Initial Rate Research Articles

Low-dose aspirin initiation rates in appropriate candidates at an academic residency program in the midwest

Low-dose aspirin initiation rates in appropriate candidates at an academic residency program in the midwest

The economic value of human milk from three cohort studies in Friuli Venezia Giulia, Italy

BackgroundThe Mothers’ Milk Tool, developed and launched by the Australian National University and Alive & Thrive in 2022, allows to estimate the volume and value of breastmilk using prevalence rates of breastfeeding by month of age from birth to 36 months. The objective of this study was to obtain these estimates for three cohort studies conducted in a region of Italy.MethodsBreastfeeding data from three cohort studies carried out in 1999, 2007 and 2016, with follow-up to 12, 24 and 36 months of 842, 400 and 265 children, respectively, were entered into the downloadable version of the tool. Breastfeeding rates charts and tables with estimates of breastmilk production and value for breastfeeding of children aged 0–36 months were produced.ResultsThe rates of initiation of breastfeeding were similar in the three cohorts, while the rates of any breastfeeding at subsequent ages increased over the years. The volumes and values of breastmilk per child increased accordingly, from around 130 L (13,000 USD) in 1999, to 200 L (20,000 USD) in 2007, to 226 L (22,600 USD) in 2016. The percentage of lost breastmilk decreased from 67.7% to 55.4% to 43.7%, respectively. Overall, the 1507 mothers of the three cohorts produced an estimated 250,000 L of breastmilk for their children aged 0–36 months. At 100 USD per litre, this would add up to around 25 million USD.ConclusionsOur study shows that the Mothers’ Milk Tool can be used to estimate per child volumes and values of breastmilk produced and lost at local levels, and to provide simple indicators of the effects of breastfeeding interventions using the percentage of lost breastmilk, where datasets on rates of breastfeeding by month of age are available. The results of such studies can be used to advocate for better and adequately funded programmes for the protection, promotion and support of breastfeeding.

Analyzing the correlation between protein expression and sequence-related features of mRNA and protein in Escherichia coli K-12 MG1655 model.

It was necessary to have a tool that could predict the amount of protein and optimize the gene sequences to produce recombinant proteins efficiently. The Transim model published by Tuller et al. in 2018 can calculate the translation rate in E. coli using features on the mRNA sequence, achieving a Spearman correlation with the amount of protein per mRNA of 0.36 when tested on the dataset of operons' first genes in E. coli K-12 MG1655 genome. However, this Spearman correlation was not high, and the model did not fully consider the features of mRNA and protein sequences. Therefore, to enhance the prediction capability, our study firstly tried expanding the testing dataset, adding genes inside the operon, and using the microarray of the mRNA expression data set, thereby helping to improve the correlation of translation rate with the amount of protein with more than 0.42. Next, the applicability of 6 traditional machine learning models to calculate a "new translation rate" was examined using initiation rate and elongation rate as inputs. The result showed that the SVR algorithm had the most correlated new translation rates, with Spearman correlation improving to R = 0.6699 with protein level output and to R = 0.6536 with protein level per mRNA. Finally, the study investigated the degree of improvement when combining more features with the new translation rates. The results showed that the model's predictive ability to produce a protein per mRNA reached R = 0.6660 when using six features, while the correlation of this model's final translation rate to protein level was up to R = 0.6729. This demonstrated the model's capability to predict protein expression of a gene, rather than being limited to predicting expression by an mRNA and showed the model's potential for development into gene expression predicting tools.

Does the resumption of international tourism heighten COVID-19 transmission?

Reopening countries also carries the risk of another wave of infections in many parts of the world, raising the question of whether we are ready to reopen our countries. This study examines the impact of reopening countries to receive foreign tourists on the spread of COVID-19 in 2022, encompassing 83 countries worldwide. We employ spatial quantile models capable of analyzing the spatial impact of tourism on the spread of the virus at different quantile levels. The research categorizes countries into three groups: low infection rate (10th-30th quantiles), moderate infection rate (40th-60th quantiles), and high infection rate (70th-90th quantiles). This allows for a more comprehensive and detailed comparison of the impacts. Additionally, considering the spatial dimension enables the explanation of both the direct and indirect effects of tourists on the country itself and neighboring countries. The findings reveal that the number of international tourists has a significant effect on the COVID-19 infection rate, particularly in countries with high initial infection rates. However, countries that effectively controlled their infection rates at a low level could maintain a low infection rate even after reopening to foreign tourists. It is also observed that reopening a country's borders negatively impacts the infection rate of neighboring countries. These important findings imply that governments of highly infected countries should shift their focus towards bolstering their economy by promoting domestic tourism and should delay reopening until the number of infections decreases.

