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Although upfront treatment of multiple myeloma has become more effective, relapses are the norm, often driven by the emergence of a genetically divergent clone selected by the initial therapy. Recent trials have demonstrated the safety and efficacy of combination therapy also in the relapsed and refractory setting and supported the regulatory approval of several new agents including new proteasome inhibitors, immunomodulatory agents, and monoclonal antibodies. We provide a detailed summary of recent practice-changing trials in relapsed and refractory MM and share a practical approach to assimilate disease and patient-features into treatment decision. Am. J. Hematol. 91:1044-1051, 2016. © 2016 Wiley Periodicals, Inc.

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a potentially curative treatment for over 70 benign and malignant hematologic and immunological processes. Over the past several decades, significant technological and post-transplant supportive advances have been made, resulting in a decrease in early transplant mortality and continued growth in the population of allo-HSCT survivors. With the expansion in the number of long-term survivors, as well as of those considering a transplant, the focus of transplant medicine has been shifted significantly to include a more prominent role for the care of the 'long-term' survivor. These patients have survived the acute critical phase of transplantation and have potentially achieved remission from their primary disease, yet allo-HSCT patients do not return to pre-transplant health status. For survivors >2 years removed, the time of transplant all-cause mortality is four- to nine-fold higher than age-matched peers within the general population. These patients represent a distinct, high-risk population that must be monitored for long-term transplant complications, including chronic GvHD (cGvHD), multi-organ dysfunctions and secondary malignancies. This article will review in a non-exhaustive manner, the approach to long-term care of an allo-HSCT recipient.

This study examined the relationship between sexual abuse in or around campus and drug use among young African-American males in college. It offers cross-sectional analysis of data collected from the Alcohol and Substance Abuse Awareness and Use Study (ASAAUS). Data collection took place in October 2004 via a self-administered survey among 181 African-American male students. Males who reported past sexual abuse in or around campus were significantly more likely than nonsexuallyabused males to have used tobacco (41% v. 19%, p < .05), alcohol (82% v. 49%, p < .05), marijuana (59% v. 30%,p < .05), and cocaine (18% v. 2%, p < .05) in the 30 day preceding the interview. Logistic regression analyses indicated that sexual abuse history in or around campus was significantly associated with past year (OR = 9.8, p ≤ 0.001) and past 30 day (OR = 5.0, p ≤ 0.001) drug use.

Measurement of, and response to, three different stigmas and their exposure (homosexual behavior, sex work, and drug use) were studied a group of 90 key-informant recruited male sex workers in Houston, Texas who were over 18 and had exchanged sex for money in the previous 7 days. Respondents reported on self-identified sexual orientation and were interviewed, including providing responses on a measure of perceived stigma relating to sexual behavior and drug use. Two thirds were white, almost all had used drugs (many in the past week), and half had ever injected. A fifth identified as heterosexual, with the remainder split between gay and bisexually-identified men. There was a high level of homelessness and contact with the criminal justice system for drug and property offences. Consciousness about drug-related stigma was moderately associated with concerns about drug-related exposure and sensitivity to rejection as a drug user, but not to exposure as homosexual or as a sex worker. Drug-using stat...

The concept of responsibility was derived originally from principles of morality, as part of a network of rights, duties and obligations. HIV risk-related studies have suggested that a sense of responsibility for condom use to protect a partner is a potentially important predictor of condom use in drug-using populations. We created a four-item scale measuring Self responsibility to use condoms and Partner's responsibility to use condoms. Data were collected from three drug-using samples: crack smokers, HIV seropositive crack smokers in an intervention study in Houston, Texas, and Tanzanian heroin users in Dar es Salaam. Data indicated that the four responsibility items had high alpha coefficients in each sample, and that there were moderate to high intercorrelations between equivalent self and partner responsibility items. There were significant differences in scale scores between the crack smokers and the HIV positive crack smokers and the Tanzanian samples, but no significant differences between the HIV positive and Tanzanian samples. Comparing within the first crack-smoker sample those who were HIV positive and negative showed significant differences in the direction of higher beliefs in responsibility to use condoms in the HIV positive group. These data suggest that responsibility is measurable, holds similar psychometric properties across three samples differing in culture and HIV serostatus, and that condom use responsibility is conceptualized as a measure of general responsibility rather than as a reciprocal self/partner responsibility.

