High Degree Of Difficulty Research Articles

Arm morbidity and financial difficulty in breast cancer survivors.

Long-term upper extremity symptoms after breast cancer treatment may impact patient-reported financial difficulty. In this cross-sectional investigation, we hypothesized that severity of arm symptoms would be associated with greater financial difficulty. Stage 0-III breast cancer patients treated at our institution from 2002 to 2012 were recruited for a 2018 survey study appraising disease-specific patient-centered outcomes using EORTC-QLQ-BR23 and EORTC-QLQ-C30 questionnaires. The association between Arm Symptom (AS) score and Financial Impact (FI) score was assessed, adjusting for clinically relevant variables. Of 1126 interested participants, 882 (78%) responded to surveys. Three hundred fourteen (36%) with incomplete responses were excluded. Median time from surgery was 9years; 181 (32%) and 117 (21%) had mastectomy with or without reconstruction, 126 (22%) received postmastectomy radiation (PMRT), and 221 (39%) underwent axillary lymph node dissection. 76 (13%) reported some degree of financial difficulty; 10 (2%) the highest degree of difficulty. Of 217 (38%) patients experiencing arm symptoms, 60 (28%) had severe symptoms. Seven (70%) of those with highest degree of financial difficulty had severe arm symptoms. Younger age at surgery (p = .029), mastectomy with reconstruction (p = 0.003), Hispanic ethnicity (p < 0.001), PMRT (p = 0.027), recurrence (p < 0.001), and higher AS score (p < 0.001) were associated with greater financial difficulty. On multivariable analysis, AS score, younger age, Hispanic ethnicity, and recurrence remained associated with financial difficulty. In this study, younger age, Hispanic ethnicity, and arm morbidity were associated with increased risk for financial difficulty. Clarifying how treatment-related adverse events such as arm morbidity increase financial hardship may guide interventions to mitigate this burden.

THE VARIATIONAL PRINCIPLE, EXPRESSIVENESS, AND VIRTUOSITY IN LUIGI BASSI'S CONCERT FANTASIA ON THEMES FROM RIGOLETTO

This scientific paper presents and highlights the musicality and virtuosity that Luigi Bassi perfected with the help of the variational principle, using themes of a unique expressiveness from the opera Rigoletto by Giuseppe Verdi. The work is addressed to clarinetists with a well-developed technique and a qualitative and homogeneous sonority throughout the clarinet's ambitus. In the present scientific and interpretive approach, we propose to decode and present elements of structure, diverse instrumental techniques, and ways of interpreting the themes and variations, that coincide with the composer's desire. We will highlight the instrumental technique problems, proposals to optimize (solve) them, and ways to highlight sound colors, depending on the message the performer conveys. We believe that this study can be of real use both to teaching staff and students in the didactic activity, but also to the valuable instrumentalists involved in the interpretative activity, bearing in mind that the work has a very high degree of difficulty.

SOSIALISASI HAK WARIS ISLAM BAGI PENGURUS DAN WARGA RW 010 KELURAHAN MADYOPURO KECAMATAN KEDUNGKANDANG MALANG

Training in the division of inheritance or the science of faraidh according to the KHI is the most important because this science is very rare in Muslim societies. This is due to the fact that it has a high degree of difficulty, especially for ordinary people, and it also becomes undesirable to talk about for fear of offending others if they are grieving. As a result, many Muslims do not understand this. Their lack of understanding can lead to quarrels and commotion in the house. There may even be bloodshed just because of fighting for inheritance. Thus, this community service activity is carried out. This is done because the community, consisting of residents and regional administrators, needs assistance to understand Islam in general. There are several activities that have been carried out, including inheritance science training according to KHI, discussion and question and answer, and mentoring aimed at providing solutions to the problem of inheritance distribution. Service activities are carried out through gradual mentoring of the chosen strategy in this activity using a combination of direct training methods, which include lectures, information discussions, and direct practice of calculating the distribution of inheritance. Weak legal awareness is overcome through the process of socialization, coaching, and inheritance law education. Where people admit that they lack a positive understanding of inheritance law. Some indicators of legal awareness include knowledge of legal statutes, knowledge of the content of statutes, views on statutes, and patterns of legal action

Job burnout and its influencing factors among village doctors during the COVID-19 pandemic: a cross-sectional study.