A Comprehensive, Multidimensional First‐Principles Model for Free‐Radical Photopolymerizations in Bulk and Thin Films

AbstractDecades of advances in understanding and simulating the polymerization kinetics and structural evolution that arises in free‐radical photopolymerizations of multifunctional monomers are combined into a single, first‐principles 3D model. The model explicitly accounts for polymerization features including diffusion‐controlled kinetics, oxygen inhibition, light attenuation, chain‐length dependent termination, reaction‐diffusion termination, heat transfer, composition and conversion‐dependent material properties, crosslinking effects, and species diffusion. Using the homopolymerization of 1,6‐hexanediol diacrylate as a model system, a minimum of two kinetics experiments performed at different initiation rates are required to fit model parameters. The model accurately predicts known relationships regarding oxygen inhibition, light intensity, and curing temperature for samples of different geometries and boundary conditions. The emphasis of the results herein is placed on the interactions between polymerization features, motivating the importance of a model that accommodates these features all in one simulation. The model is shown to be robust in its handling of thermal boundary conditions, alternative polymerization techniques or mechanisms, and characteristics of 3D voxel formation. The model in this work provides a useful tool for property prediction in a wide variety of applications, most notably coatings, dental materials, industrial photocuring processes, additive manufacturing, and holography, where complex interactions of the various features of polymerization play a substantial role.

Kinetics of nanoconfined benzyl methacrylate radical polymerization

AbstractThe effect of nanoconfinement on the kinetics of benzyl methacrylate radical polymerization is investigated using differential scanning calorimetry. Controlled pore glass (CPG), ordered mesoporous carbons, and mesoporous silica are used as confinement media with pore sizes from 2 to 8 nm. The initial polymerization rate in CPG and mesoporous silica increases relative to the bulk and increases linearly with reciprocal pore size; whereas, the rate in the carbon mesopores decreases linearly with reciprocal pore size; the changes are consistent with the rate being related to the ratio of the pore surface area to pore volume. Induction times are longer for nanoconfined polymerizations, and in the case of CPG and carbon mesopores, autoacceleration occurs earlier, presumably due to the limited diffusivity and lower termination rates for the confined polymer chains. The molecular weight of the polymer synthesized in the nanopores is generally higher than that obtained in the bulk except at the lowest temperatures investigated. The equilibrium conversion under nanoconfinement decreases with decreasing temperature and with confinement size, exhibiting what appears to be a floor temperature at low temperatures.

Complications of microwave ablation in patients with persistent/recurrent hyperparathyroidism after surgical or ablative treatment

Objective To evaluate the complications associated with microwave ablation (MWA) in treating persistent/recurrent hyperparathyroidism (HPT) post-surgical or ablative treatments. Materials and methods From January 2015 to December 2022, 87 persistent/recurrent HPT patients (primary HPT [PHPT]: secondary HPT [SHPT] = 13:74) who underwent MWA after surgical or ablative treatment were studied. Grouping was based on ablation order (initial vs. re-MWA), prior treatment (parathyroidectomy [PTX] vs. MWA), and etiology (PHPT vs. SHPT). The study focused on documenting and comparing treatment complications and analyzing major complication risk factors. Result Among the 87 patients, the overall complication rate was 17.6% (15/87), with major complications at 13.8% (12/87) and minor complications at 3.4% (3/87). Major complications included recurrent laryngeal nerve (RLN) palsy (12.6%) and Horner syndrome (1.1%), while minor complications were limited to hematoma (3.4%). Severe hypocalcemia noted in 21.6% of SHPT patients. No significant differences in major complication rates were observed between initial and re-MWA groups (10.7% vs. 13.8%, p = 0.455), PTX and MWA groups (12.5% vs. 15.4%, p = 0.770), or PHPT and SHPT groups (15.4% vs. 13.5%, p > 0.999). Risk factors for RLN palsy included ablation of superior and large parathyroid glands (>1.7 cm). All patients recovered spontaneously except for one with permanent RLN palsy in the PTX group (2.1%). Conclusion Complication rates for MWA post-surgical or ablative treatments were comparable to initial MWA rates. Most complications were transient, indicating MWA as a viable and safe treatment option for persistent/recurrent HPT patients.

