Successful Mobilization Research Articles

Structural Impediments, Domestic Politics, and Nuclear Diplomacy in Post-Kim Il-sung North Korea

This article uses theoretical insights from neoclassical realism to explain how the end of the Cold War shaped North Korea's domestic political structures and foreign-policy strategies. It suggests that political leaders are uniquely positioned at the nexus of domestic politics and international politics and employ two different strategies: utilizing international politics for domestic political gain and mobilizing domestic resources to further international ambitions. In the politicking process, political leaders are interested in maximizing both the state security and the regime security; leaders’ concern for regime security outweighs their protection of the national interest when threats to the regime appear more serious. In North Korea, the end of the Cold War forced Kim Jong-il to adopt military-first politics, in which the political power and authority of the Korean Worker's Party waned and the Korean People's Army gained the upper hand in the governing process. In foreign policy, Kim Jong-il and his son Jong-un pursued nuclear weapons to maximize national security at a lower cost and to secure the legitimacy of their rule through successful nuclear tests and mobilization of international threats.

A randomized double blind control trial comparing filgrastim and pegfilgrastim in cyclophosphamide peripheral blood hematopoietic stem cell mobilization

There are few randomized trials comparing filgrastim and pegfilgrastim in peripheral blood stem cell mobilization (PBSCM). None of the trials studied the effects of the timing of pegfilgrastim administration on the outcomes of mobilization. We conducted a randomized triple blind control trial comparing the outcomes of filgrastim 5 µg/kg daily from day 3 onwards, ‘early’ pegfilgrastim 6 mg on day 3 and ‘delayed’ pegfilgrastim 6 mg on day 7 in cyclophosphamide PBSCM in patients with no previous history of mobilization. Peripheral blood (PB) CD34+ cell count was checked on day 8 and day 11 onward. Apheresis was started when PB CD34+ ≥ 10/µl from day 11 onward. The primary outcome was the successful mobilization rate, defined as cumulative collection of ≥2 × 106/kg CD34+ cells in three or less apheresis. The secondary outcomes were the day of neutrophil and platelet engraftment post transplantation. There were 156 patients randomized and 134 patients' data analyzed. Pegfilgrastim 6 mg day 7 produced highest percentage of successful mobilization, 34 out of 48 (70.8%) analyzed patients, followed by daily filgrastim, 28 out of 44 (63.6%) and day 3 pegfilgrastim, 20 out of 42 (47.6%) (p = 0.075). Pegfilgrastim day 7 and daily filgrastim reported 1.48 (p = 0.014) and 1.49 (p = 0.013) times higher successful mobilization rate respectively as compared to pegfilgrastim day 3 after adjusting for disease, gender and exposure to myelotoxic agent. Multiple myeloma patients were three times more likely to achieve successful mobilization as compared to acute leukemia or lymphoma patients. Pegfilgrastim avoided the overshoot of white cells compared to filgrastim. There was no difference in the duration of both white cells and platelet recovery post transplantation between the three interventional arms.

A Mechanism to Avoid Call Retransmission Using Consistent Shortcut Transfigure Path Construction in Wireless Network

To ensure fair packet broadcasting without service disruption in wireless network from one network cell to another is the key to successful mobile services. However, enforcing fair packet broadcasting is challenging because decision policies within the network cell though works efficiently, considerably reduces the energy consumption level. Using MAC protocol, communication framework gets improved by cooperatively localizing the system and achieves space-time synchronization. But redundancy occurs on cellular wireless network for higher energy levels. This work presents the design and implementation of collision free packet broadcasting in wireless network known as Consistent Shortcut Transfigure Path Construction (CSTPC) mechanism. Under this mechanism the main objective is to develop a transfigure path (i.e., alter path) when the link failure occurs during broadcasting (i.e.,) handover the call. Initially, consistent shortcut is created for constructing alter path and when the link gets failed packet handover takes place. Consistent shortcut is created by combining the Midpoint and Simpsons rule procedure. The Midpoint and Simpsons procedure creates the shortcut and with this reduces the rate of energy consumption gradually. Secondly, error rate on call handover is reduced using CSTPC mechanism by applying Estimation of Distribution algorithm. The constructed Estimation of Distribution algorithm in CSTPC mechanism feasibly handover the packets to neighboring base station with minimal error rate. In this way, minimal error rate avoids retransmission of packets due to the collision and path failure. Furthermore, the CSTPC mechanism reduce the energy consumption level on transfigure path construction and also avoids the retransmission of packets (i.e.,) call in wireless network. Experimental work is carried out using factors such as avoidance of retransmission rate, energy consumption rate, and call broadcasting efficiency.

