods of stability. The associated utilization patterns are analyzed by processing Medicare claims data. Our analysis showed that over 80% of members in a group of anticipated high-risk Medicare beneficiaries over the age of 75 exhibited low utilization for 11 months out of a given year. These findings complement research exploring care redesign processes at a system level, specifically directed to high-cost episodes of care as opposed to patient-level targeting.

Changes in Forage Quality and Cattle Performance with Short-Duration Grazing of Mesic Meadows in the Intermountain West

Managers tasked with balancing livestock production and wildlife habitat in mesic meadows face a unique set of challenges. These challenges are compounded in the arid western United States because mesic areas comprise only a small portion of the landscape yet provide vital forage and water resources to livestock and wildlife and are essential to underlying ecosystem integrity and function. Our objectives were to compare the effects of short-duration grazing treatments that varied by season and intensity on the quantity and nutrient quality of pasture forage and average daily gains (ADG) of yearling cattle. We established pastures (n = 15 total pastures) in mesic meadows at the University of Idaho Rinker Rock Creek Ranch in south-central Idaho and stocked them with heifers during 2019 and 2020. Heifers grazed six pastures in June (early-season; 16 d) and six pastures in August (late-season; 16 d) at moderate (30−40%) and high (70-80%) relative utilization levels (n = 3 pastures per treatment). Three pastures were not grazed by cattle representing controls. Forage was collected and analyzed for nutrient quality at pregrazing, postgrazing, and after a period of regrowth in late September. Contrasted against all other treatments, early-season grazing at a high-intensity produced forages with the highest crude protein (P < 0.001) and lowest neutral-detergent fiber (P ≤ 0.04) after regrowth. ADGs of yearling heifers were greater (P ≤ 0.01) during the first year of the trial than the second year. Differences in ADG were not associated with grazing season (P = 0.08) or intensity (P = 0.12), despite numeric differences. Forage quantity and quality and heifer ADG responses varied between years, likely due to spring and annual precipitation differences. This study demonstrates the effectiveness of early-season grazing at a high intensity for improving forage quality and increasing ADG of livestock grazing mesic meadows.

Improving the effectiveness of Field Epidemiology Training Programs: characteristics that facilitated effective response to the COVID-19 pandemic in Uganda

BackgroundThe global need for well-trained field epidemiologists has been underscored in the last decade in multiple pandemics, the most recent being COVID-19. Field Epidemiology Training Programs (FETPs) are in-service training programs that improve country capacities to respond to public health emergencies across different levels of the health system. Best practices for FETP implementation have been described previously. The Uganda Public Health Fellowship Program (PHFP), or Advanced-FETP in Uganda, is a two-year fellowship in field epidemiology funded by the U.S. Centers for Disease Control and situated in the Uganda National Institute of Public Health (UNIPH). We describe how specific attributes of the Uganda PHFP that are aligned with best practices enabled substantial contributions to the COVID-19 response in Uganda.MethodsWe describe the PHFP in Uganda and review examples of how specific program characteristics facilitate integration with Ministry of Health needs and foster a strong response, using COVID-19 pandemic response activities as examples. We describe PHFP activities and outputs before and during the COVID-19 response and offer expert opinions about the impact of the program set-up on these outputs.ResultsUnlike nearly all other Advanced FETPs in Africa, PHFP is delinked from an academic degree-granting program and enrolls only post-Master’s-degree fellows. This enables full-time, uninterrupted commitment of academically-trained fellows to public health response. Uganda’s PHFP has strong partner support in country, sufficient technical support from program staff, Ministry of Health (MoH), CDC, and partners, and full-time dedicated directorship from a well-respected MoH staff member. The PHFP is physically co-located inside the UNIPH with the emergency operations center (EOC), which provides a direct path for health alerts to be investigated by fellows. It has recognized value within the MoH, which integrates graduates into key MoH and partner positions. During February 2020-September 2021, PHFP fellows and graduates completed 67 major COVID-related projects. PHFP activities during the COVID-19 response were specifically requested by the MoH or by partners, or generated de novo by the program, and were supervised by all partners.ConclusionSpecific attributes of the PHFP enable effective service to the Ministry of Health in Uganda. Among the most important is the enrollment of post-graduate fellows, which leads to a high level of utilization of the program fellows by the Ministry of Health to fulfill real-time needs. Strong leadership and sufficient technical support permitted meaningful program outputs during COVID-19 pandemic response. Ensuring the inclusion of similar characteristics when implementing FETPs elsewhere may allow them to achieve a high level of impact.

