Register File Research Articles

Indonesian Society of Gynecologic Oncology Cancer Registration Information System: 10 Years of Implementation, Challenge, and Future.

Indonesia still faces high disease burden from cancer and needs valid gynecologic cancer epidemiology data. The Indonesian Society of Gynecologic Oncology (INASGO) established a web-based gynecologic cancer registry. This research aims to observe and report the situation of INASGO cancer registration information system from 2011 to 2021 and provide the most recent data. This is a quality assurance research using nonexperimental design and did not perform data manipulation. This study will evaluate comparability, validity, and completeness of cancer registry data. Information was obtained by registration files, direct observation, and interviewing cancer registry supervisors in Cipto Mangunkusumo Hospital, Jakarta. This cancer registry coded its data according to international standards with many participants and large cases registered. A total of 28,692 cases were reported to the cancer registry. Cervical cancer ranked highest (68.6%) with stage III being the most common found. The most frequent age group at diagnosis is 36-55 years. The most valid basic diagnostic of gynecologic cancer is histology of primary malignancy. The main challenge of the INASGO cancer registry is the lack of data validity and completeness because of poor coordination and financial support. INASGO cancer registration information system has good prospects to provide data information of patients with gynecologic cancer in policy or research matters. Poor coordination and limited financial support have to be anticipated for the sake of this cancer registry existence in the future.

Conflict Management in Vector Register Files

The instruction set architecture (ISA) of vector processors operates on vectors stored in the vector register file (VRF) which needs to handle several concurrent accesses by functional units (FUs) with multiple ports. When the vector processor is running with high utilization, access conflicts become a major source of performance degradation. With a software model of a vector processor, we take a deep dive into the runtime impact of conflicts, their characteristics, and on ways to manage them, i.e., avoidance, resolution, and mitigation. For conflict avoidance, we study the existing approaches of banking with different static bank layouts and propose a dynamic bank layout to overcome their shortcomings. Our approach assigns newly written registers a temporarily unique starting bank. For conflict resolution, we compare different arbitration algorithms and optimize round-robin arbitration for mixed-width arithmetics by prioritizing wide operands. For conflict mitigation, operand queues (OPQs) of varying depths are studied. Our inventions are likely to increase the area efficiency of vector processors. Either, because they allow to use shallower operand queues (OPQs) while keeping the same performance, or reduce the area even further by using less banks, albeit at a performance impairment of 10 % or less. The insights of the study can further be applied to other shared-memory systems.

United States Precinct Boundaries and Statewide Partisan Election Results

We describe the creation and verification of databases of all precinct boundaries used in the United States 2016, 2018, and 2020 November general elections, enhanced with election results for all partisan statewide offices. United States election officials report election results in the smallest geographic reporting known as the precinct. Scholars and practitioners find these election results valuable for numerous use cases. However, these data cannot be augmented with other geographically-bound data, such as U.S. Census data, without precinct boundaries. Here we describe the collection of precinct boundary data from state and local election officials, sometimes provided in GIS formats, images, text descriptions, and – in rare cases – verbally. We describe how we verify boundaries with other election data, such as geocoded voter registration files. Our open-source data has appeared in redistricting litigation argued before the United States Supreme Court; and has been used by state and local redistricting authorities, media organizations, advocacy groups, scholars, and a vibrant community of mapping enthusiasts.

Pengaturan Prosedur Pemungutan Pajak Kendaraan Bermotor di Kota Kupang

Currently, the level of use of means of transportation in Indonesia is quite high, this can be found in daily life. Almost all the time we see a large number and type of vehicles popping up. This research is (1) normative research so that the data source used is a secondary data source obtained from company records, (2) empirical research so that the data source used is a primary data source obtained from the results of interviews. The results of this study show that: (1) The Regulation of Motor Vehicle Tax Collection Procedures in Kupang City is carried out based on Presidential Regulation Number 5 of 2015 concerning the Implementation of the One-Stop Manunggal Administration System by going through the stages of registration, examination of registration files, data collection, determination and control of SSPD, re-examination of SSPD and affixing of paragraphs, payment, control of SKPD, endorsement, and finally archiving, (2) The first inhibiting factor namely economic factors where there are taxpayers who have low income, high dependent burdens and unstable sources of income. The second factor is weak compliance or legal awareness of taxpayers.

