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Functional outcomes during non-small cell lung cancer (NSCLC) treatment are critically important to older adults. Yet, data on physical function and which measures best capture functional change remain limited.This multisite, mixed methods cohort study recruited adults ≥65 years with advanced NSCLC starting systemic treatment (i.e., chemotherapy, immunotherapy, and/or targeted therapy) with non-curative intent. Participants underwent serial geriatric assessments prior to starting treatment and at one, two, four, and six months, which included the Karnofsky Performance Scale (KPS, range: 0-100%), instrumental activities of daily living (IADL, range: 0-14), European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Physical Functioning subscale (EORTC QLQ-C30 PF, range: 0-100), and Life-Space Assessment (LSA, range: 0-120). For all measures, higher scores represent better functioning. In a qualitative substudy, 20 patients completed semi-structured interviews prior to starting treatment and at two and six months to explore how treatment affected their daily functioning. We created joint displays for each interview participant that integrated their longitudinal KPS, IADL, EORTC QLQ-C30 PF, and LSA scores with patient quotes describing their function.Among 87 patients, median age was 73 years (range 65-96). Mean pretreatment KPS score was 79% (standard deviation [SD] 13), EORTC QLQ-C30 PF was 69 (SD 23), and LSA was 67 (SD 28); median IADL was 13 (interquartile range [IQR] 10-14). At two months after treatment initiation, 70% of patients experienced functional decline on at least one measure, with only 13% of these patients recovering at six months. At two and six months, decline in LSA was the most common (48% and 35%, respectively). Joint displays revealed heterogeneity in how well each quantitative measure of physical function captured the qualitative patient experience.Functional decline during NSCLC treatment is common among older adults. LSA is a useful measure to detect subtle functional decline that may be missed by other measures. Given heterogeneity in how well each quantitative measure captures changes in physical function, there is value to including more than one functional measure in geriatric oncology research studies.

Acute myeloid leukemia (AML) is associated with poor outcomes in older adults. A major goal of treatment is to balance quality of life and functional independence with disease control. With the approval of new, more tolerable regimens, more older adults are able to receive AML-directed therapy. Among these options are hypomethylating agents (HMAs), specifically azacitidine and decitabine. HMAs have become an integral part of AML therapy over the last two decades. These agents are used either as monotherapy or nowadays more commonly in combination with other agents such as the Bcl-2 inhibitor venetoclax. Biological AML characteristics, such as molecular and cytogenetic risk factors, play crucial roles in guiding treatment decisions. In patients with high-risk AML, HMAs are increasingly used rather than intensive chemotherapy, although further trials based on a risk-adapted approach using patient- and disease-related factors are needed. Here, we review trials and evidence for the use of HMA monotherapy and combination therapy in the management of older adults with AML. Furthermore, we discuss the use of HMAs and HMA combination therapies in AML, mechanisms of action, their incorporation into hematopoietic stem cell transplantation strategies, and their use in patients with comorbidities and reduced organ function.

PURPOSE: Patient-reported outcome measurements (PROMs) are increasingly used for cancer patients receiving active treatment, but little is known about the implementation and usefulness of PROMs in cancer survivorship care. This systematic review evaluates how cancer survivors and healthcare providers (HCPs) perceive PROM implementation in survivorship care, and how PROM implementation impacts cancer survivors' health outcomes.METHODS: We systematically searched PubMed/MEDLINE, Embase, CINAHL, Web of Science, and Cochrane Database of Systematic Reviews from database inception to February 2022 to identify randomized and nonrandomized studies of PROM implementation in cancer survivors.RESULTS: Based on prespecified eligibility criteria, we included 29 studies that reported on 26 unique PROMs. The studies were heterogeneous in study design, PROM instrument, patient demographics, and outcomes. Several studies found that cancer survivors and HCPs had favorable impressions of the utility of PROMs, and a few studies demonstrated that PROM implementation led to improvements in patient quality of life (QoL), with small to moderate effect sizes.CONCLUSIONS: We found implementation of PROMs in cancer survivorship care improved health outcomes for select patient populations. Future research is needed to assess the real-world utility of PROM integration into clinical workflows and the impact of PROMs on measurable health outcomes.IMPLICATIONS FOR CANCER SURVIVORS: Cancer survivors accepted PROMs. When successfully implemented, PROMs can improve health outcomes after completion of active treatment. We identify multiple avenues to strengthen PROM implementation to support cancer survivors.

