Academic literature on the topic 'Missionary Research Library (New York, N.Y.)'

AbstractHuman stampedes are a major cause of mortality in mass gatherings, but they have received limited scientific attention. While the number of publications has increased, there is no recent review of new study results. This study compiles and reviews available literature on stampedes, their prevention, preparedness, and response.A search for peer-reviewed and grey literature in PubMed (National Center for Biotechnology Information, National Institutes of Health; Bethesda, Maryland USA), Google Scholar (Google Inc.; Mountain View, California USA), Web of Science (Thomson Reuters; New York, New York USA), the World Health Organization Library Database (WHOLIS; World Health Organization; Geneva, Switzerland), and ReliefWeb (UN Office for the Coordination of Humanitarian Affairs; Geneva, Switzerland) was conducted, and papers were selected according to pre-defined eligibility criteria. Included items were read and results were compiled and summarized. A total of 64 publications were included, of which, 34 were published between 2013-2016. The most studied events were Germany’s Love Parade stampede in 2010 (Duisburg, Germany; n = 6) and the United Kingdom (UK) Hillsborough Stadium stampede in 1989 (Sheffield, England; n = 4). Conflicting definitions of human stampedes were found. The common belief that they result from an irrational and panicking crowd has progressively been replaced by studies suggesting that successive systemic failures are main underlying causes. There is a lack of systematic reporting, making news reports often the only source available. Prevention measures are mainly related to crowd management and venue design, but their effectiveness has not been studied. Drills are recommended in the preparedness phase to improve coordination and communication. Delay in decisions, poor triage, or loss of medical records are common problems in the response, which may worsen the outcome.Stampedes are complex phenomenon that remain incompletely understood, hampering formulation of evidence-based strategies for their prevention and management. Documentation comes mostly from high-profile events and findings are difficult to extrapolate to other settings. More research from different disciplines is warranted to address these gaps in order to prevent and mitigate future events. A start would be to decide on a common definition of stampedes.Moitinho de AlmeidaM,von SchreebJ.Human stampedes: an updated review of current literature.Prehosp Disaster Med.2019;34(1):82–88.

A review of: Marshall, Joanne Gard. “The Impact of the Hospital Library on Clinical Decision Making: the Rochester Study.” Bulletin of the Medical Library Association 80.2 (1992): 169-78. Objective – To determine the impact of hospital library services on clinical decision making. Design – A descriptive survey. Setting – Fifteen hospitals in the Rochester area of New York, United States of America. Seven hospitals were in the city of Rochester, and eight were in surrounding rural communities. Subjects – Active physicians and residents affiliated with the Rochester hospitals. Methods – This study built upon the methodology used in an earlier study by D. N. King of the contribution of hospital libraries to clinical care in Chicago. Lists were compiled of all the active physicians and residents who were affiliated with the Rochester hospitals. In order to ensure that there was a reasonable number of participants from each hospital, and that librarians in hospitals with larger numbers of staff were not overburdened with requests, predetermined percentages were set for the sample: 10% of active physicians from hospitals with more than 25 medical staff members, 30% from hospitals with less staff, and 30% of residents and rural physicians. This resulted in a desirable sample size of 448. A systematic sample with a random start was then drawn from each hospital’s list, and physicians and residents were recruited until the sample size was achieved. Participants were asked to request information related to a clinical case from their hospital library, and to evaluate its impact on patient care, by responding to a two-page questionnaire. Main results – Based on usable questionnaires, there was an overall response rate of 46.4% (208 of 448). Eighty percent of the respondents stated that they probably (48%) or definitely (32.4%) handled a clinical situation differently due to the information received from the library. In terms of the specific aspects of care for which changes were made, 71.6% reported a change in advice given to the patient, 59.6% cited a change in treatment, 50.5% a change in diagnostic tests, 45.2% a change in drugs, and 38.5% a change in post-hospital care or treatment. Physicians credited the information provided by the library as contributing to their ability to avoid additional tests and procedures (49%), additional outpatient visits (26.4%), surgery (21.2%), patient mortality (19.2%), hospital admission (11.5%), and hospital-acquired infections (8.2%). In response to a question about the importance of several sources of information, the library received the highest rating amidst other sources including lab tests, diagnostic imaging, and discussions with colleagues. Conclusion – This study validates earlier research findings that physicians view the information provided by hospital libraries as having a significant impact on clinical decision making. Library supplied information influences changes to specific aspects of care as well as the avoidance of adverse events for patients. The significance of this influence is underscored by the finding that relative to other sources, information obtained from the hospital library was rated more highly.

