Switching Rate Research Articles

Electrical‐Triggered Multicolor Reversible Color‐Changing Ag Nanoparticles/Reduced Graphene Oxide/Polyurethane Conductive Fibers

AbstractSmart color‐changing fibers attract much attention owing to their importance as a component of flexible electronics. A facile and scalable method of multicolor reversible electro–thermochromic Ag nanoparticles/reduced graphene oxide/polyurethane conductive fiber (ETC AgNPs/rGO/PU conductive fiber) is fabricated, which contains the polyurethane (PU) as the inner layer, reduced graphene oxide (rGO) with Ag nanoparticles (AgNPs) as the conductive layer, and thermochromic paste as the outermost layer. It possesses excellent electrothermal and color‐changing properties and rapidly generates Joule heat at 0.5 V, which makes the fiber surface temperature reach 39.81 °C rapidly. The color switching rate is fast and changes from green to yellow within 2 s. During the process of 250 times on/off voltage, ETC AgNPs/rGO/PU conductive fibers still maintain excellent electrical and thermal properties and color change stability; even in the washing, strong acid, and strong alkali environment, they still have excellent durability. This human subjective adjustable electrical–thermal–color multi‐level induced modulation makes it possible to be applied to smart wearable fields such as visual camouflage, personal thermal management, and active information transfer.

S823 The Impact of Treatment Switch Among Prevalent Patients With Crohn’s Disease Treated With a First-Line Biologic: A U.S. Retrospective Claims Database Study

Introduction: Treatment switching often occurs with biologic use among patients with Crohn’s disease (CD) and has been associated with worsened clinical symptoms and functional impairment. However, little is known about its impact on healthcare resource utilization (HRU) and costs. This study assessed the economic burden associated with treatment switching among adults with CD in the United States (US). Methods: Data from the IBM® MarketScan® Commercial Subset (10/01/2015-03/31/2020) were used to identify adult patients newly diagnosed with CD (at least 2 CD diagnoses at least 30 days apart) and that were treated with a first line biologic (prescription fill/injection) on or after their CD diagnosis. The index date was defined as the date of the first line biologic. Patients were classified into the switchers or non-switchers cohort based on whether or not they switched to another biologic or 5-aminosalicylic acid or immunomodulator during the 12-month study period after the index date. Mean time to treatment switch was estimated using Kaplan-Meier analyses. All-cause HRU and healthcare costs (2020 USD) during the study period were described and compared (unadjusted) overall and for the 2 cohorts. Results: Among 4,006 patients included in the study, 640 were switchers and 3,366 were non-switchers. Overall, mean age was 39.5 years and 50.9% were female. Rates of treatment switch were 7.1% at 6 months and 16.0% at 12 months (Figure). Additionally, rates of prolonged corticosteroid use (at least 90 days) was higher in switchers compared to non-switchers (31.6% vs 8.2%; p< 0.01). Switchers also had higher rates of inpatient admissions (25.9% vs 12.6%; p< 0.01), emergency department visits (41.6% vs 35.4%; p< 0.01), and number of outpatient visits (22.8 vs 17.0; p< 0.01) compared to non-switchers (Table). Similarly to HRU, total all-cause healthcare costs were higher among switchers than non-switchers ($95,689 vs $81,027; p< 0.01), which was mainly driven by higher medical costs ($24,135 vs $14,416; p< 0.01). Among age groups, switchers 30-39 years incurred the highest total cost ($100,676 vs 78,265, p< 0.01). Conclusion: In this real-world study, patients with CD who switched biologic treatments, which is a marker of inadequate treatment, incurred significantly higher HRU and healthcare costs. These findings suggest a potential unmet need with current treatment options and highlight the impact of switching biologics on the economic burden of patients with CD.Figure 1.: Kaplan-Meier analysis for time to switch CI: confidence interval Table 1. - All-cause HRU and healthcare costs incurred during the study period Number of patients, N Switchers (N=640) Non-switchers (N=3,366) All-cause HRU, N (%) Inpatient admission 166 (25.9%) 423 (12.6%) Inpatient days, mean ± SD [median] 2.5 ± 6.4 [0.0] 1.1 ± 4.6 [0.0] Emergency department visits 266 (41.6%) 1,192 (35.4%) Days with outpatient visits 639 (99.8%) 3,331 (99.0%) Number of days with outpatient visits, mean ± SD [median] 22.8 ± 17.0 [19.0] 17.0 ± 16.3 [13.0] Healthcare costs (2020 USD), mean ± SD [median] Total (medical + pharmacy) $95,689 ± $52,295 [$85,713] $81,027 ± $50,743 [$72,464] Medical $24,135 ± $39,519 [$9,434] $14,416 ± $33,575 [$4,847] Inpatient $11,491 ± $31,526 [$0] $5,279 ± $22,861 [$0] Outpatient $10,906 ± $17,172 [$5,956] $7,909 ± $17,732 [$3,687] Emergency department $1,738 ± $4,666 [$0] $1,228 ± $5,330 [$0] Pharmacy (including biologics) $71,554 ± $35,174 [$66,355] $66,611 ± $39,793 [$62,937] HRU: healthcare resource utilization; SD: standard deviation; USD: United States dollar.

