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Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4890-4890
Author(s):  
Xitlaly Judith Gonzalez Leal ◽  
Elías Eugenio González López ◽  
Felipe Soto-Lanza ◽  
Gerardo A De la Rosa-Flores ◽  
Perla R. R. Colunga-Pedraza ◽  
...  

Abstract Introduction Allogeneic bone marrow transplantation (BMT) is a potentially curative treatment for many hematological diseases. However, lack of availability of specialized centers and high costs limit access to the procedure in low and middle income countries. Previous research has shown that Latin-American patients with hematological malignancies have worse outcomes when treated in public health systems compared to patients treated in the private setting. Healthcare in Mexico is provided by three systems: the private sector (financed by a private insurance or out of pocket), social security (government-run health systems) and a public system (partially funded by the government), where the most vulnerable population is treated. To date, disparities in outcomes of BMT between patients in public and private health systems have not been widely studied. Objectives Primary: to determine the impact of access to private healthcare in BMT recipients by comparing the outcomes of patients treated in two centers that are led by a single team. Secondary objectives were to determine differences in the overall treatment population and transplantation strategies in each context. Patients and Methods We performed a retrospective analysis of consecutive patients aged 15 and older who underwent BMT regardless of diagnosis form 2015-2021 in two Institutions: 1) A private hematology practice treating insured patients in conventional BMT units similar to those in high-income countries (Private) and 2) A public academic institution where an outpatient transplant strategy is common in the context of significant limitations in access to quality supportive care and high-cost medications (Public). Both programs are led by the same team of hematologists following similar transplant strategies with the salient features being the frequent use of peripheral blood stem cells, chemotherapy-based conditioning regimens, and the preferred use of haploidentical donors vs. matched unrelated donors. We excluded second transplants from this analysis and patients who received them were censored at the time of infusion. We compared baseline characteristics, overall survival (OS), event free survival (EFS), non-relapse mortality (NRM), and the incidence of GVHD in the two different treatment systems. Results A total of 219 patients underwent BMT from January 2015 to June 2021, n=166 (76%) were performed in the Public setting, and n=53 (24%) in the Private setting. Patients in the Private group were older, with a higher proportion of high/very high disease risk index (DRI), hematopoietic cell comorbidity index (HCT-CI) and more frequent use of myeloablative conditioning (Table 1). A similar proportion haploidentical donor grafts were performed (61 vs 57%) with a single matched unrelated donor transplant in the Private center. Median follow-up was 9.7 (0.2-71), and 10.3 (0.7-67.6) months, for Public and Private centers respectively (p=0.38). Median time to neutrophil and platelet engraftment were similar. Seventy patients (42%) in Public, and 15 patients (28%) in Private groups relapsed (p=0.049), with a median time to relapse of 17.5 vs. 47.6 months (p<0.017); there were no significant differences in non-relapse mortality at 2 years (27 vs. 18%) (Fig.1) and primary failure (9% vs 2%). Grade 2-4 aGVHD occurred in 31% patients in the Public setting vs. 19% in Private (p=0.08), without differences in grade 3-4 aGVHD (12% vs 8%). Moderate/severe cGVHD incidence was similar for both groups with (19 vs. 18%). Estimated 2-year EFS was 34% in Public vs. and 54% in Private (Fig. 2), with a median EFS of 8.8 vs 25.7 months (p= 0.024). There were no statistically significant differences in OS (p=0.65), with estimated 2-year OS of 51% for Public and 68% for Privately treated patients, and a median OS of 21.1 months vs. not reached (Fig. 3). When stratified by DRI, patients with Public BMT and a high/very high DRI had a median OS of only 9.7 months vs. not reached for the Private group (Fig. 4). Patients with high/very high DRI in the Private setting had similar outcomes to those with low/intermediate disease in the Public group with the best outcomes achieved by patients with low/intermediate disease treated privately. Conclusion Patients who undergo BMT in the public health system are at risk for significantly worse outcomes when compared to patients cared for in private systems even if a similar strategy is followed and are led by the same team. Figure 1 Figure 1. Disclosures González López: AMGEN: Honoraria; JANSSEN: Honoraria. Gomez-Almaguer: Janssen: Honoraria, Speakers Bureau; Takeda: Honoraria, Speakers Bureau; Bristol-Myers-Squibb: Honoraria, Speakers Bureau; Roche: Honoraria, Speakers Bureau. Gomez-De Leon: ASH: Research Funding; Abbvie: Honoraria; Sanofi: Honoraria; Novartis: Honoraria.


