Initial Usage Research Articles

Outpatient inhaled corticosteroid use in bronchopulmonary dysplasia.

In the outpatient setting, inhaled corticosteroids (ICS) are frequently given to children with bronchopulmonary dysplasia (BPD) for treatment of respiratory and asthma-associated symptoms. In this study we sought to determine if correlations existed between ICS use and ICS initiation and patient characteristics and outpatient respiratory outcomes. This study included children with the diagnosis of BPD (n = 661) who were seen in outpatient pulmonary clinics at the Children's Hospital of Philadelphia between 2016 and 2021. Chart review was used to determine patient demographics, use and timing of ICS initiation, asthma diagnosis, and acute care usage following initial hospital discharge. At the first pulmonary visit, 9.2% of children had been prescribed an ICS at NICU discharge, 13.9% had been prescribed an ICS after NICU discharge but before their first pulmonary appointment, and 6.9% were prescribed an ICS at the completion of initial pulmonary visit. Children started on an ICS as outpatientshad a higher likelihood of ER visits (adjusted odds ratio: 2.68 ± 0.7), hospitalizations (4.81 ± 1.16), and a diagnosis of asthma (3.58 ± 0.84), compared to children never on an ICS. Of those diagnosed with asthma, children prescribed an ICS in the outpatient setting received the diagnosis at an earlier age. No associations between NICU BPD severity scores and ICS use were found. This study identifies an outpatient BPD phenotype associated with ICS use and ICS initiation independent of NICU severity score. Additionally, outpatient ICS initiation correlates with a subsequent diagnosis of asthma and acute care usage in children with BPD.

The Shift Analysis on Woman Traditional Underwear Designs in Java and Bali from 1900 until 2000s

Indonesia is a country that pays attention to Eastern tradition, namely in politeness value either in attitude or socialization. Politeness in fashion considers the importance of the value of politeness in clothing. The politeness limitation in fashion in Indonesia was from the navel to ankles by exploring historically to find out the fashion change, especially in traditional clothing in Indonesia in some periods. This research aimed to trace the chronology of fashion change in traditional women in Indonesia from 1900 until 2000 and to study the fashion change from 1900 until 2000. The research method was historical, with data in figure samples obtained from 1900 until 2000. This research resulted in the chronology of the transformation of fashion change in traditional women's underwear from 1900 until 2000. This research found that fashion shifted from Colonialism to the Reformation. The conventional cloth changed from the initial usage, namely kemben, to bustier. Kemben usage in 1860, camisole usage in 1925, and the old order in 1954 is bustier. The length level of fashion design experienced a decrease. In the colonial period, traditional undergarments covered the breast. Still, in the reformation era, some only lasted until the peak of the breast, initially only from the navel until the ankle, then changed from the breast to the ankle. Technological advances have impacted the freedom to access information included in fashion.

Pilot to scale: Implementing a digital triage solution across a large comprehensive cancer centre.

225 Background: Princess Margaret Cancer Centre (PM) sees over 80,000 patients annually and primarily operates using an outpatient model. Historically patients use a phone/voicemail triage service to communicate with their care team between scheduled visits. Many patient queries lack critical information necessary for effective screening, assessment, and processing. In turn leading to delays or missed calls that negatively impact patient experience, system efficiency, and safety. To address these challenges, we piloted a digital triage service and subsequently implemented in sixteen clinics. This project evaluated initial adoption, usage, care patterns and satisfaction in the first 5 months post-implementation. Methods: We used human-centred service design to develop the digital triage service within the EMR (Epic). Implementation strategies to scale across all outpatient clinics included leadership buy-in, co-design with key stakeholders, a phased implementation approach, and improvement cycles. To evaluate initial adoption, usage and care patterns, we used EMR system data. To assess patient satisfaction, we surveyed patients who used the service during the first three months. We conducted semi-structured interviews with staff to understand their experience integrating digital triage into their workflow. Results: Following the go-live period, patients sent an average of 1096 digital requests per month, representing 16% of all triage requests (phone + digital). The most common requests were symptom management (36% of nursing requests) and appointment change requests (40% of administrative requests). The algorithm automatically routed 93% of requests to the most appropriate care team member, compared to 74% pre-implementation. When asked if they were satisfied with their experience, most patients agreed or were neutral (69% and 10%, respectively), while 21% disagreed. In semi-structured interviews, nurses and administrative staff described improved efficiency by having triage requests integrated within the EMR, while have challenges related to prioritizing requests across multiple channels (e.g. digital, phone, others). Conclusions: Digital triage is foundational for better cataloguing and understanding our patients' unmet needs at home and between visits, enabling a continuous learning process to understand when and why people struggle throughout their care journey. Ongoing analyses will explore disease site-specific trends, compare phone to digital triage, and identify differences between users of each method. The data will inform further improvement cycles on the build and workflows, while enabling appropriate resourcing of this critical service and shifts towards proactive care.

