Televascular consultation is one answer to rural vascular surgery shortage

Telemedicine provides an opportunity for virtual consultation between physicians and patients in remote locations. We sought to evaluate whether telemedicine consultation for vascular surgery can replace direct visits for patients in remote areas. Patients undergoing telemedicine consultation from 2014–2019 at the Veterans Affairs Medical Center (VAMC) with a large rural catchment area, were reviewed. Primary outcomes included diagnosis, type and number of telemedicine visits, and types of surgical procedures scheduled after initial visit. 574 patients participated in 708 out-patient telemedicine consultations conducted by four vascular surgeons and two advanced practitioners. Visits took place at 21 clinics across Minnesota ( n = 305), North Dakota ( n = 96), South Dakota ( n = 82), Wisconsin ( n = 20), and Iowa ( n = 2) with an average distance of 159 miles from the VAMC. There were 429 (75%) new patient visits and 279 (25%) follow-ups. After initial telemedicine consultation, 236 (55%) patients were booked for procedures. Telemedicine is feasible for vascular surgery consultation and increases patient convenience with decreased overall travel expense and wait time. Telemedicine can be a viable solution to the shortage of vascular surgeons in the rural United States.

Rancang Bangun Sistem Informasi Biaya Perjalanan Dinas

Abstract- Business travel is a routine activity carried out by almost all government agencies in Indonesia. Business travel requires special budgeting costs and at the end of the activity a report on the use of costs or an approved budget is required. Problems encountered in the official travel costs system take quite a long time to produce an effective and efficient travel expense report. Difficulties in monitoring business trips conducted both in terms of cost and time. Searching for travel cost data also takes a long time, making it difficult for auditing of official travel costs. For this reason it is important for all agencies or companies to create information systems that are known to be able to produce reports that are fast, accurate and accurate and able to carry out monitoring of official travel activities undertaken. The results of this study are an information system for official travel financing. Keywords: official travel, cost, information system

Five-Year Follow-up of Safety and Efficacy of a Phase III Randomized Trial of Ofatumumab Therapy Versus Physicians' Choice in Patients with Bulky Fludarabine Refractory Chronic Lymphocytic Leukemia

