Time Of Data Collection Research Articles

Real-World Use of Tafasitamab (tafa) for Relapsed or Refractory (R/R) Diffuse Large B-Cell Lymphoma (DLBCL) Among Racial and Ethnic Minorities in the United States

Introduction: Tafa, a CD19-targeting immunotherapy, received accelerated approval by the FDA in combination with lenalidomide (len) for the treatment of patients with R/R DLBCL ineligible for autologous stem cell transplantation. In a recent real-world study (RWS) of tafa for R/R DLBCL, nearly one-third of patients were from typically underrepresented racial groups (abstract submitted to ASH 2023). Research has shown that patient characteristics, risk factors, and outcomes for DLBCL can differ by race and ethnicity (Li Y, et al. Cancer Epidemiol. 2015;39:8-13; Ermann D et al. J Clin Oncol. 2022;40(suppl):7507). The purpose of this analysis is to understand the patient characteristics, treatment patterns, and outcomes observed in the tafa RWS by race and ethnicity. Methods: This was a retrospective cohort study in which participating physicians from Cardinal Health's Oncology Provider Extended Network abstracted data from eligible patients' medical records into electronic case report forms. Eligible patients were ≥18 years of age who initiated tafa for R/R DLBCL on or after Oct 21, 2020. Included patients had ≥4 months of follow-up unless the patient died during this period. Use of tafa in combination with len was not a requirement for study eligibility. Patients who received tafa as part of a clinical trial were excluded. Results were summarized by race (White, Black/African American, “Other”) and ethnicity (Non-Hispanic, Hispanic) using descriptive statistics. The “Other” racial category included patients with mixed race or a race other than White, Black/African American, or Unknown. The Kaplan-Meier method was used to measure time to tafa discontinuation. Due to limited follow-up and small sample size, effectiveness outcomes for subgroups smaller than 20 patients are not presented. Results: A total of 181 patients who initiated tafa for R/R DLBCL were included in this analysis. Table 1 shows patient characteristics, treatment patterns, and outcomes by racial and ethnic groups. The racial composition of the study population was 64% White, 22% Black/African American, 8% “Other,” and 6% Unknown (Unknown not displayed in Table), and ethnic composition was 82% non-Hispanic, 17% Hispanic, and 1% Unknown (Unknown not displayed in Table). Most physicians who participated in this study were from community oncology practices (83%). The median follow-up time from tafa initiation to data collection among all patients was 6.5 (interquartile range [IQR], 5.0-8.6) months. The majority of patients (96%) received tafa in combination with len. At the time of data collection, 144 patients (80%) were alive, among whom 121 (84%) were still receiving tafa. The median age at which tafa was initiated ranged from 70 to 72 years for all racial and ethnic groups. Among the racial groups, the White cohort had the highest percentage of patients with an ECOG PS ≥2 (53%) and Ann Arbor Stage IV (68%) at time of tafa initiation. Among the racial categories, the median time (IQR) from initial DLBCL diagnosis to initiation of tafa was longest in Black/African Americans (23.3 [12.6-34.8] months) and shortest in the “Other” group (18.0 [15.0-21.4] months). In non-Hispanics and Hispanics, the median (IQR) duration from initial DLBCL diagnosis to tafa initiation was 20.0 (12.4-35.0) and 19.0 (14.0-34.0) months, respectively ( Table 1). Among patients who had disease response data, the real-world overall response rate (95% CI) was 75.0% (66.8-83.2) and 77.5% (64.6-90.4) for the White and Black/African American cohorts, and 74.5% (67.3-81.7) and 80.8% (65.7-95.9) for non-Hispanic and Hispanic groups, respectively ( Figure 1). Conclusions: The diverse population in this RWS is reflective of the heterogeneous patient population with R/R DLBCL treated primarily at community oncology centers in the United States. In addition, the study results support the clinical benefit of tafa across racial and ethnic groups. The majority of patients were still receiving tafa at data cutoff and follow-up was limited in duration; the median follow-up time in this study was shorter than the median time to complete response observed in L-MIND (NCT02399085; Duell J, et al. Haematologica. 2021;106:2417-2426), the pivotal phase 2 trial that contributed to the accelerated FDA approval of tafa for R/R DLBCL. A longer follow-up is required to better assess long-term outcomes of tafa treatment for R/R DLBCL among racial and ethnic patient groups.

