Higher Index Scores Research Articles

Understanding and Measuring the Social Inclusion of Syrian Refugees in Istanbul: The Case of Zeytinburnu

Abstract Based on survey data collected during 2016–2017 from 380 Syrians in Zeytinburnu, an inner-city district of Istanbul, Turkey, this article uses multidimensional scaling to measure their social inclusion. The study shows how the level of social inclusion, treated as a dependent variable, changes with the refugees’ age, gender, education level, length of stay in Zeytinburnu, and health conditions. The sampled Syrians had high social inclusion index scores despite facing precarity at the time of survey. This study suggests that refugee-friendly social contexts and policies can improve social inclusion.

Time-dependent effects after enamel fluoride application on an acid etching system in orthodontic bracket bonding.

This study investigated the effectiveness of acid etching and bond strength in an orthodontic bonding system in accordance with various time periods after 1.23% acidulated phosphate fluoride (APF) gel applications. APF gel was applied on the enamel surface of bovine teeth, which were assigned to group F0. The tooth specimens were then immersed in distilled water for 1 (F1), 7 (F7), 14 (F14), 21 (F21) and 28 (F28) days. A group without fluoride pretreatment was a control group. All groups were etched with 35% phosphoric acid and evaluated using a surface hardness tester and scanning electron microscope (SEM). A shear bond strength (SBS) test was performed using a universal testing machine, and the bond failure modes were also examined. After the 1.23% APF gel treatment, the hardness of the acid-etched enamel surface decreased as the immersion period increased. SEM images of the test groups showed etched patterns similar to control group as the immersion period increased. The SBS increased with increasing immersion period, whereas group F21 was not significantly different from the control group. Relatively high adhesive remnant index scores were identified as the ageing period increased. The present study indicated that in order to obtain suitable bond strength, it is recommended to use an acid etching-based bonding system for the fixation of orthodontic appliances on the enamel surface 21days after the use of APF gel. Fluoride pre-treatment interferes with the acid etching effects on enamel, causing a reduction in the bond strength with orthodontic brackets.

P0457MALE LUPUS NEPHRITES: WHAT ABOUT RISK FACTORS FOR RENAL FAILURE ? EXPERIENCE OF ONE DEPARTMENT

Abstract Background and Aims The occurrence of renal involvement during the clinical course of systemic lupus erythematous (SLE) is generally considered to be the most important factor influencing the prognosis in terms of morbidity and mortality. The factors influencing prognosis in lupus nephritis (LN) are variable in literature. The aim of our study was to analyze the clinicopathological correlations, and risk factors associated with renal failure in male patients with LN. Method We retrospectively studied all male patients with kidney biopsy-proven lupus nephritis (LN) treated in our department during the period between 1979 and 2016. Looking for predictive factors related to renal prognosis, we analyzed clinical, biological and histological data by multivariate analysis using the comparison of the survival rates by the log-rank test. Results We collected 41 native renal biopsies showing LN. Patients were aged 32.17 years (17-65 years) at the time of diagnosis of LN. Diagnosis of SLE was made according to the criteria of the American College of Rheumatology. The most common clinical presentation was nephrotic syndrome (61%), and the most frequent pathological finding in sediment was proteinuria (85%). At the time of diagnosis, 17% of patients had hypertension and 39 % of patients had an eGFR under than 60 ml/min/1.73 m2. LN was of class I, II, III, IV and V in 7.5%, 12.5%, 27.5%, 47.5% and 41.5% of the cases, respectively. Fourteen patients developed end-stage renal failure. The presence of hematuria, renal failure at the time of diagnosis, nephrotic syndrome, low complement, proliferative glomerulonephritis (class IV), high activity index score of LN and thrombotic microangiopathy were significantly associated with poor renal prognosis with (p=0.0053), (p=0.0002), (p=0.0186), (p=0.0287), (p=0.0005), (p=0.058), (p=0.0117), respectively. Conclusion Renal failure at the time of diagnosis and active proliferative lesions should be diagnosed and treated as soon as possible because they influence the renal prognosis in lupus man.

Gait speed and handgrip strength as predictors of all-cause mortality and cardiovascular events in hemodialysis patients

BackgroundLow physical performance in patients undergoing maintenance hemodialysis is associated with a high mortality rate. We investigated the clinical relevance of gait speed and handgrip strength, the two most commonly used methods of assessing physical performance.MethodsWe obtained data regarding gait speed and handgrip strength from 277 hemodialysis patients and evaluated their relationships with baseline parameters, mental health, plasma inflammatory markers, and major adverse clinical outcomes. Low physical performance was defined by the recommendations suggested by the Asian Working Group on Sarcopenia.ResultsThe prevalence of low gait speed and handgrip strength was 28.2 and 44.8%, respectively. Old age, low serum albumin levels, high comorbidity index score, and impaired cognitive functions were associated with low physical performance. Patients with isolated low gait speed exhibited a general trend for worse quality of life than those with isolated low handgrip strength. Gait speed and handgrip strength showed very weak correlations with different determining factors (older age, the presence of diabetes, and lower serum albumin level for low gait speed, and lower body mass index and the presence of previous cardiovascular events for low handgrip strength). Patients with low gait speed and handgrip strength had elevated levels of plasma endocan and matrix metalloproteinase-7 and the highest risks for all-cause mortality and cardiovascular events among the groups (adjusted hazard ratio of 2.72, p = 0.024). Elderly patients with low gait speed and handgrip strength were at the highest risk for poor clinical outcomes.ConclusionGait speed and handgrip strength reflected distinctive aspects of patient characteristics and the use of both factors improved the prediction of adverse clinical outcomes in hemodialysis patients. Gait speed seems to be a better indicator of poor patient outcomes than is handgrip strength.