Patients with cancer spend significant time receiving treatment and recovering from side effects. Little is known about how patients and their caregivers perceive time spent receiving cancer treatment and how this impacts health-related quality of life (HRQoL). Our study aims to characterize perceptions of time invested in receiving cancer therapy as experienced by patients, caregivers, and oncology professionals. We conducted semi-structured interviews with patients undergoing treatment for advanced lung cancer and melanoma, their informal caregivers, and oncology professionals (physicians, nurses, social workers, and chaplains). Participants received and provided care at a tertiary cancer center. Interviews were audiorecorded and transcribed verbatim. Transcripts were analyzed qualitatively using predominantly inductive coding to identify themes relating to time perception and cancer care. We interviewed 29 participants (11 patients, 7 informal caregivers, and 11 oncology professionals) and found they consistently differentiated between time remaining in life (“existential time”) and time required to manage cancer treatment and symptoms (“chronological time”). Patients and caregivers reported distress around the mechanics of oncologic care that interrupted their daily lives (hobbies, activities). Participants described the impact of time invested in cancer care on dimensions of quality of life, ranging from minimal to substantial negative impact. We found that the time spent undergoing cancer treatment affects well-being and often prevents patients and caregivers from participating in meaningful activities. The investment of personal time undergoing cancer therapy for patients with advanced solid tumors merits further study and can enhance communication between patients, caregivers, and their oncologists.

Background Internal medicine residents face numerous career options after residency training. Little is known about when residents make their final career choice. Objective We assessed the timing and predictive factors of final career choices among internal medicine residents at graduation, including demographics, pre-residency career preferences, and rotation scheduling. Methods We conducted a retrospective study of graduates of an academic internal medicine residency program from 2014 to 2017. Main measures included demographics, rotation schedules, and self-reported career choices for residents at 5 time points: recruitment day, immediately after Match Day, end of postgraduate year 1 (PGY-1), end of PGY-2, and at graduation. Results Of the 138 residents eligible for the study, 5 were excluded based on participation in a fast-track program for an Accreditation Council for Graduate Medical Education subspecialty fellowship. Among the remaining 133 residents, 48 (36%) pursued general internal medicine fields and 78 (59%) pursued fellowship training. Career choices from recruitment day, Match Day, and PGY-1 were only weakly predictive of the career choice. Many choices demonstrated low concordance throughout training, and general medicine fields (primary care, hospital medicine) were frequently not decided until after PGY-2. Early clinical exposure to subspecialty rotations did not predict final career choice. Conclusions Early career choices before and during residency training may have low predictability toward final career choices upon graduation in internal medicine. These choices may continue to have low predictability beyond PGY-2 for many specialties. Early clinical exposure may not predict final career choice for subspecialties.

The deterministic inventory model for decayed items concerns with reliability process and flexible production rate. The rate of decayed items is assumed to be a two parameters Weibull distribution. In this study, complete backlogging shortages are acceptable and holding cost is taken as linear. Further the influence of inflation has been developed and the model is established with numerically and sensitivity analysis which has been given the impact of parameters and also interpreted through graphically. The system is designed for the producer to validate the model to optimum level.

