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Background We conducted a systematic review to evaluate and compare the accuracy of pre-hospital triage tools for major trauma in the context of the development of the Italian National Institute of Health guidelines on major trauma integrated management. Methods PubMed, Embase, and CENTRAL were searched up to November 2019 for studies investigating pre-hospital triage tools. The ROC (receiver operating characteristics) curve and net clinical benefit for all selected triage tools were performed. Quality assessment was performed using the Quality Assessment of Diagnostic Accuracy Studies–2. Certainty of the evidence was judged with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results We found 15 observational studies of 13 triage tools for adults and 11 for children. In adults, according to the ROC curve and the net clinical benefit, the most reliable tool was the Northern French Alps Trauma System (TRENAU), adopting injury severity score (ISS) > 15 as reference (sensitivity (Sn), 0.92; specificity (Sp), 0.41; 1 study; sample size, 2572; high certainty of the evidence). When mortality as reference was considered, the pre-hospital triage tool with the best net clinical benefit trajectory was the New Trauma Score (NTS) < 18 (Sn, 0.82; Sp, 0.86; 1 study; sample size, 1001; moderate certainty of the evidence). In children, high variability among all triage tools for sensitivity and specificity was found. Conclusion Sensitivity and specificity varied across all available pre-hospital trauma triage tools. TRENAU and NTS are the best accurate triage tools for adults, whereas in the pediatric area a large variability prevents any firm conclusion.

Background Blood transfusion is a lifesaving intervention for millions of recipients worldwide every year. Storing blood makes this possible but also promotes a series of alterations to the metabolism of the stored erythrocyte. It is unclear whether the metabolic storage lesion is correlated with clinically relevant outcomes and whether strategies aimed at improving the metabolic quality of stored units, such as hypoxic storage, ultimately improve performance in the transfused recipient. Study design and methods Twelve healthy donor volunteers were recruited in a two-arm cross-sectional study, in which each subject donated 2 units to be stored under standard (normoxic) or hypoxic conditions (Hemanext technology). End-of-storage measurements of hemolysis and autologous posttransfusion recovery (PTR) were correlated to metabolomics measurements at Days 0, 21, and 42. Results Hypoxic red blood cells (RBCs) showed superior PTR and comparable hemolysis to donor-paired standard units. Hypoxic storage improved energy and redox metabolism (glycolysis and 2,3-diphosphoglycerate), improved glutathione and methionine homeostasis, decreased purine oxidation and membrane lipid remodeling (free fatty acid levels, unsaturation and hydroxylation, acyl-carnitines). Intra- and extracellular metabolites in these pathways (including some dietary purines) showed significant correlations with PTR and hemolysis, though the degree of correlation was influenced by sulfur dioxide (SO2 ) levels. Conclusion Hypoxic storage improves energy and redox metabolism of stored RBCs, which results in improved posttransfusion recoveries in healthy autologous recipients-a Food and Drug Administration gold standard of stored blood quality. In addition, we identified candidate metabolic predictors of PTR for RBCs stored under standard and hypoxic conditions.

Renal artery stenosis (RAS) is one of the most common primary diseases of the renal arteries. It is associated with hypertension as well as ischemic renal disease. Its concomitant presence constitutes a high cardiovascular risk, thus timely diagnosis is important. This study aims to determine the occurrence of RAS in patients undergoing abdominal CT angiography and determines other factors that predict the highest-risk subset who have significant renal artery narrowing.

Real-time diagnostics of cold atmospheric plasma (CAP) sources can be challenging due to the requirement for expensive equipment and complicated analysis. Data analytics that rely on machine learning (ML) methods can help address this challenge. In this paper, we demonstrate the application of several ML methods for real-time diagnosis of CAPs using information-rich optical emission spectra and electro-acoustic emission. We show that data analytics based on ML can provide a simple and effective means for estimation of operation-relevant parameters such as rotational and vibrational temperature and substrate characteristic in real-time. Our findings indicate a great potential promise for ML for real-time diagnostics of CAPs.

We consider a known system that operates in an unknown environment, which is discovered by sensing and affects the known system through constraints. However, sensing quality is typically dependent on system operation. Thus, the control decisions should account for both the impact of control on sensing and the impact of sensing on control. Since the information acquired from sensing is of statistical nature, we develop a perception-aware chance-constrained model predictive control (PAC-MPC) strategy that leverages uncertainty propagation models to relate control and sensing decisions to the environment knowledge. We propose conditions for recursive feasibility and provide an overview of the stability properties in such a statistical framework. The performance of the proposed PAC-MPC is demonstrated on a case study inspired by an automated driving application.

Vehicles have been a big part of many lives; from the time it is invented and as it increases popularity in the 20th century. Though they offer the benefit of convenience, they also have certain negative effects as they add to air pollution and global warming, as well as risks when they are not handled properly. In recent years, the number of vehicles on the road is rapidly increasing and it causes different major concerns. One of the major effects of this increasing volume of vehicles is the traffic congestion it caused on our roads especially in the urban areas. This traffic congestion became one of the major problems in many cities in the world including Metro Manila, Philippines. Many options are discussed and implemented by the traffic management but it seems that it is still unsolved. In recent years, traffic congestions became unpredictable, there are parts of the cities that don’t experience traffic congestion then suddenly traffic builds up to that area. Also, traffic congestion might happen every hour of the day. With this concern, the study proposed a system for vehicle headlight recognition for on-road vehicle detection and counting. This study focused on the detection of the headlight of every vehicle that will be seen on the perimeter of the installed camera. The system can detect headlight vehicles during daytime and nighttime as we trained the AI to recognized the headlights in these scenarios. Possible applications of this system can be in monitoring the volume of vehicles within the area and it can be used by traffic management authority in monitoring the build-up of traffic or traffic situation in an area so that they can provide an immediate solution, such as re-routing, one-way street conversions, etc.

Dementia is a common term for memory loss, speech, problem-solving, and other cognitive skills that are serious enough to interfere with everyday life, and Alzheimer’s is the leading cause of dementia. Alzheimer’s disease is presumed to develop 20 years or more before symptoms occur, with degenerative changes that are unapparent to the person affected. The deep learning approach for early detection and Alzheimer’s disease classification has recently gained significant attention. This study proposed disease detection trained by utilizing the YOLO v3 algorithm that aims to detect Alzheimer’s disease based solely on Magnetic Resonance Imaging (MRI). Pascal VOC format and LabelImg tool are used for annotating the datasets, categorizing the image as non-demented and mild-demented. Model 4 was used in the system having 98.617% training accuracy, 98.8207% validation accuracy, and mAP of 96.17%. To test the accuracy of the used model, images of MRI scans are presented and it recorded 80% testing accuracy.

In Italy, chronic pain affects more than a quarter of the population, whereas the average European prevalence is 21%. This high prevalence might be due to the high percentage of Italian people who do not receive treatment, even after the passing of law 38/2010 (the right to access pain management in Italy), which created a regional network for the diagnosis and treatment of noncancer chronic pain. Italian epidemiologic studies on chronic pain are scanty, and this observational, multicenter, cross-sectional study is the first to investigate the clinical characteristics of patients who attended the pain management clinics in the Latium Region, Italy, for the management of their noncancer chronic pain. A total of 1,606 patients (mean age 56.8 years, standard deviation ± 11.4), 67% women, were analyzed. Severe pain was present in 54% of the sample. Women experienced pain and had it in two or more sites more often than men (57% vs. 50%, p = .02; and 55.2% vs. 45.9%, p .001, respectively). Chronic pain was musculoskeletal (45%), mixed (34%), and neuropathic (21%). In more than 60% of the cases, chronic pain was continuous, and in 20% it had lasted for more than 48 months; long-lasting pain was often neuropathic. Low back (33.4%) and lower limbs (28.2%) were the main locations. Severe intensity of pain was statistically significantly associated with female gender (odds ratio [OR] 1.39; 95% confidence interval [CI] 1.06-1.84); with International Classification of Diseases, Ninth Revision, codes for chronic pain syndrome (OR 2.14; 95% CI 1.55-2.95); and with continuous pain (OR 2.02; 95% CI 1.54-2.66). Neuropathic pain and mixed pain were significantly associated with number of sites, and a trend seemed to be present (OR 2.11 and 3.02 for 2 and 3 + sites; 95% CI 1.59-2.79 and 2.00-4.55, respectively).

The area of information system (IS) has created a whole different environment for information and communication technology (ICT), and the Internet plays a vital role in this work. This paper introduces an IS web-based implementation structure for the judicial system in the Philippines' Regional Trial Court (RTC). The original structure centers on helping the Judicial Officers and the Lawyer workflow. In the other hand, the administrator (authorized person) views other files: status reports, list of cases and list of clients. The research methodology includes an extensive study of information systems in the judiciary system. Two important concepts, Case Information Management System (CIMS) and Electronic Court Record-Keeping (ECRK), form the basis for the initial design. Software and the system architectures are presented.

BACKGROUND: Obesity is a global pandemic characterized by multiple comorbidities, including cardiovascular and metabolic diseases. The aim of this study was to define the associations between blood donor body mass index (BMI) and RBC measurements of metabolic stress and hemolysis. STUDY DESIGN AND METHODS: The associations between donor BMI (

Schizophrenia is a chronic neuropsychiatric disorder with a poorly understood pathophysiology. The theories about the disorder are mainly about dysregulation in one or more systems of neurotransmitters, and the progression triggers the presence of inflammatory markers indicates the possibility that the disorder is initially an inflammatory disease. The objective was to evaluate the ascorbic acid supplementation in an animal model of schizophrenia, on behavioral parameters, and cytokines involved in inflammation IL-1β, IL-10. Wistar rats with 60 days of age were used which were supplemented with ascorbic acid at 0.1, 1, and 10 mg/kg or saline for 14 days via orogastric gavage. Subsequently, four groups were given ketamine (25 mg/kg) and four groups received intraperitoneal saline from the 9th-15th day of the experiment. After 30 min of the last administration of ketamine/saline, and behavioral test, rats were killed by guillotine decapitation and the brain structures were carefully dissected for biochemical analysis. Results showed that ascorbic acid supplementation prevented motor sensory loss but nor alter other parameters evaluated. We concluded that ascorbic acid may be used as a therapeutic adjuvant in schizophrenia and may help to improve the schizophrenic patient's life quality.