Objective – To determine the information needs of nutrition, food science, and dietetics faculty members by specifically examining how they locate and access information sources and which scholarly journals are consulted for teaching, research, and current awareness; and identifying any perceived information service needs (e.g., training). Design – Online survey questionnaire. Setting – Four senior colleges within the City University of New York (CUNY) system. Subjects – Nutrition, food science, and dietetics faculty members. Methods – Using institutional websites and the assistance of relevant affiliated librarians, 29 full-time and adjunct nutrition, food science, and dietetics faculty members were identified at Queens College, Brooklyn College, Hunter College, and Lehman College (all part of the CUNY system). A survey was emailed in June and July 2007 and had 14 (48.4%) responses. The study was temporarily halted in late 2007. When resumed in January 2009, the survey was re-sent to the initial non-respondents; five additional responses were received for a final 65.5% (n=19) response rate. Main Results – The majority of respondents held a PhD in their field of study (63.1%), were full-time faculty (no percentage given), and female (89.5%). Information sources were ranked for usage by respondents, with scholarly journals unsurprisingly ranked highly (100%), followed by conference and seminar proceedings (78.9%), search engines (73.6%), government sources (68.4%), and information from professional organizations (68.4%). Respondents ranked the top ten journals they used for current awareness and for research and teaching purposes. Perhaps due to a lack of distinction by faculty in terms of what they use journals for, the two journal lists differ by only two titles. The majority browse e-journals (55.6%) rather than print, obtain access to e-journals through home or work computers (23.6%), and obtain access to print through personal collections (42.1%). Databases were cited as the most effective way to locate relevant information (63.1%); PubMed was the most heavily used database (73.7%), although Medline (via EBSCO), Science Direct, and Academic Search Premier were also used. Respondents were asked how they preferred to obtain online research skills (e.g., on their own, via a colleague, via a librarian, or in some other way). The linked data does not answer this question, however, and instead supplies figures on what types of sessions respondents had attended in the past (44.4% attended library instruction sessions, while others were self-taught, consulted colleagues, attended seminars, or obtained skills through their PhD research). Conclusion – Strong public interest in nutritional issues is a growing trend in the Western world. For those faculty members and scholars researching and teaching on nutrition and related areas, more work on their information needs is required. This study begins to address that gap and found that nutrition, food science, and dietetics faculty share strong similarities with researchers in medicine and the other basic sciences with regard to information needs and behaviours. The focus is on electronic journals, PubMed/Medline, and online access to resources. Important insights include the fact that print journals are still in modest use, researchers use grey literature (e.g., government sources) and other non-traditional formats (e.g., conference proceedings and electronic mail lists) as information sources, and training sessions need to be offered in a variety of formats in order to address individual preferences.

