Brentuximab vedotin with AVD for stage II-IV HIV-related Hodgkin lymphoma (AMC 085): phase 2 results from an open-label, single arm, multicentre phase 1/2 trial.

BACKGROUND: Brentuximab vedotin in combination with doxorubicin, vinblastine, and dacarbazine (AVD) is approved in the upfront setting for advanced stage classical Hodgkin lymphoma (cHL). People living with HIV have been excluded from these studies. We aimed to understand the activity and safety of brentuximab vedotin-AVD in people living with HIV diagnosed with Hodgkin lymphoma, while focusing on HIV disease parameters and antiretroviral therapy (ART) interactions. METHODS: We present the phase 2 portion of a multicentre phase 1/2 study. Eligible patients were 18 years or older, had untreated stage II-IV HIV-associated cHL (HIV-cHL), a Karnofsky performance status of more than 30%, a CD4+ T-cell count of 50 cells per µL or more, were required to take ART, and were not on strong CYP3A4 or P-glycoprotein inhibitors. Patients were treated intravenously with 1·2 mg/kg of brentuximab vedotin (recommended phase 2 dose) with standard doses of AVD for six cycles on days 1 and 15 of a 28-day cycle. The primary endpoint of the phase 2 portion was 2-year progression-free survival (PFS), assessed in all eligible participants who began treatment. Accrual has been completed. This trial is registered at ClinicalTrials.gov, NCT01771107. FINDINGS: Between March 8, 2013, and March 7, 2019, 41 patients received study therapy with a median follow up of 29 months (IQR 16-38). 34 (83%) of 41 patients presented with stage III-IV and seven (17%) with stage II unfavourable HIV-cHL. 37 (90%) of 41 patients completed therapy, all 37 of whom achieved complete response. The 2-year PFS was 87% (95% CI 71-94) and the overall survival was 92% (78-97). The most common grade 3 or worse adverse events were peripheral sensory neuropathy (four [10%] of 41 patients), neutropenia (18 [44%]), and febrile neutropenia (five [12%]). One treatment-related death was reported, due to infection. INTERPRETATION: Brentuximab vedotin-AVD was highly active and had a tolerable adverse event rate in HIV-cHL and is an important therapeutic option for people with HIV-cHL. The complete reponse rate is encouraging and is possibly related to a unique aspect of HIV-cHL biology. Upcoming 5-year data will evaluate the sustainability of the outcomes obtained. FUNDING: National Institutes of Health and National Cancer Institute.

IN-HOME-PDCaregivers: The effects of a combined home visit and peer mentoring intervention for caregivers of homebound individuals with advanced Parkinson's disease.

INTRODUCTION: Family caregivers of people with advanced Parkinson's Disease (PD) are at high risk of caregiver strain, which independently predicts adverse patient outcomes. We tested the effects of one year of interdisciplinary, telehealth-enhanced home visits (IN-HOME-PD) with 16 weeks of peer mentoring on caregiver strain compared with usual care. METHODS: We enrolled homebound people with advanced PD (PWPD) and their primary caregiver as IN-HOME-PD dyads. We trained experienced PD family caregivers as peer mentors. Dyads received four structured home visits focused on advanced symptom management, home safety, medications, and psychosocial needs. Starting at approximately four months, caregivers spoke weekly with a peer mentor for 16 weeks. We compared one-year change in caregiver strain (MCSI, range 0-72) with historical controls, analyzed intervention acceptability, and measured change in anxiety, depression, and self-efficacy. RESULTS: Longitudinally, IN-HOME-PD caregiver strain was unchanged (n = 51, 23.34 (SD 9.43) vs. 24.32 (9.72), p = 0.51) while that of controls worsened slightly (n = 154, 16.45 (10.33) vs. 17.97 (10.88), p = 0.01). Retention in peer mentoring was 88.2%. Both mentors and mentees rated 100% of mentoring calls useful, with mean satisfaction of 91/100 and 90/100, respectively. There were no clinically significant improvements in anxiety, depression, or self-efficacy. CONCLUSIONS: Interdisciplinary telehealth-enhanced home visits combined with peer mentoring mitigated the worsening strain observed in caregivers of less advanced individuals. Mentoring was met with high satisfaction. Future caregiver-led peer mentoring interventions are warranted given the growing, unmet needs of PD family caregivers. TRIAL REGISTRATION: NCT03189459.

