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Health‐related quality of life (HRQOL) is a patient‐reported outcome that assesses the impact of a disease or illness on different domains of a patient's life. Different general and disease‐specific measures can be used to evaluate HRQOL. This article aimed to summarize the evidence for HRQOL among patients with transfusion‐dependent (TDT) and non‐transfusion‐dependent thalassemia (NTDT). We included HRQOL data related to standard therapy with blood transfusions, iron chelation, and/or luspatercept in TDT and NTDT, as well as curative therapies for TDT, including hematopoietic stem cell transplant (HSCT) and gene therapy. Patients with thalassemia had worse HRQOL scores compared to the general population, and chronic pain was seen to increase in frequency and severity over time with age. NTDT patients reported worse physical health and functioning, mental health, general health, and vitality than TDT patients. However, TDT patients reported worse pain, change in health, and social support than NTDT. Most therapies improved overall HRQOL among thalassemia patients. Deferasirox, an oral iron chelator, was associated with more HRQOL benefits compared to deferoxamine, an intravenous iron chelator. Luspatercept showed clinically meaningful improvement in physical functioning among TDT and NTDT. Furthermore, HSCT and gene therapy were associated with better physical, emotional, and mental domains scores. [ABSTRACT FROM AUTHOR]

Sickle cell disease (SCD) is one of the most common inherited blood disorders. Deoxygenated hemoglobin S (HbS) polymerizes and causes anemia and various end organ effects. Voxelotor acts by increasing HbS oxygen affinity, decreasing anemia and hemolysis. Voxelotor is approved for use in individuals with SCD age 4 years and older. Phase 3 trials demonstrated an increase in hemoglobin levels and a decrease in markers of hemolysis; however, data or benefits related to clinical and quality of life outcomes are relatively limited and varied across different studies. This review summarizes the published clinical trials and research studies focused on the use of voxelotor in SCD to provide an evidence-based practical guide for hematology providers on its utilization in clinical settings, including physicians and independent licensed practitioners. [ABSTRACT FROM AUTHOR]

Given that appropriate long-term iron chelation is essential in the treatment of transfusion-dependent anaemias,14,15 deferiprone b.i.d. has the potential to improve treatment adherence and health outcomes in patients with transfusional iron overload. Twenty-seven patients had a primary diagnosis of thalassaemia major, one patient had -thalassaemia/haemoglobin H disease and one patient had sickle -thalassaemia. Fourteen patients reported mild AEs, 13 patients reported moderate AEs and one patient reported a severe AE. Lifelong iron chelation therapy is critical for patients with transfusion-dependent anaemias, and full adherence to therapy is essential to optimise long-term patient outcomes.1,2 Deferiprone is an oral iron chelator with high efficiency in binding and removing excess intracellular and extracellular iron.3,4 Owing to its elimination half-life of approximately 2 h, deferiprone is administered three times daily (t.i.d.) to promote longer extent of exposure and better control of labile iron.5-7 Clinical trial data show adherence rates with deferiprone t.i.d. from 79% to 98%8,9; however, real-world adherence is generally lower than in clinical trials, as the t.i.d. regimen may be inconvenient and the midday dose may often be missed.10-12 The United States Food and Drug Administration recently approved a twice-a-day modified-release formulation of deferiprone (Ferriprox TAD 1000 mg tablet; manufactured by Apotex Inc., Toronto, Ontario, Canada) for the treatment of patients with transfusional iron overload due to thalassaemia syndromes, sickle cell disease or other anaemias.13 In single-dose and multiple-dose pharmacokinetic studies of deferiprone in healthy volunteers (Tables S1 and S2), we found that the twice-daily (b.i.d.) formulation had equivalent 24-h drug exposure to the original immediate-release tablet administered t.i.d. (Figure S1), and exposure was not affected by administration with food (Table S3). [Extracted from the article]

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]

Control haemoglobinopathy blood safety project Keywords: sickle cell disease; thalassaemia; vaccines; iron overload; hepatitis EN sickle cell disease thalassaemia vaccines iron overload hepatitis e160 e164 5 11/30/21 20211201 NES 211201 Non-concordance with preventive recommendations is common among patients with chronic conditions, including sickle cell disease (SCD) and transfusion-dependent thalassaemia (TDT).1,2 Iron overload is common among chronically transfused patients with SCD and TDT leading to increased morbidity, mortality and cost of care, especially as they live longer.3-5 The Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) recommendations support completion of hepatitis A (HepA) and hepatitis B (HepB) vaccinations, including SCD and TDT.6,7 Cardiac iron overload is the leading cause of mortality in TDT,8 while it is rare in SCD.9 Guidelines recommend liver iron overload assessment every 1-2 years for patients with SCD receiving chronic transfusions.10,11 The recommendation for TDT is annual assessment of liver and cardiac iron concentration.3,8 However, there are limited data on concordance with these recommendations. Child/adolescent patients with TDT who were concordant with HepA vaccination recommendations were concordant with the other two preventive service recommendations (Fig 1B). [Extracted from the article]

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]

Poor medication adherence is associated with reduced drug effectiveness, poor health-related quality of life, increased morbidity and mortality, and increased healthcare utilization and cost. Including the patient's voice is essential in understanding barriers to adherence. Useful patient-reported adherence measures are brief, inexpensive, non-invasive; can indicate barriers to adherence; and can be incorporated in electronic health records. The NIH Patient-Reported Outcomes Measurement Information System (PROMIS®) includes high-quality, freely available patient-reported measures covering many important constructs in patient-centered research but does not include a medication adherence measure. To fill this gap, we developed the PROMIS Medication Adherence Scale (PMAS) using the rigorous PROMIS instrument development guidelines. To develop the PMAS, we first conducted a review of the reviews, which enabled us to identify content areas relevant to medication adherence behavior. Then, we conducted qualitative research to elicit patients' views of and experiences with medication adherence. This process identified the following important content areas to guide item writing: extent medication is taken, knowledge of medication regimen, beliefs about medication, remembering to take medication, skipping due to side effects, skipping due to feeling better, and cost of medications. Based on the results of these activities, we wrote items and aimed to retain 1– 2 items per content area. The final item set included 9 total adherence items, which were then refined through intensive comprehension and translatability review, as well as cognitive interviews. Future steps include testing the PMAS's validity. [ABSTRACT FROM AUTHOR]

