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A systematic investigation of SARS-CoV-2 genome concentrations in nine Southern California wastewater treatment plants (WWTPs) was carried out. The goal was to compare the variability of the viral concentration among different WWTPs that serve different communities and to correlate the concentration of virus in wastewater with the community level COVID-19 epidemic. The results showed that there were significant differences in viral concentration detected in different plants. However, the variability of SARS-CoV-2 concentration cannot easily be explained by the COVID-19 case reports because a large number of sewer-shed characteristics have important influences on the quantifiable viral concentration in the sewage samples. The results from year-long tracking of SARS-CoV-2 concentration in two large WWTPs, however, matched fairly well with the county level COVID-19 case reports. This suggests continuous monitoring of SARS-CoV-2 in the same treatment plant can offer insights into community level trends of COVID-19 and can serve as an alert for a possible resurgence of the disease. Amplicon-based sequencing targeting two SARS-CoV-2 single nucleotide polymorphism (SNP) mutations was shown as a proof-of-concept for identifying SARS-CoV-2 variants in wastewater. The outcomes of this research contribute to the advancement of wastewater-based epidemiology for COVID-19 and other infectious diseases.

To evaluate healthcare resource utilization (HCRU) by osteoarthritis (OA) pain severity.Cross-sectional surveys of US physicians and their patients were conducted between February and May 2017. Using the Numeric Rating Scale, patients were classified by self-reported pain intensity in the last week into mild (0-3), moderate (4-6), and severe (7-10) cohorts. Parameters assessed included clinical characteristics, HCRU, and current caregiver support. Descriptive statistics were obtained, and analysis of variance and chi-square tests were performed.Patients (n = 841) were mostly female (60.9%) and white (77.8%), with mean age of 64.6 years. Patients reported mild (45.4%), moderate (35.9%), and severe (18.7%) OA pain. Mean number of affected joints varied by pain severity (range mild: 2.7 to severe: 3.6;Greater current pain was associated with more prior HCRU including imaging for monitoring progression, HCP visits including more specialty care, hospitalizations, surgery/planned surgery, and loss of independence due to functional disability. Yet rates of hospitalizations and X-ray use were still sizable even among patients with mild pain. These cross-sectional findings warrant longitudinal assessment to further elucidate the impact of pain on HCRU.

Srinivas R Nalamachu,1 Rebecca L Robinson,2 Lars Viktrup,3 Joseph C Cappelleri,4 Andrew G Bushmakin,4 Leslie Tive,5 Jennifer Mellor,6 Niall Hatchell,6 James Jackson6 1Mid America PolyClinic, Overland Park, KS, USA; 2Patient Outcomes and Real-World Evidence, Eli Lilly and Company, Indianapolis, IN, USA; 3Lilly Bio-Medicines Core Team, Eli Lilly and Company, Indianapolis, IN, USA; 4Statistics, Pfizer Inc, Groton, CT, USA; 5Medical Affairs, Pfizer Inc, New York, NY, USA; 6Real World Research, Adelphi Real World, Bollington, Cheshire, UKCorrespondence: Rebecca L RobinsonEli Lilly and Company, Lilly Research Labs, Lilly Corporate Center, Indianapolis, IN 46285, USATel +1 317-224-5833Fax +1 317-277-0490Email rlrobinson@lilly.comPurpose: The purpose of this study was to assess how patient-reported pain is related to osteoarthritis (OA) treatment patterns in routine clinical practice.Patients and Methods: Data were collected between February and May 2017 from 153 United States (US) primary care physicians, rheumatologists, and orthopedic surgeons. Each invited up to nine consecutive patients to rate their OA pain in the last week. Physicians provided demographic, clinical, and treatment information for patients, including nonpharmacologic therapies ever recommended, currently recommended over-the-counter (OTC) medications, and currently and ever prescribed medications for the management of OA. Findings for patients with mild (0─3), moderate (4─6), and severe current pain (7─10) were compared using appropriate statistics.Results: Among the 841 patients (61% female; mean 65 years; 57% knee OA), 45% reported mild, 36% moderate, and 19% severe current OA pain. Current treatment modalities differed by pain severity (P< 0.05). Most patients (70%) had been recommended nonpharmacologic therapy and 40% were currently recommended OTC medications. More patients with moderate (81%) or severe pain (78%) currently received prescription medications, with or without nonpharmacologic therapy, versus those with mild pain (67%). Overall, 47% of patients currently received just one prescription drug, while 49% had received one prescription drug ever. Nonsteroidal anti-inflammatory drugs (NSAIDs) were the most common current (58%) and ever received (88%) prescriptions. Current NSAID prescriptions were not associated with pain severity. Acetaminophen recommendations, opioid prescriptions (current and ever), and multiple prescription medications tried were numerically highest in the severe pain group (all P< 0.05 by pain severity). In all groups, > 80% of treatment switches were due to lack of efficacy.Conclusion: Real-life treatment patterns for OA in the US are significantly associated with current patient-reported pain. Combining nonpharmacologic and pharmacologic treatments is common but higher pain ratings are associated with multiple failed prescription treatments. Current use of acetaminophen and opioids, but not NSAIDs, increases alongside pain severity.Keywords: nonprescription drugs, prescription drugs, therapeutics, pain management, practice patterns, physicians

