Oncology Advanced Practice Providers Chemotherapeutic Prescribing Practices

Background: Physician Assistants (PA) and Nurse Practitioners (NP), referred to as Advanced Practice Providers (APPs), are an integral part of cancer care today in community oncology (ONC) and academic institutions across the country. It has been shown, a team approach using APPs can extend the ONC workforce (PMID: 25009939). The need for ONC services will increase with the rise in cancer incidence and prevalence. As the rise continues, studies have shown ONC services will dramatically increase due to the predicted shortages of oncologists. Increasing the use of APPs is a viable solution to this shortage (PMID: 21037868). PAs and NPs have validated their value by safely prescribing chemotherapy (CT) as they provide cancer care. This value has been key for both patient and physician colleagues. The Association of Physician Assistants in Oncology (APAO) pursued research to better understand CT prescribing practices of ONC PAs. The focus was on whether or not PAs were allowed to prescribe CT drugs in their day to day practice. Methods: A survey was used to collect data. The survey focused on APPs scope of practice to include prescribing CT independently (IND) or were there restrictions by the state or organizations they are employed by. For those allowed to prescribe CT, further questions regarding training programs and time periods to demonstrate competency were asked. The survey also viewed physician and employer attitudes towards APPs prescribing CT. The survey was sent in January 2021 to 1307 APAO members via email with a 30-day collection period. Eleven percent were returned (N=149). Results: Respondents (R) were PAs, 95%, NPs, 3% and other 1%. The majority of R worked in Hematology/Medical ONC, 87%, with fewer in Surgical ONC 6%, Radiation ONC 1%, other 6%. R came from 34 states with the largest number representing Texas, 13%, New York 12%, Pennsylvania, 8%, North Carolina,7%, Massachusetts 6% and Florida 5%. Most of the R had been in ONC for 1-8 years (y) (59%), followed by 9-16 y (21%), 17-24 y (16%), and 25+ y (3%). The survey was divided into two arms, those who could IND sign CT orders and those who could not IND sign CT orders. The survey demonstrated 44% of the R were able to IND sign CT orders and 56 % of the R could not. With regard to work setting, 60% of R in this arm worked in academic ONC centers and 35% worked in community ONC centers. Also in this arm, 23% were only allowed to sign existing CT plans that did not require modification and 77% were not. The majority of R could sign existing CT orders (89%) and fewer could initiate and sign new CT orders (35%). Most R were able to prescribe intravenous and oral medication (98%), while fewer could prescribe intrathecal 34%) and clinical trial medications (49%). Of the R in the second arm, 74% worked at academic ONC centers and 19% worked at community ONC practices. When asked if their state medical board prohibited prescribing CT, the majority (77%) reported this was not the case, then if their institution/facilities prohibited prescribing CT, the majority (69%) reported this was true. To explore physician/employer attitudes, a question was posed to ask the APP if their physicians believe that limiting CT to physicians is a safety measure. Responses were mixed, 36% reporting this is true, 33% reporting this was false and 31% as unsure. Next, the APPs were asked if their physicians believed experienced APPs should be allowed to prescribe CT. Again, responses were mixed, 44% agreeing, while 11% disagreeing. Finally, 44% were unsure. When asked if their employer believed limiting CT to physicians is an important safety measure, 47% of the R reported this is true, 19% R reported this is false and 34% were unsure. When asked if their employer believed experienced APPs should be allowed to prescribe CT, 30% of the R reported this is true, 20% R report this is false and 49% were unsure. Conclusion: CT prescribing privileges, are not universal for APPs and the reason for inconsistencies in prescribing CT is not clear. This survey provided insight to the wide range of prescribing practices throughout the US based on ONC settings, geographic regions, and experience of the APP. As APPs are valued team members in extending the ONC workforce, and prescribing CT is a common practice in cancer care which APPs participate in. This would seem worthy of further research to understand the reasons why such discrepancies exist. Disclosures Diaz Duque: Morphosys: Speakers Bureau; Hutchinson Pharmaceuticals: Research Funding; Incyte: Consultancy; Astra Zeneca: Research Funding; Epizyme: Consultancy; ADCT: Consultancy.

SAFETY MEASURE OF MANDATORY TREATMENT FREEDOM OF ALCOHOLICS (STANDARD AND PRACTICE)

In accordance with modern understandings of criminal law science and solutions present in the comparative criminal legislation, the Criminal Code of the Republic of Serbia pays special attention to security measures as special and above all specific criminal sanctions. They are one of the four types of criminal sanctions provided for in this legal text. Among the eleven security measures, four are of a medical nature and they differ in a number of features, not only in relation to other criminal sanctions, but also other security measures. One of the medical safety measures is the obligatory treatment of alcoholics. There are a number of specifics of this security measure, and one of them is its manner of execution. Given this, the subject of analysis in the paper are two aspects of the safety measure of compulsory treatment of alcoholics. These are: normative and practical. The justification of this approach in the analysis of the subject matter is contained in the fact that only adequately performed and this security measure is in the function of its standardization - the function of eliminating conditions or conditions that may affect the perpetrator in the future does not commit crimes due to alcohol dependence. to the expression of criminal acts of violence that are increasingly present in the total mass of crime.

