tbuckley/cabot-search huggingface dataset:
Abstract P6-11-10: Impact of disease progression on health-related quality of life in patients with metastatic breast cancer in the PRAEGNANT breast cancer registry
Authors: M Wallwiener, N Nabieva, L Haeberle, FA Taran, AD Hartkopf, B Volz, F Overkamp, AL Brandl, H-C Kolberg, P Hadji, H Tesch, J Ettl, MP Lux, D Lueftner, E Belleville, PA Fasching, W Janni, MW Beckmann, P Wimberger, C Hielscher, T Fehm, SY Brucker, D Wallwiener, A Schneeweiss, V Mueller
Journal: Cancer Research (2018)

Abstract Background: Improved progression-free survival is considered as treatment goal for patients with metastatic breast cancer (MBC) since it is assumed to delay or prevent deterioration of quality of life.Aim of our analysis was to examine the influence of disease progression on health-related quality of life (HRQoL). Methods: The PRAEGNANT study comprises a real-life registry for patients with MBC. HRQoL was assessed with the EORTC-QLQ-C30 Version 3.0 questionnaire at study entry and every 3 months thereafter. The primary endpoint was minimally important deterioration (MID) in global HRQoL score by ≥ five points between baseline and any follow-up assessment. A logistic regression model was built with MID (yes/no) at a follow-up timepoint as outcome variable and several covariates as predictors. Results: In total, 329 patients were included in this analysis, with disease progression in 63 patients. Concerning the primary study aim, progression status predicted MID of global HRQoL status in addition to the other covariates. The adjusted odds ratio for the effect of progression status on MID was 2.22 (95% CI: 1.04 – 4.73). Comparisons of mean differences of QoL domains/scales yielded no differences. Conclusions: We provide evidence that disease progression in patients with metastatic breast cancer in a real-world registry has a significant negative impact on HRQoL as measured by MID of HRQoL. This study emphasizes the relevance of avoiding progression and prolonging PFS to maintain QoL. Citation Format: Wallwiener M, Nabieva N, Haeberle L, Taran FA, Hartkopf AD, Volz B, Overkamp F, Brandl AL, Kolberg H-C, Hadji P, Tesch H, Ettl J, Lux MP, Lueftner D, Belleville E, Fasching PA, Janni W, Beckmann MW, Wimberger P, Hielscher C, Fehm T, Brucker SY, Wallwiener D, Schneeweiss A, Mueller V. Impact of disease progression on health-related quality of life in patients with metastatic breast cancer in the PRAEGNANT breast cancer registry [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-11-10.
MSc in occupational health (policy and practice)
Authors: Carly Atkinson
Journal: BMJ (2011)

The MSc in occupational health (policy and practice) is a distance e-learning course delivered through Cardiff University. The university offers a modular course for the postgraduate diploma, with the option of completing a dissertation to gain the MSc. The course was founded by the late Denis D’Auria, who was passionate about medical education, and is now run by Huw Rees and Massoud Mansouri, both consultant occupational physicians. It focuses on common occupational health and safety issues that are important in the workplace, including fitness for work, rehabilitation, occupational hazards, and legislation such as the Equality Act.

The course intake is multiprofessional. It is relevant to doctors training in occupational medicine and covers most of the competencies set out by the Faculty of Occupational Medicine of …
Abstract P4-03-16: Cyclin E affects Smad3 pathway in trastuzumab resistant HER2+ breast cancer
Authors: JT Decker, L Wan, LD Shea, JS Jeruss
Journal: Cancer Research (2018)

