School Naming Rights and the First Amendment’s Perfect Storm

In the past five years, public schools across the country have begun to explore a new avenue of fundraising: selling naming rights to school facilities. The popularity and monetary value of these sales, however, only highlight the importance of the First Amendment concerns they raise. This Article uses school naming rights as a lens through which to examine the conflicts between government speech, commercial speech, and forum analysis, three categories of First Amendment analysis that are simultaneously and problematically implicated by school naming rights sales. Courts and scholars have long noted the internal ambiguities within these three categories, but have not yet explored the sometimes irreconcilable conflicts among them. As the growth of school naming rights shows, government sponsorship arrangements collapse many of the artificial divisions between the First Amendment’s categories and demonstrate the need for a better understanding of the categories’ interactions. This Article identifies—and attempts to resolve—some of the border disputes between these poorly defined and increasingly important areas of First Amendment law

Natural and cryptic peptides dominate the immunopeptidome of atypical teratoid rhabdoid tumors

BACKGROUND: Atypical teratoid/rhabdoid tumors (AT/RT) are highly aggressive CNS tumors of infancy and early childhood. Hallmark is the surprisingly simple genome with inactivating mutations or deletions in the SMARCB1 gene as the oncogenic driver. Nevertheless, AT/RTs are infiltrated by immune cells and even clonally expanded T cells. However, it is unclear which epitopes T cells might recognize on AT/RT cells. METHODS: Here, we report a comprehensive mass spectrometry (MS)-based analysis of naturally presented human leukocyte antigen (HLA) class I and class II ligands on 23 AT/RTs. MS data were validated by matching with a human proteome dataset and exclusion of peptides that are part of the human benignome. Cryptic peptide ligands were identified using Peptide-PRISM. RESULTS: Comparative HLA ligandome analysis of the HLA ligandome revealed 55 class I and 139 class II tumor-exclusive peptides. No peptide originated from the SMARCB1 region. In addition, 61 HLA class I tumor-exclusive peptide sequences derived from non-canonically translated proteins. Combination of peptides from natural and cryptic class I and class II origin gave optimal representation of tumor cell compartments. Substantial overlap existed with the cryptic immunopeptidome of glioblastomas, but no concordance was found with extracranial tumors. More than 80% of AT/RT exclusive peptides were able to successfully prime CD8(+) T cells, whereas naturally occurring memory responses in AT/RT patients could only be detected for class II epitopes. Interestingly, >50% of AT/RT exclusive class II ligands were also recognized by T cells from glioblastoma patients but not from healthy donors. CONCLUSIONS: These findings highlight that AT/RTs, potentially paradigmatic for other pediatric tumors with a low mutational load, present a variety of highly immunogenic HLA class I and class II peptides from canonical as well as non-canonical protein sources. Inclusion of such cryptic peptides into therapeutic vaccines would enable an optimized mapping of the tumor cell surface, thereby reducing the likelihood of immune evasion

Global, regional, and national under-5 mortality, adult mortality, age-specific mortality, and life expectancy, 1970–2016: a systematic analysis for the Global Burden of Disease Study 2016

