Post Completion Research Articles

672P Nivolumab (Nivo) and ipilimumab (Ipi) combined with radiotherapy (RT) in patients (pts) with locally advanced squamous cell carcinoma of the head and neck (LA SCCHN): Updated results on efficacy and correlative analysis

Immune checkpoint inhibitors are standard of care in recurrent/metastatic SCCHN. We evaluated concurrent radioimmunotherapy (RIT) with Nivo and Ipi in the definitive setting for patients with high-risk LA SCCHN. Pts with newly diagnosed, AJCC 7th edition stage IVA-IVB SCCHN of the oropharynx (OP; OP HPV+ were T4, N2c or N3), hypopharynx, and larynx that were eligible for chemotherapy received Nivo (3 mg/kg Q2 weeks x 17) and Ipi (1 mg/kg Q6 weeks x 6) starting 2 weeks prior to IMRT (2 Gy/fraction/day to a total of 70 Gy). The primary endpoint was safety of RIT. Secondary endpoints included progression-free survival (PFS) and overall survival (OS). Exploratory endpoints included the association of baseline PD-L1 expression as well as on-treatment changes in immune bias with treatment outcomes. 24 pts (16 OP of whom 14 HPV+) were enrolled and followed for a median of 36.1 months. At data cutoff, 7 PFS events were noted, including 5 distant recurrences, 1 regional recurrence and 1 death without evidence of disease progression. The 3-year PFS and OS rates were 74% (95% CI, 58%-94%) and 96% (95% CI, 88%-100%), respectively. PD-L1 CPS did not correlate with death or disease progression. Among peripheral blood cytokines, increased MCSF levels were associated with prolonged PFS at several timepoints (baseline [p=0.038], post-induction [p=0.031], and at the end of RT [p=0.023]); interval increase in IFNg inducing factor (IL18) within the induction phase was also associated with prolonged PFS (p=0.031), as were post-induction IFNg levels (p=0.041). 5 pts developed in-field ulcerations during consolidation immunotherapy (median time to detection was 3 months post RT completion). PD-L1 CPS did not correlate with ulceration. Interestingly, interval increase in IL9, IL4, IL12, and IL17a during concurrent RIT appeared to protect from in-field ulcerations. Definitive RIT has sufficient clinical activity to support further development. Cytokine profiles appear able to predict treatment failure, as well as in-field ulcerations early during treatment.

34420 Perspective of patients with erythropoietic protoporphyria treated with dersimelagon, a selective melanocortin-1 receptor agonist: Results of the ENDEAVOR study exit questionnaire

Background: Erythropoietic protoporphyria (EPP) imposes a significant burden on the quality of life (QoL) of patients. Dersimelagon, a novel synthetic, orally administered, selective melanocortin-1 receptor agonist, has demonstrated statistically and clinically significant improvement from baseline in average daily time to first prodromal symptoms in a phase 2 clinical trial. Methods: ENDEAVOR was a multicenter, phase 2, randomized double-blind, placebo-controlled study with a 16-week treatment and 6-week follow-up period. Here we report the results of a post hoc analysis assessing the clinical benefit of dersimelagon treatment and patient perspective of QoL using an online exit questionnaire composed of 28 close-ended questions completed after week 22 visit or post study completion. Participants rated their perceived change since the start of the study. Results: Of 102 participants, 75 (placebo, n = 24; dersimelagon, 100 mg, n = 28, 300 mg n = 23) completed the questionnaire. More recipients of dersimelagon (100 mg, 57.6%; 300 mg 31.4%) rated their EPP as “very much better” than placebo group participants (5.9%). They were also “much more often” (100 mg, 69.7%; 300 mg 48.6%) able to be outside at the end of the study than patients in the placebo group (8.8%). More participants who received dersimelagon (100 mg, 72.7%; 300 mg 62.9%) reported being “very satisfied” with the study drug vs placebo recipients (14.7%). Conclusions: A greater proportion of patients who received dersimelagon reported improvements in their EPP and associated disease impacts than placebo group participants. The findings from the exit questionnaire support the results from the primary analysis and the potential use of dersimelagon for treatment of patients with EPP.

