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The COVID-19 pandemic poses unique challenges within the austere clinical setting, and the time between patient presentation and deterioration is a critical opportunity for intervention. In some cases, this may be a life-saving transfer to a higher level of care. US Central Command (CENTCOM) has provided valuable guidance for COVID-19 management in the operational environment,1 and has proposed the National Early Warning System 2 (NEWS2) scoring tool as a useful adjunct to gauging illness severity. NEWS2, however, does not consider co-morbidities, such as diabetes or chronic cardiac disease, which could worsen the clinical course of SARS-CoV-2 patients. Thus, NEWS2 fails to address such factors during the risk stratification of patients to a higher level of care. To address this concern, June 2020, 3rd Medical Brigade, Operation Spartan Shield (OSS) developed the COVID-19 Army Rapid Assessment Tool (CARAT) with inputs from clinicians and researchers (The Team). The CARAT is a clinical scoring system, modified from the NEWS2, which combines the effects of co-morbid disease with the current physiological condition of a COVID-19 patient. The Team obtained clinical data for 105 patients from the CENTCOM area of responsibility (AOR), who presented to a military treatment facility (MTF) symptomatic for, and testing positive for SARS-CoV-2, during the time period of June to mid-August 2020. Each patient was retrospectively assigned a CARAT score based on his or her initial presentation. Preliminary review of data suggested a CARAT value of 4 or greater was an indicator for risk of further deterioration. Patients were then grouped into two categories: patients who received transfer to a higher level of care, versus "stay-in-place" supportive care. Results showed that 100% of patients with a score ≥4 had been transferred to a higher echelon of care, compared to 2% of patients with scores less than 4. A Fisher's exact test demonstrated a statistically significant difference between these two groups (p is less than 0.001). Interestingly, when compared with the NEWS2 score, the CARAT identified 9 individuals for transfer to a higher level of care, of whom only one patient was identified by the NEWS2, clearly underscoring the significance of CARAT despite small sample size. We therefore recommend that CARAT be further validated in predicting disease severity and need for emergent evacuation in larger patient settings.

Background: Despite the paucity of evidence supporting chemotherapy in the treatment of node-negative, HER2-positive breast cancer measuring

In 2011, ipilimumab was approved by the US Food and Drug Administration (FDA) for metastatic melanoma. Since its approval, numerous targeted therapies have been approved by the FDA. Population-based studies assessing the survival benefit from these agents are lacking. We therefore carried out this study to compare the 1-year, 2-year, and median overall survival (OS) among metastatic melanoma patients in pretargeted and post-targeted eras. This is a retrospective study that utilized the Surveillance, Epidemiology, and End Results (SEER-18) database, version 8.3.4 (22 March 2017). The patient groups were defined as the pretargeted era (2004-2010) and the post-targeted era (2011-2014) as ipilimumab was approved by the FDA in 2011. The database comprised of 5471 patients (3314 in the pretargeted era and 2157 in the post-targeted era). OS in the post-targeted era was found to be significantly better compared with the pretargeted era by Kaplan-Meier curve (1-year OS: 38.9 vs. 36.8%, 2-year OS: 28.3 vs. 23.5%, and median survival: 8 vs. 7 months, P=0.001 by the log-rank test). The survival was significantly better in the post-targeted era compared with the pretargeted era on multivariate analysis using a Cox proportional hazard model after adjusting for age, sex, race, and metasectomy status (adjusted hazard ratio of 0.889, 95% CI: of 0.832-0.951, P=0.001). There is significant survival benefit in metastatic melanoma patients since the introduction of immune checkpoint-blocking agents.

Indwelling inferior vena cava (IVC) filters are associated with complications, and the US Food and Drug Administration recommends their prompt removal when no longer indicated. Therefore, assessing strategies for increasing retrieval rates is warranted.To analyze the variability of IVC filter retrieval rates within our institution based on 2 separate, pre-existing processes in which IVC retrieval is planned for before or after hospital discharge.Retrospective chart review was completed for all IVC filters placed in adults between January 2005 and March 2015. Demographics and clinical data related to filter placement and retrieval were abstracted. Patients were classified into 2 groups: patients who had a trauma consultation trauma and nontrauma medical and surgical patients medical. The trauma group patients were subject to a 2-layer tracking process, in which retrieval planning was done before discharge, versus the medical group with a single-layer tracking process and retrieval planning done after discharge.Of the 588 filter placements analyzed, 236 were placed in trauma patients and 352 were placed for medical reasons. The retrieval rate of the entire cohort was 45% (262/588), with the rate among trauma patients more than double that of medical patients (155/236, 66% and 107/352, 30%; respectively, P0.0001).IVC filter retrieval rate was increased when filter removal was included in discharge planning versus postdischarge tracking. A systematic, multidisciplinary strategic approach to IVC filter management has great potential to improve filter utilization, resource allocation, patient safety, and filter retrieval.