AbstractIntroductionHistorically, the quality and performance of prehospital emergency care (PEC) has been assessed largely based on surrogate, non-clinical endpoints such as response time intervals or other crude measures of care (eg, stakeholder satisfaction). However, advances in Emergency Medical Services (EMS) systems and services world-wide have seen their scope and reach continue to expand. This has dictated that novel measures of performance be implemented to compliment this growth. Significant progress has been made in this area, largely in the form of the development of evidence-informed quality indicators (QIs) of PEC.ProblemQuality indicators represent an increasingly popular component of health care quality and performance measurement. However, little is known about the development of QIs in the PEC environment. The purpose of this study was to assess the development and characteristics of PEC-specific QIs in the literature.MethodsA scoping review was conducted through a search of PubMed (National Center for Biotechnology Information, National Institutes of Health; Bethesda, Maryland USA); EMBase (Elsevier; Amsterdam, Netherlands); CINAHL (EBSCO Information Services; Ipswich, Massachusetts USA); Web of Science (Thomson Reuters; New York, New York USA); and the Cochrane Library (The Cochrane Collaboration; Oxford, United Kingdom). To increase the sensitivity of the literature, a search of the grey literature and review of select websites was additionally conducted. Articles were selected that proposed at least one PEC QI and whose aim was to discuss, analyze, or promote quality measurement in the PEC environment.ResultsThe majority of research (n=25 articles) was published within the last decade (68.0%) and largely originated within the USA (68.0%). Delphi and observational methodologies were the most commonly employed for QI development (28.0%). A total of 331 QIs were identified via the article review, with an additional 15 QIs identified via the website review. Of all, 42.8% were categorized as primarily Clinical, with Out-of-Hospital Cardiac Arrest contributing the highest number within this domain (30.4%). Of the QIs categorized as Non-Clinical (57.2%), Time-Based Intervals contributed the greatest number (28.8%). Population on Whom the Data Collection was Constructed made up the most commonly reported QI component (79.8%), followed by a Descriptive Statement (63.6%). Least reported were Timing of Data Collection (12.1%) and Timing of Reporting (12.1%). Pilot testing of the QIs was reported on 34.7% of QIs identified in the review.ConclusionOverall, there is considerable interest in the understanding and development of PEC quality measurement. However, closer attention to the details and reporting of QIs is required for research of this type to be more easily extrapolated and generalized.HowardI, CameronP, WallisL, CastrenM, LindstromV. Quality indicators for evaluating prehospital emergency care: a scoping review. Prehosp Disaster Med. 2018;33(1):43–52.

This study aims to apply rational emotive behavior counseling as an effort to reduce cheating behavior of high school students. The design of this study was conducted using a quasi experimental method approach with a pretest-posttest non-equivalent control group design research design. Data analysis techniques using Wilcoxon mached-pairs signed test, with the Asymp.Sig (2-Tailed) 0.028 <0.05, which shows a significant difference. The Z test value is -0.730 with the Asymp.Sig (2-Tailed) number 0.466, because of the Asymp.Sig (2-Tailed) value> 0.05, it can be concluded that there is no significant difference between the posttest value and the experimental group value with the control group, Ho is rejected and Ha is accepted which means that rational emotive behavior counseling is effective in reducing student cheating behavior. The study was carried out starting from January to March 2018, which took place at Darul Hikmah High School. Based on the results of the study, the researchers proposed several suggestions, among others (1) BK teachers, counseling rational emotive behavior can be applied by BK teachers to reduce student cheating behavior practically and can be easily applied; (2) for researchers furthermore, this research uses the pretest and posttest control group design research models, for the next researcher can use other research designs such as action research in BK, or other experimental research. References Andrestia, M. (2010). Pengaruh locus of control goal orientation terhadap cheating mahasiwa Fakultas Psikologi UIN Syarif Hidayatullah Jakarta. Skripsi. Jakarta: UIN Syarif Hidayatullah Jakarta. Anitasari, L. (2012). Hubungan stres dan perilaku merokok pada remaja. Skripsi. Malang: Universitas Negeri Malang. Arabzadeh, S., Ameli, N., Zeinoddini, A., Rezaei, F., Farokhnia, M., Mohammadinejad, P., Ghaleiha, A., & Akhondzadeh, S. (2015). Celecoxib adjunctive therapy for acute bipolar mania: A randomized, double-blind, placebo-controlled trial. Bipolar Disorders, 17(6), 606-614. doi:https://doi.org/10.1111/bdi.12324 Bond, F. W., & Dryden, W. (1996). Why two central REBT hypotheses appear untestable. Journal of Rational-Emotive and Cognitive-Behavior Therapy, 14(1), 29-40. Corey, G. (2015). Theory and practice of counseling and psychotherapy. Canada: Nelson Education. Corey, G. (2012). Case approach to counseling and psychotherapy. Canada: Nelson Education. Dessy, D. A., Suranata, K. S., & Setuti, N. M. (2013). Penerapan konseling rasional emotif dengan teknik kognitif untuk meningkatkan self disclosure siswa kelas X. 6 SMA Negeri 1 Sukasada tahun pelajaran 2012/2013. Jurnal Ilmiah Bimbingan Konseling Undiksha, 1(1), 1-10. https://ejournal.undiksha.ac.id/index.php/JJBK/issue/view/91 Dryden, W. (2014). Rational emotive behaviour therapy: Distinctive features. London: Routledge. Dryden, W. (2003). Reason to change: A rational emotive behaviour therapy (REBT) workbook. London: Routledge. Fraenkel, J. R., Wallen, N. E., & Hyun, H. H. (1993). How to design and evaluate research in education (Vol. 7). New York: McGraw-Hill. Habsy, B. A. (2017a). Model konseling kelompok cognitive behavior untuk meningkatkan self esteem siswa SMK. Perspektif Ilmu Pendidikan, 31(1), 21-35. doi: https://doi.org/10.21009/PIP.311.4 Habsy, B. A. (2017b). Filosofi ilmu bimbingan dan konseling indonesia. Jurnal Pendidikan (Teori dan Praktik), 2(1), 1-11. doi: http://dx.doi.org/10.26740/jp.v2n1.p1-11 Habsy, B. A. (2018a). Konseling rasional emotif perilaku: Sebuah tinjauan filosofis. Indonesian Journal of Educational Counseling, 2(1), 13-30. doi:https://doi.org/10.30653/001.201821.25 Habsy, B. A. (2018b). Model bimbingan kelompok PPPM untuk mengembangkan pikiran rasional korban bullying siswa SMK Etnis Jawa. Jurnal Pendidikan (Teori dan Praktik), 2(2), 91-99. doi:http://dx.doi.org/10.26740/jp.v2n2.p91-99 Hartanto, D. (2012). Bimbingan & konseling menyontek: Mengungkap akar masalah dan solusinya. Jakarta: Indeks. Hetherington, E. M., & Feldman, S. E. (1964). College cheating as a function of subject and situationalvariables. Journal of Educational Psychology, 55(4), 212. McCabe, M., & Ricciardelli, L. (2001). Parent, peer and media influences on body image and strategies to both increase and decrease body size among adolescent boys and girls. Adolescence, 36(142), 225-240. https://www.questia.com/library/journal/1G1-79251794/parent-peer-and-mediainfluences-on-body-image-and Nurmayasari, K., & Murusdi, H. (2015). Hubungan antara Berpikir Positif dan Perilaku Menyontek pada Siswa Kelas X SMK Koperasi Yogyakarta. Empathy: Jurnal Fakultas Psikologi, 3(1), 8-15. http://journal.uad.ac.id/index.php/EMPATHY/ article/view/3009/1748 Santrock, J. W., & Curl, R. M. (2003). Adolescence (9th ed.). New York: McGraw-Hill. Setyani, U. (2007). Hubungan antara konsep diri dengan intensi menyontek pada siswa SMA Negeri 2 Semarang. Disertasi. Semarang: Universitas Diponegoro. Sujana, Y. E., & Wulan, R. (1994). Hubungan antara kecenderungan pusat kendali dengan intensi menyontek. Jurnal Psikologi, 21(1994). http://i-lib.ugm.ac.id/jurnal/download.php?dataId=4298 Taylor, K.R. (2003). Bracing for cheating and plagiarism. Diakses melalui https://www.eddigest.com/sub.php Permatasari, D., & Muka, J. R. (2017). Correlation between self–efficacy and cheating behavior onvocational high school students. Prosiding 8th ICLICE 2017. Valiente, C., Eisenberg, N., Haugen, R., Spinrad, T. L., Hofer, C., Liew, J., & Kupfer, A. (2011). Children’s efforftul control and academic achievement: Mediation through social functioning. Early Education and Development, 22(3), 411-433. doi: https://doi.org/10.1080/10409289.2010.505259