Coevolutionary Interactions between Sexual and Habitat Isolation during Reinforcement.

Speciation often involves the evolution of multiple genetic-based barriers to gene flow (i.e., "coupling"). However, barriers may exhibit a diversity of evolutionary interactions during speciation. These dynamics are important in reinforcement, where selection may favor different prezygotic isolating barriers to avoid maladaptive hybridization. Here we study the interaction between evolution of sexual and habitat isolation. We first review the empirical literature where both barriers were explicitly considered, and then develop a population genetic model of reinforcement. Most studies of both sexual and habitat isolation were found in phytophagous insect systems. In 76% of these studies, both barriers coevolved; the remaining cases either showed only habitat isolation (21%) or only sexual isolation (3%). Our two-allele genetic mechanism model of each barrier also found that these often coevolved, but habitat isolation was generally more effective during reinforcement. Depending on the fitness of hybrids (e.g., Dobzhansky-Muller incompatibilities) and initial migration rate, these barriers could either facilitate, curtail, or have no effect on each other. This indicates that basic parameters will alter the underlying evolutionary dynamics, and thus the nature of "speciation coupling" will be highly variable in natural systems. Finally, we studied initially asymmetrical migration rates and found that populations with higher initial emigration evolved stronger habitat isolation, while populations that initially received more immigrants exhibited stronger sexual isolation. These results are in line with observations in some empirical studies, but more data is needed to test their generality.

HYDRODYNAMIC BASES FOR CALCULATING THE MOTION OF TWO-PHASE SYSTEMS IN COMPLEX PIPELINES

Considering the conditions for the development of an oil field for different layers, the pipeline networks are different. Based on hydromechanics of homogenous fluid and gas, a new model of two-phase systems movement of fluid-gas type in horizontal tubes is suggested and the major calculation formula for complicated pipelines is developed. In constructing a complex system of pipelines transporting both single-phase and two-phase systems, firstly, it is necessary to consider the location of wells in the field, their initial and final flow rates, as well as the physicochemical properties. This method enables us to define the main parameters of complicated pipelines, considering the physical properties of two-phase systems. The equation of two-phase systems movement in simple and complicated pipelines, allowing recommending using this approach in field experience, is obtained as well. Keywords: shear stress, complicated pipeline, multiple connections, diameter, volumetric fluid, and gas discharge.

Harnessing the potential of ginkgo biloba extract: Boosting denitrification performance through accelerated electron transfer

Ginkgo biloba extract (GBE) had several effects on the human body as one of the widely used phytopharmaceuticals, but it had no application in microbial enhancement in the environmental field. The study focused on the impact of GBE on denitrification specifically under neutral conditions. At the identified optimal addition ratio of 2% (v/v), the system exhibited a noteworthy increase in nitrate reduction rate (NRR) by 56.34%, elevating from 0.71 to 1.11 mg-N/(L·h). Moreover, the extraction of microbial extracellular polymeric substance (EPS) at this ratio revealed changes in the composition of EPS, the electron exchange capacity (EEC) was enhanced from 87.16 to 140.4 μmol/(g C), and the transfer impedance was reduced within the EPS. The flavin, fulvic acid (FA), and humic acid (HA) provided a π-electron conjugated structure for the denitrification system, enhancing extracellular electron transfer (EET) by stimulating carbon source metabolism. GBE also improved electron transfer system activity (ETSA) from 0.025 to 0.071 μL O2/(g·min·prot) and the content of NADH enhanced by 22.90% while significantly reducing the activation energy (Ea) by 85.6% in the denitrification process. The synergy of improving both intracellular and extracellular electron transfer, along with the reduction of Ea, notably amplified the initiation and reduction rates of the denitrification process. Additionally, GBE demonstrated suitability for denitrification across various pH levels, enhancing microbial resilience in alkaline conditions and promoting survival and proliferation. Overall, these findings open the door to potential applications of GBE as a natural additive in the environmental field to improve the efficiency of denitrification processes, which are essential for nitrogen removal in various environmental contexts.