Effects of customer inoculation on artificial intelligence service failure

Purpose This paper aims to explore the effectiveness of customer inoculation strategies in the context of AI service failures in the hospitality and tourism industries. Furthermore, it examines how these strategies can enhance customer complaint behavior and satisfaction with service recovery, thereby improving the overall service experience. Design/methodology/approach Four distinct studies were conducted: Study 1 investigated the influence of customer inoculation on complaint behavior post-AI service failure. Study 2 assessed the impact of service remedies on customer satisfaction. Study 3 explored the implications of initial purchase and usage intentions. Finally, Study 4 validated the findings using a large-scale online survey. Findings The results indicated that customer inoculation significantly increases customer complaint behavior and satisfaction with service remedies following AI service failures. They also showed that this relationship is mediated by psychological distance. Furthermore, customer inoculation positively affects initial purchase and usage intentions, demonstrating effectiveness at various customer engagement stages. Practical implications This study enriches the literature on AI hospitality service failure and recovery by introducing the novel concept of customer inoculation. Additionally, it significantly contributes to the inoculation theory literature, which covers diverse fields. Practically, this study proposes an efficient and low-cost strategy for marketers. Originality/value This study introduces the concept of customer inoculation in the context of AI service failures, a novel approach in the hospitality and tourism literature. It provides empirical evidence of the efficacy of the strategy, bridging a crucial gap in understanding customer behavior in the face of technological disruptions.

Development of a suite of short planetary health learning resources by students for students as future health professionals.

Planetary health recognizes the interdependencies between human health and the well-being of the Earth's ecosystems. Human activities have led to the disruption and transformation of natural systems and a range of global environmental changes such as climate change, air pollution, and biodiversity loss. Health professionals must be equipped to deal with the health impacts of global environmental changes. This article describes the development and usage of a suite of 14 short online learning resources ('bricks') on Planetary Health on the ScholarRx platform. There are several principles that inform the development of these bricks, including learner-centric, peer learning, diversity, equity and inclusion, and authentic learning. The content is developed using a student-educator collaboration model, supported by an editorial team. The suite of 14 modules was published in June 2023, with the initial usage data promising with 1,990 views in the first 10 months. These digital, modular resources allow for easy dissemination and can be incorporated in different programs depending on context and need.

From trial to triumph! A longitudinal design eliciting social impact perspective for sustained usage of gamified fitness apps

PurposeAs fitness apps have integrated gamification elements into their design to transform exercise into a compelling and competitive experience, this study draws on the expectation confirmation model (ECM) and self-determination theory (SDT) to propose a comprehensive framework for sustained usage by satisfying the psychological needs of users.Design/methodology/approachA longitudinal study design is utilized where data from 598 fitness app users were gathered over two distinct phases separated by 24 weeks, where data were analyzed using structural equation modeling.FindingsThe findings until phase 1 depict that motivational affordances significantly affect mastery, autonomy and relatedness, which in turn exert a significant influence on flow. Identification and compliance have a more pronounced effect in phase 2 compared to stage 1 of the analysis.Research limitations/implicationsIndividuals are more prone to being swayed by fellow members of their social group who share an affiliation with fitness apps, leading them to sustain their usage of fitness apps. These insights can potentially guide app developers and marketers in formulating strategies based on modifiable factors to foster sustained growth for gamified fitness apps.Originality/valueThis study takes a novel stance by employing social impact theory (SIT) in a longitudinal setting to reveal how users react to identification and compliance effects during initial and post-adoption usage of gamified fitness apps.

Implementation of an Enhanced Recovery After Surgery Protocol for Cranial Vault Remodeling Procedures.

