Longer Duration Of Time Research Articles

Pengaruh Suplementasi Fe dan Vitamin C terhadap Hemoglobin dan Indeks Eritrosit Remaja Putri

Teenager girls are at risk of suffering from iron nutritional anemia. Anemic teenage girls also have less vitamin C intake. Anemia has an impact on learning achievement, ease of infection and impact when pregnant in the future. The study aimed to find out the effect of giving Fe and vitamin C tablets. The research design was a one-group pre-post test, using 41 Health Analyst female students from Tanjungkarang Health Polytechnic, which were determined by random sampling. Blood added tablets containing 60mg Fe, 400mcg folate, and 500mg vitamin C tablets were given once/week for 17 days (3 tablets). Hb levels were measured before and after supplementation using a digital analyzer MINDRAY BC-3600. Data collection was conducted from August-September 2020. The proportion of Hb <12mg/dl decreased from 20 (48,78%) at before to 16 (39,02%) subject after supplementation. The mean Hb level before supplementation was 12,15mg/dl, MCV 80,11fL, MCH 25,85 lpg and MCHC 32,22% and after supplementation, the mean of Hb was 12,05mg/dl, MCV 79,83 MCH 26,45, and MCHC 33,07. The results of statistic test showed that supplementation had a significant effect on Hb levels (p-value=0,000) MCV (p-value=0,000), MCH (p-value=0,000), and MCHC (p-value=0,000). Supplementation can reduce the proportion of anemia and improve the erythrocyte index. Another research with longer duration time and nutritional education combination is needed to confirm the increasing of nutrient intake (Fe, vitamin C) and Hb level.

Particle behavior in a turbulent flow within an axially corrugated geometry

In this numerical study particle behavior inside a sinusoidal pipe geometry is analyzed. The 3D geometry consists of three identical modules, with a periodic boundary condition applied to the flow in the stream wise direction. The incompressible, turbulent gas flow is modeled using a Large Eddy Simulation (LES) approach. Furthermore, the particle dynamics are simulated using a Lagrangian point force approach incorporating the Stokes drag and slip correction factor. Four different sizes of particles, corresponding to a Stokes number less than unity, are considered along with two different inflow conditions: continuous and pulsatile. The pulsatile inflow has an associated flow frequency of 80 Hz. The fluid flow through the sinusoidal pipe is characterized by weak flow separation in the expansion zones of the sinusoidal pipe geometry, where induced shear layers and weak recirculation zones are identified. Particle behavior under the two inflow conditions is quantified using particle dispersion, particle residence time, and average radial position of the particle. No discernible difference in the particle behavior is observed between the two inflow conditions. As the observed recirculation zones are weak, the particles are not retained within the cavities for a long duration of time, thereby reducing their likelihood of agglomerating.

A review on the impact of thermal history on compacted bentonite in the context of nuclear waste management

A deep geological repository is the most sustainable way to dispose of high-level radioactive waste. It consists of a multi-barrier system with waste containing canister, sealing material, and geology that avails a facility to provide the long-term isolation of these harmful wastes. The bentonite or sand bentonite blocks serve as a sealing material in the DGR around the waste canisters to isolate them from the surrounding atmosphere. Buffer surrounding the waste canister experiences variation in the temperature for a long duration due to the continuous reduction in the radioactivity and the temperature emitted by the element with time. The thermal flux is induced on the compacted bentonite when a high-temperature waste canister comes in contact with the bentonite buffer and due to seasonal temperature change resulting from a heat source for a long time. As the temperature inside the deep geological repository varies with a long duration of time, it creates a thermal history on the bentonite buffer and changes its physicochemical and hydromechanical properties affecting its overall performance to serve as a sealant. Past reported studies had mentioned the influence of temperature on the various bentonites, but the effect of thermal history on bentonite efficiency is rarely reported. This study presents a review of existing knowledge about the high-temperature impact on bentonite buffer behavior. It has critically investigated the impact of temperature on the physicochemical, hydromechanical, and mineralogical characteristics of bentonite. Further, the analyses are made on the influence and importance of thermal history to be considered while designing the buffer material from few recently reported studies. The physicochemical and hydromechanical properties such as Atterberg’s limits or swell pressure reduced when subjected to heat. It further reduced when time also came into the picture along with the temperature, i.e., thermal history. Such research will be very helpful and will help better understand the different physicochemical and hydromechanical reactions in a bentonite buffer before its designed values are established as part of the engineering barrier systems in the deep-geological repository.

