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His unit served on the left flank of the 2nd Marine Division and took the northern part of Kuwait City anxiety bc order cheap luvox. She is Director of the Nova Southeastern University Institute for Neuro-Immune Medicine; Professor of Medicine and Chair of the Department of Clinical Immunology at Nova Southeastern University College of Osteopathic Medicine; and Professor Emerita anxiety vomiting luvox 50 mg for sale, University of Miami School of Medicine anxiety symptoms overthinking cheap luvox online american express. His research group investigates the molecular and cellular basis of gliosis anxiety symptoms adults buy luvox 100 mg without prescription, a dominant response of the central nervous system to chemical and disease-induced injury. O’Callaghan served as the Senior Science Adviser to the Neurotoxicology Division of the National Health and Environmental Effects Research Laboratory, U. O’Callaghan has conducted extensive research on the neurotoxicity profiles of many types of chemicals. O’Callaghan has co-authored over 175 scientific papers in the area of neurotoxicology and his research findings have been presented by invitation at numerous national and international conferences. O’Callaghan’s expertise in the area of neurotoxicity, he has worked as a consultant for a number of public and private institutions, including the U. Stephen Ondra was named senior vice president and enterprise chief medical officer at Health Care Service Corporation in February 2013. Previously, he served as senior vice president and chief medical Appendix A: Committee Members | 105 officer at Northwestern Memorial Hospital. Ondra served in government as an advisor in the Obama Administration from 2009 to 2012. In 2009, he was appointed by President Obama, as the senior advisor for Health Affairs to Secretary Shinseki at the Department of Veterans Affairs. In 2010, he was moved to the Executive Office of the President and served in the Office of Science and Technology Policy. In addition to other duties at the White House, he served as a co-chair of the National Science and Technology Council for Health Information Technology, on the Deputy group for the implementation of the Affordable Care Act and on the Federal Health Information Technology Policy and Standards Committees. His research focuses on the development of flexible polymer nanoplatforms for optical sensing in tissues and the early detection and treatment of brain tumors. He has authored of more than 200 peer-reviewed scholarly manuscripts, abstracts and book chapters. Lea Steele is Research Professor of Biomedical Studies at Baylor University where she directs the Veterans Heath Research Program, a multidisciplinary program that conducts clinical and epidemiologic studies focused on complex health conditions affecting war veterans. She is an epidemiologist and human ecologist whose research, since 1998, has focused on the health consequences of military service in the 1991 Gulf War. Steele is Past Scientific Director of the Research Advisory Committee on Gulf War Veterans’ Illnesses. She previously directed the Kansas Persian Gulf War Veterans Health Initiative, a research and service program sponsored by the State of Kansas, and was principal investigator of the Kansas Gulf Veterans Health Study. Sullivan is a Research Assistant Professor at the Boston University School of Public Health department of Environmental Health. White is Professor and Chair of the Department of Environmental Health at Boston University School of Public Health, where she is also the Associate Dean for Research. She is a neuropsychologist with expertise in environmental and occupational epidemiology. Author of numerous scientific publications, her research interests include evaluation of chronic effects of exposure to neurotoxicants, the use of imaging in behavioral toxicology, modeling the effects of exposures to toxicant mixtures and exposures in the context of other environmental stressors, and the effects of exposures in vulnerable populations. Since 2008, multiple studies have examined the effects of pesticides that were present in the Gulf War in other occupational cohorts, including agricultural workers, pesticide applicators, and sheep farmers. These studies are relevant because of the importance of pesticide exposures in the Gulf War and because the health effects seen in these occupational groups closely parallel the symptoms of Gulf War illness. Enzyme activity and thyroid functioning increased as exposure increased during the rainy season. Increases in all dimethylphosphates and all diethylphosphates were associated with dose-response increases in thyrotropin. Total thryoxine increased in a dose-response manner, with increases in all dimethylphosphates and in diethylphosphate(Lacasana et al. All participants had similar level of occupational exposures to organophosphates, but participants with Parkinson’s disease had higher rates of residential exposures. They concluded that higher exposures were associated with