Virtual Implementation And Feasibility Of EXCEL: Exercise For Underserved Individuals Living With Cancer

Exercise is safe and effective for individuals living with and beyond cancer. However, disparities in access to exercise services remain, including for those in underserved areas. To address this inequity, the EXercise for Cancer to Enhance Living Well (EXCEL) implementation-effectiveness study was designed to better reach these individuals through virtual exercise delivery. PURPOSE: Describe the virtual implementation and feasibility of the EXCEL program after one year. To support sustainable implementation, EXCEL is building networks of healthcare providers (HCP), qualified exercise professionals (QEP) supported with training, and individuals living with cancer. METHODS: Participants, up to 3 years post treatment, may self-refer or HCP may refer. QEPs, aided by a moderator, lead fitness assessments (FxAx) and group-based exercise sessions for the 12-week, 2 time/week exercise intervention, via Zoom. QEPs demonstrate exercises, providing modifications to tailor to participant needs. Training for QEPs and moderators includes online cancer exercise education, a live-virtual EXCEL training day, and online moderating hours within the program. Program feasibility (FxAx completion rates, program adherence) and adverse events are tracked. RESULTS: In year one, 3 program waves enrolled 155 participants, and 17 HCPs partnered with EXCEL to refer participants across 6 provinces. Twelve QEPs were fully trained (education + moderating hours), and 9 have actively delivered online exercise classes. Over the first year, adherence to the exercise program was >83% and only one adverse event (minor) was reported. FxAx pre and post completion rates were > 98% and 89%, respectively. CONCLUSIONS: Virtual implementation of EXCEL has been both feasible and safe in year one. Network building includes educational outreach to HCPs, supporting referrals from clinic to community-based exercise programs. EXCEL provides sustainable cancer and exercise educational training for QEPs, and the online exercise oncology program assessment and delivery is feasible for participants. As in-person programs resume post-pandemic, practical virtual exercise options will remain vital for improving access to exercise oncology services, further supporting exercise as part of standard care. Supported by the CIHR-CCS and ACF.

A Digital Educational Intervention With Wearable Activity Trackers to Support Health Behaviors Among Childhood Cancer Survivors: Pilot Feasibility and Acceptability Study.

Childhood cancer survivors are at increased risk of cardiometabolic complications that are exacerbated by poor health behaviors. Critically, many survivors do not meet physical activity guidelines. The primary aim was to evaluate the feasibility and acceptability of iBounce, a digital health intervention for educating and engaging survivors in physical activity. Our secondary aims were to assess the change in survivors' physical activity levels and behaviors, aerobic fitness, and health-related quality of life (HRQoL) after participating in the iBounce program. We recruited survivors aged 8 to 13 years who were ≥12 months post cancer treatment completion. The app-based program involved 10 educational modules, goal setting, and home-based physical activities monitored using an activity tracker. We assessed objective physical activity levels and behaviors using cluster analysis, aerobic fitness, and HRQoL at baseline and after the intervention (week 12). Parents were trained to reassess aerobic fitness at home at follow-up (week 24). In total, 30 participants opted in, of whom 27 (90%) completed baseline assessments, and 23 (77%) commenced iBounce. Our opt-in rate was 59% (30/51), and most (19/23, 83%) of the survivors completed the intervention. More than half (13/23, 57%) of the survivors completed all 10 modules (median 10, IQR 4-10). We achieved a high retention rate (19/27, 70%) and activity tracker compliance (15/19, 79%), and there were no intervention-related adverse events. Survivors reported high satisfaction with iBounce (median enjoyment score 75%; ease-of-use score 86%), but lower satisfaction with the activity tracker (median enjoyment score 60%). Parents reported the program activities to be acceptable (median score 70%), and their overall satisfaction was 60%, potentially because of technological difficulties that resulted in the program becoming disjointed. We did not observe any significant changes in physical activity levels or HRQoL at week 12. Our subgroup analysis for changes in physical activity behaviors in participants (n=11) revealed five cluster groups: most active, active, moderately active, occasionally active, and least active. Of these 11 survivors, 3 (27%) moved to a more active cluster group, highlighting their engagement in more frequent and sustained bouts of moderate-to-vigorous physical activity; 6 (56%) stayed in the same cluster; and 2 (18%) moved to a less active cluster. The survivors' mean aerobic fitness percentiles increased after completing iBounce (change +17, 95% CI 1.7-32.1; P=.03) but not at follow-up (P=.39). We demonstrated iBounce to be feasible for delivery and acceptable among survivors, despite some technical difficulties. The distance-delivered format provides an opportunity to engage survivors in physical activity at home and may address barriers to care, particularly for regional or remote families. We will use these pilot findings to evaluate an updated version of iBounce. Australian New Zealand Clinical Trials Registry ACTRN12621000259842; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=ACTRN12621000259842.

