Real Utilization Research Articles

Hydrogel Plus as Alternative Technology In Sustainable Palm Oil Agricultural

Palm oil (Elaeis guineensis Jacq.) is one of the most important plantation crops in the agricultural sector. However, during the dry season the production of palm oil is decreasing, due to the reduced availability of water especially on peatlands. One way to overcome this problem is by the use of Hydrogel Plus technology (Hydrogel based bagasse with the addition of Pseudomonas fluorescens). This study aims to determine the role of Hydrogel Plus (Hydrogel with the addition of Pseudomonas fluorescens) to the growth and production of palm oil on the peat during the dry season. The method used in this research is the experimental method using Completely Randomized Design. Treatment was done by 4 treatments and each treatment was repeated 5 times. So the experimental unit amounted to 20 units. The treatments include (P1) Control, (P2) Hydrogel application (P3) Application of Pseudomonas fluoresces suspension and (P4) Hydrogel Plus applications. Based on the result of the research, it can be concluded that Hydrogel administration with the addition of Pseudomonas fluorescens bacteria tends to have a significant effect on leaf diameter, leaf number and height of plant at each treatment and only at plant height on treatment of Pseudomonas fluorescens and only hydrogel treatment which has no effect real utilization of Hydrogel Plus can provide the effect of palm oil plant growth and production to be a specific effort as an alternative technology in sustainable palm oil management in peatlands during the dry season.

DDDR-24. REAL WORLD EXPERIENCE USING THE IDH INHIBITOR IVOSIDENIB IN IDH MUTANT GLIOMA: TOLERABILITY AND OUTCOMES

Abstract BACKGROUND Mutant isocitrate dehydrogenase (IDHm) inhibitors represent a novel therapeutic strategy for treating IDHm glioma, though their optimal use outside of clinical trials remains undefined. This study describes real world utilization of the IDH1 inhibitor, ivosidenib, in patients with IDHm glioma. METHODS We retrospectively reviewed clinical and radiographic data from IDHm glioma patients treated with ivosidenib monotherapy at Dana-Farber Cancer Institute and Massachusetts General Hospital from 2020-2024. Patients with a baseline MRI at ivosidenib initiation and at least 2 subsequent scans while on ivosidenib were included in radiographic response analysis (452 scans). RESULTS This cohort included 77 patients (39 males) age 17-75 years (median 41). Thirty-eight patients (49%) had astrocytomas and 39 (51%) had oligodendrogliomas; 48 (62%) had grade 2, 26 (34%) grade 3, and 3 (4%) grade 4 gliomas. Twenty-four patients (31%) received ivosidenib as first-line therapy and 53 (69%) received ivosidenib after failing prior treatments. Among those in the radiographic analysis, 4 (6%) demonstrated partial response, 4 (6%) minor response, 44 (62%) stable disease, and 19 (27%) progressive disease (PD). Significantly higher PD rates were seen in those with enhancing disease (p<0.001) or received ivosidenib as subsequent-line therapy (p=0.002); PD rate was similar between grades 2 and 3 in the first-line group (p=0.64). One-year progression free survival was 100% in the first-line group and 66% in the subsequent-line group. At the time of our analyses, 4 patients (5%) had died (all in the subsequent-line group). Infrequent side effects included CK elevation, QTc prolongation, transaminitis, and diarrhea. One patient (1%) was dose reduced and 3 (4%) discontinued drug due to side effects. CONCLUSIONS In this real world IDHm glioma cohort, ivosidenib was well-tolerated. Better response rates were seen in patients without enhancing disease at ivosidenib initiation and those who received the drug as first-line therapy.

Real Word Autologous Transplant Utilization and Outcomes By Race and Ethnicity

Real Word Autologous Transplant Utilization and Outcomes By Race and Ethnicity

Evaluating Real World Health System Resource Utilization and Costs for a Risk-Based Breast Cancer Screening Approach in the Canadian PERSPECTIVE Integration and Implementation Project.