Enhanced recovery after surgery (ERAS) protocols have been implemented across surgical disciplines, including cranial vault remodeling for craniosynostosis. The authors aim to describe the implementation of an ERAS protocol for cranial vault remodeling procedures performed for patients with craniosynostosis at a tertiary care hospital. Institutional review board approval was received. All patients undergoing a cranial remodeling procedure for craniosynostosis at the authors' institution over a 10-year period were collected (n = 168). Patient and craniosynostosis demographics were collected as well as operative details. Primary outcome measures were intensive care unit length of stay (ICU LOS) and narcotic usage. Chi squared and independent t-tests were employed to determine significance. A significance value of 0.05 was utilized. During the time examined, there were 168 primary cranial vault remodeling procedures performed at the authors' institution - all of which were included in the analysis. Use of the ERAS protocol was associated with decreased initial 24-hour morphine equivalent usage (p < 0.01) and decreased total morphine equivalent usage (p < 0.01). Patients using the ERAS protocol experienced a shorter ICU LOS (p < 0.01), but the total hospital length of stay was unchanged. This study reiterates the benefit of developing and implementing an ERAS protocol for patients undergoing cranial vault remodeling procedures. The protocol resulted in an overall decreased ICU LOS and a decrease in narcotic use. This has implications for ways to maximize hospital reimbursement for these procedures, as well as potentially improve outcomes.

Implementation of an Enhanced Recovery After Surgery Protocol for Cleft Palate Repair

Objective This study examines an Enhanced Recovery After Surgery (ERAS) protocol for patients with cleft palate and hypothesizes that patients who followed the protocol would have decreased hospital length of stay and decreased narcotic usage than those who did not. Design Retrospective cohort study. Setting The study takes place at a single tertiary children's hospital. Patients All patients who underwent cleft palate repair during a 10-year period (n = 242). Interventions All patients underwent cleft palate repair with the most recent cohort following a new ERAS protocol. Main Outcome Measures Primary outcomes included hospital length of stay and narcotic usage in the first 24 hours after surgery. Results Use of local bupivacaine during surgery was associated with decreased initial 24-hour morphine equivalent usage: 2.25 vs 3.38 mg morphine equivalent (MME) (P &lt; 0.01), and a decreased hospital length of stay: 1.71 days vs 2.27 days (P &lt; 0.01). The highest 24-hour morphine equivalent a patient consumed prior to the ERAS protocol implementation was 24.53 MME, compared with 6.3 MME after implementation. Utilization of the ERAS protocol was found to be associated with a decreased hospital length of stay: 1.67 vs 2.18 days (P &lt; 0.01). Conclusions Use of the proposed ERAS protocol may lead to lower narcotic usage and decreased length of stay.

The influence of app function evolution on transport SuperApp use behaviour over time

AbstractIn the past few decades, there has been a significant increase in smartphone apps that are designed to help users optimise their daily activities. As a result, there has been a noticeable impact on travel demand. Some of these apps have evolved with the incorporation of additional functions in a gradual transformation into multi-function apps or SuperApps, thereby providing users with more integrated and personalised services for a wider range of activities. Focusing on Transport SuperApps (TSA) in Indonesia, this study aims to investigate how app usage behaviour interacts with the evolving functions of these apps over time. The study further examines the influence of personality traits, socio-demographic factors, and residential location on app usage patterns. In this study, longitudinal data on TSA usage from 2015–2022 was collected from users in four Indonesian cities. The Latent Markov (LMM) and Negative Binomial (NBM) Models were used to analyse the transition of behaviours, app types, and the number of apps used. The findings reveal that transport and shopping services are the most popular and consistently utilised services by users. The results suggest that the introduction of new services has a positive impact on the number of TSA services used. However, some services were found to be used only temporarily, primarily serving as alternatives to support users’ daily needs and desires. Initial higher service usage was observed among educated users with sociable and disorganised personalities, while discontinuation of usage is associated with older users and affluent households. Higher transition and continuation to use more services are also observed in larger cities like Jakarta compared to smaller cities like Cianjur.

