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© 2023 Retina. All right reserved.Purpose:To report outcomes of pediatric patients with combined hamartoma of the retina and the retina pigment epithelium followed up conservatively or after pars plana vitrectomy.Methods:This retrospective multicenter study included 62 eyes of 59 pediatric patients with combined hamartoma of the retina and the retina pigment epithelium from 13 different international centers with an average age of 7.7 ± 4.7 (0.3-17) years at the time of the diagnosis and having undergone pars plana vitrectomy or followed conservatively. At baseline and each visit, visual acuity values, optical coherence tomography for features and central foveal thickness, and tumor location were noted. Lesions were called as Zone 1, if it involves the macular and peripapillary areas, and the others were called as Zone 2 lesions.Results:Twenty-one eyes of 20 patients in the intervention group and 41 eyes of 39 patients in the conservative group were followed for a mean of 36.2 ± 40.4 (6-182) months. Best-corrected visual acuity improved in 11 (68.8%) of 16 eyes in the intervention group and 4 (12.9%) of 31 eyes in the conservative group (P < 0.001). The mean central foveal thickness decreased from 602.0 ± 164.9 µm to 451.2 ± 184.3 µm in the intervention group, while it increased from 709.5 ± 344.2 µm to 791.0 ± 452.1 µm in Zone 1 eyes of the conservative group. Posterior location of tumor, irregular configuration of the foveal contour and ellipsoid Zone defect in optical coherence tomography, subretinal exudate and prominent vascular tortuosity were associated with poor visual acuity.Conclusion:Vitreoretinal surgery is safe and effective in improving vision and reducing retinal distortion in Zone 1 combined hamartoma of the retina and the retina pigment epithelium in children.

In prior work, Friends of Cancer Research convened multiple data partners to establish standardized definitions for oncology real-world end points derived from electronic health records (EHRs) and claims data. Here, we assessed the performance of real-world overall survival (rwOS) from data sets sourced from EHRs by evaluating the ability of the end point to reflect expected differences from a previous randomized controlled trial across five data sources, after applying inclusion/exclusion criteria. The KEYNOTE-189 clinical trial protocol of platinum doublet chemotherapy (chemotherapy) vs. programmed cell death protein 1 (PD-1) in combination with platinum doublet chemotherapy (PD-1 combination) in first-line nonsquamous metastatic non-small cell lung cancer guided retrospective cohort selection. The Kaplan-Meier product limit estimator was used to calculate 12-month rwOS with 95% confidence intervals (CIs) in each data source. Cox proportional hazards models estimated hazard ratios (HRs) and associated 95% CIs, controlled for prognostic factors. Once the inclusion/exclusion criteria were applied, the five resulting data sets included 155 to 1,501 patients in the chemotherapy cohort and 36 to 405 patients in the PD-1 combination cohort. Twelve-month rwOS ranged from 45% to 58% in the chemotherapy cohort and 44% to 68% in the PD-1 combination cohort. The adjusted HR for death ranged from 0.80 (95% CI: 0.69, 0.93) to 1.15 (95% CI: 0.71, 1.85), controlling for age, gender, performance status, and smoking status. This study yielded insights regarding data capture, including ability of real-world data to precisely identify patient populations and the impact of criteria on end points. Sensitivity analyses could elucidate data set-specific factors that drive results.

Understanding barriers to implementation of Industry 4.0 strategies is a first step to enable companies to begin to use and implement new technologies; using new technologies will allow mills to improve efficiency and stay relevant in the face of increasing international competition. This study uses a mail survey to gather insights regarding awareness of technologies within the US primary wood products industry as well as the barriers to using new technologies. Awareness of technologies is generally low, especially with respect to additive manufacturing, autonomous systems, and big data. Lack of skilled workers is the primary limiting factor to implementation of new technologies with other key factors being out-of-date facilities and unclear financial benefits. Existing expertise was highest in manufacturing process monitoring and data analysis, and lowest in robotics. Only a very small group of respondents have already implemented any form of robotics. Overall, only six respondents (6.7 %) have an Industry 4.0 strategy, while 77 % did not recognize the terms “Industry 4.0” or “Smart Manufacturing.” Results suggest considerable room for additional application of I4.0 technologies in the industry., Razumijevanje prepreka za implementaciju strategija industrije 4.0 prvi je korak koji će omogućiti tvrtkama uvođenje i primjenu novih tehnologija. Uvođenjem tih novih tehnologija pilane će poboljšati svoju učinkovitost uz zadržavanje konkurentnosti. Ovo se istraživanje temelji na poštom upućenoj anketi kako bi se dobio uvid u svjesnost o tehnologijama u industriji primarne prerade drva u SAD-u, kao i o preprekama za primjenu novih tehnologija. Svjesnost o tehnologijama općenito je niska, posebice za aditivnu proizvodnju, autonomne sustave i velike baze podataka. Nedostatak kvalificiranih radnika najveći je ograničavajući faktor za primjenu novih tehnologija, a ostali su otežavajući činitelji zastarjela postrojenja i nejasnoće o financijskim koristima što ih donosi primjena novih tehnologija. Najveća je stručnost zabilježena u području praćenja proizvodnih procesa i analizi podataka, a najmanja u robotici. Samo je vrlo mala skupina ispitanika već primijenila neki od oblika robotike. Ukupno samo šest ispitanika (6,7 %) ima strategiju Industrije 4.0, dok 77 % ispitanika nije prepoznalo pojmove "industrija 4.0" ili "pametna proizvodnja". Rezultati pokazuju da postoji znatan prostor za dodatnu primjenu tehnologija Industrije 4.0 u primarnoj preradi drva.

INTRODUCTION AND OBJECTIVE:Primary treatment options for patients with high-risk non-metastatic prostate cancer (CaP) include radical prostatectomy or radiation therapy. The optimal treatment appro...