PERANCANGAN SISTEM INFORMASI PENDAFTARAN PADA TK AL-HUDA BERBASIS WEBSITE

The development of information technology in this digital era has played an important role in information and communication media in the field of education. One of them is in the school management flow, namely in accepting new students starting from registration to the registration fee payment process. When done manually, there are several ineffectivenesses such as the need to fill out forms with paper which can cause the risk of damage such as wet, torn, dirty, and can even cause the risk of losing data on the form paper. In addition, the ineffectiveness is due to the need to come many times to complete the files to the distribution of registration information which is still limited by using printed media such as brochures and flyers. This study aims to create a website-based information system that can help and reduce the obstacles that exist in the use of the manual method used previously. The information system that has been created contains information about the profile of Al-Huda Kindergarten, programs, activities, testimonials, filling out the registration form, uploading registration files to the registration fee payment process, also equipped with a trial class registration that can display the trial class schedule before parents register their children. This system can also categorize classes according to the age entered by parents when registering. The design of this information system uses the waterfall method approach. The programming languages used are HTML, CSS, and PHP supported by MySQL as its database. The results of this information system can facilitate parents of prospective students in the registration process and obtain more complete information about Al-Huda Kindergarten, an admin who can easily manage, view, and upload data on participant needs.

Ten-year trends of delayed sequential bilateral cataract surgery (DSBCS) in Sweden: a register-based study.

To study the trend of delayed sequential bilateral cataract surgery (DSBCS) in Sweden in the past decade. This register-based cohort study utilized data from the Swedish National Cataract Register (NCR) from 2010 through 2019. Register files from patients who underwent cataract surgery in both eyes during the study period were linked using their social security numbers. Bilateral surgeries on different days were classified as DSBCS. The study investigated the association between DSBCS within 3months and several variables with stratification and multivariate logistic regression. The following variables were used: operation year, region, private or public unit, age, sex, indication for surgery, type of intraocular lens (IOL), preoperative visual acuity, ocular comorbidity, posterior capsule rupture and perioperative difficulties. During the study period, 368,106 patients underwent DSBCS, of which 62.6% (n = 230,331) had bilateral surgery within 3months. The median time between the surgeries was 61days (interquartile range 26-161days), showing regional variations. Better visual acuity in the fellow eye, presence of ocular comorbidity, various perioperative events and complications were associated with longer time to surgery of the second eye. Conversely, cataract surgery in more recent years, private clinic, increasing age, anisometropia and multifocal IOL were associated with shorter timespan between surgeries. The majority of DSBCS were conducted within a 3-month timeframe, with the interval between surgeries decreasing throughout the study period. Several rational factors were associated with the time difference, in addition to regional variations. Many patients would probably benefit from less time between the surgeries, and we encourage a clinical practice taking the whole patient's visual function into account.

COVID-19 Pandemic-Induced Changes in Hospital-Based Pattern of Skin Diseases in Gharbia Governorate, Egypt

