Blockchain and IoT Technology in Transformation of Education Sector

Technology has impacted every field of life, and Education sector is no exception. It has seen seismic changes off-late. The traditional classroom teaching-learning process involved teachers and students using the black-board approach. But, the past years have seen a change in dynamics of this process. Technology has crept in and has profoundly changed it for better. On one hand, when traditional classrooms had teachers, students and books as players, the current classroom has teachers, students, robots, e-books, laptops and books as the players. Today’s classrooms have enabled the teaching-learning process cross boundaries in the form of e-lectures and tutorials. Massive amount of Information is readily available for the process. Also, a shift from “Teacher-centric” to “Student Centric” can be seen in the current scenario. Several technologies have been key-players in revolutionizing the education sector, but the focus of this paper is concentrated in exploiting the applications of Blockchain and IoT in the sector and identifying the areas where they prove to be beneficial. An extensive literature survey shall be done to understand, and identify how these technologies are a solution to major educational problems. The teaching learning process needs to be understood with respect to various parameters: change in process, change in players, change in outcomes derived, and others. The associated challenges shall also be identified. A detailed analysis of these enables us to conclude that these technologies, can revolutionize the education sector for better in future, particularly Blockchain is young, but, owing to the benefits derived from it, further research and adoption shall for surely change the teaching-learning process.

Decreasing Costs and Clinic Wait Time While Maintaining Safety for Patients Receiving Lenalidomide, Bortezomib, and Dexamethasone (RVD) for Multiple Myeloma

Background Lenalidomide, bortezomib, and dexamethasone (RVD) is a standard front-line regimen for both transplant eligible and ineligible multiple myeloma (MM) patients. Based on original APEX study data, obtaining a complete blood count (CBC) before every administration of bortezomib has been recommended. Waiting for labs could add several hours to each visit. This can be inconvenient and costly for patients, payers, and institutions. There is a clear need to decease the frequency of labs drawn to promote increased cost-savings, improved patient safety, and decreased clinic wait times. Methods The primary objective of this study was to implement and evaluate a process change to decrease the frequency of labs for eligible patients on RVD for MM. First, an institutional review board-approved descriptive, retrospective study that included patients aged ≥ 18 years with MM receiving treatment with RVD was performed to assess trends in lab values. The objective of the retrospective review was to identify patients who can safely receive RVD without repeat labs prior to each bortezomib injection. Results from this retrospective review was presented to Dana-Farber Cancer institute (DFCI) and Massachusetts General Hospital myeloma clinicians, as well as the DFCI Pharmacy and Therapeutics committee. After approval was granted to implement institutional changes, we evaluated the impact of the process change. Results Retrospective study results Eighty-nine patients were included in the study. All patients had a platelet (PLT) count ≥ 75,000 cells/µL on day 1 of cycle 2 and beyond. Grade ≥ 3 thrombocytopenia developed in less than 3% of patients. Greater than 93% patients had an absolute neutrophil count (ANC) ≥ 1,000 cells/µL on day 1 of cycle 2 and beyond. Grade 3 and 4 neutropenia developed in 6.7% and 1.1% of patients, respectively. This study demonstrated that beyond the first cycle, patients with PLTs ≥ 75,000 cells/µL and an ANC ≥ 1,000 cells/µL on the first day of a cycle do not need labs prior to each administration of bortezomib in the cycle. These results provided the rationale for implementation of a new routine workflow. Workflow Implementation Implementation of a new workflow started on July 1, 2021 and included 71 adult patients receiving RVD for MM. First, a communication order was added to all RVD treatment plan templates in the electronic medical record specifying, "if on Day 1: ANC is ≥ 1,000 and PLTs are ≥ 75,000, no labs are required for remainder of that cycle." Following that, a flowchart was developed by nursing that instructed infusion nurses to request a cancelation of future labs within the current treatment cycle (if the patient met criteria). Workflow Evaluation The Centers for Medicare & Medicaid Services reimbursement rates for a comprehensive metabolic panel and CBC with differential is $18.33. Following the implementation of this workflow, we saved over $3,904 in unnecessary healthcare related costs per month (figure 2). The average time it takes for our patients on RVD to check into their lab appointment and have labs resulted is 55 minutes. It takes an average of 47 minutes for patients to have bortezomib administered after labs are reviewed and orders are released for preparation (figure 1). Ultimately, patients spend more than 50% of their time in clinic waiting for labs compared to the time it takes to have bortezomib prepared, delivered, and administered. The implementation of this new workflow resulted in saving 195 hours of clinic chair time per month (figure 2). This time saved results in improved quality of life for patients who already have multiple visits at various healthcare facilities. Spending less time in clinic and reducing the frequency of venipunctures could potentially reduce the risk of bleeding, bruising, and discomfort amongst a patient population that is typically older and more at risk for complications. Conclusion This study demonstrates that it is economical, resourceful, and safe to implement a workflow process aimed at decreasing the frequency of lab draws in patients receiving RVD for multiple myeloma. It allowed our institution to maximize chair time that could be used for other patients and generate additional value-added revenue. This is particularly very important with the Covid-19 pandemic, where reducing several hours of wait time will keep our patients and staff safer. Figure 1 Figure 1. Disclosures Munshi: Legend: Consultancy; Janssen: Consultancy; Abbvie: Consultancy; Adaptive Biotechnology: Consultancy; Karyopharm: Consultancy; Oncopep: Consultancy, Current equity holder in publicly-traded company, Other: scientific founder, Patents & Royalties; Takeda: Consultancy; Amgen: Consultancy; Novartis: Consultancy; Celgene: Consultancy; Pfizer: Consultancy; Bristol-Myers Squibb: Consultancy.