Predictors of Diagnostic Delays and Loss to Follow-up in Women with Von Willebrand Disease

Background: Diagnostic and treatment delays in von Willebrand disease (vWD) disproportionately affect women. Such delays may lead to poor health outcomes from preventable bleeding complications related to menstruation, childbirth, and surgeries. They may also result in increased health resource utilization, including increased emergency department (ED) visits, transfusions, and surgical interventions. Patient and disease-related factors associated with diagnostic delays and loss to follow-up have been poorly documented, but are important to examine particularly in relation to gynecological outcomes. Aims: 1) To examine the prevalence and predictors of diagnostic delays and loss to follow-up in women with vWD. 2) To assess the impact of diagnostic delays on rates of ED visits, red cell transfusions, and hysterectomies. Methods: This retrospective cohort study included women ≥18 years with a diagnosis of vWD followed by the Northern Alberta Bleeding Disorders Program. Diagnostic delay was determined from the time of first documented bleeding event to the time of vWD diagnosis, with delayed diagnosis defined as >5 years. All bleeding events on the ISTH-BAT were included in the above definition, except for easy bruising due to its subjectivity and suboptimal documentation. Loss to follow-up was defined as ≥5 years since last hematology visit at the time of data collection. We collected the following patient and disease-related factors: age, rural status, year of diagnosis (pre-2000, 2000-2010, or 2011-2021), vWD type, baseline vWF activity, ISTH-BAT, family history of vWD, abnormal coagulation screen (INR/aPTT) prior to diagnosis, and status-post endometrial ablation or hysterectomy. Logistic regression was used to assess predictors of diagnostic delays and loss to follow-up. Research ethics approval was obtained. Results: We included 173 women: 140 (81%) type 1, 23 (13%) type 2, 5 (3%) type 3, and 5 (3%) platelet-type vWD. The median age of diagnosis was 27 years (IQR 18-38). The median time from first bleeding symptom to vWD diagnosis was 12.1 years (IQR 4.6-24.2), with 66 (38%) women presenting with ≥3 bleeding events prior to diagnosis. Further, 71 (41%) presented with ≥1 severe bleeding event (requiring ED visit, hospitalization, red cell transfusion, or surgical hemostasis) prior to diagnosis. Timing from first bleeding symptom to diagnosis was available in 154 (89%) women, of whom 113 (73%) experienced delayed diagnosis. Compared to women with delayed diagnosis, those diagnosed within 5 years of their first bleeding symptom were more likely to have a known family history of vWD (51% vs 26%, P=0.01) or have been diagnosed between 2000-2010 (56% vs 33%, P=0.002). Urban/rural residence, vWD type, baseline vWF activity, blood type, and abnormal coagulation screen were not significantly associated with diagnostic delays (Table 1). Of the 155 patients with available follow-up data, 44 (28%) were lost to follow-up for ≥5 years. Only rural residence (OR 1.8, 95% CI 0.9-5.3, P=0.07) trended towards higher odds of loss to follow-up. Age, year of diagnosis, vWD type, baseline vWF activity, ISTH-BAT, and prior hysterectomy/ablation status were not associated with loss to follow-up. Women with diagnostic delays had a significantly higher ISTH-BAT (median 7 vs 5, P=0.005). They also had significantly higher rates of hysterectomies for heavy menstrual bleeding (HMB; 20% vs 0%, P=0.0006), as well as a non-significant trend towards higher rates of dilatation and curettage (D&C; 12% vs 2%, P=0.11) and endometrial ablations (12% vs 5%, P=0.36) (Table 2). 17 women underwent surgical procedures for HMB (D&C, endometrial ablation, and/or hysterectomy) prior to their vWD diagnosis. Conclusion: Women with vWD often experience prolonged diagnostic delays. In our study, many women had bleeding symptoms for at least 5 years, and often greater than 10 years, prior to diagnosis. There was also a high rate of loss to follow-up, particularly in rural populations. Delayed diagnosis occurred even in women with a known family history of vWD and in women with severe bleeding events. Alarmingly, the rate of delayed diagnosis increased over time and was associated with higher rates of surgical interventions for HMB. For this reason, a high index of suspicion is paramount to ensure a prompt diagnosis of vWD, as this may prevent severe gynecological bleeding complications and their need for invasive surgical management.

1718. Effectiveness of 13-valent pneumococcal conjugate vaccine for prevention of invasive pneumococcal disease among children in the United States between 2010 and 2019: an indirect cohort study

