Social cases?

This was a cross-sectional descriptive study of in-patients over the age of 60 years at St. Luke's hospital who were deemed to be social cases (SC). The majority (58.4%) were female and the mean age was 80 years (range 60-92, SD: 6.7 years). Most (80%) were found in medical wards. The mean length of stay was 22.5 days (range 1-290 days, SD: 36.4 days). Social cases were a frail group with a mean number of co-morbidities of 2.8 (range 0-6, SD:1.5). Dependency level was also high with a mean Barthel score of 6.8 (range 0-20, SD: 7.4). A diagnosis of dementia was documented on the patient's medical record in only 12%. However significant low Abbreviated Mental Test scores were found in 64% (mean AMT 5.0, range 0-9, SD: 2.8). These findings illustrate that most social cases at St. Luke's Hospital are not only there for `social' reasons but also have other factors involved, including a high dependency level in activities of daily living which hamper their discharge to the community. Rehabilitation using an interdisciplinary approach may help the less dependent return to the community.peer-reviewe

Writing Men on the Margins: Joseph Mitchell, Masculinity, and the Flaneur

This study introduces the philosophies of the flâneur—a figure associated with the acts of wandering, observing, and reporting the realities of life on the city streets—to offer a critical reconsideration of a sociological perspective in writings of literary journalism. The study proposes that the literary journalist can be considered as a flâneur, or as a writer who employs the figure of the flâneur as a narrative device, to drive the production of (self-)reflective narratives. This approach is realized with a re-reading of one of New York City’s most widely regarded literary journalists: Joseph Mitchell. Reading Mitchell’s New Yorker profiles through a gendered lens, the article identifies Mitchell’s sociologically charged investigations into the everyday experiences of men from the margins—namely immigrants, Indigenous peoples, and African Americans—as they struggle with the conflicts that shape their masculine identities. The central themes that define these conflicts are identified as the struggle with the dominant ideologies of the self-made man and breadwinner roles, the importance of homosocial relations in the shaping of masculine identity. Possibilities of alternative roles for such men appear in Mitchell’s key profiles, “The Old House at Home” (1939), “The Mohawks in High Steel” (1949), and “Mr. Hunter’s Grave” (1956). By re-conceptualizing Mitchell as a flâneur, that is, a wandering investigator, interpreter, and writer of the discourses of New York society during this period, 1930s–1960s, we can begin to appreciate the sociological value of Mitchell’s profiles and the contribution they make to our understanding of the historical development of masculinity in the United States.publishedVersio

Orthogeriatrics in Malta : a 3 year experience

The orthogeriatric service in Malta started in 2012 and expanded in 2014. From admission, the patient is offered a ward based hip fracture programme that includes orthogeriatric assessment, management and co-ordinated multidisciplinary review. 457 patients were seen by the orthogeriatric service when this study was done. Mean age was 83 and 69% of patients were female. The Nottingham Hip Fracture Score (NHFS) is a scoring system that reliably predicts 30-day and 1-year mortality for patients after hip fracture. It is made up of seven independent predictors of postoperative mortality that have been incorporated into a risk score. The score ranges from 0-10 and the mean score for this cohort was 5.1. There was a statistically significant correlation between age and high NHFS scores. 30 day mortality was 5.9% and 1 year mortality was 24.4%. Compared with the Nottingham data both 30 day and 1 year mortality were less for the orthogeriatric department in Malta. The orthogeriatric service in Malta achieved better results when comparing mortality with the UK. In the future expansion of data collected should be considered to better evaluate standards of care in the department.peer-reviewe

Transport of ultracold Bose gases beyond the Gross-Pitaevskii description

We explore atom-laser-like transport processes of ultracold Bose-condensed atomic vapors in mesoscopic waveguide structures beyond the Gross-Pitaevskii mean-field theory. Based on a microscopic description of the transport process in the presence of a coherent source which models the outcoupling from a reservoir of perfectly Bose-Einstein condensed atoms, we derive a system of coupled quantum evolution equations that describe the dynamics of a dilute condensed Bose gas in the framework of the Hartree-Fock-Bogoliubov approximation. We apply this method to study the transport of dilute Bose gases through an atomic quantum dot and through waveguides with disorder. Our numerical simulations reveal that the onset of an explictly time-dependent flow corresponds to the appearance of strong depletion of the condensate on the microscopic level and leads to a loss of global phase coherence.Comment: 12 pages, 7 figure

