ABSTRACT
Bloodless autologous hematopoietic cell transplantation is associated with risks of severe bleeding and profound anemia. RBC or platelet transfusions are often used to prevent these hematologic complications. However, in patients such as Jehovah's Witnesses who refuse major blood components, the lack of transfusion support is not an absolute contraindication to an autologous hematopoietic cell transplant. Pennsylvania Hospital performed the world's first bloodless hematopoietic cell transplant more than 15 years ago and has gradually improved its technique with a sizable patient population. Erythropoiesis-stimulating agents were successfully employed as part of their pretransplant regimen to prevent severe anemia. Thrombopoietin agonists' potential role in bloodless transplant is also currently being explored. Although there is limited literature, available reports in combination with physiologic reasoning may support the use of these growth factors to promote transplant success. These agents offer potential benefit and may be of utility in minimizing complications of a bloodless transplant. In this review, we summarize the available literature and offer insight into how we may incorporate growth factors to allow bloodless autologous hematopoietic cell transplantation to be an available option to patients who may otherwise be denied.
Subject(s)
Hematopoietic Stem Cell Transplantation/methods , Thrombopoietin/metabolism , Transplantation Conditioning/methods , Transplantation, Autologous/methods , Humans , Jehovah's WitnessesABSTRACT
PURPOSE: Ambulatory administration of chemotherapy provides benefit to patients and institutions alike. We hypothesized that transitioning rituximab, etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin (R-EPOCH) from an inpatient to ambulatory setting would reduce inpatient bed days and overall healthcare costs. The purpose of this effort was to create a guideline that would transition R-EPOCH to the ambulatory setting. To assess institutional benefit, we assessed inpatient bed days saved and financial impact. METHODS: A single center, retrospective analysis of inpatient R-EPOCH administration from January 2013 to December 2015 defined the need for medication use guidelines for ambulatory R-EPOCH administration. While this guideline targeted a reduction in inpatient bed days, it also created desired staff-and-patient education on R-EPOCH. Multidisciplinary collaboration enabled this comprehensive approach to outpatient chemotherapy administration. RESULTS: The 42 patients included received 147 cycles of R-EPOCH. Administration was primarily inpatient, amounting to 107 cycles and 799 inpatient days. Concurrently, 40 cycles of R-EPOCH were administered to 11 patients in the ambulatory setting. Only two patients received all cycles as outpatient; the other nine patients received chemotherapy in both settings. Financial analysis showed a 53% reduction in drug acquisition cost and 30% reduction in direct costs with ambulatory R-EPOCH administration. Based on our projection, after guideline implementation, 12 patients will be eligible for ambulatory R-EPOCH annually, resulting in a savings of 360 bed days and approximately $650,000 per year. CONCLUSION: Transitioning R-EPOCH is a viable option to significantly decrease inpatient bed days and overall healthcare costs. Multidisciplinary collaboration is vital to successfully transitioning regimens to the ambulatory setting and to establishing consistent support for ambulatory administration.
Subject(s)
Ambulatory Care/methods , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Hospitalization , Rituximab/administration & dosage , Adult , Aged , Ambulatory Care/trends , Cyclophosphamide/administration & dosage , Doxorubicin/administration & dosage , Etoposide/administration & dosage , Female , Hospitalization/trends , Humans , Male , Middle Aged , Neoplasms/drug therapy , Prednisone/administration & dosage , Retrospective Studies , Vincristine/administration & dosageABSTRACT
The field of primate behavior management has had only limited success in preventing and treating abnormal behaviors, such as stereotypy and self-injury, in captive non-human primates (NHP). In contrast, applied behavior analysts have had great success in treating similar topographies of behavior in human clinical settings. By adapting and adopting the behavioral principles and methodologies commonly used by applied behavior analysts, primatologists may be able to develop more effective ways to analyze, reduce, and prevent these aberrant behaviors in NHP. This article reviews studies that have used behavior analytic techniques to successfully address problem behaviors in NHP. Additionally, relevant literature from the field of applied behavior analysis is reviewed to illustrate how adopting a theoretical framework that emphasizes the determination of the underlying operant functions of behavior could lead to new behavioral technologies and advance the field of captive primate management. Am. J. Primatol. 79:e22500, 2017. © 2015 Wiley Periodicals, Inc.