Physiological response to fetal intravenous lipid emulsion.

In preterm neonates unable to obtain sufficient oral nutrition, intravenous lipid emulsion is life-saving. The contribution of post-conceptional level of maturation to pathology that some neonates experience is difficult to untangle from the global pathophysiology of premature birth. In the present study, we determined fetal physiological responses to intravenous lipid emulsion. Fetal sheep were given intravenous Intralipid 20® (n = 4 females, 7 males) or Lactated Ringer's Solution (n = 7 females, 4 males) between 125 ± 1 and 133 ± 1 d of gestation (term = 147 d). Manufacturer's recommendation for premature human infants was followed: 0.5-1 g/kg/d initial rate, increased by 0.5-1 to 3 g/kg/d. Hemodynamic parameters and arterial blood chemistry were measured, and organs were studied postmortem. Red blood cell lipidomics were analyzed by LC-MS. Intravenous Intralipid did not alter hemodynamic or most blood parameters. Compared with controls, Intralipid infusion increased final day plasma protein (P=0.004; 3.5 ± 0.3 vs. 3.9 ± 0.2 g/dL), albumin (P = 0.031; 2.2 ± 0.1 vs. 2.4 ± 0.2 g/dL), and bilirubin (P<0.001; conjugated: 0.2 ± 0.1 vs. 0.6 ± 0.2 mg/dL; unconjugated: 0.2 ± 0.1 vs. 1.1 ± 0.4 mg/dL). Circulating IGF-1 decreased following Intralipid infusion (P<0.001; 66 ± 24 vs. 46 ± 24 ng/mL). Compared with control Oil Red O liver stains (median score 0), Intralipid-infused fetuses scored 108 (P=0.0009). Lipidomic analysis revealed uptake and processing of infused lipids into red blood cells, increasing abundance of saturated fatty acids. The near-term fetal sheep tolerates intravenous lipid emulsion well, although lipid accumulates in the liver. Increased levels of unconjugated bilirubin may reflect increased red blood cell turnover or impaired placental clearance. Whether Intralipid is less well tolerated earlier in gestation remains to be determined.

Facility-Level Variation in Racial Disparities in Anticoagulation for Atrial Fibrillation: The REACH-AF Study.

Oral anticoagulation reduces stroke risk for patients with atrial fibrillation (AF). Prior research demonstrates lower anticoagulant prescribing in Black than in White individuals but few studies have examined racial differences in facility-level anticoagulant prescribing for AF. To assess variation in anticoagulant initiation by race within Veterans Health Administration (VA) facilities. Retrospective cohort study. Black and White patients enrolled in the VA with incident AF from 2020 through 2021. The primary outcome was rate of any anticoagulant initiation (i.e., warfarin or direct oral anticoagulant [DOAC]) or any DOAC therapy within 90days of an AF diagnosis, overall and for Black and White patients at each facility. We also estimated the adjusted Black-White risk difference. In 82 VA facilities serving 26,832 Black and White patients, overall unadjusted rates of any anticoagulant therapy ranged from 56.8 to 87.1% across facilities; the corresponding ranges for Black and White patients were 47.6 to 91.3% and 58.2 to 87.1%, respectively. Overall unadjusted rates of DOAC therapy ranged from 55.1 to 85.5% by facility; ranges for Black and White patients were 42.8 to 86.9% and 56.4 to 85.5%, respectively. The adjusted risk difference between Black and White patients ranged from - 29.9 (95% CI, - 54.9 to - 4.8) to 14.2 (95% CI, - 9.1 to 25.0) across facilities for any anticoagulant therapy and from - 28.8 (95% CI, - 58.3 to 0.8) to 15.0 (95% CI, - 8.0 to 38.1) for DOAC therapy.For any anticoagulant therapy there were 3 facilities where prescribing was statistically higher in White than Black patients; for DOAC therapy there were 5 such facilities. In a national cohort of patients with AF, we observed large facility-level variation and adjusted risk differences in any anticoagulant and DOAC initiation, overall and by race. These findings represent a target for local quality improvement in AF care.