e13515 Background: Use of systemic anti-cancer treatment near the end of life (EOL) is recognized as a low value practice with limited benefit to patients. Machine learning (ML) models that identify patients in close proximity to death can help prospectively assess oncology practice of systemic therapy use. We hypothesized that systemic therapy use would be higher based on predicted survival compared with actual survival. Methods: We calculated prevalence of systemic therapy use based on predicted and actual survival among patients with metastatic cancer at Stanford Healthcare from 2008-2019. Patients were included if they were in the test set of the ML model, had an eligible outpatient oncology clinic visit for which a predicted survival was calculated and were deceased . Median predicted survival was calculated from the ML model at each outpatient oncology visit and treatment was linked to a visit date if within 14 days of each other. Prevalence of systemic therapy was calculated for patients with a predicted or actual survival of < 6 months, 6-12 months, 12-18 months and 18-24 months. The five categories of treatment were: chemotherapy, targeted/antibody, hormone, immunotherapy, and other. Results: A total of 951 deceased patients who received anticancer treatment are included and a total of 21,283 doses of treatment were administered with a mean of 22 doses per patient. The median age at metastatic cancer diagnosis was 58 years, 53% of patients were female and most patients identified as White (55%) or Asian (23%). The most common disease groups were gastrointestinal (21.6%), thoracic (18.6%) and breast (14.9%). Overall, the use of different treatment types did not differ based on either predicted or actual survival (Table). In all the survival groupings, chemotherapy remained the predominant medication type, however with a trend of decreasing use with longer predicted and actual survival. Conclusions: The use of cancer medications and the type of medication given did not change based on predicted or actual survival in a large group of patients with metastatic cancer. There was a trend of decreasing chemotherapy use with longer prognosis. Further investigation into use in time intervals closer to (predicted or actual) death and inclusion of those who did not receive any systemic therapy are underway.[Table: see text]

Patients with cancer spend significant time receiving treatment and recovering from side effects. Little is known about how patients and their caregivers perceive time spent receiving cancer treatment and how this impacts health-related quality of life (HRQoL). Our study aims to characterize perceptions of time invested in receiving cancer therapy as experienced by patients, caregivers, and oncology professionals.We conducted semi-structured interviews with patients undergoing treatment for advanced lung cancer and melanoma, their informal caregivers, and oncology professionals (physicians, nurses, social workers, and chaplains). Participants received and provided care at a tertiary cancer center. Interviews were audiorecorded and transcribed verbatim. Transcripts were analyzed qualitatively using predominantly inductive coding to identify themes relating to time perception and cancer care.We interviewed 29 participants (11 patients, 7 informal caregivers, and 11 oncology professionals) and found they consistently differentiated between time remaining in life ("existential time") and time required to manage cancer treatment and symptoms ("chronological time"). Patients and caregivers reported distress around the mechanics of oncologic care that interrupted their daily lives (hobbies, activities). Participants described the impact of time invested in cancer care on dimensions of quality of life, ranging from minimal to substantial negative impact.We found that the time spent undergoing cancer treatment affects well-being and often prevents patients and caregivers from participating in meaningful activities. The investment of personal time undergoing cancer therapy for patients with advanced solid tumors merits further study and can enhance communication between patients, caregivers, and their oncologists.

This study addresses the problem of effectively searching and selecting relevant requirements for reuse meeting stakeholders' objectives through knowledge discovery and data mining techniques maintained over a cloud platform. Knowledge extraction of similar requirement(s) is performed on data and meta-data stored in central repository using a novel intersective way method (i-way), which uses intersection results of two machine learning algorithm namely, K-nearest neighbors (KNN) and term frequency-inverse document frequency (TF-IDF). I-way is a two-level extraction framework which represents win-win situation by considering intersective results of two different approaches to ensure that selection is progressing towards desired requirement for reuse consideration. The validity and effectiveness of results of proposed framework are evaluated on requirement dataset, which show that proposed approach can significantly help in reducing effort by selecting similar requirements of interest for reuse.

Due to growing interest in the usage of sensors, endorsed by variety of applications the wireless sensor network has attracted many researchers and industrialist. They addressed huge number of problems. Through the effective solutions it gave rise to new dimension to the problem. The Wireless Sensor Networks are constructed using sensors, deployed in wide area which is limited by its capacity in terms storage, computing, communication and energy. So researchers faced quite number of issues in addressing the user requirement as well. To address communication related issues LEACH protocol is used. LEACH uses clustering concept to address the above mentioned issue headed by Cluster heads and resulted good performance. The proposed work addresses the failure of Cluster Head and to continue smooth communication without any failure. This work aims to present the associative cluster head and results shows comparatively good performance.

