Start Date Research Articles

School Leadership Strategy to IncreaseTeacher Professionalism and Its Impact on the Quality of Learning Education at Marcelo 2 Comoro School

Problem Formulation How are the school director's strategy steps to increase Professionalism Teacher in basic education. Research Objectives To analyses the School Director's strategy to increase Teacher Professionalism and its impact on improving the quality of basic education. The research findings will build theories for the School Leadership Strategy, especially increasing teacher professionalism, which focuses on the quality of learning. This knowledge will be a reference for the academic community and professionals to carry out continuous verification and discovery of this branch of science. In order to deepen our efforts, it is a basis to deepen and develop further for further research. Education is an inspiration for science, when the quality of the country's development process is in progress, the quality of basic education that is strong and strong can also affect the future development of the Nation. The leadership strategy has a range of ways to increase Professionalism teachers in order to have a good quality impact on learning for students. The method also has two or more meanings that are sought to find the practice of attitude, mentality, intellectual capacity, which has their purpose. The time for conducting the survey is on the start date and the end date. The start date of the survey was July 31th and August 11th 2023 and the location of the survey was conducted in the Basic. Education of Marcelo 2 Comoro Administrative Post of Dom Aleixo, Dili Municipality. Data collection techniques include Observation, Interview, documentation, data analysis techniques by qualitative methods, such as data collection, data reduction, data display, data verification. Research findings show that leadership responds to the same purpose that leaders aim to improve the quality of teaching learning through various ways to increase teacher professionalism to ensure quality of learning. In conclusion, the steps used by the leadership to improve the quality of the teacher's professionalism through a range of academic training, the leadership strategy is used to facilitate teachers at different levels of education to ensure quality, when implementing these strategies there are always obstacles but the leadership is low in order to overcome them, through leadership efforts it can contribute to improving the quality and quality of learning.

OptimICE-RD: sacituzumab govitecan + pembrolizumab vs pembrolizumab (± capecitabine) for residual triple-negative breast cancer.

Patients with early-stage triple-negative breast cancer (TNBC) with residual invasive disease after neoadjuvant therapy have a high risk of recurrence even with neoadjuvant and adjuvant treatment with pembrolizumab. Sacituzumab govitecan, a Trop-2-directed antibody-drug conjugate with a topoisomerase I inhibitor payload, improved progression-free survival (PFS) and overall survival (OS) versus chemotherapy in patients with pre-treated metastatic TNBC. Moreover, preclinical data suggest that topoisomerase I inhibitors may enhance the effects of immune checkpoint inhibitors through activation of the cGAS-STING pathway. Here we describe the international randomized phase III AFT-65/ASCENT-05/OptimICE-RD trial, which evaluates the efficacy and safety of sacituzumab govitecan plus pembrolizumab versus treatment of physician's choice (pembrolizumab ± capecitabine) among patients with early-stage TNBC with residual invasive disease after neoadjuvant therapy.Clinical Trial Registration: NCT05633654 (ClinicalTrials.gov)Other Study ID Number(s): Gilead Study ID: GS-US-595-6184Registration date: 1 December 2022Study start date: 12 December 2022Recruitment status: Recruiting.

Assessing the Role of Nursing Professionals in the Delivery of Integrated Primary Health Care

Background: The integration of Primary Health Care (PHC) services is crucial for improving health outcomes and efficiency in health systems globally. Nursing professionals play a critical role in delivering these integrated services. Understanding their contribution and the impact of their involvement is essential for optimising PHC delivery. The objective of this systematic review is to evaluate the roles and contributions of nursing professionals in the delivery of integrated primary healthcare services. Methods: A comprehensive search strategy will be implemented across electronic databases, including PubMed, CINAHL, and Cochrane Library, to identify relevant studies. Studies published from [start date] to [end date] will be considered. Two independent reviewers will screen titles and abstracts for eligibility, followed by a full-text review of potentially relevant articles. Data extraction and quality appraisal will be conducted using standardised forms. A narrative synthesis will be performed to analyse and summarise the findings. Conclusion: This systematic review will provide evidence on the contributions of nursing professionals to integrated primary health care delivery. The findings will recommend policy and practice in primary health care services.

What do we know about Objective Structured Clinical Examination in Sport and Exercise Medicine? A scoping review.