Abstract Background The 13-valent pneumococcal conjugate vaccine (PCV13) was introduced for infant use in the United States in 2010, replacing PCV7. A U.S. case-control study (2010–2014) demonstrated vaccine effectiveness (VE) for ≥1 dose of PCV13 at 86%; however, this study lacked statistical power to examine VE by number of doses and against individual serotypes. Methods We used the indirect cohort method to estimate VE of PCV13 against vaccine-type invasive pneumococcal disease among children < 5 years in the U.S. from May 1, 2010 to December 31, 2019. We included IPD cases identified through CDC’s Active Bacterial Core surveillance in 10 U.S. states; during 2010 – 2014, we additionally included cases enrolled in a post-licensure matched case-control study from expanded sites. Cases and controls were defined as individuals with PCV13-type-IPD (VT-IPD) and non-PCV13-type-IPD (NVT), respectively; serotype 6C was categorized as VT. We used logistic regression to estimate the adjusted odds of prior PCV13 receipt, controlling for confounders identified a priori including age category, race/ethnicity, sex, state, year, and any immunocompromising and/or chronic conditions. Results A total of 1,161 IPD cases were identified; 223 (19.2%) were VT cases and 938 (80.8%) were non-VT controls. Of those, 108 cases (48.4%; 108/223) and 600 controls (64.0%; 600/938) had received >3 PCV13 doses; 47 cases (21.1%) and 53 controls (5.7%) had received no PCV doses. Serotypes 19A (N=96), 3 (N=60), and 19F (N=45) caused 90.1% (201/223) of VT-IPD. VE of >1 or ≥3 PCV13 doses against VT-IPD was 81.7% (95% Confidence Interval: 69.1–89.1%) and 87.8% (75.2–94.0%), respectively. VE of ≥3 PCV13 doses was 87.0% (75.8–93.0%), 54.6% (-8.8–81.0%), and 92.9% (74.4–98.0%) against serotypes 19A, 3, and 19F, respectively. VE was 87.6% (67.9-95.2%) for three primary doses before 12 months of age and 92.4% (78.2–97.2%) for three primary doses and a booster at 12 months of age or older. Vaccine effectiveness estimates against PCV13-type IPD among US children under five years of age, 2010 - 2019 Conclusion VE of ≥1 PCV13 dose against IPD was consistent with the previous estimate from the case-control study, and ≥3 doses appear to provide substantial protection. Among the most commonly circulating VT-IPD, PCV13 was protective against serotypes 19A and 19F IPD; protection against serotype 3 IPD did not reach statistical significance. Disclosures Lee Harrison, MD, GSK: Advisor/Consultant|Merck: Advisor/Consultant|Pfizer: Advisor/Consultant|Sanofi: Advisor/Consultant Tamara Pilishvili, PhD MPH, GSK: Employed by GSK since February 2023. At the time of data collection and analysis for this work was employed by the CDC

Frequency of Bullying Behavior, Sources and Coping Strategies among Student Nurses in Karachi, Pakistan

Background and objective: Bullying is being increasing day by day among health care professionals and specially nursing students (NS) are victimized due to their novelty in nursing profession. The objectives of this study were to find out frequencies of bullying behavior and its association with sources (perpetrators), and coping strategies among NS in Karachi, Pakistan.
 Methodology: This cross-sectional survey was conducted among NS and study setting was Dow (institute of Nursing and Midwifery) University of Health Sciences Karachi, Pakistan. Study duration was three months. Inclusion Criteria: NS who were bullied at least in the last 03 months. Exclusion criteria: unwilling participants and those who were absent at the time of data collection. Data was collected through an adapted questionnaire. The data was analyzed and entered into the SPSS version 26. Mean, standard deviations and percentages were used to analyze different forms, frequencies of bully behavior. A chi-square test was used to find the association of forms of bully behavior with sources(perpetrators), and coping strategies of bully.
 Result: Out of 300 NS, 64% of the NS were bullied repetitively at clinical duties and 45% were occasionally bullied at the nursing institute. Most frequent source of bully was seniors (57.0%) and a largely NS (51.7%) using coping strategy by overlooking bully which is significantly (p-value <0.05 ) associated with types of bully behavior.
 Conclusion: Present study highlighted that NS were experienced various forms of bully and mainly were bullied by seniors at clinicals and mostly they have overlooked bully incidence.

Forecasting building plug load electricity consumption employing occupant-building interaction input features and bidirectional LSTM with improved swarm intelligent algorithms

Building energy consumption prediction is an essential foundation for energy supply-demand regulation. Among them, plug-load energy consumption in buildings accounts for approximately 12–50 % of the total energy consumption, making plug-load energy consumption prediction crucial. However, accurately predicting plug-load electricity consumption is challenging due to the influence of random human behaviors. This study presents a comprehensive plug-load electricity consumption prediction system. First, the conventional input system based on influence factors and the novel input system based on occupant behavior probability were proposed. Second, long short-term memory (LSTM) and its improvement (Bi-LSTM) are used as the fundamental algorithm. Finally, the whale algorithm (WO), a swarm intelligent algorithm, is utilized to improve the prediction accuracy. The results show that the prediction system proposed performs better with R increased by 0.70%–23.97 %, MAPE decreased by 5.33%–40.92 %, and CV-RMSE decreased by 1.10%–21.08 %, compared to the traditional prediction system. The combination of two input systems and four algorithms can accommodate different prediction accuracy requirements, data collection conditions, building functions, and time requirements.

