Opportunities For Synergy Research Articles

Age-friendly learning health systems: Opportunities for model synergy and care improvement.

Journal of the American Geriatrics SocietyEarly View Commentary Age-friendly learning health systems: Opportunities for model synergy and care improvement Beth Prusaczyk PhD, MSW, Corresponding Author Beth Prusaczyk PhD, MSW beth.prusaczyk@wustl.edu @bethp_DI orcid.org/0000-0001-8495-0836 @@bethp_DI Department of Medicine, Division of General Medical Sciences, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA Institute for Informatics, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA Correspondence Beth Prusaczyk, Instructor of Medicine, Washington University School of Medicine in St. Louis, 600 S. Taylor Avenue, Suite 102, St. Louis, MO 63110, USA. Email: beth.prusaczyk@wustl.eduSearch for more papers by this authorRobert E. Burke MD, MS, Robert E. Burke MD, MS orcid.org/0000-0002-9521-8699 Center for Health Equity Research and Promotion (CHERP), Corporal Michael Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA Division of General Internal Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USASearch for more papers by this author Beth Prusaczyk PhD, MSW, Corresponding Author Beth Prusaczyk PhD, MSW beth.prusaczyk@wustl.edu @bethp_DI orcid.org/0000-0001-8495-0836 @@bethp_DI Department of Medicine, Division of General Medical Sciences, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA Institute for Informatics, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA Correspondence Beth Prusaczyk, Instructor of Medicine, Washington University School of Medicine in St. Louis, 600 S. Taylor Avenue, Suite 102, St. Louis, MO 63110, USA. Email: beth.prusaczyk@wustl.eduSearch for more papers by this authorRobert E. Burke MD, MS, Robert E. Burke MD, MS orcid.org/0000-0002-9521-8699 Center for Health Equity Research and Promotion (CHERP), Corporal Michael Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA Division of General Internal Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USASearch for more papers by this author First published: 02 June 2022 https://doi.org/10.1111/jgs.17901 Research reported in this publication was supported by the National Institute on Aging of the National Institutes of Health under award number K01AG071749 and the VA Safer Aging through Geriatrics-Informed Evidence-Based Practices (SAGE) Quality Enhancement Research Initiative (QUERI) program (QUE 20-014). The content and views are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health or the Department of Veterans Affairs. Funding information: National Institute on Aging, Grant/Award Number: K01AG071749; U.S. Department of Veterans Affairs, Grant/Award Number: QUE 20-014 Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Early ViewOnline Version of Record before inclusion in an issue RelatedInformation

Bringing together monitoring approaches to track progress on adult learning and education across main international policy tools

This article critically examines how monitoring strategies currently track progress on country commitments to adult learning and education (ALE). These commitments are laid out in three main international initiatives and policy tools: (1) the Belém Framework for Action (BFA); (2) the 2015 Recommendation on Adult Learning and Education (RALE); and (3) relevant targets in the fourth Sustainable Development Goal (SDG 4). The two monitoring approaches tracking progress on these commitments are the Global Report on Adult Learning and Education (GRALE) and SDG 4 monitoring strategies for Targets 4.3 (quality vocational and tertiary education, including university), 4.4 (technical and vocational training), 4.5 (equal access), 4.6 (youth and adult literacy and numeracy), 4.7 (global citizenship and sustainable development) and 4.c (qualified teachers). The author of this article presents and reviews these two monitoring approaches, highlighting their strengths and weaknesses. Her analysis aims to identify opportunities for synergies that can support strengthening coverage and efficiency of ALE monitoring through more collaboration. Her suggested ways of bringing these two monitoring approaches closer together provide insights which will be valuable for informing upcoming discussions at the Seventh International Conference on Adult Education (CONFINTEA VII).