Despite the importance of the Objective Structured Clinical Examination (OSCE) in Sport and Exercise Medicine, the literature on the topic is fragmented and has been poorly developed. The goal of this review was to map current knowledge about how the OSCE is used in Sport and Exercise Medicine, and to identify knowledge gaps for future research. The authors conducted a scoping review. They searched PubMed and Scopus for articles using key terms related to 'OSCE' and 'sport medicine' with no limit on search start date and up to July 2022. Retrieved records were imported, abstracts were screened, and full-text articles were reviewed. A forward and backward citation tracking was conducted. Data was extracted and a qualitative meta-summary of the studies was conducted. A total of 469 records were screened, and 22 studies were included. The objectives of the studies included using OSCEs to assess knowledge/skills after a training program (n = 11), to assess an intervention (n = 8), and to assess and improve the OSCE itself (n = 3). Thirteen studies reported validity and/or reliability of the OSCE. Despite the widespread use of OSCEs in the examination of Sport and Exercise Medicine trainees, only a handful of scholarly works have been published. More research is needed to support the use of OSCE in Sport and Exercise Medicine for its initial purpose. We highlight avenues for future research such as assessing the need for a deeper exploration of the relationship between candidate characteristics and OSCE scores.

Exploration of the potential of a boosted sterile insect technique to control fruit flies in mango orchards.

An innovative version of the sterile insect technique (SIT) for pest control, called boosted SIT, relies on the use of sterile males coated with a biocide to control a target wild pest population of the same species. The objective of the present study was to assess the relevance of such technology to control the fruit fly Bactrocera dorsalis and fruit losses in mango orchards using. An agent-based simulation model named BOOSTIT was used to explore the reduction of fruit losses thank to sterile male fruit flies control and economic benefits according to different strategies of sterile male release. The simulation considered a landscape of 30.25 ha made up of four mango orchards. The SIT and the boosted SIT reduced fruit losses when releases were made before the mango fruiting period. According to model simulations, releases should be performed at least seven times at 2-week intervals and with a sterile/wild male ratio of at least 10:1. Considering the benefit/cost ratio (BCR), few releases should be done with a late start date. The BCR showed economic gains from the two control methods, the number of saved fruits and BCR being higher for SIT. Our simulations showed that SIT would have better results than the boosted SIT to contribute to an effective control of Bactrocera dorsalis at the scale of a small landscape. We highlight the need for laboratory studies of other types of pathogen to find a suitable one with higher incubation time and lower cost. © 2024 The Author(s). Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Current and Future Effects of Climate Change on Airborne Allergens.

Delineation of the impact of elevated carbon dioxide and concomitant global warming on airborne allergens is performed. European tree pollen trends in general showed earlier start and end dates and increased total pollen release, with some differences both in locale and among species. Earlier flowering was also seen with grasses and weeds. In the case of some boreal trees, flowering was delayed due to a pre-seasonal requirement for necessary accumulated chilling temperature to achieve bud-set. Anthropogenic climate change induced rise in temperature and CO2 levels has resulted in demonstrable increases in aeroallergens. This has been most dramatic in tree pollen annual load, but also seen with grasses and weeds. Collected data is greatest for the Northern Hemisphere, especially the European continent, with supporting data from North America and Australia.

Coronavirus Disease 2019 (COVID-19) Vaccination and Stillbirth in the Vaccine Safety Datalink.

Coronavirus disease 2019 (COVID-19) vaccination is recommended in pregnancy to reduce the risk of severe morbidity from COVID-19. However, vaccine hesitancy persists among pregnant people, with risk of stillbirth being a primary concern. Our objective was to examine the association between COVID-19 vaccination and stillbirth. We performed a matched case-control study in the Vaccine Safety Datalink (VSD). Stillbirths and live births were selected from singleton pregnancies among persons aged 16-49 years with at least one prenatal, delivery, or postpartum visit at eight participating VSD sites. Stillbirths identified through diagnostic codes were adjudicated to confirm the outcome, date, and gestational age at fetal death. Confirmed antepartum stillbirths that occurred between February 14, 2021, and February 27, 2022, then were matched 1:3 to live births by pregnancy start date, VSD site, and maternal age at delivery. Associations among antepartum stillbirth and COVID-19 vaccination in pregnancy, vaccine manufacturer, number of vaccine doses received, and vaccination within 6 weeks before stillbirth (or index date in live births) were evaluated using conditional logistic regression. In the matched analysis of 276 confirmed antepartum stillbirths and 822 live births, we found no association between COVID-19 vaccination during pregnancy and stillbirth (38.4% stillbirths vs 39.3% live births in vaccinated individuals, adjusted odds ratio [aOR] 1.02, 95% CI, 0.76-1.37). Furthermore, no association between COVID-19 vaccination and stillbirth was detected by vaccine manufacturer (Moderna: aOR 1.00, 95% CI, 0.62-1.62; Pfizer-BioNTech: aOR 1.00, 95% CI, 0.69-1.43), number of vaccine doses received during pregnancy (1 vs 0: aOR 1.17, 95% CI, 0.75-1.83; 2 vs 0: aOR 0.98, 95% CI, 0.81-1.17), or COVID-19 vaccination within the 6 weeks before stillbirth or index date compared with no vaccination (aOR 1.16, 95% CI, 0.74-1.83). No association was found between COVID-19 vaccination and stillbirth. These findings further support recommendations for COVID-19 vaccination in pregnancy.