BACKGROUND: Detailed assessments of mortality patterns, particularly age-specific mortality, represent a crucial input that enables health systems to target interventions to specific populations. Understanding how all-cause mortality has changed with respect to development status can identify exemplars for best practice. To accomplish this, the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) estimated age-specific and sex-specific all-cause mortality between 1970 and 2016 for 195 countries and territories and at the subnational level for the five countries with a population greater than 200 million in 2016. METHODS: We have evaluated how well civil registration systems captured deaths using a set of demographic methods called death distribution methods for adults and from consideration of survey and census data for children younger than 5 years. We generated an overall assessment of completeness of registration of deaths by dividing registered deaths in each location-year by our estimate of all-age deaths generated from our overall estimation process. For 163 locations, including subnational units in countries with a population greater than 200 million with complete vital registration (VR) systems, our estimates were largely driven by the observed data, with corrections for small fluctuations in numbers and estimation for recent years where there were lags in data reporting (lags were variable by location, generally between 1 year and 6 years). For other locations, we took advantage of different data sources available to measure under-5 mortality rates (U5MR) using complete birth histories, summary birth histories, and incomplete VR with adjustments; we measured adult mortality rate (the probability of death in individuals aged 15-60 years) using adjusted incomplete VR, sibling histories, and household death recall. We used the U5MR and adult mortality rate, together with crude death rate due to HIV in the GBD model life table system, to estimate age-specific and sex-specific death rates for each location-year. Using various international databases, we identified fatal discontinuities, which we defined as increases in the death rate of more than one death per million, resulting from conflict and terrorism, natural disasters, major transport or technological accidents, and a subset of epidemic infectious diseases; these were added to estimates in the relevant years. In 47 countries with an identified peak adult prevalence for HIV/AIDS of more than 0·5% and where VR systems were less than 65% complete, we informed our estimates of age-sex-specific mortality using the Estimation and Projection Package (EPP)-Spectrum model fitted to national HIV/AIDS prevalence surveys and antenatal clinic serosurveillance systems. We estimated stillbirths, early neonatal, late neonatal, and childhood mortality using both survey and VR data in spatiotemporal Gaussian process regression models. We estimated abridged life tables for all location-years using age-specific death rates. We grouped locations into development quintiles based on the Socio-demographic Index (SDI) and analysed mortality trends by quintile. Using spline regression, we estimated the expected mortality rate for each age-sex group as a function of SDI. We identified countries with higher life expectancy than expected by comparing observed life expectancy to anticipated life expectancy on the basis of development status alone. FINDINGS: Completeness in the registration of deaths increased from 28% in 1970 to a peak of 45% in 2013; completeness was lower after 2013 because of lags in reporting. Total deaths in children younger than 5 years decreased from 1970 to 2016, and slower decreases occurred at ages 5-24 years. By contrast, numbers of adult deaths increased in each 5-year age bracket above the age of 25 years. The distribution of annualised rates of change in age-specific mortality rate differed over the period 2000 to 2016 compared with earlier decades: increasing annualised rates of change were less frequent, although rising annualised rates of change still occurred in some locations, particularly for adolescent and younger adult age groups. Rates of stillbirths and under-5 mortality both decreased globally from 1970. Evidence for global convergence of death rates was mixed; although the absolute difference between age-standardised death rates narrowed between countries at the lowest and highest levels of SDI, the ratio of these death rates-a measure of relative inequality-increased slightly. There was a strong shift between 1970 and 2016 toward higher life expectancy, most noticeably at higher levels of SDI. Among countries with populations greater than 1 million in 2016, life expectancy at birth was highest for women in Japan, at 86·9 years (95% UI 86·7-87·2), and for men in Singapore, at 81·3 years (78·8-83·7) in 2016. Male life expectancy was generally lower than female life expectancy between 1970 and 2016, an

Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

BACKGROUND: Measurement of changes in health across locations is useful to compare and contrast changing epidemiological patterns against health system performance and identify specific needs for resource allocation in research, policy development, and programme decision making. Using the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we drew from two widely used summary measures to monitor such changes in population health: disability-adjusted life-years (DALYs) and healthy life expectancy (HALE). We used these measures to track trends and benchmark progress compared with expected trends on the basis of the Socio-demographic Index (SDI). METHODS: We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2016. We calculated DALYs by summing years of life lost and years of life lived with disability for each location, age group, sex, and year. We estimated HALE using age-specific death rates and years of life lived with disability per capita. We explored how DALYs and HALE differed from expected trends when compared with the SDI: the geometric mean of income per person, educational attainment in the population older than age 15 years, and total fertility rate. FINDINGS: The highest globally observed HALE at birth for both women and men was in Singapore, at 75·2 years (95% uncertainty interval 71·9-78·6) for females and 72·0 years (68·8-75·1) for males. The lowest for females was in the Central African Republic (45·6 years [42·0-49·5]) and for males was in Lesotho (41·5 years [39·0-44·0]). From 1990 to 2016, global HALE increased by an average of 6·24 years (5·97-6·48) for both sexes combined. Global HALE increased by 6·04 years (5·74-6·27) for males and 6·49 years (6·08-6·77) for females, whereas HALE at age 65 years increased by 1·78 years (1·61-1·93) for males and 1·96 years (1·69-2·13) for females. Total global DALYs remained largely unchanged from 1990 to 2016 (-2·3% [-5·9 to 0·9]), with decreases in communicable, maternal, neonatal, and nutritional (CMNN) disease DALYs offset by increased DALYs due to non-communicable diseases (NCDs). The exemplars, calculated as the five lowest ratios of observed to expected age-standardised DALY rates in 2016, were Nicaragua, Costa Rica, the Maldives, Peru, and Israel. The leading three causes of DALYs globally were ischaemic heart disease, cerebrovascular disease, and lower respiratory infections, comprising 16·1% of all DALYs. Total DALYs and age-standardised DALY rates due to most CMNN causes decreased from 1990 to 2016. Conversely, the total DALY burden rose for most NCDs; however, age-standardised DALY rates due to NCDs declined globally. INTERPRETATION: At a global level, DALYs and HALE continue to show improvements. At the same time, we observe that many populations are facing growing functional health loss. Rising SDI was associated with increases in cumulative years of life lived with disability and decreases in CMNN DALYs offset by increased NCD DALYs. Relative compression of morbidity highlights the importance of continued health interventions, which has changed in most locations in pace with the gross domestic product per person, education, and family planning. The analysis of DALYs and HALE and their relationship to SDI represents a robust framework with which to benchmark location-specific health performance. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform health policies, health system improvement initiatives, targeted prevention efforts, and development assistance for health, including financial and research investments for all countries, regardless of their level of sociodemographic development. The presence of countries that substantially outperform others suggests the need for increased scrutiny for proven examples of best practices, which can help to extend gains, whereas the presence of underperforming countries suggests the need for devotion of extra attention to health systems that need more robust support. FUNDING: Bill & Melinda Gates Foundation

Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990-2015 : a novel analysis from the Global Burden of Disease Study 2015

Background National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015. Methods We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure-the Healthcare Quality and Access (HAQ) Index-on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r= 0.88), an index of 11 universal health coverage interventions (r= 0.83), and human resources for health per 1000 (r= 0.77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time. Findings Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28.6 to 94.6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40.7 (95% uncertainty interval, 39.0-42.8) in 1990 to 53.7 (52.2-55.4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21.2 in 1990 to 20.1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73.8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015. Interpretation This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-systemcharacteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world. Copyright (C) The Author(s). Published by Elsevier Ltd.Peer reviewe

Expression of immunmodulation markers in correlation with immuntherapy in pediatric brain tumors

Atypische teratoide Rhabdoidtumore sind trotz Ausschöpfen der multimodalen Therapieoptionen weiterhin mit einer schlechten Prognose belastet. Gründe hierfür liegen in den oftmals unzureichenden Resektionsmöglichkeiten, dem jungen Erkrankungsalter der PatientInnen und der Resistenz der Tumorzellen gegenüber Chemotherapeutika (Frühwald et al. 2020; Egiz et al. 2022; Richards et al. 2019). Gerade deshalb versucht man durch die aktuelle Forschung zu kindlichen Hirntumoren mit Immuntherapie ein besseres Outcome zu erreichen. Wichtige Grundlagen hierzu sind durch diese Arbeit dargestellt worden. Erstmals wurde gezeigt, dass Tumorzellen der AT/RT sowohl HLA-Klasse I und -Klasse II Antigene präsentieren. Es wurde außerdem die Expression von PD-L1 nachgewiesen. Des Weiteren konnte die Anwesenheit von Immunzellen durch den Nachweis CD 3+ Zellen bewiesen werden. Insgesamt zeigte sich eine große Heterogenität innerhalb des einzelnen und unter den verschiedenen Tumoren. Es zeigte sich eine negative Korrelation zwischen der Expression von MHC I und CD 3+ Zellen, welche insgesamt für einen Tumor Escape Mechanismus sprechen könnte, wie er bereits bei Glioblastomen nachgewiesen wurde (Bagley et al. 2018; Marcu et al. 2021). Es sollte eine Ausweitung der hier begonnen Forschung mit Einbeziehung der personenbezogenen Daten und Vergrößerung der untersuchten Fallzahl erfolgen.Even with using the multimodal therapy options available, atypical teratoid rhabdoid tumors still have a poor prognosis. This is caused by limited chirurgical resection, the young age of the patient cohort and resistence to chemotherapeutics (Frühwald et al.2020; Egiz et al. 2022; Richards et al. 2019). Hence, current research is trying to acchieve a better outcome through immunotherapy. Important fundamental research is done by this work. For the first time, it has been shown that tumorcells of AT/RT express HLA-class I and -class II antigens. Furthermore PD-L1 is expressed by these tumorcells. The presence of immuncells is proved by the evidence of CD 3+ cells. In total, a great heterogeneity presented in one tumor itself and in between the diffrent tumors examined. This work pointed out a negativ correlation between the expression of MHC I and CD 3+ cells, which could show a tumor escape mechanism, like it is already proven for glioblastoma multiforme (Bagley et al. 2018; Marcu et al. 2021). Beside that here is need for further studys with a bigger case number and link to personal and clinical data

