Switching Criteria Research Articles

Effects of a Triage Checklist to Optimize Insomnia Treatment Outcomes and Reduce Hypnotic Use: The RESTING Study.

Evaluate a triaged stepped-care strategy among adults 50 and older with insomnia disorder. Participants (N=245) were classified at baseline by a Triage-Checklist. Those projected to do better if they start treatment with therapist versus digitally delivered CBT-I (tCBT-I versus dCBT-I) constituted the YES stratum (n=137); the rest constituted the NO stratum (n=108). Participants were randomized within stratum to a strategy that utilized only dCBT-I (ONLN) or to a strategy that prospectively allocated the first step of care to dCBT-I or tCBT-I based on the Triage-Checklist and switched dCBT-I non-responders at 2-months to tCBT-I (STEP). Co-primary outcomes were the insomnia severity index (ISI) and the average nightly amount of prescription hypnotic medications used (MEDS), assessed at 2,4,6,9, and 12 months post-randomization. Mixed effects models revealed that, compared to ONLN, participants in STEP had greater reductions in ISI (p=0.001; η2=0.01) and MEDS (p=0.019, η2=0.01). Within the YES stratum, compared to ONLN, those in STEP had greater reductions in ISI (p=0.0001, η2=0.023) and MEDS (p=0.018, η2=0.01). Within the ONLN arm, compared to the YES stratum, those in the NO stratum had greater reductions in ISI (p=0.015, η2=0.01) but not in MEDS. Results did not change with treatment-dose covariate adjustment. Triaged-stepped care can help guide allocation of limited CBT-I treatment resources to promote effective and safe treatment of chronic insomnia among middle age and older adults. Further refinement of the Triage-Checklist and optimization of the timing and switching criteria may improve the balance between effectiveness and use of resources.

The multi-stage adding strategy on Kriging and applied to cavitation optimization of centrifugal impeller

In order to realize the intelligent optimization design of cavitation performance of fuel centrifugal pump, a multi-stage active learning adding strategy based on Kriging is proposed. The focus is to establish the three-stage adding strategy by using MSE, EI and CV, and clarify the switching criteria for each stage. Based on the test functions such as one-dimensional function and multi-dimensional function, it is compared with the single-stage adding strategy to verify the effectiveness of the proposed strategy. Furthermore, for a certain type of fuel centrifugal pump, the optimization application of the proposed strategy in its cavitation characteristics is completed. The result of the test function calculation shows that the proposed strategy takes slightly longer to achieve the same accuracy than MSE, which is better than EI and CV. However, compared with MSE, the local accuracy of the global optimal solution is higher. The result of centrifugal pump case shows that the pressure loss at the inlet of the optimized pump decreases, the local flow such as return flow and vortex at the inlet is weakened, the pressure gradient and the vortex flow in the volute weakens. Moreover, the cavitation coefficient of the optimized pump is increased by 30.83%, the NPSH allowance is reduced by 9.14%, the cavitation ratio is reduced by 7.17%, and the gas content in the pump is reduced by 17.27%. Thus, the proposed method improves the cavitation performance of the centrifugal pump effectively.

The demand for male contraception: Estimating the potential market for users of novel male contraceptive methods using United States National Survey of Family Growth data

ObjectiveTo estimate the potential market for novel male contraceptives (NMCs) using United States National Survey of Family Growth (NSFG) data, 2015–2017. Study designWe described the market for NMCs via secondary analysis of the 2015–2017 NSFG’s weighted male respondent data, utilizing surrogate markers for contraceptive switching (NSFG) and contraceptive discontinuation data from the Contraceptive CHOICE project. Potential NMC users included men relying on: (1) no methods or less effective methods but who reported that they would be “very upset” if they got someone pregnant, (2) permanent methods but who reported that they might still want more children, (3) a female partner’s method that she might discontinue in the next year, (4) a male method even when his partner uses her own contraceptive. ResultsOf 3340 respondents—representing 55,890,830 sexually active, reproductive-age men—23.2% used no contraception at last intercourse, 15.8% condoms, 5.1% withdrawal, and 5.1% vasectomy. Among respondents relying solely on condoms, withdrawal, or no method, 19.7%, 3.8%, and 4.4% would be “very upset” if they got someone pregnant. For permanent contraceptive users, 17.3%−20.5% wanted another child. For men reliant on their partner’s long-acting reversible or combined hormonal contraceptive, 12–17% and 45–51% of partners might discontinue their method. These data conservatively suggest that 13% or more than 7 million men would potentially use NMCs, rising to 15.5 million with less restrictive contraceptive switching criteria. ConclusionAdjusting for pregnancy attitudes and likelihood of contraceptive switching, a substantial portion (between 7–15.5 million) of reproductive age men in the US are potential NMC users. ImplicationsThe population of potential novel male contraceptive users extends beyond just users of condoms, withdrawal and vasectomy and should include couples practicing dual-partner contraception and female partners using contraceptive methods that they may become dissatisfied with and discontinue.

