Incomplete Screening Research Articles

Size Effect of Negative Capacitance State and Subthreshold Swing in Van der Waals Ferrielectric Field‐Effect Transistors

AbstractAnalytical calculations corroborated by the finite element modeling show that thin films of Van der Waals ferrielectrics covered by a 2D‐semiconductor are promising candidates for the controllable reduction of the dielectric layer capacitance due to the negative capacitance (NC) effect emerging in the thin films. The NC state is conditioned by energy‐degenerated poly‐domain states of the ferrielectric polarization induced in the films under incomplete screening conditions in the presence of a dielectric layer. Calculations performed for the FET‐type heterostructure “ferrielectric CuInP2S6 film—2D‐MoS2 single‐layer—SiO2 dielectric layer” reveal the pronounced size effect of the multilayer capacitance. Derived analytical expressions for the electric polarization and multilayer capacitance allow to predict the thickness range of the dielectric layer and ferrielectric film for which the NC effect is the most pronounced in various Van der Waals ferrielectrics, and the corresponding subthreshold swing becomes much less than the Boltzmann's limit. Obtained results can be useful for the size and temperature control of the NC effect in the steep‐slope ferrielectric FETs.

Vortex confinement through an unquantized magnetic flux

Geometrically confined superconductors often experience a breakdown in the quantization of magnetic flux owing to the incomplete screening of the supercurrent against field penetration. In this study, we report that magnetic field confinement occurs regardless of the dimensionality of the system, even extending to 1D linear potential systems. By using a vector-field magnetic force microscope, we successfully create a vortex‒antivortex pair connected by a 1D unquantized magnetic flux in ultrathin superconducting films. Through an investigation of the manipulation and thermal behavior of the vortex pair, we uncover a long-range interaction mediated by the unquantized magnetic flux. These findings suggest a universal phenomenon of unquantized magnetic flux formation, independent of the geometry of the system. Our results present an experimental route for investigating the impact of confinement on superconducting properties and order parameters in unconventional superconductors characterized by extremely low dimensionality.

Solvation vs concentration fluctuations: confined dilute electrolytes near demixing at constant potential

In a recent paper, the effect of concentration fluctuations in a simple fully symmetric model of dilute electrolyte, confined between two planar electrodes, was investigated using constant charge simulations in the vicinity of the solute-solvent demixing transition. In agreement with previous theoretical findings it was shown that the total capacitance was enhanced by the occurrence of concentration fluctuations. In this work we will resort to constant potential simulations to show that the same effect is to be found in the differential capacitance. Additionally, here we will consider the effects of ion solvation by a polar solvent modelled by TIP4P/2005 water. Finally, the original fully symmetric ionic solute will be replaced by a three-site coarse grained model for a well know room temperature ionic liquid, 1-butyl-3-methyl-imidazolium tetrafluoroborate ([BMI] + [BF 4 ] − )). Our results show the presence of strong local fields within the capacitor due to incomplete local screening, and a marked asymmetry in the charge distribution. The expected capacity enhancement due to concentration fluctuations is completely mitigated by solvation effects and the response of the polar solvent to the external field.

Evaluation of Hepatitis Serology Screening Frequency and Viral Reactivation in Patients Followed with Biological Therapy or Cytotoxic Chemotherapy

Objective: Our study aimed to evaluate the results of hepatitis B and C serology screening before biological therapy and chemotherapeutic treatments in internal medicine clinics (rheumatology, medical oncology, and gastroenterology) by comparing between departments and investigating the virus reactivation status. Material and Method: The study included 1147 patients aged 18 and over who were admitted to the medical oncology, rheumatology, and gastroenterology departments between 2019 and 2021 and received cytotoxic chemotherapy and biological treatment. HBsAg, Anti-HBs, Anti-HBc, and Anti-HCV data were used to screen for hepatitis. The departments were compared and evaluated based on the frequency of screening and reactivation. Results: Before undergoing chemotherapy or biological therapy, 77% of patients in oncology, 40% in rheumatology, and 43% in gastroenterology were fully screened for hepatitis. The rates of incomplete screening were 16%, 48%, and 52%, respectively, while 3%, 10%, and 4% were never screened. In total, reactivation was observed in twelve patients (1.0%), while no reactivation was observed in 1135 patients (99.0%). A statistically significant correlation was found between the departments and the presence of reactivation (p

