Evidence of Improved Knowledge and Skills Among Hematologists/Oncologists Participating in Online CME-Certified Activities

Background: Several regimens are currently available for the treatment of newly diagnosed or relapsed/refractory multiple myeloma (R/R MM). This has subsequently led to the development of a variety of novel management strategies. Because of the rapidly changing treatment landscape, it is challenging for hematologists/oncologists (hem/oncs), particularly those in community-based settings, to stay current on recent data and clinical practice guidelines. Aim: The objective of this study was to determine if a curriculum of online continuing medical education (CME) activities could improve the knowledge, skills, and confidence of hem/oncs as it relates to the treatment of patients with MM. Methods: The curriculum contained online CME-certified activities for clinicians that focused on personalizing treatment, managing adverse events (AEs), and integrating new data and agents into clinical practice for the treatment of MM. All activities were developed with input from a steering committee of expert myeloma physicians and a nurse practitioner. There were 10 activities included in this analysis. The impact of education was examined using a repeated-pair design with a pre-/post-assessment. Questions from all activities were grouped into learning topics. Mean knowledge/skill was calculated across all activities, and included questions designed for longitudinal analysis. Statistical significance was assessed using a McNemar's test (5% significance level, P <.05). Data was collected from when the first activity posted on November 11, 2020 through July 8, 2021. Results: A total of 570 hem/oncs were included in this analysis. A majority practiced in community-based settings (51%), specialized in hematologic malignancies (specialists, 51%), and cared for 1 to 10 patients with MM in a typical month (70%). The percentage of correct responses pre- and post-education across multiple curriculum activities are displayed by subgroup in the Table. Confidence was assessed for various topics on the scale of 1-not confident to 5-very confident. Hem/oncs were considered confident if they rated their confidence a 4 or 5. The pre-/post-education percentage of hem/oncs who were confident (4 or 5 on a scale of 1 to 5) personalizing treatment: 18%/23% academic (P <.01, relative percentage improvement, RI +56%), 17%/31% community (P <.001, RI +82%), 18%/30% specialists (P <.001, RI +67%), 13%/25% average 10 or fewer patients with MM per month (P <.001, RI +91%). Conclusions: The series of CME-certified activities had a significant, positive impact on knowledge, skills, and confidence across all learning themes for all hem/oncs, but especially community-based hem/oncs and specialists in hematologic malignancies. For almost all learning themes, community-based hem/oncs demonstrated similar or higher knowledge/skills post-education than their academic-based counterparts. Community-based hem/oncs also demonstrated larger relative improvements in knowledge/skills than academic-based hem/oncs. Hem/oncs who saw fewer patients with MM on average per month demonstrated a larger relative percentage improvement with these learning themes: foundational knowledge, knowledge of clinical trial data, knowledge of treatment regimens, knowledge of SDM. Hem/oncs who saw a higher number of patients with MM on average per month demonstrated larger relative percentage improvement with these learning themes: knowledge of MRD, skills personalizing treatment, knowledge of AEs, skills managing AEs, skills using SDM. This analysis shows that online CME using multimedia formats can significantly improve the knowledge, skills, and confidence of hem/oncs in multiple areas related to best practices for treating patients with newly diagnosed or R/R MM. The impact on community-based hem/oncs was significant and closed large knowledge and skill gaps compared to their academic peers. Results also suggest the following areas warrant further education: case-based application of treatment options and AE management as well as best practices for individualizing treatment. Acknowledgements: Sukhbir Bahra contributed to data analysis for this research. These CME activities were supported by an independent educational grant from AbbVie, Bristol Myers Squibb, GlaxoSmithKline, Karyopharm Therapeutics, Oncopeptides, and Sanofi Genzyme. Reference: https://www.medscape.org/sites/advances/multiple-myeloma Figure 1 Figure 1. Disclosures Krishnan: BMS: Consultancy, Current equity holder in publicly-traded company, Speakers Bureau; MAGENTA: Consultancy; REGENERON: Consultancy; SANOFI: Consultancy; GSK: Consultancy; JANSSEN: Consultancy, Research Funding; City of Hope Cancer Center: Current Employment; Amgen: Speakers Bureau. Lonial: Takeda: Consultancy, Honoraria, Research Funding; Abbvie: Consultancy, Honoraria; TG Therapeutics: Membership on an entity's Board of Directors or advisory committees; BMS/Celgene: Consultancy, Honoraria, Research Funding; AMGEN: Consultancy, Honoraria; GlaxoSmithKline: Consultancy, Honoraria, Research Funding; Janssen: Consultancy, Honoraria, Research Funding; Merck: Honoraria. Kurtin: Abbvie, Amgen, BMS, Incyte, Pharmacyclics, GSK, AstraZeneca, Takeda: Consultancy, Speakers Bureau. Mikhael: Janssen: Consultancy; Takeda: Consultancy; Sanofi: Consultancy; Karyopharm: Consultancy; Amgen: Consultancy; BMS: Consultancy; Oncopeptides: Consultancy; GSK: Consultancy. Landgren: Amgen: Honoraria; Janssen: Honoraria; Janssen: Research Funding; Janssen: Other: IDMC; Celgene: Research Funding; Amgen: Research Funding; Takeda: Other: IDMC; GSK: Honoraria.