As avid users of technology, adolescents are a key demographic to engage when designing and developing technology applications for health. There are multiple opportunities for improving adolescent health, from promoting preventive behaviors to providing guidance for adolescents with chronic illness in supporting treatment adherence and transition to adult health care systems. This article will provide a brief overview of current technologies and then highlight new technologies being used specifically for adolescent health, such as artificial intelligence, virtual and augmented reality, and machine learning. Because there is paucity of evidence in this field, we will make recommendations for future research. [ABSTRACT FROM AUTHOR]

• Waste cooking and engine oils (WCO, WEO) were investigated as bitumen rejuvenators. • Optimum percentages of the waste oils were 3.5% for the WCO and 5.5% for the WEO. • Rejuvenated bitumen showed less tendency to short-term aging based on DSR results. • Rejuvenated bitumen by both WCO and WEO had a performance grade of PG 64-28. • Rejuvenated 100% RAP mixes cope with Egyptian limits for stability, flow, and ITS. For sustainable pavement construction, this research paper aims to investigate the feasibility of using Waste Cooking Oil (WCO) and Waste Engine Oil (WEO) as rejuvenators on the rheological properties of aged bitumen extracted from Reclaimed Asphalt Pavement (RAP). The aged bitumen was extracted from milled RAP recruited from an old pavement. The rheological characteristics of the rejuvenated bitumen were determined by penetration, softening point, Brookfield viscosity, Dynamic Shear Rheometer (DSR), and Bending Beam Rheometer (BBR) tests. In addition, the chemical composition of virgin (control), aged and rejuvenated bitumen by WCO, and WEO was investigated using Fourier Transform Infrared Spectroscopy (FTIR) and Energy Dispersive X-ray (EDX). The quality of the rejuvenated bitumen was also evaluated by the Scanning Electron Microscopy (SEM) imaging technique. Based on penetration and softening point testing results, the optimum percentages of the waste oils were found to range from 3.5 to 4.0% for the WCO and from 5.5 to 6.0% for the WEO. The aged bitumen properties were significantly improved by rejuvenators as evidenced by the chemical analysis (FTIR and SEM/EDX) along with the ratio of asphaltenes to maltenes. Furthermore, the surface morphology was renovated as well as the fundamental physical properties of the rejuvenated aged bitumen. Additionally, the rejuvenated bitumen showed less tendency to short-term aging as confirmed by the DSR results. BBR results of rejuvenated aged bitumen samples exhibited comparable performance to those of the control samples at different low temperatures having a performance grade of PG 64-28. Moreover, rejuvenated 100% RAP mixes were found to cope with Egyptian requirements for heavy traffic as binder courses and medium traffic as wearing courses in terms of Marshall stability and flow. Finally, Indirect Tensile Strength (ITS) results were within the specification limits. [ABSTRACT FROM AUTHOR]

In-flight medical emergencies (IMEs) are acute onboard events of illnesses or injuries with potential immediate risk to a passenger’s short- or long-term health, or life. IMEs are significant events that are related to public safety concerns. With the increasing amount of annual air travel every year, it is expected that the number of encountered IMEs will continue to grow. Thus, it will be critical to develop and implement appropriate measures to manage IMEs with the best possible outcome. Despite the fact that most IMEs are self-limited with no serious adverse events, serious IME can lead to death, disability, or other unfavorable health outcomes, particularly as a result of suboptimal medical care. In this article, we systematically reviewed the published up-to-date evidence on the subject of in-flight emergencies with a specific focus on pediatric population. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To determine the factors associated with exercise capacity in adults with sickle cell disease (SCD) and its relationship to hospitalizations and mortality. Methods: A total of 223 participants in the Cooperative Study of Sickle Cell Disease (CSSCD) (64% female, 70% hemoglobin SS/Sβ0 thalassemia, mean age 43.3 ± 7.5 years) underwent maximal exercise testing using a treadmill protocol with a mean duration of 11.6 ± 5.2 minutes. Results: Female sex (β = −3.34, 95% CI [−1.80, −4.88], P < 0.001), older age (β = −0.14, 95% CI [−0.24, −0.04], P = 0.005), higher body mass index (β = −0.23, 95% CI [−0.37, −0.10]; P = 0.001), and lower hemoglobin (β = 0.56, 95% CI [0.08, 1.04], P = 0.02) were independently associated with lower fitness, while there was a trend with abnormal pulmonary function testing (β = −1.42, 95% CI [−2.92, 0.07]; P = 0.06). Lower percent‐predicted forced expiratory volume in 1 second (FEV1) was independently associated with lower fitness (β = 0.08, 95% CI [0.03, 0.13], P = 0.001). Genotype and hospitalization rates for pain and acute chest syndrome (ACS) prior to testing were not associated with exercise capacity. Baseline exercise capacity predicted neither future pain or ACS nor survival in our cohort. Adults with SCD tolerated maximal exercise testing. Conclusions: Prospective studies are needed to further evaluate the impact of regular exercise and improved fitness on clinical outcomes and mortality in SCD. [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]

International Roughness Index (IRI) is an important pavement performance indicator that is widely used to reflect existing pavement condition and ride quality. Due to the importance of this significant index, the current research aims to develop a precise IRI prediction model using the Gaussian Process Regression (GPR) and Locally Weighted Polynomials (LWP). The long-term pavement performance (LTPP) datasets of pavement age, initial IRI, alligator, longitudinal and transverse cracks, standard deviation of rutting, and subgrade plasticity index variables are employed in predicting IRI. These datasets are collected from 126 different flexible pavement sections of the LTPP specific pavement studies (SPS-1) located in different climatic zones in the US. The total number of IRI measurements in the collected database is 925 which covers a wide range of IRI values. Multiple linear regression (MLR) is firstly applied to classify the input variables. Then the MLR model is compared with four machine learning techniques which are GPR, LWP, Particle Swarm Optimization-Adaptive Network based Fuzzy Inference System (PSO-ANFIS) and PSO-Artificial Neural Networks (PSO-ANN). The developed models' performance is validated using different statistical indices, including the coefficient of determination (R 2). The results demonstrate that the GPR ( R 2 = 0. 93) and LWP ( R 2 = 0. 90) outperformed the PSO-ANFIS ( R 2 = 0. 65) and PSO-ANN ( R 2 = 0. 52) in predicting IRI. Thus, the GPR model is found to be more accurate for IRI modeling compared to the hybrid investigated models. [ABSTRACT FROM AUTHOR]

