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Introduction: Survival after hematopoietic cell transplantation (HCT) has improved tremendously over the last few decades. HCT survivors are at increased risk of long-term complications and secondary cancers. This poses unique challenges to the HCT-related healthcare system given the growing need for survivorship care. Developing a HCT survivorship program with a dedicated clinic to survivors ensures equitable access to care and ongoing patient education. Herein, we describe our program survivorship model and our initial experience. Method(s): The Moffitt Cancer Center (MCC) survivorship clinic (SC) planning committee was initiated in September 2019. The SC was launched in January 2021 with the mission to provide high-quality, comprehensive, and personalized survivorship care and to empower patients and community health care providers with education and a roadmap for screening for late effects. The SC initially focused on allogeneic (allo) HCT patients and later opened to autologous (auto) HCT recipients in February 2022. HCT patients are referred by primary HCT team after HCT with an emphasis on preferred timeframe of initial SC visit no earlier than 3 months but less than 12 months from HCT. SC is located at 2 physical locations: main campus and satellite, with virtual visit options to account for the distance from MCC and COVID considerations. SC applies a consultative model. SC is staffed by dedicated advanced practice professional (APP), supervised by SC faculty. The scope of SC care includes but is not limited to prevention of infections (education, vaccinations), surveillance of late effects (endocrine, pulmonary function, cardiac, bone health), and general cancer screenings (breast, colon, skin cancer). Patients' clinical data from SC inception to August 2022 were reviewed. Result(s): From January 2021 to August 2022, a total of 138 patients were seen in SC. The majority were seen in person (62% in clinic, 38% by virtual visit). Median age was 58 years (range, 19-82). Median time to first SC visit was 21 months (range, 3-1464) after HCT. Allo HCT was the most common type of HCT seen in clinic (87%, n=120). Most common diagnoses were acute myeloid leukemia (43%, n=59), myelodysplastic syndrome (17%, n=23), and acute lymphoblastic leukemia (10%, n=14). Only 17 patients (12%) were seen in 2021 but the volume increased significantly in 2022. Currently there are more than 10 patients seen in SC per month. Conclusion(s): We report successful experience in launching a contemporary HCT SC despite the challenges of an ongoing COVID pandemic. As a stand-alone cancer center, we serve a wide geographical location with subspecialty and primary care providers dispersed throughout the community. Our consultative model and experience could provide a useful guide for other programs. In 2023, we plan to expand our SC to a broader population of patients receiving other cellular immunotherapies.Copyright © 2023 American Society for Transplantation and Cellular Therapy
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Background: The approval of atezolizumab + bevacizumab for untreated advanced HCC was a significant benefit for patients, but with an increased risk of potentially severe bleeding complications. Tivozanib (a selective VEGFR 1, 2, & 3 tyrosine kinase inhibitor [TKI]) has been combined with durvalumab in the DEDUCTIVE study;preliminary results presented in January 2022 showed that this combination was well tolerated with comparable efficacy to other immune checkpoint and VEGF containing regimens in patients with previously untreated HCC (J Clin Oncol 40, no. 4 suppl 462-462). We now report the final results of this cohort (cohort A) of patients as well as those with previously treated HCC, including safety results for all the patients. Method(s): Major eligibility criteria included age .18 yrs with documented advanced HCC, Child-Pugh Class A, ECOG 0 or 1, and creatinine clearance .40 ml/min. Major exclusion criteria included co-infection with HBV and HCV and significant organ dysfunction. Patients were treated with 0.89 mg tivozanib p.o., 21 days on followed by 7 days off and 1500 mg durvalumab i.v. every 28 days. The primary objective was to determine the safety and tolerability of this combination in patients with advanced HCC;secondary objectives included assessing objective response rate (ORR), progression free survival, and overall survival (OS). The study was amended in 2021 to include a cohort of patients previously treated with atezolizumab and bevacizumab (cohort B). Result(s): 21 patients were enrolled in cohort A and 6 in cohort B;the median age was 67, 88% of patients were male, and 24% were Asian. The median followup time was 13.2 mos and 3.4 mos for cohorts A and B, respectively. Data were available for 25 of the 27 patients enrolled. For cohort A, the ORR was 25% (5/20) and 1-year OS was 76%. For safety analysis, 24 (96%) patients had at least 1 treatment-emergent adverse event (TEAE);92% were attributed possibly to either tivozanib or durvalumab;32% were serious TEAEs and there was 1 TEAE leading to death (unrelated). Of the 8 (32%) serious TEAE, 2 were coronavirus infection. 2 patients had serious (grade 3) treatment-related AEs: 1 pneumonitis and 1 with gastrointestinal hemorrhage and anemia. There were no grade 4 or 5 treatment-related AEs. Conclusion(s): Treatment with the combination of tivozanib and durvalumab in patients with either untreated advanced HCC or those previously treated with atezolizumab and bevacizumab was well tolerated;no severe bleeding events occurred in this study. Efficacy outcomes were comparable to other IO-TKI combinations in HCC. Data for PDL1 status, HBV/HCV status was collected and will be presented along with final safety and efficacy results for both cohorts.
