“Cursed is the ground because of you”:

This paper analyses culture as a determinant of technology adoption in a developing country. While the literature discusses the influence of culture upon economic growth, little attention has been paid to the mechanisms at the micro level. Therefore, we postulate that culture plays a crucial role in hindering or fostering the diffusion of innovation, a key trigger of the engine of growth. This empirical study uses the Ethiopia Rural Household Survey to disentangle between individual cultural traits, namely, ethnicity and religion, and the cultural homogeneity of the environment as co-determinants of fertiliser adoption. To examine our hypotheses, we apply a multivariate survival model for clustered and correlated observations to account for time and location effects. The results reveal significant differences in the probability of adopting fertiliser among cultural groups. Moreover, habits and social norms, proxied by ethnicity, provide a better explanation for the role of culture, than religious beliefs, as usually posited in the literature. Also, the cultural environment turns out tobe a decisive trigger. The probability of adoption is higher in rural societies with a homogeneous ethnic environment but distinct religious variety.

Reduced intensity conditioning for acute myeloid leukemia using melphalan- vs busulfan-based regimens: a CIBMTR report

There is a lack of large comparative study on the outcomes of reduced intensity conditioning (RIC) in acute myeloid leukemia (AML) transplantation using fludarabine/busulfan (FB) and fludarabine/melphalan (FM) regimens. Adult AML patients from Center for International Blood and Marrow Transplant Research who received first RIC allo-transplant between 2001 and 2015 were studied. Patients were excluded if they received cord blood or identical twin transplant, total body irradiation in conditioning, or graft-versus-host disease (GVHD) prophylaxis with in vitro T-cell depletion. Primary outcome was overall survival (OS), secondary end points were leukemia-free survival (LFS), nonrelapse mortality (NRM), relapse, and GVHD. Multivariate survival model was used with adjustment for patient, leukemia, and transplant-related factors. A total of 622 patients received FM and 791 received FB RIC. Compared with FB, the FM group had fewer transplant in complete remission (CR), fewer matched sibling donors, and less usage of anti-thymocyte globulin or alemtuzumab. More patients in the FM group received marrow grafts and had transplantation before 2005. OS was significantly lower within the first 3 months posttransplant in the FM group (hazard ratio [HR] = 1.82, P < .001), but was marginally superior beyond 3 months (HR = 0.87, P = .05). LFS was better with FM compared with FB (HR = 0.89, P = .05). NRM was significantly increased in the FM group during the first 3 months of posttransplant (HR = 3.85, P < .001). Long-term relapse was lower with FM (HR = 0.65, P < .001). Analysis restricted to patients with CR showed comparable results. In conclusion, compared with FB, the FM RIC showed a marginally superior long-term OS and LFS and a lower relapse rate. A lower OS early posttransplant within 3 months was largely the result of a higher early NRM.

Interim analysis of hepatocellular carcinoma (HCC) screening and survival in 4,087 veterans diagnosed with HCC from 2008 to 2010.

243 Background: The Veterans Health Administration (VHA) is the largest provider of liver disease care in the US. From 2000-2007, there was a 5-fold increase in the incidence of hepatocellular carcinoma (HCC) among Veterans. The aim of the VOCAL group is to study outcomes and cost of Veterans diagnosed with cirrhosis and HCC from 2008-2010. Methods: The VA Corporate Data Warehouse was queried to identify all patients with ICD9 codes for HCC (155.0, 155.2) and cirrhosis (571.2, 571.5, 571.6). Chart abstraction was performed for each HCC patient to determine tumor characteristics, BCLC stage, and eligibility for transplantation. Results: This is an interim analysis of the first 4087 of 7,111 patients with HCC. HCC was confirmed in 3,207/4,087 (78%). Of these 3,207 patients, 778 (24%) were managed outside the VHA and 156 (6%) were diagnosed prior to 2008. Thus, 2,323 patients were analyzed. Median age was 60y (38-91). Males comprised 99% of the cohort; 61% were white, 24% were black, and 0.5% were Asian. Etiologies of cirrhosis were hepatitis C (HCV) (27%), alcohol-related (11%), HCV+alcohol (49%), hepatitis B (HBV) (9%), and other (metabolic, NASH) (2%). 63 (3%) were HIV-infected. Cirrhosis was coded in 83% (1918) prior to HCC diagnosis. Of cirrhotics, 11% (248) were optimally screened and 14% (335) were near-optimally screened; 75% of HCC were diagnosed incidentally or due to symptoms. AJCC stage was I/II/IIIA/IIIB/IIIC/IVA/IVB in 42/23/10/13/1/4/7%, respectively. 963 (41%) of patients were within Milan Criteria. BCLC staging was 0/A/B/C/D in 8/39/27/13/13%, respectively. Median OS was 400d and 1214/857/404/163/107d in BCLC 0/A/B/C/D, respectively. In multivariate survival model, age, the presence of ascites, serum albumin, serum bilirubin, serum sodium, CirCom score, Charlson-Deyo index, number of tumors, largest tumor size, and total tumor size were all statistically significantly predictive of survival. Conclusions: ICD9 codes for HCC have a PPV of ~80% for identifying true HCC cases in the CDW. Approximately 1/4 of patients received screening within AASLD 2010 guidelines. The majority of Veterans diagnosed with HCC present with intermediate to advanced disease with median survival 4.5-9.2 months.