Evaluating the impact of a multicountry interprofessional training programme to improve HIV knowledge and clinical confidence among healthcare workers in sub-Saharan Africa: a cohort study

ObjectiveTo assess the impact of an interprofessional case-based training programme to enhance clinical knowledge and confidence among clinicians working in high HIV-burden settings in sub-Saharan Africa (SSA).SettingHealth professions training institutions...

Relationship Between Baseline Rectal Tumor Length and Magnetic Resonance Tumor Regression Grade Response to Chemoradiotherapy: A Subanalysis of the TRIGGER Feasibility Study

BackgroundIt is widely believed that small rectal tumors are more likely to have a good response to neoadjuvant treatment, which may influence the selection of patients for a ‘watch and wait’ strategy.ObjectiveThe aim of this study was to investigate whether there is a relationship between baseline tumor length on magnetic resonance imaging (MRI) and response to chemoradiotherapy.MethodThe 96 patients with locally advanced rectal cancer randomised (2:1–intervention:control) in the TRIGGER feasibility study where eligible. Baseline tumor length was defined as the maximal cranio-caudal length on baseline MRI (mm) and was recorded prospectively at study registration. Magnetic resonance tumor regression grade (mrTRG) assessment was performed on the post-chemoradiotherapy (CRT) MRI 4–6 weeks (no later than 10 weeks) post completion of CRT. This was routinely reported for patients in the intervention (mrTRG-directed management) arm and reported for the purposes of this study by the central radiologist in the control arm patients. Those with an mrTRG I/II response were defined as ‘good responders’ and those with an mrTRG III–V response were defined as ‘poor responders’.ResultsOverall, 94 patients had a post-CRT MRI performed and were included. Forty-three (46%) patients had a good response (mrTRG I/II) and 51 (54%) patients had a poor response (mrTRG III/IV). The median tumor length of good responders was 43 mm versus 50 mm (p < 0.001), with considerable overlap in tumor lengths between groups.ConclusionBaseline tumor length on MRI is not a clinically useful biomarker to predict mrTRG tumor response to CRT and therefore patient suitability for a deferral of surgery trial.

Pilot exploration of low-intensity psychoeducation workbook interventions in a prison setting, adapted for use throughout the COVID-19 pandemic

PurposeThis paper aims to explore the use of low intensity in-cell workbooks within a psychological therapies service for male prisoners, an intervention adapted for use during the COVID-19 pandemic. It seeks to explore the effectiveness of the intervention in reducing psychological distress, explore individuals’ progression through the service following engagement with the workbooks and, finally, to understand individual’s experiences of the intervention through evaluating feedback provided.Design/methodology/approachCORE-10 scores from 66 male prisoners at a Category C prison were evaluated pre and post completion of an adapted in-cell workbook intervention, to explore the potential effectiveness of the intervention in reducing psychological distress. Qualitative feedback given by participants was also explored to understand individual’s experiences of engaging with the intervention.FindingsEvaluation of 66 male prisoners revealed significant reductions in psychological distress on the CORE-10. Findings demonstrated that over half of men included in the evaluation were “stepped-up” for further interventions as per the stepped-care treatment model. Feedback forms highlighted the value of the therapeutic relationship and a “something versus nothing” approach.Research limitations/implicationsThe paper considers several limitations to the research approach, of which future studies should seek to explore when carrying out similar research.Practical implicationsThe paper includes implications for the use of low intensity self-help interventions in prison psychological services, during a time when the provision of face-to-face interventions was limited due to the COVID-19 pandemic.Originality/valueThe paper explores the use of self-help materials in psychological treatment settings, of which there is very little research on in prisons. In addition, the paper contributes to the body of research on psychological well-being during the COVID-19 pandemic.