Abstract Background Introduction: The COVID-19 pandemic, declared by the World Health Organization in 2020, prompted numerous restrictions and changes in healthcare practices globally. In Egypt, measures such as curfews, the closure of public places, and the suspension of schools and universities were implemented. These changes had significant implications for healthcare delivery, including dermatology services. Aim of the Work This study aimed to investigate the effect of the COVID-19 pandemic on the pattern of skin diseases in Egypt. Patients and Methods Data from 20,509 patients (14,353 in the pre-COVID year and 6,156 during the COVID year) were analyzed at Samanod Hospital, Gharbia Governorate, Egypt. Information on date, age, sex, and diagnoses was collected from dermatology clinic registry files for both pandemic and pre-pandemic years. Results A substantial decrease in patient attendance at dermatology clinics was observed during the COVID-19 pandemic, with numbers dropping by over 50%. Age and sex distribution of patients were also influenced, with teenagers and adults showing an increase in attendance, while younger children presented less frequently. Although female patients remained predominant during the pandemic, the female-to-male ratio slightly favored males. All disease groups and subgroups demonstrated a decline in patient numbers during the pandemic compared to the pre-COVID year. Infections increased relative to hypersensitivity, with bacterial and fungal infections remaining the most common subgroups. COVID-19-related dermatoses did not significantly increase, except for herpes zoster, which showed a relative increase. Some dermatoses demonstrated significant relative increases during the pandemic, including impetigo, furunculosis, warts, abscesses, and herpes zoster, while others showed declines, such as acne, candidiasis, tinea capitis, urticaria, herpes simplex, pityriasis alba, pityriasis rosea, tinea corporis, xerosis, and chilblains. Conclusion The COVID-19 pandemic had a substantial impact on the pattern of skin diseases in Egypt, affecting patient demographics and disease prevalence. Infection-related dermatoses remained prevalent, with bacterial and fungal infections being the most common subgroups. Although minimal changes were observed in some diseases, especially COVID-related dermatoses, the overall pattern of dermatoses was preserved compared to the previous year. This study underscores the need for healthcare systems to adapt to changing disease patterns during pandemics, ensuring adequate medications, supplies, and medical team training to provide effective care. Further community-based studies are necessary to validate the findings and address potential disparities between hospital-based and community-based disease prevalence.

Fault-Resistant Partitioning of Secure CPUs for System Co-Verification against Faults

Fault injection attacks are a serious threat to system security, enabling attackers to bypass protection mechanisms or access sensitive information. To evaluate the robustness of CPU-based systems against these attacks, it is essential to analyze the consequences of the fault propagation resulting from the complex interplay between the software and the processor. However, current formal methodologies combining hardware and software face scalability issues due to the monolithic approach used. To address this challenge, this work formalizes the k-fault-resistant partitioning notion to solve the fault propagation problem when assessing redundancy-based hardware countermeasures in a first step. Proven security guarantees can then reduce the remaining hardware attack surface when introducing the software in a second step. First, we validate our approach against previous work by reproducing known results on cryptographic circuits. In particular, we outperform state-of-the-art tools for evaluating AES under a three-fault-injection attack. Then, we apply our methodology to the OpenTitan secure element and formally prove the security of its CPU’s hardware countermeasure to single bit-flip injections. Besides that, we demonstrate that previously intractable problems, such as analyzing the robustness of OpenTitan running a secure boot process, can now be solved by a co-verification methodology that leverages a k-fault-resistant partitioning. We also report a potential exploitation of the register file vulnerability in two other software use cases. Finally, we provide a security fix for the register file, prove its robustness, and integrate it into the OpenTitan project.

Abstract P365: Prevalence of Hypertension in Minnesota Adults in 2023 Using Data from a Statewide Electronic Health Record Consortium

Background: Data on prevalence of hypertension in the United States come primarily from in-person data collected by the National Health and Nutrition Examination Survey and self-reports in the Behavioral Risk Factor Surveillance Survey. Electronic phenotypic algorithms for hypertension that include diagnosis codes, blood pressure values, and antihypertensive treatment have been proposed and tested. Objective: To describe prevalence of hypertension in Minnesota adults using data from a statewide electronic health record (EHR) consortium, the Minnesota EHR Consortium (MNEHRC). Methods: Data from 11 health systems participating in the MNEHRC were standardized to a common data model allowing for distributed querying of EHR data. Data were de-duplicated using a one-way hash algorithm. Preliminary prevalence of hypertension in 2023 was estimated in Minnesota residents with ≥ 1 encounter in the past 3 years who had ≥1 diagnosis of hypertension in the past 5 years. Medicaid insurance status was determined via linkage with state enrollment files. Residential addresses of patients were geocoded to census tracts and social vulnerability index (SVI) of census tracts was determined. Results: Among 4,369,470 Minnesotan age 18 and older in 2023, 23.6% had hypertension based on ≥1 diagnosis code. Prevalence increased with age, was higher in men (26% vs. 22% in women), and adjusted for age and sex was highest in Black (30%) and Native American (27%) compared with White (23%) and Hispanic (21%) Minnesotans. Within each race/ethnic group, those insured by Medicaid had a higher adjusted hypertension prevalence than those with other insurance types. The prevalence of hypertension in census tracts with moderate to high SVI ranged from 3% to 43%, but on average was similar to the statewide prevalence of 24% (see image 1). Prevalence of hypertension in race/ethnicity, sex, and age subgroups in higher SVI census tracts was similar to the statewide prevalence in those subgroups. Conclusions: The prevalence of hypertension in Minnesota was described in detail by demographic characteristics, geography and social vulnerability. Future work will expand the electronic hypertension phenotype and examine quality of care.