poorer performance on tasks assessing motor speed and coordination, information processing speed, executive functioning, verbal abstraction, sustained attention, memory, and perception. However, only one found a correlation between cholinesterase levels and test performance: this was seen in Egyptian adolescents with high exposures (Abdel Rasoul et al. A meta-analysisby Rohlman and colleagues of research outcomes in 17 studies evaluating cognition in agricultural workers and pesticide applicators (Ismail et al. Agricultural workers performed worse on Digit Span and Trail-making Test part A compared to pesticide applicators. Overall, Wechsler Intelligence Block Design performance decreased as time of exposure in years increased (Ismail et al. Another meta-analysis of 16 research studies found that most studies demonstrated exposure-associated declines in performance on tasks assessing reaction time, fine motor control, memory, attention, visuospatial functioning and mood (Ross et al. Differences in 110 | Gulf War Illness and the Health of Gulf War Veterans performance between farmers and controls remained after controlling for mood. As exposure duration increased, performance on measures of memory, verbal ability, fine motor control, and executive functioning became worse. Pesticide exposure in a number of occupational environments has been associated with poorer cognitive function. A study of pesticide applicators found that use of pesticides was negatively associated with performance on computerized tasks from the computer-assisted Neurobehavioral Evaluation System-3 such as learning tasks, sequences A and digit-symbol. However, some positive associations between exposures and cognitive performance were found in which higher exposure was associated with better test scores (Starks et al. There was an increased risk of performance being worse at follow-up compared to baseline for almost all measures of cognition in exposed workers. Taken together, these studies on a diverse group of pesticide-exposed occupational groups reveal adverse changes in cognitive function that parallel those seen in Gulf War veterans, including associations between self-reported exposures during the Gulf War and reduced mood functioning and poorer performance on tasks of memory, attention and motor functioning (Toomey et al. These findings provide additional support to the already-compelling evidence in studies of Gulf War veterans that pesticide use is causally associated with the development of Gulf War illness. Further research in both Gulf War and occupational pesticide groups may yield results with broad mechanistic and therapeutic applications. Lacasana 136 Mexican Urine samples were assessed An interaction was found between 2010b floriculture for pesticide metabolites. Cognition Meta-Analyses and Reviews Ismail Agricultural Meta-analysis of Exposed cohorts had poorer 2012 workers and neurobehavioral performance in performance in measure(s) of memory, Appendix C: Effects of Pesticide Exposure in Non-Gulf War Cohorts | 111 pesticide 22 cohorts drawn from 17 attention, sustained attention, motor applicators studies speed and coordination, visual motor processing, verbal abilities, and perception. Performances were similar for job type, with the exception of agricultural workers performing worse on Digit Symbol and Trail Making A compared to pesticide applicators. The three remaining studies not reporting differences were found to be methodologically flawed. Cognition Primary Papers Blanc-Lapierre 614 vine workers Cognitive functioning (the Exposure resulted in a higher risk of 2013 from the Bordeaux Mini-Mental Status Exam, the performing poorly for all tests except area of France (443 Benton Visual Retention Test, the Wechsler Paired-Associates Test exposed; 171 non the Stroop Test, Trail Making for chlorpyriphos and quinalphos, and exposed controls) Test Part A, the Wechsler for Trail Making Test A with Paired-Associates Test) methidathion. The risk of worsening from baseline to follow up increased with exposure for all measures except Trail Making Test Part A with chlorpyrifos, methidathion, and phosalone. Differences remained California Computerized when mood was controlled and when 112 | Gulf War Illness and the Health of Gulf War Veterans Assessment Package, the compared to normative data instead of Medical Symptom Validity the control group. Starks 701 male private Cognitive functioning Ever use of Ethoprop was negatively 2012 pesticide (continuous performance, digit associated with digit-symbol, auditory applicators symbol, finger tapping, grooved verbal learning total, and sequences A. Cumulative lifetime use of malathion was negatively associated with digit-symbol performance and ethoprop with sequences A. The auditory verbal learning task was positively associated with ever use of coumaphos, tetrachlorvinphos, aldicarb, and carbaryl, and cumulative lifetime use fo chlorpyrifos, coumaphos, parathion, phorate, tetrachlorvinphos, aldicarb, benomyl, and carbaryl. Sequences A was positively associated with cumulative lifetime use of benomyl, and Sequences B was positively associated with cumulative lifetime use of coumaphos. However, some carbamates and organophosphates were positively associated with cognitive function. Uniquely for a clinical trial, the Department of Work and 3 Pensions also contributed to it. In clinical trials, subjective measures – patients’ self-ratings of symptoms – are influenced not only by how they actually feel but by their expectations of the treatment and their wish to please the experimenter. Another important feature of the trial was that the researchers prespecified how they would analyse its data – an established method to avoid the later ‘cherrypicking’ of favourable results.