Altered metabolism in pulmonary artery smooth muscle cells (PASMCs) and endothelial cells (PAECs) contributes to the pathology of pulmonary hypertension (PH), but changes in substrate uptake and how substrates are utilized have not been fully characterized. We hypothesized stable isotope metabolomics would identify increased glucose, glutamine and fatty acid uptake and utilization in human PASMCs and PAECs from PH versus control specimens, and that TGF-β treatment would phenocopy these metabolic changes. We used

Early toxic death (≤60 days of diagnosis) in elderly multiple myeloma (MM) patients is attributable to active disease, age and co-morbidities. Rate of early toxic deaths is 10% with conventional chemotherapy mainly due to infection and renal failure. Novel agents have improved MM outcome at the expense of newer toxicity.We analyzed 1146 individual patient data to assess toxic deaths during induction treatment with first-generation novel agents thalidomide, lenalidomide, bortezomib.During first-line therapy, 119/1146 patients (10%) died for any cause, and 47/1146 (4%) due to toxicity, including 12/1146 (1%) early deaths. The 24-month cumulative incidence was 4.1% without any difference between bortezomib (18/503 patients, 4%) and lenalidomide (29/643patients, 5%; p = 0.31). Toxic deaths occurred in 34/1039 (3%) patients80 years and 13/107 (12%) patients ≥80 years. Causes were cardiac events (28%), infections (26%) and vascular complications (15%). In a multivariate analysis, older age and unfavorable ISS stage increased the risk of death.First-generation novel agents significantly reduced toxic deaths compared to conventional chemotherapy. One third of deaths during first-line therapy were due to cumulative drug-related toxicities, thus supportive approaches and prevention strategies should be optimized. The higher mortality rate for toxicity in octogenarians confirms the need for a careful frailty assessment.

Researchers and experts had developed numerous hash-based password authentication schemes. Inappropriately, most of them are susceptible to different attacks. This study centers on the process of performing cryptanalysis on the developed Head and Tail (HT) technique for hashing passwords. The research tested the HT technique in terms of its capacity to resist a dictionary attack, rainbow tables attack, and brute-force attack. To test the strength of the HT technique, HashCat, John the Ripper, RainbowCrack, and online cracking systems from crackstation.net and hashkiller.co.uk were used as tools for cracking. After the experiment, the result shows that the cracking tools failed to crack the HT technique. Further tests showed that generating a password-hash value pair or lookup table for MD5-HT and SHA1-HT is 16 times slower than standard MD5 and SHA1. Thus, the Head and Tail (HT) technique is a secured method for hashing passwords.

Trauma is the leading cause of mortality under the age of 40 years. Recent observations on metabolic reprogramming during hypoxia and ischemia indicate that hypoxic mitochondrial uncoupling promotes the generation of succinate, which in turn mediates reperfusion injury and inflammatory sequelae upon reoxygenation. Plasma levels of succinate significantly increase in response to trauma and hemorrhage in experimental models and clinical samples, suggesting that succinate may represent a candidate marker of systemic perfusion in trauma.Quantitative mass spectrometry-based metabolomics was used to quantify succinate and lactate in 595 plasma samples from severely injured patients enrolled at the Denver Health Medical Center, a Level I trauma center in Denver, Colorado.A total of 95 severely injured patients were sampled for up to 10 time points (595 total samples), from field blood to 7 days postinjury. Results indicate that plasma levels of succinate increased up to 25.9-fold in deceased patients versus the median of the surviving patients (p = 2.75e-100; receiver operating characteristic area under the curve, 0.911). On the other hand, only 2.4-fold changes increases in lactate were observed (p = 5.8e-21; area under the curve, 0.874).Succinate represents a uniquely sensitive biomarker of postshock metabolic derangement and may be an important mediator of sequelae.Prognostic study, level III.

Background. In multiple myeloma (MM), the role of minimal residual disease (MRD) by multiparameter flow cytometry (MFC) and next-generation sequencing (NGS) is well established (H. Avet-Loiseau et al. IMW 2019, S. Oliva et al. EHA 2020). Aims. The aims of this analysis were the evaluation of (1) the rate of conversion from MRD-positivity (MRD-pos) to MRD-negativity (MRD-neg) with MFC and NGS during maintenance and (2) the impact on progression-free survival (PFS) and overall survival (OS) of MRD-neg with both techniques in different subgroups including different treatment arms. Methods. Newly diagnosed (ND)MM patients (pts) aged ≤65 years were randomized (R1) to receive carfilzomib (K)-lenalidomide (R)-dexamethasone (d) induction followed by autologous stem-cell transplantation (ASCT) and KRd consolidation (KRd_ASCT), 12 KRd cycles (KRd12), or K-cyclophosphamide(C)-d induction followed by ASCT and KCd consolidation (KCd_ASCT). After consolidation, pts were further randomized (R2) to KR vs R maintenance. MRD was assessed every 6 months (m) by 8-color second-generation flow cytometry (sensitivity 10-5) in pts with ≥very good partial response (VGPR). In pts achieving at least a complete response (≥CR), MRD was also assessed by NGS at the same time points (Adaptive Biotechnologies, Seattle, US-WA; sensitivity 10-5-10-6). Logistic regression analysis adjusted for International Staging System (ISS) stage (I vs II/III) and R1 was performed to evaluate the conversion rate from MRD-pos to MRD-neg during maintenance (KR vs R). PFS and OS of MRD-neg vs MRD-pos in the intention-to-treat (ITT) population were evaluated. For these analyses, MFC-pos pts included those who were positive by MRD plus those Results. Rates of MRD-neg by MFC and NGS before maintenance in the 3 induction/consolidation arms have been previously presented (S. Oliva et al. EHA 2020). At R2, 65% of randomized pts were MRD-neg by MFC (equally distributed in the 2 arms); 39% (48/123) of MRD-pos pts turned MRD-neg after a median of 7.6 m (IQR 6.5-12): 46% (29/63) in KR vs 32% (19/60) in R (OR 2.27; P=0.04) arms. At R2, 72% of pts evaluable for CR were MRD-neg by NGS (equally distributed in the 2 arms); 33% of MRD-pos pts (15/45) became MRD-neg at 10-5: 39% (9/23) in KR vs 27% (6/22) in R arms (=NS). In the ITT analysis, after a median follow-up of 45 m from R1, pts who were MRD-neg before maintenance by both techniques showed a superimposable prolonged PFS and OS vs pts who were MRD-pos: 3-year PFS was 80% vs 52% (HR 0.36, 95% CI 0.26-0.49 P The impact of pre-maintenance MRD negativity by MFC on PFS was explored in different treatment arms: 3-year PFS was longer in KRd_ASCT vs KRd12 and in KRd_ASCT vs KCd_ASCT arms; MRD-pos pts showed a similar PFS in the 3 arms. The same trend was shown by NGS MRD negativity: 3-year PFS was longer in KRd_ASCT vs KRd12 and in KRd_ASCT vs KCd_ASCT arms. A longer PFS was observed in pre-maintenance MRD-neg pts who were randomized to KR vs R both by MFC (HR 0.51, P=0.02) and NGS (HR 0.38, P=0.03); similar features were observed in MRD-pos pts (Fig. 1B). Conclusions. KR maintenance induced a high rate of conversion from MRD-pos to MRD-neg both by MFC and NGS. The outcomes of pts who were MRD-neg by MFC and NGS at 10-5 were similar, as well as those of pts with 1-year sustained MRD-neg both by MFC and NGS. These clinical findings confirmed a high degree of concordance between these two techniques. MRD-neg pts receiving KRD_ASCT showed a longer PFS (88% at 3 years) than pts receiving KRd12 and KCd_ASCT. KR vs R significantly prolonged PFS even in pts who were MRD-neg before maintenance. Figure 1 Disclosures Oliva: Adaptive Biotechnologies: Membership on an entity's Board of Directors or advisory committees; Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees; Amgen: Honoraria, Membership on an entity's Board of Directors or advisory committees; Celgene: Honoraria; Takeda: Membership on an entity's Board of Directors or advisory committees. Petrucci:Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees; Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees; BMS: Honoraria, Membership on an entity's Board of Directors or advisory committees; GSK: Honoraria, Membership on an entity's Board of Directors or advisory committees; Sanofi: Honoraria, Membership on an entity's Board of Directors or advisory committees; Takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees; Amgen: Honoraria, Membership on an entity's Board of Directors or advisory committees. D'Agostino:GSK: Membership on an entity's Board of Directors or advisory committees. Jacob:Adaptive Biotechnologies: Current Employment, Current equity holder in publicly-traded company. Gozzetti:Amgen: Honoraria; Takeda: Honoraria; Janssen: Honoraria, Research Funding. Kirsch:Adaptive Biotechnologies: Current Employment. Corradini:KiowaKirin: Consultancy, Honoraria; Novartis: Consultancy, Honoraria, Other: Travel and accommodations paid by for; F. Hoffman-La Roche Ltd: Consultancy, Honoraria; Sanofi: Consultancy, Honoraria; Servier: Consultancy, Honoraria; Takeda: Consultancy, Honoraria, Other; BMS: Other; Amgen: Consultancy, Honoraria, Other: Travel and accommodations paid by for; Celgene: Consultancy, Honoraria, Other: Travel and accommodations paid by for; Daiichi Sankyo: Consultancy, Honoraria; Gilead: Consultancy, Honoraria, Other: Travel and accommodations paid by for; Incyte: Consultancy; Janssen: Consultancy, Honoraria; Kite: Consultancy, Honoraria; AbbVie: Consultancy, Honoraria, Other: Travel and accommodations paid by for. Musto:Amgen: Honoraria; Celgene: Honoraria. Boccadoro:Sanofi: Honoraria, Research Funding; GlaxoSmithKline: Membership on an entity's Board of Directors or advisory committees; Mundipharma: Research Funding; AbbVie: Honoraria; Bristol-Myers Squibb: Honoraria, Research Funding; Novartis: Honoraria, Research Funding; Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Amgen: Honoraria, Research Funding; Celgene: Honoraria, Research Funding. Zamagni:Amgen: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; BMS: Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses, Speakers Bureau; Takeda: Honoraria, Other: Travel, Accommodations, Expenses, Speakers Bureau; Sanofi: Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses, Speakers Bureau; Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses, Speakers Bureau; Celgene Corporation: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Gay:Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees; Amgen: Honoraria, Membership on an entity's Board of Directors or advisory committees; Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees; Takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees; Seattle Genetics: Membership on an entity's Board of Directors or advisory committees; Adaptive: Membership on an entity's Board of Directors or advisory committees; AbbVie: Membership on an entity's Board of Directors or advisory committees; Roche: Membership on an entity's Board of Directors or advisory committees; Bristol-Myers Squibb: Honoraria, Membership on an entity's Board of Directors or advisory committees; Oncopeptides: Membership on an entity's Board of Directors or advisory committees; GSK: Membership on an entity's Board of Directors or advisory committees. OffLabel Disclosure: The presentation includes discussion of off-label use of a drug or drugs for the treatment of multiple myeloma (including carfilzomib, cyclophosphamide, lenalidomide and dexamethasone).

