EMBODIED POLITICAL ECOLOGIES OF HEALTH: A CASE STUDY OF ALCOHOL AND INFECTIOUS DISEASE IN THE UPPER WEST REGION OF GHANA

This research is a case study informed by qualitative methodologies examining perceptions of the misuse of an unregistered gin {akpeteshie), and it\u27s role within the promulgation of hepatitis b in the Upper West Region of Ghana. Four research objectives are addressed: 1) to describe the nature of alcohol use among adults; 2) to explore local perceptions about hepatitis b held by adults in the region; 3) to examine the nature of health accessibility in the region; and, 4) to examine the links between alcohol use and the spread of hepatitis b, including the social­ environmental processes that underwrite these links. Thematic analysis of nine focus groups with residents (n=88) and seven key informant interviews indicate that the relationship between alcohol misuse and hepatitis is underwritten by several factors emerging from the physical environment (i.e. drought, isolation) and the social environment (i.e. changing norms surrounding consumption, desires for coping, poverty)

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

31st Annual Meeting and Associated Programs of the Society for Immunotherapy of Cancer (SITC 2016) : part two

Background The immunological escape of tumors represents one of the main ob- stacles to the treatment of malignancies. The blockade of PD-1 or CTLA-4 receptors represented a milestone in the history of immunotherapy. However, immune checkpoint inhibitors seem to be effective in specific cohorts of patients. It has been proposed that their efficacy relies on the presence of an immunological response. Thus, we hypothesized that disruption of the PD-L1/PD-1 axis would synergize with our oncolytic vaccine platform PeptiCRAd. Methods We used murine B16OVA in vivo tumor models and flow cytometry analysis to investigate the immunological background. Results First, we found that high-burden B16OVA tumors were refractory to combination immunotherapy. However, with a more aggressive schedule, tumors with a lower burden were more susceptible to the combination of PeptiCRAd and PD-L1 blockade. The therapy signifi- cantly increased the median survival of mice (Fig. 7). Interestingly, the reduced growth of contralaterally injected B16F10 cells sug- gested the presence of a long lasting immunological memory also against non-targeted antigens. Concerning the functional state of tumor infiltrating lymphocytes (TILs), we found that all the immune therapies would enhance the percentage of activated (PD-1pos TIM- 3neg) T lymphocytes and reduce the amount of exhausted (PD-1pos TIM-3pos) cells compared to placebo. As expected, we found that PeptiCRAd monotherapy could increase the number of antigen spe- cific CD8+ T cells compared to other treatments. However, only the combination with PD-L1 blockade could significantly increase the ra- tio between activated and exhausted pentamer positive cells (p= 0.0058), suggesting that by disrupting the PD-1/PD-L1 axis we could decrease the amount of dysfunctional antigen specific T cells. We ob- served that the anatomical location deeply influenced the state of CD4+ and CD8+ T lymphocytes. In fact, TIM-3 expression was in- creased by 2 fold on TILs compared to splenic and lymphoid T cells. In the CD8+ compartment, the expression of PD-1 on the surface seemed to be restricted to the tumor micro-environment, while CD4 + T cells had a high expression of PD-1 also in lymphoid organs. Interestingly, we found that the levels of PD-1 were significantly higher on CD8+ T cells than on CD4+ T cells into the tumor micro- environment (p < 0.0001). Conclusions In conclusion, we demonstrated that the efficacy of immune check- point inhibitors might be strongly enhanced by their combination with cancer vaccines. PeptiCRAd was able to increase the number of antigen-specific T cells and PD-L1 blockade prevented their exhaus- tion, resulting in long-lasting immunological memory and increased median survival

Gimiigiwemin: Putting Knowledge Translation Into Practice With Anishinaabe Communities

In the Anishinaabemowen lagnuage, Gimiigiwemin is a concept that means, “we are exchanging gifts.” In the context of research, Indigenous communities often share their gifts with researchers by exposing them to local ways of knowing. Researchers can engage in exchanging gifts through sharing their skills and working towards producing research that meets community needs, such as supporting efforts to maintain health-sustaining relationships with traditional lands. Environmental repossession refers to the social, cultural, and political processes through which Indigenous Peoples are building resilience and reclaiming their traditional lands and ways of life. These processes are important because the health, ways of living, and knowledge systems of Indigenous Peoples all depend on access to traditional lands. This paper presents the results of a community-based participatory research study conducted in collaboration with Elders (n = 46) from two Anishinaabe communities on the north shore of Lake Superior (Ontario, Canada). This research employed locally relevant forms of integrated knowledge translation as a means of exchanging the gift of knowledge amongst all involved. This process culminated in a 2-day celebration wherein talking circles were used to explore Elders’ ideas about potential strategies for environmental repossession in their communities. Results from the talking circles pointed to four main strategies: (1) re-establishing the relationship between Elders and youth, (2) increasing time spent on traditional lands, (3) improving physical health, and (4) fostering community pride. This research emphasizes the strength of adopting culturally appropriate approaches to knowledge translation within studies aimed at supporting community aspirations of environmental repossession.

Kepler-1647B: the Largest and Longest-Period Kepler Transiting Circumbinary Planet

We report the discovery of a new Kepler transiting circumbinary planet (CBP). This latest addition to the still-small family of CBPs defies the current trend of known short-period planets orbiting near the stability limit of binary stars. Unlike the previous discoveries, the planet revolving around the eclipsing binary system Kepler-1647 has a very long orbital period (~1100 days) and was at conjunction only twice during the Kepler mission lifetime. Due to the singular configuration of the system, Kepler-1647b is not only the longest-period transiting CBP at the time of writing, but also one of the longest-period transiting planets. With a radius of 1.06+/-0.01 RJup it is also the largest CBP to date. The planet produced three transits in the light-curve of Kepler-1647 (one of them during an eclipse, creating a syzygy) and measurably perturbed the times of the stellar eclipses, allowing us to measure its mass to be 1.52+/-0.65 MJup. The planet revolves around an 11-day period eclipsing binary consisting of two Solar-mass stars on a slightly inclined, mildly eccentric (e_bin = 0.16), spin-synchronized orbit. Despite having an orbital period three times longer than Earth\u27s, Kepler-1647b is in the conservative habitable zone of the binary star throughout its orbit