The effect of COVID-19 containment measures on fresh food market vendors in Uganda

PurposeThe coronavirus disease (COVID-19) pandemic continues to impact economic systems, with devastating consequences on livelihoods. Anecdotal evidence has predicted the adverse effects of COVID-19 on the livelihood of food system actors. Uganda experienced two lockdowns in March 2020 and June 2021 with varying government containment measures. During the first lockdown, fresh food market vending was deemed essential to meet urban food demand, and was consequently exempted from a total shutdown despite the ban on public and private transport. Thus, this study sought to examine the effect of COVID-19 containment measures on fresh food market vending businesses in Uganda.Design/methodology/approachUsing primary data collected from fresh food market vendors, this study applied a pooled time-series estimation to examine the effect of the first lockdown COVID-19 containment measures on fresh food vendors' welfare.FindingsThe study revealed that COVID-19 had a significant negative impact on the income of fresh food vendors, with female vendors being the most affected. COVID-19 containment measures reduced the diversity of buyers, individual customers and the number of commodities traded in causing a greater impact on vendors' income.Research limitations/implicationsThe unavailability of data for vendors who did not return to the market at the time of data collection limits the scope of the study. Additionally, the absence of data for the second lockdown limited the analysis to only March 2020 lockdown period.Originality/valueThe empirical analysis highlights how vulnerabilities of different gender categories could be exacerbated by crises. The study provides empirical evidence of various market distortions caused by the COVID-19 pandemic and the disproportionate impact on women and men market vendors which calls for the need to integrate women's perspectives in future planning for market systems as well as advocating for gender-sensitive recovery responses.

Feasibility of Symptom monitoring WIth Feedback Trial (SWIFT) for adults on hemodialysis: a registry-based cluster randomized pilot trial

BackgroundPatients with kidney failure on hemodialysis (HD) experience considerable symptom burden and poor health-related quality of life (HRQoL). There is limited use of patient reported outcome measures (PROMs) in facility HD units to direct immediate care, with response rates in other studies between 36 to 70%. The aim of this pilot study was to evaluate feasibility of electronic PROMs (e-PROMs) in HD participants, with feedback 3-monthly to the participants’ treating team, for severe or worsening symptoms as identified by the Integrated Palliative Outcome Scale (IPOS-Renal), with linkage to the Australian and New Zealand Dialysis and Transplant (ANZDATA) registry, compared with usual care.MethodsThis is a registry-based cluster-randomized controlled pilot trial involving all adults receiving HD in 4 satellite units in Australia over a 6-month period. HD units were cluster randomized 1:1 to the control (HRQoL data collection only) or intervention arm (symptom monitoring with feedback to treating team every 3 months). Feasibility was assessed by participant response rate (percentage of eligible HD participants, including new incident participants, who completed the questionnaire at each time point); retention rate (percentage of participants who completed the baseline questionnaire and all subsequent measures); and completion time. HRQoL and symptom burden scores are described.ResultsThere were 226 unique participants who completed the e-PROMs (mean age 62 years, 69% males, 78% White-European, median dialysis vintage 1.62 years). At 6 months, response rate and retention rate for the intervention arm were 54% and 68%, respectively, and 89% and 97% in the control arm. Median time to complete IPOS-Renal was 6.6 min (5.3, 10.1) at 3 months, and when combined with the outcome measure (EQ-5D-5L), the median time was 9.4 min (6.9, 13.6) at 6 months.ConclusionsElectronic symptom monitoring among HD participants with feedback to clinicians is feasible. Variations in response and retention rates could be potentially explained by the lengthier questionnaire, and higher frequency of data collection time points for participants in the intervention arm. A definitive national RCT is underway.Trial registrationACTRN12618001976279 (07/12/2018).

Brain-Inspired Spatio-Temporal Associative Memories for Neuroimaging Data Classification: EEG and fMRI.

Humans learn from a lot of information sources to make decisions. Once this information is learned in the brain, spatio-temporal associations are made, connecting all these sources (variables) in space and time represented as brain connectivity. In reality, to make a decision, we usually have only part of the information, either as a limited number of variables, limited time to make the decision, or both. The brain functions as a spatio-temporal associative memory. Inspired by the ability of the human brain, a brain-inspired spatio-temporal associative memory was proposed earlier that utilized the NeuCube brain-inspired spiking neural network framework. Here we applied the STAM framework to develop STAM for neuroimaging data, on the cases of EEG and fMRI, resulting in STAM-EEG and STAM-fMRI. This paper showed that once a NeuCube STAM classification model was trained on a complete spatio-temporal EEG or fMRI data, it could be recalled using only part of the time series, or/and only part of the used variables. We evaluated both temporal and spatial association and generalization accuracy accordingly. This was a pilot study that opens the field for the development of classification systems on other neuroimaging data, such as longitudinal MRI data, trained on complete data but recalled on partial data. Future research includes STAM that will work on data, collected across different settings, in different labs and clinics, that may vary in terms of the variables and time of data collection, along with other parameters. The proposed STAM will be further investigated for early diagnosis and prognosis of brain conditions and for diagnostic/prognostic marker discovery.