Nanosomal docetaxel lipid suspension (NDLS) based (neo) adjuvant chemotherapy improves pathological complete response (pCR) in patients with breast cancer.

e12591 Background: Nanosomal docetaxel lipid suspension (NDLS) was developed to overcome toxicity issues associated with conventional docetaxel. We evaluated the safety and efficacy of NDLS versus conventional docetaxel-based neo/adjuvant chemotherapy in patients with breast cancer. Methods: Patients with stage IIb-III breast cancer were randomized (1:1) to receive neoadjuvant doxorubicin and cyclophosphamide (AC) followed by conventional docetaxel (arm A) or NDLS (Doceaqualip; arm B) at a dose 75 mg/m2 IV every 3-weekly for 4 cycles as neo/adjuvant therapy. Patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer received treatment as per clinical practice. The study outcomes included pathologic and clinical response rates (pCR, CR), and overall survival (OS). Results: 60 patients were randomized to arm A (n=30) or arm B (n=30). The baseline characteristics were similar in both groups. The pathological and clinical response rates were comparable between the NDLS and conventional docetaxel arms (P&gt;0.05) (Table). The efficacy outcomes were not affected by the receptor (estrogen, progesterone, and HER2) status. The pCR and CR rates were higher in patients who received neoadjuvant AC followed by neoadjuvant NDLS/T versus neoadjuvant AC followed by adjuvant NDLS/T. At a follow-up of 6 months, median OS was not evaluable in both arms as all patients were alive at follow-up post study completion. Grade 3/4 infusion-related reactions, hyperglycemia and neuropathy were noted in 5, 8 and 3 patients, respectively, in the conventional docetaxel arm while it was not reported in any patient in the NDLS arm. Conclusions: NDLS based neo/adjuvant chemotherapy was efficacious in the treatment of breast cancer and showed comparable pCR, CR and OS rates versus conventional docetaxel. NDLS was better tolerated than conventional docetaxel.[Table: see text]

Indoor air quality, thermal comfort and ventilation in deep energy retrofitted Irish dwellings

Residential building stock energy retrofits will play a key role in EU climate actions. The impact of these retrofits on indoor air quality (IAQ) and occupant comfort needs to be assessed to inform future renovation programmes. This study evaluated IAQ and occupant satisfaction in a sample (n = 14) of deep energy retrofitted Irish residences, at least 12 months post retrofit. Measurements of PM2.5, formaldehyde, total volatile organic compounds (TVOCs), carbon monoxide, radon, and carbon dioxide were made in the main bedroom and living area over a period of two days to three months (depending on the pollutant). Temperature and humidity in most homes were within design comfort limits. Higher concentrations of all pollutants were measured in bedrooms. Only 30% of bedroom data met EN16798 Category I limits for CO2 (within 380 ppm of outdoor concentrations), suggesting that bedrooms maybe under ventilated. Median formaldehyde concentrations of 25.4 and 20.7 μg/m3 were detected in bedroom and living rooms respectively, with building materials likely being the major source. All radon data (apart from one home located in a high radon area) was less than the national reference value of 200 Bq/m3. Measured ventilation extract flow rates in most participating homes would not meet the minimum performance requirements in Irish Regulations of 2019 – introduced post completion of the retrofits in this study. Greater compliance with the ventilation requirements of retrofits and the promotion and use of low emitting construction materials are recommended.