Background. Sickle cell disease (SCD) is a chronic debilitating illness. SCD-related complications result in substantial impairment in quality of life (QOL). Our study objective was to assess the relationship of participants’ characteristics, QOL, hydroxyurea adherence, and SCD-related clinical outcomes in youth with SCD. Procedure. A single-center cross-sectional study. Thirty-four youth with SCD enrolled from clinic between January and December 2015. Participants completed PROMIS® measures and ©Modified Morisky Adherence Scale. Results. Participants had a mean age of 14.8 (SD 2.9) years and 41% were female. Participants’ age correlated with fatigue (rs=0.48; P=0.006), pain (rs=0.32; P=0.07), and anxiety (rs=0.33; P=0.06) scores. Participants with chronic pain had worse upper extremity physical function (P=0.05), pain (P=0.04), anxiety (P=0.05), and depression (P=0.05). Males reported significantly higher hydroxyurea adherence (5.4 versus 3.6, P=0.02) compared to females. Participants with chronic pain had more frequent hospitalizations (P=0.02), emergency room visits (P=0.04), and longer total length of hospital stays over 12-month period (P=0.01). Conclusions. Older and female participants had worse QOL scores, and males reported higher hydroxyurea adherence. Participants with chronic pain reported significant impairment in different QOL domains and had increased healthcare utilization. Future longitudinal studies examining the relationship between participants’ characteristics, QOL, hydroxyurea adherence, and SCD-related clinical outcomes are needed. [ABSTRACT FROM AUTHOR]

Background: Sickle cell disease (SCD) patients have impaired domains of health-related quality of life (HRQOL). Hydroxyurea is safe and efficacious in SCD; however, adherence is suboptimal, and patients' perceptions are poorly understood amongst adolescents and young adults (AYA). Study objectives were to: (1) examine patients' perceptions of SCD and hydroxyurea; and (2) explore the relationship of their perceptions to clinical characteristics, HRQOL domains and hydroxyurea adherence.Methods: Thirty-four SCD patients on hydroxyurea (≥6 months) participated in a single-institution study. Study measures included Brief-Illness Perceptions Questionnaire, ©Modified Morisky Adherence Scale 8-items, and Patient Reported Outcomes Measurement Information System (PROMIS®). We assessed the relationship of patients' perceptions to hydroxyurea adherence using Wilcoxon rank-sum test, the number of hospitalizations using Kruskal-Wallis test, and the number of ED visits, adherence level, HRQOL domain scores using Spearman's rho correlations. We conducted a sub-analysis in HbSS patients to evaluate the relationship of patients' perceptions to laboratory markers of hydroxyurea adherence.Results: Participants were 59% male and 91% Black, and had a median age of 13.5 (range 12-18) years. Participants with ≥4 hospitalizations over 1-year prior (using electronic medical chart review) reported more negative perceptions of SCD-related symptoms and emotional response, and perceived hydroxyurea as less beneficial; all p-values ≤0.01. Most participants (74%) reported low hydroxyurea adherence. Participants with higher hydroxyurea adherence perceived more hydroxyurea benefits (r s = 0.44, p < 0.01) and had better emotional response to SCD (r s = -0.44, p = 0.01). In a sub-analysis of HbSS patients, perceived benefits of hydroxyurea positively correlated with HbF (r s = 0.37, p = 0.05) and MCV values (r s = 0.35, p = 0.05). Participants with more negative perceptions of SCD-related consequences, concerns, and emotional response, and fewer perceived hydroxyurea benefits reported worse fatigue (r s = 0.68; r s = 0.44; r s = 0.74; r s = -0.60), pain (r s = 0.56; r s = 0.54; r s = 0.63; r s = -0.39), anxiety (r s = 0.55; r s = 0.58; r s = 0.56; r s = -0.47), and depression (r s = 0.64; r s = 0.49; r s = 0.70; r s = -0.62), respectively, all p-values <0.05.Conclusions: Dynamics influencing hydroxyurea adherence are multifactorial, and understanding patients' perceptions is critical to overcoming adherence barriers. Patients' favorable perceptions correlated with greater adherence and better HRQOL domain scores. Prospective evaluation of patients' perceptions of SCD and hydroxyurea in relation adherence, HRQOL domains and clinical outcomes is warranted. [ABSTRACT FROM AUTHOR]

Objectives To identify barriers to hydroxyurea adherence (negative beliefs, access, and/or recall barriers), and their relationship to adherence rates and health-related quality of life ( HRQOL) among adolescents and young adults ( AYA) with sickle cell disease ( SCD). Methods A cross-sectional survey was administered to 34 AYAs (12-22 years old) in SCD clinics from January to December 2015. Study measures included Brief Medication Questionnaire, Modified Morisky Adherence Scale 8-items, visual analog scale, and Patient Reported Outcomes Measurement Information System. Results Participants (59% male; 91% Black) had a median age of 13.5 years ( IQR 12-18). Participants reported negative beliefs (32%), recall barriers (44%), and access barriers (32%). Participants with recall barriers reported worse pain ( P=.02), fatigue ( P=.05), and depression ( P=.05). The number of adherence barriers inversely correlated with adherence level using © MMAS-8 ( rs=−.38, P=.02) and VASdose ( rs=−.25, P=.14) as well as MCV ( rs=−.45, P=.01) and HbF% ( rs=−.36, P=.05), suggesting higher hydroxyurea adherence in patients with fewer barriers. Conclusions Patients with fewer barriers to hydroxyurea adherence were more likely to have higher adherence rates and better HRQOL scores. Routine assessment of hydroxyurea adherence and its related barriers could provide actionable information to improve adherence rates, HRQOL, and other clinical outcomes. [ABSTRACT FROM AUTHOR]

