Olathe Medical Center

With growth in customer demand and market competition it is more important than ever to improve the speed and accuracy of all interconnected functions in the supply chain[1]. In every domain involving supply chain, effective storage and retrieval of products in a warehouse in critical to the success of overall supply chain. Effective warehouse automation not only improves overall supply chain efficacy, but it also reduces various costs like warehouse operations cost, inventory holding cost, cost incurred due to damaged product. With advancement in technology, we have seen warehouse operations evolve from manual handling to multiple sophisticated robots working simultaneously to complete the work[1]. Irrespective of advancement, the basic requirement from automation remains same. In this paper, I try to present a basic automation of a warehouse which would address the basic requirements from an automation like safe handling of product and quicker fulfillment of order. Any sophisticated system can be built upon this fundamental building blocks.

Bispecific antibodies (BsAbs) have shown promise in the management of relapsed/refractory multiple myeloma (MM). Despite its efficacy, this class of drugs is associated with significant toxicities. In this study, we conducted a pooled analysis of the available clinical trials on BsAbs for the treatment of MM, including full publications and abstracts until April 2025. BsAbs were classified into two groups: B-cell maturation antigen (BCMA), and GPRC5D/FcRH5 BsAbs. Welch’s t-test was performed to compare the safety profiles of each agent. For clustering, we used principal component analysis (PCA). Our study analyzed 22 trials involving 2374 patients with MM from early 2023 to April 2025. Among these, 1276 patients received BCMA BsAbs, 841 treated with GPRC5D/FcRH5 BsAbs, 157 received teclistamab + talquetamab, and 65 patients received a talquetamab + daratumumab, and 35 patients received talquetamab + pomalidomide. The median follow-up for all groups was 11.83 months. Among all-grade hematologic adverse events (AEs), neutropenia occurred in 40.4%, anemia in 39.2%, thrombocytopenia in 21.4%, lymphopenia in 19.2%, infections in 45.8%, and cytokine release syndrome (CRS) in 65%. For grade 3/4 AEs, infections occurred in 20.3%, CRS in 1.5%, neutropenia in 35.2%, anemia in 24.5%%, thrombocytopenia in 13.5%, and lymphopenia in 17.7%. CRS and the need for tocilizumab were significantly less frequent with BCMA BsAbs vs GPRC5D/FcRH5 BsAbs, (P < 0.002). Skillings Mack (Generalized Friedman’s) findings emphasized substantial distinctions between BCMA and GPRC5D/FcRH5×CD3 in both overall and severe grade 3/4 AEs (p ≤ 0.0002). PCA revealed agents with all grades and grade 3/4 showed similar clustering patterns except for three agents. Overall, our findings demonstrated the excellent efficacy on the use of BsAbs in MM; however, these agents have been linked to a unique AE profile. GPRC5D/FcRH5 are associated with less grade 3/4 hematologic toxicity whereas BCMA BsAbs were associated with lower grade 3/4 CRS rates, compared to GPRC5D/FcRH5. These insights are crucial for guiding treatment decisions and developing strategies to improve patient outcomes.

e19510 Background: Colitis, an inflammation of the colon, is a significant adverse event (AE) increasingly seen in patients with multiple myeloma treated with novel immunotherapies, such as bispecific antibodies (e.g., teclistamab) and CAR T-cell therapies (e.g., ciltacabtagene). While these treatments have improved management of hematological malignancies, they are often associated with gastrointestinal toxicities, including colitis. If left untreated, colitis can lead to severe complications, such as prolonged hospitalizations, increased morbidity, and even death. Understanding the incidence, clinical manifestations, and outcomes of colitis-related AEs is vital for optimizing management strategies. Methods: This retrospective analysis compares clinical manifestations and outcomes of colitis in patients treated with teclistamab, ciltacabtagene, and idecabtagene, using FDA-reported AEs from Q1 2020 to Q3 2024. Colitis cases, including immune-mediated enterocolitis and Clostridium difficile infections, were analyzed for frequency, severity, and outcomes such as hospitalization, death, and recovery. The study also examined potential risk factors for these AEs, considering the complexity of immunotherapies. Results: Out of 5,525 patient reports, teclistamab was associated with 1,885 reports, ciltacabtagene with 1,770 reports, and idecabtagene with 870 reports. Teclistamab had the highest colitis incidence at 0.85%, including 5 Clostridium difficile cases (0.26%) and 2 immune-mediated enterocolitis cases (0.11%). Ciltacabtagene had 13 colitis cases (0.73%), with a broader range of GI issues like Crohn’s disease and ulcerative colitis. Idecabtagene had 0.57% colitis cases, primarily Clostridium difficile. Teclistamab had 23 hospitalizations (1.22%) and 5 deaths (0.27%), while ciltacabtagene showed 21 hospitalizations (1.19%) and 7 deaths (0.40%), indicating a higher mortality rate. Idecabtagene had the lowest incidence of both hospitalizations (3, 0.34%) and deaths (1, 0.11%), suggesting a more favorable safety profile. Conclusions: This analysis reveals notable differences in colitis-related AEs among patients treated with teclistamab, ciltacabtagene, and idecabtagene. Teclistamab showed the highest rates of severe colitis, including immune-mediated enterocolitis and Clostridium difficile infections. Ciltacabtagene had a broader spectrum of GI-related AEs and higher mortality rates, requiring careful monitoring. Idecabtagene demonstrated a milder safety profile, suggesting it may be more suitable for patients at higher risk for GI toxicities. These findings highlight the need for drug-specific risk assessments, vigilant monitoring, and further research to improve patient outcomes and understand the mechanisms of GI AEs.

