Journal articles on the topic 'Smart Start Program (N.C.)'

In pediatric acquired brain injury, heterogeneity of functional response to specific rehabilitation treatments is a key confound to medical decisions and outcome prediction. We aimed to identify patient subgroups sharing comparable trajectories, and to implement a method for the early prediction of the long-term recovery course from clinical condition at first discharge. 600 consecutive patients with acquired brain injury (7.4 years ± 5.2; 367 males; median GCS = 6) entered a standardized rehabilitation program. Functional Independent Measure scores were measured yearly, until year 7. We classified the functional trajectories in clusters, through a latent class model. We performed single-subject prediction of trajectory membership in cases unseen during model fitting. Four trajectory types were identified (post.prob. > 0.95): high-start fast (N = 92), low-start fast (N = 168), slow (N = 130) and non-responders (N = 210). Fast responders were older (chigh = 1.8; clow = 1.1) than non-responders and suffered shorter coma (chigh = −14.7; clow = −4.3). High-start fast-responders had shorter length of stay (c = −1.6), and slow responders had lower incidence of epilepsy (c = −1.4), than non-responders (p < 0.001). Single-subject trajectory could be predicted with high accuracy at first discharge (accuracy = 0.80). In conclusion, we stratified patients based on the evolution of their response to a specific treatment program. Data at first discharge predicted the response over 7 years. This method enables early detection of the slow responders, who show poor post-acute functional gains, but achieve recovery comparable to fast responders by year 7. Further external validation in other rehabilitation programs is warranted.

Abstract This feasibility study assessed changes in patient, staff, and family member ratings over time in a program using technology in patient care on an inpatient dementia unit in a nursing home. Method Dementia patients [N = 17; 50% Female; Age M (SD) = 84.56 (7.12); CDR M (SD) = 2.24 (5.17); MoCA M (SD) = 6.67 (.75)], caregivers (N = 17), and staff (N = 27) at a locked memory unit of a long-term care facility in the southern U.S. consented and enrolled in an individualized care program that implemented telehealth visits between a neuropsychologist and residents with staff. The start and end dates of the group varied due to new admissions and deaths. A feasibility study using a repeated measures design was conducted with monthly data collected from questionnaires (Quality of Life (QoL), Professional Care Team Burden (PCTB) Scale, and Zarit Caregiver Burden Inventory). Results QoL in residents as rated by staff was stable over a five-month interval [Baseline M (SD) = 37.94 (7.28); Month-5 M (SD) = 37.13(5.96), p = 0.98]. PCTB and Zarit responses were adequate at baseline (96.3% and 94.4%); however, due to poor response rates at Month 5 (14.3% and 27.2%), comparisons weren’t possible. Conclusion Changes in patient quality of life were not found over a five-month period. However, due to the severity and progression of dementia, a neutral finding may be positive. Anecdotally, perceptions of the program were positive. However, due to low survey response rates, we cannot accurately translate the benefits to the staff and family. Future studies should assess improving response rate or alternate forms of data collection. Generalizability is limited by size and setting.

Abstract Background Ceftolozane–tazobactam (C/T) is an antipseudomonal cephalosporin combined with a β-lactamase inhibitor. The combination was cleared by FDA and EMA and is approved in the United States and over 60 countries worldwide. Using clinical isolates collected in the United States and Canada as part of the global SMART surveillance program, we compared the activity of C/T and ceftazidime–avibactam (CAZ/AVI) against P. aeruginosa isolates and subsets nonsusceptible (NS) to selected antimicrobial agents. Methods In 2018, 31 clinical laboratories from United States and Canada collected up to 250 consecutive, aerobic or facultatively anaerobic, Gram-negative pathogens (GNP) from blood, intra-abdominal, urinary, and lower respiratory tract infections. A total of 6,178 GNP were collected, of which 1,138 (18.4%) were P. aeruginosa. MICs were determined using CLSI broth microdilution and interpreted with CLSI 2019 breakpoints. Results The MIC distributions of C/T and CAZ/AVI against 1,138 P. aeruginosa are shown below. The modal MIC value for C/T was ≥2 doubling dilutions lower than that for CAZ/AVI, and it was ≥3 dilutions lower than the C/T CLSI susceptible breakpoint, whereas the modal MIC value for CAZ/AVI was 2 dilutions lower than its susceptible breakpoint. Among all P. aeruginosa isolates, percentages of susceptibility were 96.0% (C/T), 93.8% (CAZ/AVI), 76.6% (CAZ and cefepime), 67.0% (imipenem [IMI]), 74.0% (meropenem [MEM]), 71.5% (piperacillin–tazobactam [TZP]), and 64.9% (aztreonam). Among subsets of nonsusceptible isolates, susceptibilities to C/T and CAZ/AVI were 83.5% and 74.4%, respectively (CAZ-NS subset, n = 266), 91.0% and 85.1% (IMI-NS, n = 376), 87.5% and 80.1% (MEM-NS, n = 296), 87.0% and 79.6% (TZP-NS, n = 324), and 72.4% and 57.8% among isolates nonsusceptible to all tested β-lactams (n = 116). Conclusion The activity of C/T exceeded that of CAZ/AVI and other tested comparators against a recent collection of clinical isolates of P. aeruginosa, including subsets of isolates nonsusceptible to other β-lactams. Susceptibilities to C/T were 6–14 percentage points higher than observed for CAZ/AVI among β-lactam-NS subsets. C/T promises to be an important treatment option for patients with antimicrobial-resistant P. aeruginosa infections. Disclosures All authors: No reported disclosures.

Abstract Previous experiments from our laboratory determined that postpartum beef cows with a functional corpus luteum (CL) at the start of an estrous synchronization protocol have greater pregnancy success to FTAI than those that did not have a CL. Therefore, it was hypothesized that incorporation a presynchronization program prior to FTAI in postpartum cows will improve pregnancy rates. The goal of this project was to compare the effectiveness of a presynchronization program prior to the 7-d CO-Synch+CIDR fixed timed artificial insemination (FTAI) protocol in postpartum cows. Postpartum cows (n = 310) at two locations were randomly assigned to receive either the presynchronization program, consisting of 2 PGF2α injections 14 d apart and 11 d prior to the start of the 7-d CO-Synch+CIDR protocol, or the 7-d CO-Synch + CIDR protocol. Following estrus synchronization, all cows were inseminated by trained technicians using semen from bulls of known fertility. Pregnancy status to FTAI was assessed using ultrasonographic diagnosis at 30 d post insemination. Data were analyzed using a MIXED procedure of SAS and examined for effects of inseminator, body condition score (BCS), and location and age. Statistical significance was determined at P &lt; 0.05 and a tendency at 0.05&lt; P &lt; 0.10. Age, BCS, and location did not affect (P &gt; 0.05) pregnancy rates. Cows exposed to the pre-synchronization program tended to have greater AI pregnancy rates compared to cows that did not receive the pre-synchronization program (57.7±5.3 vs. 46.9±5.3%, respectively; P = 0.0687). AI pregnancy rates were greater in cows with &gt;1 ng/mL P4 compared to cows with &lt; 1 ng/mL P4 at the start of FTAI (77.7±7 vs. 55.7±6.2%, respectively; P = 0.0204). Furthermore, AI pregnancy rates were decreased by inseminator C (26.1±7.4) compared to the other inseminators this breeding season (A-54.4±7.9; B- 62.3±5.3; D-57.8±7.2; and E -51.1±5.2; P = 0.0026). Based on these data, incorporating a pre-synchronization program to ensure the presence of a CL at the start of a FTAI protocol may improve pregnancy success in postpartum beef cows.

Abstract Background Ceftolozane-tazobactam (C/T) is an antipseudomonal cephalosporin combined with a β-lactamase inhibitor. The combination was cleared by FDA and EMA and is approved in the United States and over 60 countries worldwide. Relebactam (REL) is an inhibitor of class A and C β-lactamases that is in clinical development in combination with imipenem (IMI). Using clinical isolates collected in the United States as part of the global SMART surveillance program, we compared the activity of C/T and IMI/REL against P. aeruginosa (PA) isolates. Methods In 2016–2018, 29 clinical laboratories from the United States collected up to 250 consecutive, aerobic or facultatively anaerobic, gram-negative pathogens (GNP) from blood, intra-abdominal, urinary, and lower respiratory tract infections. A total of 14,606 GNP were collected, of which 2,774 were PA. MICs were determined using CLSI broth microdilution and interpreted with CLSI 2019 breakpoints; IMI breakpoints were used for IMI/REL. Results The activity of C/T and IMI/REL against 2,774 PA is shown (table). Among all PA, 1.8% of isolates were nonsusceptible (NS) to both agents; 4.4% were susceptible (S) to C/T but not to IMI/REL, and 2.9% were susceptible to IMI/REL but not to C/T. Among the subset of isolates collected from patients in ICUs (n = 827), 87.3% were susceptible to both C/T and IMI/REL, 2.7% were nonsusceptible to both agents, 5.8% of isolates were susceptible only to C/T, and 4.2% of isolates were susceptible only to IMI/REL. Among all C/T-NS isolates (all patient locations, n = 132), 61.4% were IMI/REL-S and <30% were susceptible to all other studied β-lactams and fluoroquinolones. Among all IMI/REL-NS isolates (n = 173), 70.5% were C/T-S and <36% were susceptible to all other studied β-lactams and fluoroquinolones. Of the tested agents, only amikacin and colistin exceeded the activity of C/T or IMI/REL against these NS subsets. Conclusion Resistance to C/T or IMI/REL was not common among recent clinical isolates of PA collected in the United States, and both agents promise to be important treatment options. A significant proportion of isolates nonsusceptible to one agent was susceptible to the other, especially among isolates from patients in ICUs. The data suggest that susceptibility to both agents should be tested at hospitals. Disclosures All authors: No reported disclosures.

Peptides fold on a time scale that is much smaller than the time required for synthesis, whence all proteins potentially fold cotranslationally to some degree (followed by additional folding events after release from the ribosome). In this paper, in three different ways, we find that cotranslational folding success is associated with higher hydrophobicity at the N-terminus than at the C-terminus. First, we fold simple HP models on a square lattice and observe that HP sequences that fold better cotranslationally than from a fully extended state exhibit a positive difference (N−C) in terminus hydrophobicity. Second, we examine real proteins using a previously established measure of potential cotranslationality known as ALR (Average Logarithmic Ratio of the extent of previous contacts) and again find a correlation with the difference in terminus hydrophobicity. Finally, we use the cotranslational protein structure prediction program SAINT and again find that such an approach to folding is more successful for proteins with higher N-terminus than C-terminus hydrophobicity. All results indicate that cotranslational folding is promoted in part by a hydrophobic start and a less hydrophobic finish to the sequence.

We examined motivation contagion in a hypothetical exercise setting. Exercise science students (n = 164) were provided with quotes of hypothetical male and female obese exercisers displaying different quality of motivation to start an exercise program. We used a 3 (exerciser motivation) × 2 (exerciser gender) × 2 (student gender) between-subjects experimental design to examine students’ (a) motivation to instruct, (b) interpersonal style, (c) perception of barrier efficacy of the exerciser, and (d) effort to identify factors that could maximize the effectiveness of an exercise program for the exerciser. Results showed that students displayed less controlled motivation and rated the exerciser as more capable of overcoming barriers to exercise when they perceived the exerciser to be autonomously motivated. However, students, particularly females, reported more autonomy support and invested more effort toward female exercisers with controlled motivation. Our findings indicate that motivation contagion effects are plausible in exercise settings and may affect interactions between fitness instructors and obese clients.

Abstract Background Ceftolozane/tazobactam (C/T) is an antipseudomonal cephalosporin combined with a β-lactamase inhibitor approved by FDA and EMA for hospital-acquired and ventilator-associated bacterial pneumonia (HABP/VABP). Elevated antimicrobial resistance rates have been reported among pathogens collected in ICUs. Using isolates collected in Asia/Pacific as part of the global SMART surveillance program, we evaluated the activity of C/T and comparators against P. aeruginosa from patients with respiratory tract infections (RTI) in ICU and non-ICU wards. Methods In 2016-2018, 55 clinical laboratories in 11 Asia/Pacific countries collected 2530 P. aeruginosa isolates from RTI. MICs were determined using CLSI broth microdilution and interpreted with CLSI breakpoints. C/T-nonsusceptible isolates (except those from India) were screened by PCR and sequencing for genes encoding β-lactamases. Results Susceptibility to C/T in Asia/Pacific was 85.3% in ICUs and 92.2% in non-ICUs, 15-23 percentage points and 13-19 percentage points, respectively, higher than to meropenem, cefepime, and piperacillin-tazobactam. C/T maintained activity against 58.8% and 69.4% of meropenem-nonsusceptible isolates from ICU (n=294) and non-ICU patients (n=346), respectively. Acquired β-lactamases were detected in 64% of C/T-nonsusceptible isolates from ICUs (n=90; 54% MBL-positive, 1% GES carbapenemase-positive, 9% ESBL-positive) and in 47% of C/T-NS isolates from non-ICUs (n=86; 33% MBL-positive, 6% GES-carbapenemase-positive, 8% ESBL-positive). The table presents country-level rates of C/T-susceptible and carbapenemase-positive P. aeruginosa for countries with n &gt;20 in both ICU and non-ICU subsets. Table Conclusion In Asia/Pacific overall, C/T maintained susceptibility rates &gt;85% in both ICU and non-ICU wards against P. aeruginosa isolates from RTI, with rates &gt;91% in most countries. Susceptibility was lower in countries with higher rates of carbapenemase-positive P. aeruginosa. C/T could provide an important treatment option for RTI infections caused by P. aeruginosa in the Asia/Pacific region. Disclosures Sibylle Lob, PhD, IHMA (Employee)Pfizer, Inc. (Consultant) Krystyna Kazmierczak, PhD, IHMA (Employee)Pfizer, Inc. (Consultant) Wei-Ting Chen, MD, Merck, Sharp & Dohme, Taiwan (Employee) Yivonne Khoo, PhD, Merck, Sharp & Dohme, Malaysia (Employee) Kanchan Balwani, MBBS, MS, Merck, Sharp & Dohme, Hong Kong (Employee) Katherine Young, MS, Merck & Co., Inc. (Employee, Shareholder)Merck & Co., Inc. (Employee, Shareholder) Mary Motyl, PhD, Merck & Co, Inc (Employee, Shareholder) Daniel F. Sahm, PhD, IHMA (Employee)Pfizer, Inc. (Consultant)Shionogi & Co., Ltd. (Independent Contractor)

SUMMARY This study compared the effectiveness of cure of bulk-fill composites using polywave light-emitting diode (LED; with various curing modes), monowave LED, and conventional halogen curing lights. The bulk-fill composites evaluated were Tetric N-Ceram bulk-fill (TNC), which contained a novel germanium photoinitiator (Ivocerin), and Smart Dentin Replacement (SDR). The composites were placed into black polyvinyl molds with cylindrical recesses of 4-mm height and 3-mm diameter and photopolymerized as follows: Bluephase N Polywave High (NH), 1200 mW/cm2 (10 seconds); Bluephase N Polywave Low (NL), 650 mW/cm2 (18.5 seconds); Bluephase N Polywave soft-start (NS), 0-650 mW/cm2 (5 seconds) → 1200 mW/cm2 (10 seconds); Bluephase N Monowave (NM), 800 mW/cm2 (15 seconds); QHL75 (QH), 550 mW/cm2 (21.8 seconds). Total energy output was fixed at 12,000 mJ/cm2 for all lights/modes, with the exception of NS. The cured specimens were stored in a light-proof container at 37°C for 24 hours, and hardness (Knoop Hardness Number) of the top and bottom surfaces of the specimens was determined using a Knoop microhardness tester (n=6). Hardness data and bottom-to-top hardness ratios were subjected to statistical analysis using one-way analysis of variance/Scheffe's post hoc test at a significance level of 0.05. Hardness ratios ranged from 38.43% ± 5.19% to 49.25% ± 6.38% for TNC and 50.67% ± 1.54% to 67.62% ± 6.96% for SDR. For both bulk-fill composites, the highest hardness ratios were obtained with NM and lowest hardness ratios with NL. While no significant difference in hardness ratios was observed between curing lights/modes for TNC, the hardness ratio obtained with NM was significantly higher than the hardness ratio obtained for NL for SDR.