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Introduction: The UK currently has six meteor camera networks that are coordinated through the UK Fireball Alliance (UKFAll) [1]. Together, these networks currently image much of the UK's night sky. Since its formal establishment in 2020, the UKFAll has organised field searches following two detected fireball events that dropped meteorites in the UK: one at 21:54 (UTC) 28th February 2021 in Gloucestershire, England, and another at 23:45 (UTC) 14th April 2022 in Shropshire, England. The former fireball detection led to the recovery of the Winchcombe CM chondrite, the first UK meteorite in 30 years [2-4], whilst our search for the Shropshire meteorite have not yet located any stones. Here, we report some lessons learned as a citizen-science and academic collaboration, and from engaging with both local and national communities in searching for meteorites in Gloucestershire and Shropshire, UK. Camera Networks: UKFAll includes the UK Meteor Network (UKMON), Network for Meteor Triangulation and Orbit Determination (NEMETODE), the UK Fireball Network (UKFN), the Fireball Recovery and InterPlanetary Observation Network (FRIPON), the Global Meteor Network (GMN), and the AllSky7 network. Orbital calculations and dark flight modelling are a collaborative effort by researchers from the Global Fireball Observatory based at Curtin University, Australia, as well as the University of Western Ontario, Canada, and FRIPON, France. Winchcombe: Since the Winchcombe meteorite fell during a national lockdown, we issued a press release asking residents in Gloucestershire to report possible meteorite finds following the fireball, as opposed to sending a search party immediately. This approach was successful, with the Wilcock family waking to find a pile of dark rocks and powder on their driveway, and having seen the news, collecting the material and contacting the UKMON. Following verification of the meteorite fall, and additional refinement of the strewn field, a small (~15 scientists) search party assembled in Gloucestershire on 4th March 2021. This led to the recovery of the largest 152 g stone at Rushbury House farm on 6th March 2021. Field Experience: Members of UKFAll with meteorite searching experience led small teams of 4 - 8 people. The search was conducted in a unique situation due to COVID. Care was taken to remain socially distanced at all times, which made coordination of the search efforts challenging. Positive engagement with the local community was prioritised from the outset, with team leaders contacting landowners for permission to search and emphasising our safety precautions and risk assessments. News of the meteorite fall spread quickly, and residents were very hospitable and enthusiastic about our activities. The UK countryside is full of "meteorwrongs", and the rural terrain was difficult to search due to long grass, bushes etc. A game was devised to help boost morale - and to see if a meteorite would be found in that field - where a convincing meteorwrong was thrown into each new area by one team member to be found by the search team. During the field search, we also received many enquiries. These were managed by dedicated UKFAll team members, who replied to emails and visited potential meteorite finds in the area. The press interest in the story following the announcement that the meteorite had been found was significant, with journalists soon arriving in Winchcombe. This press release came after the main UKFAll search had ended, and there were many requests from the the media for interviews. Following several busy days, a key lesson learned was to the need to have a designated media liaison for any future press releases. Shropshire: This meteorite search was carried out over six days by ~20 scientists in an agricultural area south of Shrewsbury that included grazing land for sheep, wheat and rapeseed fields, and woodland. Searching in mid-April proved more challenging due to the increased vegetation cover. In order to train more people in meteorite hunting strategy, search line leaders were alternated each day. An initial small team arrived for the first two days to engage with the community. This "recon" was used to assess the terrain, identify key areas, and obtain permissions, and to avoid inundating small communities with search teams without advance notice. Early on, we engaged with a business owner, who helped to spread the word using local social media groups. Within 24 hours, most residents in the strewn field were aware of the meteorite fall and our presence, with many families conducting their own searches of public land. On 18th April 2022, a press release with an approximate strewn field was issued to local journalists. As with Winchcombe, there was significant national media interest, despite no stone being found to date. This helped us to gain access to search areas, as several landowers were aware of the meteorite before we contacted them. [ FROM AUTHOR] Copyright of Meteoritics & Planetary Science is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
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This investigation report describes a case of COVID-19 in a combined military and civilian office workspace and the contact investigation and mitigation efforts that followed. This office space included an embedded public health officer who was able to conduct the contact investigation and advise on the outbreak response. Over a 3-day period, the index case unintentionally exposed 150 coworkers to SARS-CoV-2 through participation in carpools, conferences, and small meetings. Of these exposures 37 were considered medium risk at the time and 113 were considered low risk. A total of 5 contacts reported COVID-like-symptoms at the time of the investigation and another 5 developed symptoms during the14-day quarantine period and all were directed to self-isolate. None of the contacts required hospitalization and all the symptomatic contacts tested negative for SARS-CoV-2. With the advice and aid of the embedded public health officer, the office authorized telework, conducted thorough cleaning of spaces, distributed informative messaging, conducted virtual question-and-answer forums, and evaluated outbreak policies. This report demonstrates that the close integration of public health and office management can lead to rapid identification of those at risk of infection and implementation of mitigation and control efforts to stop the spread of disease.
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Transposing rule of law principles from the national to the international level, in particular to international organizations, still raises questions and can be problematic. However, rule of law considerations play an important role when international organizations exercise a substantial amount of public authority and may directly affect states as well as individuals. The World Health Organization (WHO), unlike other international organizations, has a constitutional mandate to prevent and respond to international acute emergencies in the form of disease outbreaks and pandemics. Its main normative tool is the 2005 International Health Regulations (IHR), that represent a breakthrough from past instruments but also raise questions and challenges that can be effectively analyzed from a rule of law perspective. This approach applies in particular to ambiguities in important parts of the IHR affecting their relevance and effectiveness;lack of clarity for processes leading to sensitive executive decisions;the absence of compliance assessment mechanisms resulting in lack of accountability for states parties;and an inadequate inclusion of human rights guarantees. The analysis is extended beyond WHO's functions, to the impact of COVID-19 on the organization's governance as well as its internal management. © Koninklijke Brill NV, Leiden, 2021