Reducing agalsidase beta infusion time in Fabry patients: low incidence of antibody formation and infusion-associated reactions in an Italian multicenter study

BackgroundFabry disease is a rare progressive X-linked lysosomal storage disease caused by mutations in the GLA gene that encodes α-galactosidase A. Agalsidase beta is a recombinant enzyme replacement therapy authorized in Europe at a standard dose of 1.0 mg/kg intravenously every other week at an initial infusion rate of ≤ 0.25 mg/min until patient tolerance is established, after which the infusion rate may be increased gradually. However, specific practical guidance regarding the progressive reduction in infusion time is lacking. This study investigated a new and specific protocol for reducing agalsidase beta infusion time in which a stable dosage of 15 mg/h is infused for the first four months, and the infusion rate is increased progressively from 15 to 35 mg/h for the subsequent four infusions. The shortest infusion time is reached after six months and maintained thereafter. The incidence of infusion-associated reactions (IARs) and the development of anti-drug antibodies were analyzed, and the disease burden and the clinical evolution of the disease at 12 months were evaluated.ResultsTwenty-five of the 31 patients were naïve to enzyme or chaperone treatment at baseline and six patients had been switched from agalsidase alfa. The reduced infusion time protocol was well tolerated. Only one patient exhibited an IAR, with mild symptoms that resolved with low-dose steroids. Six patients globally seroconverted during treatment (4 with a classic phenotype and 2 with late-onset disease). All but three patients were seronegative at month 12. All patients were stable at the study’s end (FAbry STabilization indEX value < 20%); reducing infusion time did not negatively impact clinical outcomes in any patient. The perceived medical assessment showed that the quality of life of all patients improved.ConclusionsThe study demonstrates that reducing agalsidase beta infusion time is possible and safe from both an immunogenic and clinical point of view. The use of a low infusion rate in the first months when the probability of onset of the development of antibodies is higher contributed to very limited seroconversion to antibody-positive status.

Effect of micro-aeration on syntrophic and methanogenic activity in anaerobic sludge

Micro-aeration was shown to improve anaerobic digestion (AD) processes, although oxygen is known to inhibit obligate anaerobes, such as syntrophic communities of bacteria and methanogens. The effect of micro-aeration on the activity and microbial interaction in syntrophic communities, as well as on the potential establishment of synergetic relationships with facultative anaerobic bacteria (FAB) or aerobic bacteria (AB), was investigated. Anaerobic sludge was incubated with ethanol and increasing oxygen concentrations (0–5% in the headspace). Assays with acetate or H2/CO2 (direct substrates for methanogens) were also performed. When compared with the controls (0% O2), oxygen significantly decreased substrate consumption and initial methane production rate (MPR) from acetate or H2/CO2. At 0.5% O2, MPR from these substrates was inhibited 30–40%, and close to 100% at 5% O2. With ethanol, significant inhibition (>36%) was only observed for oxygen concentrations higher than 2.5%. Oxygen was consumed in the assays, pointing to the stimulation of AB/FAB by ethanol, which helped to protect the syntrophic consortia under micro-aerobic conditions. This highlights the importance of AB/FAB in maintaining functional and resilient syntrophic communities, which is relevant for real AD systems (in which vestigial O2 amounts are frequently present), as well as for AD systems using micro-aeration as a process strategy.Key points•Micro-aeration impacts syntrophic communities of bacteria and methanogens.•Oxygen stimulates AB/FAB, maintaining functional and resilient consortia.•Micro-aeration studies are critical for systems using micro-aeration as a process strategy.