Background The VEDERA (Very Early vs. Delayed Etanercept in Rheumatoid Arthritis) randomised controlled trial compared the effect of conventional synthetic disease-modifying anti-rheumatic drug (csDMARD) therapy with biologic DMARD (bDMARD) therapy using the tumour necrosis factor inhibitor etanercept in treatment-naive, early rheumatoid arthritis patients. The CADERA (Coronary Artery Disease Evaluation in Rheumatoid Arthritis) trial was a bolt-on study in which VEDERA patients underwent cardiovascular magnetic resonance imaging to detect preclinical cardiovascular disease at baseline and following treatment. Objectives To evaluate whether or not patients with treatment-naive early rheumatoid arthritis have evidence of cardiovascular disease compared with matched control subjects; whether or not this is modifiable with DMARD therapy; and whether or not bDMARDs confer advantages over csDMARDs. Design The VEDERA patients underwent cardiovascular magnetic resonance imaging at baseline and at 1 and 2 years after treatment. Setting The setting was a tertiary centre rheumatology outpatient clinic and specialist cardiovascular magnetic resonance imaging unit. Participants Eighty-one patients completed all assessments at baseline, 71 completed all assessments at 1 year and 56 completed all assessments at 2 years. Patients had no history of cardiovascular disease, had had rheumatoid arthritis symptoms for ≤ 1 year, were DMARD treatment-naive and had a minimum Disease Activity Score-28 of 3.2. Thirty control subjects without cardiovascular disease were approximately individually matched by age and sex to the first 30 CADERA patients. Patients with a Disease Activity Score-28 of ≥ 2.6 at 48 weeks were considered non-responders. Interventions In the VEDERA trial patients were randomised to group 1, immediate etanercept and methotrexate, or group 2, methotrexate ± additional csDMARD therapy in a treat-to-target approach, with a switch to delayed etanercept and methotrexate in the event of failure to achieve clinical remission at 6 months. Main outcome measures The primary outcome measure was difference in baseline aortic distensibility between control subjects and the early rheumatoid arthritis group and the baseline to year 1 change in aortic distensibility in the early rheumatoid arthritis group. Secondary outcome measures were myocardial perfusion reserve, left ventricular strain and twist, left ventricular ejection fraction and left ventricular mass. Results Baseline aortic distensibility [geometric mean (95% confidence interval)] was significantly reduced in patients (n = 81) compared with control subjects (n = 30) [3.0 × 10–3/mmHg (2.7 × 10–3/mmHg to 3.3 × 10–3/mmHg) vs. 4.4 × 10–3/mmHg (3.7 × 10–3/mmHg to 5.2 × 10–3/mmHg), respectively; p < 0.001]. Aortic distensibility [geometric mean (95% confidence interval)] improved significantly from baseline to year 1 across the whole patient cohort (n = 81, with imputation for missing values) [3.0 × 10–3/mmHg (2.7 × 10–3/mmHg to 3.4 × 10–3/mmHg) vs. 3.6 × 10–3/mmHg (3.1 × 10–3/mmHg to 4.1 × 10–3/mmHg), respectively; p < 0.001]. No significant difference in aortic distensibility improvement between baseline and year 1 was seen in the following comparisons (geometric means): group 1 (n = 40 at baseline) versus group 2 (n = 41 at baseline): 3.8 × 10–3/mmHg versus 3.4 × 10–3/mmHg, p = 0.49; combined groups 1 and 2 non-responders (n = 38) versus combined groups 1 and 2 responders (n = 43): 3.5 × 10–3/mmHg versus 3.6 × 10–3/mmHg, p = 0.87; group 1 non-responders (n = 17) versus group 1 responders (n = 23): 3.6 × 10–3/mmHg versus 3.9 × 10–3/mmHg, p = 0.73. There was a trend towards a 10–30% difference in aortic distensibility between (group 1) responders who received first-line etanercept (n = 23) and (group 2) responders who never received etanercept (n = 13): 3.9 × 10–3/mmHg versus 2.8 × 10–3/mmHg, p = 0.19; ratio 0.7 (95% confidence interval 0.4 to 1.2), p = 0.19; ratio adjusted for baseline aortic distensibility 0.8 (95% confidence interval 0.5 to 1.2), p = 0.29; ratio fully adjusted for baseline characteristics 0.9 (95% confidence interval 0.6 to 1.4), p = 0.56. Conclusions The CADERA establishes evidence of the vascular changes in early rheumatoid arthritis compared with controls and shows improvement of vascular changes with rheumatoid arthritis DMARD therapy. Response to rheumatoid arthritis therapy does not add further to modification of cardiovascular disease but, within the response to either strategy, etanercept/methotrexate may confer greater benefits over standard methotrexate/csDMARD therapy. Trial registration Current Controlled Trials ISRCTN89222125 and ClinicalTrials.gov NCT01295151. Funding This project was funded by the Efficacy and Mechanism Evaluation programme, a Medical Research Council and National Institute for Health Research (NIHR) partnership, and will be published in full in Efficacy and Mechanism Evaluation; Vol. 8, No. 4. See the NIHR Journals Library website for further project information. Pfizer Inc. (New York, NY, USA) supported the parent study, VEDERA, through an investigator-sponsored research grant reference WS1092499.

