<p>La manera en que las personas y grupos explican la pobreza condiciona cómo se relacionan con ella. El presente trabajo indaga las explicaciones sobre el origen de la pobreza de estudiantes universitarios y analiza la relación de este posicionamiento con su área de formación profesional. Se administró un instrumento de evaluación que considera tres tipos de atribuciones -individualista, socioestructural y fatalista- a una muestra de 448 estudiantes universitarios avanzados de nueve carreras de ciencias sociales, con edades entre 19 y 42 años (<em>M</em> = 22,92; <em>DT</em> = 3,12). Los resultados obtenidos indican importantes variaciones en las explicaciones de la pobreza según área de formación profesional. Estudiantes de ciencias económicas enfatizaron la importancia de los factores individuales, estudiantes de psicología y abogacía tendieron a explicaciones mixtas y estudiantes de sociología mostraron una amplia preferencia por las causas socioestructurales. Se discuten las implicancias de los procesos atribucionales en las actuaciones de estos futuros profesionales hacia poblaciones en desventaja económica.</p>

Introduction It is increasingly recognized that transformed (T) diffuse large B cell lymphoma (DLBCL) is a clinically and biologically distinct entity from de novo DLBCL. Dose escalated etoposide, doxorubicin, vincristine, cyclophosphamide and prednisone with rituximab (DA-EPOCH-R) is effective in aggressive large B cell lymphomas including de novo DLBCL, Burkitt lymphoma, high grade B cell lymphoma with BCL2-Myc rearrangement and primary mediastinal B cell lymphoma. However, outcomes of transformed DLBCL (T-DLBCL) treated with DA-EPOCH-R are not well-studied. Here, we describe our experience with T-DLBCL after treatment with DA-EPOCH-R. Methods All adult patients with DLBCL diagnosed and treated with DA-EPOCH-R at Medstar Washington Hospital Center from January 2000 to November 2018 were included in this retrospective study. Data was collected from review of electronic medical records. All transformations were biopsy-proven. T-DLBCL was defined as either biopsy-confirmed DLBCL with background of indolent lymphoma (concurrently transformed (CT) DLBCL) or sequential development of DLBCL in a case of known indolent lymphoma (sequentially transformed, (ST) DLBCL). Patient characteristics including age, sex, race were recorded. Stage, extranodal disease, international prognostic index (IPI) of DLBCL were recorded. For patients with CT and ST DLBCL, histology and prior treatment of indolent lymphoma were recorded. Study objectives were to assess response rates, progression free survival (PFS) and overall survival (OS) for de novo DLBCL, CT-DLBCL and ST-DLBCL treated with DA-EPOCH-R. Fisher's exact test was used to compare categorical variables between the groups. Kaplan-Meier method was used to calculate survival curves. Log rank test was used to compare survival between de novo DLBCL, CT-DLBCL and ST-DLBCL. Results Of 183 DLBCL patients treated during the study period, 34 had T-DLBCL (17 CT-DLBCL and 17 ST-DLBCL). Total 91 received DA-EPOCH-R (25 transformed, 66 de novo) and were included in our study. Median age was 56 (23-84). Sixty percent patients were males and 42% were white. Out of 25 Tx DLBCL, 11 had CT-DLBCL and 14 had ST-DLBCL. Patients with T-DLBCL (CT and ST) had higher odds of being white, having advanced stage, extra-nodal disease and high IPI. [OR: 2.6 (CI951.7-6), 4.1 (CI951.6-10), 2.8 (CI95 2.8 (1.8-7) and 2.7 (CI951.2-6), respectively. P &lt;0.001]. Cell of origin, BCL2 and BCL6 expression was not available for all DLBCL patients. Follicular lymphoma was the most common underlying indolent lymphoma (13), followed by chronic lymphocytic leukemia (5), marginal zone lymphoma (3), low grade non-Hodgkin lymphoma not otherwise specified (3) and lymphoplasmacytic lymphoma (1). Seven of T-DLBCL had received prior rituximab and 2 had received prior anthracycline. For ST-DLBCL patients, median time to transformation was 2.25 years (0.3-15). There was no significant difference in ORR (85%, 86%, 91%) and CR (82%, 84%, 89%) of DA-EPOCH-R treated CT, ST and de novo DLBCL, respectively. Median follow up was 5 years. Median PFS and OS for CT and de novo DLBCL were not reached. ST DLBCL had median PFS and OS of 21 years and 37 years, respectively. There was no significant difference between 2-year PFS and OS of CT, ST and de novo DLBCL treated with DA-R-EPOCH. (Table 1). Conclusion T-DLBCL is more likely to have aggressive features such as advance stage, extra nodal disease and high IPI. Despite this, DA-EPOCH-R treated T-DLBCL has outcomes comparable to de novo DLBCL. Large, prospective studies are needed to examine efficacy of DA-EPOCH-R in T-DLBCL. Figure. Disclosures No relevant conflicts of interest to declare.