The rise of (sub)nations? Sub-national human development, climate targets, and carbon dioxide emissions in 163 countries

Is the notion of universal human development compatible with a world that is warmed less than 2°C? We estimate country-level quintile distributions of human development and consumption carbon dioxide (CO2) emissions for over 95% of the world's population. We find that <0.2% of the global population simultaneously experience high human development and meet long-term climate targets. Only one nation, Sri Lanka, contributed quintile populations (second and third) which exhibited both High Human Development Index (HDI) scores and long-term average per capita CO2 emissions consistent with global climate targets. Sub-national framing exposes within-country inequality, which continues to grow in China and India, and shows us that very high human development populations live in 89 nations, comprise 1.59 billion people, and are responsible for 53% of global emissions. Indeed, the wealthiest quintile in China (totaling 86% of the population of the USA in 2014) has very high human development and has per capita emissions similar to the fourth richest quintile of the USA.

Myxovirus resistance 1 (MX1) is an independent predictor of poor outcome in invasive breast cancer

BackgroundBreast cancer (BC) is a disease with variable morphology, clinical behaviour and response to therapy. Identifying factors associated with the progression of early-stage BC can help understand the risk of metastasis and guide treatment decisions. Myxovirus resistance 1 (MX1), which is involved in the cellular antiviral mechanism, plays a role in some solid tumours; however, its role in invasive BC remains unknown. In this study, we aimed to explore the clinicopathological and prognostic significance of MX1 in BC.MethodsMX1 was assessed at the protein level using tissue microarrays from a large well-annotated BC cohort (n = 845). The expression of MX1 mRNA was assessed at the transcriptomic level using the Molecular Taxonomy of Breast Cancer International Consortium (METABRIC; n = 1980) and validated using three publicly available cohorts on Breast Cancer Gene-Expression Miner (bc-GenExMiner version 4.4). The associations between MX1 expression and clinicopathological factors, and outcome were evaluated.ResultsHigh MX1 protein expression was associated with features of aggressiveness, including large tumour size, high tumour grade, high Nottingham prognostic index scores, hormone receptor negativity and high Ki67 expression. High MX1 expression showed an association with poor patient outcome and it was an independent predictor of short BC-specific survival (p = 0.028; HR = 1.5; 95% CI = 1.0–2.2). Consistent with the protein results, high MX1 mRNA levels showed an association with features of aggressive behaviour and with shorter survival.ConclusionThis study identified MX1 as an independent predictor of poor outcome in patients with BC. Further functional studies are needed to investigate the biological role of MX1 in BC and its potential value as a therapeutic target.

Baseline FDG-PET/CT detects bone marrow involvement in follicular lymphoma and provides relevant prognostic information

AbstractIn follicular lymphoma (FL), detection of bone marrow (BM) involvement (BMI) by 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) improves the accuracy of staging vs BM biopsy (BMB) alone. Our objective was to determine the diagnostic utility of PET for BMI FL and the prognostic value of BMI by PET (positive PET result [PET+]). Records of patients (2002-2016) with PET and BMB at the time of initial treatment were reviewed. BMI was identified by positive BMB result (BMB+) and/or unifocal or multifocal BM FDG uptake on blindly reviewed PET scans with no corresponding CT abnormality (PET+). Among 261 patients, BMI was diagnosed in 78 patients (29.9%) by PET+, in 81 patients (31.0%) by BMB+, and in 113 patients (43.3%) by either PET+ or BMB+. PET+ upstaged 24 patients to stage IV, including 10 from stages I or II to stage IV. Median duration of follow-up was 6.0 years (range, 0-16.6 years). In univariate analysis, a high Follicular Lymphoma International Prognosis Index (FLIPI) score, PET+, and BMB+ correlated with shorter progression-free survival (PFS; all P ≤ .03), and high FLIPI, PET+, and combined PET+ and BMB+ with shorter overall survival (OS; all P ≤ .01). In multivariate analysis, PET+ was the only independent predictor of PFS, whereas high FLIPI score and PET+ predicted OS (P ≤ .03). Combined PET and BMB identify BMI more accurately than either BMB or PET alone, but BMB rarely adds critical information. For patients initiating treatment of FL, identification of BMI by PET is predictive of PFS and OS.