Risk Factors for Meeting Criteria for Switching from Bevacizumab to Aflibercept When Treating Eyes with Diabetic Macular Edema and Visual Acuity of < 20/40

ObjectiveTo identify factors for meeting prespecified criteria for switching from bevacizumab to aflibercept in eyes with center-involved diabetic macular edema (CI-DME) and moderate vision loss initially treated with bevacizumab in DRCR Retina Network Protocol AC. DesignPost hoc analysis of data from a randomized clinical trial Participants270 participants with one or both eyes with CI-DME and visual acuity (VA) letter score of 69 to 24 (Snellen equivalent 20/50-20/320) MethodsEligible eyes were assigned to receive intravitreal aflibercept monotherapy (N=158) or bevacizumab followed by aflibercept if prespecified criteria for switching were met between 12 weeks and 2 years (N=154). Main Outcome MeasuresMeeting switching criteria: 1) at any time, 2) at 12 weeks, and 3) after 12 weeks. Associations between meeting the criteria for switching and factors measured at baseline and 12 weeks were evaluated in univariable analyses. Stepwise procedures were used to select variables for multivariable models. ResultsIn the bevacizumab first group, older participants had higher risk of meeting the switching criteria at any time, with a hazard ratio (HR) for a 10-year increase in age (95% confidence interval) of 1.32 (1.11 – 1.58). Male participants or eyes with worse baseline VA were more likely to switch at 12 weeks (HR for male vs. female = 4.84 [1.32 – 17.81]; HR for 5-letter lower baseline VA: 1.30 [1.03 – 1.63]). Worse 12-week CST (HR for 10-μm greater = 1.06 [1.04 – 1.07]) was associated with increased risk for switching after 12 weeks. The mean (SD) improvement after completing the switch to aflibercept was 3.7 (4.9) letters. ConclusionsThe identified factors can be used to refine expectations regarding the likelihood that an eye will meet protocol criteria to switch to aflibercept when treatment is initiated with bevacizumab. Older patients are more likely to be switched. At twelve weeks, thicker central subfield thickness was predictive of eyes most likely to be switched in the future.

Switching criteria analysis for a condenser moving boundary model

The switching moving boundary (SMB) scheme is widely used for numerical simulation of heat exchangers, especially in vapour compression refrigeration system. The method divides the heat exchanger into up to three zones (superheated vapour, two-phase fluid and subcooled liquid), depending on the operating conditions and treats each as a lumped-parameter system. During transients the number of zones may vary, and suitable switching criteria and related threshold values must be given, for this change to occur. Also, variables for the zones momentarily phased out need to be tracked, to allow smooth operation of the model. In this work, a switching moving boundary model of a brazed plate condenser in counter-flow arrangement is studied to obtain some useful guidelines for the selection of the optimal switching thresholds. It is shown that these values influence both the accuracy and the numerical robustness of the model; moreover an appropriate selection of these parameters may allow the usage of a fixed-step solver, which is more suitable for real-time simulations.

OP12 Adherence to Intravenous to Oral Switching Criteria in a Tertiary Governmental Hospital in Riyadh, Saudi Arabia

OP12 Adherence to Intravenous to Oral Switching Criteria in a Tertiary Governmental Hospital in Riyadh, Saudi Arabia

Switching Network Loss Minimization Through Multivariable Modulation in a Multiactive Bridge Converter

