Avelumab in paediatric patients with refractory or relapsed solid tumours: dose-escalation results from an open-label, single-arm, phase 1/2 trial

Background: We report dose-escalation results from an open-label, phase 1/2 trial evaluating avelumab (anti-PD-L1) in paediatric patients with refractory/relapsed solid tumours. Methods: In phase 1, patients aged \u3c 18 years with solid (including central nervous system [CNS]) tumours for which standard therapy did not exist or had failed were enrolled in sequential cohorts of 3–6 patients. Patients received avelumab 10 or 20 mg/kg intravenously every 2 weeks. Primary endpoints were dose-limiting toxicities (DLTs) and grade ≥ 3 treatment-emergent adverse events (AEs). Results: At data cut-off (27 July 2021), 21 patients aged 3–17 years had received avelumab 10 mg/kg (n = 6) or 20 mg/kg (n = 15). One patient had three events that were classified as a DLT (fatigue with hemiparesis and muscular weakness associated with pseudoprogression; 20 mg/kg cohort). Grade ≥ 3 AEs occurred in five (83%) and 11 (73%) patients in the 10 and 20 mg/kg cohorts, respectively, and were treatment-related in one patient (7%; grade 3 [DLT]) in the 20 mg/kg cohort. Avelumab exposure in paediatric patients receiving 20 mg/kg dosing, but not 10 mg/kg, was comparable or higher compared with approved adult dosing (10 mg/kg or 800 mg flat dose). No objective responses were observed. Four patients with CNS tumours (20 mg/kg cohort) achieved stable disease, which was ongoing in two patients with astrocytoma at cut-off (for 24.7 and 30.3 months). Conclusion: In paediatric patients with refractory/relapsed solid tumours, avelumab monotherapy showed a safety profile consistent with previous adult studies, but clinical benefits were limited

Postpartum nurses' perceptions of barriers to screening for intimate partner violence: a cross-sectional survey

Article deposited according to agreement with BMC, December 6, 2010.YesFunding provided by the Open Access Authors Fund

um cuidado especializado do enfermeiro obstetra

Observa-se, hoje em dia, que algumas práticas na maternidade tendem a ignorar as preferências das mulheres em trabalho de parto, uniformizando os cuidados com prejuízo para o bem-estar e a qualidade de vida das famílias. As práticas em Obstetrícia têm vindo a tornar-se cada vez mais repletas de intervenção, focando-se apenas nos resultados físicos (mortalidade e morbilidade) e descurando as vivências das parturientes e família, assim como as consequências psicossociais de um parto traumático. O presente Relatório de Estágio pretende refletir os cuidados em maternidade na perspetiva EEESMOG, que se visa holística, centrada no cliente e baseada na evidência. Da mesma forma, espelha as aprendizagens efetuadas em contexto do Estágio com Relatório inserido no 6º CMESMO da ESEL. Foram escolhidos como referenciais teóricos norteadores os modelos de Nola Pender – Modelo de Promoção da Saúde, e a Teoria de Empowerment em Saúde de Nelma Shearer. Foi também realizada uma Revisão Sistemática da Literatura que visou responder à seguinte questão de investigação: “Quais os cuidados do EEESMOG promotores do empowerment das mulheres direcionado para uma tomada de decisão informada relativa ao trabalho de parto?”. Adicionalmente, foi efetuado um registo da interação durante a prestação de cuidados no decorrer do estágio, sobre os quais foi efetuada uma reflexão e confrontação com os resultados da RSL. Concluiu-se que os cuidados que o EEESMOG presta que são promotores de uma tomada de decisão informada para o trabalho de parto se inserem dentro de três grandes temas, nomeadamente Competências da esfera relacional, Competências da esfera da prática clínica e Competências da esfera científica, com especial referência para os cuidados que se relacionam com o Estabelecimento de Relação Terapêutica, a Educação para a Saúde, o Cuidado da Mulher em trabalho de parto, a Promoção do exercício do Consentimento Informado e a Prática baseada na Evidência

THE EFFECTS OF MICROPLASTICS ON LYTECHINUS VARIEGATUS SURVIVORSHIP AND DEVELOPMENT**

Microplastics, plastic pieces smaller than five millimeters, are of growing concern in marine ecosystems because they cause multiple negative effects, including decreased survivorship and direct developmental defects. Sea urchin larvae are a target for microplastic studies because they easily ingest microplastics and are an important component of marine zooplankton communities. Prior studies examining the survival and development of Tripneustes gratilla larvae exposed to 5µm polyethylene beads found no effect on larval survivorship and only a small effect on body width development in five-day old larvae. However, it is unclear how generalizable these findings are to other sea urchin species and for other types of plastic. Our research aims to discover the effects of polystyrene microplastics on larval survivorship and body-size development in Lytechinus variegatus following the same procedures used with T. gratilla. In this study, L. variegatus larvae were divided among three treatments: treatment one had 300 algae/ml, treatment two had 150 algae and 150 5μm polystyrene beads/ml and treatment three had 300 5µm polystyrene beads/ml. Larvae were kept at a concentration of 5 larvae/ml. Percent survivorship was estimated from 5ml samples and were taken daily for 21 days. Body measurements were taken on five-day-old larvae using ImageJ. Five different body measurements were made: post-oral arm length (POA), body width, body length, the ratio of POA length to body width, and the ratio of POA length to body length. Treatments were replicated two times for survivorship and three times for arm length measurements because data were collected from larvae created during two, independent lab-spawning events. Survivorship estimates so far suggest that treatment one had the highest survivorship, treatment two had intermediate survivorship, and treatment three had the lowest survivorship. However, these results are based on only two replicates and will be repeated. Body measurements had two significant differences among treatments. Body width was significantly larger in treatment one than treatment two (p=0.005) or treatment three. Body length was significantly smaller for treatment three than treatment one (p\u3c0.001) or treatment two (p=.005). Our results suggest that microplastic effects on sea urchin larvae may not be generalizable among species or type of plastic