Screening and Assessment of Cancer-Related Fatigue: A Clinical Practice Guideline for Health Care Providers.

Cancer-related fatigue (CRF) is the most common side effect of cancer treatment. Regular surveillance is recommended, but few clinical practice guidelines transparently assess study bias, quality, and clinical utility in deriving recommendations of screening and assessment methods. The purpose of this clinical practice guideline (CPG) is to provide recommendations for the screening and assessment of CRF for health care professions treating individuals with cancer. Following best practices for development of a CPG using the Appraisal of Guidelines for Research and Evaluation (AGREE) Statement and Emergency Care Research Institute (ECRI) Guidelines Trust Scorecard, this CPG included a systematic search of the literature, quality assessment of included evidence, and stakeholder input from diverse health care fields to derive the final CPG. Ten screening and 15 assessment tools supported by 114 articles were reviewed. One screen (European Organisation for Research and Treatment of Cancer-Quality of Life Questionnaire-30 Core Questionnaire) and 3 assessments (Piper Fatigue Scale-Revised, Functional Assessment of Chronic Illness Therapy-Fatigue, and Patient Reported Outcome Measurement Information System [PROMIS] Fatigue-SF) received an A recommendation ("should be used in clinical practice"), and 1 screen and 5 assessments received a B recommendation ("may be used in clinical practice"). Health care providers have choice in determining appropriate screening and assessment tools to be used across the survivorship care continuum. The large number of tools available to screen for or assess CRF may result in a lack of comprehensive research evidence, leaving gaps in the body of evidence for measurement tools. More research into the responsiveness of these tools is needed in order to adopt their use as outcome measures. IMPACT: Health care providers should screen for and assess CRF using one of the tools recommended by this CPG.

IN-HOME-PD: The effects of longitudinal telehealth-enhanced interdisciplinary home visits on care and quality of life for homebound individuals with Parkinson's disease.

INTRODUCTION: Homebound individuals with advanced Parkinson's disease (PD) are underrepresented in research and care. We tested the impact of interdisciplinary, telehealth-enhanced home visits (IN-HOME-PD) on patient quality of life (QoL) compared with usual care. METHODS: Nonrandomized controlled trial of quarterly, structured, telehealth-enhanced interdisciplinary home visits focused on symptom management, home safety, medication reconciliation, and psychosocial needs (ClinicalTrials.gov NCT03189459). We enrolled homebound participants with advanced PD (Hoehn & Yahr (HY) stage ≥3). Usual care participants had ≥2 visits in the Parkinson's Outcomes Project (POP) registry. We compared within- and between-group one-year change in QoL using the Parkinson's Disease Questionnaire. RESULTS: Sixty-five individuals enrolled in IN-HOME-PD (32.3% women; mean age 78.9 (SD 7.6) years; 74.6% white; 78.5% HY ≥ 4) compared with 319 POP controls, with differences in age, race, and PD severity (37.9% women; mean age 70.1 (7.8) years; 96.2% white; 15.1% HY ≥ 4). Longitudinally, the intervention group's QoL remained unchanged (within-group p = 0.74, Cohen's d = 0.05) while QoL decreased over time in POP controls (p < 0.001, Cohen's d = 0.27). The difference favored the intervention (between-group p = 0.04). POP participants declined in 7/8 dimensions while IN-HOME-PD participants' bodily discomfort improved and hospice use and death at home-markers of goal-concordant care-far exceeded national data. CONCLUSIONS: Telehealth-enhanced home visits can stabilize and may improve the predicted QoL decline in advanced PD via continuity of care and facilitating goal-concordant care, particularly among diverse populations. Extrapolating features of this model may improve continuity of care and outcomes in advanced PD.

Peer Mentoring Program for Informal Caregivers of Homebound Individuals With Advanced Parkinson Disease (Share the Care): Protocol for a Single-Center, Crossover Pilot Study.