Barriers to enrollment in clinical trials in gynecologic oncology.

e13511 Background: While clinical trials improve survival in gynecologic oncology, racial and ethnic minorities remain underrepresented. Our objective was to evaluate factors associated with enrollment among patients considered for trials at a tertiary care center to inform future participant recruitment. Methods: We conducted a retrospective cohort study at the University of Pennsylvania Health System from 1/1/2022-12/31/2022. Our primary objective was the referral rate to clinical trials of patients discussed at a weekly multi-disciplinary tumor board. Patients could be discussed more than once and referred for screening for multiple trials. Each contact was classified as ‘referred/not referred’ for trial(s) screening and ‘enrolled/not-enrolled’ on trial(s). We collected socio-demographic, cancer, trial screening, and enrollment data, including reasons for ineligibility or non-enrollment, from electronic health records. We compared patient factors across 3 subgroups: 1) not-referred, 2) referred not-enrolled, 3) referred and enrolled. We performed descriptive analyses to characterize patient cohorts. Results: In a one-year period, 264 patients—194 unique—were discussed at tumor board. Referral rate for trial screening was 57%, representing 135 trial referrals for 111 unique patients. Patients were referred to screening for 2.2 trials on average. The median age of patients discussed was 65 years (IQR 58-73 years). 65.0% self-identified as White, 24.7% Black, and 10.3% other race. 96% identified English as their preferred language. The majority had Medicare insurance (51.0%), followed by private insurance (32.5%), and Medicaid (14.4%). Of 111 patients referred for trial screening, 12 patients enrolled in a trial for a referral-to-enrollment rate of 10.8% (12/111) and an overall enrollment rate of 6.2%. The majority of enrolled patients were white (10/12) and had Medicare (66%) or private insurance (25%). Cancer type varied by referral status, with most referrals for ovarian (n=87, 64%) and uterine cancer (n=37, 27.4%) and 5 for cervical cancer (3.7%). The non-referred cohort had lower rates of ovarian cancer (49.6%) and higher rates of cervical (12.4%) and other cancers (14.0%). Of patients referred to trial, but not enrolled, only 33.7% had a documented reason for non-enrollment. Documentation for incomplete screening or ineligibility cited the patient opting out of screening (26), medical comorbidity (22), and pursuit of other trial (16). Conclusions: While 57% of tumor board patients were referred for screening for at least one clinical trial, only 10.8% of referred patients and 6.2% of patients overall were enrolled in a trial. Disparities by race and insurance type were apparent between patients enrolled and not enrolled on trial. Improving documentation, educating patients about trials early in their disease course, and less restrictive trial criteria may help improve minority enrollment rates in clinical trials.

The role of Shenqi Fuzheng injection as adjuvant therapy for breast cancer: an overview of systematic reviews and meta-analyses