A prospective cohort study was undertaken within the PERSPECTIVE I&I project to evaluate healthcare resource utilization and costs associated with breast cancer risk assessment and screening and overall costs stratified by risk level, in Ontario, Canada. From July 2019 to December 2022, 1997 females aged 50 to 70 years consented to risk assessment and received their breast cancer risk level and personalized screening action plan in Ontario. The mean costs for risk-stratified screening-related activities included risk assessment, screening and diagnostic costs. The GETCOST macro from the Institute of Clinical Evaluative Sciences (ICES) assessed the mean overall healthcare system costs. For the 1997 participants, 83.3%, 14.4% and 2.3% were estimated to be average, higher than average, and high risk, respectively (median age (IQR): 60 [56-64] years). Stratification into the three risk levels was determined using the validated multifactorial CanRisk prediction tool that includes family history information, a polygenic risk score (PRS), breast density and established lifestyle/hormonal risk factors. The mean number of genetic counseling visits, mammograms and MRIs per individual increased with risk level. High-risk participants incurred the highest overall mean risk-stratified screening-related costs in 2022 CAD (±SD) at CAD 905 (±269) followed by CAD 580 (±192) and CAD 521 (±163) for higher-than-average and average-risk participants, respectively. Among the breast screening-related costs, the greatest cost burden across all risk groups was the risk assessment cost, followed by total diagnostic and screening costs. The mean overall healthcare cost per participant (±SD) was the highest for the average risk participants with CAD 6311 (±19,641), followed by higher than average risk with CAD 5391 (±8325) and high risk with CAD 5169 (±7676). Although high-risk participants incurred the highest risk-stratified screening-related costs, their costs for overall healthcare utilization costs were similar to other risk levels. Our study underscored the importance of integrating risk stratification as part of the screening pathway to support breast cancer detection at an earlier and more treatable stage, thereby reducing costs and the overall burden on the healthcare system.

Co-pyrolysis behaviors of biomass and polymer plastics by using reactive molecular dynamics simulation

Co-pyrolysis of oxygen-rich biomass and hydrogen-rich plastic polymer is a promising approach for waste management, which has been investigated by using reactive molecular dynamics simulation (ReaxFF MD) in this work. The blend models containing multicomponent mixtures of polymer (polyethylene, polypropylene, polystyrene) and biomass (cellulose, hemicellulose and lignin) were constructed for the first time, which is close to the real utilization of waste materials. The simulation results show that the degree of positive synergistic effect between biomass and polymer increases with temperature, where the polymer promotes biomass pyrolysis and delays its recombination. Co-pyrolysis greatly affects the product yields through cross reactions of hydrogen and hydroxyl transfer, leading to more oxygen-containing bio-oils produced with the aid of polymers providing hydrogen. Produced from heavy tar at first and light char at late pyrolysis period, char precursors are generated more and faster in the co-pyrolysis system with more biomass because oxygen functional groups provide the initial cross-linking sites. As compared to pyrolysis of only binary components, the observed qualitative synergistic results in co-pyrolysis of biomass-polymer mixtures provide important insights into the detailed reactions for co-pyrolysis process, which can complement experimental observations to modulate the nature and yield of the desired bio-oils and bio-chars.

Abstract WMP30: Real World Experience With Tenecteplase on a Mobile Stroke Unit

Background: Tenecteplase (TNK) administered on a mobile stroke unit (MSU) has demonstrated superior rates of early reperfusion compared to alteplase. Current guidelines include TNK as a second-tier option for large vessel occlusions as TNK has many benefits, including rapid IV administration and ease of dosing. The objective of this study was to describe real world utilization of TNK on a MSU. Methods: This was a retrospective observational study of patients receiving TNK as compared to alteplase between February 2021 and April 2023 at a large academic comprehensive stroke center. Baseline demographics, GCS, NIHSS, as well as time of initial imaging were collected. Primary endpoint was time from MSU door to thrombolytic administration. Secondary endpoints included: MSU door to imaging interpretation, dispatch to thrombolytic administration, and provider decision time to thrombolytic administration. Safety endpoints included symptomatic ICH within 24 hours. Results: During the studied time period 40 patients received alteplase and 32 patients received TNK on the MSU. The median age was 65.7 years and median NIHSS score was 9. There was no difference in time from MSU door to thrombolytic administration (15 vs 17.5, p=0.30). There was also no difference in time from MSU door to imaging interpretation, dispatch to thrombolytic administration, or provider decision time to thrombolytic administration. No hemorrhagic conversion occurred. Conclusion: This is the largest series to date describing real-world utilization of TNK administration in a MSU. There were no significant differences in time to therapy in any of the time points evaluated. This data is promising for the treatment of ischemic stroke in which time to administration of thrombolytic therapy is paramount and TNK is administered as a rapid IV injection as compared to alteplase infusion.