BACKGROUND: Homebound individuals with advanced Parkinson disease (PD) require intensive caregiving, the majority of which is provided by informal, family caregivers. PD caregiver strain is an independent risk factor for institutionalization. There are currently no effective interventions to support advanced PD caregivers. Studies in other neurologic disorders, however, have demonstrated the potential for peer mentoring interventions to improve caregiver outcomes. In the context of an ongoing trial of interdisciplinary home visits, we designed and piloted a nested trial of caregiver peer mentoring for informal caregivers of individuals with advanced PD. OBJECTIVE: The aim of this study was to test the feasibility of peer mentoring for caregivers of homebound individuals with advanced PD and to evaluate its effects on anxiety, depression, and caregiver strain. METHODS: This was a single-center, 16-week pilot study of caregiver peer mentoring nested within a year-long controlled trial of interdisciplinary home visits. We recruited 34 experienced former or current family caregivers who completed structured mentor training. Caregivers enrolled in the larger interdisciplinary home visit trial consented to receive 16 weeks of weekly, one-to-one peer mentoring calls with a trained peer mentor. Weekly calls were guided by a curriculum on advanced PD management and caregiver support. Fidelity to and satisfaction with the intervention were gathered via biweekly study diaries. Anxiety, depression, and caregiver strain were measured pre- and postmentoring intervention at home visits 2 and 3. RESULTS: Enrollment and peer-mentor training began in 2018, and 65 caregivers enrolled in the overarching trial. The majority of mentors and mentees were White, female spouses or partners of individuals with PD; mentors had a mean of 8.7 (SD 6.4) years of caregiving experience, and 33 mentors were matched with at least 1 mentee. CONCLUSIONS: This is the first study of caregiver peer mentoring in PD and may establish an adaptable and sustainable model for disease-specific caregiver interventions in PD and other neurodegenerative diseases. TRIAL REGISTRATION: ClinicalTrials.gov NCT03189459; http://clinicaltrials.gov/ct2/show/NCT03189459. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/34750.

Upholding Familism Among Asian American Youth: Measures of Familism among Filipino and Korean American Youth.

Although it is one of the core cultural values of Asian American families and an influential determinant of youth development, familism remains under-studied among Asian Americans and, despite crucial within-group heterogeneity, lacks subgroup specificity. This study describes the ways in which two major Asian American subgroups of youth, i.e., Filipino Americans and Korean Americans, maintain traditional familism. Specifically, this study constructed six self-report subscales of familism utilizing underused and new survey items and tested their psychometric properties. Using data collected from Filipino American (n=150) and Korean American (n=188) adolescents living in a Midwest metropolitan area, the measures were examined for validity and reliability for each group and, when appropriate, for measurement invariance across the groups. The main findings are that the finalized scales demonstrated solid reliability and validity (e.g., content and construct) in each group and some invariance and that core traditions, in the form of familism values and behaviors, persevere among second-generation Asian Americans, although familism was more evident among Filipino American youth than in Korean American youth. In both groups, subdomains of familism were not as discrete as found among their parents, who were predominantly foreign-born first-generation immigrants. The finalized familism scales were associated differently with several correlates including acculturation variables and youth outcomes. The findings are discussed with a call for further empirical research of diverse ethnic groups and immigrant generations to more accurately account for how family process interacts with cultural origin and acculturation.

Longitudinal, Interdisciplinary Home Visits Versus Usual Care for Homebound People With Advanced Parkinson Disease: Protocol for a Controlled Trial.