Functionally Graded Material Coatings (FGMC) – A Review

The coatings are substances that are applied over the surface of an object to prevent it from wear, tarnish and corrosion. Coatings maintain the properties of base metals (thermal, optical and electrical) over a long duration of time. The coatings are generally characterized by the properties like good adhesion, low porosity and substrate compatibility that include geometry and temperature. Coatings often suffer from problems like variable thermal expansion coefficient compared to their base metals. To overcome the variable thermal expansion issue, the functionally graded material (FGM) layers may be imposed. Present work aims to study the FGM coatings capable of enhancing the mechanical, thermal and tribological properties of base metals by providing scratch resistance. An attempt has been made to present a comprehensive review of high-velocity-oxy-fuel, plasma spray and other techniques adopted by industries and other groups. The effects of applying FGM coatings on the operating conditions and the performance of the base metals are also covered in detail.

Effect of Various Categories of Government Expenditure on Economic Growth in Kenya

In Kenya, government expenditure has been changing tremendously in its composition and size. Noticeably, since Kenya’s independence, government expenditure has witnessed great expansion. However, the country has not achieved consistent economic growth for a long duration of time. Despite the increase in allocation of resources through increasing public spending, economic growth has not grown at the same rate. As such, economic growth did not consummate with the increase in allocation of resources through government expenditure. The study sought to determine the effect of education expenditure, defense expenditure, health expenditure and infrastructure expenditure on economic growth. It used an explanatory research design and secondary time-series data for the period between 1985 and 2018. Data on education expenditure, defense expenditure, health expenditure as well as infrastructure expenditure and economic growth was acquired from Kenya National Bureau of Statistics. The quantitative data was collected, edited and coded into Statistical software known as STATA version 14. Analysis of the quantitative data was based on descriptive as well as inferential statistics. Correlation analysis was employed to assess the strength of correlation between independent and dependent variables whereas regression analysis determined the weight of association between independent and dependent variables. Diagnostic test was performed to test for the regression model assumptions before carrying out regression analysis. The research focused on autocorrelation test, stationarity test, autocorrelation test, normality as well as heteroscedasticity test. The study revealed that education expenditure had a positive effect on economic growth in Kenya. The study found that defense expenditure had a positive effect on economic growth in Kenya. The results revealed that health expenditure had a positive effect on economic growth in Kenya. In addition, the study found that infrastructure expenditure had a positive effect on economic growth. The study concludes that government expenditure has a significant effect on economic growth in Kenya. The study policy implication of the study is that Kenyan government as well as policy makers should formulate policies and guidelines geared towards increasing education expenditure. This will help in ensuring adequacy in a trained, qualified and productive labor that is important in ensuring an improvement in economic growth. In addition, the government of Kenya should allocate at least 15 percent of their total expenditure to the healthcare so as to ensure a productive and healthy workforce. The government also needs to increase infrastructure funding as recommended by the World Bank to between 7 and 9 percent.

Understanding the experiences of hikikomori through the lens of the CHIME framework: connectedness, hope and optimism, identity, meaning in life, and empowerment; systematic review