Background : : We explored the association of anemia severity in patients with chronic kidney disease (CKD) and anemia treatment with work productivity in China. Methods : : Cross-sectional survey data from Chinese physicians and their CKD patients were collected in 2015. Physicians recorded demographics, disease characteristics, and treatment. Patients completed the Work Productivity and Activity Impairment questionnaire. Data were stratified by dialysis-dependence, hemoglobin (Hb) level, and anemia treatment. Results : : Based on data from 1,052 patients (704 non-dialysis-dependent [NDD] and 348 dialysis-dependent [DD] patients), prescribed anemia treatment differed significantly across Hb levels (P < 0.001). In NDD patients, anemia treatment also differed significantly by on-treatment Hb level (P < 0.001). In treated NDD patients with Hb < 10 g/ dL, Hb 10 to 12 g/dL, and Hb > 12 g/dL, 31%, 59%, and 38% of patients, respectively, were prescribed oral iron, and 34%, 19%, and 0% of patients, respectively, were prescribed oral iron with erythropoiesis-stimulating agents (ESA). NDD patients were less likely to be prescribed any anemia treatment, and ESA specifically, than DD patients. When treated, 67% and 45% of NDD and DD patients, respectively, had Hb ≥ 10 g/dL (P < 0.001). Overall work and activity impairment differed significantly across Hb levels in NDD and DD patients, with the least impairment observed at the highest Hb level. Conclusion : : Approximately 40% of NDD patients and 60% of DD patients receiving anemia treatment had Hb < 10 g/dL. Compared with mild anemia patients, severe anemia patients were more likely to be treated for anemia and have impaired work productivity. Chinese CKD patients could benefit from improved anemia treatment.

Introduction To evaluate, from the patient’s perspective, the burden of pain associated with hip/knee osteoarthritis (OA) in the USA and selected European Union (EU) countries. Methods Data were drawn from the 2017 global Adelphi OA Disease Specific Programme™ (DSP). Patients with hip/knee OA were stratified based on pain intensity and the presence/absence of current opioid use. Outcomes included Western Ontario and McMaster Universities Osteoarthritis Index scores, functional limitations, unmet treatment needs, Charlson Comorbidity Index, relevant comorbid conditions, the 5-dimension 5-level EuroQol, and the Work Productivity and Activity Impairment Questionnaire: Specific Health Problem. Bivariate testing compared outcomes using patients with no/mild pain without opioid use as the reference group. Results The study population comprised 2170 patients (US: n = 623 [28.7%]; EU: n = 1547 [71.3%]) with knee (54.9%), hip (24.6%), or knee/hip (20.5%) OA. Mean (SD) age was 66.4 (11.2) years. Patients had no/mild pain without opioid use (39.6%), no/mild pain with opioid use (10.2%), moderate/severe pain without opioid use (30.6%), and moderate/severe pain with opioid use (19.7%). Compared with the reference group, patients with moderate/severe pain reported significantly (p

Objective The objective of this study was to examine if patients with migraine who responded sufficiently to acute treatment were significantly different from those who did not in terms of patient characteristics, treatment patterns, and patient level of impairment, and to identify characteristics associated with insufficient response. Background Migraine is highly prevalent and impacts functional ability substantially. Current treatment approaches are not sufficiently meeting the needs of patients, and inadequate response to acute treatment is reported by at least 56% of patients with migraine in the United States. Methods Data were obtained from the 2014 Adelphi Migraine Disease-Specific Program, a cross-sectional survey. Using logistic regression, we assessed the association between patient factors and insufficient response. Responders were defined as patients with migraine who achieved pain freedom within 2 hours of acute treatment in ≥4 of 5 attacks, while insufficient responders achieved it in ≤3 of 5 attacks. Results Of 583 patients included, insufficient responders to acute treatment constituted 34.3% (200/583) of the study population. A statistically significantly larger proportion of insufficient responders vs responders had ≥4 migraine headache days/month (46.3% [88/190] vs 31% [114/368]), had ever been prescribed ≥3 unique preventive treatment regimens (11.7% [21/179] vs 6.3% [22/347]), and had chronic migraine, medication-overuse headaches, and comorbid depression (all P values ≤.05). Patient level of impairment was statistically significantly greater among insufficient responders vs responders. Factors associated with insufficient response after adjusting for covariates included Migraine Disability Assessment total score (odds ratio [OR] = 1.04, 95% CI [1.02, 1.05]), time of administration of acute treatment (OR = 1.83, 95% CI [1.15, 2.92]), depression (OR = 1.98, 95% CI [1.21, 3.23]), sensitivity to light not listed as current most troublesome symptom (OR = 2.30, 95% CI [1.21, 4.37]), and change in the average headache days per month before being prescribed an acute treatment vs now (OR = 1.75, 95% CI [1.05, 2.90]). Conclusions Clinical characteristics, treatment patterns, and health-related quality of life measures are statistically significantly different between insufficient responders and responders to acute treatment in patients with migraine.

Background Migraine is a chronic, disabling neurological disease characterized by moderate-to-severe headache pain with other symptoms, including nausea, vomiting, and photophobia. Triptans, while generally effective, are insufficiently efficacious in 30–40% of patients and poorly tolerated by or contraindicated in others. We assessed the impact of insufficient response to triptans on health-related quality of life (HRQoL) and work productivity in patients currently receiving any prescribed triptan formulation as their only acute migraine medication. Methods Data were from the 2017 Adelphi Migraine Disease Specific Programme, a cross-sectional survey of primary care physicians, neurologists, and headache specialists and their consulting patients with migraine in the USA, France, Germany, Italy, Spain, and UK. Triptan insufficient responders (TIRs) achieved freedom from headache pain within 2 h of acute treatment in ≤3/5 migraine attacks; triptan responders (TRs) achieved pain freedom within 2 h in ≥4/5 attacks. Multivariable general linear model examined differences between TIRs and TRs in HRQoL and work productivity. Logistic regression identified factors associated with insufficient response to triptans. Results The study included 1413 triptan-treated patients (TIRs: n = 483, 34.2%; TRs: n = 930, 65.8%). TIRs were more likely to be female (76% vs. 70% for TIRs vs TRs, respectively; p = 0.011), older (mean age 42.6 vs. 40.5 years; p = 0.003), and had more headache days/month (7.0 vs. 4.4; p p p = 0.001). Work productivity and activity were impaired (absenteeism, 8.6% vs. 5.1% for TIRs vs. TRs; presenteeism, 34.3% vs. 21.0%; work impairment, 37.1% vs. 23.3%; overall activity impairment, 39.8% vs. 25.3%; all p Conclusion HRQoL and work productivity were significantly impacted in TIRs versus TRs in this real-world analysis of patients with migraine acutely treated with triptans, highlighting the need for more effective treatments for patients with an insufficient triptan response. Further research is needed to establish causal relationships between insufficient response and these outcomes.