The circadian clock is important for cellular and organ function. However, its function in sickle cell disease (SCD), a life-threatening hemolytic disorder, remains unknown. Here, we performed an unbiased microarray screen, which revealed significantly altered expression of circadian rhythmic genes, inflammatory response genes, and iron metabolic genes in SCD Berkeley transgenic mouse lungs compared with controls. Given the vital role of period 2 (Per2) in the core clock and the unrecognized role of Per2 in SCD, we transplanted the bone marrow (BM) of SCD mice to Per2(Luciferase) mice, which revealed that Per2 expression was up-regulated in SCD mouse lung. Next, we transplanted the BM of SCD mice to period 1 (Per1)/Per2 double deficient [Per1/Per2 double knockout (dKO)] and wild-type mice, respectively. We discovered that Per1/Per2 dKO mice transplanted with SCD BM (SCD → Per1/Per2 dKO) displayed severe irradiation sensitivity and were more susceptible to an early death. Although we observed an increase of peripheral inflammatory cells, we did not detect differences in erythrocyte sickling. However, there was further lung damage due to elevated pulmonary congestion, inflammatory cell infiltration, iron overload, and secretion of IL-6 in lavage fluid. Overall, we demonstrate that Per1/Per2 is beneficial to counteract elevated systemic inflammation, lung tissue inflammation, and iron overload in SCD.—Adebiyi, M. G., Zhao, Z., Ye, Y., Manalo, J., Hong, Y., Lee, C. C., Xian, W., McKeon, F., Culp-Hill, R., D’ Alessandro, A., Kellems, R. E., Yoo, S.-H., Han, L., Xia, Y. Circadian period 2: a missing beneficial factor in sickle cell disease by lowering pulmonary inflammation, iron overload, and mortality.

The occurrence of disasters is a global concern. Government authorities in different nations employ the use of strategies, techniques, and technologies in mitigating disaster impact on a country. The purpose of this study is to develop decision support models that determine the resource capacity of a disaster management unit in the occurrence of a disaster and optimize the allocation of their organic resources such as food, vehicles and evacuation centers. The developed DSS model was able to determine the capacity of the currently available food resources and evacuation centers. The model was also able to suggest an optimized combination of vehicles to be utilized during an evacuation. The conduct of beta testing to efficiently check the suitability and efficiency of the applied algorithm to the system is recommended, as well as system evaluation by the end users for validation purposes.

National Committee for Quality Assurance recommends patient-centered medical homes incorporate input from patient populations; however, many health care organizations do not. This qualitative study used two open-ended questions from 148 active duty Army Soldiers and their family members to illicit recommendations for primary care providers and clinic leadership that would improve their health care experiences. Content analysis and descriptive statistics were used to analyze responses. Participant responses were related to four major themes: Access to Care, Interpersonal Interaction, Satisfaction of Care, and Quality of Care. Participants were overall satisfied with their care; however, spending less time waiting for appointments and to see the provider or specialist were the most frequently requested improvements related to Access to Care. For Interpersonal Interaction, 82% of the responses recommended that providers be more attentive listeners, courteous, patient, caring, and respectful. Decreasing wait times and improving interpersonal skills would improve health care experiences and patient satisfaction.

We present the case of a 70-year-old man diagnosed with multiple myeloma in 2008, who after four therapy lines initiated a fifth-line treatment with pomalidomide (4 mg orally, days 1–21 of a 28-day cycle) and low-dose dexamethasone (40 mg weekly orally). The patient was treated with pomalidomide for almost 2 years achieving a complete remission after 12 cycles. Complete remission was maintained for 9 months. This case illustrates the potential of pomalidomide plus low-dose dexamethasone to overcome multiple myeloma refractoriness inducing a quick and very prolonged remission.

In recent years, with the aim of reducing transplant-related mortality, new conditioning regimens have been explored in patients not eligible for conventional haemopoietic stem cell transplantation. In this setting, we investigated safety and feasibility of the treosulfan-fludarabine-thiotepa combination prior to allogeneic haemopoietic stem cell transplantation in patients with advanced lympho-proliferative diseases and at high transplant risk. Twenty-seven consecutive patients, median age 43 years (range 19-60), entered this study. All of them were affected by lympho-proliferative disease in advanced phase and have been heavily pre-treated. The median haemopoietic stem cell transplant co-morbidity index was 1 (range 0-3). Twenty-five patients had regular engraftment, while the remaining two patients were not evaluable for early deaths. Non-haematological toxicity was limited. No patient developed veno-occlusive disease. The estimated probability of overall survival and progression-free survival with a median follow-up of 40 months was 52% (95% confidence interval 33-73) and 50% (95% confidence interval 30-70) respectively. Six patients have relapsed; all of them were not in remission before transplantation. The treosulfan-fludarabine-thiotepa combination is a reduced toxicity but myeloablative regimen that can be proposed to patients not fitting criteria for conventional myeloablative transplant regimens. Longer follow-up and prospective randomized studies are necessary to evaluate this regimen.

The existence of health disparities in military populations has become an important topic of research. However, to our knowledge, this is the first study to examine health disparities, as related to access to care and health status, among active duty soldiers and their families. Specifically, the purpose of this analysis was to evaluate whether health disparities exist in access to care and health outcomes of patient satisfaction, physical health status, and mental health status according to race, gender, and sponsor rank in the population of active duty soldiers and their family members. In this cross-sectional study, active duty army soldiers and family members were recruited from either one particular army health clinic where they received their health care or from an adjacent shopping center frequented by eligible participants. Data were collected using validated measures to assess concepts of access to care and health status. Statistical analysis, including one-way analysis of variance (ANOVA) was performed to investigate differences in study outcome measures across four key demographic subgroups: race, gender, sponsor rank, and component (active soldier or family member). A total of 200 participants completed the study questionnaires. The sample consisted of 45.5 % soldiers and 54.5 % family members, with 88.5 % reporting a sponsor rank in the category of junior or senior enlisted rank. Mean scores for access to care did not differ significantly for the groups race/ethnicity (p = 0.53), gender (p = 0.14), and sponsor rank (p = 0.10). Furthermore, no significant differences were observed whether respondents were active soldiers or their family members (p = 0.36). Similarly, there were no statistically significant subgroup (race/ethnicity, gender, sponsor rank, or component) differences in mean patient satisfaction, physical health, and mental health scores. In a health equity system of care such as the military health care system, active duty soldiers and their family members did not experience disparities in access to care or in important health outcomes of patient satisfaction, physical health status, or mental health status.