BackgroundHikikomori is a phenomenon describing people who exhibit behaviors of self-secluding themselves at home for long durations of time and usually only having face-to-face social interactions with none other than family. Existing interventions for hikikomori are inconclusive and the majority are absent in using a theoretical framework to guide its components. Therefore, applicability of the psychosocial recovery framework of Connectedness, Hope and Optimism, Identity, Meaning in Life, and Empowerment (CHIME) towards hikikomori care was reviewed.MethodFive databases were searched in April 2020 with the search formula from a published systematic review on hikikomori combined with search terms specific to domains of the CHIME framework. Articles included in the review were of the English language, of all publication years, peer-reviewed, quantitative or qualitative research studies and case studies, included study designs that were observational or interventional in nature, and involved populations of socially withdrawn youth.ResultsCHIME’s comprehensive structure and organized approach could guide researchers or service providers in determining areas needing assessments, measurement, and areas of focus. It is suggested that the CHIME framework is applicable after modifying a specific dimension—‘meaning of mental illness experiences’ into ‘meaning of the hikikomori experience’. Thematic overlap occurred between the domains of connectedness, identity, and meaning. Yet, additional dimensions or domains such as trust building, non-linearity, and spatiality can be included for addressing specific limitations in this application, which would help towards catering services to help hikikomori in recovery or in increasing quality-of-life of those individuals’ while entrapped in this withdrawn lifestyle.ConclusionCHIME framework could be applicable towards hikikomori care after applying the suggested modifications. Additionally, many knowledge gaps were found in literature during this review that warrants further investigation to improve hikikomori care.

The Problems Confronting Historians in the Reconstruction of the History of Non-Literate Societies in Africa

Human occupation of Australia dates back to at least 65,000 years. Aboriginal ontologies incorporate deep memories of this past, at times accompanied by a conviction that Aboriginal people have always been there. This poses a problem for historians and archaeologists: how to construct meaningful histories that extend across such a long duration of space and time. While earlier generations of scholars interpreted pre-colonial Aboriginal history as static and unchanging, marked by isolation and cultural conservatism, recent historical scholarship presents Australia's deep past as dynamic and often at the cutting-edge of human technological innovation. This historiographical shift places Aboriginal people at the centre of pre-colonial history by incorporating Aboriginal oral histories and material culture, as well as ethnographic and anthropological accounts. This review considers some of the debates within this expansive and expanding field, focusing in particular on questions rel...

Establishing a core outcome measure for pain in patients with autosomal dominant polycystic kidney disease: a consensus workshop report.

BackgroundPain is the highest prioritized patient-reported outcome in people with autosomal dominant polycystic kidney disease (ADPKD) but remains infrequently and inconsistently measured in clinical trials and poorly managed in clinical settings. A recently completed systematic review of pain in ADPKD identified 26 different outcome measures. None of these measures were considered appropriate as a core outcome measure due to the lack of patient-important dimensions, inadequate content, relatively long duration of completion time and limited evidence to support psychometric robustness.MethodsWe convened an international Standardized Outcomes in Nephrology–Polycystic Kidney Disease consensus workshop involving 21 patients/caregivers and 40 health professionals (clinicians, nurses, researchers, policy makers and industry representatives) from 18 countries to discuss the identification or development of a core outcome measure for pain.ResultsFour themes were identified highlighting fundamental issues for the measurement of pain in ADPKD: distressing and disrupting life participation; variability and ambiguity in defining pain; stigma, frustration and adaptation to pain; and ensuring validity and feasibility of pain measures.ConclusionsExisting measures were found to be insufficient in capturing pain as a core outcome and there was consensus on the need for a new validated measure that is simple, succinct and addresses the impact of pain on life participation. This measure will facilitate the appropriate prioritization of pain in all trials and guide clinical decision making in people with ADPKD.

The role T1-weighted fluid attenuated inversion recovery (FLAIR) post contrast enhancement to improve image quality on MRI brain

In general, head MRI examinations are performed using the T1-weighted and T2-weighted sequence techniques. T1-weighted is used to see the anatomy of the brain while T2-weighted aims to see the pathology or abnormalities that occur in the brain. Some of the clinics that are often found in head MRI include tumors, meningitis, epilepsy, intracranial lesions, metastases and others. The use of T1-weighted FLAIR sequences has a long duration of time, but produces a good image and by adding contrast media can show more sensitive abnormalities and minor abnormalities. The aim of the study was to analyze the application of the T1-weighted FLAIR Contrast Enhancement sequence to be more informative than the T1-weighted Contrast Enhancement sequence. This study uses the Systematic Literature Review (SLR) method. There are 80 literatures that have been selected in the initial stage. It was then followed by an extraction process, which produced 10 selected references. There are three stages of extraction, namely looking at the abstract title, identifying inclusion criteria, and identifying exclusion criteria. The results of this study indicate that the T1-weighted FLAIR Contrast Enhancement sequence is more sensitive to minor lesion abnormalities such as clinical parenchymal lesions, meningitis and leptomeningeal inflammatory disease than T1-weighted Contrast Enhancement.

