Combination immunotherapy for cancer

In this issue, Chapuis et al. describe the response of a single patient with metastatic melanoma to combination immunotherapy with anti-CTLA4 and adoptive T cell therapy (1). Although JEM usually discourages the submission of single case studies, the editors, like the authors, realized that this patient was unusual. He had previously been treated with anti-CTLA4 and adoptive T cell therapy administered as monotherapies, with only possible slowing of tumor growth with the former, and no response to the latter. The subsequent complete and durable clinical response to simultaneous treatment with these two modalities, therefore, allowed an argument to be made that their combination was responsible for the improved outcome

The Herts and Minds study: feasibility of a randomised controlled trial of Mentalizationbased Treatment versus usual care to support the wellbeing of children in foster care

© The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.Background: There is a lack of well-designed randomized controlled trials (RCTs) to investigate the efficacy of psychological therapies for children in foster care with emotional and behavioural difficulties. Mentalization-based therapy (MBT) focuses on supporting the carer-child relationship by promoting reflective capacity. This study examined the feasibility and acceptability of an RCT of MBT, delivered in a family-format, for children who are in foster care in the UK. Method: Herts and Minds was a phase II, blinded feasibility RCT with follow-up of at 12 and 24 weeks post-randomisation. Participants were children (age 5-16) in foster care referred to a targeted mental health service, who had some level of difficulty as identified by the Strengths and Difficulties Questionnaire (SDQ). Aims were to assess: the feasibility of recruitment processes and study uptake; capacity to train mental health practitioners to deliver MBT to an acceptable level of treatment integrity; establish acceptability and credibility of MBT as an intervention for children in foster care; establish feasibility and acceptability to participants of conducting an RCT; and estimate the likely treatment efficacy effect size. Participants were randomly allocated to either MBT (n = 15) or Usual Clinical Care (UCC) (n = 21) individually or in sibling groups. A range of qualitative and quantitative data was gathered to assess feasibility. Results: Feasibility was established with regard to: capacity to recruit participants to a study; capacity to train mental health practitioners to deliver MBT to an acceptable level of treatment integrity; acceptability and credibility of MBT; and feasibility and acceptability to participants of conducting an RCT. A number of issues made it difficult to estimate a likely treatment efficacy effect size. Conclusion: With modifications, it is feasible to run an RCT of MBT for children in foster care. Both the therapy and research design were acceptable to participants, but modifications may be needed regarding both the timing of assessments and the identification of appropriate primary outcome measures. Given the lack of evidenced based therapies for this population, such a trial would be a significant contribution to the field. Findings may be useful for other groups planning clinical trials of psychological therapies for children in foster care. Trial registration: ISRCTN 90349442. The trial was retrospectively registered on 6 May 2016.Peer reviewedFinal Published versio

Why Do Women Co-Operate More in Women's Groups?

A substantial amount of development programming assumes that women have preferences or aptitudes that are more conducive to economic development. For example, conditional cash transfer programmes commonly deliver funding to female household heads, and many microcredit schemes focus on women’s savings groups. This chapter examines a public goods game in northern Liberia. Women contributed substantially more to a small-scale development project when playing with other women than in mixed-gender groups, where they contributed at about the same levels as men. We try to explain this composition effect using a structural model, survey responses, and a second manipulation. Results suggest women in the all-women group put more weight on co-operation regardless of the value of the public good, the fear of discovery, or the desire to match others’ behaviour. We conjecture that players have stronger motivation to signal public-spiritedness when primed to consider themselves representatives of the women of the community

Why do women co-operate more in women's groups?

We examine a public goods game in 83 communities in northern Liberia. Women contributed substantially more to a small-scale development project when playing with other women than in mixed-gender groups, where they contributed at about the same levels as men. We try to explain this composition effect using a structural model, survey responses, and a second manipulation. Results suggest women in the all-women condition put more weight on co-operation regardless of value of public good, fear of discovery, or desire to match others' behaviour. Game players may have stronger motivation to signal public-spiritedness when primed to consider themselves representatives of the women of the community

Stakeholder Engagement: Achieving Sustainability in the Construction Sector

Achieving sustainability-related targets in construction projects is increasingly becoming a key performance driver. Yet sustainability is a complex concept in projects and there are many diverse stakeholders. Some stakeholders are generally recognized as important, i.e., the client and main contractor, yet there are others not always perceived as such and whose absence from the decision-making processes may result in a failure to address sustainability issues. Hence there is a need for a systematic approach to engage with stakeholders with high salience in relation to sustainability. This paper reports the results of an exploratory study involving interviews with construction project practitioners that are involved in sustainability in some way. Data were collected from the practitioners in terms of the processes for engaging with stakeholders to deliver sustainability. The data suggests six steps to a stakeholder engagement process: (i) identification; (ii) relating stakeholders to different sustainability-related targets; (iii) prioritization; (iv) managing; (v) measuring performance; and (vi) putting targets into action. The results suggest that understanding the different sustainability agendas of stakeholders and measuring their performance using key performance indicators are important stages to be emphasized in any stakeholder engagement process to achieve sustainability-related goals

Psychosocial Intervention Is Associated with Altered Emotion Processing: An Event-Related Potential Study in At-Risk Adolescents