Computer-Assisted Implant Planning: A Review of Data Registration Techniques.

Computer-assisted implant planning allows for a comprehensive treatment plan by combining radiographic data provided by a Cone Beam Computed Tomography (CBCT) with surface optical scan (IOs) data that includes patient intraoral situation and the intended restorative planning. Integrating a tailored restorative design with the patient's anatomical conditions through virtual implant planning allows for an ideal bio-restorative treatment planning to maximize biological, functional, and esthetic outcomes. This article discusses dataset registration techniques that combine radiographic CBCT data with restorative information as the main path to create a virtual patient. The described techniques include the use of removable radiographic templates with radiopaque markers, dual scan technique, and direct digital file registration of intra-oral scans using anatomical references. Depending on the individual clinical situation, different factors must be considered to appropriately select methods that achieve an optimal registration of diverse datasets. An inherent challenge lies in the presence of scattering artifacts in CBCT scans. Two approaches are proposed for these situations - the use of chairside-fabricated composite resin markers or adhesive spot-markers fabricated for the use with CBCT scans. Both techniques exhibit limitations that need to be taken into consideration. Further approaches should be developed for situations involving scattering in CBCT.

Lung Donation and Transplant Recipient Outcomes at Independent vs Hospital-Based Donor Care Units

Centralizing deceased organ donor management and organ recovery into donor care units (DCUs) may mitigate the critical organ shortage by positively impacting donation and recipient outcomes. To compare donation and lung transplant outcomes between 2 common DCU models: independent (outside of acute-care hospitals) and hospital-based. This is a retrospective cohort study of Organ Procurement and Transplantation Network deceased donor registry and lung transplant recipient files from 21 US donor service areas with an operating DCU. Characteristics and lung donation rates among deceased donors cared for in independent vs hospital-based DCUs were compared. Eligible participants included deceased organ donors (aged 16 years and older) after brain death, who underwent organ recovery procedures between April 26, 2017, and June 30, 2022, and patients who received lung transplants from those donors. Data analysis was conducted from May 2023 to March 2024. Organ recovery in an independent DCU (vs hospital-based DCU). The primary outcome was duration of transplanted lung survival (through December 31, 2023) among recipients of lung(s) transplanted from cohort donors. A Cox proportional hazards model stratified by transplant year and program, adjusting for donor and recipient characteristics was used to compare graft survival. Of 10 856 donors in the starting sample (mean [SD] age, 42.8 [15.2] years; 6625 male [61.0%] and 4231 female [39.0%]), 5149 (primary comparison group) underwent recovery procedures in DCUs including 1466 (28.4%) in 11 hospital-based DCUs and 3683 (71.5%) in 10 independent DCUs. Unadjusted lung donation rates were higher in DCUs than local hospitals, but lower in hospital-based vs independent DCUs (418 donors [28.5%] vs 1233 donors [33.5%]; P < .001). Among 1657 transplant recipients, 1250 (74.5%) received lung(s) from independent DCUs. Median (range) duration of follow-up after transplant was 734 (0-2292) days. Grafts recovered from independent DCUs had shorter restricted mean (SE) survival times than grafts from hospital-based DCUs (1548 [27] days vs 1665 [50] days; P = .04). After adjustment, graft failure remained higher among lungs recovered from independent DCUs than hospital-based DCUs (hazard ratio, 1.85; 95% CI, 1.28-2.65). In this retrospective analysis of national donor and transplant recipient data, although lung donation rates were higher from deceased organ donors after brain death cared for in independent DCUs, lungs recovered from donors in hospital-based DCUs survived longer. These findings suggest that further work is necessary to understand which factors (eg, donor transfer, management, or lung evaluation and acceptance practices) differ between DCU models and may contribute to these differences.

