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The computer control plays important role in the solar cell design and development of dual axis solar tracker for the sun's position. The main goal of this paper is to maximize energy output to reduce panel temperature (cooling), to increase efficiency of the PV panel. Small-scale solar is developed through a complete hardware and software in order to function accurately. The main parts in this work are Arduino Uno R3, kit relay, LDR (Light Dependent Resistor), LM35 (temperature sensor), high-efficiency solar panel and satellite motor. The Protuse software is used with (Arduino Uno) as embedded computer control. The results show the effectiveness of the complete tracking system.

Nivolumab has been administered using a 60-min infusion time. Reducing this time to 30 min would benefit both patients and infusion facilities. This analysis compared the safety of 30- and 60-min infusions of nivolumab in patients with previously treated advanced non-small cell lung cancer. CheckMate 153 is an open-label, phase 3b/4, predominantly community-based study ongoing in the United States and Canada. Patients with stage IIIB/IV disease with progression/recurrence after at least one prior systemic therapy received nivolumab 3 mg/kg every 2 weeks over 30 or 60 min for 1 year or until disease progression. The primary outcome overall was to estimate the incidence of grade 3–5 treatment-related select adverse events; a retrospective objective was to estimate the incidence of hypersensitivity/infusion-related reactions (IRRs) with the 30-min infusion. Exploratory pharmacokinetic analyses were performed using a population pharmacokinetics model. Of 1420 patients enrolled, 369 received only 30-min infusions and 368 received only 60-min infusions. Similar frequencies of hypersensitivity/IRRs were noted in patients receiving 30-min [2% (n = 8)] and 60-min [2% (n = 7)] infusions. Grade 3–4 treatment-related hypersensitivity/IRRs led to treatment discontinuation in

96 Background: Improving healthcare value requires new models of care including higher utilization of outpatient services. A significant social determinant of health in this mode of care is transportation, and the most vulnerable segments of society are disproportionately affected. Transportation disparity is especially troubling in radiation oncology, due to the protracted daily treatment schedule. Disruptions in treatment adversely impact clinical outcomes and survivals. This study is a pilot trial of a novel virtual logistics hub, capable of managing rideshare, taxis, wheelchair accessible vehicles, vehicles with car seats for children and stretcher vehicles in radiation oncology to measure utilization, patient satisfaction and financial impact. Methods: Over 4 months, using predictive analytics, patients with transportation barriers in a community cancer center were enrolled in a rideshare program. Those who received rides for radiation treatment were included in this study. Each patient's personal historic no-show rate in the health system was recorded. The estimated cost per no-show for a radiation treatment was set at $250. The opportunity cost was calculated as the product of the no-show rate, the no-show cost per treatment and the number of treatments. In addition, the cost of the transportation was recorded and subtracted from the opportunity cost to calculate the return on investment ROI. Qualitative data were also collected through patient surveys after each ride. Results: 29 subjects were included in this IRB-approved pilot study for a total of 419 rides. The most common diagnoses were Breast (27.6%), Lung (17.2%) and Prostate (17.2%). Most patients were racial minorities (70.0%) and had non-metastatic disease (75.9%). The median number of radiation treatments was 10 (3-40). The historic average no-show rate was 7% (0%-36%). The average expected no show cost per patient was $219.14 ($0.00-$1,837.50). The opportunity cost representing the benefit to the health system was $6,355.00. Per patient, the average transportation cost was $325.81 ($13.26-$1,034.39). The total cost of rides was $11,864.77. The ROI was -$5,509.77. When asked 'How would you rate your transportation experience today?' 82% responded Above Average. To the question 'Would you have been able to attend your appointment today if this program did not exist?' 92% answered No. Conclusions: This study shows that the cost of rideshare transportation can partially offset the cost of no-shows. This suggests that a proactive virtual transportation hub can help address transportation barriers, drive patient satisfaction and reduce the waste of no-shows. Radiation therapy represents an ambulatory medicine crucible for patients with limited transportation and social support. Scaling up rideshare innovations from radiation oncology has the potential to drive broader ambulatory strategy.