Summary Multiple-systems estimation is a key approach for quantifying hidden populations such as the number of victims of modern slavery. The UK Government published an estimate of 10000–13000 victims, constructed by the present author, as part of the strategy leading to the Modern Slavery Act 2015. This estimate was obtained by a stepwise multiple-systems method based on six lists. Further investigation shows that a small proportion of the possible models give rather different answers, and that other model fitting approaches may choose one of these. Three data sets collected in the field of modern slavery, together with a data set about the death toll in the Kosovo conflict, are used to investigate the stability and robustness of various multiple-systems-estimate methods. The crucial aspect is the way that interactions between lists are modelled, because these can substantially affect the results. Model selection and Bayesian approaches are considered in detail, in particular to assess their stability and robustness when applied to real modern slavery data. A new Markov chain Monte Carlo Bayesian approach is developed; overall, this gives robust and stable results at least for the examples considered. The software and data sets are freely and publicly available to facilitate wider implementation and further research.

We present the first deployment of an open, scalable and distributed spatial computing platform. We show in action its extensible protocols for discovering spatial services and spatial content in a geographic area, representing poses of real and virtual cameras and objects, exchanging content records, and interfacing with spatial computing services like visual localization. We also demonstrate the usage of the platform through a WebXR reference client in the first city-wide prototype testbed in Bari, Italy.

INTRODUCTION AND OBJECTIVE:Diseases of the vascular system, such as renal artery stenosis, affect a large number of patients and have resulted in a clear clinical need for the development of functi...

INTRODUCTION AND OBJECTIVE:Treatment of extensive skeletal muscle loss due to traumatic injuries, congenital defects, or diseases, such as cancer, is a clinically challenging problem for soldiers a...

INTRODUCTION AND OBJECTIVE:Over 50% of patients with renal failure do not have access to the life-saving treatments of dialysis and transplantation due to a lack of transplantable organs and the hi...

Generation of transcriptional data has dramatically increased in the last decade, driving the development of analytical algorithms that enable interrogation of the biology underpinning the profiled samples. However, these resources require users to have expertise in data wrangling and analytics, reducing opportunities for biological discovery by “wet-lab” users with a limited programming skillset. Although commercial solutions exist, costs for software access can be prohibitive for academic research groups.To address these challenges, we have developed an open source and user-friendly data analysis platform for on-the-fly bioinformatic interrogation of transcriptional data derived from human or mouse tissue, called “MouSR”. This internet-accessible analytical tool, https://mousr.qub.ac.uk/, enables users to easily interrogate their data using an intuitive “point and click” interface, which includes a suite of molecular characterisation options including QC, differential gene expression, gene set enrichment and microenvironmental cell population analyses from RNA-Seq. Users are provided with adjustable options for analysis parameters to generate results that can be saved as publication-quality images. To highlight its ability to perform high quality data analysis, we utilise the MouSR tool to interrogate our recently published tumour dataset, derived from genetically engineered mouse models and matched organoids, where we rapidly reproduced the key transcriptional findings.The MouSR online tool provides a unique freely-available option for users to perform rapid transcriptomic analyses and comprehensive interrogation of the signalling underpinning transcriptional datasets, which alleviates a major bottleneck for biological discovery.

Background The Panther (Hologic Inc) was introduced to our specialist sexual health service at point-of-care, which could provide a rapid gonorrhoea (GC) and chlamydia (CT) nucleic acid amplification test (NAAT) result within 4 hours. GC-culture testing was limited to those testing GC NAAT-positive and/or to those who received treatment before the NAAT result was available. We hypothesised that this would reduce the number of cultures and cost, but not reduce the sensitivity of GC-culture. GC isolates are required for susceptibility testing to optimise antimicrobial therapy and for Anti-microbial Resistance surveillance. Methods We obtained and compared data on NAATs taken 12 months before and 12 months after the introduction of rapid testing in November 2019. We linked GC-cultures taken within 2 weeks of the NAAT. Chi-square was used to compare proportions. Results 23,588 CT/GC NAATs were taken before and 21,588 after the introduction of the new rapid STI service of which 684(2.9%) and 766(3.5%) were GC-positive respectively. GC cultures dropped from 10881 to 6022 after November 2019 with the proportion of cultures to NAATs decreasing from 0.46 to 0.28 (p 95% in previous 8 months. Conclusions Implementation of the rapid STI service resulted in fewer GC-culture specimens being taken which reduced the cost of GC-culture but with no loss in GC-culture sensitivity overall.

Purpose To evaluate the relationship between self-reported concerns about becoming addicted to a medication and health-related quality of life (HRQoL) in patients with osteoarthritis (OA). Methods This real-world study used patient-level cross-sectional survey data collected from the US Adelphi Disease Specific Programme (DSP). The DSP for OA selected 153 physicians who collected de-identified data on their next nine adult patients with OA. Each patient completed a disease-relevant survey, which included the Likert-scale question, “I am concerned about becoming addicted to my medicine,” (CAA) with responses ranging from “completely disagree” [1] to “completely agree” [5]. HRQoL was measured by the EQ-5D-5L index value and the EQ Visual Analogue Scale (VAS). A set of ordinary least squares regressions using HRQoL measures as outcomes and CAA as a continuous predictor were estimated. Standardized effect size (ES) was used to gauge the magnitude of effects. Results A total of 866 patients with OA completed the survey (female, 61.2%; White, 77.7%; mean age, 64.2 years). Of the 775 patients who completed the CAA question, almost one-third responded that they “agree” (18%) or “completely agree” (11%), while 27% responded “completely disagree” and 20% “disagree.” Regression analyses found that patients who have concerns about medication addiction have significantly different EQ-5D-5L index values and EQ VAS scores compared with patients who do not have this concern (p Conclusion Our findings suggest that concern about medication addiction in patients with OA may have an impact on patient HRQoL, with more concerned patients reporting poorer HRQoL outcomes.