Lisocabtagene Maraleucel in Relapsed/Refractory Large B-Cell Lymphoma: Real World Analysis from the Cell Therapy Consortium

Introduction Lisocabtagene maraleucel (liso-cel) is an autologous CD19-directed CAR T cell therapy approved for the treatment of relapsed/refractory (R/R) large B-cell lymphoma (LBCL) based on the TRANSCEND (Abramson et al, Lancet 2020), TRANSFORM (Kamdar et al, Lancet 2022), and PILOT studies (Sehgal et al, Lancet Oncol 2022). Extending clinical trial results for liso-cel to the real-world setting, we performed a multicenter retrospective study to evaluate the safety and efficacy of liso-cel in standard of care practice. Methods Patients (pts) aged ≥18 years with LBCL who received commercial liso-cel infusion between February 2021 (time of FDA approval) and June 2023 at 7 academic US medical centers were identified from the Cell Therapy Consortium registry. Pt and treatment characteristics were summarized descriptively, and the Kaplan Meier method was used for survival outcomes. Cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) were graded per ASTCT consensus criteria. Tumor response was assessed per Lugano criteria locally by the treating clinician. Results As of 6/10/2023, 101 pts underwent liso-cel infusion. Detailed baseline pt characteristics are shown in Table 1. Median age at apheresis was 71 years (range: 30-85) with 35% of pts ≥75 years, 60% were male, 16% had an ECOG PS of ≥2 at apheresis, and 11% had active secondary CNS involvement. By histology, 86% of pts had DLBCL, 7% HGBL, 5% TFL, and 2% PMBCL. Baseline comorbidities included diabetes (18%), stage IV chronic kidney disease (5%), cerebrovascular disease (5%), impaired cardiac ejection fraction (2%), pulmonary dysfunction (2%), impaired hepatic function (2%), and active infection (3%), with 68% having a Charlson Comorbidity Index score of ≥3. Due to comorbidities, 30% of pts would have been ineligible for the TRANSCEND clinical trial. The median number of prior therapies was 3 (range: 1-8) and 16% of pts underwent prior autologous stem cell transplant. Bridging therapy was used in 62% of pts including 41% receiving polatuzumab-based treatment, 24% chemoimmunotherapy, and 21% radiation therapy. Seven (7%) pts received liso-cel on an expanded access trial (NCT04400591) due to a non-conforming product. Median time from apheresis to CAR T-cell infusion was 39 days (IQR: 34-43) and 85% of CAR T-cell infusions occurred inpatient. Any Grade CRS occurred in 49% (3% were Grade ≥3) and any Grade ICANS occurred in 26% (10% were Grade ≥3). Median onset of CRS and ICANS was 4 and 6 days following liso-cel infusion, respectively. Tocilizumab was administered in 31% and 31% of pts received steroids for toxicity management. Nine deaths (9%) unrelated to lymphoma progression occurred at a median of 1.2 months (range: 0.3-4.3) with 2 due to infectious complications, 2 due to other malignancy, 1 due to grade 5 neurologic toxicity, 1 due to concurrent grade 5 neurologic toxicity and grade 5 CRS, 1 due to accidental death, and 2 due to unknown causes. The 6-month incidence of non-relapse mortality was 8% (95% CI, 3.4% - 15%). The overall response rate (ORR) to bridging therapy, as assessed prior to lymphodepletion, was 45% with 17% achieving a complete response (CR). Following liso-cel infusion, response assessment was performed at day 30 and/or day 90 according to treating center practice, or in those determined to have clinical progression. Of the 89 pts evaluable at day 30, the ORR was 81% with 63% achieving a CR. Among 76 pts evaluable at day 90, the ORR was 63% with 58% achieving a CR. With a median follow-up of 10.3 months (range 0.3-22.8), month 6 outcomes were 62.7% (95% CI, 52.8% - 74.3%) for progression-free survival, 71.6% (95% CI, 60.9% - 84.1%) for duration of response, and 77.1% (95% CI, 68.4% - 86.9%) for overall survival ( Figure 1). Conclusions These analyses confirm that efficacy and safety are similar or superior to those of patients enrolled in liso-cel prospective clinical trials for R/R LBCL. Notably, these outcomes were achieved in pts predominately of advanced age and with a significant comorbid burden, recognizing that one-third would have been ineligible for TRANSCEND. These results also likely reflect advancements in patient selection and toxicity management including the real world utilization of novel bridging therapy to temporize and debulk disease. Follow-up is ongoing and updated data will be presented at the meeting.