An Online Junction Temperature Monitoring Correction Method for SiC MOSFETs at Different Parasitic Parameters

Due to the remarkable performance of silicon carbide (SiC) metal–oxide–semiconductor field-effect transistor (MOSFET) on high temperature, it is promising in future applications in various applications. The accurate online junction temperature based on dynamic temperature-sensitive electrical parameters (TSEPs) is significant for the protection and condition monitoring, which can prolong or monitor the lifetime of SiC MOSFET devices. In this article, four different dynamic TSEPs, including turn-on delay time, turn-off delay time, and maximum current turn-on and turn-off switching rates, are theoretically analyzed taking the parasitic parameters into consideration. The experimental analysis of the influence of parasitic parameters ’ dynamic TSEPs is carried on using a buck converter test setup. Based on the theoretical and experimental analyses, a junction temperature correction method is proposed for SiC MOSFET. The online junction temperature monitoring experiments are used to verify the accuracy and effectiveness of the proposed method. The results show that the proposed correction method can largely eliminate the junction temperature monitoring error at different parasitic parameters. The maximum measurement error is reduced from 147 °C to 4.7 °C after correction.

Weather stressors correlate with Escherichia coli and Salmonella enterica persister formation rates in the phyllosphere: a mathematical modeling study

Enteric pathogens can enter a persister state in which they survive exposure to antibiotics and physicochemical stresses. Subpopulations of such phenotypic dormant variants have been detected in vivo and in planta in the laboratory, but their formation in the natural environment remains largely unexplored. We applied a mathematical model predicting the switch rate to persister cell in the phyllosphere to identify weather-related stressors associated with E. coli and S. enterica persister formation on plants based on their population dynamics in published field studies from the USA and Spain. Model outputs accurately depicted the bi-phasic decay of bacterial population sizes measured in the lettuce and spinach phyllosphere in these studies. Predicted E. coli persister switch rate on leaves was positively and negatively correlated with solar radiation intensity and wind velocity, respectively. Likewise, predicted S. enterica persister switch rate correlated positively with solar radiation intensity; however, a negative correlation was observed with air temperature, relative humidity, and dew point, factors involved in water deposition onto the phylloplane. These findings suggest that specific environmental factors may enrich for dormant bacterial cells on plants. Our model quantifiably links persister cell subpopulations in the plant habitat with broader physical conditions, spanning processes at different granular scales.

The Impact of a Pharmacist-Led Intravenous to Oral Switch of Metronidazole: A Before-and-After Study.