Significance How arthritis-causing T cells trigger rheumatoid arthritis (RA) is not understood since it is difficult to differentiate T cells activated by inflammation in arthritic joints from those activated through their T cell antigen receptor (TCR) by self-antigens. We developed a model to identify and study antigen-specific T cell responses in arthritis. Nur77—a specific marker of TCR signaling—was used to identify antigen-activated T cells in the SKG arthritis model and in patients with RA. Nur77 could distinguish highly arthritogenic and autoreactive T cells in SKG mice. The enhanced autoreactivity was associated with increased interleukin-6 (IL-6) receptor signaling, likely contributing to their arthritogenicity. These data highlight a functional correlate between Nur77 expression, arthritogenic T cell populations, and heightened IL-6 sensitivity in SKG mice with translatable implications for human RA., How pathogenic cluster of differentiation 4 (CD4) T cells in rheumatoid arthritis (RA) develop remains poorly understood. We used Nur77—a marker of T cell antigen receptor (TCR) signaling—to identify antigen-activated CD4 T cells in the SKG mouse model of autoimmune arthritis and in patients with RA. Using a fluorescent reporter of Nur77 expression in SKG mice, we found that higher levels of Nur77-eGFP in SKG CD4 T cells marked their autoreactivity, arthritogenic potential, and ability to more readily differentiate into interleukin-17 (IL-17)–producing cells. The T cells with increased autoreactivity, nonetheless had diminished ex vivo inducible TCR signaling, perhaps reflective of adaptive inhibitory mechanisms induced by chronic autoantigen exposure in vivo. The enhanced autoreactivity was associated with up-regulation of IL-6 cytokine signaling machinery, which might be attributable, in part, to a reduced amount of expression of suppressor of cytokine signaling 3 (SOCS3)—a key negative regulator of IL-6 signaling. As a result, the more autoreactive GFPhi CD4 T cells from SKGNur mice were hyperresponsive to IL-6 receptor signaling. Consistent with findings from SKGNur mice, SOCS3 expression was similarly down-regulated in RA synovium. This suggests that despite impaired TCR signaling, autoreactive T cells exposed to chronic antigen stimulation exhibit heightened sensitivity to IL-6, which contributes to the arthritogenicity in SKG mice, and perhaps in patients with RA.

Increasing gender diversity is no longer just the right thing to do, but also the smart thing to do. Although there is general literature about gender diversity and the perspectives of females in top management and leadership, there are, however, very few forest sector specific studies. This exploratory study utilizes interviews to better understand how female executives in North America and the Nordic countries of Finland and Sweden perceive the impact of the situation of gender diversity in the forest industry. Respondents also provide career advice for young females entering or considering entry into the industry. Female executives in both regions agree that although the forest sector is still seen as a male-oriented industry, there are signs of increasingly positive attitudes regarding industry and company culture towards the benefits of greater gender diversity; however, the described changes represent an evolution, not revolution. Interestingly, despite the status of Nordic countries as leaders in bridging the gender gap, respondents from this region believe that there is significant progress yet to be made in the forest industry, especially at the entry level. With respect to career development, North American respondents suggested that young females should consider sacrificing their social life and leisure time activities, whereas Nordic respondents instead emphasized personal supports or using exit strategy from an unsupportive company or boss.

In recent years, the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Adult Cancer Pain have undergone substantial revisions focusing on the appropriate and safe prescription of opioid analgesics, optimization of nonopioid analgesics and adjuvant medications, and integration of nonpharmacologic methods of cancer pain management. This selection highlights some of these changes, covering topics on management of adult cancer pain including pharmacologic interventions, nonpharmacologic interventions, and treatment of specific cancer pain syndromes. The complete version of the NCCN Guidelines for Adult Cancer Pain addresses additional aspects of this topic, including pathophysiologic classification of cancer pain syndromes, comprehensive pain assessment, management of pain crisis, ongoing care for cancer pain, pain in cancer survivors, and specialty consultations.

Objectives. To examine the association of Fit2Lead, an afterschool park-based youth mental health promotion program, and neighborhood juvenile arrests (2015–2017) in Miami–Dade County, Florida. Methods. We tracked juvenile (ages 12–17 years) arrest rates over 2 years of program implementation across zip codes matched by (1) park and (2) baseline sociodemographics and youth arrests. Fit2Lead mental and physical health, meditation, resilience, and life skills activities were offered in 12 high-need areas for youths (n = 501) aged 12 to 17 years. We tested the association of Fit2Lead implementation (binary variable) and change in juvenile arrest rates by zip code, adjusting for area-level gender, age, race/ethnicity, single-parent households, and poverty. Results. Fit2Lead was offered in areas composed of 48% male youths, 60% Hispanics, 29% non-Hispanic Blacks, 33% single-parent households, and 33% of residents living in poverty. After covariate adjustment, zip codes with Fit2Lead implementation showed a significant mean reduction (P Conclusions. Park-based programs may have the potential to promote mental health and resilience, and also to prevent violence among at-risk youths.

Violence exposure increases teens' risk for emotion dysregulation, anxiety, depression, and aggression towards peers. Teens of color are disproportionately more likely to be exposed to violence and less likely to receive mental health services. Community after-school programs can help reduce disparities by offering opportunities for skills development and mental health promotion to mitigate risk associated with violence exposure. The present study explores the promise of a parks-based after-school paid internship program for black and Latinx teens with weekly, group-based enrichment to promote educational attainment, job skills, and health behaviors. University and park administrators collaborated to design a program comprised of paid work (10 hr/week at US$9.05/hr) and weekly 2 hr enrichment (e.g., job skills, meditation, and sleep health psychoeducation). The sample includes 38 youth (n = 38; 15-17 years old [M = 16.26, SD = .73]; 42.1 per cent female; 95.2 per cent non-Latinx black, 4.8 per cent Latinx white). Data analyses include pre-/post-measures of violent and nonviolent adversity, emotion regulation, anxiety, depression, and self-efficacy to manage peer conflict. There were no significant changes from Time 1 (T1) to Time 2 (T2) in teen-reported cognitive reappraisal, emotion suppression, anxiety, depression, or self-efficacy to resolve peer conflict. Teens with more violence exposure at T1 reported significant reductions in anxiety at T2. Teens with more overall adversity reported significant reductions in anxiety and improvements in self-efficacy to resolve peer conflict. Findings indicate that after-school programs infused with poly-strengths programming can benefit diverse teens at high risk for violence exposure.

In the era of effective antiretroviral therapy, persons living with HIV/AIDS (PLWHA) are living longer, transforming HIV from a universally fatal disease to a serious chronic illness, warranting discussions between patients and their loved ones about advance care planning (ACP). Evidence is needed on factors associated with patients' likelihood to discuss ACP with loved ones.To further characterize factors associated with successful ACP in PLWHAs with their loved ones, we examined associations between patients having ACP discussions with the need for assistance with personal care, chronic pain, life satisfaction, prior family disagreements over health care decisions, sex, age, and interference in daily routines due to memory problems.Data were from the Affirm Care study (N = 370), which examined social and environmental factors associated with health outcomes among PLWHAs and their informal caregivers.Slightly more than half of respondents discussed ACP with loved ones (57%). In adjusted analysis, higher levels of chronic pain (odds ratio [OR] = 2.09, P = 0.045), needing assistance with personal care (OR = 1.63, P = 0.023), greater life satisfaction (OR = 1.02, P = 0.002), prior family arguments over health care decisions (OR = 2.80, P 0.001), and female sex (OR = 2.22, P = 0.001) were associated with higher odds of discussing ACP with loved ones, whereas age, drug use, education level, depression, and memory problems were nonsignificant.These results suggest that interventions to increase ACP among PLWHAs and their loved ones should target males. The findings also suggest PLWHAs with chronic pain, the need for assistance with personal care, and those with a history of prior family arguments over health care decisions may be primed for ACP.