Application of the Machine Learning Method to Determine Spring Load Limits and Winter Weight Premium

Freight transportation plays a crucial role in sustaining the Canadian economy. However, heavy truck transportation also puts enormous pressure on roadway networks. Spring Load Restrictions (SLR) are implemented to minimize road damage caused by heavy traffic during the thaw-weakening season, and Winter Weight Premium (WWP) is used to reduce the impact of SLR on trucking operations by allowing higher axle loads in winter. However, existing policies apply fixed dates each year for these restrictions, regardless of the actual structural capacity of the pavement. Different methods have been proposed to improve the application of SLR and WWP; however, they rely mainly on indirect indices, such as the cumulative thawing index and cumulative freezing index, which pose challenges in their calculation. This study explores the practical implementation of machine learning models for accurately determining the start and end dates of SLR and WWP. In a novel approach, machine learning models directly derive the start and end dates of SLR and WWP from frost and thaw depths in the pavement structure which are determined by pavement temperature and moisture content. In contrast to previous studies that neglected the influence of soil moisture content on determining the start and end dates of SLR and WWP, this study examines the variation in soil moisture content to evaluate the validity of existing theories. The findings reveal a high level of agreement between the machine learning model’s estimations of frost and thaw depths and the measured values, with R2 values exceeding 0.91.

Sodium phenylbutyrate-taurursodiol access, adherence and adverse event in patients with amyotrophic lateral sclerosis: Experience at one center in the United States.

Sodium phenylbutyrate-taurursodiol (PB-TURSO) was recently approved for treating amyotrophic lateral sclerosis (ALS). Third-party payors' coverage policies are evolving, and adverse events are just being fully assessed. The goals of this study were to evaluate patients' experiences in obtaining and continuing PB-TURSO and assess adverse events and medication adherence. Medical records of 109 ALS patients who were considered PB-TURSO candidates by the treating physician at a tertiary ALS clinic from October 2022 to May 2023 were reviewed. Data was recorded for demographics, clinical, and insurance information. A survey was e-mailed to patients asking about out-of-pocket expenses for PB-TURSO, financial assistance, medication start and (if applicable) stop dates, and reasons for discontinuation. Insurance information was available for 91 patients [57 males (62%); mean age 64.8 years (range 25.7-88)]. Of 79 who applied for insurance approval, 71 (90%) were approved; however, 19 required 1-3 appeals. Among 73 patients with available data about medication status, 54 started PB-TURSO and 19 did not, most commonly due to personal choice or out-of-pocket expenses. About 44% of patients (24/54) stopped taking PB-TURSO, primarily due to adverse events. Monthly out-of-pocket expenses varied from $0 to $3500 and 36 patients qualified for financial assistance. Administrative and nursing staff devoted 7.2 hours/week to the insurance authorization process. Most patients received insurance approval for PB-TURSO, but one-fourth required appeals. Some out-of-pocket costs were very high. Investment of staff time was substantial. These findings have implications for insurance coverage of, and adherence to, future ALS treatments.

Characterizing clinical trials for CAR T targeting solid tumors from 2018 to 2023: A systematic review.

e15080 Background: In the last decade, there have been many advances in the treatment of solid tumors, including new chemotherapy agents, immunotherapy, and most recently, cellular therapies. Chimeric antigen receptor T-cell (CAR T) therapy, first approved for acute lymphoblastic leukemia in 2017, represented a paradigm shift in hematologic malignancies, producing response rates that dramatically outpaced alternative regimens in a relapsed/refractory patient setting. Approvals in large B-cell lymphomas and multiple myeloma followed. Excited by the potential of CAR T, investigators worldwide have initiated trials to investigate the use of CAR T in solid tumors. This review explores the trials conducted globally, evaluating the potential molecular targets and the status of current clinical trials. Methods: This systematic review identified CAR T clinical trials specifically targeting solid tumors starting in 2018 to 2023 registered at ClinicalTrials.gov as of January 8, 2024. Trial-related variables including trial phase, primary trial site location, primary endpoints, start and end dates, and molecular target were captured. Results: We screened 110 clinical trials, ultimately including 103 studies for analysis after excluding trials without a CAR T construct in the methods. The number of new clinical trials increased over time, with a significantly larger increase (440%) seen with non-US sponsors compared to US sponsors (100%), p< 0.0001. Only 19 trials (18%) are/were being conducted in the United States in the studied time period. There were 33 unique molecular targets used, with mesothelin (17%), and the claudin protein family (13%) as the most frequented targets. Conclusions: The success that CAR T has demonstrated in hematologic malignancies has created great hope in solid tumor malignancies, although tempered by differences between the two categories. Unlike hematologic cancers, solid tumors exhibit significant biomarker variation, with interpatient biomarker expression varying greatly, even within the same tissue diagnosis. To deal with this issue, the majority of clinical trials that were reviewed here were not restricted to a single disease location such as breast cancer or esophageal cancer but were rather restricted by the expression of the targeted epitope, to allow for the heterogeneity inherent in these tumors. As presented here, substantial efforts are being made worldwide to improve these technologies, but the United States appears to be lagging in clinical trial efforts, compared to other nations. Further investigation is warranted into this topic, as the usage of CAR T quickly spreads from a therapy only used in hematology to one with promise in solid tumors, infectious diseases, and beyond.

