...the understanding of the neuropharmacology of the administrated drugs and the skills of the anaesthesiologists need to be synchronized to facilitate a predictable and fast-track emergence from ...anaesthesia. ...you need to plan the emergence in neurosurgical patients so as to fast-track awakening but at the same time maintain the quality of emergence. ...reversal of residual neuromuscular blockade prior to return of consciousness may add on to the ongoing cerebral instability.
Recent research on economic returns to higher education in the United States suggests that those with the highest wage returns to a college degree are least likely to obtain one. We extend the study ...of heterogeneous returns to tertiary education across multiple institutional contexts, investigating how the relationship between wage returns and the propensity to complete a degree varies by the level of expansion, differentiation, and cost of higher education. Drawing on panel data and matching techniques, we compare findings from the US with selection into degree completion in Germany and the UK. Contrary to previous studies, we find little evidence for population level heterogeneity in economic returns to higher education.
Despite a wealth of preclinical studies, it is unclear whether PIK3CA or phosphatase and tensin homolog (PTEN) gene aberrations are actionable in the clinical setting. Of 1,656 patients with ...advanced, refractory cancers tested for PIK3CA or PTEN abnormalities, PIK3CA mutations were found in 9% (146/1,589), and PTEN loss and/or mutation was found in 13% (149/1,157). In multicovariable analysis, treatment with a phosphatidylinositol 3-kinase (PI3K)/AKT/mammalian target of rapamycin (mTOR) inhibitor was the only independent factor predicting response to therapy in individuals harboring a PIK3CA or PTEN aberration. The rate of stable disease ≥6 months/partial response reached 45% in a subgroup of individuals with H1047R PIK3CA mutations. Aberrations in the PI3K/AKT/mTOR pathway are common and potentially actionable in patients with diverse advanced cancers. This work provides further important clinical validation for continued and accelerated use of biomarker-driven trials incorporating rational drug combinations.
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•PIK3CA mutations and/or PTEN aberrations are frequent in diverse advanced cancers•Testing for PIK3CA and PTEN aberrations can predict benefit of PI3K/mTOR inhibitors•Results further support accelerated use of biomarker-driven trials in cancer
Despite a wealth of preclinical studies, it is unclear whether PIK3CA or PTEN gene aberrations are actionable in the clinical setting. Janku and colleagues show that, even in patients with advanced refractory tumors, treatment with PI3K/AKT/mTOR axis inhibitors can produce significant responses and that these responses are observed across multiple histologies. Furthermore, patients whose tumors harbor an H1047R PIK3CA mutation may do especially well when cognate inhibitors are given. This work has important implications for clinical management.
PurposeHumanitarian supply chains (HSCs) by their very nature require urgent reaction to unforeseeable needs, making it difficult to properly plan for the support of actual demands. As such, ...integrating sustainability into traditional HSC practices continues to present a challenge to governments, nongovernmental organizations (NGOs) and other humanitarian-related agencies. This study focuses on identifying and categorizing the leading enablers to green humanitarian supply chains (GHSCs) and proposes a model for improving the responsiveness based upon a fuzzy total interpretive structural modelling approach.Design/methodology/approachTotal interpretive structural modelling (TISM) uses group decision-making to identify contextual relationships among each pair of enablers and elucidates the nature of each underlying relationship. The fuzzy TISM shows the level of strength (very high influence, high influence, low influence and very low influence) of each enabler in relation to other enablers, which can help to inform management decision-making.FindingsGHSC management requires strategic planning of inventory and logistics management. The importance of collaborative relationship building with HSC partners for developing capability and the effective use of available resources are keys to success. These improved relationships also help to promote postponement and similar speculation-based logistics strategies, as well as advanced purchasing and pre-positioning strategies. Finally, the speed and quality of response is found to be the top enabler in GHSC management.Research limitations/implicationsOne noted shortcoming of the chosen research method is its reliance on subjective expert judgement. However, collecting judgements is at the basis of many research methods, and the research team took utmost care throughout the research process to allay biases. Future empirical research can further examine the relationships suggested herein. Managers can use the model developed in this research to consider impactful ways to design and execute sustainable HSCs.Originality/valueTo the best of the authors' knowledge, this is a novel attempt to identify enablers to GHSC management. Secondly, the research team has used an advanced methodology (fuzzy TISM) to develop the contextual inter-relationships among the enablers which has not been used earlier in this direction before and thus advances the GHSC literature.
•A unique decision-modeling framework is developed for the ready-made garment industry in Bangladesh.•The framework integrates Delphi method and the fuzzy analytic hierarchy process.•Key supply chain ...disruption factors and drivers are identified.•Supply chain disruption factors and drivers are analyzed thoroughly.•A sensitivity analysis is also conducted to confirm the validity of the framework.
The purpose of this paper is to develop a framework to identify, analyze, and to assess supply chain disruption factors and drivers. Based on an empirical analysis, four disruption factor categories including natural, human-made, system accidents, and financials with a total of sixteen disruption drivers are identified and examined in a real-world industrial setting. This research utilizes an integrated approach comprising both the Delphi method and the fuzzy analytic hierarchy process (FAHP). To test this integrated method, one of the well-known examples in industrial contexts of developing countries, the ready-made garment industry in Bangladesh is considered. To evaluate this industrial example, a sensitivity analysis is conducted to ensure the robustness and viability of the framework in practical settings. This study not only expands the literature scope of supply chain disruption risk assessment but through its application in any context or industry will reduce the impact of such disruptions and enhance the overall supply chain resilience. Consequently, these enhanced capabilities arm managers the ability to formulate relevant mitigation strategies that are robust and computationally efficient. These strategies will allow managers to take calculated decisions proactively. Finally, the results reveal that political and regulatory instability, cyclones, labor strikes, flooding, heavy rain, and factory fires are the top six disruption drivers causing disruptions to the ready-made garment industry in Bangladesh.