PURPOSE Pemetrexed or bevacizumab is used for maintenance therapy of advanced nonsquamous non–small-cell lung cancer (NSCLC). The combination of bevacizumab and pemetrexed has also demonstrated efficacy. We conducted a randomized study to determine the optimal maintenance therapy. PATIENTS AND METHODS Patients with advanced nonsquamous NSCLC and no prior systemic therapy received carboplatin (area under the curve, 6), paclitaxel (200 mg/m2), and bevacizumab (15 mg/kg) for up to four cycles. Patients without progression after four cycles were randomly assigned to maintenance therapy with bevacizumab (15 mg/kg), pemetrexed (500 mg/m2), or a combination of the two agents. The primary end point was overall survival, with bevacizumab serving as the control group. RESULTS Of the 1,516 patients enrolled, 874 (57%) were randomly assigned after induction therapy to one of the three maintenance therapy groups. With a median follow-up of 50.6 months, median survival with pemetrexed was 15.9 months, compared with 14.4 months with bevacizumab (hazard ratio [HR], 0.86; P = .12); median survival with pemetrexed and bevacizumab was 16.4 months (HR, 0.9; P = .28); median progression-free survival was 4.2, 5.1 (HR, 0.85; P = .06), and 7.5 months (HR, 0.67; P < .001) for the three groups, respectively. Incidence of worst grade 3 to 4 toxicity was 29%, 37%, and 51%, respectively, for bevacizumab, pemetrexed, and the combination regimen. CONCLUSION Single-agent bevacizumab or pemetrexed is efficacious as maintenance therapy for advanced nonsquamous NSCLC. Because of a lack of survival benefit and higher toxicity, the combination of bevacizumab and pemetrexed cannot be recommended.

e21734 Background: Lung cancer is the leading cause of cancer death in the US. Significant improvements in survival have occurred with improved treatments. Payer status has been recognized as a barrier to treatment access across multiple cancer types including lung. This study aims to evaluate the impact of payer on 2-year survival rates for patients presenting in one health system with newly diagnosed lung or bronchus cancer. Methods: This is a retrospective survival analysis. There were 1,681 patients with lung cancer (small and non-small) under observation from time of first diagnosis. The first diagnosis date in the Cone health system defined study entry. Failure was defined as death during the 2-year observation period with right censoring after 2-years. Patients were categorized as underinsured if they had no insurance or Medicaid while those with commercial and Medicare were considered having full coverage. Cox proportional hazard models were used reporting hazard ratios. Results: Mortality rates per 10 patients diagnosed with lung or bronchus cancers were 3.5 for those with commercial insurance, 3.8 for Medicare, 3.3 for Medicaid and 5.4 for uninsured patients. Of those patients considered underinsured, 56.7% presented with stage IV cancer compared to those with full coverage (41.4%)*. 40.7% of those without insurance or underinsured were current tobacco product users compared to 25.1% of those with full coverage. Cox proportional hazard models revealed the risk of death is 1.34* times (95% CI 1.07-1.68) greater for underinsured patients compared to those with full coverage. The model adjusted for age, race, gender, marital status, language, Gini coefficient, Elixhauser comorbidity index, illicit drug use, cigarette smoker, smokeless tobacco user, alcohol use, PCP on record, and religion. However, when we add the AJCC stage to this model, the underinsured estimate is no longer statistically significant (1.23; 95% CI 0.92-1.65). Conclusions: Patients without insurance are diagnosed at later stages of disease. This late diagnosis is the primary driver of poor survival. Although being underinsured or uninsured is associated with a greater risk of death after diagnosis, adjusting for stage mitigates this effect. These findings support the need for equal access to early screening and diagnosis regardless of payer. *statistically significant at p < 0.05.

Introduction Advanced non-small cell lung cancer (NSCLC) is a severe disease with burdensome symptoms and traditionally poor outcomes. The treatment of advance disease is based on chemotherapy, with the recent addition of immunotherapy. Patients who respond to initial treatment can opt to receive maintenance therapy (MT). It is important to understand why patients with advanced NSCLC choose to accept or refuse therapy, and how physician recommendations play into this decision-making process. This study characterized patient and physician decision-making regarding treatment for patients with advanced non-squamous NSCLC in the USA using the example of MT. Methods and Materials This study employed multiple approaches: patient interviews, a patient survey, and a physician survey. Qualitative interviews were conducted among patients who had been offered MT to identify factors influencing treatment decision-making. The patient survey explored the decision-making process and quantified challenges and motivators for receiving MT. The physician survey included a discrete choice experiment to understand the relationship between physician treatment recommendations and patient characteristics. Results Interviewed patients (n = 10) were motivated to receive MT in the hope of extending their lives and being proactive against their cancer, and they anticipated reduced adverse effects compared with first-line therapy. Surveyed patients (n = 77) described several deterrents to receiving therapy; the most prominent was severity of adverse effects, which was an influencing factor for 34% of patients. The major motivator for receiving therapy was the potential to extend life, which influenced 97% of patients. A total of 100 oncologists participated in the physician survey. Patients’ lack of treatment motivation/inconvenience, disease progression, presence of severe renal co-morbidities, and older age decreased the likelihood of physicians recommending the use of MT. Conclusion This study identified challenges and motivators influencing advanced NSCLC patients’ decisions to accept or refuse therapy, as well as patient and disease characteristics associated with physician’s treatment recommendations for MT. Electronic supplementary material The online version of this article (10.1007/s40271-018-0327-3) contains supplementary material, which is available to authorized users.