Association of characteristics of cancer, patient, and county with telemedicine services use: Impact of the waiver of reimbursement restrictions on telemedicine.

11058 Background: Telemedicine services have great potential to improve access to care of cancer patients who are vulnerable in health status and may experience financial hardship due to the cost of their care. However, very little is known about how the Centers for Medicare and Medicaid Services’ waiver of reimbursement restrictions on telemedicine and characteristics of cancer affected their use of telemedicine services. We examined the changes in frequency of telemedicine use before and after the waiver and, after the waiver, the determinants of telemedicine use across medical provider types. Methods: We used the 5% Surveillance, Epidemiology and End Results registry file linked to Medicare data among patients who had a newly diagnosed cancer in 2019 and were enrolled in Medicare Parts A and B during 2019-2020, and Area Health Resources File. Our outcomes were binary variables of telemedicine services use in outpatient (OP), office-based clinics (OB), and emergency department (ED), respectively, and for detailed provider types in OB. Primary independent variables included the ten most frequently observed cancer sites (reference: all other sites), sequence of cancer, stage of diagnosis, and quarter of diagnosis in 2019. Analysis was by a multilevel mixed effects logistic regression model, adjusting characteristics of cancer, patient and county. Results: Among eligible patients (n = 14,226), telemedicine services use for all provider types increased from 4.3% in pre-waiver period to 40.3% (5.2% in OP, 39.3% in OB, and 0.2% in ED) in post-waiver period. Telemedicine services use varied by primary cancer site, but was higher for those with a cancer recurrence (odds ratio [OR] 1.36, 95% confidence interval [CI] 1.16-1.60) and advanced cancer stage (OR 1.24, 95% CI 1.03-1.48). For visits to oncologists, cancer characteristics such as recurrence (OR 1.67, 95% CI 1.34-2.08), advanced stage (OR 5.52, 95% CI 4.12-7.40) and diagnosis in the last quarter in 2019 (OR 1.39, 95% CI 1.20-1.61) were associated with greater use of telemedicine. Patients of older age and minority race/ethnicity and in non-Northeast regions were less likely to use telemedicine, while women, patients with dual eligibility for Medicaid, and those living in a county with high median household income and high availability of hospital beds were more likely to use telemedicine. Conclusions: Cancer patients used telemedicine services more frequently after the waiver and their cancer characteristics were most strongly associated with that use, implying their greater need for, and benefit from, telemedicine. Disparities in telemedicine use related to individual and county-level socio-demographics and medical supply suggest health policy changes to improve equitable access to telemedicine and efficient cancer care planning.

Risk of Hospitalization Associated with Use of Consumer-Directed Attendant Care

ABSTRACT Older people with disabilities living independently often use attendant care, also known as Personal Assistive Services (PAS). The aides providing care can come from a home health agency contracted by the state Medicaid authority, known as agency-directed PAS, or the Medicaid recipient can receive a monthly budget and arrange their own care, known as consumer-directed care. Consumer-directed care is hypothesized to have some possible benefits but could also potentially lead to health hazards. This study examined whether people receiving consumer-directed PAS versus people receiving agency-directed PAS faced a higher risk of hospitalization. The data for this study came from Pennsylvania Medicaid claims, enrollment files, standardized assessments, and hospitalization claims from Medicare and Medicaid. The analysis used two-stage least square regression, with the percentage of people in a county using consumer-directed care as an instrument for the type of PAS. People using consumer-directed care did not have a statistically significant difference in risk for hospitalization compared to people using agency-directed PAS (p = .976). Risk of hospitalization was not different for people using consumer-directed care compared to people using agency-directed care.