BackgroundBreast cancer (BC) is the most frequent malignancy in the world. Chemotherapy (CT) is a common treatment for BC but is accompanied by toxicity and side effects. Shenqi Fuzheng Injection (SFI) is an adjuvant therapy with promising results in improving efficacy and reducing toxicity in clinical studies. This overview of systematic reviews and meta-analysis (SRs/MAs) aimed to summarize the benefits and evaluate the quality of evidence supporting SFI adjuvant as CT for BC.MethodsA systematic search for SRs/MAs of randomized controlled trials (RCTs) on SFI treatment for BC was performed by searching PubMed, Web of Science, EMbase, Cochrane Library, CNKI, Wanfang, VIP, and SinoMed databases from inception to October 1, 2022. The quality of SRs/MAs was evaluated using AMSTAR-2, PRISMA 2020, ROBIS, and GRADE by two reviewers. The corrected covered area (CCA) was used to quantify the degree of duplication of the original SRs/MAs. Finally, quantitative analysis of RCTs was conducted using RevMan 5.4 software. This study was registered with PROSPERO, CRD42022377290.ResultsSix SRs/MAs including 61 RCTs with 5593 patients were included in this study. Studies were published between 2015 and 2019, the original RCTs ranged from 7–49, with sample sizes ranging from 336–1989. The quantitative meta-analysis found that adjuvant CT of SFI improved the clinical response rate (RR=1.37, 95% CI=1.28, 1.46; P<0.00001) and the KPS score (RR=1.66, 95% CI 1.54, 1.79, P<0.00001) of patients with BC. In terms of immune function, CD3+ (SMD=1.51, 95% CI 0.91, 2.10; P<0.00001), CD4+ (SMD=1.87, 95% CI 1.18, 2.56; P<0.00001), CD4+/CD8+ (SMD=0.86, 95% CI 0.48, 1.23; P<0.00001), and NK cell levels (SMD=0.94, 95% CI 0.63, 1.24; P<0.00001) in the adjuvant CT group SFI were better than those with CT alone. Adverse reactions following SFI adjuvant CT showed reduced incidence of leukopenia (RR=0.53, 95% CI 0.46, 0.62; P<0.00001) and gastrointestinal reactions (RR=0.48, 95% CI 0.39, 0.58; P<0.00001). However, the GRADE results showed ‘very low’ to ‘moderate’ evidence for the 42 outcomes, without high-quality evidence supporting them, limited mainly by deficiencies in the design of RCTs (42/42, 100.00%), inconsistency (19/42, 45.24%), publication bias (41/42, 97.62%), and inaccuracy (3/42, 7.14%). The unsatisfactory results of AMSTAR-2, PRISMA 2020, and ROBIS were limited to lack of registration of study protocols, explanation of inclusion basis of RCTs, description of funding sources for the included studies, incomplete search strategy and screening process, addressing heterogeneity and sensitivity, and reporting potential conflicts of interest.ConclusionAdjuvant CT with SFI for BC had better benefits and a lower risk of adverse events. The methodology and quality of the evidence are generally low, highlighting a need of greater attention during study implementation. More objective and high-quality studies are needed to verify the efficacy of adjuvant CT with SFI in clinical decision-making for BC.

Evaluating Preconception Health and Behaviour Change in Australian Women Planning a Pregnancy: The OptimalMe Program, a Digital Healthy Lifestyle Intervention with Remotely Delivered Coaching.

OptimalMe is a digital healthy lifestyle intervention for women planning a pregnancy, with remotely delivered coaching. This follow-up study of Australian women, stratified by coaching delivery mode (phone vs. videoconferencing), assessed alignment to preconception care guidelines and self-reported behaviour change. Overall, 298 women enrolled with a mean (SD) age of 31.8 (4.3) years and mean BMI of 25.7 (6.1) kg/m2. Suboptimal preconception behaviours were reported at baseline, including alcohol consumption (57.2%), infrequent weighing (37.2%) and incomplete cervical cancer screening (15.8%) and prenatal supplementation (38.5). At follow-up (4.5 months) (n = 217), a statistically significant shift towards desired behaviours was reported for alcohol consumption (z = -2.6045, p = 0.00932), preconception supplementation (z = -2.7288, p = 0.00634) and frequent weight monitoring (z = -5.2911, p < 0.00001). An insignificant shift towards adherence to cervical cancer screening (z = -1.8679, p = 0.06148) was observed, with a positive trend towards adherence. Results indicate that women who are actively planning a pregnancy require support to optimise health and lifestyle in preparation for pregnancy and general health and lifestyle improvement. Women demonstrated improvement in lifestyle behaviours and self-monitoring, indicating the uptake of low-intensity, non-prescriptive information provision. Supporting the provision of knowledge-enhancing tools and general healthy lifestyle information combines with skilled health coaching as an effective method for behaviour change and self-management. OptimalMe also shows significant improvements in rates of healthcare engagement, which suggests coaching-based digital health interventions may decrease women's barriers for preconception care and improve engagement in clinical settings.