Subject(s)
Behavior, Animal , Primates , Self-Injurious Behavior , Animals , Animals, Laboratory , Humans , Stereotyped BehaviorABSTRACT
Pair housing of macaques has become a widely implemented compromise between meeting the social needs of the monkeys and allowing for their use in biomedical research. While beneficial to the animals, pair housing can provide challenges for those caring for them. Drawing from both scientific literature and direct experience, this paper provides a review of practical aspects of pair housing including partner selection, pairing methodologies, staff education, and equipment considerations. Recommendations include selecting a pairing method appropriate to the facility and the individual animals being paired, educating staff on social behavior, and establishing a pair monitoring program to facilitate long-term pair maintenance. Assessment of behavior is essential in determining the compatibility of new pairs and in identifying established pairs that may need interventions to enhance their long-term compatibility. The pair housing program at the Yerkes National Primate Research Center is described as one model of a successful program. Am. J. Primatol. 79:e22485, 2017. © 2015 Wiley Periodicals, Inc.
Subject(s)
Macaca , Pair Bond , Social Behavior , Animals , Animals, Laboratory , Housing, Animal , PrimatesABSTRACT
The field of applied behavior analysis has been directly involved in both research and applications of behavioral principles to improve the lives of captive zoo animals. Thirty years ago, Forthman and Ogden (1992) wrote one of the first papers documenting some of these efforts. Since that time, considerable work has been done using behavioral principles and procedures to guide zoo welfare efforts. The current paper reexamines and updates Forthman and Ogden's original points, with attention to the 5 categories they detailed: (a) promotion of species-typical behavior, (b) reintroduction and repatriation of endangered species, (c) animal handling, (d) pest control, and (e) animal performances. In addition, we outline 3 current and future directions for behavior analytic endeavors: (a) experimental analyses of behavior and the zoo, (b) applied behavior analysis and the zoo, and (c) single-case designs and the zoo. The goal is to provide a framework that can guide future behavioral research in zoos, as well as create applications based on these empirical evaluations.
Subject(s)
Animal Husbandry , Applied Behavior Analysis , Animals , Humans , Animal Husbandry/methods , Animal Welfare , Behavior, Animal , Animals, ZooABSTRACT
With millions of dogs housed in shelters each year, it is important to consider how the shelter environment impacts welfare. Social isolation and a lack of control over the environment can negatively impact wellbeing. However, providing social opportunities requires costly resources and can raise concerns about increased barking. In this study, 17 dogs were observed before, during, and after a visual barrier was partially removed to increase the ability to see to other dogs and the surrounding room. Stress behaviors, crate position, and resting behaviors did not differ significantly across phases; however, vocalizations were lower in the visual access and post phases (Friedman's test, p = .02). In addition, in-room barking data (N = 66) revealed no change in barking duration when barriers were removed. This absence of an increase in vocalizations should alleviate some concerns with allowing visual social contact. However, the lack of impact on stress and resting behaviors may indicate that visual social contact alone is insufficient for providing significant welfare benefits and that shelters should prioritize increasing social contact through playgroups or group housing.
ABSTRACT
Social housing improves the well-being of monkeys in research settings; however, little is known about factors influencing the long-term stability of established, full-contact pairs. Archival data were examined to determine whether sex, age, weight, duration pair housed, familiarity, social interruptions, room changes, or sedation events predicted eventual separation of pairs for social incompatibility (n = 80) or for nonsocial reasons (e.g., research or health needs) (n = 1143). Using a logistic regression model (Wald Χ2(8) = 42.325, p < .001), three significant factors were identified. Pairs in which partners had known prior familiarity in group housing were less likely to experience social incompatibility (p = .034). Pairs housed together longer (p < .001) and who staff had temporarily separated through the placement of a cage divider to reduce physical contact were more likely to require permanent separation for social incompatibility (p < .001); additional analysis revealed that dividers were often placed for social reasons, suggesting early signs of social instability. Findings may be useful for primate caregivers when making decisions about managing social partners.