This paper presents a unified and generalized modeling, circuit analysis and power flow optimization techniques for a n-port multi-active bridge (MAB) dc-dc converter comprised of n active full bridges and a multi-winding transformer. The work aims at improving the efficiency of the MAB converter for a wide load and port voltage gain range by proposing an optimal phase-duty control variable-based modulation strategy. The loss optimization technique constitutes of two stages: firstly, both the switching and conduction loss objective functions are equivalently formulated by relating them to the transformer winding current peaks and RMSs that are synthesized by employing the proposed generalized harmonic approximation (GHA) based computational model; secondly, a multivariable multi-constrained optimization technique is adopted in order to minimize the converter power loss for wide load-gain range. Moreover, the universal zero-voltage switching (ZVS) criteria for any MAB port is also derived by proposing a port-equivalent converter model. A 600W quadruple active bridge (QAB) converter proof-of-concept is designed and tested to validate the theoretical analysis, claims, thus verifying the applicability of the generic MAB loss optimization technique for any converter candidate under the MAB family. With the implementation of proposed optimal phase-duty control, the experimental results show efficiency increment up to 17% at non-unity voltage gain and 10% loading condition, when compared to the conventional phase modulation technique.

Data-Mechanism Adaptive Switched Predictive Control for Heterogeneous Platoons With Wireless Communication Interruption

Benefiting from the advancement of intelligent transportation systems (ITSs), intelligent connected vehicles (ICVs) are ushering in a once-in-a-generation development opportunity. Considering the widespread presence of heterogeneous vehicles with disturbances and uncertain dynamics in actual platoon scenarios as well as the multimodel switching produced by unavoidable interruptions in the communication process, this paper proposes a data–mechanism adaptive switched predictive (DASP) control strategy. The characteristics of the mechanism model are mapped based on state data to more accurately describe the system’s dynamic characteristics and improve the interpretability of variables. The introduction of Givens rotations and switching criteria enables online adaptive switching of the controller. A robustness analysis of heterogeneous platoon switching control under bounded disturbance is presented, and sufficient conditions for <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$\mathcal{L}_{2}$</tex-math> </inline-formula> string stability are provided. Finally, CarSim simulations and real-time bench experiments are reported to demonstrate the effectiveness of the DASP algorithm for heterogeneous multivehicle regulation with communication interruptions.

A High‐Order Accurate Summation‐By‐Parts Finite Difference Method for Fully‐Dynamic Earthquake Sequence Simulations Within Sedimentary Basins

AbstractWe present an efficient numerical method for earthquake sequences in 2D antiplane shear that incorporates wave propagation. A vertical strike‐slip fault governed by rate‐and‐state friction is embedded in a heterogeneous elastic half‐space discretized using a high‐order accurate Summation‐by‐Parts finite difference method. Adaptive time‐stepping is applied during the interseismic periods; during coseismic rupture we apply a non‐stiff method, enabling a variety of explicit time stepping methods. We consider a shallow sedimentary basin and explore sensitivity to spatial resolution and the switching criteria used to transition between solvers. For sufficient grid resolution and switching thresholds, simulations results remain robust over long time scales. We explore the effects of full dynamics and basin depth and stiffness, making comparisons with quasi‐dynamic counterparts. Fully‐dynamic ruptures generate higher stresses, faster slip rates and rupture speeds, producing seismic scattering in the bulk. Because single‐event dynamic simulations penetrate further into sediments compared to the quasi‐dynamic simulations, we hypothesize that the incorporation of inertial effects would produce sequences of only surface‐rupturing events. However, we find that subbasin ruptures can still emerge with elastodynamics, for sufficiently compliant basins. We also find that full dynamics can increase the frequency of surface‐rupturing events, depending on basin depth and stiffness. These results suggest that an earthquake's potential to penetrate into shallow sediments should be viewed through the lens of the earthquake sequence, as it depends on basin properties and wave‐mediated effects, but also on self‐consistent initial conditions obtained from seismogenic cycling.

Canal switch: a possible complication of physical therapeutic manoeuvers for posterior canal benign paroxysmal positional vertigo.

To study the frequency of canal switch in posterior canal benign paroxysmal positional vertigo (BPPV) treated by canalith repositioning manoeuver (CRP), quick liberatory rotation manoeuver (QLR) or Semont manoeuver (SM). Retrospective study on 1158 patients, 637 women and 521 men suffering from geotropic posterior canal BPPV treated by CRP, QLR, or SM, retested after 15 minutes and about seven days. 1146 patients recovered from the acute phase; treatments failed in 12 patients treated with CRP. We observed 12 canal switches from posterior to lateral canal and 2 from posterior to anterior canal during or after CRP in 13/879 cases (1.5%) and after QLR in 1/158 (0.6%) with no significant difference between CRP vs SM and QLR. We did not consider slight positional downbeat nystagmus after the therapeutic manoeuvers as a sign of canal switch into the anterior canal, but as a sign of persistent small debris in the non-ampullar arm of the posterior canal. Canal switch is rare for any manoeuver and it does not belong to the criteria to choose one manoeuver over another. Notably, due to the canal switching criteria, SM and QLR cannot be preferred over those with a more prolonged extension of the neck.