Real World Utilization of Cranial or Craniospinal Radiation in Adult Acute Lymphoid Leukemia Patients: Data from the Center for International Blood and Marrow Transplant Research

Though CNS involvement at diagnosis in adult acute lymphoid leukemia (ALL) is relatively rare (3-7%), >50 % of patients will develop CNS relapse without CNS-directed therapy. Radiation therapy is commonly used as part of stem cell transplant (SCT) conditioning. Historically, a cranial boost was given to reduce risk of CNS relapse. While a CNS boost is not a universal part of prophylaxis, CNS directed RT is used in patients at highest risk for CNS relapse following transplantation, typically those with CNS disease at diagnosis or after induction. There is little data on real world utilization of CNS directed radiation as part of SCT for adult ALL patients. The Center for International Blood and Marrow Transplant Research (CIBMTR) database was queried for adult ALL patients undergoing SCT between 2013 - 2019 who received TBI as part of their regimen where data was available on CNS directed RT. Patient demographics, pre-transplant response to induction, CNS status pre/post-transplant, and overall survival information were collected. Results were stratified by cranial irradiation (CNS-RT), craniospinal irradiation (CSI), or no cranial RT (nCRT). Radiation dose is not collected by the CIBMTR. The data presented here are preliminary and were obtained from the Statistical Center of the Center for International Blood and Marrow Transplant Research. The analysis has not been reviewed or approved by the Advisory or Scientific Committees of the CIBMTR. A total of 1240 patients were identified, of which 59 (5%) received CNS-RT, 2 (0.2%) received CSI, 989 (80%) received nCRT, and 190 (15%) had unknown CNS RT status. Median age was younger in patients receiving CNS-RT (26y, range 19-66y) or CSI (34y, 22-46y) compared to patients receiving nCRT (42y, 18-79y). Patients receiving CNS radiation had more advanced disease at time of transplant (17% requiring 3+ lines of induction before CR vs 50% vs 5%, respectively). 24% of CNS-RT patients and 50% of CSI patients had CNS disease at diagnosis compared to 7% of nCRT patients. 37% of CNS-RT patients and 100% of CSI patients had CNS disease prior to transplant compared to 11% of nCRT patients. Overall survival at 1-5 years was numerically higher with CNS-RT compared to no RT, though 95% confidence intervals overlapped at each follow up point. Data from the CIBMTR on real world utilization of CNS-RT or CSI in adult ALL patients suggest inconsistent practice patterns with 11% of patients without any cranial RT having CNS disease prior to transplant and 57% of CNS-RT patients having no CNS disease prior to transplant. These data offer an interesting analysis of current CNS radiation practice patterns in the past 10 years for adult ALL patients, though interpretation is limited by the retrospective nature of the study and by significant limitations of available data.

Functionalized Carbon Nanotubes Encapsulated Alginate Beads for the Removal of Mercury Ions: Design, Synthesis, Density Functional Theory Calculation, and Demonstration in a Batch and Fixed-Bed Process.

Various nanomaterials have been envisaged mainly through batch studies for environmental remediation application. The real utilization of these new generation adsorbents in large scale pose a difficulty due to its low density and small size which makes it difficult for isolation after application. In this context, nanoadsorbents polymer composite beads can be seen as a way out. Here, functionalized CNTs (carbon nanotubes) have been fabricated into micro beads with sodium alginate. The alginate-functionalized CNT (Alg-f-CNT) beads were then comprehensively evaluated for batch and fixed-bed column separation of divalent mercury ions from an aqueous medium. The effects of process parameters such as pH, contact time, feed Hg2+ concentration, and temperature were studied. Simulation of the experimental data suggested that adsorption is an endothermic spontaneous process which follows the pseudo-second-order kinetic and Langmuir isotherm model. The desorption of the Hg2+ ion from used adsorbent was possible with 1 M HNO3. The breakthrough curves at different process parameters were investigated during fixed-bed column separation and found to be in good agreement with Thomas model. The regeneration and reusability of the adsorbent were tested up to five cycles without a significant decrease in the removal performance. Density functional theory studies revealed stronger interaction of Alg-f-CNT with Hg compared to free alginic acid and established the role of carboxyl and oxo groups present in the adsorbent in the coordination of the Hg2+ ions. The experimental results demonstrate that functionalized CNT-encapsulated alginate beads are a promising alternate material, which can be used to remove mercury in the fixed-bed column mode of the operation.