Transfusional iron overload represents a substantial challenge in the management of patients with sickle cell disease ( SCD) who receive chronic or episodic red blood cell transfusions. Iron-induced cardiomyopathy is a leading cause of death in other chronically transfused populations but rarely seen in SCD. Study objectives were to: (i) examine the extent of myocardial and hepatic siderosis using magnetic resonance imaging ( MRI) in chronically transfused SCD patients, and (ii) evaluate the relationship between long-term (over the 5 years prior to enrolment) mean serum ferritin ( MSF), spot-ferritin values and liver iron content ( LIC) measured using MRI and liver biopsy. Thirty-two SCD patients (median age 15 years) with transfusional iron overload were recruited from two U.S. institutions. Long-term MSF and spot-ferritin values significantly correlated with LIC by MRI-R2* ( r = 0·77, P < 0·001; r = 0·82, P < 0·001, respectively). LIC by MRI-R2* had strong positive correlation with LIC by liver biopsy ( r = 0·98, P < 0·001) but modest inverse correlation with cardiac MRI-T2* ( r = −0·41, P = 0·02). Moderate to severe transfusional iron overload in SCD was not associated with aberrations in other measures of cardiac function based on echocardiogram or serum biomarkers. Our results suggest that SCD patients receiving chronic transfusions may not demonstrate significant cardiac iron loading irrespective of ferritin trends, LIC and erythropoiesis suppression. [ABSTRACT FROM AUTHOR]

This paper mainly aims at investigating the effect of using multi-wall carbon nanotubes (MWCNTs) as an additive on the rheological properties of asphalt. Pristine (P-MWCNTs) were mixed at 120 °C with control asphalt at contents of 0.5%, 1.0%, 2.0% and 3.0% by asphalt weight. The empirical and rheological properties (using the Superpave testing) of the control and modified asphalts were evaluated at different aging conditions. The rheological properties of the modified asphalts were found to improve with increasing the percentage of P-MWCNTs. The high failure temperature and rutting resistance of both unaged and rolling thin film oven aged (RTFO) modified asphalts increased with increasing P-MWCNTs percentage and became suitable for the Egyptian climatic conditions as required by the Superpave binder characterization. At a given temperature, the fatigue cracking resistance and low temperature cracking resistance decreased with increasing P-MWCNTs percentage. [ABSTRACT FROM AUTHOR]

Highlights: [•] NCHRP1-37A yielded better E * values compared to NCHRP 1-40D model at all binder characterization input levels. [•] NCHRP1-37A E * model with Level 3 binder characterization produced the most accurate and the least biased estimates. [•] Because of the hot desert climate in KSA, care should be taken when using such models for E * predictions. [Copyright &y& Elsevier]

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]

• SEA modified with rPE is sustainable, economic, and ecofriendly alternative. • rPE made SEA stiffer/elastic thus better resistance to rutting/fatigue cracking. • Addition of rPE to SEA improved elastic and viscous properties. This research evaluates the rheological properties of virgin asphalt and sulfur extended asphalt (SEA) modified with two types of recycled plastic waste (rPW). The investigated plastic wastes are the recycled low-density polyethylene (rLDPE) and recycled high-density polyethylene (rHDPE). It also assesses the environmental and economic benefits of recycling such materials. A total of 16 modified binder samples are produced by adding rLDPE and rHDPE modifiers to virgin asphalt and SEA in four different concentrations of 2%, 4%, 6%, and 8% by weight of asphalt. The basic and rheological properties of the virgin and modified asphalts are explored by conventional tests, and advanced rheological tests at different aging conditions. Finally, cost-effectiveness and environmental analyses are conducted. The environmental benefit analysis is performed by comparing carbon and non-methyl volatile organic compound (NMVOC) emission from the various recycled polyethylene (rPE) with the manufacturing process of the same quantities of virgin LDPE and HDPE when used to modify asphalt. The effect of incorporating sulfur into virgin asphalt on the environment is also determined. Results show that modification yields a higher binder complex shear modulus (G*) and a lower loss tangent (tan δ) at all traffic speeds meaning improved rut resistance behavior under heavy traffic loading and high temperature conditions. About 29% reduction in material cost occurs when rPE-modified SEA is used instead of virgin asphalt. The environmental and economic analyses show that using SEA modified with rPE for road construction is an economic, sustainable, and ecological alternative with better performance compared to virgin asphalt. [ABSTRACT FROM AUTHOR]

This study addresses the development of traffic characteristics to facilitate the implementation of the Mechanistic-Empirical Pavement Design Guide (MEPDG) in Idaho. Classification and weight data collected at 25 weigh-in-motion (WIM) sites were procured from Idaho Transportation Department (ITD). Among these 25 sites, only 12 sites were found to have complete and accurate data. Site-specific axle load spectra (ALS), monthly adjustment factors (MAF), vehicle class distribution factors (VCD), and number of axles per truck type were developed. Predicted distresses and International Roughness Index (IRI) based on a typical pavement section and traffic data obtained at the investigated WIM sites (level 1) were compared to predicted distresses/IRI using statewide/national (level 3) default traffic inputs. This comparison revealed that ALS, VCD, and MAF input level have significant impact on longitudinal cracking. Statewide ALS yielded high differences in alligator cracking predictions while MAF and VCD yielded only moderate differences compared to site-specific ALS. Very low prediction differences occurred in rutting when statewide/national default ALS, MAF, and VCD were used as opposed to site-specific data. The level of input of the investigated traffic parameters did not affect IRI. Finally, it was found that statewide/national number of axles per truck can be used instead of site-specific values without sacrificing accuracy of pavement performance predictions. [ABSTRACT FROM AUTHOR]