Delay from Onset of Symptoms to Reporting at a Cancer Care Facility and the Impact of Alternate Medicine Usage as a Contributing Factor

Cancer patients often present after a period of certain delay from onset of symptoms. By tradition, alternate medicine has been the commonly sought after remedy for them. The objective of this study was to evaluate the delay in presentation to a cancer care facility, with respect to advanced stage at diagnosis and the use of alternate medicine. A cross-sectional study was undertaken in a tertiary care hospital from eastern India over 5 months where patients with cytological or histological proof of malignancy were interviewed using a pretested questionnaire. Comparative analysis was done with cross tables along with Kruskal–Wallis test for association between delay and the independent variables (demographic parameters and alternate medicine usage). Predictors for delay were assessed with logistic regression analysis. Spearman's rank test was used to measure the direction and strength of correlation of delay and alternate medicine use against stage at presentation. One-thousand twenty-two subjects were interviewed of whom 61.44% presented in advanced stage (either stage III and IV). About 56.1% patients had 4 to 6 months delay, while 19.1% patients presented after more than 6 months. About 27.5% patients had history of initial alternate medicine usage. Progressive increase in subjects presenting in advanced stage was observed with corresponding increase in delay, from 62.63% in more than 1 month delay to 80.48% in more than 3-month delay and 98.47% in those having more than 6-month delay. More of alternate medicine users presented with significant delay versus who did not (96.08 vs. 67.34% for &gt;3 months delay) and the difference further increased with longer delay. About 89.67% of those who had used alternate medicine presented in advanced stage. Among them, this percentage progressively escalated with increase in delay period. Positive correlation between delay (ρ = 0.742 for total sample) and (ρ = 0.592 for alternate medicine users) advanced stage was observed. This study found a considerably high occurrence of delay in presentation among cancer patients after onset of symptoms. This delay was strongly associated with advanced stage at diagnosis and alternate medicine use initially. It provides substantial information to formulate policies for implementing awareness on symptoms of cancer and benefits of its early detection.

Potential of Bamboo Leaf Ash for Soil Stabilization - Literature Review

Soil stabilization is an important topic in geotechnical engineering as many problematic soils were found during construction. One of the commonly used soil stabilization is cement, but it is widely known as a non-sustainable material. Much research provided the usage of industrial waste as a substitute for cement, which is then known as a supplementary cementitious material (SCM). One of the alternatives is bamboo, which has the second highest silica content after rice husk. This paper conducted a literature review on the potential of using bamboo leaf ash (BLA), which is the main composition of silica in bamboo. Various studies indicated the usage of BLA, ranging from its initial usage in concrete to its development in soil stabilization. Five studies were pointed out as the extensive research of BLA usage in Nigeria, focusing on lateritic soils. The results indicated that stabilizing lateritic soils with BLA increases the CBR values and the bearing capacity, whereas it decreases plasticity index values. Later studies followed by using other types of soils. The results are all consistent, where the shear strength of soil and CBR values increases with the usage of BLA as SCM.

Analysis of the factors influencing prognosis of the adult in-hospital cardiac arrest

