bluuebunny/crossref_metadata_2025 huggingface dataset:
Immunomodulatory effects of heat-killed Mycobacterium obuense on human blood dendritic cells
Authors: Bazzi Samer , Modjtahedi Helmout , Mudan Satvinder , Achkar Marcel , Akle Charles , Bahr Georges M.
Published: August 2017

Heat-killed (HK) Mycobacterium obuense is a novel immunomodulator, currently undergoing clinical evaluation as an immunotherapeutic agent in the treatment of cancer. Here, we examined the effect of in vitro exposure to HK M. obuense on the expression of different categories of surface receptors on human blood myeloid (m) and plasmacytoid (p) DCs. Moreover, we have characterized the cytokine and chemokine secretion patterns of purified total blood DCs stimulated with HK M. obuense. HK M. obuense significantly up-regulated the expression of CD11c, CD80, CD83, CD86, CD274 and MHC class II in whole-blood mDCs and CD80, CD123 and MHC class II in whole-blood pDCs. Down-regulation of CD195 expression in both DC subpopulations was also noted. Further analysis showed that HK M. obuense up-regulated the expression of CD80, CD83 and MHC class II on purified blood DC subpopulations. TLR2 and TLR1 were also identified to be engaged in mediating the HK M. obuense-induced up-regulation of surface receptor expression on whole blood mDCs. In addition, our data demonstrated that HK M. obuense augmented the secretion of CCL4, CCL5, CCL22, CXCL8, IL-6, IL-12p40 and TNF-α by purified total blood DCs. Taken together, our data suggest that HK M. obuense exerts potent differential immunomodulatory effects on human DC subpopulations.
Scars of disengagement: perspectives on community leadership and youth engagement in rural South Africa
Authors: Majee Wilson , Jooste Karien , Aziato Lydia , Anakwe Adaobi
Published: August 2017

Given the emerging global youth disengagement epidemic, anticipated population growth, and the threat of continued rural–urban migration among young adults, recent research has focused on community leadership practice and the factors that influence youth engagement at the local level. Studying these practices and factors can elicit interventions that can improve youth engagement and youth health. This study engaged South African rural community leaders in interviews to collect perceptions and experiences on community leadership and factors that influence youth engagement and their health behaviors. Content analysis was used to analyze the data. Emergent themes are categorized into four domains: conceptualizations of leadership, current youth behaviors, barriers to youth engagement, and youth leadership opportunities and potential solutions. Findings demonstrate a clear grasp of the concept of community leadership among community leaders, and an awareness of the complex interplay of social, economic and environmental factors on youth disengagement and the potential interventions to promote more youth participation.
Promoting smoking cessation in China: a foot-in-the-door approach to tobacco control advocacy
Authors: Chan Sophia Siu Chee , Cheung Yee Tak Derek , Wong David Chung Ngor , Jiang Chao Qiang , He Yao , Yang Li , Jiang Bin , Wu Lei , Tan Shou Yong , Cheng Kar Keung , Lam Tai-hing
Published: August 2017

Introduction:

The Chinese government’s implementation of the MPOWER policies and compliance with the WHO Framework Convention on Tobacco Control requirements has been slow. We used the ‘foot-in-the-door’ approach to promote tobacco control advocacy through capacity building of healthcare leaders, and establishment of smoking cessation clinics in Guangzhou and Beijing (two of the largest cities in China).

Methods:

This collaborative pilot project involved the University of Hong Kong and three major hospitals in Guangzhou and Beijing. A steering committee conducted the smoking cessation training workshops starting from April 2006, and set up three smoking cessation model clinics during August 2006 to October 2008. We followed up the trained health care professionals (HCPs) in 2014 and 2015 to assess their impacts on tobacco control beyond smoking cessation.

Results:

We emphasized the importance of the general tobacco control atmosphere during smoking cessation training of 139 HCPs to motivate them to engage in tobacco control advocacy. In addition to enhancing their knowledge and skills in cessation, the HCPs were then involved in the establishment of three in-hospital smoking cessation clinics and served as smoking cessation counselors since June 2008. Moreover, they ventured outside the clinics and the community to publicize smoking cessation. Their effort has contributed to smoke-free legislation, better surveillance on smoking and media advocacy on tobacco control in China.

Conclusions:

The training and establishment of smoking cessation clinics could serve as a means to motivate and empower HCPs who could contribute to broaden tobacco control policy in China.
The Faustian Bargain of Tropical Soybean Production
Authors: Goldsmith Peter
Published: August 2017

I use three case studies in this essay to show that policies promoting commercial soy production in the tropics involve a Faustian Bargain. Faustian Bargains, strictly defined, comprise a conflict one faces when a decision-maker trades one’s “soul” for greater knowledge. Applied more liberally in the context of soybean development, commercial crop technologies, like soybean, offer the potential for improved labor productivity over traditional staples, and as a result, they can provide a pathway out of poverty traps. However, they also may cause considerable changes to traditional norms, cultivation practices, market relationships, natural resources, and the natural environment, hence, the Faustian Bargain. Relevant to this special issue of Tropical Conservation Science, the three case study examples demonstrate how and why commercial crop production requires a shift to intensive input usage. Thus, promoting commercial crops means introducing chemical fertilizers and herbicides into environments where heretofore traditional methods involved little or no inputs other than labor. The Faustian framework involves the tradeoff between potentially greater economic opportunities, but at a cost to traditional norms, practices, and potentially the natural environment.
Rethinking the subject, reimagining worlds
Authors: Ruddick Susan M
Published: August 2017