(1) Background. Intravenous (IV) to oral switch (IVOS) of antibiotics can reduce the length of hospitalisation, risk of IV catheter complications, and hospital costs. Pharmacists can play an instrumental role in implementing an IVOS initiative. The aim of this study is to evaluate the impact of pharmacist-led IVOS of metronidazole. (2) Method. This was an observational study conducted in a New Zealand hospital. During a 3-month intervention period, pharmacists identified patients receiving IV metronidazole; then initiated an IVOS for patients who met the criteria. The comparator groups were patients who were not switched by pharmacists in the post-intervention (post-IVOS) group, or patients treated with either IV or oral metronidazole prior to the intervention (pre-IVOS). Primary outcome measures were switch rate and duration of IV metronidazole treatment. Secondary outcome measures were readmission and/or repeat surgery within 90 days of discharge and the length of hospital stay. (3) Results. In total, 203 patients were included: 100 in the pre-IVOS and 103 in the post-IVOS groups. Pharmacists switched 63/93 (67.7%) of eligible patients to oral metronidazole in the post-IVOS period. Only 9/89 (10.1%) of IVOS eligible patients were switched in the pre-IVOS group. In the post-IVOS group, the mean duration of IV metronidazole treatment in patients switched by pharmacists was shorter than in those who were not switched by pharmacists (2.5 ± 2.8 days vs. 4.8 ± 5.9 days, p = 0.012). No significant difference was found in readmission or repeat surgery within 90 days of discharge for patients switched by pharmacists versus patients who were not switched by pharmacists. (4) Conclusion. Our data have demonstrated successful implementation of the hospital-approved pharmacist-led IVOS service.

Persistence, Adherence, and Switching to Higher-Cost Therapy in Patients with Multiple Sclerosis Initiating Oral Disease-Modifying Therapies: A Retrospective Real-World Study.

Therapeutic efficacy of disease-modifying therapies (DMTs) for multiple sclerosis (MS) is often hindered by poor persistence and adherence, impacted by patient-perceived efficacy concerns, adverse effects, inconvenience, and forgetfulness. This study measured persistence, adherence, and time to switching to higher-cost therapy among patients with MS initiating teriflunomide, dimethyl fumarate, fingolimod, or diroximel fumarate treatment. This retrospective study used Symphony Health US claims data from patients with MS newly initiated on one of four oral DMTs between January and June 2020. Persistence was defined as the duration a patient continued their medication. Adherence was measured using medication possession ratio (MPR); patients with MPR ≥ 80% were considered adherent. Switching was measured by comparing proportions of patients switching and mean time to switch to one of three higher-cost therapies (ocrelizumab, natalizumab, or cladribine). Kaplan-Meier curves assessed persistence. Chi-square tests determined proportions of patients on therapy after 12months. A total of 6934 patients newly initiated on oral DMTs met study inclusion criteria (teriflunomide, n = 1968; dimethyl fumarate, n = 3409; diroximel fumarate, n = 616; fingolimod, n = 941). Patients newly initiated on teriflunomide and fingolimod had significantly higher persistence rates after 12months (60% and 66%, respectively vs 44% dimethyl fumarate and 49% diroximel fumarate; p < 0.0001), and the highest proportion of adherent patients at 6months (71% and 76%, vs 60% dimethyl fumarate and 58% diroximel fumarate) and 12months (55% and 59%, vs 40% dimethyl fumarate and 44% diroximel fumarate).Mean time to switching to higher-cost therapies ranged from 247days (diroximel fumarate to natalizumab) to 342days (teriflunomide to ocrelizumab), with the highest rate of switching in patients on dimethyl fumarate (7%). Patients newly initiated on teriflunomide and fingolimod had better real-world persistence and adherence at 6 and 12months, and longer time to switch to higher-cost therapies, than patients on dimethyl fumarate or diroximel fumarate.