To explore the factors influencing prognosis of patients with in-hospital cardiac arrest (IHCA). A retrospective observational study was conducted. The clinical data of patients who developed IHCA and underwent cardiopulmonary resuscitation (CPR) at the Second Xiangya Hospital of Central South University from January 1, 2016, to December 31, 2022 were analyzed. The patients' information, including gender, age, medical history, pre-cardiac arrest related parameters [1-hour pre-cardiac arrest neurological function, 24-hour pre-cardiac arrest hemoglobin (Hb) levels, 1-hour pre-cardiac arrest vital signs], initial CPR-related factors (implementation time and location, initial rhythm, ventilation method, defibrillation and resuscitation drugs) as well as restoration of spontaneous circulation (ROSC) related parameters (vital signs at ROSC and 1 hour after ROSC, 24-hour post-cardiac arrest Hb, and IHCA events), were collected through the hospital's electronic medical record system. The clinical data were compared between ROSC and non-ROSC patients as well as between patients with favorable neurological function [cerebral performance category (CPC) grades 1-2] and unfavorable neurological function (CPC grades 3-5) at 28 days. The factors with statistical significance in univariate analysis and clinical significance were enrolled in a binary multivariate Logistic regression model to analyze the influencing factors of ROSC and neurological function at 28 days after ROSC. The predictive value of factors influencing neurological function at 28 days was assessed using receiver operator characteristic curve (ROC curve). A total of 277 IHCA-CPR patients were enrolled, of which 230 achieved ROSC (83.0%) and 47 were not achieved (17.0%). Compared with non-ROSC patients, ROSC patients had lower prevalence of cerebrovascular disease history and proportion of adrenaline usage, but a higher proportion of initial shockable rhythms. In the multivariate Logistic regression analysis, it was found that using a bag-mask ventilation+endotracheal intubation (compared with a bag-mask ventilation alone) was beneficial for achieving ROSC in IHCA-CPR patients [odds ratio (OR) = 2.895, 95% confidence interval (95%CI) was 1.204-6.962, P = 0.018], while a initial non-shockable rhythm was not conducive to achieving ROSC in IHCA-CPR patients (OR = 0.349, 95%CI was 0.147-0.831, P = 0.017). Among the 230 ROSC patients, 42 had good neurological function at 28 days (18.3%), and 188 had poor neurological function (81.7%). Compared with the patients with good neurological function, the patients with the poor neurological function were older and had a higher prevalence of 1-hour pre-cardiac arrest neurological dysfunction and low perfusion, initial non-shockable rhythms, endotracheal intubation, and usage of adrenaline, vasopressors and sodium bicarbonate, a lower proportion of defibrillation and antiarrhythmic medication usage as well as lower 24-hour post-cardiac arrest Hb levels. The multivariate Logistic regression analysis revealed that female (OR = 6.449, 95%CI was 1.837-22.642, P = 0.004), older age (OR = 1.054, 95%CI was 1.017-1.093, P = 0.004), 1-hour pre-cardiac arrest neurological dysfunction (OR = 25.044, 95%CI was 2.737-229.169, P = 0.004), 1-hour pre-cardiac arrest low perfusion (OR = 3.880, 95%CI was 1.306-11.524, P = 0.028), endotracheal intubation (compared with a bag-mask ventilation; OR = 8.712, 95%CI was 1.402-54.141, P = 0.020) and face mask+endotracheal intubation during CPR (compared with a bag-mask ventilation; OR = 11.089, 95%CI was 3.482-35.320, P = 0.000), IHCA events > 1 time (OR = 4.221, 95%CI was 1.249-14.226, P = 0.020) were positively associated with poor neurological function at 28 days, which were independent risk factors those were not conducive to 28-day neurological function recovery after ROSC in IHCA-CPR patients. In contrast, usage of antiarrhythmic medication (OR = 0.345, 95%CI was 0.134-0.890, P = 0.028) and 24-hour post-cardiac arrest Hb (OR = 0.983, 95%CI was 0.966-0.999, P = 0.043) were negatively associated with poor neurological function at 28 days, which were protective factors those were beneficial for the recovery of neurological function. ROC curve analysis showed that the area under the ROC curve (AUC) of 24-hour post-cardiac arrest Hb for predicting poor neurological function at 28 days after ROSC in IHCA-CPR patients was 0.659 (95%CI was 0.577-0.742), with a cut-off value of 99.5 g/L (sensitivity was 76.2%, specificity was 57.8%). Defibrillation and tracheal intubation during CPR are crucial for IHCA patients. It was also observed that patients with low Hb (< 99.5 g/L should be of high concern), older age, 1-hour pre-cardiac arrest neurological function and hypoperfusion, and IHCA events > 1 time were significantly related to unfavorable neurological outcome in adult resuscitated patients with IHCA.

Enhancing Communication in Critically Ill Patients with a Tracheostomy: A Systematic Review of Evidence-Based Interventions and Outcomes.

Tracheostomy, a common procedure performed in intensive care units (ICU), is associated with communication impairment and affects patient well-being. While prior research has focused on physiological care, there is a need to address communication needs and quality of life (QOL). We aimed to evaluate how different types of communication devices affect QOL, speech intelligibility, voice quality, time to significant events, clinical response and tolerance, and healthcare utilization in patients undergoing tracheostomy. Following PRISMA guidelines, a systematic review was conducted to assess studies from 2016 onwards. Eligible studies included adult ICU patients with a tracheostomy, comparing different types of communication devices. Data were extracted and synthesized to evaluate QOL, speech intelligibility, voice quality, time to significant events (initial communication device use, oral intake, decannulation), clinical response and tolerance, and healthcare utilization and facilitators/barriers to device implementation. Among 9,228 studies screened, 8 were included in the review. Various communication devices were employed, comprising both tracheostomy types and speaking valves, highlighting the multifaceted nature of interventions. Quality of life improvements were observed with voice restoration interventions, but challenges such as speech intelligibility impairments were noted. The median time for initial communication device usage post-intervention was 11.4 ± 5.56 days. The median duration of speech tolerance ranged between 30-60 minutes to 2-3 hours across different studies. Complications such as air trapping or breathing difficulties were reported in 15% of cases. Additionally, the median ICU length of stay post-intervention was 36.5 days. Key facilitators for device implementation included early intervention, while barriers ranged from service variability to physical intolerance issues. Findings demonstrate that various types of communication devices can significantly enhance the quality of life, speech intelligibility, and voice quality for patients undergoing tracheostomy, aligning with the desired outcomes of improved clinical response and reduced healthcare utilization. The identification of facilitators and barriers to device implementation further informs clinical practice, suggesting a tailored, patient-centered approach is crucial for optimizing the benefits of communication devices in this population.