none 330 Women live longer and outnumber men. On the other hand, older women develop more chronic diseases and conditions such as arthritis, osteoporosis and depression, leading to a greater number of years of living with disabilities. The aim of this study was to describe whether or not there are gender differences in the demographic profile, disease distribution and outcome in a population of hospitalized elderly people.Retrospective observational study including all patients recruited for the REPOSI study in the year 2010. Analyses are referred to the whole group and gender categorization was applied.A total of 1380 hospitalized elderly subjects, 50.5\% women and 49.5\% men, were considered. Women were older than men, more often widow and living alone or in nursing homes. Disease distribution showed that malignancy, diabetes, coronary artery disease, chronic kidney disease and chronic obstructive pulmonary disease were more frequent in men, but hypertension, osteoarthritis, anemia and depression were more frequent in women. Severity and comorbidity indexes according to the Cumulative Illness Rating Scale (CIRS-s and CIRS-c) were higher in men, while cognitive impairment evaluated by the Short Blessed Test (SBT), mood disorders by the Geriatric Depression Scale (GDS) and disability in daily life measured by Barthel Index (BI) were worse in women. In-hospital and 3-month mortality rates were higher in men.Our study showed a gender dimorphism in the demographic and morbidity profiles of hospitalized elderly people, emphasizing once more the need for a personalized process of healthcare. none S. Corrao;P. Santalucia;C. Argano;C. D. Djade;E. Barone;M. Tettamanti;L. Pasina;C. Franchi;T. K. Eldin;A. Marengoni;F. Salerno;M. Marcucci;P. M. Mannucci;A. Nobili; and R. E. P. collaborators; Mannucci M; Nobili A; Tettamanti M; Pasina L; Franchi C; Salerno F; Corrao S; Marengoni A; Marcucci M; Sparacio E; Alborghetti S; Di Costanzo R; Tettamanti M; Djignefa Djade C; Prisco D; Silvestri E; Cenci C; Barnini T; Delitala G; Carta S; Atzori S; Guarnieri G; Zanetti M; Spalluti A; Serra MG; Bleve MA; Vanoli M; Grignani G; Casella G; Gasbarrone L; Maniscalco G; Gunelli M; Tirotta D; Brucato A; Ghidoni S; Bernardi M; Bassi SL; Santi L; Agnelli G; Iorio A; Marcucci M; Marchesini E; Mannarino E; Lupattelli G; Rondelli P; Paciullo F; Fabris F; Carlon M; Turatto F; Baroni MC; Zardo M; Manfredini R; Molino C; Pala M; Fabbian F; Nuti R; Valenti R; Ruvio M; Cappelli S; Paolisso G; Rizzo MR; Laieta MT; Salvatore T; Sasso FC; Utili R; Durante Mangoni E; Pinto D; Olivieri O; Stanzial AM; Fellin R; Volpato S; Fotini S; Barbagallo M; Dominguez L; Plances L; D'Angelo D; Rini G; Mansueto P; Pepe I; Licata G; Calvo L; Valenti M; Borghi C; Strocchi E; Rinaldi ER; Zoli M; Fabbri E; Magalotti D; Auteri A; Pasqui AL; Puccetti L; Laghi Pasini F; Capecchi PL; Bicchi M; Sabbà C; Vella FS; Marseglia A; Luglio CV; Palasciano G; Modeo ME; Aquilino A; Raffaele P; Pugliese S; Capobianco C; Postiglione A; Barbella MR; De Stefano F; Fenoglio L; Brignone C; Bracco C; Giraudo A; Musca G; Cuccurullo O; Cricco L; Fiorentini A; Cappellini MD; Fabio G; Seghezzi S; De Amicis MM; Fargion S; Bonara P; Bulgheroni M; Lombardi R; Magrini F; Massari F; Tonella T; Peyvandi F; Tedeschi A; Rossio R; Moreo G; Ferrari B; Roncari L; Monzani V; Savojardo V; Folli C; Magnini M; Mari D; Rossi PD; Damanti S; Prolo S; Lilleri MS; Cricco L; Fiorentini A; Micale G; Podda M; Selmi C; Meda F; Salerno F; Accordino S; Conca A; Monti V; Corazza GR; Miceli E; Lenti MV; Padula D; Balduini CL; Bertolino G; Provini S; Quaglia F; Murialdo G; Bovio M; Dallegri F; Ottonello L; Quercioli A; Barreca A; Secchi MB; Ghelfi D; Chin WS; Carassale L; Caporotundo S; Anastasio L; Carbone M; Traisci G; De Feudis L; Davì G; Guagnano MT; Sestili S; Bergami E; Rizzioli E; Cagnoni C; Bertone L; Manucra A; Buratti A; Tognin T; Liberato NL; Bernasconi G; Nardo B; Bianchi GB; Benetti G; Quagliolo M; Centenaro GR; Purrello F; Di Pino A; Piro S; Mancuso G; Calipari D; Bartone M; Gullo F; Cortellaro M; Magenta M; Perego F; Meroni MR; Cicardi M; Magenta AG; Sacco A; Bonelli A; Dentamaro G; Rozzini R; Falanga L; Giordano A; Perin PC; Lorenzati B; Gruden G; Bruno G; Montrucchio G; Greco E; Tizzani P; Fera G; Di Luca ML; Renna D; Perciccante A; Coralli A; Tassara R; Melis D; Rebella L; Menardo G; Bottone S; Sferrazzo E; Ferri C; Striuli R; Scipioni R; Salmi R; Gaudenzi P; Gamberini S; Ricci F; Morabito C; Fava R; Semplicini A; Gottardo L; Delitala G; Carta S; Atzori S; Vendemiale G; Serviddio G; Forlano R; Bolondi L; Rasciti L; Serio I; Masala C; Mammarella A; Raparelli V; Rossi Fanelli F; Delfino M; Amoroso A; Violi F; Basili S; Perri L; Serra P; Fontana V; Falcone M; Landolfi R; Grieco A; Gallo A; Zuccalà G; Franceschi F; De Marco G; Chiara C; Marta S; Bellusci M; Setti D; Pedrazzoli F; Romanelli G; Pirali C; Amolini C; Rosei EA; Rizzoni D; Castoldi L; Picardi A; Gentilucci UV; Mazzarelli C; Gallo P; Guasti L; Castiglioni L; Maresca A; Squizzato A; Contini S; Molaro M; Annoni G; Corsi M; Zazzetta S; Bertolotti M; Mussi C; Scotto R; Ferri MA; Veltri F; Arturi F; Succurro E; Sesti G; Gualtieri U; Perticone F; Sciacqua A; Quero M; Bagnato C; Loria P; Becchi MA; Martucci G; Fantuzzi A; Maurantonio M; Corinaldesi R; De Giorgio R; Serra M; Grasso V; Ruggeri E; Carozza LM; Pignatti F) S. Corrao;P. Santalucia;C. Argano;C. D. Djade;E. Barone;M. Tettamanti;L. Pasina;C. Franchi;T. K. Eldin;A. Marengoni;F. Salerno;M. Marcucci;P. M. Mannucci;A. Nobili; and R. E. P. collaborators; Mannucci M; Nobili A; Tettamanti M; Pasina L; Franchi C; Salerno F; Corrao S; Marengoni A; Marcucci M; Sparacio E; Alborghetti S; Di Costanzo R; Tettamanti M; Djignefa Djade C; Prisco D; Silvestri E; Cenci C; Barnini T; Delitala G; Carta S; Atzori S; Guarnieri G; Zanetti M; Spalluti A; Serra MG; Bleve MA; Vanoli M; Grignani G; Casella G; Gasbarrone L; Maniscalco G; Gunelli M; Tirotta D; Brucato A; Ghidoni S; Bernardi M; Bassi SL; Santi L; Agnelli G; Iorio A; Marcucci M; Marchesini E; Mannarino E; Lupattelli G; Rondelli P; Paciullo F; Fabris F; Carlon M; Turatto F; Baroni MC; Zardo M; Manfredini R; Molino C; Pala M; Fabbian F; Nuti R; Valenti R; Ruvio M; Cappelli S; Paolisso G; Rizzo MR; Laieta MT; Salvatore T; Sasso FC; Utili R; Durante Mangoni E; Pinto D; Olivieri O; Stanzial AM; Fellin R; Volpato S; Fotini S; Barbagallo M; Dominguez L; Plances L; D'Angelo D; Rini G; Mansueto P; Pepe I; Licata G; Calvo L; Valenti M; Borghi C; Strocchi E; Rinaldi ER; Zoli M; Fabbri E; Magalotti D; Auteri A; Pasqui AL; Puccetti L; Laghi Pasini F; Capecchi PL; Bicchi M; Sabbà C; Vella FS; Marseglia A; Luglio CV; Palasciano G; Modeo ME; Aquilino A; Raffaele P; Pugliese S; Capobianco C; Postiglione A; Barbella MR; De Stefano F; Fenoglio L; Brignone C; Bracco C; Giraudo A; Musca G; Cuccurullo O; Cricco L; Fiorentini A; Cappellini MD; Fabio G; Seghezzi S; De Amicis MM; Fargion S; Bonara P; Bulgheroni M; Lombardi R; Magrini F; Massari F; Tonella T; Peyvandi F; Tedeschi A; Rossio R; Moreo G; Ferrari B; Roncari L; Monzani V; Savojardo V; Folli C; Magnini M; Mari D; Rossi PD; Damanti S; Prolo S; Lilleri MS; Cricco L; Fiorentini A; Micale G; Podda M; Selmi C; Meda F; Salerno F; Accordino S; Conca A; Monti V; Corazza GR; Miceli E; Lenti MV; Padula D; Balduini CL; Bertolino G; Provini S; Quaglia F; Murialdo G; Bovio M; Dallegri F; Ottonello L; Quercioli A; Barreca A; Secchi MB; Ghelfi D; Chin WS; Carassale L; Caporotundo S; Anastasio L; Carbone M; Traisci G; De Feudis L; Davì G; Guagnano MT; Sestili S; Bergami E; Rizzioli E; Cagnoni C; Bertone L; Manucra A; Buratti A; Tognin T; Liberato NL; Bernasconi G; Nardo B; Bianchi GB; Benetti G; Quagliolo M; Centenaro GR; Purrello F; Di Pino A; Piro S; Mancuso G; Calipari D; Bartone M; Gullo F; Cortellaro M; Magenta M; Perego F; Meroni MR; Cicardi M; Magenta AG; Sacco A; Bonelli A; Dentamaro G; Rozzini R; Falanga L; Giordano A; Perin PC; Lorenzati B; Gruden G; Bruno G; Montrucchio G; Greco E; Tizzani P; Fera G; Di Luca ML; Renna D; Perciccante A; Coralli A; Tassara R; Melis D; Rebella L; Menardo G; Bottone S; Sferrazzo E; Ferri C; Striuli R; Scipioni R; Salmi R; Gaudenzi P; Gamberini S; Ricci F; Morabito C; Fava R; Semplicini A; Gottardo L; Delitala G; Carta S; Atzori S; Vendemiale G; Serviddio G; Forlano R; Bolondi L; Rasciti L; Serio I; Masala C; Mammarella A; Raparelli V; Rossi Fanelli F; Delfino M; Amoroso A; Violi F; Basili S; Perri L; Serra P; Fontana V; Falcone M; Landolfi R; Grieco A; Gallo A; Zuccalà G; Franceschi F; De Marco G; Chiara C; Marta S; Bellusci M; Setti D; Pedrazzoli F; Romanelli G; Pirali C; Amolini C; Rosei EA; Rizzoni D; Castoldi L; Picardi A; Gentilucci UV; Mazzarelli C; Gallo P; Guasti L; Castiglioni L; Maresca A; Squizzato A; Contini S; Molaro M; Annoni G; Corsi M; Zazzetta S; Bertolotti M; Mussi C; Scotto R; Ferri MA; Veltri F; Arturi F; Succurro E; Sesti G; Gualtieri U; Perticone F; Sciacqua A; Quero M; Bagnato C; Loria P; Becchi MA; Martucci G; Fantuzzi A; Maurantonio M; Corinaldesi R; De Giorgio R; Serra M; Grasso V; Ruggeri E; Carozza LM; Pignatti F)

At Wafer Level Chip Scale Package, Every Sawn Wafers underwent Automatic Optical Inspection to ensure that all Dice affected by Mechanical Defect specifically Chippings will be screened-out effectively. An average of 151 defect per million of Chippings has been effectively screen-out at AOI process from WW07'15 to WW32'15.