SHREG: Mitigating register redundancy in GPUs

Graphics Processing Units (GPUs) have become dominant accelerators for Machine Learning (ML) and High-Performance Computing (HPC) applications due to their massive parallelism capabilities, through the utilization of general matrix-to-matrix multiplication (GEMM) kernels. However, GEMM kernels often suffer from duplicated memory requests, mainly caused by matrix tiling used for handling large matrices. While GPUs have adopted programmable shared memory to mitigate this issue by preserving frequently reused data in shared memory, GEMM still introduces duplication in register files. Our observations show that the matrix tiling issues memory requests to the same shared memory address for neighboring threads, and this results in a substantial increase in the number of duplicated data in the register files. Such duplication degrades GPU performance by limiting warp-level parallelism due to the register shortage and redundant memory requests to shared memory. We find that the data duplication can be categorized into two types that occur with fixed patterns during the matrix tiling. Based on these observations, we introduce SHREG, an architecture design that enables different threads to share registers for overlapped data from shared memory, effectively reducing duplicated data within the register files. By leveraging the duplication patterns, SHREG utilizes register sharing and improves performance with minimal hardware overhead. Our evaluation shows that SHREG improves performance by 31.4% on various ML applications over the baseline GPU.

Development of Customized MIPS_32 Core Processor for Image Processing Applications

Definitely, image processing operations without advanced and expensive microprocessors consume more time, power, and larger programs. So, improving the reasonable cost of microprocessors is crucial in this situation. This paper proposes an improvement for the MIPS_32 architecture that is called a Customized MIPS_32 (CMIPS_32) to enhance the capabilities of image processing (IP) operations. The proposal aims to increase throughput by minimizing the iterative fetching of instructions required by a certain IP operation into a single customized IP instruction. The architecture of MIPS_32 was developed in two phases. Firstly, the Register File, control unit, and ALU are modified to manipulate the information related to the IP operations. Secondly, two new units, the address calculation unit and the last pixel detection unit, were proposed to determine a certain image's starting and ending addresses. Furthermore, the MIPS_32 pipeline is customized to have five to six stages depending on the intensity of operation required by a certain IP instruction to decrease the number of machine clocks and the power consumed. The proposal was implemented using the Zed-Board XC7Z020CLG484-1 FPGA. The results showed that the computation speedup increased by a factor equal to the number of standard instructions required to execute the same operation performed by one of the proposed IP instructions. The CMIPS_32 consumed less power than other models that were implemented on Spartan3-XC3S1500L, Virtex5-XC5VFX30T, Virtex6-XC6VLX75T, and Virtex6-Low-Power-XC6VLX75T by 0.0138W, 0.6468W, 1.31W, and 0.7898W, respectively. Comparing the power consumed by the proposal with the GPU proved that the CMIPS_32 consumes less than the NVIDIA-GPU-GTX980 by 63.8698W. Index Terms— FPGA, Image processing instructions, MIPS_32, Verilog.

Study of vesicular mole and its outcomes

Vesicular mole is defined as the premalignant form of gestational trophoblasticneoplasia. I5-20% of complete moles and &amp;#60;5% of partial moles will develop into Gestational Trophoblastic Neoplasia. It is of clinical and epidemiological interest because of its potential for significant consequences on women's health. The study aims to determine the incidence, outcomes and complications of pregnancy with vesicular mole at SKNMC hospital, Pune. It was a retrospective study. Approval for the study was obtained from institutional ethical committee. Data was collected from OPD, OT register and Indoor patient record file from August 2015 to August 2020. Proformas were filled. All the collected data was compiled in a master chart, analysed and outcomes of different variables under study have been expressed in the form of mean, frequencies, percentages and charts. The incidence of molar pregnancy was 0.17% or 1 in 561 deliveries. Vesicular mole occurred more in the age group 16 to 25 years, was lowest in age group 31-35yrs. Vesicular mole was most common in nulliparous women. The mean gestational age of the patients at presentation was 9.4 week. Hemorrhage after suction and evacuation was seen in 26% cases needing intra and post-operative blood transfusion. 6% of patients developed thyrotoxicosis. During follow up invasive mole was diagnosed in 2 cases (6%). The case fatality rate is 2.9% in our study. 1 patient (3%) developed choriocarcinoma and died within 6months after hysterectomy and chemotherapy. The incidence of 1 in 561 deliveries which is higher than non-Asian countries 1/752 but lower than other Asian countries 1/387. The routine first trimester ultrasonography helps in early detection of asymptomatic women. If not followed up regularly it can be life threatening.

