Starter Pack Research Articles

Adjunctive use of cenobamate for pediatric refractory focal-onset epilepsy: A single-center retrospective study

ObjectiveWe explored the efficacy and safety profile of cenobamate as an adjunctive therapy in patients with refractory focal-onset epilepsy in the pediatric population. MethodsThis was a retrospective, single-center study of cenobamate used as an adjunctive medication in pediatric patients with refractory focal-onset epilepsy . We measured seizure reduction, median reduction in seizure frequency, median dose, responder rate, and treatment-emergent adverse events. ResultsWe studied the efficacy and safety profile of cenobamate in 21 pediatric patients (mean age 15.9). Cenobamate was up titrated using the prescribed starter pack with final doses ranging from 100 mg to 400 mg daily. The mean and median dose of cenobamate was 209.8 mg (±98.87 mg) and 200 mg (175–275), respectively. For patients weighing less than 50 kg, mean and median dose was 4.0 mg/kg/day (3.20–4.63) and 4.32 mg/kg/day, respectively. Mean and median baseline seizure frequency per month in this cohort was 15.38 and 16, respectively, prior to the introduction of cenobamate. After the adjunctive use of cenobamate, mean and median seizure frequency per month reduced to 7.29 and 1, respectively; median reduction in seizure frequency was 93.7%. Seizure reduction of at least 50% (responder rate) was noted in 13 (62.5%) patients and a seizure reduction of at least 75% noted in 11 (52.4%) patients, similar to that seen in adults. Four patients (19%) achieved seizure freedom. Of the 21 pediatric patients, 9 (42.8%) patients had treatment-emergent adverse events (TEAE) with the most commonly reported symptom being ataxia (5, 23.8%) and sedation (2, 9.5%). Three (14.3%) patients discontinued early due to these side effects. No children developed drug rash with eosinophilia and systemic symptoms (DRESS). ConclusionCenobamate demonstrates similar efficacy rates and safety profile within the pediatric population when compared to the published adult data, making it an effective, safe, and tolerable adjunctive medication for children with refractory focal-onset epilepsy, even at the maximum daily dose.

An Open-Label, Randomized, Prospective, Comparative, Three-Arm Clinical Trial to Evaluate the Safety and Effectiveness of Apremilast with Three Different Titration Methods in Patients with Chronic Plaque Psoriasis in India.

PurposeTo minimize adverse effects (AEs), apremilast is recommended to titrate at the initiation of therapy. But still, many patients experience AEs, resulting in discontinuation of therapy. As a result, many dermatologists have adapted to further titrate apremilast in different ways. The present study was planned to evaluate the safety and effectiveness of apremilast in different dose titration methods as initiation therapy in the treatment of plaque psoriasis.Patients and MethodsIn this open-label, randomized, prospective, comparative, three-arm, single center study, 128 plaque psoriasis patients were included. Patients were randomized into three groups. Group I received standard titration for the first 6 days; Group II received all tablets in a starter pack as once a day (OD) total for 13 days; and Group III received two starter packs as 8 tablets each of apremilast 10 mg and 20 mg as OD and 10 tablets of 30 mg as OD, in total for 26 days. All groups received apremilast 30 mg as twice a day after initial titration. The total duration of apremilast therapy in all groups was 16 weeks.ResultsIn safety assessment, AEs were reported in 50%, 41.3% and 25% in Groups I, II and III, respectively (p <0.05) with nausea being the most common AE. In Group I, 10.53% of patients discontinued apremilast whereas 6.52% and 2.27% discontinued in Groups II and III respectively. Maximum number of AEs were seen in Group I in first week only (74.19%) compared with other groups. At week 16, on the Psoriasis Area and Severity Index, PASI 75 was achieved in 31.43%, 42.4% and 33.3% of patients in Groups I, II and III, respectively with no statistical difference between any groups.ConclusionIt can be concluded that slower titration is a useful strategy for minimizing AEs while at the same time maintaining effectiveness of apremilast.

