Increase In Rate Of Utilization Research Articles

Challenges and Opportunities for Collaboration Between Academic Biobanks and Industry: Results of an International Survey of Academic Biobanks.

Aim of the Survey: When it comes to collaboration between academic biobanks and the pharmaceutical/biotechnology industry, the criteria for effective collaborations are still unclear. Researchers in industry and academic biobanks can have different incentives and requirements that the other party is often not familiar with. This survey was conducted in an attempt to increase understanding of these fundamental knowledge gaps that may be obstacles to optimal collaboration between academia and industry. Key Findings from the Survey: There were 53 total respondents. Although this was a global survey, most respondents (n = 29) were from North America, likely reflecting overall investment in research in this region and possibly increased interactions between academia and industry as well. Most respondent academic biobanks collect multiple sample types with most (>90%) collecting both biofluids (including blood) and tissue. Most of the participating academic biobanks were aware that they were not (35%), or only partially (35%), using the full potential of their inventory. One option for increasing utilization rates is by collaborating with industry partners. The main issues when working with industry were perceived to be a combination of challenges including contractual (55%), consent restrictions (45%), timelines (41%), or time pressure (36%). Time taken to put agreements together was also a significant hurdle (54%), together with the industry's administrative requirements (36%). Brief Conclusions from the Survey: To take advantage of opportunities for joint collaboration, it is essential that the parties involved build trust. The first step is to understand the different requirements and needs of the other party and to establish efficient structures for joint cooperation. This survey has highlighted key areas to be addressed as the next steps for strengthening bonds between academic biobanks and industry partners.

EXPLORING INNOVATIONS IN SPORTS VENUE MANAGEMENT IN CHINA: BALANCING UTILIZATION AND SUSTAINABILITY

This paper explores innovative strategies for enhancing the utilization, financial sustainability, and community engagement of sports venues in China. As the industry faces challenges related to underutilization and economic viability, the study emphasizes the importance of multifunctional transformation and community-based operations. By reconfiguring sports venues to host a variety of events beyond traditional sports, operators can significantly increase utilization rates and revenue streams. The integration of digital and smart management technologies is identified as crucial for optimizing operational efficiency and enhancing the user experience. Additionally, the paper highlights the need for diversified revenue models, including retail services, corporate sponsorships, and digital content monetization, combined with sustainable development practices such as energy efficiency and waste reduction. These strategies not only secure the long-term financial health of sports venues but also align with broader environmental and social goals. The study concludes that sports venues adopting these innovative approaches will be better positioned to thrive in a competitive and evolving market landscape. KEYWORDS：Sports Venue Management，Multifunctional Transformation，Community-Based Operations，Digital and Smart Technologies，Diversified Revenue Models，Sustainable Development

Hypofractionated Radiation Therapy: A Cross-sectional Survey Study of US Radiation Oncologists.

For many malignancies, hypofractionated radiotherapy (HFRT) is an accepted standard associated with decreased treatment time and costs. United States provider beliefs regarding HFRT likely impact its adoption but are poorly studied. We surveyed US-based radiation oncologists (ROs) to gauge HFRT utilization rates for prostate (PC), breast (BC), and rectal cancer (RC) and to characterize the beliefs governing these decisions. From July to October 2021, an anonymized, online survey was electronically distributed to ROs actively practicing in the United States. Demographic and practice characteristic information was collected. Questions assessing rates of offering HFRT for PC, BC, and RC and perceived limitations towards using HFRT were administered. A total of 203 eligible respondents (72% male, 72% White, 53% nonacademic practice, 69% with 11+ years in practice) were identified. Approximately 50% offered stereotactic body radiation therapy (SBRT) for early/favorable intermediate risk PC. Although >90% of ROs offered whole-breast HFRT for early-stage BC, only 33% offered accelerated partial-breast irradiation (APBI). Overall, 41% of ROs offered short-course neoadjuvant RT for RC. The primary reported barriers to HFRT utilization were lack of data, inexperience, and referring provider concerns. HFRT is safe, effective, and beneficial, yet underutilized-particularly prostate SBRT, APBI, and short-course RT for RC. Skills retraining and education of ROs and referring providers may increase utilization rates.