THE EFFECTS OF MICROPLASTICS ON SEA URCHIN LARVAL SURVIVORSHIP AND DEVELOPMENT**

Microplastics, plastic pieces smaller than five millimeters, are of growing concerns in marine ecosystems because they cause multiple negative effects, including decreased survivorship and direct developmental defects. Sea urchin larvae are a target for microplastic studies because they easily ingest microplastics and are an important component of marine zooplankton communities. Prior studies examining the survival and development of Tripneustes gratilla larvae exposed to 5µm polyethylene beads found no effect on larval survivorship and limited effects on body width development at five days post feeding (dpf). However, it is unclear how generalizable these findings are to other sea urchin species and for other types of plastic. Our research aims to understand the effects of polystyrene microplastics on larval survivorship and body-size development in Lytechinus variegatus and Arbacia punctulata following similar procedures as used with T. gratilla. In this study, L. variegatus and A. punctulata larvae were divided among three treatments that varied in microplastic concentration but were consistent in total particle concentration. The treatments were 1) 300 algae/ml; 2) 150 algae and 150 5μm polystyrene beads/ml; 3) 300 5µm polystyrene beads/ml. Larvae were kept at a concentration of 5 larvae/ml for all treatments. Percent survivorship was estimated from 5ml samples taken daily until survivorship was around zero. Body measurements were taken at 5 dpf for both species and 9 dpf for just A. punctulata larvae. Five different body measurements were made: post-oral arm length (POA), body width, body length, the ratio of POA length to body width, and the ratio of POA length to body length. Current results suggest that for L. variegatus there is lower survivorship in the treatments with beads relative to the 300 algae/ml treatment, but replication is needed for statistical analysis. Survivorship for A. punctulata was statistically lower in the treatments with beads at 5 dpf. For both species, initial results suggest limited effects on body measurements, but replication is needed. So far, our results suggest that it may be a general trend among sea urchin larvae that there are limited effects of microplastics on development, but microplastics have a larger effect on larval survivorship

Are Rural and Urban Emergency Departments Equally Prepared to Reduce Avoidable Hospitalizations?

Introduction: Attempts to reduce low-value hospital care often focus on emergency department (ED) hospitalizations. We compared rural and urban EDs in Michigan on resources designed to reduce avoidable admissions.Methods: A cross-sectional, web-based survey was emailed to medical directors and/or nurse managers of the 135 hospital-based EDs in Michigan. Questions included presence of clinical pathways, services to reduce admissions, and barriers to connecting patients to outpatient services. We performed chi-squared comparisons, regression modeling, and predictive margins.Results: Of 135 EDs, 64 (47%) responded with 33 in urban and 31 in rural counties. Clinical pathways were equally present in urban and rural EDs (67% vs 74%, p=0.5). Compared with urban EDs, rural EDs reported greater access to extended care facilities (21% vs 52%, p=0.02) but less access to observation units (52% vs 35%, p=0.04). Common barriers to connecting ED patients to outpatient services exist in both settings, including lack of social support (88% and 76%, p=0.20), and patient/family preference (68% and 68%, p=1.0). However, rural EDs were more likely to report time required for care coordination (88% vs 66%, p=0.05) and less likely to report limitations to home care (21% vs 48%, p=0.05) as barriers. In regression modeling, ED volume was predictive of the presence of clinical pathways rather than rurality.Conclusion: While rural-urban differences in resources and barriers exist, ED size rather than rurality may be a more important indicator of ability to reduce avoidable hospitalizations

Are Rural and Urban Emergency Departments Equally Prepared to Reduce Avoidable Hospitalizations?

Introduction: Attempts to reduce low-value hospital care often focus on emergency department (ED) hospitalizations. We compared rural and urban EDs in Michigan on resources designed to reduce avoidable admissions. Methods: A cross-sectional, web-based survey was emailed to medical directors and/or nurse managers of the 135 hospital-based EDs in Michigan. Questions included presence of clinical pathways, services to reduce admissions, and barriers to connecting patients to outpatient services. We performed chi-squared comparisons, regression modeling, and predictive margins. Results: Of 135 EDs, 64 (47%) responded with 33 in urban and 31 in rural counties. Clinical pathways were equally present in urban and rural EDs (67% vs 74%, p=0.5). Compared with urban EDs, rural EDs reported greater access to extended care facilities (21% vs 52%, p=0.02) but less access to observation units (52% vs 35%, p=0.04). Common barriers to connecting ED patients to outpatient services exist in both settings, including lack of social support (88% and 76%, p=0.20), and patient/family preference (68% and 68%, p=1.0). However, rural EDs were more likely to report time required for care coordination (88% vs 66%, p=0.05) and less likely to report limitations to home care (21% vs 48%, p=0.05) as barriers. In regression modeling, ED volume was predictive of the presence of clinical pathways rather than rurality. Conclusion: While rural-urban differences in resources and barriers exist, ED size rather than rurality may be a more important indicator of ability to reduce avoidable hospitalizations