The purpose of this study was to evaluate the potential collective opportunities and challenges of transforming real-world data (RWD) to real-world evidence (RWE) for clinical effectiveness by focusing on aligning analytic definitions of oncology endpoints. Patients treated with a qualifying therapy for advanced non-small cell lung cancer (aNSCLC) in the frontline setting meeting broad eligibility criteria were included to reflect the real-world population. While a trend toward improved outcomes in patients receiving PD-(L)1 therapy over standard chemotherapy was observed in RWD analyses, the magnitude and consistency of treatment effect was more heterogeneous than previously observed in controlled clinical trials. The study design and analysis process highlighted the identification of pertinent methodological issues and potential innovative approaches that could inform the development of high-quality RWD studies.

Purpose To describe a patient with an unusual presentation of iris metastasis from breast cancer and her response to systemic therapy. Methods Retrospective chart review of one patient. Results A 57-year-old woman presented with a superonasal translucent vascularized iris stromal mass with fish egg-like structures budding from the surface. High frequency anterior segment ultrasonography demonstrated a solid iris stromal mass measuring 6.0 x 3.3 x 1.9 mm. On optical coherence tomography, the egg-like structures appeared as hyperreflective spheres, some of which were detached from the main iris stromal tumor. Oncologic evaluation revealed metastatic breast cancer involving the brain and lung. She was treated with oral abemaciclib and letrozole, as well as external beam radiotherapy to the brain. The iris mass had completely regressed within 4 months and remained undetectable through 8 months follow-up. The other metastatic lesions responded well to therapy. Conclusion We report a case of iris metastasis as the presenting sign of cancer dissemination that was successfully treated with targeted systemic therapy without ocular radiotherapy.

Immune checkpoint inhibitors (ICIs) are the standard of care for the treatment of several cancers. While these immunotherapies have improved patient outcomes in many clinical settings, they bring accompanying risks of toxicity, specifically immune-related adverse events (irAEs). There is a need for clear, effective guidelines for the management of irAEs during ICI treatment, motivating the Society for Immunotherapy of Cancer (SITC) to convene an expert panel to develop a clinical practice guideline. The panel discussed the recognition and management of single and combination ICI irAEs and ultimately developed evidence- and consensus-based recommendations to assist medical professionals in clinical decision-making and to improve outcomes for patients.

Background The COVID-19 pandemic remains a significant global threat. However, despite urgent need, there remains uncertainty surrounding best practices for pharmaceutical interventions to treat COVID-19. In particular, conflicting evidence has emerged surrounding the use of hydroxychloroquine and azithromycin, alone or in combination, for COVID-19. The COVID-19 Evidence Accelerator convened by the Reagan-Udall Foundation for the FDA, in collaboration with Friends of Cancer Research, assembled experts from the health systems research, regulatory science, data science, and epidemiology to participate in a large parallel analysis of different data sets to further explore the effectiveness of these treatments. Methods Electronic health record (EHR) and claims data were extracted from seven separate databases. Parallel analyses were undertaken on data extracted from each source. Each analysis examined time to mortality in hospitalized patients treated with hydroxychloroquine, azithromycin, and the two in combination as compared to patients not treated with either drug. Cox proportional hazards models were used, and propensity score methods were undertaken to adjust for confounding. Frequencies of adverse events in each treatment group were also examined. Results Neither hydroxychloroquine nor azithromycin, alone or in combination, were significantly associated with time to mortality among hospitalized COVID-19 patients. No treatment groups appeared to have an elevated risk of adverse events. Conclusion Administration of hydroxychloroquine, azithromycin, and their combination appeared to have no effect on time to mortality in hospitalized COVID-19 patients. Continued research is needed to clarify best practices surrounding treatment of COVID-19.

Innovation in the forest sector is a growing research interest and within this field, there is a growing attention for institutional, policy and societal dimensions and particular when it comes to the question of how to support innovativeness in the sector. This Special Issue therefore focuses on governance aspects, relating to and bridging business and political-institutional-societal levels. This includes social/societal factors, goals and implications that have recently been studied under the label of social innovation. Furthermore, the emergence of bioeconomy as a paradigm and policy goal has become a driver for a variety of innovation processes on company and institutional levels. Our article provides a tentative definition of “innovation governance” and attempts a state-of-art review of innovation governance research in the forest sector. For structuring the research field, we propose to distinguish between organizational/managerial, policy or innovation studies. For the forestry sector, specifically, we suggest to distinguish between studies focusing on (i) innovative governance of forest management and forest goods and services; on (ii) the governance of innovation processes as such, or (iii) on specific (transformational) approaches that may be derived from combined goals such as innovation governance for sustainability, regional development, or a bioeconomy. Studies in the forest sector are picking up new trends from innovation research that increasingly include the role of societal changes and various stakeholders such as civil society organizations and users. They also include public-private partnership models or participatory governance. We finally should not only look in how far research approaches from outside are applied in the sector but we believe that the sector could contribute much more to our general scientific knowledge on ways for a societal transformation to sustainability.