소비자-브랜드-인게이지먼트 구축의 새로운 커뮤니케이션 방법론으로서의 브랜드 앱의 특성 고찰

소셜 미디어 혁신의 주체로서 스마트 폰은 광고 및 마케팅 커뮤니케이션의 새로운 플랫폼으로 자리 잡고 있다. 최근 성공적인 모바일 광고 형태로 부각되고 있는 브랜드 앱(branded mobile app)은 SNSs라는 플랫폼을 이용하는 대신 특정 브랜드나 기업이 직접 배포하는 어플리케이션으로서 소비자의 편익 과 정보 제공은 물론 온라인 및 오프라인 체험을 통해 소비자 스스로 브랜드 유용성과 가치를 느끼도록 하는 데 최적화 된 전략이다. 이러한 성공적인 브랜드 앱의 특성 분석을 통해 새롭게 변화되는 사회에서의 소비자들과의 커뮤니케이션 전략, 사회적 실천의 변화가 지니는 함의 고찰을 목적으로 수행된 이 연구는 다음과 같은 분석의 결과를 얻었다. 수상작들은 브랜드 표적 집단들의 명확한 니즈 파악과 해결점 제시를 통해 적극적이고 자발적인 소셜 커뮤니케이션 구현의 공간을 제공하고 있으며, 혁신적 테크놀로지 기반의 체화된 혼합 현실을 제공하되 감성적이며 인간적인 인터랙션을 실현시킨다. 결론적으로 모바일 소셜 미디어 사회에서 요구되는 새로운 광고 및 마케팅 커뮤니케이션은 곧 사회적 행위자들을 둘러싼 총체적인 환경에 대한 고찰이 선행되어야 한다고 할 수 있다. 따라서 브랜드 앱의 성공은 곧 전혀 새로운 맥락에서 지배적인 가치를 전복시키며 스스로 재생산하는 미디어 어포던스를 지닌 소비자들과의 커뮤니케이션임을 주지해야 한다.

What can 1 billion trials tell us about visual search?

Mobile technology (e.g., smartphones and tablets) has provided psychologists with a wonderful opportunity: through careful design and implementation, mobile applications can be used to crowd source data collection. By garnering massive amounts of data from a wide variety of individuals, it is possible to explore psychological questions that have, to date, been out of reach. Here we discuss 2 examples of how data from the mobile game Airport Scanner (Kedlin Co., http://www.airportscannergame.com) can be used to address questions about the nature of visual search that pose intractable problems for laboratory-based research. Airport Scanner is a successful mobile game with millions of unique users and billions of individual trials, which allows for examining nuanced visual search questions. The goals of the current Observation Report were to highlight the growing opportunity that mobile technology affords psychological research and to provide an example roadmap of how to successfully collect usable data.

Integrating participatory community mobilization processes to improve dengue prevention: an eco-bio-social scaling up of local success in Machala, Ecuador.

BackgroundThis project investigates the effectiveness and feasibility of scaling-up an eco-bio-social approach for implementing an integrated community-based approach for dengue prevention in comparison with existing insecticide-based and emerging biolarvicide-based programs in an endemic setting in Machala, Ecuador.MethodsAn integrated intervention strategy (IIS) for dengue prevention (an elementary school-based dengue education program, and clean patio and safe container program) was implemented in 10 intervention clusters from November 2012 to November 2013 using a randomized controlled cluster trial design (20 clusters: 10 intervention, 10 control; 100 households per cluster with 1986 total households). Current existing dengue prevention programs served as the control treatment in comparison clusters. Pupa per person index (PPI) is used as the main outcome measure. Particular attention was paid to social mobilization and empowerment with IIS.ResultsOverall, IIS was successful in reducing PPI levels in intervention communities versus control clusters, with intervention clusters in the six paired clusters that followed the study design experiencing a greater reduction of PPI compared to controls (2.2 OR, 95% CI: 1.2 to 4.7). Analysis of individual cases demonstrates that consideration for contexualizing programs and strategies to local neighborhoods can be very effective in reducing PPI for dengue transmission risk reduction.ConclusionsIn the rapidly evolving political climate for dengue control in Ecuador, integration of successful social mobilization and empowerment strategies with existing and emerging biolarvicide-based government dengue prevention and control programs is promising in reducing PPI and dengue transmission risk in southern coastal communities like Machala. However, more profound analysis of social determination of health is called for to assess sustainability prospects.

Setting up for success for mobilisation to major hazard facilities—a contractor's perspective

The challenges for a contractor to mobilise to a major hazard facility come from differences in expectations between stakeholders, gaps and inconsistencies between health, safety and environment (HSE) management systems, and the logistical challenges of initial training and competency verification. Differences in expectations can arise between the corporate office and site or also between various functional silos. HSE management system challenges manifest in the detailed procedures when the safety case is in operation. Training and competency assessment is an ongoing requirement, but the initial demand at first mobilisation creates a one-off logistical burden. The steps to lessen the impact of these challenges and to enable a successful outcome include: alignment workshops with customers and other stakeholders to create a shared safety culture and expectations of management systems; joint HSE management system gap analysis and risk workshops; early interface meetings with stakeholders; and, requirements having a comprehensive definition and pre-planning to deliver best practice. A successful mobilisation is characterised by the alignment of systems, improvements made during the alignment process by delivering best practice, meeting all HSE obligations for employees (including seconded personnel and sub-contractors), bridging the gap with sub-contractor management when implementing the safety case, and having all personnel trained before mobilisation. This extended abstract draws on lessons from recent real-world experience and offers a framework to overcome challenges a contractor can encounter, and sets up successful mobilisation for a major hazard facility.