Alternative Using of Fine Aggregate in Concrete with Acid Curing

One of the most widely used construction materials is concrete. Concrete technology is currently developing, one of which is looking for alternative materials concrete forming. This research focuses on the use of slag as a fine aggregate in concrete, especially in environments containing sulfuric and chloride acid. Observations were made by testing compressive strength, indirect tensile strength, and flexural strength, with 171 cylindrical specimens and 27 sample beam specimens. The test results show that the relative percentage of compressive strength of normal concrete on H2SO4 curing against normal curing decreased 1.85% and 2.58% on HCl curing. The biggest reduction in the percentage of concrete compressive strength was found in 30% slag substitution with a value 8.42%, while the percentage reduction in the relative strength of the indirect tensile strength concrete is found in concrete with a slag substitution of 35% with a value 9.26%. As well as the decrease in relative percentage of flexural strength was found in 35% slag substitution with a value 12.84%. Although there is a decrease in each characteristic of concrete, slag material can be used as a constituent for concrete under environmental conditions of sulfuric acid and chloride acid.

The cumulative radiation dose paradigm in pediatric imaging

Medical imaging professionals have an accountability for both quality and safety in the care of patients that have unexpected or anticipated repeated imaging examinations that use ionizing radiation. One measure in the safety realm for repeated imaging is cumulative effective dose (CED). CED has been increasingly scrutinized in patient populations, including adults and children. Recognizing the challenges with effective dose, including the cumulative nature, effective dose is still the most prevalent exposure currency for recurrent imaging examinations. While the responsibility for dose monitoring incorporates an element of tracking an individual patient cumulative radiation record, a more complex aspect is what should be done with this information. This challenge also differs between the pediatric and adult population, including the fact that high cumulative doses (e.g.,>100 mSv) are reported to occur much less frequently in children than in the adult population. It is worthwhile, then, to review the general construct of CED, including the comparison between the relative percentage occurrence in adult and pediatric populations, the relevant pediatric medical settings in which high CED occurs, the advances in medical care that may affect CED determinations in the future, and offer proposals for the application of the CED paradigm, considering the unique aspects of pediatric care.

The empirical formula for calculating the incident air Kerma in intraoral radiographic imaging

Objectives: The aim of this paper is to determine the empirical formula for calculating the incident air kerma (Ki), used as a patient dose descriptor in the intraoral radiographic imaging. Methods: The data for the formula were collected during the regular annual inspection of intraoral dental X-ray units in 2018, 2019 and early 2020. The measurement data of 50 X-ray units were processed to develop the formula. Exposure factors for imaging molars of the upper jaw of an average patient in a clinical setting were used in the measurement. The formula validity was statistically evaluated using coefficient of correlation, standard error of the fitted function and the mean relative percentage deviation. Results: measurement values of the radiation doses and calculated values obtained by using the final formula showed good agreement - the mean relative percentage deviation values less than ±15%. Conclusions: Although there are differences in X-ray units, voltages, manufacturers and device architectures (single-phase and high-frequency), the measurement data comply well with computed ones in all cases.