Association of C-reactive protein with mortality in Covid-19 patients: a secondary analysis of a cohort study

Our study aimed to explore the association between serum C-reactive protein (CRP) and COVID‐19 mortality. This is a retrospective cohort study of all patients admitted to 4 hospitals within the Montefiore Health System between March 1 and April 16, 2020, with SARS-CoV-2 infection. All-cause mortality were collected in 7 May 2020. The mortality risk was estimated using Cox proportional hazards models. Of the 3545 patients with a median age of 63.7 years, 918 (25.9%) died within the time of cohort data collection after admission. When the CRP was < 15.6 mg/L, the mortality rate increased with an adjusted HR of 1.57 (95% CI 1.30–1.91, P < 0.0001) for every 10 mg/L increment in the CRP. When the CRP was ≥ 15.6 mg/L, the mortality rate increased with an adjusted HR of 1.11 (95% CI 0.99–1.24, P = 0.0819) for every 10 mg/L increment in the CRP. For patients with COVID‐19, the association between the CRP and the mortality risk was curve and had a saturation effect. When the CRP was small, the mortality rate increased significantly with the increase of CRP. When CRP > 15.6 mg/L, with the increase of CRP, the mortality rate increases relatively flat.

Understanding healthcare engagement for people who inject drugs.

People who inject drugs (PWID) are at an increased risk of multimorbid mental health and chronic diseases, which are frequently underdiagnosed and under-treated due to systemic barriers and ongoing substance use. Healthcare engagement is essential to address these conditions and prevent excess morbidity and mortality. The goal of this study was to understand how PWID engage in care for their chronic health conditions and substance use treatment given the known historic and pervasive barriers. We conducted 24 semistructured qualitative interviews informed by the Behavioral Model for Vulnerable Populations between July-September 2019. Participants were sampled across a range of comorbidities, including co-occurring mental health disorders. Thematic analysis was conducted to explore experiences of healthcare engagement for multimorbid chronic diseases, mental health, and treatment for substance use disorder. Mean age for participants was 58 years; 63% reported male sex and 83% reported Black race. Interviews yielded themes regarding healthcare access and wraparound services, positive patient-provider relationships, service integration for substance use treatment and mental health, healthcare needs alignment,medication of opioid use disorder stigma, and acceptance of healthcare. Taken together, participants described how these themes enabled healthcare engagement. Engagement in care is crucial to support health and recovery. Clinical implications include the importance of strengthening patient-provider relationships, encouraging integration of medical and mental health services, and counseling on substance use treatment options in a non- stigmatizing manner. Additionally, policy to reimburse wrap-around support for substance use recovery can improve care engagement and outcomes related to chronic diseases, mental health, and substance use among PWID. No Patient or Public Contribution: While we acknowledge and thank ALIVE participants for their time for data collection and sharing their perspectives, no ALIVE participants, other people who use drugs, and service users were involved in data collection, analysis or interpretation of data, or in preparation of the manuscript.

AHP P01 A Survey To Explore The Use Of Nutritional Outcome Measures In Clinical Practice By Dietitians In Oesophago-Gastric Cancer Care In The British Isles

Abstract Background Dietitians in clinical practice face the challenge of providing high quality care whilst demonstrating clinical effectiveness and continuous improvement. Assessing the effectiveness of dietetic intervention is vital in ensuring the provision of clinically effective dietetic services. Nutritional outcome measures are key in identifying the impact of dietetic interventions; enabling dietitians to objectively measure the effectiveness of their care as well as providing patients, other health care professionals and commissioners with data around the value of care provision. Currently there are no specific nutritional outcomes associated with oesophago-gastric cancer care in the UK. Methods A survey was disseminated through direct personal emails to 93 Dietitians known to be working in UGI, a list derived from NOGCA audit sites of 2021, with the aim of assessing the current use of nutritional outcome measures by Dietitians working in oesophago-gastric cancer acute care in the British Isles. Further promotion was directed through a UGI Dietitians Forum and through social media posts. A YouTube video was produced and distributed alongside the survey, with the aim of providing education around identifying nutritional outcomes. The video also aimed to connect personally with people, with a visual presentation from the researcher. Results 54 responses represented the entire patient journey. Whilst 72% of respondents reported identifying and documenting dietetic outcomes, the quality of these assessments was low, mainly focusing on weight, weight changes and hand grip strength. Other common themes related to nutritional intake, quality of life and symptom impact. Less common outcomes measured included standardised nutritional assessment (PG-SGA), gastro-intestinal symptom evaluation, optimised prehabilitation, biochemical parameters and patient experience. There was little standardisation in how outcomes are used and when they were taken. There is no national database available to collate OG nutritional outcome data, representing a missed opportunity to support national benchmarking. Conclusions This study has presented not only the inconsistencies in nutritional outcome data collection (definition, timing and tools) and the need for standardisation of outcomes use in this speciality, it has also demonstrated the challenges around the promotion of outcomes measures and application/roll out into clinical practice. Novel ways of obtaining and evaluating nutritional outcomes will need to be considered. This will form the basis of a further research study, exploring barriers to completion of nutritional outcomes.