Abstract Objectives Adapt and pilot Simple Suppers (SS)—a site-based 8-week family meals program for Head Start (HS) families offered in fall, winter, and spring—to an online platform using a community-based participatory approach, in response to COVID-19. Methods Researchers collaborated with community partners and HS families to adapt the core components (caregiver education; child education; family meal) of SS to an online format. Feasibility outcomes (demand: response rate, attendance, retention; acceptability: satisfaction; implementation: fidelity, cost; limited effectiveness: diet, weight status) were measured: pre, post, or throughout programming via count, survey, focus group, or direct measure. Baseline demographic data were also collected. Results The research-community team came to consensus on: a) utilizing e-methods families were accustomed to in local HS programs and elementary schools (Google Classroom; Zoom; YouTube videos) for the educational components; b) enhancing the educational components with a supplemental program-specific weekly magazine (“SS Digest”); c) creating a weekly meal kit delivery for the family meal component (“SS Chef's Crate”); and d) adding an additional week to programming (8 to 9) to orient families to the new online format. 13 of 40 families enrolled in HS participated in the fall session of SS-GO programming (32.5% response rate) and mean (SD) weekly attendance was 4.0 (0.86). 11 of the 13 families engaged in the research, and 10 of 11 completed pre- and post-test data collection (91% retention). Survey and focus group data revealed high levels of satisfaction for SS-GO. Weekly lessons were delivered as intended 92.8% of the time, and Chef's Crates were received by families 100% of the time. Mean (SD) food cost of programming was $212.33 (66.06) or $16.33 per family. Limited effectiveness data are forthcoming. Baseline mean (SD) caregiver age was 32.5 (9.32) years (n = 11), 100% (n = 11) female, 72.7% (n = 11) Black, mean (SD) BMI 36.3 (9.31), 36.4% (n = 4) low income, and 36.4% (n = 11) had low or very low food insecurity. Mean (SD) child age was 3.45 (0.69) (n = 11), 45.5% (n = 5) were female, and had a mean (SD) BMI z-score 0.63 (0.76) (n = 11). Conclusions SS-GO demonstrates feasibility utilizing a community-based participatory approach. Data will guide future iterations of the program—in COVID-19 and after. Funding Sources USDA NIFA CYFAR

A series of new platinum(II) complexes containing chelating safrole (or its derivatives) and various amines have been synthesized to evaluate their anticancer activity. Here we report the structure determination of [Pt((MeO)2Ph)(o-toluidine)Cl] (1) and [Pt((MeO)2Ph)(piperidine)Cl] (2), with (MeO)2Ph 3,4-dimethoxyphenyl-2-propene. Plate-like crystals of (1), suitable for x-ray diffraction measurement were obtained by slow evaporation from an ethanol solution. Rod-like crystals of (2) were harvested from ethanol after slow evaporation of acetone from an ethanol-acetone solution. Diffraction data were collected on a diffractometer equipped with a Bruker-AXS SMART 6000 CCD detector and integrated by the program SAINT. A multi-scan absorption correction was performed by the program SADABS. Both structures were solved by direct methods using the SHELXS program and refined according to the least-squares method to R-values of for 0.0204 (1) and 0.0280 for (2). The crystal of (1) to the orthorhombic space group P212121 and that of (2) belongs to the triclinic space group P-1. The asymmetric unit of (1) comprises one molecule of [Pt((MeO)2Ph)(o-toluidine)Cl]. The asymmetric unit of (2) consists of one ethanol molecule and one [Pt((MeO)2Ph)(piperidine)Cl] molecule. Both structures are similar with respect to the configuration and geometry of the Pt complex. Considering the centroid Cg of the allyl C=C bond as one ligand, the coordination geometry of Pt is square planar (other ligands are Cl, N (amine) and C (phenyl ring)). The angle between the best planes through the (MeO)2Ph and amine ligands is 84.3(1)0in (1) and 25.2(5)0in (2). The best plane through the allyl group makes an angle of 55.6(2)0and 56.4(4)0with the best plane through the (MeO)2Ph group, respectively in (1) and (2). The allyl double bond C=C is nearly perpendicular to Pt–Cg line, 89.8(2)0in (1) and 87.4(8)0in (2). For (1) the packing is essentially the result of van der Waals' interactions and two weak hydrogen bonds of type C-H...Cl and C-H...O. In (2) the packing is determined by the O-H...O hydrogen bond (O...O distance 2.870(4) Å) between ethanol and one of the methoxy substituents.

Abstract The prognosis has improved for BL or BLL, particularly with use of short, intensive, multi-agent chemotherapy programs. Outcome of 26 non-HIV Burkitt leukemia patients (pts) treated with the intensive chemotherapy hyper-CVAD showed an overall CR rate of 81% with an induction mortality of 19% owing to systemic fungal infections in patients aged 60 years and older [Thomas et al, JCO 17:2461, 1999]. In addition, older age was an adverse feature predicting relapse with shorter 3-year overall survival compared with younger pts (17% versus 77%). Thus, the program was modified to give the induction course in laminar air flow rooms for pts aged 60 years or older. Given the high expression of CD20 in BL and BLL, rituximab was added to the regimen. From November 1999 to April 2004, 40 pts with newly diagnosed BL (n=28) or BLL (n=12) were enrolled. The median age was 47 years (range, 17–77 years) with 23% older than 60 years. Nine pts were HIV-positive. Advanced Ann Arbor stage III/IV was present in 80% (10% had CNS involvement). The median white blood cell count (WBC) was 8.3 x 109/L; 38% had WBC > 10 x 109/L. Rituximab was given at a standard dose of 375 mg/m2 days 1 and 11 of courses 1 and 3 with hyper-CVAD (fractionated cyclophosphamide, vincristine, doxorubicin, dexamethasone) and days 1 and 8 of courses 2 and 4 with high dose methotrexate and ara-C. A total of 8 courses was planned along with 2 intrathecal prophylactic treatments of methotrexate and ara-C per course (total 16 intrathecals). The overall complete response rate in 22 evaluable non-HIV pts (2 too early, 7 with CR at start either due to one course of prior therapy or resected disease) was 95%, with no detectable difference between BL and BLL subtypes. No induction deaths were observed in the non-HIV group. After a median follow up of 18 months (range, 3 – 50+ months) in the non-HIV group, 2 relapses were observed. Six of 9 HIV pts achieved CR (2 resistant, 1 early death) but either died in CR of HIV-related infections (n=3) or relapsed (n=1), with 2 in continuous CR at 5 and 42+ months. Seventeen of the 31 non-HIV pts have been followed over one year from start of therapy without recurrence; one pt died in CR related to co-morbid conditions. Toxicity profile was similar to hyper-CVAD alone. Rituximab added to the hyper-CVAD regimen appears to improve outcome in BL and BLL.

Self-regulation for pre-school children is very important to support children’s adjustments in all situations and conditions. The current problem is the instrument of self-regulation is more focused on regulation in learning which is not suitable for young children. This study aims to examine the validity and reliability of Preschool Self-Regulation Assessment (PSRA) in Indonesia by modifying several children self-regulation theories. The instrument was translated from English into Indonesian and it retranslated into the native language by linguists. The questions, then, were validated through a process of professional judgment and cognitive de-briefing. The study was carried out to 179 children aged 6 to 7 years old. Data were analyzed by using confirmatory factor analysis (CFA). It showed that there are 5 dimensions of children's self-regulation, namely: attentional focus, behavioral control, self-motivated, self-autonomy and emotional control. The result showed that the five-dimensional model is agreed with the data and prove to measure children’s self-regulation. Cronbach’s alpha coefficient value was 0.899, indicating high scale reliability. Thus, the pre-school children’s self-regulation assessment has well psychometric for further use. Keywords: Children’s self-regulation, Confirmatory Factor Analysis, Construct validation, Pre-school self-regulation assessment, Reliability References Amanda, N. ., Antara, P. ., & Magta, M. (2016). Hubungan Pola Asuh Orangtua dengan Regulasi Diri Anak Usia 5-6 Tahun. Journal Pendidikan Anak Usia Dini Universitas Pendidikan Ganesha, 4(2), 1–11. Bentley, J. J. (2013). Parental Involvement, Parent-Child Warmth and School Engagement as Mediated by Self-Regulation. Brigham Young University. Bierman, K. L., Domitrovich, C. E., Nix, R. L., Welsh, J. A., Greenberg, M. T., Blair, C., … Gill, S. (2008). Promoting academic and social-emotional school readiness: The Head Start REDI program. Child Development, 79(6). Blair, C., & Diamond. (2008). Developing your Children Self-Regulation through Everyday Experiences. Blair, C., & Raver, C. C. (2015). School readiness and self-regulation: A developmental psychobiological approach. Annual Review of Psychology, 66, 711–731. Eisenberg, N., Hofer, C., & Vaughan, J. (2007). Effortful Control and Its Socioemotional Consequences. In J. J. Gross (Ed.), Handbook of emotion regulation (hal. 287–306). New York: Guilford Press. Eisenberg, N., Spinrad, T. L., & Eggum, N. D. (2010). Emotion-Related Self-Regulation and Its Relation to Children’s Maladjustment. Annual Reviews Clinical Psychology, 27(6), 495–525. Eisenberg, N., Valiente, C., & D.Eggum, N. (2010). Self-Regulation and School Readiness. Early Education Development., 21(5), 681–698. Goyette, P., Carrol, K., Smith-Donald, R., Metzger, M., Young, T., & Raver, C. C. (2006). Field Administration of an Emotional and Behavioral Assessment of Head Start Children:Preliminary Findings from the Preschool Self-Regulation Assessment. Grolnick, W. S., & Farkas, M. (2002). Parenting and the development of children’s self-regulation. In M. H. Bornstein (Ed.), Handbook of parenting (Vol. 5, hal. 89–110). Practical issues in parenting. Pino, D., & Whitebread, D. (2010). The Role of Parenting in Children’s Self-Regulated Learning. Educational Research Review, 5(3), 220–242. Raver, C. C., Jones, S. M., Li-Grining, C., Zhai, F., Bub, K., & Pressler, E. (2011). CSRP’s impact on low-income preschoolers’ pre-academic skills: Self-regulation and teacher-student relationships as two mediating mechanisms. Child Development, 82(1), 362–378. Rimm-Kaufman, S. E., Curby, T. W., Grimm, K. J., Nathanson, L., & Brock, L. L. (2009). The contribution of children’s self-regulation and classroom quality to children’s adaptive behaviors in the kindergarten classroom. Developmental Psychology, 45(4). Rochmah, S. N. (2017). Hubungan Konsep Diri Guru Terhadap Regulasi Diri Anak Usia Dini. Jurnal Tunas Siliwangi SPS UPI, 3(2), 160–174. Smith-Donald, R., Carroll, K., Goyette, P., Metzger, M., Young, T., & Raver, C. C. (2006). Preliminary Validity of the Preschool Self-Regulation Assessment (PSRA). Smith-Donald, R., Raver, C. C., Hayes, T., & Richardson, B. (2007). Preliminary construct and concurrent validity of the Preschool Self-regulation Assessment (PSRA) for field-based research. Early Childhood Research Quarterly, 22(2), 173–187. Tanribuyurdu, Findik, E., Yildiz, & Guler, T. (2014). Preschool Self-Regulation Assessment (PSRA): Adaptation Study for Turkey. Education and Science, 39(176), 317–328. Wang, L., Hamaker, E., & Bergeman, C. (2014). Investigating inter-individual differences in short-term intra-individual variability. Psychological Methods, 17(4), 2012. Zimmerman, B. (2002). Becoming a Self-Regulated Learner: An Overview. Theory Into Practice, 41(2), 64–70

Knowledge about clean and healthy life in children needs to be given early to shape behavior in everyday life. Knowledge about healthy living can be provided at school through various learning programs. This study aims to find the effectiveness of health promotion programs (JUMSIH) to increase children's knowledge about clean and healthy living. The research method is a pre-experimental one-shot case study design. The respondents of this study were 68 students aged 7-8 years. The results showed that the JUMSIH program can help children have knowledge about healthy living. Based on data analysis, n = 15 generally obtained scores above 2.6. It was concluded that healthy living skills are often performed by students such as hand washing, bathing, and toothbrush behavior which are basic skills for children to be able to live healthy lives. Suggestions for further research which is the development of various programs to increase awareness of clean and healthy living from an early age. Keywords: Clean and healthy life Knowledge, Early Childhood, Health Promotion Program (JUMSIH) References: Akçay, N. O. (2016). Implementation of Cooperative Learning Model in Preschool. Journal of Education and Learning, 5(3), 83–93. https://doi.org/10.5539/jel.v5n3p83 Allport, B. S., Johnson, S., Aqil, A., Labrique, A. B., Nelson, T., KC, A., … Marcell, A. V. (2018). Promoting Father Involvement for Child and Family Health. Academic Pediatrics, 18(7), 746–753. https://doi.org/10.1016/j.acap.2018.03.011 Bonuck, K. A., Schwartz, B., & Schechter, C. (2016). Sleep health literacy in head start families and staff: Exploratory study of knowledge, motivation, and competencies to promote healthy sleep. Sleep Health, 2(1), 19–24. https://doi.org/10.1016/j.sleh.2015.12.002 Considerations, P., & Framework, N. Q. (2010). Health , Hygiene and Infection Control Strategies for Policy Implementation :2010(Vic). Conti, G., Heckman, J. J., & Pinto, R. (2016). 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(2011). Analisis Manajemen Promosi Kesehatan Dalam Penerapan Perilaku Hidup Bersih dan Sehat (PHBS) Tatanan Rumah Tangga di Kota Padang Tahun 2011. Padang: Universitas Andalas. Maryunani, A. (2013). Perilaku Hidup Bersih dan Sehat. Jakarta: Trans Info Media. McClure, M., Tarr, P., Thompson, C. M., & Eckhoff, A. (2017). Defining quality in visual art education for young children: Building on the position statement of the early childhood art educators. Arts Education Policy Review, 118(3), 154–163. https://doi.org/10.1080/10632913.2016.1245167 Mcisaac, J. D., Sim, S. M., Penney, T. L., & Kirk, S. F. L. (2012). School Health Promotion Policy in Nova Scotia: A Case Study. Revue PhénEPS / PHEnex Journal, 4(2). McIsaac, J. L. D., Penney, T. L., Ata, N., Munro-Sigfridson, L., Cunningham, J., Veugelers, P. J., … Kuhle, S. (2017). Evaluation of a health promoting schools program in a school board in Nova Scotia, Canada. 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Abstract Background Relebactam (REL) inhibits class A and C β-lactamases, including KPC, and was approved in the United States combined with imipenem (IMI) and cilastatin for complicated urinary tract and intraabdominal infections. We evaluated the activity of IMI/REL against non-Morganellaceae (NME) and P. aeruginosa collected as part of the global SMART surveillance program from patients with bloodstream infections (BSI) in the US and Canada. Methods In 2018, 24 US and 8 Canadian hospitals each collected up to 50 consecutive aerobic or facultative gram-negative pathogens from patients with BSI. MICs were determined using CLSI broth microdilution and interpreted with 2020 CLSI breakpoints. Multidrug-resistance (MDR) was defined as resistance to ≥3 of the following sentinel drugs: amikacin, aztreonam, cefepime, ceftazidime (NME only), ciprofloxacin, colistin, imipenem, and piperacillin/tazobactam. Results The 5 most common species among 1463 collected BSI isolates were E. coli (46.9%), K. pneumoniae (16.0%), P. aeruginosa (8.5%), P. mirabilis (4.8%), and E. cloacae (4.3%). Susceptibility to IMI/REL and comparators of selected species and subsets of resistant phenotypes is shown in the table. IMI/REL was active against 99.8% of NME isolates; only meropenem, ceftazidime/avibactam, and amikacin showed comparable activity. Per 2020 CLSI guidelines, Enterobacterales and P. aeruginosa isolates are no longer considered susceptible to colistin. IMI/REL maintained activity against 89-100% of NME isolates that were nonsusceptible (NS) to β-lactams or MDR. Among P. aeruginosa, IMI/REL was active against 94.4% of isolates; a susceptibility rate only exceeded by amikacin. The addition of relebactam lowered the MIC90 for P. aeruginosa from 16 µg/mL to 1 µg/mL. IMI/REL maintained activity against 40-77% of P. aeruginosa isolates NS to β-lactams or MDR; susceptibility rates only exceeded by amikacin. Susceptibility to IMI/REL was similar in the US (99.8% of NME [n=846]; 93.8% of P. aeruginosa [n=96]) and Canada (99.7% of NME [n=339]; 96.4% of P. aeruginosa [n=28]). Table Conclusion In the US and Canada, IMI/REL could provide an important treatment option for patients with BSI caused by resistant gram-negative organisms. Disclosures Sibylle Lob, PhD, IHMA (Employee)Pfizer, Inc. (Consultant) Katherine Young, MS, Merck & Co., Inc. (Employee, Shareholder)Merck & Co., Inc. (Employee, Shareholder) Mary Motyl, PhD, Merck & Co, Inc (Employee, Shareholder) Daniel F. Sahm, PhD, IHMA (Employee)Pfizer, Inc. (Consultant)Shionogi & Co., Ltd. (Independent Contractor)

Abstract Background Relebactam (REL) inhibits class A and C β-lactamases and was approved in the US combined with imipenem (IMI) and cilastatin for complicated urinary tract and intraabdominal infections. Using isolates collected as part of the global SMART surveillance program in the US, we evaluated the activity of IMI/REL against gram-negative pathogens (GNP) from patients with lower respiratory tract infections (LRTI), including a comparison of isolates from ICU and non-ICU wards. Methods In 2017-2018, 27 US hospitals each collected up to 100 consecutive aerobic or facultative GNP from LRTI patients per year. MICs were determined using CLSI broth microdilution and breakpoints. Results Among 3878 GNP isolates from LRTI, the most common species collected were P. aeruginosa (Psa, 33.3%), K. pneumoniae (10.9%), E. coli (10.4%), and S. marcescens (6.9%). Susceptibility of GNP is shown in the table. IMI/REL inhibited 93% of Psa and Enterobacterales, which included 174 isolates of Morganellaceae that are not expected to be susceptible to IMI or IMI/REL. S. marcescens also showed low susceptibility to IMI, with improved but still reduced activity upon addition of REL. IMI/REL inhibited 83% of all GNP combined, 7-18 percentage points higher than the comparator β-lactams. Of the tested comparators, only amikacin exceeded the activity of IMI/REL. Only Psa showed substantial differences in susceptibility between isolates from ICU (n=486) and non-ICU wards (n=611), with 63.4% and 70.2%, respectively, susceptible to IMI, 71.6/78.7% to cefepime, and 64.2/73.3% to piperacillin/tazobactam (P/T). Susceptibility to IMI/REL was high in both settings (91.4/93.6%). Among Enterobacterales, susceptibility was generally similar in ICU and non-ICU wards (IMI/REL, 92.5% in both settings; IMI, 86.3 and 87.1%, respectively; cefepime, 89.9/89.0%; P/T, 88.7/87.4%). Table Conclusion Although resistance rates have frequently been reported to be higher in ICU than non-ICU wards, this pattern was seen in the current study only among Psa isolates. IMI/REL showed activity &gt;90% against both Enterobacterales and Psa from both ward types. These in vitro data suggest that IMI/REL could provide an important treatment option for patients with LRTI in the US, including those in ICUs. Disclosures Sibylle Lob, PhD, IHMA (Employee)Pfizer, Inc. (Consultant) Katherine Young, MS, Merck & Co., Inc. (Employee, Shareholder)Merck & Co., Inc. (Employee, Shareholder) Mary Motyl, PhD, Merck & Co, Inc (Employee, Shareholder) Daniel F. Sahm, PhD, IHMA (Employee)Pfizer, Inc. (Consultant)Shionogi & Co., Ltd. (Independent Contractor)

Currently, a gap exists in inventorying and monitoring the impact of land use and management on soil resources. Reducing the number of samples required to determine the impact of land management on soil carbon (C) and mineral constituents via proximal sensing techniques such as hyper-spectral radiometry can reduce the cost and personnel required to monitor changes in our natural resource base. Previously, we used an expensive, high signal-to-noise ratio (SNR) field spectrometer to correlate soil constituents to hyperspectral diffuse reflectance (HDR), over the 350–2500 nm (VIS-SWIR) wavelength range. This research is an extension of preceding research but focuses solely on the 400–1000 nm (VIS-NIR) region of the electromagnetic spectrum. This region can be measured using less expensive (albeit with lower SNR), miniaturized, field spectrometers that allow minimal sample preparation. Our objectives are to: (1) further evaluate the use of soil HDR in the visible and near-infrared (VIS-NIR) region acquired using an expensive field hyperspectral spectroradiometer for prediction of soil C and selected fractions and nitrogen (N) constituents, (2) repeat the above measurements using HDR data from samples examined in objective (1) using lower SNR hyperspectral radiometers, and (3) add to the limited literature that addresses determinations of selected soil properties using proximal sensing in the VIS-NIR region. Data analyzed in this study confirms that good to satisfactory prediction equations for soil constituents can be developed from spectral reflectance data within the 400–1000 nm wavelength region obtained using relatively inexpensive field radiometers. This application could reduce the time and resources required to monitor gains or losses in carbon constituents, information that can be used in programing such as Conservation Technical Assistance (CTA), the Conservation Reserve Program (CRP) and Climate-smart agriculture (CSA).