A systematic review of placebo-controlled studies has shown that antibiotics reduce the risk 53 of short-term mortality by 77% anxiety 4th luvox 50 mg low cost, treatment failure by 53% and sputum purulence by 44% anxiety symptoms in head 100 mg luvox mastercard. In the outpatient setting anxiety depression 100mg luvox amex, sputum cultures are not feasible as they take at least two days and frequently do not give reliable results for technical reasons anxiety zap reviews 100 mg luvox fast delivery. Another biomarker that has been investigated is procalcitonin, a marker that is more specific for bacterial infections and that may be of value 58 in the decision to use antibiotics, but this test is expensive and not readily available. Several studies have suggested that procalcitonin-guided antibiotic treatment reduces 59-61 antibiotic exposure and side effects with the same clinical efficacy. A recent meta analysis of available clinical studies suggests that procalcitonin-based protocols to trigger antibiotic use are associated with significantly decreased antibiotic prescription and total antibiotic exposure, without affecting clinical outcomes. However, the quality of this evidence is low to moderate, because of methodological limitations and smaller overall study populations. Procalcitonin-based protocols may be clinically effective; however, confirmatory trials with rigorous methodology 62 are required. The choice of the antibiotic should be based on the local bacterial resistance pattern. Usually initial empirical treatment is an aminopenicillin with clavulanic acid, macrolide, or 65,66 tetracycline. In patients with frequent exacerbations, severe airflow limitation, and/or 67 exacerbations requiring mechanical ventilation, cultures from sputum or other materials from the lung should be performed, as gram-negative bacteria. The route of administration (oral or intravenous) depends on the patient’s ability to eat and the pharmacokinetics of the antibiotic, although it is preferable that antibiotics be given orally. Depending on the clinical condition of the patient, an appropriate fluid balance, use of diuretics when clinically indicated, anticoagulants, treatment of comorbidities and nutritional aspects should be considered. At all times, healthcare providers should strongly enforce the need for smoking cessation. Supplemental oxygen should be titrated to improve the patient’s hypoxemia with a target 72 saturation of 88-92%. Once oxygen is started, blood gases should be checked frequently to ensure satisfactory oxygenation without carbon dioxide retention and/or worsening acidosis. A recent study demonstrated that venous blood gas to assess bicarbonate levels 73 and pH is accurate when compared with arterial blood gas assessment. Additional data are needed to clarify the utility of venous blood gas sampling to make clinical decisions in scenarios of acute respiratory failure; most patients included had a pH > 7. Venturi masks (high 34 flow devices) offer more accurate and controlled delivery of oxygen than do nasal prongs. Admission of patients with severe exacerbations to intermediate or special respiratory care units may be appropriate if adequate personnel skills and equipment exist to identify and manage acute respiratory failure. Ventilatory support in an exacerbation can be provided by either noninvasive (nasal or facial mask) or invasive (oro-tracheal tube or tracheostomy) ventilation. More importantly, mortality 77,82-84 81 and intubation rates are reduced by this intervention. The indications for initiating invasive mechanical ventilation during an exacerbation are shown in Table 5. In patients who fail non invasive ventilation as initial therapy and receive invasive ventilation as subsequent rescue 80 therapy, morbidity, hospital length of stay and mortality are greater. When possible, a clear statement of the patient’s own treatment wishes, such as an advance directive or “living will”, makes these difficult decisions easier to resolve. Major hazards include the risk of ventilator-acquired pneumonia (especially when multi-resistant organisms are prevalent), barotrauma and volutrauma, and the risk of tracheostomy and consequential prolonged ventilation. Despite this, there is evidence that patients who might otherwise survive are frequently denied admission to intensive care for intubation 87 because