Acute myeloid leukemia: negative prognostic impact of early blast persistence can be in part overcome by a later remission prior to post-induction therapy

In acute myeloid leukemia, there is an ongoing debate on the prognostic value of the early bone marrow assessment in patients receiving intensive therapy. In this retrospective study, we analyzed the prognostic impact of the early response in 1,008 patients with newly diagnosed acute myeloid leukemia, who were treated at our institution with intensive chemotherapy followed by consolidation chemotherapy and/or allogeneic hematopoietic stem cell transplantation (HSCT). We found that early blast persistence has an independent negative prognostic impact on overall survival, event-free survival and relapse-free survival. This negative prognostic impact may only be overcome in patients showing at least a partial remission at the early bone marrow assessment and who subsequently achieve blast clearance by additional induction chemotherapy prior to consolidation therapy with allogeneic HSCT. In accordance, we propose that the time slope of remission is an additional leukemia-related dynamic parameter that reflects chemosensitivity and thus may inform post-induction therapy decision-making. In addition to patient-related factors, European LeukemiaNet risk group, measurable residual disease monitoring and donor availability, this may particularly apply to European LeukemiaNet intermediate-risk patients, for whom a decision between consolidation chemotherapy and allogeneic HSCT remains challenging in many cases.     

Two novel loci,COBL and SLC10A2, for Alzheimer's disease in African Americans

Introduction

African Americans' (AAs) late-onset Alzheimer's disease (LOAD) genetic risk profile is incompletely understood. Including clinical covariates in genetic analyses using informed conditioning might improve study power.

HOLISTIC OBSTETRICAL PROBLEM EVALUATION (HOPE): TESTING A THEORY TO PREDICT BIRTH OUTCOMES IN A GROUP OF WOMEN FROM APPALACHIA

The purpose of this study was to test the Holistic Obstetrical Problem Evaluation (HOPE) theory by determining the effects of prenatal factors from the biophysical, psychosocial, spiritual, and perceptual domains of the HOPE theory with infant birth outcomes. Face-to-face interviews were conducted using standard and reliable questionnaires with a convenience sample of 120 pregnant women between the ages of 14 and 44 years and 16-28 weeks gestation, and attending three prenatal clinics in East Tennessee. Based on the multiple regression analysis, absence of maternal partner support during pregnancy and African-American race predicted variance for infant birth weight ( p < .05), while lower levels of self-esteem, use of drugs and alcohol, and active religiosity predicted shorter length of gestation at birth ( p < .05). The multiple logistic regression analysis model revealed that the HOPE theory was significantly related to a greater incidence of preterm birth ( p = .03), Chi 2 = 28.16, R 2 = .22. Within this model, lower levels of self-esteem and a woman's negative perception of her pregnancy, were significant predictors for preterm birth ( p < .05). Although there was preliminary support for this holistic theory, further research with a larger and more diverse population of women is needed.     

Revolutionizing Child Welfare with Outcomes Management

Outcomes management technology holds great promise for improving the quality of services provided to youth in the child welfare system. Advantages include better detection of behavioral health and trauma-related issues, early indicators of case progress or risk of failure, and program- and system-level learning. Yet organizational barriers to implementation persist. Attention is spent in this paper on addressing these barriers so the use of outcomes management technology becomes a common practice. A model for predicting resiliency is presented, along with case examples demonstrating its potential use for treatment planning and monitoring progress.     

Community Health In a Mountain Neighborhood

To test the hypothesis that during high periods of carbon monoxide (CO) pollution, persons with acute cardiovascular disease would be adversely affected, we have studied case fatality rates for patients admitted with myocardial infarction (Ml) to 35 Los Angeles hospitals during 1958. The results indicate that there is an increased Ml case fatality rate in “high”-pollution areas and that this difference is only evident during periods of relatively increased CO pollution.

At the present time, our interpretation of these findings is that an association could exist between ME case fatality rate and atmospheric CO pollution but we cannot draw any firm conclusions about causality at this time.