Simple Risk Index Score and Hospitalization Mortality in Patients with ST-Elevation Myocardial Infarction

Introduction: Hospitalization mortality in ST-elevation Myocardial Infarction (STEMI) patients areaffected by several factors, including initial identification of the risks at hospital admission. Riskscore tools as a predictor of STEMI complication and death event in STEMI patients is a simple riskindex score. The aim of this study was to determine the association between simple risk index scoreand hospitalization mortality in STEMI patients.Methods: We retrospectively enrolled 60 consecutive patients who were admitted to our hospitaldiagnosed with STEMI. The simple risk index score was calculated for each patient using equation:heart rate x [age/10]2/systolic blood pressure. The patients were assigned into 2 groups according tothis score, high score and low score group. Incidence of death during hospitalization in STEMIpatients was recorded.Results: The total subjects were 60 people. The subjects consisted of 30 patients with low score and30 subjects with high score. The incidence of death during hospitalization in the group of high simplerisk index score were 26 patients, and in the group of low simple risk index score were 13 patients.The association between the simple risk index score and the deaths during hospitalization in STEMIpatients based on statistical analysis was significant (p= 0.00) and value of risk relative (RR) is 2.167;95% CI: 1.368-3.433; (p=0.000).Conclusion: Simple risk index score is associated with hospitalization mortality in ST-elevationmyocardial Infarction (STEMI) patients.

Does Baseline BUN Have an Additive Effect on the Prediction of Mortality in Patients with Acute Pulmonary Embolism?

Background: In patients with heart failure, elevated levels of blood urea nitrogen (BUN) is a prognostic factor. In this study, we investigated the prognostic value of elevated baseline BUN in short-term mortality among patients with acute pulmonary embolism (PE). Methods: Between 2007 and 2014, cardiac biomarkers and BUN levels were measured in patients with acute PE. The primary endpoint was 30-day mortality, evaluated based on the baseline BUN (≥14 ng/L) level in 4 groups of patients according to the European Society of Cardiology’s risk stratification (low-risk, intermediate low-risk, intermediate high-risk, and high-risk). Results: Our study recruited 492 patients with a diagnosis of acute PE (mean age=60.58±16.81 y). The overall 1-month mortality rate was 6.9% (34 patients). Elevated BUN levels were reported in 316 (64.2%) patients. A high simplified pulmonary embolism severity index (sPESI) score (OR: 5.23, 95% CI: 1.43–19.11; P=0.012), thrombolytic or thrombectomy therapy (OR: 2.42, 95% CI: 1.01–5.13; P=0.021), and elevated baseline BUN levels (OR: 1.04, 95% CI: 1.01–1.03; P=0.029) were the independent predictors of 30-day mortality. According to our receiver-operating characteristics analysis for 30-day mortality, a baseline BUN level of greater than 14.8 mg/dL was considered elevated. In the intermediate-low-risk patients, mortality occurred only in those with elevated baseline BUN levels (7.2% vs. 0; P=0.008). Conclusion: An elevated baseline BUN level in our patients with PE was an independent predictor of short-term mortality, especially among those in the intermediate-risk group.

Differences in Incidence and Mortality Trends of Colorectal Cancer Worldwide Based on Sex, Age, and Anatomic Location

We studied incidence and mortality trends of colorectal cancer (CRC) in 39 countries according to age, sex, and anatomic location (colon vs rectum). We retrieved incidence data from registries from 36 countries. The registries included the following: Cancer Incidence in 5 Continents volumes I to XI; the Surveillance, Epidemiology, and End Results Program of the National Cancer Institute; and the Nordic Cancer Registries from Europe. We obtained mortality data from 39 countries of the World Health Organization database. We evaluated average annual percentage changes in CRC incidence and mortality in the past decade using joinpoint regression analysis. From 2007 to 2016, 2006 to 2015, or 2005 to 2014, depending on the availability of the data, the incidence of colon cancer increased in 10 of 36 countries analyzed (all in Asia or Europe); India had the greatest increase, followed by Poland. All 10 of these countries have medium to high Human Development Index (HDI) scores. Six countries had a decrease in colon cancer incidence; these countries had the highest HDI scores; the United States had the greatest decrease, followed by Israel. Seven countries (including all countries from Northern America) had a decrease in incidence among persons older than 50 years. Eight countries had an increase in colon cancer incidence among persons younger than 50 years, including the United Kingdom and India. Countries with a decreased or stable incidence among persons 50 years or older but a significant increase in persons younger than 50 years, included Germany, Australia, the United States, Sweden, Canada, and the United Kingdom. Only Italy had a decrease in CRC incidence among persons younger than 50 years. Among women, 12 of 36 countries (all from Asia and Europe) had an increase in colon cancer incidence and 7 countries had a decrease; India had the greatest increase followed by Slovenia. Five of 36 countries had an increase in incidence of rectal cancer and 8 countries had a decrease; Ecuador and Thailand had the greatest increases in incidence. The incidence of rectal cancer among persons younger than 50 years increased significantly in Finland, Australia, Canada, the United States, and The Netherlands. Four countries had an increase in the incidence of rectal cancer in women; Ecuador had the greatest increase followed by Thailand. The incidence of rectal cancer in women decreased in 8 countries. Among women younger than 50 years, rectal cancer incidence increased, despite a decrease in women older than 50 years, in Costa Rica, Slovenia, Japan, Slovakia, Canada, and the United States there was an increase in incidence, although their elder population had a stable or decreased incidence. Twenty-four countries reported a reduction in CRC mortality, including North America, Oceania, and most European countries. Nevertheless, some countries from Asia, Latin America, and Southern Europe had significant increases in CRC mortality. In an analysis of incidence and mortality databases from 39 countries, we found that the incidence of colon and rectal cancers has continued to increase in countries with medium to high HDI and in younger populations. Preventive strategies are needed for countries with increasing CRC and rectal cancer incidence and mortality.