Cryopreservation of human adult ventricular tissue for the preparation of viable myocardial slices

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): REGeRNA Myocardial slices are ultra-thin slices of living adult myocardium which can be cultured. As a multicellular 3-D culture model, myocardial slices offer a novel opportunity to investigate how adult cardiomyocytes (CMs) interact with other cardiac cell types and the extracellular matrix, while providing long-term preservation of CMs cytoarchitecture and electrical phenotype. Additionally, myocardial slices are a new tool in drug discovery by allowing to test chronic treatments, as opposed to isolated CMs which are limited to acute timepoints. Despite their benefits over other cardiac preparations, myocardial slices also have several limitations, of which one is the quality of the slices. The main determinant of myocardial slice quality is the procedure by which the cardiac tissue block is handled. Current methods depend on the preparation of slices directly after tissue excision, therefore limiting the moment when the experiment is performed. We developed a protocol for the cryopreservation of human adult ventricular tissue allowing preparation of viable myocardial slices afterwards. Fresh and cryopreserved cardiac tissue from donor hearts was processed and evaluated for viability, tissue integrity, and inflammatory markers using molecular biology and histological assays. The tissue samples retained viability, biomass, and tissue and vascular integrity following cryopreservation compared to fresh tissue. Additionally, we compared myocardial slices obtained from fresh or cryopreserved tissue and cultured for 24 hours. Histologically, normal cytomorphological features and gap junctions between CMs were preserved in all slices. Comparable retention of tissue viability and structural integrity post cryopreservation (4-6 weeks) and culture (up to 7 days) was observed in cardiac samples from 3 additional donors. In summary, cold storage extends the time-interval between sample collection and slice preparation, allowing for more long-term, complex endpoints. Moreover, efficient banking of cryopreserved cardiac samples from various donors and disease states is critical for regular use of myocardial tissue slices in drug discovery and development. Additional research on the effects of cryopreservation on different cardiac cell types will allow to improve donor organ management to extend the donor pool and increase utilization rate.

Contraception in Medically Complex Adolescents and Young Adults.

Contraception is a significant part of comprehensive sexual and reproductive health (SRH) care for adolescents and young adults (AYA). While providers may assume that AYA with chronic illness are not sexually active, studies have shown that there are no differences in their sexual practices compared to their counterparts without an illness. This assumption may result in less SRH screening, preventative services, and counseling by providers resulting in decreased basic sexual knowledge, increased risk of unplanned pregnancy, and other health disparities. Sexually active AYA with medical complexity are particularly in need of contraception for a variety of reasons. A better understanding of the complexities around contraception counseling can help increase utilization rates, improve shared-decision making around family planning, and reduce the stigma around sexual health counseling in this population. We have included three sections. First, a general overview of contraception methods. Next, an overview of contraceptive methods currently available, their efficacy, and medical eligibility criteria for their use in AYA who have certain characteristics or medical conditions. Finally, cases adapted from real clinical scenarios to highlight specific recommendations for contraception in AYA women living HIV, autoimmune conditions, and those who have received a solid organ transplant. This information will help providers to consider the multiple factors that influence contraception decision-making (including clinical status, thrombosis risk, medication interactions, safety), and optimize care for AYA living with chronic illness.