Individual- and neighborhood-level characteristics of lung cancer screening participants undergoing telemedicine shared decision making

BackgroundAlthough lung cancer screening (LCS) for high-risk individuals reduces lung cancer mortality in clinical trial settings, many questions remain about how to implement high-quality LCS in real-world programs. With the increasing use of telemedicine in healthcare, studies examining this approach in the context of LCS are urgently needed. We aimed to identify sociodemographic and other factors associated with screening completion among individuals undergoing telemedicine Shared Decision Making (SDM) for LCS.MethodsThis retrospective study examined patients who completed Shared Decision Making (SDM) via telemedicine between May 4, 2020 – March 18, 2021 in a centralized LCS program. Individuals were categorized into Complete Screening vs. Incomplete Screening subgroups based on the status of subsequent LDCT completion. A multi-level, multivariate model was constructed to identify factors associated with incomplete screening.ResultsAmong individuals undergoing telemedicine SDM during the study period, 20.6% did not complete a LDCT scan. Bivariate analysis demonstrated that Black/African-American race, Medicaid insurance status, and new patient type were associated with greater odds of incomplete screening. On multi-level, multivariate analysis, individuals who were new patients undergoing baseline LDCT or resided in a census tract with a high level of socioeconomic deprivation had significantly higher odds of incomplete screening. Individuals with a greater level of education experienced lower odds of incomplete screening.ConclusionsAmong high-risk individuals undergoing telemedicine SDM for LCS, predictors of incomplete screening included low education, high neighborhood-level deprivation, and new patient type. Future research should focus on testing implementation strategies to improve LDCT completion rates while leveraging telemedicine for high-quality LCS.

AstroYOLO: A hybrid CNN–Transformer deep-learning object-detection model for blue horizontal-branch stars

Abstract Blue horizontal-branch stars (BHBs) are ideal tracers for studying the Milky Way (MW) due to their bright and nearly constant magnitude. However, an incomplete screen of BHBs from a survey would result in bias of estimation of the structure or mass of the MW. With surveys of large sky telescopes like the Sloan Digital Sky Survey (SDSS), it is possible to obtain a complete sample. Thus, detecting BHBs from massive photometric images quickly and effectually is necessary. The current acquisition methods of BHBs are mainly based on manual or semi-automatic modes. Therefore, novel approaches are required to replace manual or traditional machine-learning detection. The mainstream deep-learning-based object-detection methods are often vanilla convolutional neural networks whose ability to extract global features is limited by the receptive field of the convolution operator. Recently, a new Transformer-based method has benefited from the global receptive field advantage brought by the self-attention mechanism, exceeded the vanilla convolution model in many tasks, and achieved excellent results. Therefore, this paper proposes a hybrid convolution and Transformer model called AstroYOLO to take advantage of the convolution in local feature representation and Transformer’s easier discovery of long-distance feature dependences. We conduct a comparative experiment on the 4799 SDSS DR16 photometric image dataset. The experimental results show that our model achieves 99.25% AP@50, 93.79% AP@75, and 64.45% AP@95 on the test dataset, outperforming the YOLOv3 and YOLOv4 object-detection models. In addition, we test on larger cutout images based on the same resolution. Our model can reach 99.02% AP@50, 92.00% AP@75, and 61.96% AP@95 respectively, still better than YOLOv3 and YOLOv4. These results also suggest that an appropriate size for cutout images is necessary for the performance and computation of object detection. Compared with the previous models, our model has achieved satisfactory object-detection results and can effectively improve the accuracy of BHB detection.

Evaluating preconception health and behaviour change following a digital intervention: OptimalMe