A Survey of Consortium Blockchain and Its Applications

Blockchain is a revolutionary technology that has reshaped the trust model among mutually distrustful peers in a distributed network. While blockchain is well-known for its initial usage in a public manner, such as the cryptocurrency of Bitcoin, consortium blockchain, which requires authentication of all involved participants, has also been widely adopted in various domains. Nevertheless, there is a lack of comprehensive study of consortium blockchain in terms of its architecture design, consensus mechanisms, comparative performance, etc. In this study, we aim to fill this gap by surveying the most popular consortium blockchain platforms and assessing their core designs in a layered fashion. Particularly, Byzantine fault tolerant (BFT) state machine replication (SMR) is introduced to act as a basic computational model of consortium blockchain. Then the consortium blockchain is split into the hardware layer, layer-0 (network layer), layer-I (data layer, consensus layer and contract layer), layer-II protocols, and application layer. Each layer is presented with closely related discussion and analysis. Furthermore, with the extraction of the core functionalities, i.e., robust storage and guaranteed execution, that a consortium blockchain can provide, several typical consortium blockchain-empowered decentralized application scenarios are introduced. With these thorough studies and analyses, this work aims to systematize the knowledge dispersed in the consortium blockchain, highlight the unsolved challenges, and also indicate the propitious avenues of future work.

The impact of the 2019 ESC/EAS dyslipidaemia guidelines on real-world initial lipid-lowering therapy in patients with acute myocardial infarction.

This study aimed to investigate the impact of the latest guidelines on the real-world clinical practice of initial lipid-lowering therapy, especially on the use of ezetimibe and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors in China. All adult patients diagnosed with acute myocardial infarction in our hospital between August 31, 2018, and August 31, 2020, were divided into the following 2 groups: those patients treated before the latest guideline release, and those patients treated after the release. A propensity score-matched method was used, and logistic regression was used to assess the association with intensive statin, ezetimibe and PCSK9 inhibitor usage together with treatment results between the 2 groups. A total of 325 patients were enrolled in this study, including 141 patients who were admitted before the release of the latest guideline and 184 patients who were admitted after the release. After a median follow-up time of 8.20 months, the mean low-density lipoprotein cholesterol was 1.87 ± 0.59 mmol/L (1.87 ± 0.55 in the before group vs 1.88 ± 0.62 in the after group, P = .829). After propensity score matching, the initial usage of intensive statin therapy was decreased after guideline release without statistical significance (17.00% vs 28.00%, P = .090), whereas the usage of ezetimibe and PCSK9 inhibitors was increased (19.00% vs 8.00%, P = .039; and 10.00% vs 3.00%, P = .085, respectively). In logistic regression models, the release of the guideline was associated with a statistically significantly increased use of ezetimibe (odds ratio [OR]: 1.91; 95% confidence interval [CI]: 1.21, 3.02; P = .005), a marginally decreased use of intensive statins (OR: 0.68; 95% CI: 0.45, 1.03; P = .069) and a marginally increased use of PCSK9 inhibitors (OR: 1.31; 95% CI: 0.98, 1.76; P = .068). In this single-center, real-world data analysis, after the release of the 2019 European Society of Cardiology/European Atherosclerosis Society guidelines, an increasing number of patients with a recent acute myocardial infarction were initially receiving ezetimibe and PCSK9 inhibitors.