The ecological crisis is also an ontological crisis. It raises questions about our ethical response-ability to this world, calling for a rethinking of the human–nature divide. Vitalist approaches and scholarship on the affective turn have shifted our understanding of our relations to nonhuman others, but they remain constrained: limited to proximate attachments; ambivalent or agnostic in the face of conflict; unable to move beyond the celebration of a lively earth. At issue I feel is a methodological individualism that haunts these offerings when confronted with questions of the ethical composition of a larger whole. Building upon Sharp’s invitation to explore ‘our continuity with nonhuman agencies’, I investigate the ethical basis for a reimagined subject in a series of becomings: the becoming nature of God, becoming animal of man, and becoming sign of earth. Drawing on the writings of Spinoza, Deleuze and Guattari, and Peirce, I rework this familiar terrain on two counts. First, I examine how the content of each becoming invokes distinct relational dynamics and complicates the ‘problem of composition’. Second, I draw on Spinoza’s differentiated concept of power (as potentia and potestas) and the concept of the composite individual to suggest an alternative way of framing our collaborations with the nonhuman world.
Deleuze, subjectivity and nonhuman becomings in the Anthropocene
Authors: Stark Hannah
Published: August 2017

This commentary takes up Ruddick’s ((2017) Rethinking the subject, reimagining worlds. Dialogues in Human Geography) imperative to reimagine subjectivity against the backdrop of the current ecological crisis. It contextualizes Ruddick’s reading of Deleuze and Guattari’s becoming-animal with a broader trajectory of Deleuze’s work on subjectivity. It does so in order to question how a shift from the liberal humanist subject to constructivist and relational models of subjectivity might be beneficial as we grapple with the concept of the human in the Anthropocene.
Spinoza and the possibilities for radical climate ethics
Authors: Sharp Hasana
Published: August 2017

In this commentary, I endeavor to respond to what I identify as the core question of Ruddick’s paper: How does the theoretical dethroning of humanity force us to reinvent ethics? I expand on Spinoza’s profound contribution to the radical rethinking of the subject at the level of ontology. Although Ruddick invokes Spinoza, first and foremost, as a potential resource for ethics in light of climate disruption, I conclude that those resources offer only a glimmer of how to live differently. The work of reimagination at the level of metaphysics is flourishing, but we have yet to develop its implications for ethics and politics.
Assemblage and relationality in social-ecological systems
Authors: Lejano Raul P
Published: August 2017

How does one begin to construct lasting solutions to environmental problems, the lived experiences of which exceed and defy their framing as environmental (or even as problematic)? Situations exhibit an irreducible autonomy often not amenable to strategic intervention. An emerging concept, proposed as an analytical framework for complex systems, is that of the response assemblage, which is the phenomenal convergence of autonomous elements into provisional, revisable wholes. I argue that these proposals provide interesting possibilities for analysis which, at this point, are not yet operational. Furthermore, when these concepts begin to be translated into analysis, we should encounter a number of unavoidable conceptual issues. I describe some tentative analytical strategies that might be useful for assemblage work, such as a hermeneutic approach to describing the relational. With each provisional analytical turn, I describe how these obdurate conceptual questions re-emerge.
Why I fell for assemblages
Authors: Briassoulis Helen
Published: August 2017

This response to the commentaries on my paper (Briassoulis (2017) Response assemblages and their socioecological fit: conceptualizing human responses to environmental degradation. Dialogues in Human Geography (this issue)) clarifies conceptual, methodological, policy, planning, and politics issues and summarizes the value of assemblage-based approaches for studying and intervening in sociospatial phenomena. Assemblage Thinking implies a processual view of socioecological systems and their associated spatial hierarchy as multiplicities constituted by assemblages that provide an ontological alternative either to wholes/essences or to the ontological void of many empirical studies. It offers a common framework to reconceptualize concepts such as degradation, responses, and the effectiveness, or fit, of plans, policies, and management schemes implemented to address them. It views these as constantly and contingently produced out of relatively autonomous human and nonhuman components through formal and informal situated practices. It provides an all-embracing context and apposite integrative constructs for substantive theory building to address dynamic, socioecological problems. It challenges researchers to approach and analyze these problems as relational, and therefore through methodological openness, pluralism, and judicious and masterful synthesis of both multidisciplinary scientific and traditional/lay knowledge, accomplished through both quantitative and qualitative techniques. It embeds policy and planning analysis and practice in the uncertain and unpredictable milieu of multiplicities and emphasizes morphogenetic processes, nonlinear relationships, and emergent, situated policy outcomes. It thus keeps analysts and managers alert and open to all possibilities, prompts a reconceptualization of policy making and planning as re/de/territorializing processes, and points to process-based adaptive governance.
Museum ethnography: Researching punishment museums as environments of narrativity
Authors: Thurston Hannah
Published: August 2017