Acute lymphoblastic leukemia (ALL) is the most common malignancy in children and young adults. Treatment is long and involves 2–3 years of a prolonged maintenance phase composed of oral chemotherapies. Adherence to these medications is critical to achieving good outcomes. However, adherence is difficult to determine, as there is currently no consensus on measures of adherence or criteria to determine nonadherence. Furthermore, there have been few studies in pediatric B-ALL describing factors associated with nonadherence. Thus, we performed a systematic review of literature on oral chemotherapy adherence during maintenance therapy in ALL following PRISMA guidelines. Published studies demonstrated various objective and subjective methods of assessing adherence without generalizable definitions of nonadherence. However, the results of these studies suggested that nonadherence to oral maintenance chemotherapy was associated with increased risk of relapse. Future studies of B-ALL therapy should utilize a uniform assessment of adherence and definitions of nonadherence to better determine the impact of nonadherence on B-ALL outcomes and identify predictors of nonadherence that could yield targets for adherence improving interventions. [ABSTRACT FROM AUTHOR]

The newly Mechanistic-Empirical Pavement Design Guide (MEPDG) allows engineers to design pavement structural layers to sustain predefined limits of distress levels due to traffic loads and environmental conditions based on nationally/locally calibrated performance models. Users are required to input variables related to traffic, environment, and materials. In addition, reliability and limiting values of the distresses are required inputs. MEPDG in its current version is an analysis procedure rather than a design tool. However, it is intended to be also used as a design tool. Thus, the design process of the pavement structure in MEPDG is a trial process. It starts with assuming a structure and material properties and then performing the analysis. If the proposed trail did not meet the criteria, then the material properties and/or layer(s) thicknesses are changed until the design meets the criteria. This paper presents a reference document to assist pavement designers in identifying the most important MEPDG key inputs to modify such that the predicted distresses meet predefined design criteria. Results showed that, pavement structural design should be coupled with the mix design and selection of material properties in order to achieve an economic design complying with the criteria. [ABSTRACT FROM AUTHOR]

The authors focus on the ineffectiveness of the medical flight kit (MFK) in treating children during in-flight medical emergencies (IME). Topics include the challenges of managing paediatric IME, the lack of medical equipment for infants in emergency situations in airlines under the U.S. Federal Aviation Administration (FAA) and European Aviation Safety Agency (EASA), and the need for paediatricians and commercial airlines to improve paediatric IME and ensure medical safety onboard.

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]

Purpose: To examine the relations between patient-reported outcomes (PROs) within a conceptual model for adults with sickle cell disease (SCD) ages 18 – 45 years enrolled in the multi-site Sickle Cell Disease Implementation Consortium (SCDIC) registry. We hypothesized that patient and SCD-related factors, particularly pain, and barriers to care would independently contribute to functioning as measured using PRO domains. Methods: Participants (N = 2054) completed a 48-item survey including socio-demographics and PRO measures, e.g., social functioning, pain impact, emotional distress, and cognitive functioning. Participants reported on lifetime SCD complications, pain episode frequency and severity, and barriers to healthcare. Results: Higher pain frequency was associated with higher odds of worse outcomes in all PRO domains, controlling for age, gender and site (OR range 1.02–1.10, 95% CI range [1.004–1.12]). Reported history of treatment for depression was associated with 5 of 7 PRO measures (OR range 1.58–3.28 95% CI range [1.18–4.32]). Fewer individual barriers to care and fewer SCD complications were associated with better outcomes in the emotion domain (OR range 0.46–0.64, 95% CI range [0.34–0.86]). Conclusions: Study results highlight the importance of the biopsychosocial model to enhance understanding of the needs of this complex population, and to design multi-dimensional approaches for providing more effective interventions to improve outcomes. [ABSTRACT FROM AUTHOR]

Background. Sickle cell disease (SCD) is a hemoglobinopathy with increasing global prevalence resulting in pain episodes and multiorgan complications. Complications of SCD have been shown to adversely impact health-related quality of life (HRQOL) comprised of physical, social, and emotional domains; hence, HRQOL measures can serve as an effective evaluator of disease burden. Hydroxyurea (HU) and other disease-modifying therapies have demonstrated to significantly improve clinical outcomes in patients with SCD. Medication adherence is an essential mediator of the clinical benefits of these therapies; low adherence has been shown to increase disease burden and healthcare utilization. This systematic literature review intends to determine the association between adherence to disease-modifying therapies and HRQOL in patients with SCD. Methods. We found a total of 12 articles involving 788 participants, which included both patients with SCD and caregivers/parents. Adherence was measured using self-report instruments, laboratory markers, such as fetal hemoglobin and mean corpuscular volume, and mHealth medication trackers. HRQOL was measured using self-report instruments. Results. All studies demonstrated a correlation between higher HU adherence and better HRQOL scores. Higher HU adherence was associated with lower pain impact, less frequent pain episodes, less fatigue, and improved physical function and mobility, reflecting better physical HRQOL outcomes. Higher adherence was also associated with improved emotional response, decreased anxiety and depressive symptoms, and better social functioning and peer relationships. In addition, our findings indicated that having less frequent barriers to HU adherence was associated with better HRQOL scores. No studies evaluated HRQOL outcomes in relation to adherence to l-glutamine, voxelotor, or crizanlizumab. Conclusions. Optimizing HU adherence has the potential to improve HRQOL in patients with SCD in addition to reducing healthcare utilization and improving treatment satisfaction. Addressing barriers to HU adherence can positively strengthen the relationship between adherence and HRQOL to potentially improve patient outcomes. [ABSTRACT FROM AUTHOR]

One of the main difficulties with employing recycled asphalt pavement (RAP) in hot mix asphalt (HMA) is bitumen aging; hence, the percentage of RAP in the HMA is limited. This research evaluates the rheological properties of the RAP binder and the performance of HMA containing high RAP content using waste engine oil (WEO) from an Electrical Power Plant as a rejuvenator. The rheological and microstructural properties of the RAP binder and rejuvenated RAP binder were determined in the laboratory. Both the recycled and rejuvenated recycled mixes were tested for Marshall stability, indirect tensile strength, dynamic modulus (E*), and flow number tests. The RAP binder was recovered using two different processes: rotavapor distillation followed by centrifugation (RCRD) and column distillation without centrifugation (RNCCD). The optimal WEO percentages for the RCRD and RNCCD recovery procedures were 0.5% and 3%, respectively. The Marshall test results revealed that adding WEO to the recycled mix enhanced its stability and flow compared to the control mix. The rejuvenated mix containing recovered binder from the RCRD recovery process was found to be better than the rejuvenated mix containing recovered binder from the RNCCD recovery process. The rejuvenated recycled mixes outperformed the recycled mix in terms of moisture resistance, which was evidenced by tensile strength ratio values of 0.88, 0.90, and 0.91 for the control and 0.5% and 3% WEO modified mixes, respectively. Finally, the results of dynamic modulus and flow number testing revealed that the rejuvenated mixes had a modest drop in both the dynamic modulus and flow number compared to the non-rejuvenated mix. [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]

