A simple checklist, that is all it takes: a cluster randomized controlled field trial on improving the treatment of suspected terrorists by the police

Funder: University of CambridgeAbstract: Objectives: When it comes to interviewing suspected terrorists, global evidence points to harsh interrogation procedures, despite the likelihood of false positives. How can the state maintain an effective counterterrorism policy while simultaneously protecting civil rights? Until now, the shroud of secrecy of “national security” practices has thwarted attempts by researchers to test apparatuses that engender fair interrogation procedures. The present study aims to test one approach: the use of a “procedural justice checklist” (PJ Checklist) in interviews of suspected terrorists by counterterrorism police officers in port settings. Methods: Using a clustered randomized controlled field test in a European democracy, we measure the effect of implementing Procedural Justice (PJ) Checklists in counterterrorism police settings. With 65 teams of officers randomly-assigned into treatment and control conditions, we compare post-interrogation surveys of suspects (n = 1418) on perceptions of legitimacy; obligations to obey the law; willingness to cooperate with the police; effectiveness of counterterrorism measures; distributive justice; feelings of social resistance to the state; and PJ. A series of multi-level linear, logistic, and ordered logit regression models are used to estimate the treatment effect, with Hedges’ g and odds ratios used for effect sizes. Results: When compared with control conditions, implementing a policy of PJ Checklist causes statistically significant and large enhancement in all measured dimensions, including the willingness of suspects to obey the law (g = 1.022 [0.905, 1.138]), to cooperate with the police (g = 1.118 [0.999, 1.238]), distributive justice (g = 0.993 [0.880, 1.106]), effectiveness (g = 1.077 [0.959, 1.195]), procedural justice (g = 1.044 [0.930, 1.158]), and feelings of resistance towards the state (g = − 0.370 [− 0.259, − 0.482]). Conclusions: PJ checklists offer a simple, scalable means of improving how state agents interact with terrorism suspects. The police can use what is evidently a cost-effective tool to enhance legitimacy and cooperation with the police, even in a counterterrorism environment

Hydra: A mixture modeling framework for subtyping pediatric cancer cohorts using multimodal gene expression signatures.

Precision oncology has primarily relied on coding mutations as biomarkers of response to therapies. While transcriptome analysis can provide valuable information, incorporation into workflows has been difficult. For example, the relative rather than absolute gene expression level needs to be considered, requiring differential expression analysis across samples. However, expression programs related to the cell-of-origin and tumor microenvironment effects confound the search for cancer-specific expression changes. To address these challenges, we developed an unsupervised clustering approach for discovering differential pathway expression within cancer cohorts using gene expression measurements. The hydra approach uses a Dirichlet process mixture model to automatically detect multimodally distributed genes and expression signatures without the need for matched normal tissue. We demonstrate that the hydra approach is more sensitive than widely-used gene set enrichment approaches for detecting multimodal expression signatures. Application of the hydra analysis framework to small blue round cell tumors (including rhabdomyosarcoma, synovial sarcoma, neuroblastoma, Ewing sarcoma, and osteosarcoma) identified expression signatures associated with changes in the tumor microenvironment. The hydra approach also identified an association between ATRX deletions and elevated immune marker expression in high-risk neuroblastoma. Notably, hydra analysis of all small blue round cell tumors revealed similar subtypes, characterized by changes to infiltrating immune and stromal expression signatures

Are we killing them with kindness? Evaluation of sustainable marine wildlife tourism

The increasing popularity of marine wildlife tourism (MWT) worldwide calls for assessment of its conservation outcomes and the development of appropriate management frameworks to ensure the conservation of the species and habitats involved as well as the long-term sustainability of this industry. While many studies have examined the positive and/or negative implications of particular forms of MWT, few have attempted to identify factors of concern shared across different types of marine tourism, or examine their implications for sustainability in a broader perspective. We reviewed the existing literature to highlight common impacts on animal behaviour, health and ecology, and to identify successful cases based on minimal negative affects and/or lack of chronic/ irreversible impacts on target species or habitats. To ensure the achievement of both economic and ecologic objectives, the following steps should be integrated in MWT management: 1) Increase of research on the biology and ecology of target species/habitat and application of relevant information for the development of suitable policies, frameworks and management strategies; 2) Structured enforcement of existing policies and enhancement of ecological awareness of visitors through active education; 3) Application of an adaptive management framework to continuously improve the codes of conduct employed; 4) Involvement of different stakeholders and local communities in the development and improvement of the MWT activity. Combining these strategies with the extrapolation of frameworks and policies from cases where adverse ecological impacts have been addressed and successfully resolved can further contribute in ensuring the long-term health and conservation of the species/ habitats involved in MWT activities

Implications for sequencing of biologic therapy and choice of second anti-TNF in patients with inflammatory bowel disease:results from the IMmunogenicity to Second Anti-TNF therapy (IMSAT) therapeutic drug monitoring study