Acne vulgaris, commonly called as acne, is a skin problem that occurs when oil and dead skin cells clog up in a person’s pores. This is because hormones change which makes the skin oilier. The problem is people really do not know the real assessment of sensitivity of their skin in terms of fluid development on their faces that tends to develop acne vulgaris, thus having more complications. This research aims to assess Acne Vulgaris using luminescent visualization system through optical imaging and integration of image processing algorithms. Specifically, this research aims to design a prototype for facial fluid analysis using luminescent visualization system through optical imaging and integration of fluorescent imaging system, and to classify different facial fluids present in each person. Throughout the process, some structures and layers of the face will be excluded, leaving only a mapped facial structure with acne regions. Facial fluid regions are distinguished from the acne region as they are characterized differently.

BACKGROUND: Much of the research on African-Americans’ HPV vaccine acceptance has largely focused on racial/ethnic differences related to cognitive, socio-economical, and structural factors that contribute to differences in HPV vaccine acceptance and completion. A growing body of literature suggest that cultural factors, such as mistrust of healthcare providers (HCPs) and the healthcare system, religion, and social norms related to appropriate sexual behaviors, also plays a prominent role in their HPV vaccine acceptance. However, these studies were limited in their use of theoretical approaches necessary to conceptualize and operationalize culture. OBJECTIVE: To explore the influence of culture on African-American mothers’ and daughters’ HPV vaccine acceptance using the PEN-3, a culturally-centered conceptual framework. METHODS: Grounded theory techniques were used to explore cultural factors that influenced the acceptance of the HPV vaccine among African-American mothers (n=28) and their daughters (n=34). RESULTS: Positive attitudes towards vaccination stemmed from beliefs that the HPV vaccine has cancer prevention benefits and that vaccinations in general protected against infectious diseases. Negative attitudes stemmed from beliefs that the HPV vaccine was too new, not effective, daughters were too young, and that vaccines were not a one-size-fits-all intervention. Majority of mothers and daughters indicated that their religious doctrine did not impede their HPV vaccination decisions. For a few mothers, religious beliefs could not be separated from their HPV vaccination decisions and ultimately deterred HPV vaccine acceptance. HCP recommendations were valued however mothers were often dissatisfied with the detail of information communicated. Support networks provided both positive and negative types of social support to mothers and daughters. The media highlighted the cancer prevention benefits of the HPV vaccine and unintentionally communicated negative information of the HPV vaccine, which deterred HPV vaccine acceptance. CONCLUSION: Study findings can inform the development of culturally appropriate interventions that advances the evidence on cervical cancer prevention.

Tissue injury and hemorrhagic shock induce significant systemic metabolic reprogramming in animal models and critically injured patients. Recent expansions of the classic concepts of metabolomic aberrations in tissue injury and hemorrhage opened the way for novel resuscitative interventions based on the observed abnormal metabolic demands. We hypothesize that metabolic demands and resulting metabolic signatures in pig plasma will vary in response to isolated or combined tissue injury and hemorrhagic shock.A total of 20 pigs underwent either isolated tissue injury, hemorrhagic shock, or combined tissue injury and hemorrhagic shock referenced to a sham protocol (n = 5/group). Plasma samples were analyzed by UHPLC-MS.Hemorrhagic shock promoted a hypermetabolic state. Tissue injury alone dampened metabolic responses in comparison to sham and hemorrhagic shock, and attenuated the hypermetabolic state triggered by shock with respect to energy metabolism (glycolysis, glutaminolysis, and Krebs cycle). Tissue injury and hemorrhagic shock had a more pronounced effect on nitrogen metabolism (arginine, polyamines, and purine metabolism) than hemorrhagic shock alone.Isolated or combined tissue injury and hemorrhagic shock result in distinct plasma metabolic signatures. These findings indicate that optimized resuscitative interventions in critically ill patients are possible based on identifying the severity of tissue injury and hemorrhage.

Among African-Americans, religion impacts health-seeking behaviors. This qualitative study used criterion purposeful sampling and thematic analysis in analysis of data from 31 African-American cancer patients to understand the influence of religion on the utilization of cancer care services. Our findings suggest that religious beliefs and practices positively influenced attitudes toward their illness and ability to endure treatment. God's ability to heal and cure, God's control over survival, God's will over their lives, and God's promise for health and prosperity were examples of survivor's religious beliefs. Religious practices such as prayer promoted a trusting relationship with healthcare providers and were a source of strength and encouragement.

Background: The role of Minimal residual disease (MRD) as surrogate for survival in Multiple Myeloma (MM) patients is well established. Therefore, new response criteria recommend including Multiparameter Flow cytometry (MFC) and next generation Sequencing (NGS) MRD negativity (minimum sensitivity of 1 in 105 nucleated cell) to deeply characterize complete remission (CR) [Kumar SK, Lancet Oncol 2016]. Here we analyzed and compared MRD data from the FORTE trial both by MFC and NGS techniques. Methods: Newly diagnosed MM patients ≤65 years were randomized to receive carfilzomib, lenalidomide, dexamethasone (KRd) induction - autologous stem cell transplantation (ASCT) intensification - KRd consolidation (KRd_ASCT); KRd12 and carfilzomib, cyclophosphamide, dexamethasone (KCd) induction - ASCT intensification - KCd consolidation (KCd_ASCT). Thereafter, patients were randomized to maintenance therapy with lenalidomide alone or lenalidomide plus carfilzomib. MRD evaluation was performed by 8-color second generation flow cytometry (sensitivity 10-5) in patients who achieved at least a very good partial response (VGPR) before maintenance. In a subgroup of these ≥ VGPR patients, next generation flow (NGF; sensitivity 10-5 - 10-6) was performed. Moreover, in patients achieving ≥ CR, MRD pre-maintenance was also assessed by NGS (Adaptive Biotechnologies, Seattle, WA; sensitivity 10-5 - 10-6). Therefore, only patients achieving ≥ CR have both MFC and NGS evaluations, and we focused on this ≥ CR population to compare MRD results with the 2 techniques. Spearman's rank correlation coefficient was used to measure the concordance between MFC and NGS. Fisher or Pearson's Chi-squared tests were adopted, where appropriate, to evaluate the statistical significance, at the level of 0.05. Results: ≥ CR pre-maintenance was achieved in 233 patients enrolled in the trial; at data cut-off, MFC and NGS data were available for 176/233 (76%) patients who were included in this analysis (62 received KRd_ASCT, 65 KRd12 and 49 KCd_ASCT). Median age of this ≥ CR population is 57 years (IQR 52-62), 14% have International Staging System (ISS) III stage and 26% high risk cytogenetics by FISH features [either del(17p) or t(4;14) or t(14;16)] reflecting baseline clinical features of the entire FORTE population. 139/176 (79%) ≥ CR patients were MFC negative at a cut-off of at least 10-5. Rate of MRD negative MFC among ≥ CR negative in the 3 arms were: 53/62 (85%) in KRd_ASCT, 51/65 (78%) in KRd12 and 35/49 (71%) in KCd_ASCT, reflecting the higher rate of MCF MRD negativity pre-maintenance reported by ITT in the overall population in the 2 KRD arms [Gay F, ASH 2018]. NGS negativity at a cut-off of at least 10-5 was detected in 87/176 (49%) of ≥ CR patients. Rate of MRD negative NGS at least 10-5 among ≥ CR negative in the 3 arms were: 35/62 (56%) in KRd_ASCT, 31/65 (48%) in KRd12 and 21/49 (43%) in KCd_ASCT. NGS negativity at a cut-off 10-6 was detected in 34/123 (28%) of ≥ CR patients (for 53/176 CR patients 10-6 sensitivity was not reached). Rate of MRD negative NGS at least 10-6 among ≥ CR negative in the 3 arms were:14/41 (34%) in KRd_ASCT, 10/44 (23%) in KRd12 and 10/38 (26%) in KCd_ASCT. Thereafter, we have analyzed the concordance between MRD results by the two techniques. Overall (samples at 10-5 and 10-6 sensitivity), Spearman's coefficient is 0.63 (p < 0.001); discordances between the two methods have been observed in 54/176 paired samples (30%). In particular, 53 samples (30%) are NGS positive but MFC negative, of which 34/53 (64%) have reached 10-6 sensitivity by NGS. Only 1 MFC positive sample is NGS negative. In a subgroup of patients evaluable both by NGS and NGF (26 paired samples, sensitivity 10-6), Spearman' s coefficient is 0.83 (p < 0.001), although a higher sample size is needed to confirm these preliminary concordant results. Conclusion: In patients who achieved ≥ CR, rate of at least 10-5 MRD MCF negativity was 79% and rate of at least 10-5 NGS negativity was 49%. Assessment both by MFC and NGS showed a good concordance, particularly if the same sensitivity is reached. Longer follow up is needed to assess the impact of MFC in comparison with NGS on patients' outcomes, particularly to evaluate if 10-6 NGS or NGF sensitivity may provide further clinical information, possibly identifying patients with very long survival or potentially cured. Disclosures Oliva: Celgene: Honoraria; Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees; Adaptive Biotechnologies: Membership on an entity's Board of Directors or advisory committees; Takeda: Membership on an entity's Board of Directors or advisory committees; Amgen: Honoraria, Membership on an entity's Board of Directors or advisory committees. Belotti:Janssen: Membership on an entity's Board of Directors or advisory committees; Amgen: Membership on an entity's Board of Directors or advisory committees; Celgene: Membership on an entity's Board of Directors or advisory committees. Galli:Bristol-Myers Squibb: Honoraria; Takeda: Honoraria; Leadiant (Sigma-Tau): Honoraria; Janssen: Honoraria; Celgene: Honoraria. Offidani:Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees; Takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees; Amgen: Honoraria, Membership on an entity's Board of Directors or advisory committees; Bristol-Myers Squibb: Honoraria, Membership on an entity's Board of Directors or advisory committees; Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees. Vozella:Amgen: Honoraria; Celgene: Honoraria. Zambello:Janssen: Membership on an entity's Board of Directors or advisory committees; Celgene: Membership on an entity's Board of Directors or advisory committees. Kirsch:Adaptive Biotechnologies: Employment. Jacob:Adaptive Biotechnologies: Employment, Other: shareholder. Ballanti:Amgen: Honoraria; Bristol-Myers Squibb: Honoraria; Janssen: Honoraria; Celgene: Honoraria. Corradini:Roche: Honoraria; Sanofi: Honoraria; KiowaKirin: Honoraria; Kite: Honoraria; Novartis: Honoraria, Other: Travel Costs; BMS: Other: Travel Costs; Servier: Honoraria; Takeda: Honoraria, Other: Travel Costs; Gilead: Honoraria, Other: Travel Costs; AbbVie: Consultancy, Honoraria, Other: Travel Costs; Amgen: Honoraria; Celgene: Honoraria, Other: Travel Costs; Daiichi Sankyo: Honoraria; Jazz Pharmaceutics: Honoraria; Janssen: Honoraria, Other: Travel Costs. Omedé:Janssen: Membership on an entity's Board of Directors or advisory committees. Cavo:takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; amgen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; celgene: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: travel accommodations, Speakers Bureau; janssen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: travel accommodations, Speakers Bureau; bms: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; sanofi: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; novartis: Honoraria; AbbVie: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees. Musto:Amgen: Honoraria; Celgene: Honoraria. Boccadoro:Sanofi: Honoraria, Research Funding; Celgene: Honoraria, Research Funding; Amgen: Honoraria, Research Funding; Janssen: Honoraria, Research Funding; Novartis: Honoraria, Research Funding; Bristol-Myers Squibb: Honoraria, Research Funding; AbbVie: Honoraria; Mundipharma: Research Funding. Gay:AbbVie: Membership on an entity's Board of Directors or advisory committees; Bristol-Myers Squibb: Honoraria, Membership on an entity's Board of Directors or advisory committees; Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees; Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees; Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees; Takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees; Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees; Amgen: Honoraria, Membership on an entity's Board of Directors or advisory committees; Takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees; Roche: Membership on an entity's Board of Directors or advisory committees; Bristol-Myers Squibb: Honoraria, Membership on an entity's Board of Directors or advisory committees; Amgen: Honoraria, Membership on an entity's Board of Directors or advisory committees; AbbVie: Membership on an entity's Board of Directors or advisory committees; Roche: Membership on an entity's Board of Directors or advisory committees. OffLabel Disclosure: The presentation includes discussion of off-label use of a drug or drugs for the treatment of multiple myeloma.