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]

Summary: Depressive symptoms are prevalent in individuals living with sickle cell disease (SCD) and may exacerbate pain. This study examines whether higher depressive symptoms are associated with pain outcomes, pain catastrophizing, interference and potential opioid misuse in a large cohort of adults with SCD. The study utilized baseline data from the 'CaRISMA' trial, which involved 357 SCD adults with chronic pain. Baseline assessments included pain intensity, daily mood, the Patient Health Questionnaire (PHQ), the Generalized Anxiety Disorders scale, PROMIS Pain Interference, Pain Catastrophizing Scale, the Adult Sickle Cell Quality of Life Measurement Information System and the Current Opioid Misuse Measure. Participants were categorized into 'high' or 'low' depression groups based on PHQ scores. Higher depressive symptoms were significantly associated with increased daily pain intensity, negative daily mood, higher pain interference and catastrophizing, poorer quality of life and a higher likelihood of opioid misuse (all p < 0.01). SCD patients with more severe depressive symptoms experienced poorer pain outcomes, lower quality of life and increased risk of opioid misuse. Longitudinal data from this trial will determine whether addressing depressive symptoms may potentially reduce pain frequency and severity in SCD. [ABSTRACT FROM AUTHOR]

Severe acute and chronic pain are the most common complications of sickle cell disease (SCD). Pain results in disability, psychosocial distress, repeated clinic visits/hospitalizations, and significant healthcare costs. Psychosocial pain interventions that teach cognitive and behavioral strategies for managing pain have been effective in other adolescent populations when delivered in person or through digital technologies. Our aim was to conduct a multisite, randomized, controlled trial to improve pain and coping in youth aged 12 to 18 years with SCD using a digital cognitive–behavioral therapy program (iCanCope with Sickle Cell Disease; iCC-SCD) vs Education control. We enrolled 137 participants (ages 12-18 years, 59% female) and analyzed 111 adolescents (107 caregivers), 54 randomized to Education control and 57 randomized to iCC-SCD. Ninety-two percent of youth completed posttreatment assessments and 88% completed 6-month follow-up. There was a significant effect of treatment group (iCC-SCD vs Education) on reduction in average pain intensity from baseline to 6-month follow-up (b = −1.32, P = 0.009, 95% CI [−2.29, −0.34], d = 0.50), and for the number of days with pain, adolescents in the iCC-SCD group demonstrated fewer pain days compared with the Education group at 6-month follow-up (incident rate ratio = 0.63, P = 0.006, 95% CI [0.30, 0.95], d = 0.53). Treatment effects were also found for coping attempts, momentary mood, and fatigue. Several secondary outcomes did not change with intervention, including anxiety, depression, pain interference, and global impression of change. Future studies are needed to identify effective implementation strategies to bring evidence-based cognitive–behavioral therapy for sickle cell pain to SCD clinics and communities. [ABSTRACT FROM AUTHOR]

Summary: Sickle cell disease (SCD) is an inherited red blood cell disorder associated with frequent painful events and organ damage. Hydroxyurea (HU) is the recommended evidence‐based treatment of SCD. However, among patients eligible for HU, prescription rates are low. Utilizing a scoping review approach, we summarized and synthesized relevant findings regarding provider barriers and facilitators to the prescription of HU in youth and adults with SCD and provided suggestions for future implementation strategies to improve prescription rates. Relevant databases were searched using specified search terms. Articles reporting provider barriers and/or facilitators to prescribing HU were included. A total of 10 studies met the inclusion criteria. Common barriers to the prescription of HU identified by providers included: doubts around patients' adherence to HU and their engaging in required testing, concerns about side effects, lack of knowledge, cost and patient concerns about side effects. Facilitators to the prescription of HU included beliefs in the effectiveness of HU, provider demographics and knowledge. Findings suggest significant provider biases exist, particularly in the form of negative perceptions towards patients' ability to adhere to taking HU and engaging in the required follow‐up. Improving provider knowledge and attitudes towards HU and SCD may help improve low prescription rates. [ABSTRACT FROM AUTHOR]

Hydroxyurea is the only medication approved by the U.S. Food and Drug Administration for sickle cell disease, and there is strong evidence to support the efficacy and the cost effectiveness of using hydroxyurea is patients with sickle cell disease by increasing fetal hemoglobin levels. It is important to clarify the relationship between patients' nutritional status/intake and fetal hemoglobin levels. In particular, hydroxyurea has been recommended for patients with poor growth, and the recent guidelines from the National Institute of Health suggested offering hydroxyurea to patients as young as nine month old of age. [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]

Highlights • New resilient modulus master surface approach was developed. • The approach characterizes both granular pavement materials and subgrade soils. • The approach considers the effect of stress state and moisture content levels. • The proposed master surface-2018 model produces accurate predictions. Abstract Resilient modulus is a fundamental material property used for pavement materials characterization. A new methodology for predicting the resilient modulus of unbound/stabilized pavement materials and subgrade soils is developed based on a master surface function at a reference water content. The resilient modulus measurements at different levels of water content are shifted horizontally with respect to the octahedral shear stress, and bulk normal stress; simultaneously. A total of 2754 resilient modulus laboratory measurements, obtained from literature, for five granular base materials, four subgrade soils, one recycled crushed concrete material, and three cement-treated stabilized fine materials are used to evaluate the proposed Master Surface model for the resilient modulus prediction as a function of the stress state, and water content. The proposed predictive methodology is compared to well-known models from literature. The comparison of the investigated models exhibits that the Master Surface model has the most precise and unbiased predictions after numerically optimizing the resilient modulus data. [ABSTRACT FROM AUTHOR]