Dynamic Modelling Analysis on The Effectiveness of Coastal Land Resources for Aquaculture Activities Utilization

Coastal areas are considered biodiversity zones. This study aimed to analyze the effectiveness of land use on aquaculture productivity rate in coastal areas using a dynamic modeling analysis system. This study was conducted in the Pekalongan Province. Water quality parameters and qualitative research data were obtained from an in-depth survey. Furthermore, the data were analyzed using dynamic modeling analysis. The results of this study indicate that the level of coastal land use has a variable relationship with the productivity rate of aquaculture. Based on the causal loop model, it could be analyzed that the social, environmental conditions in coastal areas were described as continuing to experience quantification of population increase and environmental utilization rates. Overall, the productivity level of aquaculture cultivation in coastal areas tended to decrease along with the increasing value of productive land use accompanied by increased inputs and the number of human resource populations in coastal areas. The optimal inclusion of this study was that the optimal land use level would impact the productivity management level of aquaculture cultivation in coastal areas. Based on the results of this study, it can be concluded that the optimal utilization of coastal land greatly impacted the management of the productivity level of aquaculture cultivation, which was carried out in an integrated manner. Furthermore, the analysis of the dynamic modeling system also illustrated the increasing social-environmental conditions in coastal land utilization.

Neonatal nociceptive stimulation results in pain sensitization, reduction of hippocampal 5-HT1A receptor, and p-CREB expression in adult female rats

Painful invasive procedures are often performed on newborns admitted to intensive care units (ICU). The acute and long-term effects caused by these stimuli can be investigated in animal models, such as newborn rats. Previous studies have shown that animals subjected to nociceptive stimuli in the neonatal period show sex-specific behavioral changes such as signs of anxiety or depression. Under the same conditions, neonatal stimuli also provoke an increase in the rate of neurogenesis and cell activation in the hippocampal dentate gyrus. So, this study aims to identify the possible roles of central monoamines, receptor expression (5-HT1A), and signaling factors (p-CREB) underlying the long-term effects of neonatal nociceptive stimulation. For this, noxious stimulation was induced by intra-plantar injection of Complete Freund´s adjuvant (CFA) on the postnatal day 1 (P1) or 8 (P8). Control animals were not stimulated. On P75 the behavioral tests were conducted (hotplate and elevated plus maze), followed by sacrifice and molecular studies. Our results showed that neonatal nociceptive stimulation alters pain sensitization specially in females, while stimulation on P1 increases pain threshold, P8-stimulated animals respond with reduced pain threshold (P < 0.001). Hippocampal expression of 5-HT1A receptor and p-CREB were reduced in P8 F group (P < 0.001) in opposition to the increased utilization rate of dopamine and serotonin in this group (P < 0.05). This study shows sex- and age-specific responses of signaling pathways within the hippocampus accompanied by altered behavioral repertoire, at long-term after neonatal painful stimulation.

Palliative Care Use Trends, Racial/Ethnic Disparities, and Overall Survival Differences Among Patients With Metastatic Breast Cancer.

Background: Palliative care improves cancer patients' quality of life. Limited research has investigated racial/ethnic disparities in palliative care utilization and its associated survival among metastatic breast cancer (MBC) patients. Objectives: To examine racial/ethnic palliative care use disparities and assess racial/ethnic overall survival differences in MBC patients stratified by palliative care use. Design: A retrospective study of MBC patients from the 2004-2020 National Cancer Database. Measurements: Palliative care was defined as noncurative cancer treatment, including surgery, radiotherapy, systemic therapy, and/or pain management; utilization was coded "yes/no." Racial/ethnic groups included Asian, American Indian or Alaska Native (AIAN), Black, Hawaiian or Other Pacific Islander (HPI), Hispanic, and White. Logistic regression was performed to assess palliative care use disparities. Overall survival was modeled using Cox regression. Results: Of 148,931 patients, the mean age was 62 years; 99% were female; 73% identified as White, 17% as Black, 6% as Hispanic, 3% as Asian, 0.3% as AIAN, and 0.3% as HPI; 42% and 39% had Medicare and private insurance, respectively. Overall, 21% used palliative care, with an increasing utilization rate from 2004 to 2020 (3.6% increase per year, p-trend <0.001). Black (adjusted odds ratio [aOR] = 0.89; 95% confidence interval [CI]: 0.84 to 0.94), Asian (aOR = 0.76; 95% CI: 0.68 to 0.86), and Hispanic (aOR = 0.68; 95% CI: 0.62 to 0.74) patients had a lower likelihood of palliative care utilization than White patients. Among palliative care users, compared with White patients, Black (adjusted hazard ratio [aHR] = 1.14, 95% CI: 1.07 to 1.21) patients had a greater mortality risk, while Asian (aHR = 0.83, 95% CI: 0.71 to 0.97) and Hispanic (aHR = 0.77, 95% CI: 0.69 to 0.87) patients had a lower mortality risk. Conclusions: Palliative care utilization among MBC patients significantly increased but remained suboptimal. Racial/ethnic minority patients were less likely to use palliative care, and Black patients had worse survival, than White patients, suggesting the need for improving palliative care access and ameliorating disparities in MBC patients.