Data on self-reported perceived exposure to anti-smoking messages were collected from 1,608 high school students surveyed through the ASPIRE (A Smoking Prevention Interactive Experience) Program in Houston, Texas. Data collection took place between October 2002 and March 2003. Logistic regression identified that African Americans perceived significantly less exposure to anti-smoking advertisements via television (OR = .50, p ≤ 0.05) and posters (OR = .61, p ≤ 0.05) than whites. However, they had nearly twice as much perceived exposure to anti-smoking advertisements at movies (OR = 1.79, p ≤ 0.05) and sporting events (OR = 2.1, p ≤ 0.05) than their white counterparts. Hispanic youth perceived significantly less exposure to anti-smoking posters (OR = .51, p ≤ 0.05) and significantly higher exposure to anti-smoking messages at sporting events (OR = 1.92, p ≤ 0.05) and school programs (OR = 3.44, p ≤ 0.05) compared to white youth. While the relationships tested in this study are exploratory, they provide initial evidence for an important nexus between race and communication channels that may impact perceived exposure to tobacco advertising.

A barrier to the development and refinement of ethics education in and across health professional schools is that there is not an agreed upon instrument or method for assessment in ethics education. The most widely used ethics education assessment instrument is the Defining Issues Test (DIT) I & II. This instrument is not specific to the health professions. But it has been modified for use in, and influenced the development of other instruments in, the health professions. The DIT contains certain philosophical assumptions (“Kohlbergian” or “neo-Kohlbergian”) that have been criticized in recent years. It is also expensive for large institutions to use. The purpose of this article is to offer a rubric—which the authors have named the Health Professional Ethics Rubric—for the assessment of several learning outcomes related to ethics education in health science centers. This rubric is not open to the same philosophical critiques as the DIT and other such instruments. This rubric is also practical to use. This article includes the rubric being advocated, which was developed by faculty and administrators at a large academic health science center as a part of a campus-wide ethics education initiative. The process of developing the rubric is described, as well as certain limitations and plans for revision.

This study shows the important link between higher drug use and self-medication among youth with higher reported posttraumatic stress reactions after natural disasters. The study offers secondary analysis of cross-sectional data collected on 170 predominately African American males through the Fifth Ward Enrichment program (FWEP) in Houston, Texas, between November and December 2009. Men who stated that in the last week they tried to keep from thinking or talking about the hurricane or things that remind them of what happen were significantly more likely to use alcohol (p.05), marijuana (p.01), codeine cough syrup (p.00), anti-energy drinks (p.00), crystal methamphetamines (p.00), and Viagra (p.00). Unadjusted logistic regression showed that they also experienced over twice the odds of reporting past 30 day use of alcohol (OR = 2.57, 95% CI = .98, 6.8), marijuana (OR = 4.31, 95% CI = 1.2, 15.3), codeine cough syrup (OR = 5.22, 95% CI = 1.4, 19.5), and anti-energy drinks (OR = 3.27, 95% CI = 1.0, 1.4). Adjusted logistic regression revealed that male youth post-traumatic stress reaction is a significant predictor of marijuana use (OR = 4.1, 95% CI = 1.0, 16.5). This study shows the important link of higher drug use and self-medication among youth with higher reported posttraumatic stress reactions after natural disasters.

