ALBERT

Description: Contemporary intellectuals have rushed to embrace the concept of *#8220;community.” What does this tell us about American political thought? Why are intellectuals uneasy with modern liberal individualism and its institutional policy results? Why is political intellectual discourse dominated today by complaint?In The Dance with Community Robert Booth Fowler reflects upon these and related questions. “My goal,” he writes, “is to present contemporary political thought about community for what it is—a conversation interactive, spirited, and sometimes tough.”There have been many interpretations of the muchdiscussed decline in community spirit. Rather than offer another, Fowler steps back to look at the debate itself. He examines from the perspective of an intellectual historian the attention to community in current American political thought and explores the setting of that attention.He also identifies five alternative models of community integral to the current debates and sketches a clear image of each—its relationship to others, the logic of its appeal, and its emphases and problems. In each instance he places the model into the larger conversation over alternative communities and the value of community itself.

Description: Has the United States become more pluribus than unum? In terms of the nation's political beliefs, Robert Booth Fowler answers both yes and no. While his study affirms significant diversity among an elite cadre of public intellectuals, it vigorously denies it in a general public that collectively adheres to the same set of liberal core values.Enduring Liberalism pursues two objectives. One, it explores the political thought of public intellectuals and the general public since the 1960s. Two, it assesses contemporary and classic interpretations of American political thought in light of the study's findings.Fowler interprets the writings of public intellectuals like Robert Bellah, Jean Bethke Elshtain, Michael Walzer, William Bennett, Seymour Martin Lipset, William Galston, and others, as well as survey data of American political attitudes, to spotlight this oftignored divide between citizens and highprofile commentators, whose contentious debates are mistakenly assumed to reflect countrywide rifts.Fowler's argument is straightforward, but the interpretation is controversial. He recounts how the consensus liberal view in postWorld War II American political thought collapsed among public intellectuals during the tumult of the 1960s and remains so to this day. His book examines the resultant diversity among contemporary public intellectuals, focusing on three predominant themes: concern for community, worry about the environment, and interest in civil society. In marked contrast to these disputatious commentators, Fowler finds the realm of popular opinion to be characterized by much greater consensus. Indeed, there seems to be a trend toward an even more general embrace of the liberal values that characterize our attitudes toward the individual, individual liberty, political equality, economic opportunity, and consent of the governed. Liberal values—above all the celebration of the individual and individual rights—have revolutionized the socalled private realms of life like family and religious communities to an extent unimagined in the 1950s.From these conclusions, Fowler demonstrates that most interpretations of American political thinking have exaggerated the extent of conflict and diversity in our nation's often raucous policy disputes. But he also cautions us not to overstate the public's widely shared liberal values and, by doing so, miss opportunities to facilitate problem solving or to recognize the ways in which our reform efforts may be constrained.

Description: Rationale: No published randomized trials have compared low molecular weight heparin (LMWH) to unfractionated heparin (UFH) for thromboprophylaxis in medical-surgical ICU patients. Objectives: A) Our Feasibility Objectives were to assess: 1) timely enrollment and complete, blinded study drug administration, 2) LMWH bioaccumulation in renal insufficiency, 3) twice weekly leg ultrasounds, and 4) recruitment rates for a future trial. B) Our Clinical Objectives were to assess 1) the effectiveness of LMWH vs UFH by estimating DVT, and pulmonary embolism (PE) rates, and 2) the safety of LMWH vs UFH regarding bleeding, thrombocytopenia and HIT. Methods: In this prospective randomized stratified concealed blinded multicenter trial, we included patients ≥18 with expected ICU stay ≥72h. We excluded trauma, orthopaedic, cardiac, or neurosurgery, severe hypertension, DVT, PE or hemorrhage within 3 mos, INR 〉2ULN, PTT 〉2ULN, platelets 99% of scheduled doses; every dose was blinded. 2) No LWMH bioaccumulation was observed as measured by anti-Xa levels when creatinine clearance decreased to