Adapting to Challenging Circumstances: Pessary Care in a Racially Diverse Urban Population Within a U.S. Epicenter of the COVID-19 Pandemic.

ObjectivesThe aim of the study was to describe time intervals between pessary maintenance visits in racially diverse women receiving care in a U.S. epicenter of the COVID-19 pandemic. We secondarily aimed to determine whether time interval between pessary changes is associated with adverse outcomes and to identify factors associated with adverse pessary outcomes.MethodsWe performed a retrospective study of women undergoing pessary care after the COVID-19 pandemic began. Time between the most recent visit before the pandemic and first visit after the pandemic began was recorded. Pessary care data were collected from the latter visit, including vaginal bleeding, vaginal discharge, and erosion. Patient-reported symptoms and demographics were also recorded. The relationship between time interval between pessary visits and adverse outcomes as well as between adverse outcomes and demographic data was assessed.ResultsWe identified 104 women undergoing pessary care, of which 35.6% were Hispanic and 32.7% were Black and 26.2% ± 10.5% lived in poverty. The median time to in-person visit was 4.5 months (interquartile range, 3.7–5.3 months). Seven women (8.7%) had vaginal bleeding, 15 (14.6%) had vaginal discharge, and 7 (6.8%) had erosions. There was no significant association between time interval between pessary visits and adverse outcomes or between adverse outcomes and patient characteristics (all P > 0.05).ConclusionsLonger duration of time between pessary maintenance visits is not associated with increased adverse outcomes in this group of racially diverse women. Extended intervals between pessary visits can be considered to minimize risk and maintain patient safety during challenging circumstances, such as the COVID-19 pandemic.

ANALYSIS OF SENSITIVITY OF TARGET TRACKING SYSTEMS TO EXTERNAL INTERFERENCE IN MULTICHANNEL RADARS WITH FIXED PARAMETERS

The multichannel and fixed parameters radars for tracking targets with the phased array antennas are widely used in modern military surveillance systems. The modular integration of a phased antenna array with digital processors allows to realize the command and control functions of antenna patterns for tracking multiple targets in the time resolution modes. Tracking of the air targets in range, radial speed and angular coordinates of evaluations and azimuth is provided by means of the multichannel radars without adaptation modes to the characteristics of external influences. Thus, adjusting the algorithms of tracking systems to the maximum maneuverability of the air targets can lead to a significant reduction in the accuracy of surveillance in comparison with the potentially achievable accuracy for such radars of tracking the linear flight targets in the long duration of time. In the case of adjusting the algorithms of tracking systems to either low intensity of flying targets, or lack of the aircraft maneuvering, it is possible to significantly increase the error of the aircraft flying information, and as a result to have a disruption of tracking the air targets. The increase in the parameters of the tracking error in relation to the influence of external interference were obtained as a result of the study. As a result of research, it is possible to assess the feasibility of adapting to certain characteristics of external influences, and provide recommendations for selecting and fixing the parameters of algorithms of tracking systems to ensure their versatility to surveillance targets with both high maneuverability, and implementing the stealth technology.

Learning to teach mathematics with robots: Developing the ‘T’ in technological pedagogical content knowledge

A multiple case study was conducted to investigate how Lego robotics instruction incorporated into a middle grades mathematics methods course could inform pre-service teachers’ (PSTs) TPACK through the lens of Social Constructivist Theory. The qualitative data analysis revealed that when instruction on Lego robotics technology is integrated into semester long mathematics methods courses, PSTs are able to improve their TPACK knowledge in regard to the robotics. Overall, the findings suggest instruction of educational technology tools should be incorporated into methods courses over a longer duration of time, and in depth, to better support the development of PSTs’ TPACK. To meet the demands of the teacher shortages while simultaneously supporting the needs of school districts, this research provides preliminary evidence of the need to incorporate content-specific technology into all methods courses.