An open label randomized placebo-controlled study of apremilast in common immune mediated papulosquamous hair and pigmentary dermatoses

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Apremilast is a novel PDE4 inhibitor which interferes with several key processes of inflammation. The objective of this study was to determine the efficacy and safety profile of apremilast in common immune mediated papulosquamous, hair and pigmentary dermatoses. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; It was a prospective, open labelled, randomised, placebo-controlled study done over a period of 18 months. A total number of 100 patients were enrolled in which 50 were cases and 50 were controls. Psoriasis, lichen planus, alopecia areata and vitiligo cases were randomly enrolled at our OPD. Apremilast starter pack was given initially for 1 week followed by 30 mg twice daily for four months. All patients were followed up every 4 weeks for 16 weeks. Photographic documentation, assessment of PASI, LPSI, SALT, VASI and adverse effects were noted at baseline and at each visit. Patients were followed up for 6 months after the treatment for any recurrences.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Mean percentage improvement of PASI score in psoriasis group, LPSI score in LP group, SALT score in alopecia areata group and VASI score in vitiligo group was 62%, 71%, 24.4% and 15% respectively. Apremilast was more effective in psoriasis and lichen planus groups.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Apremilast is an effective treatment option for mild to moderate psoriasis and lichen planus but was found to be less efficacious in alopecia areata and vitiligo, according to our study. Apremilast was well tolerated with minimal side effects which were manageable with symptomatic treatment.&lt;/p&gt;

Determinan Kepatuhan Wajib Pajak Sektor Telekomunikasi Usaha Kecil Menengah di Sumatera Barat

This study aims to identify the factors that influence the compliance of MSME taxpayers in the telecommunications sector in West Sumatra. In particular, this study seeks to empirically examine the effect of tax rates, socialization, tax sanctions, and understanding of taxation on the level of taxpayer compliance. This research is quantitative, sourced from primary data obtained from taxpayers of SMEs in the Telecommunication Sector in West Sumatra. The sample of this study consisted of 40 compulsory people. This study found that tax sanctions and understanding of taxation have a positive effect on taxpayer compliance. Meanwhile, tax rates and socialization do not affect the level of compliance. Regardless of the applicable tax rate, taxpayers will automatically pay taxes at whatever tax rate level is following their income. In contrast, the socialization carried out is still classified as having a short duration, so that it is difficult for respondents to pay taxes. Understand socialization. Practically this research can contribute to the preparation of regulations regarding the calculation and collection of value-added tax and income tax on income in connection with the sale of credit, starter packs, tokens, and vouchers; it is necessary to review the regulations issued and effective in a short period so that taxpayers have not fully understood the socialization of this policy.

911. Rapid Hepatitis C Treatment Initiation in Young People Who Inject Drugs: Final Results from the HCV-Seek, Test and Rapid Treatment (HCV-ST&amp;RT) Randomized Pilot Clinical Trial

BackgroundYoung people who inject drugs (PWID) have higher HCV incidence and lower treatment initiation rates compared to their older peers. Novel, simplified care models need to be developed to engage, treat and cure hard to reach patient populations, such as young PWID.MethodsWe present final data from the randomized pilot clinical trial HCV-Seek Test & Rapid Treatment (HCV-ST&RT) for curing HCV in young PWID. Eligible participants were 18-29 years of age, HCV Ab+, treatment naïve, and had injected drugs in the past 30 days. Participants were randomized 1:1 to the Rapid Treatment or Usual Care arm. Participants randomized to Rapid Treatment received a same-day medical evaluation, confirmatory and baseline lab testing, and 7-day starter pack of sofosbuvir/velpatasvir. Participants in Usual Care received same-day HCV confirmatory testing and, if positive, facilitated referral to local providers. The primary endpoint was sustained virologic response (SVR12) in RNA+ participant within 12 months of enrollment. ResultsAmong 47 eligible participants, 38 were enrolled and randomized. 14/18 in the Rapid Treatment arm and 11/20 in the Usual Care arm were confirmed HCV RNA+ and included in the intention-to-treat analysis. Demographics of the RNA+ participants were similar in the two arms with a mean age of 26 years; 24% women; 36% Hispanic and 4% non-Hispanic black. At baseline 24% were homeless, 52% received medication for opioid use disorder in the prior 90 days, and participants injected a median of 20 of the last 30 days. In the intention-to-treat analysis, 9/14 (64%) of the Rapid Treatment arm and 2/11 (18%) of the Usual Care arm had confirmed SVR12 (p=0.042). Of the 5 participants in the Rapid Treatment arm who did not achieve SVR12, 1 had treatment failure, 1 never started DAA therapy, 1 had an on-treatment response with pending SVR12 confirmation, and 2 were lost to follow-up. ConclusionAmong young HCV RNA+ PWID, significantly higher rates of cure were achieved using the Rapid Treatment model with same day, low-threshold, simplified HCV care compared to facilitated referral. Meeting young PWID where they’re at and initiating HCV treatment ‘in the moment’ without the need for repeat visits appears to be a promising strategy for treating this hard to reach population.Disclosures Benjamin Eckhardt, MD, MS, Gilead Sciences (Grant/Research Support) Shashi Kapadia, MD, Gilead Sciences Inc (Grant/Research Support) Kristen Marks, MD, Gilead Sciences (Grant/Research Support)