Background The management of chronic thoracic aortic aneurysms includes conservative management, watchful waiting, endovascular stent grafting and open surgical replacement. The Effective Treatments for Thoracic Aortic Aneurysms (ETTAA) study investigates timing and intervention choice. Objective To describe pre- and post-intervention management of and outcomes for chronic thoracic aortic aneurysms. Design A systematic review of intervention effects; a Delphi study of 360 case scenarios based on aneurysm size, location, age, operative risk and connective tissue disorders; and a prospective cohort study of growth, clinical outcomes, costs and quality of life. Setting Thirty NHS vascular/cardiothoracic units. Participants Patients aged > 17 years who had existing or new aneurysms of ≥ 4 cm in diameter in the arch, descending or thoracoabdominal aorta. Interventions Endovascular stent grafting and open surgical replacement. Main outcomes Pre-intervention aneurysm growth, pre-/post-intervention survival, clinical events, readmissions and quality of life; and descriptive statistics for costs and quality-adjusted life-years over 12 months and value of information using a propensity score-matched subsample. Results The review identified five comparative cohort studies (endovascular stent grafting patients, n = 3955; open surgical replacement patients, n = 21,197). Pooled short-term all-cause mortality favoured endovascular stent grafting (odds ratio 0.71, 95% confidence interval 0.51 to 0.98; no heterogeneity). Data on survival beyond 30 days were mixed. Fewer short-term complications were reported with endovascular stent grafting. The Delphi study included 20 experts (13 centres). For patients with aneurysms of ≤ 6.0 cm in diameter, watchful waiting was preferred. For patients with aneurysms of > 6.0 cm, open surgical replacement was preferred in the arch, except for elderly or high-risk patients, and in the descending aorta if patients had connective tissue disorders. Otherwise endovascular stent grafting was preferred. Between 2014 and 2018, 886 patients were recruited (watchful waiting, n = 489; conservative management, n = 112; endovascular stent grafting, n = 150; open surgical replacement, n = 135). Pre-intervention death rate was 8.6% per patient-year; 49.6% of deaths were aneurysm related. Death rates were higher for women (hazard ratio 1.79, 95% confidence interval 1.25 to 2.57; p = 0.001) and older patients (age 61–70 years: hazard ratio 2.50, 95% confidence interval 0.76 to 5.43; age 71–80 years: hazard ratio 3.49, 95% confidence interval 1.26 to 9.66; age > 80 years: hazard ratio 7.01, 95% confidence interval 2.50 to 19.62; all compared with age < 60 years, p < 0.001) and per 1-cm increase in diameter (hazard ratio 1.90, 95% confidence interval 1.65 to 2.18; p = 0.001). The results were similar for aneurysm-related deaths. Decline per year in quality of life was greater for older patients (additional change –0.013 per decade increase in age, 95% confidence interval –0.019 to –0.007; p < 0.001) and smokers (additional change for ex-smokers compared with non-smokers 0.003, 95% confidence interval –0.026 to 0.032; additional change for current smokers compared with non-smokers –0.034, 95% confidence interval –0.057 to –0.01; p = 0.004). At the time of intervention, endovascular stent grafting patients were older (age difference 7.1 years; 95% confidence interval 4.7 to 9.5 years; p < 0.001) and more likely to be smokers (75.8% vs. 66.4%; p = 0.080), have valve disease (89.9% vs. 71.6%; p < 0.0001), have chronic obstructive pulmonary disease (21.3% vs. 13.3%; p = 0.087), be at New York Heart Association stage III/IV (22.3% vs. 16.0%; p = 0.217), have lower levels of haemoglobin (difference –6.8 g/l, 95% confidence interval –11.2 to –2.4 g/l; p = 0.003) and take statins (69.3% vs. 42.2%; p < 0.0001). Ten (6.7%) endovascular stent grafting and 15 (11.1%) open surgical replacement patients died within 30 days of the procedure (p = 0.2107). One-year overall survival was 82.5% (95% confidence interval 75.2% to 87.8%) after endovascular stent grafting and 79.3% (95% confidence interval 71.1% to 85.4%) after open surgical replacement. Variables affecting survival were aneurysm site, age, New York Heart Association stage and time waiting for procedure. For endovascular stent grafting, utility decreased slightly, by –0.017 (95% confidence interval –0.062 to 0.027), in the first 6 weeks. For open surgical replacement, there was a substantial decrease of –0.160 (95% confidence interval –0.199 to –0.121; p < 0.001) up to 6 weeks after the procedure. Over 12 months endovascular stent grafting was less costly, with higher quality-adjusted life-years. Formal economic analysis was unfeasible. Limitations The study was limited by small numbers of patients receiving interventions and because only 53% of patients were suitable for both interventions. Conclusions Small (4–6 cm) aneurysms require close observation. Larger (> 6 cm) aneurysms require intervention without delay. Endovascular stent grafting and open surgical replacement were successful for carefully selected patients, but cost comparisons were unfeasible. The choice of intervention is well established, but the timing of intervention remains challenging. Future work Further research should include an analysis of the risk factors for growth/rupture and long-term outcomes. Trial registration Current Controlled Trials ISRCTN04044627 and NCT02010892. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 6. See the NIHR Journals Library website for further project information.