Abstract Introduction and Objective: HER2 amplification is found in approximately 20% of patients with breast cancer and is associated with poor prognosis. Trastuzumab, a humanized anit-HER2 antibody, has been shown to improve patient outcomes, but clinical efficacy for this treatment is limited by the high rate of drug resistance. Cyclin E overexpression and cyclin-dependent kinase 2 (CDK2) activation correlate with trastuzumab resistance, and the underlying mechanisms of this correlation are an area of active study. In this work, we examined the contribution of cyclin E/CDK2-mediated Smad3 noncanonical phosphorylation to trastuzumab resistance in HER2+ breast cancer. Methods: Trastuzumab resistant BT474R2 cells were developed by culturing BT474 cells in trastuzumab-supplemented media for 18 months. These cells were then inoculated into immunodeficient mice and treated with trastuzumab twice weekly. BT474 and BT474R2 cells were used to study cell proliferation, phosphorylation in the Smad3 linker region and transcription factor activities with a living cell array. Results: Inhibition of cyclin E activity with CDK2 inhibitor therapy (CDK2i, 600 nM) significantly decreased BT474R2 cell proliferation. CDK2i treatment led to decreased phosphorylation at T179 (p&amp;lt;0.01), S204 (p&amp;lt;0.01) and S213 (p&amp;lt;0.05) in the Smad linker region. Further, CDK2i increased expression of p15 (p&amp;lt;0.05) and decreased expression of c-myc (p&amp;lt;0.05) in comparison with trastuzumab treatment. Transduction of BT474R2 cells with a 5M Smad3 construct containing inhibitory mutations in 5 CDK2 phosphorylation sites resulted in decreased cell proliferation. In a transfected cell array using BT474 and BT474R2 cells, activities of cell proliferation and metastasis-associated transcription factors were significantly different between the trastuzumab sensitive and resistant cells. Conclusions: Taken together, overexpression of cyclin E leads to Smad3 noncanonical phosphorylation and results in trastuzumab resistance in HER2+ breast cancer. CDK2i treatment may be a promising therapeutic strategy for patients with trastuzumab resistance. Citation Format: Decker JT, Wan L, Shea LD, Jeruss JS. Cyclin E affects Smad3 pathway in trastuzumab resistant HER2+ breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-03-16.
Toward a National Surgical Strategy for Type 2 Diabetes Resolution
Authors: Michel Gagner
Journal: JAMA Surgery (2018)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Surgery HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Surgery journal
Gabapentin Approvals, Off-Label Use, and Lessons for Postmarketing Evaluation Efforts
Authors: Joshua D. Wallach, Joseph S. Ross
Journal: JAMA (2018)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
I want to join a vocational training scheme and I need to find a job for three to four months first. Which specialty would prove useful?
Authors: Judith Harvey
Journal: BMJ (2006)

Have a career or related problem that needs answering? Can9t find the right person to point you in the right direction? Log on to the Advice Zone for reliable medical careers advice. You can post a question or see if one of our 300 advisers has already answered a similar question. Here is a selection of questions and answers posted on the site. <b>www.bmjcareers.com/advicezone</b>
Hepatocellular Carcinoma With Portal Venous Invasion
Authors: Khashayar Farsad, Charlotte E. Costentin, Andrew X. Zhu
Journal: JAMA Oncology (2018)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Oncology HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Oncology journal
Phase Ib trial of ALT-803, an IL-15 superagonist, plus BCG for the treatment of BCG-naïve patients with non-muscle-invasive bladder cancer.
Authors: Charles Joel Rosser, Jeffrey Nix, Lydia Ferguson, Liza Hernandez, Hing C. Wong
Journal: Journal of Clinical Oncology (2018)

510 Background: The current standard of care for patients with high risk NMIBC is a TURBT or biopsy followed by a 6-week induction course of intravesical BCG and supplementary maintenance therapies every 3 months thereafter (Lamm 2000). While clinical response is significantly improved with BCG, 50% of patients are still expected to recur within 12 months ( Sfakianos 2014). The pursuit of novel agents to prevent progression and recurrence of NMIBC remains critical. This phase Ib clinical trial evaluates the safety and tolerability of ALT-803, an IL-15 superagonist, plus BCG in BCG-naïve NMIBC patients. Methods: A dose escalation 3+3 design was employed to evaluate intravesical ALT-803 plus 50 mg BCG in BCG-naïve patients with intermediate or high-risk Ta, T1 or Tis stage NMIBC. Patients received intravesical ALT-803 in conjunction with BCG weekly for 6 consecutive weeks (induction) and then encouraged (but not required) to receive maintenance BCG alone as per standard practices. Patients had a routine cystoscopy and voided urinary cytology (VUC) every 3 months for 2 years to determine response. Negative cystoscopy, VUC and/or biopsy yielded a complete response (CR). No cohort (100, 200 or 400 μg/instillation ALT-803) experienced any dose limiting toxicities. Results: All patients are disease-free (CR) at 24 months; no patients experienced disease recurrence or progression. Adverse events consistent with SoC BCG treatment (hematuria and urinary tract pain) were reported in all cohorts. One patient experienced a grade 3 adverse event of hypertension that resolved the same day. No grade 4 toxicities or DLTs were observed. Clinical trial information: NCT02138734. Conclusions: Intravesical ALT-803 plus BCG treatment is well tolerated in BCG-naïve patients with NMIBC. All patients are disease-free 24 months after treatment with BCG and ALT-803. A randomized phase II trial is currently underway.[Table: see text]
<i>IFNγ</i> mRNA signature (<i>IFNγ</i> sig), circulating tumor DNA (ctDNA), and survival in NSCLC or urothelial cancer (UC) treated with durvalumab (D).
Authors: Brandon W. Higgs, Chris Morehouse, Michael Kuziora, Philip Z. Brohawn, Sriram Sridhar, Rajiv Raja, Natasha Angra, Shaad Essa Abdullah, Koustubh Ranade
Journal: Journal of Clinical Oncology (2018)