This study presents a mode choice (MC) behavioural model for individuals' trips in Mansoura City in Egypt. Mansoura city lies in the delta region and considered as one of the most crowded cities in Egypt. The absence of effective application of urban transportation planning process in the city results in deficiencies in choosing the suitable transport policies to reduce the transportation related problems resulting from urban development and fast population increase. Mansoura does not have a transportation model; hence, developing a mode choice model for the city is considered very crucial for predicting the use of each mode, and the factors that affect selecting a specific mode. Around 10,000 online questionnaires were collected in 2015 using Google Forms. These questionnaires represent around 30,000 individual trips. In this study, only persons older than 13-years old were considered (i.e., 15,265 records). Two-thirds of the data were randomly selected and used in developing the MC model and the remaining one-third was used in validating the developed model. The developed model covers the five main modes of transportation currently employed in the city, which are Private car, Taxi, Microbus, Walking, and others. The results indicate that the developed model exhibits a good fit for the data with prediction accuracy of about 85%. Moreover, the model shows that total travel time, total cost, ownership of transport means, driving license ownership, occupational status, residence status, gender, and personal income are the main factors that significantly affect the choice of transport modes. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "A multinational trial of prasugrel for sickle cell vaso-occlusive events" by Matthew M. Heeney and colleagues in the February 18, 2016 issue.

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]

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]

Objectives: Discrete choice experiments (DCEs) are increasingly used to elicit preferences for health and healthcare. Although many applications assume preferences are homogenous, there is a growing portfolio of methods to understand both explained (because of observed factors) and unexplained (latent) heterogeneity. Nevertheless, the selection of analytical methods can be challenging and little guidance is available. This study aimed to determine the state of practice in accounting for preference heterogeneity in the analysis of health-related DCEs, including the views and experiences of health preference researchers and an overview of the tools that are commonly used to elicit preferences.Methods: An online survey was developed and distributed among health preference researchers and nonhealth method experts, and a systematic review of the DCE literature in health was undertaken to explore the analytical methods used and summarize trends.Results: Most respondents (n = 59 of 70, 84%) agreed that accounting for preference heterogeneity provides a richer understanding of the data. Nevertheless, there was disagreement on how to account for heterogeneity; most (n = 60, 85%) stated that more guidance was needed. Notably, the majority (n = 41, 58%) raised concern about the increasing complexity of analytical methods. Of the 342 studies included in the review, half (n = 175, 51%) used a mixed logit with continuous distributions for the parameters, and a third (n = 110, 32%) used a latent class model.Conclusions: Although there is agreement about the importance of accounting for preference heterogeneity, there are noticeable disagreements and concerns about best practices, resulting in a clear need for further analytical guidance. [ABSTRACT FROM AUTHOR]

Summary: It is not known whether obesity has a differential effect on allogeneic haematopoietic cell transplantation outcomes with alternative donor types. We report the results of a retrospective registry study examining the effect of obesity [body mass index (BMI) > 30] on outcomes with alternative donors (haploidentical related donor with two or more mismatches and receiving post‐transplant cyclophosphamide [haplo] and cord blood (CBU)] versus matched unrelated donor (MUD). Adult patients receiving haematopoietic cell transplantation for haematologic malignancy (2013–2017) (N = 16 182) using MUD (n = 11 801), haplo (n = 2894) and CBU (n = 1487) were included. The primary outcome was non‐relapse mortality (NRM). The analysis demonstrated a significant, non‐linear interaction between pretransplant BMI and the three donor groups for NRM: NRM risk was significantly higher with CBU compared to haplo at BMI 25–30 [hazard ratio (HR) 1.66–1.71, p < 0.05] and MUD transplants at a BMI of 25–45 (HR, 1.61–3.47, p < 0.05). The results demonstrated that NRM and survival outcomes are worse in overweight and obese transplant recipients (BMI ≥ 25) with one alternative donor type over MUD, although obesity does not appear to confer a uniform differential mortality risk with one donor type over the other. BMI may serve as a criterion for selecting a donor among the three (MUD, haplo and CBU) options, if matched sibling donor is not available. [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]

• Recycled Plastic Waste (RPW) improved virgin (VA) & sulfur extended asphalt (SEA). • RPW made VA&SEA stiffer/elastic thus better resistance to rutting/fatigue cracking. • Addition of RPW to VA&SEA slowed the oxidation reactions of the binder. • Addition of RPW to VA&SEA made binder more suitable for wider range of temperature. • The modification effect of RPW on asphalt included chemical and physical processes. This study examines the effect of two different recycled plastic waste (RPW) which are high and low-density polyethylene (RHDPE and RLDPE) on the rheological/viscoelastic characteristics and aging performance of virgin asphalt and sulfur extended asphalt (SEA). Four dosages of the RPW additives representing 2%, 4%, 6%, and 8% by weight of the asphalt binder were investigated. The rheological characteristics of the RPW modified binders (virgin and SEA) are characterized at original and short-term aging conditions through the Rotational Viscometer (RV) and dynamic shear rheometer (DSR) tests. Fatigue performance is also characterized at the long-term aging condition. Also, high-temperature performance, dynamic storage stability (DSS), multiple stress creep and recovery (MSCR) are studied. Testing results show that RPWs lead to improved rutting and fatigue performance. Adding RPW to the virgin and SEA binders slows the binder oxidation reactions during the short-term aging. The Aging Index (AI) is found to be dependent on the asphalt rheological properties, amount/type of RPW, binder type, and temperature. RHDPE leads to an unstable modified virgin asphalt. Less than 4% RHDPE or 8% RLDPE with virgin asphalt show good DSS in terms of degradation and separation. The RPW with SEA meets the requirement of time degradation and separation set by the Federal Highway Administration (FHWA). The temperature susceptibility of asphalt binder decreases dramatically with the RPW modification making the asphalt binder more suitable for use at a wider range of temperatures. [ABSTRACT FROM AUTHOR]