Pengaruh Iklan Dan Kualitas Produk Terhadap Keputusan Pembelian Produk Kartu Perdana Smartfren Pada Masyarakat Perumnas Muara Siban Kabupaten Lahat

Technology brings humans into individuals who prioritize practicality in carrying out various activities. In terms of communication, cellular phones have become part of the life of modern Indonesian society as a technology that provides easy communication for its users. This background of consumer desires certainly motivates the cellular industry to compete. Advertising is very important to spur the development of products on the market in the face of competition between similar companies. In addition to paying attention to product quality, the company also pays attention to advertising which is no less important. The data collection method used in this research is literature study, which is a method used to obtain theoretical data related to the problems discussed. Then field studies, namely interviews, observations, which relate to the problem under study. to get clear data. The analytical method used in this study is qualitative, namely comparing the existing theory with the influence of advertising and product quality on purchasing decisions for Smartfren prime card products and quantitative analysis, namely data analysis using multiple linear regression statistical formulas with equations. Based on the results of research that has been carried out in the Perumnas Muara Siban Community, Lahat Regency, and the results of the analysis of the influence of advertising and product quality on purchasing decisions for Smartfren starter packs, the following conclusions can be drawn: In the t test, it was found that there was a significant effect of the advertising variable (X1) on the Purchase Decision of the Smartfren starter pack product, while the product quality variable has no effect on the purchase decision of the Smartfren starter pack. In the F test, it was found that there was a linear relationship between advertising (X1) and product quality (X2) together or simultaneously having a significant influence on the Purchase Decision of Smartfren starter pack products (Y). Of the three factors, namely advertising and product quality, the most dominant influence on the Smartfren starter pack product purchase decision is advertising.&#x0D; Keywords: Advertising, Product Quality and Purchase Decision

Expanding access to HIV services during the COVID-19 pandemic\u2014Nigeria, 2020

BackgroundTo accelerate progress toward the UNAIDS 90-90-90 targets, US Centers for Disease Control and Prevention Nigeria country office (CDC Nigeria) initiated an Antiretroviral Treatment (ART) Surge in 2019 to identify and link 340,000 people living with HIV/AIDS (PLHIV) to ART. Coronavirus disease 2019 (COVID-19) threatened to interrupt ART Surge progress following the detection of the first case in Nigeria in February 2020. To overcome this disruption, CDC Nigeria designed and implemented adapted ART Surge strategies during February–September 2020.MethodsAdapted ART Surge strategies focused on continuing expansion of HIV services while mitigating COVID-19 transmission. Key strategies included an intensified focus on community-based, rather than facility-based, HIV case-finding; immediate initiation of newly-diagnosed PLHIV on 3-month ART starter packs (first ART dispense of 3 months of ART); expansion of ART distribution through community refill sites; and broadened access to multi-month dispensing (MMD) (3–6 months ART) among PLHIV established in care. State-level weekly data reporting through an Excel-based dashboard and individual PLHIV-level data from the Nigeria National Data Repository facilitated program monitoring.ResultsDuring February–September 2020, the reported number of PLHIV initiating ART per month increased from 11,407 to 25,560, with the proportion found in the community increasing from 59 to 75%. The percentage of newly-identified PLHIV initiating ART with a 3-month ART starter pack increased from 60 to 98%. The percentage of on-time ART refill pick-ups increased from 89 to 100%. The percentage of PLHIV established in care receiving at least 3-month MMD increased from 77 to 93%. Among PLHIV initiating ART, 6-month retention increased from 74 to 92%.ConclusionsA rapid and flexible HIV program response, focused on reducing facility-based interactions while ensuring delivery of lifesaving ART, was critical in overcoming COVID-19-related service disruptions to expand access to HIV services in Nigeria during the first eight months of the pandemic. High retention on ART among PLHIV initiating treatment indicates immediate MMD in this population may be a sustainable practice. HIV program infrastructure can be leveraged and adapted to respond to the COVID-19 pandemic.