Background : In 2014, a planned interim analysis of an open-label, two-arm, randomized, phase III study of ofatumumab (OFA) vs physicians' choice (PC) treatment (most patients received rituximab-, alemtuzumab-, alkylator-, or fludarabine-based therapies) in patients with bulky fludarabine-refractory chronic lymphocytic leukemia (BFR CLL) was performed to assess the effectiveness of OFA in the time-period prior to administering small molecule kinase inhibitors. The study did not meet its primary endpoint of progression-free survival (PFS) as assessed by the independent review committee (median PFS 5.4 months vs 3.6 months; hazard ratio [HR]=0.79, 95% confidence interval [CI]: 0.50, 1.24; p=0.268). Here, we report the 5-year follow-up of the study. Methodology : Patients with BFR CLL who required therapy and had received at least 2 prior therapies were randomized (2:1) to receive either OFA or PC therapy. Eligible participants were stratified based on del (17p) status, the Eastern Cooperative Oncology Group (ECOG) Performance Status (0, 1, or 2), and fludarabine-refractory status (no response vs <6 months response).Patients in the OFA arm received an initial dose of 300 mg, followed 1 week (w) later with 2000 mg once weekly for 7 w, followed 4 w later by one infusion of 2000 mg every 4 w for 4 infusions, with total 12 infusions over 24 w. Patients in PC therapy received non-OFA regimen permitted therapies for CLL and standard of care regimens for up to 6 months. After 24 w in the OFA arm, if patients achieved at least stable disease or better, they were further randomized to either OFA extended arm (additional dose regimen of 2000 mg once every 4 w up to 24 w) or OFA observation arm (no further therapy). Patients in PC arm who received OFA after experiencing progressive disease (PD) had an option to receive single-agent OFA therapy in the salvage arm. The primary objective of the study was to evaluate improvement in PFS. The key secondary objectives were overall response rate (ORR), overall survival (OS), and evaluation of safety and tolerability of OFA. Results: After 24 w of OFA treatment, 122 patients who were randomized to PC (n=43) or OFA (n=79) underwent a second randomization (24 continued OFA in the extended arm and 13 stopped OFA in the observation arm). Of the 43 patients who were randomized to PC arm, 22 received OFA salvage therapy at PD. Patient disposition is described in Figure 1. Patients received a median of 6 and 3 treatment cycles in the OFA and PC arms, respectively. The interim analysis of PFS was presented earlier (Osterborg et al., 2016). The investigator-assessed ORR for the OFA and PC arms remained unchanged from the interim analysis (49% vs 37%, respectively). However, in the OFA salvage arm (55%), there was a 5% increase in the investigator-assessed ORR compared to that of the previous analysis. The median OS for the OFA arm vs PC arm was 19.2 months vs 14.5 months (HR=0.75, 95% CI: 0.48, 1.17; p=0.173, log-rank test). The most common adverse events (AEs) in the OFA and PC arms (>15% in either) were neutropenia (21% vs 19%), pneumonia (18% vs 19%), and anemia (9% vs 19%), respectively. Grade 3, 4, and 5 AEs (>10%) in the OFA and PC arms were neutropenia (17% vs 16%), pneumonia (14% vs 9%), febrile neutropenia (9% vs 12%), and anemia (6% vs 14%), respectively. Serious AEs (≥5%) in the OFA and PC arms were pneumonia (13% vs 16%), febrile neutropenia (9% each), pyrexia (5% vs 7%), anemia (3% vs 9%), sepsis (0% vs 9%), autoimmune hemolytic anemia (0% vs 5%), and neutropenic sepsis (1% vs 5%), respectively. There were 8 (10%) on-treatment deaths in the OFA arm and 5 (12%) on-treatment deaths in the PC arm. Post-treatment anti-cancer therapies are described in Table 1. Conclusions: At the 5-year follow-up of this phase III trial, there was a numerical but statistically not significant longer median OS (+4.7 months) in the OFA arm. As only few patients had the chance to receive a kinase inhibitor later, the study displays the survival of BFR CLL patients in the period prior to receiving small molecule inhibitors. This and other studies have demonstrated a longer PFS with the use of low-dose maintenance CD20 monoclonal antibody therapy vs not, a finding that may be re-explored in the new targeted therapeutic landscape in CLL. OFA is a safe option in multi-resistant advanced CLL cases. Disclosures Miklos: AOP Orphan: Honoraria; Novo nordisk: Honoraria. Strugov:Janssen: Honoraria, Other: Travel expense, Research Funding; Abbvie: Other: Travel expense. Lewerin:Abbvie: Consultancy. Grosicki:Affimed: Research Funding. Steurer:Novartis: Consultancy, Honoraria, Research Funding. Montillo:Janssen: Consultancy, Honoraria; AbbVie: Consultancy, Honoraria, Speakers Bureau; Gilead: Consultancy, Honoraria, Speakers Bureau; Roche: Consultancy, Honoraria, Research Funding. Middeke:Roche: Membership on an entity's Board of Directors or advisory committees; Abbvie: Membership on an entity's Board of Directors or advisory committees; Janssen: Membership on an entity's Board of Directors or advisory committees, Research Funding. Stefanelli:Novartis: Employment, Equity Ownership. Vincent:Novartis: Employment. G:Novartis: Employment. Österborg:Beigene: Research Funding; Abbvie: Research Funding; Gilead: Consultancy, Research Funding; Janssen: Research Funding; Pharmacyclics: Research Funding.

Optimal Design of the Feeder-Bus Network Based on the Transfer System

This paper studied the classic feeder-bus network design problem (FBNDP), which can be described as follows: for the passenger travel demand between rail stations and bus stops on a given urban transit network, it designs the optimal feeder bus routes and frequencies so as to minimize the passengers’ travel expense and the operator’s cost. We extended the demand pattern of M-to-1 in most existing researches to M-to-M. We comprehensively considered the passenger travel cost, which includes the waiting and riding cost on the bus, riding cost on rail, and transfer cost between these two transportation modes, and presented a new genetic algorithm that determines the optimal feeder-bus operating frequencies under strict constraint conditions. The numerical examples under different demand patterns have been experienced and analysed, which showed the robustness and efficiency of the presented algorithm. We also found that the distribution pattern of the travel demand has a significant influence on the feeder-bus network construction.

Tampa Electronics: An Instructional Case in Computer-Assisted Fraud Examination

ABSTRACT: This case is designed to impart practical skills in data analysis techniques aimed at fraud examination. Instructors could employ any one of widely available tools such as ACL, IDEA, Microsoft Access, or Picalo, which is an open-source data analysis tool. Couched in the context of a manufacturer of electronic components in the southeastern United States, the case involves the identification of potentially fraudulent travel expense reimbursements. In the case scenario, traveling salespersons submit expense reimbursement claims, which are subject to a number of business rules. Using data analysis techniques, students are required to identify potentially fraudulent travel expense reimbursements. The data analysis techniques covered in the case include basic features such as identifying duplicates and gaps to more advanced features like joining tables, finding unmatched records, filtering data based on various criteria, and classifying and summarizing data. The degree of structure provided to students is within the control of the instructor, with less structure making for a more realistic and challenging assignment. Spreadsheet files containing the travel expense data are designed to facilitate easy changing of numbers between semesters.