Strategic Purchasing Arrangements in Uganda and Their Implications for Universal Health Coverage

ABSTRACT Several purchasing arrangements coexist in Uganda, creating opportunities for synergy but also leading to conflicting incentives and inefficiencies in resource allocation and purchasing functions. This paper analyzes the key health care purchasing functions in Uganda and the implications of the various purchasing arrangements for universal health coverage (UHC). The data for this paper were collected through a document review and stakeholder dialogue. The analysis was guided by the Strategic Health Purchasing Progress Tracking Framework created by the Strategic Purchasing Africa Resource Center (SPARC) and its technical partners. Uganda has a minimum health care package that targets the main causes of morbidity and mortality as well as specific vulnerable groups. However, provision of the package is patchy, largely due to inadequate domestic financing and duplication of services funded by development partners. There is selective contracting with private-sector providers. Facilities receive direct funding from both the government budget and development partners. Unlike government-budget funding, payment from output-based donor-funded projects and performance-based financing (PBF) projects is linked to service quality and has specified conditions for use. Specification of UHC targets is still nascent and evolving in Uganda. Expansion of service coverage in Uganda can be achieved through enhanced resource pooling and harmonization of government and donor priorities. Greater provider autonomy, better work planning, direct facility funding, and provision of flexible funds to service providers are essential elements in the delivery of high-quality services that meet local needs and Uganda’s UHC aspirations.

Integrating Environment and Aging Research: Opportunities for Synergy and Acceleration.

Despite significant overlaps in mission, the fields of environmental health sciences and aging biology are just beginning to intersect. It is increasingly clear that genetics alone does not predict an individual’s neurological aging and sensitivity to disease. Accordingly, aging neuroscience is a growing area of mutual interest within environmental health sciences. The impetus for this review came from a workshop hosted by the National Academies of Sciences, Engineering, and Medicine in June of 2020, which focused on integrating the science of aging and environmental health research. It is critical to bridge disciplines with multidisciplinary collaborations across toxicology, comparative biology, epidemiology to understand the impacts of environmental toxicant exposures and age-related outcomes. This scoping review aims to highlight overlaps and gaps in existing knowledge and identify essential research initiatives. It begins with an overview of aging biology and biomarkers, followed by examples of synergy with environmental health sciences. New areas for synergistic research and policy development are also discussed. Technological advances including next-generation sequencing and other-omics tools now offer new opportunities, including exposomic research, to integrate aging biomarkers into environmental health assessments and bridge disciplinary gaps. This is necessary to advance a more complete mechanistic understanding of how life-time exposures to toxicants and other physical and social stressors alter biological aging. New cumulative risk frameworks in environmental health sciences acknowledge that exposures and other external stressors can accumulate across the life course and the advancement of new biomarkers of exposure and response grounded in aging biology can support increased understanding of population vulnerability. Identifying the role of environmental stressors, broadly defined, on aging biology and neuroscience can similarly advance opportunities for intervention and translational research. Several areas of growing research interest include expanding exposomics and use of multi-omics, the microbiome as a mediator of environmental stressors, toxicant mixtures and neurobiology, and the role of structural and historical marginalization and racism in shaping persistent disparities in population aging and outcomes. Integrated foundational and translational aging biology research in environmental health sciences is needed to improve policy, reduce disparities, and enhance the quality of life for older individuals.

Chatbot use cases in the Covid-19 public health response.

ABSTRACTObjectiveTo identify chatbot use cases deployed for public health response activities during the Covid-19 pandemic.Material and MethodsWe searched PubMed/MEDLINE, Web of Knowledge, and Google Scholar in October 2020 and performed a follow-up search in July 2021. We screened articles based on their abstracts and keywords in their text, reviewed potentially relevant articles, and screened their references to (a) assess whether the article met inclusion criteria and (b) identify additional articles. Chatbots, their use cases, and chatbot design characteristics were extracted from the articles and information from other sources and by accessing those chatbots that were publicly accessible.ResultsOur search returned 3334 articles, 61 articles met our inclusion criteria, and 61 chatbots deployed in 30 countries were identified. We categorized chatbots based on their public health response use case(s) and design. Six categories of public health response use cases emerged comprising 15 distinct use cases: risk assessment, information dissemination, surveillance, post-Covid eligibility screening, distributed coordination, and vaccine scheduler. Design-wise, chatbots were relatively simple, implemented using decision-tree structures and predetermined response options, and focused on a narrow set of simple tasks, presumably due to need for quick deployment.ConclusionChatbots’ scalability, wide accessibility, ease of use, and fast information dissemination provide complementary functionality that augments public health workers in public health response activities, addressing capacity constraints, social distancing requirements, and misinformation. Additional use cases, more sophisticated chatbot designs, and opportunities for synergies in chatbot development should be explored.

