Stem cell therapy for the treatment of early stage avascular necrosis of the femoral head: a systematic review

BACKGROUND: Avascular necrosis (AVN) of the femoral head (FH) is believed to be caused by a multitude of etiologic factors and is associated with significant morbidity in younger populations. Eventually, the disease progresses and results in FH collapse. Thus, a focus on early disease management aimed at joint preservation by preventing or delaying progression is key. The use of stem cells (SC) for the treatment of AVN of the FH has been proposed. We undertook a systematic review of the medical literature examining the use of SC for the treatment of early stage (precollapse) AVN of the FH, in both pre-clinical and clinical studies. METHODS: Data collected included: Pre-clinical studies – model of AVN, variety and dosage of SC, histologic and imaging analyses. Clinical studies – study design, classification and etiology of AVN, SC dosage and treatment protocol, incidence of disease progression, patient reported outcomes, volume of necrotic lesion and hip survivorship. RESULTS: In pre-clinical studies, the use of SC uniformly demonstrated improvements in osteogenesis and angiogenesis, yet source of implanted SC was variable. In clinical studies, groups treated with SC showed significant improvements in patient reported outcomes; however hip survivorship was not affected. Discrepancies regarding dose of SC, AVN etiology and disease severity were present. CONCLUSIONS: Routine use of this treatment method will first require further research into dose and quality optimization as well as confirmed improvements in hip survivorship

Veiled Women in the American Courtroom: Is the Niqab a Barrier to Justice?

U.S. courts and policy-makers have recently authorized laws and practices that interfere with the wearing of religious modesty attire that conceals the hair or face in contexts such as courtroom testimony or driver’s license issuance. For example, in response to a court’s dismissal of the case of a woman who refused to remove her niqab in the courtroom, the Michigan Supreme Court decided that judges can exercise “reasonable control” over the appearance of courtroom parties. But what degree of control over religious attire is reasonable? The Constitution will not allow a blanket niqab removal policy based on any of the following needs: to judge demeanor or veracity, to identify witnesses, to compel accountability, or to identify and avert bias. Where the state’s interest in niqab removal is truly compelling, for the sake of religious free exercise it should be protected in the least restrictive manner. I argue that because Muslim women who wear the niqab in the courtroom are neither disruptive nor an affront to the dignity of the court, their religious freedom to dress modestly should be accommodated in straightforward and available ways

Automated underwriting in life insurance: Predictions and optimisation

© Springer International Publishing AG, part of Springer Nature 2018. Underwriting is an important stage in the life insurance process and is concerned with accepting individuals into an insurance fund and on what terms. It is a tedious and labour-intensive process for both the applicant and the underwriting team. An applicant must fill out a large survey containing thousands of questions about their life. The underwriting team must then process this application and assess the risks posed by the applicant and offer them insurance products as a result. Our work implements and evaluates classical data mining techniques to help automate some aspects of the process to ease the burden on the underwriting team as well as optimise the survey to improve the applicant experience. Logistic Regression, XGBoost and Recursive Feature Elimination are proposed as techniques for the prediction of underwriting outcomes. We conduct experiments on a dataset provided by a leading Australian life insurer and show that our early-stage results are promising and serve as a foundation for further work in this space

Cancer incidence in the south Asian population of England (1990–92)

Cancer incidence among English south Asians (residents in England with ethnic origins in India, Pakistan or Bangladesh) is described and compared with non-south Asian and Indian subcontinent rates. The setting for the study was areas covered by Thames, Trent, West Midlands and Yorkshire cancer registries. The study identified 356 555 cases of incident cancer (ICD9:140–208) registered between 1990 and 1992, including 3845 classified as English south Asian. The main outcome measures were age specific and directly standardized incidence rates for all cancer sites (ICD9:140–208). English south Asian incidence rates for all sites combined were significantly lower than non-south Asian rates but higher than Indian subcontinent rates. English south Asian rates were substantially higher than Indian subcontinent rates for a number of common sites including lung cancer in males, breast cancer in females and lymphoma in both sexes. English south Asian rates for childhood and early adult cancer (0–29 years) were similar or higher than non-south Asian rates. English south Asian rates were significantly higher than non-south Asian rates for Hodgkin's disease in males, cancer of the tongue, mouth, oesophagus, thyroid gland and myeloid leukaemia in females, and cancer of the hypopharynx, liver and gall bladder in both sexes. The results are consistent with a transition from the lower cancer risk of the country of ethnic origin to that of the country of residence. They suggest that detrimental changes in lifestyle and other exposures have occurred in the migrant south Asian population. © 1999 Cancer Research Campaig

“Not walled facts, their essence”: Derek Walcott’s Tiepolo’s Hound and Camille Pissarro