Position-Based Multipath Route Switching Protocol for Intelligent VANETs Using Wiedemann Car-Following Model

The high dynamicity in VANET topology increases the possibility of frequently broken links and degraded the type of service provided to its customers (i.e., comfort and safety services) that may lead into a catastrophe. In this paper, a Quality-of-Service (QoS)-aware position-based multipath route switching protocol for VANETs-based intelligent transportation systems is proposed. The proposed protocol adopts one of three main route switching criteria: Least Connection Delay (LDD), least number of path-switching (LPS), and the least number of path-switching with the minimum delay (LPSMD). The proposed protocol finds multiple paths between the source and the destination and predicts the future connectivity of each path using the Wiedemann Car-Following Model (Wiedemann and Reiter-99). According to the requested QoS and the route switching criterion adopted, the route switching protocol dynamically switches between the pre-defined multiple paths such that the Network Performance Metrics (NPMs) are guaranteed for the entire VANET. Using different network parameters such as vehicular node density, vehicular node speed, and the time-period for collecting vehicle information, extensive simulation results show that the proposed LDD-based route switching protocol outperforms the other route switching criteria in guaranteeing the studied NPMs (i.e., 1) Packet delivery ratio with a 3.6% enhancement over LPSMD and 8.6% enhancement over LPS; 2) Average end-to-end total packet delay with a 4.2% enhancement over LPSMD and 3.4% enhancement over LPS).

Stability and bifurcation of a delayed prey-predator eco-epidemiological model with the impact of media

&lt;abstract&gt;&lt;p&gt;In this paper, a delayed prey-predator eco-epidemiological model with the nonlinear media is considered. First, the positivity and boundedness of solutions are given. Then, the basic reproductive number is showed, and the local stability of the trivial equilibrium and the disease-free equilibrium are discussed. Next, by taking the infection delay as a parameter, the conditions of the stability switches are given due to stability switching criteria, which concludes that the delay can generate instability and oscillation of the population through Hopf bifurcation. Further, by using normal form theory and center manifold theory, some explicit expressions determining direction of Hopf bifurcation and stability of periodic solutions are obtained. What's more, the correctness of the theoretical analysis is verified by numerical simulation, and the biological explanations are also given. Last, the main conclusions are included in the end.&lt;/p&gt;&lt;/abstract&gt;

805 FAILURE OF RYTHMIQ, AN ALGORITHM FAVOURING INTRINSIC CONDUCTION: WHEN IS TOO MUCH OF A GOOD THING?

Abstract An 80-year-old woman received a dual chamber pacemaker (Boston Scientific Accolade MRI DR) for pre-syncopal episodes associated with transient type 1 and 2:1 II degree atrioventricular block, recorded in 24-hour Holter monitoring. Due to residual AV conduction, pacemaker was set with RYTHMIQ algorithm, in order to reduce inappropriate ventricular pacing. A month later, the patient began to complain of severe asthenia and bradycardia (46-48 bpm). Telemetry-supported pacemaker control revealed III degree AV block with junctional escape rhythm, unmasking failing to switch of RYTHMIQ algorithm. Why did it happen? The RythmIQ algorithm has been designed to promote intrinsic conduction in Boston Scientific devices. With RythmIQ the device provides AAI(R)[i] at the lower rate limit and/or sensor indicated rate. It provides backup VVI pacing at a rate 15 bpm slower than the programmed lower rate limit, with backup VVI pacing rate limited to no slower than 30 bpm and no faster than 60 bpm. If 3 slow ventricular beats are detected in a window of 11 beats, the device automatically switches to DDD(R) mode. A slow beat is defined as a ventricular paced or ventricular sensed event that is at least 150 ms slower than the AAI(R) pacing rate. Slow ventricular beats are any of the following: - V paced event- V sensed event &amp;gt; AAI lower rate limit + 150 ms- V sensed event &amp;gt; AAI(R) sensor indicated rate + 150 ms In our case LRL was set at 50 bpm (1200 ms). During III degree AV block, patient's ventricular rate was always about 46-48 bpm, due to stable junctional escape rhythm. Thus no ventricular sensed event occurred with a V-V cycle greater than AAI lower rate limit + 150 ms, namely 1350 ms (around 44 bpm). Moreover the device didn't provide backup VVI pacing at a rate 15 bpm slower, namely 35 bpm. This two conditions impaired Rhythm IQ switching from AAI with VVI backup to DDD. The device was set manually in DDD with restoring of AV synchrony and adequate ventricular rate followed by complete resolution of symptoms. Rhythm-IQ algorithm doesn't check for AV synchrony, providing switch from AAI with VVI backup to DDD just in case of sudden and marked bradycardia. Loss of AV synchrony doesn't represent a switching criteria and moreover it is not recognized by the device. This condition could be dangerous failing to correct AV conduction disturbances in pacemaker recipient, especially if LRL was set ≤ 50 bpm. For this reason, adequate knowledge of the algorithm would indicate greater caution in using RythmIQ in certain categories of patients, such as the one in the case just described.