BACKGROUND: The current understanding of advanced Parkinson disease (PD) and its treatment is largely based on data from outpatient visits. The most advanced and disabled individuals with PD are disconnected from both care and research. A previous pilot study among older, multimorbid patients with advanced PD demonstrated the feasibility of interdisciplinary home visits to reach the target population, improve care quality, and potentially avoid institutionalization. OBJECTIVE: The aim of this study protocol is to investigate whether interdisciplinary home visits can prevent a decline in quality of life of patients with PD and prevent worsening of caregiver strain. The protocol also explores whether program costs are offset by savings in health care utilization and institutionalization compared with usual care. METHODS: In this single-center, controlled trial, 65 patient-caregiver dyads affected by advanced PD (Hoehn and Yahr stages 3-5 and homebound) are recruited to receive quarterly interdisciplinary home visits over 1 year. The 1-year intervention is delivered by a nurse and a research coordinator, who travel to the home, and it is supported by a movement disorder specialist and social worker (both present by video). Each dyad is compared with age-, sex-, and Hoehn and Yahr stage-matched control dyads drawn from US participants in the longitudinal Parkinson's Outcome Project registry. The primary outcome measure is the change in patient quality of life between baseline and 1 year. Secondary outcome measures include changes in Hoehn and Yahr stage, caregiver strain, self-reported fall frequency, emergency room visits, hospital admissions, and time to institutionalization or death. Intervention costs and changes in health care utilization will be analyzed in a budget impact analysis to explore the potential for model adaptation and dissemination. RESULTS: The protocol was funded in September 2017 and approved by the Rush Institutional Review Board in October 2017. Recruitment began in May 2018 and closed in November 2019 with 65 patient-caregiver dyads enrolled. All study visits have been completed, and analysis is underway. CONCLUSIONS: To our knowledge, this is the first controlled trial to investigate the effects of interdisciplinary home visits among homebound individuals with advanced PD and their caregivers. This study also establishes a unique cohort of patients from whom we can study the natural course of advanced PD, its treatments, and unmet needs. TRIAL REGISTRATION: ClinicalTrials.gov NCT03189459; http://clinicaltrials.gov/ct2/show/NCT03189459. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/31690.

Disempowering Parenting and Mental Health among Asian American Youth: Immigration and Ethnicity.

Guided by the concept of ABCDG (Abusive, Burdening, Culturally Disjointed, Disengaged, and Gender Prescriptive) parenting, this study investigated how subdomains of disempowering parenting adversely influence young people's mental health, independently and collectively, using a large-scale longitudinal survey data of community samples among Filipino American (FA) and Korean American (KA) youth (M AGE =15.01, N=1,580; 391 FA and 417 KA families). Regression results showed that the subdomains of disempowering parenting, while individually harmful, were differentially associated with mental health. For example, abusive and disengaged parenting and culturally disjointed parenting (a.k.a. intergenerational cultural conflict) were the most notably adverse subdomains and remained significant when all subdomains were accounted together. This study pinpoints specific aspects of disempowering parenting that may lead to mental distress among FA and KA youth and underscores a need for culturally tailored intervention programs that address the harms of disempowering parenting approaches.

Explaining the Asian American Youth Paradox: Universal Factors versus Asian American Family Process Among Filipino and Korean American Youth.

This study used longitudinal survey data of Filipino American and Korean American youth to examine ways in which universal factors (e.g., peer antisocial behaviors and parent-child conflict) and Asian American (AA) family process variables (e.g., gendered norms) independently and collectively predict grade point average (GPA), externalizing, and internalizing problems. We aimed to explain the "Asian American youth paradox" in which low externalizing problems and high GPA coexist with high internalizing problems. We found that universal factors were extensively predictive of youth problems and remained robust when AA family process was accounted for. AA family process also independently explained youth development and, in part, the AA youth paradox. For example, gendered norms increased mental distress. Academic controls did the opposite of what it is intended, that is, had a negative impact on GPA as well as other developmental domains. Family obligation, assessed by family-centered activities and helping out, was beneficial to both externalizing and internalizing youth outcomes. Parental implicit affection, one of the distinct traits of AA parenting, was beneficial, particularly for GPA. This study provided important empirical evidence that can guide cross-cultural parenting and meaningfully inform intervention programs for AA youth.

Este estudio utilizó datos de una encuesta longitudinal de jóvenes filipinoamericanos y coreanoamericanos para analizar las maneras en las que los factores universales (p. ej.:las conductas antisociales entre pares y el conflicto entre padres e hijos) y las variables de los procesos familiares asiáticoamericanos (p. ej.: las normas de género) predicen independientemente y colectivamente el promedio de calificaciones y los problemas interiorizados y exteriorizados. Nos propusimos explicar la "paradoja de los jóvenes asiáticoamericanos" en la cual un bajo grado de problemas exteriorizados y un alto promedio de calificaciones coexisten con un alto grado de problemas interiorizados. Descubrimos que los factores universales fueron en gran parte predictivos de los problemas de los jóvenes y se mantuvieron firmes cuando se tuvo en cuenta el proceso familiar asiáticoamericano. El proceso familiar asiáticoamericano también explicó independientemente el desarrollo de los jóvenes y, en parte, la paradoja de los jóvenes asiáticoamericanos. Por ejemplo, las normas de género aumentaron el distrés mental. Los controles académicos hicieron lo opuesto a lo deseado, por ejemplo, tuvieron un efecto negativo en el promedio de calificaciones así como en otras áreas del desarrollo. La obligación familiar, evaluada por actividades centradas en la familia y por la colaboración, fue beneficiosa tanto para los resultados exteriorizados como interiorizados de los jóvenes. El afecto implícito de los padres, uno de los rasgos distintivos de la crianza de los asiáticoamericanos, fue beneficioso, particularmente para el promedio de calificaciones. Este estudio ofreció importante conocimiento empírico que puede guiar la crianza intercultural y respaldar de manera significativa programas de intervención para jóvenes asiáticoamericanos.