Abstract Background Reproductive-aged women are a high-risk group for accelerated weight gain and obesity development. The objective of the current study was to assess the impact of a digital healthy lifestyle intervention for women planning a pregnancy, in optimising preconception health and lifestyle behaviours. Methods Australian women with the intention to conceive were invited to participate in OptimalMe. To be eligible women must be aged 18-44 years, not pregnant but wanting to conceive within 12 months of recruitment and have internet access. All participants receive the same digital lifestyle intervention, supported by health coaching and text messages during preconception. A parallel 2-arm design with sequential randomisation to compare telephone with videoconference delivery methods for health coaching was adopted. Results Overall, 298 women enrolled, with a mean ± (SD) age of 31.7 (4.6) years and BMI 25.5 (6.3) kg/m2. Suboptimal preconception behaviours were reported at baseline including alcohol consumption (57.0%), infrequent weighing (37.2%), and incomplete cervical cancer screening (15.8%) and prenatal supplementation (38.6%). The OptimalMe evaluation was completed by 217 women, 72.8% of the study population, an average of 4.5 months after commencing the intervention. At follow-up, a significant shift towards desired behaviours was reported for alcohol consumption (non-drinker) (z = 2.727, p = 0.00634), prenatal supplementation (taking supplement) (z=-11.082, p &amp;lt; 0.00001) and weighing behaviour (frequent weigher) (z=-5.291, p &amp;lt; 0.00001). Conclusions Results indicate that women who are actively planning a pregnancy require support to optimise health and lifestyle in preparation for pregnancy. Post intervention outcomes suggest that remotely delivered preconception interventions improve lifestyle behaviours and engagement with clinical preconception care objectives. Key messages • Digital health interventions show positive change to important lifestyle behaviours. • Women planning a pregnancy demonstrate sub optional health and lifestyle behaviours therefore interventions are needed to improve this.

Chronic hepatitis B in hospitalized rheumatologic patients: problems of screening and reactivation of infection

Objective: to evaluate the completeness of screening for hepatitis B virus (HBV) infection in HBsAg-positive patients admitted to a rheumatology hospital and to follow the history of HBV reactivation/seroversion during antirheumatic therapy. Material and methods. The results of initial and repeated (if applicable) hospitalizations were analyzed in 80 patients with rheumatic diseases (RD), including 55 (69%) women and 25 (31 %) men, with Australian surface antigen (HBsAg), admitted to the V.A. Nasonova Institute of Rheumatology from January 1, 2020 to July 20, 2022 (30 months). Results and discussion. The total number of hospitalizations to the clinic during the observation period, including repeat admissions, was 13,681. The number of hospitalizations in 80 patients with HBV infection during the observation period, including repeat admissions, was 144, of which for systemic vasculitis – 6 (8 %), other systemic connective tissue diseases – 16 (20 %), osteoarthritis and post-traumatic changes of joints – 14 (15 %), inflammatory joint diseases – 42 (54 %). Cases of HBV reactivation/seroverion, both in anamnesis and during observation, were detected in 9 (11 %) patients, and most frequently (n = 5) they were registered during methotrexate therapy. Conclusion. HBV infection in patients with RD leads to significant difficulties in the selection of drug therapy, due to the risk of reactivation of the infection. The results obtained indicate incomplete screening of patients with RD for HBV infection during the preclinical phase. Further investigation is needed to develop clear recommendations for the management of patients with RD infected with HBV.

Barriers to referral and evaluation and corresponding navigation services for toddlers screening positive for autism spectrum disorder.

Children from disadvantaged populations receive referrals, diagnoses, and services for autism spectrum disorder (ASD) late or not at all. We describe barriers to referral for and receipt of evaluation for ASD among young children from disadvantaged families and activities by autism family navigators (AFNs) to address these barriers. Trained AFNs offered navigation to families of children aged 16-30 months with positive ASD screens from community health center clinics in 2015-2018. AFNs interviewed families to identify perceived barriers to care and documented system barriers and navigation activities. We coded, categorized, and described barriers and AFN activities. Case studies illustrate barriers and navigation activities. Of 22 participating mothers, 82% were Latinx and 64% were native Spanish-speaking; 71% had household incomes <$30,000/year and 57% had no high school diploma. Half of the families experienced five or more barriers to ASD evaluation, most commonly pragmatic barriers. Information barriers/needs were 5 times more common among Spanish-speaking than English-speaking mothers. One-fifth of families identified negative experiences or expectations of care. System barriers included incomplete screening tests, inadequate referrals, and waiting lists. AFNs implemented navigation activities, most frequently categorized as care coordination (95%), education (68%), social/emotional support (36%), family advocacy (27%), and self-advocacy coaching (23%). AFNs also trained providers and staff to improve screening and referral implementation. In this largely Latinx sample, families experienced numerous barriers to obtaining ASD evaluations for their screen-positive children, likely reflecting the complexity of negotiating both healthcare and educational systems. Trained AFNs can assist parents to overcome barriers to timely diagnosis. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Interval cancers in a national colorectal screening programme based on faecal immunochemical testing: Implications for faecal haemoglobin concentration threshold and sex inequality.