The aim of this study is to understand the job burnout of village doctors during the COVID-19 epidemic and its influencing factors, and to provide a reference for effectively alleviating the job burnout of village doctors. A cross-sectional survey was conducted among village doctors in S province in December 2021. The survey included a general information questionnaire and the CMBI Burnout Scale. Epidata was used for dual input, and descriptive analysis, t-test, chi-square test, and binary Logistic regression for statistical analysis were used. A total of 993 village doctors participated in the survey. Most of them were male village doctors (62.84%), with an average age of 46.57 (SD = 7.50). Village doctors believed that the impact of the epidemic on work was serious, with a score of 3.87 ± 0.91. The economic support was small, with a score of 2.31 ± 0.99. The development space was low, with a score of 2.62 ± 0.98. The overall incidence of burnout was 53.47%. In the burnout group, 54.05% were mild, 33.14% were moderate, and 12.81% were severe. The high degree of difficulty in using WeChat (OR = 1.436, 95%CI: 1.229-1.679), high work pressure (OR = 1.857, 95%CI: 1.409-2.449), high risk of practice (OR = 1.138, 95%CI: 1.004-1.289), less economic support (OR = 0.825, 95%CI: 0.684-0.995), less technical support (OR = 0.696, 95%CI: 0.565-0.858), and poor emotional support (OR = 0.632, 95%CI: 0.513-0.780) were more likely to have job burnout. Burnout is a common phenomenon among village doctors during the COVID-19 pandemic, which needs to be prevented and alleviated by various measures.

Варианты герменевтического толкования текста «Бардо Тхедол»: аллюзии и метафоры

Tibetan Buddhism is represented by several schools or traditions, each of which includes certain religious and mystical practices and is based on the meditative experience of the guru. In addition, Tibetan Buddhist schools are based on specific teachings presented in written and oral sources. The study of written sources is carried out most often from the standpoint of hermeneutics and textual studies, since it requires interpretation, interpretation and understanding of existing texts. One such text containing a special Tibetan teaching is the Bardo Thedol, or Book of the Dead, which largely reflects the peculiarities of Buddhism and its traditions. The reference to the text of the Book of the Dead has been carried out several times, because this source is characterized by a high degree of difficulty in understanding, and its hermeneutic interpretation in the context of this article allows us to reflect in more detail the allusiveness and metaphorical description of the mystical practice of dying.

Developing a workshop model for high school mathematics teachers in constructing HOTS questions through the Pendidikan Matematika Realistik Indonesia approach

Indonesia's Program for International Student Assessment (PISA) results from 2000 to 2018 are worrisome because they are at the bottom of the international rankings. This result illustrates the low quality of education in Indonesia, which correlates with the qualifications of teachers. The quality of education will increase proportionally to the proportion of teachers who possess the necessary skills. Therefore, this study aims to train teachers to improve their professionalism in developing HOTs questions using the Pendidikan Matematika Realistik Indonesia (PMRI) approach. Design research-type development studies with two stages, preliminary and formative evaluation, are utilized. The results of the workshop revealed that the teacher's competency scores in developing HOTs questions increased by 45.70% (before the workshop), 77.14% (workshop 1), and 85.70% (workshop 2), respectively. It is evidenced by the teacher's ability to develop HOTs questions with the characteristics of questions investigating number content within the local context of selling duku fruits (langsat), which is a typical fruit of the East Ogan Komering Ulu (OKU) Regency and with a high degree of difficulty. This research also affects students in that it can stimulate their critical thinking abilities.

Insights into Cottonseed Cultivar Identification Using Raman Spectroscopy and Explainable Machine Learning

Securing authentic cottonseed identity information is crucial for preserving the livelihoods of farmers. Traditional seed identification methods are generally time-consuming, and have a high degree of difficulty. Raman spectroscopy, in combination with machine learning (ML), has opened up new avenues for seed identification. In this study, we explored the feasibility of using Raman spectroscopy combined with ML for cottonseed identification. Using Raman confocal microscopy, we constructed fingerprints of cottonseeds and analyzed their important Raman peaks. We integrated two feature exploration methods (Principal Component Analysis and Harris Hawk optimization) and three ML algorithms (Support Vector Machine, eXtreme Gradient Boosting, and Multi-Layer Perceptron) into a Raman spectroscopy analysis framework to accurately identify cottonseed cultivars. Through the utilization of SHapley Additive exPlanations (SHAP), we provide an in-depth explanation of the model’s decision-making process. Our results demonstrate that XGBoost, a tree-based model, exhibits outstanding accuracy (overall accuracy of 0.94–0.88) in cottonseed identification. Notably, lignin emerged as a pivotal factor that strongly influenced the model’s prediction of cottonseed cultivars, as revealed by the XGBoost interpretation. Overall, our study illustrates the effectiveness of combining Raman spectroscopy with ML to precisely identify cottonseed cultivars. The SHAP framework used in our study enables seed-related personnel to better comprehend the model’s prediction mechanism. These valuable insights are expected to enhance seed planting and management practices in the future.