Abstract Background Relebactam (REL) inhibits class A and C β-lactamases and was approved in the USA in combination with imipenem (IMI) and cilastatin for the treatment of complicated intraabdominal and urinary tract infections. We evaluated the activity of IMI/REL against clinical isolates collected in Asia/Pacific as part of the global SMART surveillance program. Methods In 2016-2018, 56 clinical laboratories each collected up to 250 consecutive, aerobic and facultative gram-negative pathogens from various infection sources per year. Susceptibility was determined using CLSI broth microdilution and CLSI breakpoints. IMI-nonsusceptible isolates (except from India) were screened for β-lactamase genes. Results Among 5501 K. pneumoniae and 4362 P. aeruginosa isolates, 46.6% and 65.3%, respectively, were collected from patients with lower respiratory tract infections, 25.6% and 17.1% from intraabdominal infections, 19.9% and 13.9% from urinary tract infections, and 7.2 and 2.9% from bloodstream infections. No infection source was specified for 0.7% of isolates from either species. 90.7% of collected K. pneumoniae isolates were IMI/REL-susceptible, ranging from 56.8% in India and ~80% in Thailand and Vietnam (~16% MBL-positive) to ≥97% in 7 countries (0-2% MBL-positive). 28.6% (202/707) of IMI-nonsusceptible K. pneumoniae were IMI/REL-susceptible. Of the 425 molecularly characterized IMI-nonsusceptible K. pneumoniae, 187 (44.0%) were MBL/OXA-48-like negative and 83.4% of these (156/187) were IMI/REL-susceptible; 82 isolates (19.3%) were KPC-positive and 91.5% of these (75/82) were IMI/REL-susceptible. The table shows percent susceptible and percent MBL-positive among all collected P. aeruginosa isolates. 74.3% of IMI-nonsusceptible P. aeruginosa (n=1236) were IMI/REL-susceptible. Table Conclusion IMI/REL was active against 91% of K. pneumoniae and 89% of P. aeruginosa isolates collected in Asia/Pacific overall, with higher activity in countries with lower MBL-positive rates. IMI/REL promises to be an important treatment option for IMI-nonsusceptible MBL-negative isolates, including KPC-producing K. pneumoniae. Disclosures Sibylle Lob, PhD, IHMA (Employee)Pfizer, Inc. (Consultant) Krystyna Kazmierczak, PhD, IHMA (Employee)Pfizer, Inc. (Consultant) Wei-Ting Chen, MD, Merck, Sharp & Dohme, Taiwan (Employee) Tsz Kin Khan, PhD, Merck, Sharp & Dohme, Hong Kong (Employee) Katherine Young, MS, Merck & Co., Inc. (Employee, Shareholder)Merck & Co., Inc. (Employee, Shareholder) Mary Motyl, PhD, Merck & Co, Inc (Employee, Shareholder) Daniel F. Sahm, PhD, IHMA (Employee)Pfizer, Inc. (Consultant)Shionogi & Co., Ltd. (Independent Contractor)

311 Background: Noninvasive biomarkers are needed for diagnosis, prognosis, and molecular profiling of HCC due to scarcity of tumor tissue and heterogeneous tumor biology. CTC are detectable in metastatic HCC using methods which enrich for expression of the cell adhesion molecule, EpCAM. Because a subset of HCC does not express EpCAM, however, non-EpCAM enrichment methods are needed for CTC studies in HCC. Methods: This CTC cohort was derived from patients enrolled on multicenter phase 1 and 2 trials of the combination of sorafenib plus temsirolimus in advanced HCC (NCT01008917, NCT01687673) with approval and funding from the National Comprehensive Cancer Network (NCCN) Oncology Research Program. Eligibility required histologic diagnosis of incurable HCC with no prior systemic therapy. All patients in the cohort were treated at the recommended phase 2 dose of sorafenib 200 mg PO BID and temsirolimus 10 mg IV weekly. Whole blood samples were collected at baseline and on treatment. CTC were enumerated and analyzed cytomorphologically using a high-definition, single cell assay without EpCAM enrichment and blinded to clinical outcomes. Results: The CTC cohort was comprised of 36 patients (phase 1 n = 9, phase 2 n = 27). Characteristics: male 89%; white 64%, Asian/PI 28%, black 6%; HBsAg+ 31%, HCV+ 44%; Child Pugh A 92%, B7 8%; BCLC C 83%; tumor vascular invasion 47%; median AFP 74 ng/mL. Median OS from start of treatment was 392 days (95% CI: 214, 569). CTC ≥ 1/mL were detectable at baseline in 23/36 (64%) overall (95% CI: 47%, 80%), with similar findings in the phase 1 (56%) and phase 2 (67%) subsets. There was no significant relationship between baseline CTC values ≥ 1, 2, or 5/mL and overall survival (OS) on univariate analysis. Analyses of CTC relationship to clinical characteristics and time to progression, changes on treatment, and multivariable analysis for relationship to OS will be presented. Conclusions: CTC were detected in over 60% of patients in this advanced HCC clinical trial cohort using a non-EpCAM, high-definition single cell assay, suggesting future potential for noninvasive molecular profiling of HCC.

89 Background: The rapid shift to oral oncolytic therapy presents challenges to oncology practitioners. The purpose of this study is to describe how participation in a statewide oral oncolytic improvement collaborative where best practices and resources were shared can readily impact quality of care as measured by national standards. Methods: The Michigan Oncology Quality Consortium (MOQC) hosted a series of learning collaborative sessions focused on topics and deployment of resources specific to oral oncolytic management and quality improvement. Participating practices performed pre/post self-assessments in Oct. 2013 and Apr. 2015 (n = 3). Concordance with national ASCO QOPI and ONS standards was compared, including documentation (5 measures), patient education (7 measures), and follow-up/monitoring (4 measures). A response scale of always, sometimes, and never was used. Specifically, practices were surveyed to assess which evidence-based MOQC resources were implemented: patient intake template, drug-specific self-management guides, start date mailer, medication calendar, primary care physician communication template, Edmonton Symptom Assessment Scale (ESAS), and patient adherence questionnaires. Results: Practice A showed improvement in documentation, patient education, and monitoring. This practice used the initial oral chemotherapy template, ESAS, patient education templates, and patient calendar (Table). Practice B implemented 6 resources and demonstrated improvements in 15 metrics. Practice C implemented 4 resources, namely patient-focused resources, to improve all patient education and monitoring metrics. Conclusions: Use of the collaborative model and supplying oncology teams with scientific evidence, standard workflows, and resources improves concordance with national standards of care. Large-scale deployment of this model program may provide a clinically efficient and effective mechanism to enhance widespread change. [Table: see text]

Background: Type VI Secretion System (T6SS) has been found in approximately onequarter of the gram-negative bacterial species, and its structural characteristics appear to slightly differ from species to species. The genes encoding T6SS are designated as type six secretion A–M (tssA–M). The expression of the tss gene cluster is regulated by various accessory genes, designated as type VI-associated genes A–P (tagA–P). Tag family proteins have been commonly found in bacteria expressing T6SS but not in all bacterial species. For instance, the tag gene cluster is well-conserved in Pseudomonas aeruginosa (Pa). The PaTagF protein has large homology with ImpM in Rhizobium leguminosarum and SciT in Salmonella enterica. The overexpression of PaTagF represses T6SS complex accumulation and suppresses T6SS antibacterial activity. Thus, the functions of TagF are mediated through direct interactions with the forkhead-associated protein Fha, as evident from the results of the yeast-two hybrid assays. Fha is involved in recruiting a membrane-associated complex either in threonine phosphorylation pathway-dependent or - independent manner. However, functional reports of the tag gene cluster are still limited. </P><P> Objective: In this article, our motivation is to understand the molecular mechanism underlying the regulation of expression of the type VI secretion system complex. Methods: In this article, we start with obtaining the gene encoding PaTagF protein by polymerase chain reaction (PCR). Subsequently, the cloned gene is applied to overexpress of PaTagF protein in Escherichia coli, then purify the recombinant PaTagF protein. Thereafter, the protein is crystallized in a condition of 2.5 M NaCl, 0.1 M imidazole (pH 8.0), 3.2 M NaCl, 0.1 M BIS-TRIS propane (pH 7.0) and diffraction datasets of the PaTagF crystals are collected at the Pohang Accelerator Laboratory (PAL). The molecular structure of PaTagF protein is determined by molecular replacement using the uncharacterized protein PA0076 (PDB code:2QNU) as an initial search model by PHENIX crystallographic software package. Model building of PaTagF structure is performed using Coot program. Finally, the structural model is validated using phenix.refine program. Results: PaTagF exists as a tetramer in the asymmetric unit, and the overall fold of each monomer is composed of continuous beta-sheets wrapped by alpha-helices. Each monomer has variable conformations and lengths of both the N- and C-termini. Twelve residues, including the His6 tag from the N-terminus of a symmetry-related molecule, have been found in two of the tetrameric PaTagF structures. A structural homology search revealed that PaTagF was similar to the α-β-α sandwichlike structure of the longin domain on the differentially expressed in normal and neoplastic (DENN) superfamily, which is commonly found in proteins related to trafficking. Conclusion: The tetrameric structure of PaTagF comprises varied N- and C-terminal regions in each subunit and may be stabilized by a symmetry-related molecule. This feature was also shown in the TssL structure from V. cholerae. Furthermore, our study showed that the overall fold of PaTagF is homologous to the longin domain of the DENN family. Therefore, further studies are warranted to elucidate the structure-based evolutionary relationship between protein transport systems from the bacteria and eukaryotic cells.

The influence of family, school and peers on students' emotional social development is very important as a starting point for the design of school activities that will also improve student development in an integral way. The Star of the Week program was developed with the aim of helping students apply the knowledge, attitudes, and skills needed to socialize and understand and manage emotions. This study uses the Thiagarajan model stages, namely define, design, develop, and disseminate (4D). The results of the validity test from the experts show that this program has workable value with 91.1% material aspects, 90% emotional development aspects and 92% presentation aspects. For the practicality test results through teacher questionnaires obtained scores of 90%, and 88.67% through teacher observations of children who are in the high practical category. 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OBJECTIVES/SPECIFIC AIMS: A course of oral broad-spectrum antibiotics frequently has a positive effect on morbidity and mortality in severe acute malnutrition (SAM), but the actual mechanism for this effect is unknown. This mechanism is especially important to find and quantify because of the possibility that using antibiotics prophylactically may accelerate the danger from antibiotic resistant infections. This study aims to answer (1) how antibiotic therapy improves the nutritional recovery and (2) how much it affects the prevalence of resistance genes in the microbiome. METHODS/STUDY POPULATION: Stool samples were collected from children with SAM between 6 and 60 weeks of age who received either one week of amoxicillin or placebo (n=164). The children were followed for 12 weeks with longitudinal sampling, and a subset were followed out to 2 years. All samples were frozen at −80°C and prepared for metagenome shotgun sequencing via the Illumina Nextera platform. RESULTS/ANTICIPATED RESULTS: Antibiotic treatment at the start of the nutritional program is associated with significant improvements in weight gain, mid-upper-arm circumference, and graduation from the treatment program. It is also associated with qualitative decreases in early-life fermenter Lactobacillus and known enteropathogen Campylobacter. Two years after the use of amoxicillin, the Shannon diversity index is significantly higher than that of malnourished children (effect size 0.507, 95% CI: 0.204–0.630, p=0.0007), while children who received placebo are not distinguishable from malnourished children by the same metric (effect size 0.147, 95% CI: −0.311, 0.630, p=0.5878). Sustained antibiotic resistance gene enrichment within the microbiota did not occur, as the enrichment effects disappears by week 4 of follow-up. DISCUSSION/SIGNIFICANCE OF IMPACT: The use of amoxicillin to treat uncomplicated SAM has therapeutic benefits visible by anthropometry and by content of the gut microbiota. The main concern with the use of prophylactic antibiotics for this purpose is the effect on antibiotic resistance gene enrichment in the children’s microbiota. This concern was not supported here. The benefit/cost ratio for the use of prophylactic antibiotics for individuals in this cohort is positive when weighing effects on anthropometry, microbiome, and antibiotic resistance. The results of this study impact the treatment of millions of children each year at nutritional therapy clinics around the world.

Abstract The efficiency of D4 Gaussian elimination on a vector computer, the Cray- 1/S, it examined. The algorithm used in this work is employed routinely in Phillips Petroleum Co. reservoir simulation models. Comparisons of scalar Phillips Petroleum Co. reservoir simulation models. Comparisons of scalar and vector Cray-1/S times are given for various example cases including multiple unknowns per gridblock. Vectorization of the program on the Cray- 1/S is discussed. Introduction In reservoir simulation, the solution of large systems of linear equations accounts for a substantial percentage of the computation time. Methods used today consist of both iterative and direct solution algorithms. Because of the theoretical savings in both storage and computing labor, D4 Gaussian elimination is a popular direct solution algorithm and is used widely on conventional scalar computers. In this paper we investigate the efficiency of the D4 algorithm on a computer with vector processing capabilities-the Cray-1/S. The D4 (or alternate diagonal) algorithm originally was presented by Price and Coats in 1973. Since that time much work has been done on the Price and Coats in 1973. Since that time much work has been done on the algorithm including an investigation by Nolen on the vector performance of D4 on the CDC Star 100 and Cyber 203 on single-unknown-per-gridblock example cases. Levesque has presented a comparison of the Cray-1 and Cyber 205 in reservoir simulation that includes the D4 algorithm. Vector performance of the Cray-1 on linear algebra kernels, both sparse and dense, performance of the Cray-1 on linear algebra kernels, both sparse and dense, also has been reported. Vector performance on these kernels typically is expressed in terms of million floating point operations per second (MFLOPS). Our objective here is to evaluate vector performance on a typical production code written in FORTRAN for a scalar computer. Therefore, performance, or efficiency, will be evaluated in terms of both scalar and vector CPU times on the Cray-1/S. We include vector performance on the original code with automatic vectorization enabled, and vector performance on the same code with minor restructuring, automatic performance on the same code with minor restructuring, automatic vectorization enabled, and the use of Cray assembly language (CAL) basic linear algebra kernels. Example cases for multiple unknowns per gridblock are presented. Reservoir Flow Equations The reservoir flow equations written using a seven-point finite difference formulation can be expressed as ...........................(1) where the terms A, B... G are matrices of order N equal to the number of unknowns per gridblock. represents the vector of unknowns at cell i, j, k, and H is the vector of residuals of the flow equations at cell i, j, k at iteration . Values of N from 1 to 10 typically are encountered depending on the type of simulator and the degree of implicitness used. For example, N is equal to one for an implicit pressure, explicit saturation (IMPES) black-oil model; three for a fully implicit black-oil model; five for an implicit three-component steamflood model and usually 10 or less for an implicit compositional model. Driver Program To facilitate timing studies in this work, a driver program was written to calculate coefficients for the D4 Gaussian elimination routine. Input to the program consists of grid dimensions and the number of unknowns per gridblock. All elements of the off-diagonal matrices (A, C, D... G) were set equal to 1. To guarantee a nonsingular solution, the B matrix was set equal to -5 for one unknown and as below for N unknowns. ............................(2) Right-side coefficients, H, were calculated by assuming a unit solution for . No-flow boundary conditions were used, which require specific matrices, such as A for I = 1 and C for I = NX, to be set equal to zero. Description of Hardware and Software All run times reported in this work were obtained on the Cray-1/S, Serial No. 23, at United Computing Systems in Kansas City, MO. Serial No. 23 contains 1 million 64-bit words of central memory interleaved in 16 memory banks and no input/output (I/O) subsystems. The FORTRAN compiler used was CFT 1.09. CPU times were obtained by calling SECOND, a FORTRAN-callable utility routine that returns CPU time since the start of the job in FPS'S. CPU overhead incurred for each call to SECOND is approximately 2.5 microseconds. For all reported Cray-1/S times, "vector" refers to the original FORTRAN code run with automatic vectorization enabled, which is the normal operating mode. SPEJ p. 121