Clinical outcomes and post-progression retreatment in patients with metastatic NSCLC who complete two years of treatment with immune checkpoint blockade.

8633 Background: Immune checkpoint inhibition (ICI) has significantly improved survival in patients (pts) with metastatic non-small cell lung cancer (NSCLC). While ICI duration is commonly limited to two years, the optimal duration of ICI and post-progression treatment outcomes in pts who received at least two years of ICI are unknown. Methods: We conducted an international, multi-center study of pts with metastatic NSCLC treated with ICI for at least two years to characterize clinical outcomes and post-progression treatment patterns. Log-rank tests were used to test for differences in event-time distributions, and Cox proportional hazards models were used to estimate HRs. Results: We identified 255 pts with metastatic NSCLC treated with ICI alone (N=210, 82.3%) or ICI + chemotherapy (N=45, 17.7%) for least two years. Median age was 63.0, 42.4% were women, 93.0% had history of tobacco use, 79.2% had adenocarcinoma histology, 61.4% had a PD-L1 TPS ≥50%. From the start of ICI, the median time to progression (mTTP) was 6.9 years (95%CI 4.9-NR) and the median overall survival (mOS) was 9.5 years (95%CI 8.0-NR). Pts wo achieved a complete/partial response to ICI had a significantly longer mTTP (HR 0.41, P<0.01) and mOS (HR 0.30, P<0.01) compared to those with a best objective response of stable disease. Patients with high PD-L1 ≥50% (HR 0.6, P=0.02 vs PD-L1 <50%), very high tumor mutational burden (TMB) ≥20 mut/Mb (HR 0.7, P=0.03, vs <20 mut/Mb) and ever smoking status (HR 0.52, P=0.04, vs never smokers) had also significantly longer mTTP. There was no difference in mTTP (HR: 0.98, P=0.94) and mOS (HR: 0.61, P=0.06) between pts who stopped ICI at two years of treatment (N=112) and those who continued ICI beyond two years (N=143). Among 96 pts who progressed after ICI, 33.3% (N=32) received local ablative therapies (surgery or radiation), 9.3% (N=9) pts received systemic chemotherapy and 31.2% (N=30) pts received ICI retreatment. Among those retreated with ICI, the response rate was 63%, mTTP and mOS from the date of start of ICI retreatment were 22.7 (95%CI 11.2-NR), and 41.7 months (19.3-NR), respectively. Clinico-genomic predictors of response to ICI retreatment included higher TMB at baseline (15 vs 7.6 mut/Mb, P<0.001), adenocarcinoma histology (94.4% vs 50.0%, P=0.01), and longer ICI treatment duration prior to retreatment (31.2 vs 24.5 months, P=0.02). Conclusions: Pts who received a minimum of two years of treatment with ICI experienced unprecedented long-term survival. There was no difference in outcomes between pts who stopped at two years compared to those who continue therapy. After completing two years of initial ICI therapy, a large fraction of pts who subsequently experience disease progression and are retreated with ICI experience an objective response, particularly those with longer duration of prior ICI treatment, higher TMB, and adenocarcinoma histology.

Efficacy of chemotherapy followed by chemoradiation versus initial chemoradiation as part of the total neoadjuvant therapy for patients with locally advanced rectal cancer: An NCDB analysis.

e15629 Background: Results from multiple trials lead to modern management for locally advanced rectal cancer, with total neoadjuvant therapy (TNT) followed by surgery. However, the best sequence of different treatment modalities is unclear. Methods: We used the National Cancer Database (NCDB) to identify patients with locally advanced rectal adenocarcinoma. We divided patients into different categories based on the timing of chemo and radiation therapy relative to surgery. We used chi-square and Wilcoxon rank test for unadjusted comparison. To compare treatment efficacy with initial chemotherapy to concurrent chemoradiation in downstaging (clinical to pathological stage), we used a linear mixed effect model (LME) with adjustments on age, sex, race, facility type, and year of diagnosis. Also, we evaluated the probability of having positive lymph nodes in the pathological specimen (N+) in the multivariable logistic regression model with adjustment on the clinical stage in addition to the previously mentioned variables. All analyses were done using R 4.6.2. Results: A total of 100509 patients were identified. Only 695 patients received six cycles of neoadjuvant chemotherapy before concurrent chemoradiation (TNT chemotherapy), and 8677 patients received upfront radiation therapy with neoadjuvant chemotherapy administered within 12 weeks of neoadjuvant radiation therapy (TNT radiation). Patients whose start date of chemotherapy or radiation after surgery were excluded. The median age of participants was 63 (IQR = 54-63), and 83% were white. Patients who had TNT chemotherapy were younger (56.4 VS 59.5, P-value < 0.01), had clinically and pathologically advanced stage (IIIB, IIIC) compared to TNT radiation (64%VS 37% and 33%VS 29%, P-value < 0.01). Patients who received TNT radiation had an upgrade in their pathological stage compared to their clinical stage by 0.67 points in the LME (P value < 0.01). In multivariable logistic regression. TNT chemotherapy had a 17% lower risk of (N+) with an OR of 0.83 (0.95 CI 0.59-1.16). However, it was not statistically significant. The two groups had no difference in OS, with a median OS of 137 months (0.95 CI 110 -NR) and 143 (0.95 CI 137-151), respectively. Conclusions: Upfront chemotherapy before starting chemoradiation could be associated with more significant downstaging. Future trials to validate our finding is warranted. [Table: see text] [Table: see text]