The extent and growth of prior authorization in Medicare Advantage.

To assess trends in the use of prior authorization requirements among Medicare Advantage (MA)plans. Descriptive quantitative analysis. Data were from the CMS MA benefit and enrollment files for 2009-2019, supplemented with area-level data on demographic and provider market characteristics. For each service category, we calculated the annual share of MA enrollees in plans requiring at least some prior authorization and plotted trends over time. We mapped the county-level share of MA enrollees exposed to prior authorization in 2009 vs 2019. We quantified the association between local share of MA enrollees exposed to prior authorization and characteristics of that county in the same year. Finally, we plotted the share of MA enrollees exposed to prior authorization requirements over time for the 6 largest MA carriers. From 2009 to 2019, the share of MA enrollees in plans requiring prior authorization for any service remained stable. By service category, the share of MA enrollees exposed to prior authorization ranged from 30.7% (physician specialist services) to 72.2% (durable medical equipment) in 2019, with most service categories requiring prior authorization more often over time. Several area-level demographic and provider market characteristics were associated with prior authorization requirements, but these associations weakened over time. The use of prior authorization varied widely across plans. In 2019, roughly 3 in 4 MA enrollees were in a plan requiring prior authorization. Service-level, area-level, and carrier-level patterns suggest a wide range of approaches to prior authorization requirements.

Prescription Opioid Exposure During Pregnancy and Risk of Spontaneous Preterm Delivery

Opioid exposure during pregnancy has been associated with preterm birth, but prior studies have not differentiated between spontaneous and indicated preterm birth or fully investigated these associations as functions of opioid dose. To determine whether prescription opioid use during pregnancy is associated with spontaneous preterm birth and whether the association is dose-dependent. This case-control study examined a retrospective cohort of pregnant patients enrolled in Tennessee Medicaid. Enrollment files were linked to health care encounters, hospital discharge information, birth certificate data, and prescription fills. Eligible participants were pregnant people ages 15 to 44 years without opioid use disorder who experienced birth of a single fetus at 24 weeks gestation or greater between 2007 and 2019 with linked birth certificate data. Cases of spontaneous preterm birth were matched with up to 10 controls based on pregnancy start date, race, ethnicity, age at delivery within 2 years, and history of prior preterm birth. Cases and matched controls were continuously enrolled in TennCare for at least 90 days prior to the index date (case delivery date). Total opioid MME filled during the 60 days prior to the index date. The primary outcome was spontaneous preterm birth determined by a validated algorithm using birth certificate data. Conditional logistic regression was used to estimate the association between spontaneous preterm birth and total opioid morphine milligram equivalents (MME) dispensed, adjusting for parity, prepregnancy body mass index, education level, tobacco use, hepatitis infections, and pain indications. A total of 25 391 cases (median [IQR] age, 23 [20-28] years; 127 Asian [0.5%], 9820 Black [38.7%], 664 Hispanic [2.6%]; 14 748 non-Hispanic White [58.1%]) with spontaneous preterm birth were identified and matched with 225 696 controls (median [IQR] age, 23 [20-27] years; 229 Asian [0.1%], 89 819 Black [39.8%], 3590 Hispanic [1.6%]; 132 002 non-Hispanic White [58.5%]) (251 087 patients total), with 18 702 patients (7.4%) filling an opioid prescription in the 60 days prior to the index date. Each doubling of nonzero opioid MME was associated with a 4% increase in the odds of spontaneous preterm birth compared with no opioid exposure (adjusted odds ratio, 1.04; 95% CI, 1.01-1.08). In this case-control study, a positive association was found between total prescription opioid dose dispensed and the odds of spontaneous preterm birth. These findings support guidance to minimize opioid exposure during pregnancy and prescribe the lowest dose necessary.