Association of coincident self-reported mental health problems and alcohol intake with all-cause and cardiovascular disease mortality: A Norwegian pooled population analysis.

The disease burden attributable to mental health problems and to excess or harmful alcohol use is considerable. Despite a strong relationship between these 2 important factors in population health, there are few studies quantifying the mortality risk associated with their co-occurrence in the general population. The aim of this study was therefore to investigate cardiovascular disease (CVD) and all-cause mortality according to self-reported mental health problems and alcohol intake in the general population. We followed 243,372 participants in Norwegian health surveys (1994-2002) through 2014 for all-cause and CVD mortality by data linkage to national registries. The mean (SD) age at the time of participation in the survey was 43.9 (10.6) years, and 47.8% were men. During a mean (SD) follow-up period of 16.7 (3.2) years, 6,587 participants died from CVD, and 21,376 died from all causes. Cox models estimated hazard ratios (HRs) with 95% CIs according to a mental health index (low, 1.00-1.50; high, 2.01-4.00; low score is favourable) based on the General Health Questionnaire and the Hopkins Symptom Checklist, and according to self-reported alcohol intake (low, <2; light, 2-11.99; moderate, 12-23.99; high, ≥24 grams/day). HRs were adjusted for age, sex, educational level, marital status, and CVD risk factors. Compared to a reference group with low mental health index score and low alcohol intake, HRs (95% CIs) for all-cause mortality were 0.93 (0.89, 0.97; p = 0.001), 1.00 (0.92, 1.09; p = 0.926), and 1.14 (0.96, 1.35; p = 0.119) for low index score combined with light, moderate, and high alcohol intake, respectively. HRs (95% CIs) were 1.22 (1.14, 1.31; p < 0.001), 1.24 (1.15, 1.33; p < 0.001), 1.43 (1.23, 1.66; p < 0.001), and 2.29 (1.87, 2.80; p < 0.001) for high index score combined with low, light, moderate, and high alcohol intake, respectively. For CVD mortality, HRs (95% CIs) were 0.93 (0.86, 1.00; p = 0.058), 0.90 (0.76, 1.07; p = 0.225), and 0.95 (0.67, 1.33; p = 0.760) for a low index score combined with light, moderate, and high alcohol intake, respectively, and 1.11 (0.98, 1.25; p = 0.102), 0.97 (0.83, 1.13; p = 0.689), 1.01 (0.71, 1.44; p = 0.956), and 1.78 (1.14, 2.78; p = 0.011) for high index score combined with low, light, moderate, and high alcohol intake, respectively. HRs for the combination of a high index score and high alcohol intake (HRs: 2.29 for all-cause and 1.78 for CVD mortality) were 64% (95% CI 53%, 74%; p < 0.001) and 69% (95% CI 42%, 97%; p < 0.001) higher than expected for all-cause mortality and CVD mortality, respectively, under the assumption of a multiplicative interaction structure. A limitation of our study is that the findings were based on average reported intake of alcohol without accounting for the drinking pattern. In the general population, the mortality rates associated with more mental health problems and a high alcohol intake were increased when the risk factors occurred together.

Real-Life Effectiveness and Safety of Sofosbuvir-Based Therapy in Genotype 2 Chronic Hepatitis C Patients in South Korea, with Emphasis on the Ribavirin Dose.

Background/AimsSofosbuvir (SOF)-based therapy has been used in Korean patients with chronic hepatitis C virus (HCV) infection since January 2016. This study aimed to investigate the real-life effectiveness and safety of SOF-based therapy in genotype 2 HCV infection.MethodsFrom January to December 2016, 458 genotype 2 HCV-infected patients who received ≥1 dose of SOF-based therapy were consecutively enrolled in seven tertiary hospitals. Sustained virologic response (SVR) rates and safety were determined by intention-to-treat (ITT) and per-protocol (PP) analyses.ResultsThe mean age of the patients was 61.0 years; 183 (40%) were male, and 13.1% showed a high viral load (>6,000,000 IU/mL). Among the 378 treatment-naïve patients, the SVR rates were 94.2% (ITT) and 96.7% (PP). Among the 80 treatment-experienced patients, the SVR rates were 96.3% (ITT) and 98.7% (PP). Patients with a relatively high fibrosis-4 index score (>3.25) had similar SVR rates to those with a relatively low score (p=0.756). A total of 314 patients (68.6%) were treated with a reduced ribavirin dose at the prescriber’s discretion, but they showed similar SVR rates to those treated with the weight-based dose (ITT 95.5% and 92.3%, PP 97.4% and 96.3%, respectively). Adverse events were observed in 191 patients (41.7%), including 86 (18.8%) with anemia, but only one (0.2%) discontinued antiviral therapy due to nausea.ConclusionsSOF-based therapy showed high real-life efficacy and tolerability in Korean patients with genotype 2 chronic HCV infection, regardless of previous antiviral treatment experience and fibrosis score. A reduced ribavirin dose can be considered in this patient cohort.

Discontinuation of new hepatitis C drugs among Medicare patients.