51 Background: Associations between early reduction in plasma ctDNA, pretreatment tumoral IFNγ sig, liver metastases and outcomes, and between tumor mutational burden (TMB) and CD274 (PD-L1) mRNA or IFNγ sig in TCGA were evaluated in NSCLC and UC pts treated with D. Methods: Pts received 10 mg/kg Q2W of D in a Phase 1/2 study in advanced solid tumors. RNAseq measured a 4-gene IFNγ sig; top tertile was IFNγ sig+. Pts with PD-L1 expression (Ventana SP263) ≥ 25% tumor cells in NSCLC or ≥ 25% tumor or immune cells in UC were PD-L1+. 70 genes were assayed for DNA variants (Guardant360) in plasma ctDNA pre/posttreatment. TCGA was used to calculate TMB; ≥ median TMB was high. Results: IFNγ sig+ NSCLC or UC pts had higher response and longer median PFS and OS compared with PD-L1+, PD-L1- and IFNγ sig- pts (Table). Responders showed significant decreases in ctDNA mean variant allele frequency (VAF) posttreatment with D; pts with progressive disease showed increased VAF. Pts with decreased VAF at week 6 had longer median PFS and OS compared with those with VAF increases. VAF changes were not associated with IFNγ sig. NSCLC without liver metastases had higher IFNγ sig (P &lt; 0.001) than pts with liver metastases. In TCGA NSCLC and UC, IFNγ sig+ correlated with high TMB; CD274 mRNA did not. Conclusions: IFNγ sig correlated with outcomes and with TMB in NSCLC and UC. CtDNA VAFs were reduced in NSCLC or UC responders after treatment and correlated with longer survival, suggesting utility as an early indicator of clinical benefit. Clinical trial information: NCT01693562. [Table: see text]
RELATIONSHIP BETWEEN MODEL FOR END-STAGE LIVER DISEASE EXCLUDING INR(MELD-XI) SCORE AND LIVER FIBROGENESIS MARKER IN ACUTE HEART FAILURE
Authors: Kenji Aida, Kazuya Nagao, Kenji Kajitani, Takayasu Kobayashi, Akinori Tamura, Kiyotaka Simamura, Hiroshi Yukawa, Yohei Kobayashi, Naoki Takahashi, Eiichiro Nakagawa, Haruyasu Ito, Fujio Hayashi, Toshinori Makita, Tsukasa Inada, Masaru Tanaka
Journal: Journal of the American College of Cardiology (2018)
Roles for neuropsychology in the neuro-oncology MDT
Authors: Stuart Anderson
Journal: Neuro-Oncology (2018)

Cognitive impairment is detectable in the majority of patients presenting with primary brain tumour and is a major cause of disability, often being cited as the single greatest cause of burden to affected individuals and their carers (Locke et al. 2008). In addition, psychological reactions to diagnosis and treatment can include acute distress, anxiety and depression. Collectively, these symptoms may complicate treatment and influence quality of life (QOL). This presentation provides a rationale for the inclusion of neuropsychologists in neuro-oncology multidisciplinary teams. It summarises relevant outcomes of brain tumours and associated treatments and highlights evidence-based neuropsychological practice. This includes not only psychometric assessment but also cognitive rehabilitation and psychologically-based interventions (e.g. Cognitive Behaviour Therapy). Learning outcomes include exposure to a specific assessment approach using the Neuropsychological Assessment Battery (NAB), components of cognitive rehabilitation, and the psychological impact of brain tumours. Locke et al (2008). Cognitive rehabilitation and problem-solving to improve quality of life of patients with primary brain tumours: A pilot study. J Support Oncol, 6, 383–391.
A Shift in Thinking to Reduce Mother-to-Infant Transmission of Hepatitis B
Authors: Geoffrey Dusheiko
Journal: New England Journal of Medicine (2018)