Man's experience on treatment and emotional support for induced abortion

Bakgrund: Abort kan utföras medicinskt eller kirurgiskt. I världen beräknades cirka 20 procent av alla graviditeter avslutas genom abort. Årligen sker 35 000 – 40 000 aborter i Sverige. Sveriges nuvarande abortlag stiftades år 1974 och ger kvinnan ensamrätt att besluta om abort till och med utgången graviditetsvecka 18. Tidigare studier fokuserar främst på kvinnors perspektiv på och erfarenheter av bemötande och stöd vid abort. Undersökningar och studier som utgår från mäns upplevelser och inställning till abort visar att män i många fall också är i behov av stöd och samtal. Syfte: Syftet var att beskriva mannens upplevelse av bemötande och emotionellt stöd från hälso- och sjukvårdspersonal vid inducerad abort. Metod: Studien utgick från en kvalitativ metod som gav möjlighet att ta del av mannens perspektiv på bemötande och emotionellt stöd vid en inducerad abort. Sex män i åldrarna 23-28 år deltog i studien. Intervjuguiden som användes vid intervjuerna inriktades på två teman, bemötande och emotionellt stöd. Samtliga intervjuer spelades in med ljudbandspelare, varefter de transkriberades och analyserades med hjälp av innehållsanalys som metod. Resultat: Vid intervjuerna framkom att männen erhöll individanpassad information gällande hela abortprocessen, vilket de ansåg som positivt och viktigt. Männen framhöll att vårdpersonalen agerade utifrån ett professionellt förhållningssätt. De beskrev professionellt förhållningssätt som t.ex. att de hade kunskap inom området, höll sina egna åsikter utanför och att de visade förståelse för parets situation. Alla män påverkades känslomässigt av aborten och var därmed i behov av emotionellt stöd. Mannens känslomässiga upplevelse kring aborten varierade från individ till individ, vilket gjorde att behovet av emotionelltstöd såg olika ut. Gemensamt var att de ville ha någon att tala och dela sina känslor med. Slutsats: Studiens resultat visade att män som varit med om inducerad abort upplevde bemötandet och det emotionella stödet från vårdpersonalen som positivt. Vidare tyder resultatet på att mannen var i behov av och fick individanpassad information som fokuserade på hela abortprocessens gång. Genom ett professionellt förhållningssätt och emotionellt stöd från vårdpersonal som utgick från individens behov kände mannen sig delaktig i abortprocessen. Den viktigaste slutsatsen som kan dras utifrån denna studie är att vårdpersonalen har fokus på både mannen och kvinnan när det gäller bemötande och stöd vid inducerad abort

Design of user interface for application to assist elderly in every day life

I denna rapport beskrivs arbetet med att ta fram ett gränssnitt till en applikation för äldre. Målet med applikationen är att öka tryggheten och underlätta för äldre i vardagen, samt att minska social isolering. Frågeställningarna grundades dels på vilka funktioner som är relevanta och önskvärda i en sådan applikation, dels hur applikationen ska anpassas efter såväl låg teknikvana, som fysiska och kognitiva nedsättningar som är vanliga vid hög ålder. Arbetet inleddes med litteraturstudier om målgruppen, dess behov och svårigheter. Relaterade arbeten och liknande produkter granskades. Dessutom studerades olika designmetoder och -verktyg som ansågs vara relevanta för projektet. Arbetsprocessen bestod av iterativa cyklar där designval och funktioner diskuterades och utvecklades med hjälp av olika designverktyg. Dessa utvärderades sedan genom användartester. Resultatet från testerna analyserades och bidrog till ändringar och vidarutvecklingar i nästa cykel. Resultatet består av en interaktiv prototyp som grundar sig i teori och de upptäckter som gjorts under arbetets gång. Rapporten avslutas med en diskussion om huruvida resultatet uppfyllde målen och vad som fungerat bra och mindre bra i arbetsprocessen. Dessutom diskuteras etiska aspekter med arbetet och möjlig vidareutveckling

Analys av utleveransprocessen hos PostNord Logistics

En utleveransprocess hos PostNord Logistics analyserades för att identifiera problemområden i processen. Utleveransprocessen analyserades genom en kartläggning och med hjälp av simuleringsverktyget Arena. Lean strategin användes sedan för att hitta grundorsakerna till problemområdet som identifierats i simuleringsmodellen. De främsta rekommendationerna till PostNord Logistics är att organisera produkterna i lager, införa en plockstrategi för att skapa en effektivare process och eliminera problemområdena

Design of user interface for application to assist elderly in every day life

I denna rapport beskrivs arbetet med att ta fram ett gränssnitt till en applikation för äldre. Målet med applikationen är att öka tryggheten och underlätta för äldre i vardagen, samt att minska social isolering. Frågeställningarna grundades dels på vilka funktioner som är relevanta och önskvärda i en sådan applikation, dels hur applikationen ska anpassas efter såväl låg teknikvana, som fysiska och kognitiva nedsättningar som är vanliga vid hög ålder. Arbetet inleddes med litteraturstudier om målgruppen, dess behov och svårigheter. Relaterade arbeten och liknande produkter granskades. Dessutom studerades olika designmetoder och -verktyg som ansågs vara relevanta för projektet. Arbetsprocessen bestod av iterativa cyklar där designval och funktioner diskuterades och utvecklades med hjälp av olika designverktyg. Dessa utvärderades sedan genom användartester. Resultatet från testerna analyserades och bidrog till ändringar och vidarutvecklingar i nästa cykel. Resultatet består av en interaktiv prototyp som grundar sig i teori och de upptäckter som gjorts under arbetets gång. Rapporten avslutas med en diskussion om huruvida resultatet uppfyllde målen och vad som fungerat bra och mindre bra i arbetsprocessen. Dessutom diskuteras etiska aspekter med arbetet och möjlig vidareutveckling