Kant and Secular Transcendentalism

This writing argues that some embedded moral and religious linkages in Kant’s metaphysical thought have been unobserved in much recent philosophical commentary, something we may attribute to the de-emphasis of metaphysics within significant parts of the contemporary academic world, combined with a lack of awareness of the religious milieu within which he worked. Paradoxically in the light of this, and based on the religious content I find in the first Critique and elsewhere, I explore what I perceive to be Kant’s attempt to steer traditional religious doctrines and practice into a secular, individualised, scientifically congruent, completely independent and universally acceptable format. From this, I develop the idea that an appreciation of these efforts to reform earlier theological thought allows for a more complete and coherent interpretation of critical philosophy than has previously been available, with application, for example, to a heightened understanding of the employment of the idea of things in themselves. The primary notion involved in this amended reading is the primacy Kant gives to practical reason..

The combined immunohistochemical expression of AMBRA1 and SQSTM1 identifies patients with poorly differentiated cutaneous squamous cell carcinoma at risk of metastasis: A proof of concept study

\ua9 2024 AMLo Biosciences Ltd. Journal of Cutaneous Pathology published by John Wiley & Sons Ltd.Background: Cutaneous squamous cell carcinoma (cSCC) incidence continues to increase globally with, as of yet, an unmet need for reliable prognostic biomarkers to identify patients at increased risk of metastasis. The aim of the present study was to test the prognostic potential of the combined immunohistochemical expression of the autophagy regulatory biomarkers, AMBRA1 and SQSTM1, to identify high-risk patient subsets. Methods: A retrospective cohort of 68 formalin-fixed paraffin-embedded primary cSCCs with known 5-year metastatic outcomes were subjected to automated immunohistochemical staining for AMBRA1 and SQSTM1. Digital images of stained slides were annotated to define four regions of interest: the normal and peritumoral epidermis, the tumor mass, and the tumor growth front. H-score analysis was used to semi-quantify AMBRA1 or SQSTM1 expression in each region of interest using Aperio ImageScope software, with receiver operator characteristics and Kaplan–Meier analysis used to assess prognostic potential. Results: The combined loss of expression of AMBRA1 in the tumor growth front and SQSTM1 in the peritumoral epidermis identified patients with poorly differentiated cSCCs at risk of metastasis (*p < 0.05). Conclusions: Collectively, these proof of concept data suggest loss of the combined expression of AMBRA1 in the cSCC growth front and SQSTM1 in the peritumoral epidermis as a putative prognostic biomarker for poorly differentiated cSCC

Absence of superconductivity in ultra-thin layers of FeSe synthesized on a topological insulator

The structural and electronic properties of FeSe ultra-thin layers on Bi$_{2}$Se$_{3}$ have been investigated with a combination of scanning tunneling microscopy and spectroscopy and angle-resolved photoemission spectroscopy. The FeSe multi-layers, which are predominantly 3-5 monolayers (ML) thick, exhibit a hole pocket-like electron band at \bar{\Gamma} and a dumbbell-like feature at \bar{M}, similar to multi-layers of FeSe on SrTiO$_{3}$. Moreover, the topological state of the Bi2Se3 is preserved beneath the FeSe layer, as indicated by a heavily \it{n}-doped Dirac cone. Low temperature STS does not exhibit a superconducting gap for any investigated thickness down to a temperature of 5 K

A multi-data set comparison of the vertical structure of temperature variability and change over the Arctic during the past 100years

We compare the daily, interannual, and decadal variability and trends in the thermal structure of the Arctic troposphere using eight observation-based, vertically resolved data sets, four of which have data prior to 1948. Comparisons on the daily scale between historical reanalysis data and historical upper-air observations were performed for Svalbard for the cold winters 1911/1912 and 1988/1989, the warm winters 1944/1945 and 2005/2006, and the International Geophysical Year 1957/1958. Excellent agreement is found at mid-tropospheric levels. Near the ground and at the tropopause level, however, systematic differences are identified. On the interannual time scale, the correlations between all data sets are high, but there are systematic biases in terms of absolute values as well as discrepancies in the magnitude of the variability. The causes of these differences are discussed. While none of the data sets individually may be suitable for trend analysis, consistent features can be identified from analyzing all data sets together. To illustrate this, we examine trends and 20-year averages for those regions and seasons that exhibit large sea-ice changes and have enough data for comparison. In the summertime Pacific Arctic and the autumn eastern Canadian Arctic, the lower tropospheric temperature anomalies for the recent two decades are higher than in any previous 20-year period. In contrast, mid-tropospheric temperatures of the European Arctic in the wintertime of the 1920s and 1930s may have reached values as high as those of the late 20th and early 21st centurie

