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There are significant disparities with regards to incidence, timely diagnosis, access to treatment, clinical trial participation and health care utilization that negatively impact outcomes for African American patients with multiple myeloma. Health care providers have a role in ameliorating these disparities with thoughtful consideration of historical, sociocultural, individual and disease characteristics that influence the care provided to African American patient population. This review by a group of experts committed to health disparity in multiple myeloma provides a snapshot of disparities at both biologic and non-biologic levels, barriers to clinical care, and best practices to ensure that African American patients receive the best care available. [ABSTRACT FROM AUTHOR]

Belantamab mafodotin (belamaf) demonstrated deep and durable responses in patients with heavily pretreated relapsed or refractory multiple myeloma (RRMM) in DREAMM-2 (NCT03525678). Corneal events, specifically keratopathy (including superficial punctate keratopathy and/or microcyst-like epithelial changes (MECs), eye examination findings with/without symptoms), were common, consistent with reports from other antibody–drug conjugates. Given the novel nature of corneal events in RRMM management, guidelines are required for their prompt identification and appropriate management. Eye examination findings from DREAMM-2 and insights from hematology/oncology investigators and ophthalmologists, including corneal specialists, were collated and used to develop corneal event management guidelines. The following recommendations were formulated: close collaboration among hematologist/oncologists and eye care professionals is needed, in part, to provide optimal care in relation to the belamaf benefit–risk profile. Patients receiving belamaf should undergo eye examinations before and during every treatment cycle and promptly upon worsening of symptoms. Severity of corneal events should be determined based on corneal examination findings and changes in best-corrected visual acuity. Treatment decisions, including dose modifications, should be based on the most severe finding present. These guidelines are recommended for the assessment and management of belamaf-associated ocular events to help mitigate ocular risk and enable patients to continue to experience a clinical benefit with belamaf. [ABSTRACT FROM AUTHOR]

The mixed land covers encompassing bridges (MLB) are integral indicator of the socio-economic hydrological system, and their progressions are vital for flood risk assessment. However, most of the previous studies have neglected a thorough evaluation of MLBs (e.g., types, areas, and depths) on impacting flood vulnerability. This paper addresses this research gap by methodically assessing the spatial characteristics of MLBs in floodplains and their divergent impacts on flood vulnerability using four case studies of Alabama State in the USA. The hydrological and bridge data were synthesized from United States Geological Survey and National Bridge Inventory, respectively. A union of Hydrologic Engineering Center's-River Analysis System (HEC-RAS), Geographic Information System, and Surface Difference Model were employed to retrieve water surface profiles and floodplain assessments in MLBs. The results highlighted that the occurrence of floodplains was more correlated to flood depths compared to flood areas in the MLBs of Alabama. The spatial contribution of the diverse MLBs in producing deep (19%) and shallow (30%) flood depths in the bridges of Alabama were 49%, while medium flood depths were impacted only on 4% of the MLBs. The highest and lowest flood areas were noticed in the MLBs of pastures and mixed forests, respectively. Overall, the findings implied that the contribution of the individual MLBs in floodplains is multifaceted in the bridges of Alabama with spatially varying land cover distribution. Further, it is recommended that for assessing flood vulnerability, the stakeholders should focus not only on the MLBs but also on its spatially dynamic characteristics. [ABSTRACT FROM AUTHOR]

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Background: Hepatitis C virus (HCV) has the lymphotropic feature that is supposed to be the reason of related extrahepatic manifestation. HCV viral oncoproteins may participate in the regulation of some gene expression that has been implicated in tumorigenesis. Our aim is to evaluate the HCV-NS4 circulating levels in breast cancer (BC) and to investigate its relation with BC tumor aggressiveness.Methods: This study was performed among 158 Egyptian women (120 with BC and 38 with benign breast diseases). ELISA was used for detection of anti-HCV antibodies, HCV-NS4, fibronectin, and CA 15-3.Results: No association between HCV detection in this group of BC patients (27.5% in BC vs. 23.7% in breast benign diseases, P = 0.687). Among HCV-infected patients, the mean HCV-NS4 serum level in BC was significantly higher than benign group (61.7 μg/mL vs. 33.9 μg/mL, P = 0.0005). Fibronectin levels were higher (P = 0.014) in patients infected with HCV than noninfected BC patients. Elevated HCV-NS4 levels were associated with tumor severity features like large size, late stages, high grades, and infiltrated lymph nodes. The elevated levels of HCV-NS4 (> 40 μg/mL) yielded an estimated odds ratio (95% confidence intervals) of 2.5 (0.98-6.36), 1.2 (0.44-3.33), 1.9 (0.53-7.00), and 2.5 (0.87-7.33) for developing large size, late stages, high grades, and infiltrated lymph nodes, respectively. Interestingly, HCV-NS4 levels significantly correlated with other BC tumor marker like CA15-3 (r = 0.535; P = 0.0009) and fibronectin (r = 0.432; P < 0.0001).Conclusions: HCV-NS4 appears to be associated with BC progression features. Oncologists treating such BC patients should consider HCV screening to enable the early identification and to prevent progression of the disease. [ABSTRACT FROM AUTHOR]