Design of gain-scheduling cascade control for a motion compensated gripper frame

The offshore wind market is growing, resulting in larger wind turbines being installed farther away from the coast and into deeper waters. This trend brings challenges to an industry strongly depending on the use of jack-up vessels. A floating vessel equipped with a Dynamic Positioning (DP) system and a Motion Compensated Gripper Frame (MCGF) provides a more efficient solution to guide XXL monopoles during the installation phase. According to strict regulations, the offset angle of monopiles shall not be over 0.25°. To ensure this, a robust control method is required to deal with gradual change in soil stifness, wave induced motions and sensor delays. The control force exerted by the gripper frame can significantly affect the floating vessel dynamics, hence, this should be optimized.Therefore, the research goal is to analyse the system and design a robustly stable control for the MCGF. In the context of this research, cascade PID control with gain-scheduling is chosen, which is able to control the Gripper Frame during all installation steps for different soil stiffness and to reject wave disturbances.With the use of the lumped multiplicative uncertainty structure, the changing and uncertain soil-characteristics are modelled. The sensor delay to measure the monopile inclination, has a significant impact on system stability. Robust stability criteria are validated using the Nyquist criterion and by analysing the system’s closed-loop poles. With the use of gain-scheduling it is possible to switch control settings during the installation. Time-domain results show that with this design approach the installation criteria are met such as the maximum monopile angle and the applied control force.Ultimately, it is shown that robust PID control with gain-scheduling for a MCGF can ensure safe, efficient and cost-effective installation of the next generation wind turbines. Future research should focus into the definition and implementation of the gain-scheduling switching criteria.

Viscoelastoplastic and incremental analysis of bridge with functional bearing

The functional bearing is one kind of the seismic isolation merging the advantages of the sliding system and the bearing system and it is widely used in Taiwan. To evaluate the performance of the functional bearing in a bridge effectively, a simple but accurate model is appreciated. The present paper attempts to model a bridge with functional bearing taking into account that the rate-dependent pier with hardening behavior. The proposed model is viscoelastoplastic and contains four phases including a viscoelastic-sticking, a viscoelastic-sliding, a viscoplastic-sticking, and a viscoplastic-sliding phase. The theoretical analysis in the state-space space enables us to obtain an exact solution for each phase. In order to simulate the exact behavior of the bridge system, the phase switching criteria with four conditions are derived and four computing modules for computations in four phases as well as four pull-back modules to direct toward to an exact module are developed. The four-phase model and the exact arrangement of computation qualitatively and quantitatively provide the exact duration of each phase and the proper indices for the plastic degradation of the pier as well as the consumption of the friction interface. One comparison between the simulation and the experimental result of a bridge’s shaking table test demonstrates the accuracy of the proposed model and its algorithm for the response of the bridge with functional bearing. Three numerical demonstrations show the performance of the proposed incremental analysis and the capability of the proposed model to distinguish the behavior of the bridge system under the near-fault and the far-fault earthquake. The duration of each of the four phases is accurately determined and the plastic degradation of the pier as well as the consumption of the friction interface are exactly evaluated. The difference of the behavior of the bridge system under the near-fault and the far-fault earthquake is qualitatively and quantitatively recognized.