of unwarranted prognostic pessimism. Patients who did not have a previously diagnosed comorbidity, had respiratory failure due to a potentially reversible cause (such as an infection), or were relatively mobile and not using long-term oxygen, did well after ventilator support. Accordingly, there are no standards that can be applied to the timing and nature of discharge. However, it is recognized that recurrent exacerbations leading to short-term readmission and increased all-cause mortality are associated with the initial hospitalization for an acute episode of deterioration. Consequently, the clinical practice and management of the acute hospitalization have been studied extensively and the introduction of factors thought to be beneficial has been investigated increasingly in recent years. When features related to re-hospitalization and mortality have been studied, defects in perceived optimal management have been identified including spirometric assessment and arterial blood gas 89 analysis. Mortality relates to patient age, the presence of acidotic respiratory failure, the 90 need for ventilatory support and comorbidities including anxiety and depression. The introduction of care bundles at hospital discharge to include education, optimization of medication, supervision and correction of inhaler technique, assessment and optimal management of comorbidities, early rehabilitation, telemonitoring and continued patient 91 contact have all been investigated to address these issues (Table 5. Whereas these measures all seem sensible there is insufficient data that they influence either readmission 89,90,92,93 90 rates or short-term mortality and there is little evidence of cost-effectiveness. Nevertheless, it remains good clinical practice to cover these issues before discharge and their effectiveness on health status and readmission rates may be increased if they are 94 delivered with an approach that includes motivational interview-based health coaching. The only possible exception is early rehabilitation as there is some evidence that this factor 93 is associated with increased mortality, although the reasons remain unknown. Early follow-up (within one month) following discharge should be undertaken when possible 96 and has been related to less exacerbation-related readmissions. There are many patient issues that prevent early follow-up; those not attending early follow-up have increased 90 day mortality. This may reflect both patient compliance, limited access to medical care, poor social support, and/or the presence of more severe disease. Nevertheless, early follow-up permits a careful review of discharge therapy (and especially any remaining need for long-term oxygen treatment by assessment of both oxygen saturation and arterial blood gases) and an opportunity to make any needed changes in therapy (antibiotic and steroid therapy review). In addition, arterial oxygen saturation and blood gas assessment will determine the need for long-term oxygen therapy more accurately at prolonged follow-up compared to shortly after discharge. A further detailed assessment of the presence and management of 86 comorbidities should also be undertaken (Table 5. Prevention of exacerbations After an acute exacerbation, appropriate measures for prevention of further exacerbations should be initiated (Table 5. For the following treatment modalities significant effects on exacerbation risk/frequency could be shown in clinical trials. Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease. Early therapy improves outcomes of exacerbations of chronic obstructive pulmonary disease. Infections and airway inflammation in chronic obstructive pulmonary disease severe exacerbations. Acute exacerbations of chronic obstructive pulmonary disease: identification of biologic clusters and their biomarkers. Blood eosinophils to direct corticosteroid treatment of exacerbations of chronic obstructive pulmonary disease: a randomized placebo-controlled trial. Impact of Prolonged Exacerbation Recovery in Chronic Obstructive Pulmonary Disease. Role of infection and antimicrobial therapy in acute exacerbations of chronic obstructive pulmonary disease. Predictors of mortality in hospitalized adults with acute exacerbation of chronic obstructive pulmonary disease. Action plans with brief patient education for exacerbations in chronic obstructive pulmonary disease. Methylxanthines for exacerbations of chronic obstructive pulmonary disease: meta-analysis of randomised trials. Intravenous aminophylline in patients admitted to hospital with non-acidotic exacerbations of chronic obstructive pulmonary disease: a prospective randomised controlled trial. Comparison of nebulized budesonide and oral prednisolone with placebo in the treatment of acute exacerbations of chronic obstructive pulmonary disease: a randomized controlled trial. Effect of systemic glucocorticoids on exacerbations of chronic obstructive pulmonary disease. Efficacy of corticosteroid therapy in patients with an acute exacerbation of chronic obstructive pulmonary disease receiving ventilatory support. Outpatient oral prednisone after emergency treatment of chronic obstructive pulmonary disease. Respiratory viruses, symptoms, and inflammatory markers in acute exacerbations and stable chronic obstructive pulmonary disease.