Improving detection of plasma etching end point using light compensation on optical emission spectra

When the high aspect ratio contact, called as HARC, hole dry etching process with a high degree of difficulty is carried out in the high performance memory manufacturing process, there is a problem that the sensitivity of the optical signal detection is low due to the small open ratio and the high aspect ratio of the hole when detecting the etching end point signal using the plasma light emission. In particular, due to the fluorocarbon polymer characteristics of fluorocarbon gas, such as C4F6, C4F8, C3F8, and CH2F2, which is mainly used in the HARC hole dry etching process, the viewport, which is a part to which the optical lens is connected to measure the plasma light emitting signal with optical emission spectroscopy, called as OES, can be contaminated with the fluorocarbon polymer coating. As a result of this viewport clogging phenomenon, the intensity of the optical signal collected gradually decreases during the process (∼4%), and thus the sensitivity of the etching end point signal indicating that the etching process is terminated gradually decreases. In this study, a xenon flashlamp for optical signal compensation was additionally applied to the existing OES structure to improve the detection of the etching end point during the HARC hole dry etching process. This can improve the detection sensitivity of the OES etching end point by monitoring the viewport clogging phenomenon in real time and compensating for the reduction of the collected OES signal. The pattern wafer for testing used to verify the effect of the etching end point consists of a structure in which a mold layer sequentially stacked with Si3N4, SiO2, and SiO2 are mixed as a single layer, and as a result of the experiment, it was confirmed that the detection sensitivity of the etching end point applied with the optical signal compensation method was 18% improved from the signal measured only by the existing OES. The method is expected to improve the detection sensitivity of etching end point during the next generation high difficulty HARC hole etching process to improve the plasma etching process control method.

Z-Test-Based Analysis for Validating the Effectiveness of NPTEL E-Learning Modules

The present article proposes use of a z-model to validate learning progress after experimenting on student’s performance. A statistical map of z-values is used to calculate the z-value. This paper is divided into two parts - First examine the students' learning outcomes in various computer science and engineering (CSE) subjects during regular classroom instruction as well as examine the students by an interactive learning model in which traditional classroom instruction and e-learning modules are combined and then, the second part administers a related exam to the same group of students. Z-test is used as a tool for evaluating the results. Based on the findings we found that students' performance increased dramatically after incorporating an e-learning module into their classroom instruction. The e-learning module has now been introduced into the classroom. Each subject would have a separate test paper with a higher degree of difficulty. It has been found that a substantial increase in the learning outcome of the students after Appling the proposed approach.

Body composition of patients suffering from pancreatic cancer.

Pancreatic cancer, despite significant progress in diagnosis and treatment still has poor prognosis. Surgical treatment remains the only cure option. Unfortunately, the percentage of patients in whom radical tumor removal is possible is less than 20%. Resection procedures are burdened with a high degree of difficulty, as well as a high complication rate. One of the important factors contributing to the high morbidity of the perioperative period is malnutrition, and rapidly progressing malnutrition which occurs in about 85% of pancreatic cancer patients. Abnormal nutritional status is closely related to a change in the composition in the body.The aim of the study was to determine the changes in the body composition of patients with pancreatic cancer and their consequences based on the results of the current research.The available reports have shown that the body composition of a patient with pancreatic cancer undoubtedly changes and is dependent on the stage, location and type of cancer. Furthermore, the fact if antitumor treatment is applied or not, also plays a significant role.It appears that in patients with pancreatic cancer, weight loss with a decline in parameters such as body fat and skeletal muscle mass appears early and worsens as the tumor grows and the disease progresses. The above data suggest that knowing the patient&apos;s body composition and observing its changes may be a prognostic factor for survival and the occurrence of complications. Additionally, there are reports that dosing chemotherapy based on body composition rather than conventional measures can help reduce the toxicity of the treatment. Therefore, knowing the patient&apos;s body composition seems to be an important aspect.