Like all museums, punishment museums and sites of penal tourism are inherently political and moral institutions, offering cultural memories of a collective past. As environments of narrativity, these are significant spaces in which the public ‘learn’ about the past and how it continues to inform the present. In line with recent studies about ‘dark’ tourist sites, this article argues that the crime/punishment museum and jail cell tour can – and should – be understood as an ethnographic opportunity for narrative analysis. Rather than focus on just the findings of such an analysis, this article seeks to provide a practical guide to data collection and analysis in the context of criminological museum research. Offering illustrative examples from a study of Texan sites of penal tourism, it demonstrates how the history of punishment – as represented in museums – is an important part of cultural identity more broadly, playing a significant role in how we conceptualise (in)justice, morality and the purpose of punishment. In short, this article discusses how we can evoke the ethnographic tradition within museum spaces in order to interrogate how crime and punishment are expressed through narratives, images, objects and symbols.
Researching victimisation using auto-ethnography: Wearing the Muslim veil in public
Authors: Zempi Irene
Published: August 2017

This article reflects upon my personal experiences of undertaking auto-ethnography on victimisation through wearing the Muslim veil in public. Wearing the veil was suggested by some of my respondents as a way to get insider knowledge of their own day-to-day experiences of victimisation. Here, I explore the emotional, psychological and physical impacts of being targeted because of my (perceived/adopted) Muslim identity. I discuss the advantages and disadvantages of covert auto-ethnographic research and consider the ethical challenges and practical difficulties of performing auto-ethnography. Also, I discuss the theoretical and methodological issues that arise from undertaking auto-ethnography as an insider/outsider when researching the targeted victimisation of veiled Muslim women. Finally, I discuss the usefulness and limitations of auto-ethnography as a method for understanding victimisation. I conclude that auto-ethnographic research into victimisation has great potential, although researchers need to be aware of some risks inherent in this approach and, thus, proceed with caution.
The Current Studies of Education for a Traditional and Complementary Medicine in Malaysia
Authors: Kim Yun Jin
Published: August 2017

The aim of this study is to understand the current tradition and complementary medicine (T&CM) education in Malaysia. We referred to literature regarding to traditional medicine education in Malaysia, and collected the information via website or interview with faculty of T&CM in universities/colleges and Division of T&CM, Ministry of Health, Malaysia. T&CM education in Malaysia has been following China’s T&CM systems for 50 years. Currently, Division of T&CM, Ministry of Health; and Ministry of Higher Education has approved 11 institutions to offer T&CM education. Students may major in Chinese herbal medicine, acupuncture, or other T&CM subjects. Generally, clinical training programs in China, Taiwan, or Australia include substantial proportion of clinical training. We report on the general information of T&CM education in Malaysia. This result would be the first-stage information for the establishment of a strategy regarding the enhancement of T&CM education in Malaysia.
Exploring the Relationship Between Job Quality, Performance Management, and Career Initiative: A Two-Level, Two-Actor Study
Authors: Van Veldhoven Marc , Dorenbosch Luc , Breugelmans Anouk , Van De Voorde Karina
Published: August 2017

This study examines how job quality and performance management influence career initiative in the workplace. Based on signaling theory and the notion of internal fit in performance management and HRM, we argue that performance management with a learning orientation further enhances career initiative, whereas performance management with a results orientation constrains it. Combining the two performance management types is expected to diminish career initiative. In addition, we expect the positive effect of job quality to be contingent upon the performance management types. A total of 772 employees working in the (public) service industry or manufacturing industry and nested within 53 work units rated their job quality (job variety and job autonomy) as well as career initiative. Line managers from these work units rated the performance management types practiced. Results indicate that job variety and learning-oriented performance management positively relate to career initiative. The positive relationships between learning-orientated performance management, job variety, and career initiative are weakened when line managers simultaneously practice results-oriented performance management. These findings underline the need to focus on how performance management orientations and job quality combine to influence career initiative.
Prevalence of Anemia and Its Determinants Among Pregnant, Lactating, and Nonpregnant Nonlactating Women in India
Authors: Siddiqui Mohammad Zahid , Goli Srinivas , Reja Tamal , Doshi Riddhi , Chakravorty Swastika , Tiwari Chhavi , Kumar Nomita P. , Singh Deepshikha
Published: August 2017

Despite the existence of several policies and programs, anemia among pregnant and lactating women continues to be a serious concern for public health policy in India. The main objective of this study is to examine the prevalence and determinants of anemia among pregnant and lactating versus nonpregnant nonlactating (NP-NL) women for priority setting in health policies of the country. Data from the National Family Health Survey (NFHS3) conducted in 2005-2006 has been used for the analyses of this study. The results revealed that the prevalence of anemia was higher among lactating women (63%), followed by pregnant women (59%) than NP-NL women (53%). Younger lactating (71%) and older pregnant women (67%) had a higher burden of anemia. Along with socioeconomic factors, demographic indicators such as children ever born and program factors like nutrition advice and supplementary nutrition during anti natal care and postnatal care emerged as significant predictors in the case of anemia among both pregnant and lactating women, while socioeconomic indicators emerged as critical factors in the case of anemia among NP-NL women. Hence, targeting demographic and program factors, along with key socioeconomic and demographic factors in public health policy, is critical in reducing anemia among lactating and pregnant women, while targeting significant socioeconomic factors is the key for reducing anemia among NP-NL women.
Proxies for Success: How the Application Process Correlates to PhD Pursuit for a Small Diversity Research Program
Authors: Whittington Dawayne , Wallace Latricia E. , Shadding Cherilynn R.
Published: August 2017

