Laboratory Prognostic Index (LaPI): Three Laboratory Variables Are Able to Stratify Diffuse Large B-Cell Lymphoma NOS Patients in Prognostic Clusters at Diagnosis

Introduction: Defining high-risk profiles at diffuse large B-cell lymphoma (DLBCL) diagnosis is a current effort of the scientific community in an attempt to design more aggressive therapeutic approaches for those patients. Several prognostic scores have been created combining biological, clinical and laboratory parameters. The prognostic impact of laboratory variables has widely been studied, with variable results in literature. Our aim was to evaluate the outcome impact of relevant laboratory parameters with different cut-offs in a homogeneous DLBCL series, and to design a simple and practical prognostic model. Methods: A retrospective evaluation of de novo DLBCL not otherwise specified cases (2013-2020 period) with a complete blood test at diagnosis (n=126) was performed. Twelve laboratory variables with different cut-off points were analysed (30 parameters). The thresholds for each variable were chosen based on previous literature, Institutional Laboratory ranges, and ROC curves for both event-free survival (EFS) and overall survival (OS). The EFS and OS univariate hazard ratios (UV HR) were analysed by Cox regression model to assess the prognostic impact of each variable and their different cut-offs. A multivariate analysis (MV) for the EFS was performed including the most significant parameters (UV HR >1 and P <0.1). The variables were chosen in different steps (EFS MV HR >1 and P <0.1) until the final model was designed. The point score assigned to each variable was carried out proportionally according to their excess of risk measured by the regression coefficient (B). Three prognostic clusters were grouped according to the EFS of each score level (0-4 points) graphed by Kaplan-Meier curves. The model was applied in parallel to the OS. Results: The cohort consisted of 64 females and 62 males, median age 70 years (28-89). The median follow-up of the series was 29 months (0.3-97). In Figure 1A are presented by forest plots the UV HR of the laboratory variables and their different cut-offs for both EFS and OS. The final model, which included 100 patients, combined three parameters (Figure 1B): lactate dehydrogenase (LDH) >235 U/L (EFS MV HR 1.9, 95% CI 0.9-4; point score 1), hemoglobin (Hb) <120 g/L in females and <135 g/L in males (EFS MV HR 1.8, 95% CI 0.9-3.8; point score 1), and beta-2 microglobulin (β2M) >4 mg/L (EFS MV HR 3.1, 95% CI 1.6-5.9; point score 2). The patients were divided into three clusters with different prognosis (Figure 1C): 0 points (n=17; 3-year EFS 86%, 3-year OS 92%), 1-2 points (n=46; 3-year EFS 63%, 3-year OS 71%), and 3-4 points (n=37; 3-year EFS 27%, 3-year OS 35%). Conclusions: Here is presented a Laboratory Prognostic Index (LaPI) based on three variables routinely evaluated at DLBCL diagnosis: LDH, Hb and β2M. The model is simple and is able to classify DLBCL cases into three clusters with different EFS and OS. This score would allow clinicians to have preliminary prognostic information through a basic blood test. The purpose is to prospectively validate this model in a larger cohort, focusing on the identification of high-risk patients who may benefit from more aggressive therapeutic approaches. Figure 1 Figure 1. Disclosures Garcia Gutierrez: Pfizer: Consultancy, Honoraria, Research Funding; Incyte: Consultancy, Honoraria, Research Funding; Novartis: Consultancy, Honoraria, Research Funding; BMS: Consultancy, Honoraria, Research Funding.

Do people want smarter ballots?

We ascertain whether citizens want to have smart ballots, that is, whether they appreciate having the possibility to express some support for more than one option (expression across options) and to indicate different levels of support for these options (expression within options). We conducted two independent yet complementary survey experiments at the time of the Super Tuesday Democratic primaries to examine which voting method citizens prefer, one with the real candidates in the states holding Democratic primaries and one with fictitious candidates in the whole country. In both surveys, respondents were asked to vote using four different voting rules: single, approval, rank, and point (score). After they cast their vote, respondents were asked how satisfied they were using each voting method. The findings are consistent in both studies: the single vote is the most preferred voting method. We show that this is a reflection of a status quo bias, as citizens’ views are strongly correlated with age.