ABSTRACT In this article, multiple circularly polarised (CP) stacked patch antenna designs are proposed with different perturbation techniques that can be used in future CubeSat missions using NASA Near Earth Network (NEN) or Deep Space Network (DSN) ground stations. The stacked patches with different perturbations aim to optimise the axial ratio bandwidth of the antennas to cover both uplink and downlink frequency bands of NASA NEN/DSN. Combining the axial ratio bandwidth of the two stacked patches, proposed antennas can be made wideband or dual‐band to replace multiple antenna systems for uplink and downlink communications. Proposed CP antennas provide the solution to overcome some of the major design challenges, such as antenna placement, limited space for solar cells and mass/volume constraints of CubeSats. The proposed antennas achieve axial ratio (AR) 3 dB bandwidths of 1.2–1.33 GHz (16%–17%) covering the X band uplink and downlink frequencies of NASA NEN. A dual‐band antenna covering the uplink and downlink of NASA DSN is also achieved using the stacked patch antenna design. Alongside a wide axial ratio bandwidth, the antennas also offer a wide axial ratio beamwidth (maximum achieved ) and high RHCP gain (maximum 8.05 dBic gain achieved) RHCP gain. Results of the proposed designs were validated through prototype fabrication and measurements.

This study evaluated four different formulations of itraconazole and amiodarone. Formulation 1 was Vida's combination tablet containing both active pharmaceutical ingredients (APIs). Formulation 2 was separate, commercially available human generic capsules and tablets of itraconazole and amiodarone, respectively. Formulation 3 was separate, compounded suspensions of itraconazole and amiodarone. Formulation 4 was a compounded chewable tablet of itraconazole. Eight female dogs were dosed with 5 mg/kg of itraconazole and 15 mg/kg amiodarone (except for formulation 4, which only received 5 mg/kg itraconazole) once weekly for 4 weeks using a modified Latin Square design, ensuring that all dogs received all formulations with a 7-day washout between treatments. Animals were fasted overnight prior to each dose administration, with food returned to all animals 4 h post-dose. Blood samples (3 mL) were collected pre-treatment (0) and at appropriate time points over 72 h after each dose for a total of 14 samples per dog per treatment. There was high variability in the serum concentration data within treatment groups for itraconazole. The compounded suspensions were difficult to dose due to the nature of the formulations. The volumes dosed were accurate and consistent, but the suspension was thin and settled immediately when shaking was stopped for both itraconazole and amiodarone. All serum samples following itraconazole chewable tablet administration were not detectable or just above itraconazole's LOQ and thus did not allow for pharmacokinetic determination.

Maturity at harvest is an important determinant of fruit quality in kiwiberry [ Actinidia arguta (Siebold &amp; Zucc.) Planch. ex Miq.], a climacteric fruit that is harvested after reaching physiological maturity but not yet ready-to-eat ripeness. Although a recommended cultivar for commercial kiwiberry producers in the northeastern United States is ‘Geneva 3’, no published research exists regarding recommended harvest and postharvest practices for this variety. In this study, conducted across two seasons, ‘Geneva 3’ kiwiberries were harvested at a range of mean maturities (6.5, 8.0, and 10.0°Brix), held in cold storage for various durations (4, 6, and 8 weeks), and then ripened at room temperature. At regular time points during ripening (0, 3, 6, 9, and 12 days), visual quality was assessed, and measurements were taken of soluble solids content, dry matter content, and firmness as a means of characterizing fruit quality. Results show that berries harvested at 6.5°Brix largely became visually unacceptable under cold storage conditions and resulted in lower overall quality fruit. Harvesting at 8.0°Brix resulted in high-quality fruit amenable to cold storage, and such quality was not enhanced by delaying harvest to 10.0°Brix. Fruit harvested at 8.0°Brix after 4 weeks in cold storage was found to be acceptable for consumption for, on average, a 3-day window after ripening at room temperature for 4 days. After 6 weeks in cold storage, the consumability window shortened to ∼2 days, starting after 3 days of ripening at room temperature. After 8 weeks in cold storage, the fruit were found to be largely visually unacceptable for fresh eating. In summary, the results indicate that harvesting ‘Geneva 3’ kiwiberries at 8.0°Brix produces berries with the greatest storability (at least 6 weeks in cold storage), the longest window of peak consumability, and the highest overall quality, while mitigating the risks associated with leaving physiologically mature fruit to ripen further in the field.