Abstract Background: ITP is a rare disorder characterized by low platelet counts, which leads to an increased tendency to bleed and bruise. Previously, we reported real-world estimates of the incidence of BREs in adult patients with primary ITP using a large administrative commercial claims database in the US, where BREs were defined as a bleeding event and/or the use of a rescue or emergency ITP therapy (Cetin et al., Blood 2014: 124 [21]). We found that the majority of ITP patients experienced at least one BRE. To further advance our understanding of ITP disease burden, we expanded on this work by examining the economic impact of the BREs observed in this study. Methods: The study was conducted using the MarketScan Commercial Claims and Encounters and Medicare Supplemental and Coordination of Benefits Databases. Patients diagnosed with primary ITP were identified between the years 2007 and 2012 if they had at least 2 outpatient claims separated by at least 30 days or 1 inpatient claim with ICD-9-CM diagnosis code (287.31) for primary ITP. The occurrence of a BRE, occurring between 2007 and 2013, was defined according to a combination of diagnosis codes and/or procedure codes indicating a form of bleeding, administration of intravenous immunoglobulin, anti-D or IV corticosteroids, or platelet transfusion. For cost estimates, the total reimbursed amount received by the providers (including out-of-pocket costs and reimbursement from insurance) was used. Specifically, for outpatient costs, cost on any records with a BRE-related code (diagnosis or procedure) from the start date of the BRE to (1) the date prior to the start date of the next BRE, or (2) a date followed by three consecutive days without any BRE-related claims, whichever came first, was included. For inpatient costs, cost for all services from the admission date (or BRE start date if not the first BRE during the hospital stay) until the earlier of (1) the date prior to the start date of a new BRE, or (2) the discharge date was counted. All costs were adjusted to 2013 dollars using the appropriate Consumer Price Indices (CPI) (hospital and related services CPI and medical care CPI were used for inpatient and outpatient cost adjustment, respectively). Mean and 95% confidence interval (CI) for BRE costs were estimated and subgroup analyses (splenectomy status and BRE types) were conducted. The differences among subgroups were tested by analysis of variance (ANOVA) at a significance level of 0.05 and the standard errors were clustered at the individual patient level. Results: As previously reported, among 6,651 patients with primary ITP, a total of 14,115 BREs were identified. The mean (SD) age was 55(18) years at the start of corresponding BRE and females accounted for 59% of the population. The mean total cost of a BRE was $5,606 (Table 1), with a mean inpatient BRE cost of $41,545 and a mean outpatient BRE cost of $2,046. The cost per BRE was approximately $2,300 higher in splenectomized patients compared with non-splenectomized patients, but the difference was not statistically significant. The cost of BREs with actual bleeding only was $9,591, whereas with solely rescue therapy was $2,652. The cost of BREs that included both bleeding and rescue therapy use was $10,380. Conclusion: Our study offers insight into the healthcare expenditures incurred by patients with ITP who experience BREs. Higher costs were found among patients requiring hospitalization and in those using bleeding therapy. Table 1. Cost of BREs in Adult Patients with Primary ITP Group N Mean Lower 95% CI Upper 95% CI P a Overall 14,115 $5,606 $5,051 $6,161 <.0001 Inpatient b 1,272 $41,545 $36,822 $46,269 Outpatient c 12,843 $2,046 $1,827 $2,266 Gender 0.0665 Male 5,415 $6,268 $5,359 $7,178 Female 8,700 $5,194 $4,494 $5,893 Age 0.0023 18-34 2,071 $6,629 $5,191 $8,066 35-44 1,948 $6,047 $4,432 $7,661 45-54 2,648 $5,833 $4,640 $7,026 55-64 3,359 $6,423 $5,037 $7,809 65+ 4,089 $4,060 $3,263 $4,856 Splenectomy status 0.1948 No 13,192 $5,455 $4,915 $5,995 Yes 923 $7,765 $4,304 $11,225 BRE Type <.0001 Bleeding & Rescue 261 $10,380 $7,836 $12,924 Bleeding only 5,718 $9,591 $8,313 $10,870 Rescue only 8,136 $2,652 $2,368 $2,935 a Analysis of Variance (ANOVA) b Inpatient group refers to BREs requiring inpatient care and other subsequent patient care in different settings if any c Outpatient group refers to BREs only requiring outpatient care Disclosures Lin: Amgen, Inc.: Employment, Equity Ownership. Zhang:Amgen, Inc: Other: Internship program. Li:Amgen, Inc.: Employment, Equity Ownership. Altomare:Amgen Inc.: Consultancy, Honoraria. Wasser:Amgen, Inc: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding. Cetin:Amgen, Inc: Employment, Equity Ownership.

Background The HealthBeaconTM is a smart sharps bin for patients who self-inject medications at home. It is digitally connected and programmed with a patient’s medication schedule and uses customized reminders to help them start and stay on track with their medication. The HealthBeacon device was launched in May 2015; since then, it has been used by 8000+ patients and has tracked 250,000+ injections across 11 markets. The HealthBeacon is designed to be passive. The patient is not asked to do anything; the device captures the act of disposal which is a highly accurate method for measuring drug adherence. Several studies on the adoption of self-tracking devices have found that the percentages of people who stopped using their device within relative short-term follow up periods may vary between 33-75%. A behavioral analysis was completed to determine if the patient-centric design of HealthBeacon technology can overcome barriers to patient adoption and improve persistence to therapy. Objective The objective was to evaluate the adoption of a connected device to monitor and improve patient adherence and persistence to therapy. Methods For the purpose of the study the patients were classified into two categories. 1) If all conditions outlined below were met, the patient “adopted” the technology: A) Patient consented to support program; B) HealthBeacon was delivered and established in the home; C) Patient utilized the technology correctly; D) Technology successfully tracked injections and communicated with HealthBeacon platform; E) Patient remains on HealthBeacon achieving high persistence to medication or continued until treatment completion. 2) If any of the following circumstances arose, the patient was considered as “rejected” as they failed to adopt the technology: A) Upon introduction to HealthBeacon the patient requested a regular sharps bin; B) Patient never disposed an injection into the HealthBeacon; C) Patient has not interacted with the device for 90+ days; D) Patient accepted the HealthBeacon initially but returned it for reasons other than their treatment ending Results Data were measured over a 24-month period from May 2017 to May 2019 for the 756 patients were involved in the study; 584 (77%) of the patients adopted the technology and 172 (23%) rejected it. Of the patients that adopted, 478 (82%) continue to utilize the technology and 106 (18%) are no longer active. The reason for stopping was associated with their treatment ending rather than an adoption issue. Of the 172 patients (23%) rejected the technology, 26 (15%) requested a standard sharps bin after receiving the introduction; 45 (26%) accepted the HealthBeacon but never disposed an injection into it; 86 (50%) used the HealthBeacon initially but had not interacted with it for 90+ days; 2 (1%) rejected it due to a technical issue; and 13 (8%) accepted it initially but reported that they prefer to manage adherence on their own. Conclusions With almost 80% of patients adopting the technology, and 82% of the adopters persisting, this study demonstrates that patient-centered design that deploys passive adherence monitoring can overcome barriers to adoption of technology.

Abstract Abstract 2504 Whereas treatment strategies for AML patients (pts) aged <60 years are well established, therapy in the elderly deserves special consideration. In the present study, we analysed survival and risk factors predicting outcome in 192 consecutive patients (pts) with de novo AML aged ≥60 years (median age: 70.5 years, range 60–89 years). Pts were treated at a single center (Medical University of Vienna) between November 1994 and January 2011, and received conventional induction chemotherapy with DAV (daunorubicin, 45 mg/m2/day, days 1–3; etoposide, 100 mg/m2/day, days 1–5; ARA-C, 2 × 100 mg/m2/day, days 1–7; between 1994 and 2008). Pts achieving a complete hematologic remission (CR) were scheduled to receive a full consolidation program with up to 4 cycles of IDAC (ARA-C, 2 × 1 g/m2/day i.v. on days 1, 3, and 5). Of the 192 pts, 115 (60%) achieved a CR following induction therapy, 57 pts (30%) did not achieve a CR, and 20 pts (10%) died within 40 days after start of induction therapy. Among several parameter including the leukocyte count, hemoglobin, platelet count, LDH, and fibrinogen, only the karyotype according the the Breems-Score was an independent predictor for achieving CR in our multivariate analyses. CR rates in pts with core binding factor (CBF) AML, cytogenetically normal (CN) AML, non-monosomal karyotype (Mkneg) AML, and monosomal karyotype (Mkpos) AML, were 100% (8/8), 66% (57/87), 56% (33/59), and 44% (11/25), respectively (p<0.05). Of the 115 pts in CR, 106 (92%) received up to 4 cycles of IDAC (4 cycles, n=53 pts [50%]; 3 cycles, n=20 pts [19%]; 2 cycles, n=20 [19%]; and 1 cycle, n=13 [12%]). Treatment was well tolerated without grade 3 or 4 neurotoxicity. The most frequent non hematologic toxicity was febrile neutropenia requiring antibiotics (1st consolidation: 50.5%; 2nd consolidation: 58.4%, 3rd consolidation: 55.6%, 4th consolidation: 51.0%). A remarkable finding was that the median time of absolute neutropenia in all IDAC cylces (8–9 days/consolidation) was relatively short when compared to induction chemotherapy or other consolidation regimens. Only two patients died during consolidation with IDAC (cardiac failure, n=1, severe sepsis, n=1). The median overall survival (OS) for all pts was 9.7 months, and for pts achieving a CR, the OS amounted to 24.2 months. The most important predictive variables for continuous complete remission (CCR) were the karyotype and the presence of an NPM1 mutation determined by PCR and melting point analysis. As assessed by uni- and multivariate analysis, both parameters were found to be independent predictive variables (p<0.05), whereas the other markers examined, i.e. FLT3 ITD, overexpression of ERG, MN1, or BAALC, as well as the number of induction cycles required to achieve CR, showed no predictive value. The median CCR and CCR after 5 years were 17.9 and 31.3%, respectively in pts with CN/Mkneg-NPM1 mutated AML, and 11.3 months and 25% for pts with CBF AML (p<0.001; see figure). In pts with CN/Mkneg and wild type NPM1 AML and Mkpos AML, the median CCR rates were 10.8 and 6.0 months, respectively. Together, our data show that elderly patients with CN/Mkneg-NPM1 mutated AML or CBF AML can achieve long term CCR when treated with intensive chemotherapy and up to 4 consolidation cycles of IDAC, whereas pts with CN/Mkneg-NPM1 wild type AML and Mkpos AML did not achieve long term CCR despite intensive consolidation. These results are in favour of individualized chemotherapy in elderly pts with AML and suggest that patient-selection in advanced age should not only be based on patient-related factors and the karyotype but also on the NPM1 mutation status. Disclosures: No relevant conflicts of interest to declare.

In this preliminary study, in vitro embryo production and cryopreservation in two river type buffaloes (Murrah and Nili-Ravi) imported into China have been carried out. The objective of the study was enhancement of the genetic merit and productive performances of imported river buffaloes in conjunction with the utilization of local swamp buffaloes. In order to improve milk and meat production in China local swamp buffaloes (2n = 48), which are the predominant subspecies, have been crossbred with imported river buffaloes (Murrah and Nili-Ravi: 2n = 50). At present, several hundred thousand crossbred heads have been produced, and although both males and females can reproduce with 2n = 49 crossbred buffaloes, their reproductive performances are significantly reduced when compared to 2n = 50 buffaloes. As an alternative approach, a program of embryo production in river buffaloes and transfer into both river and swamp buffaloes has been implemented at the Guangxi Buffalo Research Institute, in Nanning, P.R. China. Some preliminary results are presented: from a start-up experiment, a total of 46 river buffaloes were subjected to 2 to 3 ovum pickup sessions at 4-day intervals. A total of 750 antral follicles were punctured and 495 (66%) cumulus-oocyte complexes (COCs) were retrieved. Only COCs characterized by at least one layer of granulosa cells (n = 451; 91.1%) were considered for in vitro maturation (IVM). COCs were matured in TCM 199 + 10% FCS, 0.5 μg/mL FSH, 5 μg/mL LH, and 1 μg/mL estradiol in the presence of cysteamine (50 μM) at 39°C under 5% CO2 in humidified air for 24 h. Of the initial 451 COCs matured, only 277 could be considered for in vitro fertilization (IVF). IVF was performed at 39°C under CO2 in humidified air in TALP medium supplemented with 0.2 mM penicillamine, 0.1 mM hypotaurine, and 0.01 mM heparin. Frozen/thawed sperm from a tested bull was treated by swim-up procedure and used at a final concentration of 20 million/mL. Following 20 to 22 h of co-incubation, presumptive zygotes were cultured in SOF medium, supplemented with essential and non-essential amino acids and 8 mg/mL BSA, in a gas atmosphere of 5% CO2, 7% O2, and 88% N2. A total of 41 (14.8%) blastocysts were produced, of which 33 were vitrified and 8 transferred immediately into available swamp and river buffalo recipients. Two calves were born (25%) from the transfer of fresh embryos into one river and one swamp buffalo. In vitro embryo production in the buffalo species is still characterized by a high degree of variable results. However, these preliminary results reinforce the need to implement newly developed reproductive technologies not only for speeding up genetic gain of already productive species, but also for the utilization of local breeds characterized by reduced productive performance.