Author(s):  
Jingyi Gu

In this paper, I consider live/life streaming as a mediated venue for making social relationships and a mediatized world constituted of diverse livelihoods. Drawing from my digital ethnography on two Chinese live streaming platforms Inke and Huajiao, I document the emergence of narratives, performances, and interactions that are either sexually suggestive or have gendered implications. I identify patterns of emotional expression and self-disclosure that lie within these interactions and analyze their alignment with and distinction from those that have been considered within the existing theorization of intimacy. In doing so, I examine how live/life streaming constructs scalable “mediated intimacy,” in the one-versus-many semi-public setting, through nurturing gendered performances and building subtle sexual tension between its participants.


2021 ◽  
Author(s):  
Joshua Townsley ◽  
Stuart J Turnbull-Dugarte ◽  
Siim Trumm ◽  
Caitlin Milazzo

Abstract While most voters in democratic countries still cast their ballot on election day, the proportion of the electorate which opts for postal voting has been steadily, and often dramatically, increasing. This transformation in electoral politics, however, is under-researched, particularly with regards to the motivations underlying the decision to cast a postal vote. In this article, we analyse the factors that drive an individual to vote by post rather than at the polling station. Using data from the 2019 British Election Study, we show, among other findings, that citizens for whom in-person voting would entail higher costs, such as the elderly and disabled, are more likely to opt for the convenience of postal voting. In addition, we find that partisans are unlikely to vote by post, suggesting that they derive greater expressive benefits from voting in a public setting. Finally, our analysis demonstrates that constituency marginality matters when it comes to opting for postal voting: citizens in more competitive constituencies are significantly more likely to ensure their votes by casting their ballots by post rather than on election day.


2021 ◽  
pp. 003802612110346
Author(s):  
Sofie Henze-Pedersen ◽  
Margaretha Järvinen

This article explores the family relationships of mothers and children living at a women’s refuge because of intimate partner violence. Theoretically, the article contributes to the sociological literature analysing family relationships in terms of ‘doing’ and ‘displaying’ rather than ‘being’ a family. Empirically, it is based on ethnographic fieldwork and semi-structured interviews with children living at a refuge in Denmark. The article shows that family display at the refuge is conducted by both mothers and children and sometimes in conflicting ways, not least when it comes to the question of how to define the position of the father (who has committed the violence) in the family’s future life. This highlights how display – as an evaluative practice – can be done in different ways in order to protect or reject family relationships, both internally and when addressing external audiences. Furthermore, the article analyses family relationships in a semi-public setting (the refuge) where powerful audiences are active interpreters of the family display enacted, and participants in decisions concerning the families’ futures.


2021 ◽  
pp. 109019812110265
Author(s):  
Ashleigh Haynes ◽  
Andrea Nathan ◽  
Clover Maitland ◽  
Helen Dixon ◽  
Anna Nicholson ◽  
...  

Skin cancer prevention efforts in Australia have increasingly incorporated a focus on protection during incidental sun exposure. This complements the long-present messages promoting protection in high-risk settings and avoidance of acute intense bouts of sun exposure. Data from two waves of a cross-sectional direct observational survey was used to assess the prevalence and correlates of N = 12,083 adolescents’ and adults’ sun protection behavior (arm and leg cover, hat, sunglasses, and shade cover). Individuals were observed in public outdoor settings in Melbourne, Australia during peak ultraviolet (UV) times (11 a.m.–3 p.m.) on summer weekends. Settings included pools and beaches, parks and gardens, and for the first time in 2018, outdoor streets and cafés which may capture more incidental forms of sun exposure and represent another public setting where Australians commonly spend time outdoors. Females and older adults were consistently better protected than males and adolescents. Physical activity was strongly associated with low shade cover across settings. Weather was more strongly associated with sun protection at outdoor streets/cafes and parks/gardens than at pools/beaches but use of observed sun protection (particularly arm cover and covering hat) was low across settings. Continued public education about UV risk and its relation to weather and the seasons is needed to promote the routine use of multiple forms of sun protection during outdoor activities in peak UV times, especially among males and adolescents. Findings also highlight the importance of considering activity demands of public spaces in shade planning to optimize sun protection during outdoor activities in public spaces.


Author(s):  
Costel Vasile Siserman

Frotteurism disorder or frotteurism is one of the paraphilic disorders that cause sexual arousal. It is the act of touching or rubbing the genitals against a person in a sexual manner, without their consent, to obtain sexual pleasure or to reach orgasm. Those who practice frotteurism find pleasure in having a private sexual experience in a public setting.