In spite of the challenge previously stated anxiety physical symptoms effective luvox 100 mg, the researcher further analyzed and crossed results using the codes anxiety symptoms eye pain generic luvox 100 mg amex, and found some correlating results with one particular case anxiety symptoms skin rash purchase luvox cheap. In Figure 17 anxiety cat buy generic luvox, Student #1 (not the actual code nor any real number), to be called for now, “Sam Student” a self-reported male, reported sleep-loss behaviors that were correlated perfectly with the teacher’s in-class observations of that individual. The morning after Sam Student entered his first night’s survey journal input, he and other classmates attended their regular morning class. The teacher made observations of sleep-loss related behaviors exhibited by students during class. The check column #1 indicates the teacher observed: student tardy; rubbing eyes, vision or blinking or squinting issues; seems very tired, sleepy, or lethargic; drinking something (unknown) or H2O. Additionally, the teacher’s general profile of the student, completed at a later date, included the response: “Student does not seem to get enough sleep on a regular basis. In-class “sleepy” behaviors observed by high school teacher: See student #1(red arrow) whose teacher-reported behaviors match student-reported behaviors Figures 18 and 19 below show a portion of the initial survey input entered by “Sam Student” on the first night of the study. Of note is the student response to a question (Figure 18, Q14) of whether the practice of gaming may be helping with schoolwork: “No, it is hindering/interfering with schoolwork. Excerpts of “Sam Student’s” survey response for Night 1 shows student interest in online gaming 313 jel. Excerpts of “Sam Student’s” survey response for Night 1 shows student going to bed around midnight and awakening 6. The student survey input for that following night confirms the teacher’s observation of sleep-loss behaviors. As seen in Figure 20, Sam Student reported that he had continued to use his cell phone (smart phone) 30 minutes-one hour in bed the previous night (before the Tuesday class). The student selected these behaviors for that day at school: I felt sleepy; I yawned more than once; I almost fell asleep in a class; I was late to my first class because of oversleeping or tiredness; I complained about being tired; I wish I had gotten more sleep last night. No other sleep log surveys were completed by this participant, yet the teacher continued to observe “sleepy”/lack of sleep behaviors in this student for the rest of the week. There is clearly a correlation between this student’s use of nighttime online electronics, lack of healthy sleep, and resulting diminished academic aptitude in class the next morning. Excerpts of “Sam Student’s” survey response for Night 2 show student acknowledgement of electronic use replacing sleep time, and related sleep-loss behaviors that day in the classroom High school students were also given the opportunity to optionally comment about the study in this question: Optional: Any comments or concerns about your age group, teenagers-late teens, early twenties and electronics/internet/sleep And the internet helps us stay connected to what’s going on in the world, and locally, faster than it used to be. Discussion this investigation into technology and sleep habits of local adolescents yielded rich and varied results. As studies of current adolescent behavior in these areas within the United States are rare, this examination is helpful. With these results we are able to compare with the few previous studies and see if our students are indeed within the average. Additionally, this study provides some information and insight that previously may not have been documented in the same manner. The reported results are very straightforward, as it is clearly a case of “the numbers speak volumes” and “a picture is worth 1000 words. A possible oversight of the current study is that participants were not asked about their main mode of internet connection, nor were they asked which device they were reporting/responding upon (Group R). Even without that information, with a majority of students having both access to online networking and a device to do it upon, one may assume that they would access whenever they feel or want to access. College students, and high school students to a slightly lesser degree, are spending a tremendous amount of time on electronic devices, and this isn’t really news, except for the part about only about half of that time is spent for academic purposes—Since 75% of students report being on devices over 3 hours a day, then, on the low end, they are getting a large amount of entertainment and social connection with their devices. This is not “bad” yet causes one to wonder if