Search

The medical needs of individuals with sickle cell disease (SCD) are complex. Patients with SCD experience complications such as recurrent pain episodes and increased hospitalizations. Over 70% of AYA and their parents seek medical information from the Internet; 83% inquire on sites that have interactive/social features, such as Facebook or Twitter, yet accuracy remains unclear. Our objective was to assess the accuracy of the SCD-information posted on social media. We hypothesized that most of the posted information is inaccurate. We coded one month of threads from two common SCD Facebook groups (Sickle Cell Warriors Unity and Sickle Cell Anemia) to identify the purpose of each post and the accuracy of medical information posted. Amongst both social media sites, there were 487 posts. Most of the posts were directed toward socializations (n = 311, 63.8%), while other posts mainly focused mainly on SCD and its management (n = 173, 35.5%). When looking at the medical posts, 44.9% were accurate, whereas 55.1% of the posts included inaccurate information. We found that less than half of the medical information posted on interactive social media is inaccurate. Our findings raise potentially serious implications for individuals with SCD and/or their caregivers who may rely on social media to gather more information about their or their child's disease. Our data highlight the importance of health care providers encouraging patients and parents to ask any questions they may have about SCD, given they may consult social media and Internet site that provide inaccurate information. [ABSTRACT FROM AUTHOR]

Sickle cell disease (SCD) state level surveillance data are limited. We performed a retrospective review of emergency department (ED) visits and hospitalizations from individuals with SCD in Illinois (2016–2020) using the Illinois Health and Hospital Association's Comparative Health Care and Hospital Data Reporting Services. There were 48,094 outpatient ED visits and 31,686 hospitalizations. Most visits (67%) occurred in Cook County, were covered by public insurance (77%) and were from individuals with medium high (40.3%) or high (36.1%) poverty levels. SCD healthcare utilization remains high and surveillance data may inform SCD program development and resource allocation at the state level. Abbreviations CDC Centers for Disease Control and Prevention ED Emergency Department FDA Food & Drug Administration ICD International Classification of Diseases IL Illinois SCD Sickle cell disease [ABSTRACT FROM AUTHOR]

Sickle cell disease (SCD) results in severe complications, such as anaemia and pain episodes. Hydroxyurea (HU) is efficacious in SCD, yet adherence remains low. To assess the relationship of HU adherence to health care utilization and patients' characteristics. This is a 5-year retrospective chart review. Patients' demographics and medical history were collected from the electronic medical record (EMR). HU adherence was evaluated using foetal haemoglobin "HbF%", mean corpuscular volume "MCV", and absolute neutrophil count "ANC". Age groups included children (<12 years), adolescents (12–17 years), and young adults (≥18 years). A total of 113 SCD patients on HU were included (median age 14 years, IQR 10–20; 50% female; 88% HbSS). Young adults had significantly higher HU adherence compared to adolescents and children, including higher median HbF% (24.2 vs. 12.4 vs. 8.6, p =.003), MCV (fl) (106.4 vs. 96.2 vs. 95.4, p =.01) and lower ANC (103/ml) (3.25 vs. 4.9 vs. 4.2, p =.01), respectively. Patients with chronic pain had lower HU adherence (HbF% 15.3 vs. 10.7, p =.04; ANC 3.6 vs. 6.3, p =.002; MCV 102.3 vs. 93.1, p =.1). Patients with higher HbF or MCV and lower ANC had significantly less frequent emergency room visits (rs=–0.26, p =.01; rs=–0.23, p =.01; rs=0.24, p =.01) and hospitalizations (rs=–0.27, p =.01; rs=–0.31, p =.01; rs=0.21, p =.02) as well as shorter length of stays (rs=–0.27, p =.0045; rs=–.34, p = 0.004; rs=0.23, p =.02), respectively. Similar trends in HU adherence and health care utilization were seen in subgroup analysis of only HbSS patients. There was no significant association of HU adherence to patients' sex, socio-economic status, distance from hospital, and HU duration. Young adults with SCD had significantly higher HU adherence compared to children and adolescents. Patients with lower HU adherence and/or chronic pain had increased health care utilization. Future studies examining barriers to adherence and evaluating interventions to optimize HU adherence in SCD are warranted. Young adults with SCD had significantly higher HU adherence, as reflected in their laboratory markers, compared to children and adolescents. Patients with higher HU adherence and/or those without chronic pain had lower or less frequent health care utilization. No significant association of HU adherence to patients' sex, socio-economic status and distance from hospital. [ABSTRACT FROM AUTHOR]