Multidisciplinary Approach Optimizes Characterization, Completion in Shale Play

_ This article, written by JPT Technology Editor Chris Carpenter, contains highlights of paper URTeC 3871303, “Using a Multidisciplinary Approach to Reservoir and Completion Optimization Within the Woodford Shale Play of the Arkoma Basin,” by Stephen C. Zagurski, SPE, and Steve Asbill, SPE, Foundation Energy Management, and Christopher M. Smith, Advanced Hydrocarbon Stratigraphy, et al. The paper has not been peer reviewed. _ Subsurface complexities related to the formation of peripheral foreland basins can have significant effects on unconventional resource development. In the Arkoma Basin of southeast Oklahoma, the onset of thrusting and tectonic loading induced a complex series of dip/slip and strike/slip faults during basin formation. The operator used a series of technologies to increase understanding of the reservoir and its hazards and provide insight into economic implications for future development plans and strategies. Introduction The Woodford is primarily a Type II kerogen source rock. The formation typically is classified as either siliceous mudstone or cherty siltstone. Variable thermal maturity across the basin places the Woodford in both the wet-gas and dry-gas phase windows (moving west to east across the basin). Complex faulting regimes within the Arkoma add a layer of complexity to horizontal development of the Woodford. The operator wanted to increase the understanding of the Woodford and the effects of faulting through the reservoir in a recent development unit in the liquids-rich fairway. The development unit consists of an existing parent well (Well X) and a pair of child wells (Well Y and Well Z). The background of Unit XYZ begins with the completion of parent Well X 4–6 years before infill development. In this portion of the basin, Well X’s initial production rate and its cumulative production to date rank it in the top 25% of wells. The wellbore is subjected to a pair of faults and was drilled in the upper half of the Woodford. Placement of Well X is substantially further east than most parent wells because it is approximately 1,600 ft from the unit boundary. This limited infill development to two wells instead of three; the Arkoma typically has seen spacing of four, and sometimes five, wells per section. Wells Y and Z were planned and drilled east of Well X with 1,100–1,600 ft of well spacing. Well spacing in the unit was slightly hindered by surface location limitations and limited true vertical depth (TVD) between surface casing and landing point. Structural complexity within the unit partially impaired infill development of the unit. Specifically, Well Y and its lateral length was shortened. In this portion of the Arkoma, fault-derived water production typically is the highest-weighted variable in a well’s operating expenditure. Thus, the ability to limit excess water production within Unit XYZ and the surrounding acreage is of paramount importance.

Crystalloid Fluid Management of Non-Traumatic Hypotension by New South Wales Ambulance

Introduction Shock is circulatory insufficiency, inadequate oxygen delivery, and cellular hypoxia. Intravenous fluids are essential for shock management. Despite treatment, patients can face persistent shock with ongoing hypotension, contributing to higher mortality. This analysis aims to quantify hypotensive non-traumatic cases in an Australian ambulance service, determine persistent hypotension prevalence, and assess paramedic-administered intravascular fluids’ impact on blood pressure changes. Methods This study is a retrospective analysis of prehospital fluid resuscitation by New South Wales Ambulance paramedics during 2022. Hypotension is defined as a systolic blood pressure of ≤ 90 mmHg, and persistent hypotension is a systolic blood pressure consistently below 90 mmHg across all observations, with a final blood pressure below 90 mmHg. This study aimed to determine the volume of fluid resuscitation at which a plateau in population-level systolic blood pressure response is observed, by calculating the derivative of the fitted logistic regression model. Moreover, this analysis identified the relative contribution of factors influencing the probability of an attempt at intravenous or intraosseous access using machine learning. Results Among 796,865 attendances, 23,049 (2.9%) involved non-traumatic patients with hypotension. In total 7,388 (32.1%) of the hypotensive cases resulted in persistent hypotension, of which 3,235 (43.8%) received Hartmann’s solution and 1,745 (53.9%) received at least 500 ml of fluids but still had hypotension. The model showed that systolic blood pressure tends to stop increasing after 500–600 milliliters of fluid are given. This suggests that, on average, giving more fluid than this may not raise blood pressure further in a prehospital setting, though individual patient needs can differ. The top four factors from the machine learning shows that as initial respiratory rate goes up, the probability of intravascular access rises. Transport times less than 20 min are associated with a smaller chance of access and younger patients are less likely to receive an attempt. Finally, extremes of systolic blood pressure are more likely to receive access attempts. Conclusion This study found that three percent of non-traumatic attendances have at least one episode of hypotension, and that more than half of these have persistent hypotension. Only 44% of persistently hypotensive received fluids, and half of persistently hypotensive patients stayed hypotensive despite a reasonable volume of prehospital crystalloids.