Background In Japan, detailed information on the characteristics, disease burden, and treatment patterns of people living with migraine is limited. The aim of this study was to compare clinical characteristics, disease burden, and treatment patterns in people with episodic migraine (EM) or chronic migraine (CM) using real-world data from clinical practice in Japan. Methods This was an analysis of data collected in 2014 by the Adelphi Migraine Disease Specific Programme, a cross-sectional survey of physicians and their consulting adult patients in Japan, using physician and patient questionnaires. We report patient demographics, prescribed treatment, work productivity, and quality-of-life data for people with CM (≥15 headache days/month) or EM (not fulfilling CM criteria). In descriptive analyses, continuous and categorical measures were assessed using t-tests and Chi-squared tests, respectively. Results Physicians provided data for 977 patients (mean age 44.5 years; 77.2% female; 94.5% with EM, 5.5% with CM). A total of 634/977 (64.9%) invited patients (600 with EM; 34 with CM) also provided data. Acute therapy was currently being prescribed in 93.7% and 100% of patients with EM and CM, respectively (p = 0.069); corresponding percentages for current preventive therapy prescriptions were 40.5% and 68.5% (p

Pose graph optimization is a common problem in robotics and associated fields. Most commonly, pose graph optimization is performed by finding the set of pose estimates which are the most likely for a given set of measurements. In some situations, arbitrarily large errors in pose graph initialization are unavoidable and can cause these pose-based methods to diverge or fail especially in cases where global inputs become available after some time after initialization. This letter details the parameterization of the classic pose graph problem in a relative context, optimizing directly over relative edge constraints between vertices in the pose graph and not on the poses themselves. Unlike previous literature on relative optimization, this letter details relative optimization over an entire pose graph, instead of a subset of edges, resulting in greater robustness to arbitrarily large errors than the classic pose-based or prior relative edge-based methods. Several small-scale simulation comparison studies, along with single and multi-agent hardware experiments, are presented. Results point to relative edge optimization as a strong candidate for solving real-world pose graph optimization problems that contain large heading propagation or initialization errors.

OBJECTIVE: To determine how osteoarthritis (OA) severity correlates with self-reported outcomes relevant from the patient’s perspective in the Italian clinical setting.METHODS: Data were drawn from the 2017-18 Adelphi OA Disease Specific ProgrammeTM (DSP). Data were collected in the Italian clinical practice settings by primary care physicians, rheumatologists, orthopedists, and their patients with OA, during their regular office visits. Physicians completed information about OA-related visits to healthcare professionals (HCPs), tests/scans conducted, emergency room (ER) visits, surgeries, and OA-related treatment. Physicians also rated patients’ functioning on a 0 to 10 scale (0 = fully functional; 10 = completely impaired). Outcomes included Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, functional limitations, treatment needs, EuroQoL-5 Dimension (EQ-5D) visual analogue scale (VAS), the work productivity and activity impairment. Descriptive statistics (numbers and percent for categorical variables; means with standard deviations [SD] for continuous variables) were used to evaluate the different variables as appropriate.RESULTS: The study population comprised 900 patients from Italy with knee (40.9%), back (38.7%), hip (27.9%), and/or shoulder (20.3%) OA. Mean age was 66.6 years with a prevalence of female (63%) patients. Patients had mild (26%), moderate (54%), severe (20%) disease severity. Patients with severe disease reported higher functional limitations, greater use of treatments, reduced quality of life, and impaired work productivity and activity. The burdens were higher among elderly and obese patients and in patients with highest pain severity score.CONCLUSIONS: The results from this cross-sectional study show the impact of OA disease severity on all dimensions of health-related quality of life (HRQoL), as well as in OA-related health care resource use.

The failure of the U.S. education system to create access to educational opportunities in STEM for Black Americans is a social justice issue reflecting a long history of exclusion and barriers to the success of Blacks. While the demographics of the U.S. population are in transition, the National Science Foundation’s report on STEM Education Data and Trends (2019) suggests that representation of Blacks and Hispanics in the U.S. STEM Workforce has fallen significantly behind their representation in the population. This underrepresentation of Blacks in the education pipeline and STEM workforce has a significant impact on basic research science, education, and training in STEM. The National Science Foundation’s NCSES data (NSF, 2016–2017) found that in 2016 only 8.27% of SE Gasman & Arroyo, 2014).

We present a case of Classical Hodgkin lymphoma, nodular sclerosis subtype, Stage IIB EX presenting with a large left lung mass, mediastinal lymph nodes, night sweats, 19% weight loss, erythrocyte sedimentation rate (ESR) of 110 ml/hr and a suboptimal response to 6 cycles of ABVD (Adriamycin, Bleomycin, Vinblastine and Dacarbazine) chemotherapy. The patient then underwent radiation to the left lung followed by radiation to residual disease using what we describe as a “shrinking lung” radiation technique. A PET-CT done 8 months after radiation treatment was completed demonstrated a complete response. This case highlights the use of a traditional radiation technique in treatment of chemotherapy refractory Hodgkin’s lymphoma to achieve a complete remission.