Summary Background Tocilizumab, a monoclonal antibody directed against the interleukin-6 receptor, has been proposed to mitigate the cytokine storm syndrome associated with severe COVID-19. We aimed to investigate the association between tocilizumab exposure and hospital-related mortality among patients requiring intensive care unit (ICU) support for COVID-19. Methods We did a retrospective observational cohort study at 13 hospitals within the Hackensack Meridian Health network (NJ, USA). We included patients (aged ≥18 years) with laboratory-confirmed COVID-19 who needed support in the ICU. We obtained data from a prospective observational database and compared outcomes in patients who received tocilizumab with those who did not. We applied a multivariable Cox model with propensity score matching to reduce confounding effects. The primary endpoint was hospital-related mortality. The prospective observational database is registered on ClinicalTrials.gov , NCT04347993 . Findings Between March 1 and April 22, 2020, 764 patients with COVID-19 required support in the ICU, of whom 210 (27%) received tocilizumab. Factors associated with receiving tocilizumab were patients' age, gender, renal function, and treatment location. 630 patients were included in the propensity score-matched population, of whom 210 received tocilizumab and 420 did not receive tocilizumab. 358 (57%) of 630 patients died, 102 (49%) who received tocilizumab and 256 (61%) who did not receive tocilizumab. Overall median survival from time of admission was not reached (95% CI 23 days–not reached) among patients receiving tocilizumab and was 19 days (16–26) for those who did not receive tocilizumab (hazard ratio [HR] 0·71, 95% CI 0·56–0·89; p=0·0027). In the primary multivariable Cox regression analysis with propensity matching, an association was noted between receiving tocilizumab and decreased hospital-related mortality (HR 0·64, 95% CI 0·47–0·87; p=0·0040). Similar associations with tocilizumab were noted among subgroups requiring mechanical ventilatory support and with baseline C-reactive protein of 15 mg/dL or higher. Interpretation In this observational study, patients with COVID-19 requiring ICU support who received tocilizumab had reduced mortality. Results of ongoing randomised controlled trials are awaited. Funding None.

BackgroundHydroxychloroquine has not been associated with improved survival among hospitalized COVID-19 patients in the majority of observational studies and similarly was not identified as an effective prophylaxis following exposure in a prospective randomized trial. We aimed to explore the role of hydroxychloroquine therapy in mildly symptomatic patients diagnosed in the outpatient setting.MethodsWe examined the association between outpatient hydroxychloroquine exposure and the subsequent progression of disease among mildly symptomatic non-hospitalized patients with documented SARS-CoV-2 infection. The primary outcome assessed was requirement of hospitalization. Data was obtained from a retrospective review of electronic health records within a New Jersey USA multi-hospital network. We compared outcomes in patients who received hydroxychloroquine with those who did not applying a multivariable logistic model with propensity matching.ResultsAmong 1274 outpatients with documented SARS-CoV-2 infection 7.6% were prescribed hydroxychloroquine. In a 1067 patient propensity matched cohort, 21.6% with outpatient exposure to hydroxychloroquine were hospitalized, and 31.4% without exposure were hospitalized. In the primary multivariable logistic regression analysis with propensity matching there was an association between exposure to hydroxychloroquine and a decreased rate of hospitalization from COVID-19 (OR 0.53; 95% CI, 0.29, 0.95). Sensitivity analyses revealed similar associations. QTc prolongation events occurred in 2% of patients prescribed hydroxychloroquine with no reported arrhythmia events among those with data available.ConclusionsIn this retrospective observational study of SARS-CoV-2 infected non-hospitalized patients hydroxychloroquine exposure was associated with a decreased rate of subsequent hospitalization. Additional exploration of hydroxychloroquine in this mildly symptomatic outpatient population is warranted.Lay SummaryIn this observational study of 1,274 COVID-19 patients, hydroxychloroquine given as an outpatient treatment was associated with a 47% reduction in the hazard of hospitalization. Adverse events were not increased (2% QTc prolongation events, 0% arrhythmias). Further validation is required. Use of hydroxychloroquine to treat COVID-19 in the outpatient setting should be reserved for a clinical trial or after discussion with a physician regarding risks and benefits.

IntroductionCOVID-19 disproportionately affects those with comorbidities and the elderly. Hypertension is the most common pre-existing condition amongst COVID-19 patients. Upregulation of the renin-angiotensin-aldosterone system (RAAS) is common in hypertensive patients and may promote inflammation and ensuing cytokine storm in COVID-19. It is unknown whether RAAS inhibition with ACE1 inhibitors or angiotensin-receptor blockers (ARB) can be harmful or beneficial.MethodsWithin Hackensack Meridian Health network, the largest healthcare provider in New Jersey, we performed a retrospective, multicenter, convenience sampling study of hospitalized COVID-19 patients. Demographics, clinical characteristics, treatments, and outcomes were manually abstracted. Fishers exact tests, and logistic regression were performed.ResultsAmong 3017 hospitalized COVID-19 patients, 1584 (52.5%) carried a diagnosis of hypertension. In the discharged or deceased cohort, the overall mortality was significantly increased at 35% vs 13% among COVID-19 patients with hypertension. However, when adjusted for age, the effect of hypertension on mortality was greatly diminished, with a reduction in odds-ratio by over half; and completely disappeared when adjusted for other major covariates. The mortality rates were lower for hypertensive patients prescribed ACE1 (27%, p=0.001) or ARBs (33%, p=0.12) compared to other anti-hypertensive agents (39%) in the unadjusted analyses. RAAS inhibitor therapy appeared protective compared to other anti-hypertensive agents (p=0.001).ConclusionsWhile our results are limited by the retrospective nature of our study and by potential confounders, our data argue against a harmful effect of RAAS inhibition and support the HFSA/AHA/ACC joint statement recommending continuing ACE1 and ARB therapy in hypertensive COVID-19 patients.

Although there are continuous efforts aimed at increasing gender diversity, the forest sector is still largely perceived as a male dominated field, indicated by a persistent masculine image. As a result, women are still underrepresented. Utilizing interviews, we found that greater representation of women in the forest sector is considered as one of the best solutions to attract young women to the industry. However, it presents a &lsquo, Catch-22&rsquo, in which the solution is denied by a circumstance inherent in the problem. We propose to change the forest sector image by tackling gender issues such as sexual harassment, and by simultaneously focusing on the good features of the industry such as its important role in a sustainable future and solutions for the modern world. For example, the sector can show its role in mitigating climate change and in supporting a more sustainable future economy (e.g., bioeconomy and green jobs) and urban built environment. In addition, changing the forest sector image should be supported with better marketing and promotion in various platforms, both online and offline. The sector also needs to utilize social media to attract younger generations.

Immune checkpoint inhibitors (ICIs) have opened an exciting chapter in the treatment of patients with advanced cancer. For the palliative care clinician, however, ICIs present several new challenges, including new ways to define treatment success, as well as treatment-related toxicities that differ in nature and timing from traditional chemotherapy. In this article, we review the mechanism of action of ICIs, as well as selected published data supporting the efficacy of ICIs in patients with advanced cancer. In addition, we summarize existing data of ICI toxicity prevalence, patterns of severity, and timing of onset. Finally, we briefly review key principles from published guidelines on the management of ICI toxicities.

