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

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

Bumblebee electric charge stimulates floral volatile emissions in Petunia integrifolia but not in Antirrhinum majus

The timing of volatile organic compound (VOC) emission by flowering plants often coincides with pollinator foraging activity. Volatile emission is often considered to be paced by environmental variables, such as light intensity, and/or by circadian rhythmicity. The question arises as to what extent pollinators themselves provide information about their presence, in keeping with their long co-evolution with flowering plants. Bumblebees are electrically charged and provide electrical stimulation when visiting plants, as measured via the depolarisation of electric potential in the stem of flowers. Here, we test the hypothesis that the electric charge of foraging bumblebees increases the floral volatile emissions of bee pollinated plants. We investigate the change in VOC emissions of two bee-pollinated plants (Petunia integrifolia and Antirrhinum majus) exposed to the electric charge typical of foraging bumblebees. P. integrifolia slightly increases its emissions of a behaviorally and physiologically active compound in response to visits by foraging bumblebees, presenting on average 121 pC of electric charge. We show that for P. integrifolia, strong electrical stimulation (600-700 pC) promotes increased volatile emissions, but this is not found when using weaker electrical charges more representative of flying pollinators (100 pC). Floral volatile emissions of A. majus were not affected by either strong (600-700 pC) or weak electric charges (100 pC). This study opens a new area of research whereby the electrical charge of flying insects may provide information to plants on the presence and phenology of their pollinators. As a form of electroreception, this sensory process would bear adaptive value, enabling plants to better ensure that their attractive chemical messages are released when a potential recipient is present

Space robotics: Recent accomplishments and opportunities for future research

The Langley Guidance, Navigation, and Control Technical Committee (GNCTC) was one of six technical committees created in 1991 by the Chief Scientist, Dr. Michael F. Card. During the kickoff meeting Dr. Card charged the chairmen to: (1) establish a cross-Center committee; (2) support at least one workshop in a selected discipline; and (3) prepare a technical paper on recent accomplishments in the discipline and on opportunities for future research. The Guidance, Navigation, and Control Committee was formed and selected for focus on the discipline of Space robotics. This report is a summary of the committee's assessment of recent accomplishments and opportunities for future research. The report is organized as follows. First is an overview of the data sources used by the committee. Next is a description of technical needs identified by the committee followed by recent accomplishments. Opportunities for future research ends the main body of the report. It includes the primary recommendation of the committee that NASA establish a national space facility for the development of space automation and robotics, one element of which is a telerobotic research platform in space. References 1 and 2 are the proceedings of two workshops sponsored by the committee during its June 1991, through May 1992 term. The focus of the committee for the June 1992 - May 1993 term will be to further define to the recommended platform in space and to add an additional discipline which includes aircraft related GN&C issues. To the latter end members performing aircraft related research will be added to the committee. (A preliminary assessment of future opportunities in aircraft-related GN&C research has been included as appendix A.