Loyola University Chicago

The American College of Physicians (ACP) developed these rapid practice points addressing the efficacy, comparative effectiveness, and harms of respiratory syncytial virus (RSV) vaccines in adults aged 18 years or older who are not pregnant or immunocompromised. The ACP Population Health and Medical Science Committee developed the rapid practice points based on a rapid review by the ACP Center for Evidence Reviews at Cochrane Austria. Adults aged 75 years or older should receive a protein subunit RSV vaccine. Adults aged 60 to 74 years who are at increased risk for severe RSV may consider receiving a protein subunit RSV vaccine.

Survival prediction in metastatic long-bone disease is essential for surgical decision-making, yet the performance of legacy prognostic models has declined in the era of immunotherapy and molecularly targeted agents. As these systemic therapies become routine, treatment patterns themselves may influence survival in ways not captured by earlier models. We, therefore, quantified preoperative systemic therapy use over the last decade and evaluated its association with postoperative overall survival in patients undergoing surgery for long-bone metastases. We conducted a retrospective cohort study of 975 consecutive adults who underwent surgery for long-bone metastases at two affiliated tertiary centers between January 2010 and June 2022. Preoperative systemic therapy was categorized into four groups: chemotherapy only, targeted therapy only, combined chemotherapy and targeted therapy, or neither. Postoperative was defined as time from surgery to death from any cause. We described temporal uptake of therapies by calendar year and assessed associations with postoperative survival using multivariable Cox regression adjusting for demographics, ECOG performance status, Katagiri primary tumor grouping, visceral/brain metastases, and laboratory variables. Adjusted survival over calendar time was summarized via marginal standardization at fixed horizons (1, 3, 12, and 24months). Use of targeted agents including checkpoint inhibitors rose markedly, from 2% in 2015 to 43% in 2022. In multivariable Cox models, preoperative chemotherapy alone was associated with worse survival versus no preoperative systemic therapy (HR 1.41, 95% CI 1.21-1.65; p<0.01), as was combined chemotherapy plus targeted therapy (HR 1.24, 95% CI 1.05-1.47; p=0.01). In contrast, targeted therapy alone before surgery was associated with better survival (HR 0.76, 95% CI 0.58-0.99; p=0.04). Adjusted survival appeared to increase modestly across calendar years, but the pre-specified joint Wald test for the calendar year spline terms was not significant (p=0.17), indicating a non-significant trend over time. This study found that preoperative systemic therapy patterns are strongly associated with post-operative survival in metastatic long-bone disease: targeted therapy alone correlates with improved survival whereas preoperative use of chemotherapy-alone or combined with targeted agents-was associated with worse survival. These findings support incorporating contemporary treatment exposure into prognostic models and suggest that model recalibration to the immunotherapy era may be warranted.

Illness severity may influence the relationship between opioid use disorder (OUD) and adverse outcomes, yet factors affecting severity are not fully understood. The objective of this study is to examine sociodemographic and hospital-related factors associated with severity among OUD-related hospitalizations. We used data from the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) from 2015 to 2022. The HCUP NIS includes severity measures that assign patients overall severity of illness (SOI) and risk of mortality (ROM) subclasses (ie, minor, moderate, major, and extreme) based on their secondary diagnoses and other clinical characteristics (eg, age, procedures). Partial proportional odds models were used to measure the association between sociodemographic/clinical factors and SOI/ROM subclass severity among OUD-related hospitalizations. SOI shifted toward more severe subclasses in 2019-2022 and ROM in 2015-2022 (higher share major/extreme). Medicare and self-pay, compared with private insurance, were associated with higher odds (adjusted odds ratio [aOR] [95% CI]) of extreme SOI (vs. minor, moderate, or major) (Medicare: 1.07 [1.05, 1.09]; self-pay: 1.08 [1.05, 1.11]). Rural hospitals, compared with urban ones, had lower odds of higher SOI severity (aOR 0.80 [0.77, 0.82]). Results were similar for ROM. Age, sex, race, income, region, hospital size, admission timing, and admission type were also significantly associated with SOI/ROM. Structural/systematic factors play a role in shaping the course of inpatient OUD. These findings highlight the need to strengthen hospital addiction care capacity, address insurance and income-related inequities, and develop targeted inpatient risk stratification strategies to improve outcomes for patients with OUD.