Iron chelation therapy (ICT) is essential to prevent complications of iron overload in patients with transfusion-dependent thalassaemia. However, there is currently no standard for how to best measure adherence to ICT, nor what level of adherence necessitates concern for poor outcomes, especially in paediatric patients. The objectives of this review are to identify rates of adherence to ICT, predictors of adherence, methods of measurement, and adherence-related health outcomes in children and adolescents. This review covers the literature published between 1980 and 2020 on ICT in thalassaemia that assessed adherence or compliance. Included studies reflect original research. The preferred reporting items of systematic reviews and meta-analyses (PRISMA) guidelines were followed for reporting results, and the findings were critically appraised with the Oxford Centre for Evidence-based Medicine criteria. Of the 543 articles, 37 met the inclusion criteria. The most common methods of assessing adherence included patient self-report (n = 15/36, 41.7%), and pill count (n = 15/36, 41.7%), followed by subcutaneous medication monitoring (5/36, 13.8%) and prescription refills (n = 4/36, 11.1%). Study sizes ranged from 7 to 1115 participants. Studies reported adherence either in "categories" with different levels of adherence (n = 29) or "quantitatively" as a percentage of medication taken out of those prescribed (n = 7). Quantitatively, the percentage of adherence varied from 57% to 98.4% with a median of 89.5%. Five studies focussed on interventions, four of which were designed to improve adherence. Studies varied in sample size and methods of assessment, which prohibited performing a meta-analysis. Due to a lack of clinical consensus on how adherence is defined, it is difficult to compare adherence to ICT in different studies. Future studies should be aimed at creating guidelines for assessing adherence and identifying suboptimal adherence. These future efforts will be crucial in informing evidence-based interventions to improve adherence and health outcomes in thalassaemia patients. Predictive factors associated with ICT adherence in the paediatric population include age, social perception of ICT, social support, and side effects/discomfort. Increased adherence in the paediatric population is associated with decreased serum ferritin and improved cardiac, hepatic, and endocrine outcomes. Inadequate adherence to ICT is associated with increased lifetime health costs. There are few studies that focussed on interventions to increase adherence in the paediatric population, and the studies that do exist all focussed on different types of interventions; successful interventions focussed on consistent, long-term engagement with patients. [ABSTRACT FROM AUTHOR]

This paper represents the results of a comprehensive experimental work on developing high performance concrete mixes containing different percentages of electric arc furnace steel slag (EAFSS) coarse aggregate (0, 25, 50, 75, and 100% by weight) for sustainable pavements. The use of steel slag powder (SSP) and silica fume (SF) as a mineral filler was also investigated. Mechanical properties of concrete such as compressive, splitting tensile and flexural strengths, modulus of elasticity, permeability, and thermal conductivity, were measured in the laboratory. The morphological and microstructural properties of the investigated steel slag were also determined. Finally, the field performance of the investigated concrete mixes was predicted using the AASHTOWare Pavement ME for a typical Jointed Plain Concrete Pavement (JPCP) system in terms of transverse cracking, faulting, and roughness. The results of this research indicate that, all investigated mechanical properties for steel slag mixes are better than the natural aggregate mix with optimum mechanical properties and performance for the concrete mix with 50% EAFSS. Using the SSP powder with or instead of SF did not show significant improvement in mechanical properties/performance. The results emphasise that EAFSS is a viable sustainable construction material for rigid pavements. [ABSTRACT FROM AUTHOR]