Asian American mental health: Longitudinal trend and explanatory factors among young Filipino- and Korean Americans.

OBJECTIVES: This study examined a longitudinal trend of mental health among young Asian Americans during the transition from adolescence to emerging adulthood and investigated explanatory factors of the trend. METHOD: We longitudinally followed a cohort of Filipino American and Korean American youth and their families in Midwest since 2014 (N = 1,574 in Wave 1). This study used three waves of youth data (n = 781, M AGE  = 15 in W1). RESULTS: Depressive symptoms and suicidal ideation significantly increased among the samples between 2014 and 2018, which also became more serious in severity. Intergenerational cultural conflict in the family and the experience of racial discrimination significantly contributed to the upsurge of mental health distress. Conversely, a strong peer relationship and ethnic identity were critical resources suppressing both depressive symptoms and suicidal ideation. CONCLUSIONS: This study substantiated a troubling upward trend in mental health struggles among young Asian Americans and demonstrated a significant additive influence of culture and race/ethnicity on mental health beyond the normative influences of family process and peers. These key factors should be targeted in intervention to better serve Asian American young people who may mask their internal struggles.

Interdisciplinary palliative care for people with advanced Parkinson's disease: a view from the home.

BACKGROUND: Advanced Parkinson's disease (PD) is a multidimensional neurodegenerative condition with motor and non-motor symptoms contributing to increasing disability and decreasing quality of life. As the disease progresses, patients may become homebound and estranged from neurological care, with dire consequences. We describe the increasing epidemiologic burden of and individual risks faced by patients with palliative-stage PD and their caregivers. METHODS: With the aim of mitigating these risks, we designed and iterated two models of interdisciplinary home visits to maintain continuity of care and illuminate the unmet needs and barriers to care faced by this population. We describe both models in detail, with data on feasibility and patient-centered outcomes achieved in the initial model, and baseline characteristics of participants in the ongoing expanded model. Finally, we illustrate the scope and common themes of such palliative care-informed home visits with two cases. RESULTS: The pilot model involved over 380 visits with 109 individual patients. Among those patients, PD severity worsened by nearly 12 points annually on the Unified Parkinson's Disease Rating Scale (UPDRS), without a corresponding decline in quality of life. In an ongoing study of the second iteration of the model, 52 patient-caregiver dyads have completed their initial visit, with 44% bearing a diagnosis of dementia and the majority requiring an assistive device or being bedbound. Two cases highlight the critical importance of thorough medication reconciliation and home safety assessment in the comprehensive evaluation and management of such patients. CONCLUSIONS: As our population ages, therapies increase, and the number of individuals living with advanced PD and related disorders grows, so too does the imperative to recognize and address the palliative care needs of such patients and families. For many, home may be a viable, and perhaps optimal, site for this care.

Mobile Mammography Screening as an Opportunity to Increase Access of Rural Women to Breast Cancer Research Studies.

OBJECTIVES: Rural women are underrepresented in cancer research. We hypothesized that providing access to a research study to rural, medically underserved women who were receiving their breast cancer screening using a mobile mammography unit would increase the representation of rural women in a cancer cohort study. DESIGN: This study is a cross-sectional study using a cohort of women who have been recruited to a breast cancer study in Arkansas. SETTING: Recruiters accompanied a mobile mammography unit, the MammoVan, to implement a novel method for reaching and recruiting underrepresented rural Arkansas women into the study. Participants include 5850 women recruited from 2010 through 2012 as part of the Arkansas Rural Community Health (ARCH) study. RESULTS: Participants recruited during their mammography screening on the MammoVan tended to be more rural, less educated, and more likely to be non-Hispanic than those recruited in other venues. A significant difference was not noted for race or age. CONCLUSION: Collaboration with the MammoVan greatly aided the recruitment of rural participants. These strategies can facilitate the representation of this historically underserved and understudied rural population in future research studies.