Abstract P024: Using innate immune ligands to activate adaptive immune cells for glioblastoma therapy

Abstract Glioblastoma (GBM) is one of the most aggressive and immunosuppressive brain tumors in adults. Despite conventional therapy of surgical resection, radiotherapy and temozolomide (TMZ) chemotherapy, tumors invariably recur and become resistant. The Natural Killer Group 2 Member D (NKG2D) receptor plays a key role in the innate immune control of cancers. The ligands for this receptor (NKG2DLs) are minimally expressed or absent on healthy cells. Stressed or malignant cells upregulate NKG2DLs, resulting in immune activation. We have developed a strategy targeting upregulated NKG2DLs on GBM cells with bi-specific T cell engagers (BiTEs). NKG2D BiTE contains a recombinant NKG2D receptor linked to an anti-CD3 domain. Simultaneous binding of the NKG2D BiTE to NKG2DLs on GBM cells and CD3 on T cells causes antigen-independent activation, pro-inflammatory cytokine release, and tumor cell death. Pre-treating GBM cells with radiation and TMZ causes further NKG2DL upregulation, increased NKG2D BiTE-mediated T cell activation, and sensitises GBM cells to T cell lysis. Meanwhile, healthy non-cancer cells exposed to the same pre-treatment do not trigger T cell activation with NKG2D BiTE. To deliver the BiTE directly into the tumor, the NKG2D BiTE has been encoded into the genome of an oncolytic herpes simplex virus 1 (oHSV-1). This oHSV is capable of selective infection, replication and cell lysis within GBM cells, but not healthy cells. Alongside the direct oncolytic capacity of the oHSV-1, it can also act as a gene therapy vector to express the NKG2D BiTE in situ to activate endogenous tumor infiltrating lymphocytes and direct cytotoxicity towards the remaining cancer cells. Combining conventional radio/chemotherapy with NKG2D BiTE immunotherapy presents an opportunity for synergy by enhancing NKG2DL expression on GBM cells and directing T cell lysis specifically towards these tumor cells, whilst avoiding responses towards non-cancerous cells. Meanwhile, local delivery of the NKG2D BiTE using an oncolytic virus endows tumor-specific expression directly within the tumor. Citation Format: Richard T. Baugh, Hena Khalique, Janet Lei-Rossmann, Len Seymour. Using innate immune ligands to activate adaptive immune cells for glioblastoma therapy [abstract]. In: Abstracts: AACR Virtual Special Conference: Tumor Immunology and Immunotherapy; 2021 Oct 5-6. Philadelphia (PA): AACR; Cancer Immunol Res 2022;10(1 Suppl):Abstract nr P024.

Arabinoxylans: A new class of food ingredients arising from synergies with biorefining, and illustrating the nature of biorefinery engineering

Arabinoxylans (AX) are hemicellulose polysaccharides comprising a linear backbone of xylose sugars with arabinose residues attached along the chain. They offer interesting functional properties that could have application as a new class of food ingredients or for non-food applications. The emergence in recent decades of biorefineries gives a context in which commercial production of a portfolio of AX products could be feasible, through integration with bioethanol production, using ethanol to precipitate the AX. Extending the concept, AX fractions of different functionality can be precipitated at different ethanol concentrations, giving further scope for efficiencies through bioethanol pinch analysis, while producing a portfolio of products with different potential markets and end uses. The current work demonstrates the potential of AX fractions extracted from sugarcane bagasse as bread ingredients. Bagasse AX fractions increased the water absorption in dough formulations, by more than double their own weight for fractions larger than 10 kDa, and increased dough development time in a Chopin Mixolab. As well as promising in their own right, AX also illustrate the more general opportunity for synergies between biorefining and the food industry, with the rise of biorefineries giving opportunities to provide the food industry with new ingredients not currently available.