To compare interval cancer proportions (ICP) in the faecal immunochemical test (FIT)-based Scottish Bowel Screening Programme (SBoSP) with the former guaiac faecal occult blood test (gFOBT)-based SBoSP and investigate associations between interval cancer (IC) and faecal haemoglobin concentration (f-Hb) threshold, sex, age, deprivation, site, and stage. The ICP data from first year of the FIT-based SBoSP and the penultimate year of the gFOBT-based SBoSP were compared in a prospective cohort design. With FIT, 801 colorectal cancers (CRCs) were screen detected (SDC), 802 were in non-participants, 548 were ICs, 39 were colonoscopy missed and 72 were diagnosed after incomplete screening; with gFOBT: 540, 904, 556, 45, and 13, respectively. FIT had a significantly higher proportion of SDC compared to IC than gFOBT. For FIT and gFOBT, ICP was significantly higher in women than men. As f-Hb threshold increased, ICP increased and, for any f-Hb threshold for men, a lower threshold was required for comparable ICP in women. In Scotland, the current threshold of ≥80 µg Hb/g faeces would have to be lowered to ≥40 µg Hb/g faeces for women to achieve sex equality for ICP. In the FIT-based SBoSP, there were four times as many stage I SDC than IC. This was reversed in advanced stages, with twice as many stage IV CRC diagnosed as IC versus SDC. Reducing the numbers of IC requires lowering the f-Hb threshold. Using different f-Hb thresholds for women and men could eliminate the sex disparity, but with additional colonoscopy.

Paper 45: Which Osteochondritis Dissecans Subjects Will Heal Non-Operatively? An Application of Machine Learning Methods to the ROCK Cohort

Paper 45: Which Osteochondritis Dissecans Subjects Will Heal Non-Operatively? An Application of Machine Learning Methods to the ROCK Cohort

Flexible transition probability model for assessing cost-effectiveness of breast cancer screening extension to include women aged 45-49 and 70-74.

Breast cancer is the most common cancer among Western women. Fortunately, organized screening has reduced breast cancer mortality. New recommendation by the European Union suggests extending screening with mammography from 50-69-year-old women to 45-74-year-old women. However, before extending screening to new age groups, it's essential to carefully consider the benefits and costs locally as circumstances vary between different regions and/or countries. We propose a new approach to assess cost-effectiveness of breast cancer screening for a long-ongoing program with incomplete historical screening data. The new model is called flexible stage distribution model. It is based on estimating the breast cancer incidence and stage distributions of breast cancer cases under different screening strategies. The model parameters, for each considered age group, include incidence rates under screening/non-screening, probability distribution among different stages, survival by stages, and treatment costs. Out of these parameters, we use the available data to estimate survival rates and treatment costs, while the modelling is done for incidence rates and stage distributions under screening policies for which the data is not available. In the model, an ongoing screening strategy may be used as a baseline and other screening strategies may be incorporated by changes in the incidence rates. The model is flexible, as it enables to apply different approaches for estimating the altered stage distributions. We apply the proposed flexible stage distribution model for assessing incremental cost of extending the current biennial breast cancer screening to younger and older target ages in Finland.

Relationship between Detection of Preeclampsia High-Risk by Pregnant Women and Health Workers with the Success of the Preeclampsia Eradication Program at the Nogosari Health Center