Background: Multiple myeloma (MM) risk stratification schemata such as the International Staging System (ISS) and Revised-ISS (R-ISS) were derived from clinical trial subjects made up predominately of younger White individuals with adequate renal function. It is unknown whether these prognostic indices are applicable to all patients with newly diagnosed (ND) MM, especially among Black individuals, older adults, and those with renal dysfunction. The R-ISS expanded on the ISS by including and serum lactate dehydrogenase (LDH) and high-risk cytogenetic abnormalities (HRCA) identified by fluorescence in-situ hybridization (FISH), but HRCA may not translate into poor prognosis for older adults and for Black individuals. We sought to create an inclusive risk prognostic index for NDMM using real-world data derived from electronic health records. Methods: De-identified NDMM patient-level data in the real-world setting was provided by COTA, Inc. 3000 patients were identified who met the inclusion criteria of NDMM between 2005 and 2020. Baseline diagnostic parameters available within 60 days before or after diagnosis were included. Progression free survival (PFS) was defined as the time from diagnosis to disease progression or death of any cause. Overall survival (OS) was defined as the time from diagnosis to death of any cause. Proportional hazards models were used to calculate hazard ratios (HR) and 95% confidence intervals for all-cause mortality. Age-adjusted univariate analyses identified variables significantly associated with OS, and continuous variables were dichotomized based on accepted cutoffs. Multivariate Cox models to identify the variables with the strongest association with OS were performed adjusting for age, sex, Black race, receipt of proteasome inhibitor and immunomodulatory imide during induction, autologous stem cell transplant within 1 year of diagnosis, ECOG performance status, and creatinine. An additive risk score was created with one point given to each significant variable. The risk score was then validated for PFS using the Multiple Myeloma Research Foundation's (MMRF) CoMMpass database (version IA15). Results: 3000 NDMM pts from the COTA, Inc. real-world database were initially evaluated, and a total of 689 NDMM pts had sufficient level of data to be included. The median follow-up time was 49.9 months (interquartile range (IQR) 29.1-76.2 months). Median age was 64 (IQR 32-86), including 44% age 65+. Of the 607 with reported race, 474 (78%) were White, 86 (14%) Black, 17 (3%) Asian, and 30 (5%) other. Of the 676 pts with reported serum creatinine (mg/dL), the median was 1 mg/dL (IQR 0.8-1.3) with 85 (13%) measuring >2 mg/dL. Examined peripheral blood variables were: calcium (corrected for albumin), albumin3.5 mcg/mL, LDH >250 U/L, hemoglobin 3 g/dL, and IgA isotype. Variables with significance using multivariate analysis at p250 U/L, B2M >3.5 mcg/mL, hemoglobin Validation of the inclusive risk prognostic index (IRPI) using the MMRF CoMMpass database in 938 patients with all four criteria showed median PFS was 44 (std) vs 33 (int) vs 20.5 months (high). In comparison, median PFS by ISS was 45.9 (I) vs 31.5 (II) vs 20.5 (III) months. Median PFS by R-ISS was 50.1 (I) vs 32.7 (II) vs 19.1 (III) months. Conclusions: Employing real-world datasets that incorporate a more diverse patient population led to the generation of an inclusive risk prognostic index incorporating beta2-microgloublin, LDH, hemoglobin, and IgA isotype. This IRPI does not require bone marrow sampling, performs similarly to ISS and R-ISS in predicting PFS, and with datasets with longer follow-up may prove to predict OS. Figure 1 Figure 1. Disclosures Derman: Sanofi: Membership on an entity's Board of Directors or advisory committees. Belli: COTA, Inc.: Current Employment, Other: Equity ownership. Wang: COTA, Inc.: Current Employment, Other: Equity ownership. Hansen: COTA, Inc.: Current Employment. Jakubowiak: Amgen: Membership on an entity's Board of Directors or advisory committees; Karyopharm: Membership on an entity's Board of Directors or advisory committees; Gracell: Membership on an entity's Board of Directors or advisory committees; BMS: Membership on an entity's Board of Directors or advisory committees; GSK: Membership on an entity's Board of Directors or advisory committees; Abbvie: Membership on an entity's Board of Directors or advisory committees; Sanofi: Membership on an entity's Board of Directors or advisory committees; Janssen: Membership on an entity's Board of Directors or advisory committees; Celgene: Membership on an entity's Board of Directors or advisory committees.