Patients' satisfaction with the quality of care upon implementation of electronic health records system at the 37 Military Hospital, Ghana.

Background: To resolve delays faced by patients when accessing health services, the electronic health records system (EHRs) was introduced as part of the health management information system (HMIS) to enhance the quality of care. Objective: This study assessed patients' satisfaction with the quality of care upon the implementation of the electronic health records system at the 37 Military Hospital in Ghana. Methods: The study adopted a cross-sectional study design using a quantitative method. A simple random sampling method was applied to recruit 228 outpatients who were seeking healthcare at the time of data collection to respond to a structured questionnaire. A Chi-square test and logistic regression analysis were used to assess the association between the dependent variable and independent variables. A p-value of 0.05 at a 95% confidence interval was used as the threshold for statistical significance. Results: The results showed a high quality of care with respect to attention to patients' needs (M=3.68, SD=0.525), the responsiveness of health providers to emergencies (M=3.81, SD=0.651), the efficiency of services rendered (M=3.78, SD=0.576), timeliness of healthcare (M=3.78, SD=0.576), patient-provider communication (M=3.42, SD=0.683) and general patients' care (M=3.86, SD=0.528). Similarly, the results showed high patient satisfaction in relation to waiting time for services (M=4.32, SD=0.93), adequacy of attention from health providers (M=3.29, SD=0.98), health provider-patient relationship (M=3.63, SD=1.05) and level of service provision after the implementation of EHRs (M=3.89, SD=0.95). Efficiency of services rendered (OR=0.36, 95% CI; 0.276, 0.653, p &lt; 0.05), timeliness of healthcare (OR=0.42, 95% CI; 0.153, 0.693, p &lt; 0.05),and general patients' care (OR=0.43, 95% CI; 0.023, 0.678, p &lt; 0.05) were strong predictors of patients' satisfaction. Conclusion: The study demonstrated patients' overall satisfaction with the operation of electronic health records systems. The study recommends that the management of the 37 Military Hospital should continuously improve the quality of care of the health services to ensure sustained patient satisfaction

Social acceptance of photovoltaic systems in heritage buildings and landscapes: Exploring barriers, benefits, drivers, and challenges for technical stakeholders in northern Italy

This study investigates the factors influencing the social acceptance of photovoltaic (PV) systems in heritage contexts. It aims to identify barriers, potentials, drivers, and challenges for the widespread adoption of PV technology while considering heritage conservation, land preservation, energy production, and climate mitigation. The research focuses on Italian technical stakeholders in the construction sector, including Heritage and Public Authorities, designers, and energy consultants. The survey delves into their opinions and perceptions of PV technologies, emphasizing both building and urban integration, as well as landscape integration. Noteworthy aspects of this study include its originality in addressing PV integration on heritage buildings and landscapes, the specific targeting of technical groups, interdisciplinary collaboration, and the timing of data collection during the Covid-19 pandemic and pre-energy crisis period for potential comparisons. The study finds that in heritage contexts, the acceptance of PV systems is driven by economic and aesthetic benefits. Respondents value the enhancement of historical buildings and landscapes, as well as discreet PV integration. For historic buildings, benefits include reuse of old buildings, pleasure aesthetics of innovative PV, and cost reduction for energy use. For protected landscapes, benefits include security of abandoned areas, unobtrusive PV integration, and production of renewable energy. Cultural concerns, particularly the risk of impacting historical and natural identities, are the main barriers to acceptance. Lack of knowledge about PV technology is not a significant issue. These findings emphasize the need to address cultural and aesthetic considerations when promoting PV integration in heritage settings.

Cardiovascular Follow-up of Patients Treated for MIS-C.

To assess the prevalence of residual cardiovascular pathology by cardiac MRI (CMR), ambulatory rhythm monitoring, and cardiopulmonary exercise testing (CPET) in patients ∼6 months after multisystem inflammatory disease in children (MIS-C). Patients seen for MIS-C follow-up were referred for CMR, ambulatory rhythm monitoring, and CPET ∼6 months after illness. Patients were included if they had ≥1 follow-up study performed by the time of data collection. MIS-C was diagnosed on the basis of the Centers for Disease Control and Prevention criteria. Myocardial injury during acute illness was defined as serum Troponin-I level >0.05 ng/mL or diminished left ventricular systolic function on echocardiogram. Sixty-nine of 153 patients seen for MIS-C follow-up had ≥1 follow-up cardiac study between October 2020-June 2022. Thirty-seven (54%) had evidence of myocardial injury during acute illness. Of these, 12 of 26 (46%) had ≥1 abnormality on CMR, 4 of 33 (12%) had abnormal ambulatory rhythm monitor results, and 18 of 22 (82%) had reduced functional capacity on CPET. Of the 37 patients without apparent myocardial injury, 11 of 21 (52%) had ≥1 abnormality on CMR, 1 of 24 (4%) had an abnormal ambulatory rhythm monitor result, and 11 of 15 (73%) had reduced functional capacity on CPET. The prevalence of abnormal findings was not statistically significantly different between groups. The high prevalence of abnormal findings on follow-up cardiac studies and lack of significant difference between patients with and without apparent myocardial injury during hospitalization suggests that all patients treated for MIS-C warrant cardiology follow-up.