Background: The association of community factors and outcomes after hematopoietic cell transplantation (HCT) has not been comprehensively described. Using the County Health Rankings and Roadmaps (CHRR) and the Center for International Blood and Marrow Transplant Research (CIBMTR), this study evaluated the impact of community health status on allogeneic HCT outcomes. Methods: This study included 18,544 adult allogeneic HCT recipients reported to the CIBMTR by 170 US centers in 2014‐2016. Sociodemographic, environmental, and community indicators were derived from the CHRR, an aggregate community risk score was created, and scores were assigned to each patient (patient community risk score [PCS]) and transplant center (center community risk score [CCS]). Higher scores indicated less healthy communities. The impact of PCS and CCS on patient outcomes after allogeneic HCT was studied. Results: The median age was 55 years (range, 18‐83 years). The median PCS was –0.21 (range, –1.37 to 2.10; standard deviation [SD], 0.42), and the median CCS was –0.13 (range, –1.04 to 0.96; SD, 0.40). In multivariable analyses, a higher PCS was associated with inferior survival (hazard ratio [HR] per 1 SD increase, 1.04; 99% CI, 1.00‐1.08; P =.0089). Among hematologic malignancies, a tendency toward inferior survival was observed with a higher PCS (HR, 1.04; 99% CI, 1.00‐1.08; P =.0102); a higher PCS was associated with higher nonrelapse mortality (NRM; HR, 1.08; 99% CI, 1.02‐1.15; P =.0004). CCS was not significantly associated with survival, relapse, or NRM. Conclusions: Patients residing in counties with a worse community health status have inferior survival as a result of an increased risk of NRM after allogeneic HCT. There was no association between the community health status of the transplant center location and allogeneic HCT outcomes. A new community risk score for hematopoietic cell transplant recipients, derived from a large publicly available database (the County Health Rankings and Roadmaps), has been developed to describe the community health status of patients and transplant centers. A patient community risk score is associated with nonrelapse mortality and overall survival; however, a center community risk score is not associated with transplant outcomes. [ABSTRACT FROM AUTHOR]

Background: Upfront autologous hematopoietic stem cell transplantation (AHCT) remains an important therapy in the management of patients with multiple myeloma (MM), a disease of older adults. Methods: The authors investigated the outcomes of AHCT in patients with MM who were aged ≥70 years. The Center for International Blood and Marrow Transplant Research (CIBMTR) database registered 15,999 patients with MM in the United States within 12 months of diagnosis during 2013 through 2017; a total of 2092 patients were aged ≥70 years. Nonrecurrence mortality (NRM), disease recurrence and/or progression (relapse; REL), progression‐free survival (PFS), and overall survival (OS) were modeled using Cox proportional hazards models with age at transplantation as the main effect. Because of the large sample size, a P value <.01 was considered to be statistically significant a priori. Results: An increase in AHCT was noted in 2017 (28%) compared with 2013 (15%) among patients aged ≥70 years. Although approximately 82% of patients received melphalan (Mel) at a dose of 200 mg/m2 overall, 58% of the patients aged ≥70 years received Mel at a dose of 140 mg/m2. On multivariate analysis, patients aged ≥70 years demonstrated no difference with regard to NRM (hazard ratio [HR] 1.3; 99% confidence interval [99% CI], 1‐1.7 [P =.06]), REL (HR, 1.03; 99% CI, 0.9‐1.1 [P = 0.6]), PFS (HR, 1.06; 99% CI, 1‐1.2 [P = 0.2]), and OS (HR, 1.2; 99% CI, 1‐1.4 [P =.02]) compared with the reference group (those aged 60‐69 years). In patients aged ≥70 years, Mel administered at a dose of 140 mg/m2 was found to be associated with worse outcomes compared with Mel administered at a dose of 200 mg/m2, including day 100 NRM (1% [95% CI, 1%‐2%] vs 0% [95% CI, 0%‐1%]; P =.003]), 2‐year PFS (64% [95% CI, 60%‐67%] vs 69% [95% CI, 66%‐73%]; P =.003), and 2‐year OS (85% [95% CI, 82%‐87%] vs 89% [95% CI, 86%‐91%]; P =.01]), likely representing frailty. Conclusions: The results of the current study demonstrated that AHCT remains an effective consolidation therapy among patients with MM across all age groups. Upfront autologous hematopoietic stem cell transplantation (AHCT) remains an important therapy for the management of patients with multiple myeloma, which is a disease of older adults. The results of the current large database study confirm that AHCT remains an effective consolidation therapy in fit older adults aged ≥70 years. [ABSTRACT FROM AUTHOR]

The main goal of this study is to assess the technical viability of using cement dust as part of the fines percentage in the unbound granular base/subbase pavement layers' and subgrade soil as a viable sustainable solution. This study investigates the effect of adding cement dust to five types of pavement road materials which are collected from different ongoing roadway construction projects (1) Reclaimed Asphalt Pavement (RAP), (2) crushed stone base aggregates, (3) blend of crushed stone base aggregates with RAP, (4) crushed stone subbase aggregates, and (5) sandy subgrade soil. The resilient modulus (Mr) is selected as the main characteristic for evaluating the investigated materials' stiffness. The regression parameters (k1, k2, and k3) of the universal Mr prediction model are found by fitting the experimental results of Mr testing for two replicates per each material type. The r esults show that using 3-5% of cement dust improves the estimated Mr of the investigated base/subbase materials and subgrades at the anticipated field stresses b y 8-21%.,As a result the structural layer coefficients are enhanced by 11-17%. KENLAYER nonlinear damage analysis confirms that using 3-5% of cement dust improves the predicted rutting life by up to 12% and the fatigue life up to 27%. Based on a typical pavement structure, enhancing pavement base/subbase layers and subgrade soils with 3-5% of cement dust reduces asphalt layer thickness from 11.25 to 12.50% and increases base/subbase layer thickness from 8.75 to 12.50% to maintain the same predicted rutting and fatigue lives of the typical structure. This positively affects the total construction cost in addition to the ecological benefits. [ABSTRACT FROM AUTHOR]