Background Migraine has a severe impact on health-related quality of life (HRQoL) affecting physical, emotional, and social aspects of daily living of an individual. Preventive treatment has been demonstrated to improve HRQoL by reducing the frequency of migraine headache days. Methods The study used data from 2017 Adelphi Migraine Disease Specific Program, which is a cross-sectional survey of physicians and their consulting patients with migraine in the United States (US) and five European countries (EU [Germany, France, UK, Italy and Spain]). Objectives were to evaluate patient-reported outcome (PRO) measures in the following two subgroups and by region (US and EU): (i) patients who are eligible for migraine preventive treatment (≥4 migraine headache days/month), and (ii) patients who are non-eligible for preventive treatment (

Introduction: Millions of Americans are admitted to the intensive care unit per year. Many survivors of the intensive care unit (ICU) will experience posttraumatic stress disorder (PTSD); although volumetric hippocampal and amygdala studies have been conducted in other trauma survivors (ie veterans), the association between PTSD symptoms and hippocampal and amygdala volumes in ICU survivors has not been described. We hypothesize that the severity of posttraumatic stress symptoms in ICU survivors is associated with lower volumes of both the hippocampus and amygdala at 3 and 12 months. Methods: Secondary analysis of the VISIONS study, a prospective sub-study of the BRAIN-ICU cohort, which included survivors of critical illness. The PTSD Checklist Specific (PCL-S) was used at 3 and 12 months to evaluate the ICU as a traumatic experience. A Philips Achieva 3T MRI scanner was used to scan patients at both discharge and 3 months. To compare median brain volumes at discharge and 3 months for those with and without PTSD symptomatology, we used a Kruskal-Wallis (KW) test. Results: At 3 month follow up, 3 patients had PTSD symptomatology and N=1 at 12 month follow up. There was no difference between median brain volumes (hippocampus or amygdala) between individuals with PTSD symptomatology at either 3 or 12 months (p-values >0.05). Discussion: Although our study did not reveal significant differences in brain volumes between PTSD patients and non-PTSD patients, sample size was a major limitation and larger scale studies should be undertaken to elucidate possible neurobiological markers of PTSD in ICU survivors.

Background and Aims Anaemia, a complication of chronic kidney disease (CKD), is commonly defined as serum haemoglobin (Hb) levels of Method Preliminary data were drawn from the Adelphi CKD Disease Specific ProgrammeTM, a point-in-time study conducted between November 2019 and January 2020 with nephrologists and PCPs from Germany, Italy and the United Kingdom. Physicians completed a detailed online survey providing information on their demographics, opinions on the diagnosis and treatment of anaemia, and the current unmet needs they believe exist in the management and treatment of anaemia. Results are based on interim data and analysed descriptively. Results A total of 144 physicians (n=94 nephrologists; n=50 PCPs) were included in the analysis. Among those who responded, the majority used Hb levels to diagnose anaemia in CKD patients. Over two thirds of physicians mentioned using ferritin to diagnose anaemia and over half reported using transferrin saturation (TSAT) levels. Reported use of ferritin and TSAT testing was lower among PCPs. Three quarters of nephrologists and PCPs (76% of each respectively) reported Hb levels to be the most important factor that triggers initiation of anaemia treatment in CKD patients, followed by fatigue/weakness (53% of both nephrologists and PCPs) and overall health/QoL (29% nephrologists; 18% PCPs). Ferritin levels (24% of each respectively); TSAT levels (23% nephrologists; 24% PCPs) and shortness of breath (22% nephrologists; 24% PCPs) were also among the most important factors. The top three unmet needs in the management and treatment of CKD anaemia, as reported by nephrologists were: treatment for refractory/resistant patients (34%), lower cost of therapy (34%) and need for more oral treatments (33%). PCPs’ top three unmet needs were reported as: treatment for refractory/resistant patients (42%), fewer side effects (42%) and need for more oral treatments (34%). Differences observed between nephrologists and PCPs related to a need for alternative treatments (19% nephrologists; 26% PCPs), access to ESA treatment (17% nephrologists; 30% PCPs) and treatments with lower risk of CV events (26% nephrologists; 12% PCPs). Conclusion This data reinforced that Hb levels, ahead of ferritin and TSAT levels have an important role in the diagnosis and initial prescription of therapy for anaemia in CKD patients. It also highlighted an unmet need for treatment of refractory/resistant patients and the desire among both nephrologists and PCPs for safer and affordable novel treatments for anaemia patients.

Evidence from clinical trials suggest that newer antihyperglycemic agents (AHAs) have a better clinical profile at a higher dose. However, the utilization of the different doses in the real world is not well known. This study aimed to assess the dose utilization of the 2 newer classes of AHAs using the 2018 Adelphi T2DM Disease Specific Programme, a survey involving 730 physicians and 8794 patients in the U.S. and Europe. The analysis included 1612 patients on sodium glucose cotransporter 2 inhibitors (SGLT2i) and 1073 patients on glucagon like peptide-1 receptor agonist (GLP-1RA), either monotherapy or combined therapy. Dose cut points for SGLT2i drugs were based on doses utilized in cardiovascular outcomes trials (at a compound level, Table 1). There is no standard cut point on dosing in GLP-1RA, therefore a conservative approach was applied (see Table for details). Analyses were performed at class level. SGLT2i drugs were more likely to be prescribed at a high dose (85.7%) to patients who were slightly younger than those receiving a lower dose (57.1 vs. 58.9 years). GLP-1RA were prescribed at high dose in 63.2% of the patients. Mean BMI was higher in patients receiving high dose of a GLP-1 receptor agonist. Disclosure D. Lautsch: Employee; Self; Merck & Co., Inc. E. McLeod: Employee; Self; Pfizer Inc. Stock/Shareholder; Self; Pfizer Inc. T. Wang: Employee; Spouse/Partner; Janssen Pharmaceuticals, Inc. Employee; Self; Merck & Co., Inc. C.D. Gonzalez: Employee; Self; Merck & Co., Inc. S. Rajpathak: Employee; Self; Menarini Group. S. Malkani: None. J. Jackson: None. G. Milligan: None. V. Higgins: None. Funding Merck Sharp & Dohme Corp; Pfizer Inc.