Real world utilization and outcomes of immunotherapy regimens in metastatic castration resistant prostate cancer (mCRPC).

e17038 Background: While immune checkpoint inhibitors (ICIs) have shifted the treatment paradigm in many cancers, their efficacy in mCRPC is limited. Ongoing research suggests distinct subpopulations of mCRPC may derive benefit or that combinatorial regimens including ICIs may overcome treatment resistance. This single-center retrospective study aims to describe real-world utilization patterns of ICIs for patients with mCRPC and assess the treatment effects. Methods: The EHR database was queried for patients with PC who were treated with an ICI outside of a clinical trial. Additional data were obtained from chart review and the cancer registry. Patients were excluded if ICI was given for another cancer type, non-metastatic disease, or as a component of small-cell lung cancer regimens. Kaplan-Meier curves were used to estimate time to events. Results: 31 patients are included in the study. From years 2016 to 2022, 13 patients received ICI alone. Starting in 2019, 18 patients received ICI combined with cabozantinib (C). ICI+C had PSA response rate (RR) of 50%, median duration of treatment (DOT) of 5.5 months, and median overall survival (OS) of 8 months (Table 1). 3 of these patients received therapy for ≥ 12 months. ICI alone had a RR of 0%. 94% of patients who received ICI+C were not a candidate for CONTACT-2 (NCT04446117). Conclusions: Oncologists continue to use ICI for mCRPC. While noncomparative, ICI+C demonstrated favorable activity over a historical cohort of ICI alone. Ongoing clinical trial participation is vital for patients with mCRPC; however, off-label prescribing may provide additional access to treatment options. [Table: see text]

RWD161 Real World Utilization of Androgen Deprivation Therapy Among Urology Practices: Characterizing Initiation and Transition to Relugolix for Patients with Prostate Cancer (THE REAL ADT TRANSITIONS STUDY)

Relugolix was FDA approved in December 2020 as the first oral gonadotropin releasing hormone (GnRH) receptor antagonist to treat advanced prostate cancer and became commercially available in January 2021. Previous studies have documented transitions between injectable GnRH agonists and antagonists. This study examined the real-world utilization of relugolix during its first year of availability (January – December 2021) and documented transitions between injectable and oral androgen deprivation therapy (ADT).

A novel patient-centric longitudinal data registry platform to generate insights into real-world cholangiocarcinoma (CCA) clinical practice.

4084 Background: Treatment of advanced CCA has changed dramatically over the past five years with the advent of molecularly targeted therapy, now approved in the 2nd line and beyond. However, real world utilization of molecular profiling and targeted therapy is still unknown and these data are critical to empower treatment decision-making. Methods: In 2019, the Cholangiocarcinoma Foundation (CCF) and Ciitizen (a wholly owned subsidiary of Invitae Corporation) collaboratively launched a registry platform that directly consents patients and collects comprehensive medical records. De-identified data including clinical characteristics, molecular testing, interventions, and outcomes are extracted and standardized for research use. The data is longitudinal with regularly planned updates; registry participants can be re-engaged to obtain additional data and communicate tailored insights. Results: We quantified the rate of molecular testing, the presence of targetable biomarkers, and the utilization and outcomes on matched targeted therapies for 372 individuals with CCA. 328 (88.2%) individuals had molecular testing, with the identified targetable mutations and matched therapies reported. Of 328 individuals who had molecular testing, 111 (33.8%) individuals had one or more targetable mutations (116 mutations total). Only 46% (51) of individuals with targetable mutations received targeted therapy. Of the 54% (60) individuals with targetable mutations that did not receive any matched therapy, the majority (61.7%, 37) were in early disease or first line of treatment and therefore not yet eligible for targeted therapy. These individuals will be informed that based on their molecular profile, a targeted therapy may be an option, and suggest they discuss with their treating physician. Conclusions: A novel prospectively-maintained database registry for CCA has been formed in collaboration between a patient advocacy organization (CCF) and industry (Invitae). Prevalence of actionable biomarkers was higher than historically expected and may reflect patient utilization bias of the registry platform. Molecular profiling and access to targeted therapeutics remains suboptimal at this time in CCA. Future directions for the registry include identifying and targeting disparities in care and supporting biopharmaceutical development and regulatory decisions. [Table: see text]

Real world utilization and disparities in outcome in the use of novel anti-androgen agents for metastatic prostate cancer.