STRATEGI INDONESIA MEMBENTUK CYBER SECURITY DALAM MENGHADAPI ANCAMAN CYBER CRIME MELALUI BADAN SIBER DAN SANDI NEGARA

Cyber security has become a priority issue for all countries in the world since information and communication technology is used in various aspects of life, both in social, economic, legal, organizational, health, education, culture, government, security, defense, and other aspects. In direct proportion to the high level of utilization of information and communication technology, the level of risk and threat of misuse of information and communication technology is also getting higher and more complex. In response to these events, Indonesia then formed the National Cyber and Crypto Agency (BSSN) as a model for national cyber security institutions. This study uses a qualitative method with a descriptive approach. The purpose of this research is to find out how Indonesia's strategy in establishing cyber security in dealing with the threat of cyber crime through the National Cyber and Crypto Agency.

The Development of an Android-Based Classical Guidance and Counseling Service Application for Junior High Schools

This study aims to (1) describe the needs for the development of an Android-based classical guidance and counseling service mobile application in 5 schools in Pujananting District, (2) describe the prototype of an Android-based classical guidance and counseling service mobile application, and (3. determine the level of validity of an Android-based classical guidance and counseling service mobile application. The validity testing was conducted by a content expert and a technology expert to ensure the utility, accuracy and feasibility of the application. The study was conducted by adapting to the stages of Research and Development by Borg and Gall. Data were collected using observations, interviews, and questionnaires, and were analyzed using qualitative and quantitative data analysis. The results showed that (1) the Android-based classical guidance and counseling service application needed to be developed in 5 junior high schools in Pujananting District to facilitate students in receiving online counseling services, (2) the prototype of application through planning and developing early product as well as validity testing was found to have high levels of utility and feasibility, (3) the Android-based classical guidance and counseling and service application was useful, feasible and accurate as a media to provide online classical guidance and counseling guidance services.

Density and width-weight relationship of blue swimming crab (Portunus pelagicus) in Letman Waters, Southeast Maluku

Blue swimming crab (Portunus pelagicus) is a fishery commodity with a fairly high selling value, both as a local commodity and as an export commodity. The high level of utilization and trade of blue swimming crabs is not matched by knowledge of how to conserve these resources which can result in a decrease in blue swimming crab resource stocks. Sampling was carried out in November 2021 using a selected random sampling method. The density of the male blue swimming crab is 94,118 ind/km2 and the female is 58,824 ind/km2. The results of the analysis of the width-weight relationship of the blue swimming crab showed the nature of the blue swimming crab growth was negative allometric with a b value of 2.579.Keywords: density, width-weight relationship, blue swimming crab, Letman

Density and width-weight relationship of blue swimming crab (Portunus pelagicus) in Letman Waters, Southeast Maluku

Blue swimming crab (Portunus pelagicus) is a fishery commodity with a fairly high selling value, both as a local commodity and as an export commodity. The high level of utilization and trade of blue swimming crabs is not matched by knowledge of how to conserve these resources so that it can result in a decrease in blue swimming crab resource stocks. Sampling was carried out in November 2021 using a selected random sampling method. The density of the male blue swimming crab is 94,118 ind/km2 and the female is 58,824 ind/km2. The results of the analysis of the width-weight relationship of the blue swimming crab showed the nature of the blue swimming crab growth was negative allometric with a b value of 2.579.Keywords: blue swimming crab; density; Letman; width-weight relationship

S-DABT: Schedule and Dependency-aware Bug Triage in open-source bug tracking systems

Fixing bugs in a timely manner lowers various potential costs in software maintenance. However, manual bug fixing scheduling can be time-consuming, cumbersome, and error-prone. In this paper, we propose the Schedule and Dependency-aware Bug Triage (S-DABT), a bug triaging method that utilizes integer programming and machine learning techniques to assign bugs to suitable developers. Unlike prior works that largely focus on a single component of the bug reports, our approach takes into account the textual data, bug fixing costs, and bug dependencies. We further incorporate the schedule of developers in our formulation to have a more comprehensive model for this multifaceted problem. As a result, this complete formulation considers developers' schedules and the blocking effects of the bugs while covering the most significant aspects of the previously proposed methods. Our numerical study on four open-source software systems, namely, EclipseJDT, LibreOffice, GCC, and Mozilla, shows that taking into account the schedules of the developers decreases the average bug fixing times. We find that S-DABT leads to a high level of developer utilization through a fair distribution of the tasks among the developers and efficient use of the free spots in their schedules. Via the simulation of the issue tracking system, we also show how incorporating the schedule in the model formulation reduces the bug fixing time, improves the assignment accuracy, and utilizes the capability of each developer without much comprising in the model run times. We find that S-DABT decreases the complexity of the bug dependency graph by prioritizing blocking bugs and effectively reduces the infeasible assignment ratio due to bug dependencies. Consequently, we recommend considering developers' schedules while automating bug triage.