Combined modality for localized gastric diffuse large B-cell lymphoma: Long-term outcomes of 50 patients.

7079 Background: R-CHOP is the primary treatment for gastric diffuse large B-cell lymphoma (GDLBCL); for localized disease, the role of consolidative radiation therapy (RT) after chemotherapy remains underexplored. This study focuses on localized GDLBCL undergoing a combined modality therapy of R-CHOP followed by gastric RT, comparing outcomes between those receiving short-course (3-4 cycles) and full-course (6 cycles) R-CHOP. Methods: A retrospective analysis identified 50 consecutive PGDLBCL pts treated with R-CHOP followed by RT between 1/2000-1/2021. Baseline characteristics and follow-up data were collected. Lugano PET criteria and endoscopy (EGD) assessed overall response rate. Kaplan-Meier and univariable cox regression models estimated overall survival (OS) and (PFS). Results: Of the 50 pts with localized (Stage I-II) disease, 34 (68%) received 3-4 cycles of R-CHOP and 16 (32%) received 6 cycles. Pre-RT disease evaluation varied, with 36 (72%) undergoing EGD and PET, 4 (8%) EGD and CT, and 6 (12%) PET alone. One pt (3%) exhibited active DLBCL post 3-4 cycle R-CHOP, while 5 (31%) did so after 6 cycles (p=0.1). Median time from last R-CHOP dose to RT start date was 1.2 months with a median 3060 cGy delivered dose for both groups (range 2340-3060 in the 3-4 cycle group, 3000-4500 in the 6-cycle group). Median follow-up time from RT end is 58 months. No in-field failures occurred post-complete response (CR); however, 1 pt did not achieve a CR following R-CHOP and RT, progressing in the stomach and subsequently at new, out-of-field (OOF) sites. 3 pts had OOF progression without relapses in the stomach in a median time of 21 months. Low-grade lymphoma in the stomach post-DLBCL CR was observed in 2 pts, 3 and 22 months from RT end, with 1 OOF marginal zone lymphoma 2 years-post RT. OS and PFS did not significantly differ between the 3-4 and 6 cycle groups (96-month OS 70% vs. 86%, p=0.8; 96-month PFS 76% vs. 86%, p=0.7). OS and DLBCL PFS were analyzed for pts with evidence of residual DLBCL pre-RT compared to those without evidence of disease after R-CHOP. The 24-month DLBCL PFS was 92% in the CR group and 67% for those with incomplete response (p=0.14), with 92% and 67% 24-month survival probability (p=0.11). On univariate analysis, pre-RT evidence of active DLBCL by PET and/or EGD, pre-RT PET FDG uptake, and achieving CR on first-post-RT imaging were not statistically significant for DLBCL PFS. Conclusions: Recognizing the limitations of a retrospective study, our study documents the effectiveness of short-course R-CHOP followed by RT in localized GDLBCL, with similar outcomes to the full 6-cycle regimen. Excellent disease control was observed, with few instances of DLBCL or low-grade lymphoma relapse. Further analysis will include a cohort receiving R-CHOP alone without consolidative RT. This analysis aims to contribute to the evolving standard of care for GDLBCL, providing insights for future treatment strategies.