Language skills are essential for early childhood, being able to speak clearly and process speech sounds, understand others, express ideas, and interact with others are the building blocks for a child's development. Therefore, this study will examine the effect of the Inside Outside Circle (IOC) instructional strategies with media images on children's language skills. This research is a quasi-experimental design with a posttest only and using a control group. The sample in this study were children in two kindergartens in the village of Banjar Tegal. Data analysis in this study was carried out by quantitative descriptive methods using t-test analysis techniques. The results of this study in kindergarten students in Banjar Tegal Village show that there is an influence of the IOC learning model with picture media on children's language skills (tcount = 6.28> ttable = 2.00). 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Background:The efficacy and safety of upadacitinib (UPA), a selective Janus kinase inhibitor, has been evaluated in the SELECT rheumatoid arthritis (RA) clinical program,1–6 but its real-world effectiveness remains to be investigated. The UPwArds study will assess the association of C-reactive protein (CRP) level with remission and other efficacy outcomes in patients with RA treated with UPA in German real-world practice.Objectives:To describe the baseline characteristics of patients enrolled in the UPwArds study.Methods:The prospective, open-label, multicenter, non-interventional, post-marketing UPwArds study included adult patients with moderate-to-severe RA (swollen joint count [SJC28] ≥3 and inadequate response or intolerance to ≥1 disease-modifying antirheumatic drug [DMARD]). Patients were treated with UPA 15 mg once daily, as monotherapy or in combination with methotrexate (MTX; 50:50 mono:combo enrollment planned), according to the German label. Variables assessed included medical history (disease duration, previous RA therapy, and vaccination status), CRP level, and disease activity (disease activity score [DAS28(CRP)], tender joint count [TJC28], and SJC28). There was no recruitment restriction regarding CRP level. This descriptive interim analysis reports patient baseline characteristics after enrollment was complete. All data were analyzed as observed, with no imputation of missing data.Results:533 patients (UPA monotherapy: 257 [48%]; UPA plus MTX: 276 [52%]) were included. Mean patient age was 58 years; mean disease duration was 9 years (Table 1). Despite having active RA, almost half the population (44%; n=237) did not have elevated CRP at the start of UPA treatment. Mean DAS28(CRP) was 4.6; mean TJC28 and SJC28 were 7.7 and 5.6, respectively. Overall, 39% of patients had not been treated with any biologic (b) DMARD or targeted synthetic (ts) DMARD before enrollment; 25% and 36% had previously been treated with 1 or ≥2 bDMARDs or tsDMARDs, respectively (Figure 1). 8.7% of patients had previously received a herpes zoster vaccination (8.1% Shingrix; 0.6% Zostavax).Conclusion:In German clinical practice, the population of patients with RA in the UPwArds study was predominantly treatment-refractory. Half of these patients had no elevated CRP despite active disease; future analyses will assess the impact of CRP on efficacy outcomes.References:[1]Smolen JS, et al. Lancet 2019;393:2303–11;[2]Burmester GR, et al. Lancet 2018;391:2503–12;[3]Genovese MC, et al. Lancet 2018;391:2513–24;[4]van Vollenhoven R, et al. Arthritis Rheumatol 2020;72:1607–20;[5]Fleischmann R, et al. Arthritis Rheumatol 2019;71:1788–800;[6]Rubbert-Roth A, et al. N Engl J Med 2020;383:1511–21.Table 1.Baseline characteristicsAge, yearsUPAUPA + MTXTotal57.7 (13.2)n=25758.1 (11.4)n=27657.9 (12.3)n=533Disease duration, years9.4 (8.3)8.5 (7.7)9.0 (8.0)n=253n=272n=525CRP, mg/dL1.3 (1.9)1.1 (1.7)1.2 (1.8)n=257n=276n=533CRP >ULN, n (%)137 (53.3)159 (57.6)296 (55.5)n=257n=276n=533TJC287.4 (6.0)7.9 (6.4)7.7 (6.2)n=257n=276n=533SJC285.5 (3.7)5.6 (4.1)5.6 (3.9)n=257n=276n=533Patient’s Global Assessment6.2 (1.9)6.3 (1.8)6.3 (1.8)n=257n=276n=533Physician’s Global Assessment5.8 (1.5)5.9 (1.6)5.9 (1.6)n=257n=276n=533DAS28(CRP)4.6 (1.0)4.6 (1.0)4.6 (1.0)n=257n=276n=533DAS28(ESR)4.8 (1.1)4.9 (1.2)4.9 (1.1)n=224n=239n=463CDAI24.9 (10.2)25.7 (10.8)25.4 (10.5)n=257n=276n=533SDAI26.2 (10.5)26.9 (11.3)26.6 (10.9)n=257n=276n=533RAID5.7 (2.0)5.7 (2.0)5.7 (2.0)n=255n=275n=530Pain (RAID-1)6.2 (2.2)6.1 (2.3)6.2 (2.2)n=255n=275n=530SF-12 Physical Component Summary32.6 (8.5)33.9 (8.6)33.3 (8.6)n=245n=262n=507SF-12 Mental Component Summary42.4 (11.6)42.6 (11.3)42.5 (11.5)n=245n=262n=507HAQ-DI1.3 (0.7)1.3 (0.6)1.3 (0.6)n=250n=270n=520PHQ-98.9 (5.3)8.6 (5.3)8.7 (5.3)n=252n=272n=524Erosions, n (%)87 (33.9)95 (34.4)182 (34.1)n=257n=276n=533Data are mean (SD), n unless otherwise statedAcknowledgements:AbbVie funded this study; contributed to its design; participated in data collection, analysis, and interpretation of the data; and in the writing, review, and approval of the abstract. AbbVie and the authors thank all study investigators for their contributions and the patients who participated in this study. No honoraria or payments were made for authorship. Medical writing support was provided by Grant Thomas Kirkpatrick, MSc, of 2 the Nth (Cheshire, UK), and was funded by AbbVie.Disclosure of Interests:Torsten Witte Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Chugai, Gilead, Janssen, Lilly, MSD, Mylan, Novartis, Pfizer, Roche, and UCB., Uta Kiltz Consultant of: AbbVie, Biocad, Eli Lilly and Company, Grünenthal, Hexal, Janssen, MSD, Novartis, Pfizer, Roche, and UCB, Grant/research support from: AbbVie, Amgen, Biogen, Fresenius, GSK, Hexal, Novartis, and Pfizer, Florian Haas Consultant of: AbbVie, Celgene, Novartis, and Pfizer, Grant/research support from: AbbVie, BMS, Celgene, Chugai, MSD, Novartis, Pfizer, Roche, and Sanofi Genzyme, Elke Riechers Consultant of: AbbVie, Chugai, Novartis, and UCB, Grant/research support from: AbbVie, Chugai, Lilly, Janssen, Novartis, Pfizer, Roche, and UCB, Ulrich Prothmann Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Chugai, Glaxo Smith Kline, Novartis, Pfizer, Roche, Sanofi, SOBI, and UCB, Daniela Adolf Employee of: Employee of StatConsult and may own stock or options, Carsten Holland Employee of: Employee of AbbVie and may own stock or options, Rouven Hecht Employee of: Employee of AbbVie and may own stock or options, Alexander Roessler Employee of: Employee of AbbVie and may own stock or options, Kirsten Famulla Employee of: Employee of AbbVie and may own stock or options, Klaus Krueger Grant/research support from: AbbVie, Biogen, BMS, Celltrion, Gilead, Hexal, Janssen, Lilly, Medac, MSD, Novartis, Pfizer, Roche, and UCB.

Abstract The intensive combination chemotherapy program hyper-CVAD in newly diagnosed Ph+ ALL yields complete remission (CR) rates of 90%, but remissions are brief with median CR duration of 16 months [Kantarjian et al, JCO 18:547, 2000]. The activity of the tyrosine kinase inhibitor imatinib given as a single agent in relapsed or refractory Ph+ ALL or chronic myelogenous leukemia in lymphoid blast phase was 20% [Druker et al, NEJM 344:1084, 2001]. A phase II trial of imatinib and hyper-CVAD was conducted in newly diagnosed Ph+ ALL. Imatinib was given 400 mg days 1–14 of each course of therapy (fractionated cyclophosphamide, vincristine, doxorubicin and dexamethasone alternating with high dose methotrexate and ara-C). Preliminary results were published in the first 20 patients (pts) treated, with CR rates of 100% in the de novo group, and improvement of disease-free survival (DFS) compared with hyper-CVAD alone [Thomas et al, Blood 103:4396, 2004]. To date, 32 pts with Ph+ ALL have been treated from April 2001 to February 2004. Twenty-six patients had active disease, either untreated (n=21) or refractory (n=5) to one induction course without imatinib. Six pts were in CR at study entry after one induction course without imatinib mesylate. Median age was 48 years (range, 17–75); 59% were male. Five had CNS disease (16%). Twenty-five of 26 pts (96%) with active disease at study entry achieved CR (1 failed to meet platelet criteria for CR). Median days to response was 21 days. Two of 26 pts (8%) required 2 courses to achieve CR. Allogeneic stem cell transplant (SCT) was performed in 13 pts in CR within a median of 3 months from start of therapy (range, 1–12). After a median follow-up of 2 years (range, 4–36 months), 1 primary refractory pt relapsed at 12 mos (bcr-abl/abl RT-PCR ratio <.05 at 9 mos), 1 pt relapsed day 149 after matched related SCT despite negative nested PCR for bcr-abl, and 2 pts changed therapy after 5 mos for persistent marrow Ph+ metaphases without overt leukemia relapse. Five pts died in CR, 3 older pts related to comorbid conditions (2 were negative for bcr-abl by nested PCR) and 2 related to complications of allogeneic SCT. Molecular response rate (negative bone marrow RT-PCR for bcr-abl confirmed by nested PCR) was approximately 50% in 19 pts who did not undergo allogeneic SCT. Outcome appears better with the hyper-CVAD and imatinib regimen with 2-year DFS rates of 87% (all pts) compared with 28% for hyper-CVAD alone or 12% for VAD (p<.001). Unexpected toxicities related to the addition of imatinib mesylate were not observed. The hyper-CVAD and imatinib regimen with or without allogeneic SCT continues to appear promising with additional accrual and longer follow-up.

The 3-D interconnection started at 3D PLUS in 1996 and led to the stacking of nearly all types of analogical and logical components, sensors, MEMS, etc for the Hi-Rel field (Space, Defence, Medical, Industrial). This technology is extremely robust (−130°C +175°C, 40000g), and is fully qualified by all worldwide most important Space Agencies and for Defence applications. A technological break started in 2002 ; It consisted in another 20 to 30 reduction factor of the weight and volume of these 3-D modules.The Z pitch is 100μm and the X Y size is given by the size of the larger die plus 100μm of polymer around it. This is a stacked of Known Good Rebuilt Wafer of full wafer level technique. The dice are received in wafers and following operations are carried out :- Pick, flip and place of the good dice on a “sticking skin”- Moulding of the whole of this « pseudo wafer » in order to obtain what we call a « Known Good Rebuilt Wafer (KGRW) ». These two first steps are already developed by Infineon and mainly Freescale (RCP technique up to 300mm)- Stacking and gluing of KGRW 1, 2, 3…, n, by means of an adhesive film- Dicing of these stacked rebuilt wafers by techniques identical to the dicing of standard wafers- Metallization of the dicing streets with nickel + gold by electroless chemical plating identical to the UBM plating technique- Direct laser patterning by laser with our edge connection technique up to 100μm pitch. Below this pitch, the Thru Polymer Via (TPV) are made through the stacked wafers. The equivalent pitch will be 20μm. it can be noticed that the shielding can be made on the dicing street.- Electrical test at the stacked wafer level- Singulation of the 3D modules This approach allows using standard dice without any modification. It is multi sources and the stacking of the good rebuilt wafers allows to get an excellent yield. A development agreement has been signed with a semiconductors manufacturer. A development is in progress with the most worldwide important manufacturer of smart cards in order to integrate 5 levels of dice (including a MEMS) within a cavity of 550 μm inside the 800μm SIM card. Other applications with MEMS will be presented:- “Abandoned Sensors” for Heath Monitoring of the aircraft structure developed during the European Program: “e-Cubes” ,- Gyroscope with 6 MEMS,- Micro camera for endoscopy…- Medical applications with an important development made for 3 major pacemaker manufacturers. This « full wafer level » approach will allow to build System in Package (SiP) or “Abandoned Sensors” at very low costs, since the process uses mainly the steps of wafers building; the “panelization” allows to be in parallel processing from A to Z steps. Moreover, the use of Known Good Rebuilt Wafer like the RCP allows stacking Good wafer at the reverse what is impossible with the wafer to wafer approach.

Este trabajo surge a partir de la investigación general de las técnicas hidropónicas teniendo en cuenta sus ventajas y desventajas para de esta forma poder encontrar aquel factor determinante a través de una comparación de técnicas hidropónicas que permitan clasificarlas y escoger la mejor opción que genere menos impacto ambiental negativo y demuestre ser más productivo en los entornos urbanos. Adicionalmente, un factor determinante en las ciudades es su espacio limitado por lo que la mejor opción también deberá incluir un óptimo manejo del espacio que permita a casi cualquier individuo poder aplicarlos desde su entorno sin recurrir a excesivas modificaciones. Como principal resultado se escogió a la Hidroponía recirculante como método predominante por los excelentes resultados que se obtienen con relación a los demás, adicionalmente, este puede ser fácilmente aplicado en los ambientes urbanos por su versatilidad y buen manejo de recursos. 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Abstract The spectrum of infectious complications occurring in the first 100 days in lymphoma patients undergoing AHCT has not been well described in the contemporary era of improved supportive care practices and antimicrobial prophylaxis.We conducted a retrospective cohort study to describe early infections in this population and to evaluate the association of early infections with long-term outcomes. From our BMT Program database, we identified 544 consecutive patients (age ≥18 years) who received their first AHCT for lymphoma between 2007 and 2016 and had consented for use of their data for research. Median age was 55 (range, 19-78) years, 63% patients were male, 79% had non-Hodgkin lymphoma (NHL), 96% had KPS ≥80, 39% had AHCT Comorbidity Index score ≥3, and 78% had intermediate/high risk disease. Stem cell mobilization was performed with chemotherapy priming (58%) or G-CSF ± plerixafor (42%). The majority of patients received conditioning regimen consisting of busulfan, cyclophosphamide and etoposide (97%). All patients were hospitalized from start of conditioning chemotherapy until neutrophil engraftment. Routine antimicrobial prophylaxis consisted of ciprofloxacin and fluconazole starting on hospitalization and continued until neutrophil engraftment, and acyclovir for 6 months after transplantation.The following infections were evaluated: all (excluding febrile neutropenia [FN]), bacterial, viral, fungal, C difficile, central line associated blood stream infection (CLABSI), blood stream, pneumonia, and other sites, and FN. Compared to patients without infections, those who had early infections were older (median 57 vs 55 years, P=0.04), more likely to have NHL (86% vs 77%, P=0.04), and had earlier stage disease (P<0.01); there was no difference in the CD34 cell dose or time to neutrophil engraftment. Cumulative incidence of all infections at 100 days (excluding FN) was 19.1% and that of FN was 77.4% (Table). Among bacterial infection episodes (N=114), E coli(18%), C difficile(15%), and S aureus(9%) were the most common organisms identified; the majority of viral infection episodes were caused by respiratory viruses (62%). Compared to no infections, patients with infections had a significantly longer transplant hospitalization and more readmissions, and fewer days alive and out of hospital in first 100 days; there was no difference in 100 day overall mortality between the two groups (3.2% vs 4.8%, P=0.42). In multivariable analyses, older age at AHCT was the only risk factor for any infection (excluding FN; HR 1.21 per 10 year increase, 95% cumulative incidence 1.06-1.39, P=0.006); no association was observed with other risk factors examined, including KPS score, comorbidities, prior therapy, disease risk or time since diagnosis. Disease risk was the only factor independently predictive of FN; compared to low risk disease, patients with intermediate risk (HR 0.78, P=0.01) and high risk (HR 0.71, P=0.05) disease had lower risks of FN. Older age was the only risk factor for C difficilecolitis (HR 2.19 per 10 year increase, P<0.001), while risks for CLABSI increased over time (HR 1.41 per 1 year increase, P=0.002). In a landmark analysis including 100 day survivors (N=525 patients), patients with infections within the first 100 days had higher CI of 1-year non-relapse mortality (4% vs. 1% for no infections, P=0.02) and lower 1-year overall survival (81% vs. 90%, P<0.001), which was confirmed on multivariable analyses (HR 1.92, P=0.02 for non-relapse mortality, HR 1.80, P<0.001 for overall mortality). Although representative of our institutional practices, our study describes the spectrum and incidence of early infectious complications after AHCT for lymphoma in the current era. Early infections are relatively common, impact long-term survival, and have significant resource implications. Notwithstanding advances in supportive care, continued focus in this area is needed to improve outcomes in this population. Disclosures Hill: Amgen: Research Funding; Pfizer: Honoraria, Membership on an entity's Board of Directors or advisory committees; Abbvie: Honoraria, Membership on an entity's Board of Directors or advisory committees; Seattle Genetics: Honoraria, Membership on an entity's Board of Directors or advisory committees; Pfizer: Honoraria, Membership on an entity's Board of Directors or advisory committees; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees; Pharmacyclics: Honoraria, Membership on an entity's Board of Directors or advisory committees; Abbvie: Honoraria, Membership on an entity's Board of Directors or advisory committees; Seattle Genetics: Honoraria, Membership on an entity's Board of Directors or advisory committees; Genentech: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Pharmacyclics: Honoraria, Membership on an entity's Board of Directors or advisory committees; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees. Majhail:Atara: Honoraria; Anthem, Inc.: Consultancy; Incyte: Honoraria.

The introduction of basic computer media for early childhood is very important because it is one of the skills that children need in this century. Need to support parents and teachers in developing the implementation of the use of computer technology at home or at school. This study aims to determine and understand the state of learning conducted based on technology. This research uses a qualitative approach with a case study model. This study involved 15 children and 5 parents. Data obtained through interviews (children and parents) and questionnaires for parents. The results showed that children who were introduced to and taught basic computers earlier became more skilled in learning activities. Suggestions for further research to be more in-depth both qualitatively and quantitatively explore the use of the latest technology to prepare future generations who have 21st century skills. 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Norwegian early childhood teachers’ stated use of subject-related activities with children, and their focus on science, technology, environmental issues and sustainability. International Journal of Primary, Elementary and Early Years Education. https://doi.org/11250/2435060/955-11623-1-PB Tate, T. P., Warschauer, M., & Kim, Y. S. G. (2019). Learning to compose digitally: the effect of prior computer use and keyboard activity on NAEP writing. Reading and Writing, 32(8), 2059–2082. https://doi.org/10.1007/s11145-019-09940-z Theodotou, E. (2010). Using Computers in Early Years Education: What Are the Effects on Children’s Development? Some Suggestions Concerning Beneficial Computer Practice. Online Submission, (December). UNESCO. Rethinking Education. Towards a global common good. , (2015). Vartuli, S., Bolz, C., & Wilson, C. (2014). A Learning Combination: Coaching with CLASS and the Project Approach. Early Childhood Research & Practice Journal, 1–16. Vittrup, B., Snider, S., Rose, K. 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BackgroundThe anti-CD19 CAR T-cell products Axicabtagene Ciloleucel (Axi-cel) and Tisagenlecleucel have been approved by the EMA for the treatment of patients (pts) with relapse/refractory (r/r) diffuse large B-cell lymphoma (DLBCL) in August 2018. In clinical trials, both cell products induced ongoing complete responses in heavily pretreated patients. However, this activity was associated with significant toxicity. We evaluated the outcomes of DLBCL pts treated with Axi-cel and Tisagenlecleucel at the LMU Munich.Materials and MethodsCAR T cell product characteristics, toxicity and response rates of pts treated at our center between January and October 2019 were retrospectively assessed.ResultsAs of October 2019, 24 out of 34 r/r DLBCL pts (71%) with confirmed CAR T cell treatment indication were leukapheresed. Four apheresed pts died before CAR T cell therapy due to rapidly progressive disease. So far, 17 DLBCL pts have been treated. Median age was 60 years (range 19–74). ECOG was 0–1 in eleven, and 2–3 in six pts. Eight pts had undergone prior stem cell transplant (6 autologous, 2 allogeneic SCT). 13 pts received bridging chemotherapy between leukapheresis and CAR T cell transfusion. Only 6 (35%) of the 17 transfused pts would have met the inclusion criteria of the pivotal clinical trials (JULIET, ZUMA-1).CRS occurred in all pts (53% CRS °1, 29% °2 and 18% °3) with a median onset on day 2 (range days 0–7) and a median duration of 4 days (range 1–21). Tocilizumab was administered at least once in all pts. Ten pts (59%) experienced Immune Effector Cell associated Neurotoxicity Syndrome (ICANS, 30% °1, 10% °2, 30% °3, 20% °4 and 10% °5) with a median onset between day 7 and 8 and a median duration of 8 days (range 3–49). Cytopenia was significant following CAR T-cell treatment: all but one pts had neutropenia <500/µl for more than seven days.Response assessment four weeks after CAR T-cell transfusion was available for 15 pts.Objective response rate (ORR) at this early follow-up was 67%, with complete remission (CR) in four (27%) and partial remission (PR) in six pts (40%). Interestingly, ORR was higher in the four pts not receiving bridging chemotherapy between leukapheresis and CAR T-cell therapy than in pts in which bridging was applied (100% vs. 55%). Responders had significantly higher LDH levels at apheresis, start of lymphodepletion and CAR T-cell transfusion than non-responders.ConclusionsSince January 2019, the CAR T cell program has been successfully initiated at the LMU Munich, and 17 r/r DLBCL pts have been treated at our center to date. CAR T cells induced responses in heavily pretreated pts with response rates within the expected range. Toxicity was significant but manageable in most pts. Involvement of a multidisciplinary ImmunoTaskforce was a key element for adequate patient care. Preliminary data supports the hypothesis that low tumor dynamics are associated with favorable outcomes of CD19 CAR T cell therapy.Disclosure InformationV. Bücklein: None. V. Blumenberg: None. C. Schmidt: None. K. Rejeski: None. M. Ruzicka: None. N. Müller: None. A. Reischer: None. L. von Baumgarten: None. A. Völkl: None. B. Wagner: None. A. Humpe: None. J. Tischer: None. H. Stemmler: None. M. von Bergwelt: None. M. Subklewe: None.