152 Body Weight Standardized Cull Sow Non-edible Trim Loss Evaluation

Non-edible trim loss has been shown to reduce value in market hogs (Johnson et al., 2013). Non-edible trim loss from pork carcasses results from; adhesions, arthritis, and abscess (Keenlislide, 2005). Sow harvest facilities often encounter sow carcasses having one or more non-edible trim loss factors (Knauer, 2007). Non-edible trim loss observed repeatedly in high levels will result in carcass discounts to the seller. The objective of this study was to evaluate the economic impact of non-edible trim loss from cull sow carcasses. Data were collected as a convenience sample from a Midwestern cull-sow harvest facility. This facility focuses on harvesting high quality animals and harvesting “lean” or “boner” sows occurs relatively infrequently. For this study, trim was expressed as a percentage of carcass weight. At this harvest facility all carcasses have some non-edible trim loss. The average total pre-trim carcass weight was 149 kgs (n = 87). The relative percentage of non-edible trim loss was sorted into quartiles. Based on percent trim and average carcass weight the quartiles were classified as 1st Qu. = normal trim (0.5% – 1.2%, n = 22), 2nd Qu. = low trim (1.2% – 2.1%, n =20), 3rd Qu. = medium trim (2.1% – 3.4%, n = 21), and 4th Qu. = high trim (3.4% – 20.9%, n = 22). A 5-year average cull sow price (USDA, ERS) was utilized to calculate the economic loss represented from each quartile of percentage trim. Normal trim, low trim and medium trim showed to have low economic impact. High trim loss had an average economic loss of $9.37 (s.d. = 6.9) on a standardized basis. Substantial economic losses are observed when high trim is measured. Additional work is needed in identifying significant trim loss prior to harvest.

Relationship among Agroclimatic Variables, Soil and Leaves Nutrient Status with the Yield and Main Composition of Kaffir Lime (Citrus hystrix DC) Leaves Essential Oil

Previous studies revealed the impact growing location has on the quantity and quality of essential oils derived from numerous Citrus spp., except on the kaffir lime. This study aims to analyze the relationship shared by agroclimatic variables and soil-plant nutrient status to kaffir lime leaves essential oil yield and main composition. The experiment was conducted between February and April 2019 in four growing locations, namely Bogor (6°36′36″ S, 106°46′47″ E), West Bandung (6°48′12″ S, 107°39′16″ E), Pasuruan (7°45′5″ S, 112°40′6″ E) and Tulungagung (8°6′27″ S, 112°0′35″ E). The highest essential oil yield was obtained from Bogor (1.5%), while the lowest one was from Tulungagung (0.78%). The yield was positively and significantly correlated with the rainfall, soil organic carbon, soil pH, and macronutrient levels, i.e., nitrogen, phosphorus, and magnesium. Citronellal, the major component in metabolites’ profile of kaffir lime leaves essential oils, was significantly affected by the growing location. The absolute content of citronellal was positively and significantly correlated with the actual soil pH and leaf Ca content; furthermore, it negatively correlated with the leaf content of Fe, Mn, Zn, Cu. Pearson correlation analysis also showed (i) a negative significant correlation between the relative percentage of citronellol and annual rainfall intensity; (ii) a negative significant correlation between altitude and relative percentage of caryophyllene, and (iii) a positive significant correlation between the relative percentage of linalool and leaf K content.

Modification of the Method for Determining Myeloperoxidase in Blood Neutrophils

Myeloperoxidase is a heme-containing peroxidase expressed primarily in neutrophils and to a lesser extent in monocytes. Determining the activity of myeloperoxidase in blood cells is one of the tests of the immune status of animals. Conventional methods are based on the oxidation of benzidine by the peroxide system to the unstable benzidine blue, which spontaneously turns into stable brown benzidine. The aim of this study was to develop a modification of the cytological determination of the myeloperoxidase enzyme using metol. The relative percentage of peroxidase-positive neutrophils in the peripheral blood of animals was determined after 100 neutrophils had been counted. The task was achieved by using the reaction with metol in the method of cytological determination of the activity of neutrophil myeloperoxidase in animal blood smears, which was based on the oxidation of metol by a peroxide system. Images of micropreparations were digitized using a Sony device for processing the received images of the cells. The Image Tool computer program was used for this purpose. The biological substrate was processed from a buffer-incubation mixture with subsequent drying and microscopy. The main new modification of the method was using metol. Metol does not have the ability to inhibit the activity of myeloperoxidase. The research showed easy and fast results. This method is economical and perspective for using in practice. Keywords: myeloperoxidase, blood, neutrophils, metol