Patterns of breast cancer trial enrollment in a prospective patient database at a comprehensive cancer center.

e23026 Background: Clinical trials (CTs) play a crucial role in expanding the landscape of breast cancer (BC) treatment, improving patient’s (pts) outcome and quality of life. Success of CTs relies heavily on pt recruitment. Understanding barriers for CT non-enrollment (NE) despite opportunities to enroll in real world diverse populations can provide valuable insight into barriers to and facilitators of CT participation. Methods: Coordinators registered pts offered BC trial opportunities at the O’Neal Comprehensive Cancer Center at UAB (University of Alabama at Birmingham) from 12/2020 to 12/2023. Identifiers, ethnicity, race, NE reasons and dates (referral, consent, enrollment, and NE) were recorded. CTs were grouped as Pharmaceutical versus Academic based on sponsorship. Descriptive analysis, Fisher’s exact and Mann Whitney U were calculated using Python. Results: A total of 559 pts were offered a CT with a median age of 55 years. There were 145 pts (27%) enrolled (Gp1), 65 (12%) signed consent with NE (Gp2), and 334 (61%) were NE prior to signed consent (Gp3). Most common NE reason in Gp2 and Gp3 was not meeting protocol eligibility (66% & 43%). Gp3 NE reasons included lack of interest or confidence, insurance and logistics, concern over adverse events, delayed therapy start and change to Standard of Care. In terms of ethnicity and race, most pts were Non-Hispanic White (NHW 312, 56%) followed by Black (NHB 165, 30%). Gp1, Gp2 and Gp3 were 28% vs 15%, 59% vs 56%, 11% vs 15% respectively. NHW pts had higher enrollment to CTs compared to NHB (OR 1.135, p 0.73). For Gp2 and Gp3, patterns of NE were similar among NHW and NHB pts such as lack of interest or confidence (11% in Gp3). In Gp2, More NHB pts had NE due to not meeting protocol eligibility (58% vs 75%). In Gp3, NHW pts had higher NE due to insurance and logistics (8% vs 4%). Median Gp1 consent to enrollment and Gp2 consent to NE were 14 and 11 days. Academic CTs (467, 84%), when compared to Pharmaceutical CTs (92, 16%), had higher enrollment (Gp1 28% vs 16%. OR 2.07, p 0.01). NE reasons did not change significantly between CT types in Gp2 and Gp3. Pharmaceutical CTs had longer median time from referral to enrollment (27 vs 13 days, p 0.001). Of those who signed consent (Gp1 and Gp2), enrollment rate was 69%, with more NHW than NHB pts participating (73% vs 63%, OR 1.56, p 0.19) and more participation to Academic than Pharmaceutical CTs (71% vs 58%, OR 1.77, p 0.18). Conclusions: UAB exceeded the national average of BC CT enrollment (27% vs 9%). Only 50% of NE was related to not meeting protocol eligibility criteria. Issues such as lack of confidence in CTs, concern over adverse events, delayed therapy start date and logistics remain active barriers. NHW and NHB pts had similar enrollment rates, consistent with prior data. NHB pts had higher protocol ineligibility due to more Denovo Stage 4 diagnoses. Academic CTs had better enrollment rate and shorter time to enrollment. Further studies are needed to overcome barriers to enrollment on clinical trials.

Breeding ecology of the endangered Algerian Nuthatch (Sitta ledanti) endemic to the Babors′ Kabylia (Northeastern Algeria): Implications of conservation

Abstract The endemic Algerian Nuthatch Sitta ledanti, is classified as an endangered species by the IUCN and protected species by Algerian law. Available information on its nesting and breeding biology is sporadic and incomplete, the purpose of which is to provide additional data on the different aspects of multi-site nesting of the species. 22 nests are monitored across five forests, during the nesting season of 2021. An endoscopic camera was used to monitor eggs and nestlings in the nests during the whole study. Most of the nests (n = 20) were constructed in different parts of the dead trees such as trunks or branches of the Atlas cedar Cedrus atlantica, the Algerian oak Quercus canariensis, the African oak Quercus afares or Cork oak Quercus suber. The laying dates were from early April to the end of May when April 28 (± 13 days) is the laying season’s median start date. The average clutch size was 4.6 (n = 21). The mean hatching success was 89.2%, while mean fledging success was 88.2%. The nestling sex ratio was 14 males versus 18 females. Data on clutch dates and fecundity of breeding pairs should be considered in any conservation approach and strategy in the context of habitat management and preservation.

Real-world treatment patterns and outcomes in US patients (pts) with advanced non-small cell lung cancer (NSCLC) after platinum-based chemotherapy (PBC) and anti–PD-(L)1 treatment.