Introduction: A partnership was formed with the local school district. Stroke education was presented to high school students in the Health Science Academy, who then disseminated stroke education to other students in the district. Objective: To determine the effect of formal stroke education among elementary, middle, and high school students in the region. Methods: Surveys differentiated for each school level were administered to students prior to and a month after stroke education to assess knowledge of stroke signs and symptoms, risk factors, and behavioral action. Results: A total of 3,145 students in elementary, middle, and high school received stroke education. At the elementary level, knowledge of where a stroke occurs significantly increased post education (18.5% vs 37.3%, p Conclusions: In conclusion, stroke education in school age children can improve awareness of what organ is affected in stroke, signs and symptoms, and the correct actions that should be taken when suspecting stroke symptoms. However, retention of the presented information after one month was suboptimal. Further steps are needed to refine and sustain stroke education within the local school district. Stroke education need to be included in the school curriculum and should probably be provided on yearly basis.

The purpose of this study was to determine if receipt of chemotherapy was associated with utilization of the 21-gene recurrence score assay (RS assay) or with recurrence score (RS) in eligible patients. Using the National Cancer Data Base (NCDB), we identified female patients eligible for RS assay based on National Comprehensive Cancer Network (NCCN) guidelines: age 18–70, ER-positive and HER2-negative early-stage breast cancer diagnosed during 2010–2013. We excluded patients not meeting testing guidelines. Inclusion required result of RS in patients who underwent RS assay and status for receipt of chemotherapy. Multivariable logistic regression models and propensity matched analysis were used to determine associations between RS assay and RS with receipt of chemotherapy. Among 129,765 patients who were eligible, 74,778 underwent RS assay and had results available. Of these, 59.5 % (44,505) had low-risk, 32.0 % (23,920) had intermediate-risk, and 8.5 % (6353) had high-risk RS. Patients with intermediate- and high-risk RS were more likely to receive chemotherapy [OR 12.9 (CI 12.2–13.6), p

Purpose: This study assesses the effectiveness of a single institution’s breast cancer survivorship program on patient perceptions, quality of life (QOL), and compliance with National Comprehensive Cancer Network (NCCN) guidelines for follow-up. Methods: Sampled patients completed all their breast cancer treatment at a single tertiary center. Surveys designed to evaluate QOL were obtained, and retrospective medical record review was conducted to assess NCCN compliance. Survivorship clinic (SC) attendees and nonattendees were matched for age and disease stage for comparison of the outcomes (QOL, NCCN compliance, and overall effectiveness). Results: SC patients (n = 63) tended to perceive their concerns in various categories to be addressed more adequately than did nonattendees (n = 54), with significant differences in the areas of practical concerns (P = .03) and late-term adverse effects (P = .03). There was a significant difference in compliance with three NCCN guidelines (history and physical every 3 to 6 months, annual mammography, and a pelvic examination if on tamoxifen) between survivorship attendees and nonattendees (P < .001, P = .02, and P < .001, respectively). Women who attended an SC used other survivorship support resources more often. Conclusion: Survivorship programs can be time and resource consuming, but our study is one of the first to show that a survivorship program effectively changes patient behavior in important ways. Patients who attended an SC were more likely to be compliant with NCCN-recommended follow-up and to use other survivorship resources and felt their concerns were better addressed. These measures can be used to help us improve our survivorship services and by other institutions to measure the quality and effectiveness of their programs.

BACKGROUND/AIM The role of cytoreductive nephrectomy (CN) for metastatic renal cell cancer (mRCC) is not clearly understood after the approval of targeted therapies, particularly in the elderly population. The aim of this study was to compare survivals between patients who did and did not receive CN. PATIENTS AND METHODS The SEER-18 database was utilized in order to identify elderly patients with mRCC to compare overall survival (OS) and cancer-specific survival (CSS) between patients who did or did not receive CN between February 2006 and 2012. Kaplan-Meier curve and log rank test were used to compare OS and CSS between these two arms. Cox proportional hazard model was used for multivariate analysis and statistical significance was defined as p≤0.05. RESULTS There was a significant survival benefit for those who received CN compared to those who did not receive CN (median OS: 18 months vs. 4 months, p

Rapid advancements in endovascular technologies over the past decade have increased the number of patients successfully treated with this minimally invasive technique. Consequently, utilization of hospital resources and costs has both risen. A process change at our institution allowed neuroendovascular patients hemodynamically stable and extubated to be admitted directly to the neuroscience unit (NSU) as opposed to the intensive care unit (ICU). The NSU nursing staff is specifically trained to care for neuroendovascular intervention patients and some hold advanced certification in stroke or neurosciences. This study is the first to our knowledge that compares post-operative complications and costs between groups admitted to the ICU versus the NSU after neuroendovascular treatment. Retrospective chart review of elective and emergent neuroendovascular procedures requiring inpatient admission from 01/01/2013- 06/01/2017 was conducted. Procedures included for review were carotid artery stenting, intracranial or extracranial stenting, embolization of intracranial vascular malformation, dural AV fistula, thrombectomy for stroke, or unruptured aneurysm. Patient demographics, clinical characteristics, hospitalization data and follow-up data were extracted from the electronic medical record. Procedures between 2013 and 02/28/2016 were analyzed as the pre-process change group and compared to the post-process change group after 02/28/2016. There was a transitional period of approximately 6 months in which staff was trained and patients were gradually accepted to the NSU. Of the 209 procedures reviewed, we found no significant difference in perioperative (p= 0.18) and 30 day complications (P=0.99) or in overall survival (p=0.88) between the pre (n=111) and post (n=98) process change eras. The change in admission location resulted in cost savings of approximately $670 to the institution per patient for the first day and $2466 for each additional day. These results suggest that ICU admission is not necessary for patients that are hemodynamically stable and extubated post neuroendovascular treatment. Admission to the NSU did not negatively impact patient outcomes, yet it decreased patient hospital stay costs and institutional expenses.