perhaps we don’t have enough knowledge and information about how devices may be used in academic work (other than word processing). Also, perhaps instructors are not integrating technology into the assignments in a practicable manner so that students can see how to use their devices as academic tools for other applications. Indeed, although 62% of students are using Blackboard or Moodle for school, all of the other sites and apps used (top half of Figure 3) are entertainments and social-networking oriented. It seems that incorporating a social component into academic technology use would be productive and applicable. For example, as an instructor, I could include Edmodo, a Facebook group page, collaborative wiki or google drive projects, apps like Quizlet, and collaborative app-based video projects, and allow students to create assignments within virtual world games. If we want to reach them “where they live,” then we need to see technology as a connective tool between the academic and social worlds rather than a divisive force. The fact that a majority of students are using devices immediately before and into bed is a huge concern. This practice is clearly affecting the amount of healthy uninterrupted sleep that students are getting. We’ve added to that a distracting device that brings with it an element of stress, an always-on connection (“What am I missing Compounded with the propensity of students to not put the device into a sleep mode, and to react and wake up and respond. This is perhaps shocking to those who had naively believed that their students were behaving in the manner of the parents and grandparents generations. Previous studies into adolescent technology behaviors have not questioned and investigated whether or not the subjects slept with their devices. Many adults assume that “going to bed” means disconnection, but for many students today, it means physically being in a bed while they continue their always-on digital lives. Pre-digital college generations would joke about sleeping with textbooks, and whether a process of diffusion of knowledge could occur. Naturally it couldn’t and didn’t, and yet sleeping with the instruments of knowledge incurred zero risk of harm. At the very least, the disruption and displacement of sleep incurs risk of harm, as the loss of sleep puts the physical body and mental capacity in a diminished state. That a majority of students are getting far less than the recommended eight hours of sleep, or even just seven hours of sleep is concerning. With such high numbers of students reporting that during the day they felt sleepy, yawned more than once, complained about not getting enough sleep, and wished they had gotten more sleep, it seems that there is some predisposition in this group to need for us to provide better sleep education, better value of sleep emphasis in the culture, and a means of structure or guidelines to support the generation’s need for discipline. For example, as an instructor, I would put forth in my syllabus a request that my students put “mobile” electronics to sleep one hour before bed, and to place them in a silent sleep “Do not disturb” mode so that texts do not interrupt. Perhaps I would even develop an online incentive program in which students could earn extra flex-points for going to bed, putting devices to sleep, logging 7 or more hours of sleep and similar positive sleep behaviors. Although qualitative data was not gathered and perhaps could have been gathered had the researcher planned it in advance, about half-way or so through the college survey, participants often would begin to speak aloud or laugh or comment aloud to their friends nearby. It seemed that just the exposure to being questioned about their behaviors, and the direct thinking about them, caused many students to begin to reflect in a way they had not intentionally done before. Some said things about how some of their choices may be adverse, and that they were now going to look at it differently. Many seemed surprisingly open and not averse to information about managing their habits. Having had the opportunity to be very “on their own” for a couple of months into college, it appeared that some students were looking for a little bit of “momming” chatting informally with the researcher. In many universities, beginning students are required to complete a “library” course that covers aspects of using 317 jel. Some colleges will have an alcohol education of sexual abuse short course that students complete in the first semester of college. It seems appropriate for universities to have an “on your own” health course that incorporates some brief basics of college nutrition, technology use, and sleep. Most adolescents are desirous of making their own decisions about their health and choices, and it is right for us to allow them to do so. Yet, it is irresponsible of us to not provide them with adequate and accurate information so that their choices are better informed. The first research question asked with what impact evening media use interferes with either school work/study