8627 Background: Effective treatment options for advanced or metastatic NSCLC are limited, especially for pts who progress after treatment with PBC and an anti–programmed cell death 1 protein (PD-1) or ligand 1 (PD-L1) regimen. Examining real-world treatment patterns and long-term outcomes, we report on progression-free survival (PFS) and overall survival (OS) in pts with NSCLC who previously received PBC and anti–PD-(L)1 regimens. Methods: This study used the nationwide Flatiron Health electronic health record–derived deidentified database. Pts included in the analysis were ≥18 years old with an initial diagnosis of advanced or metastatic NSCLC and an ECOG PS of 0 or 1 who had received prior PBC and anti–PD-(L)1 therapy in 1 (in combination) or 2 (in sequence) lines and had initiated ≥1 subsequent line of treatment between 2018 and 2023; the start date of subsequent treatment (defined as the index regimen) was the index date. Pts were followed up until death or last available data through Mar 31, 2023. Pt characteristics, treatment patterns, and outcomes were analyzed for the overall pt group and according to initial treatment cohort (cohort 1: first-line [1L] PBC plus anti–PD-(L)1; cohort 2a: 1L PBC and second-line [2L] anti–PD-(L)1; or cohort 2b: 1L anti-PD-(L)1 and 2L PBC). PFS and OS were estimated using Kaplan-Meier methods. Results: Of 1793 pts, most were in cohort 1 (73.5%), with fewer pts in cohorts 2a (22.5%) and 2b (4.1%). The majority of pts in cohort 2b had PD-L1 ≥50% (n = 57, 78.1%), while the percentage was lower in cohorts 1 (n = 262, 19.9%) and 2a (n = 72, 17.9%). Most pts (n = 1626, 90.7%) had stage IV disease. Median time from advanced diagnosis to index date was 10.5 months (range, 1.1-103.8); median follow-up from index date was 7.8 months (range, 0.0-65.0). A broad range of treatments were used after PBC and anti–PD-(L)1 regimens; among all pts, the most common were docetaxel + ramucirumab and docetaxel monotherapy. Among all pts, median PFS and OS from the time of starting these index regimens were 5.29 and 11.20 months, respectively; PFS and OS were similar across cohorts. Conclusions: A broad range of subsequent treatments were used following PBC and anti–PD-(L)1 regimens, most commonly docetaxel with or without ramucirumab. Short median PFS and OS underscore a significant unmet need among pts previously treated with PBC and anti–PD-(L)1. [Table: see text]

A handheld device for intra-cavity and ex vivo fluorescence imaging of breast conserving surgery margins with 5-aminolevulinic acid

BackgroundVisualization of cancer during breast conserving surgery (BCS) remains challenging; the BCS reoperation rate is reported to be 20-70% of patients. An urgent clinical need exists for real-time intraoperative visualization of breast carcinomas during BCS. We previously demonstrated the ability of a prototype imaging device to identify breast carcinoma in excised surgical specimens following 5-aminolevulinic acid (5-ALA) administration. However, this prototype device was not designed to image the surgical cavity for remaining carcinoma after the excised lumpectomy specimen is removed. A new handheld fluorescence (FL) imaging prototype device, designed to image both excised specimens and within the surgical cavity, was assessed in a clinical trial to evaluate its clinical utility for first-in-human, real-time intraoperative imaging during index BCS.ResultsThe imaging device combines consumer-grade imaging sensory technology with miniature light-emitting diodes (LEDs) and multiband optical filtering to capture high-resolution white light (WL) and FL digital images and videos. The technology allows for visualization of protoporphyrin IX (PpIX), which fluoresces red when excited by violet-blue light. To date, n=17\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$n = 17$$\\end{document} patients have received 20mgkg\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$20\\frac{\ ext {mg}}{\ extrm{kg}}$$\\end{document} bodyweight (BW) 5-ALA orally 2-4 h before imaging to facilitate the accumulation of PpIX within tumour cells. Tissue types were identified based on their colour appearance. Breast tumours in sectioned lumpectomies appeared red, which contrasted against the green connective tissues and orange-brown adipose tissues. In addition, ductal carcinoma in situ (DCIS) that was missed during intraoperative standard of care was identified at the surgical margin at <1 mm depth. In addition, artifacts due to the surgical drape, illumination, and blood within the surgical cavity were discovered.ConclusionsThis study has demonstrated the detection of a grossly occult positive margin intraoperatively. Artifacts from imaging within the surgical cavity have been identified, and potential mitigations have been proposed.Trial RegistrationClinicalTrials.gov Identifier: NCT01837225 (Trial start date is September 2010. It was registered to ClinicalTrials.gov retrospectively on April 23, 2013, then later updated on April 9, 2020, to reflect the introduction of the new imaging device.)

A decade of analysis describe of maternal and neonatal characteristics of live births in southern Brazil

Introduction: Child health is conditioned by the circumstances of pregnancy, childbirth, and early life. Objective: To describe the maternal and neonatal characteristics of live births (LBs) in the Information System on Live Births of Santa Catarina (SC), Brazil. Materials and methods: A cross-sectional study describedthe maternal and neonatal characteristics of 940,059 LBs, from 2010 to 2019. Pearson’s chi-square test and Fisher’s exact test were conducted, with a statistical significance level of p &lt; 0.05. Results: The mean values of maternal age, number of live children, and number of fetal deaths as well as abortions were 27.1 years, 0.9, and 0.2, respectively. The averages of the number of gestation weeks, number of prenatal consultations, the start date of the prenatal care, and birth weight were 38.5 weeks, 8.1 months, 2.5 monthsand 3,217.1 grams, respectively. Low birth weight (LBW) was prevalent among mothers without education (p &lt; 0.001), including those without prenatal visits (p &lt; 0.001). A higher prevalence of being underweight was observed among female neonates (p &lt; 0.001) and with a maternal age of ≥ 40 years (10.8%; p &lt; 0.001) compared to newborns with good vitality. Newborns with good vitality had a low prevalence of underweight (p &lt; 0.001). The frequency of the variables studied increased, comparing the beginning and end of the period and whether the differences are statistically significant. Conclusions: The study draws attention to the need for interventions to improve the indicators that determine LBW.