Introduction: Acute myeloid leukemia (AML) is a disease of the older population, with a median age at diagnosis of 68 years. Outcomes remain poor for patients (pts) older than 60 years of age who are unfit to receive intensive chemotherapy. Ven based combination therapy has become the standard of care based on the results of the Viale-A and Viale-C in combination with hypomethylating agents (HMA) or low dose cytarabine (LDAC), respectively. This combination therapy is myelosuppressive leading to multiple dose adjustments in the real-world setting, which may impact the validity of the trial responses and overall survival (OS) in a community-based practice. We therefore sought to investigate the outcomes of pts treated with ven based combination therapy in the real-world setting to better understand efficacy and patterns of adverse events. Methods: Pts 65 years of age or older, diagnosed with AML on or after January 1, 2019, and who received frontline ven based combination therapy with azacitidine (aza), decitabine (dac) or LDAC were identified in the COTA real-world database. The COTA database is a USA-based dataset comprised of longitudinal, Health Insurance Portability and Accountability Act (HIPAA)-compliant data on the diagnosis, clinical management, and outcomes of pts with cancer. Clinical outcomes, including real-world overall response rate (rwORR), OS and adverse events were calculated by treatment group. Responses were defined per treating physician as complete response (CR) or partial (PR) or progressive disease (PD). Categorical variables and rwORR were compared using Fisher's exact test. Survival outcomes were calculated using the Kaplan-Meier method and compared amongst groups using log-rank test. Results: A cohort of 112 pts were treated with ven based combination: ven/aza (n=54), ven/dac (n=52) and ven/LDAC (n=6). Across all treatment groups, the majority (91.1%) of pts were treated in the community setting. The median age at diagnosis was 77 yrs (IQR: 71-81 yrs). Per ELN risk, 6.2% had favorable, 19.6% had intermediate and 62.5% had high-risk AML. Five of the 6 pts receiving ven/LDAC had secondary AML (Table 1). The most common molecular abnormalities across the cohort were TP53 (38.4%), TET2 (26.8%), ASXL1 (27.7%), and DNMT3A (20.5%). The rwORR by treatment was 57.7% for ven/dac, 55.6% for ven/aza and 33.3% for ven/LDAC (ven/dac vs. ven/aza, p=0.85). Median OS (mOS) was similar for ven/dac with a longest mOS of 13.9 mo, followed by ven/aza with a mOS of 11.3 mo, and ven/LDAC mOS of 6.5 mo (ven/dac vs. ven/aza, p=0.77). The most common reasons for treatment discontinuation were toxicity (32.1%) followed by progression/inadequate response (10.7%). The most common toxicities were related to myelosuppression/cytopenias (Table 3). In this cohort, only 6 pts underwent an allogeneic stem cell transplant in first remission and no pts underwent an allogeneic transplant in second remission. Conclusions: To our knowledge, this dataset represents the largest cohort of pts treated with ven based combination therapy in the real world setting across multiple community practices. As less intense regimens are used to treat AML, more pts are receiving induction in the community setting, making these findings relevant in clinical practice. Although ven/dac combination had the longest OS, this was not significantly different from ven/aza. The ven/HMA response rates were lower and survival outcomes were shorter than those reported in the Viale-A trial, which raises concerns about early discontinuation of therapy in the real world setting due to myelosuppression. Ven/LDAC combination had the shortest OS, though most of these patients had sAML. Despite this enriched population for targeted therapies, the outcomes remained poor overall. There are drawbacks to interpreting retrospective outcomes data. First, there were no treatment related AML cases in this dataset, which would be highly unusual in an elderly population of 112 cases of AML. It is more plausible that the diagnosis of treatment related AML was not utilized in the patient's chart. Other data points that were not adequately captured were cause of death and International Working Group response criteria. Mutational panel testing remains underutilized for AML patients in a community-based practice setting. However, this dataset highlights the need for larger datasets to compare the outcomes of AML therapy by practice setting. Figure 1 Figure 1. Disclosures Madanat: Blue Print Pharmaceutical: Honoraria; Stem line pharmaceutical: Honoraria; Onc Live: Honoraria; Geron Pharmaceutical: Consultancy. Belli: COTA, Inc.: Current Employment, Other: Equity ownership. Hansen: COTA, Inc.: Current Employment. Foss: COTA, Inc.: Current Employment. Schulte: COTA, Inc.: Current Employment. Wang: COTA, Inc.: Current Employment, Other: Equity ownership.

Introduction: The advent of CAR-T cell therapies have significantly improved outcomes of patients with relapsed/refractory B-cell malignancies - particularly those with diffuse large B-cell lymphoma (R/R DLBCL) with chemorefractory disease. However, despite the early promise and improved access, utilization of commercially approved CAR-T treatments has lagged behind early estimates generated by historical outcomes of patients with R/R DLBCL. The influences and challenges that limit utilization of CAR-T treatments and practice-specific treatment patterns in CAR-T-eligible patients have also not been studied systematically. Herein we provide comprehensive comparative characteristics, treatment patterns, and outcomes of patients with R/R DLBCL who would be deemed eligible for CAR-T therapy, per the criteria utilized in pivotal clinical trials performed for commercial approval of these agents. Methods: This retrospective study utilized the COTA real-world database, a de-identified database of RWD derived from the electronic health records of partnered healthcare providers in the United States. A total of 1663 patients treated for DLBCL after 2016 were included in the analysis. Patient and disease outcomes, therapy utilizations and comparative outcomes with respect to clinical trial criteria were extracted and analyzed descriptively. Line of therapy was assigned programmatically utilizing standard definitions and guidelines. Survival and mortality outcomes were assessed by KM method across various subgroups. Results: In the 1663 patients with DLBCL included in this study, the median age was 66 years (IQR: 56-75). 58.9% were males and 73.6% were Caucasians. Practice setting distribution of this cohort was 50.6% academic and 49.4% community. 7.9% of the population (N=131) had primary refractory disease and 45.1% had relapsed disease, including 4.5% (N=75) who relapsed following autologous stem cell transplantation (ASCT). Most common histology was DLBCL not otherwise specified, 31.1% had bulky disease and 69.3% had extranodal disease at initial presentation. Double- or triple-hit status was not assessed in 52.0% of patients. With a median follow up of 1.8 years, the 12-month overall survival (OS) from time of starting first line treatment of the entire cohort was 84%. Patients with primary refractory disease had a median OS of 21.2 months and patients with relapsed disease post ASCT had a median OS of 33 months. We further evaluated the outcomes of 145 patients who underwent CAR-T therapy (8.7% of the entire cohort) and compared outcomes to 169 patients who did not undergo CAR-T therapy despite meeting the eligibility criteria utilized in the pivotal ZUMA-1 or JULIET trial for axicabtagene cilolecleucel and tisagenlecleucel respectively (10.1% of the entire cohort). Patients who did not undergo CAR-T therapy were older (median age 63 vs. 59 years respectively, p=0.031) and almost all in the academic setting (96.4% vs 56.6% respectively, p Conclusions: Our study details the characteristics of a real-world population of patients with DLBCL and evaluates outcomes specifically with respect to CAR-T therapy utilization. Outcomes of patients undergoing CAR-T therapies are similar to previously reported data. While retrospective reviews are limited in their ability to truly assess all patient and physician factors that influence therapeutic selection, our study highlights clinical characteristics of potentially eligible patients who do not undergo CAR-T treatment. Furthermore, it provides an avenue to compare outcomes of novel therapies in the relapsed setting especially when compared to CAR-T treatment and the promising survival outcomes observed presumably due to their use. Disclosures Awan: Verastem: Consultancy; ADCT therapeutics: Consultancy; Incyte: Consultancy; MEI Pharma: Consultancy; Abbvie: Consultancy; Cardinal Health: Consultancy; Merck: Consultancy; BMS: Consultancy; Beigene: Consultancy; Kite pharma: Consultancy; Celgene: Consultancy; Karyopharm: Consultancy; Pharmacyclics: Consultancy; Gilead sciences: Consultancy; Janssen: Consultancy; Johnson and Johnson: Consultancy; Astrazeneca: Consultancy; Dava Oncology: Consultancy; Genentech: Consultancy. Belli: COTA, Inc.: Current Employment, Other: Equity ownership. Hansen: COTA, Inc.: Current Employment. Chung: COTA, Inc.: Current Employment. Wang: COTA, Inc.: Current Employment, Other: Equity ownership.