Assistance dogs are a key intervention to support the autonomy of people with tetraplegia. Previous research on assistive technologies have investigated ways to, ultimately, replace their labour using technology, for instance through the design of smart home environments. However, both the disability studies literature and our interviews suggest there is an immediate need to support these relationships, both in terms of training and bonding. Through a case study of an accessible dog treats dispenser, we investigate a technological intervention responding to these needs, detailing an appropriate design methodology and contributing insights into user requirements and preferences.

INTRODUCTION AND OBJECTIVE:End-stage chronic kidney disease is an incurable condition for which dialysis and renal transplantation are the only available treatments. 3D bioprinting strategies in ti...

INTRODUCTION AND OBJECTIVE:Vascularization is one of the major hurdles affecting the survival and integration of implanted three-dimensional tissue constructs in vivo. We have developed a biomimeti...

INTRODUCTION AND OBJECTIVE:Treatment of muscle function loss due to traumatic injury, congenital defects, or tumor ablations is clinically challenging. The current treatment standard is grafting of...

People want to be comfortable, and perception of what makes each user comfortable can vary greatly. This makes it important that vehicle products meet the different expectations of users through flexibility in their interior environment design. One of the most prominent predictions in personal mobility progression is a move towards shared autonomous vehicles. SUaaVE is a European project aiming at improving acceptance, trust and comfort of future shared automated vehicle users, through development of a system concept known as ALFRED. This paper presents a theoretical framework for an adaptive model, with comfort componentised into attributes. Application of the model aims to drive a response to vehicle user’s individual characteristics and preferences - such that their comfort can be optimised intelligently by manipulation of vehicle features and functions as part of the ALFRED concept.

As relevant technologies become smaller and less expensive, micro air vehicles (MAVs) are transitioning from predominantly military and hobbyist applications to mainstream use. Exciting new applications include the delivery of medical supplies to remote areas, infrastructure inspection, environmental change detection, precision agriculture, survelliance of visible satellites. These issues are particularly prevalent when flying near the ground, where safety and reliability are especially important.

James DS Jackson,1 Sarah E Cotton,1 Sara Bruce Wirta,2 Catia C Proenca,3 Milun Zhang,4 Raquel Lahoz,5 Bogdan Balas,5 Frederico J Calado5 1Real World Research, Adelphi Real World, Bollington, UK; 2Real World Evidence, Cardio-Metabolic Franchise, Novartis Sweden AB, Stockholm, Sweden; 3Wellmera AG, Basel, Switzerland; 4Health Economics and Outcomes Research, Novartis Pharma China, Beijing, China; 5Medical Affairs, Cardio-Metabolic Franchise, Novartis Pharma AG, Basel, Switzerland Purpose: The objective of this study was to describe the clinical care pathways, management and treatment patterns, and hospitalizations for patients with heart failure (HF) in China. Subjects and methods: A cross-sectional survey of cardiologists and their patients with HF was conducted. Patient record forms were completed by 150 cardiologists for 10 consecutive patients. Patients for whom a patient record form was completed were invited to complete a patient self-completion questionnaire. Results: Most of the 1,500 patients (mean [SD] age 66 [10] years; 55% male) included in the study received care in tier-2 and -3 hospitals in large cities. Cardiologists were responsible for initial consultation, diagnosis, and treatment of patients with HF. The use of guideline-recommended diagnostics was high. However, guideline-recommended double- and triple-combination therapy was received by only 51% and 18% of patients, respectively. In total, 20% of patients with HF reported that they were not consulted on the choice of therapy. Concordance was high (≥80%) between matched cardiologist and patient pairs for the occurrence of side effects, while cardiologists more often under- than overreported the occurrence of side effects of treatment reported by patients. Conclusion: The management of HF was predominantly overseen by cardiologists. The use of diagnostic tests was high, but the use of guideline-recommended treatment was low in this population. Improved communication between patients and cardiologists is essential to optimize treatment decision making and to increase awareness of treatment side effects. Keywords: heart failure, disease management, patient preference, treatment satisfaction, real-world evidence

James DS Jackson,1 Sarah E Cotton,1 Sara Bruce Wirta,2 Catia C Proenca,3 Milun Zhang,4 Raquel Lahoz,5 Frederico J Calado5 1Real World Research, Adelphi Real World, Bollington, Cheshire, UK; 2Real World Evidence Center of Excellence, Novartis Sweden AB, Stockholm, Sweden; 3Wellmera AG, Basel, Switzerland; 4Health Economics and Outcomes Research & Access Strategy, Novartis Pharma China, Beijing, China; 5Real World Evidence Center of Excellence, Novartis Pharma AG, Basel, Switzerland Purpose: Family and friends play a pivotal role in caring for patients with heart failure (HF); however, evidence of the impact of caregiving is limited. The objectives of this study were to describe the burden of caregiving on informal caregivers of patients with chronic HF in China.Materials and methods: A cross-sectional survey of cardiologists, their patients with HF, and those patients’ caregivers was conducted. Patient record forms were completed by 150 cardiologists for 10 consecutive patients. Caregivers of these patients were invited to complete a questionnaire.Results: Overall, 458 caregivers completed a questionnaire (mean ± standard deviation age 60.1±10.6 years; 60% female; 77% spouses; 74% retired). Caregivers spent a mean of 24.5 (16.9) hours caregiving per week, and a third reported a reduction in their social activity, time for themselves, or time for family. Caregivers in employment took several days off work in the past 3months owing to caregiving, sometimes resulting in reduced income. Up to 79% of caregivers reported an impact on their physical or emotional well-being, and 57% reported deterioration in their objective health status. Inconsistencies stemming from differences in the three-level five-dimension EuroQol questionnaire and HF Caregiver Questionnaire were observed for the impact of caregiving on caregivers’ health-related quality of life. Conclusion: Assisting patients with HF is associated with caregiver burden. Addressing the needs of caregivers may help to promote their continued support and improve patient outcomes.Keywords: burden, caregiver, China, health-related quality of life, heart failure&nbsp