Efficacy of vinorelbine plus G-CSF for CD34+ hematopoietic progenitor cell mobilization in patients with multiple myeloma

We aimed to assess the efficacy of vinorelbine plus G-CSF for chemo-mobilization of CD34+ hematopoietic progenitor cells (HPC) in patients with multiple myeloma and to identify adverse risk factors for successful mobilization. Vinorelbine 35 mg/m(2) was administered intravenously on day 1 in an outpatient setting. Filgrastim 5 μg per kg body weight (BW) was given twice daily subcutaneously from day 4 on until the end of the collection procedure. Leukapheresis was scheduled to start on day 8 and performed for a maximum of three consecutive days until at least 4x10(6) CD34+ cells per kg BW were collected. Overall, 223 patients were mobilized and 221 (99%) patients proceeded to leukapheresis. Three (1.5%) patients required an unscheduled hospitalization after chemo-mobilization due to neutropenic fever and renal failure (n=1), severe bone pain (n=1), and abdominal pain with constipation (n=1). In 211 (95%) patients the leukaphereses were started as planned at day 8, while in 8 (3%) patients the procedure had to be postponed to day 9 and in two (1%) patients to day 10. In the great majority of patients (77%) the predefined amount of HPC could be collected with one leukapheresis. Fourty-four (20%) patients needed a second leukapheresis, while only 6 (3%) patients required a third leukapheresis procedure. The median number of CD34+ cells collected was 6.56x10(6) (range, 0.18-25.9x10(6)) per kg BW at the first day of leukapheresis and 7.65x10(6) (range, 0.18-25.9x10(6)) per kg BW in total. HPC collection was successful in 212 (95%) patients after a maximum of three leukaphereses. Patient age (p=0.02) and prior exposition to lenalidomide (p<0.001) were independent risk factors for a lower HPC amount collected in multiple regression analysis. Vinorelbine plus G-CSF enables a very reliable prediction of the timing of leukapheresis and results in successful HPC collection in 95% of the patients.

Delivering smart specialization in peripheral regions: the role of Universities

Successful mobilization of the resources of universities can have a positive effect on regional economies; even more so in peripheral regions. The role of universities in regional development, innovation and growth comes into even sharper focus with the emergence of ‘smart specialization’ strategies, an ex-ante conditionality for accessing European Structural Funds from 2014. However, partnerships between universities and regions can fail to achieve their early ambitions, often due to a lack of understanding of each side’s drivers and barriers for cooperation. The collaboration between Region Värmland and Karlstad University in Sweden demonstrates a systemic and broad-based view of innovation that fits well within the policy framework of European and national innovation strategies. While recognizing the complexities and tensions inherent in such collaborations, this case study provides valuable insights for other European universities, regions and policy-makers in peripheral places that are seeking to work more closely to support smart specialization.

Evaluation of Dutch guideline for just-in-time addition of plerixafor to stem cell mobilization in patients who fail with granulocyte-colony-stimulating factor.

Plerixafor in combination with granulocyte-colony-stimulating factor (G-CSF) is approved for the use of stem cell collection in patients who fail to mobilize on G-CSF. In 2009 the Stem Cell Working Party of the Dutch-Belgian Cooperative Trial group for Hematology Oncology (HOVON) composed a guideline for the use of plerixafor. According to this guideline it is recommended to add plerixafor to G-CSF in patients with circulating CD34+ cell counts of fewer than 20 × 10(6) /L on 2 consecutive days accompanied by increasing white blood cells. In this analysis we evaluated retrospectively the outcome of the use of this guideline in the Netherlands. In total 111 patients received plerixafor with a median one administration (range, one to four administrations). Of these patients 55.8% had non-Hodgkin lymphoma, 31.5% multiple myeloma, 8.1% Hodgkin lymphoma, and 4.5% nonhematologic malignancies. In 63.9% patients sufficient numbers of CD34+ cells were collected. In patients with multiple myeloma more successful mobilizations with plerixafor were observed compared to patients with non-Hodgkin lymphoma (71.4% vs. 61.3%). In patients with circulating CD34+ cell counts of at least 2.0 × 10(6) /L before administration of plerixafor a successful mobilization was achieved in 76.5%, and in the patients with very low (0-1 × 10(6) /L) circulating CD34+ cell counts the success rate was 44.2%. Application of the HOVON guideline on the just-in-time administration of plerixafor is effective for mobilization of hematopoietic stem cells in the majority of patients. Stem cell yield in patients with non-Hodgkin lymphoma was lower compared to patients with multiple myeloma. Also patients with very low circulating CD34+ cells before addition of plerixafor might benefit from this approach.