Science, technology, engineering, and mathematics (STEM) diversity research programs seek to make progress in increasing the number of underrepresented students that pursue STEM at the highest degree levels. Yet few programs have outlined their path to help students achieve the STEM PhD. Our program, Opportunities in Genomics Research (OGR), showed significant increases in PhD matriculation over 8 years of National Institutes of Health (NIH) funding. We explored typical measures, which include grade point average (GPA), institution classification, and graduate school ranking, and found that these measures alone do not explain the improved outcomes. We examined changes in the application materials as proxies for commitment to a PhD degree. These data show a significant correlation of desired degree pursuit to increased proxies and proxy type (open- or close-ended questions answered by applicant or referee). We demonstrate that changes in application procedures for diversity research programs correlate to improved program outcomes with statistical significance.
Post-operative fever in orthopaedic surgery: How effective is the ‘fever workup?’
Authors: Ashley Blair , Spiegel David A , Cahill Patrick , Talwar Divya , Baldwin Keith D
Published: August 2017

Background:

Defining the appropriate threshold at which to initiate a fever workup is imperative to promote patient safety, appropriate resource utilization, and antibiotic stewardship. Our group performed a systematic review of the available literature on perioperative fever (POF) workups in orthopaedic patients to evaluate the frequency, timing and utility of blood cultures (BC) and other investigations in the POF workup, to determine the clinical relevance of any infections and to evaluate their cost effectiveness.

Methods:

Studies were identified by searching MEDLINE, EMBASE, Pubmed, Cochrane and Google Scholar for articles through September 2016. Forty-nine articles were retrieved and 22 articles met the pre-determined inclusion criteria. Proportions of positive studies were noted and averaged using random effects analysis.

Results:

Post-operative pyrexia ranged in prevalence between 8.1% and 87.3%. The studies routinely performed during a fever workup had wide ranges of diagnostic yield, including chest X-rays from 0% to 40%, urinalyses from 8.2% to 38.7%, urine cultures from 0% to 22.4% and BC from 0% to 13.3%. Only two patients with positive BC developed clinical sepsis. Cost per fever evaluation ranged from $350 to $950.

Conclusion:

The findings of this review suggest that early post-operative fever is an expected event following orthopaedic surgery. Based on the available literature, any kind of workup in the absence of localizing symptoms in the third post-operative day or before is unwarranted and is an inappropriate use of hospital resources.
Pasteurella multocida Bacteremia and Peritonitis in a Patient With Cirrhosis: A Life-Threatening Case From a Prick of a Cactus
Authors: Wallace Jodi-Anne , Hussain Jonathan , Unzueta Alberto , Morelli Giuseppe
Published: August 2017

A 58-year-old male with nonalcoholic steatohepatitis cirrhosis presents with right lower extremity cellulitis, abdominal tenderness, and severe sepsis after sustaining puncture injury from a cactus on a property with feral cats. Blood cultures and diagnostic paracentesis were consistent with spontaneous bacterial peritonitis due to Pasteurella multocida, a gram-negative coccobacillus found in the respiratory tract of domestic animals. The patient received timely antibiotic coverage with resolution of spontaneous bacterial peritonitis and sepsis after 14-day treatment. This case emphasizes the life-threatening nature of systemic Pasteurella multocida infection as well as an indirect way of acquiring a zoonotic infection in a patient with end-stage liver disease.
Improving Patient Experiences and Outcomes Through Personal Care Aide Training
Authors: Luz Clare C , Hanson Katherine V , Hao Yuning , Spurgeon Elizabeth
Published: August 2017

Introduction:

The rapidly aging US population is resulting in major challenges including delivering quality care at lower costs in the face of a critical health-care workforce shortage. The movement toward home care has dramatically increased the need for qualified, paid personal care aides (PCAs). Adequate PCA training that focuses on skills for person-centered, at home support is an imperative. This study provides evidence that clients of PCAs who have completed a comprehensive, evidence-based PCA training program, titled Building Training…Building Quality (BTBQ), report higher satisfaction and better health outcomes, compared to clients of PCAs with lesser or other training.

Methods:

A mixed-methods, quasi-experimental design was used to compare self-reported survey responses from clients of BTBQ-trained PCAs (treatment group) with responses from clients of non-BTBQ-trained PCAs (control group).

Results:

Clients of BTBQ-trained PCAs had significantly fewer falls and emergency department visits compared to clients whose PCAs had no BTBQ training ( P < .05). Conclusion: BTBQ-like PCA training reduces costly adverse events.
Epididymal Tuberculosis: A Diagnostic Challenge, Sonographic Findings, and Differential Diagnosis
Authors: Mahaveer Jeevan , Weston Michael , Wolstenhulme Stephen
Published: August 2017

A male patient was referred to radiology with scrotal pain and swelling. Prior to diagnosis, the patient had three sonograms for scrotal swelling, which progressed to a discharging scrotal sinus. At the second scan, a risk factor of past history of pulmonary tuberculosis (PTB) was noted. The first sonogram showed findings suggestive of left epididymitis, the second sonogram showed possible primary testicular tumor or epididymal tuberculosis (EPTB), the third sonogram showed epididymal pathology extending to involve the tunica vaginalis and scrotal wall leading to a sinus tract formation, and the fourth sonogram was normal. This case highlights the sonographic findings during progression of EPTB and the differential diagnosis to consider in such cases. It is a useful educational aid for radiologists and sonographers when evaluating the role of sonography in the management of a patient with scrotal swelling and discharging scrotal sinus.
Uncovering the mystery of opposite circadian rhythms between mouse and human leukocytes in humanized mice
Authors: Zhao Yue , Liu Min , Chan Xue Ying , Tan Sue Yee , Subramaniam Sharrada , Fan Yong , Loh Eva , Chang Kenneth Tou En , Tan Thiam Chye , Chen Qingfeng
Published: August 2017