This paper argues that a decolonial response is needed in Southeast Asia to challenge the persisting neocoloniality of the higher education landscape in the region. Southeast Asia’s regional higher educational project is strongly influenced by internal (e.g., the Association of Southeast Asian Nations, or ASEAN) and external (e.g., European Union) forces that influence how higher education cooperation and collaboration are conceived. Due to the evidence of neocoloniality in the functioning of ASEAN, this paper argues that there is a decolonial imperative to challenge the existing modernity/coloniality dynamic in Southeast Asia’s higher education landscape. Utilizing an epistemic decolonization lens, this paper critically examines the role of Western (American and European) and non-Western (East Asian) neocolonial forces in charting Southeast Asia’s current higher education landscape. With decoloniality as the framework of analysis, this paper posits pluriversal possibilities grounded in three indigenous philosophies — namely, Malayan sejahtera, Papuan social ecology, and Filipino kapwa. These regional philosophies reflect a localized, collaborative, and sustainable vision for Southeast Asians that runs counter to the dominant higher education narratives of hyper-productivity and free market-oriented outcomes. Finally, this paper argues that a rethinking of the ASEAN Way is critically needed. The following three principles through which the ASEAN Way can be reimagined are proposed: the championing of equitable skills and knowledge redistribution, the development of each nation’s higher educational defining strength/s, and the investment in localized human capital. The new ASEAN Way posits a critical reimagining of existing policies to chart a decolonial Southeast Asian higher education regionalism identity.

S0221 investigated weekly vs every 2 weeks dosing of doxorubicin (A) and cyclophosphamide (C) followed by paclitaxel in patients with high-risk early breast cancer. After an interim analysis, random assignment to the 2 AC arms was stopped for futility, and the trial was modified to study only the paclitaxel schedules. Between December 2003 and November 2010, a total of 2716 patients were randomly assigned in a 2 × 2 factorial design to 15 weeks of weekly A and daily C vs 6 cycles of every 2 weeks AC; and weekly paclitaxel for 12 weeks vs 6 cycles of every 2 weeks paclitaxel. Between January 2011 and January 2012, an additional 578 patients were assigned to 4 cycles of every 2 weeks AC and randomly assigned to weekly vs every 2 weeks paclitaxel. Updated survival was assessed using log-rank tests and Cox regression models. We compared outcomes by breast cancer subtype as well. At a median follow-up of 12.1 years, there were no statistically significant differences among the 4 treatment arms in disease-free survival (DFS) (P = .91) or overall survival (P = .34) in the original protocol. Among the 578 patients assigned AC for 4 cycles and randomly assigned to paclitaxel weekly vs every 2 weeks paclitaxel, there were no overall differences in DFS (P = .32) or overall survival (P = .42). As there were no statistically significant outcome differences in DFS or overall survival between the studied schedules of AC and paclitaxel with extended follow-up in the original or revised protocol, either paclitaxel schedule may be recommended, with selection based on toxicity, cost, or patient preference.

Intrusion Detection Systems (IDS) play a vital role in safeguarding modern networks against increasingly complex cyberattacks. However, the presence of high-dimensional, redundant, and noisy features in network traffic data often degrades detection accuracy and scalability. To address this challenge, this paper proposes GSFOIDS (Group Search Based Feature Optimization for Intrusion Detection System), a hybrid framework that integrates Group Search Optimization (GSO) with a Convolutional Neural Network (CNN) for efficient and accurate intrusion detection. Initially, the intrusion dataset is cleaned and preprocessed to remove irrelevant attributes and improve data quality. GSO is then employed to identify an optimal subset of discriminative features using cooperative producer, scrounger, and ranger search strategies. A CNN-based fitness function guides the optimization process by assessing classification accuracy. Experimental results demonstrate that GSFOIDS significantly outperforms existing models across multiple evaluation metrics