An immunotherapy survivor population: health-related quality of life and toxicity in patients with metastatic melanoma treated with immune checkpoint inhibitors

© The Author(s) 2019. 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.Purpose The immune checkpoint inhibitors (ICIs) have resulted in subgroups of patients with metastatic melanoma achievinghigh-quality durable responses. Metastatic melanoma survivors are a new population in the era of cancer survivorship. The aimofthis study was to evaluate metastatic melanoma survivors in terms of health-related quality of life (HRQoL), immune-relatedadverse events (irAEs) and exposure to immunosuppressive agents in a large single centre in the UK.Methods We defined the survivor population as patients with a diagnosis of metastatic melanoma who achieved a durableresponse to an ICI and had been followed-up for a minimum of 12 months from initiation of ICI without disease progression.HRQoL was assessed using SF-36. Electronic health records were accessed to collect data on demographics, treatments, irAEsand survival. HRQoL data was compared with two norm-based datasets.Results Eighty-four metastatic melanoma survivors were eligible and 87% (N = 73) completed the SF-36. ICI-related toxicity ofany grade occurred in 92%of patients and 43%had experienced a grade 3 or 4 toxicity. Almost half (49%) of the patients requiredsteroids for the treatment of ICI-related toxicity, whilst 14% required treatment with an immunosuppressive agent beyondsteroids.Melanoma survivors had statistically significant lower HRQoL scores with regard to physical, social and physical rolefunctioning and general health compared with the normative population. There was a trend towards inferior scores in patientswith previous exposure to ipilimumab compared with those never exposed to ipilimumab.Conclusions Our results show that metastatic melanoma survivors have potentially experienced significant ICI-related toxicityand experience significant impairments in specific HRQoL domains. Future service planning is required to meet this population’sunique survivorship needs.Peer reviewe

Interprofessional communication with hospitalist and consultant physicians in general internal medicine : a qualitative study

This study helps to improve our understanding of the collaborative environment in GIM, comparing the communication styles and strategies of hospitalist and consultant physicians, as well as the experiences of providers working with them. The implications of this research are globally important for understanding how to create opportunities for physicians and their colleagues to meaningfully and consistently participate in interprofessional communication which has been shown to improve patient, provider, and organizational outcomes

Comprehension as social and intellectual practice: Rebuilding curriculum in low socioeconomic and cultural minority schools

This article reframes the concept of comprehension as a social and intellectual practice. It reviews current approaches to reading instruction for linguistically and culturally diverse and low socioeconomic students, noting an emphasis on comprehension as autonomous skills. The Four Resources model (Freebody & Luke, 1990) is used to make the case for the integration of comprehension instruction with an emphasis on student cultural and community knowledge, and substantive intellectual and sociocultural content in elementary school curricula. Illustrations are drawn from research underway on the teaching of literacy in primary schools in low SES communities

Knowledge exchange with Sistema Scotland

This paper reports on a knowledge exchange project, funded by the Scottish Funding Council and with the aim of improving the ‘two-way flow of people and ideas between the research environment and wider economy, thereby contributing to national prosperity, the quality of life of citizens, and cultural enrichment of our society’ (Scottish Funding Council, n.d). The project was undertaken by a group of researchers from three higher education institutions with a combined knowledge of education, music and psychology which has guided their knowledge exchange activities with the project partner and among themselves. The project partner was Sistema Scotland, a charity which is attempting to implement a major programme of social change, originating in Venezuela, within a disadvantaged area of Scotland, and therefore a highly appropriate focus for knowledge exchange. The paper outlines the development of Sistema Scotland and the programme, El Sistema, on which it is based. It details the knowledge exchange activities undertaken, which used Derrida’s (1993) notion of aporia to try to engage Sistema Scotland with different perspectives and understandings, and a practical method for conducting meetings based on Open Space Technology. The various ‘encounters’ with children, service providers and stakeholders are reported and this is followed by a critique of the processes of knowledge exchange which were both permitted and prohibited. The paper ends with a discussion of the conditions that are necessary for knowledge exchange to be successful

Dewey and the democratic curriculum

This paper uses Dewey’s seminal Democracy and Education (1916) as a key text to investigate the concept of the democratic curriculum. I argue that a democratic curriculum is one where a series of educational innovations or procedures are followed. These are: a removal of the exisiting division between ‘academic’ and ‘vocational’ education; pedagogy in the form of discussion and dialogue; negotiation of curriculum aims and objectives with students and other local stakeholders. The focus of attention will be on the English school curriculum (both primary and secondary), especially concerning the National Curriculum, and the debate over ‘standards’ and testing . A tentative link between the democratic curriculum and increased student motivation and participation is made

High attaining students, marketisation and the absence of care: everyday experiences in an urban academy