Description of Musculoskeletal Disorders and Work Position in Citrus Farmers at Sukoreno Village, Umbulsari District, Jember

Musculoskeletal disorder has related to ergonomics. Musculoskeletal disorders are caused by the habit of working position of farmers in carrying out their activities such as lifting or carrying heavy loads, doing repetitive movements and habits of wrong positions at work. The study purposed to identify the percentage of musculoskkeletal disorders and work position on citrus farmers in Sukoreno village, Umbulsari district, Jember. This study used a quantitative approach with 116 farmers using simple random sampling method. The questionnaire used in this study was the Nordic body map to determine musculoskeletal disorders and the Upper Extermity Work Demand Scale Revision (UEWD-R) to determine the habits of farmer's work position. The results showed that 60 farmers (51.7%) had high levels of musculoskeletal disorders and work position when harvesting citrus fruits had the highest average of 70.95% with a maximum value of 24. musculoskeletal disorders felt by Citrus farmers were caused by the work done manually with a long duration of time and requires excessive physical ability so that the impact of muscles that contract during work will caused pain in some of limbs.

Healthcare utilization and cost outcomes for a multicenter first seizure and new onset epilepsy clinic

RationaleA First Seizure/New Onset Epilepsy (FS/NOE) protocol was implemented to ensure proper evaluation by an epileptologist and improve overall care for patients. We compared healthcare utilization and cost incurred by patients pre and post protocol implementation. MethodsClinical data were retrospectively collected from the EMR and cost data from the financial database. Patients were identified by FS event and grouped into either the pre-implementation (pre-FSC) or post-implementation cohort (post-FSC). Pre-FSC patients were seen between January 2014–December 2015 and post-FSC between March 2016–January 2018. Utilization outcomes include time from FS to neurology appointment, MRI, and electroencephalogram (EEG). Cost outcomes included the annualized median difference in pre versus post costs for ER, inpatient, outpatient or ambulatory, and total hospital services. Cost and utilization outcomes were collected within 90 days or 6 months post first-seizure event. Pre and post cohorts were compared using Kaplan–Meier analysis and Cox proportional hazard models for time-to-event outcomes, multivariable median regression models for cost differences and negative binomial regression models for utilization analyses. Models were adjusted for age, sex, health insurance, and comorbidities. ResultsOne-hundred and fifty six patients were included with 84 (53.8%) pre- and 72 (46.2%) post-FSC patients. Kaplan–Meier and Cox regression results indicated post-FSC patients had significantly faster time-to-first neurology appointment (5.0 vs. 20.9 days, p < .001; Adjusted Hazard Ratio (HR) = 5.98, p < .001), time-to-MRI (9.0 vs. 27.0 days; p = 0.005; HR = 1.88, p = .021) and EEG (3.6 vs. 48.6 days, p < .001; HR = 9.01, p < .001). A total of 138 patients had at least one cost in the financial database. For 6-month follow-up period, post-FSC patients had higher adjusted all-cause total median costs (+$830, p = 0.009) and outpatient costs (+$1203, p < .001) but lower ED costs (−245, p = 0.073), not significant. Results were similar for seizure-related costs. Similarly, Post-FSC patients had a significantly higher likelihood of all-cause (Adjusted Rate Ratio (ARR) = 1.41, p = .029) and outpatient utilization (ARR = 1.72, p = .008) but lower ED utilization (ARR = 0.54, p < .001). ConclusionsImplementation of the FSC decreased time to evaluation by a neurologist and time to diagnostic workup. Ultimately, total healthcare costs and ambulatory costs increased but ED costs and utilization were reduced. It is our hypothesis that faster access to initial care and diagnosis would result in better control of seizures and reduce long-term costs and utilization. Further research over a longer duration of time across a broader population is needed to evaluate the full implications of an epilepsy specialist-populated FSC.