The high cost of healthcare in the United States has not been consistently associated with improved health outcomes or quality of care, necessitating a focus on value-based care. We identified busulfan dosing frequency during allogeneic hematopoietic cell transplantation (HCT) conditioning as a potential target for optimization. To improve patient convenience and to decrease the cost of busulfan-based conditioning regimens, our institution changed busulfan dose frequency from every 6 hours (q6h) to once-daily (q24h). We compared costs and patient outcomes between these 2 dosing schedules. In June 2017, our institution transitioned from q6h to q24h busulfan dosing. We compared patients who received busulfan/cyclophosphamide conditioning regimens (BU/CY) for allogeneic HCT in the year before the dosing change (q6h cohort) and those who did so in the year after the dosing change (q24h cohort). The primary outcomes were differences in cost, day +90 mortality, and day +90 relapse. Between June 1, 2016, and June 1, 2018, 104 patients (median age 49 years; range, 20 to 63 years) received BU/CY before allogeneic HCT. Fifty-nine patients (57%) received q6h busulfan and 45 (43%) received q24h busulfan. There were fewer men in the q24h busulfan cohort compared with the q6h busulfan cohort (42% versus 64%; P = .024), but there were no other significant differences between the groups. There was an average annual cost savings of $19,990 per patient with q24h busulfan compared with q6h busulfan, and an annual busulfan cost savings of $899,550. There was a significantly lower day +90 mortality in the q24h busulfan cohort compared to the q6h busulfan cohort (0% versus 10%; P = .028). There were no significant differences in relapse at day +90 or in hospital length of stay. Our data indicate that i.v. busulfan dosing for allogeneic HCT conditioning is a target for improved value-based care. At our institution, patients who received q24h busulfan dosing had similar or superior outcomes compared with those receiving q6h dosing, with an average annual cost reduction of $19,990 per patient and an overall annual reduction in busulfan cost of approximately $900,000. These data support the adoption of q24h i.v. busulfan dosing as a standard of care to improve value-based care in allogeneic HCT.

Context Immune checkpoint inhibitors (ICIs) are increasingly used to treat a variety of cancers, but comparatively little is known about patient-reported outcomes (PROs) and health-related quality of life (HRQoL) among patients receiving these novel therapies. Objectives We performed a systematic review to examine PROs and HRQoL among cancer patients receiving ICIs as compared to other anticancer therapies. Methods We systematically searched PubMed, CINAHL, Embase, Web of Science, and Scopus, using search terms representing ICIs, PROs, and HRQoL on August 10, 2018. Eligible articles were required to involve cancer patients treated with ICIs and to report PROs and/or HRQoL data. Results We screened 1453 references and included 15 publications representing 15 randomized controlled trials in our analysis. Studies included several cancer types (melanoma, lung cancer, genitourinary cancer, and head/neck cancer), used four different ICIs (nivolumab, pembrolizumab, atezolizumab, and ipilimumab), and compared ICIs to a wide range of therapies (chemotherapy, targeted therapies, other immunotherapy strategies, and placebo). Studies used a total of seven different PROs to measure HRQOL, most commonly the European Organisation for the Research and Treatment of Cancer core quality of life questionnaire (EORTC QLQ-C30) (n = 12, 80%). PRO data were reported in a variety of formats and at a variety of time points throughout treatment, which made direct comparison challenging. Some trials (n = 11, 73%) reported PROs on specific symptoms. In general, patients receiving ICIs had similar-to-improved HRQoL and experiences when compared to other therapies. Conclusion Despite the broad clinical trials experience of ICI therapies across cancer types, relatively few randomized studies reported PROs and patient HRQoL data. Available data suggest that ICIs are well tolerated in terms of HRQoL compared to other anticancer therapies although the conclusions are limited by the heterogeneity of trial designs and outcomes. Currently used instruments may fail to capture important symptomatology unique to ICIs, underscoring a need for PROs designed specifically for ICIs.