Hyperelastic models for the description and simulation of rubber subjected to large tensile loading

Purpose: Rubber is widely used in tires, mechanical parts, and user goods where elasticity is necessary. Some essential features persist unsolved, primarily if they function in excessive mechanical properties. It is required to study elastomeric Rubber's performance, which is operational in high-level dynamic pressure and high tensile strength. These elastomeric aims to increase stress breaking and preserve highly pressurised tensile strength. Design/methodology/approach: The effects of carbon black polymer matrix on the tensile feature of different Rubber have been numerically investigated in this research. Rubber's material characteristics properties were measured using three different percentages (80%, 90%and 100%) of carbon black filler parts per Hundreds Rubber (pphr). Findings: This study found that the tensile strength and elongation are strengthened as the carbon black filler proportion increases by 30%. Practical implications: This research study experimental tests for Rubber within four hyperelastic models: Ogden's Model, Mooney-Rivlin Model, Neo Hooke Model, Arruda- Boyce Model obtain the parameters for the simulation of the material response using the finite element method (FEM) for comparison purposes. These four models have been extensively used in research within Rubber. The hyperelastic models have been utilised to predict the tensile test curves—the accurate description and prediction of elastomer rubber models. For four models, elastomeric material tensile data were used in the FEA package of Abaqus. The relative percentage error was calculated when predicting fitness in selecting the appropriate model—the accurate description and prediction of elastomer rubber models. For four models, elastomeric material tensile data were used in the FEA package of Abaqus. The relative percentage error was calculated when predicting fitness in selecting the appropriate model. Numerical Ogden model results have shown that the relative fitness error was the case with large strains are from 1% to 2.04%. Originality/value: In contrast, other models estimate parameters with fitting errors from 2.3% to 49.45%. The four hyperelastic models were tensile test simulations conducted to verify the efficacy of the tensile test. The results show that experimental data for the uniaxial test hyperelastic behaviour can be regenerated effectively as experiments. Ultimately, it was found that Ogden's Model demonstrates better alignment with the test data than other models.

Stability of the Cross Linking Component of the Biosensor Receptor Layer after Addition of Gold Nanoparticles

In this study, the stability of the receptor layer component of a biosensor after addition of gold nanoparticles was investigated. Accelerated conformational changes under the influence of Au were demonstrated. The relative percentage changes over time between the pure protein and the Au doped protein were calculated. It was shown that these changes are greater with time and exceed 20 % in the last days of the experiment.

68Ga-DOTATOC PET/CT Follow Up after Single or Hypofractionated Gamma Knife ICON Radiosurgery for Meningioma Patients

68Ga-DOTATOC represents a useful tool in tumor contouring for radiosurgery planning. We present a case series of patients affected by meningiomas on who we performed 68Ga-DOTATOC positron emission tomography (PET)/CT pre-operatively, a subgroup of which also underwent a post-operative 68Ga-DOTATOC PET/CT to evaluate the standardized uptake value (SUV) modification after Gamma Knife ICON treatment in single or hypofractionated fractions. Twenty patients were enrolled/included in this study: ten females and ten males. The median age was 52 years (range 33–80). The median tumor diameter was 3.68 cm (range 0.12–22.26 cm), and the median pre-radiotherapy maximum SUV value was 11 (range 2.3–92). The average of the relative percentage changes between SUVs at baseline and follow up was −6%, ranging from −41% to 56%. The SUV was reduced in seven out of 12 patients (58%), stable in two out of 12 (17%), and increased in three out of 12 (25%), suggesting a biological response of the tumor to the Gamma Knife treatment in most of the cases. 68Ga-DOTATOC-PET represents a valuable tool in assessing the meningioma diagnosis for primary radiosurgery; it is also promising for follow-up assessment.