Analytical and Numerical Treatment of Continuous Ageing in the Voter Model

The conventional voter model is modified so that an agent’s switching rate depends on the ‘age’ of the agent—that is, the time since the agent last switched opinion. In contrast to previous work, age is continuous in the present model. We show how the resulting individual-based system with non-Markovian dynamics and concentration-dependent rates can be handled both computationally and analytically. The thinning algorithm of Lewis and Shedler can be modified in order to provide an efficient simulation method. Analytically, we demonstrate how the asymptotic approach to an absorbing state (consensus) can be deduced. We discuss three special cases of the age-dependent switching rate: one in which the concentration of voters can be approximated by a fractional differential equation, another for which the approach to consensus is exponential in time, and a third case in which the system reaches a frozen state instead of consensus. Finally, we include the effects of a spontaneous change of opinion, i.e., we study a noisy voter model with continuous ageing. We demonstrate that this can give rise to a continuous transition between coexistence and consensus phases. We also show how the stationary probability distribution can be approximated, despite the fact that the system cannot be described by a conventional master equation.

Multilayer Network Analysis of Dynamic Network Reconfiguration in Adults With Posttraumatic Stress Disorder

BackgroundBrain functional network abnormalities are reported in posttraumatic stress disorder (PTSD). Most resting-state functional magnetic resonance imaging studies have assumed that the functional networks remain static during the scans. How these might change dynamically in PTSD remains unclear. MethodsResting-state functional magnetic resonance imaging data were collected from 71 noncomorbid, treatment-naïve patients with PTSD and 70 demographically matched, trauma-exposed non-PTSD control subjects. Network switching rate was used to characterize dynamic changes of individual resting-state functional networks. Results were analyzed by comparing switching rates between the PTSD and trauma-exposed non-PTSD groups, testing for diagnosis × sex interactions, and examining correlations with PTSD symptom severity. ResultsAt the global level, the PTSD group showed significantly lower network switching rates than the trauma-exposed non-PTSD group. These were observed mainly in the frontoparietal, default mode, and limbic networks at the subnetwork level and in the frontal and temporal regions at the nodal level. These network switching rate alterations were correlated with PTSD symptom severity. There were no significant effects of sex. ConclusionsThese disruptions of dynamic functional network stability, reflected by lower network switching rates in the resting state, are a feature of PTSD and suggest that the frontoparietal, default mode, and limbic networks may play a critical role in the underlying neural mechanisms.

Effectiveness of bevacizumab step therapy for neovascular age-related macular degeneration.

To determine the effectiveness of bevacizumab step therapy for neovascular age-related macular degeneration (nAMD) in routine clinical practice. In this retrospective case series, eyes initiating treatment for nAMD at an academic medical centre from 2011-2019 were included. Exclusion criteria included previous intravitreal anti-VEGF injections, prior non-cataract intraocular surgery, <1 year of treatment, and not starting on monthly bevacizumab therapy. Of 895 eligible eyes, 548 were excluded, yielding 347 eyes in the study population. These eyes were treated for nAMD under the bevacizumab step therapy protocol with an option to switch to another agent in the event of predefined treatment failure. Treatment failure was defined as losing 15 or more Early Treatment Diabetic Retinopathy Study letters or switching to an alternative anti-VEGF agent. Eyes that did not meet these criteria were deemed treatment successes. Annual change in mean VA from baseline (ΔVA) was the primary outcome. Secondary outcomes included treatment success rate, medication switch rate, and post-switch ΔVA. After 1 year, mean ΔVA was +8.4 letters (95% CI: +6.1 to +10.6 letters). 86% had treatment success, and 6% of eyes had switched to aflibercept. In years 2-7, ΔVA ranged from +7.0 to -0.7 letters, and treatment success rates ranged from 68 to 82%. 11% (n = 38) of eyes were switched to aflibercept. The post-switch ΔVA in these eyes was -7.1 letters (95% CI: -13.3 to -0.1) after a mean of 17.7 ± 12.6 injections over an average of 2.7 ± 2.0 years. A bevacizumab step therapy protocol in routine clinical practice is effective for long-term treatment of nAMD.