This article draws on the work of Nel Noddings to suggest that the current neoliberal, marketised system of education is eroding caring relationships in schools. Data are drawn from a small-scale qualitative study of an ethnically diverse group of high attaining sixth form students from a successful urban academy. Based on this data, we argue that two fundamental aspects of care, students’ relationships with their teachers and an attention to their personal and social concerns, were neglected because of the overriding focus on examination success to maintain the school’s position in the education marketplace. The article offers detailed evidence from the students’ perspective to support the claim that the marketisation of the education system leads to students being valued only in as far as they bring value to the school. It also suggests that care is one of the main casualties in such a system

Gender politics in 21st century literacy reform

From 2001 to 2004 Education Queensland undertook significant literacy reform in schools through the Literate Futures Project. Research into the impact of this reform has revealed that significant demands were placed on women at all levels, from those producing resources to those leading change within schools. Although the reform was a government response to globalisation, many women were driven by a commitment to a collaborative approach to professional learning that addressed equity and improving educational outcomes for all students. But what was the cost of this commitment to the project? Failure to acknowledge the emotion work demanded by educational reform effectively silences women and the significant contribution they make. This paper examining a 21st century literacy reform draws on the work of Fraser and Boler to argue for gender justice and acknowledgement of emotion work

Impacts of the 2014-2015 Holuhraun eruption on the UK atmosphere

Volcanic emissions, specifically from Iceland, pose a pan-European risk and are on the UK National Risk Register due to potential impacts on aviation, public health, agriculture, the environment and the economy, both from effusive and explosive activity. During the 2014-2015 fissure eruption at Holuhraun in Iceland, the UK atmosphere was significantly perturbed. This study focuses one major incursion in September 2014, affecting the surface concentrations of both aerosols and gases across the UK, with sites in Scotland experiencing the highest sulfur dioxide (SO2) concentrations. The perturbation event observed was confirmed to originate from the fissure eruption using satellite data from GOME2B and the chemical transport model, EMEP4UK, which was used to establish the spatial distribution of the plume over the UK during the event of interest. At the two UK European Monitoring and Evaluation Program (EMEP) supersite observatories (Auchencorth Moss, SE Scotland and Harwell, SE England) significant alterations in sulfate (SO42-) content of PM10 and PM2.5 during this event, concurrently with evidence of an increase in ultrafine aerosol, most likely due to nucleation and growth of aerosol within the plume, were observed. At Auchencorth Moss, higher hydrochloric acid (HCl) concentrations during the September event (max = 1.21 µg m-3, c.f annual average 0.12 µg m-3 35 in 2013), were assessed to be due to acid displacement of chloride (Cl-) from sea salt (NaCl) to form HCl gas rather than due to primary emissions of HCl from Holuhraun. The gas and aerosol partioning at Auchencorth moss of inorganic species by thermodynamic modelling, confirmed the observed partioning of HCl. Using the data from the chemical thermodynamic model, ISORROPIA-II, there is evidence that the background aerosol, which is typically basic at this site, became acidic with an estimated pH of 3.8 during the peak of the event. Volcano plume episodes were periodically observed by the majority of the UK air quality monitoring networks during the first 4 months of the eruption (August – December 2014), at both hourly and monthly resolution. In the low resolution networks, which provide monthly SO2 averages, concentrations were found to be significantly elevated at remote “clean” sites in NE Scotland and SW England, with record high SO2 concentrations for some sites in September 2014. For sites which are regularly influenced by anthropogenic emissions, taking into account the underlying trends, the eruption led to statistically unremarkable SO2 concentrations (return probabilities >0.1, ~10 months). However for a few sites, SO2 concentrations were clearly much higher than has been previously observed (return probability 3000 months). The Holuhraun Icelandic eruption has resulted in a unique study providing direct evidence of atmospheric chemistry perturbation of both gases and aerosols in the UK background atmosphere. The measurements can be used to both challenge and verify existing atmospheric chemistry of volcano plumes, especially those originating from effusive eruptions, which have been under-explored, due to limited observations available in the literature. If all European data sets were collated this would allow improved model verification and risk assessments for future volcanic eruptions of this type

Schools and civil society : corporate or community governance

School improvement depends upon mediating the cultural conditions of learning as young people journey between their parochial worlds and the public world of cosmopolitan society. Governing bodies have a crucial role in including or diminishing the representation of different cultural traditions and in enabling or frustrating the expression of voice and deliberation of differences whose resolution is central to the mediation of and responsiveness to learning needs. A recent study of governing bodies in England and Wales argues that the trend to corporatising school governance will diminish the capacity of schools to learn how they can understand cultural traditions and accommodate them in their curricula and teaching strategies. A democratic, stakeholder model remains crucial to the effective practice of governing schools. By deliberating and reconciling social and cultural differences, governance constitutes the practices for mediating particular and cosmopolitan worlds and thus the conditions for engaging young people in their learning, as well as in the preparation for citizenship in civil society