This study presents a novel hybrid intelligent approach using Extreme Learning Machine (ELM) and Equilibrium Optimiser (EO) (ELM-EO) for predicting resilient modulus, Mr of Unbound Granular Materials (UGMs). Fourteen various blends of Recycled Concrete Aggregate (RCA) with Recycled Clay Masonry (RCM), and Electric Arc Furnace Steel (EAFS) slag with limestone aggregates were tested in the laboratory using routine and advanced tests. The laboratory Mr testing produced 224 measurements based on the average of triplicate samples for each blend. The performance of the ELM-EO approach was evaluated and compared with conventional regression, ELM-biogeography-based optimisation (BBO) (ELM-BBO) and ELM-genetic algorithm (ELM-GA) approaches using the same input properties. The inputs used for the Mr prediction are the bulk stress, percent of RCM, and/or percent of EAFS. The results demonstrate that the performance of ELM-EO and ELM-BBO approaches is better than ELM-GA and regression approaches for predicting Mr. The overall statistical measures of the proposed approaches show that the ELM-EO approach ranks first as it outperforms the other approaches with coefficient of determination (R2) of 0.924 and Root Mean Square Error (RMSE) of 37.08 MPa. [ABSTRACT FROM AUTHOR]

Iron chelation therapy (ICT) is essential to prevent complications of iron overload in patients with transfusion-dependent thalassemia. However, the role that adherence to ICT plays in health-related outcomes is less well known. Our objectives were to identify adherence rates of ICT, and to assess methods of measurement, predictors of adherence, and adherence-related health outcomes in the literature published between 1980 and 2020. Of 543 articles, 43 met the inclusion criteria. Studies measured ICT adherence, predictors, and/or outcomes associated with adherence. Most studies were across multiple countries in Europe and North America (n = 8/43, 18.6%), recruited in clinics (n = 39/43, 90.7%), and focused on β-thalassemia (β-thal) (n = 25/43, 58.1%). Common methods of assessing ICT adherence included patient self-report (n = 24/43, 55.8%), pill count (n = 9/43, 20.9%), prescription refill history (n = 3/43, 7.0%), provider scoring (n = 3/43, 7.0%), and combinations of methods (n = 4/43, 9.3%). Studies reported adherence either in 'categories' with different levels of adherence (n = 24) or 'quantitatively' as a percentage of doses of medication taken out of those prescribed (n = 17). Adherence levels varied (median 91.7%, range 42.0–99.97%). Studies varied in sample size and methods of adherence assessment and reporting, which prohibited meta-analysis. Due to a lack of consensus on how adherence is defined, it is difficult to compare ICT adherence reporting. Further research is needed to establish guidelines for assessing adherence and identifying suboptimal adherence. Behavioral digital interventions have the potential to optimize ICT adherence and health outcomes. [ABSTRACT FROM AUTHOR]

International Roughness Index (IRI) is a key parameter in pavement performance evaluation. This study investigates developing a reliable prediction model that can be used to estimate IRI of rigid pavements using innovative machine learning techniques. Optimally Pruned Extreme Learning Machine (OP-ELM) and Wavelet analysis are integrated to improve the OP-ELM results and design a novel hybrid Wavelet-OPELM (WOPELM) model for the IRI prediction. The proposed model is compared statistically to the OP-ELM and conventional feed-forward Artificial Neural Network (ANN) as well as regression model with respect to their efficiency to predict IRI of jointed plain concrete pavement (JPCP) sections in USA. The relevant data was collected from the Long-Term Pavement Performance (LTPP) database. Eight input variables, initial IRI, pavement age, transverse cracks, percent joints spalled, flexible and rigid patching areas, total joint faulting, freeze index, and percent subgrade passing No. 200 U.S. sieve, are assessed and used to predict the IRI. The results show that the initial IRI, total joint faulting, and freezing index are the most significant parameters for IRI prediction. The WOPELM is found to be a robust and more accurate modelling technique compared to OP-ELM, ANN, and regression for IRI prediction with only a 7% prediction error. [ABSTRACT FROM AUTHOR]

Infertility secondary to chemotherapy, myeloablative conditioning regimens prior to stem cell transplantation, radiation therapy, and/or surgery is an important cause of morbidity and psychosocial distress among pediatric cancer patients. Known options exist for fertility preservation; however, knowledge among providers varies. We conducted a pilot study with an educational intervention over one-hour for hematology-oncology faculty, fellows, and advanced practice providers. Participants completed pre-/post-test assessment on fertility preservation knowledge. Participants' pretest mean (SD) score was 53% (17%), which significantly increased to 72% (11%) in the post-test (p = 0.0004). We demonstrated that a fertility education intervention could improve knowledge regarding infertility risk assessment and fertility preservation options. [ABSTRACT FROM AUTHOR]