Background: There have been significant advancements in the treatment of multiple myeloma (MM) over the last 20 years including an influx of recently approved novel therapies. However, with these advances in treatment, the optimal combination and sequence of agents remain largely unknown especially in relapsed/refractory MM. A major unmet need in MM is patients with high-risk disease. Revised International Staging System is used to identify patients with high-risk MM, however a better definition of high risk includes "functional high risk" (i.e. patients relapsing within 18 months from diagnosis). As it has been previously shown that clinical trial populations are not universally representative of those in the routine practice setting, real-world data (RWD) can provide valuable insight into this rapidly evolving treatment landscape and high-risk population. Here we explore treatment patterns and outcomes of functional high-risk MM, patients who relapse within 18 months of initial diagnosis. Methods: This retrospective study utilized the COTA real-world database, a de-identified database of RWD derived from the electronic health records of partnered healthcare providers in the United States. A total of 958 patients were identified as having been diagnosed with active MM between Jan. 1, 2015 and Jan. 1, 2020 and experienced early relapse (defined as relapse within 18 months of initial active MM diagnosis and treatment). Practice setting distribution of this cohort was 84% academic and 16% community. Line of therapy was assigned programmatically utilizing IMWG definitions and guidelines. Patient characteristics and treatment patterns across the first (1L) and second lines (2L) of treatment were assessed using descriptive statistics. Time to next treatment (TTNT) was calculated overall and within treatment subgroups of interest as a surrogate for progression-free survival. Results: Among this functional high-risk patient population, the mean age was 64 yrs. (SD ±11.3) and the patients were predominantly white (72.6%). The most common cytogenetic abnormalities at diagnosis were del(13) (46.0% positive), 1q (36.4%), and t(11;14) (25.4%). In 1L, the majority of patients received a triplet regimen (75.4%), most commonly proteosome inhibitor (PI) + immunomodulator (IMiD) + steroids (45.0%). A total of 56 patients (5.9%) received stem-cell transplant (SCT) in 1L. Overall, 16.3% of the population did not receive 2L therapy due to death. Among the patients who received 2L therapy after early relapse (N=869), 50.5% received an SCT. TTNT was significantly longer for patients receiving SCT in 2L as compared to those who did not (34.8 vs. 5.8 months, respectively). Among patients who did not receive SCT (N=430), triplet therapy was most common (61.2%) with PI + IMiD + steroids representing the largest regimen group (30.2%). Table 1 shows the distribution of PI drugs within the 2L PI + IMID + steroids group and their associated median TTNT. No significant differences were observed when comparing median TTNT of 2L PI + IMID + steroids to daratumumab-based regimens (5.3 vs. 5.6 months, respectively). Conclusions: In our real-world population, median TTNT for functional high-risk patients was 17.8 months. 50.5% of these functional high-risk patients received SCT in 2L with the most common induction regimen containing cyclophosphamide + etoposide + dexamethasone (CED). For patients not receiving SCT in 2L, the most common regimen type included PI + IMID + Steroids. In comparing antibody-based therapy vs. PI + IMID + dexamethasone-based therapy, daratumumab-based combinations showed no significant difference in unadjusted analysis. Our study highlights some very important observations in functional high-risk patients. First, if patients are SCT eligible and it is not performed as part of first line treatment, SCT still provides the best outcomes in regard to TTNT in the second line setting. For patients not receiving SCT, our RWD demonstrates that 30.2% receive PI + IMID + dexamethasone as 2L treatment with only 13% receiving carfilzomib-based combination. Our study highlights the poor outcome of functional high-risk patients and provides insight into treatment patterns in 2L therapy. Further research is needed to explore patient and disease characteristics of functional high-risk patients and study novel treatment strategies like CAR T cell therapy or T-cell engagers in these patient population. Disclosures Belli: COTA, Inc.: Current Employment, Current equity holder in private company. Hansen:COTA, Inc.: Current Employment, Current equity holder in private company. Kansagra:Alnylam Pharmaceuticals, Bristol Myers Squibb /Celgene, GlaxoSmithKline, Janssen, Pharmacyclics, Takeda Pharmaceuticals, Pfizer, Karyopharm Therpeutics: Other: Advisory Board. Dilwali:COTA, Inc.: Current Employment, Current equity holder in private company. Wang:COTA, Inc.: Current Employment, Current equity holder in private company.

This cohort study estimates the association of a park-based violence prevention and mental health promotion after-school program with youth arrest rates in Miami-Dade County, Florida.

BackgroundHydroxychloroquine has been touted as a COVID-19 treatment. Tocilizumab, an inhibitor of IL-6, has been proposed as a treatment of critically ill patients.ObjectiveTo describe the association between mortality and hydroxychloroquine or tocilizumab therapy among hospitalized COVID-19 patients.DesignRetrospective observational cohort study of electronic health records Setting: 13-hospital network spanning the state of New Jersey.ParticipantsPatients hospitalized between March 1, 2020 and April 22, 2020 with positive polymerase chain reaction results for SARS-CoV-2. Follow up was through May 5, 2020.Main OutcomesThe primary outcome was death.ResultsAmong 2512 hospitalized patients with COVID-19 there have been 547 deaths (22%), 1539 (61%) discharges and 426 (17%) remain hospitalized. 1914 (76%) received at least one dose of hydroxychloroquine and 1473 (59%) received hydroxychloroquine with azithromycin. After adjusting for imbalances via propensity modeling, compared to receiving neither drug, there were no significant differences in associated mortality for patients receiving any hydroxychloroquine during the hospitalization (HR, 0.99 [95% CI, 0.80-1.22]), hydroxychloroquine alone (HR, 1.02 [95% CI, 0.83-1.27]), or hydroxychloroquine with azithromycin (HR, 0.98 [95% CI, 0.75-1.28]). The 30-day unadjusted mortality for patients receiving hydroxychloroquine alone, azithromycin alone, the combination or neither drug was 25%, 20%, 18%, and 20%, respectively. Among 547 evaluable ICU patients, including 134 receiving tocilizumab in the ICU, an exploratory analysis found a trend towards an improved survival association with tocilizumab treatment (adjusted HR, 0.76 [95% CI, 0.57-1.00]), with 30 day unadjusted mortality with and without tocilizumab of 46% versus 56%.ConclusionsThis observational cohort study suggests hydroxychloroquine, either alone or in combination with azithromycin, was not associated with a survival benefit among hospitalized COVID-19 patients. Tocilizumab demonstrated a trend association towards reduced mortality among ICU patients. Our findings are limited to hospitalized patients and must be interpreted with caution while awaiting results of randomized trials.Trial RegistrationClinicaltrials.gov Identifier: NCT04347993

The beginning of the 21st century was marked by the new definition and framework of health systems strengthening (HSS). The global movement to improve access to high-quality care garnered new resources to design and implement comprehensive HSS programs. In this effort, billions of dollars flowed from novel mechanisms such as The Global Fund to Fight AIDS, Tuberculosis and Malaria; Gavi, the Vaccine Alliance; and several bilateral funders. However, poor health outcomes, particularly in low-income countries, raise questions about the effectiveness of HSS program implementation. While several evaluation projects focus on the ultimate impact of HSS programs, little is known about the short- and mid-term reactions occurring throughout the active implementation of HSS interventions. Using the well-documented WHO framework of six HSS building blocks, we describe the evolution and phases of health system reconstitution syndrome (HSRS), including: (1) quiescent phase, (2) reactive phase, (3) restorative phase and (4) stability phase. We also discuss the implications of HSRS on global health funding, implementation, policy and research. Recognizing signs of HSRS could improve the rigour of HSS program design and minimize premature decisions regarding the progress of HSS interventions.