Introduction: Half of grade school-age children in the U.S. receive after school care from their grandparents or another adult family member. Yet, few studies have investigated if educating youth about stroke is an effective vehicle for spreading stroke knowledge to their families and the impact on onset-to-door time. Objective: To assess the level of knowledge about stroke warning signs and behavioral actions in school-aged children. Methods: Surveys differentiated to each school level- elementary (K-5), middle (6-8) and high school (9-12) - were administered to students in 3 community school districts. 6-8 and 9-12 grade students completed the surveys via an online tool, while K-5 students were guided through a picture-based survey. Topics included identifying the signs and symptoms of a stroke, risk factors for stroke and what action to take if the student thought someone was having a stroke. Results: Among 3 participating school districts, 3,425 elementary, 1,239 middle school and 1,594 high school students were surveyed. Less than half (43.7%) of K-5 students recognized 3 main signs of stroke (face, arm and speech). Stroke knowledge level is low among all students in elementary, middle and high school (Figure 1). Previous education was reported in 22% of K-5, 53% in 6-8 and 15% in 9-12 students. Those noting previous stroke education had increased knowledge at all 3 levels (p Conclusions: Children know how to respond to a medical emergency, yet their knowledge about the signs of a stroke is low. Educating youth increases their awareness regardless of age, making the student population a prime target for educational efforts. We plan to partner with school districts to develop curriculum appropriate for the elementary, middle and high school as the next step to increasing awareness about stroke.

Introduction: Delayed presentation to the hospital persists as a significant barrier to early intervention of stroke with tPA treatment. Community knowledge about stroke symptoms is moderate at best and not parallel with behavior. Objective: To assess our community’s level of knowledge about stroke to direct the development of targeted educational efforts. Methods: Members of communities in our regional stroke alert locations were asked to complete a 15-item survey that included questions about basic demographics, stroke symptoms, behavior actions and interest in and barriers to attending stroke education. Surveys were collected from local businesses, online and in public venues. Overall scores were calculated by summing the number of correct responses and, with the exception of questions pertaining to the BEFAST mnemonic, subtracting the number of incorrect or unmarked responses. Reported metrics include overall survey scores and demographics of survey respondents. Total scores were compared between demographic groups via the Wilcoxon Rank Sum, while question level comparisons utilized the χ2 or Fisher’s exact test. GIS technology was applied to identify geographic clusters of different knowledge levels. Results: Among 1118 participants, 86% had low levels of stroke knowledge as defined by a survey score of ≤ 70% accuracy (medium = 71-89%; high ≥ 90-100%). Knowledge was low throughout most of our community with isolated pockets of higher knowledge in outlying areas. Awareness was highest (though still low) among females, middle-aged adults (36-55 yo), those with post-high school degrees, and those with previous formal stroke education. In case of stroke, older adults (55+ yo) were least likely to call 9-1-1. Only 21.6% of participants were likely or highly likely to attend stroke education. Conclusions: The level of stroke knowledge in our community is low. People tend to not be interested in attending formal stroke education outside of their regular day. Efforts must be made to raise awareness about stroke symptoms and treatment in order to increase more positive outcomes following stroke. Incorporating stroke education into work and school curriculums will be our targeted approach.

Ecological research using biometric data is only sound if biometrics themselves are accurate and not confounded by measurement error. Given concerns about the accuracy of biometrics taken directly (physical measurement of animals), digital measurement of photographs is often advocated, particularly for small or live specimens. However, there is currently limited understanding of intra- and inter-observer variability of such measurements (i.e. variability of multiple measurements of the same specimen by the same observer, and variability of multiple measurements of the same specimen by different observers, respectively). We took biometrics (two linear, two curvilinear, two angular) from moth photographs using standard image software and calculated two fluctuating asymmetry measures. Inter-observer variability was always higher than intra-observer variability. Measurement error was low for linear/curvilinear measurements (< ∼4%), but high for angular variables (52%) and asymmetry measures (45%). Measurement precision correlated positively with trait size. Variability caused significant differences in mean measurements inter-specifically for half the biometrics; there were no significant intra-specific differences. We discuss the implications of our findings for research using photographically-derived biometrics and offer recommendations for reducing measurement error.