The emerging field of nanotechnology requires new methodologies to be developed in order to address the needs of fabrication, manipulation, control, and measurement of motions of molecules and devices on the nanoscale. Optical excitation and control of translational, vibrational, and rotational motions can offer a unique way to achieve the desired goals by using a sequence of short laser pulses, e.g., tuned to initiate certain nuclear motions of well studied photo active proteins (e.g. PYP or Rhodopsin) or engineered larger molecular structures. Measuring nuclear motions requires structurally sensitive spectroscopy methods, and therefore spontaneous Raman and coherent Raman spectroscopies can be applied to qualitatively test and quantitatively measure such motions. Polarization Sensitive Resonance Coherent anti‐Stokes Raman Spectroscopy (PSCARS), steady state or time‐resolved, can measure controlled dipole moment reorientation through the anisotropic third order nonlinear optical susceptibility. The measured vibrational spectra are sensitive to photo induced isomerization or internal molecular rotation if the rotating chemical group is coupled to or interacting with internal normal modes or to the surrounding molecules e.g. in solutions. In our study, the method was applied to measure the vibrational manifold and reorientation of DCVJ for the first time. DCVJ is a charge transfer molecular rotor showing a viscosity dependent fluorescence quantum yield. This dependence is attributed to the “friction” type interaction between the 90 degree internal rotation of the molecule upon photo‐excitation and the solvent cage surrounding it. Quantum chemical studies using DFT and normal mode calculations support our findings related to the conformational evolution of the molecule. Theoretical and experimental principles associated with CARS with an emphasis on points relevant to the interpretation of the results will be presented. The design and operation of an all solid‐state broadband nanosecond CARS system will be also presented. Finally, an overview of applications of molecular rotors in biology, nanotechnology and perhaps information technology will be outlined.

Data on the perceived sources of cessation information and the reasons why alternative school students would attend a smoking cessation program were collected from 302 students at an alternative high school who were surveyed through the Safer Decisions Program in Houston, Texas. Data collection took place between September 2006 and January 2007. Logistic regression identified that non-smokers were more likely to believe it was important to receive cessation information from doctors (4.93 adjusted odds ratio 95% confidence interval CI=1.96; 12.40), health educators (4.70 AOR; 95% CI=1.46; 15.10), people who have been affected by smoking (3.20 AOR; 95% CI=1.04; 9.80), teachers (2.73 AOR; 95% CI=1.3; 5.60), and celebrities (2.44 AOR; 95% CI=1.21; 4.92) compared to smokers. In addition, persons who had smoked in the past 30 days were twice as likely to report embarrassment (1.86 AOR; 95% CI=1.00; 3.44) and feel that it was not right to smoke (2.24 AOR; 95% CI=1.00; 5.00) compared to respondents who had not smoked during the past 30 days. While the relationships tested in this study are exploratory, they provide initial evidence for understanding the importance of smoking cessation recruitment strategies that may impact minority alternative school youth.

Data on self-reported perceived exposure to pro-smoking messages were collected from 1,608 high school students surveyed through the ASPIRE (A Smoking Prevention Interactive Experience) Program in Houston, Texas, in 2003. Results indicated that high school smoking quitters had approximately twice the odds of perceived exposure to pro-smoking messages as nonsmokers through billboard advertisements (Adjusted Odds Ratio [AOR] = 2.04, 95% CI: 1.09, 3.81), newspapersmagazines (AOR: 1.97, 95% CI: 1.09, 3.56), and movies (AOR: 1.94, 95% CI: 1.03, 3.65). Smoking experimenters marginally perceived more exposure to pro-smoking radio messages (AOR = 1.31, 95% CI: 1.04, 1.67) and billboard advertisements (AOR = 1.28, 95% CI: 1.02, 1.61) compared to nonsmokers. Lastly, current smokers were 1.82 times as likely to report exposure to pro-smoking poster advertisements as nonsmokers (95% CI: 1.19, 2.79, por = .05). These findings suggest that experimenters and quitters may pay more attention to smoking advertisements than nonsmokers and current smokers.

The spring 2006 edition of The American Journal on Addictions published an insightful article entitled “Characterizing the Emerging Population of Prescription Opioid Abusers,” which described the a...