Diffuse large B-cell lymphoma in octogenarians aged 85 and older can benefit from treatment with curative intent: a report on 129 patients prospectively registered in the Elderly Project of the Fondazione Italiana Linfomi (FIL)

Octogenarian patients with diffuse large B-cell lymphoma are managed mainly with palliation, but recent improvement in their overall condition makes potentially curative treatment a possibility. Studies have shown that half of selected octogenarians may be cured using reduced-dose anthracycline chemoimmunotherapy. However, patients aged >85 (late octogenarians [LO]) were underrepresented, and selection criteria were poorly defined. We analyzed the clinical characteristics and outcomes of LO enrolled in the FIL Elderly Project in terms of the treatment received (palliative vs. curative) and of their simplified geriatric assessment (sGA), then compared them with early octogenarians (EO) aged 80-84 and with those aged 65-79 classified as UNFIT or FRAIL according to sGA enrolled in the same study. Of the 1,163 patients, 370 were >80 and 129 LO. Clinical characteristics were similar between LO and EO, but LO more frequently received palliation (50% vs. 23%; P=0.001) and had worse 2-year overall survival (OS) (48% vs. 63%; P=0.001) and 2-year progression-free survival (PFS) (43% vs. 56%; P=0.01). Patients receiving anthracycline did better than patients receiving palliation (P<0.001), without any difference between full or reduced doses. Rituximab within palliation improved outcome (2-yr OS with or without rituximab 42% vs. 22%; P=0.008). Elderly Prognostic Index (EPI) performed better than sGA in identifying different risk categories, and high-risk EPI retained an independent unfavorable effect on OS and PFS, together with treatment without anthracycline. In conclusion, late octogenarians can benefit from a curative approach with reduced-dose anthracycline and from rituximab within palliation. EPI may help in patient selection more than sGA can

Galathea: a Case-Based Planning Tool for Knowledge Navigation in the Architectural Design Process

We report on an on-going Ph.D. research aimed at the analysis of the nature of process knowledge in architectural design and the development of a conceptual model for a case-based navigation tool for its support. We describe architectural design from a process viewpoint and assume it as a form of intentional planning, leading from an initial state configuration toward a desired situation, by means of an incremental specification of goals, constraints and involved variables. We consider the very essence of design and of the specific professional skill characterising designers as the continual recursive transformation of the initial solution model, in order to map the desired state onto the enacted one and the capability to govern a number of continually changing variables in this direction. On the basis of this general concept of the design process, we describe the model of Galathea, a case-based planning tool, aimed at progressively representing the enlarging space of acquired knowledge, and at supporting the designeris central role in the management of the design process

Applying CBR to the Teaching of Architectural Design

This paper presents an approach to the analysis and description of the nature of process knowledge in architectural design, the development of a conceptual model for Galathea, a case-based navigation tool for its support, and the application of this theoretical foundation to the teaching of design to a group of about 100 second-year architecture students. Design is assumed as a globally coherent information, memory and experience-intensive process in which professional skill is the capability to govern a large number of continually evolving variables in the direction of desired change. This viewpoint on design has guided the development of Galathea, the model of a tool aimed at describing architectural design through the description, mapping and management of the complete decision-making path of projects by means of the dynamic representation of the relationship between goals, constraints and the decisions/actions adopted at specific nodes and through the creation of a case-base aimed at the storage, retrieval and adaptation of relevant design moves in similar project contexts. This conceptual model is applied to educational activity at the faculty of Architecture of Milan, with the aim of teaching how to govern a project from the outset considering it as an evolving but coherent map of design moves, which allow the adoption of the correct decisions involving the most disparate types of information, experience and memory, and which altogether conduct to the desired goal. The resolution paths of the students, all applied to the same architecture problem, result in a design move case-base, the further utilisation and interest of which is open to collegial discussion

COPD patients’ self-reported adherence, psychosocial factors and mild cognitive impairment in pulmonary rehabilitation

Antonia Pierobon,1 Elisa Sini Bottelli,1 Laura Ranzini,1 Claudio Bruschi,2 Roberto Maestri,3 Giorgio Bertolotti,4 Marinella Sommaruga,5 Valeria Torlaschi,1 Simona Callegari,1 Anna Giardini1 1Psychology Unit, 2Department of Pulmonary Rehabilitation, 3Department of Biomedical Engineering, Istituti Clinici Scientifici Maugeri, IRCCS, Montescano, 4Psychology Unit, Istituti Clinici Scientifici Maugeri, IRCCS, Tratate, 5Clinical Psychology and Social Support Unit, Istituti Clinici Scientifici Maugeri, IRCCS, Camaldoli, Italy Abstract: In addition to clinical comorbidities, psychological and neuropsychological problems are frequent in COPD and may affect pulmonary rehabilitation delivery and outcome. The aims of the study were to describe a COPD population in a rehabilitative setting as regards the patients depressive symptoms, anxiety, mild cognitive impairment (MCI) and self-reported adherence and to analyze their relationships; to compare the COPD sample MCI scores with normative data; and to investigate which factors might predict adherence to prescribed physical exercise. This was a multicenter observational cross-sectional study. Of the 117 eligible stable COPD inpatients, 84 were enrolled according to Global initiative for chronic Obstructive Lung Disease (GOLD) criteria (mainly in Stage III–IV). The assessment included Mini Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), anxiety, depression and self-reported pharmacological and nonpharmacological adherence. From the MMSE, 3.6% of patients were found to be impaired, whereas from the MoCA 9.5% had a likely MCI. Patients referred had mild-severe depression (46.7%), anxiety (40.5%), good pharmacological adherence (80.3%) and difficulties in following prescribed diet (24.1%) and exercise (51.8%); they struggled with disease acceptance (30.9%) and disease limitations acceptance (28.6%). Most of them received good family (89%) or social (53%) support. Nonpharmacological adherence, depression, anxiety and MCI showed significant relations with 6-minute walking test, body mass index (BMI) and GOLD. Depression was related to autonomous long-term oxygen therapy modifications, disease perception, family support and MCI. In the multivariate logistic regression analysis, higher BMI, higher depression and lower anxiety predicted lower adherence to exercise prescriptions (P=0.0004, odds ratio =0.796, 95% CI =0.701, 0.903; P=0.009, odds ratio =0.356, 95% CI =0.165, 0.770; and P=0.05, odds ratio =2.361, 95% CI =0.995, 5.627 respectively). In COPD patients, focusing on pharmacological and nonpharmacological adherence enhance the possibility of tailored pulmonary rehabilitation programs. Keywords: depression, anxiety, mild cognitive impairment, adherence, COPD, pulmonary rehabilitatio