Research using biometric data relies on consistent measurements within, and often among, observers. However, research into the relative importance of intra- and inter-observer variability is limited. More importantly, the influence of biometric variability on accurate quantification of biometric-based condition indices has not been analysed: it is unclear whether multiple errors become magnified or cancel one another out. Here, we quantify intra- and inter-specific variability in multiple biometrics, and derived condition indices, using museum bird specimens. Inter-observer variability was higher than intra-observer variability for all parameters. Measurement error (ME) varied from < 1% to > 50% for different biometrics. ME was magnified in condition estimates, reaching > 80% within-observers and > 90% among-observers. Significant differences in mean measurements were found for 17% and 67% of biometrics within-and among-observers, respectively; for condition indices, the figures were 50% and 67%, respectively. We discuss the implications of these findings for research into species' ecology, taxonomy and behaviour.

e17569Background: Surgery is potentially curative in patients with stage I Endometrial Stromal Sarcoma (ESS) and uterine adenosarcoma; however, 20-40% patients will develop recurrence, suggesting n...

425 Background: Data guiding selection of optimal nonsurgical therapies for management of localized hepatocellular carcinoma (HCC) are lacking. Because there are limited prospective comparative data for these treatment modalities, we aimed to compare the effectiveness of chemotherapy (systemic or arterial directed) versus radiofrequency ablation (RFA) versus radioembolization (RE) in nonsurgically managed patients with stage I and II HCC using the National Cancer Database. Methods: We identified patients who received chemotherapy, RFA or RE for nonsurgically managed Stage I (T1N0M0) and II (T2N0M0) HCC between 2008 and 2013. Patients excluded included those who received upfront lobectomy or resection or extended lobectomy or hepatectomy or transplant, and if they had Ishak fibrosis score of 5-6 or total bilirubin > 3 mg/dl or international normalized ratio (INR) of > 3. Overall survival (OS) was compared between treatment groups using propensity score matched (1:1:1) and weighted analyses. We also verified balance of all available confounders, and assessed sensitivity to unobserved confounding. Results: Overall 2622 (73.2%), 837 (23.3%) and 125 (3.5%) patients with nonsurgically managed stage I and II HCC received chemotherapy, RFA and RE, respectively. RE treated patients tend to be older, live in the areas with a higher median income and higher percentage of high school- educated residents, and have stage II disease. The propensity matched cohort included 303 patients with baseline characteristics well balance between all arms. After propensity matching, 5-year OS was 17.4% (95% CI, 6.6% to 32.3%) in the chemotherapy group, 27.2% (95% CI, 14.2% to 42%) in the RFA group and 36.6% (95% CI, 23.1% to 50.1%) in RE group (p = 0.48). Conclusions: To our knowledge, this is the first study comparing various different nonsurgical therapies for localized HCC. All chemotherapy, RFA and RE are effective treatment options for nonsurgically managed patients with stage I and II HCC. Although these data are retrospective, RE appears to be a reasonable first-line treatment of nonsurgically managed stage I and II HCC in carefully selected patients.

Les specimens rassembles en 1997, 1998 et 1999 a la suite des collectes dans les zones nationales de conservation de la diversite NBCA a Xe et dans le calcaire Khammouan de la republique democratique du peuple du Laos sont l'objet d'un inventaire taxonomique. Les specimens ont ete collectes dans 11 chantiers dans le calcaire Khammouan NBCA et de 3 sites a Xe Piane NBCA. Les restes crâniens et mandibulaires des pelotes de rapaces ont ete collectes dans les grottes, ainsi que par les chasseurs ou dans les dejections de carnivores. Des restes de 287 individus de 13 especes de Muridae ont ete identifies : 3 especes de Xe Piane NBCA et 13 especes du calcaire Khammouan NBCA. On a aussi trouve des restes attribuables a deux genres supplementaires. Deux especes Mus shortridgei et Rattus argentiventer n'avaient jamais ete signales dans la republique democratique populaire du Laos.

Comprehensive expression profiling of tumors using DNA microarrays has been used recently for molecular classification and biomarker discovery, as well as a tool to identify and investigate genes involved in tumorigenesis. Application of this approach to a cohort of benign and malignant adrenocortical tissues would be potentially informative in all of these aspects. In this study, we generated transcriptional profiles of 11 adrenocortical carcinomas (ACCs), 4 adrenocortical adenomas (ACAs), 3 normal adrenal cortices (NCs), and 1 macronodular hyperplasia (MNH) using Affymetrix HGU95Av2 oligonucleotide arrays representing 10,500 unique genes. The expression data set was used for unsupervised hierarchical cluster analysis as well as principal component analysis to visually represent the expression data. An analysis of variance on the three classes (NC, ACA plus MNH, and ACC) revealed 91 genes that displayed at least threefold differential expression between the ACC cohort and both the NC and ACA cohorts at a significance level of P < 0.01. Included in these 91 genes were those known to be up-regulated in adrenocortical tumors, such as insulin-like growth factor (IGF2), as well as novel differentially expressed genes such as osteopontin (SPP) and serine threonine kinase 15 (STK15). Increased expression of IGF2 was identified in 10 of 11 ACCs (90.9%) and was verified by quantitative reverse transcriptase-polymerase chain reaction. Select proliferation-related genes (TOP2A and Ki-67) were validated at the protein level using immunohistochemistry and adrenocortical tissue microarrays. Our results demonstrated significant and consistent gene expression changes in ACCs compared to benign adrenocortical lesions. Moreover, we identified several genes that represent potential diagnostic markers and may play a role in the pathogenesis of ACC. (Am J Pathol 2003, 162:521–531) Adrenocortical carcinoma (ACC) is a rare but highly lethal cancer with an annual incidence of 0.5 to 2 patients

Family therapists are expected to engage in ethical and responsible research, while maintaining rigorous ethical standards and adhering to federal regulations that require protection for research participants. We present a short historical overview of the significant events and ethical controversies leading to the formulation of current regulations in human subject research and review. Federal regulations and guidelines, including issues of informed consent, special populations, and conflict of interest are reviewed. A short list of recommendations to assist family therapists in staying abreast of contemporary research protocol is provided.