Weak localization with nonlinear bosonic matter waves

We investigate the coherent propagation of dilute atomic Bose-Einstein condensates through irregularly shaped billiard geometries that are attached to uniform incoming and outgoing waveguides. Using the mean-field description based on the nonlinear Gross-Pitaevskii equation, we develop a diagrammatic theory for the self-consistent stationary scattering state of the interacting condensate, which is combined with the semiclassical representation of the single-particle Green function in terms of chaotic classical trajectories within the billiard. This analytical approach predicts a universal dephasing of weak localization in the presence of a small interaction strength between the atoms, which is found to be in good agreement with the numerically computed reflection and transmission probabilities of the propagating condensate. The numerical simulation of this quasi-stationary scattering process indicates that this interaction-induced dephasing mechanism may give rise to a signature of weak antilocalization, which we attribute to the influence of non-universal short-path contributions.Comment: 67 pages, 19 figure

Prevalence and clinical characteristics of serum neuronal cell surface antibodies in first-episode psychosis: a case-control study

$\textbf{Background}$ Psychosis is a common presenting feature in antibody-mediated encephalitis, for which prompt recognition and treatment usually leads to remission. We aimed to investigate whether people with circumscribed schizophrenia-like illnesses have such antibodies—especially antibodies against the N-methyl-D-aspartate receptor (NMDAR)—more commonly than do healthy controls. $\textbf{Methods}$ We recruited patients aged 14–35 years presenting to any of 35 mental health services sites across England with first-episode psychosis, less than 6 weeks of treatment with antipsychotic medication, and a score of 4 or more on at least one selected Positive and Negative Syndrome Scale (PANSS) item. Patients and controls provided venous blood samples. We completed standardised symptom rating scales (PANSS, ACE-III, GAF) at baseline, and tested serum samples for antibodies against NMDAR, LGI1, CASPR2, the GABAA receptor, and the AMPA receptor using live cell-based assays. Treating clinicians assessed outcomes of ICD diagnosis and functioning (GAF) at 6 months. We included healthy controls from the general population, recruited as part of another study in Cambridge, UK. $\textbf{Findings}$ Between Feb 1, 2013, and Aug 31, 2014, we enrolled 228 patients with first-episode psychosis and 105 healthy controls. 20 (9%) of 228 patients had serum antibodies against one or more of the neuronal cell surface antibodies compared with four (4%) of 105 controls (unadjusted odds ratio 2·4, 95% CI 0·8–7·3). These associations remained non-significant when adjusted for current cigarette smoking, alcohol consumption, and illicit drug use. Seven (3%) patients had NMDAR antibodies compared with no controls (p=0·0204). The other antibodies did not differ between groups. Antibody-positive patients had lower PANSS positive, PANSS total, and catatonia scores than did antibody-negative patients. Patients had comparable scores on other PANSS items, ACE-III, and GAF at baseline, with no difference in outcomes at 6 months. $\textbf{Interpretation}$ Some patients with first-episode psychosis had antibodies against NMDAR that might be relevant to their illness, but did not differ from patients without NMDAR antibodies in clinical characteristics. Our study suggests that the only way to detect patients with these potentially pathogenic antibodies is to screen all patients with first-episode psychosis at first presentation.Medical Research Counci

Influence of OATP1B1 Function on the Disposition of Sorafenib-β-D-Glucuronide

The oral multikinase inhibitor sorafenib undergoes extensive UGT1A9-mediated formation of sorafenib-β-D-glucuronide (SG). Using transporter-deficient mouse models, it was previously established that SG can be extruded into bile by ABCC2 or follow a liver-to-blood shuttling loop via ABCC3-mediated efflux into the systemic circulation, and subsequent uptake in neighboring hepatocytes by OATP1B-type transporters. Here we evaluated the possibility that this unusual process, called hepatocyte hopping, is also operational in humans and can be modulated through pharmacological inhibition. We found that SG transport by OATP1B1 or murine Oatp1b2 was effectively inhibited by rifampin, and that this agent can significantly increase plasma levels of SG in wildtype mice, but not in Oatp1b2-deficient animals. In human subjects receiving sorafenib, rifampin acutely increased the systemic exposure to SG. Our study emphasizes the need to consider hepatic handling of xenobiotic glucuronides in the design of drug-drug interaction studies of agents that undergo extensive phase II conjugation

