Low Rates of Venoocclusive Disease and Non-Relapse Mortality in Pediatric Patients Undergoing Allogeneic Hematopoietic Cell Transplantation Following Inotuzumab Ozogamicin Reinduction for Relapsed or Refractory B Cell Acute Lymphoblastic Leukemia

Background: Inotuzumab ozogamicin (INO) is a humanized, anti-CD22 antibody conjugated to calicheamicin with FDA approval for treatment of adults with relapsed or refractory (r/r) B-acute lymphoblastic leukemia (B-ALL). While it is associated with favorable complete remission rates in r/r B-ALL patients (pts), hepatotoxicity both during treatment and with subsequent hematopoietic cell transplantation (HCT) remains a challenge. In general, venoocclusive disease (VOD) during HCT in pediatric pts is estimated at 10-20%. Following treatment with INO, however, up to 52% of pts undergoing HCT have been reported to develop VOD, of which 18% of cases were fatal (Bhojwani et al. 2019). Here we report our institutional HCT experience in pediatric pts with r/r B-ALL who underwent HCT following INO reinduction and our strategy of using defibrotide prophylaxis to reduce the risk of VOD. Methods: A retrospective chart review was conducted for pts with r/r B-ALL who underwent HCT at our institution from December 2015 to January 2021. Clinical characteristics, laboratory parameters, and radiographic evaluations were reviewed. Patients who received ≥1 course of INO during reinduction were included in the INO group. Development of VOD was defined as a clinical diagnosis of VOD post-HCT based on either the Baltimore, Seattle, or European Society for Blood and Marrow Transplantation (EBMT) diagnostic criteria.Clinical characteristics were summarized. Time to VOD, graft versus host disease (GVHD), non-relapse mortality (NRM), and relapse were estimated under the competing risk setting, in which death without the event of interest was considered to be an absorbing competing risk. Results: Fifty-seven patients with relapsed or refractory B-ALL were transplanted between December 2015 and January 2021. Seventeen (30%) received at least 1 course (3 doses) of INO as part of their pre-HCT reinduction regimen. Fifty-five of 57 pts (97%), including all pts in the INO-group received a myeloablative regimen (51 total body irradiation/cyclophosphamide-based, 4 busulfan-based). Two patients in the non-INO group received a reduced-intensity regimen. Median time from last dose of INO to HCT (Day 0) was 34 days (range 24-71 days). Median number of INO doses received was 6 (range 3-9). Four patients had been transplanted previously, 1 in the INO group and 3 in the non-INO group. Two of these patients developed VOD during their current HCT, both from the non-INO group. Pts receiving INO were more likely to be transplanted in CR3 or higher, and to have required 3 regimens in reinduction to achieve that CR. Median follow-up was 20 months. Rates of VOD were similar between the INO (3 of 17, 18%) and non-INO (4 of 40, 10%) groups (p=0.4, Figure 1). All cases were severe or very severe by EBMT criteria. There was no VOD-related mortality in either group. Defibrotide prophylaxis was used in 82% (14 of 17) of pts in the INO group. Of the 3 patients in the INO group who developed VOD, 2 received defibrotide prophylaxis and 1 did not. Reasons to defer defibrotide prophylaxis included increased risk of CNS bleeding and provider preference. Defibrotide prophylaxis was used in 15% of pts in the non-INO group (6 of 40). In the non-INO group, 1 of 4 patients who developed VOD had received defibrotide prophylaxis. All pts received vitamin E and ursodiol per institutional practice. There were no treatment-related deaths in the INO group and no statistically significant differences were detected in (NRM) (0% vs 10%, p=0.25), median time to engraftment (24 vs 26.5 days, p=0.1), or GVHD (24% vs 55%, p=0.1) in the INO vs non-INO groups. Conclusions: HCT was well tolerated with low rates of VOD and NRM in pediatric pts following reinduction with INO. The results of ongoing prospective studies will provide further insight into the role of INO for reinduction of r/r B-ALL. In our cohort, rates of VOD were similar between pts who had and had not previously received INO, with the majority of pts in the INO group receiving defibrotide prophylaxis during HCT, suggesting that inotuzumab ozogamicin reinduction may safely be used with this approach. Figure 1 Figure 1. Disclosures Margossian: Cue Biopharma: Current Employment. Silverman: Takeda, Servier, Syndax, Jazz Pharmaceuticals: Current equity holder in publicly-traded company, Membership on an entity's Board of Directors or advisory committees. Neuberg: Pharmacyclics: Research Funding; Madrigal Pharmaceuticals: Other: Stock ownership. OffLabel Disclosure: This study evaluates the safety of transplant following inotuzumab ozogamicin re-induction for children with B lymphoblastic leukemia.