One form of early mathematical recognition is to introduce the concept of geometric shapes. Geometry is an important scientific discipline for present and future life by developing various ways that fit 21st century skills. This study aims to overcome the problem of early mathematical recognition of early childhood on geometry, especially how to recognize geometric forms based on computer learning. A total of 24 children aged 4-5 years in kindergarten has to carrying out 2 research cycles with a total of 5 meetings. Treatment activities in each learning cycle include mentioning, grouping and imitating geometric shapes. There were only 7 children who were able to recognize the geometric shapes in the pre-research cycle (29.2%). An increase in the number of children who are able to do activities well in each research cycle includes: 1) The activities mentioned in the first cycle and 75% in the second cycle; 2) Classifying activities in the first cycle were 37.5% and 75% in the second cycle; 3) Imitation activities in the first cycle 54.2% and 79.2% in the second cycle. The results of data acquisition show that computer learning application can improve the ability to recognize geometric shapes, this is because computer learning provides software that has activities to recognize geometric shapes with the animation and visuals displayed. Keywords: Early Childhood Computer Learning, Geometry Forms, Early Math Skills Reference Alia, T., & Irwansyah. (2018). Pendampingan Orang Tua pada Anak Usia Dini dalam Penggunaan Teknologi Digital. A Journal of Language, Literature, Culture and Education, 14(1), 65– 78. https://doi.org/10.19166/pji.v14i1.639 Ameliola, S., & Nugraha, H. D. (2013). 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Abstract Background. Ara-c based chemo-immunotherapy followed by autologous stem cell transplantation (ASCT) is the most effective approach in young mantle cell lymphoma (MCL) patients, though few if any patients are cured. Recent data indicate that subsequent Rituximab maintenance (RM) prolongs PFS and OS (Le Gouill NEJM 2017). Lenalidomide is an oral agent effective in MCL, considered suitable for prolonged maintenance programs, but has never been tested in this setting. The FIL MCL0208 trial (NCT02354313) is a prospective, international randomized, phase III trial, comparing Lenalidomide maintenance (LM) vs observation (OBS) after an intensive Ara-c containing chemo-immunotherapy (R-HDS) program, followed by ASCT in previously untreated MCL patients. Patients and Methods. Adult patients aged 18-65 years, with advanced stage MCL without clinically significant comorbidities were enrolled. Patients received 3 R-CHOP-21, followed by R-HDS i.e. R-high-dose Cyclophosphamide (R-HD-CTX) (4g/m2), 2 cycles of R-high-dose Ara-C (R-HDAC) (2g/m2 q12x3 d). CD34+ cells were collected after the first course of R-HDAC. The conditioning regimen for ASCT was BEAM. After ASCT, responding patients were randomized between LM (15 mg days 1-21 every 28 days) for 24 months or observation. Primary endpoint analysis was scheduled at the occurrence of the 60th PFS event in the randomized population, which occurred on June 20th, 2017 and data were analyzed for the present abstract on March 3rd 2018. Results. Three-hundred three patients were enrolled from May 2008 to August 2015 by 48 Italian and 1 Portuguese Center. Three patients were excluded after central histological review. Median age was 57 years (IQR 51-62), M/F ratio 3.6/1. Ninety-two percent of patients had stage IV, 33% bulky disease (>5 cm), 33% elevated LDH, and 75% BM infiltration. Ki67 ≥30% was observed in 32%, MIPI was low (L) in 54%, intermediate in 31% and high (H) in 15% of patients. MIPI-c was L in 49%, low-intermediate (LI) in 29%, high-intermediate (HI) in 14%, H in 9%. Nine percent had blastoid variant. Fifty-two (17%) patients interrupted treatment before randomization (8 toxic deaths, 1 death for car accident, 24 progressions and 19 toxicity/refusals). On an ITT basis, the R-HDS + ASCT program induced 78% of CR, 7% of PRs, 10% of PD, 3% of toxic deaths (TRM) and 2% NA. Median follow-up (mFU) from inclusion was 51 months. Three years PFS and OS for the enrolled population were 67% and 84%, respectively. Of 248 patients who received ASCT, 205 were randomized either to LM (n=104) or OBS (n=101) and 43 (17%) were not because of: lack of response (8), refusal/PI decision/delay (8), unresolved infections (3) and inadequate hematopoietic recovery (24). Feasibility and efficacy were assessed on an ITT basis while toxicity was analyzed on subjects receiving at least one Lenalidomide dose. In the LM arm, 53 out of 104 patients did not start or complete the planned maintenance because of death (2), AE (26), PD (7), still ongoing (2), other causes (16). In the OBS arm 32 patients did not complete the observation phase because of death (1), AE (1), PD (20), still ongoing (10), other causes (1). Overall 28% of patients received less than 25% of the planned Lenalidomide dose. Despite suboptimal exposure to study drug, with a mFU from randomization of 35 months, 22 PFS events were recorded in the LM cohort vs 38 in the OBS arm, resulting in a 3y-PFS of 80% (95% CI; 70%-87%) in the LM arm vs. 64% in the OBS arm (95% CI; 53%-73%), stratified HR 0.51; 95% CI 0.30-0.87; p=0.013 (Fig 1A). OS was superimposable in the two arms: 93% vs 86%, stratified HR 0.96, 95% CI 0.44-2.11, p= 0.91 (Fig1B). Two deaths were observed in the LM arm due to pneumonia and thrombotic thrombocytopenic purpura and one in the OBS arm due to pneumonia. Grade 3-4 hematological toxicity was seen in 63% of patients in LM vs 11% in the OBS arm with 59% vs 10% of patients experiencing granulocytopenia. Non-hematological grade 3 toxicity was comparable in the two arms except grade 3-4 infections (11% vs. 4%; Fisher's p=0.10). Second cancers occurred in 7 patients in the LM and 3 in the OBS arm (Fisher's p=0.20). Conclusions. Results from the MCL0208 trial indicate that LM has a clinically meaningful anti-lymphoma activity in MCL. However, the applicability of LM has some limitations in the context of patients undergoing intensified chemoimmunotherapy. Overall these data support the use of a maintenance regimen after ASCT in young MCL patients. Disclosures Ladetto: Roche: Honoraria; Celgene: Honoraria; Acerta: Honoraria; Jannsen: Honoraria; Abbvie: Honoraria; Sandoz: Honoraria. Di Rocco:Roche: Membership on an entity's Board of Directors or advisory committees; Janssen: Membership on an entity's Board of Directors or advisory committees. Rossi:Novartis: Honoraria; Jazz: Membership on an entity's Board of Directors or advisory committees; Pfizer: Membership on an entity's Board of Directors or advisory committees; Abbvie: Membership on an entity's Board of Directors or advisory committees; Sanofi: Membership on an entity's Board of Directors or advisory committees; Teva: Membership on an entity's Board of Directors or advisory committees; Gilead: Membership on an entity's Board of Directors or advisory committees, Other: Travel expenses; Amgen: Membership on an entity's Board of Directors or advisory committees; Celgene: Membership on an entity's Board of Directors or advisory committees, Other: Travel expenses; Janssen: Membership on an entity's Board of Directors or advisory committees, Travel expenses; Roche: Membership on an entity's Board of Directors or advisory committees; BMS: Honoraria; Mundipharma: Honoraria; Sandoz: Honoraria; Seattle Genetics: Research Funding; Alexion: Other: Travel expenses. Chiappella:Janssen: Membership on an entity's Board of Directors or advisory committees, Other: lecture fees; Roche: Other: lecture fees; Teva: Other: lecture fees; Nanostring: Other: lecture fees; Amgen: Other: lecture fees; Celgene: Membership on an entity's Board of Directors or advisory committees, Other: lecture fees. Rusconi:Celgene: Research Funding. Gomes da Silva:Abbvie: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: lecture fees; Janssen: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: lecture fees, Institution's payment for consultancy, Travelling support; Celgene: Other: Travelling support; BMS: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: lecture fees; Roche: Other: Institution's payment for consultancy, Travelling support; Gilead Sciences: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: lecture fees, Research Funding. Vitolo:Takeda: Speakers Bureau; Sandoz: Speakers Bureau; Janssen: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Celgene: Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Roche: Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Gilead: Speakers Bureau. Martelli:Sandoz: Membership on an entity's Board of Directors or advisory committees; Janssen: Membership on an entity's Board of Directors or advisory committees; F. Hoffman-La Roche: Membership on an entity's Board of Directors or advisory committees; Servier: Membership on an entity's Board of Directors or advisory committees; Celgene: Membership on an entity's Board of Directors or advisory committees; Mundipharma: Membership on an entity's Board of Directors or advisory committees; Novartis: Membership on an entity's Board of Directors or advisory committees; Gilead: Honoraria, Membership on an entity's Board of Directors or advisory committees.

Disciplinary behavior increases children's responsibility and self-control skills by encouraging mental, emotional and social growth. This behavior is also related to school readiness and future academic achievement. This study aims to look at read aloud with the media of large books in improving disciplinary behavior during early childhood. Participants were 20 children aged 5-6 years. By using qualitative methods as a classroom action research, data collection was carried out by observation, field notes, and documentation. The results of pre-cycle data showed that the discipline behavior of children increased to 42.6%. In the first cycle of intervention learning with ledger media, the percentage of children's discipline behavior increased to 67.05%, and in the second cycle, it increased again to 80.05%. Field notes found an increase in disciplinary behavior because children liked the media which was not like books in general. However, another key to successful behavior of the big book media story. Another important finding is the teacher's ability to tell stories to students or read books in a style that fascinates children. The hope of this intervention is that children can express ideas, insights, and be able to apply disciplinary behavior in their environment. Keywords: Early Discipline Behavior, Read aloud, Big Book Media References Aksoy, P. (2020). The challenging behaviors faced by the preschool teachers in their classrooms, and the strategies and discipline approaches used against these behaviors: The sample of United States. Participatory Educational Research, 7(3), 79–104. https://doi.org/10.17275/per.20.36.7.3 Anderson, K. L., Weimer, M., & Fuhs, M. W. (2020). Teacher fidelity to Conscious Discipline and children’s executive function skills. Early Childhood Research Quarterly, 51, 14–25. https://doi.org/10.1016/j.ecresq.2019.08.003 Andriana, E., Syachruroji, A., Alamsyah, T. P., & Sumirat, F. 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Discipline and rules in four Hong Kong kindergarten classrooms : a qualitative case study. International Journal of Early Years Education, 1–15. https://doi.org/10.1080/09669760.2017.1316242 Hoffman, L. L., Hutchinson, C. J., & Reiss, E. (2005). Training teachers in classroom management: Evidence of positive effects on the behavior of difficult children. In The Journal of the Southeastern Regional Association of Teacher Educators (Vol. 14, Issue 1, pp. 36–43). Iraklis, G. (2020). Classroom (in) discipline: behaviour management practices of Greek early childhood educators. Education 3-13, 0(0), 1–9. https://doi.org/10.1080/03004279.2020.1817966 Kalb, G., & van Ours, J. C. (2014). Reading to young children: A head-start in life? Economics of Education Review, 40, 1–24. https://doi.org/doi:10.1016/j.econedurev.2014.01.002 Kemmis, S., & McTaggart, R. (1988). The action research planner (3rd ed.). Deakin University Press. Ledger, S., & Merga, M. K. (2018). Reading aloud: Children’s attitudes toward being read to at home and at school. Australian Journal of Teacher Education, 43(3), 124–139. https://doi.org/10.14221/ajte.2018v43n3.8 Longstreth, S., Brady, S., & Kay, A. (2015). Discipline Policies in Early Childhood Care and Education Programs : Building an Infrastructure for Social and Academic Success Discipline Policies in Early Childhood Care and Education Programs : Building an Infrastructure. Early Education and Development, 37–41. https://doi.org/10.1080/10409289.2011.647608 Mahayanti, N. W. S., Padmadewi, N. N., & Wijayanti, L. P. A. (2017). Coping With Big Classes: Effect of Big Book in Fourth Grade Students Reading Comprehension. International Journal of Language and Literature, 1(4), 203. https://doi.org/10.23887/ijll.v1i4.12583 Martha Efirlin, Fadillah, M. (2012). Penanaman Perilaku Disiplin Anak Usia 5-6 Tahun di TK Primanda Untan Pontianak. Pendidikan Anak Usia Dini, 1–10. Merga, Margaret K. (2017). Becoming a reader: Significant social influences on avid book readers. School Library Research, 20(Liu 2004). Merga, Margaret Kristin. (2015). “She knows what I like”: Student-generated best-practice statements for encouraging recreational book reading in adolescents. Australian Journal of Education, 59(1), 35–50. https://doi.org/10.1177/0004944114565115 Merga, Margaret Kristin. (2017). Interactive reading opportunities beyond the early years: What educators need to consider. Australian Journal of Education, 61(3), 328–343. https://doi.org/10.1177/0004944117727749 Milles;, M. B., & Huberman, M. (2014). Qualitative Data Analysis. Sage Publications. Moberly, D. A., Waddle, J. L., & Duff, R. E. (2014). Journal of Early Childhood Teacher Education The use of rewards and punishment in early childhood classrooms The use of rewards and punishment in early childhood classrooms. Journal of Early Childhood Teacher Education, 37–41. https://doi.org/10.1080/1090102050250410 Mol, S. E., & Bus, A. G. (2011). To Read or Not to Read: A Meta-Analysis of Print Exposure From Infancy to Early Adulthood. Psychological Bulletin, 137(2), 267–296. https://doi.org/10.1037/a0021890 Pegg, L. A., & Bartelheim, F. J. (2011). Effects of daily read-alouds on students’ sustained silent reading. Current Issues in Education, 14(2), 1–8. Penno, J. F., Wilkinson, I. A. G., & Moore, D. W. (2002). Vocabulary acquisition from teacher explanation and repeated listening to stories: Do they overcome the Matthew effect? Journal of Educational Psychology, 94(1), 23–33. https://doi.org/10.1037/0022-0663.94.1.23 Septyaningrum, A., & Mas’udah. (2015). Pengaruh metode bercerita berbasis dongeng terhadap kedisiplinan anak. Fakultas Ilmu Pendidikan, 1–5. Swanson, E., Vaughn, S., Wanzek, J., Petscher, Y., Heckert, J., Cavanaugh, C., Kraft, G., & Tackett, K. (2011). A synthesis of read-aloud interventions on early reading outcomes among preschool through third graders at risk for reading difficulties. Journal of Learning Disabilities, 44(3), 258–275. https://doi.org/10.1177/0022219410378444 Turan, F., & Ulutas, I. (2016). Using storybooks as a character education tools. Journal of Education and Practice, 7(15), 169–176. Turuini Ernawati, Rasdi Eko Siswoyo, Wahyu Hardyanto, T. J. R. (2018). Local- Wisdom-Based Character Education Management In Early Childhood Education. The Journal Of Educational Development. Westbrook, J., Sutherland, J., Oakhill, J., & Sullivan, S. (2019). ‘Just reading’: the impact of a faster pace of reading narratives on the comprehension of poorer adolescent readers in English classrooms. Literacy, 53(2), 60–68. https://doi.org/10.1111/lit.12141 Yılmaz, S., Temiz, Z., & Karaarslan Semiz, G. (2020). Children’s understanding of human–nature interaction after a folk storytelling session. Applied Environmental Education and Communication, 19(1), 88–100. https://doi.org/10.1080/1533015X.2018.1517062 Zachos, D. T., Delaveridou, A., & Gkontzou, A. (2016). 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Child Distance Learning (CDL) during the pandemic has led to an optimal development of children and effective teaching and learning processes in kindergartens. To overcome this, teachers need to apply a teaching approach in accordance with the principles of kindergarten education. In addition, teachers' self-efficacy of their ability to teach is also important for developing children's skills. This study aims to describe the teaching approach and the efficacy of kindergarten teachers during the CDL process and to identify the relationship between the two. The research method used is quantitative through document analysis as a source of data findings. A total of 116 Public Kindergarten (PK) teachers in DKI Jakarta participated in filling out the Classroom Management Scale and Teachers' Sense of Efficacy Scale online. All data were processed using descriptive statistics and correlation. Furthermore, there is a document analysis carried out on the Daily / Weekly Learning Program Design in PK Jakarta. The findings identified that the teaching approach of kindergarten teachers during CDL included only two principles of kindergarten education, namely thematic teaching and developing life skills. Furthermore, PK teachers in the Jakarta area showed low self-efficacy during CDL. The teaching approach and self-efficacy were caused by teachers' unpreparedness in facing challenges during CDL. In addition, other findings indicate that there is a relationship between teaching approaches and teacher self-efficacy. Another CDL model Interventions to increase teacher self-efficacy and the extent to which the relationship between the two variables can be studied further in future studies. Keywords: Early Childhood, Distance Learning, Teaching Approach, Teacher Self-Efficacy References: Agustin, M., & Wahyudin, U. (2011). Penilaian perkembangan anak usia dini. Refika Aditama. 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Abstract Introduction Fusion oncogenes (FGs) resulted due to chromosomal abnormalities are directly responsible for leukemogenesis in pediatric B-cell acute lymphoblastic leukemia (ALL) 1. The most common FGs in pediatric B-cell ALL are BCR-ABL, MLL-AF4, ETV6-RUNX11 and TCF3-PBX1, which have implication in prognostic stratification and form the basis for selection of 3-, 4- or 5 drug based remission induction regimen 1, 2. Genetic Testing for FGs also help determine the option for tyrosine kinase inhibitors for BCR-ABL+ subtypes in consolidation phase 3. Moreover, the frequencies of these clinically important genetics subtypes may not be uniform in different parts of the world because of the racial, ethnic and environmental variations 2. It shows that studies on fusion oncogenes become very important for clinical management and health policy making for pediatric B-cell ALL in a given area. Therefore, objective of this study was to find frequencies of the most common FGs and their association with clinical pattern. Methods FGs were studied in 188 pediatric B-cell ALL patients using RT-PCR2at diagnosis and results confirmed using interphase-F.I.S.H. Data was analyzed using SPSS version 17 to find out association of FGs with clinical characteristics and treatment outcome. Results Overall, FGs were detected in 87.2% (164/188) of the patients .Overall survival was around 140 weeks (Mean survival: 70.9 weeks (95% CI: 60.3-81.6) and median survival was 40 weeks (95% CI: 20.1-59.9). Our 3-years overall survival was 31.9% (60/188) and 3-year relapse free survival was 18.1% (34/188) while 4 patients (2.12%) died of treatment-related toxicities (Figures 1-3). Patients with ETV6-RUNX1 (36/188, 19.14%) had significantly better survival than patients with other FGs (Mean: 110.9 weeks, 95% CI: 92.7-129.1) (p=0.030). TCF3-PBX1 (2.1%, 4/188) was associated with an inferior outcome and a higher risk of CNS relapse. MLL-AF4 (34/188, 18.1%) was predominant in age group 8-15 years (p=0.001), with frequent organomegaly, low platelet count and poor survival (Figures 1-3). Interestingly, frequency of BCR-ABL was found to be 47. 9% (90/188, Figure 1) (Figures 1-3). Frequency of occurrence was directly proportional to age (6 less than 2 year age group, 32 in the 2–7 year age group & 52 in the 7-15 year age group). BCR-ABL positive patients had significantly lower remission rates, shorter survival (43. 73 ± 4. 24 weeks) (Figure 1) and higher white cell count as compared to other FGs except MLL-AF4. Discussion & Conclusions Our study revealed the highest reported frequency of BCR-ABL FO in pediatric ALL, in consistent with various other reports from Pakistan 2, 4, 5 & rest of the world 6, which, consequently, was associated with poor overall survival. This identifies an immediate need for BCR-ABL testing at all cancer centers and children hospitals, incorporation of imatinib in pediatric ALL treatment protocols as well as immediate start of clinical trials of tyrosine kinase inhibitors like dasatinib, nilotinib and ponatinib in for very high number of high risk BCR-ABL+ pediatric ALL in our population 2, 3, 7. Facilities for the stem cell transplantation, which are currently very rare, are needed to be developed at all pediatric leukemia treatment centers. We are urge international research community to develop research collaboration and provide training to our scientists and junior physicians interested in pediatric oncology to better understand the reasons for high BCR-ABL frequency and to betters manage morbidities and mortalities associated with this fatal type of pediatric B-cell ALL. References: 1. Martinez-Mancilla M, Rodriguez-Aguirre I, Tejocote-Romero I, et al. J Pediatr Hematol Oncol. 2013 Apr;35(3):170-3. 2. Awan T, Iqbal Z, Aleem A, et al. Asian Pac J Cancer Prev. 2012;13(11):5469-75. 3. Hunger SP. Hematology Am Soc Hematol Educ Program. 2011;2011:361-5. 4. Iqbal Z, Iqbal M, Akhter T. J Pediatr Hematol Oncol. 2007 Aug;29(8):585. 5. Faiz M, Qureshi AM, Qazi I. IJAVMS. 2011; 5(5): 497-507. 6. Siddiqui R, Nancy N, Naing WP, et al. Cancer Genet Cytogenet. 2010 Jul 15;200(2):149-53. 7: Gao C, Zhao XX, Li WJ, et al. Am J Hematol. 2012 Nov;87(11):1022-7. Disclosures: Saglio: Novartis: Consultancy, Honoraria; Bristol Myers Squibb: Consultancy, Honoraria; Ariad: Consultancy, Honoraria; Celgene: Consultancy, Honoraria.