Shaping of converter interference for error rate reduction in PLC based smart metering systems

Smart metering systems often utilize Power Line Communication (PLC) for bidirectional data exchange between smart energy meters and data concentrators. Electromagnetic interference generated by power electronic converters have been found as a main cause of communication errors in PLC data transmission. In this paper novel, modified pseudo-random pulse width modulation technique was developed to significantly reduce PLC frame error rate caused by interference generated by power electronic converters. Moreover, cyber–physical system has been presented as a case study providing high flexibility in controlling the switching rate of change of the modulation. As a general contribution, in the paper has been proposed the concept of electromagnetic interference noise shaping to broaden the possibility of preventing and mitigating non-compatibility scenarios between power electronic converters and telecommunications devices. The experimental results might be useful for system integrators involved in assurance of electromagnetic compatibility of power electronic interfaces and PLC based smart metering systems.

The Australia Smoking and Vaping Model: The Potential Impact of Increasing Access to Nicotine Vaping Products.

We model the potential impact of relaxing current nicotine vaping product (NVP) restrictions on public health in Australia. A Restricted NVP Scenario was first developed to project current smoking and vaping rates, where a U.S. smoking model was calibrated to recent Australian trends. To model less restrictive NVP policies, a Permissive NVP Scenario applied rates of switching from smoking to vaping, initiation into NVP and cigarette use, and cessation from smoking and vaping based on U.S. trends. The model measures vaping risk relative to the excess mortality rate of smoking. The public health impacts are measured as the difference between smoking- and vaping-attributable deaths (SVADs) and life years lost (LYLs) in the Restricted and Permissive NVP Scenarios. Sensitivity analysis is conducted regarding the NVP excess risk and other factors. Assuming an NVP excess risk of 5% that of smoking, 104.2 thousand SVADs (7.7% reduction) and 2.05 million LYLs (17.3% reduction) are averted during 2017-2080 in the Permissive NVP Scenario compared to the Restricted NVP Scenario. Assuming 40% NVP excess risk, 70 thousand SVADs and 1.2 million LYLs are averted. The impact is sensitive to the rate at which smokers switch to NVPs and quit smoking, and relatively insensitive to the smoking initiation and NVP initiation and cessation rates. The model suggests the potential for public health gains to be achieved by relaxing NVP access regulations. However, the model would benefit from better information regarding the impact of NVPs on smoking under a relaxation of current restrictions. Australia has implemented a strong array of cigarette-oriented policies, but has restricted access to NVPs. The Smoking and Vaping Model offers a framework for modeling hypothetical policy scenarios. The Australian model shows the potential for public health gains by maintaining cigarette-oriented policies while relaxing the current restrictive NVP policy. Modeling results under a permissive NVP policy are particularly sensitive to the estimated rates of smoking cessation and switching to vaping, which are not well established and will likely depend on past and future cigarette-oriented policies and the specific NVP policies implemented in Australia.

Variations in Medicare Advantage Switching Rates Among African American and Hispanic Medicare Beneficiaries With Alzheimer's Disease and Related Dementias, by Sex and Dual Eligibility.

The objective of this study was to identify rates of switching to Medicare Advantage (MA) among fee-for-service (FFS) Medicare beneficiaries with Alzheimer's disease and related dementias (ADRD) by race/ethnicity and whether these rates vary by sex and dual-eligibility status for Medicare and Medicaid. Data came from the Medicare Master Beneficiary Summary File from 2017 to 2018. The outcome of interest for this study was switching from FFS to MA during any month in 2018. The primary independent variable was race/ethnicity including non-Hispanic White, non-Hispanic African American, and Hispanic beneficiaries. Two interaction terms among race/ethnicity and dual eligibility, and race/ethnicity and sex were included. The model adjusted for age, year of ADRD diagnosis, the number of chronic/disabling conditions, total health care costs, and ZIP code fixed effects. The study included 2,284,175 FFS Medicare beneficiaries with an ADRD diagnosis in 2017. Among dual-eligible beneficiaries, adjusted rates of switching were higher among African American (1.91 percentage points [p.p.], 95% confidence interval [CI]: 1.68-2.15) and Hispanic beneficiaries (1.36 p.p., 95% CI: 1.07-1.64) compared to non-Hispanic White beneficiaries. Among males, adjusted rates were higher among African American (3.28 p.p., 95% CI: 2.97-3.59) and Hispanic beneficiaries (2.14 p.p., 95% CI: 1.86-2.41) compared to non-Hispanic White beneficiaries. Among persons with ADRD, African American and Hispanic beneficiaries are more likely than White beneficiaries to switch from FFS to MA. This finding underscores the need to monitor the quality and equity of access and care for these populations.