What adolescents see on Instagram: Content analysis of #intermittentfasting, #keto, and #lowcarb.

To describe popular diet content visible on #intermittentfasting, #keto, and #lowcarb on adolescent social media accounts. An adolescent Instagram profile captured 200 'top' images from three popular diet hashtags (#intermittentfasting, #keto, and #lowcarb) across two timepoints. Images were coded using a pre-determined ontology as food (core or discretionary; common foods/food groups), people (group, individual, before/after), or informative. Descriptive statistics were used to summarise these categories across hashtags. At the time of first data collection, there were 3.8 million #intermittentfasting, 19 million #keto, and 22 million #lowcarb posts on Instagram. At the second timepoint there were 4.3 million #intermittentfasting, 21.5 million #keto, and 24.3 million #lowcarb posts. Images tagged #intermittentfasting were categorised as 44% food, 39% people, 10% information; #keto were 64% food, 28% people, 5% information; and #lowcarb were 69% food, 14% people, 16% information. Food images mostly depicted animal proteins (58.6% of #intermittentfasting; 62.9% of #keto; and 40.1% of #lowcarb). Images of people were individual (44%) or before/after (39%); mostly female (77%), of white (53%) ethnicity. Across all posts, 12.5% were linked to a commercial product/program, and 2.3% provided nutrition information. Diet-related images visible when adolescents search #intermittentfasting, #keto, and #lowcarb on Instagram promote animal-based foods with or without vegetables. These diet hashtags on Instagram do not provide nutrition information and are not helpful for young people searching for diet information online.

Real-life after sacral nerve modulation implantation: Rate, reasons, and risk factors for mid-term follow-up discontinuation

To evaluate follow-up after implantation of a sacral nerve modulation implantable pulse generator (IPG) and to investigate the reasons and risk factors for follow-up discontinuation. All patients who underwent an IPG implantation to treat lower urinary tract symptoms between 2014-2019 within 6hospital centers located in the district of "Hauts-de-France" (France) were systematically called during the year 2020 for a standardized (tele)consultation. Patients were divided into 3 distinct profiles according to the regularity of their 5-year postoperative follow-up: "Regular follow-up", "Irregular follow-up" and "Lost to follow-up". The primary outcome was the change in the annual proportion of the 3 follow-up profiles over the 5 years following IPG implantation. As secondary outcomes we described the reasons reported for follow-up discontinuation and looked for risk factors associated with. Overall, 259 patients were included. At the time of data collection, after a mean follow-up of 28.4 (±19.8) months, 139 patients (53.7%) had a "Regular follow-up", 54 (20.8%) had an "Irregular follow-up" and 66 (25.5%) were "Lost to follow-up". The proportion of patients with a "Regular follow-up" decreased year by year, representing only 46.2% of patients at five-years. 175 patients (67.6%) underwent a standardized (tele)consultation. In multivariate analysis, only "lack of knowledge of the follow-up protocol" was statistically associated with follow-up discontinuation (OR=5.16; 95% CI [2.12-13.57]). The proportion of patients followed up after IPG implantation decreased steadily over the years, often related to a lack of therapeutic education.

Transitioning from junior to senior: a case study on elite judokas in South Korea.

This study explores the experiences of Korean elite judokas during their junior to senior transition (JST), including both male and female participants, to provide empirical evidence for the development of tailored support services or programs for this target population. We recruited 12 elite judokas for our study, comprising eight males and four females, all in their first year of university. Given their preferences and availability at the time of data collection, participants were divided into three focus groups: Focus Group 1 (FG1; four male participants), Focus Group 2 (FG2; four female participants), and Focus Group 3 (FG3; four male participants). Thematic analysis was applied to analyze the data from the focus group interviews. Five main themes were identified: (a) COVID-19-Induced Frustration, (b) From Big Fish in a Small Pond to Small Fish in a Big Pond, (c) Challenges in Academic Commitment, (d) Adapting to Transitions in Living Arrangements, and (e) Recognizing Support Needs for the JST. The findings of this study provide both theoretical and practical implications that could improve judokas' experiences during the challenging physical and mental phase of JST, as well as inform the establishment of tailored support programs and schemes for successful and smooth JSTs for athletes.