Outcomes after Perioperative Transient Ischemic Attack Following Cardiac Surgery.

Perioperative transient ischemic attacks (PTIAs) are associated with significantly increased rates of postoperative complications such as low cardiac output, atrial fibrillation, and significantly higher mortality in cardiac procedures. The current literature on PTIAs is sparse and understudied. Therefore, we aim to understand the effects of PTIA on hospital utilization, readmission, and morbidity. Using data on all the cardiac procedures at the University of Pittsburgh Medical Center from 2011 to 2019, fine and gray analysis was performed to identify whether PTIAs and covariables correlate with increased hospital utilization, stroke, all-cause readmission, Major Adverse Cardiac and Cerebrovascular Events (MACCE), MI, and all-cause mortality. Logistic regression for longer hospitalization showed that PTIA (HR: 2.199 [95% CI: 1.416-3.416] increased utilization rates. Fine and gray modeling indicated that PTIA (HR: 1.444 [95% CI: 1.096-1.902], p < 0.01) increased the rates of follow-up all-cause readmission. However, PTIA (HR: 1.643 [95% CI: 0.913-2.956] was not statistically significant for stroke readmission modeling. Multivariate modeling for MACCE events within 30 days of surgery (HR: 0.524 [95% CI: 0.171-1.605], p > 0.25) and anytime during the follow-up period (HR: 1.116 [95% CI: 0.825-1.509], p > 0.45) showed no significant correlation with PTIA. As a result of PTIA's significant burden on the healthcare system due to increased utilization, it is critical to better define and recognize PTIA for timely management to improve perioperative outcomes.

The effects of various factors on spontaneous imbibition in tight oil reservoirs

Slickwater fracturing fluids have gained widespread application in the development of tight oil reservoirs. After the fracturing process, the active components present in slickwater can directly induce spontaneous imbibition within the reservoir. Several variables influence the eventual recovery rate within this procedure, including slickwater composition, formation temperature, degree of reservoir fracture development, and the reservoir characteristics. Nonetheless, the underlying mechanisms governing these influences remain relatively understudied. In this investigation, using the Chang-7 block of the Changqing Oilfield as the study site, we employ EM-30 slickwater fracturing fluid to explore the effects of the drag-reducing agent concentration, imbibition temperature, core permeability, and core fracture development on spontaneous imbibition. An elevated drag-reducing agent concentration is observed to diminish the degree of medium and small pore utilization. Furthermore, higher temperatures and an augmented permeability enhance the fluid flow properties, thereby contributing to an increased utilization rate across all pore sizes. Reduced fracture development results in a lower fluid utilization across diverse pore types. This study deepens our understanding of the pivotal factors affecting spontaneous imbibition in tight reservoirs following fracturing. The findings act as theoretical, technical, and scientific foundations for optimizing fracturing strategies in tight oil reservoir transformations.

The International Monetary System’s Structural Flaws, a Process of Economic Development, and the Job Guarantee

The international monetary system currently suffers from three structural flaws that disproportionately affect developing nations: an asymmetric balance of payments adjustment mechanism, the Triffin Paradox, and an inequity bias against developing nations. Thus, as currently constituted, this global monetary framework is biased against the development prospects of developing nations and is antagonistic to their development efforts. However, the author’s contention is that developing countries can use a Job Guarantee (JG) to address these shortcomings because it offers five significant international macroeconomic benefits that involve presenting developing nations with an enhanced degree of domestic policy options, altering how global liquidity is provisioned and the need for acquiring it, and inciting a direct challenge to the neoliberal conventional wisdom of global political economy. As a result, developing nations can use a JG as a cornerstone in any development strategy that seeks to sustainably mobilize underemployed labor resources and increase productive capacity and utilization rates while remaining free of the structural constraints imposed by the international monetary system. JEL Classification: B52, O11, F40

Individual, Community, and Health Facility Predictors of Postnatal Care Utilization in Rural Tanzania: A Multilevel Analysis.