Tools for harmonization of data in World‐Wide FINGERS

AbstractBackgroundWorld‐Wide FINGERS (WW‐FINGERS) is a global network of multidomain lifestyle intervention trials for dementia risk reduction and prevention (Kivipelto et al., 2020). With over 30 countries conducting studies within the network, harmonizing interventions and data collection wherever possible is a priority. However, study‐specific adaptations are inevitable to accommodate differences in language, culture, and environment. Thus, a single data collection system is not feasible across WW‐FINGERS and opportunities for synergies between study‐specific systems should be explored.MethodREDCap (Research Electronic Data Capture) is a secure, web‐based software platform which supports validated data capture for research studies (Harris et al., 2009). The underlying blueprint for each REDCap project is a ‘data dictionary’ – a .csv file containing all metadata required to recreate case report forms (CRF) for each point of data collection, including variable names and response options. Data dictionaries can be easily exported, shared, and imported into other REDCap instances. This enables utilization of the same overall structure where possible and preserves response options and variable names while making needed adaptations. Within the WW‐FINGERS network, the study to Protect Brain Health through a Lifestyle Intervention to Reduce Risk (U.S. POINTER) developed a REDCap system based on its protocol and shared its data dictionary with two other WW‐FINGERS studies – AUstralian‐Multidomain Approach to Reduce Dementia Risk by PrOtecting Brain Health with Lifestyle Intervention (AU‐ARROW) and LatAm FINGERS (Latin American initiative for lifestyle Intervention to Prevent Cognitive Decline and reduce risk study).ResultAU‐ARROW and LatAm FINGERS are in the process of incorporating relevant pieces of the U.S. POINTER REDCap project into REDCap systems developed for their studies. While the systems are not identical given the different intervention structures, we aim to standardize 50‐75% of the common variables used across the studies.ConclusionUsing REDCap allows each WW‐FINGERS study to develop its own customized system for data capture, while easily standardizing common variable names, response options, and CRFs; along with exporting de‐identified data. As a result, data sharing and analysis across the WW‐FINGERS network can be streamlined. Furthermore, this process may serve as a roadmap for other global consortia’s similar efforts.

Amazon Hydrology From Space: Scientific Advances and Future Challenges

AbstractAs the largest river basin on Earth, the Amazon is of major importance to the world's climate and water resources. Over the past decades, advances in satellite‐based remote sensing (RS) have brought our understanding of its terrestrial water cycle and the associated hydrological processes to a new era. Here, we review major studies and the various techniques using satellite RS in the Amazon. We show how RS played a major role in supporting new research and key findings regarding the Amazon water cycle, and how the region became a laboratory for groundbreaking investigations of new satellite retrievals and analyses. At the basin‐scale, the understanding of several hydrological processes was only possible with the advent of RS observations, such as the characterization of "rainfall hotspots" in the Andes‐Amazon transition, evapotranspiration rates, and variations of surface waters and groundwater storage. These results strongly contribute to the recent advances of hydrological models and to our new understanding of the Amazon water budget and aquatic environments. In the context of upcoming hydrology‐oriented satellite missions, which will offer the opportunity for new synergies and new observations with finer space‐time resolution, this review aims to guide future research agenda toward integrated monitoring and understanding of the Amazon water from space. Integrated multidisciplinary studies, fostered by international collaborations, set up future directions to tackle the great challenges the Amazon is currently facing, from climate change to increased anthropogenic pressure.

The science of statistics versus data science: What is the future?

The importance and relevance of the discipline of statistics with the merits of the evolving field of data science continues to be debated in academia and industry. Following a narrative literature review with over 100 scholarly and practitioner-oriented publications from statistics and data science, this article generates a pragmatic perspective on the relationships and differences between statistics and data science. Some data scientists argue that statistics is not necessary for data science as statistics delivers simple explanations and data science delivers results. Therefore, this article aims to stimulate debate and discourse among both academics and practitioners in these fields. The findings reveal the need for stakeholders to accept the inherent advantages and disadvantages within the science of statistics and data science. The science of statistics enables data science (aiding its reliability and validity), and data science expands the application of statistics to Big Data. Data scientists should accept the contribution and importance of statistics and statisticians must humbly acknowledge the novel capabilities made possible through data science and support this field of study with their theoretical and pragmatic expertise. Indeed, the emergence of data science does pose a threat to statisticians, but the opportunities for synergies are far greater.