E‐cigarettes versus nicotine replacement treatment as harm reduction interventions for smokers who find quitting difficult: randomized controlled trial

The majority of smokers accessing the current best treatments continue to smoke. We aimed to test if e-cigarettes (EC) compared with nicotine replacement treatment (NRT) can help such smokers to reduce smoking. Randomized controlled trial of EC (n=68) versus NRT (n=67) with 6-month follow-up. Stop smoking service in London, UK. A total of 135 smokers (median age=40years, 51% male) previously unable to stop smoking with conventional treatments. Participants received either NRT of their choice (8-week supply) or an EC starter pack and instructions to purchase further e-liquids of strength and flavours of their choice themselves. Products were accompanied by minimal behavioural support. Participants who reported that they stopped smoking or reduced their daily cigarette consumption by at least 50% at 6-month follow-up were invited to provide a carbon monoxide (CO) reading. The primary outcome was biochemically validated reduction in smoke intake of at least 50% at 6months and the main secondary outcome was sustained validated abstinence at 6months. Drop-outs were included as 'non-reducers'. Validated smoking reduction (including cessation) was achieved by 26.5 versus 6.0% of participants in the EC and NRT study arms, respectively [relative risk (RR)=4.4, P=0.005, 95% confidence interval (CI)=1.6-12.4]. Sustained validated abstinence rates at 6months were 19.1 versus 3.0% (RR=6.4, P=0.01, 95% CI=1.5-27.3). Product use was high and equal in both study arms initially, but at 6months allocated product use was 47% in the EC arm versus 10% in the NRT arm (χ2 (1) =22.0, P<0.001), respectively. Adverse events were minor and infrequent. In smokers unable to quit using conventional methods, e-cigarettes were more effective than nicotine replacement therapy in facilitating validated long-term smoking reduction and smoking cessation when limited other support was provided.

Apremilast Titration

Background: Apremilast is recommended to titrate in initial period to reduce adverse effects (AE). But inspite of that, in India; many dermatologists experienced a lot of AE resulting in discontinuation of therapy. As a result, many of them have adapted to titrate the dose in different ways. Objectives: To evaluate the AE profile and rate of discontinuation of apremilast during initial titration in different ways. Materials and Methods: A multicentre, retrospective data analysis was done at 121 dermatology clinics across India in the adult patients diagnosed with chronic plaque psoriasis and prescribed at least one dose of apremilast. Patient characteristics and data were obtained from medical records when available. Results: Out of 582 patients, 175 were prescribed apremilast starter pack in licensed dose (Group 1); 202 were prescribed starter pack in OD dosing (Group 2) for 13 days and 205 were prescribed 2 starter packs in OD dosing (Group 3) for 26 days. 45.14% had AE in Group 1 whereas 36.63% and 30.24% had in Group 2 &amp; 3 respectively. Gastrointestinal upset, headache &amp; nausea were most common. In Group 1, 17.71% of patients discontinued apremilast whereas 16.33% and 10.24% discontinued in Group 2 &amp; 3 respectively. On comparison within group, Group 3 had significant difference over Group 1 (p value &lt;0.05). Conclusion: It is concluded that slower titration of apremilast in initial phase leads to lesser AE profile and hence discontinuation of therapy and thus increasing adherence.

Evaluating the clinical experience of a regional in-center nocturnal hemodialysis program: The patient and staff perspective.