The background of Preeclampsia Eradication Program is a program that seeks to accelerate the reduction in the incidence of preeclampsia in pregnancy, delivery and postpartum as well as comprehensive management of preeclampsia events, so that it is expected to reduce the number of maternal mortality rates (MMR). In Boyolali, Indonesia, the number of MMR in 2020 was 17 cases, where one of the causes of death was preeclampsia. Efforts are being made by the government to reduce MMR and infant mortality due to preeclampsia in pregnancy with the preeclampsia eradication program which began in 2018. The purpose of the study was to determine the relationship between detection of preeclampsia high-risk by pregnant women and health workers with increasing the success of the Eradication Program at the Nogosari Health Center. Research design Quantitative research that uses correlation analysis by using the approach retrospective. The results of data analysis using chi-square obtained results of detection of preeclampsia high-risk by pregnant women obtained the value of p-value 0.00 while for FIGO screening by health workers obtained a value of p-values 0.00. The results of the study showed that the variable detection of preeclampsia by pregnant women, FIGO screening by health workers had a significant relationship with the success of the preeclampsia eradication program with p value = 0.000, p = 0.000. where most of the respondents had poor knowledge as many as 40 respondents (66.7%), while for FIGO screening by health workers the score was obtained p-value 0.00 &lt; 0.05 where most of the respondents, namely 41 respondents (68.3%) received incomplete FIGO screening.

Identifying Opportunities for Impact of Community-Based Pharmacist-Led Biometric Health Screenings on ASCVD Risk.

Community-based pharmacists are positioned uniquely to assist in the early detection of underlying cardiovascular disease (CVD) which affects approximately 50% of adults in the United States. Organizations utilize community-based pharmacists to conduct annual biometric health screenings to help employees identify health risks previously undetected. The goal of this study was to evaluate how community-based pharmacists could impact lifetime atherosclerotic cardiovascular disease (ASCVD) risk for a large population. This study was a retrospective analysis of annual pharmacist-led 15-minute biometric health screening data from a large regional community-based pharmacy chain. Employees between the ages of 20 and 79 who had completed at least three biometric health screenings between July 1, 2015 and June 30, 2020 were included. Incomplete biometric health screening records were excluded. To calculate lifetime ASCVD risk and identify perceived gaps in care, prescription fill history of study participants was used. The pharmacists did not make clinical interventions; however, education was provided with the information found. A total of 10,001 patients were included. Median baseline ASCVD risk was 1.5% and increased to 1.8% (p < 0.001). Additionally, 1,187 patients with an elevated ASCVD risk ≥ 7.5%, showed statistically significant improvements in blood pressure, body mass index, and cholesterol. Improvements for high-risk patients were seen in several biometric health screening parameters including blood pressure, body mass index, and cholesterol. Community-based pharmacists were well positioned to intervene clinically to support reduction of ASCVD life-time risk.

Parametric simulations of composite barrier FTJs under external bias at room temperature

A study on a parametrized model of a composite barrier ferroelectric tunneling junction (FTJ), three-interface system with a non-polar dielectric layer, under an external bias voltage, Va, and at room temperature, using Finite Element Method-based simulations, has been performed. The approach involves the Thomas–Fermi model assuming incomplete screening of polarization charges for building the energy barrier profile, and numerically simulates the electron transport through the barrier by bias-voltage-dependent tunneling, using Tsu-Esaki formulation. That naturally includes the temperature dependent contributions to the total current density. The tunneling electroresistance ratio (TER) and current densities are computed considering variations of a large set of parameters that describe the composite barrier system in realistic physical range of values with respect to a reference (prototypical) system. In this study, the parametric simulations were performed starting from selected data reported on the SrRuO3/SrTiO3/BaTiO3/SrRuO3 heterostructure. The most important results of our work can be stated as follows: (i) The simulations prove to be a reliable approach when we are interested in the prediction of FTJ characteristics at temperatures close to 300 K, and (ii) We show that several configurations with large TER values can be predicted, but at the expense of low current densities in the ON state. We suggest that the results may be useful for assessing the FTJ performances at ambient temperature, as well as to design preoptimized FTJs by using different combinations of materials to comply with a set of properties of a specific model.

