Does It Pay to Be Informed? Expenditure Efficiency in the US Mutual Fund Industry

The mutual fund industry would like us to believe that fund expenses are justifiable by their extensive management expertise, security analysis and the consequent delivery of returns that exceed the market performance. Management know-how is costly and thus it drives up the expenditure of actively managed mutual funds and potentially lowers their net returns. Nevertheless the fund managers argue that their contributions to the returns fully outweigh their costs and in general their trading strategies add value to the investors. On the other hand many academics hold that such claims are fundamentally misleading and actively managed funds cannot continuously outperform a market index. [excerpt

Writings of Esther Discherheit „Das Leben in zwischen“

Juden behaupten, dass sie nicht jüdisch genug ist. Deutsche sagen, dass sie nicht deutsch genug ist. Gesteckt zwischen zwei Welten und zwei Kulturen, ist Esther Discherheit eine von der wichtigsten Schriftstellerinnen im heutigen Deutschland. Als die weltbekannte Stimme einer gegenwärtigen jüdisch-deutscher Generation, kämpft sie stark gegen Kategorisierung, Stereotypen und Heuchelei. In ihren Werken finden wir alle Probleme vom heutigen Deutschland und jungen deutschen Juden. In dieser Arbeit versuche ich die Texte von Esther Discherheit zu analysieren und die „inneren“ und „äußerlichen“ Schwierigkeiten von ihrer Mix-Identität zu untersuchen. Ich werde mich hauptsächlich auf zwei von ihren Werken konzentrieren – den Essay Keine Ausgang aus diesem Judentum, und den Roman Joemis Tisch. Weil Esther Discherheit über viele Themen und viele Probleme schreibt, werde ich nur ihre jüdische Identität und die „Stimmen von Erinnerungen“ in ihren Texten examinieren. Aber bevor wir diese Werke und Motive studieren können, müssen wir erstens die Hintergründe von dieser Autorin besser verstehen. [excerpt

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 \u3c .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 \u3c .001). Long-term relapse was lower with FM (HR = 0.65, P \u3c .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

Comparison of outcomes of HCT in blast phase of BCR-ABL1- MPN with de novo AML and with AML following MDS

Comparative outcomes of allogeneic hematopoietic cell transplantation (HCT) for BCR-ABL1- myeloproliferative neoplasms (MPNs) in blast phase (MPN-BP) vs de novo acute myeloid leukemia (AML), and AML with prior myelodysplastic syndromes (MDSs; post-MDS AML), are unknown. Using the Center for International Blood and Marrow Transplant Research (CIBMTR) database, we compared HCT outcomes in 177 MPN-BP patients with 4749 patients with de novo AML, and 1104 patients with post-MDS AML, using multivariate regression analysis in 2 separate comparisons. In a multivariate Cox model, no difference in overall survival (OS) or relapse was observed in patients with MPN-BP vs de novo AML with active leukemia at HCT. Patients with MPN-BP in remission had inferior OS in comparison with de novo AML in remission (hazard ratio [HR], 1.40 [95% confidence interval [CI], 1.12-1.76]) due to higher relapse rate (HR, 2.18 [95% CI, 1.69-2.80]). MPN-BP patients had inferior OS (HR, 1.19 [95% CI, 1.00-1.43]) and increased relapse (HR, 1.60 [95% CI, 1.31-1.96]) compared with post-MDS AML. Poor-risk cytogenetics were associated with increased relapse in both comparisons. Peripheral blood grafts were associated with decreased relapse in MPN-BP and post-MDS AML (HR, 0.70 [95% CI, 0.57-0.86]). Nonrelapse mortality (NRM) was similar between MPN-BP vs de novo AML, and MPN-BP vs post-MDS AML. Total-body irradiation-based myeloablative conditioning was associated with higher NRM in both comparisons. Survival of MPN-BP after HCT is inferior to de novo AML in remission and post-MDS AML due to increased relapse. Relapse-prevention strategies are required to optimize HCT outcomes in MPN-BP

Survival following allogeneic transplant in patients with myelofibrosis

Allogeneic hematopoietic cell transplantation (HCT) is the only curative therapy for myelofibrosis (MF). In this large multicenter retrospective study, overall survival (OS) in MF patients treated with allogeneic HCT (551 patients) and without HCT (non-HCT) (1377 patients) was analyzed with Cox proportional hazards model. Survival analysis stratified by the Dynamic International Prognostic Scoring System (DIPSS) revealed that the first year of treatment arm assignment, due to upfront risk of transplant-related mortality (TRM), HCT was associated with inferior OS compared with non-HCT (non-HCT vs HCT: DIPSS intermediate 1 [Int-1]: hazard ratio [HR] = 0.26, P \u3c .0001; DIPSS-Int-2 and higher: HR, 0.39, P \u3c .0001). Similarly, in the DIPSS low-risk MF group, due to upfront TRM risk, OS was superior with non-HCT therapies compared with HCT in the first-year post treatment arm assignment (HR, 0.16, P = .006). However, after 1 year, OS was not significantly different (HR, 1.38, P = .451). Beyond 1 year of treatment arm assignment, an OS advantage with HCT therapy in Int-1 and higher DIPSS score patients was observed (non-HCT vs HCT: DIPSS-Int-1: HR, 2.64, P \u3c .0001; DIPSS-Int-2 and higher: HR, 2.55, P \u3c .0001). In conclusion, long-term OS advantage with HCT was observed for patients with Int-1 or higher risk MF, but at the cost of early TRM. The magnitude of OS benefit with HCT increased as DIPSS risk score increased and became apparent with longer follow-up