Intermittent attractive interactions lead to microphase separation in nonmotile active matter.

Nonmotile active matter exhibits a wide range of nonequilibrium collective phenomena yet examples are crucially lacking in the literature. We present a microscopic model inspired by the bacteria Neisseria meningitidis in which diffusive agents feel intermittent attractive forces. Through a formal coarse-graining procedure, we show that this truly scalar model of active matter exhibits the time-reversal-symmetry breaking terms defining the Active Model B+ class. In particular, we confirm the presence of microphase separation by solving the kinetic equationsnumerically. We show that the switching rate controlling the interactions provides a regulation mechanism tuning the typical cluster size, e.g., in populations of bacteria interacting via type IV pili.

Efficacy of switches within the class of IL-17 inhibitors: An analysis of data from the Czech nationwide registry of psoriatic patients receiving biological/targeted therapy (BIOREP).

The IL-17 cytokine family encompasses six different homodimers and heterodimers referred to as IL-17A-F. Due to some differences in the mechanism of IL-17 inhibition, aninsufficient effect of one IL-17 inhibitor does not necessarily imply lack of efficacy of the other agent of the same class. Aim of study was analysis of the success rate of switches among IL-17 inhibitors (secukinumab, ixekizumab, and brodalumab) in patients treated in the Czech Republic. Data were obtained from the Czech nationwide registry of psoriatic patients receiving biological/targeted therapy (BIOREP). Our analysis involved data of a total of 90 patients with severe chronic plaque psoriasis and baseline PASI scores >10 both prior to first-line biological therapy initiation and after switch to another agent of the class of IL-17 inhibitors. The most effective switch was that from secukinumab to brodalumab, with PASI 90 reached by 64.7% and 73.3% of patients at weeks 12 and 24. Among patients switched from secukinumab to ixekizumab target PASI 90 responses were achieved (at weeks 12 and 24) by 41.2% and 55.2% of patients. Among patients switched from ixekizumab to brodalumab target PASI 90 responses were achieved, at the above time points, by 30.8% and 38.5% of patients. Our analysis showed a high success rate of switches from secukinumab to ixekizumab and brodalumab, followed by the ixekizumab-to-brodalumab switch. Importantly, the therapeutic response and success rates of individual switches are independent of the patient's body weight and presence of psoriatis arthritis.

High-repetition rate acousto-optic gated SAF-LIBS for quantitative analysis

The self-absorption-free LIBS (SAF-LIBS) we developed recently was demonstrated to be effective in reducing the effects of self-absorption, but it is difficult to be applied to industrial production because of the need for expensive, large size and fragile components such as ICCD and echelle spectrometer. In this study, a novel quantitative analysis technology named as high repetition rate acousto-optic gated SAF-LIBS is proposed, in which AOM acts as the optical gating switch and high-repetition rate laser as the excitation source, so that the miniaturized CCD spectrometer can be used in the SAF-LIBS. Univariate quantitative analysis results show that the linear correlation coefficient of the calibration curve of aluminum is 0.98, and the average absolute error is 0.15%, indicating that the measurement accuracy is almost the same as traditional SAF-LIBS. This work will greatly reduce the cost and size of the system and improve the practicability of SAF-LIBS.

An aggregation model of cockroaches with fast-or-slow motion dichotomy.