Postnatal care (PNC) is an underused service in the continuum of care for mothers and infants in sub-Saharan Africa. There is little evidence on health facility characteristics that influence PNC utilization. Understanding PNC use in the context of individual, community, and health facility characteristics may help in the development of programs for increased use. We analyzed data from 4,353 women with recent births in Kigoma Region, Tanzania, and their use of PNC (defined as at least 1 checkup in a health facility in the region within 42 days of delivery). We used a mixed-effects multilevel logistic regression analysis to explain PNC use while accounting for household, individual, and community characteristics from a regionwide population-based reproductive health survey and for distance to and adequacy of proximal health facilities from a health facility assessment. PNC utilization rate was low (15.9%). Women had significantly greater odds of PNC if they had a high level of decision-making autonomy (adjusted odds ratio [aOR]: 1.56; 95% confidence interval [CI]=1.11, 2.17); had a companion at birth (aOR: 1.57; 95% CI=1.19, 2.07); had cesarean delivery (aOR: 2.27; 95% CI=1.47, 3.48); resided in Kasulu district (aOR: 3.28; 95% CI=1.94, 5.52); or resided in a community that had at least 1 adequate health facility within 5 km (aOR: 2.15; 95% CI=1.06, 3.88). Women's decision-making autonomy and presence of companionship at birth, as well as proximity to a health facility with adequate infrastructure, equipment, and workforce, were associated with increased PNC use. More efforts toward advocating for the health benefits of PNC using multiple channels and increasing quality of care in health facilities, including companionship at birth, can increase utilization rates.

Economic impact of a more extensive use of FENO testing on the Italian population with asthma

BackgroundAsthma is a common chronic inflammatory airway affecting over 260 million people worldwide, and characterized, in the large majority of cases, by the so-called “type 2 inflammation”. Fractional exhaled nitric oxide (FENO) testing is noninvasive point-of-care tool to assess type 2 inflammation and therefore improve asthma management. It has been suggested to determine eligibility for a specific biologic therapy and predict likelihood to respond. The aim of this study was to estimate the overall economic impact of an extensive use of FENO testing on the Italian population with asthma, including extra costs of testing and savings generated by more appropriate prescriptions, increased adherence and lower frequency of exacerbations.MethodsA cost of illness analysis was firstly performed to estimate the yearly economic burden from the National Healthcare Service (NHS) perspective in Italy of the management of asthmatic patients with standard of care (SOC) according to the application of GINA (Global Initiative for Asthma) guidelines; then, we evaluated the changes in the economic burden in patient management by introducing FENO testing into clinical practice. The cost items considered were: visits/exams, exacerbations, drugs, management of adverse events caused by short-term oral corticosteroids use. Efficacy of FeNO test and SOC is based on literature evidence. Costs refer to published data or Diagnosis Related Group/outpatient tariffs.ResultsConsidering one asthma visit every 6 months, the total yearly cost for the management of patients with asthma in Italy is 1,599,217,876€ (409.07€ per patient), while for FENO testing strategy this figure is 1,395,029,747€ (356.84€ per patient). An increased utilization rate of FENO testing from 50 to 100% of patients may lead to savings for the NHS from about 102 to 204 million € compared to SOC.ConclusionsOur study showed that FeNO testing strategy may improve the management of asthmatic patients leading to significant savings for the NHS.

Real-time assessment of kidney allografts during HOPE using flavin mononucleotide (FMN) - a preclinical study.