Successful Stem Cell Mobilization with High-Dose Cytarabine Plus G-CSF after Lenalidomide Therapy for Multiple Myeloma - a Series of Four Cases

Of late years, newly developed agents, such as bortezomib, lenalidomide, thalidomide, are widely used for treatment against multiple myeloma. After induction therapy, candidates for autologous stem cell transplantation are supposed to be followed by stem cell harvesting. There are several reports showing lenalidomide has a negative impact on stem cell mobilization. This opinion tends to let us refrain from using lenalidomide on the myeloma patients who are eligible for transplantation, even lenalidomide is expected promising. We experienced a series of three clinical cases presenting that stem cells were poorly mobilized with cyclophosphamide (CY) plus G-CSF after lenalidomide treatment, but sequential stem cell mobilization was incredibly improved with high-dose cytarabine plus G-CSF. One additional case who was treated with lenalidomide also presented successful stem cell mobilization with high-dose cytarabine plus G-CSF. Here we show all four cases in detail.Case 1: 66 years old male, symptomatic myeloma after smoldering period. After three course of bortezomib induction, the response was insufficient. Sequentially he was treated with lenalidomide (25mg/day, every day for three weeks with one week rest period) and dexamethasone (Dex) (40mg/day, weekly) for two courses, and finally achieved Partial response (PR). First peripheral blood stem cell harvesting was attempted with high-dose CY (2.0 g/m2, day1-2) + lenograstim (5mg/kg daily, on days 7 until leukapheresis), but mobilization was unsuccessful so harvesting was not performed. For subsequent mobilization, high-dose cytarabine was administered at a dose of 2.0 g/m2 twice daily (day1-2) + lenograstim. Second mobilization was markedly improved, and finally 33.0 x 106/kg CD34+ cells were obtained.Case 2: 63 years old male, symptomatic myeloma, IgG type. This patient was treated with bortezomib, CY and Dex but resulted in disease progression. As an alternative therapy, lenalidomide (10mg/day, daily for three weeks with one week rest) and Dex (40mg, weekly) were used for three cycles. The dose of lenalidomide was reduced due to renal dysfunction. PR was obtained, then first harvesting was attempted with high-dose CY + lenograstim, as case 1, and 0.088 x 106/kg of CD34+ cells were collected, which was not sufficient for transplantation. Second mobilization was performed with high-dose cytarabine as case 1, and consequently we could obtain 60.1 x 106/kg of CD34+ cells; the yield was dramatically improved.Case 3: 41 years old female, symptomatic myeloma after one year course of smoldering myeloma. As an induction therapy, bortezomib, CY and Dex were selected, but finally she could not achieved PR after three cycles. We gave up bortezomib-based induction, and then lenalidomide (15-25 mg on day1-21 with 1 week rest) and Dex (40 mg, weekly) were administrated for five courses, followed by PR. As previous two cases, the first peripheral stem cell collection was initiated with high-dose CY + lenograstim, and it was not sufficient (0.059 x 106/kg of CD34+ cells). And the second mobilization with high-dose cytarabine with lenograstim recovered the yield of stem cell up to 6.90 x 106/kg.Case 4: 63 years old male, symptomatic myeloma. He was treated with bortezomib, Dex with/without CY, but this regimen was not very effectual, and CY caused elevation of aminotransferase (CTCAE grade 3). Then lenalidomide (10-15 mg on day 1-21) and Dex (40 mg, weekly) were administrated for four courses, and the patient achieved PR. Due to the adverse effect of liver dysfunction, we could not use high-dose CY for mobilization. For this case, high-dose cytarabine was selected for first mobilization, and it was very successful, 50.2 x 106/kg of CD34+ cells were harvested. The yields of PBSC from all four cases are summarized on Table 1.These four cases suggest mobilization with high-dose cytarabine could be an alternative option for poor mobilizer of myeloma patient treated with lenalidomide-based induction. This fact may enable us to choose lenalidomide, not only bortezomib, for induction even for transplant-eligible cases. [Display omitted] DisclosuresIshiko:Celgene: Honoraria.

Successful Stem Cell Mobilization and Autologous Stem Cell Transplantation after Pretreatment Consisting of Bendamustine, Prednisone and Bortezomib (BPV) in 35 Patients with Newly Diagnosed/Untreated Multiple Myeloma