This study aimed to assess the association between exposures to outdoor environmental factors and autism spectrum disorder (ASD) prevalence in a diverse and spatially distributed population of 8-year-old children from the USA (n = 2,097,188) using the air quality index (AQI) of the US Environmental Protection Agency as well as satellite-derived data of PM2.5 concentrations, sunlight, and maximum heat index. Multivariable logistic regression analyses were performed to determine whether the unhealthy AQI, PM2.5, sunlight, and maximum heat index were related to the odds of ASD prevalence based on gender and race and taking into consideration the confounding factors of smoking and socioeconomic status. The logistic regression odds ratios for ASD per 10% increase in the unhealthy AQI were greater than 1 for all categories, indicating that unhealthy AQI is related to the odds of ASD prevalence. The odds ratio of ASD due to the exposure to the unhealthy AQI was higher for Asians (OR = 2.96, 95% CI = 1.11-7.88) than that for Hispanics (OR = 1.308, 95% CI = 0.607-2.820), and it was higher for Blacks (OR = 1.398, 95% CI = 0.827-2.364) than that for Whites (OR = 1.219, 95% CI = 0.760-1.954). The odds ratio of ASD due to the unhealthy AQI was slightly higher for males (OR = 1.123, 95% CI = 0.771-1.635) than that for females (OR = 1.117, 95% CI = 0.789-1.581). The effects of the unhealthy environmental exposures on the odds ratios of ASD of this study were inconclusive (i.e., statically insignificant; p value > 0.05) for all categories except for Asians. The odds ratios of ASD for Asians were increased by 5, 12, and 14% with increased levels of the environmental exposures of 10 μg/m3 of PM2.5, 1000 kJ/m2 of sunlight, and 1 °F of maximum heat index, respectively. The odds ratios of ASD prevalence for all categories, except for Asians, were increased with the inclusion of the smoking covariate, reflecting the effect of smoking on ASD prevalence besides the unhealthy environmental factors. [ABSTRACT FROM AUTHOR]

Despite recent therapeutic advances, multiple myeloma (MM) remains largely incurable. Here we report results of a phase I/II trial to evaluate the safety and activity of autologous T cells engineered to express an affinity-enhanced T cell receptor (TCR) recognizing a naturally processed peptide shared by the cancer-testis antigens NY-ESO-1 and LAGE-1. Twenty patients with antigen-positive MM received an average 2.4 × 109 engineered T cells 2 d after autologous stem cell transplant. Infusions were well tolerated without clinically apparent cytokine-release syndrome, despite high IL-6 levels. Engineered T cells expanded, persisted, trafficked to marrow and exhibited a cytotoxic phenotype. Persistence of engineered T cells in blood was inversely associated with NY-ESO-1 levels in the marrow. Disease progression was associated with loss of T cell persistence or antigen escape, in accordance with the expected mechanism of action of the transferred T cells. Encouraging clinical responses were observed in 16 of 20 patients (80%) with advanced disease, with a median progression-free survival of 19.1 months. NY-ESO-1-LAGE-1 TCR-engineered T cells were safe, trafficked to marrow and showed extended persistence that correlated with clinical activity against antigen-positive myeloma. [ABSTRACT FROM AUTHOR]

The feasibility of a sequentially enhanced process for the remediation of soils contaminated by mixed contaminants, specifically multiple polycyclic aromatic hydrocarbons (PAHs) and heavy metals, was investigated. This process consists of sequential flushing using two chemical agents: a surfactant and a chelate. A series of laboratory column experiments was conducted with three different sequential schemes, designated as SEQ1, SEQ2, and SEQ3, in two distinct flushing stages, to remove PAHs and heavy metals from a field-contaminated soil. The SEQ1 scheme involved flushing 0.2 M ethylenediaminetetraacetic acid (EDTA) followed by flushing 5 % Igepal. The SEQ2 scheme involved flushing 5 % Igepal followed by flushing 0.2 M EDTA. SEQ1 was investigated under a constant hydraulic gradient of 1.2, while the SEQ2 scheme was investigated under hydraulic gradients that increased from 1.2 to 4.0. The SEQ3 scheme consisted of sequential flushing of 5 % Igepal (first stage) and 0.2 M EDTA (second stage) under a constant low hydraulic gradient of 0.2. The selected sequential schemes allowed an assessment of the efficacy of sequencing the surfactant and chelating flushing for the removal of multiple heavy metals and PAHs under various hydraulic gradients. The hydraulic conductivity (or flow) was found to vary depending on the flushing agent and the sequence scheme. Under the high hydraulic gradient, the hydraulic conductivity was lower during chelant flushing stage as compared with surfactant flushing stage in both SEQ1 and SEQ2. However, under a low gradient condition (SEQ3), the hydraulic conductivity was approximately the same during both chelant and surfactant flushing stages. The contaminant removal was also significantly affected by the flushing agent and sequence and the applied hydraulic gradient. Heavy metals were removed during chelant flushing, while PAHs were removed during surfactant flushing. The total removal efficiencies of Pb, Zn, and Cu were 76 %, 63 %, and 11 % in SEQ1 and 42 %, 40 %, and 7 % in SEQ2, respectively, while the total removal efficiencies of phenanthrene, anthracene, benz(a)anthracene, and pyrene were 51 %, 35 %, 58 %, and 39 % in SEQ1 and 69 %, 50 %, 65 %, and 69 % in SEQ2, respectively. Overall, the total mass removal of heavy metals and PAHs was higher in SEQ1 as compared with SEQ2, demonstrating that SEQ1 is the effective sequence scheme. Comparison of the results of high and low gradient conditions (SEQ2 and SEQ3) reveals that the removal of contaminants, especially heavy metals, is rate-limited. Overall, this study showed that the removal of co-existing heavy metals and PAHs from soils is possible through the careful selection of the sequence under which the flushing of chelant and surfactant occurs and depends on the site-specific soil and contaminant conditions. Additional research is needed to establish the most optimal flushing scheme (sequence duration and flow velocity) to remove the mixed contaminants effectively and efficiently. [ABSTRACT FROM AUTHOR]