PLASMAPHERESIS IN THE TREATMENT OF MYASTHENIA GRAVIS: OUTCOME AND COMPLICATIONS

Objective: To assess the outcome and complications of plasmapharesis in treatment of myasthenia gravis and factors linked to poor outcome at hematology unit of a tertiary care teaching hospital of Pakistan&#x0D; Study Design: Prospective comparative study.&#x0D; Place and Duration of Study: Pak Emirates Military Hospital/Armed Forces Institute of Pathology, Rawalpindi, from Jan 2018 to Jul 2019.&#x0D; Methodology: A prospective study was conducted on patients of myasthenia gravis presented at our neurology department. All the complications of the procedure were recorded. Outcomes included recovery, shifting to intensive care unit and death. Pearson chi-square was applied to relate the factors with presence of complications or poor outcome.&#x0D; Results: Hypotension 3 (6%) was the commonest complication faced by the patients followed by chest discomfort 2 (4%) during or after the plasmapharesis. Out of 50 patients, 47 (94%) recovered, 8 (16%) had minor complications, 2 (4%) were shifted to the intensive care unit and 1 (2%) died. Long duration of time between onset of symptoms and first session of plasmapharesis had a significant relationship (p-value &lt;0.05) with presence of complications or poor outcome among the patients of myasthenia gravis undergoing plasmapharesis.&#x0D; Conclusion: Plasmapharesis emerged as effective treatment for this immune based neurological disorder with limited side effects. A neurologist should be aware of these common minor and rare major side effects and pay special attention to the patients with generalized myasthenia gravis and those with long duration of time between onset of symptoms and first session of plasmapharesis.Keywords: ,.

66 Prescribing Patterns of Opioids and Adjunctive Analgesics for Patients with Burn Injuries

Abstract Introduction Large quantities of analgesics are prescribed to control pain among patients with burn injuries and may lead to chronic use and dependency. This study aimed to determine whether patients are overprescribed analgesics at discharge and to identify factors that influence prescribing patterns. Methods A retrospective review of patient charts (n = 199) between July 1, 2015 - 2018 were reviewed from a registry at a single burn center. Opioid, neuropathic pain agent (NPAs), acetaminophen, and ibuprofen quantities given before and at discharge were compared. Linear mixed regression models were used to identify factors that increased the amount of analgesics prescribed among burn care providers. Results On average, patients were prescribed significantly more analgesics at discharge compared to what was consumed pre-discharge (p &amp;lt; 0.0001). Specifically, on average, providers did not overprescribe the daily dose of analgesics, but overprescribed the duration of pain medications required. For every increase in percent TBSA, 14 MEQ more opioids, 203 mg more NPAs, 843 mg more acetaminophen, and 126 mg more ibuprofen were prescribed (p &amp;lt; 0.05). Surgery was a predictor for higher opioid and NPA prescriptions (p = 0.03), while length of stay was associated with fewer NPAs prescribed (p = 0.04). Fewer ibuprofen were given to patients with a history of substance misuse (p = 0.01). Conclusions The quantity of analgesics prescribed at discharge varied widely and often prescribed for long durations of time. Standardized prescribing guidelines should be developed to optimize how analgesics are prescribed at discharge.

Association between dental extraction after radiotherapy and osteoradionecrosis: A multi-centre retrospective study.

Radiotherapy (RT) carries a substantial risk for the development of osteoradionecrosis (ORN) of the jaw. This study was performed to investigate the relationship between dental extractions after RT and the development of ORN. Thirty-two patients with head and neck cancer who underwent tooth extraction after RT were investigated for correlations between the development of ORN and various factors. Postextraction ORN was diagnosed in 12 (12.1%) teeth of 9 patients. The RT dose against the site of tooth extraction was 62.0 and 37.4Gy in the ORN and Non-ORN groups, respectively (p<.001). The duration from RT to tooth extraction was 41.2 and 28.2months in the ORN and Non-ORN groups, respectively (p=.025). Tooth extraction was significantly associated with ORN in patients with a high RT dose against the site (odds ratio=1.231) and a longer duration of time from RT (odds ratio=1.084). Extraction of non-restorable teeth and those with a poor prognosis should not necessarily be postponed even when patients are undergoing RT. However, clinicians should pay special attention to postoperative management after tooth extraction in patients with a high RT dose and longer time from RT.