To examine factors associated with discontinuation of new hepatitis C drugs-second-generation direct-acting antivirals (DAAs)-among Medicare beneficiaries with chronic hepatitis C. A retrospective analysis using 2014-2016 Medicare claims. The study population was patients with chronic hepatitis C in fee-for-service Medicare with Part D who initiated a DAA therapy between January 1, 2014, and September 1, 2016. We defined discontinuation of DAA therapy as filling prescriptions for fewer weeks than the expected duration of the DAA identified. We estimated adjusted odds ratios (aORs) of DAA discontinuation by patient characteristics using multivariable logistic regression. We estimated the model separately for patients with a Part D low-income subsidy (LIS) and those without an LIS. Of 82,056 patients who initiated a DAA therapy during the study period, 5171 (6.3%) did not complete the therapy. Discontinuation rates varied across DAAs, ranging from 4.7% (elbasvir/grazoprevir) to 11.8% (ombitasvir/paritaprevir/ritonavir/dasabuvir). Women with an LIS were more likely to discontinue DAA therapy than men with an LIS (aOR, 1.16; 95% CI, 1.08-1.25; P <.01). Non-LIS black and Hispanic patients had higher odds of discontinuation than non-LIS white patients (black: aOR, 1.49; 95% CI, 1.28-1.73; P <.01; Hispanic: aOR, 1.56; 95% CI, 1.01-2.44; P <.05). High comorbidity index score increased the odds of DAA discontinuation among patients with an LIS. Real-world discontinuation of DAA therapy was low, but it was 3 times more likely than in clinical trials and varied by patient characteristics. Efforts to increase DAA adherence would help lower patients' risk of developing resistance to future treatments and reduce potential waste of resources.

China’s prefectural digital divide: Spatial analysis and multivariate determinants of ICT diffusion

Much research has made efforts to elaborate upon different dimensions to the digital divide, including informational and communications technology (ICT) access, ICT usage, and ICT outcomes. We assess the utility of such perspectives for studying digital inequality across prefectural cities in China. China is the world's largest ICT market in terms of the number of mobile devices in use, internet users, and broadband subscriptions, yet it has notable digital inequality within and between provinces, prefectural cities, and counties. In this study, we built a conceptual framework of digital divides for prefectural cities in China, examined spatial agglomeration using cluster analysis, and explored the leading correlates using a geographically-weighted regression (GWR) model. A large digital divide among the prefectural cities in China was revealed, with cities with a high administrative level having a relatively high digital development index(DDI) score. Prefectural cities with high DDI levels are mainly agglomerated in large metropolitan areas, such as Beijing–Tianjin–Hebei, the Yangtze River Delta, the Pearl River Delta, and the West Coast Economic Zone of the Taiwan Straits. Prefectural cities with low DDI levels are concentrated in the rural-mountainous regions in southwest China and poverty-stricken areas in central and western China. This study also found that the leading determinants of the digital divide are urban residential income, the secondary education gross enrollment ratio, rural residential income, and the working age population ratio, which indicates that socio-economic problems, rather than institution and innovation aspects, have to be solved for improving ICT use and outcomes.

Measuring assessors’ experiences of grading marginal student performances in clinical assessments – The assess-safe tool: Development and preliminary psychometric validation

Assessment of fitness for practice in the nursing student population is an essential yet challenging component of nursing education. The aim of this research was to describe the development and preliminary validation of the Assess-Safe instrument that explores assessors' experiences of grading nursing student performances in clinical courses when that performance is not a clear pass or fail. A 3 phase approach was used to develop and psychometrically test the instrument. Phase 1 involved the development of a pool of items following a literature review, coupled with findings from qualitative data. In phase 2, an expert panel rated the items for clarity and relevance, reducing the item pool. Assessors of Australian undergraduate nursing students from industry and academia were recruited for this study. A sample of 149 assessors across industry and academia completed the resultant survey to pilot test the instrument; constituting Phase 3. A high content validity index score of 0.95 was achieved through expert review. Construct validity using factor analysis revealed four factors including: assessor support; process support; assessor introspection; and student support. The Assess-Safe instrument achieved good internal reliability with an overall Cronbach's alpha coefficient of 0.77; and sub-scale scores ranging from 0.71 to 0.79. The Assess-Safe instrument demonstrated satisfactory psychometric properties and has utility for education programmes, research and policy development across a variety of practice based professions. Nonetheless, further psychometric validation is warranted.

Preference for sleep management strategies among prostate cancer patients: An Aotearoa/New Zealand perspective✰

IntroductionMany men with prostate cancer (PCa) experience insomnia symptoms post-treatment. We explore here PCa patients’ preference for strategies to manage their sleep. Patients and MethodsA brief online survey was launched on Facebook and promoted by Prostate Cancer Foundation New Zealand. The survey contained validated questionnaires on various sleep-related parameters, as well as questions about sleep management strategies. ResultsWe recruited 82 PCa patients (67.9 ± 6.3 years old). Participants with high insomnia severity index (ISI) scores reported significantly worse daytime sleepiness, more severe fatigue, being less of a “morning person”, and more frequent dreaming. Most participants (71–95%) were open to trying behavioural strategies for improving sleep hygiene, especially by improving their sleeping conditions and having a consistent sleep-wake schedule. Insomnia severity and past use of androgen deprivation therapy were significant predictors for the number of sleep treatments used. Participants with a high ISI were more likely to have used medication, CBT, and herbal remedies or supplements for treating sleep issues than those with low ISI. Furthermore, in patients who had not used these treatments options, those with a high ISI were more willing to try CBT and hypnosis compared to those with a low ISI. Reasons for not willing to try various sleep treatments were documented. ConclusionMost PCa patients are willing to adjust their behavior or lifestyle to improve their sleep habits/behaviours. Patients with severe insomnia are more likely to have both used and express willingness to try, interventions to improve sleep, with preferences for CBT and hypnosis.