Bilinear and Multidimensional Cultural Orientations and Indigenous Family Process among Korean Immigrant Mothers and Fathers.

This study examined how parental cultural orientations and family process are related among Korean immigrant parents (272 mothers, and 164 fathers, N=436) and how the relationship varies across fathers and mothers. Multiple scales were used to assess bilinear, multidimensional cultural orientation towards both the culture of origin and mainstream culture. The dimensions of language, identity, and cultural participation as well as the number of years living in U.S. were analyzed. The main findings include: (1) parents who maintain heritage culture orientation were more likely to preserve traditional parenting values and practices, (2) parental host culture orientation largely had no impact on traditional parenting but some elements of the host culture orientation were in fact associated with stronger endorsements of traditional parenting, (3) each dimension of acculturation differentially related to traditional parenting, and (4) significant relationships were more pronounced among parenting values than practices. These patterns were largely similar across mothers and fathers. Although some mixed findings suggest the complexity of the hypothesized relationships, the present study findings highlight the importance of bilinear and multidimensional acculturation and core vs. peripheral elements of culture in family process. Implications for practice and future research are discussed.

Explicating Acculturation Strategies among Asian American Youth: Subtypes and Correlates across Filipino and Korean Americans.

Acculturation strategy, a varying combination of heritage and mainstream cultural orientations and one of the significant determinants of youth development, has been understudied with Asian American youth and particularly at a subgroup-specific level. This study used person-oriented latent profile analysis (LPA) to identify acculturation strategy subtypes among Filipino American and Korean American adolescents living in the Midwest. Associations between the subtypes and numerous correlates including demographics, family process and youth outcomes were also examined. Using large scale survey data (N = 1580; 379 Filipino American youth and 377 parents, and 410 Korean American youth and 414 parents; MAGE of youth = 15.01), the study found three acculturation subtypes for Filipino American youth: High Assimilation with Ethnic Identity, Integrated Bicultural with Strongest Ethnic Identity, and Modest Bicultural with Strong Ethnic Identity; and three acculturation subtypes for Korean American youth: Separation, Integrated Bicultural, and Modest Bicultural with Strong Ethnic Identity. Both Filipino American and Korean American youth exhibited immersion in the host culture while retaining a strong heritage identity. Although bicultural strategies appear most favorable, the results varied by gender and ethnicity, e.g., integrated bicultural Filipino Americans, comprised of more girls, might do well at school but were at risk of poor mental health. Korean American separation, comprised of more boys, demonstrated a small but significant risk in family process and substance use behaviors that merits in-depth examination. The findings deepen the understanding of heterogeneous acculturation strategies among Asian American youth and provide implications for future research.

Safety and Preliminary Efficacy of Vorinostat With R-EPOCH in High-risk HIV-associated Non-Hodgkin's Lymphoma (AMC-075).

INTRODUCTION: Vorinostat (VOR), a histone deacetylase inhibitor, enhances the anti-tumor effects of rituximab (R) and cytotoxic chemotherapy, induces viral lytic expression and cell killing in Epstein-Barr virus-positive (EBV+) or human herpesvirus-8-positive (HHV-8+) tumors, and reactivates latent human immunodeficiency virus (HIV) for possible eradication by combination antiretroviral therapy (cART). PATIENTS AND METHODS: We performed a phase I trial of VOR given with R-based infusional EPOCH (etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin hydrochloride) (n = 12) and cART in aggressive HIV-associated B-cell non-Hodgkin lymphoma (NHL) in order to identify safe dosing and schedule. VOR (300 or 400 mg) was given orally on days 1 to 5 with each cycle of R-EPOCH for 10 high-risk patients with diffuse large B-cell lymphoma (1 EBV+), 1 EBV+/HHV-8+ primary effusion lymphoma, and 1 unclassifiable NHL. VOR was escalated from 300 to 400 mg using a standard 3 + 3 design based on dose-limiting toxicity observed in cycle 1 of R-EPOCH. RESULTS: The recommended phase II dose of VOR was 300 mg, with dose-limiting toxicity in 2 of 6 patients at 400 mg (grade 4 thrombocytopenia, grade 4 neutropenia), and 1 of 6 treated at 300 mg (grade 4 sepsis from tooth abscess). Neither VOR, nor cART regimen, significantly altered chemotherapy steady-state concentrations. VOR chemotherapy did not negatively impact CD4+ cell counts or HIV viral loads, which decreased or remained undetectable in most patients during treatment. The response rate in high-risk patients with NHL treated with VOR(R)-EPOCH was 100% (complete 83% and partial 17%) with a 1-year event-free survival of 83% (95% confidence interval, 51.6%-97.9%). CONCLUSION: VOR combined with R-EPOCH was tolerable and seemingly efficacious in patients with aggressive HIV-NHL.

