Patient needs in advanced Renal Cell Carcinoma: What are patients’ priorities and how well are we meeting them?

Treatment options and duration of therapy for patients with metastatic renal cell carcinoma (mRCC) have increased. Many patients now spend in excess of 2 years on active therapy. These patients’ needs, and the ability of health services to respond to them, are poorly understood. Ten patients living with mRCC for more than 2 years and treated with at least one targeted agent were selected at random from three hospitals in the United Kingdom (UK). One interviewer who was not involved in their care conducted in-depth interviews. Interview transcripts were analysed using Interpretative Phenomenological Analysis (IPA) to identify issues of greatest importance to patients, and to understand how well patients felt their needs were being addressed. Perceived delay in initial diagnosis was a major theme. Being told the truth about treatment side effects upfront was important, but was often at odds with perceived delivery. ‘Dealing with side effects’, understanding dose and its effects and not letting ‘negative thoughts get in’ were highlighted as important, but were highly personal to patients and areas where patients struggled. Concordance was observed with delivery of ‘a clear next step’ for treatment, timely access to drugs and guidance on a drug ‘holiday’. Patient experience of mRCC and its treatment requires a tailored approach. This research suggests there are key opportunities for service improvement and improved communication throughout the pathway to better meet the needs of patients, including non-clinical support to build personal resilience

Spatial patterns of reproduction suggest marginal habitat limits continued range expansion of black bears at a forest-desert ecotone

Investigating spatial patterns of animal occupancy and reproduction in peripheral populations can provide insight into factors that form species range boundaries. Following historical extirpation, American black bears (Ursus americanus) recolonized the western Great Basin in Nevada from the Sierra Nevada during the late 1900s. This range expansion, however, has not continued further into the Great Basin despite the presence of additional habitat. We aimed to quantify whether reduced reproduction toward the range edge contributes to this range boundary. We analyzed black bear detections from 100 camera traps deployed across black bear distribution in western Nevada using a multistate occupancy model that quantified the probability of occupancy and reproduction (i.e., female bears with cubs occupancy) in relation to changes in habitat type and habitat amount toward the range boundary. We detected a strong effect of habitat amount and habitat type on the probability of black bear occupancy and reproduction. At similar levels of landscape-scale habitat amount (e.g., 50%), estimated probability of occupancy for adult bears in piñon-juniper woodlands near the range boundary was 0.39, compared to ~1.0 in Sierra Nevada mixed-conifer forest (i.e., core habitat). Furthermore, estimated probability of cub occupancy, conditional on adult bear occupancy, in landscapes with 50% habitat was 0.32 in Great Basin piñon-juniper woodlands, compared to 0.92 in Sierra Nevada mixed-conifer forest. Black bear range in the western Great Basin conforms to the center–periphery hypothesis, with piñon-juniper woodland at the range edge supporting ecologically marginal habitat for the species compared to habitat in the Sierra Nevada. Further geographic expansion of black bears in the Great Basin may be limited by lower occupancy of reproducing females in piñon-juniper woodland. Center–periphery range dynamics may be common in large carnivore species, as their dispersal ability allows them to colonize low-quality habitat near range edges

Transparency and adaptability aid in realigning the complexity of objectives, approaches, and systems in human-wildlife coexistence research

Human-wildlife interactions are situated within dynamic systems, characterized by social and ecological complexity. Human-wildlife coexistence research, however, typically focuses on one component of these systems in isolation. We inadvertently followed this norm while carrying out semi-structured interviews of livestock-owners in Northern Tanzania. As existing literature highlighted that this area was a hotspot for livestock depredation, our research questions focused on human interactions with carnivores. Interestingly, almost three quarters (72%, n = 72 of 100) of study participants independently raised African elephants (Loxodonta africana) as presenting the greatest impediments to coexistence. By centering our interviews on carnivores, we omitted vital components of this complex system. To counteract the effects of this oversimplification, we changed our intended analytical process after data collection. Instead of conducting a quantitative analysis of rates of livestock depredation and perceptions of risk posed by a suite of sympatric carnivores, we applied a grounded theory approach to assess interactions across multiple dimensions of this complex system. Through this transparent effort to realign our approaches with the complexity of the study system, we highlight the importance of designing research approaches that effectively reflect the complexities inherent to human-wildlife coexistence

