Re-Imagining Localism and Food Justice: Co-Op Cincy and the Union Cooperative Movement

Co-op Cincy is an incubator of worker- and community-owned cooperatives, including the farm and food hub Our Harvest. The incubator is part of the innovative 1worker1vote.org network of unionized worker cooperatives stemming from a partnership between the Spanish Mondragon Cooperatives and the United States Steelworkers. This Community Case Study examines Co-Op Cincy’s food sector organizing as an example of resistance to the industrial, corporate food system. Their hybrid and experimental approach creatively re-imagines both cooperative ownership and localist food systems. Whereas some local efforts fail to address questions of social justice or drift from social justice missions, this essay describes how Co-Op Cincy and Our Harvest 1) define their social justice goals in pursuit of locally rooted ownership, 2) raise consciousness about the connections among food systems and racial and class disparities as well as the need for sustainability, solidarity, and democratic ownership, and 3) embody these commitments in everyday organizing. Their experimentation lends insights into potential paths to create a more equitable food system and a more just economy

Obeticholic acid for the treatment of non-alcoholic steatohepatitis: interim analysis from a multicentre, randomised, placebo-controlled phase 3 trial

Background Non-alcoholic steatohepatitis (NASH) is a common type of chronic liver disease that can lead to cirrhosis. Obeticholic acid, a farnesoid X receptor agonist, has been shown to improve the histological features of NASH. Here we report results from a planned interim analysis of an ongoing, phase 3 study of obeticholic acid for NASH. Methods In this multicentre, randomised, double-blind, placebo-controlled study, adult patients with definite NASH,non-alcoholic fatty liver disease (NAFLD) activity score of at least 4, and fibrosis stages F2–F3, or F1 with at least oneaccompanying comorbidity, were randomly assigned using an interactive web response system in a 1:1:1 ratio to receive oral placebo, obeticholic acid 10 mg, or obeticholic acid 25 mg daily. Patients were excluded if cirrhosis, other chronic liver disease, elevated alcohol consumption, or confounding conditions were present. The primary endpointsfor the month-18 interim analysis were fibrosis improvement (≥1 stage) with no worsening of NASH, or NASH resolution with no worsening of fibrosis, with the study considered successful if either primary endpoint was met. Primary analyses were done by intention to treat, in patients with fibrosis stage F2–F3 who received at least one dose of treatment and reached, or would have reached, the month 18 visit by the prespecified interim analysis cutoff date. The study also evaluated other histological and biochemical markers of NASH and fibrosis, and safety. This study is ongoing, and registered with ClinicalTrials.gov, NCT02548351, and EudraCT, 20150-025601-6. Findings Between Dec 9, 2015, and Oct 26, 2018, 1968 patients with stage F1–F3 fibrosis were enrolled and received at least one dose of study treatment; 931 patients with stage F2–F3 fibrosis were included in the primary analysis (311 in the placebo group, 312 in the obeticholic acid 10 mg group, and 308 in the obeticholic acid 25 mg group). The fibrosis improvement endpoint was achieved by 37 (12%) patients in the placebo group, 55 (18%) in the obeticholic acid 10 mg group (p=0·045), and 71 (23%) in the obeticholic acid 25 mg group (p=0·0002). The NASH resolution endpoint was not met (25 [8%] patients in the placebo group, 35 [11%] in the obeticholic acid 10 mg group [p=0·18], and 36 [12%] in the obeticholic acid 25 mg group [p=0·13]). In the safety population (1968 patients with fibrosis stages F1–F3), the most common adverse event was pruritus (123 [19%] in the placebo group, 183 [28%] in the obeticholic acid 10 mg group, and 336 [51%] in the obeticholic acid 25 mg group); incidence was generally mild to moderate in severity. The overall safety profile was similar to that in previous studies, and incidence of serious adverse events was similar across treatment groups (75 [11%] patients in the placebo group, 72 [11%] in the obeticholic acid 10 mg group, and 93 [14%] in the obeticholic acid 25 mg group). Interpretation Obeticholic acid 25 mg significantly improved fibrosis and key components of NASH disease activity among patients with NASH. The results from this planned interim analysis show clinically significant histological improvement that is reasonably likely to predict clinical benefit. This study is ongoing to assess clinical outcomes

From Patient Navigation to Cancer Justice: Toward a Culture-Centered, Community-Owned Intervention Addressing Disparities in Cancer Prevention

In this study, we analyze data from an ongoing academic–community collaboration targeted at conceptualization and delivery of a patient navigation intervention for cancer prevention. Echoing overall United States trends, the region under study is earmarked by significant socioeconomic and racial disparities in cancer outcomes. While there is a large body of research on the use of patient navigation across the continuum of cancer care, the role of communication in shaping navigation is unclear in the literature. Responding to this gap, we use the culture-centered approach to document how community-based “lay” patient navigators’ local knowledge and cultural expertise shaped the scope and meanings of patient navigation for a predominantly African-American population. Qualitative data in the form of navigator interviews, participant observation of navigation, and research team members’ reflexive journals were used to document how the definition and scope of navigation were re-inscribed by community navigators. While navigation was initially equated with screening promotion, interaction with community members led to the development of more listening-focused and structural barrier-focused conceptualization of patient navigation. Finally, we discuss the implications and contributions and limitations of this study