Subject(s)
Housing, Animal , Social Behavior , Animals , Decision Making , Humans , Logistic Models , Macaca mulattaABSTRACT
The influence of pair bond status, age and sex on aggression rates in a flock of 84 captive Chilean flamingos at Zoo Atlanta was examined. Analysis showed no difference between aggression rates of male and female flamingos, but adult flamingos had higher rates of aggression than juveniles. There were also significant differences in aggression depending on pair bond status (single, same-sex pair, male-female pair or group). Bonded birds were significantly more aggressive than single birds, which is consistent with the concept that unpaired birds are not breeding and do not need to protect pair bonds or eggs. Birds in typical pair bonds (male-female) and atypical pair bonds (same-sex pairs or groups) exhibited similar rates of aggression. These results contribute to the existing body of research on aggression in captive flamingos.
Subject(s)
Aggression/physiology , Behavior, Animal/physiology , Birds/physiology , Animal Husbandry , Animals , Animals, Zoo , Female , Male , Reproduction , SeasonsABSTRACT
BACKGROUND: Daratumumab is an anti-CD38 monoclonal antibody indicated for the treatment of multiple myeloma. Infusion-related reactions (IRRs) are among the most common adverse events associated with daratumumab. IRRs are most common with the first infusion of daratumumab. Recommended premedications to be given prior to the daratumumab dose include acetaminophen, diphenhydramine, and a corticosteroid. There is emerging data to suggest that the addition of montelukast to this premedication regimen can lower the incidence of daratumumab-related IRRs. PATIENTS AND METHODS: This was a single-center, retrospective chart review conducted at a large, multistate health system with several different hematology/oncology practice sites. Eligible patients included those with a primary diagnosis of a plasma cell disorder who received at least 1 dose of daratumumab. The primary outcome was the incidence of IRRs with the first daratumumab infusion. RESULTS: A total of 141 patients receiving daratumumab-based therapy were included in this study. All patients received acetaminophen, diphenhydramine, and a corticosteroid as premedications prior to the first infusion of daratumumab. Overall, 46 (33%) patients experienced an IRR with the first infusion of daratumumab. The incidence of IRR was lower in patients that received montelukast as a premedication compared with those that did not (montelukast, n = 25 [27%]; no montelukast, n = 21 [45%]; P = .0371). Patients in each arm experienced similar rates of overall, composite pulmonary, gastrointestinal, and systemic IRR manifestations. CONCLUSION: The use of montelukast prior to the first daratumumab infusion led to a reduction in the incidence of IRRs in our experience.
Subject(s)
Acetates/therapeutic use , Antibodies, Monoclonal/adverse effects , Antineoplastic Agents/adverse effects , Cyclopropanes/therapeutic use , Cytochrome P-450 CYP1A2 Inducers/therapeutic use , Drug-Related Side Effects and Adverse Reactions/drug therapy , Quinolines/therapeutic use , Sulfides/therapeutic use , Acetates/pharmacology , Cyclopropanes/pharmacology , Cytochrome P-450 CYP1A2 Inducers/pharmacology , Female , Humans , Male , Quinolines/pharmacology , Sulfides/pharmacologyABSTRACT
INTRODUCTION: Daratumumab is approved for the treatment of multiple myeloma in both frontline and relapsed/refractory settings. Its major limitation is the long infusion time, especially with the first dose. Recent data demonstrated the feasibility of infusing daratumumab at an accelerated rate of 90 minutes starting from cycle 1 on day 15. Herein, we report the safety profile and cost associated with rapid daratumumab infusion protocol. PATIENTS AND METHODS: A chart review was performed to identify patients who completed at least 1 cycle of daratumumab (single agent or in combination) from April 2016 to October 2018. Patients were divided into 2 cohorts: cohort 1 received rapid daratumumab infusion after its implementation in March 2018, whereas cohort 2 included patients treated with daratumumab administered at the standard rate. The primary endpoint was to compare differences in rates of infusion-related reactions (IRRs). An Excel (Microsoft)-based model was developed to estimate cost and productivity. RESULTS: A total of 100 patients with relapsed/refractory disease were included in this study (53 in cohort 1 and 47 in cohort 2). Of the 53 patients in cohort 1, 18 (34%) received rapid daratumumab infusion starting with cycle 1. Overall, there was no statistically significant difference in rates of IRRs between cohort 1 and 2 (1.9% vs. 4.3%, P = .59); 1 patient in cohort 1 developed an IRR. The total costs estimated for a 52-week regimen of daratumumab infused at standard and rapid rates were $137,200 and $122,200 (P < .001), respectively. CONCLUSION: Our findings indicate that rapid daratumumab infusion is safe and tolerable and provides cost savings for patients with relapsed/refractory disease.