Introduction Patients with chronic kidney disease (CKD) have an increased risk of comorbid conditions, including cardiovascular disease (CVD). Anemia is prevalent in the CKD population and worsens as kidney function declines, resulting in a diminished quality of life and increased morbidity/mortality. The purpose of this secondary analysis was to determine the real-world prevalence of CVD among patients with non-dialysis-dependent CKD (NDD-CKD), with and without comorbid anemia, and to assess the impact of these conditions on quality of life (QoL) and work productivity. Methods Data were drawn from the Adelphi CKD Disease-Specific Programme, conducted in France, Germany, Italy, Spain, and the UK (2012). Anonymized data were collected via patient record forms and patient-completed questionnaires. Patient data were stratified by anemic status and the presence of CVD comorbidity. Results Data were collected by physicians for 1993 patients, of whom 867 completed a patient-completed questionnaire. A total of 61.4% of patients had anemia, and the prevalence of anemia increased with CKD stage. Patients with anemia had a higher mean number of cardiovascular comorbidities than non-anemic patients (1.27 vs 0.95, respectively; P

Objectives To develop algorithms mapping the Kidney Disease Quality of Life 36-Item Short Form Survey (KDQOL-36) onto the 3-level EQ-5D questionnaire (EQ-5D-3L) and the 5-level EQ-5D questionnaire (EQ-5D-5L) for patients with end-stage renal disease requiring dialysis. Methods We used data from a cross-sectional study in Europe (France, n = 299; Germany, n = 413; Italy, n = 278; Spain, n = 225) to map onto EQ-5D-3L and data from a cross-sectional study in Singapore (n = 163) to map onto EQ-5D-5L. Direct mapping using linear regression, mixture beta regression and adjusted limited dependent variable mixture models (ALDVMMs) and response mapping using seemingly unrelated ordered probit models were performed. The KDQOL-36 subscale scores, i.e., physical component summary (PCS), mental component summary (MCS), three disease-specific subscales or their average, i.e., kidney disease component summary (KDCS), and age and sex were included as the explanatory variables. Predictive performance was assessed by mean absolute error (MAE) and root mean square error (RMSE) using 10-fold cross-validation. Results Mixture models outperformed linear regression and response mapping. When mapping to EQ-5D-3L, the ALDVMM model was the best-performing one for France, Germany and Spain while beta regression was best for Italy. When mapping to EQ-5D-5L, the ALDVMM model also demonstrated the best predictive performance. Generally, models using KDQOL-36 subscale scores showed better fit than using the KDCS. Conclusions This study adds to the growing literature suggesting the better performance of the mixture models in modelling EQ-5D and produces algorithms to map the KDQOL-36 onto EQ-5D-3L (for France, Germany, Italy, and Spain) and EQ-5D-5L (for Singapore).

Purpose Tinnitus is a chronic medical condition that can result in distress, concentration difficulties, and clinical depression. An effective, objective measure of tinnitus distress does not currently exist. Endocrinal studies into the condition have been few, with those investigating the cortisol awakening response limited in scope. It was hypothesized that distressed individuals with tinnitus would awaken and be unable to effectively prepare for the day ahead due to a blunted cortisol response. Method Twenty individuals with varying tinnitus distress were compared with a control group ( n = 10) in a pilot study, which measured salivary cortisol concentrations on awakening. Multiple exclusion variables were applied. Results In line with previous studies, total cortisol volume (as measured by area under the curve) was not found to be significantly different in the most distressed individuals with tinnitus, F (2, 26) = 0.254, p = .777ns. However, a separate measure of changing cortisol levels—the area under the curve with respect to increase (or AUC i )—was found to be significantly less robust in those individuals reporting the most severe tinnitus distress, F (2, 26) = 7.671, p = .002. This indicates that fewer resources would be available to cope with the demands of the day ahead. Additionally, the AUC i correlated negatively with tinnitus distress later the same day. Conclusions Relationships between proposed objective and self-reported components of self-reported tinnitus distress are considered, with some aspects of tinnitus distress more closely related to physiological mechanisms than others. It is suggested that, with further research, the cortisol awakening response (AUC i ) may be put forward as a credible objective biomarker of tinnitus distress.

Background Reductions in health-related quality of life (HRQoL) in patients with chronic kidney disease (CKD) are thought to be exacerbated by the low hemoglobin (Hb) levels that define anemia, a common complication of CKD. The current analysis evaluated the impact of anemia on HRQoL and work productivity in patients with non-dialysis dependent and dialysis-dependent CKD using real-world data. Methods Data were collected in France, Germany, Italy, Spain, the UK, the USA and China in 2012–2018 in the Adelphi Real World Disease Specific Programme™ for CKD, a large, cross-sectional, survey of physicians and their patients. Patients completed three patient-reported outcomes (PRO) instruments: the EuroQol 5-Dimension 3-level (EQ-5D-3 L), the Kidney Disease Quality of Life (KDQOL-36) instrument and the Work Productivity and Activity Impairment questionnaire. PROs were assessed by CKD stage and Hb levels, and regression analyses were performed with CKD stage and Hb level as independent variables and PROs as outcome variables, while adjusting for age, sex, CKD stage, comorbidities and cardiovascular risk. Results Overall, 5276 patients participated in the survey, including 28% stage 4 and 36% dialysis patients. Patients with lower Hb levels more often reported problems/issues on all EQ-5D-3 L domains (p p p p Conclusions Lower Hb levels worsen the impact of CKD on HRQoL, and are associated with lower work productivity in patients with CKD. Assessment and treatment of anemia should be recognized as a key component of integral CKD management throughout all stages of the disease.

