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Indications for and Adverse Effects of Red-Cell Transfusion
Advances in clinical research have led to reduced use of blood products. Judicious use has reduced the incidence of lung injury and circulatory overload. Testing of blood products for infectious agents has reduced their transmission.
Journal Article
Perspectives on rural tourism geographies : case studies from developed nations on the exotic, the fringe and the boring bits in between
This book examines rural tourism across three different contexts, acknowledging the complexity of rural places. It applies a systematic comparative framework across nine case studies from Australia, Canada and Sweden. The case studies address the uniqueness of different rural spaces, while the framework incorporates many theoretical aspects from human geography including spatial, historic, institutional, demographic, socio-economic and network perspectives. In the course of applying this comparative case study framework, the book identifies numerous implications for planning and policy in rural settings. These contributions from international, expert authors help to identify the opportunities and challenges that affect rural regions, from places at the urban fringe to exotic remote spaces and taking in the `boring bits in between.' Both the analysis and the framework used will be of value to scholars and students of rurality, tourism, regional development, rural policy, geography, and destination management. Readers will gain a deeper understanding of the rural context in developed countries and a robust conceptualization of rural tourism geographies.
Book
Mechanisms and microbial influences on CTLA-4 and PD-1-based immunotherapy in the treatment of cancer: a narrative review
Background
The relationship between gastrointestinal (GI) bacteria and the response to anti-CTLA-4 and anti-PD-1 immunotherapy in the treatment of cancer can potentially be enhanced to allow patients to maximally respond to these treatments. Insight into the complex interaction between gut microbiota and the human adaptive immune system will help guide future immunotherapeutic cancer treatments to allow a more robust clinical response and fewer adverse effects in patients requiring these drugs. This review highlights these interactions as well as the potential for the creation of “oncomicrobiotics” that would selectively tailor one’s GI bacteria to maximally respond to anti-CTLA-4 and anti-PD-1 treatments will fewer adverse effects.
Main body
CTLA-4 is an antigen on the surface of T cells which, upon stimulation, leads to inhibition of activated T cells to terminate the immune response. However, many types of tumor cells can upregulate CTLA-4 in the tumor microenvironment, allowing these cells to evade targeting and destruction by the body’s immune system by prematurely inhibiting T cells. Increased representation of
Bacteroides fragilis
,
Burkholderia cepacia
and the
Faecalibacterium genus
in the GI tract of patients receiving CTLA-4-based immunotherapy led to a stronger therapeutic effect while minimizing adverse side effects such as colitis. In addition, by introducing bacteria involved in vitamin B and polyamine transport to the GI tracts of patients treated with anti-CTLA-4 drugs led to increased resistance to colitis while maintaining therapeutic efficacy. PD-1 is another molecule upregulated in many tumor microenvironments which acts in a similar manner to CTLA-4 to tone down the anti-neoplastic actions of T cells. Antibodies to PD-1 have shown promise to help allow the body’s natural immune response to appropriately target and destroy tumor cells. The presence of
Bifidobacterium breve
and
longum
,
Akkermansia muciniphila
and
Faecalibacterium prausnitzii
in the GI tracts of cancer patients has the potential to create a more robust immune response to anti-PD-1 drugs and prolonged survival. The development of “oncomicrobiotics” has the potential to help tailor one’s gut microbiota to allow patients to maximally respond to immunotherapy without sacrificing increases in toxicity. These oncomicrobiotics may possibly include antibiotics, probiotics, postbiotics and/or prebiotics. However, many challenges lie ahead in the creation of oncomicrobiotics.
Conclusion
The creation of oncomicrobiotics may allow many patients receiving anti-CTLA-4 and PD-1 immunotherapy to experience prolonged survival and a better quality of life.