Managing patients with hematological malignancies during COVID-19 pandemic

The outbreak of the coronavirus disease 2019 (COVID‐19) has posed an unprecedented challenge to the health care communities across the globe. As of June 17th, 2020, a total of 8,339,829 confirmed COVID-19 cases with 448,420 deaths have been reported [2]. Different parts of the world are seeing different levels of COVID-19 activity with regards to the infection rate, susceptible population, and mortality rate. The COVID-19 pandemic is a rapidly evolving emergency and is a subject of regular debate and advanced research. Patients with hematological disorders and solid malignancies have special needs and oncologists are facing a compound challenge

Randomized controlled trial of individualized treatment summary and survivorship care plans for hematopoietic cell transplantation survivors

Survivorship care plans may facilitate long-term care for cancer survivors, but their effectiveness has not been established in hematopoietic cell transplantation recipients. We evaluated the impact of individualized survivorship care plans on patient-reported outcomes among transplant survivors. Adult (\u3e/=18 years at transplant) survivors who were 1-5 years post-transplantation, proficient in English, and without relapse or secondary cancers were eligible for this multicenter randomized trial. Care plans were developed based on risk-factors and treatment exposures using patient data routinely submitted by transplant centers to the Center for International Blood and Marrow Transplant Research and published guidelines for long-term follow-up of transplant survivors. Phone surveys assessing patient-reported outcomes were conducted at baseline and 6-months. Primary endpoint was confidence in survivorship information, and secondary endpoints included cancer and treatment distress, knowledge of transplant exposures, health care utilization and health-related quality of life. Of 495 patients enrolled, 458 completed a baseline survey and were randomized (care plan=231, standard care=227); 200 (87%) and 199 (88%) completed the 6-month assessments, respectively. Patient characteristics were balanced in the two arms. Participants on care plan arm reported significantly lower distress scores at 6-months and an increase in the Mental Component Summary quality of life score assessed by the SF12 instrument. No effect was observed on the endpoint of confidence in survivorship information or other secondary outcomes. Provision of individualized survivorship care plans generated using registry data was associated with reduced distress and improved mental domain of quality of life among 1-5 year hematopoietic cell transplantation survivors. (clinicaltrials.gov NCT02200133)

Functional Heterogeneity of Marginal Zone B Cells Revealed by Their Ability to Generate Both Early Antibody-forming Cells and Germinal Centers with Hypermutation and Memory in Response to a T-dependent Antigen

Marginal zone (MZ) B cells play a major role in the first-line responses against blood-born T-independent bacterial antigens (TI), but the full scope of their immune functions is not known. Here we compare the responses of MZ and follicular (FO) B cells to a T-dependent antigen (TD), hapten–(4-hydroxy-3-nitrophenyl)acetyl (NP) coupled to chicken γ-globulin, in a cell transfer system. Consistent with the conventional paradigm, MZ B cells but not FO B cells rapidly generated the early burst of NP-specific antibody-forming cells (AFC), high levels of IgM Ab, and early IgG with relatively high affinity to NP. However, MZ B cells were also capable of forming germinal centers (GCs) albeit with a delay, compared with FO B cells. The early AFCs and the GCs originated from different MZ precursors, but the MZ- and FO-derived GCs were similar in VH gene repertoire, somatic mutation, and production of late AFC and IgG Ab. Surprisingly, the MZ but not the FO memory response included IgM Ab. We conclude that MZ B cells are heterogeneous, comprising cells for both early AFC response and GC/memory pathway against TD antigens

The Reflection of Covid-19 Distance Education in Health Profession in Czechia: Comparison of View of Higher Education Teachers and Students

The paper focuses on the perception of Covid-19 Distance Education in health care profession in Czechia from perspective of higher education teachers and students.  The study answers two research questions: 1) How satisfied were health profession students and teachers with their education during the COVID-19 pandemic? and 2) How did the perspectives on education in terms of methods differ between health professions teachers and students with education during the COVID-19 pandemic? The research used mixed methods research (quantitative survey and focus groups). There is a significant distance between students' and teachers' perceptions of online education and its forms. Teachers see online education less negatively (29%) than students (51,1%). One of the reasons, it was the lack of communication and support from HEIs. Teachers have didactic problems in managing their teaching, especially when they try to activate students. On the contrary students perceive themselves as active, but this does not entirely correspond to the view of their teachers. Students remain more conservative in their perception of online learning. However, student do not perceive any teaching method simple negatively. An exercise followed by simulation teaching and demonstration teaching and lecture are the best rate the form of teaching by students. Teachers rate demonstration and simulation teaching, discussions and exercises the best