Totally Laparoscopic Left Colectomy With Preoperative Simulation Using 3D CT Angiography and Intraoperative Navigation Using the Indocyanine Green (ICG) Fluorescence Method

Introduction Laparoscopic reconstruction after left colectomy is mostly performed with functional end-to-end anastomosis through about 5–7 cm sized incision. However, this procedure poses some problems, including increased intestinal mobilization range and parietal destruction, insufficient blood flow to the intestinal tract due to arterial arch malformation, and dominant artery dissection. In this paper, we present a case of descending colon cancer for which totally laparoscopic surgery and intracorporeal anastomosis could be performed safely with preoperative simulation and intraoperative navigation. Case presentation A 34-year-old male was complaint fecal occult blood positive and a colonoscopy was performed. The patient was diagnosed with descending colon cancer cT2N0N0 Stage I. Preoperative CT angiography findings showed that the inferior mesenteric artery (IMA) branched into the left colic artery (LCA) and the sigmoid arteries (S1, S2) in order and showed LCA and S1 as the dominant arteries, and a totally laparoscopic descending colectomy (D2 dissection and S2 artery preserving) was scheduled. At his operation, for investigate blood flow of anastomotic region, ICG was used. After an intravenous injection of ICG, blood flow was evaluated and intestinal dissection was performed at the scheduled dissection line. Intracorporeal anastomosis was then performed using the overlap method and a linear stapler. Conclusion Although the intracorporeal anastomosis procedure has a high degree of difficulty, the use of preoperative simulation and intraoperative navigation may reduce the surgeon's intraoperative stress and enable safe and accurate intestinal dissection and anastomosis in the totally laparoscopic surgery.

Deep learning model for distributed denial of service (DDoS) detection

Distributed denial of service (DDoS) attacks is one of the serious threats in the domain of cybersecurity where it affects the availability of online services by disrupting access to its legitimate users. The consequences of such attacks could be millions of dollars in worth since all of the online services are relying on high availability. The magnitude of DDoS attacks is ever increasing as attackers are smart enough to innovate their attacking strategies to expose vulnerabilities in the intrusion detection models or mitigation mechanisms. The history of DDoS attacks reflects that network and transport layers of the OSI model were the initial target of the attackers, but the recent history from the cybersecurity domain proves that the attacking momentum has shifted toward the application layer of the OSI model which presents a high degree of difficulty distinguishing the attack and benign traffics that make the combat against application-layer DDoS attack a sophisticated task. Striding for high accuracy with high DDoS classification recall is key for any DDoS detection mechanism to keep the reliability and trustworthiness of such a system. In this paper, a deep learning approach for application-layer DDoS detection is proposed by using an autoencoder to perform the feature selection and Deep neural networks to perform the attack classification. A popular benchmark dataset CIC DoS 2017 is selected by extracting the most appealing features from the packet flows. The proposed model has achieved an accuracy of 99.83% with a detection rate of 99.84% while maintaining the false-negative rate of 0.17%, which has the heights accuracy rate among the literature reviewed so far.

Analysis of sodium 2-mercaptoethane sulfonate in rat plasma using high performance liquid chromatography tandem-mass spectrometry

Sodium 2-mercaptoethane sulfonate (MESNA) is a thiol-containing compound that has proven to be effective in inactivating acrolein, the toxic metabolite of some anti-cancer drugs (e.g., cyclophosphamide and ifosphamide). Also, it scavenges free radicals which cause numerous disorders by attacking biological molecules. Current methods available to analyze MESNA in biological matrices include colorimetry and high-performance liquid chromatography (HPLC) with ultraviolet, fluorescence, or electrochemical detection. These methods have several limitations including low sensitivity, poor selectivity, a high degree of difficulty, and long analysis times. Hence, a rapid, simple, and sensitive HPLC tandem mass spectrometry (MS/MS) method was developed and validated to quantify MESNA in rat plasma following IP administration. The analysis of MESNA was accomplished via plasma protein precipitation, centrifugation, supernatant evaporation, reconstitution, and HPLC-MS/MS analysis. The method showcases an outstanding limit of detection (20 nM), excellent linearity (R2 = 0.999, and percent residual accuracy >90%) and a wide linear range (0.05–200 μM). The method also produced good accuracy and precision (100 ± 10% and <10% relative standard deviation, respectively). The validated method was successfully used to analyze MESNA from treated animals and will allow easier development of MESNA for therapeutic purposes.

