Post-Autologous Hematopoietic Cell Transplant Care in the "Home Sweet Home" Setting: A Treatment Paradigm Shift.

BACKGROUND: Multiple myeloma (MM) is the second most common hematologic malignancy, with 34,470 estimated new cases in 2022. High-dose therapy followed by autologous hematopoietic cell transplantation (auto-HCT) remains a standard treatment for MM even in the era of novel therapies. This is usually performed in hospital-based settings, either in the inpatient or outpatient units. Advanced Care at Home (ACH) represents a virtual hybrid hospital-at-home program that combines a virtual provider-staffed command center with a vendor-mediated supply chain capable of delivering high-acuity care in the comfort of the patients' own homes. In our program, we used the existing ACH platform to deliver post-HCT care for recipients of auto-HCT. PATIENTS AND METHODS: Four patients (female = 2, 50%) with MM, with a median age of 60 (range, 40-74) years, were admitted to the inpatient Blood and Marrow Transplant (BMT) unit. The conditioning regimen consisted of melphalan 200 mg/m2, administered on day -2. All patients received stem cell infusion (day 0) in the inpatient setting, with a median dose of 3.64 (range, 2.92-8.22) × 106/kg CD34 cells. RESULTS: Patients were discharged to their homes after completing the infusion on day 0 or day +1 at the latest. Post-infusion care was provided by the ACH team in coordination with the BMT team. The median time intervals to absolute neutrophil count and platelet engraftment were 12 (range, 11-13) and 11 (range, 9-16) days, respectively. All patients were successfully discharged from the ACH program at a median of day +14 (range, day +14 to day +15). CONCLUSIONS: Our results highlight the feasibility of delivering post-HCT care for auto-HCT recipients in the home setting and confirm the generalizability of this approach.

Visual memories for perceived length are well preserved in older adults.

Three experiments compared younger (mean age was 23.7years) and older (mean age was 72.1years) observers' ability to visually discriminate line length using both explicit and implicit standard stimuli. In Experiment 1, the method of constant stimuli (with an explicit standard) was used to determine difference thresholds, whereas the method of single stimuli (where the knowledge of the standard length was only implicit and learned from previous test stimuli) was used in Experiments 2 and 3. The study evaluated whether increases in age affect older observers' ability to learn, retain, and utilize effective implicit visual standards. Overall, the observers' length difference thresholds were 5.85% of the standard when the method of constant stimuli was used and improved to 4.39% of the standard for the method of single stimuli (a decrease of 25%). Both age groups performed similarly in all conditions. The results demonstrate that older observers retain the ability to create, remember, and utilize effective implicit standards from a series of visual stimuli.

Blindness enhances tactile acuity and haptic 3-D shape discrimination.

This study compared the sensory and perceptual abilities of the blind and sighted. The 32 participants were required to perform two tasks: tactile grating orientation discrimination (to determine tactile acuity) and haptic three-dimensional (3-D) shape discrimination. The results indicated that the blind outperformed their sighted counterparts (individually matched for both age and sex) on both tactile tasks. The improvements in tactile acuity that accompanied blindness occurred for all blind groups (congenital, early, and late). However, the improvements in haptic 3-D shape discrimination only occurred for the early-onset and late-onset blindness groups; the performance of the congenitally blind was no better than that of the sighted controls. The results of the present study demonstrate that blindness does lead to an enhancement of tactile abilities, but they also suggest that early visual experience may play a role in facilitating haptic 3-D shape discrimination.

Aging and the discrimination of object weight.

A single experiment was carried out to evaluate the ability of younger and older observers to discriminate object weights. A 2-alternative forced-choice variant of the method of constant stimuli was used to obtain difference thresholds for lifted weight for twelve younger (mean age = 21.5 years) and twelve older (mean age = 71.3 years) adults. The standard weight was 100 g, whereas the test weights ranged from 85 to 115 g. The difference thresholds of the older observers were 57.6% higher than those of the younger observers: the average difference thresholds were 10.4% and 6.6% of the standard for the older and younger observers, respectively. The current findings of an age-related deterioration in the ability to discriminate lifted weight extend and disambiguate the results of earlier research.