Can Health Improvements from a Community-Based Exercise and Lifestyle Program for Older Adults with Type 2 Diabetes Be Maintained? A Follow up Study

Background: Older people consistently report a desire to remain at home. Beat It is a community-based exercise and lifestyle intervention that uses evidence-based strategies to assist older people with type 2 diabetes mellitus (T2DM) to improve physical and functional fitness, which are crucial to maintain independence. This follow up, real-world study assessed the efficacy of Beat It and whether older adults with T2DM were able to maintain improvements in physical activity, waist circumference and fitness one year post completion. Methods: We have previously reported methods and results of short-term outcomes of Beat It. This paper reports anthropometric measurements and physical fitness outcomes of Beat it at 12-months post program completion and compares them to validated standards of fitness required to retain physical independence. Results: Improvements that were observed post program were maintained at 12 months (n = 43). While the number of participants who met fitness standards increased post program, not all increases were maintained at 12 months. Conclusions: This study provides promising early evidence that an eight-week, twenty-hour community-based clinician-led exercise and lifestyle program can improve health outcomes in older adults with T2DM which were retained for at least a year after program completion.

M2HepPrEP: study protocol for a multi-site multi-setting randomized controlled trial of integrated HIV prevention and HCV care for PWID

BackgroundOpioid use is escalating in North America and comes with a multitude of health consequences, including HIV and hepatitis C virus (HCV) outbreaks among persons who inject drugs (PWID). HIV pre-exposure prophylaxis (PrEP) and HCV treatment regimens have transformative potential to address these co-occurring epidemics. Evaluation of innovative multi-modal approaches, integrating harm reduction, opioid agonist therapy (OAT), PrEP, and HCV treatment is required. The aim of this study is to assess the effectiveness of an on-site integrated care model where delivery of PrEP and HCV treatment for PWID takes places at syringe service programs (SSP) and OAT programs compared with referring PWID to clinical services in the community through a patient navigation model and to examine how structural factors interact with HIV prevention adherence and HCV treatment outcomes.MethodsThe Miami-Montreal Hepatitis C and Pre-Exposure Prophylaxis trial (M2HepPrEP) is an open-label, multi-site, multi-center, randomized, controlled, superiority trial with two parallel treatment arms. A total of 500 persons who injected drugs in the prior 6 months and are eligible for PrEP will be recruited in OAT clinics and SSP in Miami, FL, and Montréal, Québec. Participants will be randomized to either on-site care, with adherence counseling, or referral to off-site clinics assisted by a patient navigator. PrEP will be offered to all participants and HCV treatment to those HCV-infected. Co-primary endpoints will be (1) adherence to pre-exposure prophylaxis medication at 6 months post-randomization and (2) HCV sustained virological response (SVR) 12 weeks post-treatment completion among participants who were randomized within the HCV stratum. Up to 100 participants will be invited to participate in a semi-structured interview regarding perceptions of adherence barriers and facilitators, after their 6-month assessment. A simulation model-based cost-effectiveness analysis will be performed to determine the comparative value of the strategies being evaluated.DiscussionThe results of this study have the potential to demonstrate the effectiveness and cost-effectiveness of offering PrEP and HCV treatment in healthcare venues frequently attended by PWID. Testing the intervention in two urban centers with high disease burden among PWID, but with different healthcare system dynamics, will increase generalizability of findings.Trial registrationClinicaltrials.gov NCT03981445. Trial registry name: Integrated HIV Prevention and HCV Care for PWID (M2HepPrEP). Registration date: June 10, 201.

Assessment of Knowledge Gain of Farmers on Attending Training Programmes on Scientific Dairy Farming

The present study was conducted with an aim to assess the knowledge gained by trainees about various aspects of scientific dairy farming organised by Krishi Vigyan Kendra, Lakhimpur. A total of 172 numbers of trainees participated in trainings on scientific dairy farming over a period during 2019 and 2020. The data were collected pre and post completion of the training with the help of questionnaire which were distributed to the trainees before training. The questionnaire consisted of 15 different aspects of breed, management, breeding, feeding, marketing and diseases of cattle. A score of one and zero score was assigned for each correct and incorrect response and percentage calculation was carried out for analysis of knowledge level and knowledge gain. It was found that majority of the trainees were middle aged (47.67%), followed by young (29.65%) and Old age (22.67%).Majority of the trainees were from general category (34.30%) followed by OBC (31.39%), scheduled caste (22.09%) and scheduled tribe (12.20%). Among those who attended training 23.83% had education till middle school level followed by primary 22.67%, 21.51% were found completed secondary education, whereas ,15.69% completed higher secondary. 9.88% were illiterate lastly followed by graduates with 6.39%.The overall knowledge of trainees on pre training evaluation was found to be 25.54% which came up to 91.35% on post training evaluation. Evaluation of knowledge gain on various aspects of scientific dairy farming showed that maximum knowledge was gained on vaccination in cattle (85.46%, Rank I) and minimum gain was in knowledge on oestrus period of cow (47.67%, Rank XV).