6616 Background: Despite advances in treatment, disparities exist in prostate cancer treatment and utilization of treatment resources based on several factors including race and socioeconomic status. As evidence-based guidelines increasingly define novel androgen receptor inhibitors (ARIs) as the standard of care, it is important to understand how the utilization of ARIs impacts the outcome. In this study, we investigated the relationship between the utilization of the two most commonly used ARIs, Abiraterone and Enzalutamide, and survival among patients with metastatic prostate cancer. Methods: We conducted a retrospective analysis of patients in the Surveillance, Epidemiology, and End Results (SEER)-Medicare database from January 1st, 2013 to December 31, 2017. All patients aged 18 years and above with metastatic prostate cancer were included. The objective of these study was to determine the utilization of ARIs in different groups (age, race, location, income status and marital status) and investigate the impact of these variables on the survival. Kaplan-Meir survival curves were used for the survival analysis. Patients were stratified by: who received an ARI alone or in combination vs. who did not. Log-rank tests were used to compare the stratified survival probability curves by groups. A multivariate proportional hazards model was used to compare the instantaneous risk of death in metastatic prostate cancer between patients based on selected covariates. All hypothesis tests were two-tailed with a p-value < 0.05 considered statistically significant. Results: A total of 5889 patients with metastatic prostate cancer were included in the analysis. The median age was 73 years; 39% of patients received an ARI alone or in combination with other agents. Among the patients who received ARIs, 77 %, 15% and 8% were white, black and of other races, respectively. Use of ARIs were more in urban locations (98.1% vs. 1.9% at rural locations) and in patients with higher and mid-level incomes (73.0% vs. 22.7% in low-income group). While survivals were inferior in all subgroups of patients who did not receive ARIs, survivals was better in white race (vs. black and others) as well as in younger age group who received ARIs. However, in the latter group, there was no statistical difference in survival in rural vs. urban locations and low income vs. high and mid-income groups. Conclusions: Our study shows that 39% of patients with metastatic prostate cancer in the SEER Medicare population utilized an ARI.There was a significant underutilization of ARIs in non-white, rural locations and low-income subgroup. White race and younger age populations were associated with better survival irrespective of use of ARIs. Among patients who did not receive ARIs, survivals were inferior in rural (vs. urban) and low-income (vs. high and mid-income) patients, but survivals were equivalent in these subgroups who received ARIs.

External heating-induced thermal runaway and gas venting characteristics of polymer lithium-ion cells with LiNixCoyMnzO2 cathode

Thermal runaway is an important issue in the process of storage and application of lithium-ion cells. Herein, to better grasp gas venting characteristics and assess its risk, several sets of thermal runaway experiments and hazard analysis were conducted on polymer lithium-ion cells under external heating. Results demonstrate that 50–100% SOC cells exhibit fierce venting accompanied by higher surface temperature, temperature rate, voltage dropping, and mass loss compared to 25% SOC cells. The gas centerline temperature distribution covered with venting oscillation conforms to piecewise exponential expressions of height and heat release rate. The venting rate and internal pressure were deduced by temperature and mass loss, which increase monotonously with SOC increasing. The maximum heat release rate increases from 1.45 kW to 5.54 kW for 50–100% SOC cells, while it rapidly rises to 73.3 kW for 100% SOC cells under a secondary ignition. The heat release rate predicted by mass loss or flame surface area coincides well with experimental results. Besides, the asphyxiant harm of the gas emission was also evaluated by the fractional effective dose method. The findings give guidance for process safety evaluation, fire prevention and rescue in a real practical engineering utilization of cells.