Introduction: Transportation equity ensures that all citizens benefit from a clean, fair, safe and healthy environment. Residential segregation also impacts health, and transportation disadvantage is particularly high in areas with high segregation, where residents typically lack proximity to quality education, jobs, healthy food, safe playgrounds, and medical care. Recent research demonstrates improvements in cardiovascular risk profiles among minority girls after reduced exposure to segregation. There is a need to examine differences in the segregation-youth cardiovascular health association across transportation vulnerability and gender to inform health equity interventions. Hypothesis: It was hypothesized that girls with reduced segregation exposure and low transportation vulnerability would have the most improved cardiovascular health. Methods: Data for these analyses were drawn from the Fit2Play dataset (2010-2018; N=2742). Youth were followed over 4 consecutive years of participation in a year-long afterschool physical activity program. Change in segregation exposure was based on concentration of minorities living in block groups from the participant’s home to program areas using the 2010 Census. Transportation vulnerability was based on percent of households in the participant’s home zip code with vehicle access (0, 1, 2, or ≥3 vehicles) drawn from the American Community Survey (2012-16). Longitudinal mixed models were used to compare the association between change in residential segregation and five cardiovascular health risk measures (body mass index, systolic and diastolic blood pressure, skinfold thickness and 400 meter run tests) stratified by transportation vulnerability and gender. Results: Participants were 54% male, 51% Hispanic, 49% non-Hispanic black, and 52% high poverty (mean age 9.5 years). After accounting for child age, race/ethnicity, poverty, and year, girls with high transportation vulnerability and reduced segregation exposure showed the most reduced cardiovascular health risk profiles, including improvements in body mass index (26%, 95% CI: 23.84, 28.30), skinfold thicknesses (18%, 95% CI: 14.90, 20.46), run time (17%, 95% CI: 14.88, 18.64), systolic blood pressure (15%, 95% CI: 11.96, 17.08), and diastolic blood pressure (12%, 95% CI: 9.09, 14.61). In contrast, no clear patterns emerged for low transportation vulnerable girls, and high or low transportation vulnerable boys. Conclusions: In conclusion, high transportation vulnerable girls exposed to reduced segregation had greater improvements in all cardiovascular health risk outcomes compared with low transportation vulnerable girls, and both high and low transportation vulnerable boys. Transportation equity interventions may provide a means to reduce youth cardiovascular health disparities, particularly for girls living highly segregated areas.

Dalam sebuah perencanaan gedung, perencanaan struktur merupakan unsur terpenting agar tidak terjadi kesalahan-kesalahan konstruksi, seperti penurunan bangunan. Beberapa faktor yang mempengaruhi besarnya penurunan, yaitu: kondisi tanah, berat bangunan, kesalahan perencanaan, dan tingkat muka air tanah. Penelitian dengan judul ‘Hubungan Differential Settlement Dengan Kekuatan Elemen Struktur Balok dan Kolom (Studi Kasus Hotel Sleeper Space Semarang)’, bertujuan agar perencanaan komponen struktur mampu menahan terjadinya penurunan. Penelitian ini menggunakan perangkat lunak ETABS 2018 v18.0.2. Penelitian dimulai dengan menentukan gedung yang akan diteliti, analisa penurunan bangunan menggunakan bantuan perangkat lunak ETABS 2018 v18.0.2, menggunakan 5 variabel penurunan dalam centimeter, dan pada akhirnya didapatkan besaran momen pada balok dan kolom untuk menentukan kemampuan Hotel Sleeper Space Semarang apabila mengalami penurunan.

This is the accepted, refereed and final manuscript to the article Corporate social responsibility (CSR) literature holds that CSR can help firms gain a competitive advantage by enabling them to differentiate themselves from their competition and reduce costs. In the strategy literature, differentiation and cost reduction are recognized as two major competitive strategies that firms pursue to outcompete rival firms. Yet, how CSR is linked to a firm's choice of competitive strategy is not explicitly explored in the extant literature. The present paper fills this gap. Using data collected from 478 small firms representing multiple industries in the US, this paper finds that a firm's focus on competing through differentiation strategy is associated with its level of community engagement but not with its level of environmental engagement. Competing through a strategy of cost-leadership is associated with neither community nor environmental engagement. The paper concludes that, except for seeking differentiation through community engagement, the approach of small firms to CSR remains largely characterized by adhoc decisions with few ties to their competitive strategies. The paper advances the understanding of CSR in small firms and provides novel insights into how CSR is linked with competitive strategies. 2, Forfatterversjon

Going green in consumption is gaining momentum globally, but little is known how national cultural values and consumers’ ethical ideologies explain green consumption. With a culturally rich sample of 1929 responses from consumers in Finland, Germany, Portugal, and the United Kingdom, the present study examines how cultural long-term orientation and collectivism predict consumers’ green consumption values, and if these relationships are moderated by ethical ideologies. The study finds that cultural collectivism has a significant positive effect on green consumption values, as expected. However, the results show that the two long-term orientation constructs, namely planning and tradition, point in opposite directions when predicting green consumption. We demonstrate that while long-term planning has a significant positive effect on green consumption values, the effect of traditional values is negative. We further show that this negative effect varies across consumers’ ethical ideologies so that the effect is the greatest for Exceptionists and Absolutists, that is, those who rely in their actions on universal moral principles rather than particular circumstances. Therefore, our research contributes to the literature by providing new evidence for the cultural and ethical aspects in green consumption values. Furthermore, the study suggests that managers pay special attention to the consumers who have high collectivistic and future-oriented values to promote environmentally friendly consumption.