Efficacy and feasibility of stereotactic radiotherapy after folfirinox in patients with locally advanced pancreatic cancer (LAPC-1 trial)

Background: We conducted a multicentre phase II trial to investigate feasibility and antitumor activity of sequential FOLFIRINOX and Stereotactic Body Radiotherapy (SBRT) in patients with locally advanced pancreatic cancer (LAPC), (LAPC-1 trial). Methods: Patients with biopsy-proven LAPC treated in four hospitals in the Netherlands between December 2014 and June 2017. Patients received 8 cycles of FOLFIRINOX followed by SBRT (5 fractions/8 Gy) if no tumour progression after the FOLFIRINOX treatment was observed. Primary outcome was 1-year overall survival (OS). Secondary outcomes were median OS, 1-year progression-free survival (PFS), treatment-related toxicity, and resection rate. The study is registered with ClinicalTrials.gov, NCT02292745, and is completed. Findings: Fifty patients were included. Nineteen (38%) patients did not receive all 8 cycles of FOLFIRINOX, due to toxicity (n = 12), disease progression (n = 6), or patients’ preference (n = 1). Thirty-nine (78%) patients received the SBRT treatment. The 1-year OS and PFS were 64% (95% CI: 50%-76%) and 3

Pazopanib exposure decreases as a result of an ifosfamide-dependent drug-drug interaction: Results of a phase I study

Background:The vascular endothelial growth factor receptor (VEGFR) pathway plays a pivotal role in solid malignancies and is probably involved in chemotherapy resistance. Pazopanib, inhibitor of, among other receptors, VEGFR1-3, has activity as single agent and is attractive to enhance anti-tumour activity of chemotherapy. We conducted a dose-finding and pharmacokinetic (PK)/pharmacodynamics study of pazopanib combined with two different schedules of ifosfamide.Methods:In a 3+3+3 design, patients with advanced solid tumours received escalating doses of oral pazopanib combined with ifosfamide either given 3 days continuously or given 3-h bolus infusion daily for 3 days (9 g m -2 per cycle, every 3 weeks). Pharmacokinetic data of ifosfamide and pazopanib were obtained. Plasma levels of placental-derived growth factor (PlGF), vascular endothelial growth factor-A (VEGF-A), soluble VEGFR2 (sVEGFR2) and circulating endothelial cells were monitored as biomarkers.Results:Sixty-one patients were included. Pazopanib with continuous ifosfamide infusion appeared to be safe up to 1000 mg per day, while combination with bolus infusion ifosfamide turned out to be too toxic based on a variety of adverse events. Ifosfamide-dependent decline in pazopanib exposure was observed. Increases in PlGF and VEGF-A with concurrent decline in sVEGFR2 levels, consistent with pazopanib-mediated VEGFR2 inhibition, were observed after addition of ifosfamide.Conclusion:Continuous as opposed to bolus infusion ifosfamide can safely be combined with pazopanib. Ifosfamide co-administration results in lower exposure to pazopanib, not hindering biological effects of pazopanib. Recommended dose of pazopanib for further studies combined with 3 days continuous ifosfamide (9 g m -2 per cycle, every 3 weeks) is 800 mg daily

Translating environments

Far from being inert materials activated by human ingenuity, natural resources come to be made and unmade through ongoing processes of translation, through which they acquire new potentialities and meanings. In this introduction, we review the key concept of translation for anthropology and explore some of its multiple analytical possibilities in the context of human-environment relations. Based on insights offered by the articles in this collection, we propose a twofold definition of environments as both translating subjects and objects of translation. In grounding our analytical definition, we focus on the enactment of material transformations (as the result of both relations of mutual determination with humans and processes of objectification of the environment), the implications of incommensurability and erasure in processes of (attempted) translation, and the indeterminacy that accompanies (re)configurations of materials, relations and values