Association between Chronic Kidney Disease or Acute Kidney Injury and Clinical Outcomes in COVID-19 Patients.

BackgroundA population-based study would be useful to identify the association between chronic kidney disease (CKD) or acute kidney injury (AKI) and prognosis of coronavirus disease 2019 (COVID-19) patients.MethodsThis retrospective study utilized the claim data from Korea. Patients who underwent COVID-19 testing and were confirmed to be positive were included and divided into the following three groups based on the presence of CKD or requirement of maintenance dialysis: Non-CKD (participants without CKD), non-dialysis CKD (ND-CKD), and dialysis-dependent CKD (DD-CKD) patients. We collected data on the development of severe clinical outcomes and death during follow-up. Severe clinical outcomes were defined as the use of inotropics, conventional oxygen therapy, high-flow nasal cannula, mechanical ventilation, or extracorporeal membrane oxygenation and the development of AKI, cardiac arrest, myocardial infarction, or acute heart failure after the diagnosis of COVID-19. AKI was defined as the initiation of renal replacement therapy after the diagnosis of COVID-19 in patients not requiring maintenance dialysis. Death was evaluated according to survival at the end of follow-up.ResultsAltogether, 7,341 patients were included. The median duration of data collection was 19 (interquartile range, 11–28) days. On multivariate analyses, odds ratio (OR) for severe clinical outcomes in the ND-CKD group was 0.88 (95% confidence interval [CI], 0.64–1.20; P = 0.422) compared to the Non-CKD group. The DD-CKD group had ORs of 7.32 (95% CI, 2.14–33.90; P = 0.004) and 8.32 (95% CI, 2.37–39.21; P = 0.002) compared to the Non-CKD and ND-CKD groups, respectively. Hazard ratio (HR) for death in the ND-CKD group was 0.79 (95% CI, 0.49–1.26; P = 0.318) compared to the Non-CKD group. The DD-CKD group had HRs of 2.96 (95% CI, 1.09–8.06; P = 0.033) and 3.77 (95% CI, 1.29–11.06; P = 0.016) compared to the Non-CKD and ND-CKD groups, respectively. DD-CKD alone was associated with severe clinical outcomes and higher mortality. There was no significant difference in frequency of severe clinical outcomes or mortality rates between the Non-CKD and ND-CKD groups. In patients not requiring maintenance dialysis, AKI was associated with old age, male sex, and high Charlson's comorbidity index score but not with the presence of CKD. HRs for patients with AKI were 11.26 (95% CI, 7.26–17.45; P < 0.001) compared to those for patients without AKI in the multivariate analysis. AKI was associated with severe clinical outcomes and patient survival, rather than underlying CKD.ConclusionCKD requiring dialysis is associated with severe clinical outcomes and mortality in patients with COVID-19; however, the development of AKI is more strongly associated with severe clinical outcomes and mortality.

IDENTIFIKASI INDEKS KENYAMANAN KOTA YOGYAKARTA BERDASARKAN KRITERIA CULTURAL HERITAGE

The ideal city planning, in fact is the combination between livable and sustainable city, where the city is able to maintain the quality of life in the present as well as the future, furthermore it generates a comfortable atmosphere for a place to live as seen from many aspects. Yogyakarta is one of the livable cities in Indonesia with the highest index score, 68.14% for social life and 70.89% for the preservation of cultural heritage building. Considering the mission of Yogyakarta which is to enhance cultural quality and strengthen morality, behavior and cultural value of the community, it is considerable to conduct a research regarding to livable city index in Yogyakarta based on the criteria of cultural heritage. Furthermore, this research used scoring dichotomy data as a methodology with variables: the changes in building's form and function, the ownership status and the usage of cultural heritage building, as well as the amount of cultural heritage buildings that have been demolished and/or in the process of demolition. The results show the highest livable index for preservation of cultural heritage building is in cultural preservation area Kotagede (41.77%), followed by Kraton (20.66%), Malioboro (14.06%), Pakualaman (13.21%) and the least is Kotabaru (10.03%). Kotagede has the highest livable index due to the amount of cultural heritage building compared to other preservation areas. From the total percentage, 42.9% of the buildings are in the original form, 30% have its function changed, 70% are in personal ownership, 21.6% are in group/association, and 45.5% are not demolished. The conclusion of this study is that the existence of cultural heritage building in the city will increase the value of environmental identity which is resembles the character of the area and the community within

Low Pre-Treatment Hemoglobin and Creatinine Clearance Correlate with Worse Overall Survival, Treatment-Related Mortality, and Regimen-Related Toxicities in Patients Undergoing a Reduced-Intensity Allogeneic Stem Cell Transplantation with Fludarabine and Melphalan