Wpływ cyfryzacji rejestru przedsiębiorców Krajowego Rejestru Sądowego na bezpieczeństwo obrotu gospodarczego

The article deals with the issues related to IT solutions implemented in the Polish registration procedure and their importance for economic transactions. The functioning of the IT system (Court Registers Portal) in the registration proceedings regarding the register of entrepreneurs kept by the National Court Register was shown. The introduced technological solutions have improved the registration procedure, although some functional shortcomings of the Court Registers Portal system remain visible and require its improvement. The advantage of digitization of the registration procedure is efficient access to registration files and financial documents of an entity entered in the National Court Register, which is a manifestation of the principle of openness of the registration procedure and improves business transactions. The analysis conducted leads to the conclusion that the implemented solutions constitute the right reform direction, which still requires further clarification.

On Hardware Flexibility and Heterogeneity: A Vision for Monte Carlo Codes on Incoming RISC-V Computing Devices with AI-based Cross Section

As an open-sourced instruction set and being flexible in hardware extension, RISC-V begins its pace to enter the world of high performance computing. One of the distinguished feature of processing units adopting RISC-V is its ability to add custom circuits with special purpose accelerators. As the artificial general intelligence becomes practical, AI accelerators become an indispensable part of computing devices, where RISC-V is a great fit for the CPU to glue accelerators together. A system of chip designed by Alibaba T-head is one of the early chip in the massive production adopting RISC-V CPU, where the CPU, named Xuantie-910, has a high performance design with 128-bit RISC-V vector processing units, which are designed for accelerating AI applications. OpenMC has been adapted to run on Xuantie-910. In the Monte Carlo method for reactor physics, fetching the neutron cross sections is the hotspot that takes the majority of the computational burden. The traditional point-wise cross sections are slow because of memory latency caused by accessing many nonconsecutive memory addresses. An AI model for cross section is hence proposed. With 2.2 KB of runtime size, the smallest in the published work, the data can be fetched entirely in the L1 cache during on-the-fly cross section evaluation through single memory read. The in-house AI model also covers the entire energy range, unlike only the resonance range is supported in previous work. So, the effects from memory latency is minimized. The average relative error in AI modeled U-238 elastic cross section is 0.6% from point-wise cross section. With a modified version of OpenMC on Apple M3 Max, for a VERA pin-cell problem, compared to the point-wise cross section, the adoption of AI modeled cross section reduces the total runtime by 7%, although the runtime for calculating U-238 elastic cross section causes 40% more runtime. The adoption of AI modeled U-238 elastic cross section leads to K-effective 302 pcm higher than the case of adoption of point-wise cross sections. Advantage of AI model has been verified. With AI modeled cross section, the neutron slowing down problems with pure elastic scattering on U-238 has been studied on Xuantie-910. The average relative error in 65,536 group fluxes is about 0.9% from using point-wise cross section. However, with accelerating with the 128-bit vector processing units, the performance degrades by 35%, because of the narrow 64-bit load and store interface to the vector register files. The performance with Al modeled cross section is about 1/4 of the case with point-wise cross sections. In addition, the 1,024-bit width Ara RISC-V vector processing has been used to study the cost of AI modeled cross section evaluation. Being able to access the open-sourced hardware design in SystemVerilog, cycle accurate circuit simulation is performed. Using the vector processing units, the cost is reduced to 65% of the case using scalar instructions. The 128-bit load and store interface to vector processing units is a major contributor to the speeding up. The width of the load and store interface to vector processing units should be the main optimization factor in chip design to accelerate the AI modeled cross section evaluation.