Factors Affecting Retention of Undergraduate Students in Fisheries and Wildlife Programs

Undergraduate enrollment in agriculture and natural resources‐related programs has steadily declined for the past decade or more. College administrators and faculty struggle to separate the real causes of this decline from the superficial and often mythical factors. How programs should address this decline is of similar concern. Rather than speculate on why students do not pursue a degree in a natural resources field, specifically fisheries and wildlife (FW), we decided to investigate the question of FW student retention from the perspective of the students themselves. Specifically, we wanted to know: (a) Why do students say they chose to leave the FW program at MSU? (b) Why did students who persisted in program say they chose to stay? and (c) What reasons did transfer students give for choosing FW as a major? We conducted a series of face‐to‐face interviews with these three groups of students, and asked them a series of 10‐14 questions related to their experiences in the Department of Fisheries and Wildlife at Michigan State University in an effort to better understand student reasons for leaving, persisting, and immigrating into the program. Although our project is just beginning, preliminary results offer some interesting insights into the departure puzzle. Specific, but limited, findings from interviewees include: (a) the importance of job prospects and earnings potential, (b) a general reluctance to pursue postgraduate education, (c) a degree of disillusionment at the relative lack of outdoor experiences offered by the program in classroom and extracurricular activities, and (d) a desire for more active participation and field experiences in the undergraduate program. Several students in this study told us that they selected FW out of a desire to spend more time in the field, and were disappointed this was frequently not the case. Some students expressed a general feeling of deception at the realities of the departmental curriculum, although these were poorly defined and may be the product of other issues such as unrealistic program expectations. This ongoing study has the potential to inform natural resource programs on techniques to attract, retain, and educate undergraduate students

Hazard Detection Software for Lunar Landing

The Autonomous Landing and Hazard Avoidance Technology (ALHAT) Project is developing a system for safe and precise manned lunar landing that involves novel sensors, but also specific algorithms. ALHAT has selected imaging LIDAR (light detection and ranging) as the sensing modality for onboard hazard detection because imaging LIDARs can rapidly generate direct measurements of the lunar surface elevation from high altitude. Then, starting with the LIDAR-based Hazard Detection and Avoidance (HDA) algorithm developed for Mars Landing, JPL has developed a mature set of HDA software for the manned lunar landing problem. Landing hazards exist everywhere on the Moon, and many of the more desirable landing sites are near the most hazardous terrain, so HDA is needed to autonomously and safely land payloads over much of the lunar surface. The HDA requirements used in the ALHAT project are to detect hazards that are 0.3 m tall or higher and slopes that are 5 or greater. Steep slopes, rocks, cliffs, and gullies are all hazards for landing and, by computing the local slope and roughness in an elevation map, all of these hazards can be detected. The algorithm in this innovation is used to measure slope and roughness hazards. In addition to detecting these hazards, the HDA capability also is able to find a safe landing site free of these hazards for a lunar lander with diameter .15 m over most of the lunar surface. This software includes an implementation of the HDA algorithm, software for generating simulated lunar terrain maps for testing, hazard detection performance analysis tools, and associated documentation. The HDA software has been deployed to Langley Research Center and integrated into the POST II Monte Carlo simulation environment. The high-fidelity Monte Carlo simulations determine the required ground spacing between LIDAR samples (ground sample distances) and the noise on the LIDAR range measurement. This simulation has also been used to determine the effect of viewing on hazard detection performance. The software has also been deployed to Johnson Space Center and integrated into the ALHAT real-time Hardware-in-the-Loop testbed

Membranoproliferative glomerulonephritis recurrence after kidney transplantation: using the new classification.