Autoencoder-Based Semantic Novelty Detection: Towards Dependable AI-Based Systems

Many autonomous systems, such as driverless taxis, perform safety-critical functions. Autonomous systems employ artificial intelligence (AI) techniques, specifically for environmental perception. Engineers cannot completely test or formally verify AI-based autonomous systems. The accuracy of AI-based systems depends on the quality of training data. Thus, novelty detection, that is, identifying data that differ in some respect from the data used for training, becomes a safety measure for system development and operation. In this study, we propose a new architecture for autoencoder-based semantic novelty detection with two innovations: architectural guidelines for a semantic autoencoder topology and a semantic error calculation as novelty criteria. We demonstrate that such a semantic novelty detection outperforms autoencoder-based novelty detection approaches known from the literature by minimizing false negatives.

Urban Greening: An Alternative Mechanism to Address Public Health and Safety in Underserved Communities

Community safety is increasingly understood to be intertwined with public health and quality of life. However, health and safety are often appraised and budgeted independently, impeding the ability of local governments to identify efficient interventions to benefit communities. Urban greening is widely acknowledged to improve public health but is also a cost-effective public safety measure associated with reductions in aggression, violence, and crime. Current research suggests that the physiological and psychosocial factors that mediate the benefits of green spaces fall at the intersection of health and safety. Critically, historically marginalized, low-income, and over-policed neighborhoods are also typically those that most acutely lack urban greenery, exacerbating substandard health and safety outcomes. Investing in green spaces is therefore a promising solution to mitigate existing disparities across both public health and safety sectors. We propose that Los Angeles prioritize urban greenery in underserved neighborhoods as a public safety measure and reallocate funding from law enforcement and incarceration budgets to small-scale changes in green spaces (e.g., sidewalk planting and park maintenance). Green spaces are a promising alternative to traditional public safety methods and would improve the health and safety of disadvantaged neighborhoods, mitigate the harms of heat and pollution, and begin to counteract a history of structurally racist neighborhood policies.

Simulation Study of Rear-End Crash Evaluation considering Driver Experience Heterogeneity in the Framework of Three-Phase Traffic Theory

Driving safety is considered to have a strong relationship with traffic flow characteristics. However, very few studies have addressed the safety impacts in the three-phase traffic theory that has been demonstrated to be an advancement in explaining the empirical features of traffic flow. Another important issue affecting safety is driver experience heterogeneity, especially in developing countries experiencing a dramatic growth in the number of novice drivers. Thus, the primary objective of the current study is to develop a microsimulation environment for evaluating safety performance considering the presence of novice drivers in the framework of three-phase theory. First, a car-following model is developed by incorporating human physiological factors into the classical Intelligent Driver Model (IDM). Moreover, a surrogate safety measure based on the integration concept is modified to evaluate rear-end crashes in terms of probability and severity simultaneously. Based on a vehicle-mounted experiment, the field data of car-following behavior are collected by dividing the subjects into a novice group and an experienced group. These data are used to calibrate the proposed car-following model to explain driver experience heterogeneity. The results indicate that our simulation environment is capable of reproducing the three-phase theory, and the changes in the modified surrogate safety measure are highly correlated with traffic phases. We also discover that the presence of novice drivers leads to different safety performance outcomes across various traffic phases. The effect of driver experience heterogeneity is found to increase the probability of the rear-end crashes as well as the corresponding severity. The results of this study are expected to provide a scientific understanding of the mechanisms of crash occurrences and to provide application suggestions for improving traffic safety performance.

A Study to assess the Effectiveness of Information Booklet on Knowledge regarding First aid and Safety Measure among Early Adolescent age (10 – 14 years) Children in selected schools at Udaipur

Introduction: Basic first aid knowledge helps children to deal with emergency situations. Everyone needs to teach children about being mentally prepared for emergencies. Children should be taught about different first aid measures, both at home and at school, which helps emphasize the importance of child safety. This enables them overcome difficult situations like injuries, burns and outdoor emergencies. First aid is all about using common sense in the hour of need. Objectives of the study: To evaluate the effectiveness of self Instructional module by comparing the pretest and post test knowledge of school children. Method and Material: quantitative pre experimental one group pre test post test research design was used. by using Simple random sampling technique. This study was also done on 120 samples; data was collected by semi structured questionnaire to assess the knowledge regarding First aid and safety measure among Early Adolescent age (10-14 year). Results: The pre test means score was 10.58, standard deviation was 1.71 and the mean % was 52.9. The post test means score was 14.94, standard deviation was 1.39 and the mean % was 74.7. The difference in mean% was 21.8. The calculated ‘t’ value of 22.31 which showed high statistical significance at p<0.001 level. There was no significant association of post test level of knowledge with any of the demographic variables. Regarding First aid and safety measure. Conclusion: The present study assessed the knowledge of school children regarding first aid and safety measures, the school children had inadequate knowledge regarding first aid safety measures. After reading Self Instructional Module, there was a significant improvement in school children knowledge regarding first aid and safety measures.