Strategi pengelolaan hutan mangrove Kampung Kayu Ara Permai Kecamatan Sungai Apit Kabupaten Siak

Mangrove forest management is an effort to protect mangrove forests into conservation forest areas. This study aims to (1) analyze internal and external factors that influence mangrove forest management and (2) mangrove forest management strategies in Kayu Ara Permai Village, Sungai Apit District, Siak Regency. The research was conducted using qualitative research with descriptive research methods. The data collected consisted of primary and secondary data and were analyzed using the SWOT analysis approach (Strength, Weakness, Opportunity, and Threat). The results of the study showed a strategy in mangrove forest management in Kampung Kayu Ara Permai, namely encouraging community participation in mangrove forest management, capacity building Human resources both for the community and the Laskar Mandiri Conservation group. Development of mangrove ecotourism in Kampung Kayu Ara Permai Encouraging mangrove forest management to become Social Forestry with the Community Forestry scheme

Creation of high-performing medical department

Background: Transforming dysfunctional medical groups into high-performing departments is a process that physician leaders are not typically trained to enact. Multiple issues challenge the ability to successfully create a financially sound department that offers high-quality care along with impactful academic deliverables.Methods: We present an example of a critical care group that was highly dysfunctional that was transformed into a highperforming medical department. It underwent a change that was achieved through three stages: (1) Defining Purpose; (2) Relationship Building and Problem Solving; and (3) Group Development. The later stage is approached in a three-phase cycle.Results: Success was achieved on all deliverables including clinical care, academics and finances as validated by external measures. The department was awarded best practice for delivery of clinical care by an international accreditation group. It was twice recognized as their hospital’s highest engaged medical group. Academic deliverables increased to become a high performer all while financial stability was achieved. The importance of health and wellness is highlighted.Conclusions: The process for transforming departments is suggested in a step-wise approach for other groups to achieving similar success.

Breaching Learners’ Social Distancing through Social Media during the COVID-19 Pandemic

Higher education has been shifted toward blended learning during the COVID-19 pandemic. An increase in social media usage intensity and reduced face-to-face interaction due to the COVID-19 pandemic urged instructional communication researchers to revisit the dynamics of learners’ group development in terms of their socialization and academic performance during the COVID-19 crisis. This research aimed to determine the mediating role of social media sociability between face-to-face socialization and academic performance of higher education students in blended learning environments during the COVID-19 pandemic. It was also the aim of the study to determine the moderating effect of social media usage intensity on social media sociability. A cross-sectional survey was conducted with the students (n = 340) enrolled in science teacher education departments of universities in Pakistan. Partial least squares structural equation modeling (PLS-SEM) was used for multivariate analysis. Results revealed that face-to-face socialization gave an essential start to develop a learning group. However, when face-to-face socialization was reduced due to the COVID-19 pandemic, it was mediated by social media usage in blended learning environments to increase their socialization and academic performance during the crisis. The findings of the study are useful for higher education institutions to adopt social media strategies for students’ socialization during the crisis.

Practical Application of Integrated Simulation Technologies for Asset Development and Surface Facilities Design of Gas Fields

The main goal of this paper is to describe the automation process for asset design solutions assessment in accordance with the expected production levels in dynamics. The integrated model contains embedded sub-models (various assessment elements, such as pipeline networks, compression facilities, gas treatment units, reservoir simulation models for production profiles simulation and an economic model to obtain an instant investment estimate). A continuous data flow between all the component models provides a quick assessment of different variables influence on the final efficiency of the integrated asset development option; this approach makes possible the rapid expansion of options range as well as the increase in analysis depth. We describe this approach on the example of the gas assets group development project, which includes the integration of following part of surface facilities: pipeline networks (gathering system) for well pads with the corresponding booster compressor stations and transport network to deliver well product to gas process unit. The work shows the recommendations about how to set up the optimal configuration of an integrated model (type and composition of sub-models, linking algorithms, data exchange directions, etc.) to solve various issues of long-term planning. In addition, we show the example of standardizing the process of managing the sub- models to provide the integrated model fast update when new production data arrives or when the surface facilities concept is changed and to make the approach transfer to other close projects easier. The novelty of the work lies in the creation of a unique approach to solve the issues of conceptual design by flexible configuration of an integrated model for specific tasks. This approach includes processing of production data different formats, the ability to connect an economic model to obtain the instant investment assessment of surface facilities option within comprehensive analysis. In addition, it includes the ability to connect detailed models of the gas-processing unit and booster compressor station with prospective economic efficiency assessment in accordance with the production profiles updates. The integrated model example and overall approach that we provide in this paer is unique due to the following factors: – "flexibility" of the model, which changes its appearance depending on the tasks. – prompt update of the economic indicators of the project. – clear accounting of transport and process facilities (use of detailed models for pipeline and processing systems (including booster compressor stations).