Abstract Background The epitome of cancer treatment personalization is N=1 segmentation where a custom therapy is designed for every patient. Because most cancer aberrations are not actionable mutations and tumors can have more than one actionable mutation, this one biomarker/one drug approach to cancer personalization has inherent limitations due to its over simplification. Personalization 2.0 methodology creates a patient simulation avatar incorporating a patient’s genomic profile information holistically. Methods Bone marrow samples from two myeloma patients (P1 and P2) refractory to most recent treatment was collected, and P1’s sample was sorted into CD138+ and CD138- cells. The patient cells were analyzed for chromosomal alterations using Comparative Genomic Hybridization (aCGH) arrays by GenPath Diagnostics and cytogenetic chromosome analysis by Washington University School of Medicine and New York University (NYU), respectively. Using this information, a predictive simulation avatar model of each patient was created by Cellworks based on genomic profile of patients. A digital functional library of over 80 FDA-approved drugs and agents currently in clinical trials were simulated individually and in combination using the two patient avatars to create a personalized treatment for each patient. The findings were prospectively validated using patient cells ex vivo as assessed by MTT assay at New York University. Results P1 aberrations included trisomy of CCND1 and deletion of TP53 along with single copy losses in different arms of chromosomes 1, 6, 8, 12, 13, 14, 16, 17 and 22 and gains in different arms and regions of chromosomes X, 1, 4, 7, 9, 17, 3, 5, 11, 15 and 19, indicating the presence of hyperdiploid clones. Using this information, 897 gene perturbations were included to model this patient simulation avatar. Simulation predicted high beta-catenin (CTNNB1) activity with increased hedgehog and NOTCH pathways that were inherent causes of Bortezomib resistance. Significant activation of STAT3 and STAT5 due to amplification of IL6 pathway, JAK2 and JAK3 was noted. Amplifications of MET, IGFR and FGFR converged at ERK and AKT signaling loops. Along with deletion of TP53, this profile had amplification of many anti-apoptotic genes including survivin, MCL1 and XIAP. Modeling predicted sensitivity to the JAK inhibitor Tofacitinib, a drug approved for rheumatoid arthritis. This was prospectively validated ex vivo, and the experimental data correlated with the prediction showing a reduction in viability. P2 aberrations include losses in chromosomes X and 9 and a chromosome 11:14 translocation that is a common occurrence in MM. This translocation results in an amplification of CCND1 expression. The genomic aberrations reported include knockdown of tumor suppressors RXRA, TGFBR1, TJP2 and TSC1. TSC1 regulates the mTOR pathway, and its deletion causes an aberrant activation of mTOR and its downstream targets. Reduced expression of RXRA and TJP2 both in different manners leads to increase in AP1 activation. NFkB is also activated due to RXRA reduction. TGFBR1 reduction decreases the expression of cell cycle inhibitors via SMAD2/3 down-regulation. In this patient avatar, modeling predicted sensitivity to a combination of Sirolimus and Trametinib. Ex vivo validation confirmed this prediction of additive synergy of these two drug agents in the context of this patient. Conclusions This study demonstrates and validates the personalization of treatment through two patient cases based on creating predictive simulation avatar models using genomic profile information. This modeling holistically incorporates all genomic aberration information and is not limited to associating drugs to actionable mutations. Disclosures Doudican: Cellworks: Research Funding. Vali:Cellworks: Employment. Basu:Cellworks: Employment. Kumar:cellworks: Employment. Singh:Cellworks: Employment. Sultana:Cellworks: Employment. Abbasi:Cellworks: Employment, Equity Ownership.