The gap between available donor grafts and patients on the waiting lists is constantly growing. This leads to an increased utilization of high-risk and therefore more vulnerable kidney grafts. The use of high-risk organs requires further optimization of machine preservation and assessment strategies before transplantation. Hypothermic machine perfusion (HMP) is the standard of care for kidneys originating from donation after circulatory death (DCD), whereas the evidence of HMP with additional oxygen (HOPE) is still very limited. Furthermore, an objective quality assessment of HMP-perfused kidneys is lacking. Recently, the release of mitochondria derived fragments, i.e., flavin mononucleotide (FMN) of complex I during machine liver perfusion was shown to be predictive for liver graft function before implantation. Therefore, the aim of this study was to evaluate, if FMN is useful also for assessment of kidney injury before use. A porcine perfusion model was used to investigate the feasibility of assessment of kidney grafts during hypothermic oxygenated perfusion (HOPE) with either 0, 30 or 60 minutes of warm ischemia. The model with warm ischemia times (WIT) of 30 min and 60 min, was used to mimic a clinically relevant scenario. A group with no warm ischemia time (0' WIT) served as control group. The groups underwent minimal static cold storage (SCS) of 2 h followed by 2 h of end-ischemic HOPE with repeated real-time FMN measurements. In a further step, these values were related to the release of damage-associated molecular patterns (DAMPs) and to the functionality of the respiratory chain, represented by the capacity of ATP production. We demonstrate, first, feasibility of perfusate FMN measurements in perfused kidneys, and secondly its correlation with donor warm ischemia time. Accordingly, FMN measurement showed significantly higher release in the 60-minute WIT group (n = 4) compared to the 30-minute WIT (n = 4) and the control group (n = 4). FMN release correlated also with DAMP signaling, such as the release of 8-OHdG and HMGB1. Finally, ATP replenishment proved to be best in control kidneys, followed by kidneys with 30 min and then by kidneys with 60 min of WIT. This study demonstrates the feasibility of FMN measurement in kidneys during HOPE. In addition, we show a correlation between FMN quantification and pre-existing kidney graft injury. Based on this, real-time FMN measurement during HOPE may be an objective assessment tool to accept high-risk kidneys for transplantation while minimizing post-transplant dysfunction, moving away from former "gut feeling" towards objective criteria in accepting marginal kidney grafts for transplantation. Graft evaluation based on these results may close the gap between available grafts and patients on the waiting lists by increasing utilization rates without significant impact for the recipients.

Grid Value Analysis of Medium-Voltage Back-to-Back Converter on DER Hosting Enhancement

This paper presents an analysis of the value that can be realized by medium-voltage back-to-back (MVB2B) converters in terms of the increased utilization rate of distributed energy resources (DERs) and the improvement in operational conditions. A systematic, transferrable, and scalable methodology has been designed to analyze and quantify the increased DER value from three perspectives: 1) curtailment reduction of the DER generation, 2) size reduction of the energy storage needed to otherwise realize DER hosting levels, and 3) hosting capacity improvement of the DERs compared to the base distribution circuit capability. In the case study, the proposed methodology is applied to two utility distribution systems for analysis and quantification of the grid value of the MVB2B converter, installed in the distribution circuit, and provided to the solar photovoltaic (PV) DERs. The analysis results demonstrate that the MVB2B converter can deliver significant value to the PV hosting enhancement of two adjacent distribution systems when they are connected by the MVB2B converter. Based on this case study, this paper analyzes and summarizes the approximate realized grid value of the MVB2B converter for distribution systems dominated by different shares of customer classes.