Introduction: Bendamustine is a bifunctional alkylating agent with low toxicity that produces both single- and double-strand breaks in DNA, and shows only partial cross resistance with other alkylating drugs. Treatment of patients with newly diagnosed multiple myeloma using Bendamustine and Prednisone in comparison to Melphalan and Prednisone results in superior complete response rate and prolonged time to treatment failure (Poenisch et al, Res Clin Oncol 132: 205-212;2006). So far, however, reliable information on stem cell toxicity and mobilization of stem cells for autologous stem cell transplantation (SCT) after induction treatment with a combination of bendamustine, prednisone and bortezomib (BPV) is missing.Material and Methods: A retrospective analysis of peripheral blood stem cell mobilization and autologous SCT was performed in 35 patients with multiple myeloma who had received at least two cycles of a BPV induction therapy consisting of bendamustine 60 mg/m2 on days 1 and 2, bortezomib 1.3 mg/m² on days 1, 4, 8 and 11, and prednisone 100 mg on days 1, 2, 4, 8 and 11 between October 2008 and May 2014. The mobilization regimen consisted of cyclophosphamide 4 g/m2 and G-CSF (2x5µg/kg). Apheresis was started as soon as peripheral blood CD34+ counts exceeded 20x106/l with a harvest target of 8x106 CD34+/kg. The minimal accepted target was 2x106 CD34+/kg.Results: A median number of two (range 1–5) BPV treatment cycles were given to the patients. The majority of the patients (n = 31, 89 %) responded including 2 sCR, 5 nCR, 11 VGPR, and 13 PR. Three patients had MR, and 1 SD. Stem cell mobilization and harvest was successful in all patients. In 19 of 35 patients (54 %) a single apheresis was sufficient to reach the target. The median number of aphereses was one (range 1-4) and the median CD34+ cell-count/kg was 13.5 (range 3.2-33.1) x106. All patients received an autologous SCT. The pre-transplantation conditioning therapy consisted of melphalan 200 mg/m2. In 8 patients with concomitant heart amyloidosis or severe renal insufficiency melphalan dose was reduced to 100 or 140 mg/m2. Engraftment was successful in 34 of 35 patients. The median time to leucocytes count >l×109/l was reached after 11 (range 9–18) days and the time to untransfused platelet count of >50×109/l was 13 (range 10–55) days. 34 patients (97%) responded after the autologous SCT with 11 sCR, 2 CR, 7 nCR, 7 VGPR, and 7 PR. The progression free survival at 18 months was 87 % and overall survival was 92 %.Conclusion: Stem cell mobilization and autologous SCT is feasible in multiple myeloma patients who have received BPV induction therapy. DisclosuresAl-Ali:Novartis: Consultancy, Honoraria, Research Funding; Celgene: Honoraria, Research Funding. Lange:Novartis: Consultancy, Honoraria, Research Funding.

Remobilization with G-CSF Is Less Effective Than the Initial Mobilization in Healthy Donors Undergoing Peripheral Blood Stem Cell Collection for Allogeneic Transplantation

Background: The need to repeat peripheral blood stem cell (PBSC) mobilization and collection arises infrequently in healthy donors, but may be required due to insufficient initial collection, graft failure, or relapse of the recipient’s disease. Currently no published data exists on the efficacy of remobilization of healthy PBSC donors. Studies of remobilization in patients undergoing autologous transplantation (ASCT) have largely focused on the use of alternative mobilization agents such as chemotherapy or plerixafor. Boeve et al (Bone Marrow Transplant, 2004) reported that remobilization with G-CSF in patients undergoing ASCT who failed initial mobilization with G-CSF, resulted in higher numbers of CD34+ cells collected than the initial collection, though this required a doubling of the dose of G-CSF.Patients/Methods: We performed retrospective chart review of 977 consecutive adult (>18 yrs) donors who underwent apheresis for PBSC donation at Washington University School of Medicine from 1995 through 2013. We identified 66 donors who had undergone more than one mobilization. Two cohorts of donors were identified for analysis: Group 1 included donors mobilized initially and again subsequently with G-CSF (10 ug/kg/day), or GM-CSF (5 ug/kg/day) + G-CSF (10 ug/kg/day). Group 2 consisted of donors mobilized with a CXCR4 antagonist, plerixafor (240-320 ug/kg) or POL6326 (1000-2500 ug/kg), and subsequently were remobilized with G-CSF (10 ug/kg/day).Statistical Analysis: Spearman correlations were performed to analyze the relationship between peak peripheral blood (PB) CD34+/uL level; the number of CD34+ cells collected per kg (recipient weight); and the number of CD34+ cells per L of apheresis collected during initial mobilization (MOB1) and remobilization (MOB2); and the interval (days) between MOB1 and MOB2. One-way ANOVA with repeated measures analyses were performed to determine the relationship of PB CD34+/uL, CD34+/kg and CD34+/L during MOB1 and MOB2.Results: Group 1 included 30 donors. The median age was 49 years (range 18-75) and 15 were male. The median number of days between MOB1 and MOB2 was 140 (range 26-2238). All 30 donors were remobilized due to graft failure or relapse of the recipient’s disease. PB CD34+/uL, CD34+/kg and CD34+/L all correlated between MOB1 and MOB2. The mean PB CD34/uL at MOB1 was 69 compared to 37 at MOB2 (p= 0.029); the mean CD34/kg collected at MOB1 was 5.6x106 compared to 3.3x106 at MOB2 (p= 0.002); and the mean CD34/L collected at MOB1 was 24.0x106 compared to 17.6x106at MOB2 (p= 0.023). The interval between MOB1 and MOB2 did not correlate with any of the MOB2 variables. Results from the analysis are summarized in Table 1.Group 2 included 32 donors. The median age was 51 years (range 21-67) and 18 were male. The median number of days between MOB1 and MOB2 was 20 (range 4-1123). 18 donors were remobilized due to mobilization failure, while 14 were remobilized due to graft failure or relapse of the recipient’s disease. The mean PB CD34/uL at MOB1 was 15 compared to 68 at MOB2 (p< 0.001); the mean CD34/kg collected at MOB1 was 2.5x106 compared to 7.1x106 at MOB2 (p< 0.001); and the mean CD34/L collected at MOB1 was 10.6x106 compared to 30.1x106at MOB2 (p< 0.001). The interval between MOB1 and MOB2 did not correlate with any of the MOB2 variables. Results from the analysis are summarized in Table 2.Conclusion: Remobilization with G-CSF or GM-CSF and G-CSF after initial successful mobilization with the same regimen results in poorer mobilization while remobilization with G-CSF after initial mobilization with a CXCR4 antagonist results in dramatically improved mobilization. The reason for this remains unclear, but in this study the interval between collections was not associated with successful remobilization.Abstract 850. Table 1Group 1MOB 1MOB 2One-way ANOVASpearman CorrelationPB CD34/ul69 (13-417)37 (1-115)F(1.0, 29.0) = 5.26, p= 0.029r= 0.615, p< 0.001CD34/kg (x106)5.6 (0.8-13.8)3.3 (0.3-10.6)F(1.0, 29.0) = 11.77, p= 0.002r= 0.483, p= 0.007CD34/L (x106)24.0 (4.5-72.0)17.6 (2.8-41.3)F(1.0, 29.0) = 5.74, p= 0.023r= 0.566, p< 0.001Abstract 850. Table 2Group 2MOB 1MOB 2One-way ANOVASpearman CorrelationPB CD34/ul15 (2-54)68 (14-358)F(1.0, 31.0) = 23.16, p< 0.001r= 0.433, p= 0.013CD34/kg (x106)2.5 (0.2-19.7)7.1 (1.7-42.4)F(1.0, 31.0) = 33.84, p< 0.001r= 0.769, p< 0.001CD34/L (x106)10.6 (1.4-67.1)30.1 (6.0-165.0)F(1.0, 31.0) = 34.70, p< 0.001r= 0.774, p< 0.001 DisclosuresNo relevant conflicts of interest to declare.