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BackgroundHome oxygen therapy (HOT) is commonly used for patients with severe chronic heart failure (CHF) who have intractable breathlessness. There is no trial evidence to support its use.ObjectivesTo detect whether or not there was a quality-of-life benefit from HOT given as long-term oxygen therapy (LTOT) for at least 15 hours per day in the home, including overnight hours, compared with best medical therapy (BMT) in patients with severely symptomatic CHF.DesignA pragmatic, two-arm, randomised controlled trial recruiting patients with severe CHF. It included a linked qualitative substudy to assess the views of patients using home oxygen, and a free-standing substudy to assess the haemodynamic effects of acute oxygen administration.SettingHeart failure outpatient clinics in hospital or the community, in a range of urban and rural settings.ParticipantsPatients had to have heart failure from any aetiology, New York Heart Association (NYHA) class III/IV symptoms, at least moderate left ventricular systolic dysfunction, and be receiving maximally tolerated medical management. Patients were excluded if they had had a cardiac resynchronisation therapy device implanted within the past 3 months, chronic obstructive pulmonary disease fulfilling the criteria for LTOT or malignant disease that would impair survival or were using a device or medication that would impede their ability to use LTOT.InterventionsPatients received BMT and were randomised (unblinded) to open-label LTOT, prescribed for 15 hours per day including overnight hours, or no oxygen therapy.Main outcome measuresThe primary end point was quality of life as measured by the Minnesota Living with Heart Failure (MLwHF) questionnaire score at 6 months. Secondary outcomes included assessing the effect of LTOT on patient symptoms and disease severity, and assessing its acceptability to patients and carers.ResultsBetween April 2012 and February 2014, 114 patients were randomised to receive either LTOT or BMT. The mean age was 72.3 years [standard deviation (SD) 11.3 years] and 70% were male. Ischaemic heart disease was the cause of heart failure in 84%; 95% were in NYHA class III; the mean left ventricular ejection fraction was 27.8%; and the median N-terminal pro-B-type natriuretic hormone was 2203 ng/l. The primary analysis used a covariance pattern mixed model which included patients only if they provided data for all baseline covariates adjusted for in the model and outcome data for at least one post-randomisation time point (n = 102: intervention,n = 51; control,n = 51). There was no difference in the MLwHF questionnaire score at 6 months between the two arms [at baseline the mean score was 54.0 (SD 18.4) for LTOT and 54.0 (SD 17.9) for BMT; at 6 months the mean score was 48.1 (SD 18.5) for LTOT and 49.0 (SD 20.2) for BMT; adjusted mean difference –0.10, 95% confidence interval (CI) –6.88 to 6.69;p = 0.98]. At 3 months, the adjusted mean MLwHF questionnaire score was lower in the LTOT group (–5.47, 95% CI –10.54 to –0.41;p = 0.03) and breathlessness scores improved, although the effect did not persist to 6 months. There was no effect of LTOT on any secondary measure. There was a greater number of deaths in the BMT arm (n = 12 vs.n = 6). Adherence was poor, with only 11% of patients reporting using the oxygen as prescribed.ConclusionsAlthough the study was significantly underpowered, HOT prescribed for 15 hours per day and subsequently used for a mean of 5.4 hours per day has no impact on quality of life as measured by the MLwHF questionnaire score at 6 months. Suggestions for future research include (1) a trial of patients with severe heart failure randomised to have emergency oxygen supply in the house, supplied by cylinders rather than an oxygen concentrator, powered to detect a reduction in admissions to hospital, and (2) a study of bed-bound patients with heart failure who are in the last few weeks of life, powered to detect changes in symptom severity.Trial registrationCurrent Controlled Trials ISRCTN60260702.FundingThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 19, No. 75. See the NIHR Journals Library website for further project information.