BACKGROUND: Membranoproliferative glomerulonephritis (MPGN) is an uncommon glomerular disorder that may lead to end stage renal disease (ESRD). With new understanding of the disease pathogenesis, the classical classification as MPGN types I, II, III has changed. Data on post-transplant MPGN, in particular with the newly refined classification, is limited. We present our center\u27s experience of MPGN after kidney transplantation using the new classification. METHODS: This is a retrospective study of 34 patients with ESRD due to MPGN who received 40 kidney transplants between 1994 and 2014. We reviewed the available biopsies\u27 data using the new classification. We assessed post transplantation recurrence rate, risk factors of recurrence, the response to therapy and allografts\u27 survival. RESULTS: Median time of follow up was 5.3 years (range 0.5-14 years). Using the new classification, we found that pre-transplant MPGN disease was due to immune complex-mediated glomerulonephritis (ICGN) in 89 % of cases and complement-mediated glomerulonephritis (CGN) in 11 %. Recurrence was detected in 18 transplants (45 %). Living related allografts (P = 0.045), preemptive transplantations (P = 0.018), low complement level (P = 0.006), and the presence of monoclonal gammopathy (P = 0.010) were associated with higher recurrence rate in ICGN cases. Half of the patients with recurrence lost their allografts. The use of ACEi/ARB was associated with a trend toward less allograft loss. CONCLUSIONS: MPGN recurs at a high rate after kidney transplantation. The risk of MPGN recurrence increases with preemptive transplantation, living related donation, low complement level, and the presence of monoclonal gammopathy. Recurrence of MPGN leads to allograft failure in half of the cases

Datathons and Software to Promote Reproducible Research

Background: Datathons facilitate collaboration between clinicians, statisticians, and data scientists in order to answer important clinical questions. Previous datathons have resulted in numerous publications of interest to the critical care community and serve as a viable model for interdisciplinary collaboration. Objective: We report on an open-source software called Chatto that was created by members of our group, in the context of the second international Critical Care Datathon, held in September 2015. Methods: Datathon participants formed teams to discuss potential research questions and the methods required to address them. They were provided with the Chatto suite of tools to facilitate their teamwork. Each multidisciplinary team spent the next 2 days with clinicians working alongside data scientists to write code, extract and analyze data, and reformulate their queries in real time as needed. All projects were then presented on the last day of the datathon to a panel of judges that consisted of clinicians and scientists. Results: Use of Chatto was particularly effective in the datathon setting, enabling teams to reduce the time spent configuring their research environments to just a few minutes—a process that would normally take hours to days. Chatto continued to serve as a useful research tool after the conclusion of the datathon. Conclusions: This suite of tools fulfills two purposes: (1) facilitation of interdisciplinary teamwork through archiving and version control of datasets, analytical code, and team discussions, and (2) advancement of research reproducibility by functioning postpublication as an online environment in which independent investigators can rerun or modify analyses with relative ease. With the introduction of Chatto, we hope to solve a variety of challenges presented by collaborative data mining projects while improving research reproducibility

Reducing in-stent restenosis therapeutic manipulation of miRNA in vascular remodeling and inflammation

Background: Drug-eluting stents reduce the incidence of in-stent restenosis, but they result in delayed arterial healing and are associated with a chronic inflammatory response and hypersensitivity reactions. Identifying novel interventions to enhance wound healing and reduce the inflammatory response may improve long-term clinical outcomes. Micro–ribonucleic acids (miRNAs) are noncoding small ribonucleic acids that play a prominent role in the initiation and resolution of inflammation after vascular injury.<p></p> Objectives: This study sought to identify miRNA regulation and function after implantation of bare-metal and drug-eluting stents.<p></p> Methods: Pig, mouse, and in vitro models were used to investigate the role of miRNA in in-stent restenosis.<p></p> Results: We documented a subset of inflammatory miRNAs activated after stenting in pigs, including the miR-21 stem loop miRNAs. Genetic ablation of the miR-21 stem loop attenuated neointimal formation in mice post-stenting. This occurred via enhanced levels of anti-inflammatory M2 macrophages coupled with an impaired sensitivity of smooth muscle cells to respond to vascular activation.<p></p> Conclusions: MiR-21 plays a prominent role in promoting vascular inflammation and remodeling after stent injury. MiRNA-mediated modulation of the inflammatory response post-stenting may have therapeutic potential to accelerate wound healing and enhance the clinical efficacy of stenting