Which features matter to make a successful mobile game?

As mobile game distribution costs gets near zero, the number of available games on app stores, which is already enormous, continues to grow. It gets increasingly difficult for game developers to build a mobile game and achieve the top positions on charts. With it in mind, this paper’s main purpose is to investigate the relationship between game features and the performance achieved by mobile games in terms of number of downloads and gross revenue. A total of 37 game features were analyzed in order to study how each of them influence mobile games’ performance on app stores. The performance of mobile games is measured based on their current position in download and revenue charts on Google Play store. A linear regression model that maps game features and charts performance is trained using a M5 prime classifier and data from 64 mobile games. Results show how each game feature influences the download and revenue performance of successful mobile games.

Efficacy of Vinorelbine Plus Granulocyte Colony–Stimulation Factor for CD34+ Hematopoietic Progenitor Cell Mobilization in Patients with Multiple Myeloma

We aimed to assess the efficacy of vinorelbine plus granulocyte colony–stimulating factor (G-CSF) for chemo-mobilization of CD34+ hematopoietic progenitor cells (HPC) in patients with multiple myeloma and to identify adverse risk factors for successful mobilization. Vinorelbine 35 mg/m2 was administered intravenously on day 1 in an outpatient setting. Filgrastim 5 μg/kg body weight (BW) was given twice daily subcutaneously from day 4 until the end of the collection procedure. Leukapheresis was scheduled to start on day 8 and be performed for a maximum of 3 consecutive days until at least 4 × 106 CD34+ cells per kg BW were collected. Overall, 223 patients were mobilized and 221 (99%) patients proceeded to leukapheresis. Three (1.5%) patients required an unscheduled hospitalization after chemo-mobilization because of neutropenic fever and renal failure (n = 1), severe bone pain (n = 1), and abdominal pain with constipation (n = 1). In 211 (95%) patients, the leukaphereses were started as planned at day 8, whereas in 8 (3%) patients the procedure was postponed to day 9 and in 2 (1%) patients to day 10. In the great majority of patients (77%), the predefined amount of HPC could be collected with 1 leukapheresis. Forty-four (20%) patients needed a second leukapheresis, whereas only 6 (3%) patients required a third leukapheresis procedure. The median number of CD34+ cells collected was 6.56 × 106 (range, .18 to 25.9 × 106) per kg BW at the first day of leukapheresis and 7.65 × 106 (range, .18 to 25.9 × 106) per kg BW in total. HPC collection was successful in 212 (95%) patients after a maximum of 3 leukaphereses. Patient age (P = .02) and prior exposition to lenalidomide (P < .001) were independent risk factors for a lower HPC amount collected in multiple regression analysis. Vinorelbine plus G-CSF enables a very reliable prediction of the timing of leukapheresis and results in successful HPC collection in 95% of the patients.