Clinical Study on Early Extubation and Sequential Non-Invasive Respiratory Support for Children with Acute Respiratory Failure Receiving Invasive Mechanical Ventilation

To explore the treatment outcome of the strategy of early extubation and then switching to non-invasive mechanical ventilation in children with acute respiratory failure, and the safety and feasibility of using the strategy to replace traditional methods. A total of 102 children, aged between 1 month to 14 years old, who had acute respiratory failure and were admitted to the pediatric ICU of West China Second University Hospital, Sichuan University between January 2019 and December 2020 were enrolled and randomly assigned to treatment group 1 (n=55) and treatment group 2 (n=47). In addition, 53 children who had the same condition in the 12 month prior to the beginning of the study were included in the control group. In the two treatment groups, the patients were extubated first, and then weaned off the ventilator. In group 1, when the patient met the invasive-non-invasive switching criteria, the tracheal tube was pulled out and non-invasive bi-level positive airway pressure (BiPAP) ventilation was used for respiratory support. In group 2, high-flow nasal cannula (HFNC) oxygen therapy was used for respiratory support. The traditional progressive weaning method was adopted for the control group (extubing and weaning were performed at the same time). The incidence of ventilator-associated pneumonia (VAP) during the period of tracheal intubation was compared and the mortality of the two groups was evaluated from the point when the patients were recruited. At the time of extubation in the treatment groups and extubation plus weaning in the control group, the pressure support levels, or PC above PEEP, intubation time, sequential time (between 2 treatment groups only), weaning failure rate, and the incidence of laryngeal edema and nasal pressure ulcer were compared. The subjects of the study were predominantly infants (93 cases, 60%) and young children (31 cases, 20%). Among the 155 cases, 82 (53%) were male. There was no statistical difference in age distribution or gender among the groups. There was no significant difference in the clinical indicators among the three groups before tracheal intubation. At the time of extubation, the PC above PEEP in the two treatment groups was higher than that in the control group, and higher in group 1 than that of group 2, the difference being statistically significant (P<0.05). The intubation time of the two treatment groups was shorter than that of the control group, and shorter in group 1 than that of group 2 (P<0.05). The sequential time of group 2 was shorter than that of group 1 (P<0.05). The extubation failure rate and the incidence of VAP in the two treatment groups were lower than those in the control group, and there was no statistically significant difference between the two treatment groups. The incidence of nasal pressure ulcers in group 1 was higher than that in the other two groups (P<0.05). There was 1 death in treatment group 1, and no deaths in treatment group 2 or the control group. There was no significant difference in mortality or the incidence of laryngeal edema after extubation in the three groups. Early extubation and then switching to non-invasive mechanical ventilation can be well tolerated by the patients, and can be used in clinical practice as an effective weaning method for children with acute respiratory failure.

Real World Biologic Use and Switch Patterns in Severe Asthma: Data from the International Severe Asthma Registry and the US CHRONICLE Study.

IntroductionInternational registries provide opportunities to describe use of biologics for treating severe asthma in current clinical practice. Our aims were to describe real-life global patterns of biologic use (continuation, switches, and discontinuations) for severe asthma, elucidate reasons underlying these patterns, and examine associated patient-level factors.MethodsThis was a historical cohort study including adults with severe asthma enrolled into the International Severe Asthma Registry (ISAR; http://isaregistries.org, 2015–2020) or the CHRONICLE Study (2018–2020) and treated with a biologic. Eleven countries were included (Bulgaria, Canada, Denmark, Greece, Italy, Japan, Kuwait, South Korea, Spain, UK, and USA). Biologic utilization patterns were defined: 1) continuing initial biologic; 2) stopping biologic treatment; or 3) switching to another biologic. Reasons for discontinuation/switching were recorded and comparisons drawn between groups.ResultsA total of 3531 patients were included. Omalizumab was the most common initial biologic in 2015 (88.2%) and benralizumab in 2019 (29.6%). Most patients (79%; 2791/3531) continued their first biologic; 10.2% (356/3531) stopped; 10.8% (384/3531) switched. The most frequent first switch was from omalizumab to an anti–IL-5/5R (49.6%; 187/377). The most common subsequent switch was from one anti–IL-5/5R to another (44.4%; 20/45). Insufficient efficacy and/or adverse effects were the most frequent reasons for stopping/switching. Patients who stopped/switched were more likely to have a higher baseline blood eosinophil count and exacerbation rate, lower lung function, and greater health care resource utilization.ConclusionThe description of real-life patterns of continuing, stopping, or switching biologics enhances our understanding of global biologic use. Prospective studies involving structured switching criteria could ascertain optimal strategies to identify patients who may benefit from switching.