The morbidity and mortality that are associated with hepatitis B virus (HBV) infection have been overshadowed by the public health prominence of other infectious diseases, including human immunodeficiency virus (HIV) infection, tuberculosis, and malaria. There is a dawning realization that the disease burden from HBV infection is increasing, despite the existence of an effective vaccine.1 The World Health Organization (WHO) estimates that chronic HBV infection results in a quarter million deaths each year in the countries that are eligible for Global Vaccine Alliance (GAVI) support or cofinancing.2 A positive status for hepatitis B e antigen (HBeAg) and a maternal HBV . . .
LEFT ATRIAL DYNAMICS DURING EXERCISE IN HEART FAILURE WITH REDUCED, MID-RANGE, AND PRESERVED EJECTION FRACTION: INSIGHTS FROM EXERCISE ECHOCARDIOGRAPHY COMBINED WITH GAS EXCHANGE ANALYSIS
Authors: Tadafumi Sugimoto, Francesco Bandera, Greta Generati, Eleonora Alfonzetti, Marco Guazzi
Journal: Journal of the American College of Cardiology (2018)
CARDIAC STRESS TESTING GUIDES SUBSEQUENT PATIENT MANAGEMENT: RATES OF CORONARY ANGIOGRAPHY BASED ON MYOCARDIAL PERFUSION IMAGING RESULTS
Authors: David B. Min, Steve Mason, Stacey Knight, JD Ethington, Viet T. Le, Kent Meredith, Ritesh Dhar, Jeffrey Anderson, J. Muhlestein, Donald Lappe, Kirk Knowlton
Journal: Journal of the American College of Cardiology (2018)
General practice is “under severe threat of extinction,” RCGP chair warns
Authors: Abi Rimmer
Journal: BMJ (2014)

The chairwoman of the Royal College of General Practitioners has warned that general practice was under severe threat of extinction and has called for the “imbalance” in NHS funding between primary and secondary care to be redressed.

“General practice as we know it is now under severe threat of extinction,” Maureen Baker said. “It is imploding faster than people realise, and patients are already bearing the brunt of the problem. This will only get worse unless urgent action is taken to redress the huge …
The lncRNA MACC1-AS1 promotes gastric cancer cell metabolic plasticity via AMPK/Lin28 mediated mRNA stability of MACC1
Authors: Yang Zhao, Yajing Liu, Li Lin, Qiong Huang, Wanming He, Shuyi Zhang, Shumin Dong, Zhaowei Wen, Jinjun Rao, Wangjun Liao, Min Shi
Journal: Molecular Cancer (2018)