Infection Prevention and Antimicrobial Stewardship Program Collaboration During the COVID-19 Pandemic: a Window of Opportunity.

Purpose of ReviewWe describe the similarities between antimicrobial stewardship programs (ASPs) and infection prevention programs (IPPs), and we discuss how these similarities lend themselves to synergy between programs. We also discuss how the COVID-19 pandemic has generated further opportunities for future collaborations that could benefit both programs.Recent FindingsThe COVID-19 pandemic has created new needs, such as real-time data and access to personnel important to both programs, such as information technologists and infectious diseases specialists. It has also increased concerns about rising rates of antimicrobial resistance and healthcare-associated infections, both of which overlap significantly and are key focus areas for both ASPs and IPPs. These emergent issues have highlighted the need for enhanced program infrastructure and new team models. The shift towards telecommunication and telework has facilitated the creation of enhanced infrastructures for collaboration on activities ranging from data access and reporting to providing telehealth services to remote hospitals. These enhanced infrastructures can be leveraged in future collaborative efforts between ASPs and IPPs.SummaryCollaboration between IPPs and ASPs can mitigate setbacks experienced by health systems during the current pandemic, enhance the performance of both programs in the post-pandemic era and increase their preparedness for future pandemic threats. As health systems plan for the post-pandemic era, they should invest in opportunities for synergy between ASPs and IPPs highlighted during the pandemic.

Mindfulness-based interventions for eating disorders: The potential to mobilize multiple associative-learning change mechanisms.

Mindfulness is a two-component skill that includes mindful awareness (attentional monitoring of present moment experience) and mindful acceptance (adopting an attitude of acceptance toward this experience). Although mindfulness-based interventions (MBIs) are efficacious for many conditions, there is a lack of research on MBIs for eating disorders (EDs). We propose that MBIs may be promising for EDs given their potential to mobilize not one, but multiple associative-learning change mechanisms in EDs-defined as adaptive processes of change involving one of two forms of associative-learning: Pavlovian and operant learning. We hypothesize how MBIs-via increasing either mindful awareness or mindful acceptance-may mobilize up to eight associative-learning change mechanisms, two involving Pavlovian learning, and six involving operant learning. We also elaborate on similarities and differences between MBIs and CBT approaches for EDs, as well as opportunities for synergy. Finally, we present recommendations for future research related to the development and evaluation of novel MBI interventions for EDs and the testing of mechanisms and patient-treatment matching hypotheses.

The four smarts of Industry 4.0: Evolution of ten years of research and future perspectives

The Industry 4.0 literature has exponentially grown in the past decade. We aim to understand how this literature has evolved and propose future research opportunities. We focus on four smart dimensions of Industry 4.0: Smart Manufacturing, Smart Products and Services, Smart Supply Chain, and Smart Working. We perform a machine learning-based systematic literature review. Our analysis included 4,973 papers published from 2011 to 2020. We conducted a chronological network analysis considering the growth of these four dimensions and the connections between them. We also analyzed keywords and the main journals publishing on these four smart dimensions. We show that the literature has mainly been devoted to the study of Smart Manufacturing, although attention to the other smart dimensions has been growing in recent years. Smart Working is the less explored dimension, with many opportunities for future research. We show that research opportunities are concentrated in the interfaces between the different smart dimensions. Our findings support the vision of Industry 4.0 as a concept transcending the Smart Manufacturing field, thus creating opportunities for synergies with other related fields. Scholars can use our findings to understand the orientation of journals and gaps that can be fulfilled by future research.

Radiation and CAR T-cell Therapy in Lymphoma: Future Frontiers and Potential Opportunities for Synergy.

CAR T-cell therapy has revolutionized the treatment approach to patients with relapsed/refractory hematologic malignancies; however, there continues to be opportunity for improvement in treatment toxicity as well as response durability. Radiation therapy can play an important role in combined modality treatments for some patients undergoing CAR T-cell therapy in various clinical settings. In this review, we discuss the current evidence for RT in the setting of CAR T-cell therapy for patients with hematologic malignancies and propose potential opportunities for future investigation of RT and CAR T-cell treatment synergy. Future research frontiers include investigation of hypotheses including radiation priming of CAR T-cell mediated death, pre-CAR T-cell tumor debulking with radiation therapy, and selection of high risk patients for early radiation salvage after CAR T cell therapy.