Outcomes of retrograde intrarenal surgery in renal calculi of varying size.

Introduction:Technological advancements have made it possible to attempt retrograde intrarenal surgery (RIRS) in patients with large renal calculi. The objective of this study was to compare the intraoperative adverse events, postoperative complications and stone free rates (SFR) of RIRS in patients with renal calculi of varying sizes.Methods:Patients who underwent RIRS for renal calculi between January 2016 and June 2020 were categorized into six size groups according to the longest dimension or cumulative measurement of the longest dimension of calculi as follows: Group 1 (1–9 mm), Group 2 (10–19 mm), Group 3 (20–29 mm), Group 4 (30–39 mm), Group 5 (40–49 mm) and Group 6 (≥50 mm). All the patients were followed up for a period of 6 months post treatment completion and the outcomes of interest were computed and compared.Results:Two hundred and ten patients were included in the analysis. Intraoperative adverse events were noted in 9.5%, 8%, 16.9%, 9.1%, 6.7% and 28.6% of the patients in groups 1–6, respectively (P = 0.453). The postoperative complications were noted in 4.8%, 5.3%, 6.8%, 15.2%, 26.7% and 42.9% of patients in groups 1–6, respectively (P = 0.024). The final SFRs were 95.2%, 100%, 96.6%, 90.9%, 86.7% and 71.4% in groups 1–6, respectively (P = 0.012).Conclusions:RIRS is an effective treatment option for the management of renal stones, including those larger than 20 mm in size. We noted a size dependent increase in the postoperative complications and a reduction in the SFRs. The majority of the postoperative complications were low grade and no stone related events occurred in the patients who were managed conservatively for residual stones after surgery, on the short term follow up.

Role of 18-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography in Predicting Residual Disease Posttreatment Completion in Retinoblastoma Patients

Background:Retinoblastoma (RB) is the most common primary intraocular malignancy of childhood. Magnetic resonance imaging (MRI) of the orbit and brain is the preferred imaging modality to diagnose and define extent of disease as well as to assess response to therapy. Sometimes, it may be difficult to differentiate the presence of active residual disease from therapy-related changes based on posttreatment completion MRI.Materials and Methods:RB patients who completed treatment between January 2017 and October 2019 were retrospectively analyzed. We evaluated the utility of F-18-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) to predict active disease in RB patients who continued to have residual disease on MRI at completion of treatment.Results:Out of the 89 patients who completed treatment, dilemma regarding remission status was present in 11 children. All 11 patients underwent FDG-PET-CT. None of them had evidence of metabolically active disease in the orbit, optic nerve, brain, or rest of the body. After a median follow-up of 24 months, no children developed any evidence of disease progression in the form of local or distant relapse.Conclusion:Our results showed that in MRI doubtful cases, a nonavid FDG-PET is reassuring in avoiding further therapy as long as close follow-up can be ensured. FDG-PET-CT may emerge as a useful functional modality to predict disease activity in RB.

Quality of Life Profiles of Colorectal Cancer Patients After Treatments in Oman

Background: Persons treated for colorectal cancer (CRC) continue to suffer from physical, psychological, emotional, and social problems after post-treatment completion. Objective: To explore whether different profiles exist in a cohort of patients treated for CRC regarding their sociodemographic characteristics, medical, and quality of life outcomes. Methods: A cross-sectional study screened 124 patients, with 118 participating in the study (response rate of 95.2%). Data were collected from August 2020 to February 2021 using convenience sampling. Instruments included sociodemographic characteristics, medical history, and the EORTC QLQ-CR29 questionnaire. Cluster analysis, t-test, chi-square, Fisher’s exact tests were used for data analysis. Results: Cluster 1 (n = 44) was characterized as a “poor-to-moderate functional and severe symptom” group. Cluster 2 (n = 74) was characterized as a “good functional and less symptom” group. Conclusions: There are substantial differences in age, gender, marital status, employment status, symptoms, and functional deficiencies between the two clusters. A customized, individualized care plan and a specifically tailored approach are needed for those in cluster 1. Implications for Practice: It is essential that oncology nurses recognize that a one-sizefits-all policy is not adequate to address the needs of two distinct groups of adult survivors of CRC in Oman. What is Foundational: Despite knowledge gaps on the need of survivors of CRC, findings from this research can be used to enhance oncology nurses’ understanding of the need and support from different symptom and function groups.