The reduced-intensity conditioning (RIC) regimen consisting of fludarabine and melphalan 140 mg/m2 (Flu/Mel140) prior to allogeneic hematopoietic stem cell transplant (HSCT) has been widely adopted in clinical practice. However, pharmacokinetic (PK) studies report up to a 10-fold interpatient variability in melphalan exposure (AUC). Specifically, melphalan binds to proteins in the red blood cell membrane, leading to higher plasma concentrations in patients with lower hemoglobin. Likewise, since renal elimination contributes significantly to melphalan clearance (~ 40%), the presence of renal impairment also leads to higher concentrations. We previously identified lower hemoglobin and/or creatinine clearance as strong predictors of survival and toxicities after high dose melphalan and autologous transplant. Given this, we hypothesized that clinical variables, in particular, pre-treatment hemoglobin, could predict for outcomes after Flu/Mel140 and HSCT. We analyzed 67 consecutive patients who received Flu/Mel140. In addition to standard clinical parameters, hemoglobin (Hgb) and creatinine clearance (CrCl) on day -6 were obtained. Hemoglobin was grouped as low or high relative to the median (&lt;9.5 or ≥ 9.5 g/dL), and CrCl was divided into two groups (&lt; 60 or ≥ 60 ml/min). In the entire cohort, the median age was 57 (21-73) years, with most patients being female (n=37; 55.2%) and white (n=27; 40.3%) or African-American (n=16; 23.9%). Most patients were diagnosed with AML/MDS (n=27; 40.3%) or idiopathic myelofibrosis (n=14; 20.9%), and the median lines of prior therapy was 2 (0-7). Prior to HSCT, 36 (53.7%) patients presented with intermediate disease risk index (DRI) and 19 (28.4%) with high DRI, while 31 (62%) patients had a high hematopoietic cell transplantation-specific comorbidity index (HCT-CI) score. Thirty (45.5%) patients received a matched related donor transplant, while 31 (47%) received a matched unrelated donor transplant. The median time to neutrophil and platelet engraftment was 15 (9-26) and 16 (8-104) days, respectively. The median overall survival (OS) was significantly shorter in patients with a lower Hgb (113 vs. 2536 days; p=0.004). This difference was attributed to an increased rate of transplant-related mortality (TRM) in patients with a lower Hgb (n=26; 81.3%) versus a higher Hgb (n=11; 36.7%) (p=0.0005). Time to relapse between patients with a lower and higher Hgb was not different (p=0.89). The median OS in patients with a lower CrCl was significantly worse (75 vs. 317 days; p=0.003). The rate of TRM was also found to be significantly worse in patients with a lower CrCl (n=10; 90.1%) compared to patients with a higher CrCl (n=27; 52.9%) (p=0.0023). Time to relapse was not different between patients with a lower and higher Cr Cl (p=0.29). Patients with both a low Hgb and CrCl experienced a shorter median OS (75 days vs. not reached; p&lt;0.0001; Figure 1). Multivariate Cox proportional hazards model with adjustment for clinical and prognostic factors found that a higher Hgb strongly predicted for better OS (HR 0.12, 95% CI 0.03-0.52; p=0.004) and less TRM (HR 0.13, 95% CI 0.03-0.53; p=0.004). The combination of a higher Hgb and CrCl ≥ 60 ml/min predicted for better OS (HR 0.08, 95% CI 0.01-0.63; p=0.017) and trended towards a decreased rate of TRM (HR 0.16, 95% CI 0.02-1.43; p=0.102). We then analyzed regimen-related toxicities among patients with a lower and higher Hgb and lower and higher CrCl. In patients with a lower hemoglobin, the median duration of hospitalization (35 vs. 29 days; p=0.02) and the mean duration of diarrhea (14.6 vs. 7.2 days; p=0.008) were significantly longer. In patients with a lower CrCl, the median duration of hospitalization (40 vs. 29 days; p=0.06) and the mean duration of diarrhea (20.9 vs. 8.6 days; p=0.0009) were longer, and the rate of infection was higher (90.9% vs. 49.1%; p=0.02). We show for the first time that pre-treatment Hgb and CrCl represent important determinants of clinical outcomes after Flu/Mel140 and HSCT. A lower hemoglobin in particular was strongly associated with a shorter OS and TRM. This is consistent with PK studies showing increased melphalan exposure in patients with low Hgb and CrCl. We conclude that consideration of clinical factors that affect melphalan exposure and implementation of PK-directed dosing may be beneficial in achieving optimal outcomes in patients receiving FluMel140 and HSCT. Figure Disclosures Galvin: Incyte: Consultancy. Patel:Celgene: Speakers Bureau; Amgen: Consultancy, Speakers Bureau; Janssen: Speakers Bureau.