S54 Improving Influenza and Pneumococcal Vaccination Rates in an Inflammatory Bowel Disease Clinic at Tan Tock Seng Hospital, Singapore

Background: Despite a higher risk of infections (such as influenza and pneumococcal disease) with or without immunosuppressive or biologic therapies, vaccination rates remain low among inflammatory bowel disease (IBD) patients in Tan Tock Seng Hospital. Specifically, our 3 months’ retrospective data revealed that ≤15% of patients had completed their influenza and pneumococcal vaccinations. Hence, in January 2021, a team comprising of 3 IBD physicians and 2 new IBD nurses came together to work on a quality improvement (QI) project and streamline the vaccination processes. The primary aim was to improve vaccination rates through a nurse-led vaccination screening, assessment and referral exercise as well as addressing vaccination hesitancy. Methods: A cause and effect QI tool (fish-bone diagram) was adopted to assess and study areas for improvement. Through this root cause analysis, the team was able to identify gaps which contributed to poor vaccination uptake. They included system (unavailability of IBD vaccination protocol, no written education materials for IBD patients, inconvenient vaccination access), physician (limited physician time consult, incomplete vaccination screening or assessment) and patient factors (patient’s perceived lack of benefit, vaccine misconceptions, fear of side effects). In order to address aforementioned factors causing the poor vaccination rates, vaccination guidelines were first protocolised based on national and international clinical guidelines. An information pamphlet was also prepared to help patients better understand the importance and benefits of vaccinations. At each outpatient appointment, IBD nurses would first establish the patient’s vaccination eligibility based on age, disease activity, use of immunosuppressive therapy and vaccination history. Where appropriate, vaccination counselling and pamphlet will be provided to the patient. With patient’s consent, patients would then be referred to the treatment room at the clinic for vaccination administration, all within the same clinical setting. Results: There were 246 patients attended IBD clinic from June to November 2021. Our 6-months post-intervention study reported the following: 1. Clear and systematic vaccination screening and assessment- Vaccination documentation in electronic health records increased from 30% to 100% - a 70% increase compared to pre-intervention 2. Influenza vaccination- 60% of IBD patients fulfilled vaccination eligibility - Influenza vaccination completion increased from 13% to 55% – a 42% increase compared to pre-intervention 3. Pneumococcal vaccination- 28% of IBD patients fulfilled vaccination eligibility - Pneumococcal vaccination completion increased from 2% to 48% - a 46% increase compared to pre-intervention. Conclusion(s): The role of vaccination screening and recommendations were traditionally performed by physicians and pharmacists. However, with the implementation of nurse-led vaccination exercise, it had helped to improve and better identify eligible patients for vaccination in a systematic and concise manner in this one-stop service. It further empowered the 2 new IBD nurses in exercising their clinical judgement skills while freeing up time for physicians to address patients who may have higher medical needs requiring longer consultations. Most importantly, with increasing vaccination rates, IBD patients could be better protected against these vaccines-preventable diseases. We believe that we can achieve higher rates of vaccinations in due time through education and being a vaccine(s) advocate to further reduce vaccine hesitancy.

Effects of flexoelectric polarization on surface potential of dielectric thin-film heterostructures: A comparative study

Recently, flexoelectric effect has attracted considerable attention owing to ubiquitous existence in all dielectrics, regardless of the symmetry. It promises intriguingly physical phenomena, such as strain gradient-induced electric polarizations, photocurrents, and interfacial transports, as well as their electromechanical coupling with external force loading, in diverse materials for multifunctional applications in electronics. In this work, we report the flexoelectric-modulation on surface potential of LaFeO3 (LFO) thin-film heterostructures. The LFO thin film with or without the flexoelectric effect has been achieved by controlling epitaxial misfit against a substrate. Lattice structures and strain behaviors are observed by atomic-resolution high-angle annular dark-field imaging. Grown on a LaAlO3 substrate, a giant strain gradient of ∼3 × 106 m−1 is generated in the LFO thin film due to the gradual relaxation of large misfit strain with increasing thickness, yielding a robust flexoelectric polarization pointing to the heterostructure surface. In contrast, the LFO is almost fully strained on a SrTiO3 substrate due to the small lattice mismatch. The flexoelectric polarization results in an increase in surface potential in the LFO heterostructure due to the incomplete screening of positive polarization bound charges, as observed by scanning kelvin probe microscopy. Furthermore, x-ray photoelectron spectroscopy reveals that the flexoelectric polarization can downward bend the band alignment of the LFO layer and modulate the interfacial potential barriers. These results provide the way for experimental observations of the flexoelectric effect and deliver physical insight into deep understanding of interfacial electronic structures of flexoelectric-based devices.