Coexpression of SFRP1 and WIF1 as a Prognostic Predictor of Favorable Outcomes in Patients with Colorectal Carcinoma

Colorectal tumorigenesis is ascribed to the activity of Wnt signaling pathway in a ligand-independent manner mainly through APC and CTNNB1 gene mutations and in a ligand-dependent manner through low expression of Wnt inhibitors such as WNT inhibitory factor 1 (WIF1) and secreted frizzled related protein 1 (SFRP1). In this study we found that WIF1 protein expression was increased and SFRP1 was decreased significantly in CRC tissue versus normal tissue, and high expression of WIF1 was associated with big tumor diameters and deep invasion, and loss of SFRP1 expression was associated with the left lesion site, deep invasion, and high TNM stage. Among the four expression patterns (WIF+/SFRP1+, WIF+/SFRP1−, WIF−/SFRP1+, and WIF−/SFRP1−) only coexpression of WIF1 and SFRP1 (WIF+/SFRP1+) was associated with favorable overall survival, together with low TNM stage, as an independent prognostic factor as shown in a multivariate survival model. The results indicated that WIF1 seemed to play an oncogenic role, while SFRP1 seemed to play an oncosuppressive role although both of them are secreted Wnt antagonists. Coexpression of SFRP1 and WIF1, rather than SFRP1 or WIF1 alone, could be used, together with low TNM stage, as a prognostic predictor of favorable outcomes in CRC.

Pharmacogenomics of bortezomib test-dosing identifies hyperexpression of proteasome genes, especially PSMD4, as novel high-risk feature in myeloma treated with Total Therapy 3

Gene expression profiling (GEP) of purified plasma cells 48 hours after thalidomide and dexamethasone test doses showed these agents' mechanisms of action and provided prognostic information for untreated myeloma patients on Total Therapy 2 (TT2). Bortezomib was added in Total Therapy 3 (TT3), and 48 hours after bortezomib GEP analysis identified 80 highly survival-discriminatory genes in a training set of 142 TT3A patients that were validated in 128 patients receiving TT3B. The 80-gene GEP model (GEP80) also distinguished outcomes when applied at baseline in both TT3 and TT2 protocols. In context of our validated 70-gene model (GEP70), the GEP80 model identified 9% of patients with a grave prognosis among those with GEP70-defined low-risk disease and 41% of patients with favorable prognosis among those with GEP70-defined high-risk disease. PMSD4 was 1 of 3 genes common to both models. Residing on chromosome 1q21, PSMD4 expression is highly sensitive to copy number. Both higher PSMD4 expression levels and higher 1q21 copy numbers affected clinical outcome adversely. GEP80 baseline-defined high risk, high lactate dehydrogenase, and low albumin were the only independent adverse variables surviving multivariate survival model. We are investigating whether second-generation proteasome inhibitors (eg, carfilzomib) can overcome resistance associated with high PSMD4 levels.

Practical Application of a Calculator for Conditional Survival in Colon Cancer

Purpose Conditional survival (CS) estimates provide important prognostic information for clinicians and patients who have survived a period after diagnosis. In this study we performed a contemporary evaluation of conditional survival among colon cancer patients and created a browser-based tool for real-time determination of conditional survival expectancies. Patients and Methods Patients with colon adenocarcinoma diagnosed between 1988 and 2000 were identified from the Surveillance Epidemiology End Results (SEER) registry. Conditional survival estimates were calculated by using the multiplicative law of probability after adjustment for age; sex; ethnicity; grade; and American Joint Commission on Cancer, sixth edition stage. A browser-based calculator was constructed. Results A total of 83,419 patients were analyzed. As the time alive after initial treatment increased from 0 to 5 years, significant improvements in CS were observed for patients in all stages except stage I, which was associated with good CS even at diagnosis and which reflected the high likelihood of cure. Notably, adjusted 5-year CS rates improved from 42% to 80% for stage IIIC cancers and from 5% to 48% for stage IV cancers during the first 5 years. Differences in cancer-related CS at diagnosis were identified on the basis of age, ethnicity, and grade, but these differences decreased over time. A browser-based CS calculator was implemented by using the multivariate survival model (concordance index, 0.81). Conclusion For patients with colon cancer who survive over time, 5-year, cancer-specific CS improved dramatically, and the greatest improvements were among patients with poorer initial prognoses. These prognostic data are critical to inform patients for non–treatment-related life decisions and to inform treating physicians for planning of follow-up and surveillance strategies.