Where will the money come from? Alternative mechanisms to HIV donor funding.

BackgroundDonor funding for HIV programs has flattened out in recent years, which limits the ability of HIV programs worldwide to achieve universal access and sustain current progress. This study examines alternative mechanisms for resource mobilization.MethodsPotential non-donor funding sources for national HIV responses in low- and middle-income countries were explored through literature review and Global Fund documentation, including data from 17 countries. We identified the source, financing agent, magnitude of resources, frequency of availability, as well as enabling and risk factors.ResultsFour non-donor funding sources for HIV programs were identified: earmarked levy for HIV from country budgets; risk-pooling schemes such as health insurance; debt conversion, in which the creditor country reduces the debt of the debtor country and allocates at least a part of that reduction to health; and concessionary loans from international development banks, which unlike grants, must be repaid. The first two are recurring sources of funding, while the latter two are usually one-time sources, and, if very large, might negatively affect the debtor country’s economy. Insurance schemes in five African countries covered less than 6.1% of the HIV expenditure, while social health insurance in four Latin American countries covered 8–11% of the HIV expenditure; in Colombia and Chile, it covered 69% and 60%, respectively. Most low-income countries will find concessionary loans hard to repay, as their HIV programs cost 0.5–4% of GDP. Even in a middle-income country like India, a US$255 million concessionary loan to be repaid over 25 years provided only 7.8% of a 5-year HIV budget. Earmarked levies provided only 15% of the annual HIV funding needs in Zimbabwe and Kenya. Debt conversion provided the same share in Indonesia, but in Pakistan it was much higher - the equivalent of 45% of the annual cost of the national HIV program.ConclusionsDomestic sources of funding are important alternatives to consider and might be able to replace donor HIV funding in specific country contexts, coupled with effective prioritization and efficiency measures. Successful resource mobilization design and implementation require close collaboration with other sectors, particularly with the Ministry of Finance, to make sure that the new financing mechanism is fully synchronized with economic growth and that HIV investments yield returns in the form of higher social benefits.

Interim Analysis of an Ongoing Phase Ii Trial Assessing Safety and Efficacy of R-Idea As Salvage Therapy in Patients with Relapsed/Refractory Dlbcl: an Intergroup Study of the Society of Lymphoma Treatment in Japan (Solt-J) and the West Japan Hematology/Oncology Group (Westjhog)

ABSTRACT Aim: High dose chemotherapy (HDT) with autologous stem cell support (ASCT) has been proven effective in relapsed(rel)/refractory(ref) Diffuse large B cell lymphoma (DLBCL), but the benefit is limited to the patients (pts) who are sensitive to salvage chemotherapy (CTx) and are able to mobilize sufficient peripheral blood stem cells (PBSCs). The salvage CTx regimen IDEA was previously reported as effective (ORR; 67.6%) and feasible to mobilize PBSCs (77.8%). (Nishimori et al. Antican Res 2009) Accordingly, we designed a multicenter phase II trial addressing safety and efficacy of IDEA plus Rituximab(R) in rel/ref DLBCL pts (UMI04892). Herein, we report the interim analysis on the first 20 enrolled pts. Methods: This study includes pts aged 18-65 years with primary refractory or first relapse CD20+ DLBCL after anthracycline-containing CTx. The R-IDEA regimen consisits of R 375mg/m2 on day 1, IFO 1.3g/m2, ETP 150mg/m2 on days 2-4, Dex 33mg IV on days 2-5 and Ara-C 750mg/m2 twice daily on days 3-4. R-IDEA was administered every 21 days for a total of 3 cycles. PBSCs were harvested after cycle 3. Pts in a CR/PR after R-IDEA and who got successful mobilization (>2 million of CD34+ cells/kg) received HDT/ASCT. Primary endpoint was mobilization adjusted response rate (MARR; [CR] + [PR] - mobilization failure). Results: 20 pts were enrolled (median age 59.5, range 42-65; M:F ratio 11:9). 17 pts were enrolled after first relapse and three were primary refactory. 5 pts relapsed within 1 year from initial diagnosis. The most frequent grade 3/4 adverse events were neutropenia (55/56 cycles), thrombocytopenia (46/56 cycles), anemia (24/56 cycles), and febrile neutropenia (26/56 cycles). No other grade 5 adverse event occurred. After completion of R-IDEA, 7 pts (35%) achieved CR, 5 (25%) PR, one had SD, and 7 had PD. The median CD34+ count was 2.64 million/kg (range: 0.17-43.7). 3 pts failed to mobilize >2 million of CD34+ cells/kg, for a MARR of 45% (9/20). No patient of primary refractory or relapsed within 1 year after initial diagnosis and 9 pts relapsed >1 year from diagnosis achieved mobilization adjusted response (p = 0.001). The nine pts proceeded to HDT/ASCT. Conclusions: R-IDEA is feasible and well tolerated in pts with rel/ref DLBCL. Primary refractory and early relapsed DLBCL pts had a poorer prognosis. New treatment strategy seems to be warranted for the high risk pts. Disclosure: All authors have declared no conflicts of interest.