Ixazomib for relapsed or refractory multiple myeloma : review from an evidence review group on a NICE single technology appraisal

Ixazomib is an oral proteasome inhibitor used in combination with lenalidomide plus dexamethasone (IXA-LEN-DEX) and licensed for relapsed or refractory multiple myeloma. As part of a single technology appraisal (ID807) undertaken by the National Institute of Health and Care Excellence, the Evidence Review Group, Warwick Evidence was invited to independently review the evidence submitted by the manufacturer of ixazomib, Takeda UK Ltd. The main source of clinical effectiveness data about IXA-LEN-DEX came from the Tourmaline-MM1 randomized controlled trial in which 771 patients with relapsed or refractory multiple myeloma received either IXA-LEN-DEX or placebo-LEN-DEX as their second-, third-, or fourth-line treatment. Takeda estimated the cost effectiveness of IXA-LEN-DEX using a de-novo partitioned-survival model with three health states (pre-progression, post-progression, and dead). In their first submission, this model was used to estimate the cost effectiveness of IXA-LEN-DEX vs. bortezomib plus dexamethasone (BORT-DEX) in second-line treatment, and of IXA-LEN-DEX vs. LEN-DEX in third-line treatment. To estimate the relative clinical performance of IXA-LEN-DEX vs. BORT-DEX, Takeda conducted network meta-analyses for important outcomes. The network meta-analysis for overall survival was found to be flawed in several respects, but mainly because a hazard ratio input for one of the studies in the network had been inverted, resulting in a large inflation of the claimed superiority of IXA-LEN-DEX over BORT-DEX and a considerable overestimation of its cost effectiveness. In subsequent submissions, Takeda withdrew second-line treatment as an option for IXA-LEN-DEX. The manufacturer’s first submission comparing IXA-LEN-DEX with LEN-DEX for third-line therapy employed Tourmaline-MM1 data from third- and fourth-line patients as proxy for a third-line population. The appraisal committee did not consider this reasonable because randomization in Tourmaline-MM1 was stratified according to one previous treatment and two or more previous treatments. A further deficiency was considered to be the manufacturer’s use of interim survival data rather than the most mature data available. A second submission from the company focussed on IXA-LEN-DEX vs. LEN-DEX as third- or fourth-line treatment (the two or more previous lines population) and a new patient access scheme was introduced. Covariate modeling of survival outcomes was proposed using the most mature survival data. The Evidence Review Group’s main criticisms of the new evidence included: the utility associated with the pre-progression health state was overestimated, treatment costs of ixazomib were underestimated, survival models were still associated with great uncertainty, leading to clinically implausible anomalies and highly variable incremental cost-effectiveness ratio estimates, and the company had not explored a strong assumption that the survival benefit of IXA-LEN-DEX over LEN-DEX would be fully maintained for a further 22 years beyond the observed data, which encompassed only approximately 2.5 years of observation. The appraisal committee remained unconvinced that ixazomib represented a cost-effective use of National Health Service resources. Takeda’s third submission offered new base-case parametric models for survival outcomes, a new analysis of utilities, and proposed a commercial access agreement. In a brief critique of the third submission, the Evidence Review Group agreed that the selection of appropriate survival models was problematic and at the request of the National Institute for Health Care and Excellence investigated external sources of evidence regarding survival outcomes. The Evidence Review Group considered that some cost and utility estimates in the submission may have remained biased in favor of ixazomib. As a result of their third appraisal meeting, the committee judged that for the two to three prior therapies population, and at the price agreed in a commercial access agreement, ixazomib had the potential to be cost effective. It was referred to the Cancer Drugs Fund so that further data could accrue with the aim of diminishing the clinical uncertainties