Cognitive Impairment Is Associated with Inferior Survival and Increased Non-Relapse Mortality in Older Allogeneic Hematopoietic Cell Transplant (alloHCT) Recipients: A Multicenter Retrospective Study

Introduction: Use of alloHCT is increasing in older patients, but the best means of determining alloHCT candidacy is uncertain. Geriatric assessment (GA), including validated geriatric metrics such as Instrumental Activities of Daily Living (IADL), offers promise to improve prognostication and decision making. We identified a multicenter retrospective cohort of older patients (pts) with pre-alloHCT GA data and examined the impact of GA impairments on post-alloHCT outcomes as reported to the Center for International Blood and Marrow Transplant (CIBMTR) registry. Methods: Pts across 6 participating centers were included in the cohort who met the following inclusion criteria: first alloHCT performed in the U.S. from 2011-2017; age ≥50 years; consented to CIBMTR registry study; and GA incorporating an IADL score collected within 3 months prior to transplant. Additional pre-alloHCT geriatric metrics were collected where available and included: Medical Outcomes Study Physical Health score (MOS-PH), Timed Up and Go (TUG), and Blessed Orientation Memory Concentration (BOMC). Univariate regression analyses examined the effect of demographic, clinical, and geriatric covariates on overall survival (OS), progression-free survival (PFS) and non-relapse mortality (NRM). Variables significant at p&lt;0.1 were included in multivariate models. Results: Among 330 pts meeting inclusion criteria, median age was 63 (range 50-77), 60% were male, and 89% were Caucasian. AML and MDS accounted for 79% of transplant indications (46% and 33% respectively). Conditioning was myeloablative in 32%. Karnofsky performance status (KPS) was ≤ 80 in 27%, and 51% of patients had Hematopoietic Cell Transplant Comorbidity Index (HCTCI) ≥3. Median follow up was 24 months (range 3-61). GA metrics available for analysis included IADL in 100% of pts, MOS-PH in 70%, TUG in 83%, and BOMC in 71%. GA impairments, using published cutoffs, were frequent: of evaluable pts, 36% had IADL impairment (score &lt;14), 57% had MOS-PH ≤ the cohort median of 80, 14% had TUG ≥ 13.5 seconds and 17% had cognitive impairment (BOMC score ≥7). In multivariate analysis (MVA), only BOMC ≥7 was significantly associated with inferior 1-year OS (hazard ratio [HR] 1.94, 95% confidence interval [CI] 1.14-3.31, p=0.01). IADL impairment was of marginal significance (HR 1.41, 95% CI 0.96-2.08, p=0.08). Similar findings were seen for 2-year OS (BOMC ≥7 HR 1.60, 95% CI 0.99-2.56, p=0.05; and IADL HR 1.33, 95% CI 0.96-1.86, p=0.09). With respect to PFS, high/very high Disease Risk Index score (HR 1.62, 95% CI 1.17-2.24, p=0.004) and BOMC ≥7 (HR 1.79, 95% CI 1.14-2.81, p=0.01) both were associated with inferior 2-year PFS. With respect to NRM, HCTCI ≥3 and BOMC ≥7 were the only significant predictors of increased NRM at both 1 and 2 years (subdistribution HR [SHR] 1.82, 95% CI 1.07-3.09, p=0.03 and SHR 2.41, 95% CI 1.29-4.53, p=0.006 respectively for 2-year NRM). Figure 1A and 1B show unadjusted OS and NRM according to the presence of cognitive impairment by BOMC ≥7. No GA metrics were predictive of relapse risk, and age was not associated with any post-alloHCT outcomes. In a pre-planned subgroup analysis of GA metrics in 224 patients aged ≥60 years, impaired cognition by BOMC ≥7 was the sole geriatric metric predictive of 2-year NRM (SHR 2.72, 95% CI 1.32-5.63, p=0.007). Conclusion: In this multicenter study of patients ≥50 years undergoing alloHCT, pre-alloHCT cognitive impairment was significantly associated with inferior OS due to increased NRM. In contrast to prior single center studies, IADL impairment was not significantly associated with outcomes. GA validation studies, integrating more refined cognitive testing, should be pursued both to determine candidacy for alloHCT and to identify those likely to benefit from strategies to reduce NRM. Figure 1 Disclosures Olin: Daiichi Sankyo: Research Funding; Astellas: Research Funding; Genentech: Consultancy, Research Funding; Pfizer: Research Funding; Jazz Pharmaceuticals: Consultancy, Honoraria; Revolution Medicine: Consultancy; AstraZeneca: Research Funding; Clovis: Research Funding; Ignyta: Research Funding; MedImmune: Research Funding; Mirati Therapeutics: Research Funding; Novartis: Research Funding; Spectrum: Research Funding. Pasquini:Kite Pharmaceuticals: Research Funding; Novartis: Research Funding; BMS: Research Funding; Medigene: Consultancy; Amgen: Consultancy; Pfizer: Consultancy. Bhatt:Agios: Consultancy; Abbvie: Consultancy; Partner therapeutics: Consultancy; Incyte: Consultancy, Research Funding; Tolero Pharmaceuticals: Research Funding; National Marrow Donor Program: Consultancy; CSL Behring: Consultancy; Pfizer: Consultancy. Giralt:Celgene: Consultancy, Research Funding; Amgen: Consultancy, Research Funding; Takeda: Consultancy, Research Funding; Novartis: Consultancy; Actinium: Consultancy, Research Funding; Miltenyi: Research Funding; Johnson &amp; Johnson: Consultancy, Research Funding; Jazz Pharmaceuticals: Consultancy; Kite: Consultancy; Spectrum Pharmaceuticals: Consultancy. Popat:Jazz: Consultancy; Bayer: Research Funding; Incyte: Research Funding. Weisdorf:Fate Therapeutics: Consultancy; Pharmacyclics: Consultancy; Incyte: Research Funding. Artz:Miltenyi: Research Funding.