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Background:Uterine fibroids, also called leiomyomas, are diagnosed in over two-third of females of reproductive age; about a quarter warrant treatment. Venous thromboembolism (VTE) is a challenging complication in patients with fibroids due to the increased risk of bleeding with anticoagulation, especially in the setting of associated menorrhagia. The incidence of deep vein thrombosis (DVT) is increased with higher uterine weight which may be related to the extrinsic venous compression of the iliac veins or the inferior vena cava. However, there is reported discordance between the site of uterine fibroid and the site of the DVT along with pulmonary embolism (PE) without evidence of lower extremity DVT suggesting an underlying hypercoagulable state that is more complex than mere hormonal and mechanical factors. Data regarding VTE in patients with uterine fibroids in the US is sparse and is limited to case reports. We performed a retrospective case control study to describe the rate and associated risk factors of VTE in patients with uterine fibroids. Objectives:Evaluate the incidence of VTE events in patients with uterine fibroids and explore trends and associations. Methods:A retrospective chart review of patients at our single, academic, DC metropolitan hospital was conducted. Patients were identified using electronic medical records via ICD-10 codes. Those seen as an inpatient or outpatient in our tertiary care fibroid center with a new diagnosis of uterine fibroids between January 1, 2015, and December 31, 2019 were included and compared to age matched controls of patients with uterine fibroids without VTE in a 1:2 ratio. Statistical analysis was reported as means and medians for descriptive data. Pearson's correlation was performed to determine associations. Results:A total of 6095 patients were diagnosed with uterine fibroids in 5 years, of which 2.2% (n=139) were found to have VTE after the diagnosis of uterine fibroid was made (see table 1). Of the patients with VTE, 88 had DVTs,63 had PE and 12 developed both DVT and PE. The mean age at diagnosis of VTE was 54 (SD=14.95) years. The majority of the patients in the VTE group were African Americans (86%) and mean BMI was 34.52 (SD =9.53), of which about 2/3 were obese or morbidly obese. Average weight of fibroid(s) for those who underwent surgical resection who had available records was noted to be 321 grams (n=11). Data regarding anticoagulation was available for 78% of the patients; the anticoagulant of choice being enoxaparin in 59%, warfarin in 9% and DOACs in 10% of the patients. Two Hundred and thirty-six age matched controls were identified. Statistically significant associations with BMI, race and comorbidities (including atrial fibrillation, congestive heart failure, diabetes, hypertension, HIV, pregnancy and cancer) were found in cases when compared to the control population. Furthermore, cases were found to have a lower mean hemoglobin (10.4 mg/dL) and higher platelet count (311,000/microL) which were statistically significant (p=0.0003). The use of non-steroidal anti-inflammatory drugs and iron supplementation was significantly more in cases than controls. D-dimer and ferritin levels seemed to trend higher and iron saturation lower in cases than controls but were not found to be statistically significant. Conclusions:VTE was found in 2.2% of patients with uterine fibroids, which is higher than the reported VTE incidence of 1-2 per 1000 in the general population. A significant association was found with race, which is consistent with literature that suggests African American patients have a higher rate of incident VTE and also comorbid conditions. Women with low hemoglobin and higher platelet count were more likely to experience VTE. The next steps include understanding more associations, laboratory and clinical, that will assist in risk stratification and tailoring management. Future prospective studies to recognize biomarkers that contribute the hypercoagulable state of uterine fibroids is warranted. Disclosures Morozov: Medtronic:Consultancy;Lumenis:Speakers Bureau;AbbVie:Speakers Bureau.Fitzpatrick:Pfizer:Honoraria.