Assessment of Sieving as a Mean to Increase Utilization Rate of Biomass Fly Ash in Cement-Based Composites

Biomass fly ash is a growing challenge for combustion by-product (CBP) management. This research was conducted to investigate the influence of activation by sieving through a 63 µm sieve and a 125 µm sieve on fresh and hardened cement mortar properties. Sieving increased the CaO content by 9.3 percentage points (p.p.) in the oxide composition of the fly ash. The 28-day Strength Activity Indices increased by 24.9 p.p. A 25% replacement rate of cement with fly ash sieved with a 63 µm sieve increased the 2-day compressive strength of mortars by 24% when compared with untreated fly ash. The 90-day compressive strength results of cement mortars with a 15% replacement rate of cement with fly ash sieved with a 63 µm sieve were similar to the control specimen results. The utilization rate of biomass fly ash can be increased to 15% of binder mass without the detrimental effect of the mechanical properties of cement mortar. SEM and TG analyses showed that activated biomass fly ash promoted the growth of the C-S-H phase and ettringite.

Trends in pharmacotherapy utilization among patients with heart failure with preserved ejection fraction

Study objectiveHalf of patients with heart failure have preserved ejection fraction (HFpEF). Over the years, guidelines have recommended or advised against various therapies for HFpEF management. However, there is limited evidence on the trends in utilization of the various medications. The aim of this study was to examine the trends in the use of pharmacotherapies among patients with HFpEF from 2008 through 2020. DesignRetrospective cohort study of patients with HFpEF used MarketScan® Commercial and Medicare Supplemental Databases (2007–2020). ParticipantsPatients with HFpEF. Outcome measuresUtilization rates for angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), angiotensin receptor-neprilysin inhibitors (ARNIs), aldosterone receptor antagonists (ARAs), diuretics, β-blockers, calcium channel blockers (CCBs), phosphodiesterase 5 inhibitors (PDE5Is), nitrates, digoxin, and sodium glucose cotransporter-2 inhibitors (SGLT2i) within 90 days of the first HFpEF diagnosis. ResultsWe identified 156,730 patients with HFpEF (mean [SD] age, 73 [13.4] years; 57 % females). From 2008 to 2020, we found increased utilization rates for ARNIs (0.02 % vs. 0.17 % of all patients, p < 0.01), ARBs (14.3 % vs. 18.6 %, p < 0.01), ARAs (7.0 % vs. 8.4 %, p < 0.01), CCBs (30.6 % vs. 33.4 %, p < 0.01), and SGLT2i (0.001 % vs. 0.021 %, p < 0.01). By contrast, the utilization of ACEIs (30.4 % vs. 20.5 %, p < 0.01), digoxin (9.5 % vs. 2.4 %, p < 0.01), nitrates (10.7 % vs. 4.9 %, p < 0.01), diuretics (54.1 % vs. 50.4 %, p = 0.20), and β-blockers (52.6 % vs. 51.7 %, p < 0.01) decreased, while utilization rates of PDE5Is remained stable (1.5 % vs. 1.1 %, p = 0.90) . ConclusionsDuring the 13-year study period, the utilization of ARNIs, ARBs, ARAs, CCBs, and SGLT2i increased while the utilization of digoxin, nitrates, diuretics, and β-blockers decreased among patients with HFpEF.

SLAP repair and bicep tenodesis: a comparison of utilization and revision rates for SLAP tears

The management of superior labrum anterior to posterior (SLAP) tears typically consists of either repair or biceps tenodesis (BT). While repair is more frequently recommended in younger patients, patients older than 40 years are often treated with BT. The purpose of this study is to determine whether there has been a change in utilization of these procedures over the past decade with respect to patient age as well as compare reoperation rates between the two procedures. The Pearldiver database was queried to identify BT and SLAP repairs indicated for SLAP tears performed from 2010 to 2019. The primary outcome was utilization rate, stratified by age. A secondary outcome was 2-year shoulder reoperation rates. Trends were reported in terms of compounded annual growth rate. Outcome analysis was conducted using univariate and multivariable analysis. From 2010 to 2019, SLAP repair was the most common procedure performed for SLAP tears. Regardless of age, BT performed for SLAP tear had a significantly increased utilization rate; whereas, SLAP repair had a significantly decreased utilization rate. SLAP repair was more commonly performed in younger patients compared to BT. Following multivariable analysis, patients who underwent SLAP repair had significantly higher odds (odds ratio (OR): 1.453; 95% confidence interval (CI): 1.26-1.68; P<.001) of requiring an arthroscopic reoperation within 2 years when compared to those who underwent BT with no significant difference with respect to 2-year open reoperation. Although SLAP repair is still more commonly used to treat SLAP tears than BT, especially for younger patients, the utilization of SLAP repair is decreasing while BT is increasing. The increased utilization of BT may be associated with lower rates of shoulder reoperation for problematic SLAP tears.