(102) A Preliminary Analysis of Outcomes and Complication Rates for Patients Undergoing Inflatable Penile Prosthesis Implantation Following Intracavernosal Injection Therapy With or Without Concurrent Anticoagulation

Abstract Introduction Medications, namely antiplatelets (AP) and anticoagulation (AC), are effective at avoiding fatal vascular complications and prolonging the lives of our patients. As such, more and more men seeking treatment for erectile dysfunction (ED) also take blood thinners. This is an interaction we must better understand to provide safe, individualized care to our patients and minimize peri-operative morbidity. Currently, there is no published information on whether differences exist in the escalation of treatment for patients with erectile dysfunction and on AC. A previous study has demonstrated no statistically significant difference in complications between AC and non-AC groups while on ICI, despite there being a higher rate of absolute bleeding events for AC patients. Objective To compare outcomes and complication rates in patients undergoing IPP implantation following ICI therapy with or without concurrent anticoagulation. Methods A retrospective observational study was undertaken. Electronic patient records from January to September 2021 were reviewed. Included patients were those who had either currently or previously utilized ICI therapy for ED treatment. ICI therapy surveys and Erectile Dysfunction Inventory for Treatment Satisfaction (EDITS) questionnaire were obtained. 85 patients met the inclusion criteria; 43 concurrently using AC during ICI therapy and 42 with no AC use. Patients who were unable to completely stop their AC medications a week before surgery due to cardiovascular concerns or recommendations, underwent bridging with a shorter half life and reversible AC. Extra measures taken during the IPP for such patients, including meticulous hemostasis, compression dressing and drain insertion. Additional data regarding IPP implantation as well as any complications or infections experienced following IPP surgery which were compared between the AC and no AC groups. Results Patient demographics, IPP implantation information and subsequent complication rates are listed below in Table 1. There was no statistically significant difference in the rate of patients who underwent IPP placement between the AC and no AC cohorts. Moreover, there was also no statistically significant difference in median time from date of initial ICI usage to time of IPP placement as well as median time from IPP placement to last follow-up. Among the 12 total patients who underwent IPP placement, none experienced any complications, including infection, mechanical failure, device removal or revision at any time point up to last follow-up (longest was 18 months). No statistically significant differences in EDITS score between both groups was observed. Conclusions These preliminary findings, while requiring large-scale follow up, show that there is no statistically significant difference in rate of patients opting for IPP surgery following initiation of ICI therapy regardless of concomitant AC usage as well as the rate of complications following IPP implantation. Lastly, there is no drawbacks in performing such procedure in this specific cohort of patients, provided that all necessary measures are taken into consideration to minimize bleeding complications. Disclosure No.

(390) A Preliminary Analysis of Outcomes and Complication Rates for Patients Undergoing Inflatable Penile Prosthesis Implantation following Intracavernosal Injection Therapy With or Without Concurrent Anticoagulation

Abstract Introduction Medications, namely antiplatelets (AP) and anticoagulation (AC), are effective at avoiding fatal vascular complications and prolonging the lives of our patients. As such, more and more men seeking treatment for erectile dysfunction (ED) also take blood thinners. This is an interaction we must better understand to provide safe, individualized care to our patients and minimize peri-operative morbidity. Currently, there is no published information on whether differences exist in the escalation of treatment for patients with erectile dysfunction and on AC. A previous study has demonstrated no statistically significant difference in complications between AC and non-AC groups while on ICI, despite there being a higher rate of absolute bleeding events for AC patients. Objective To compare outcomes and complication rates in patients undergoing IPP implantation following ICI therapy with or without concurrent anticoagulation. Methods A retrospective observational study was undertaken. Electronic patient records from January to September 2021 were reviewed. Included patients were those who had either currently or previously utilized ICI therapy for ED treatment. ICI therapy surveys and Erectile Dysfunction Inventory for Treatment Satisfaction (EDITS) questionnaire were obtained. 85 patients met the inclusion criteria; 43 concurrently using AC during ICI therapy and 42 with no AC use. Patients who were unable to completely stop their AC medications a week before surgery due to cardiovascular concerns or recommendations, underwent bridging with a shorter half life and reversible AC. Extra measures taken during the IPP for such patients, including meticulous hemostasis, compression dressing and drain insertion. Additional data regarding IPP implantation as well as any complications or infections experienced following IPP surgery which were compared between the AC and no AC groups. Results Patient demographics, IPP implantation information and subsequent complication rates are listed below in Table 1. There was no statistically significant difference in the rate of patients who underwent IPP placement between the AC and no AC cohorts. Moreover, there was also no statistically significant difference in median time from date of initial ICI usage to time of IPP placement as well as median time from IPP placement to last follow-up. Among the 12 total patients who underwent IPP placement, none experienced any complications, including infection, mechanical failure, device removal or revision at any time point up to last follow-up (longest was 18 months). No statistically significant differences in EDITS score between both groups was observed. Conclusions These preliminary findings, while requiring large-scale follow up, show that there is no statistically significant difference in rate of patients opting for IPP surgery following initiation of ICI therapy regardless of concomitant AC usage as well as the rate of complications following IPP implantation. Lastly, there is no drawbacks in performing such procedure in this specific cohort of patients, provided that all necessary measures are taken into consideration to minimize bleeding complications. Disclosure No.

