Striking enhancement at the site of radiation for nivolumab-induced Stevens-Johnson syndrome

Stevens-Johnson syndrome is a rare adverse cutaneous drug reaction characterized by epidermal detachment of <10% body surface area with an average mortality rate of 1-5%. The mechanism of SJS is not fully understood. Nivolumab is a monoclonal antibody directed against programmed cell death-1 protein (PD-1), a receptor with immune checkpoint inhibitory and antineoplastic activities. We present a case of SJS in a patient being treated with anti-PD-1 therapy nivolumab for metastatic squamous cell carcinoma of the oropharynx. This case is unusual because of the severe accentuation with striking enhancement at his prior radiation site and in the cutaneous region with heavier tumor burden from his metastatic disease. This reaction may give insight to the underlying pathophysiology of SJS, suggesting that immune checkpoint inhibitors can activate T-cells to target keratinocytes and that external factors may be involved in creating distinct epitopes for T-cell recognition. We hope this case adds to the body of knowledge in the pathogenesis of Stevens-Johnson syndrome and cutaneous adverse events seen with checkpoint inhibitors

Debate: ‘Robust performance management’ or workplace bullying? Not just the ‘what’ but the ‘how’

There is a very fine and difficult to detect line between what can be called ‘robust performancfae management’ and workplace bullying. Most policies, guidance notes, codes of practice and legislative provisions are clear in that ‘reasonable management’ action does not constitute workplace bullying. But what is ‘reasonable management’ action? And are these few simple words enough to delineate justified management behaviour for corrective action from workplace bullying behaviour that is abusive, unfair, harsh, aggressive, ‘over-the-top’, ‘nit-picky’ and unrelenting? This distinction is more complicated than it first appears. A study of workplace bullying in the Australian public service found that a small number of victims reported increased productivity after being bullied. This may point to a number of scenarios, including the alleged victims’ performance having been sub-standard in the first place, and/or manager action having had positive effects on productivity, quality of work and output. It may also be that the alleged victims pushed themselves even harder in response to being bullied, and performed better in the hope that the bullying would stop. So, is this robust performance management and therefore ‘reasonable management’ action, or is it workplace bullying? The answer here is not only about the ‘what’, but also the ‘how’

Public sector work intensification and negative behaviors

Purpose – The purpose of this paper is to explore issues associated with sector specific change in the Australian Public Service (APS). Evidence is presented on the impact of New Public Management (NPM) on work intensification and subsequent negative behaviors by giving voice to APS employees who were subject to the NPM changes. Design/methodology/approach – Data were collected from APS employees, human resource managers and policy makers across 11 agencies on the nature of the changes, context of work, and workplace interactions. The study adopted a triangulated mixed method interpretivist approach using a survey instrument, stories, focus groups, and interviews. Findings – The NPM changes were aimed at creating a more professional and accountable APS. This resulted in individual agencies pursuing different approaches to productivity and efficiency while being accountable to the public and the government within a tight regulatory framework. These changes created competing priorities, affected the nature of the work through intensification, and fueled workplace tensions, thus affecting progress toward the goals of NPM. Practical implications – The findings of this study will be useful in alerting organizational leaders of possible unintended negative consequences of poorly implemented change programs. Originality/value – This current study provides evidence that the negative behaviors which arise from the implementation of efficiency focussed change can be damaging to individuals, the nature of work, and therefore organizations and the outcomes sought. Many change management activities in the public sector can lead to negative behaviors if implemented in a way lacking in respect for staff

Educational Dimension of Woman's Character in the Narration's of Prophets as Stated in the Holy Qur'an

The Holy Qur'an has addressed the needs of women and their status in a way never done before in any other religious text. Woman's exalted position in Islam is due, primarily, to her role as a child rearer. It is she who is considered the "first madrasah" (first school) by Islam, and it is from her that children will learn about their responsibility as future 'standard bearers' of Islam and society. The research examines stories and biographies of women in the Qur'an, narrated by various prophets (peace be upon them) through the ages. These stories have been drawn from sound Islamic sources. not the doubtful narrations of Israelite scriptures, showing, through their life stories, women's attitude nature, some positive and others negative. This provides an authentic and comprehensive view of Muslim women from the Qur'anic perspective. It puts forward an educational model for women to realize their true role in the challenging times in which we live. By studying the attitudes and dispositions of women in the Holy Qur'an and the Sunna of the Prophet Muhammad (peace and blessings be upon him) the research illustrates the merits. morals and role of women as educators in the family, as well as society. It also shows the extent to which a Muslim women can harm or benefit each member of her family. The study also shows the scope of educational techniques in the Holy Qur'an and their impact on the attitudes and character of women. It delineates the educational role of women and the features of women's character through investigation of previous religions and comparison with those in Islam. In this way, we can become more acquainted with the characteristics of women, her tasks, rights, duties and the type of work suited to her outside the family