On the choosing the installation location the balancing devices in low-voltage distribution electric networks

The experimental studies result on the power quality and additional power losses analysis caused by the asymmetric modes occurrence in three-phase four-wire 0.38 kV electrical networks are considered. The operating modes 38 kV networks several types simulation – with power take-off nodes distributed along the power line, and an electric network with a concentrated load is carried out. The programs have been developed that allow to assess the change in indicators characterizing asymmetric modes, as well as programs that allow us to visualize this process change. The most installing special symmetrical devices appropriate places in electric networks with a distributed load (rural electric distribution networks) and concentrated power take-off nodes electric networks (urban electric networks) have been identified to minimize losses and improve the power quality. A numerical studied indicators analysis was performed.

Acclimation Response and Ability of Growth and Photosynthesis of Terrestrial Cyanobacterium Cylindrospermum sp. Strain FS 64 Under Combined Environmental Factors

This investigation tested the hypothesis that the native cyanobacteria can acclimatize and grow under the combination of environmental factors and/or how does their process change with the age of culture? Here, we tried to combine multiple factors to simulated what happens in natural ecosystems. We analyzed the physiological response of terrestrial cyanobacterium, Cylindrospermum sp. FS 64 under combination effect of different salinity (17, 80, and 160 mM) and alkaline pHs (9 and 11) at extremely limited carbon dioxide concentration (no aeration) up to 96h. Our evidence showed that growth, biomass, photosystem II, and phycobilisome activity significantly increased under 80 mM salinity and pH 11. In addition, this combined condition led to a significant increase in maximum light-saturated photosynthesis activity and photosynthetic efficiency. While phycobilisomes and photosystem activity decreased by increasing salinity (160 mM) which caused decreased growth rates after 96h. The single-cell study (CLMS microscopy) which illustrated the physiological state of the individual and active-cell confirmed the efficiency and effectiveness of both photosystems and phycobilisome under the combined effect of 80 mM salinity and pH 11.

Shared decision-making to foster same-day discharge for patients with breast cancer undergoing mastectomy with or without immediate implant-based reconstruction.

65 Background: In 2020, over 324,500 cases of invasive and non-invasive breast cancer were diagnosed, of which 36% underwent mastectomies. The post-operative period for these breast cancer patients can be an especially taxing time, not just because of the physical recovery involved, but the associated financial toxicity a patient may face. Consideration of these factors, and a desire to optimize shared decision-making between providers, nursing staff and patients, prompted the breast team at Banner MD Anderson Cancer Center (BMDACC) to coordinate a system change in post-operative planning for mastectomy patients. Methods: Implementing same day discharge (SDD) as a quality improvement process change for breast cancer patients undergoing mastectomy with or without immediate implant-based reconstruction began in December 2018. A collaborative effort to reduce length of stay while maintaining quality and safety was the goal of the process change. Shared decision making was utilized as the methodology for the quality initiative. Open communication and honest expectations of the postoperative management allowed the patient to be actively involved and helped to remove any preconceived notions about the necessity of post-operative hospitalization. A chart review comprised of retrospective data from 2017-2018 and prospective data from 2019-2020 was performed on SDD and admitted (ADM) patients who underwent mastectomy with or without immediate implant-based reconstruction. The SDD group was contacted to voluntarily answer a survey on their outpatient surgical experience using the Consumer Assessment of Healthcare Providers and Systems Outpatient and Ambulatory Surgery Survey (OAS CAHPS) .Results: The utilization of shared decision-making revealed an increase in SDD with no increase in readmission or adverse events (Table). The OAS CAHPS survey was completed by78% SDD; findings revealed 95% of patients responded positively to all questions. Conclusions: For patients undergoing mastectomy, with or without immediate implant-based reconstruction, SDD is a safe and value-based initiative that has been adopted as standard of care at BMDACC. [Table: see text]