The Emerging Challenges of Adopting BIM in the Construction Industry: Evidence from Sabah, Malaysia

Building Information Modelling (BIM) is the cornerstone of digital transformation in the architecture, engineering, and construction (AEC) industry. Building Information Modelling (BIM) is critical in boosting the productivity and quality of a building not only during design and construction stages but also includes post completion’s maintenance period. However, the majority of project stakeholders are still having difficulties in adopting BIM into practice, especially in the Sabah Construction Industry. In addressing the issues, the research aim is hence will analyze the challenges of adopting BIM and examine the Sabah state governments’ strategies that have been implemented to address the issues. The list of fourteen (14) BIM challenges that cover cost, process, people, technology were derived from a comprehensive literature review and further investigated through the use of 212 questionnaires distributed using online platform. The respondents were architects, engineers, and quantity surveyors. It was revealed that among the top challenges highlighted are: people being comfortable with the conventional process, high software cost, as well as incompetent staff to operate the software. The Sabah state government has assisted with the implementation of BIM by offering standard guidelines and continuous financial support; however, the strategies provided by them were still not enough. The result of this study showed that the implementation of BIM in the construction project in Sabah is still below expectations. The awareness among construction players on how beneficial BIM is in assisting their daily project tasks should be further enhanced for better BIM implementation in the region. The outcomes of this study will hopefully provide some directions towards developing managerial strategies for the government to aggressively promote BIM practices among project stakeholders.

Student perspectives of event design: Learning and transformation using the #EventCanvas methodology

The purpose of this study was to explore how students experienced the #EventCanvas methodology as part of an undergraduate, event management course incorporating the Event Design Collective, Young Professional Program at a public university in the United States. The #EventCanvas radically shifts the common routine of event planners and intentionally breaks the practice of jumping into event execution details such as the venue, décor, entertainment, etc. This study aimed to identify student's perceptions of event design practices pre and post course completion as compared to current scholarship in event management and examine students change in behavior. This research is of interest to both academic and industry partners focused on changing the event design landscape and developing the necessary knowledge and skills for successful student integration into the event management sector.

Ventricular mechanics in adolescents with Fontan circulation: comparison to healthy controls

Abstract Funding Acknowledgements Type of funding sources: None. Background While preserved torsion was demonstrated in very young patients with single ventricle (SV) physiology immediately post Fontan completion, there is very limited data about the changes in univentricular mechanics during adolescence and its association with outcomes. Objective We aimed to a) examine changes in ventricular strain and torsion in adolescents and young adults with SV in comparison to healthy controls, and b. examine its association with markers of myocardial fibrosis on cardiac magnetic resonance (CMR). Methods This is a retrospective single center study of adolescents with Fontan circulation in comparison with controls. Speckle-tracking echocardiography was used to assess ventricular strain, torsion, and untwist. Torsion was measured as difference between apical and basal rotations. CMR volumetric and T1 relaxometry data closest to echocardiograms were obtained. Patients were compared to controls in 1:2 match. Results 50 SV patients (27 LV, 17 RV, and 6 co-dominant) were compared to 100 controls. Demographics, echocardiographic, and CMR measurements are shown in table 1. Median duration from Fontan completion was 13.8 (10.6-16.6) years. Compared to controls, adolescents with SV demonstrated reduced global longitudinal strain [-17.1% (-7.4 to -20.1) vs -20.1%(-12.3 to -24.5), p = 0.01], circumferential strain [-15.2% (-9.1 to – 20.3) vs -19.2% (-12.3 to -23.7), p = 0.007], and radial strain [25.2% (15.8 to 54.3) vs 39.4% (25.7 to 62.1), p = 0.01]. Torsion was reduced in patients compared to controls [5.2˚/cm (-4.5 to 16.1) vs 9.2˚/cm (-6.8 to 17.4) vs, p = 0.01] with decreased apical rotation [3.9˚/cm (-10.2 to 14.8) vs 5.7˚/cm (1.6 to 15.6), p = 0.001] and basal rotation [-1.5˚/cm (-7.5 to 3.7) vs -3.9˚/cm (-0.3 to -8.5), p = 0.04], respectively. T1 values were higher in SV patients compared to controls [1009 ± 36ms vs 958 ± 40ms, p = 0.004] and correlated with worse circumferential strain (r = 0.59, p = 0.04) and inversely correlated with torsion (r=−0.71, p = 0.02). Conclusion Adolescents with SV demonstrated a significant decrease in ventricular torsion compared to controls. The increased T1 times and its association with decreased ventricular strain and torsion in SV patients highlights a potential role for myocardial fibrosis in impairment of ventricular mechanics of these patients. Abstract Figure.