Key Points

Human circulating leukocytes in humanized mice reproduce similar circadian oscillations as seen in humans. A novel molecular clock network exhibiting opposite effects on regulating human and mouse leukocyte circadian rhythm is discovered.
An explorative qualitative study to determine the footwear needs of workers in standing environments
Authors: Anderson Jennifer , Williams Anita E. , Nester Christopher
Published: August 2017

Background

Many work places require standing for prolonged periods of time and are potentially damaging to health, with links to musculoskeletal disorders and acute trauma from workplace accidents. Footwear provides the only interaction between the body and the ground and therefore a potential means to impact musculoskeletal disorders. However, there is very limited research into the necessary design and development of footwear based on both the physical environmental constraints and the personal preference of the workers. Therefore, the purpose of this study was to explore workers needs for footwear in the ‘standing’ workplace in relation to MSD, symptoms, comfort and design.

Method

Semi‐structured interviews were conducted with participants from demanding work environments that require standing for high proportions of the working day. Thematic analysis was used to analyse the results and gain an exploratory understanding into the footwear needs of these workers.

Results

Interviews revealed the environmental demands and a very high percentage of musculoskeletal disorders, including day to day discomfort and chronic problems. It was identified that when designing work footwear for standing environments, the functionality of the shoe for the environment must be addressed, the sensations and symptoms of the workers taken into account to encourage adherence and the decision influencers should be met to encourage initial footwear choice. Meeting all these criteria could encourage the use of footwear with the correct safety features and comfort. Development of the correct footwear and increased education regarding foot health and footwear choice could help to reduce or improve the effect of the high number of musculoskeletal disorders repeatedly recorded in jobs that require prolonged periods of standing.

Conclusion

This study provides a unique insight into the footwear needs of some workers in environments that require prolonged standing. This user based enquiry has provided information which is important to workplace footwear design.
Phase III Trial of Ipilimumab Combined With Paclitaxel and Carboplatin in Advanced Squamous Non–Small-Cell Lung Cancer
Authors: Govindan Ramaswamy , Szczesna Aleksandra , Ahn Myung-Ju , Schneider Claus-Peter , Gonzalez Mella Pablo Fernando , Barlesi Fabrice , Han Baohui , Ganea Doina Elena , Von Pawel Joachim , Vladimirov Vladimir , Fadeeva Natalia , Lee Ki Hyeong , Kurata Takayasu , Zhang Li , Tamura Tomohide , Postmus Pieter E. , Jassem Jacek , O’Byrne Kenneth , Kopit Justin , Li Mingshun , Tschaika Marina , Reck Martin
Published: August 2017

Purpose

Patients with squamous non–small-cell lung cancer (NSCLC) have poor prognosis and limited treatment options. This randomized, double-blind, phase III study investigated the efficacy and safety of first-line ipilimumab or placebo plus paclitaxel and carboplatin in advanced squamous NSCLC.

Patients and Methods

Patients with stage IV or recurrent chemotherapy-naïve squamous NSCLC were randomly assigned (1:1) to receive paclitaxel and carboplatin plus blinded ipilimumab 10 mg/kg or placebo every 3 weeks on a phased induction schedule comprising six chemotherapy cycles, with ipilimumab or placebo from cycles 3 to 6 and then, after induction treatment, ipilimumab or placebo maintenance every 12 weeks for patients with stable disease or better. The primary end point was overall survival (OS) in patients receiving at least one dose of blinded study therapy.

Results

Of 956 randomly assigned patients, 749 received at least one dose of blinded study therapy (chemotherapy plus ipilimumab, n = 388; chemotherapy plus placebo, n = 361). Median OS was 13.4 months for chemotherapy plus ipilimumab and 12.4 months for chemotherapy plus placebo (hazard ratio, 0.91; 95% CI, 0.77 to 1.07; P = .25). Median progression-free survival was 5.6 months for both groups (hazard ratio, 0.87; 95% CI, 0.75 to 1.01). Rates of grade 3 or 4 treatment-related adverse events (TRAEs), any-grade serious TRAEs, and TRAEs leading to discontinuation were numerically higher with chemotherapy plus ipilimumab (51%, 33%, and 28%, respectively) than with chemotherapy plus placebo (35%, 10%, and 7%, respectively). Seven treatment-related deaths occurred with chemotherapy plus ipilimumab, and one occurred with chemotherapy plus placebo.

Conclusion

The addition of ipilimumab to first-line chemotherapy did not prolong OS compared with chemotherapy alone in patients with advanced squamous NSCLC. The safety profile of chemotherapy plus ipilimumab was consistent with that observed in previous lung and melanoma studies. Ongoing studies are evaluating ipilimumab in combination with nivolumab in this population.
Efficacy of Thalidomide in Preventing Delayed Nausea and Vomiting Induced by Highly Emetogenic Chemotherapy: A Randomized, Multicenter, Double-Blind, Placebo-Controlled Phase III Trial (CLOG1302 study)
Authors: Zhang Lingyun , Qu Xiujuan , Teng Yuee , Shi Jing , Yu Ping , Sun Tao , Wang Jingyan , Zhu Zhitu , Zhang Xiuna , Zhao Mingfang , Liu Jing , Jin Bo , Luo Ying , Teng Zan , Dong Yuyang , Wen Fugang , An Yuzhi , Yuan Caijun , Chen Tiejun , Zhou Lizhong , Chen Ying , Zhang Jian , Wang Zhenghua , Qu Jinglei , Jin Feng , Zhang Jingdong , Jin Xiuhua , Xie Xiaodong , Wang Jun , Man Li , Fu Lingyu , Liu Yunpeng
Published: August 2017

Purpose

We examined the efficacy and safety of thalidomide (THD) for the prevention of delayed nausea and vomiting in patients who received highly emetogenic chemotherapy (HEC).