After the lockdown it is not easy to get into the previous position. All producers need to change their working method as there is no production during the whole period and to deal with such a huge mass is not an easy task. As the production is stopped during the lockdown. When lockdown is open, inventory will be almost finished. The demand of economy falls so rapidly that there is a requirement to adopt such technique that can be used to cope up with such situation and raise an economy. Just in Time (JIT) is such a technique used in inventory that is not only cost saving but also time saving. In this paper, a mathematical model of JIT is introduced and an example with numerical is applied. Certain methods ought to adopt to implement JIT to raise an economy of the country.

Hypermucoid Klebsiella pneumoniae, known for its association with multiple-organ infection, has gradually increased in prevalence beyond where it was first characterized in East Asia. Here we describe a unique presentation of suppurative lymphadenitis due to hypermucoid Klebsiella in a patient from Tonga, a country with few reported cases.

Automatic speech recognition (ASR) and natural language understanding are critical components of spoken language understanding (SLU) systems. One obstacle to providing services with SLU systems in multiple languages is the cost associated with acquiring all of the language-specific resources required for ASR in each language. Modeling graphemes eliminates the need to obtain a pronunciation dictionary which maps from speech sounds to words and is one way to reduce ASR resource dependencies when rapidly developing ASR in new languages. However, little is known about the downstream impact on SLU task performance when selecting graphemes as the acoustic modeling unit. This work investigates acoustic modeling for the ASR component of an SLU system using grapheme-based approaches together with convolutional and recurrent neural network architectures. We evaluate both ASR word accuracy and spoken utterance classification (SUC) accuracy for English, Italian and Spanish language tasks and find that it is possible to achieve SUC accuracy that is comparable to conventional phoneme-based systems which leverage a pronunciation dictionary.

Article history: Received July 18, 2014 Accepted December 18 2014 Available online December 21 2014 In this study, a volume flexible inventory system for deteriorating items with stock & time dependent demand has been developed over a finite planning horizon. Shortages are permitted with partial backorder. Uncertainties are inherent in real inventory problems due to complexities of market situation. This uncertainty can be handled by the concept of randomness. As a result, backorder rate is taken as random and follows a probability distribution. All the costs are influenced by the learning effect. The optimal number of production cycles that minimize the total cost is considered. Numerical illustrations together with sensitivity analysis are given to elucidate the model. Furthermore, the numerical results of the finite planning horizon model have been plotted graphically. Growing Science Ltd. All rights reserved. 5 © 201

Introduction: Chronic graft-versus-host disease (cGVHD) is a serious complication of allogeneic hematopoietic stem cell transplantation. Pulmonary cGVHD consists of both obstructive and restrictive pulmonary changes, and as such, represents a broad spectrum of disease. While corticosteroids are a mainstay of treatment, there is no established standard-of-care for second line therapy. The Bruton's tyrosine kinase inhibitor ibrutinib was recently approved for treatment of cGVHD after failure of 1 or more lines of systemic therapy. However, the role of ibrutinib in patients with pulmonary cGVHD is not well understood. Here we report an institutional experience of ibrutinib as non-first-line therapy for pulmonary cGVHD. Methods: We performed a retrospective study of adult patients with steroid-dependent or steroid-refractory pulmonary cGVHD treated with ibrutinib as non-first line therapy between 2014 and 2018. Patients were diagnosed with pulmonary cGVHD if they met the 2014 National Institutes of Health cGVHD Consensus Panel criteria or were diagnosed based on expert opinion. All patients received appropriate GVHD prophylaxis at the time of transplant. The severity of pulmonary cGVHD was assessed by pulmonary function testing (PFT) done prior to and 180 days after initiation of ibrutinib therapy. The primary clinical outcome was absolute change in the percentage of predicted forced expiratory volume in 1 second (%FEV1) over 180 days. Patients were identified as having a complete response (normalization of %FEV1), partial response (≥10% increase in %FEV1), stable disease ( Results: A total of 17 patients received ibrutinib for pulmonary cGVHD (mean age 46 ± 11 years, 59% male), with a mean duration of 34 ± 17 weeks from transplant to diagnosis of cGVHD (31% de novo, 31% progressive, 38% interrupted). On average, patients had 5 involved organs, received 4 treatments for cGVHD prior to ibrutinib, and 14/17 (82%) were on at least 0.25 mg/kg/day of prednisone (or an equivalent dose of corticosteroid) at the time of ibrutinib initiation. The median %FEV1 at time of ibrutinib initiation was 50 ± 24%. At 180 days after initiation, 14/17 patients (82%) continued receiving ibrutinib (1 patient each discontinued therapy for lack of symptomatic improvement, oral ulcers, and enrollment in a clinical trial). Among the 14 patients who completed 180 days of therapy, only 3 had disease progression (Figure 1). Conclusions: Ibrutinib was generally well tolerated as a non-first line therapy for pulmonary cGVHD. In this cohort of patients with steroid-dependent or steroid-refractory disease who had progression on multiple lines of therapy, most had stable or improved pulmonary function by %FEV1 while on ibrutinib. Given the heterogeneity of pulmonary cGVHD, further studies can help clarify which patients are most likely to demonstrate response. Disclosures Miklos: Becton Dickinson: Consultancy; Adaptive Biotechnologies: Consultancy, Research Funding; Pharmacyclics: Consultancy, Patents & Royalties, Research Funding; Celgene-Juno: Consultancy; AlloGene: Consultancy; Janssen: Consultancy; Precision Bioscience: Consultancy; Kite, A Gilead Company: Consultancy, Research Funding; Miltenyi: Consultancy, Research Funding; Novartis: Consultancy.