プロセスと空間からみたエリア一体型リノベーションまちづくりに関する研究愛知県岡崎市籠田公園周辺地区を対象として

The purpose of this study is to clarify the actual situation of area-integrated renovation town planning in the Kagoda Park neighborhood of Okazaki City. The findings are follows, 1) the overall process of the redevelopment of public space by the government and the utilization of idle real estate by the private sector activities was clarified, 2) the redevelopment of Kagoda Park and Central Avenue created many spaces where many people can stay, based on the opinions of citizens, 3) few businesses were affected by both public space redevelopment and idle real estate utilization activities.

Real-world combination therapy patterns in patients receiving leuprolide or relugolix for androgen deprivation therapy in 2021 (The REAL-ADT COMBO Study): Analysis from a US EMR database.

74 Background: Relugolix, an oral gonadotropin releasing hormone (GnRH) receptor antagonist, was FDA approved for the treatment of adults with advanced prostate cancer (PC) in December 2020 and became commercially available in January 2021. Data from a subgroup of patients from the Phase 3 HERO study showed patients combining relugolix with enzalutamide or docetaxel had similar efficacy and safety as other cohorts in the study. However, due to limited data, some guidelines do not recommend relugolix in combination with other therapies. We evaluated real world utilization of leuprolide and relugolix in combination with other PC medications. Methods: An observational retrospective analysis was conducted using Electronic Medical Record (EMR) data. PPS Analytics data from 89 urology practices with patients represented across all 50 states in the US were analyzed. Patients with at least one record of androgen deprivation therapy (ADT) in 2021 were included. Patients whose date of ADT initiation could not be determined were excluded from this analysis. This analysis focused on the occurrence of patients with ADT as well as in combination with other PC medications. Data are reported for all patients treated with leuprolide or relugolix and stratified by new and continuing ADT use. Combination PC medications were reported for these two ADT groups. Results: In 2021, 51,735 patients were treated with ADT; 45,599 (88.1%) were treated with leuprolide and 3,096 (6.0%) patients had at least 1 prescription for relugolix. Combination PC medications (ComboPCRx) were proportionately higher in relugolix patients than in leuprolide patients (698 [22.5%] vs 8,897 [19.5%] respectively; p < 0.0001). ComboPCRx in users new to ADT was more frequent for relugolix users (342/2,169 [15.8%]) than for leuprolide users (1934/17,737 [10.9%]). In both groups, novel anti-androgens were the most frequent type of ComboPCRx. Conclusions: In this real-world EMR analysis, relugolix use in combination with other PC medication was frequently observed, for both new to ADT and continuing ADT patients. The percentage of combination therapy with PC medications was higher for relugolix users than it was for leuprolide users. These results provide insight into the real-world use of relugolix in combination with other PC medications. Further analyses are needed to make informed treatment decisions. [Table: see text]

Research on the intelligent supervision and operation platform of railway real estate

Railway real estate is the fundamental element of railway transportation production and operation. Effective management and rational utilization of railway real estate is essential for railway asset operation. Based on the investigation of the requirements of railway real estate management and operation, combined with Beidou positioning, GIS (Geographic Information System), multi-source data fusion and other cutting-edge technologies, this paper puts forward the multi-dimensional dynamic statistical method of real estate information, the identification method of railway land occupation and the comprehensive evaluation method of real estate development and utilization potential, and build the railway real estate supervision and operation platform, design the function of the platform, so as to provide intelligent solutions for the railway real estate operation.

Exploring the Perceived and Real Metacognitive Reading Strategies of Iranian EFL Learners: Different Text Types in Focus

This mixed methods study examined whether perceived metacognitive reading strategies differed in Iranian EFL learners with different reading abilities. It also compared their actual (real) utilization of metacognitive reading strategies in different English text types (narrative and expository). Four hundred Iranian university students studying TEFL were selected according to their performance on the Oxford Placement Test. A Persian Reading Comprehension Placement Test, Reading Section of PET, and English and Persian Perceived Reading Strategy Questionnaires were administered. One hundred thirty-three students were selected and divided into two groups based on the Persian Reading Comprehension Placement Test scores. Those who achieved above the mean score were classified as high readers and others as low readers. After administering the questionnaires and conducting think-aloud, the data were analyzed through chi-square, MANOVA, and theme-based analysis. The findings revealed that the realizations of global reading strategies regarding frequency and type were not different in Iranian EFL learners’ perceived metacognitive reading strategies. The findings also indicated a significant difference between the frequency and type of problem-solving reading strategies. The results confirmed that learners used the same global and problem-solving strategies in reading narrative and expository text types, while the pattern of using support-reading strategies was different. The most frequent support reading strategies used in expository text were paraphrasing, circling the information, and reading aloud while summarizing and asking questions were the most frequent support reading strategies used in narrative text. The theoretical and pedagogical implications of the study were finally pointed out.