Effects of cardiopulmonary resuscitation training on mortality rates after out-of-hospital cardiac arrest: protocol for a systematic review and meta-analysis

IntroductionAn out-of-hospital cardiac arrest occurs at a rate of 67–170 cases per 100 000 inhabitants per year in Europe. The early recognition of the occurrence of a cardiac arrest, placing...

Quality use of publicly subsidised tapentadol in Australia: a population-based analysis.

Sustained-release (SR) tapentadol was listed on Australia's Pharmaceutical Benefits Scheme (PBS) in 2014 for chronic severe pain requiring long-term opioid treatment. Dispensings have increased since listing despite declining trends in other PBS-listed opioids. Preferential prescribing of SR opioids may increase the risk of dependence and accidental overdose, particularly when used to treat acute pain. To explore the quality use of publicly subsidised tapentadol in Australia. We examined annual initiation rates and patterns of use of tapentadol (SR) in the dispensing records of a 10% random sample of PBS-eligible Australians (2014-2021). We used national tapentadol sales data to assess the proportion of sales attributable to the PBS. Tapentadol initiation increased from 2014, peaking at 7.5/1000 adult population in 2019 before declining to 5.3/1000 in 2021. We identified 63 766 new users between 2014 and 2020, of whom 92.8% discontinued in the first year following initiation, 58.0% had only a single dispensing and 34.3% had no other opioids dispensed in the 3 months before or after initiation. 27.8% of new users were dispensed tapentadol on the same day as potentially interacting medicines. There was a sustained drop in the proportion of sales attributable to the PBS from June 2020 onwards, from an average of 69.1%, to 63.9% of pack sales. Patterns of use suggest tapentadol (SR) is generally used for short duration. Although most tapentadol sold in Australia is subsidised, there is evidence of a shift towards private sales.

Exploring workplace barriers faced by breastfeeding mothers who are PAs.

To explore physician associate/assistant (PA) mothers' breastfeeding intention, duration, as well as workplace barriers for breastfeeding among working PA mothers and to determine if specialty has an effect on breastfeeding duration. A cross-sectional online survey was administered to PA mothers who had at least one biological child while a PA student or practicing as a PA. Study participants were recruited through the American Academy of Physician Associates' special interest group, PA Moms. The 545 participants reported a breastfeeding goal of 12 months in 76.8% of births. Breastfeeding rates among participants were 96.3% at birth, 83.8% at age 3 months, 78.1% at age 6 months, and 54.8% at age 12 months. Exclusive breastfeeding rates were 77.9% at birth, 75% at age 3 months, and 42.6% at age 6 months. Workplace support from colleagues and support staff was associated with longer exclusive breastfeeding duration and any breastfeeding duration. Adequate time and place for expression of breastmilk and support from supervising or collaborating physicians were associated with longer duration of breastfeeding. Specialty had a statistically significant effect on exclusive breastfeeding duration. PA mothers failed to meet their breastfeeding goals, despite high initiation rates. Dedicated time and space to express breastmilk and workplace support may significantly improve PA mothers' breastfeeding duration.

Large Scale Ontology Matching System (LSMatch)

Background: Ontology matching provides a solution to the semantic heterogeneity problem by finding semantic relationships between entities of ontologies. Over the last two decades, there has been considerable development and improvement in the ontology matching paradigm. More than 50 ontology matching systems have been developed, and some of them are performing really well. However, the initial rate of improvement was measurably high, which now is slowing down. However, there still is room for improvement, which we as a community can work towards to achieve. Method: In this light, we have developed a Large Scale Ontology Matching System (LSMatch), which uses different matchers to find similarities between concepts of two ontologies. LSMatch mainly uses two modules for matching. These modules perform string similarity and synonyms matching on the concepts of the ontologies. Results: For the evaluation of LSMatch, we have tested it in Ontology Alignment Evaluation Initiative (OAEI) 2021. The performance results show that LSMatch can perform matching operations on large ontologies. LSMatch was evaluated on anatomy, disease and phenotype, conference, Knowledge graph, and Common Knowledge Graphs (KG) track. In all of these tracks, LSMatch’s performance was at par with other systems. Conclusion: Being LSMatch’s first participation, the system showed potential and has room for improvement.