Adaptive Stretch-Forming Process: A Computer Vision and Statistical Analysis Approach

An industrial process is defined through its quality of parts and their production costs. Labour-intensive operations must be applied to produce high-quality components with inexpensive resources. Recent development in dedicated software allows the industrial sector to rely on more and more autonomous solutions to obtain an optimum ratio between part quality and cost. The stretch forming process is an operation that has a high degree of difficulty, due to the process parameters and the spring-back effect of materials. Our approach to solving several of the shortcomings of this process was to develop a self-adaptive algorithm with computer vision capabilities that adapts to the process in real-time. This experimental study highlights the results obtained using this method, as well as a comparison to a classical method for the stretch-forming process (SFP). The results have noted that the stretch-forming algorithm improves the process, while adapting its decisions with each step.

A Mathematical Model for the Take-Off in Platform Diving.

In platform diving the take-off phase is of outstanding importance in order to achieve both a high level of performing quality and a high degree of difficulty. The diver has to produce the right forces and direction of the center of mass (COM) in order to attain the required angular momentum and dive height. To support the development of an optimum take-off technique, the Institute for Applied Training Science designed a dryland measuring and feedback system. Using the example of the dive back 1¼ somersault tucked in preparation for the dive back 3½ somersault tucked (207 C) from the 10-m-platform, kinematic and kinetic reference values for key positions were determined. Therefore, we developed a mathematical model using a multi-step examination plan with the following parts: (1) variables defined using nonparametric correlation analyses rs of the motion parameters, (2) statistical modelling to predict values of the parameters, (3) stochastic modelling. The model is based on a selection of 18 dives from 10 different elite divers of the German Swimming Federation (DSV). The approach presented provides helpful insights into the mechanisms of an optimal take-off, enables a target-performance comparison with objective motion parameters and therefore, enables individualized feedback to guide the training process more efficiently.

Intensification of the professional-applicative physical training process of military firefighters

The general, specific and specialized physical training determines the level of development of the motor possibilities of the personnel, reached in the process of the systematic practice of the professional-applicative physical exercises. The problem solved in this research was to identify new ways to intensify the professional-applied physical training of the operative personnel, military personnel within the intervention subunits of the Inspectorate for Emergency Situations. The study was conducted over a period of 2 months (May-June 2019) on the field / training plateau of the Botosani and Dorohoi Fire Brigade and had as subjects a sample of 10 non-commissioned officers (military personnel) who took two individual tests: with/without a respirator device. The research methods: the study of the specialized literature, the direct observation, the experiment, the comparison, the statistical-mathematical analysis. Ways to test the physical capacity, the type of effort made (aerobic, anaerobic) in one or more motor actions are numerous and at the same time, very demanding, necessary for the special device and a larger study. During the experiment there was a reduction in time but also an increase in motor potential at the unit stage (initial testing), as well as obtaining the honorable 3rd place in the national phase (final testing) of the contest "The most powerful firefighter" Alba-Iulia , 2019 edition, of the non-commissioned officers from the Inspectorate for Emergency Situations "Nicolae Iorga" of Botosani. Following some application routes with a high degree of difficulty, we can say that it must be customized in this activity has significantly improved their motor skills.

Correlation of Panoramic Radiography, Cone-Beam Computed Tomography, and Three-Dimensional Printing in the Assessment of the Spatial Location of Impacted Mandibular Third Molars.

The development of radiology, rapid prototyping techniques, and the increasingly common use of 3D printing in dentistry inspires the use of these techniques to improve diagnostic and therapeutic processes. This study aimed to conduct a retrospective comparative analysis of dental panoramic radiographs, cone-beam computed tomography, and 3D printing in preoperative assessment of the procedure’s difficulty. Thirty clinical cases with a high degree of difficulty were selected, and based on evaluation with CBCT, a virtual 3D model of the region of surgical procedure was created, which was then printed using a 3D printer. The comparative analysis included the linear measurements performed in dental panoramic radiographs, cone-beam computed tomography, and 3D models in a preoperative assessment of the degree of retention and difficulty of impacted mandibular third molars in the mandible. Linear measurements performed on dental panoramic radiographs were significantly lower than in cone-beam computed tomography and 3D models. No statistically significant differences were obtained in linear measurements between 3D models and cone-beam computed tomography images except for the measurement of the lingual lamina thickness; however, due to the insignificant differences in measurements, with a mean of only 80 µm, the elective procedure of removal of the impacted third molar in the mandible may be safe.