We propose a mathematical model, namely a reaction-diffusion system, to describe social behaviour of cockroaches. An essential new aspect in our model is that the dispersion behaviour due to overcrowding effect is taken into account as a counterpart to commonly studied aggregation. This consideration leads to an intriguing new phenomenon which has not been observed in the literature. Namely, due to the competition between aggregation towards areas of higher concentration of pheromone and dispersion avoiding overcrowded areas, the cockroaches aggregate more at the transition area of pheromone. Moreover, we also consider the fast reaction limit where the switching rate between active and inactive subpopulations tends to infinity. By utilising improved duality and energy methods, together with the regularisation of heat operator, we prove that the weak solution of the reaction-diffusion system converges to that of a reaction-cross-diffusion system.

33172 Real-world treatment patterns of adults with psoriasis initiated on apremilast or biologics

Background: Patients with psoriasis (PsO) commonly switch treatments due to adverse events and declining efficacy. This study used real-world data to assess treatment switching, discontinuation, and persistence in biologic- and apremilast-naive patients with PsO. Methods: Optum Clinformatics Data Mart claims were used to identify adults with PsO who newly initiated (index) treatment with apremilast, tumor necrosis factor inhibitors (TNFi; infliximab, adalimumab, etanercept, certolizumab pegol), or interleukin inhibitors (ILi; ustekinumab, guselkumab, tildrakizumab, risankizumab, brodalumab, secukinumab, ixekizumab) between 7/1/2014 and 12/31/2019, and had continuous enrollment for ≥1 year pre-index and ≥2 years post-index. Patients were propensity score matched 1:1:1 to adjust for possible selection bias. Rates of treatment switch, discontinuation, and persistence were measured over 24 months (24 m) of follow-up. Results: 2535 patients were included (845 per cohort). At 24 m, switch rates were highest for TNFi (32%), followed by apremilast (21%) and ILi (14%), with the majority of patients switching to treatment with a different mechanism of action. Overall discontinuation rates at 24m were 59%, 42%, and 58% for apremilast, TNFi, and ILi, respectively. More patients reinitiated ILi after discontinuing (65%) than either apremilast (40%) or TNFi (37%). At 24m, 21%, 25%, and 28% of patients on apremilast, TNFi, and ILi, respectively, persisted with same index treatment. Conclusion: This retrospective study showed that switching PsO treatment is common and increases over time. Oral treatments had lower switch rates compared with TNFi despite lower effectiveness in biologic-naive patients. Discontinuation was higher and persistency was lower for apremilast than for more effective biologic treatments.

Clinical and economic burden of tumor lysis syndrome among patients with chronic lymphocytic leukemia/small lymphocytic lymphoma: A real-world US retrospective study.