End-stage kidney disease causes significant morbidity, mortality, and reduced quality of life. Despite improvements in conventional hemodialysis, these problems persist. In-center nocturnal hemodialysis (INHD) has been shown to be beneficial in observational studies. This report outlines a 4-year renal network experience of INHD from the patient and frontline staff perspective. Staff and patients' experiences of INHD were evaluated through two work streams. Work stream one: 12 patients who chose to stop INHD and 24 patients who chose to continue with INHD completed an anonymous survey. Work stream two: one-to-one interviews with 20 patients receiving INHD and seven staff working INHD shifts were conducted. Clinical incident reporting for conventional hemodialysis and INHD from April 2014 to December 2018 was reviewed. Work stream one: Five themes were identified; facilities, time, health and well-being, sleep, and transport. A patient "starter pack" was developed and improvements to the dialysis unit were completed. Work stream two: Patient interviews demonstrated starter packs to aid sleep were well received; sleep itself was not a single reason to discontinue INHD. Staff indicated that their greatest concern was staffing levels; although staff-to-patient ratio remains unchanged, total numbers on INHD shifts were fewer, causing concern around less colleague availability for support during an emergency. 363 clinical incidents were reported across all dialysis shifts; for conventional hemodialysis, a larger proportion were due to medical interventions, infection control, and transport; for INHD, most incidents centered around communication with patients and relatives, delays in patient transfer, and issues with medical equipment or facilities. Patients continue with INHD due to increased social time and perceived health benefits. Patient starter packs and adjustments to the dialysis unit may enhance sleep. This experience has optimized the design of the NightLife study; a randomized controlled trial evaluated the effect of INHD on quality of life.

Manualising the induction of higher trainees in psychiatry for North Wales: The CiSGC Guide (“Croeso i Seiciatreg Gogledd Cymru”)

AimsThere is a significant period of adjustment for new higher trainees in psychiatry given the presence of inter-trust differences in the National Health Services (NHS). It may take some time for a trainee to become familiar with the new administrative system and workflow of the new environment, which may be even longer for an international medical graduate (IMG). Although there is an existing induction system, having a written structured manual will assist the trainees to get through this process more easily. Hence, this Quality Improvement Project (QIP) outlined the creation of an induction manual that serves as a starter pack to facilitate the settling-in process of new North Wales higher trainees in psychiatry, i.e. the “Croeso i Seiciatreg Gogledd Cymru” (CiSGC) guide (means Welcome to North Wales Psychiatry in Welsh).MethodThe induction manual was initially drafted by the authors based on the available printed policies and information online. Further input and from different stakeholders were obtained to triangulate and enrich the manual. Specific links and further references were included in the manual for the reference of prospective manual users. Authors’ contact details were included for any further clarification, suggestions or input.ResultThe manual consisted of four sections: A) General Process before, during and after Reporting Duty, B) Trainees’ Duty, 3) Speciality-specific Guidance, and 4) Health Board-related Information. The General Process section covered the visa-related information, post-acceptance paperwork process, access to email and hospital informative system, medical practice-related issues (including section 12(2) approval and medical indemnity). The Trainees’ Duty section briefed on time-tabling and clinical duty. The Specialty-specific Guide provided important information related to training. Lastly, the section of Health Board-related Information highlighted the administrative structure of the NHS Health Board, important contact numbers, link to information. Specialty specific sections were created for general adult psychiatry and old age psychiatry as there is no other higher training of psychiatry in North Wales at the moment. Further sections in the pipeline include substance misuse and liaison psychiatry.ConclusionThis induction manual is neither prescriptive nor exhaustive. It serves as a generic reference to facilitate new trainees in their adjustment process. Further review and revision will be conducted before every induction process to ensure the information is up-to-date and incorporating new input from the trainees.

Pengaruh Bauran Pemasaran Terhadap Keputusan Pembelian Konsumen Produk Kartu Perdana Pascabayar Halo Pada PT. Telkomsel Grapari Makassar