Culture and Family Process: Measures of Familism for Filipino and Korean American Parents.

This study tests the psychometric properties of multiple survey items and scales that are either underused or newly developed to assess familism among Asian Americans. Using data collected from 150 Filipino and 188 Korean American parents (mostly mothers) in the Midwest region in 2013, the measures were examined for validity and reliability for each group and, when appropriate, for cross-cultural equivalence across the groups. Several scales and their items showed high quality psychometric properties and are ready for use to more accurately assess family process of each target group and to conduct comparative analyses. The findings also show that, contrary to the expectation, Filipino American families express more traditional aspects of familism than do Korean American families, and are more likely to reinforce traditional familism beliefs and behaviors among their children. This study reinforces a need for more empirical- and subgroup-specific research effort.

Acute Leukemia of Ambiguous Lineage in Elderly Patients - Analysis of Survival Using Surveillance Epidemiology and End Results-Medicare Database.

BACKGROUND: Acute leukemia of ambiguous lineage (ALAL) is a rare leukemia with sparse data availability about the survival and management strategies in elderly patients. METHODS: We used the Surveillance Epidemiology and End Results (SEER)-Medicare database to describe the overall survival (OS) and treatment pattern of elderly patients (age > 65 years) with ALAL. OS analysis was done using the Kaplan-Meier method, and its determinants were analyzed using the Cox proportional hazard regression method with a significant P < .05. RESULTS: We included 705 patients with ALAL and a median age of 80 years. The 2-year OS was 16.4% for patients aged 66 to 70 years, 8.1% for patients aged 71 to 75 years, 5.5% for patients aged 76 to 80 years, and 3.7% for patients aged > 80 years (P < .01). Two-year OS did not significantly vary by race or gender. Among the study cohort, 151 patients received chemotherapy. Two-year OS was 17% in the chemotherapy group and 3% in the no-chemotherapy group (P < .001). On multivariate analysis, age less than 80 years (Age 66-70 years: hazard ratio [HR]; 0.66, 95% confidence interval [CI], 0.52-0.85; age 71-75 years: HR, 0.80; 95% CI, 0.65-0.99; age 76-80 years: HR, 0.80; 95% CI, 0.66-0.98; P = .004) and chemotherapy (HR, 0.51; 95% CI, 0.42-0.62; P = .001) significantly reduced the hazard for mortality. CONCLUSION: Our study suggests that the OS of elderly patients with ALAL remains poor. Although treatment improved the OS, only 21.5% of patients received therapy. The optimal choice of therapy needs to be determined by prospective studies.

Hypolipidemic and cardioprotective benefits of a novel fireberry hawthorn fruit extract in the JCR:LA-cp rodent model of dyslipidemia and cardiac dysfunction.

Hawthorn is a widely used herbal alternative medicine for the treatment of various cardiovascular diseases. However, the attributed health benefits, purported to be due to the presence of phenolic compounds, may depend on both the specific species and plant part. Studies to date investigating effects of hawthorn on heart disease(s) have used well-described European and/or Asian species, while little is known regarding the bioactivity of species native to North America. Six weeks of supplementation of both fireberry hawthorn berry (native Crataegus chrysocarpa) and English hawthorn leaf (C. monogyna, naturalized in North America) in the JCR:LA-cp rat, resulted in a significant reduction in heart weight, fasting LDL-C and improved heart function (p < 0.05). Fasting triglyceride and myocardial fibrosis were also reduced, but only by the berry extract. We demonstrate that both of the Canadian-sourced hawthorn extracts (introduced leaf and native berry) have cardioprotective benefits, likely via increased availability of nitric oxide.