A limited subset of HIV-1 infected adult individuals typically after at least 2-3 years of chronic infection, develop broadly neutralizing antibodies (bnAbs), suggesting that highly conserved ...neutralizing epitopes on the HIV-1 envelope glycoprotein are difficult for B cell receptors to effectively target, during natural infection. Recent studies have shown the evolution of bnAbs in HIV-1 infected infants.
We used bulk BCR sequencing (BCR-seq) to profile the B cell receptors from longitudinal samples (3 time points) collected from a rare pair of antiretroviralnaïve, HIV-1 infected pediatric monozygotic twins (AIIMS_329 and AIIMS_330) who displayed elite plasma neutralizing activity against HIV-1.
BCR-seq of both twins revealed convergent antibody characteristics including V-gene use, CDRH3 lengths and somatic hypermutation (SHM). Further, antibody clonotypes with genetic features similar to highly potent bnAbs isolated from adults showed ongoing development in donor AIIMS_330 but not in AIIMS_329, corroborating our earlier findings based on plasma bnAbs responses. An increase in SHM was observed in sequences of the IgA isotype from AIIMS_330.
This study suggests that children living with chronic HIV-1 can develop clonotypes of HIV-1 bnAbs against multiple envelope epitopes similar to those isolated from adults, highlighting that such B cells could be steered to elicit bnAbs responses through vaccines aimed to induce bnAbs against HIV-1 in a broad range of people including children.
Geographies of the pollinator commons Allington, Ginger RH; Luthra, Aman
Progress in environmental geography,
03/2024, Letnik:
3, Številka:
1
Journal Article
Recenzirano
The problem of insect pollinator declines and pollination scarcity is impacting food production and ecosystem integrity worldwide. The term “pollinator commons” has often been invoked in existing ...literature, but there is little actual evidence of collective action to manage pollinators, pollination services or foraging resources. This may be due to the availability of a technical fix to the problem of pollination scarcity in some places, or the purported lack of awareness and undervaluation of pollination services. Given the increasing extent of the problem, there may be some conditions under which collective governance of the pollinator commons could emerge. We predict that collective action to manage a pollinator commons is more likely to emerge among farmers: (a) whose farms are small, and livelihoods are dependent on high-value crops for which wild pollination services cannot be easily substituted; (b) whose neighbors are similarly dependent on pollinator-dependent crops; and (c) who are able to make reasonable cost-benefit determinations based on information about other farmers and pollinator status. Geographers are particularly well-positioned with the theoretical and methodological tools to engage with this important, yet under-explored system to understand the potential for collective action to manage pollinators as a common pool resource.
For population databases, multivariable regressions are established analytical standards. The utilization of machine learning (ML) in population databases is novel. We compared conventional ...statistical methods and ML for predicting mortality in biliary acute pancreatitis (biliary AP).
Using the Nationwide Readmission Database (2010-2014), we identified patients (age ≥18 years) with admissions for biliary AP. These data were randomly divided into a training (70%) and test set (30%), stratified by the outcome of mortality. The accuracy of ML and logistic regression models in predicting mortality was compared using 3 different assessments.
Among 97,027 hospitalizations for biliary AP, mortality rate was 0.97% (n = 944). Predictors of mortality included severe AP, sepsis, increasing age, and nonperformance of cholecystectomy. Assessment metrics for predicting the outcome of mortality, the scaled Brier score (odds ratio OR, 0.24; 95% confidence interval CI, 0.16-0.33 vs 0.18; 95% CI, 0.09-0.27), F-measure (OR, 43.4; 95% CI, 38.3-48.6 vs 40.6; 95% CI, 35.7-45.5), and the area under the receiver operating characteristic (OR, 0.96; 95% CI, 0.94-0.97 vs 0.95; 95% CI, 0.94-0.96) were comparable between the ML and logistic regression models, respectively.
For population databases, traditional multivariable analysis is noninferior to ML-based algorithms in predictive modeling of hospital outcomes for biliary AP.
Herpes simplex virus uveitis without corneal reactivation is more frequent than previously thought. Although herpes simplex virus has been implicated as a cause of postoperative uveitis and ...endophthalmitis, it has not been reported as a cause of acute postoperative endophthalmitis within the early postoperative period, specifically within one week following cataract extraction. A 55-year-old man with vascularized irregular central disc-shaped stromal corneal opacity with complicated cataracts underwent cataract surgery. Intraoperatively, there was posterior capsular rent, requiring anterior vitrectomy. On postoperative day three, the patient had an increase in inflammation in the anterior chamber (grade 4+) with marked vitreous haze (grade 4). Vitreous taps were negative for bacteria and fungi, and despite intravitreal injections of vancomycin and ceftazidime, the patient had worsening of inflammation with increasing exudates and the appearance of the fibrinous membrane in the anterior chamber. Polymerase chain reaction (PCR) of aqueous and vitreous samples at this point of time yielded positive serology for herpes viral DNA, and the patient was started on oral valacyclovir. The ocular inflammation resolved soon after switching to oral valacyclovir. Typical acute postoperative endophthalmitis starts two to seven days after surgery, and the most common isolate in vitreous biopsies is coagulase-negative staphylococci. We report a rare case of acute-onset herpetic endophthalmitis presenting within 72 hours following cataract surgery for a complicated cataract in a patient with a history of pre-existing healed viral keratitis. Our case highlights that a suspicion of viral endophthalmitis should be kept in mind as a cause of acute-onset post-cataract surgery endophthalmitis, especially in cases of surgery that fail to yield a positive result on Gram's stain, culture or PCR for bacteria and fungi.
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