Expenditure and Utilization Patterns of Cancer Care in Kuwait

#Introduction Cancer is among the leading causes of morbidity and mortality worldwide. However. The trends in utilization of cancer services and related expenditures in Kuwait are poorly known. We aim to investigate the expenditure and utilization patterns of cancer care in Kuwait. Methods A three-year retrospective analysis study of expenditure and utilization pattern in KCCC was performed from 2015 to 2017 in MOH in Kuwait. Results We report a considerable variation of utilizations and expenditure levels over the three-year period. After adjusting the data, there was significant increase in utilization rates and expenditure in 2015-16 followed by significant decrease in year 2016-17. The expenditure was observed to increase by 1.1% in 2016 before it declined by 1.9% in 2017. Conclusions This study is the first of its kind in Kuwait. We report adequate utilization and expenditure of cancer care in Kuwait. However, we recommend heavy investments in precision medicine technology and patient outcomes research to improve overall financial and operational performance pertaining to cancer care in MOH in Kuwait.

Prostate Brachytherapy Utilization in the COVID-19 Era: A Cross-Sectional Study of Radiation Oncologists in the United States

Purpose/Objective(s)Brachytherapy (BT) is indicated as monotherapy for lower risk prostate cancer (PC) or to boost external beam radiation therapy (EBRT) for higher risk disease. Despite its advantages, such as decreased treatment time and cost, BT utilization in the United States (US) is declining. We surveyed US radiation oncologists (ROs) to determine the proportion of providers who offer BT for PC, by risk group, and whether the COVID-19 pandemic influenced practice patterns. We hypothesized that rates of utilization would continue to lag EBRT.Materials/MethodsFrom July-October 2021, an anonymized survey was distributed to currently practicing US ROs. Demographic and practice characteristics were collected. Questions assessing utilization of BT and EBRT for patients of varying risk group and the effect of the pandemic on practice patterns were administered. The primary endpoint was the rate of BT utilization by risk group. Descriptive statistics were performed. The bivariate relationships between provider characteristics and likelihood of offering BT were assessed using 2-sided chi-squared tests (α=0.05).ResultsOf 203 respondents (72% male, 72% white, 53% non-academic, 69% >10 years in practice), 156 (77%) treated PC. For low (41% total; 25% low dose rate [LDR], 10% high dose rate [HDR], 6% both) and favorable intermediate (FI) (37% total; 21% LDR, 10% HDR, 6% both) PC, BT was less commonly offered then stereotactic body (SBRT – 54% and 48%), moderately hypofractionated (MHFRT – 83% and 87%), and conventionally fractionated (CFEBRT – 37 and 38%) radiation therapy. For unfavorable intermediate PC, BT alone (7%) and BT+EBRT (37%) were less offered then moderately HFRT (82%) and CFEBRT (46%). For high and very high-risk PC, BT boost was not routinely offered (44% and 37%, respectively). For every risk group, academic ROs were more likely to offer BT (50-60% vs. 29-46%, all p < 0.05) (Table 1). For FI only, ROs treating both urban and rural patients were less likely to offer BT than those in an urban or rural setting (p=0.045). No other characteristics were associated with offering BT. <1% of respondents reported increased BT usage due to the pandemic.ConclusionDespite its advantages for patients, BT remains underutilized, particularly in non-academic settings, with <1/2 of surveyed ROs offering BT monotherapy for low to FI risk PC or to boost higher risk disease. Practice patterns were unaffected by COVID-19 likely due to barriers to starting a BT program. Provider retraining may be critical to increasing utilization rates.