11579 Background: PROs are increasingly used as a key tool in patient-focused treatment decisions. However, many cancer PROs were designed to capture the patient experience of those treated with chemotherapeutic agents. Less is known about the utility of PRO instruments in assessing symptoms from ICIs. Methods: We systematically searched the literature to identify peer-reviewed publications that reported PROs for patients receiving ICIs. We excluded case reports/series, narrative reviews, and publications without original data. We then selected the studies that compared ICIs to cytotoxic chemotherapy. Clinician-documented adverse events (AEs) occurring in at least 10% of patients in a study arm were extracted and examined for concordance with symptoms included in the PROs administered to study patients. Results: Of 1,450 identified studies, eight met criteria for inclusion. Seven assessed PROs with the European Organization for the Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30), six used the EuroQOL EQ-5D, and one used the Lung Cancer Symptom Scale (LCSS). Across the studies, fatigue, nausea, vomiting, appetite loss, diarrhea, constipation, pruritus, rash, and pyrexia were among the most common clinician-documented AEs. Of these AEs, six are directly correlated with questions on the PRO instruments, and three (pruritus, rash, and pyrexia) are not. AEs with corresponding PRO questions were more common in chemotherapy patients. Pruritus, rash, and pyrexia – AEs without corresponding PRO questions – were more common in patients treated with ICIs (see Table). Conclusions: Existing PRO instruments do not specifically query important symptoms associated with ICIs, underscoring the need to revise the instruments to more appropriately reflect the toxicity profiles of novel agents. [Table: see text]

e23160 Background: Immune checkpoint inhibitors (ICIs) have been met with a wave of excitement due to their novel mechanism. We hypothesized that this may impact how patients (via PROs) report treatment tolerability in comparison to traditional therapies. We sought to examine if there was a notable difference in PROs in blinded vs unblinded trials of ICIs. Methods: We systematically searched PubMed, CINAHL, Embase, Web of Science, and Scopus in August 2018 for publications with quantitative PRO data comparing ICIs to cytotoxic chemotherapy. Case series, narrative reviews, and publications lacking original data were excluded. Eligible publications were reviewed to assess if patients were blinded to the agent received, and a comparison for common PRO metrics was performed. Results: Of the 1,450 unique references identified, eight met inclusion criteria: 1 double blinded placebo-controlled trial and 7 trials where patients were aware of the assigned arm. The blinded trial had quantitative PRO data in the form of the European Organisation for Research and Treatment of Cancer (EORTC) global health status (GHS) score and patient reported symptom burden at week 12. Most (6 of 7; 86%) unblinded trials reported the GHS at either week 12 or 15, and patient symptom burden at these time points as well (5 of 7; 71%). For the EORTC GHS, the blinded trial showed no inter-arm difference at week 12. 4 of 6 (67%) open label trials noted statistically significant differences in GHS favoring the ICI arm. For symptom burden at week 12 or 15, there was no difference found in the blinded study. In unblinded trials, there were domains where patients receiving ICIs reported a statistically significant lower symptom burden than those receiving chemotherapy: fatigue (4 of 5 trials favoring ICIs; 80%), dyspnea (2 of 5; 40%), insomnia (1 of 4; 25%), appetite loss (1 of 4; 25%), and diarrhea (1 of 5; 20%). There were no differences in pain (n = 5), nausea/vomit (n = 5), and constipation (n = 5). Conclusions: We found a trend towards more favorable reporting on common symptoms in unblinded studies of patients receiving ICIs. Our analysis is limited by the lack of available comparisons in the published literature.