This research was conducted with the aim of: (1) examining and analyzing the effect of the product on consumer purchasing decisions for postpaid hello card products; (2) examining and analyzing the effect of price on consumer purchasing decisions for postpaid starter pack hello; (3) examining and analyzing the effect of promotion on consumer purchasing decisions for postpaid starter pack hello; (4) examining and analyzing the effect of place on consumer purchasing decisions for postpaid starter pack hello; (5) examining and analyzing the four factors that have the most dominant influence on consumer purchasing decisions for postpaid hello card products. This study uses primary data and secondary data. In this study, the sample used was 100 consumers. based on secondary data at the end of 2015 to December 2016. Data was collected through questionnaires and data tabulation was carried out. Methods of data analysis using multiple linear regression analysis and analysis of the coefficient of determination and descriptive analysis with the help of the Statistical Product and Service Solutions (SPSS) program. These results indicate that: (1) the product variable has a positive but insignificant effect on consumer decision making to buy postpaid starter pack hello: (2) the price variable has a positive and significant effect on the decision to buy a postpaid starter pack hello: (3) promotion variable has a significant effect on the decision to buy postpaid starter pack hello: (4) the place variable does not have a positive and significant effect on the decision to buy the postpaid starter card hello: (5) the most dominant variable influencing decision making is the price variable.&#x0D; Keywords: Product, Price, Place, Promotion, and Purchase Decision

Don't Prescribe Refills for Starter Packs.

Don't Prescribe Refills for Starter Packs.

Achieving Sustainable Development Goals 2016-2030 in Nigeria through Female Enrolment into Electrical/Electronics Engineering Trade in Technical Colleges of Adamawa State

Purpose: This study investigated female enrolment into electrical/electronics engineering trade in technical colleges of Adamawa State in order to suggest ways of augmenting it for Sustainable Development Goals (SDGs) 2016-2030.&#x0D; Approach/ Methodology/ Design: Two research questions and two null hypotheses were formulated to guide the study. A descriptive survey research design was adopted for the study. The sample of the study comprised of 38 teachers and 140 parents. A 50-item Female Enrolment in Electrical/Electronics Engineering Trade (FEEET) Questionnaire was developed by the researchers and used for data collection. The questionnaire was validated by three experts from the Department of Electrical Technology Education, Modibbo Adama University of Technology, Yola, Adamawa State. Reliability co-efficient of 0.81 was obtained for the instrument using Cronbach’s Alpha reliability method. Mean statistic was used to answer the two research questions while z-test statistics was used to test the two hypotheses at 0.05 level of significance.&#x0D; Findings: The findings of the study revealed that inadequate knowledge on female participation in electrical/electronics engineering trade, hazards involved in working with electricity, and poor gender policy implementation among others were factors affecting female enrolment into the programme. Establishment of electrical/electronics engineering trade skill acquisition centres for females and provision of starter packs for female graduates of electrical/electronics engineering trade among others were strategies identified for improving female enrolment into the programme. &#x0D; Practical Implication: The study has practical implications for achieving sustainable development goals in Nigeria. A sustainable financing scheme for the female trainees of electrical/electronics engineering trade should be established in order to boost their interests in the programme.&#x0D; Originality/Value: The study identified that inadequate knowledge on female participation in electrical/electronics engineering trade, hazards involved in working with electricity, societal perception about electricity, cultural sanctions on women, early marriages, and poor gender policy implementation are the main factors that affect female enrolment in technical colleges in Nigeria.

Adverse outcomes associated with inappropriate direct oral anticoagulant starter pack prescription among patients with atrial fibrillation: a retrospective claims-based study.

Direct oral anticoagulant (DOAC) starter packs are designed for unique treatment dosing for acute venous thromboembolism (VTE). Inappropriate use of 30-day DOAC starter packs in patients with atrial fibrillation (AF) may increase the risk for bleeding events given higher dosing in the first 1-3weeks of treatment. A retrospective analysis of medical and outpatient pharmacy claims data from 2015 to 2018 in Optum's De-identified Clinformatics® Data Mart was performed.Patients greater than 18years of age with AF and a new prescription of apixaban or rivaroxaban were included. Patients with an acute VTE were excluded. The main outcome of interest was adverse events (emergency department [ED] visits, hospitalizations, and deaths within 90days after prescription fill date) associated with inappropriate DOAC starter pack prescription. A total of 90,950 DOAC-treated patients with AF were identified. The mean age was 74.5years (SD 10.0) and 42,717 (47.0%) were female. Inappropriate starter packs were used by 117 (0.1%) patients, who were younger than non-starter pack patients (71.3years vs. 74.5years). Patients who received an inappropriate DOAC prescription were more likely to identify as Black (12.0% vs. 8.8%). Rates of ED visits, hospitalizations, and deaths overall were numerically lower in patients with starter pack compared to non-starter pack DOAC prescriptions. In contrast, rates ofED visits and hospitalizationsrelated to significant bleeding were numerically higherin patients with starter pack compared to non-starter pack DOAC prescriptions. Among patients with AF but no VTE, those who received an inappropriate DOAC starter pack had numerically higher rates of severe bleeding leading to ED visits and hospitalizations compared to those prescribed an appropriate non-starter pack DOAC anticoagulant.