Subject(s)
Antibodies, Monoclonal/economics , Antibodies, Monoclonal/therapeutic use , Adult , Aged , Aged, 80 and over , Antibodies, Monoclonal/pharmacology , Cost-Benefit Analysis , Female , Humans , Infusion Pumps , Male , Middle Aged , Retrospective StudiesABSTRACT
Fluorescent spatial sequencing brings next-generation sequencing into a new realm capable of identifying nucleic acids in the cell's natural environment. For the first time, scientists are able to multiplex the assignment of specific locations to hundreds of transcriptional targets and lay the foundation for understanding how genetic changes control the fate of each cell within the tissue microenvironment. In this perspective, we discuss the capabilities of fluorescent spatial sequencing in the context of other spatial imaging technologies and describe how these new technologies offer a data-rich, multiomic solution to many research applications. Fluorescent spatial sequencing has opened options for exploring many fundamental questions in biology, helping us gain a better understanding of cell and tissue development and disease progression.
Subject(s)
Cell Lineage/genetics , High-Throughput Nucleotide Sequencing/methods , Molecular Imaging , Sequence Analysis, RNA/methods , Fluorescence , HumansABSTRACT
The use of systematic preference assessments can enhance positive reinforcement training with captive animals. We found that the multiple stimulus without replacement (MSWO) technique identified food preferences in laboratory housed rhesus macaques, with raisins and grapes being ranked higher on average than dried apricot, pasta, and green beans (Friedman Test, χ2 (4)â¯=â¯35.52, pâ¯<â¯.001). Agreement between individuals (Nâ¯=â¯21) was moderate (Kendall's W = 0.42), and consistency across time varied among individuals (Wâ¯=â¯.03-.90). Highly preferred items identified by the MSWO assessment were subsequently found to increase subjects' engagement in a husbandry task on which they were being trained (Mann-Whitney Uâ¯=â¯6.00, pâ¯=â¯.002) and to improve performance on a progressive ratio schedule (Wilcoxon signed-rank test, Z = -2.17, pâ¯=â¯.03) when compared with low preference items. The progressive ratio technique supplements other preference assessment techniques by measuring the amount of work a subject will do to gain access to an item. The use of more effective reinforcers identified through systematic assessment has the potential to increase animal performance on husbandry and research tasks and to improve animal welfare in the laboratory setting.
Subject(s)
Behavior, Animal/physiology , Choice Behavior/physiology , Food Preferences/physiology , Macaca mulatta/physiology , Reinforcement, Psychology , Animals , Female , Humans , MaleABSTRACT
Literature-based recommendations regarding how to separate pairs of laboratory-housed NHP when required for research, veterinary, or management needs are unavailable. This study assessed 2 separation techniques-rapid and stepwise-to determine whether a period of limited social access mitigates the behavioral stress response after complete separation. Researchers observed 12 pairs of mother-reared, adolescent male rhesus macaques before and after separation with a solid divider; 6 of the pairs experienced a transitional week of limited social access through a perforated panel. Observers collected 30-min focal animal scans during study phase, totaling 144 h of behavioral data. Target behaviors included those classified as protest, agitation, tension, and withdrawn or self-directed. Social separation resulted in a significant change in behavior. Separated monkeys displayed more withdrawn or self-directed behaviors (for example, huddling, self-directed stereotypies) than when pair-housed. Stepwise separation resulted in increased agitation behaviors in the limited contact phase and did not mitigate separation effects. Adverse behavioral changes during the limited contact phase support continuous pair housing until required individual housing.