This study examined the expectations and experiences of caregivers throughout their caregiving career. Forty-five primary caregivers of Alzheimer's patients were invited to participate in the study. Caregivers were invited to share their experiences as Alzheimer's caregivers during in-depth interviews. Of the 45 caregivers interviewed, all fit into a stage of caregiving (early, moderate, late, and bereavement). Overall, the caregivers in the early stages tended to share more positive than negative aspects about their caregiving experience. Those who cared for someone in the middle stage described the difficulty of caring for someone with Alzheimer's and how overwhelming the experience was. The late stage of caregiving involved the most emotional, physical, and financial output by the caregiver, and caregivers in the bereavement stage described feeling a sense of relief mixed with feelings of chronic grief. Findings supported the development of a stages of caregiving model in regard to biopsychoso...

With the growing appeal for technology in learning environments, opportunities for distance education in marriage and family therapy programs are being recognized as essential for expanding training and teaching experiences to students, teachers, and practicing clinicians. The authors will describe a total on-line graduate level course on Supervision Methods and Practice in marriage and family therapy education. The course expanded learning beyond the classroom for students who wished to learn more about supervision contracts, evaluation and record keeping, models of supervision, ethical dilemmas in supervision, and developmental, biological, socio-cultural, gender, and family of origin issues in regard to supervision practice. This course created a new opportunity to a) bring technology into supervision training, b) utilize creative teaching through web-based technology, c) bring colleagues together who would have otherwise been isolated due to proximity, and d) extend training to dedicated prac...

Alzheimer's disease has been described as a complex chronic illness that is known to cause significant stress for its caregivers. It has created dramatic role alterations in families, has increasingly more biopsychosocial demands as it progresses, and often taxes caregivers to the point of compromising their own health and well-being. This study used qualitative analyses to explore the stories of Alzheimer's care-givers. Of the 45 caregivers interviewed, all but nine mention an expression or significant event related to spirituality, whether religious or secular in nature. Specifically, twelve caregivers described a negative experience with their spiritual community, whereas twenty-four shared positive encounters. Findings supported the incorporation of a bio-psychosocial-spiritual model of healthcare to optimize caregiver well-being. Recommendations were given to assist family therapists in including spiritual beliefs and faith communities in the design and delivery of services.

Alzheimer's Disease is a complicated illness that has atre-mendous impact on all areas of life for both the patient and primary care-giver. This qualitative study is based on in-depth interviews with 45 primary caregivers of Alzheimer's patients with mild to severe mental and physical symptoms. Caregivers offered narratives of their experience and how the disease and their interaction with multiple practitioners have impacted their lives. Spiritual, legal, financial, housing, medical, and emotional needs, concerns, and strengths were discussed. Results from this study include: (1) how the Alzheimer's diagnosis and disease biopsychosocially and spiritually impacts primary caregivers, (2) how practitioners from diverse fields, family, and friends impact the caregiving experience, and (3) recommendations for mental health practitioners who wish to include a biopsychosocial approach in their system of care.

Alzheimer's is a chronic disease that is often times described by a stages model of progression. This study uses qualitative analyses to explore the experiences of Alzheimer's caregivers. Through this study, stages of caregiving emerge including early, middle, late, and bereavement stages. Through the caregivers' experiences, two additional themes became apparent: spirituality and meaning-making. All but eight of the caregivers mention a positive or negative expression or experience related to spirituality, whether religious or secular in nature. Of the 45 caregivers, twenty-four mention positive and eleven mention negative experiences with their faith, church community, or their spirituality. Findings support the incorporation of using the stages model when working with caregivers and to include spirituality to promote a more satisfying caregiving experience. Recommendations are given to encourage spiritual leaders and practitioners to include spiritual beliefs, faith, or church community in ass...

SUMMARY System of care (SOC) philosophy and principles were developed and systems of care are designed and implemented to improve the mental health services that are delivered to children and families. The identification and effective use of resources to assist families in managing their concerns and difficulties are important considerations with SOC. Flexibility including the use of traditional and non-traditional services and resources is central to SOC philosophy and practice. In terms of resource identification and utilization, the family's spiritual beliefs and their faith community are often underutilized or overlooked. Reasons for this are described in this article, along with the advantages of and strategies for including them in SOC.