Patients and Methods

In a randomized, double-blind, active-controlled, phase III trial, chemotherapy-naive patients with cancer who were scheduled to receive HEC that contained cisplatin or cyclophosphamide-doxorubicin/epirubincin ≥ 50 mg/m2 regimens were randomly assigned to a THD group (100 mg twice daily on days 1 to 5) or placebo group, both with palonosetron (0.25 mg on day 1) and dexamethasone (12 mg on day 1; 8 mg on days 2 to 4). Primary end point was complete response to vomiting—no emesis or use of rescue medication—in the delayed phase (25 to 120 h). Nausea and anorexia on days 1 to 5 were evaluated by the 4-point Likert scale (0, no symptoms; 3, severe). Quality of life was assessed by the European Organization for Research and Treatment of Cancer QLQ-C30 version 3 questionnaire on days −1 and 6.

Results

Of 656 patients, 638 were evaluable: 317 in the THD group and 321 in the control group. Compared with placebo, delayed and overall (0 to 120 h) complete response rates to vomiting were significantly higher with THD: 76.9% versus 61.7% ( P < .001) and 66.1% versus 53.3% ( P = .001), respectively. Rates of no nausea were also higher in the THD group (delayed: 47.3% v 33.3%; P < .001; overall: 41% v 29.6%; P = .003), and mean scores of anorexia were lower overall (0.44 ± 0.717 v 0.64 ± 0.844; P = .003). Adverse effects were mild to moderate. The THD group had increased sedation, dizziness, constipation, and dry mouth, but experienced better quality of life after chemotherapy.

Conclusion

Thalidomide combined with palonosetron and dexamethasone significantly improved HEC-induced delayed nausea and vomiting prevention in chemotherapy-naive patients.
MicroRNA-221-3p Regulates Angiopoietin-Like 8 (ANGPTL8) Expression in Adipocytes
Authors: Mysore Raghavendra , Ortega Francisco J , Latorre Jèssica , Ahonen Maria , Savolainen-Peltonen Hanna , Fischer-Posovszky Pamela , Wabitsch Martin , Olkkonen Vesa M , Fernández-Real José M , Haridas P A Nidhina
Published: August 2017

Context

Angiopoietin-like 8 (ANGPTL8) has been identified as a key regulator of lipid metabolism.

Design

We addressed the correlation between ANGPTL8 messenger RNA (mRNA) with hallmark insulin-regulated and lipogenic genes in human adipose tissue (AT). The regulation of ANGPTL8 expression in adipocytes was studied after inflammatory challenge, and the role of microRNA (miRNA)-221-3p therein was investigated.

Results

ANGPTL8 gene expression in subcutaneous AT (SAT) and visceral AT (VAT) was highly correlated with SLC2A4/GLUT4, ADIPOQ, fatty acyl synthase, and diacylglycerol O-acyltransferase 1. ANGPTL8 mRNA in human adipocytes was suppressed by the inflammatory impact of conditioned medium of lipopolysaccharide-stimulated macrophages, which markedly induced miR-221-3p. MiR-221-3p was shown to target the ANGPTL8 mRNA, and to reduce adipocyte ANGPTL8 protein expression. Analysis of SAT biopsies from 69 subjects ranging from lean to morbidly obese and of VAT of 19 female subjects biopsied during gynecologic surgery demonstrated a trend of negative correlation between ANGPTL8 and miR-221-3p. Significant negative correlation of ANGPTL8 and miR-221-3p was identified in presurgery SAT samples from 22 morbidly obese subjects undergoing bariatric surgery, but vanished after ∼2-year surgery-induced weight loss, which also resulted in a marked reduction of miR-221-3p. ANGPTL8 correlated negatively with the AT inflammatory gene phospholipase A2 G7, whereas miR-221-3p showed a significant positive correlation with this marker. Of note, no correlation was found between AT ANGPTL8 mRNA expression and plasma ANGPTL8.

Conclusions

The inflammation-induced miR-221-3p regulates ANGPTL8 expression in adipocytes. This miRNA impact may become especially prominent under pathologic conditions such as morbid obesity, putatively contributing to the impaired AT lipid metabolism in metabolic disease.
Rationalizing Thyroid Function Testing: Which TSH Cutoffs Are Optimal for Testing Free T4?
Authors: Henze Meg , Brown Suzanne J , Hadlow Narelle C , Walsh John P
Published: August 2017

Context

Thyroid function testing often uses thyrotropin (TSH) measurement first, followed by reflex testing for free thyroxine (T4) if TSH is outside the reference range. The utility of different TSH cutoffs for reflex testing is unknown.

Objective

To examine different TSH cutoffs for reflex free T4 testing.

Design, Setting, and Patients

We analyzed concurrent TSH and free T4 results from 120,403 individuals from a single laboratory in Western Australia (clinical cohort) and 4568 Busselton Health Study participants (community cohort).