Journal Article
Carson McCullers : stories, plays & other writings
Celebrated worldwide for her masterly novels, Carson McCullers was equally accomplished, and equally moving, when writing in shorter forms. This Library of America volume brings together for the first time her twenty extraordinary stories, along with plays, essays, memoirs, and poems. Here are the indelible tales \"Madame Zilensky and the King of Finland\" and \"A Tree. A Rock. A Cloud.\" as well as her previously uncollected story about the civil rights movement, \"The March\"; her award- winning Broadway play The Member of the Wedding and the unpublished teleplay The Sojourner; twenty-two essays; and the revealing unfinished memoir Illumination and Night Glare. This wide-ranging gathering of shorter works reveals new depths and dimensions of the writer whom V.S. Pritchett praised for her \"courageous imagination -- one that is bold enough to consider the terrible in human nature without loss of nerve, calm, dignity, or love.\" From the Hardcover edition.
BOOK
Liberal or Restrictive Transfusion in High-Risk Patients after Hip Surgery
This trial compared a restrictive hemoglobin threshold with a liberal threshold for blood transfusion among hip-surgery patients with risk factors for CVD. The liberal strategy resulted in more transfusions and did not reduce death or inability to walk independently.
In the United States, more than 17 million red-cell units are collected annually, and 15 million units are transfused.
1
Blood transfusions are frequently given to surgical patients and to the elderly.
2
,
3
Yet, the indications for postoperative transfusion have not been adequately evaluated and remain controversial. Most clinical trials have been small.
4
One adequately powered trial involving adults in intensive care units showed a nonsignificant decrease in 30-day mortality with a restrictive transfusion strategy, as compared with a liberal strategy (18.7% vs. 23.3%).
5
However, the effect of a restrictive approach on functional recovery or risk of myocardial infarction in patients . . .
Journal Article
Approaching closed spherical, full-view detection for photoacoustic tomography
Significance: Photoacoustic tomography (PAT) is a widely explored imaging modality and has excellent potential for clinical applications. On the acoustic detection side, limited-view angle and limited-bandwidth are common key issues in PAT systems that result in unwanted artifacts. While analytical and simulation studies of limited-view artifacts are fairly extensive, experimental setups capable of comparing limited-view to an ideal full-view case are lacking.
Aims: A custom ring-shaped detector array was assembled and mounted to a 6-axis robot, then rotated and translated to achieve up to 3.8π steradian view angle coverage of an imaged object.
Approach: Minimization of negativity artifacts and phantom imaging were used to optimize the system, followed by demonstrative imaging of a star contrast phantom, a synthetic breast tumor specimen phantom, and a vascular phantom.
Results: Optimization of the angular/rotation scans found ≈212 effective detectors were needed for high-quality images, while 15-mm steps were used to increase the field of view as required depending on the size of the imaged object. Example phantoms were clearly imaged with all discerning features visible and minimal artifacts.
Conclusions: A near full-view closed spherical system has been developed, paving the way for future work demonstrating experimentally the significant advantages of using a full-view PAT setup.
Journal Article
Poemhood, our black revival : history, folklore & the Black experience: a young adult poetry anthology
Featuring contributions from an award-winning, bestselling group of Black voices, past and present, this powerful poetry anthology elicits vital conversations about race, belonging, history and faith to highlight Black joy and pain.
Book
Elucidating the role of the gastrointestinal microbiota in racial and ethnic health disparities
Genetics and the microbiota Although it is well known that race and ethnicity are poor proxies for genetic ancestry, these factors may be somewhat correlated. [...]host genetics may marginally contribute to racial/ethnic differences in gastrointestinal microbial composition and functionality. Periodontal disease may be attributable to complex and difficult-to-measure differences in socioeconomic and other social factors occurring over the life course that contribute to a lack of health care access and utilization. [...]oral health metrics and their associated oral microbiota may be proxies for these complex exposures. [...]the annual National Health and Nutrition Examination Survey (NHANES) ascertains the health and nutritional status of children and adults via questionnaires and biospecimen collection in a nationally representative sample of approximately 5000 individuals [13]. Because of their oversampling of targeted groups of individuals, NHANES has become an invaluable resource for reliably estimating various US exposures, including those pertaining to social determinants of health. [...]study populations like those represented in NHANES are particularly suitable for future collection of oral and fecal samples to characterize the gastrointestinal microbiota of a representative portion of the US population.
Journal Article