INFLUENCE OF BUDGETING AND DEBT MANAGEMENT LITERACY TRAINING ON FINANCIAL PERFORMANCE OF EQUITY BANK TRAINED WOMEN SELF HELP GROUPS IN MACHAKOS TOWN, KENYA

Purpose: The purpose of the study was to find out the influence of financial literacy on budgeting and debt management skills on financial performance of Equity bank trained women self-help groups in Machakos Town, Kenya. Methodology: The research methodology employed two theories namely; The Bruce Tuckman’s Theory of group development and Expectancy Theory. Empirical studies were outlined and existing literature critiqued hence the research gap. The target population was 33 women self-help groups that are registered and trained by Equity Bank. Census sampling design was used for accuracy of the subdivisions of the subdivision and purposive sampling technique was used to calculate sample size because it focuses on particular characteristics of a population. The study used structured questionnaire as its data collection instrument. Analyzed data was presented through graphs and charts. Results: Findings on budget training established a significant relationship between budget training and financial performance of women self-help groups in Machakos Town, r=0.255, p=0.035<0.05 indicating that adding a unit on budget training will increase financial performance of women self-help groups in Machakos Town by 0.255 multiple units. Further findings on debt management skills training established a significant relationship between debt management training skills training and financial performance of women self-help groups in Machakos Town, r=0.600, p=0.005<0.05 indicating that adding a unit on debt management training skills will increase financial performance of women self-help groups in Machakos Town by 0.600 multiple units.

Co-living space: The shared living behavior of the millenial generation iin Indonesia

The continuous improvement in the growth rate of urbanization in Indonesia is causing an increased need for work, limited residential land, and high prices for residential development in urban areas. This phenomenon has an impact on the low occupancy rate for the millennial generation and this makes developers offer co-living space which is considered capable of solving the problem of accommodation and its use as a living space is becoming increasingly popular in recent times. Therefore, this study aimed to identify the factors influencing the formation of habitual occupancy among millennials in the co-living space of Indonesia. The process involved using a survey method with online questionnaires to collect data from the study population which consisted of the millennial generation with a sample size of 190 respondents. The data obtained were processed using exploratory multivariant statistics to show the relationship between the latent variables used in forming habitual behavior in shared living. The results showed 10 factors which constitute the living behavior in co-living space and they include public facilities, social, place attachment, feeling of satisfaction, environment, intrinsic, extrinsic, group development, economy, and workspace availability.

The Group Nurturance Inventory — initial psychometric evaluation using Rasch and factor analysis

Background This paper describes the development and psychometric evaluation of a behavioral assessment instrument primarily intended for use with workgroups in any type of organization. The instrument was developed based on the Nurturing Environments framework which describes four domains important for health, well-being, and productivity; minimizing toxic social interactions, teaching and reinforcing prosocial behaviors, limiting opportunities for problem behaviors, and promoting psychological flexibility. The instrument is freely available to use and adapt under a CC-BY license and intended as a tool that is easy for any group to use and interpret to identify key behaviors to improve their psychosocial work environment. Methods Questionnaire data of perceived frequency of behaviors relevant to nurturance were collected from nine different organizations in Sweden. Data were analyzed using confirmatory factor analysis, Rasch analysis, and correlations to investigate relationships with relevant workplace measures. Results The results indicate that the 23-item instrument is usefully divided in two factors, which can be described as risk and protective factors. Toxic social behaviors make up the risk factor, while the protective factor includes prosocial behavior, behaviors that limit problems, and psychological flexibility. Rasch analysis showed that the response categories work as intended for all items, item fit is satisfactory, and there was no significant differential item functioning across age or gender. Targeting indicates that measurement precision is skewed towards lower levels of both factors, while item thresholds are distributed over the range of participant abilities, particularly for the protective factor. A Rasch score table is available for ordinal to interval data transformation. Conclusions This initial analysis shows promising results, while more data is needed to investigate group-level measurement properties and validation against concrete longitudinal outcomes. We provide recommendations for how to work in practice with a group based on their assessment data, and how to optimize the measurement precision further. By using a two-dimensional assessment with ratings of both frequency and perceived importance of behaviors the instrument can help facilitate a participatory group development process. The Group Nurturance Inventory is freely available to use and adapt for both commercial and non-commercial use and could help promote transparent assessment practices in organizational and group development.