Background: Intravascular large B cell lymphoma (IVLBCL) is a rare and aggressive non-Hodgkin lymphoma lacking any prior US based population studies. We aimed to conduct a population based study of IVLBCL in the US and compare characteristics and survival to diffuse large B cell lymphoma, not otherwise specified (DLBCL, NOS). Methods: We used Surveillance, Epidemiology, and End Results (SEER) registries from 2000 to 2013 to calculate incidence rates (case/1,000,000) and age-adjusted to the US 2000 standard population. We collected patient level data from the NCDB Participant User Files using ICD-O-3 histology code 9680 with ICD-O-3 primary site modifier C499 and analyzed for demographic and clinical characteristics as well as overall survival (2004-2013). Chi-Square test was used to compare the characteristics of patients with IVLBCL to that of DLBCL, NOS. Overall survival analysis was performed using Kaplan- Meier method and compared by log rank. Overall survival (OS) of IVLBCL was compared to propensity-matched cohort of DLBCL, NOS. Multivariate analysis was conducted using weighted Cox Proportional Hazard regression model. Results: In the years 2000-2013, the overall crude incidence rate of IVLBCL was 0.093 (case/1,000,000) and age-adjusted incidence rate of IVLBCL was 0.095 (case/1,000,000). A total of 388 IVLBCL patients were identified in NCDB database. Patients with IVLBCL (n=388), compared to DLBCL, NOS (n=155,436), were more likely to be of age ≥ 65 (64.2% vs 56.9%, p=0.0039), female (51.8% vs 46.5, p=0.036), diagnosed at advanced stage (stage IV, 51.5% vs 33.4%, p Conclusions: This is the largest series of IVLBCL reported to date. Our study provides characteristics and OS of a large cohort of this rare entity, which can be used for patient education and may provide background information for future research. In the Rituximab era, the OS of patients with IVLBCL is comparable to DLBCL, NOS. In addition, our study also reports predictors of OS in patients with IVLBCL. Disclosures No relevant conflicts of interest to declare.

Background: Erythropoiesis Stimulating Agents (ESAs) are FDA approved for chemotherapy induced anemia and anemia of chronic kidney disease. These indications are more frequent in patients with multiple myeloma. Use of ESAs has been associated with an increased risk of heart attack, stroke, venous thromboembolism (VTE), and all-cause mortality. In patients with cancer, ESA's have been associated with worse progression free survival (PFS) and overall survival (OS) Previous research regarding ESA use in patients with multiple myeloma has been limited and conflicting. In this study, we evaluate the effects of ESA use in patients with multiple myeloma. Additionally, we examined the frequency of ESA usage after the 2007 FDA safety update revising product labeling for ESAs. Methods: A retrospective chart review was conducted on patients diagnosed with active multiple myeloma between January 1st, 2000 and December 31st, 2015 at Gundersen Health System in La Crosse Wisconsin. Collected data include patient demographics, medications, lab tests, comorbidities, and the dates of any VTE, stroke, or myocardial infarction. Both a logistic regression and a matched case-control analysis were used to compare rates of complications in patients using ESAs to those that did not. ESA effect on median survival time was also calculated for each International Staging System (ISS) stage of disease. Results:There were 278 patients included for demographic analysis (Table 1), of which 268 were included in the logistic regression analysis and 124 (62 pairs) in the matched case-control analysis. A logistic regression model constructed via stepwise selection found that bone lesions at diagnosis (Odds Ratio (OR): 2.5 [1.2-5.1]), antiplatelet drug use (OR: 3.7 [1.2-11.3]) and ESA use (OR: 4.7 [2.2-9.9]) were associated with increased risk of VTE in our patient population. Use of an Angiotensin Converting Enzyme (ACE) inhibitor (OR: 0.4 [0.2-0.9]) was associated with a decreased risk of VTE. Increased odds of VTE with ESA usage (OR: 5.9 [1.9 - 18.8]) were also noted in the matched case-control analysis. There was no association found between rate of stroke and ESA usage in either logistic or matched case-control analysis. No significant association between ESA use and overall survival was noted in either logistic or matched case-control analysis. When comparing outcomes based upon pre and post FDA revised product labeling, we found a 50% reduction in ESA usage within our institution. In this same time period, the percentage of patients with multiple myeloma developing VTEs has been significantly reduced (18.6% vs 12.8% [p Conclusions: In our population, the use of ESAs in multiple myeloma patients was associated with increased risk of VTE. No significant association between ESA use and overall survival was noted. The observed decrease in both ESA use and rate of VTE in patients with myeloma after the 2007 revised safety labelling by the FDA may reflect practice changes in response to this revision at our institution. Further study in a prospective large multicenter dataset with further control of confounding variables is warranted. Table 1 Table 1. Disclosures No relevant conflicts of interest to declare.

A whole-genome radiation hybrid (RH) panel was used to construct a high-resolution map of the rat genome based on microsatellite and gene markers. These include 3,019 new microsatellite markers described here for the first time and 1,714 microsatellite markers with known genetic locations, allowing comparison and integration of maps from different sources. A robust RH framework map containing 1,030 positions ordered with odds of at least 1,000:1 has been defined as a tool for mapping these markers, and for future RH mapping in the rat. More than 500 genes which have been mapped in mouse and/or human were localized with respect to the rat RH framework, allowing the construction of detailed rat-mouse and rat-human comparative maps and illustrating the power of the RH approach for comparative mapping.