Background It is well known that atrial fibrillation (AF) and chronic kidney disease (CKD) are associated with a higher risk of stroke, and new evidence links AF to cognitive impairment, independently from an overt stroke (CI). Our aim was to investigate, assuming an underlying role of atrial microembolism, the impact of CI and CKD in elderly hospitalized patients with AF. Methods We retrospectively analyzed the data collected on elderly patients in 66 Italian hospitals, in the frame of the REPOSI project. We analyzed the clinical characteristics of patients with AF and different degrees of CI. Multivariate logistic analysis was used to explore the relationship between variables and mortality. Results Among the 1384 patients enrolled, 321 had AF. Patients with AF were older, had worse CI and disability and higher rates of stroke, hypertension, heart failure, and CKD, and less than 50% were on anticoagulant therapy. Among patients with AF, those with worse CI and those with lower estimated glomerular filtration rate (eGFR) had a higher mortality risk (odds ratio 1.13, p = 0.006). Higher disability levels, older age, higher systolic blood pressure, and higher eGFR were related to lower probability of oral anticoagulant prescription. Lower mortality rates were found in patients on oral anticoagulant therapy. Conclusions Elderly hospitalized patients with AF are more likely affected by CI and CKD, two conditions that expose them to a higher mortality risk. Oral anticoagulant therapy, still underused and not optimally enforced, may afford protection from thromboembolic episodes that probably concur to the high mortality.

none 22 no Background: Few studies evaluated the clinical outcomes of Community Acquired Pneumonia (CAP), Hospital-Acquired Pneumonia (HAP) and Health Care-Associated Pneumonia (HCAP) in relation to the adherence of antibiotic treatment to the guidelines of the Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS) in hospitalized elderly people (65 years or older). Methods: Data were obtained from REPOSI, a prospective registry held in 87 Italian internal medicine and geriatric wards. Patients with a diagnosis of pneumonia (ICD-9 480-487) or prescribed with an antibiotic for pneumonia as indication were selected. The empirical antibiotic regimen was defined to be adherent to guidelines if concordant with the treatment regimens recommended by IDSA/ATS for CAP, HAP, and HCAP. Outcomes were assessed by logistic regression models. Results: A diagnosis of pneumonia was made in 317 patients. Only 38.8% of them received an empirical antibiotic regimen that was adherent to guidelines. However, no significant association was found between adherence to guidelines and outcomes. Having HAP, older age, and higher CIRS severity index were the main factors associated with in-hospital mortality. Conclusions: The adherence to antibiotic treatment guidelines was poor, particularly for HAP and HCAP, suggesting the need for more adherence to the optimal management of antibiotics in the elderly with pneumonia. none Raffaella Rossio; Carlotta Franchi; Ilaria Ardoino; Codjo D. Djade; Mauro Tettamanti; Luca Pasina; Francesco Salerno; Alessandra Marengoni; Salvatore Corrao; Maura Marcucci; Flora Peyvandi; Elia M. Biganzoli; Alessandro Nobili; Pier Mannuccio Mannucci; REPOSI Investigators [...; Mauro Bernardi; Claudio Borghi; Marco Zoli; Luigi Bolondi; Roberto Corinaldesi; Roberto De Giorgio;...] Raffaella Rossio; Carlotta Franchi; Ilaria Ardoino; Codjo D. Djade; Mauro Tettamanti; Luca Pasina; Francesco Salerno; Alessandra Marengoni; Salvatore Corrao; Maura Marcucci; Flora Peyvandi; Elia M. Biganzoli; Alessandro Nobili; Pier Mannuccio Mannucci; REPOSI Investigators [..; Mauro Bernardi; Claudio Borghi; Marco Zoli; Luigi Bolondi; Roberto Corinaldesi; Roberto De Giorgio;..]

Purpose To determine whether psychosocial factors predict depression among older African American cancer patients.

Disclaimer The views expressed in this manuscript are those of the authors and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government. Objective The purpose of this study was to explore whether a particular combination of individual characteristics influences patient satisfaction with the health care system among a sample of African American men in North Carolina with prostate cancer. Patient satisfaction may be relevant for improving African American men’s use of regular care, thus improving the early detection of prostate cancer and attenuating racial disparities in prostate cancer outcomes. Methods This descriptive correlation study examined relationships of individual characteristics that influence patient satisfaction using data from 505 African American men from North Carolina, who prospectively enrolled in the North Carolina-Louisiana Prostate Cancer Project from September 2004 to November 2007. Analyses consisted of univariate statistics, bivariate analysis, and multiple regression analysis. Results The variables selected for the final model were: participation in religious activities, mistrust, racism, and perceived access to care. In this study, both cultural variables, mistrust ( p = p = F = 5.59), were significantly negatively associated with patient satisfaction and accounted for the majority of the variability represented by individual characteristics. Conclusion Mistrust and racism are cultural factors that are extremely important and have been negatively associated with patient satisfaction and decreased desires to utilize health care services for African American men. To overcome barriers in seeking health care services, health care providers need to implement a patient-centered approach by creating a clinical environment that demonstrates cultural competence and eliminating policies, procedures, processes, or personnel that foster mistrust and racism.

This work presents an approach to detect the emotional state of users immersed in a virtual environment by involving them in an activity to relieve their emotional response. Likewise, the main aspect is to identify the current emotional state by monitoring a set of biometrics, the principal activity involves a signal based analysis of emotional processing in order to validate the height interpretations.

Metabolomics is the comprehensive characterization of endogenous small molecules metabolites, xenometabolites and their metabolisms. The recent introduction of high-throughput metabolomics approaches has fostered strides related to the capacity to in silico elaborate metabolomics data by means of system biology. Recent progresses in bioanalytical technologies assisted with algorithms enabling large-scale data analysis potentiate application of metabolomics approaches in biomarker- based disease diagnosis, therapeutic target identification, personalized medicine, and the monitoring of clinical outcomes. In this review article we will focus on recent applications of metabolomics approaches in the identification of potential therapeutic candidates based on our and others' confirmed experience with this cutting-edge technology.

Background: Increased serum uric acid has been considered a cardiovascular risk factor but no study has assessed its relation with hospital mortality or length of stay. On the basis of data obtained from a prospective registry, the prevalence of gout/hyperuricemia and its association with these and other clinical parameters was evaluated in an Italian cohort of elderly patients acutely admitted to internal medicine or geriatric wards. Methods: While the prevalence of gout was calculated by counting patients with this diagnosis hyperuricemia was inferred in patients taking allopurinol at hospital admission or discharge, on the assumption that this drug was only prescribed owing to the finding of high serum levels of uric acid. A series of clinical and demographic variables were evaluated for their association with gout/hyperuricemia. Results: Of 1380 patients, 139 (10%) had a diagnosis of gout or were prescribed allopurinol. They had more co-morbidities (7.0 vs 5.6; P < 0.0001) and consumed more drugs (6.8 vs 5.0; < b 0.0001). The CIRS (co-morbidity index) was worse in these patients (OR 1.28 95% CI 1.15-1.41). Multivariable regression analysis showed that only renal and heart failures were independently associated with gout/allopurinol intake. Moreover, this combined event was associated with an increased risk of adverse events during hospitalization (OR 1.66, 95% CI 1.16-2.36), but not with the risk of re-hospitalization, length of hospital stay or death. Conclusions: Gout/allopurinol intake has a high prevalence in elderly patients acutely admitted to hospital and are associated with renal and cardiovascular diseases, an increased rate of adverse events and a high degree of drug consumption. In contrast, this finding did not affect the length of hospitalization nor hospital mortality.