Vital Signs: Use of Recommended Health Care Measures to Prevent Selected Complications of Sickle Cell Anemia in Children and Adolescents - Selected U.S. States, 2019.

IntroductionSickle cell disease (SCD), a group of inherited blood cell disorders that primarily affects Black or African American persons, is associated with severe complications and a >20-year reduction in life expectancy. In 2014, an expert panel convened by the National Heart, Lung, and Blood Institute issued recommendations to prevent or reduce complications in children and adolescents with the most severe SCD subtypes, known as sickle cell anemia (SCA); recommendations included 1) annual screening of children and adolescents aged 2–16 years with transcranial Doppler (TCD) ultrasound to identify those at risk for stroke and 2) offering hydroxyurea therapy to children and adolescents aged ≥9 months to reduce the risk for several life-threatening complications.MethodsData from the IBM MarketScan Multi-State Medicaid Database were analyzed. TCD screening and hydroxyurea use were examined for 3,352 children and adolescents with SCA aged 2–16 years and continuously enrolled in Medicaid during 2019. Percentage change during 2014–2019 and variation by health subgroups were assessed. Analyses were stratified by age.ResultsDuring 2014–2019, TCD screening increased 27% among children and adolescents aged 10–16 years; hydroxyurea use increased 27% among children aged 2–9 years and 23% among children and adolescents aged 10–16 years. However, in 2019, only 47% and 38% of children and adolescents aged 2–9 and 10–16 years, respectively, had received TCD screening and 38% and 53% of children and adolescents aged 2–9 years and 10–16 years, respectively, used hydroxyurea. For both prevention strategies, usage was highest among children and adolescents with high levels of health care utilization and evidence of previous complications indicative of severe disease.Conclusion and Implications for Public Health PracticeDespite increases since 2014, TCD screening and hydroxyurea use remain low among children and adolescents with SCA. Health care providers should implement quality care strategies within their clinics and partner with patients, families, and community-based organizations to address barriers to delivering and receiving recommended care.

Feasibility, acceptability, and utility of a nurse-led survivorship program for people with metastatic melanoma (MELCARE)

PurposeImmune checkpoint inhibitors (ICIs) andtargeted therapy (TT) have improved the survival of people with metastatic melanoma. We assessed the feasibility, acceptability, and utility of a novel model of nurse-led, telehealth-delivered survivorship care (MELCARE) for this survivor group.MethodsPeople ≥ 18 years diagnosed with unresectable stage III or stage IV melanoma who were ≥ 6 months post initiation of ICI/TT with a radiological response suggestive of a long-term response to ICI/TT were recruited from a specialist melanoma centre in Australia. All participants received MELCARE, a nurse-led survivorship program involving two telehealth consultations 3 months apart, needs assessment using the Distress Thermometer (DT) and Problem List, and creation of a survivorship care plan. Feasibility, acceptability, and utility were assessed using rates of consent and study completion, time taken to complete each component of MELCARE, the Acceptability of Intervention Measure (AIM), and a customised utility survey.Results31/54 (57%) people consented. Participants were male (21, 68%), with a median age of 67 (range: 46–82). Eleven (35%) were receiving/had received ipilimumab and nivolumab and 27 (87%) had ceased treatment. Feasibility was demonstrated with 97% completing MELCARE. Utility was demonstrated on a customised survey and supported by a reduction in the mean DT score (initial: 5.6, SD: 2.9; follow-up: 1.5, SD: 1.2). Acceptability was demonstrated on 3/4 AIM items.ConclusionMELCARE was feasible and acceptable with high levels of utility. However, the consent rate was 57% indicating some people do not require support. Future studies should consider MELCARE’s optimal timing, resourcing, and cost-effectiveness.