Introduction Retrievable inferior vena cava (IVC) filters are frequently used to prevent pulmonary embolus (PE). Indwelling filters can be associated with complications; timely removal is recommended. In our institution, activated trauma (AT) patients are enrolled in a prospective protocol and tracked by the trauma team, who refer for retrieval as soon as feasible. Interventional radiology maintains a database for traumatic injury (TI) and medical (M) patients and calls them for retrieval at 90 days. To this end, the primary goal of this study was to assess different retrieval patterns between Level 1 and 2 trauma patients, traumatic injury patients not triggering trauma response, and those with medical indications for IVC filters. An additional analysis to examine rates of recurrent thrombosis stratified for filter retention and anticoagulation status was performed. Methods A retrospective chart review was performed for all patients who had an IVC filter placed between January 2005 and March 2015 at Gundersen Medical Center in La Crosse, WI. Data were collected regarding patients' demographics, risk factors for thrombosis, indications for and details of filter type and placement, post-placement anticoagulation, filter retrieval, and complications arising from filter placement, retention, and retrieval. Patients were divided into AT, TI, and M groups. AT consisted of Level 1 or 2 traumas triggering management by trauma service, TI patients had lesser trauma not triggering trauma team referral, and M patients had filters for medical indications. Those who were lost to follow up or died within 30 days were excluded from all analysis except demographics. Those with permanent filters were omitted from retrieval analysis. Results Of the 633 charts reviewed, 4 were excluded for lack of data, 41 were lost to follow-up and 68 died within 30 days. Table 1 summarizes patient category characteristics. Activated trauma patients were younger and had their filter retrieved more often (p Discussion Higher rates of DVT in patients with a filter in place are in line with current research associating IVC filters with DVT formation. We observed that patients on lifelong anticoagulation had a higher rate of recurrent thrombosis but increased risk factors for thrombosis, thus identifying a higher risk group for thrombotic events. AT patients in a protocol setting had higher IVC filter retrieval rates compared to the M and IT patients with routine efforts at retrieval. The large gap between M/TI and AT filter retrieval is associated with but not fully explained by the increased risk factors and age of the M and IT groups. Protocolized retrieval of IVC filters increases retrieval rates. Further research is warranted in assessing the impact of protocolized retrieval in the medical and traumatic injury populations. Table 1. Patient Category Characteristics Patient Category N (%) Age (median, range) Retrieval Rate (%) Activated trauma (AT) 195 (31%) 41 (15-92) 78% Traumatic injury (TI) 74 (11.8%) 44 (16-93) 43% Medical (M) 360 (57.2%) 68 (17-101) 38% Disclosures Parsons: Celgene: Speakers Bureau.

Summary Darwin's On the Origin of Species [1] introduced the world to the most fundamental concept in biological sciences — evolution. However, in the 150 years following publication of his seminal work, much has been made of the fact that Darwin was missing at least one crucial link in his chain of evidence — he had no evidence for contemporary evolution through natural selection. Indeed, as one commentator noted on the centenary of the publication of Origin , " Had Darwin observed industrial melanism he would have seen evolution occurring not in thousands of years but in thousands of days - well within his lifetime. He would have witnessed the consummation and confirmation of his life's work " [2].

e22250 Background: The hypermetabolic nature of advanced cancer is well known. Previous research suggests that cancer patients have different cholesterol profiles compared to non-cancer controls. T...

e11511 Background: Oncotype DX, a 21 gene recurrence score (RS) is used to predict the likelihood of benefit from systemic chemotherapy in women with node-negative, estrogen receptor (ER) positive ...

A 3000-rad radiation hybrid panel was constructed for cattle and used to build outline RH maps for all 29 autosomes and the X and Y chromosomes. These outline maps contain about 1200 markers, most of which are anonymous microsatellite loci. Comparisons between the RH chromosome maps, other published RH maps, and linkage maps allow regions of chromosomes that are poorly mapped or that have sparse marker coverage to be identified. In some cases, mapping ambiguities can be resolved. The RH maps presented here are the starting point for mapping additional loci, in particular genes and ESTs that will allow detailed comparative maps between cattle and other species to be constructed. Radiation hybrid cell panels allow high-density genetic maps to be constructed, with the advantage over linkage mapping that markers do not need to be polymorphic. A large quantity of DNA has been prepared from the cells forming the RH panel reported here and is publicly available for mapping large numbers of loci.