Aims: The objective of this study was to evaluate the prevalence of the prescription of QT-prolonging drugs at hospital admission and discharge and the risk factors associated with their use in older people (aged 65Âyears and older). Methods: Data were obtained from the REPOSI (REgistro POliterapie SIMI [Società Italiana di Medicina Interna]) registry, which enrolled 4035 patients in 2008 (nÂ=Â1332), 2010 (nÂ=Â1380), and 2012 (nÂ=Â1323). Multivariable logistic regression was performed to determine the risk factors independently associated with QT-prolonging drug use. QT-prolonging drugs were classified by the risk of Torsades de Pointes (TdP) (definite, possible, or conditional) according to the Arizona Center for Education and Research on Therapeutics (AzCERT) classification. Specific drug combinations were also assessed. Results: Among 3906 patients prescribed at least one drug at admission, 2156 (55.2Â%) were taking at least one QT-prolonging drug. Risk factors independently associated with the use of any QT-prolonging drugs were increasing age (odds ratio [OR] 1.02, 95Â% CI 1.01–1.03), multimorbidity (OR 2.69, 95Â% CI 2.33–3.10), hypokalemia (OR 2.79, 95Â% CI 1.32–5.89), atrial fibrillation (OR 1.66, 95Â% CI 1.40–1.98), and heart failure (OR 3.17, 95Â% CI 2.49–4.05). Furosemide, alone or in combination, was the most prescribed drug. Amiodarone was the most prescribed drug with a definite risk of TdP. Both the absolute number of QT-prolonging drugs (2890 vs. 3549) and the number of patients treated with them (2456 vs. 2156) increased at discharge. Among 1808 patients not prescribed QT-prolonging drugs at admission, 35.8Â% were prescribed them at discharge. Conclusions: Despite their risk, QT-prolonging drugs are widely prescribed to hospitalized older persons. The curriculum for both practicing physicians and medical students should be strengthened to provide more education on the appropriate use of drugs in order to improve the management of hospitalized older people.

Low-grade inflammation is associated with an increased risk of chronic degenerative disease, but its relationship with mortality is less well explored. We aimed at evaluating, at a large epidemiological level, the possible association of low-grade inflammation, as measured by a composite score, with overall mortality risk. We conducted a population-based prospective investigation on 20,337 adult subjects free from major hematological disease and acute inflammatory status, randomly recruited from the general population of the Moli-sani study. A low-grade inflammation score was obtained from the sum of 10-tiles of plasmatic (C-reactive protein) and cellular (leukocyte and platelet counts, granulocyte/lymphocyte ratio) biomarkers of low-grade inflammation; higher levels indicated increased low-grade inflammation. Hazard ratios were calculated using multivariable Cox proportional hazard models with 95% confidence intervals. At the end of follow-up (median 7.6 years), 837 all-cause deaths were recorded. As compared to subjects in the lowest quartile of the low-grade inflammation score, those in the highest category had a significantly increased risk in overall mortality (HR=1.44; 1.17-1.77), independently of possible confounders, including the presence of chronic diseases and a number of health-related behaviors. The magnitude of the association of low-grade inflammation with mortality was relatively higher in type 2 diabetic patients (HR=2.90; 1.74-4.84) and in individuals with a history of cardiovascular disease (HR=2.48; 1.50-4.11) as compared to their counterparts who were free from the disease. In conclusion, an elevated degree of low-grade inflammation, as measured by a composite score of inflammatory biomarkers, is an independent risk factor for total mortality in an apparently healthy adult general population.

OBJECTIVE African Americans are often viewed as ineffective communicators during medical encounters. However, most previous studies have been conducted among noncancer populations and based on the perceptions of health care providers (HCP) and researchers. This study aimed to explore African American cancer patients' perspectives of HCPs' communication behaviors and how these communication patterns facilitate or hinder their cancer management and survivorship experiences. METHODS This is a secondary data analysis of qualitative interviews with 28 African American cancer patients residing in the Southeastern U.S. Participants were purposefully selected to represent patients of both genders with varied sociodemographic characteristics. Grounded theory techniques of constant comparison were used to identify patterns of responses from the participants. RESULTS Four major themes were identified about communication patterns between these cancer patients and their HCPs during diagnosis and treatment: (1) communication of cancer information; (2) communication of shared decision making; (3) communication of empathy and understanding; and (4) communication of respect. This study also described the effects of patient-HCP communication (e.g., satisfaction with oncology care, emotional distress, patient loyalty, treatment adherence, decisional regrets). CONCLUSIONS African American cancer patients in this study perceived that HCPs demonstrated different levels of communication sensitivity and skills during cancer diagnosis and treatment. They also believed that HCPs' communication behaviors directly affected their survivorship experiences. Our findings help to gain knowledge of patient-HCP communication and to identify potential strategies for better communication between patients and HCPs among middle-aged and older African American cancer patients, which will ultimately promote culturally sensitive oncology care.

Malignant gliomas have poor prognosis and urgently require new therapies. Activating Transcription Factor 5 (ATF5) is highly expressed in gliomas, and interference with its expression/function precipitates targeted glioma cell apoptosis in vitro and in vivo. We designed a novel deliverable truncated-dominant-negative (d/n) form of ATF5 fused to a cell-penetrating domain (Pen-d/n-ATF5-RP) that can be intraperitoneally/subcutaneously administered to mice harboring malignant gliomas generated; (1) by PDGF-B/sh-p53 retroviral transformation of endogenous neural progenitor cells; and (2) by human U87-MG xenografts. In vitro Pen-d/n-ATF5-RP entered into glioma cells and triggered massive apoptosis. In vivo, subcutaneously-administered Pen-d/n-ATF5-RP passed the blood brain barrier, entered normal brain and tumor cells, and then caused rapid selective tumor cell death. MRI verified elimination of retrovirus-induced gliomas within 8-21 days. Histopathology revealed growth-suppression of intracerebral human U87-MG cells xenografts. For endogenous PDGF-B gliomas, there was no recurrence or mortality at 6-12 months versus 66% mortality in controls at 6 months. Necropsy and liver-kidney blood enzyme analysis revealed no adverse effects on brain or other tissues. Our findings thus identify Pen-d/n-ATF5-RP as a potential therapy for malignant gliomas.

Ex-situ carbonation of mixtures of caustic byproduct materials and produced oil-field brine provides a niche opportunity to sequester anthropogenic CO2, while concomitantly reducing the basicity of the reactive slurry. A series of tests were conducted to investigate a novel reaction concept designed to achieve neutralization of mixtures of acidic oil field produced brine and caustic industrial byproducts while sequestering substantial quantities of anthropogenic carbon dioxide (CO2) in a mixed-flow reactor. Experiments were conducted to determine the CO2-bearing capacity of reactive mixtures of brine from the Oriskany Sandstone Formation with three caustic industrial byproducts: flue gas desulfurization (FGD) spray dryer ash, Class C fly ash subbituminous coal combustion byproduct, and bauxite residue slurry from the alumina production process. Reactions were conducted in a closed, well-mixed (1,500 rpm) reactor with gas composed of 29.46% vol./vol. CO2 balanced by nitrogen gas (N2) fed at a rate...

Background African-Americans and Latinos suffer the highest cervical cancer burden compared to other populations and have sub-optimal HPV vaccination rates. Objective To condense research findings of studies conducted with African-Americans and Latinos on factors associated with HPV vaccine acceptability and uptake. Methods Standards for conducting an integrative review were used. PubMed, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO databases were searched. Results Awareness about HPV and the HPV vaccine varied by demographics of parents. For Latino parents, acculturation and awareness were associated. However, findings were mixed regarding the association between acculturation and knowledge. Among African-Americans, higher socioeconomic status (SES) and awareness were associated. Sexuality-related concerns, concerns about safety and low perceived risk of daughter’s acquiring HPV emerged as barriers to vaccination among Latinos and African-Americans. Among Latinos, vaccine acceptability was associated with the vaccine’s cancer prevention benefits and a provider’s recommendation. Among African-Americans, acceptability was associated with awareness, perceived risk of acquiring HPV, religion, and a provider’s recommendation. Few interventions have been developed to increase HPV vaccine acceptance. Importantly, few studies assessed the influence of culture on vaccine acceptance and uptake. Conclusions Future research should be informed by culture-centered theories as this is the first step to inform the development of culturally-grounded interventions.