A core outcome set for localised prostate cancer effectiveness trials

Objective: To develop a core outcome set (COS) applicable for effectiveness trials of all interventions for localised prostate cancer. Background: Many treatments exist for localised prostate cancer, although it is unclear which offers the optimal therapeutic ratio. This is confounded by inconsistencies in the selection, definition, measurement and reporting of outcomes in clinical trials. Subjects and methods: A list of 79 outcomes was derived from a systematic review of published localised prostate cancer effectiveness studies and semi-structured interviews with 15 prostate cancer patients. A two-stage consensus process involving 118 patients and 56 international healthcare professionals (HCPs) (cancer specialist nurses, urological surgeons and oncologists) was undertaken, consisting of a three-round Delphi survey followed by a face-to-face consensus panel meeting of 13 HCPs and 8 patients. Results: The final COS included 19 outcomes. Twelve apply to all interventions: death from prostate cancer, death from any cause, local disease recurrence, distant disease recurrence/metastases, disease progression, need for salvage therapy, overall quality of life, stress urinary incontinence, urinary function, bowel function, faecal incontinence, sexual function. Seven were intervention-specific: perioperative deaths (surgery), positive surgical margin (surgery), thromboembolic disease (surgery), bothersome or symptomatic urethral or anastomotic stricture (surgery), need for curative treatment (active surveillance), treatment failure (ablative therapy), and side effects of hormonal therapy (hormone therapy). The UK-centric participants may limit the generalisability to other countries, but trialists should reason why the COS would not be applicable. The default position should not be that a COS developed in one country will automatically not be applicable elsewhere. Conclusion: We have established a COS for trials of effectiveness in localised prostate cancer, applicable across all interventions which should be measured in all localised prostate cancer effectiveness trials

Science with a lunar low-frequency array: from the dark ages of the Universe to nearby exoplanets

Low-frequency radio astronomy is limited by severe ionospheric distortions below 50 MHz and complete reflection of radio waves below 10-30 MHz. Shielding of man-made interference from long-range radio broadcasts, strong natural radio emission from the Earth's aurora, and the need for setting up a large distributed antenna array make the lunar far side a supreme location for a low-frequency radio array. A number of new scientific drivers for such an array, such as the study of the dark ages and epoch of reionization, exoplanets, and ultra-high energy cosmic rays, have emerged and need to be studied in greater detail. Here we review the scientific potential and requirements of these and other new scientific drivers and discuss the constraints for various lunar surface arrays. In particular we describe observability constraints imposed by the interstellar and interplanetary medium, calculate the achievable resolution, sensitivity, and confusion limit of a dipole array using general scaling laws, and apply them to various scientific questions. Whichever science is deemed most important, pathfinder arrays are needed to test the feasibility of these experiments in the not too distant future. Lunar low-frequency arrays are thus a timely option to consider, offering the potential for significant new insights into a wide range of today's crucial scientific topics. This would open up one of the last unexplored frequency domains in the electromagnetic spectrum.Comment: 36 pages, many figures, accepted for publication by New Astronomy Review

Outcomes of COVID-19 related hospitalization among people with HIV in the ISARIC WHO Clinical Characterization Protocol (UK):a prospective observational study

BACKGROUND:Evidence is conflicting about how HIV modulates COVID-19. We compared the presentation characteristics and outcomes of adults with and without HIV who were hospitalized with COVID-19 at 207 centers across the United Kingdom and whose data were prospectively captured by the ISARIC WHO CCP study. METHODS:We used Kaplan-Meier methods and Cox regression to describe the association between HIV status and day-28 mortality, after separate adjustment for sex, ethnicity, age, hospital acquisition of COVID-19 (definite hospital acquisition excluded), presentation date, ten individual comorbidities, and disease severity at presentation (as defined by hypoxia or oxygen therapy). RESULTS:Among 47,592 patients, 122 (0.26%) had confirmed HIV infection and 112/122 (91.8%) had a record of antiretroviral therapy. At presentation, HIV-positive people were younger (median 56 versus 74 years; p<0.001) and had fewer comorbidities, more systemic symptoms and higher lymphocyte counts and C-reactive protein levels. The cumulative day-28 mortality was similar in the HIV-positive vs. HIV-negative groups (26.7% vs. 32.1%; p=0.16), but in those under 60 years of age HIV-positive status was associated with increased mortality (21.3% vs. 9.6%; p<0.001 [log-rank test]). Mortality was higher among people with HIV after adjusting for age (adjusted hazard ratio [aHR] 1.47, 95% confidence interval [CI] 1.01-2.14; p=0.05), and the association persisted after adjusting for the other variables (aHR 1.69; 95% CI 1.15-2.48; p=0.008) and when restricting the analysis to people aged <60 years (aHR 2.87; 95% CI 1.70-4.84; p<0.001). CONCLUSIONS:HIV-positive status was associated with an increased risk of day-28 mortality among patients hospitalized for COVID-19