BACKGROUND: Tumor lysis syndrome (TLS) is a potentially fatal complication of antineoplastic treatments for hematologic malignancies, including chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL). Patients developing TLS require intensive care, adding to the overall clinical and economic burden of CLL/SLL. OBJECTIVE: To analyze TLS-associated health care resource utilization (HCRU) and costs in patients with CLL/SLL treated with regimens associated with a high TLS risk (per treatment guidelines), ie, anti-CD20-based chemoimmunotherapy (CIT), lenalidomide, obinutuzumab, or venetoclax. METHODS: Adult patients with CLL/SLL in the MarketScan Databases (January 1, 2006, to April 30, 2020) initiated on CIT, lenalidomide, obinutuzumab, or venetoclax (index date) on or after January 1, 2007, were included in the analysis. Treatment-emergent TLS was defined as TLS occurring in the first 90 days of active treatment. The post-index period was divided into 30-day intervals until the end of the index regimen; intervals pre-TLS were non-TLS intervals and those starting from the TLS event were TLS intervals. Per-patient-per-month (PPPM) HCRU and costs were compared between TLS and non-TLS intervals using generalized linear models adjusted for baseline and time-varying confounders. The proportion of patients in the TLS cohort (patients with treatment-emergent TLS) and non-TLS cohort (patients with no treatment-emergent TLS) who switched treatment within 90 days post-index was compared using Kaplan-Meier rates with logrank P values. RESULTS: Among 6,343 patients with CLL/SLL, 71 (1.1%) developed treatment-emergent TLS (venetoclax: 11.5%; other regimens: 0.8%) after a mean (median) of 12.7 (7.0) days following treatment initiation (mean [median] duration of index regimen: 16.0 [10.0] months); 12 (0.2%) developed clinical TLS (venetoclax: 3.1%; other regimens: 0.1%). TLS was associated with 1.7 times more inpatient admissions (P < 0.001), 2 times more days of inpatient stay (P = 0.012), 22% fewer days of antineoplastic drug administration (P = 0.020), and $3,062 PPPM higher health care costs (P = 0.016), which were mainly driven by $1,688 PPPM higher inpatient costs (P = 0.044). Higher costs were observed among both patients who initiated venetoclax (TLS: $24,170; non-TLS: $20,091) and those who initiated other regimens (TLS: $8,746; non-TLS: $6,915). More patients in the TLS vs non-TLS cohort switched treatment in the first 90 days of treatment (12.6% vs 5.1%, P = 0.006). CONCLUSIONS: TLS was associated with a substantial cost burden (driven by inpatient costs) and higher rate of treatment switching (vs non-TLS cohort) in patients with CLL/SLL treated with CIT, obinutuzumab, lenalidomide, or venetoclax. The risk of treatment-emergent TLS and associated incremental HCRU and costs, as well as the potential impact on quality of life, should be weighed when evaluating the risk-benefit of therapies in CLL/SLL management. DISCLOSURES: Dr Rogers has received research funding from Genentech, AbbVie, Novartis, and Janssen (not for the present study); consulting fees from Acerta Pharma, AstraZeneca, Innate Pharma, Pharmacyclics, Genentech, and AbbVie; and travel funding from AstraZeneca. Mr Emond, Mr Kinkead, Ms Lafeuille, and Mr Lefebvre are employees of Analysis Group, Inc., which has provided paid consulting services to Janssen Scientific Affairs, LLC. Drs Lu and Huang are employees of Janssen Scientific Affairs, LLC, and stockholders of Johnson & Johnson. Ms Côté-Sergent was an employee of Analysis Group, Inc., at the time the study was conducted. This study was funded by Janssen Scientific Affairs, LLC. The sponsor was involved in the study design; data collection, analysis, and interpretation; manuscript writing; and the decision to publish the article.

Microstrip feed dual band and triple band frequency reconfigurable antenna for diverse applications

A compact reconfigurable antenna which can operate at wide range of frequency bands like ITU-band (7.725 GHz– 8.5 GHz), X-band (8-12.5GHz) and Wi-Fi (3.6 GHz, 5 GHz, and 5.9 GHz) very efficiently with gain ranging from 10dB to 12dB which can be useful for commercial applications is designed. A circular shaped antenna with microstrip line feeding is designed with highest switching rate with the abet of two-diodes which provides state of flexibility in terms of frequency reconfigurability, number of operating bands, frequency reconfigurability and stable radiation pattern with easily fabricating opportunities consists of stub loaded circular patch radiator. The novelty of proposed ultramodern antenna in terms of the band-width frequency reconfigurability, and multiple operating modes are achieved due to the collation performance of the suggested antenna operates in commercial applications.

Keep flexible—Keep switching? Boundary conditions of the influence of forced task switching on voluntary task switching.

Frequent forced switching between tasks has been shown to reduce switch costs and increase voluntary switch rates. So far, however, the boundary conditions of the influence of forced task switching on voluntary task switching are unknown. Thus, the present study was aimed to test different aspects of generalizability (across items, tasks, and time) of switching-induced flexibility established in forced-choice trials on voluntary switching in free-choice trials. To this end, stimuli and tasks were systematically varied between forced- and free-choice trials in a hybrid task-switching paradigm. In a series of three experiments, we manipulated forced-choice switch probability (25% vs. 75%) and found that switching-induced flexibility generalizes to new items, but arguably not to new tasks. This task-specific effect is rather short-lived, limited to the first free-choice trial following a forced-choice trial. Underlying mechanisms of switching-induced flexibility, the versatility of flexibility and implications for the trainability of cognitive flexibility are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).