Metabolic plasticity has been increasingly thought to be a determinant of tumor growth and metastasis. MACC1, a transcriptional regulator of MET, was recognized as an oncogene in gastric cancer (GC); however, its transcriptional or post-translational regulation was not clear. We previously reported the metabolic role of MACC1 in glycolysis to promote GC progression. MACC1-AS1 is the antisense lncRNA of MACC1, yet its function was previously unknown. We profiled and analyzed the expression of MACC1-AS1 utilizing the TCGA database as well as in situ hybridization using 123 pairs of GC tissues and matched adjacent normal gastric mucosa tissues (ANTs). The biological role of MACC1-AS1 in cell growth and metastasis was determined by performing in vitro and in vivo functional experiments. Glycolysis and antioxidant capabilities were assayed to examine its metabolic function. Further, the specific regulatory effect of MACC1-AS1 on MACC1 was explored transcriptionally and post-transcriptionally. MACC1-AS1 was shown to be expressed significantly higher in GC tissues than in ANTs, which predicted poor prognosis in GC patients. MACC1-AS1 promoted GC cell proliferation and inhibited cell apoptosis under metabolic stress. Mechanistically, MACC1-AS1 stabilized MACC1 mRNA and post-transcriptionally augmented MACC1 expression. Further, MACC1-AS1 was shown to mediate metabolic plasticity through MACC1 upregulation and subsequent enhanced glycolysis and anti-oxidative capabilities, and this was suggested to be coordinated by the AMPK/Lin28 pathway. Elevated expression of MACC1-AS1 in gastric cancer tissues is linked to poor prognosis and promotes malignant phenotype upon cancer cells. MACC1-AS1 is elevated under metabolic stress and facilitates metabolic plasticity by promoting MACC1 expression through mRNA stabilization. Our study implicates lncRNA MACC1-AS1 as a valuable biomarker for GC diagnosis and prognosis.
LEFT VENTRICULAR CHAMBER DILATION PREDICTS THERAPEUTIC RESPONSE TO MITRACLIP: IMPACT OF ADVERSE LV REMODELING ON MITRAL REGURGITATION RECURRENCE FOLLOWING PERCUTANEOUS REPAIR
Authors: Jiwon Kim, Javid Alakbarli, Meridith P. Pollie, Richard B. Devereux, Joseph Krepp, S. Chiu Wong, Geoffrey Bergman, Omar K. Khalique, Robert Levine, Mark Ratcliffe, Jonathan W. Weinsaft
Journal: Journal of the American College of Cardiology (2018)
<i>Irg1</i> expression in myeloid cells prevents immunopathology during <i>M. tuberculosis</i> infection
Authors: Sharmila Nair, Jeremy P. Huynh, Vicky Lampropoulou, Ekaterina Loginicheva, Ekaterina Esaulova, Anshu P. Gounder, Adrianus C.M. Boon, Elizabeth A. Schwarzkopf, Tara R. Bradstreet, Brian T. Edelson, Maxim N. Artyomov, Christina L. Stallings, Michael S. Diamond
Journal: The Journal of Experimental Medicine (2018)

Immune-Responsive Gene 1 (Irg1) is a mitochondrial enzyme that produces itaconate under inflammatory conditions, principally in cells of myeloid lineage. Cell culture studies suggest that itaconate regulates inflammation through its inhibitory effects on cytokine and reactive oxygen species production. To evaluate the functions of Irg1 in vivo, we challenged wild-type (WT) and Irg1-/- mice with Mycobacterium tuberculosis (Mtb) and monitored disease progression. Irg1-/-, but not WT, mice succumbed rapidly to Mtb, and mortality was associated with increased infection, inflammation, and pathology. Infection of LysM-Cre Irg1fl/fl, Mrp8-Cre Irg1fl/fl, and CD11c-Cre Irg1fl/fl conditional knockout mice along with neutrophil depletion experiments revealed a role for Irg1 in LysM+ myeloid cells in preventing neutrophil-mediated immunopathology and disease. RNA sequencing analyses suggest that Irg1 and its production of itaconate temper Mtb-induced inflammatory responses in myeloid cells at the transcriptional level. Thus, an Irg1 regulatory axis modulates inflammation to curtail Mtb-induced lung disease.
National offers system for specialty recruitment is postponed
Authors: Helen Jaques
Journal: BMJ (2012)

The launch of a national system to coordinate specialty training job offers and acceptances across the United Kingdom has been pushed back to 2013.

Development of the UK Offers system (UKOFFS), which has been underway since 2010, has progressed but not enough to enable its full implementation, Medical Education England (MEE) has stated. 

Instead pilots will run in 2012 in anaesthesia (West Midlands deanery), public health (East Midlands deanery), and neurosurgery (Yorkshire and the Humber deanery) to fully test the offers system with live data. 

The UKOFFS, …
Consultants reject calls to end contract negotiations
Authors: Abi Rimmer
Journal: BMJ (2016)

Consultants have voted against stopping contract negotiations despite unhappiness with the government’s proposals.

Delegates at the BMA’s annual UK consultants’ conference in London on 3 March voted against a motion to “immediately terminate” the contract negotiation process. Earlier in the meeting consultants heard that the government had asked for further discussions on the contract with a deadline of the end of March, and that it had yet to announce its final contract offer.

Proposing the motion, Kevin O'Kane, …