Abstract IntroductionBurnout syndrome is a prolonged response to chronic emotional and interpersonal stressors and is becoming an increasing concern in the medical community. Burnout in emergency medicine (EM) pharmacists has not been previously assessed.ObjectivesTo identify the prevalence of burnout among EM pharmacists, in addition to demographic, professional, seasonal, and job‐related associations.MethodsPharmacists practicing greater than 50% of their time in the emergency department (ED) setting were invited through the American College of Clinical Pharmacy Emergency Medicine Practice and Research Network listserv to complete a survey at three separate, 4‐week, time periods (July 2018, October 2018, and April 2019). The survey contained the Maslach Burnout Inventory for Medical Personnel to detect burnout. Questions regarding personal and job‐specific demographics were asked. Descriptive statistics were used to report demographics and burnout dimensions in each period. Spearman's rank correlation and univariate and multivariate analyses were performed to identify predictors of burnout and potential associations.ResultsA total of 485 surveys were completed across all periods (116 [July], 207 [October], 162 [April]) and response rates were 18.4%, 31.6%, and 22.7%, respectively. Burnout was identified in 69.8%, 67.1%, and 68.5% of respondents with no difference between periods. A majority of participants had high depersonalization scores (50.6‐76.3%) during the three survey periods.Younger age, more ED visits per year, level I trauma center designation, and lower percentage of direct patient care time were associated with increased odds of burnout in the July 2018 period. Intent to leave one's current position or the specialty of EM and consideration of a job with different hours had positive correlations with burnout.ConclusionsBurnout is prevalent in a majority of EM pharmacists throughout the year. It is difficult to identify exact predictors of burnout; however, potential contributors include age, trauma center designation, patient volumes, and direct patient care time.

Fatalities due to being left in motor vehicles is an important cause of pediatric mortality. Few studies in the medical literature focus on this topic. This study aims to describe the circumstances surrounding these deaths, to determine their geographic distribution, and to evaluate the legal consequences for those responsible. This is a retrospective cohort study of individuals ≤14 years old who died of heatstroke after being left in motor vehicles from 1990 through 2016 using a database provided by KidsAndCars.org. Descriptive data and specified outcomes regarding victims and responsible individuals were recorded. Of the 541 cases included for analysis, 528 fatalities involved a single victim and 26 fatalities involved 2 or more victims left in a vehicle. Of all fatalities, 54.4% were male and the mean age was 16.4 (±13.7) months. The responsible individual(s) unknowingly left the victim(s) in the vehicle in 78.2% of cases and knowingly left the victim(s) in 16.6% of cases. A single individual was responsible for leaving the victim(s) in 88.9% of cases. The cases were noted in 45 of 50 states and most commonly occurred in Texas (15%), Florida (12%), and California (7%). Criminal charges against the responsible individual(s) occurred in 58.2% of cases. Pediatric fatalities due to being left in motor vehicles most commonly occur when a caregiver leaves a child unknowingly in a home parking area. These fatalities occur most often in Texas, Florida, and California. Responsible individuals are frequently charged with a crime.

Postharvest losses of fresh produce constitute the biggest portion of the total food losses occurring in food chains globally. The main driver behind the postharvest losses of fresh fruits and vegetables is temperature abuse occurring mainly during transportation and storage. This is a particular problem for small-acreage producers, who frequently have limited access to postharvest handling resources like optimum refrigeration conditions. Passive modified atmosphere packaging (MAP) is a relatively inexpensive intervention that does not require specialized equipment and has demonstrated some potential for maintaining the quality and extending the shelf life of fresh produce stored in nonoptimum temperatures. Our objective was to determine the effect of passive MAP on the quality and storage life of spinach ( Spinacia oleracea cv. Corvair) when stored in nonoptimum temperatures. Mature spinach leaves (≈320 g) were packaged in passive MAP bags, developed using the BreatheWay technology, and non-MAP produce bags and subsequently stored at 13 or 21 °C. Spinach physical and nutritional quality was evaluated throughout its storage life in terms of overall quality, water loss, leaf tenderness, surface color, chlorophyll content, electrolyte leakage, chlorophyll fluorescence, antioxidant capacity, total phenolic content, and vitamin C content. Spinach that was stored in MAP bags reached headspace equilibrium at ≈6% Ο 2 and 11% CΟ 2 at 13 °C and ≈4% Ο 2 and 8% CΟ 2 at 21 °C after 2 days of storage for both temperatures. The spinach stored in passive MAP at 13 or 21 °C demonstrated significantly higher overall quality during storage and 2 and 1 day longer storage life, respectively, when compared with the control. The spinach in passive MAP demonstrated a slower rate of yellowing and water loss during storage. The limiting factor for the spinach stored in MAP was decay due to condensation at 13 °C and yellowing at 21 °C. There were no statistical differences in the examined nutritional quality parameters between the spinach stored in MAP and produce bags. This study shows that passive MAP can be a valuable tool for reducing the food losses occurring in small-acreage fruit and vegetable operations that have limited access to cooling and refrigerated storage.