DNA barcodes from four loci provide poor resolution of taxonomic groups in the genus Crataegus.

DNA barcodes can facilitate identification of organisms especially when morphological characters are limited or unobservable. To what extent this potential is realized in specific groups of plants remains to be determined. Libraries of barcode sequences from well-studied authoritatively identified plants represented by herbarium voucher specimens are needed in order for DNA barcodes to serve their intended purpose, where this is possible, and to understand the reasons behind their failure to do so, when this occurs. We evaluated four loci, widely regarded as universal DNA barcodes for plants, for their utility in hawthorn species identification. Three plastid regions, matK, rbcLa and psbA-trnH, and the internal transcribed spacer 2 (ITS2) of nuclear ribosomal DNA discriminate only some of the species of Crataegus that can be recognized on the basis of their morphology etc. This is, in part, because in Rosaceae tribe Maleae most individual plastid loci yield relatively little taxonomic resolution and, in part, because the effects of allopolyploidization have not been eliminated by concerted evolution of the ITS regions. Although individual plastid markers provided generally poor resolution of taxonomic groups in Crataegus, a few species were notable exceptions. In contrast, analyses of concatenated sequences of the 3 plastid barcode loci plus 11 additional plastid loci gave a well-resolved maternal phylogeny. In the ITS2 tree, different individuals of some species formed groups with taxonomically unrelated species. This is a sign of lineage sorting due to incomplete concerted evolution in ITS2. Incongruence between the ITS2 and plastid trees is best explained by hybridization between different lineages within the genus. In aggregate, limited between-species variation in plastid loci, hybridization and a lack of concerted evolution in ITS2 all combine to limit the utility of standard barcoding markers in Crataegus. These results have implications for authentication of hawthorn materials in natural health products.

Temporal recovery of activities of daily living in the first year after ischemic stroke: a prospective study of patients admitted to a rehabilitation unit.

BACKGROUND: The ability to perform basic activities of daily living (ADL) independently is a marker of functional recovery after a stroke. However, there few studies documenting their long-term recovery. OBJECTIVE: To document temporal recovery of activities of daily living (ADL) and establish predictors of ADL in a cohort of ischemic stroke patients in the first year after stroke. METHODS: Prospective cohort study of 163 patients with first-ever ischemic stroke admitted to a rehabilitation centre. The Modified Barthel Index (MBI) was used to measure the patient's ability to perform the following 10 ADLs: feeding, grooming, dressing, bathing, toileting, bladder and bowel continence, transfers, ambulation and stair climbing. It was assessed on rehabilitation admission, discharge, and at 3, 6 and 12 months after stroke. The Motricity Index was used to measure motor power of the hemiplegic limb. RESULTS: The mean age was 63.8 (10.7) years, with 111 males and 52 females. The mean total MBI scores on rehabilitation admission, rehabilitation discharge, 3, 6 and 12 months after stroke were 41.3 (24.6), 72.9 (20.5), 88.4 (18.6), 90.5 (17.2) and 84.2 (20.4) respectively. Median scores of feeding, grooming, toileting, bladder/bowel continence, transfers and ambulation plateaued by 3 months after stroke. Median scores of dressing and stair climbing plateaued at 6 months and that for bathing, 12 months after stroke. None of the patients were functionally independent (defined as MBI score of 100) on rehabilitation admission, but this improved to 8.6% on discharge, and 32.1%, 41.4% and 50.3% at 3, 6 and 12 months after stroke respectively. The MBI and Motricity scores were strongly correlated at all periods of follow up (r = 0.67 to 0.69, p < 0.0001). Univariate analysis showed that age, neglect, a cortical stroke, admission MBI, NIHSS, Motricity Index and Abbreviated Mental Score scores were predictors of functional independence at 12 months after stroke. On logistic regression, only age remained significant, younger patients being more likely than older patients to be functionally independent. CONCLUSION: Most recovery of ADL occurs by 3 months after stroke. For individual ADLs, dressing, stair climbing and bathing appear to take a longer time to recover. Older age was a negative predictor of functional dependence at 12 months after stroke.