Simulations of text encryption and decryption by applying vertical bit rotation algorithm

Cryptography is the study of hiding text and numbers in the form of codes. Vertical Bit Rotation (VBR) is one of the most widely implemented cryptographic algorithms as a one-way hash function that simplifies the encryption process with a high degree of difficulty in decryption. The purpose of this study is to apply VBR hash algorithm modeling to binary value characters with bit rotation keys 10, 11, 7, 3, 2, 7, 5, and 4. Thus, generating a passcode. The results of the encryption simulation show the code in the form of letters and characters, then the result of the decryption with the opposite rotation to the encryption process returns the value from ciphertext to plaintext based on ASCII characters. Cryptographic algorithms are applied to avoid cryptanalytic experiments in opening encryption codes.

Validity and Reliability of Community Satisfaction Measurement Instrument in Health Care Institution

The Community Satisfaction Survey is mandatory based on Ministry of Administrative and Bureaucratic Reform Regulation number 14 in the year of 2017. An alternative measurement tool has been developed by expanding the measurement items. The research objective was to explore the validity and reliability of public satisfaction instruments in health institutions. The design was non-experimental, with a quantitative and cross sectional approach. The research was carried out in two entities, namely primary health care and hospital. Data collection using the IKM-29 questionnaire. Data processing with Rasch modeling and winsteps application. The results showed that the item reliability at PHC and hospital was 0.95 and 0.97 with Cronbach's alpha 0.95. The separation is more than 3 and the raw variance is more than 40%. In the two entities there are several different misfit items. Item 8 related to the perception of waiting time has a high degree of difficulty and is paradoxical. The results of the analysis show that the instrument is valid and reliable enough to be used as an alternative measurement of community satisfaction in PHC and Hospitals.

Stroke associated with non-adherence and non-persistence with direct oral anticoagulants in Germany

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): Daiichi Sankyo Europe GmbH Background Based on results of multiple randomised controlled trials, direct oral anticoagulants (DOACs) are frequently used to reduce stroke risk in patients with atrial fibrillation (AF). The hypothesis is that in the real-world setting DOACs are effective in reducing the risk of stroke but ensuring continuous use is essential because of the rapid decline in anticoagulation activity when doses are omitted. Purpose The aim of this study was to assess the relationship between non-adherence, discontinuation of DOAC treatment and incidence of ischaemic stroke. Methods A nested case-control study was conducted in the InGef database, an anonymised healthcare claims database in Germany. AF patients starting DOACs between drug approval date and 31/12/2018 were included. We restricted to patients aged ≥45, ≥1 year database history, ≥1 year follow-up and at least two DOAC dispensings after cohort entry date (CED) (date of first dispensing). Patients with an ischaemic stroke during follow-up were selected as cases and compared with matched controls (matched on age +/- 5 years, sex, year of CED and CHA₂DS₂-VASc-score at CED). Controls were assigned the index date (date of first stroke diagnosis) of the corresponding case. Adherence to treatment was assessed among current users (DOAC use at or within 30 days before index date) and defined as proportion of days covered (PDC) ≥80% during CED and index date. Persistent users were defined as those with continuous DOAC use from CED to index date. We also assessed the effect of current, recent (DOAC use within 30-365 days before index date) and past use (DOAC use more than 1 year before index date). Odds ratios (ORs) with 95% confidence intervals (CIs) for ischaemic stroke were determined in logistic regression models. Results 900 cases and 3,570 controls were included. Among cases and controls, mean ± sd age was 80 ± 8 years and 49% were male. Current users who were non-adherent had a significant 1.21 higher odds (95% CI 1.01-1.45) of ischaemic stroke compared to adherent users. Similar results were observed in twice-daily (BID) users (OR 1.42 (1.15-1.75)). However, among once-daily (QD) users, the odds was not different between the adherent and non-adherent users (OR 0.99 (95% CI 0.58-1.69)). The risk of ischaemic stroke was significantly higher among non-persistent users compared to persistent users (OR 1.91 (95% CI 1.64-2.22)). Similar findings were observed among QD and BID users. The comparison of past and recent users to current users showed that the OR became higher the longer a patient had stopped DOAC use. Conclusion Both non-adherence and non-persistence were found to increase the risk of ischaemic stroke, showing that continuous use is essential for both BID and QD users. In BID users, there seems to be a stronger association between non-adherence and risk of stroke than in QD users. An explanation might be the higher degree of difficulty in adhering to a BID than QD regimen.