This paper presents a bench-scale experimental study performed to investigate the remediation of low permeable soil contaminated with pentachlorophenol (PCP) using the electrokinetic technique. A total of six electrokinetic tests were performed using kaolin soil spiked with 100 mg/kg of PCP. The first three tests were performed with an applied voltage gradient of 1 VDC/cm, where each test employed one of the three different flushing solutions: deionized water, electrolyte, or buffered electrolyte. The other three tests were performed using the same electrolyte solution, but each employed voltage gradient of 2 VDC/cm under constant and periodic application modes and constant voltage gradient with electrode liquid recirculation. The results of this study showed that PCP can be degraded in an electrokinetic system due to the direct electrochemical reduction process at the electrodes. The degradation of PCP ranged from 52% to about 78% depending on the conditions present. As the applied voltage gradient across the PCP-contaminated soil increased, the electroosmotic flow and PCP migration toward the cathode increased, resulting in higher PCP degradation by the direct reduction process. In the tests with electrolyte flushing solution, PCP degradation was about 58% and 65% under the applied voltage gradients of 1 and 2 VDC/cm, respectively. The mode of application of voltage potential across the PCP-contaminated soil showed noticeable effect on the system pH and electroosmotic flow and hence the PCP degradation. The highest PCP degradation (i.e., 78%) was in the test with constant 2 VDC/cm voltage gradient and recirculation application. Overall, this study demonstrated that electrokinetic technology has the potential to remediate PCP-contaminated clay soils by the direct reductive process. The electroosmatic flow as well as degree of PCP degradation during electrokinetics depend on the applied potential gradient and properties of the aqueous phase such as pH, ionic strength, and presence of carbonates. [ABSTRACT FROM AUTHOR]

This paper presents the chemical speciation and retention behavior of chromium (Cr), nickel (Ni), and cadmium (Cd) prior to and after the electrokinetic remediation in glacial till soil. The speciation of the metals was predicted using the chemical speciation program MINEQL+. The simulations were performed for single-contaminant with only Cr(VI) or Ni, and multi-contaminants consisting of: (1) Cr(VI), Ni, and Cd; (2) Cr(III), Ni and Cd; (3) Cr(VI), Cr(III), Ni and Cd; (4) Cr(VI), Ni, and Cd with reducing agents; and (5) Cr(III), Ni, and Cd with oxidizing agent (Mn). The results showed that the speciation and distribution of cationic metals [Ni, Cd, and Cr(III)] in glacial till soil remain unaffected or slightly affected during electrokinetics. This is attributed to the high pH buffering capacity of the glacial till, leading the metals to precipitate in the soil prior to and after electrokinetics. This study showed that during electrokinetics, Cr(VI) existed as anionic complex and migrated towards the anode and the migration is maximum in case of a single-contaminant system. The study also showed that near the anode in the absence of any reducing and oxidizing agent, Cr(VI) mostly adsorbed, and some of Cr(VI) reduced to Cr(III) and migrated towards the cathode and finally precipitated due to high pH conditions. Ni and Cd remain adsorbed or precipitated due to the high pH conditions throughout the soil. Among the reducing agents, the sulfide had significant effect on the migration of metals compared to ferrous ions. While in the presence of oxidizing agent (Mn), no noticeable Cr(VI) was found in the soil sample indicating the reduction of Cr(VI) to Cr(III) and the predominance of reducing conditions due to the presence of naturally occurring iron in the glacial till soil. Overall, this study provides a reasonable explanation of the speciation and distribution of chromium, nickel and cadmium during the electrokinetic remediation of glacial till soil. [ABSTRACT FROM AUTHOR]