In recent years there has been increasing interest in mapping thehorse genome, particularly to identify disease and performance-enhancing genes. Although a number of horse mapping tools havebeen developed and have proved very useful (genetic maps, so-matic cell hybrid panels, and a BAC library), the benefits ofwhole-genome–radiation hybrid (WG-RH) mapping have not beenavailable. Its advantages over genetic linkage mapping are: (i) theresolving power is not lost in regions of the genome with a lowrecombination rate, because it does not rely on meiotic recombi-nation events; (ii) it is especially useful in animals such as thehorse with relatively long generation times and single births; and(iii) genetic and physical maps can be integrated, as both poly-morphic and non-polymorphic markers can be placed on the samemap. The WG-RH panel constructed in this study is the first suchpanel to be reported for the horse, and its preliminary character-ization demonstrates its usefulness for horse genome mapping.The panel was constructed by the fusion of horse embryonicendothelial primary lung cells (male) to the established hamsterfibroblast cell line A23 (Westerveld et al. 1971) by using themethod described in McCarthy et al. (1997). A series of fusions,involving irradiation (3000 rads) of donor cells prior to fusion withequal numbers of recipient cells, generated ∼160 hybrids in total.From these 160 hybrids, 94 were selected at random and screenedby using 20 widely distributed markers (representing 17 chromo-somes). Any hybrids that did not produce an amplification productwith these markers were screened by FISH to determine whetherthey contained horse DNA from other chromosomes or regions ofchromosomes (not represented by the 20 markers); hybrids foundto be negative by the FISH screen were replaced at random fromthe remaining unused hybrids, and the same PCR and FISH screen-ing procedure was repeated until 94 hybrids were assembled.These 94 hybrids were used for preliminary characterization as amapping panel. It is expected that the majority of the hybrids(>95%) characterized here will be represented in the TM99 panelof 94 hybrids that is being grown on a large scale by ResearchGenetics Inc. (Huntsville, Ala. 35801).The amount of horse DNA retained by the hybrids in the panelwas evaluated by examining the retention of the 20 widely dis-tributed horse markers. On average each marker was retained in27.8% of the hybrids (ranging from 10.6% to 71.3%; Table 1),implying that the panel as a whole retains the equivalent of ap-proximately 26 horse genomes. These retention frequencies com-pare well with those found for the human and mouse RH panels,which have been used successfully for creating whole-genomemaps (Gyapay et al. 1996; McCarthy et al. 1997).The mapping ability of the panel was assessed by producingRH maps for the two horse chromosomes with the most markersavailable, and comparing these with the latest genetic maps (Swin-burne et al. 2000a). In total, 39 markers on Chromosome (Chr) 1and 15 markers on Chr 10 were analyzed (Table 1). The averageretention of markers was 15.4% (ranging from 5.3% to 29.8%) onChr 1, and was higher, 25.4% (ranging from 16.0% to 44.7%) onChr 10. An increase in the retention frequency on smaller chro-mosomes was also noted in human and mouse RH panels (Gyapayet al. 1996; McCarthy et al. 1997). For each chromosome, linkagegroups with at least 4-LOD units support were identified; four suchgroups were found on Chr 1 and two were detected on Chr 10(Figs. 1 and 2). Within each of these linkage groups, frameworkmarkers were ordered with 3-LOD units support, and most of thenon-framework markers were ordered with 2-LOD units support.Some non-framework markers had lower statistical support fortheir order (shown in italics, Figs. 1 and 2). Similarly, the relativeorder of some linkage groups was suggested by linkage analysisbut had low statistical support [Chr 1 (groups B and C) and Chr 10(groups A and B)]. The relative order of the other RH linkagegroups was determined by comparison with the genetic map andFISH localizations.The genetic map can give a misleading impression of markerdensity because genetic distances may be small owing to regionshaving a low meiotic recombination rate. In such regions the mark-ers may actually be physically far apart and, therefore, at a lowerdensity than predicted by the genetic map. Since RH panels requirea high density of markers, this might account for the low statisticalsupport for the ordering of some markers and linkage groups. Alow density of available markers could also explain why two mark-ers (HLM5, ICA22) could not be placed on the RH map. HLM5 hasalready been shown to be 24 cM from its nearest neighboringmarker on the genetic map. Three other markers could not beplaced on the RH map (UM004, HTG12, and HMS15), but wereable to be placed on the genetic map in a region equivalent to RHlinkage group D; this discrepancy between the two maps should beresolved as both maps are characterized further.This study has demonstrated the ability of the horse WG-RHpanel to produce an accurate genome map as there is good agree-ment of the genetic and physical maps with the RH maps for Chrs1 and 10 (Figs. 1 and 2). Only a few differences between the mapswere observed, and experiences with human mapping suggest thatsuch differences are common and are resolved as more markers areincorporated into the maps (Walter et al. 1994). The WG-RH panelwas able to order some markers that co-segregate on the geneticlinkage map, i.e., Chr 1 markers LEX39 and ICA18, and ICA41 andICA32, and Chr 10 markers LEX8 and COR015, and NVHEQ18

Saxatilomys paulinae, a new genus and species of murid rodent in the Dacnomys Division is described. It is based on two whole specimens and 14 individuals represented by fragments recovered from owl pellets. The samples come from the Khammouan Limestone National Biodiversity Conservation Area in Khammouan Province in central Lao PDR. This tower karst landscape is part of the Quy Dat limestone massif, which extends eastward into north-central Vietnam (Binh Tri Thien Province). The new genus and species is morphologically (and probably phylogenetically) allied to species of Niviventer and Chiromyscus, which are also members of the Dacnomys Division, but its semispinous dark gray upperparts, dark frosted gray underparts, large, extremely bulbous footpads, and a combination of derived and primitive cranial and dental traits exclude it from membership in Niviventer, Chiromyscus, or any other described genus of Indo-malayan murid. The new species is likely petricolous, and is part of a small but unique...