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BackgroundCraniofacial arteriovenous malformation (AVM) is a challenging disease to eradicate, often requiring the combination of embolization and reconstructive surgery. The tortuosity of distal feeding arteries and the presence of abundant collaterals make it difficult to obliterate the nidus with transarterial embolization. In this small case series, we report curative transvenous embolization of craniofacial AVM under transient arrest of arterial inflow.Materials and methodsFour patients with craniofacial AVMs (two in the scalp, one in the face and one in the forehead) were embolized transvenously with Onyx. In all cases, the dominant feeding arteries were first embolized with Onyx to reduce arterial inflow. The major draining veins were then accessed transfemorally or via direct puncture. Detachable coils were placed in the venous pouches to further obstruct outflow from the AVM nidus. After arterial inflow was completely stopped with the placement of a tourniquet on the head or inflation of a balloon catheter in the external carotid artery, we injected Onyx into the venous pouch to retrogradely fill the entire AVM nidus. Follow-up angiograms were performed 1 year later.ResultsAngiographic cure was achieved in all four patients. The mass effect from the Onyx cast was not disfiguring. No patient had skin necrosis or a visible black mark on the skin. The first two patients underwent surgical removal of the Onyx cast which was scheduled before embolization. The next two patients declined surgery because they were not bothered by the Onyx cast. No recurrence was found at the 1 year follow-up angiogram.ConclusionHead and neck AVM can be safely cured with transvenous embolization using Onyx.Abstract P-018 Figure 1Angiogram of a facial arteriovenous malformation before and after embolization.Abstract P-018 Figure 2Transvenous embolization with Onyx after partial coiling and transient occlusion of the external carotid artery with a balloon (A). Onyx cast showing the nidus and numerous small feeders (B).

Background: Medical training is an exciting and enriching experience, but can pose physical, emotional and social challenges. Physician burnout is extremely prevalent and found in about two thirds of the physicians worldwide. For trainees and training programs, this issue is now gaining well-deserved attention. There is increasing interest in interventions to curb burnout among trainees who are vulnerable to the stresses of caring for sick patients while still learning to make crucial clinical decisions. Short-term integrative mind-body interventions have been studied and are helpful in building self-awareness and resilience which can both mitigate the risk of burnout. Virtual reality (VR) is a popular technological interface that allows users to experience computer-generated environment within a controlled setting and harness aspects of mindfulness technique. We conducted an observational study to evaluate the feasibility and acceptance of use of a VR tool to help trainees with mindfulness techniques. Our eventual goal involves evaluating burnout after more frequent use of this tool. We present the results of the first phase of the study which determined feasibility and acceptance of the VR tool. Methods: Five participants were planned to enroll in the feasibility phase. Study information was provided to the seven Hematology/Oncology fellows at their academic noon conferences. Informed consent was obtained from the first five participants who approached the study team and were enrolled in the study. The VR Oculus Go headset, with the "Guided Meditation VR" application downloaded on it, was provided to the fellows and instructions for use were given. They were encouraged to use the VR intervention for at least 10 min per session and at least 3 times per week in a quiet place. After 2 weeks, participants were required to fill out a feasibility post-survey. The survey contained both quantitative and qualitative sections. This study was revised and updated at the 2019 ASH Medical Educator's Institute and was funded by MedStar Washington Hospital Center's Graduate Medical Education department. Results: Five fellows participated between July 6, 2020- July 31, 2020. The majority (60%) were over 30 years of age, all participants were between post graduate years 4-7 and were sub-specialty fellows. Two-thirds were on an inpatient rotation and the rest were rotating in outpatient clinics. Only 20% reported practicing mindfulness on a regular basis before enrolling in the study. All participants completed the post-survey and had used the VR tool at least 1-5 times. Eighty percent were interested in using this technology again for the purpose of performing mindfulness exercises. Barriers that prevented the use of the VR tool included not getting enough time and technical issues preventing the VR tool from working properly. Most (80%) of the participants reported feeling happier and less stressed after using the VR tool. All participants only used the VR tool at home. Other methods of mindfulness used by the participants included meditation, walking and home exercise routine Conclusions: This is the first reported study evaluating feasibility and acceptance of a VR-based intervention for mindfulness with the goal of eventually decreasing burn out in medical trainees. Our study shows that the using the VR tool for guided mediation is feasible and accepted by a subset of Hematology/Oncology fellows. Future directions include using a larger sample to determine if the randomized introduction of a VR intervention or no intervention will reduce self-reported burnout in medical trainees. Disclosures No relevant conflicts of interest to declare.