Results

In the clinical cohort, restricting free T4 measurement to individuals with TSH <0.3 or >5.0 mU/L resulted in a 22% reduction in free T4 testing compared with a TSH reference range of 0.4 to 4.0 mU/L; using TSH cutoffs of 0.2 and 6.0 mU/L resulted in a 34% reduction in free T4 testing. In the community cohort, the corresponding effect was less: 3.3% and 4.8% reduction in free T4 testing. In the clinical cohort, using TSH cutoffs of 0.2 and 6.0 mU/L, elevated free T4 would go undetected in 4.2% of individuals with TSH levels of 0.2 to 0.4 mU/L. In most, free T4 was marginally elevated and unlikely to indicate clinically relevant hyperthyroidism. Low free T4 would go undetected in 2.5% of individuals with TSH levels of 4 to 6 mU/L; in 94%, free T4 was marginally reduced and unlikely to indicate clinically relevant hypothyroidism.

Conclusions

Setting TSH cutoffs at 0.1 to 0.2 mU/L less than and 1 to 2 mU/L greater than the reference range for reflex testing of free T4 would reduce the need for free T4 testing, with minimal effect on case finding.
Reductions in Average Lengths of Stays for Surgical Procedures Between the 2008 and 2014 United States National Inpatient Samples Were Not Associated With Greater Incidences of Use of Postacute Care Facilities
Authors: Dexter Franklin , Epstein Richard H.
Published: August 2017

BACKGROUND:

Diagnosis-related group (DRG) based reimbursement creates incentives for reduction in hospital length of stay (LOS). Such reductions might be accomplished by lesser incidences of discharges to home. However, we previously reported that, while controlling for DRG, each 1-day decrease in hospital median LOS was associated with lesser odds of transfer to a postacute care facility (P = .0008). The result, though, was limited to elective admissions, 15 common surgical DRGs, and the 2013 US National Readmission Database.

METHODS:

We studied the same potential relationship between decreased LOS and postacute care using different methodology and over 2 different years. The observational study was performed using summary measures from the 2008 and 2014 US National Inpatient Sample, with 3 types of categories (strata): (1) Clinical Classifications Software’s classes of procedures (CCS), (2) DRGs including a major operating room procedure during hospitalization, or (3) CCS limiting patients to those with US Medicare as the primary payer.

RESULTS:

Greater reductions in the mean LOS were associated with smaller percentages of patients with disposition to postacute care. Analyzed using 72 different CCSs, 174 DRGs, or 70 CCSs limited to Medicare patients, each pairwise reduction in the mean LOS by 1 day was associated with an estimated 2.6% ± 0.4%, 2.3% ± 0.3%, or 2.4% ± 0.3% (absolute) pairwise reduction in the mean incidence of use of postacute care, respectively. These 3 results obtained using bivariate weighted least squares linear regression were all P < .0001, as were the corresponding results obtained using unweighted linear regression or the Spearman rank correlation.

CONCLUSIONS:

In the United States, reductions in hospital LOS, averaged over many surgical procedures, are not accomplished through a greater incidence of use of postacute care.
Outcomes in Patients Undergoing Cardiac Surgery Who Decline Transfusion and Received Erythropoietin Compared to Patients Who Did Not: A Matched Cohort Study
Authors: Duce Lorent , Cooter Mary L. , McCartney Sharon L. , Lombard Frederick W. , Guinn Nicole R.
Published: August 2017

BACKGROUND:

Erythropoiesis-stimulating agents, such as erythropoietin (EPO), can be used to treat preoperative anemia. Some studies suggest an increased risk of mortality and thrombotic events, and use in cardiovascular surgery remains off-label. This study compares outcomes in cardiac surgery patients declining blood transfusion who received EPO with a matched cohort who did not.

METHODS:

After institutional review board approval, we conducted a retrospective review of all patients who decline blood transfusion who underwent cardiac surgery and received EPO between January 1, 2004, and June 15, 2015, at a single institution. Control patients who did not receive EPO and were not transfused allogeneic red blood cells perioperatively were identified during the same period. Two controls were matched to each EPO patient using an optimal matching algorithm based on age, date of surgery, gender, operative procedure, and surgeon. The European System for Cardiac Operative Risk Evaluation (EuroSCORE) and baseline characteristics remaining unbalanced in the matched cohorts were controlled for in assessing patient outcomes. The primary outcome was a composite of mortality and thrombotic events, and secondary outcomes included change in hemoglobin (Hb) from baseline to discharge, acute kidney injury (AKI), sternal wound infection, atrial fibrillation, time to extubation, intensive care unit, and hospital length of stay (LOS).

RESULTS:

Fifty-three patients who decline transfusion and received EPO were compared to 106 optimally matched control patients who did not receive EPO or red blood cell transfusion in the perioperative period. The median additive EuroSCORE was similar between the EPO and control group [6 (4, 9) vs 5 (3, 7), respectively; P = .39]. There was no difference in the primary outcome (P = .12) and mortality was zero in both groups. The EPO group had a higher mean preoperative Hb (13.91 g/dL vs 13.31; P = .02) and a smaller change in Hb from baseline (−2.65 vs −3.60; P = .001). The incidence of AKI (47.17% vs 41.51%; P = .49) was similar and there was no significant difference in all other outcomes, including time to extubation, hospital LOS, or intensive care unit LOS.