Subsidy, tax or green awareness: Government policy selection for promoting initial shore power usage and sustaining long-run use

Shore power (SP) can provide electricity from the land for ships instead of from ship engines; this approach can eradicate carbon emissions and foster green port development. However, due to the high SP installation cost and high electricity prices faced by shipping operators, the utilization rate of SP is still low. For the government, it is important and urgent to develop an effective policy to promote shore power usage. However, previous studies have not compared the effects of different government policies and have ignored the differences in SP usage stages. Therefore, in this study, three kinds of policies, subsidy, carbon tax and shipper green awareness improvement, are taken into consideration. The SP usage process is divided into two stages, namely, stimulating ship retrofitting for SP in the short term and sustaining SP usage in the long run. The purpose of this study is to provide policy-selection suggestions for short- and long-term SP promotion. Considering shipping supply chain competition, game theory is applied, and a series of Nash game models are formulated to investigate the equilibrium strategies of shipping operators on SP usage under different policies. A comparison of the results reveals that in the short run, the subsidy policy is superior to the carbon tax policy when both can promote SP usage. However, a moderate carbon tax is able to remedy the failure of subsidies. In the long run, a carbon tax may promote SP at the cost of diminishing social welfare. Improving shipper green awareness is more likely to be a preferable choice for both SP usage and social welfare. This paper also analyses the impacts of scale-based port congestion and green awareness. These findings can provide valuable suggestions for government and shipping operators to promote SP usage, reduce emissions and achieve the goal of green port construction.

A jingmenvirus RNA-dependent RNA polymerase structurally resembles the flavivirus counterpart but with different features at the initiation phase.

Jingmenviruses are a category of emerging segmented viruses that have garnered global attention in recent years, and are close relatives of the flaviviruses in the Flaviviridae family. One of their genome segments encodes NSP1 homologous to flavivirus NS5. NSP1 comprises both the methyltransferase (MTase) and RNA-dependent RNA polymerase (RdRP) modules playing essential roles in viral genome replication and capping. Here we solved a 1.8-Å resolution crystal structure of the NSP1 RdRP module from Jingmen tick virus (JMTV), the type species of jingmenviruses. The structure highly resembles flavivirus NS5 RdRP despite a sequence identity less than 30%. NSP1 RdRP enzymatic properties were dissected in a comparative setting with several representative Flaviviridae RdRPs included. Our data indicate that JMTV NSP1 produces characteristic 3-mer abortive products similar to the hepatitis C virus RdRP, and exhibits the highest preference of terminal initiation and shorter-primer usage. Unlike flavivirus NS5, JMTV RdRP may require the MTase for optimal transition from initiation to elongation, as an MTase-less NSP1 construct produced more 4-5-mer intermediate products than the full-length protein. Taken together, this work consolidates the evolutionary relationship between the jingmenvirus group and the Flaviviridae family, providing a basis to the further understanding of their viral replication/transcription process.

Optimization of Initial Cell Density and Usage Efficiency of Seed Culture Medium During Lipid Production from Distillery Wastewater by Rhodosporidium toruloides

For the environmentally sustainable development, the recovery of resource or energy from wastes has attracted worldwide attention in recent years. The wastewater produced from distillery is more difficult to treat than the domestic wastewater due to the high organic loads. This study explores the possibility of developing a process, which could produce microbial lipid convertible to biodiesel by recovering nutrients from non-sterile wastewater while simultaneously removing part of organic matters through cultivating oleaginous microorganisms. Especially, it is intended to further optimize the initial cell density and the usage efficiency of seed culture medium. The lipid productivity by oleaginous yeast Rhodosporidium toruloides was studied using wastewater from rice wine distillery, at 30ºC under different initial cell densities (2 x 107, 1 x 107, 0.8 x 107, and 0.5 x 107 cells/mL) and incubation periods (2-5 days). Chemical oxygen demand (COD) removal efficiency, cell yield, and lipid yield were analyzed and the potential for bioenergy recovery from wastewater was assessed. The seed culture medium was found reusable for the second time without the addition of extra nutrient and possible for the third time with the addition of glucose.