Currently, Egypt is using the [AASHTO, 1993. Guide for design of pavement structures. Washington, DC: American Association of State Highway and Transportation Officials] guide for the flexible pavement structural design. In this method the resilient modulus (MR) of the unbound granular base/subbase materials and subgrade soils is a measure of material stiffness used for characterisation. It is considered one of the major factors affecting the pavement layerthicknesses. However, in Egypt, California Bearing Ratio (CBR) is the main strength parameter used for characterisation of the unbound materials and subgrade soils due to its availability and simplicity. In this research, a comprehensive experimental testing programme was conducted on different unbound granular base/subbase materials typically used in pavement construction projects in Egypt. The testing programme includes MR, CBR, and basic material properties. The effect of aggregate gradation on MR is investigated. A model predicting MR as a function of the basic material properties is proposed. The MR–CBR relationship adopted in the current Egyptian Code of Practice is verified based on the testing results. The experimental data warranted the calibration of the current model. The calibrated model has reasonable goodness of fit statistics and yields rational MR estimates for the local materials. [ABSTRACT FROM AUTHOR]

Sickle cell disease (SCD) is a lifelong burdensome disorder of heterogenic expression. This study investigated the longer-term economic burden of severe presentation of SCD. As SCD treatment landscapes evolve toward curative intent gene therapies, understanding how SCD-associated costs may change over the patient lifetime will be important for medical decision-making. Patients with severe presentation of SCD (presence of acute vaso-occlusive events [VOEs] or history of stroke and/or other disease-related sequelae), were identified within the MarketScan Commercial and Medicare Supplemental and Multi-state Medicaid Databases from 1/1/2010 to 12/31/2018. The first SCD claim served as the index date and patients were followed over a 5-year post-period. Clinical characteristics and healthcare resource utilization and costs were assessed over follow-up for eligible cohorts of commercial and Medicaid patients with severe SCD presentation and age-based subgroups (<18, 18–30, and ≥31). A total of 4,487 patients, primarily insured via Medicaid (79.2%), qualified for the analysis. Patients evidenced persistent VOEs over follow-up; prevalence of most comorbidities increased with age. Mean total healthcare costs over the 5-year follow-up were $275,143 (SD± $406,770) and $362,728 (SD± $620,189) in the commercial and Medicaid samples, respectively. Disease severity, assessed by the number of VOEs and utilization of inpatient and emergency services, peaked in the 18–30 year group in both samples. These groups also evidenced the highest mean healthcare costs over the 5-year follow-up at $344,776 (SD± $434,521) and $671,321 (SD± $938,764) in the commercial and Medicaid samples respectively. Results indicate high clinical need and economic burden among patients with severe presentation of SCD. These findings not only highlight the need for improved therapeutic options to limit or prevent disease progression, but also start to provide insight on lifetime costs of SCD that will be needed in the evaluation of emerging curative intent therapies. [ABSTRACT FROM AUTHOR]

International Roughness Index (IRI) and Pavement Condition Index (PCI) are among other pavement condition indices used to assess pavement surface condition. The literature suggests that most of the pavement indices are related as a result of which several models have been developed to predict one index from the other. This study uses the Long-Term Pavement Performance (LTPP) database to develop a simplified regression model that links PCI with IRI. Measured pavement distresses from 1448 LTPP sections from the Specific Pavement Studies (SPS) and General Pavement Studies (GPS) representing 12744 data points were utilised for the PCI estimation. A total of 1208 sections with 10868 data points were used for model development while 240 sections with 1876 data points were used for the model validation. A sigmoid function is found to best express the relationship between PCI and IRI with a coefficient of determination (R2) of 0.995. The bias in the predicted IRI values is significantly very low. The model validation using a different dataset also yielded highly accurate predictions (R2 = 0.992). Finally, a pavement condition rating based on IRI is proposed. This system yields rating equivalent to the widely used PCI rating method which is based on the pavement condition. [ABSTRACT FROM AUTHOR]