The present article involves an empirical psycholinguistic study aimed at examining syntactic complexity in English as a Foreign Language (EFL) by early balanced Bosnian/Swedish bilingual EFL learners. 15 early balanced bilingual Bosnian/Swedish EFL learners were recruited for the study and matched with their respective control groups of intermediate EFL learners (15 speakers of Bosnian as their first language (L1) and 15 speakers of Swedish as their L1). The experimental task involved an unprepared writing assignment in English about the most significant invention of the 20th century. The corpus of the participants’ written assignments was analysed in L2 Syntactic Complexity Analyzer and SPSS software programs respectively. Data analysis involved measures of syntactical complexity. It has been found that the participants’ written assignments are characterised by statistically significant number of T-units scores in comparison with the Swedish L1 monolingual controls. 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Background: Although sleep has been identified as an important modifiable risk factor for sports injury, the effect of decreased sleep on sports injuries in adolescents is poorly studied. Purpose: To systematically review published literature to examine if a lack of sleep is associated with sports injuries in adolescents and to delineate the effects of chronic versus acute lack of sleep. Methods: PubMed and EMBASE databases were systematically searched for studies reporting statistics regarding the relationship between sleep and sports injury in adolescents aged <19 years published between 1/1/1997 and 12/21/2017. From included studies, the following information was extracted: bibliographic and demographic information, reported outcomes related to injury and sleep, and definitions of injury and decreased sleep. Additionally, a NOS (Newcastle-Ottawa Scale) assessment and an evaluation of the OCEM (Oxford Center for Evidence-Based Medicine) level of evidence for each study was conducted to assess each study’s individual risk of bias, and the risk of bias across all studies. Results: Of 907 identified articles, 7 met inclusion criteria. Five studies reported that adolescents who chronically slept poorly were at a significantly increased likelihood of experiencing a sports or musculoskeletal injury. Two studies reported on acute sleep behaviors. One reported a significant positive correlation between acutely poor sleep and injury, while the other study reported no significant correlation. In our random effects model, adolescents who chronically slept poorly were more likely to be injured than those who slept well (OR 1.58, 95% CI 1.05 to 2.37, p = 0.03). OCEM criteria assessment showed that all but one study (a case-series) were of 2b level of evidence—which is the highest level of evidence possible for studies which were not randomized control trials or systematic reviews. NOS assessment was conducted for all six cohort studies to investigate each study’s individual risk of bias. Five out of six of these studies received between 4 to 6 stars, categorizing them as having a moderate risk of bias. One study received 7 stars, categorizing it as having a low risk of bias. NOS assessment revealed that the most consistent source of bias was in ascertainment of exposure: all studies relied on self-reported data regarding sleep hours rather than a medical or lab record of sleep hours. Conclusions: Chronic lack of sleep in adolescents is associated with greater risk of sports and musculoskeletal injuries. Current evidence cannot yet definitively determine the effect of acute lack of sleep on injury rates. 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This study aimed to explore the perceived barriers to physical activity among college students Study Design: Qualitative research design Eight focus group discussions on 67 college students aged 18-24 years (48 females, 19 males) was conducted on College premises. Data were analysed using inductive approach. Participants identified a number of obstacles to physical activity. Perceived barriers emerged from the analysis of the data addressed the different dimensions of the socio-ecological framework. The result indicated that the young adults perceived substantial amount of personal, social and environmental factors as barriers such as time constraint, tiredness, stress, family control, safety issues and much more. Understanding the barriers and overcoming the barriers at this stage will be valuable. Health professionals and researchers can use this information to design and implement interventions, strategies and policies to promote the participation in physical activity. This further can help the students to deal with those barriers and can help to instil the habit of regular physical activity in the later adult years.

Abstract Background Ceftolozane/tazobactam (C/T) is approved in 70 countries, including the United States, for the treatment of patients with hospital-acquired and ventilator-associated bacterial pneumonia caused by susceptible Gram-negative pathogens. C/T is of particular importance as an agent for the treatment of multidrug-resistant (MDR) Pseudomonas aeruginosa infections. The current study summarizes 2018–2019 data from the United States on lower respiratory tract isolates of Gram-negative bacilli from the SMART global surveillance program. The CLSI reference broth microdilution method was used to determine in vitro susceptibility of C/T and comparators against isolates of P. aeruginosa and Enterobacterales. Results C/T inhibited 96.0% of P. aeruginosa (n = 1237) at its susceptible MIC breakpoint (≤4 μg/ml), including > 85% of meropenem-nonsusceptible and piperacillin/tazobactam (P/T)-nonsusceptible isolates and 76.2% of MDR isolates. Comparator agents demonstrated lower activity than C/T against P. aeruginosa: meropenem (74.8% susceptible), cefepime (79.2%), ceftazidime (78.5%), P/T (74.4%), and levofloxacin (63.1%). C/T was equally active against ICU (96.0% susceptible) and non-ICU (96.7%) isolates of P. aeruginosa. C/T inhibited 91.8% of Enterobacterales (n = 1938) at its susceptible MIC breakpoint (≤2 μg/ml); 89.5% of isolates were susceptible to cefepime and 88.0% susceptible to P/T. 67.1 and 86.5% of extended-spectrum β-lactamase (ESBL) screen-positive isolates of Klebsiella pneumoniae (n = 85) and Escherichia coli (n = 74) and 49.6% of MDR Enterobacterales were susceptible to C/T. C/T was equally active against ICU (91.3% susceptible) and non-ICU (92.6%) Enterobacterales isolates. Conclusion Data from the current study support the use of C/T as an important treatment option for lower respiratory tract infections including those caused by MDR P. aeruginosa.

Abstract Background Carbapenem-nonsusceptible and multidrug-resistant (MDR) P. aeruginosa, which are more common in patients with lower respiratory tract infections (LRTIs) and in patients in ICUs, pose difficult treatment challenges and may require new therapeutic options. Two β-lactam/β-lactamase-inhibitor combinations, ceftolozane/tazobactam (C/T) and imipenem/relebactam (IMI/REL), are approved for treatment of hospital-acquired/ventilator-associated bacterial pneumonia. Methods CLSI-defined broth microdilution methodology was used to determine MICs against P. aeruginosa isolates collected from patients with LRTIs in ICU (n=720) and non-ICU wards (n=914) at 26 United States hospitals in 2017-2019 as part of the SMART surveillance program. Results Susceptibility to commonly used β-lactams including carbapenems was 5-9 percentage points lower and MDR rates 7 percentage points higher among isolates from patients in ICUs than non-ICU wards (p&lt;0.05). C/T and IMI/REL maintained activity against 94.0% and 90.8% of ICU isolates, respectively, while susceptibility to all comparators except amikacin (96.0%) was 63-76%. C/T and IMI/REL inhibited 83.1% and 68.1% of meropenem-nonsusceptible (n=207) and 71.4% and 65.7% of MDR ICU isolates (n=140), respectively. Among all ICU isolates, only 2.5% were nonsusceptible to both C/T and IMI/REL, while 6.7% were susceptible to C/T but not to IMI/REL, and 3.5% were susceptible to IMI/REL but not to C/T. Conclusions These data suggest that susceptibility to both C/T and IMI/REL should be considered for testing at hospitals, as both agents could provide important new options for treating patients with LRTIs, especially in ICUs where collected isolates showed substantially reduced susceptibilities to commonly used β-lactams.

ABSTRACT Relebactam is a non-β-lactam, bicyclic diazabicyclooctane β-lactamase inhibitor of class A and class C β-lactamases, including Klebsiella pneumoniae carbapenemases (KPCs). It is in phase 3 clinical development in combination with imipenem/cilastatin. The in vitro activities of imipenem-relebactam, imipenem, and comparators were determined using the Clinical and Laboratory Standards Institute (CLSI) reference broth microdilution method for isolates of Enterobacteriaceae ( n = 3,419) and Pseudomonas aeruginosa ( n = 896) collected in 2016 by 21 U.S. hospital laboratories participating in the SMART (Study for Monitoring Antimicrobial Resistance Trends) global surveillance program. Relebactam was tested at a fixed concentration of 4 μg/ml. Imipenem-relebactam MICs were interpreted using CLSI breakpoints for imipenem. Rates of susceptibility to imipenem-relebactam and imipenem for non- Proteeae Enterobacteriaceae ( n = 3,143) and P. aeruginosa were 99.1% (3,115/3,143) and 95.9% (3,013/3,143) and were 94.4% (846/896) and 74.7% (669/896), respectively. Relebactam restored imipenem susceptibility to 78.5% (102/130) of imipenem-nonsusceptible non- Proteeae Enterobacteriaceae and to 78.0% (177/227) of imipenem-nonsusceptible P. aeruginosa isolates. Susceptibility to imipenem-relebactam was 98.2% (444/452) and 82.2% (217/264) for multidrug-resistant (MDR) non- Proteeae Enterobacteriaceae and MDR P. aeruginosa , respectively. Given the ability of relebactam to restore susceptibility to imipenem in nonsusceptible isolates of both non- Proteeae Enterobacteriaceae and P. aeruginosa and to demonstrate potent activity against current MDR isolates of both non- Proteeae Enterobacteriaceae and P. aeruginosa , further development of imipenem-relebactam appears warranted.

ABSTRACT Relebactam (formerly MK-7655) is an inhibitor of class A and C β-lactamases, including Klebsiella pneumoniae carbapenemase (KPC), and is currently in clinical development in combination with imipenem-cilastatin. Using Clinical and Laboratory Standards Institute (CLSI)-defined broth microdilution methodology, we evaluated the in vitro activities of imipenem-relebactam, imipenem, and seven routinely tested parenteral antimicrobial agents against Gram-negative ESKAPE pathogens (including Klebsiella pneumoniae, n = 689; Acinetobacter baumannii, n = 72; Pseudomonas aeruginosa, n = 845; and Enterobacter spp., n = 399) submitted by 21 clinical laboratories in the United States in 2015 as part of the SMART (Study for Monitoring Antimicrobial Resistance Trends) global surveillance program. Relebactam was tested at a fixed concentration of 4 μg/ml in combination with doubling dilutions of imipenem. Imipenem-relebactam MICs were interpreted using CLSI imipenem breakpoints. The respective rates of susceptibility to imipenem-relebactam and imipenem were 94.2% (796/845) and 70.3% (594/845) for P. aeruginosa, 99.0% (682/689) and 96.1% (662/689) for K. pneumoniae, and 100% (399/399) and 98.0% (391/399) for Enterobacter spp. Relebactam restored imipenem susceptibility to 80.5% (202/251), 74.1% (20/27), and 100% (8/8) of isolates of imipenem-nonsusceptible P. aeruginosa, K. pneumoniae, and Enterobacter spp. Relebactam did not increase the number of isolates of Acinetobacter spp. susceptible to imipenem, and the rates of resistance to all of the agents tested against this pathogen were >30%. Further development of imipenem-relebactam is warranted given the demonstrated ability of relebactam to restore the activity of imipenem against current clinical isolates of Enterobacteriaceae and P. aeruginosa that are nonsusceptible to carbapenems and its potential as a therapy for treating patients with antimicrobial-resistant Gram-negative infections.