A Step-by-Step Guide to Mosquito Electroantennography.

Female mosquitoes are the deadliest animals on earth, claiming the lives of more than 1 million people every year due to pathogens they transmit when acquiring a blood-meal. To locate a host to feed on, mosquitoes rely on a wide range of sensory cues, including visual, mechanical, thermal, and olfactory. The study details a technique, electroantennography (EAG), that allows researchers to assess whether the mosquitoes can detect individual chemicals and blends of chemicals in a concentration-dependent manner. When coupled with gas-chromatography (GC-EAG), this technique allows to expose the antennae to a full headspace/complex mixture and determines which chemicals present in the sample of interest, the mosquito can detect. This is applicable to host body odors as well as plant floral bouquets or other ecologically relevant odors (e.g., oviposition sites odorants). Here, we described a protocol that permits long durations of preparation responsiveness time and is applicable to both female and male mosquitoes from multiple genera, including Aedes, Culex, Anopheles, and Toxorhynchites mosquitoes. As olfaction plays a major part in mosquito-host interactions and mosquito biology in general, EAGs and GC-EAG can reveal compounds of interest for the development of new disease vector control strategies (e.g., baits). Complemented with behavioral assays, the valence (e.g., attractant, repellent) of each chemical can be determined.

Abstract PS10-09: Real-world analysis of concomitant medication use with potential drug-drug interactions (DDI) in patients with metastatic breast cancer (MBC) treated with cylin dependent kinase (CDK) 4/6 inhibitors

Abstract Background: In combination with endocrine therapy, the CDK4/6 inhibitors (CDK4/6i) ribociclib, palbociclib, and abemaciclib have improved progression free survival and in some cases overall survival in women with hormone receptor positive (HR+)/HER2 negative MBC. Use of concomitant medications and the potential for drug-drug interactions (DDI) is an important issue in clinical oncology, particularly among patients with MBC treated for long durations of time with CDK4/6i, and could lead to sub-optimal medication adherence or subsequent dose reductions/discontinuations. Objective: To describe concomitant medication use that could lead to DDI with CDK4/6i as well as CDK4/6i dosing, adherence, and discontinuation patterns in real-world clinical practice. Methods: Adult women with HR+/HER2- MBC initiating treatment with ribociclib, palbociclib, or abemaciclib as the first CDK4/6i (index therapy) were retrospectively identified from the Optum Clinformatics Data Mart (1/1/2017 - 9/30/2019), a large US healthcare claims database. Eligibility included 3 months of baseline (pre-index date) and at least 3 months of follow-up (post-index date) data. Concomitant medications (identified from the literature) evaluated at baseline included CYP3A inhibitors and inducers, P-glycoprotein (P-gp) inhibitors and inducers, and medications associated with risk of torsades de pointes (TdP). Treatment persistence was analyzed using Kaplan-Meier (KM) as time from index date to discontinuation, defined as an interruption of at least 90 consecutive days of the index treatment or end of patient enrollment or switch to another medication. Adherence was measured by proportion of days covered (PDC), using the recommended administration schedule of 21 days of treatment followed by 7 days off. Results: A total of 2,994 women were included: 184 initiated ribociclib as first CDK4/6i; 2,550 palbociclib; and 260 abemaciclib. Median duration of follow-up was 13.7 [Interquartile range (IQR)] 11.8); 13.1 (IQR 13.5); and 9.3 (IQR 9.2) months. The majority in each cohort were postmenopausal (ribociclib: 89.1%; palbociclib: 92.8%; abemaciclib: 90%) and received the index CDK4/6i as &amp;gt; 2nd line of therapy (ribociclib: 81.5%; palbociclib: 87.6%; abemaciclib: 88.9%). Mean age (66.4; 66.8; and 65.3 yrs) and National Cancer Institute comorbidity index [mean/SD: 1.2 (1.6); 1.2 (1.7); 1.1 (1.6)] were similar for the ribociclib, palbociclib, and abemaciclib cohorts, respectively. Patients with ≥ one concomitant medication (60.3%; 64.2%; 65.8%) and those with &amp;gt; one medication associated with TdP (57.1%; 59.4%; 61.9%) were similar for the 3 cohorts. The CDK4/6i discontinuation rates, starting dose, dose reduction, and adherence results are listed below (Table). Conclusions: Use of concomitant medications that could lead to a DDI with a CDK4/6i, especially those with risk of TdP, CDK4/6i treatment discontinuation, and adherence was similar between ribociclib, palbociclib, and abemaciclib in this real-world retrospective descriptive study. More patients in the ribociclib cohort maintained starting dose and less decreased to &amp;lt;50% of the starting dose compared to palbociclib and abemaciclib, although the cohort is small. Results are limited by the relatively smaller number in the ribociclib and abemaciclib cohorts. Descriptive analysis on characteristics in follow up period by index drug groupRibociclib (N = 184)Palbociclib (N = 2550)Abemaciclib (N = 260)Discontinuation of Index Treatment, n (%)96 (52.2)1266 (49.7)123 (47.3)Starting dose, mean (SD)532.6 (141.1)118.5 (13.4)287.7 (56.6)Patients with first time dose changeNo change during the entire follow up period, n (%)148 (80.4)1740 (68.2)176 (67.7)Decrease &amp;gt; 50%, n (%)7 (3.8)0 (0)5 (1.9)Decrease ≤ 50%, n (%)20 (10.9)773 (30.3)68 (26.2)Adherence (PDC), mean (SD)0.85 (0.2)0.87 (0.2)0.87 (0.2) Citation Format: Hope S. Rugo, Sanjeev Balu, Yunfeng Li, Guifang Chen, Xin Li, Stuart Turner, Roxana Sin. Real-world analysis of concomitant medication use with potential drug-drug interactions (DDI) in patients with metastatic breast cancer (MBC) treated with cylin dependent kinase (CDK) 4/6 inhibitors [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS10-09.