Structural Number (SN) is a numerical value used as pavement structural capacity indicator. This paper reviews the most recognised historical SN prediction models. These models are COST, Schnoor and Horak, Kavussi et al., Rohde, and Kim et al. These models predict the structural number of existing flexible pavement systems (SNeff) based primarily on the Falling Weight Deflectometer (FWD) data. One major drawback of these models, is that they ignore the effect of temperature on the backcalculated modulus of the Asphalt Concrete (AC) layer and hence the predicted SNeff values. The accuracy of the investigated SNeff prediction models after applying temperature correction to the AC layer modulus (EAC) and the FWD peak deflection (Do) to a reference temperature of 21°C was examined. FWD data and backcalculated moduli of pavement layers were collected from the Long Term Pavement Performance (LTPP) database. Fourteen pavement test sections covering the four climatic regions in the U.S. with 1293 FWD test points were used to evaluate and improve the accuracy of the investigated models compared to the AASHTO 1993 method. The most prominent models were calibrated and/or simplified. The proposed calibrated/simplified models produced more accurate and less biased SNeff predictions as compared to the original models. The proposed modified models were validated using another set of LTPP data and they yielded comparable predictions. [ABSTRACT FROM AUTHOR]

International Roughness Index (IRI) is a pavement performance indicator which reflects not only the pavement condition but also the ride quality and comfort level of road users. The aim of this paper is to develop an accurate IRI prediction model for flexible pavements using both multiple linear regression analysis and artificial neural networks (ANNs). The models were developed based on the Long-Term Pavement Performance Database. The data were collected for both original and overlaid flexible pavements from the general pavement studies (GPS-1, GPS-2 and GPS-6) and the specific pavement studies (SPS-1, SPS-3 and SPS-5). The final database consisted of 506 sections with 2439 observations. The proposed models (regression and ANNs) predict IRI as a function of pavement age, initial IRI (IRI just after pavement construction), transverse cracks, alligator cracks and standard deviation of the rut depth. The regression model yielded a coefficient of determination (R2) value of 0.57 while the ANNs model resulted in a much higher R2 value of 0.75. [ABSTRACT FROM AUTHOR]

Background: Sickle cell disease (SCD) complications lead to poor health-related quality of life (HRQOL) and increased healthcare utilization in this population, which could be mitigated with hydroxyurea therapy; however, adherence is suboptimal. We assessed the relationship of healthcare utilization to hydroxyurea adherence and HRQOL amongst youth with SCD. Methods: Thirty-four patients with SCD (median age 14 years, IQR 12-18) on hydroxyurea participated in this cross-sectional study and completed Morisky Adherence Scale 8-items and Patient Reported Outcomes Measurement Information System (PROMIS®) HRQOL measures. A medical chart review was conducted to assess healthcare utilization. Results: Participants with more frequent hospitalizations and emergency room (ER) visits and longer length of stay (LOS) had significantly lower fetal hemoglobin (rs=-0.44; rs=-0.45; rs=-0.46, p < 0.05) and mean corpuscular volume (rs=-0.47; rs=-0.42; rs=-0.48, p < 0.05), respectively. More frequent hospitalizations and ER visits and longer LOS correlated significantly with worse fatigue (rs=0.51; rs=0.41; rs=0.53, p < 0.05), pain (rs=0.41; rs=0.38; rs=0.47, p < 0.05), physical function mobility (rs=-0.67; rs=-0.59; rs=-0.67, p < 0.05), depression (rs=0.38; rs=0.31; rs=0.42, p < 0.05), and social isolation (rs=0.76; rs=0.76; rs=-0.84, p < 0.05), respectively. Conclusions: We conclude that increased healthcare utilization in youth with SCD is associated with low adherence to hydroxyurea and worse HRQOL domain scores. It is important emphasize the clinical benefits of high adherence to hydroxyurea, particularly among youth with SCD. Future longitudinal studies are warranted to assess the directionality of these relationships, and may reveal modifiable behavioral factors associated with early changes in hydroxyurea adherence levels. [ABSTRACT FROM AUTHOR]