CONCLUSIONS:

In this retrospective matched cohort study of patients declining transfusion and receiving EPO matched to control patients, there were no clinically meaningful differences in the outcomes.
Mechanical Coupling Between Muscle-Tendon Units Reduces Peak Stresses
Authors: Maas Huub , Finni Taija
Published: August 2017

The presence of mechanical linkages between synergistic muscles and their common tendons may distribute forces among the involved structures. We review studies, using humans and other animals, examining muscle and tendon interactions and discuss the hypothesis that connections between muscle bellies and within tendons may serve as a mechanism to distribute forces and mitigate peak stresses.
Recent advances in managing hepatitis D
Authors: Yurdaydin Cihan
Published: August 2017

Hepatitis D virus (HDV) infection leads to the most severe form of chronic viral hepatitis and requires the attention of a liver specialist. In this review, I will recapitulate recent advances in the management of HDV, present background information on HDV infection as well as current chronic hepatitis D treatment, briefly examine the HDV life cycle and discuss new management strategies.
The first 3D printed multiple sclerosis brain: Towards a 3D era in medicine
Authors: Avasarala Jagannadha , Pietila Todd
Published: August 2017

Conventional magnetic resonance imaging (MRI) studies depict disease of the human brain in 2D but the reconstruction of a patient’s brain stricken with multiple sclerosis (MS) in 3D using 2D images has not been attempted.

Using 3D reconstruction algorithms, we built a 3D printed patient-specific brain model to scale. It is a first of its kind model that depicts the total white matter lesion (WML) load using T2 FLAIR images in an MS patient. The patient images in Digital Imaging and Communications in Medicine (DICOM) format were imported into Mimics inPrint 2.0 (Materialise NV, Leuven, Belgium) a dedicated medical image processing software for the purposes of image segmentation and 3D modeling.  The imported axial images were automatically formatted to display coronal and sagittal slices within the software. The imaging study was then segmented into regions and surface rendered to achieve 3D virtual printable files of the desired structures of interest.

Rendering brain tumor(s) in 3D has been attempted with the specific intent of extending the options available to a surgeon but no study to our knowledge has attempted to quantify brain disease in MS that has, for all practical purposes, no surgical options.
Hepatic deletion of p110α and p85α results in insulin resistance despite sustained IRS1-associated phosphatidylinositol kinase activity
Authors: Chaudhari Aditi , Ejeskär Katarina , Wettergren Yvonne , Kahn C. Ronald , Rotter Sopasakis Victoria
Published: August 2017

Background: Class IA phosphatidylinositol-4,5-bisphosphate 3-kinase (PI3K) is an integral mediator of insulin signaling. The p110 catalytic and p85 regulatory subunits of PI3K are the products of separate genes, and while they come together to make the active heterodimer, they have opposing roles in insulin signaling and action. Deletion of hepatic p110α results in an impaired insulin signal and severe insulin resistance, whereas deletion of hepatic p85α results in improved insulin sensitivity due to sustained levels of phosphatidylinositol (3,4,5)-trisphosphate. Here, we created mice with combined hepatic deletion of p110α and p85α (L-DKO) to study the impact on insulin signaling and whole body glucose homeostasis.

Methods: Six-week old male flox control and L-DKO mice were studied over a period of 18 weeks, during which weight and glucose levels were monitored, and glucose tolerance tests, insulin tolerance test and pyruvate tolerance test were performed. Fasting insulin, insulin signaling mediators, PI3K activity and insulin receptor substrate (IRS)1-associated phosphatidylinositol kinase activity were examined at 10 weeks. Liver, muscle and white adipose tissue weight was recorded at 10 weeks and 25 weeks.

Results: The L-DKO mice showed a blunted insulin signal downstream of PI3K, developed markedly impaired glucose tolerance, hyperinsulinemia and had decreased liver and adipose tissue weights. Surprisingly, however, these mice displayed normal hepatic glucose production, normal insulin tolerance, and intact IRS1-associated phosphatidylinositol kinase activity without compensatory upregulated signaling of other classes of PI3K.

Conclusions: The data demonstrate an unexpectedly overall mild metabolic phenotype of the L-DKO mice, suggesting that lipid kinases other than PI3Ks might partially compensate for the loss of p110α/p85α by signaling through other nodes than Akt/Protein Kinase B.
Forensic nursing and the palliative approach to care: an empirical nursing ethics analysis
Authors: Wright David Kenneth , Vanderspank-Wright Brandi , Holmes Dave , Skinner Elise
Published: August 2017

Background:

A movement is underway to promote a palliative approach to care in all contexts where people age and live with life-limiting conditions, including psychiatric settings. Forensic psychiatry nursing—a subfield of mental health nursing— focuses on individuals who are in conflict with the criminal justice system. We know little about the values of nurses working in forensic psychiatry, and how these values might influence a palliative approach to care for frail and aging patients.

Method:

Interviews with four nurses working on one of two forensic units of a university-affiliated mental health hospital in an urban area of eastern Canada.

Findings:

Three specific values were found to guide forensic nurses in their care of aging patients that are commensurate with a palliative approach: hope, inclusivity, and quality of life.

Conclusion:

When we started this project, we wondered whether the culture of forensic nursing practice was antithetical to the values of a palliative approach. Instead, we found several parallels between forensic nurses' moral identities and palliative philosophy. These findings have implications for how we think about the palliative approach in contexts not typically associated with palliative care, but in which patients will increasingly age and die.