Detecting at-risk students on Computer Science bachelor programs based on pre-enrollment characteristics

The purpose of this paper is to investigate the pre-enrollment attributes of first-year students at Computer Science BSc programs of the University of Miskolc, Hungary in order to find those that mostly contribute to failure on the Programming Basics first-semester course and, consequently to dropout. Our aim is to detect at-risk students early, so that we can offer appropriate mentorship program to them. The study is based on secondary school performance and first-semester Programming Basics course results from the last decade of over 500 students. Secondary school performance is characterized by the rank of the school, admission point score, and foreign language knowledge. The correlation of these data with the Programming Basics course result is measured. We have tested three hypotheses, and found that admission point score and school rank together have significant impact on the first-semester Programming Basics course results. The findings also support our assumption that students having weaknesses in all examined pre-enrollment attributes are subject to dropout. This paper presents our analysis on students' data and the method we used to determine the attributes that mostly affect dropout.

Abstract P819: Individualized Patients’ Risk of Post Rt-pa ICH in Acute Ischemic Stroke by Using a Simple Predictive Model

Background and Purpose: A simple and reliable prediction of post intravenous recombination tissue plasminogen activator (rt-PA) intracerebral hemorrhage (ICH) is useful for stroke team to inform individual risk and improve hospitalization care. We aim to develop and validate a simple predictive score model to assess the 24-hour risk of ICH post rt-PA. Methods: This retrospective study included 739 acute ischemic stroke patients who received intravenous rt-PA between October 2005 and June 2020 at Siriraj Hospital, Bangkok, Thailand. Multiple logistic regression was used to evaluate the value of independent variables associated with any ICH and symptomatic intracerebral hemorrhage (SICH) measure by the European Cooperative Acute Stroke Study II (ECASS II) definition. Adjusted ORs of independent variables were converted to point score, summated of point score provide a probability of ICH and SICH. The predictive scores were internal validated in 95 patients and performance tested with an area under a receiver operating characteristic curve (AUC-ROC). Results: From a total of 739 patients, 19.2% had an ICH in which 5.9% was SICH. The predictive model of ICH included hyperdense middle cerebral artery sign (HDMCA) (3 points), initial blood glucose > 180mg/dl (3 points), coronary artery disease (CAD) (2 points), international normalized ratio (INR) > 1.0 (2 points) and 10 year increase of age ( 1 point per 10 year increase; age ≤ 20 year = 1). The performance of the predictive model showed AUC-ROC was 0.72 (95% confidence interval, 0.60 - 0.82) in the derivative cohort and AUC-ROC was 0.74 (95% confidence interval, 0.66 - 0.85) in the validation cohort. Conclusions: This simple predictive model provides a better prediction of a 24-hour risk of ICH post rt-PA in AIS among Thai patients. An individualized ICH risk post rt-PA can assist frontline physicians and relatives in rt-PA decision making process. Further external validation and prospectively confirmed in a larger cohort is recommend.

Quantifying the Activity Profile of Female Beach Volleyball Tournament Match-Play

Effective time-motion analysis can provide information directly applicable to the design of physical conditioning and testing programmes. The aim of the present study was to determine the external output of female beach volleyball players during tournament match-play and to assess the effect of competition level, margin of score differential and alterations of external output within matches. The external output profile of ten adult level (age 27 ± 3 y) and ten under 23 (‘U23’; age 19 ± 2 y) female beach volleyball players were determined using GPS technology (10 Hz) during 60 matches (n = 50 first and second sets and 20 third sets files) played during their respective Australian Beach Volleyball Championship tournaments. Comparisons between groups and the influence of contextual factors on the external output within matches were analysed using linear mixed models. Adult beach volleyball players covered a greater relative distance (i.e., m·min-1) in speed zone 2 (1.0-1.99 m·s-1; 42.0% of total relative distance) and zone 3 (≥2.0 m·s-1; 10.9% of total relative distance) compared to U23 players. Relative distance, mean acceleration/deceleration and the relative distance covered in acceleration zone 2 and deceleration zone 2 and 3 was greater in set 1 compared to set 2. Sets that were decided by smaller score margins (<6-point score differential) were comprised of a greater relative distance, peak speed, greater mean acceleration and deceleration output and a greater relative distance in speed zone 1 and 3 compared to sets decided by larger score margins (>5-point score differential). The findings from this study suggest that there are contextual factors that influence the speed and acceleration/deceleration profile of female beach volleyball players such as tournament level, score margin and set-to-set variations that may have implications for the physiological and mechanical requirements of female players preparing for competition.