Power and persuasion in the vaccine debates: an analysis of political efforts and outcomes in the United States, 1998-2012.

This article examines trends in state-level childhood vaccine policies in the United States from 1998 to 2012 and explains the trajectories for both vaccine-critical and proimmunization legislative efforts. Successful mobilization by vaccine critics during the height of the autism and thimerosal scares (roughly 1998 to 2003) yielded a few state-level expansions for the most permissive type of exemption from vaccine mandates for public school attendance, those based on personal beliefs. Vaccine-critical positions, however, have largely become discredited. How has vaccine critics' ability to advance preferred policies and prevent the passage of unfavorable legislation changed over time? We created a unique data set of childhood vaccine bills (n = 636), introduced from 1998 to 2012 across the 50 state legislatures, and coded them by type of effort (exemption, mandate, mercury ban, and information policies) and outcome. We then mapped out the trends in vaccine policies over time. In order to contextualize the trends we identified, we also reviewed numerous primary sources and conducted interviews with stakeholders. In general, we found that vaccine critics' legislative success has begun to wane. In only 20 bills in our data set were vaccine critics able to change policy in their preferred direction via the legislative process. Only 5 of those wins were significant (such as obtaining a new philosophical exemption to vaccine mandates), and the last of these was in 2007. Critics were more successful at preventing passage of proimmunization legislation, such as mandates for the human papillomavirus (HPV) vaccine. Recent legislation in California, Oregon, and Washington that tightened philosophical exemptions by means of informational requirements suggests that vaccine politics may be entering another phase, one in which immunization supporters may be able to counter increasing opt-out rates, particularly in states with recent outbreaks and politicians favoring science-based policies.

Patriotic Enthusiasm at the Beginning of the First World War

In the present paper from the constructionist perspective is examined one of the most controversial issues of the modern western historiography of the First World War - the issue of patriotic enthusiasm of 1914, its scopes and nature. On the basis of a wide range of primary sources, including Russian and foreign archives, memoirs and letters of contemporaries the author carries out a comparative analysis of the response to the beginning of the war of urban and rural population of Great Britain, France and Russia. Against the backdrop of numerous patriotic demonstrations in large cities, the rural population's response looked much more constrained and passive. At the same time the latter attests rather to the peculiarities of rural culture than to the absence of patriotic upsurge. The author points out that besides apparent distinctions there was a lot of similarities in the urban and rural population's reaction to the beginning of the war. This refers to an immensely successful mobilization of continental armies, a rush of volunteers to the British army, and a drop of the labor movement in all European countries. The author comes to the conclusion that the patriotic upsurge in Europe in 1914 was not founded on a momentary outburst of chauvinism, but reflected a broad popular consensus on the war.

Plerixafor added to G-CSF-supported paclitaxel-ifosfamide-cisplatin salvage chemotherapy enhances mobilization of adequate numbers of hematopoietic stem cells for subsequent autografting in hard-to-mobilize patients with relapsed/refractory germ-cell tumors

An appreciable percentage of patients with relapsed/refractory germ-cell tumors (GCTs), candidates for high-dose chemotherapy (HDC) and autologous hematopoietic cell transplantation (HCT), fail to mobilize adequate hematopoietic stem cells (HSCs) numbers with granulocyte colony-stimulating factor (G-CSF)±salvage chemotherapy. Plerixafor has shown a potential to mobilize adequate CD34+HSCs numbers in this context. Here, we applied plerixafor in combination with G-CSF after salvage chemotherapy in 'poor' mobilizers with relapsed/refractory GCTs for HDC+HCT. Patients with relapsed/refractory GCTs (n=10) received salvage paclitaxel-ifosfamide-cisplatin (TIP) chemotherapy+G-CSF to mobilize adequate HSCs to support HDC, mainly with two courses of high-dose thiotepa-etoposide-carboplatin (TEC). Patients failing to achieve the minimum collection threshold of 2.0×10/kg CD34+ cells, to support at least one cycle of HDC, were administered plerixafor before the anticipated HSC collection during subsequent cycle(s). Overall, seven patients mobilized adequate CD34+ cells (>5.0×10/kg) aiming to support two cycles of HDC. Three patients did not mobilize adequate numbers of CD34+ cells after previous G-CSF plus salvage TIP, and plerixafor was added in subsequent cycle(s). This led to a collection of adequate CD34+ cells, able to support HDC with TEC (1-2 cycles). Hematopoietic engraftment for neutrophils (absolute neutrophil count>500/μl) and platelets (platelet count>20 000/μl) with plerixafor-mobilized HSCs occurred after a median of 9 and 14 days, respectively. Salvage TIP+G-CSF leads to successful HSC mobilization in patients with less heavily pretreated GCTs, whereas the addition of plerixafor to G-CSF+TIP led to mobilization of adequate HSCs that supported autografting after one to two TEC cycles.