Subject(s)
Animal Welfare , Macaca mulatta/physiology , Social Behavior , Animals , Anxiety , Behavior, Animal , Housing, Animal , MaleABSTRACT
This study addresses a recommendation in The Guide for the Care and Use of Laboratory Animals to provide singly housed nonhuman primates with intermittent access to large, enriched (play) caging. Research on the potential benefits of this type of caging is limited. The present study examines the effects of play caging on behavior, activity, and enrichment use. Singly housed, adult male, rhesus macaques (n = 10) underwent a baseline phase in their home cages, a 2-wk treatment phase with housing in play cages, and a posttreatment phase after returning to their home cages. Each subject underwent focal behavioral observations (n = 10; duration 30 min each) during each study phase, for a total of 150 h of data collection. Results showed increases in locomotion and enrichment use and a trend toward decreased abnormal behavior while subjects were in the play cage, with the durations of these behaviors returning to baseline levels after treatment. Anxiety-related behaviors decreased between the treatment and posttreatment phases but not between baseline and treatment, suggesting that outside factors may have influenced the decline. During the treatment phase, subjects spent more time in the upper quadrants of the play caging and preferred a mirror and forage boards as forms of enrichment. The greatest behavioral improvement occurred during the first week in the play cage. This study provides evidence to support the benefits of play caging for singly housed rhesus macaques.
Subject(s)
Behavior, Animal , Environment Design , Macaca mulatta/psychology , Play and Playthings/psychology , Self-Injurious Behavior/psychology , Adult , Animals , Animals, Laboratory , Anxiety/psychology , Housing, Animal , Humans , Laboratories , Male , Self-Injurious Behavior/prevention & controlABSTRACT
A functional analysis identified the reinforcer maintaining feces throwing and spitting exhibited by a captive adult chimpanzee (Pan troglodytes). The implementation of a function-based treatment combining extinction with differential reinforcement of an alternate behavior decreased levels of inappropriate behavior. These findings further demonstrate the utility of function-based approaches to assess and treat behavior problems exhibited by captive animals.
Subject(s)
Behavior, Animal/physiology , Interpersonal Relations , Pan troglodytes/physiology , Animals , Humans , Male , Reinforcement, PsychologyABSTRACT
Positive reinforcement training (PRT) has successfully been used to train diverse species to execute behaviors helpful in the everyday care and wellbeing of the animals. Because little information is available about training sooty mangabeys (Cercocebus atys atys), we analyzed PRT with a group of 30 adult males as they were trained to shift from 1 side of their enclosure to the other. Over a 4-mo period we conducted 57 training sessions totaling 26.5 h of training and recorded compliance information. During training, compliance increased from 76% of the animals during the first 5 training sessions to 86% of the animals shifting during the last 5 sessions. This result indicated progress but fell short of our goal of 90% compliance. After 25 training sessions, problem-solving techniques were applied to help the consistently noncompliant animals become more proficient. The techniques included reducing social stress by shifting animals so that noncompliant monkeys could shift into an unoccupied space, using more highly preferred foods, and 'jackpot'-sized reinforcement. To determine whether social rank affected training success, animals were categorized into high, medium, and low dominance groups, based on 7 h of behavioral observations. A Kruskal-Wallis test result indicated a significant difference in compliance according to the category of dominance. Although training a group this large proved challenging, the mangabeys cooperated more than 90% of the time during follow-up sessions. The training program improved efficiency in caring for the mangabeys.