e18202 Background: Patient-reported outcomes (PROs) are increasingly valued as a key tool in patient-focused treatment decisions. However, a lack of standardization leads to significant variability in PRO collection and reporting in ground-breaking clinical trials of novel agents. We sought to characterize the mechanisms of assessment and variability by which PROs are reported for newly approved anti-cancer therapies. Methods: We reviewed the U.S. Food and Drug Administration (FDA) approvals between 2011 and 2017 for anti-cancer new molecular entities (NMEs) and new biologic approvals (BLAs). For each therapy, the pivotal clinical trial leading to FDA approval was identified using the national clinical trial (NCT) number and assessed for inclusion of PROs. A separate PubMed search was conducted to evaluate for PRO publication distinct from the original trial based on national clinical trial registry number. Results: From 2011 to 2017, the FDA approved 66 NMEs/BLAs based on 74 clinical trials for cancer treatment. Of the 74 clinical trial publications, 21 (28%) of the trials published PRO data in their original clinical publication, 18 (24%) published a separate PRO analysis, and 35 (47%) did not publish PRO data in either format. Among the 32 clinical trials (43%) that listed PROs as pre-specified outcomes, 72% published PROs (23/32). The separate PRO analyses (N = 18) were published considerably later following FDA approval (mean 605 days) than the original clinical trials (mean 20 days, N = 74, P < 0.001). Conclusions: As cancer treatment options expand, therapy decisions become increasingly nuanced. PROs assist decision-making by providing detailed information on important aspects of quality of life and tolerability. Our research has identified a significant lag in the publication of companion studies of PRO data associated with pivotal clinical trials, representing a meaningful gap in information critical to patients and oncologists in the process of making informed decisions.

This article was migrated. The article was not marked as recommended. Purpose: The Stanford Hospitalist Advanced Practice and Education (SHAPE) Program was established in 2015 as a hospital medicine training track within an academic internal medicine residency program. It is unique because it was created and is currently run by residents with a goal of better preparing residents for careers in hospital medicine. The SHAPE curriculum is based on three principles: (1) clinical excellence in hospitalist-relevant clinical areas, (2) academic development through research and quality improvement, and (3) career mentorship. We provide a two-year follow-up since the establishment of SHAPE and resident attitudes toward the program's effectiveness. Methods: We assessed resident attitudes toward the SHAPE Program and subjective readiness to begin practice via electronic survey from 2015 to 2017. Results: 154 out of 324 (47.5%) total internal medicine residents responded to the surveys. Of those, 17 out of 21 (81.0%) were members of SHAPE. Compared to non-hospitalist-bound residents, SHAPE residents reported improved readiness for independent practice (OR 3.39 [95% CI: 1.1-10.9]) and providing care within the specific domain of palliative care. Conclusions: Here we describe the challenges of maintaining a hospitalist curriculum and the successes that have come from the first resident-run hospitalist training program in the country.