Implementasi Data Mining pada Penjualan Kartu Perdana Internet di Purnama Ponsel Menggunakan Metode Algoritma Apriori

Purnama Ponsel is a mobile business which is engaged in selling internet starter packs. Internet starter packs are cards that are used with restrictions or limits on internet usage, where by using this internet starter pack the user can save credit because all activities use quotas except telephone (voice calls) and Short Message Service (SMS). Some companies compete by issuing internet premieres so as to reduce access costs. This competition can be seen from the number of internet starter packs that are sold simultaneously and know the inventory for the next month. So to facilitate the calculation of cell phone owners using data mining with apriori algorithm method to complete this research. Using the apriori algorithm method can help mobile full moon owners in the calculation process on full moon cellphones using the Tanagra application and is expected to reduce the number of cards that expire and can predict how many card supplies are needed for the following month.

Inappropriate Prescription of Direct Oral Anticoagulant Starter Packs

BackgroundThe 30-day direct oral anticoagulant starter pack has simplified the treatment of acute venous thromboembolisms, but it is not appropriate for use in patients with other indications for anticoagulation. MethodsA retrospective analysis of national outpatient pharmacy claims data between January 1, 2015 and December 31, 2018, was performed. Adult patients (ages >18 years) with continuous insurance enrollment at least 12 months prior to and 1 month following a direct oral anticoagulant starter pack prescription during the study period were included. The primary study outcome was the rate of inappropriate prescription of direct oral anticoagulant starter packs, defined as a prescription without a venous thromboembolism diagnosis within the prior 45 days or a prescription with a prior starter pack fill within the past 45 days. ResultsA total of 3711 direct oral anticoagulant starter pack prescription fills were identified, representing 3634 unique patients. The mean patient age was 62.8 years (standard deviation [SD] 15.1) and 1871 (50.4%) were females. There were 770 (20.7%) direct oral anticoagulant starter pack fills identified as potentially inappropriate. Patients prescribed inappropriate fills were likely to be older than patients with appropriate fills (64.7 years vs 62.4 years, P < 0.001). There was no significant difference in the race or geographic location between patients with inappropriate and appropriate prescriptions. ConclusionsA significant proportion of patients using direct oral anticoagulant starter packs did not have a diagnosis of acute venous thromboembolism, raising concerns about inappropriate prescribing and potential bleeding complications. Future studies are needed to identify factors associated with inappropriate direct oral anticoagulant starter pack prescription and evaluate efforts to reduce this practice.

Digital Training in the Aeronautical Industry: Measuring the Usability of Two Mobile Applications

The air traffic control industry is highly regulated, with stringent processes and procedures to ensure that IP (Intellectual Property) and workplaces are kept secure. The training of air traffic controllers (ATCs) and other roles relating to air traffic services is a lengthy and expensive process. The rate in which trainees can be trained is projected to fall significantly short of the demand for staff to work in the air traffic industry. This paper focuses on two prototype mobile training applications - Location Indicators (LI) and the Aircraft Control Positions Operator (ACPO) Starter Pack. LI and the ACPO Starter Pack have been produced to explore how air traffic control training could be improved and supported using digital applications. Each application explores a key learning area for trainees in the air traffic control industry and presents an alternative to the equivalent training that is currently in use. The two prototypes that have been designed focus on producing a succinct user experience alongside gamified elements to improve engagement. As part of this paper, usability testing has been undertaken with LI and the ACPO Starter Pack. A total of nine usability tests have been undertaken at four different locations. These usability tests consisted of participants from differing demographics, varying experience with the current training and differing amounts of time with both applications. The System Usability Scale (SUS) was adapted and used to quantify participant’s reactions to the usability of each application. Usability scores for both applications were collected and then averaged to produce an overall score for each application. We can conclude from both usability scores and qualitative feedback that digital applications have the potential to engage future trainees in the air traffic services industry.