Optical density changes of subretinal hyperreflective material in age-related macular degeneration after switching therapy from ranibizumab to aflibercept.

BACKGROUND:Subretinal hyperreflective material (SHRM) is a hyperrefiective material seen on optical coherence tomography (OCT) and located under the retina and above the retinal pigment epithelium. This study aims to examine the effect of SHRM on the functional prognosis of age-related macular degeneration (AMD) patients who switched from intravitreal ranibizumab to intravitreal aflibercept treatment.MATERIALS AND METHODS:This is a retrospective, nonrandomized clinical study. AMD patients meeting the switching criteria underwent a complete ophthalmic examination, including spectral-domain OCT and fundus fluorescein angiography. The best-corrected visual acuity and OCT parameters were measured at the switch and 3, 6, 12, and 24 months after. SHRM(+/−), maximum SHRM thickness, and subjective and objective reflectivity stages of SHRM (grades 1–3) were evaluated.RESULTS:SHRM was observed in 24/48 (50.0%) of eyes at the time of the switch. The differences in maximum SHRM thicknesses were not statistically significant. SHRM's mean subjective reflectivity stages at the switch and subsequent examinations were 2.37, 2.75, 2.75, 2.74, and 2.81; SHRM's objective reflectivity staging also confirmed them. Functional changes after the switch showed a significant VA loss in the SHRM(+) group and significant gain in the SHRM(−) group.CONCLUSION:This study showed that the presence of SHRM and higher optical reflectivity at the switch from ranibizumab to aflibercept caused a poor prognosis after the switch. On the other hand, SHRM(−) patients achieved good functional results after the switch.

Discontinuous dynamics of an asymmetric 2-DOF friction oscillator with elastic and rigid impacts

• An asymmetric 2 DOF oscillator with elastic and rigid impacts is investigated. • Negative feedback forces and nonlinear spring of cubic term are considered. • Switching conditions of motion at separation boundaries are explored. • Several typical motions are simulated numerically by MATLAB software. In this paper, by using flow switching theory of discontinuous dynamical systems , the discontinuous dynamic behavior of a 2-DOF (two-degree-of-freedom) friction oscillator with elastic impact and rigid impact on different sides is investigated. For the 2-DOF friction oscillator, when the direction of object’s velocity changes, the negative feedback works and the inequality of maximum static friction force and kinetic friction force leads to the existence of flow barriers. In addition, the elastic impact and rigid impact can change motion states of object, resulting in the discontinuity of this 2-DOF system. Considering the multiple motion states of object and better analyzing the equation of object’s motion, the phase space of each object is divided into different motion domains and boundaries in relative and absolute coordinates by means of the discontinuities resulted from the friction and impact. Moreover, because the elastic impact exists in a time period, there will be a variety of motion behaviors coexisting, such as elastic and rigid impacts occur simultaneously. With that in mind, in absolute coordinate system, the phase space of the system is divided in six cases according to whether there are stick motion and stuck motion. Based on flow switching theory, the switching conditions at discontinuous boundaries for all possible motions are given by using G-functions, and it should be noted that the vanishing conditions of the sliding motion become more complicated due to the existence of flow barriers at speed boundaries. Through defining the switching sets on separation boundaries, the mapping structures are further introduced to demonstrate the global dynamic behavior and periodic motions. For a better understanding of the object’s motion and the switching criteria at separation boundaries, the numerical simulation method is used to demonstrate several typical motions such as passable motion, sliding motion, grazing motion, stick motion (elastic impact), rigid impact and periodic motions etc. The results obtained have reference value for the optimization design and noise control of mechanical systems with gap couplings and negative feedbacks.

Tenofovir Alafenamide improves proximal tubular markers in CHB patients long-term treated with Tenofovir Disoproxil Fumarate: A real-life study based on the EASL switching criteria

Introduction: The effectiveness of switching TDF-treated CHB patients to TAF in a real-life setting is currently unknown.