Emotion processing is vital for healthy adolescent development, and impaired emotional responses are associated with a number of psychiatric disorders. However, it is unclear whether observed differences between psychiatric populations and healthy controls reflect modifiable variations in functioning (and thus could be sensitive to changes resulting from intervention) or stable, non-modifiable, individual differences. The current study therefore investigated whether the Late Positive Potential (LPP; a neural index of emotion processing) can be used as a marker of therapeutic change following psycho-social intervention. At-risk male adolescents who had received less than four months intervention (minimal-intervention, N = 32) or more than nine months intervention (extended-intervention, N = 32) passively viewed emotional images whilst neural activity was recorded using electroencephalography. Significant differences in emotion processing, indicated by the LPP, were found between the two groups: the LPP did not differ according to valence in the minimal-intervention group, whereas the extended-intervention participants showed emotion processing in line with low risk populations (enhanced LPP for unpleasant images versus other images). Further, an inverse relationship between emotional reactivity (measured via the LPP) and antisocial behaviour was observed in minimal-intervention participants only. The data therefore provide preliminary cross-sectional evidence that abnormal neural responses to emotional information may be normalised following psychosocial intervention. Importantly, this study uniquely suggests that, in future randomised control trials, the LPP may be a useful biomarker to measure development and therapeutic change

Psychosocial intervention in at-risk adolescents: using event-related potentials to assess changes in decision making and feedback processing

Decision making and feedback processing are two important cognitive processes that are impacted by social context, particularly during adolescence. The current study examined whether a psychosocial intervention could improve psychological wellbeing in at-risk adolescent boys, thereby improving their decision making and feedback processing skills. Two groups of at-risk adolescents were compared: those who were relatively new to a psychosocial intervention, and those who had engaged over a longer time period. Electroencephalography was recorded while the young people participated in a modified version of the Taylor Aggression Paradigm. The late positive potential (LPP) was measured during the decision phase of the task (where participants selected punishments for their opponents). The feedback-related negativity (FRN) and P3 components were measured during the task’s outcome phase (where participants received ‘win’ or ‘lose’ feedback). Adolescents who were new to the intervention (the minimal-intervention group) were harsher in their punishment selections than those who had been engaged in the program for much longer. The minimal-intervention group also showed an enhanced LPP during the decision phase of the task, which may be indicative of immature decision making in that group. Analysis of the FRN and P3 amplitudes revealed that the minimal-intervention group was physiologically hypo-sensitive to feedback, compared with the extended-intervention group. Overall, these findings suggest that long-term community-based psychosocial intervention programs are beneficial for at-risk adolescents, and that event-related potentials can be employed as biomarkers of therapeutic change. However, because participants were not randomly allocated to treatment groups, alternative explanations cannot be excluded until further randomized controlled trials are undertaken

Commitment Problems and War in International Bargaining

In the context of international bargaining, standard models predict that a shift in military power can cause preventive war because it changes the relative bargaining position between states. We find that shifts in military power are not the only cause of war under commitment problems and that commitment problems per se are not necessarily a cause of war even if the relative bargaining position changes substantially.Plötzliche und substantielle Verlagerungen der militärischen Stärke zwischen Staaten gelten in der relevanten Literatur als mögliche Ursache von Präventionskriegen. Formal betrachtet kann eine Verlagerung der militärischen Stärke zu einer Veränderung der relativen Verhandlungsposition führen. Dies bedeutet, dass ein militärisch schwächer werdender Staat befürchten muss, in zukünftigen Verhandlungen mit einem militärisch stärker werdenden Staat, ein schlechteres Verhandlungsergebnis zu erzielen. Wenn der stärker werdende Staat nicht glaubhaft versichern kann, seine Stärke nicht zu nutzen, um in Zukunft ein besseres Ergebnis zu erreichen, kann es aus Sicht des schwächer werdenden Staates rational sein, durch sofortigen Krieg, seine gegenwärtige Stärke auszunutzen, um ein Ergebnis herbeizuführen, das in Zukunft durch Verhandlung nicht mehr möglich ist. Wir erweitern das in der Literatur etablierte Verhandlungsmodell und zeigen, dass eine plötzliche und substantielle Verlagerung der militärischen Stärke nicht der einzige Grund ist, warum es zu einem Präventionskrieg kommen kann. Zudem untersuchen wir weitere Gründe, die zu einer veränderten Verhandlungsposition führen können und finden heraus, dass selbst eine deutliche Verschiebung der relativen Verhandlungsposition im Gleichgewicht nicht notwendigerweise Krieg zur Folge hat

Is the sexual behaviour of young people in sub-Saharan Africa influenced by their peers? A systematic review.

Adolescents in sub-Saharan Africa are highly vulnerable to HIV, other sexually transmitted infections (STIs) and unintended pregnancies. Evidence for the effectiveness of individual behaviour change interventions in reducing incidence of HIV and other biological outcomes is limited, and the need to address the social conditions in which young people become sexually active is clear. Adolescents' peers are a key aspect of this social environment and could have important influences on sexual behaviour. There has not yet been a systematic review on the topic in sub-Saharan Africa. We searched 4 databases to find studies set in sub-Saharan Africa that included an adjusted analysis of the association between at least one peer exposure and a sexual behaviour outcome among a sample where at least 50% of the study participants were aged between 13 and 20 years. We classified peer exposures using a framework to distinguish different mechanisms by which influence might occur. We found 30 studies and retained 11 that met quality criteria. There were 3 cohort studies, 1 time to event and 7 cross-sectional. The 11 studies investigated 37 different peer exposure-outcome associations. No studies used a biological outcome and all asked about peers in general rather than about specific relationships. Studies were heterogeneous in their use of theoretical frameworks and means of operationalizing peer influence concepts. All studies found evidence for an association between peers and sexual behaviour for at least one peer exposure/outcome/sub-group association. Of all 37 outcome/exposure/sub-group associations tested, there was evidence for 19 (51%). There were no clear patterns by type of peer exposure, outcome or adolescent sub-group. There is a lack conclusive evidence about the role of peers in adolescent sexual behaviour in Sub-Saharan. We argue that longitudinal designs, use of biological outcomes and approaches from social network analysis are priorities for future studies