Visual-inertial navigation methods have been shown to be an effective, low-cost way to operate autonomously without GPS or other global measurements, however most filtering approaches to VI suffer from observability and consistency problems. To increase robustness of the state-of-the-art methods, we propose a three-fold improvement. First, we propose the addition of a linear drag term in the velocity dynamics which improves estimation accuracy. Second, we propose the use of a partial-update formulation which limits the effect of linearization errors in partially-observable states, such as sensor biases. Finally, we propose the use of a keyframe reset step to enforce observability and consistency of the normally unobservable position and heading states. While all of these concepts have been used independently in the past, our experiments demonstrate additional strength when they are used simultaneously in a visual-inertial state estimation problem.In this paper, we derive the proposed filter and use a Monte Carlo simulation experiment to analyze the response of visual-inertial Kalman filters with the above described additions. The results of this study show that the combination of all of these features significantly improves estimation accuracy and consistency.

INTRODUCTION AND OBJECTIVES:Platelet rich plasma (PRP) is a novel therapeutic increasingly promote for various indications, including several within urology. PRP is a platelet concentrate extracted...

INTRODUCTION AND OBJECTIVES:Drug-induced nephrotoxicity often occurs in the patients with existing renal dysfunction or renal ischemia, potentially leading to chronic kidney disease (CKD). Prompt t...

Sara Bruce Wirta,1 Bogdan Balas,2 Catia C Proenca,3 Hollie Bailey,4 Zoe Phillips,4 James Jackson,4 Sarah Cotton4 1Real World Evidence, Cardio-Metabolic Franchise, Novartis Sweden, Stockholm, Sweden; 2Real World Evidence, Cardio-Metabolic Franchise, Novartis Pharma, Basel, Switzerland; 3Wellmera AG, Basel, Switzerland; 4Real World Research, Adelphi Real World, Bollington, UK Purpose: Explore the extent to which heart failure (HF) symptoms and side effects of HF treatment experienced by patients are recognized by cardiologists, and concordance between patient–cardiologist perceptions of HF severity and patients’ contributions to treatment decision-making. Methods: A multinational, cross-sectional survey of cardiologists and patients with HF was conducted. Patient-record forms (PRFs) were completed by cardiologists for consecutive consulting patients with HF, who completed a patient self-completion questionnaire (PSC). Responses from PRFs with an associated PSC were analyzed to compare patient- and cardiologist-reported occurrences of HF symptoms and treatment side effects, patient-perceived severity of HF and cardiologists’ perceived risk of death within 12 months, and patient input into treatment decisions. Concordance was calculated as the number of response agreements between PSCs and PRFs for total number of matched pairs. Over- or underreporting of symptoms and side effects by cardiologists relative to patient-reported occurrences were calculated. Results: Overall, 2,454 patient–cardiologist pairs were identified. High levels of concordance between matched pairs were observed for the occurrence of reported HF symptoms (93%), side effects (77%–98%) and degree of patient input into treatment decisions (74%); for perceived HF severity, concordance was 54%. Most symptoms (except dyspnea when active and fatigue/weakness, experienced by >50% of patients) were underreported by cardiologists. Of patients reporting to have been informed by their cardiologist that their HF was mild, 28% were perceived by their cardiologist to have a moderate–high/very high risk of death within 12 months. Treatment choice was not discussed with almost a third of patients. When discussed, 94% of patients (n=1,540) reported the cardiologist made the final decision. Cardiologists more often under- than overreported the occurrence of side effects reported by patients. Conclusion: Improved patient–cardiologist dialogue and shared decision-making is required for optimizing patient care and outcomes in HF. Keywords: patient influence, disease awareness, treatment decision-making, patient-reported outcomes, disease-specific program, real world

Temperature regulation in women undergoing emergency caesarean section is a complex topic about which there is a paucity of evidence-based recommendations. The adverse effects of inadvertent peri-operative hypothermia are well described. Hyperthermia is also associated with adverse neonatal outcomes, an increased risk of obstetric intervention and increased treatment for suspected sepsis. We conducted a multi-centre observational cohort study to identify the prevalence of hypothermia and hyperthermia during emergency caesarean section. S: Participants undergoing emergency caesarean section were recruited across 14 sites in the UK. The primary end point was maternal temperature in the recovery room. Temperature was measured using a zero heat-flux temperature monitoring device.Two hundred and sixty-five participants were recruited over a 12-month period. The prevalence of hypothermia (36.0°C) was 10.7% and the prevalence of hyperthermia (37.5°C) was 14.7% on admission to recovery. The prevalence of hypothermia, normothermia, and hyperthermia differed among type of anaesthesia: 71.4% of the hypothermic group had received a spinal anaesthetic whereas 76.9% of the hyperthermic group had received epidural top-up anaesthesia. There was a significant decrease in maternal temperature between the time of delivery and admission to the recovery room of 0.20°C (95% CI 0.15 to 0.25, P0.001).Both hypothermia and hyperthermia are prevalent findings in mothers who undergo emergency caesarean section. Therefore, accurate temperature measurement is essential to ensure that an appropriate intra-operative temperature management strategy is employed.

INTRODUCTION AND OBJECTIVE:Organ-on-a-chip is a microengineered biomimetic system containing microfluidic channels and tissue-specific cell types, which replicate functional units of living organs ...

INTRODUCTION AND OBJECTIVE:Cell-based tissue engineering strategies have gained attention in restoring normal tissue function for reconstructive procedures; however, these approaches require a dono...