Background The aim of this study was to compare propofol–ketamine (ketofol) with propofol–fentanyl in pediatric patients undergoing diagnostic upper gastrointestinal endoscopy. Patients and methods This was a prospective, randomized, double-blinded study to compare the effect of propofol–ketamine and propofol–fentanyl on oxygen saturation, heart rate (HR), and systolic blood pressure (SBP) when used for sedation in pediatric patients undergoing elective upper gastrointestinal endoscopy. Sixty ASA I–II patients, aged 6–12 years were included in the study. Oxygen saturation, HR, and SBP of all patients were recorded perioperatively, after induction, 5 min later, and at the end of the procedure. All patients received propofol 1.5 mg/kg, intravenous + either fentanyl 1 μg/kg, intravenous (propofol–fentanyl group) or ketamine 0.5 mg/kg, intravenous (propofol–ketamine group). The procedure started when the sedation score was 4–6. Additional propofol (1 mg/kg) was administered when needed in either group. Demographic data, operative data, and intraoperative and postoperative side effects (hypoxia, nausea and/or vomiting, increased oral secretions, and emergence reactions, or hallucinations) were recorded. Results There were no significant differences between both groups regarding the demographic and operative data (duration of the procedures, onset of anesthesia, number of patients needed additional dose (s), recovery time, discharge time, modified Ramsay sedation scale). The mean values of oxygen saturation, HR, and SBP were significantly lower (P 0.05). Conclusion Propofol–ketamine 3: 1 mixture was associated with hemodynamic stability and better oxygen saturation without affecting the recovery and without significant side-effects.

Aim The aim of this study was to investigate the effects of renal transplantation on cardiac function and morphology in patients with ESRD on regular hemodialysis at the post-transplant period. Background End stage renal disease (ESRD) is considered an overall general health issue related to increased morbidity & mortality. The mortality rate among cases with ESRD who have been experiencing dialysis has been approximately seven times higher than for comparable cases in the general population and has been to a great extent related to cardiovascular causes. Cardiac diseases have been common in cases with chronic kidney disease (CKD). About 75% of cases with CKD who begin dialysis have left ventricular hypertrophy, left ventricle dilatation or diminished left ventricle functional shortening; these cardiac anomalies keep on progressing during the first year of hemodialysis. Besides these changes, impairment of diastolic function has been also expected in these cases. For example, Left ventricular hypertrophy has been a very common pathological condition in cases with ESRD and considered as an independent risk variable for death and cardiac disease. Generally, many risk variables including uremic toxins, fluid retention & chronic volume over-load, anemia, hypoalbuminemia, hyperparathyroidism, arterio-venous fistula and pressure over-load were involved in the pathogenesis for Left Ventricular Hypertrophy in cases with ESRD. Renal transplantation is a well-established treatment for ESRD, allowing most patients to return to a satisfactory quality of life. It is the most acceptable treatment modality for the patients with ESRD, which improves some complications of renal failure such as chronic uremia and volume overload. Methods This cross sectional study was done on 40 kidney transplant recipients enrolled from the patients in the NIUN according to the inclusion and exclusion criteria. We compared echocardiographic findings and some cardiac risk factors after transplantation with those done before transplantation. Results There was highly significant reduction with respect to serum creatinine, blood urea, phosphorus. Comparison of echocardiographic findings between the pre-transplant period and post-transplant period. Ejection fraction (EF) was significantly increased at the post-transplant period while left ventricular systolic dimension (LVSD), left ventricular diastolic dimension (LVDD), and LVH showed a significant decrease after transplantation. Conclusions We have found that cardiac parameters showed significant improvement after transplantation as well as cardiac risk factors including anemia, hyperparathyroidism and volume & pressure overload.