Introduction Higher costs of healthcare in the United States have not consistently been associated with improved health outcomes or quality of care, necessitating interventions to improve value-based care. We identified busulfan dosing frequency during preparation for allogeneic hematopoietic cell transplantation (HCT) as a potential target for optimization. To improve patient convenience and decrease the cost of the busulfan preparative regimen, our institution changed busulfan dose frequency from every 6 hours (q6h) to once-daily dosing (q24h). We examined differences in costs and patient outcomes between these two protocols. Methods In June 2017, our institution transitioned from q6h to q24h busulfan dosing. We compared patients who received inpatient busulfan and cyclophosphamide (BU/CY) preparative regimens for allogeneic HCT from one year prior to one year after implementation of the dosing change. The primary outcomes were difference in cost, day +90 mortality, and day +90 relapse. Secondary outcomes included hospital length of stay and peak serum total bilirubin level. Two-sided T-test and Chi-squared analyses were conducted to compare these outcomes between the two treatment groups. Results There were a total of 104 patients (age 49 ± 11 years, 55% male) who received the preparatory BU/CY regimen before allogeneic HCT from June 1, 2016 to June 1, 2018 (Table 1). Of these, 43% (N=45) received q24h busulfan. There were fewer men in the q24h busulfan cohort (42%) compared to the q6h busulfan cohort (64%, p=0.024), but there were no other significant differences between the treatment groups (Table 1). There was an average cost savings of $12,554.34 per patient who received q24h busulfan compared to q6h busulfan. There was a significantly lower day +90 mortality in the q24h busulfan cohort compared to the q6h busulfan cohort (0% vs 10%, p=0.028, Table 2). There were no differences in relapse at day +90 or hospital length of stay. Conclusions Busulfan dosing during preparation for allogeneic HCT represents a target for improving value-based care in the inpatient setting. At our institution, patients who received a q24h busulfan dosing regimen had similar or superior outcomes with those receiving q6h dosing, with a reduction in annual hospital drug charges of approximately $500,000. This retrospective study serves as a proof of concept for the adoption of q24h busulfan dosing as a standard of care to improve value-based care in allogeneic HCT.

This paper addresses a multi items volume flexible system for time dependent decaying items with the concept of machine breakdown and imprecise environment. In this study, partially backlogged shortages have been discussed. All the costs are fuzzified with signed distance method. Numerical examples are given to illustrate the theoretical results and sensitivity analysis is given to validate the results for various parameters.

This study develops an integrated perishable items inventory replenishment model for decaying items with multiple market demand under volume flexibility. Flexibility is a desirable property of production systems which quite often is presented as a panacea to numerous realistic problems. The production rate is taken as flexible. Deterioration rate depends upon quality level and time. The time related function for deterioration follows a two-parameter Weibull distribution. Holding cost is taken as linear increasing function of time. To make the study realistic quality dependent setup cost has been taken. Numerical example along with graphical illustrations is presented to discuss the optimality of the model.

The non-superconducting phases in 123 superconducting compound YBa2Cu3O7-x using X-ray diffraction pattern have been studied. The 123 superconducting phase has been found to decompose on isothermal heating at 750°C. The growth of non-superconducting phases has been accelerated in the presence of traces of CO2 gas which is normally present in air and oxygen gas of commercial grade. These phases are quite stable once they have formed.

The effects of treatment of mice with an aqueous extract of Listeria monocytogenes on lymphoid populations and on immune responsiveness were studied. Thymus weight was decreased to a third of the control, whereas spleen weight was proportionally increased as the number of treatments was increased. The total numbers of cells in the thymus and bone marrow were diminished, whereas the number in the spleen was increased. Serum hemolysin production and plaque-forming cell response to sheep erythrocytes were suppressed in treated mice when the extract was given before administration of antigen. Spleen cells from treated mice failed to mount an antibody response upon transfer to syngeneic γ-irradiated recipients, suggesting that potential antibody-producing cells were impaired by the treatment.

The effects of sintering conditions of cold-pressed superconducting YBa2Cu3Ox pellets made from calcined powders using different raw materials are reported. Very slow densification has been noticed between 800 and 920 degrees C with the powder of 1.7 mu m size. In general at any sintering temperature the rate of densification in the first three to four hours of sintering is found to be very high and thereafter it is slower. Pellets sintered at 960 degrees C contain other non-superconducting phases besides the superconducting 123 phase, due to the decomposition of the latter. Abnormal discontinuous grain growth and faceted grains are observed in the samples sintered for longer periods. It is further noticed that the low-temperature oxidation at 450 degrees C is found to cause intergranular and transgranular cracks.