PIK3CA testing and treatment patterns among patients with metastatic breast cancer in US community clinical practice.

e13059 Background: PIK3CA mutations are present in ~35-40% of HR+/HER2- breast cancer patients. Targeted treatments are approved and in development for patients with advanced disease, and clinical guidelines recommend biomarker testing. This retrospective cohort study characterized PIK3CA mutation testing and treatment patterns among HR+/HER2- metastatic breast cancer (mBC) patients in United States (US) community clinical practices. Methods: We used the nationwide Flatiron Health electronic health record-derived de-identified database to select patients diagnosed with HR+/HER2- mBC from January 2011 to May 2023. We described baseline characteristics of patients tested and not tested for PIK3CA mutation. We captured rates of PIK3CA mutation testing (anytime and ≤1 year) prior to starting first-line (1L), second-line (2L), and third-line (3L) treatment; test and sample types; secular trends over time; and test turnaround time (TAT). Treatment patterns for patients with a PIK3CA-mutated tumor were also described from 2019 onwards. Results: Among 14,246 HR+/HER2- mBC patients treated at community sites, 4,537 had a PIK3CA mutation test result during the study period. 25% of patients had more than one PIK3CA mutation test. Test rates increased from 2011 to 2023 for all patients starting 1L, 2L, or 3L during the study period (Table). In 2023, the percentage of patients tested anytime prior to 1L, 2L, and 3L start dates were 11% (37 of 324 patients), 52% (140 of 271 patients), and 65% (133 of 204 patients), respectively. Among tested patients, those who were tested between 1L and 2L increased from 32% in 2018 to 45% in 2023. Median time from mBC diagnosis date to first test was variable across years: 8, 10, and 3 months in 2018, 2020, and 2022, respectively. During the study period, most PIK3CA mutation tests were next-generation sequencing (NGS) (88%) and used tumor tissue (72%). Median TAT decreased from 12 days in 2018 to 7 days in 2023. Among patients with a PIK3CA-mutated tumor in 2019 and onwards who received treatment, 36% of patients received alpelisib-containing regimens. Conclusions: PIK3CA mutation testing in HR+/HER2- mBC patients has increased over time in community clinical practice, and timing has shifted to earlier lines of therapy among tested patients. However, overall testing and subsequent treatment with pathway-directed therapy are still low despite clinical guidelines, which may reflect potential gaps in access to PIK3CA mutation testing and the continued unmet need regarding available targeted agents within the current treatment landscape. [Table: see text]

Combined Use of Multiple Cloud‐Free Snow Cover Products in China and Its High‐Mountain Region: Implications From Snow Cover Identification to Snow Phenology Detection

AbstractAccurate snow phenology detection, including snow cover days (SCD), snow start date (SSD), and snow end date (SED), is increasingly important for understanding mountain hydrology such as snow heterogeneity and snowmelt seasonality. Multiple cloud‐free daily snow cover products have recently been developed in China, employing diverse retrieval algorithms and cloud‐gap‐filling methods, resulting in varying accuracy levels. However, comprehensive analysis of differences among products and their impact on snow phenology detection is lacking. This study systematically evaluates eight state‐of‐the‐art snow cover products in China, focusing on the challenging Tibetan Plateau (TP). We introduce a novel metric, the consistency‐weighted correlation coefficient (CWR), customized for SSD and SED detection, and propose product‐combining schemes like “ensemble voting” and “sensor preference” to enhance reliability. Our findings highlight the prime influence of retrieval algorithms under clear‐sky conditions on accuracy, surpassing the importance of cloud‐gap‐filling methods. Specifically, a product optimizing normalized difference snow index thresholds for diverse landcover types consistently outperforms others in detecting all three snow phenology parameters, with correlation coefficients for SCD of 0.82 and 0.69, and CWR values for SSD of 0.54 and 0.40, and for SED of 0.53 and 0.37 in both China and the TP, respectively. Moreover, our proposed scheme combining three high‐accuracy products significantly enhances snow cover identification and SCD detection, especially when the best‐performing product alone faces substantial uncertainty. These findings provide immediate, crucial implications for optimizing the use of multiple cloud‐free products to enhance snow phenology detection, ultimately advancing the applicability of derived snow parameters in mountain hydrology research.