Purpose: Reliable detection of drug-sensitive activating EGFR mutations is critical in the care of advanced non–small cell lung cancer (NSCLC), but such testing is commonly performed using a wide variety of platforms, many of which lack rigorous analytic validation. Experimental Design: A large pool of NSCLC cases was assayed with well-validated, hybrid capture–based comprehensive genomic profiling (CGP) at the request of the individual treating physicians in the course of clinical care for the purpose of making therapy decisions. From these, 400 cases harboring EGFR exon 19 deletions (Δex19) were identified, and available clinical history was reviewed. Results: Pathology reports were available for 250 consecutive cases with classical EGFR Δex19 (amino acids 743–754) and were reviewed to assess previous non-hybrid capture–based EGFR testing. Twelve of 71 (17%) cases with EGFR testing results available were negative by previous testing, including 8 of 46 (17%) cases for which the same biopsy was analyzed. Independently, five of six (83%) cases harboring C-helical EGFR Δex19 were previously negative. In a subset of these patients with available clinical outcome information, robust benefit from treatment with EGFR inhibitors was observed. Conclusions: CGP identifies drug-sensitive EGFR Δex19 in NSCLC cases that have undergone prior EGFR testing and returned negative results. Given the proven benefit in progression-free survival conferred by EGFR tyrosine kinase inhibitors in patients with these alterations, CGP should be considered in the initial presentation of advanced NSCLC and when previous testing for EGFR mutations or other driver alterations is negative. Clin Cancer Res; 22(13); 3281–5. ©2016 AACR.

The recent discovery of relevant biomarkers has reshaped our approach to therapy selection for patients with non-small cell lung cancer. The unprecedented outcomes demonstrated with tyrosine kinase inhibitors in molecularly defined cohorts of patients has underscored the importance of genetic profiling in this disease. Despite published guidelines on biomarker testing, successful tumor genotyping faces significant hurdles at both academic and community-based practices. Oncologists are now faced with interpreting large-scale genomic data from multiple tumor types, possibly making it difficult to stay current with practice standards in lung cancer. In addition, physicians’ lack of time, resources, and face-to-face opportunities can interfere with the multidisciplinary approach that is essential to delivery of care. Finally, several challenges exist in optimizing the amount and quality of tissue for molecular testing. Recognizing the importance of biomarker testing, a series of advisory boards were recently convened to address these hurdles and clarify best practices. We reviewed these challenges and established recommendations to help optimize tissue acquisition, processing, and testing within the framework of a multidisciplinary approach. Implications for Practice: Although several professional societies have incorporated biomarker testing recommendations into clinical practice guidelines for the diagnosis and management of non-small cell lung cancer (NSCLC), health care providers still face considerable challenges when establishing and implementing these standards. Developing and instituting protocols to ensure that all appropriate patients are tested for molecular biomarkers requires communication among the various specialists involved in the care of patients with NSCLC. This report provides insights into key challenges and recommendations for molecular testing of patients with metastatic NSCLC, summarized from a multidisciplinary team of experts spanning academic, community, and integrated health systems.

3059Background: Nivolumab,aprogrammed death-1 (PD-1) immune checkpoint inhibitor, is approved in the US for previously treated metastatic NSCLC and renal cell carcinoma, and for advanced melanoma, ...

182 Background: In 2006, maintenance therapy was added as a treatment guideline for patients with advanced non-squamous (nsq) NSCLC. This study aimed to identify patient- and disease-related factors that impact maintenance therapy decision making. Methods: An online discrete choice survey was administered to physicians currently managing patients with advanced nsq NSCLC in the US. Physicians viewed 12 patient profiles differing in levels of the following attributes: 1st line treatment response (complete, partial, stable, progression), adverse events during 1st line therapy (none, mild, moderate, severe), comorbidities (none, mild renal, severe renal, other), patient motivation/convenience (+/+, +/-, -/+, -/-), patient insurance co-pay rate (0, 5, 10, 20%), and age (45, 58, 68, 80 years). No specific maintenance treatments were stated. For each profile, physicians indicated if they would recommend maintenance therapy. Recommendations were analyzed using a mixed-effects logistic regression model. Odds ratios (ORs) were calculated to estimate the relative odds of a maintenance therapy recommendation for levels of each attribute. Results: The survey was completed by 100 physicians (81% male; mean years of experience: 15.4). The study design was balanced and orthogonal. Maintenance therapy was recommended for 75% of the profiles; 98% of physicians recommended maintenance therapy for at least 1 profile, with 26% recommending it for all profiles. The odds of recommending maintenance therapy were significantly lower when the patient profile included disease progression relative to stable response (OR: 0.17; p