Introduction I think the Privacy Act is a huge edifice to protect the minority of things that could go wrong. I’ve got a good example for you, I’m just trying to think … yeah the worst one I’ve ever seen was the Balga Youth Program where we took these students on a reward excursion all the way to Fremantle and suddenly this very alienated kid started to jump under a bus, a moving bus so the kid had to be restrained. The cops from Fremantle arrived because all the very good people in Fremantle were alarmed at these grown-ups manhandling a kid and what had happened is that DCD [Department of Community Development] had dropped him into the program but hadn’t told us that this kid had suicide tendencies. No, it’s just chronically bad. And there were caseworkers involved and … there is some information that we have to have that doesn’t get handed down. Rather than a blanket rule that everything’s confidential coming from them to us, and that was a real live situation, and you imagine how we’re trying to handle it, we had taxis going from Balga to Fremantle to get staff involved and we only had to know what to watch out for and we probably could have … well what you would have done is not gone on the excursion I suppose (School Principal, quoted in Balnaves and Luca 49). These comments are from a school principal in Perth, Western Australia in a school that is concerned with “at-risk” students, and in a context where the Commonwealth Privacy Act 1988 has imposed limitations on their work. Under this Act it is illegal to pass health, personal or sensitive information concerning an individual on to other people. In the story cited above the Department of Community Development personnel were apparently protecting the student’s “negative right”, that is, “freedom from” interference by others. On the other hand, the principal’s assertion that such information should be shared is potentially a “positive right” because it could cause something to be done in that person’s or society’s interests. Balnaves and Luca noted that positive and negative rights have complex philosophical underpinnings, and they inform much of how we operate in everyday life and of the dilemmas that arise (49). For example, a ban on euthanasia or the “assisted suicide” of a terminally ill person can be a “positive right” because it is considered to be in the best interests of society in general. However, physicians who tacitly approve a patient’s right to end their lives with a lethal dose by legally prescribed dose of medication could be perceived as protecting the patient’s “negative right” as a “freedom from” interference by others. While acknowledging the merits of collaboration between people who are working to improve the wellbeing of students “at-risk”, this paper examines some of the barriers to collaboration. Based on both primary and secondary sources, and particularly on oral testimonies, the paper highlights the tension between privacy as a negative right and collaborative helping as a positive right. It also points to other difficulties and dilemmas within and between the institutions engaged in this joint undertaking. The authors acknowledge Michel Foucault’s contention that discourse is power. The discourse on privacy and the sharing of information in modern societies suggests that privacy is a negative right that gives freedom from bureaucratic interference and protects the individual. However, arguably, collaboration between agencies that are working to support individuals “at-risk” requires a measured relaxation of the requirements of this negative right. Children and young people “at-risk” are a case in point. Towards Collaboration From a series of interviews conducted in 2004, the school authorities at Balga Senior High School and Midvale Primary School, people working for the Western Australian departments of Community Development, Justice, and Education and Training in Western Australia, and academics at the Edith Cowan and Curtin universities, who are working to improve the wellbeing of students “at-risk” as part of an Australian Research Council (ARC) project called Smart Communities, have identified students “at-risk” as individuals who have behavioural problems and little motivation, who are alienated and possibly violent or angry, who under-perform in the classroom and have begun to truant. They noted also that students “at-risk” often suffer from poor health, lack of food and medication, are victims of unwanted pregnancies, and are engaged in antisocial and illegal behaviour such as stealing cars and substance abuse. These students are also often subject to domestic violence (parents on drugs or alcohol), family separation, and homelessness. Some are depressed or suicidal. Sometimes cultural factors contribute to students being regarded as “at-risk”. For example, a social worker in the Smart Communities project stated: Cultural factors sometimes come into that as well … like with some Muslim families … they can flog their daughter or their son, usually the daughter … so cultural factors can create a risk. Research elsewhere has revealed that those children between the ages of 11-17 who have been subjected to bullying at school or physical or sexual abuse at home and who have threatened and/or harmed another person or suicidal are “high-risk” youths (Farmer 4). In an attempt to bring about a positive change in these alienated or “at-risk” adolescents, Balga Senior High School has developed several programs such as the Youth Parents Program, Swan Nyunger Sports Education program, Intensive English Centre, and lower secondary mainstream program. The Midvale Primary School has provided services such as counsellors, Aboriginal child protection workers, and Aboriginal police liaison officers for these “at-risk” students. On the other hand, the Department of Community Development (DCD) has provided services to parents and caregivers for children up to 18 years. Academics from Edith Cowan and Curtin universities are engaged in gathering the life stories of these “at-risk” students. One aspect of this research entails the students writing their life stories in a secured web portal that the universities have developed. The researchers believe that by engaging the students in these self-exploration activities, they (the students) would develop a more hopeful outlook on life. Though all agencies and educational institutions involved in this collaborative project are working for the well-being of the children “at-risk”, the Privacy Act forbids the authorities from sharing information about them. A school psychologist expressed concern over the Privacy Act: When the Juvenile Justice Department want to reintroduce a student into a school, we can’t find out anything about this student so we can’t do any preplanning. They want to give the student a fresh start, so there’s always that tension … eventually everyone overcomes [this] because you realise that the student has to come to the school and has to be engaged. Of course, the manner and consequences of a student’s engagement in school cannot be predicted. In the scenario described above students may have been given a fair chance to reform themselves, which is their positive right but if they turn out to be at “high risk” it would appear that the Juvenile Department protected the negative right of the students by supporting “freedom from” interference by others. Likewise, a school health nurse in the project considered confidentiality or the Privacy Act an important factor in the security of the student “at-risk”: I was trying to think about this kid who’s one of the children who has been sexually abused, who’s a client of DCD, and I guess if police got involved there and wanted to know details and DCD didn’t want to give that information out then I’d guess I’d say to the police “Well no, you’ll have to talk to the parents about getting further information.” I guess that way, recognising these students are minor and that they are very vulnerable, their information … where it’s going, where is it leading? Who wants to know? Where will it be stored? What will be the outcomes in the future for this kid? As a 14 year old, if they’re reckless and get into things, you know, do they get a black record against them by the time they’re 19? What will that information be used for if it’s disclosed? So I guess I become an advocate for the student in that way? Thus the nurse considers a sexually abused child should not be identified. It is a positive right in the interest of the person. Once again, though, if the student turns out to be at “high risk” or suicidal, then it would appear that the nurse was protecting the youth’s negative right—“freedom from” interference by others. Since collaboration is a positive right and aims at the students’ welfare, the workable solution to prevent the students from suicide would be to develop inter-agency trust and to share vital information about “high-risk” students. Dilemmas of Collaboration Some recent cases of the deaths of young non-Caucasian girls in Western countries, either because of the implications of the Privacy Act or due to a lack of efficient and effective communication and coordination amongst agencies, have raised debates on effective child protection. For example, the British Laming report (2003) found that Victoria Climbié, a young African girl, was sent by her parents to her aunt in Britain in order to obtain a good education and was murdered by her aunt and aunt’s boyfriend. However, the risk that she could be harmed was widely known. The girl’s problems were known to 6 local authorities, 3 housing authorities, 4 social services, 2 child protection teams, and the police, the local church, and the hospital, but not to the education authorities. According to the Laming Report, her death could have been prevented if there had been inter-agency sharing of information and appropriate evaluation (Balnaves and Luca 49). The agencies had supported the negative rights of the young girl’s “freedom from” interference by others, but at the cost of her life. Perhaps Victoria’s racial background may have contributed to the concealment of information and added to her disadvantaged position. Similarly, in Western Australia, the Gordon Inquiry into the death of Susan Taylor, a 15 year old girl Aboriginal girl at the Swan Nyungah Community, found that in her short life this girl had encountered sexual violation, violence, and the ravages of alcohol and substance abuse. The Gordon Inquiry reported: Although up to thirteen different agencies were involved in providing services to Susan Taylor and her family, the D[epartment] of C[ommunity] D[evelopment] stated they were unaware of “all the services being provided by each agency” and there was a lack of clarity as to a “lead coordinating agency” (Gordon et al. quoted in Scott 45). In this case too, multiple factors—domestic, racial, and the Privacy Act—may have led to Susan Taylor’s tragic end. In the United Kingdom, Harry Ferguson noted that when a child is reported to be “at-risk” from domestic incidents, they can suffer further harm because of their family’s concealment (204). Ferguson’s study showed that in 11 per cent of the 319 case sample, children were known to be re-harmed within a year of initial referral. Sometimes, the parents apply a veil of secrecy around themselves and their children by resisting or avoiding services. In such cases the collaborative efforts of the agencies and education may be thwarted. Lack of cultural education among teachers, youth workers, and agencies could also put the “at-risk” cultural minorities into a high risk category. For example, an “at-risk” Muslim student may not be willing to share personal experiences with the school or agencies because of religious sensitivities. This happened in the UK when Khadji Rouf was abused by her father, a Bangladeshi. Rouf’s mother, a white woman, and her female cousin from Bangladesh, both supported Rouf when she finally disclosed that she had been sexually abused for over eight years. After group therapy, Rouf stated that she was able to accept her identity and to call herself proudly “mixed race”, whereas she rejected the Asian part of herself because it represented her father. Other Asian girls and young women in this study reported that they could not disclose their abuse to white teachers or social workers because of the feeling that they would be “letting down their race or their Muslim culture” (Rouf 113). The marginalisation of many Muslim Australians both in the job market and in society is long standing. For example, in 1996 and again in 2001 the Muslim unemployment rate was three times higher than the national total (Australian Bureau of Statistics). But since the 9/11 tragedy and Bali bombings visible Muslims, such as women wearing hijabs (headscarves), have sometimes been verbally and physically abused and called ‘terrorists’ by some members of the wider community (Dreher 13). The Howard government’s new anti-terrorism legislation and the surveillance hotline ‘Be alert not alarmed’ has further marginalised some Muslims. Some politicians have also linked Muslim asylum seekers with terrorists (Kabir 303), which inevitably has led Muslim “at-risk” refugee students to withdraw from school support such as counselling. Under these circumstances, Muslim “at-risk” students and their parents may prefer to maintain a low profile rather than engage with agencies. In this case, arguably, federal government politics have exacerbated the barriers to collaboration. It appears that unfamiliarity with Muslim culture is not confined to mainstream Australians. For example, an Aboriginal liaison police officer engaged in the Smart Communities project in Western Australia had this to say about Muslim youths “at-risk”: Different laws and stuff from different countries and they’re coming in and sort of thinking that they can bring their own laws and religions and stuff … and when I say religions there’s laws within their religions as well that they don’t seem to understand that with Australia and our laws. Such generalised misperceptions of Muslim youths “at-risk” would further alienate them, thus causing a major hindrance to collaboration. The “at-risk” factors associated with Aboriginal youths have historical connections. Research findings have revealed that indigenous youths aged between 10-16 years constitute a vast majority in all Australian States’ juvenile detention centres. This over-representation is widely recognised as associated with the nature of European colonisation, and is inter-related with poverty, marginalisation and racial discrimination (Watson et al. 404). Like the Muslims, their unemployment rate was three times higher than the national total in 2001 (ABS). However, in 1998 it was estimated that suicide rates among Indigenous peoples were at least 40 per cent higher than national average (National Advisory Council for Youth Suicide Prevention, quoted in Elliot-Farrelly 2). Although the wider community’s unemployment rate is much lower than the Aboriginals and the Muslims, the “at-risk” factors of mainstream Australian youths are often associated with dysfunctional families, high conflict, low-cohesive families, high levels of harsh parental discipline, high levels of victimisation by peers, and high behavioural inhibition (Watson et al. 404). The Macquarie Fields riots in 2005 revealed the existence of “White” underclass and “at-risk” people in Sydney. Macquarie Fields’ unemployment rate was more than twice the national average. Children growing up in this suburb are at greater risk of being involved in crime (The Age). Thus small pockets of mainstream underclass youngsters also require collaborative attention. In Western Australia people working on the Smart Communities project identified that lack of resources can be a hindrance to collaboration for all sectors. As one social worker commented: “government agencies are hierarchical systems and lack resources”. They went on to say that in their department they can not give “at-risk” youngsters financial assistance in times of crisis: We had a petty cash box which has got about 40 bucks in it and sometimes in an emergency we might give a customer a couple of dollars but that’s all we can do, we can’t give them any larger amount. We have bus/metro rail passes, that’s the only thing that we’ve actually got. A youth worker in Smart Communities commented that a lot of uncertainty is involved with young people “at-risk”. They said that there are only a few paid workers in their field who are supported and assisted by “a pool of volunteers”. Because the latter give their time voluntarily they are under no obligation to be constant in their attendance, so the number of available helpers can easily fluctuate. Another youth worker identified a particularly important barrier to collaboration: because of workers’ relatively low remuneration and high levels of work stress, the turnover rates are high. The consequence of this is as follows: The other barrier from my point is that you’re talking to somebody about a student “at-risk”, and within 14 months or 18 months a new person comes in [to that position] then you’ve got to start again. This way you miss a lot of information [which could be beneficial for the youth]. Conclusion The Privacy Act creates a dilemma in that it can be either beneficial or counter-productive for a student’s security. To be blunt, a youth who has suicided might have had their privacy protected, but not their life. Lack of funding can also be a constraint on collaboration by undermining stability and autonomy in the workforce, and blocking inter-agency initiatives. Lack of awareness about cultural differences can also affect unity of action. The deepening inequality between the “haves” and “have-nots” in the Australian society, and the Howard government’s harshness on national security issues, can also pose barriers to collaboration on youth issues. Despite these exigencies and dilemmas, it would seem that collaboration is “the only game” when it comes to helping students “at-risk”. To enhance this collaboration, there needs to be a sensible modification of legal restrictions to information sharing, an increase in government funding and support for inter-agency cooperation and informal information sharing, and an increased awareness about the cultural needs of minority groups and knowledge of the mainstream underclass. Acknowledgments The research is part of a major Australian Research Council (ARC) funded project, Smart Communities. The authors very gratefully acknowledge the contribution of the interviewees, and thank *Donald E. Scott for conducting the interviews. References Australian Bureau of Statistics. 1996 and 2001. Balnaves, Mark, and Joe Luca. “The Impact of Digital Persona on the Future of Learning: A Case Study on Digital Repositories and the Sharing of Information about Children At-Risk in Western Australia”, paper presented at Ascilite, Brisbane (2005): 49-56. 10 April 2006. http://www.ascilite.org.au/conferences/brisbane05/blogs/proceedings/ 06_Balnaves.pdf>. Dreher, Tanya. ‘Targeted’: Experiences of Racism in NSW after September 11, 2001. Sydney: University of Technology, 2005. Elliot-Farrelly, Terri. “Australian Aboriginal Suicide: The Need for an Aboriginal Suicidology”? Australian e-Journal for the Advancement of Mental Health, 3.3 (2004): 1-8. 15 April 2006 http://www.auseinet.com/journal/vol3iss3/elliottfarrelly.pdf>. Farmer, James. A. High-Risk Teenagers: Real Cases and Interception Strategies with Resistant Adolescents. Springfield, Ill.: C.C. Thomas, 1990. Ferguson, Harry. Protecting Children in Time: Child Abuse, Child Protection and the Consequences of Modernity. London: Palgrave Macmillan, 2004. Foucault, Michel. Power/Knowledge: Selected Interviews and Other Writings, 1972-1977. Ed. Colin Gordon, trans. Colin Gordon et al. New York: Pantheon, 1980. Kabir, Nahid. Muslims in Australia: Immigration, Race Relations and Cultural History. London: Kegan Paul, 2005. Rouf, Khadji. “Myself in Echoes. My Voice in Song.” Ed. A. Bannister, et al. Listening to Children. London: Longman, 1990. Scott E. Donald. “Exploring Communication Patterns within and across a School and Associated Agencies to Increase the Effectiveness of Service to At-Risk Individuals.” MS Thesis, Curtin University of Technology, August 2005. The Age. “Investing in People Means Investing in the Future.” The Age 5 March, 2005. 15 April 2006 http://www.theage.com.au>. Watson, Malcolm, et al. “Pathways to Aggression in Children and Adolescents.” Harvard Educational Review, 74.4 (Winter 2004): 404-428. Citation reference for this article MLA Style Kabir, Nahid, and Mark Balnaves. "Students “at Risk”: Dilemmas of Collaboration." M/C Journal 9.2 (2006). echo date('d M. Y'); ?> <http://journal.media-culture.org.au/0605/04-kabirbalnaves.php>. APA Style Kabir, N., and M. Balnaves. (May 2006) "Students “at Risk”: Dilemmas of Collaboration," M/C Journal, 9(2). Retrieved echo date('d M. Y'); ?> from <http://journal.media-culture.org.au/0605/04-kabirbalnaves.php>.

Abstract Background Evidence-based guideline recommendations for follow-up of patients with esophageal atresia (EA) include regular surveillance esophagogastroduodenoscopy (EGD) with biopsies and a pH(-impedance) measurement (pH-MII) to evaluate gastroesophageal reflux disease (GERD) in asymptomatic patients. In addition, high-resolution manometry (HRM) is considered useful to assess esophageal dysmotility. Additional testing is recommended when symptoms are present. Our aim was to evaluate the diagnostic and clinical yield of these tests. Methods All EA patients who underwent EGD, pH-MII, and HRM according to EA guideline recommendations in 2017 and 2018 were included. Results Seventy-eight patients (53% male, 78% type C, median age 5 (0–17) years) were included. Thirty-one patients had EGD (n = 30), pH-MII (n = 11), and/or HRM (n = 7) as part of a routine surveillance program. Forty-seven patients had EGD (n = 47), pH-MII (n = 26), and HRM (n = 9) for symptom evaluation. Symptoms at the time of testing included dysphagia (51%), regurgitation (41%), and heartburn (24%). Results and consequences of the surveillance and clinically indicated tests are shown in Tables 1 and 2, respectively. Macroscopic EGD findings included stricture (21%), signs of eosinophilic esophagitis (EoE, 3%), and signs of reflux esophagitis (3%). Histological findings included EoE (13%) and reflux esophagitis (17%). Clinical implications of EGD results included medication alteration (GERD/EoE), esophageal dilation, antireflux surgery, or diet change. MII-pH was performed in 37 patients; 15 (41%) were on acid suppressive medication during measurement. Clinical implications of MII-pH results were: start or adjustment of acid suppressive therapy (30%), start or increase of other medication (22%), ceasing of acid suppressive therapy (14%), and referral for fundoplication (3%). HRM was performed in 16 patients (21%, n = 2 uninterpretable due to continuous crying) and showed absent peristalsis in 8/14 (50%), ineffective peristalsis in 4/14 (25%), and fragmented peristalsis in 2/14 patients (12.5%). Clinical implications of manometry results included referral for contrast esophagram (n = 1), increased gastrostomy feeding (n = 1), and gastrostomy placement (n = 1). Conclusion EGD, MII-pH, and HRM reveal multiple abnormalities that have clinical consequences when performed as per recommended surveillance guidelines, which highlights their importance. In most symptomatic patients, additional testing demonstrates underlying pathology. Abnormal diagnostic tests can help guide clinical management in asymptomatic and symptomatic EA patients.