Rate and Predictors of Neonatal Jaundice in Northwest Ethiopia: Prospective Cohort Study.

BackgroundNeonatal jaundice is one of the most common clinical disorders occurred worldwide. About 1.1 million neonates develop jaundice per year globally and the vast majority of them found in sub-Saharan Africa and South Asia. There is a paucity of evidence on the incidence rate and predictors of neonatal jaundice in Ethiopia. Therefore, this study was aimed at determining the rate and predictors of neonatal jaundice in the northwest, Ethiopia.MethodsA prospective cohort study design was conducted at Debre Markos comprehensive, specialized Hospitals using 334 neonates from October 1, 2019, to June 30, 2020. Using a systematic random sampling technique, the study subjects were drawn. Data were entered into the Epi-DataTM Version 4.2 and analyzed using STATATM Version 14.0. The Kaplan-Meier survival curve was used to estimate the survival time. A generalized Log rank test was used to compare the survival curves of different categorical variables. Finally, both bi-variable and multivariable Cox-proportional hazards regression models were used to identify the predictors of neonatal jaundice.The ResultsThe overall incidence rate of jaundice among neonates was 4.5 per 100 person-hours. Long duration of labor [ARR = 3.5; 95% confidence interval (CI), (2.8–8.7)], being male neonates [ARR= 5.2; 95% CI (3.5–7.3)], “O” blood group mothers [ARR = 4.5; 95% CI (3.4–10.3)], and having neonatal sepsis 3.4 [ARR=3.4; 95% CI: (2.5–6.1)] were predictors.ConclusionThe incidence rate of jaundice was higher in this study than the finding of the previous one. Being male, prolonged duration of labor, “O” blood group mothers and sepsis were the significant predictors. Hence, an effort has to be made to decrease the incidence rate of neonatal jaundice through improving newborn care and timely intervention for neonates with sepsis and delivered at a long duration of time as well as the neonates born from “o” blood type mothers are our recommendation.