2021 ◽  
Author(s):  
Michael P. Peterson ◽  
Paul Hunt

The display of maps on computer monitors in a public setting can be used to emphasize their value in conveying spatial patterns. For thematic maps, by removing the possibility for interaction, more attention can be focused on the mapped distributions. Maps that lend themselves best for public display are those that are frequently updated, such as weather maps. Other types of frequently updated maps (FUMs) include those of earthquakes, air pollution, and health conditions, such as the spread of a virus. These types of maps are increasingly provided through the internet in an interactive format, making the resultant maps less suited for public display. Described here are available maps that could be displayed in a public setting, and a method to make maps for quick display based on available data. A series of these maps can then be assembled and shown in a continuous loop. The display of maps for the public can be implemented using the low-cost, Raspberry Pi computer. Maps that are suitable for public display, instructions for implementation and the required code are available at: maps.unomaha.community/FUMPD/About.html.


Author(s):  
Carina Leal ◽  
Nuno Almeida ◽  
Maria Silva ◽  
Antonieta Santos ◽  
Helena Vasconcelos ◽  
...  

<b><i>Introduction:</i></b> Advances in endoscopy and open-access systems led to an increase in endoscopic procedures. However, overuse of endoscopy has been consistently reported. This study aims to assess the appropriateness of esophagogastroduodenoscopy (EGD) and colonoscopy referral in the private and public setting. <b><i>Patients and Methods:</i></b> We conducted a prospective, multicenter study at 2 public and 5 private endoscopy units. Patients scheduled for elective EGD or colonoscopy were enrolled. Clinical data and endoscopy findings were recorded. Appropriateness of endoscopy was defined according to the American Society for Gastrointestinal Endoscopy guidelines (for EGD) and the European Panel on Appropriateness of Gastrointestinal Endoscopy II (for colonoscopy). <b><i>Results:</i></b> Regarding EGD: 215 patients enrolled (43.7% were males) with a mean age of 61.0 ± 15.1 years; 54.0% (<i>n</i> = 116) were in public hospitals. Referral by a gastroenterologist was made for 34.9% (<i>n</i> = 75). Appropriate indications were made for 62.3% (<i>n</i> = 134): 42.4% in private versus 79.3% in public endoscopy units (odds ratio [OR] 5.20; 95% confidence interval [CI] 2.85–9.49; <i>p</i> &#x3c; 0.01). Rate of appropriate EGD was 74.7% for gastroenterologist referral and 56.1% for other specialties (OR 2.31; 95% CI 1.24–4.28; <i>p</i> &#x3c; 0.01). Diagnostic yield for relevant findings was 47.9%. No association between indication appropriateness, gastroenterologist referral, and relevant endoscopic findings was found. Regarding colonoscopy: 287 patients enrolled (49.1% were males) with a mean age of 60.4 ± 14.4 years; 48.1% (<i>n</i> = 138) were in public hospitals. Referral by a gastroenterologist was made for 20.6% (<i>n</i> = 59). Appropriate indications were made for 70.0% (<i>n</i> = 201): 53.0% in private vs. 88.4% in public endoscopy units (OR 6.75; 95% CI 3.66–12.47; <i>p</i> &#x3c; 0.01). Diagnostic yield was 57.1%. Relevant endoscopic diagnosis was associated with indication: 63.2% in the appropriate vs. 43.0% in the nonappropriate indication group (<i>p</i> &#x3c; 0.05). <b><i>Discussion:</i></b> A significant percentage of endoscopies, mainly in the private setting, were performed without an appropriate indication. This influenced the diagnostic yield. The use of adequate criteria is fundamental for the rational use of an open-access system.


2021 ◽  
Author(s):  
Saad Gulzar ◽  
Muhammad Yasir Khan

How can we motivate `good' politicians -- those that will carry out policy that is responsive to citizens' preferences -- to enter politics? In a field experiment in Pakistan, we vary how political office is portrayed to ordinary citizens. We find that emphasizing pro-social motives for holding political office instead of personal returns -- such as the ability to help others versus enhancing one's own respect and status -- raises the likelihood that individuals run for office and that voters elect them. It also better aligns subsequent policies with citizens' preferences. The candidacy decisions are explained by social influence, and not information salience -- we find that social versus personal messaging matters only when randomly delivered in a public setting but not in private. Results also show that changes in political supply, not citizen preferences or behavior, explain policy alignment. Taken together, the results demonstrate that non-financial motivations for political entry shape how politicians perform in office.


2021 ◽  
Vol 1 (1) ◽  
pp. 145-151
Author(s):  
Gabriel Kacsó
Keyword(s):  

"Despite Romania’s significant quantity improvement in terms of radiotherapy infrastructure during the last 5-10 years, quality has experienced a slow upgrade, at least in the public setting. This is a pandemic eye view perspective on the current romanian radiotherapy, triggering differential incentives adjusted for quality / complexity of delivered RT."


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