NASW’s Supervisory Leaders in Aging: one-year practice change outcomes of an innovative training program for social work supervisors

ABSTRACT Social work supervision addresses professional development, staff support, and management of direct service workers. It is important in aging-services settings because of the impacts of complex and evolving biopsychosocial forces in clients’ lives. This article presents findings of the Supervisory Leaders in Aging (SLA) study based on data available one-year post completion. SLA is a 30-hour certificate program for supervisors from aging-services settings addressing best practices in supervision of gerontological practice. The study compares participants’ self-assessment of use of supervisory best practices before attending a 3-month workshop series and at two times following graduation. This article reports findings from the analysis of data provided by 114 out of 129 supervisors who completed the program. Participants increased the frequency of use of best practices at both three and 12 months after graduation. These increases were conceptually meaningful and statistically significant among participants who were low users of best practices prior to the program. SLA has led to significant adoption and maintenance of supervisory best practices among participating social work supervisors and especially among those who have not previously adopted routine use of best practices. The interactive small-group learning activities of SLA’s educational model should be promoted and the curriculum of best practices should be further refined and tested as SLA is implemented in other communities.

Assessment of Safety of Remdesivir in Covid - 19 Patients with Estimated Glomerular Filtration Rate (eGFR) < 30 ml/min per 1.73 m^2.

Safety of remdesivir in patients with renal impairment is unknown. Incidence of liver injury secondary to remdesivir is also unknown. The objective of this study is to assess the incidence of acute kidney injury (AKI) and to trend the liver enzymes during remdesivir treatment and change in eGFR from baseline to end of treatment as well as 48 h post completion of remdesivir therapy. This is a retrospective chart review study including adult patients admitted with COVID-19 receiving remdesivir with a baseline eGFR < 30 ml/min per 1.73 m^2 from December 2020 to May 2021. The primary outcome was to assess the incidence of AKI and hepatic injury. The secondary outcome was to assess the efficacy of remdesivir defined by change in oxygen requirement. Seventy-one patients were included in the study. Patients experienced an improvement in eGFR from baseline (T0) to end of remdesivir treatment (T1), as well as 48 h after the end of the treatment (T2) ( + 30.3% and + 30.6% respectively, P < .0001). Creatinine reduced from baseline (T0) to T1 and T2 (-20.9% and -20.5% respectively, P < .0001). Creatinine clearance improved from baseline to T1 and T2 ( + 26.6% and + 26.2% respectively, p < .0001). Elevation of aminotransferase (AST) was observed at T1 ( + 2.5%, P = .727), however, AST reduction was seen at T2 (-15.8%, P = .021). Elevation in alanine transaminase (ALT) was observed at T1 and T2 ( + 25% and + 12%, P = .004 and P = .137 respectively). Both direct and total bilirubin remained stable and were not significantly changed from baseline. Our study showed that remdesivir use in renally-impaired patients with eGFR < 30 ml/min is safe. Remdesivir may be considered as a therapeutic option in this population with COVID-19 infection.