and/or sufficient healthy sleep The anticipated outcome was that student participants would indeed have intense use of electronics in the evening, for both study and social media, and that recommend hours of sleep would not be met by participants age 16-25. Participants clearly spend a great deal of evening time using electronic media, and it clearly interferes with sleep, as evidenced by both the reported use of media and reported lack of adequate sleep. Although the original research question just addressed the use of electronic media, an additional insight brought out by this study is that the media use is mainly online use, and dominantly social media and networking media use. Students connect to the online world, and their social networks both near and far. The second research question asked with what impact may there be a compromise in students’ ability or aptitude for positive academic success, related to either lack of sleep or electronic media use The anticipated outcome was that students would acknowledge that lack of sleep occurred related to evening media use, and the lack affected their daytime performance academically.
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Intensive tx was defined as receipt of high dose cytarabine and/or 365 autologous transplant in 1st remission anxiety symptoms handout discount 50mg luvox. Maddocks1 | available data) anxiety symptoms pain cheap luvox master card, complex karyotype in 27% (12/44 with available data) anxiety medication cheap luvox 50 mg otc, M anxiety symptoms everyday buy cheap luvox 50mg on line. Mathews10 | 11 11 12 agent 19% and in combination 9%), bendamustine (benda) based che M. Guo | 13 13 14 lenalidomide and/or bortezomib (len/bortez) in 16%, and other tx M. Grover, N: Con with very poor outcomes for all pts regardless frontline tx and post sultant Advisory Role: Seattle Genetics. Disclosures: Maddocks, K: Honoraria: Teva, Bayer, Novartis, Hamadani, M: Consultant Advisory Role: Cellerant, Celgene, Pharmacyclics; Research Funding: Pharmacyclics, Merck, Bristol-Myers MedImmune, Janssen; Research Funding: MedImmune, Sanofi Genzyme, Squibb. Flowers, Pfizer, Pharmacyclics, Abbvie, Genentech, Novartis, Seattle Genetics; C: Consultant Advisory Role: Denovo Biopharma, Spectrum, Honoraria: Pfizer, Pharmacyclics, Novartis, Abbvie, Seattle Genetics, Gen Pharmacyclics, Bayer, Gilead, OptumRx, Genentech/Roche, Abbvie, entech; Research Funding: Amgen. Blum, patients with B-cell malignancies (total average confidence shift; K: Research Funding: Seattle Genetics, Novartis, Celgene, Morphosys. Rodriguez | questions and 1 self-efficacy question were selected from the set of S. Chuang intra-activity questions to be repeated immediately after activity par ticipation. A chi-square test was used to identify differences between pre and post-assessment Background: Standard therapy for first relapsed Diffuse Large B-cell responses. To date, there are no patient or tumor factors that are pre Results: Results are for those who have completed the pre and post dictive for response. Early identification of lack of response could assessment questions during the study period (n = 166 hem/onc; n = allow for alternative therapy selection, avoidance of toxic and futile 363 nurses). Upon completion of the activity, an improvement from pre therapy, and potentially impact clinical outcomes. The response rates on day 4 were: com Results: Fifty-one patients were included for study. A larger study of baseline parameters and outcome seems peutic failure and could be considered for alternative therapeutic warranted. Only Instituto Oncohematologico Formosa, Formosa, Argentina; in 62% of pts (167/267) R was available from the 1st cycle by the 17Hematology, Instituto Alexander Fleming, Buenos Aires, Argentina; health coverage. Objectives: To define the impact generated by the delay in the differ Discussion: Argentina has a very heterogeneous health system (pub ent diagnostic-therapeutic stages, from the onset of symptoms to the lic, social security and prepaid medicine). Our patients population receive attention in public and pri their relationship with socioeconomic factors. Unfortunately, this high-risk propor Czech Republic; 7Department of Oncology, Hospital Ceske Budejovice, tion of patients requiring urgent therapy (< 7 days; 23%) usually fails Ceske Budejovice, Czech Republic; 8Department of Haematooncology, to enter into majority of clinical trials. Gilbertson | inclusion/exclusion criteria in clinical trials, time to therapy initiation 2 S. In comparing the non-trial and trial groups, >1 51 (25) 38 (26) 89 (26) no statistically significant difference between the aforementioned Ann Arbor 0. The addition of rituximab significantly improves 374 the survival, especially in patients aged 70 years. Relapse (n=3) was the main course of Conclusions: Both hypogammaglobulinemia and hyp death. All these data were Odense University Hospital, Odense, Denmark; 5Department of obtained from the Ankara University Faculty of Medicine, Department of Hematology and Bone Marrow Transplant