Description: Introduction:The prognosis of patients with hematologic malignancies (HM) admitted to intensive care units (ICU) is historically poor due to complications of treatment and disease progression with reported overall mortality rates of 24.3% to 84.1%. There is little known regarding predictive variables for ICU admission in adult patients with HM. Objective: Our primary objective was to audit the clinical outcomes including mortality of our HM patients admitted to any hospital ICU unit and compare their characteristics and outcomes with non-ICU hospitalized patients. A secondary objective was to identify the predictive factors for ICU admission and survival. Methods: In this single centre retrospective study, we audited 656/2141 consecutive patients with HM who were admitted to our hospital from 2009-2015 and compared the disease, patient characteristics, and clinical outcomes of HM patients who did or did not get admitted to any ICU. We excluded patients admitted for palliative care and in instances where the patient was admitted more than once, we included only the most recent admission. We enriched for patients who were admitted to the ICU over this 6-year period to improve the statistical power of comparing these two populations. The variables considered included: reason for admission, underlying diagnosis, the modified Charlson Comorbidity Index (CCI), selected laboratory parameters at admission to hospital, previous chemotherapy type, line of treatment, timing and intent, body mass index (BMI), GSCF use, age and sex. We also screened for electronic documentation of advanced directives preceding ICU or hospital admission. We compared the characteristics of ICU (n=179, 27%) and non ICU (n=477, 73%) admitted patients using the Fisher exact test and Wilcoxon rank-sum non parametric test for categorical and continuous variables, respectively. To search for the significant predictive factors for ICU admissions and mortality, univariate and multivariate logistic regression analyses were used. Results: Over the 6-year period, the admission rate to any ICU for HM patients was 9.4%. Median age of the 656 patients was 65.0 (IQR 55-74) and 57% were male with a median time from last chemotherapy and diagnosis of 1 month (IQR 0-3) and 7.8 months (IQR 2.3-44), respectively. Selected patient and disease characteristics comparing ICU and non- ICU admitted patients are in Table 1. There were no differences in median age, BMI, gender, time from last chemotherapy, reasons for admission, WBC, and line of chemotherapy. Patients admitted to any ICU were more likely to have received chemotherapy with curative intent (p=0.0323) and have myeloid cancers (p= 0.0008). They had shorter times from diagnosis, lower hemoglobin, platelet and albumin levels but higher creatinine levels, lactate dehydrogenase (LDH) and liver enzymes. ICU admitted patients had higher CCI scores and in particular history of cardio/cerebro-vascular disease. They also had lower rates of advanced directives (32% vs 49%, p=0.0001). 50% of ICU patients were mechanically ventilated and 25% received vasopressors. Median length of hospital stay was 19 days for ICU and 6 days for non-ICU patients and median ICU length of stay was 3 days (IQR 2-6 days). 34 patients (19.0%) died in ICU and but in hospital mortality was 33% (compared with 8% for non ICU). In the multivariate analysis, six covariates significantly related to ICU admission: chemotherapy intent (curative vs. palliative), history of myocardial infarction, lower platelets, creatinine and albumin levels and no advanced directives (Table 2). Median overall survival was 4.7 months vs. not yet reached for ICU and non ICU admitted patients respectively. 30-day and 6-month survivals were 67% and 47% (ICU) compared with 89%, and 77% in non-ICU admitted patients. The predictors of death in ICU admitted patients were male sex (OR 2.6, 95% CI 1-6.7, p =0.03) and mechanical ventilation (OR 6.55, 95% CI 2.6-18.5, p=0.0001). Conclusions:We validate the previously reported high rates of ICU mortality for patients with hematologic malignancies and have identified the risk factors for ICU admission. Patients without advanced directives have a high likelihood for admission to ICU and potentially represent a targetable group for interventions to avoid inappropriately aggressive care. A predictive score is in development to help identify the patients warranting closer scrutiny and goals of care discussions. Disclosures Buckstein: Celgene: Honoraria, Research Funding; Novartis: Honoraria.