Origin of modern humanity in the light of system analysis

ABSTRACT This paper describes dynamic process of a small sapient group development, left Africa about 130 ka BP, which led to the fact that they, having turned into modern humans – Homo sapiens sapiens, became the only human species that dominates on the Earth. It is shown how, in the course of this process, one branch of the sapiens captured an enclave in Levant from Neanderthals, and the other settled in Asia, mainly in Southeast. How, after explosion of Toba stratovolcano 72 ka BP, almost all Asian sapiens died, with the exception of three small groups that survived this Catastrophe: in Khatlon valley among Pamir mountains in the north, on Timor in the south, and also Big Luzon in the east, which gave the beginning of three types of modern mankind – northern, southern and eastern. Further, the northerners and easterners (with a lag of ~ 15 kyr) settled the depopulated territories in Asia, and the southerners – lands in Sahul that had never known a man before. After that, the northerners achieved victory in war in Europe, as a result of which Neanderthals disappeared forever, and survived a new, at least, all-European catastrophe – the explosion of Archiflegreo stratovolcano 39.3 ka BP. Then they re-settled in depopulated lands of Europe and cold northeastern Asian territories (from which they were later driven out by newcomers from east), and in south there was a meeting of easterners with southerners on the so-called Wallace Line. A group of northerners at the same time invaded Africa, and drove out there aboriginal archaic sapiens gradually almost completely. All elements of this process, the description of which was obtained through the use of a system analysis of available information, not only fully agree with archaeological, anthropological, paleogenetic, paleoclimatic, geological, physical and other data known to us, but also answer almost all questions about the origin and ways of modern mankind expansion and remove those contradictions and problems, which discuss in scientific community. RESUMEN En este trabajo se describe el proceso dinámico de desarrollo de un pequeño grupo de sapiens, que abandonó África alrededor de 130 ka BP, y que condujo a que, convertidos en humanos modernos -Homo sapiens sapiens-, se convirtieran en la única especie humana que domina la Tierra. Se muestra cómo, en el curso de este proceso, una rama del sapiens capturó un enclave en Levante de los neandertales, y la otra se asentó en Asia, principalmente en el sureste. Cómo, tras la explosión del estratovolcán Toba 72 ka BP, murieron casi todos los sapiens asiáticos, con la excepción de tres pequeños grupos que sobrevivieron a esta catástrofe: en el valle de Khatlon, entre las montañas de Pamir, en el norte, en Timor, en el sur, y también en el Gran Luzón, en el este, lo que dio lugar al inicio de tres tipos de humanidad moderna: norteños, sureños y orientales. Además, los norteños y orientales (con un desfase de ~ 15 kyr) se asentaron en los territorios despoblados de Asia, y los sureños, en tierras de Sahul que nunca habían conocido al hombre. Después, los norteños consiguieron la victoria en la guerra en Europa, como resultado de la cual los neandertales desaparecieron para siempre, y sobrevivieron a una nueva catástrofe, al menos, totalmente europea: la explosión del estratovolcán Archiflegreo 39,3 ka BP. Luego se reasentaron en tierras despobladas de Europa y en territorios fríos del noreste de Asia (de los que fueron expulsados más tarde por los recién llegados del este), y en el sur se produjo un encuentro de orientales con sureños en la llamada Línea Wallace. Un grupo de norteños invadió al mismo tiempo África, y expulsó allí a los sapiens arcaicos aborígenes gradualmente casi por completo. Todos los elementos de este proceso, cuya descripción se obtuvo mediante el uso de un sistema de análisis de la información disponible, no sólo concuerdan plenamente con los datos arqueológicos, antropológicos, paleogenéticos, paleoclimáticos, geológicos, físicos y otros conocidos por nosotros, sino que también responden a casi todas las preguntas sobre el origen y las formas de expansión de la humanidad moderna y eliminan aquellas contradicciones y problemas, que se discuten en la comunidad científica.