Unit. Their diagnosis Hematology, Zealand University Hospital, Roskilde, Denmark; 6Department of Hematology, Sygehus Lillebaelt, Vejle, Denmark; were as following; 17 diffuse large B cell lymphoma (primary refrac 7Department of Medicine, University of Iowa, Iowa City, United States; tory or relapsed disease), 8 mantle cell lymphoma (first complete 8Department of Laboratory Medicine and Pathology, Mayo Clinic, remission), 2 follicular lymphoma, 1 anaplastic large cell lymphoma Rochester, United States; 9Department of Hematology, Sydvestjysk and 1 peripheral t cell lymphoma. We compared the toxicity profile Sygehus, Esbjerg, Denmark; 10Department of Hematology, Aalborg and outcome between the research group: patient aged 60 years and University Hospital, Aalborg, Denmark; 11Department of Hematology, above and the control group: patient <60 years. Based on multivariable analysis, lower pre-treatment patients had Hgb levels below the lower limit of normal. Data Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel were collected by eletronic medical records. Introduction: the reported prevalence of hypercalcemia in non Results: Fifty-eight patients were analyzed. Patients older than 80 years old represented biomarker for an underlying aggressive biological feature. During the observation period less than half of the sensitivity and specificity (57. The analysis was age and gender-adjusted, observa tional period was 2014 and 2015. The treatment sites were neck/nasal cav Deauville score 4-5 pre radiotherapy 12 55 ity in 9 (64. Major causes of death and worsening of Method: We carried out a single centre retrospective review of general condition were pulmonary infection and aging-related illness. Although durable response and long Results: Twenty two patients were treated between 2010 and 2016. All patients received at least management is necessary to avoid deaths from cancer-unrelated 30 Gy in 15 fractions with a median dose of 36 Gy in 18 fractions causes. Qayum5** still suboptimal, and approximately 40% of patients have refractory 1Hematology and Medical Oncology, Tulane University School of disease or relapse. Results: Our search yielded five trials conducted between the years 2010 and 2018, including 2020 patients (one abstract, and four publi shed in peer review journals). The added drug was bortezomib in two trials; gemcitabine, bevacizumab and ibrutinib each drug in one trial. Qayum**,N:Employment Leadership Posi Methods: Databases were searched in September 2018 (Embase, tion: Roche. Cardiac risk factors that were present 2 19 (23%) included: ischaemic heart disease (n= 30), hypertension (n=29) and 3 23 (28%) conduction disorders (n=25). Twenty pts escalated to a Gem dose of 3-4 10 (12%) 1000mg/m2 on C3D1, 10/20 pts maintained the 1000mg/m2 dose in B symptoms Present 32 (39%) C4D1, 3/20 in C5D1 and 3/20 in C6D1. Rituximab (375 mg/m2 on day 1); a maximum number of 6 cycles was planned; 387 response assessment was performed after cycles 4 and 6. According to the Ray and Rai method less than 15/23 Treatment 2L 3L 4L 5L adverse events were also required for the safety coprimary received (N=993) (N=386) (N=166) (N=70) endpoint. We included patients Conclusions: the results of the planned interim analysis of our study with at least one prior line of therapy who initiated treatment within confirmed the initial efficacy and safety hypotheses of R2 combina 90 days of their diagnosis. The median age of patients receiving R-Benda was 75 years (inter quartile range 68–79); 90% of patients were 60 years or older. Patients refractory to their last prior line of therapy 1 2 3 4 accounted for 40% of the R-Benda-treated population. R-Benda was among the more commonly used regimens in a cohort of unselected patients. Most patients who Introduction: Bendamustine is approved for the treatment of indolent received R-Benda were older, which suggests the regimen may be lymphomas. However, bendamustine has been studied and used off favoured in the elderly, transplant-ineligible population. One hundred and thirty-six Ogbu, U: Employment Leadership Position: Genentech, Inc. Becquerel, Rouen, France; 6Radiology, Henri Mondor, Creteil, France; 7Radiology, Centre de Lutte anti Cancer H. Shirouchi | with blinatumomab in study 1, 4 (16%) evaluable patients achieved 1 1 1 T. Longer-term follow up Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, is needed to fully characterize the durability of complete response to Japan blinatumomab. The pathological diagnosis was performed based on mor Advisory Role: Autolus; Other Remuneration: Travel fees received from phological and immunohistochemical analyses. Ott | used to evaluate the stage at the diagnosis and the response after 15 2 1 1 A. The statistical analysis of characteristics of patients were per formed by Fisher’s exact test. The survivals were calculated by the 1Department of Hematology, Oncology and Pneumology, University Kaplan Meier method, and statistical analysis were performed by log Hospital Munster, Munster, Germany; 2Institute for Informatics, Statistics rank test.