Implementation of Cancer Plans in the United States: A Review.

State cancer plans facilitate prioritization and stakeholder engagement in preventing and controlling cancer. Implementation plans further help stakeholders prioritize efforts, reduce redundancy, and find opportunities for work synergies. A review of cancer plan implementations plans was performed in the development of an implementation plan for the Florida Cancer Plan. This review sought to identify, characterize, and summarize the use of implementation plans that support comprehensive cancer control activities. Although 100% of states and territories published a cancer plan and 78% of states provided funding for implementing their state cancer plans, only 32% published an implementation plan. Commonalities and unique features of state cancer plan implementations are presented and discussed. An example implementation plan is provided for states without a plan to model.

Harnessing nanotechnology to expand the toolbox of chemical biology.

Although nanotechnology often addresses biomedical needs, nanoscale tools can also facilitate broad biological discovery. Nanoscale delivery, imaging, biosensing, and bioreactor technologies may address unmet questions at the interface between chemistry and biology. Currently, many chemical biologists do not include nanomaterials in their toolbox, and few investigators develop nanomaterials in the context of chemical tools to answer biological questions. We reason that the two fields are ripe with opportunity for greater synergy. Nanotechnologies can expand the utility of chemical tools in the hands of chemical biologists, for example, through controlled delivery of reactive and/or toxic compounds or signal-binding events of small molecules in living systems. Conversely, chemical biologists can work with nanotechnologists to address challenging biological questions that are inaccessible to both communities. This Perspective aims to introduce the chemical biology community to nanotechnologies that may expand their methodologies while inspiring nanotechnologists to address questions relevant to chemical biology.

122. The Buck Stops Here. PICC Line Utilization: Stewardship Is Not Only About Antimicrobials Any More

BackgroundThe Choosing Wisely guidelines recommend avoiding placement of PICCs in patients with GFRs less than 45. A recent study found that 1 in 4 PICCs are placed in patients with CKD and the majority of PICCs are for antibiotics. Recent studies have demonstrated early and safe transition from IV to PO antibiotics forgoing PICC use. To our knowledge no studies assess opportunities to reduce PICC use and adverse events through infectious disease. This study aims to identify opportunities for improved PICC utilization.MethodsThis was a single center retrospective analysis of all PICCs in adults from January 2017 to October 2019 at the University of Nebraska Medical Center (UNMC). Data was abstracted via chart review including demographics, index hospital stay, PICC details, PICC indication(s), PICC duration, GFR prior to PICC placement. If present, antimicrobial indication, and infection information.Results211 patients were included. PICC lines were placed in 18.0% (n=38) of patients with GFR < 45. 123 PICCs were for antibiotics. Breakdown of IV antibiotic duration in Figure 1. Infection types treated in < 7 days noted in Figure 2. Infection types treated in 7 – 13 days noted in Figure 2. There was a statistically significant finding of increased duration of antibiotics when infectious disease was consulted with 90.0% (n=63) of cases 14 + days, 60.9% (n = 14) for 7 – 13 days, and 56.7% (n=17) in cases < 7 days (p=0.002).Figure 1 Figure 2 Figure 3 ConclusionInfectious disease providers are trained to consider antimicrobial stewardship. Antimicrobials directly impact therapeutic choices for patients. However, less frequently considered is the insertion of PICCs in patients with tenuous renal function. Given the prevalence of PICCs in patients with GFR < 45, contrary to guideline recommendations, as well as increasing evidence for use of shorter durations and oral antibiotics for treatment there is opportunity for quality improvement and intersectional synergy.Disclosures All Authors: No reported disclosures

Languages of Games and Play

Digital games are a powerful means for creating enticing, beautiful, educational, and often highly addictive interactive experiences that impact the lives of billions of players worldwide. We explore what informs the design and construction of good games to learn how to speed-up game development. In particular, we study to what extent languages , notations , patterns, and tools , can offer experts theoretical foundations, systematic techniques, and practical solutions they need to raise their productivity and improve the quality of games and play. Despite the growing number of publications on this topic there is currently no overview describing the state-of-the-art that relates research areas, goals, and applications. As a result, efforts and successes are often one-off, lessons learned go overlooked, language reuse remains minimal, and opportunities for collaboration and synergy are lost. We present a systematic map that identifies relevant publications and gives an overview of research areas and publication venues. In addition, we categorize research perspectives along common objectives, techniques, and approaches, illustrated by summaries of selected languages. Finally, we distill challenges and opportunities for future research and development.