Accuracy of prehospital ambulance stroke test in terms of diagnosis of patients with acute ischemic stroke: A multi-center study

Background: Andsberg et al. have recently introduced a novel scoring system entitled “PreHospital Ambulance Stroke Test (PreHAST)”, which helps to early identification of patients with acute ischemic stroke (AIS) even in prehospital setting. Its validity has not been assessed in a study yet, and the purpose of this study was to assess this scoring system on a larger scale to provide further evidence in this regard. Methods: This was a cross-sectional multi-center accuracy study, in which, sampling was performed prospectively. All patients over 18 years of age admitted to the emergency department (ED) and suspected as AIS cases were included. All required data were recorded in a form consisting of 3 parts: baseline characteristics, neurological examination findings required for calculating PreHAST score, and the ultimate diagnosis made from interpretation of their brain magnetic resonance imaging (MRI). Results: Data from 805 patients (57.5% men) with the mean age of 67.1 ± 13.6 years were analyzed. Of all the patients presenting with suspected AIS, 562 (69.8%) had AIS based on their MRI findings. At the suggested cut-off point (score ≥ 1), PreHAST had a specificity of 46.5% [95% confidence interval (CI): 40.1%-53.0%) and a sensitivity of 93.2% (95%CI: 90.8%-95.2%). Conclusion: According to the findings of our study, at the suggested cut-off point (score ≥ 1), PreHAST had 93.2% sensitivity and 46.5% specificity in detection of patients with AIS, which were somewhat different from those reported in the original study, where 100% sensitivity and 40% specificity were reported for this scoring system.

Assessment of the Medical Students Preparedness and Willingness for Integration into a War-torn Healthcare System: The example of COVID-19 Pandemic Scenario

Background: The question about the role of the senior medical students in the fight against COVID-19 pandemic was raised after the serious shortage in healthcare workers faced by many healthcare systems. This research aimed to explore the ability of the final-year medical students to assist during COVID-19 in a war-torn health system.Methods: Final-year medical students in Syrian Universities were approached between 9th-17th April 2020 through an online questionnaire that assessed the students’ COVID-19-related medical knowledge (5-point score), clinical judgment (5-point score), preparedness and willingness to integrate in the healthcare facilities. An overall score of 10 points was built and multivariate analysis was conducted.Results: A total of 1764 responses were received. Valid responses were (1673) with 1199 (71.66%) responses from the final-year students. Of the latter, 728 (60.71%) scored 4 points or higher in the medical knowledge score (mean 3.69 points [SD 0.96]), while 298 (24.85%) scored 4 or higher in the clinical judgment score. Final-year students scored significantly higher than the fourth-year students in the clinical judgment score (mean 2.69 points [SD 1.12] vs 2.47 [1.15]; adjusted P=0.012). Nearly 72.4% of the final-year participants had an overall score of 7 points or more out of 10 (mean 6.39 points [SD 1.57]). Having fears of infection (log OR 0.24, 95% CI 0.05– 0.44; P=0.01) correlated with a higher overall score, contritely to beginner, intermediate English level, and male gender (log OR -0.68 [95% CI -1.01– -0.35]; P<0.001, -0.3 [-0.5 – -0.1]; P= 0.003, -0.25 [-0.43 – -0.08]; P=0.004, respectively). Finally, 682 (56.88%) of the final-year students expressed willingness to volunteer with healthcare teams.Conclusion: Integrating final-year medical students may be an alternative in case of pandemics especially for fragile systems or those hit by a long-lasting war, while taking into consideration fulfilling personal protective measures, intensive training, and/or adequate supervision.