Joint trajectory design and spectrum allocation for unmanned aerial vehicle task efficiency

AbstractIn unmanned aerial vehicle (UAV)‐assisted wireless sensor networks (WSNs), UAVs are employed to collect sensing data from each sensor node (SN). Because of limited battery capacity, shortening the time of data collection by the UAV is necessary. Notably, the task completion time is related to UAV trajectory and spectrum allocation. In this paper, joint trajectory design and spectrum allocation is studied to minimize the task completion time of UAVs while ensuring the target upload data amount for each SN. The cases that all SNs are located within the communication range of a UAV is explored first; the formulated problem is non‐convex and difficult to solve directly. Hence, an iterative algorithm based on block coordinate descent and successive convex approximation is proposed to decompose and transformed the original problem into two convex optimizations. Furthermore, the proposed algorithm is applied to the general case that all SNs are widely distributed by leveraging the spiral algorithm and traveling salesman problem technique. Simulation results show that the proposed algorithm can effectively reduce the task time of UAV compared to other benchmark algorithms.

Advancing social procurement: an institutional work perspective

PurposeThe adoption of social procurement, the emerging practice of using a firm's spending power to generate social value, requires buying firms to navigate conflicts of institutional logics. Adopting an institutional work perspective, this study aims to investigate how buying firms change their existing procurement institutions to adopt and advance social procurement.Design/methodology/approachThe authors conducted an in-depth case study of a social procurement initiative in the UK. This case study comprised of 16 buying firms that were actively participating in the social procurement initiative at the time of data collection (2020–2021). The data were largely captured through a set of 41 semi-structured interviews.FindingsFour types of institutional work were observed: reducing institutional conflicts, crossing institutional boundaries, legitimising institutional change and spreading the new institutional logic. These different types of institutional work appeared in a sequential way.Originality/valueThis study contributes to various strands of literature investigating the role of procurement in generating value and benefits within societies, adopting an institutional lens to investigate the buying firms' purposeful actions to change procurement institutions. Secondly, this study complements the existing literature investigating the conflicts of institutional logics by illustrating the ways firms address such institutional conflicts when adopting and advancing social procurement. Finally, this work contributes to the recently emerging research on institutional work that examines the creation and establishment of new institutions by considering the existing procurement institutions in the examination of institutional work.

PSVII-2 The Impact of Genomic Information Inclusion on Breeding Value Prediction for a Novel Parasite Resistance Indicator Trait in Brazilian Anglo-Nubian Goats: a Pilot Study

Abstract Infection by Haemonchus contortus is the gastrointestinal parasitosis of greatest economic and social importance in the production of goats, being the leading cause of mortality in the Brazilian goat industry. Genetic selection for resistance to parasites in Anglo-Nubian goats has proven to be a viable alternative to traditional methods of controlling gastrointestinal nematodes, producing animals genetically superior in resistance to parasites. This study aimed to evaluate the impact of including genomic information on the estimation of variance components, genetic parameters, and predictive accuracy of genetic values for the new trait Parasitic Resistance (PR) in Anglo-Nubian goats. The PR is generated by measuring Body Condition Score, FAMACHA chart (ranging from 1 to 5), and Fecal Egg Count on a regular scale. These three traits were used as input variables in the CAPRIOVI software, which uses fuzzy logic to create the PR score, ranging from 0 to 10. Animals with lower scores are more likely to be parasitized and require treatment, while animals with higher scores are less likely to be infected. We used information from 352 animals, totaling 3,855 repeated measurements of PR over the years (2001 to 2020) and 1,500 animals in the pedigree. Animals with less than three measurements for any of the three input traits were removed from the dataset. Contemporary groups were built from information from the year of birth, data collection season, birth season, and physiological stage of the animal, considered as fixed effects, and age at the time of data collection as a covariate in an animal repeatability model. A total of 89 animals were genotyped using the Bead Chip Goats SNP50. After quality control, the remaining 38,659 SNPs (Table 1) were used to build the hybrid matrix (H). The variance components (VC) were estimated using the Bayesian Gibbs Sampling method, and breeding values were predicted using the Best Linear Unbiased Prediction (BLUP) and single-step Best Linear Unbiased Prediction (ssGBLUP) methods. The additive genetic variance and heritability estimation ranged from 0.13 to 0.14 and 0.04 to 0.05, respectively (Table 2). The accuracies obtained for PR with BLUP and ssGBLUP were 0.12 and 0.14, respectively, representing a gain of 16.7%. The genomic information (25 % of all animals with phenotypes) with the repeated records improved the predictive model capability based on accuracy. It also improved the VC estimation for PR in Anglo-Nubian goats raised in the Brazilian semi-arid region. These results highlight the positive impact of genetic evaluation of goats for PR, even with few phenotypes and genotyped animals. In addition to elucidating the additive genetic influence of parasite resistance, it can be a great source of information on the selection and production of Anglo-Nubian goats.