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Background: Patients with hematologic malignancies have impaired humoral immunity secondary to their malignancy and its treatment, placing them at risk of severe coronavirus disease-19 (COVID-19) infection and reduced response to vaccination.Methods: The authors retrospectively analyzed serologic responses to initial and booster COVID-19 vaccination in 378 patients with hematologic malignancy and subsequently tracked COVID-19-related outcomes.Results: Seroconversion occurred in 181 patients (48%) after initial vaccination; patients who had active malignancy or those who were recently treated with a B-cell-depleting monoclonal antibody had the lowest rates of seroconversion. For initial nonresponders to vaccination, seroconversion after a booster dose occurred in 48 of 85 patients (56%). The seroconversion rate after the booster was similar for patients on (53%) and off (58%) active therapy (p = .82). Thirty-three patients (8.8%) developed a COVID-19 infection, and there were three COVID-19-related deaths (0.8%). Although no significant association was observed between postvaccination seroconversion and the incidence of COVID-19 infection, no patient with seroconversion died from COVID-19, and no patient who received tixagevimab/cilgavimab (N = 25) was diagnosed with a COVID-19 infection.Conclusions: Booster vaccinations can promote seroconversion in a significant proportion of patients who are seronegative after the initial vaccination course regardless of the specific vaccine or on/off treatment status at the time of revaccination. Although postvaccination seroconversion may not be associated with a decrease in any (including asymptomatic) COVID-19 infection, the authors' experience suggested that effective vaccination (including a booster), supplemented by passive immunization using tixagevimab/cilgavimab in case of lack of seroconversion, effectively eliminated the risk of COVID-19 death in the otherwise high-risk population.Lay Summary: Patients with hematologic malignancy, especially lymphoma, have an impaired response to coronavirus disease 2019 (COVID-19) vaccination. In this single-institution review, less than one half of the patients studied made detectable antibodies. For those who did not make detectable antibodies after initial vaccination, over one half (65%) were able to produce antibodies after booster vaccination. By the end of February 2022, 33 of the original 378 patients had a documented COVID-19 infection. The only deaths from COVID-19 were in those who had undetectable antibodies, and no patient who received prophylactic antibody therapy developed a COVID-19 infection. [ABSTRACT FROM AUTHOR]

Abstract: This chapter discusses the higher education system in Germany and presents findings on the use of the Teacher Behavior Checklist to examine those qualities and corresponding behaviors that German university students identified in ideal teachers. [ABSTRACT FROM AUTHOR]

The article presents the study on the impact of aspirin on waefarin control in therapeutic range. It mentions that warfarin is an oral anticoagulant prescribed for thromboembolic indications including venous thromboembolism (VTE), deep vein thrombosis (DVT) and the prevention of stroke associated for atrial fibrillation (AF).

Despite prescribing guidance, limited data exist to describe the use of apixaban in patients with end-stage renal disease ( ESRD) requiring hemodialysis ( HD). Current apixaban dosing recommendations for this patient population are based largely on a single-dose pharmacokinetic study of eight patients. We describe the clinical application and pharmacodynamic monitoring of apixaban in a 62-year-old 156-kg African-American woman with nonvalvular atrial fibrillation and ESRD requiring hemodialysis who developed calciphylaxis while receiving warfarin therapy. Based on a multidisciplinary clinical judgment decision due to concern for drug accumulation after multiple doses in patients with ESRD receiving HD, she was anticoagulated with apixaban 2.5 mg twice/day, as opposed to 5 mg twice/day as recommended by the package insert. Antifactor Xa monitoring was used, and resultant peak and trough apixaban concentrations were above the upper limit of detection for our clinical laboratory (more than 2.00 IU/ml). On day 7 of her hospitalization, the patient developed gastrointestinal bleeding, and apixaban was discontinued; no further clinical signs of bleeding occurred during her subsequent hospitalization course. Use of the Naranjo Adverse Drug Reaction Probability Scale indicated a probable relationship (score of 6) between apixaban exposure and the manifestation of gastrointestinal bleeding. The patient ultimately died 44 days after the acute bleeding event; however, coagulation concerns were not implicated in the patient's death. To our knowledge, this is the first case report that describes apixaban use and associated antifactor Xa monitoring in a patient with ESRD receiving HD, and it provides concern for current apixaban dosing recommendations in this patient population. Further pharmacokinetic and clinical data are likely necessary to better characterize apixaban use in these patients to optimize safety and efficacy. [ABSTRACT FROM AUTHOR]

PURPOSE: To identify qualitative studies that have examined actual and perceived adaptation of patients to an implanted cardioverter-defibrillator (ICD). The question explored was do recipients of ICDs experience real or perceived physical or psychological adaptation distress? Do themes expressed indicate a need for intervention that will facilitate postimplantation adjustment? DATA SOURCES: A systematic search of the scientific literature uncovered 153 studies of which 12 met the following inclusion criteria: qualitative English research of psychological adaptation to the implantable defibrillator or qualitative research literature reviews. Exclusion criteria included unpublished studies, studies involving cardiac pacemaker devices without defibrillator, and quantitative research studies. CONCLUSION: Multiple themes pertaining to adjustment to ICD therapy were identified, which warrants further study for potential therapeutic interventions. Themes identified by ICD recipients and their partners include perception of fear, anxiety, and dependence, and the desire for enhanced support and information. Increasing awareness of the complex adaptation issues related to ICD implantation should be a priority of primary care clinicians who provide follow-up care for these patients. IMPLICATIONS FOR PRACTICE: ICD recipients have reported multiple physical and psychological adjustment issues that require further study to determine gravity and duration. Clinicians must be familiar with adjustment difficulty expressed by ICD recipients in order to facilitate appropriate tailored interventions. The findings of this literature review emphasize a need for support groups for ICD recipients and their partners; behavioral and sexual counseling; continued education after discharge; and a supportive healthcare provider who is knowledgeable in device adjustment issues. The research indicates a need for a post-ICD implantation plan, and data are available for the design testing of tailored interventions. [ABSTRACT FROM AUTHOR]

BSTRACT: In order to plan for land use in a lake basin to maintain or improve lake water quality, municipal planners need a method of evaluating lakeshore and watershed land use that is technically sound, objective, reasonably quick, and cheap enough to be incorporated into their time and dollar budgets. Such a system is presented. It consists of measuring and rating four lakeshore land use characteristics (type of sewage disposal system, lot size, road proximity, and intensity of public use areas), and three upland watershed land use characteristics (intensity of development, forest cover, and agriculture and open space). These seven characteristics are measured, rated, and then combined to provide a two-digit index number. This number, when compared with the indexes of other lakes in the region and interpreted with assistance from officials of the State Health and Water Resources Department, indicates on a relative basis the degree to which various land uses are contributing to accelerated, cultural eutrophication. Interpretation of the index suggests land use controls necessary to improve lake water. It supplements, and should be used with, an index of lake vulnerability to accelerated eutrophication and a comparative measure of present water quality. [ABSTRACT FROM AUTHOR]