Foldable paper microfluidic device based on single iron site-containing hydrogel nanozyme for efficient glucose biosensing

Peroxidase-mimicking nanozymes have been extensively studied, but their real utilization is limited by their working conditions limited to acidic pH, which makes it difficult to couple with oxidative enzymes operating at near-neutral pH. Here, we have developed a foldable paper microfluidic device that enables a highly convenient cascade reaction between peroxidase-mimicking nanozymes and oxidative enzymes to visually identify the target molecules. A single-atom iron-site-containing poly-γ-glutamic acid/chitosan hydrogel nanoparticle (PGA-Fe/CS NP) was developed, as a model peroxidase-like nanozyme, via rapid ionic gelation. Glucose oxidase (GOx) was used as a model oxidative enzyme. The paper device was constructed by simple wax-printing, including two parts with a foldable configuration: the first is for glucose oxidation under neutral pH and the second is for H2O2 reduction to produce a colorimetric signal under acidic pH. By dropping the sample solution in the first part, the device allowed efficient glucose oxidation by the immobilized GOx at neutral pH. On merely folding the device, the produced H2O2 from the glucose oxidation easily transfers to the second part of the device where PGA-Fe/CS NP was immobilized, inducing the peroxidase-like catalytic reaction at acidic pH. Using the foldable paper microfluidic device, the target glucose was successfully determined with excellent selectivity, sensitivity, stability, and reliability, using an image acquired by a smartphone. Since any oxidative enzymes could be incorporated into the device with the peroxidase-like PGA-Fe/CS NP, we expect that the foldable paper microfluidic device, which conveniently allows the cascade reaction under different pH environments, would be highly beneficial for the detection of various clinically important target molecules, thus laying the groundwork for future biosensing applications of nanozymes in point-of-care testing environments.

Spironolactone Utilization among Patients with Reduced and Preserved Ejection Fraction Heart Failure

Background: Spironolactone is a mineralocorticoid receptor antagonist indicated for the management of heart failure with reduced ejection fraction (HFrEF). In a previous clinical trial, spironolactone significantly lowered the incidence of heart failure (HF) hospitalizations among HF patients with preserved ejection fraction (HFpEF). Real world utilization of spironolactone in HFrEF and HFpEF is unknown. Methods: We conducted a retrospective cohort study using data from FDA’s Sentinel System. We identified patients with HFrEF or HFpEF using diagnosis and procedure codes from a previously validated algorithm. We required patients to be continuously enrolled in the 183 days prior to HF diagnosis. Follow-up started on the day of HF diagnosis and ended at the earliest occurrence of a spironolactone dispensing, disenrollment, death, or end of data. We calculated the proportion of spironolactone utilization, and for those initiating treatment, we estimated the dose and duration of the first continuous treatment episode. Results: Among 2,009,529 HFrEF patients, 57.8% were male, and mean age was 73.8 ± 12.1 years. Among 9,257,514 HFpEF patients, 42.7% were male, and mean age was 73.0 ± 12.1 years. The proportion of spironolactone utilization following HFrEF diagnosis was 20.7% versus 7.6% after HFpEF. The median time (days) to initiation of spironolactone after HFrEF diagnosis was 90 (IQR: 19–385) versus 286 (IQR: 57–851) after HFpEF diagnosis. The median duration (days) of first treatment episode in HFrEF patients was 120 (IQR: 44–321) and 114 (IQR: 32–301) for HFpEF patients. The median dose was similar (25 mg/day) for both HF cohorts. Conclusion: Findings of low real-world utilization of spironolactone from our large, geographically, and demographically diverse multi-site study in the US are consistent with reports from smaller studies in the literature. Similar spironolactone dosing and duration were observed in both the HFpEF and HFrEF cohorts. Future research characterizing spironolactone treated and untreated HFpEF cohorts will be needed to identify treatment gaps.