Synthesis and characterization of perovskite oxides lafe1-xcuxo3 (0 ≤ x ≤ 0.4) obtained by sol-gel method

LaFe1-xCuxO3 (where x ranged from 0 to 0.4) powders are successfully synthesized by the solgel method employing metal nitrate salts as cations precursors and methanol as solvent. Thermogravimetric and differential thermal analysis (TGA/DTA) results exhibit that decomposition of the precursor to the oxide completed at about 750°C. XRD patterns exhibit that the materials belong to a cubic system. All samples show two IR active vibrational modes, one at 560 cm-1 assigned to Fe-O stretching vibration and another one at 1385 cm-1 assigned to the stretching of metal carbonates. SEM images of the samples show that the particle size is from 63 to 158 nm and the specific surface areas are relatively low. The electrochemical measurements exhibit that the catalytic activity is influenced by copper doping. The highest electrode performance is achieved with the oxide LaFe0.7Cu0.3O3.Keywords: perovskite oxide, sol-gel, thermogravimetric analysis, powder diffraction,electrochemical properties

Making sense of 'bullying' behaviour: Individual perspectives on critical incidents

Despite the recent growth of research on workplace bullying researchers have had little opportunity to study how individuals come to be labeled as bullies. While bullying is sometimes described in terms of individuals‟ perceptions, researchers lack a framework for working through the subjectivities on both sides of the labelling process. Using the lens of sensemaking (Weick 1995), this paper considers stories of bullying related by participants in public service organisations in Australia, where data was collected from the alleged perpetrators as well as from „victims‟, bystanders and those charged with managing complaints of bullying. Our goal is to raise alternative perspectives for interpreting bullying scenarios and to commence a process of highlighting some different options for managers and researchers seeking to understand actions labelled as bullying. Sensemaking theory offers quite a different and detailed account of the social construction processes that might go into the use of such a label

Prenatal inhibition of the tryptophan–kynurenine pathway alters synaptic plasticity and protein expression in the rat hippocampus

Glutamate receptors sensitive to N-methyl-d-aspartate (NMDA) are important in early brain development, influencing cell proliferation and migration, neuritogenesis, axon guidance and synapse formation. The kynurenine pathway of tryptophan metabolism includes an agonist (quinolinic acid) and an antagonist (kynurenic acid) at these receptors. Rats were treated in late gestation with 3,4-dimethoxy-N-[4-(3-nitrophenyl)thiazol-2-yl]-benzene-sulphonamide (Ro61-8048), an inhibitor of kynurenine-3-monoxygenase which diverts kynurenine metabolism to kynurenic acid. Within 5 h of drug administration, there was a significant decrease in GluN2A expression and increased GluN2B in the embryo brains, with changes in sonic hedgehog at 24 h. When injected dams were allowed to litter normally, the brains of offspring were removed at postnatal day 21 (P21). Recordings of hippocampal field excitatory synaptic potentials (fEPSPs) showed that prenatal exposure to Ro61-8048 increased neuronal excitability and paired-pulse facilitation. Long-term potentiation was also increased, with no change in long-term depression. At this time, levels of GluN2A, GluN2B and postsynaptic density protein PSD-95 were all increased. Among several neurodevelopmental proteins, the expression of sonic hedgehog was increased, but DISC1 and dependence receptors were unaffected, while raised levels of doublecortin and Proliferating Cell Nuclear Antigen (PCNA) suggested increased neurogenesis. The results reveal that inhibiting the kynurenine pathway in utero leads to molecular and functional synaptic changes in the embryos and offspring, indicating that the pathway is active during gestation and plays a significant role in the normal early development of the embryonic and neonatal nervous system