A Non-yeast Kefir-like Fermented Milk Development with Lactobacillus acidophilus KCNU and Lactobacillus brevis Bmb6.

The use of yeast assist kefir fermentation, but also can cause food spoilage if uncontrolled. Hence, in this study, the microbial composition of an existing commercial kefir starter was modified to produce a functional starter, where Lactobacillus acidophilus KCNU and Lactobacillus brevis Bmb6 were used to replace yeast in the original starter to produce non-yeast kefir-like fermented milk. The functional starter containing L. acidophilus KCNU and L. brevis Bmb6 demonstrated excellent stability with 1010 CFU/g of total viable cells throughout the 12 weeks low-temperature storage. The newly developed functional starter also displayed a similar fermentation efficacy as the yeast-containing control starter, by completing the milk fermentation within 12 h, with a comparable total number of viable cells (108 CFU/mL) in the final products, as in control. Sensory evaluation revealed that the functional starter-fermented milk highly resembled the flavor of the control kefir, with enhanced sourness. Furthermore, oral administration of functional starter-fermented milk significantly improved the disease activity index score by preventing drastic weight-loss and further deterioration of disease symptoms in DSS-induced mice. Altogether, L. acidophilus KCNU and L. brevis Bmb6 have successfully replaced yeast in a commercial starter pack to produce a kefir-like fermented milk beverage with additional health benefits. The outcome of this study provides an insight that the specific role of yeast in the fermentation process could be replaced with suitable probiotic candidates.

What's in a number?

Many countries have adopted laws setting minimum cigarette pack sizes at 20 per pack. Going further to standardize pack sizes makes sense to disrupt brand marketing but a larger quantity per pack (e.g. carton size of 100 cigarettes per pack) would make purchasing cigarettes less affordable. It is a good question to ask, as increased standardization of the product and package are effective strategies to limit the marketing of cigarettes 3-9. Cigarette companies have experimented with different pack sizes, such as sampling packs with four cigarettes and starter packs with 10 cigarettes, but mostly cigarettes are sold in packs with 20 cigarettes; that has been the industry standard. Blackwell and colleagues 1 speculate that larger cigarette pack sizes might promote more smoking and be detrimental to public health in the same way as providing larger food and beverage portion sizes leads to an increased consumption of calories. However, I do not believe that this is likely to be the case with cigarette packaging, as research suggests that most addicted smokers self-titrate to their daily dose of nicotine 10, 11. zThe typical smoker needs approximately 20 cigarettes per day to satisfy their nicotine addiction. I recall a conversation I had many years ago with a former marketing director of a major US cigarette manufacturer, who explained to me that if public health authorities really wanted to disrupt the cigarette market, they should limit the sale of cigarettes to carton sizes (i.e. 100 cigarettes in a box). I was told this would accomplish several things, including making it much more expensive to purchase cigarettes, lowering the marketing appeal of cigarettes for retailers as customers would not be coming into their stores as frequently to buy them. It would also make it more difficult for stores to display many different cigarette brands around checkout counters, as 20 cigarette pack sizes are small enough to allow companies to display several different brand and brand variants around checkout counters in retail stores. Of course, larger pack sizes could encourage some smokers to smoke more cigarettes, which would be bad. However, I am inclined to believe that a standardized pack size of 100 cigarettes or greater would be more of a detriment to the cigarette industry than a benefit. If the goal of a standard pack size is to discourage smoking, I think public health authorities ought to seriously consider a much larger minimum package size than the current minimum standard of 20 cigarettes per package. Government regulators should not let cigarette companies define the optimum package sizes, as their financial motives are not in line with the goals of public health. In the end, I suspect the answer to the question to ‘what's in a number’ may turn out to be more important to tobacco control than we might once have appreciated. K.M.C. has received payment as a consultant to Pfizer, Inc. for service on an external advisory panel to assess ways to improve smoking cessation delivery in health-care settings. K.M.C. also has served as paid expert witness in litigation filed against the tobacco industry. K.M.C. receives funding support from grants from the US National Cancer Institute (P01 CA200512, P30 CA138313).