8003 Background: Phase I/II studies showed the safety and efficacy of KRd and KCd in NDMM pts (Jakubowiak Blood 2012, Bringhen Blood 2014). Methods: NDMM pts ≤65 yrs were randomized (1:1:1; stratification ISS and age) to: 4 28-day KCd cycles (carfilzomib:20/36 mg/m2 IV d 1,2,8,9,15,16; cyclophosphamide 300 mg/m2 d 1,8,15; dexamethasone:20 mg d 1,2,8,9,15,16) followed by MEL200-ASCT and consolidation with 4 KCd cycles; or 4 28-day KRd cycles (carfilzomib and dexamethasone as above; lenalidomide:25 mg d 1-21) followed by MEL200-ASCT and 4 KRd cycles; or 12 KRd cycles. After the 4th induction cycle, all pts received Cyclophosphamide 2 g/m2, followed by PBSC collection. We report results of the first planned safety interim analysis on induction and mobilization and preliminary efficacy data. We pooled the 2 KRd groups since treatment was the same until mobilization. Data cut-off was October 30, 2016. Results: 281 pts were evaluated (KCd, n=94; KRd, n=187). The most frequent grade 3-4 AEs plus SAEs in both arms were hematological (mainly neutropenia) and infections (mainly pneumonia/fever); increased AST/ALT/GGT (mainly reversible) and dermatological (rash) AEs were higher in KRd; cardiac AEs were 2% (atrial fibrillation[1%]/ischemic heart disease[1%]) in KRd vs 1% (atrial fibrillation) in KCd. In KCd, 1 pt died of infection (not treatment-related) vs 3 in the KRd (2 cardiac arrest [1 not treatment-related],1 infection not treatment-related). In the KCd vs KRd arms, 99% vs 95% (P=0.44) of pts mobilized stem cells (median number of PBSC collected:9 vs 6x10^6CD34/Kg with KCd vs KRd); 10% vs 24% (P=0.01) required Plerixafor. Rate of ≥VGPR was 61% with KCd vs 74% with KRd (P=0.05). Conclusions: Safety profile was acceptable; more pts required plerixafor in KRd. Rate of VGPR was higher with KRd. Updated data on more patients will be presented at the meeting. Clinicaltrials.gov NCT02203643. [Table: see text]

This qualitative study explored strategies African-American cancer survivors use to overcome their fears and fatalistic attitudes toward cancer at the point of diagnosis through completion of treatment. Thirty-one African-American cancer survivors who had completed or nearly completed treatment were recruited through criterion purposeful sampling. In-depth, open-ended interviews were used to collect data. The data were analyzed using thematic analysis. Of the 31 survivors interviewed, 26 reported being fearful of cancer and believed that cancer would result in death. These cancer survivors were particularly fearful of having a cancer had spread, of being isolated, and performing less effectively at work. Strategies used to overcome these fears included increasing their own awareness about cancer, using positive self-talk, and avoiding negative people. The findings suggest that past experiences continue to influence fears and fatalistic perspectives about cancer and that educational resources to inform the public about cancer may be ignored until there is a confirmed diagnosis of cancer. Televised news broadcasts of high-profile personalities who had died from cancer were also anxiety provoking, particularly if the cancer survivor died of a recurrence from cancer. Prevalent sources of information and support for these survivors were family members or close friends they trusted with personal information, perceived as strong, or experienced in the care of other cancer survivors.

Background The role of single vs double autologous stem cell transplantation (ASCT) in patients with newly diagnosed (ND) multiple myeloma (MM) needs to be prospectively investigated in the novel agent era. Methods The phase III EMN02/HO95 study was designed to compare (first randomization, R1) (stratification according to ISS stage) standard-dose intensification therapy with bortezomib-melphalan-prednisone (VMP) vs high-dose intensification therapy with melphalan at 200 mg/m2 (HDM) followed by ASCT after 3-4 cycles of bortezomib-cyclophosphamide-dexamethasone as induction therapy. A second randomization to consolidation therapy vs no consolidation was performed after intensification therapy, to be followed by lenalidomide maintenance until progression or toxicity in both arms. A primary study endpoint was progression-free survival (PFS) from R1. In centers with a policy of double ASCT, patients were randomized in a 1:1:1 ratio to either VMP or single ASCT (ASCT-1) or two sequential courses (administered 2 to 3 months apart) of HDM and double ASCT (ASCT-2) in order to prospectively compare ASCT-1 with ASCT-2, which was an additional study objective. Results From February 2011 to April 2014, 1510 pts aged ≤65 years with symptomatic NDMM were registered and 1192 of these were eligible for R1. According to the design of the study, 614 eligible patients who received the diagnosis of MM in centers with a double intensification policy were randomly assigned to either VMP (n=199) or ASCT-1 (n=208) or ASCT-2 (n=207). Patients randomized to ASCT-1 or ASCT-2 were included in the current pre-specified analysis. Median age was 59 years for patients in the ASCT-1 group and 57 years for those in the ASCT-2 group. The frequency of ISS stage III was 18% and 19%, while revised ISS stage III was 9% and 11%, respectively. Cytogenetic abnormalities were detected by FISH analysis of CD138+ plasma cells. A high-risk (HR) cytogenetic profile, defined by t(4;14) and/or del(17p) and/or t(14;16) (HR cyto-3), was observed in 26% of evaluable patients who were randomized to ASCT-1 and in 21% of those randomly assigned to ASCT-2. If amp(1q) and/or del(1p) were added for the definition of high-risk disease, a HR cytogenetic profile that included at least 1 of the 5 above mentioned chromosomal abnormalities (HR cyto-5) was reported in 55% of evaluable patients in the ASCT-1 group and in 54% of those in the ASCT-2 group. Median follow-up from R1 was 27 (IQR: 20-35) months. On an intention-to-treat basis, the median PFS was 45 months in the ASCT-1 arm and was not yet reached for patients in the ASCT-2 arm; 3-year estimates of PFS were 60% and 73%, respectively (HR=0.66; 95% CI=0.45-0.96; P=0.030). PFS benefit with ASCT-2 was retained across predefined subgroups, including patients with β2-microglobulin >3.5 mg/L (HR=0.59; CI=0.34-0.99; P=0.005), bone marrow plasma cells >60% (HR=0.41; CI=0.22-0.77; P=0.006), LDH values above the upper limits (HR=0.52; CI=0.28-095; P=0.034), revised ISS stage II (HR=0.50; CI=0.31-0.80; p=0.004), HR cyto-3 (HR=0.49; CI=0.24-1.02; P=0.057) and HR cyto-5 (HR=0.57; CI=0.35-0.93; P=0.024). In a multivariate Cox regression analysis stratified by ISS stage, randomization to ASCT-2 (HR=0.62; CI=0.40-0.95; P=0.027) and HR cyto-5 (HR=2.63; CI=1.63-4.16; P Conclusions Upfront double ASCT after bortezomib-based induction therapy for newly diagnosed MM was superior over a single ASCT in terms of prolonged PFS. Clinical benefits of double ASCT were mostly seen in patients with disease-related factors predicting for poor prognosis. Disclosures Cavo: Bristol-Myers Squibb: Honoraria; Takeda: Honoraria; Celgene: Honoraria, Research Funding; Janssen: Honoraria, Research Funding; Amgen: Honoraria. Offidani:Janssen: Honoraria; Celgene: Honoraria, Research Funding. Boccadoro:Janssen: Honoraria, Research Funding; CELGENE: Honoraria, Research Funding; Mundipharma: Research Funding; Amgen: Honoraria, Research Funding; SANOFI: Honoraria, Research Funding; BMS: Honoraria, Research Funding; Novartis: Honoraria, Research Funding; Abbivie: Honoraria.

To determine which individual characteristics (religious participation, mistrust, racism/discrimination, spirituality, perceived access to care, and continuity of care) were predictors of patient outcomes (patient satisfaction, physical health, and mental health status) for an Army health care clinic transitioning to the Patient-Centered Medical Home (PCMH).A descriptive, correlational design using stepwise multivariate regression analyses to assess the effect of individual characteristics on patient outcomes for 200 Army Soldiers and family members receiving health care services.Perceived access to care was positively and mistrust was negatively related to patient satisfaction (p0.001 for both variables). Participants who reported more support from God and more mistrust also reported poorer physical health status (p0.008 and p0.003, respectively). Perceived access to care was the only individual characteristic that showed a significant (p0.019) positive association with a better mental health status.This study suggests that better access to care improves patient satisfaction and mental health status; however, those with higher levels of mistrust tend to have lower patient satisfaction and poorer health. Participants with poorer health also tend to rely on more support from God. These important individual characteristics should be the considered when implementing the PCMH.

Background Scores for cardio-embolic and bleeding risk in patients with atrial fibrillation are described in the literature. However, it is not clear how they co-classify elderly patients with multimorbidity, nor whether and how they affect the physician's decision on thromboprophylaxis. Methods Four scores for cardio-embolic and bleeding risks were retrospectively calculated for ≥ 65 year old patients with atrial fibrillation enrolled in the REPOSI registry. The co-classification of patients according to risk categories based on different score combinations was described and the relationship between risk categories tested. The association between the antithrombotic therapy received and the scores was investigated by logistic regressions and CART analyses. Results At admission, among 543 patients the median scores (range) were: CHADS22 (0-6), CHA2DS2-VASc 4 (1-9), HEMORR2HAGES 3 (0-7), HAS-BLED 2 (1-6). Most of the patients were at high cardio-embolic/high-intermediate bleeding risk (70.5% combining CHADS2and HEMORR2HAGES, 98.3% combining CHA2DS2-VASc and HAS-BLED). 50-60% of patients were classified in a cardio-embolic risk category higher than the bleeding risk category. In univariate and multivariable analyses, a higher bleeding score was negatively associated with warfarin prescription, and positively associated with aspirin prescription. The cardio-embolic scores were associated with the therapeutic choice only after adjusting for bleeding score or age. Conclusion REPOSI patients represented a population at high cardio-embolic and bleeding risks, but most of them were classified by the scores as having a higher cardio-embolic than bleeding risk. Yet, prescription and type of antithrombotic therapy appeared to be primarily dictated by the bleeding risk. © 2013 European Federation of Internal Medicine.

A Mediterranean dietary pattern has been associated with reducing the risk of cardiovascular and chronic disease. The aim of this study was to evaluate the role of nutrition knowledge in determining possible differences among dietary patterns in a general population from a Mediterranean region. We conducted a cross-sectional study on a subsample of 744 subjects enrolled in the population-based cohort of the Moli-sani Project. A 92-item questionnaire on nutrition knowledge was elaborated, validated and administered. Dietary information were obtained from the EPIC food frequency questionnaire and adherence to a Mediterranean dietary pattern was evaluated both by the a priori Greek Mediterranean diet score and the a posteriori approach obtained by principal component analysis. Nutrition knowledge was significantly associated with higher adherence to a Mediterranean dietary pattern. The odds of having higher adherence to a Mediterranean dietary pattern increased with greater nutrition knowledge. The odds ratio of being obese significantly decreased with increasing nutrition knowledge levels. The results showed that nutrition knowledge was significantly associated with higher adherence to a Mediterranean dietary pattern and with lower prevalence of obesity in a Southern Italian region with Mediterranean diet tradition independently from education and other socioeconomic factors.