BACKGROUND: Anti-drug antibodies are associated with treatment failure to anti-TNF agents in patients with inflammatory bowel disease (IBD).AIM: To assess whether immunogenicity to a patient's first anti-TNF agent would be associated with immunogenicity to the second, irrespective of drug sequence METHODS: We conducted a UK-wide, multicentre, retrospective cohort study to report rates of immunogenicity and treatment failure of second anti-TNF therapies in 1058 patients with IBD who underwent therapeutic drug monitoring for both infliximab and adalimumab. The primary outcome was immunogenicity to the second anti-TNF agent, defined at any timepoint as an anti-TNF antibody concentration ≥9 AU/ml for infliximab and ≥6 AU/ml for adalimumab.RESULTS: In patients treated with infliximab and then adalimumab, those who developed antibodies to infliximab were more likely to develop antibodies to adalimumab, than patients who did not develop antibodies to infliximab (OR 1.99, 95%CI 1.27-3.20, p = 0.002). Similarly, in patients treated with adalimumab and then infliximab, immunogenicity to adalimumab was associated with subsequent immunogenicity to infliximab (OR 2.63, 95%CI 1.46-4.80, p < 0.001). For each 10-fold increase in anti-infliximab and anti-adalimumab antibody concentration, the odds of subsequently developing antibodies to adalimumab and infliximab increased by 1.73 (95% CI 1.38-2.17, p < 0.001) and 1.99 (95%CI 1.34-2.99, p < 0.001), respectively. Patients who developed immunogenicity with undetectable drug levels to infliximab were more likely to develop immunogenicity with undetectable drug levels to adalimumab (OR 2.37, 95% CI 1.39-4.19, p < 0.001). Commencing an immunomodulator at the time of switching to the second anti-TNF was associated with improved drug persistence in patients with immunogenic, but not pharmacodynamic failure.CONCLUSION: Irrespective of drug sequence, immunogenicity to the first anti-TNF agent was associated with immunogenicity to the second, which was mitigated by the introduction of an immunomodulator in patients with immunogenic, but not pharmacodynamic treatment failure

Implications for sequencing of biologic therapy and choice of second anti-TNF in patients with inflammatory bowel disease:results from the IMmunogenicity to Second Anti-TNF therapy (IMSAT) therapeutic drug monitoring study

BACKGROUND: Anti-drug antibodies are associated with treatment failure to anti-TNF agents in patients with inflammatory bowel disease (IBD).AIM: To assess whether immunogenicity to a patient's first anti-TNF agent would be associated with immunogenicity to the second, irrespective of drug sequence METHODS: We conducted a UK-wide, multicentre, retrospective cohort study to report rates of immunogenicity and treatment failure of second anti-TNF therapies in 1058 patients with IBD who underwent therapeutic drug monitoring for both infliximab and adalimumab. The primary outcome was immunogenicity to the second anti-TNF agent, defined at any timepoint as an anti-TNF antibody concentration ≥9 AU/ml for infliximab and ≥6 AU/ml for adalimumab.RESULTS: In patients treated with infliximab and then adalimumab, those who developed antibodies to infliximab were more likely to develop antibodies to adalimumab, than patients who did not develop antibodies to infliximab (OR 1.99, 95%CI 1.27-3.20, p = 0.002). Similarly, in patients treated with adalimumab and then infliximab, immunogenicity to adalimumab was associated with subsequent immunogenicity to infliximab (OR 2.63, 95%CI 1.46-4.80, p < 0.001). For each 10-fold increase in anti-infliximab and anti-adalimumab antibody concentration, the odds of subsequently developing antibodies to adalimumab and infliximab increased by 1.73 (95% CI 1.38-2.17, p < 0.001) and 1.99 (95%CI 1.34-2.99, p < 0.001), respectively. Patients who developed immunogenicity with undetectable drug levels to infliximab were more likely to develop immunogenicity with undetectable drug levels to adalimumab (OR 2.37, 95% CI 1.39-4.19, p < 0.001). Commencing an immunomodulator at the time of switching to the second anti-TNF was associated with improved drug persistence in patients with immunogenic, but not pharmacodynamic failure.CONCLUSION: Irrespective of drug sequence, immunogenicity to the first anti-TNF agent was associated with immunogenicity to the second, which was mitigated by the introduction of an immunomodulator in patients with immunogenic, but not pharmacodynamic treatment failure

HLA-DQA1*05 carriage associated with development of anti-drug antibodies to infliximab and adalimumab in patients with Crohn's Disease

Anti-tumor necrosis factor (anti-TNF) therapies are the most widely used biologic drugs for treating immune-mediated diseases, but repeated administration can induce the formation of anti-drug antibodies. The ability to identify patients at increased risk for development of anti-drug antibodies would facilitate selection of therapy and use of preventative strategies.This article is freely available via Open Access. Click on Publisher URL to access the full-text