Re-thinking health through design: collaborations in research, education and practice

Current health-care systems are confronted with progressively complex demands: ageing populations, growing drug ineffectiveness, health mis/disinformation and access to comprehensive services are just a few of the challenges faced today. Design offers methods, practices and processes to help address these challenges. While design and health have a long history of working together, much of this work has been limited. In this article, we make the case for further opportunities for design and health to work together in deep, innovative and human ways. We start by reviewing the transforming space(s) of design, moving on to a discussion of the similarities between healthcare and design. Next, we present three case studies that employ design methods and processes within healthcare settings, exploring new opportunities for synergy. We conclude by summarizing the areas of opportunity uncovered through these case studies, articulating future possibilities for design and healthcare to collaborate.

Association Between Black Race And Improved Survival Following Sipuleucel-T Immunotherapy In Metastatic Castrate-Resistant Prostate Cancer: Implications For Immune Biology And Integration Of Radiation Therapy With Immunotherapy

The biology of prostate cancer in black patients may differ from white patients. For example, recent data suggests that black patients may harbor tumors that are more sensitive to radiation or immune-directed therapy. Sipuleucel-T, a cell-based immunotherapy approved for use in men with metastatic castrate-resistant prostate cancer (mCRPC), is currently also being studied in early-stage non-metastatic prostate cancer. To explore possible immunologic differences and opportunities for synergy with radiation therapy, we examined the association between race and overall survival (OS) among patients receiving sipuleucel-T therapy for mCRPC using a novel real-world database. Using the CancerLinQ database, we identified 474 patients with mCRPC managed with sipuleucel-T. We used Cox modeling to examine the association between race (black vs white) and OS, with or without adjustment for other prognostic variables (age, prior systemic therapy, and prostate-specific antigen [PSA]), and performed subgroup analyses stratifying by the median PSA (16.6 ng/mL). In secondary analyses, we used Cox modeling to estimate treatment-free survival following sipuleucel-T and we used competing risks regression to model time to initiation of a subsequent systemic therapy. Median follow-up was 38.8 months. Black patients (n = 68) experienced significantly improved OS compared to white patients (n = 406) (median 43.1 months vs 30.2 months, hazard ratio [HR] = 0.638, 95% confidence interval [CI] 0.443-0.920, p = 0.016). These results persisted on multivariable analysis (adjusted HR 0.542, 95% CI 0.371-0.792, p = 0.002). Among patients with PSA > 16.6 ng/mL, median OS was 37.7 months vs 20.3 months (HR = 0.463, 95% CI 0.277-0.775, p = 0.003). For patients with PSA < = 16.6 ng/mL, there was no significant difference in median OS (43.1 months vs 40.6 months, HR = 0.842, 95% CI 0.487-1.456, p = 0.538). There were no significant differences in treatment-free survival (HR = 0.777, 95% CI 0.581-1.040, p = 0.090) or initiation of a subsequent systemic therapy (HR = 1.287, 95% CI 0.802-2.065, p = 0.295) by race. Black patients were more likely to receive subsequent cabazitaxel therapy compared to white patients (26.5% vs 15.0%, p = 0.019) but there were no significant differences in the receipt of other therapies (docetaxel, abiraterone, enzalutamide, radium-223). Among men with mCRPC who received sipuleucel-T, black patients had significantly longer OS compared to white patients but no difference in the time to subsequent systemic therapy, mirroring the results of prior immunotherapy studies. This finding may reflect differences in the underlying immune biology of prostate cancer in black versus white patients and may have implications for the integration of radiation therapy and immunotherapy in prostate cancer.