Immune checkpoint inhibitors‐induced neuromuscular toxicity: From pathogenesis to treatment

Immune checkpoint inhibitors (ICIs) are increasingly used and are becoming the standard of care in the treatment of various tumour types. Despite the favourable results in terms of oncological outcomes, these treatments have been associated with a variety of immune-related adverse events (irAEs). Neurological irAEs are rare but potentially severe. Neuromuscular disorders represent the most common neurological irAEs following anti-PD-1, anti-PDL-1 and anti-CTLA-4 treatment, and include myositis, myasthenia gravis and demyelinating polyradiculoneuropathy. Instrumental findings may differ from typical neuromuscular disorders occurring outside ICIs treatment. Despite initial severity, neurological irAEs often respond to immune-modulating therapies. Prompt irAEs diagnosis, ICIs discontinuation, and early treatment with corticosteroids, together with patient education and a multidisciplinary approach, are important for optimizing clinical outcomes. Intravenous immunoglobulin, plasma exchange and other immune-modulating treatments should be considered in more severe cases. Consideration of rechallenging with the same immunotherapy drug may be given in some cases, based on clinical picture and initial severity of irAEs. This article is protected by copyright. All rights reserved

Material conflict: MOOCs and institutional logics in business education

Although the notion of incompatibility is implicit in the research on conflicting institutional logics, few studies explicitly address it. The chapter draws on the concept of materiality and theories of digital objects to explain how materiality affects the organizational templates and reasons for the conflict. The chosen context of Massive Open Online Course (MOOCS) contradicts the conventional organizing templates in business schools (BS) but it emerges a powerful force regardless. The focus on digital materiality helps us to elaborate the role of materiality in institutional logics. By juxtaposing and reconciling the substance of the physical mater and the substantive mattering of matter, the chapter enhances the definition and the theoretical boundaries of the concept

Building capabilities for international operations through networks: a study of Indian firms

In this study we seek to explain how firms from emerging markets build capabilities to operate in international markets through learning from parental networks. The building of these capabilities is of particular interest, as firms from emerging markets may not necessarily possess the monopolistic advantages commonly referred to in IB literature, which allow a firm to succeed in international markets. Using lagged cross-sectional regression models on a sample of 794 Indian firms, we found that firms draw on the international experience of their parental and foreign networks to build such capabilities. Findings also indicate that network scope is beneficial for increasing exposure to international markets only in the case of networks that are either small or medium sized. Additionally, we found that firms lacking market power in their home market benefit through foreign partnerships when internationalizing operations. Journal of International Business Studies (2007) 38, 541–555. doi:10.1057/palgrave.jibs.8400280

High Rates of Prescribing Antimicrobials for Prophylaxis in Children and Neonates: Results From the Antibiotic Resistance and Prescribing in European Children Point Prevalence Survey

BACKGROUND: This study was conducted to assess the variation in prescription practices for systemic antimicrobial agents used for prophylaxis among pediatric patients hospitalized in 41 countries worldwide. METHODS: Using the standardized Antibiotic Resistance and Prescribing in European Children Point Prevalence Survey protocol, a cross-sectional point-prevalence survey was conducted at 226 pediatric hospitals in 41 countries from October 1 to November 30, 2012. RESULTS: Overall, 17693 pediatric patients were surveyed and 36.7% of them received antibiotics (n = 6499). Of 6818 inpatient children, 2242 (32.9%) received at least 1 antimicrobial for prophylactic use. Of 11899 prescriptions for antimicrobials, 3400 (28.6%) were provided for prophylactic use. Prophylaxis for medical diseases was the indication in 73.4% of cases (2495 of 3400), whereas 26.6% of prescriptions were for surgical diseases (905 of 3400). In approximately half the cases (48.7% [1656 of 3400]), a combination of 2 or more antimicrobials was prescribed. The use of broad-spectrum antibiotics (BSAs), which included tetracyclines, macrolides, lincosamides, and sulfonamides/trimethoprim, was high (51.8% [1761 of 3400]). Broad-spectrum antibiotic use for medical prophylaxis was more common in Asia (risk ratio [RR], 1.322; 95% confidence interval [CI], 1.202-1.653) and more restricted in Australia (RR, 0.619; 95% CI, 0.521-0.736). Prescription of BSA for surgical prophylaxis also varied according to United Nations region. Finally, a high percentage of surgical patients (79.7% [721 of 905]) received their prophylaxis for longer than 1 day. CONCLUSIONS: A high proportion of hospitalized children received prophylactic BSAs. This represents a clear target for quality improvement. Collectively speaking, it is critical to reduce total prophylactic prescribing, BSA use, and prolonged prescription