Life-writing — a genre which goes beyond traditional biography, includes both fact and fiction, and is concerned with either entire lives or days-in-the-lives of individuals, communities, objects, or institutions — has always played an important role in Derek Walcott’s work, from Another Life (1973),Walcott’s autobiography in verse, to his last play O Starry Starry Night (2014), where he re-imagines Paul Gauguin and Vincent Van Gogh’s (often tempestuous) cohabitation in the so-called “Yellow House” in 1888 Arles. In Tiepolo’s Hound (2000), Walcott’s life rhymes with that of the Impressionist painter Jacob Camille Pissarro, who was born in the Caribbean island of St Thomas in 1830. In this work, biographical and autobiographical impulses, fact and fiction, are productively combined, as “creation” (what “might have happened”) shapes Walcott’s life-writing as much as “recreation” (what “actually” happened). Walcott’s Pissarro is an individual immersed in a set of historical networks but also a figure at the centre of a web of imagined relations which illuminate the predicament of present and past artists in the Caribbean region and the ways in which they articulate their vision vis-à-vis the metropolitan centre, their relationship with their social and natural environment, and their individual and collective identity. Tiepolo’s Hound is enriched by the inclusion of twenty-six of Walcott’s own paintings which engage in conversation with the poet’s words and add complexity to his meditation on the nature and purpose of (re)writing and (re)creating lives. Extending the catholicity of life-writing to animals, in this case dogs and, in particular, mongrels, Tiepolo’s Hound also entails a careful, if counterintuitive, evaluation of anonymity

Predictors of Multidrug- and Extensively Drug-Resistant Tuberculosis in a High HIV Prevalence Community

BACKGROUND: Multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB) have emerged in high-HIV-prevalence settings, which generally lack laboratory infrastructure for diagnosing TB drug resistance. Even where available, inherent delays with current drug-susceptibility testing (DST) methods result in clinical deterioration and ongoing transmission of MDR and XDR-TB. Identifying clinical predictors of drug resistance may aid in risk stratification for earlier treatment and infection control. METHODS: We performed a retrospective case-control study of patients with MDR (cases), XDR (cases) and drug-susceptible (controls) TB in a high-HIV-prevalence setting in South Africa to identify clinical and demographic risk factors for drug-resistant TB. Controls were selected in a 1:1:1 ratio and were not matched. We calculated odds ratios (OR) and performed multivariate logistic regression to identify independent predictors. RESULTS: We enrolled 116, 123 and 139 patients with drug-susceptible, MDR, and XDR-TB. More than 85% in all three patient groups were HIV-infected. In multivariate analysis, MDR and XDR-TB were each strongly associated with history of TB treatment failure (adjusted OR 51.7 [CI 6.6-403.7] and 51.5 [CI 6.4-414.0], respectively) and hospitalization more than 14 days (aOR 3.8 [CI 1.1-13.3] and 6.1 [CI 1.8-21.0], respectively). Prior default from TB treatment was not a risk factor for MDR or XDR-TB. HIV was a risk factor for XDR (aOR 8.2, CI 1.3-52.6), but not MDR-TB. Comparing XDR with MDR-TB patients, the only significant risk factor for XDR-TB was HIV infection (aOR 5.3, CI 1.0-27.6). DISCUSSION: In this high-HIV-prevalence and drug-resistant TB setting, a history of prolonged hospitalization and previous TB treatment failure were strong risk factors for both MDR and XDR-TB. Given high mortality observed among patients with HIV and drug-resistant TB co-infection, previously treated and hospitalized patients should be considered for empiric second-line TB therapy while awaiting confirmatory DST results in settings with a high-burden of MDR/XDR-TB

Microtubule sliding activity of a kinesin-8 promotes spindle assembly and spindle length control

Molecular motors play critical roles in the formation of mitotic spindles, either through controlling the stability of individual microtubules, or by cross-linking and sliding microtubule arrays. Kinesin-8 motors are best known for their regulatory roles in controlling microtubule dynamics. They contain microtubule-destabilizing activities, and restrict spindle length in a wide variety of cell types and organisms. Here, we report for the first time on an anti-parallel microtubule-sliding activity of the budding yeast kinesin-8, Kip3. The in vivo importance of this sliding activity was established through the identification of complementary Kip3 mutants that separate the sliding activity and microtubule destabilizing activity. In conjunction with kinesin-5/Cin8, the sliding activity of Kip3 promotes bipolar spindle assembly and the maintenance of genome stability. We propose a “slide-disassemble” model where Kip3’s sliding and destabilizing activity balance during pre-anaphase. This facilitates normal spindle assembly. However, Kip3’s destabilizing activity dominates in late anaphase, inhibiting spindle elongation and ultimately promoting spindle disassembly