Aging and the perception of slant from optical texture, motion parallax, and binocular disparity.

The ability of younger and older observers to perceive surface slant was investigated in four experiments. The surfaces possessed slants of 20 degrees, 35 degrees, 50 degrees, and 65 degrees, relative to the frontoparallel plane. The observers judged the slants using either a palm board (Experiments 1, 3, and 4) or magnitude estimation (Experiment 2). In Experiments 1-3, physically slanted surfaces were used (the surfaces possessed marble, granite, pebble, and circle textures), whereas computer-generated 3-D surfaces (defined by motion parallax and binocular disparity) were utilized in Experiment 4. The results showed that the younger and older observers' performance was essentially identical with regard to accuracy. The younger and older age groups, however, differed in terms of precision in Experiments 1 and 2: The judgments of the older observers were more variable across repeated trials. When taken as a whole, the results demonstrate that older observers (at least through the age of 83 years) can effectively extract information about slant in depth from optical patterns containing texture, motion parallax, or binocular disparity.

Stereopsis and aging.

Three experiments investigated whether and to what extent increases in age affect the functionality of stereopsis. The observers' ages ranged from 18 to 83 years. The overall goal was to challenge the older stereoscopic visual system by utilizing high magnitudes of binocular disparity, ambiguous binocular disparity [cf., Julesz, B., & Chang, J. (1976). Interaction between pools of binocular disparity detectors tuned to different disparities. Biological Cybernetics, 22, 107-119], and by making binocular matching more difficult. In particular, Experiment 1 evaluated observers' abilities to discriminate ordinal depth differences away from the horopter using standing disparities of 6.5-46 min arc. Experiment 2 assessed observers' abilities to discriminate stereoscopic shape using line-element stereograms. The direction (crossed vs. uncrossed) and magnitude of the binocular disparity (13.7 and 51.5 min arc) were manipulated. Binocular matching was made more difficult by varying the orientations of corresponding line elements across the two eyes' views. The purpose of Experiment 3 was to determine whether the aging stereoscopic system can resolve ambiguous binocular disparities in a manner similar to that of younger observers. The results of all experiments demonstrated that older observers' stereoscopic vision is functionally comparable to that of younger observers in many respects. For example, both age groups exhibited a similar ability to discriminate depth and surface shape. The results also showed, however, that age-related differences in stereopsis do exist, and they become most noticeable when the older stereoscopic system is challenged by multiple simultaneous factors.

Aging preserves the ability to perceive 3D object shape from static but not deforming boundary contours.

A single experiment investigated how younger (aged 18-32 years) and older (aged 62-82 years) observers perceive 3D object shape from deforming and static boundary contours. On any given trial, observers were shown two smoothly-curved objects, similar to water-smoothed granite rocks, and were required to judge whether they possessed the "same" or "different" shape. The objects presented during the "different" trials produced differently-shaped boundary contours. The objects presented during the "same" trials also produced different boundary contours, because one of the objects was always rotated in depth relative to the other by 5, 25, or 45 degrees. Each observer participated in 12 experimental conditions formed by the combination of 2 motion types (deforming vs. static boundary contours), 2 surface types (objects depicted as silhouettes or with texture and Lambertian shading), and 3 angular offsets (5, 25, and 45 degrees). When there was no motion (static silhouettes or stationary objects presented with shading and texture), the older observers performed as well as the younger observers. In the moving object conditions with shading and texture, the older observers' performance was facilitated by the motion, but the amount of this facilitation was reduced relative to that exhibited by the younger observers. In contrast, the older observers obtained no benefit in performance at all from the deforming (i.e., moving) silhouettes. The reduced ability of older observers to perceive 3D shape from motion is probably due to a low-level deterioration in the ability to detect and discriminate motion itself.