We implemented a guideline for appropriate acid suppressant use in hematology-oncology patients. This intervention resulted in a sustained reduction in proton pump inhibitor (PPI) use without an increase in rates of gastrointestinal bleeding. Practice guidelines are effective in reducing PPI use, which is associated with risk of Clostridioides difficile infection.

BACKGROUND: IGTS is a rare phenomenon of paradoxical germ cell tumor (GCT) growth during or following treatment despite normalization of tumor markers. We sought to evaluate the frequency, clinical characteristics and outcome of IGTS in patients in 21 North-American and Australian institutions. METHODS: Patients with IGTS diagnosed from 2000-2017 were retrospectively evaluated. RESULTS: Out of 739 GCT diagnoses, IGTS was identified in 33 patients (4.5%). IGTS occurred in 9/191 (4.7%) mixed-malignant GCTs, 4/22 (18.2%) immature teratomas (ITs), 3/472 (0.6%) germinomas/germinomas with mature teratoma, and in 17 secreting non-biopsied tumours. Median age at GCT diagnosis was 10.9 years (range 1.8-19.4). Male gender (84%) and pineal location (88%) predominated. Of 27 patients with elevated markers, median serum AFP and Beta-HCG were 70 ng/mL (range 9.2-932) and 44 IU/L (range 4.2-493), respectively. IGTS occurred at a median time of 2 months (range 0.5-32) from diagnosis, during chemotherapy in 85%, radiation in 3%, and after treatment completion in 12%. Surgical resection was attempted in all, leading to gross total resection in 76%. Most patients (79%) resumed GCT chemotherapy/radiation after surgery. At a median follow-up of 5.3 years (range 0.3-12), all but 2 patients are alive (1 succumbed to progressive disease, 1 to malignant transformation of GCT). CONCLUSION: IGTS occurred in less than 5% of patients with GCT and most commonly after initiation of chemotherapy. IGTS was more common in patients with IT-only on biopsy than with mixed-malignant GCT. Surgical resection is a principal treatment modality. Survival outcomes for patients who developed IGTS are favourable.

This essay examines and compares the treatment of the Decalogue in the theological ethics of Karl Barth and Dietrich Bonhoeffer. It argues that while both theologians orient their exposition of the Decalogue by attending to its primary character as divine self-revelation, approach it with a view to a Christian ethics of divine command, and frame their understandings in decisively christological terms, they differ markedly on the extent to which the commandments themselves can and ought to be understood as representing concrete divine commands.

Although researchers have developed evidence-based practices and identified other effective practices that show promise for improving outcomes for students with disabilities, these practices are all too frequently not used in inclusive classrooms. Some have posited that this research-to-practice gap may result because teachers lack confidence in these practices and do not find them feasible for use in their classrooms. More recently, researchers have begun to examine whether teacher education may contribute to this research-to-practice gap. We contend that teacher preparation is an important contributor to the research-to-practice gap, and discuss how teacher preparation might be changed to better prepare teachers to use effective practices in inclusive classrooms. Primary changes that are needed include identifying a set of high-leverage practices that serve as the core curriculum of teacher education and using a practice-based approach to systematically prepare future teachers to use these practices.

In a cohort of inpatients with hematologic malignancy and positive enzyme immunoassay (EIA) or polymerase chain reaction (PCR) Clostridium difficile tests, we found that clinical characteristics and outcomes were similar between these groups. The method of testing is unlikely to predict infection in this population, and PCR-positive results should be treated with concern.

Infect Control Hosp Epidemiol 2018;863–866

Let $P_{1},\ldots ,P_{k}:\mathbb{Z}\rightarrow \mathbb{Z}$ be polynomials of degree at most $d$ for some $d\geqslant 1$ , with the degree $d$ coefficients all distinct, and admissible in the sense that for every prime $p$ , there exists integers $n,m$ such that $n+P_{1}(m),\ldots ,n+P_{k}(m)$ are all not divisible by $p$ . We show that there exist infinitely many natural numbers $n,m$ such that $n+P_{1}(m),\ldots ,n+P_{k}(m)$ are simultaneously prime, generalizing a previous result of the authors, which was restricted to the special case $P_{1}(0)=\cdots =P_{k}(0)=0$ (though it allowed for the top degree coefficients to coincide). Furthermore, we obtain an asymptotic for the number of such prime pairs $n,m$ with $n\leqslant N$ and $m\leqslant M$ with $M$ slightly less than $N^{1/d}$ . This asymptotic is already new in general in the homogeneous case $P_{1}(0)=\cdots =P_{k}(0)=0$ . Our arguments rely on four ingredients. The first is a (slightly modified) generalized von Neumann theorem of the authors, reducing matters to controlling certain averaged local Gowers norms of (suitable normalizations of) the von Mangoldt function. The second is a more recent concatenation theorem of the authors, controlling these averaged local Gowers norms by global Gowers norms. The third ingredient is the work of Green and the authors on linear equations in primes, allowing one to compute these global Gowers norms for the normalized von Mangoldt functions. Finally, we use the Conlon–Fox–Zhao densification approach to the transference principle to combine the preceding three ingredients together. In the special case $P_{1}(0)=\cdots =P_{k}(0)=0$ , our methods also give infinitely many $n,m$ with $n+P_{1}(m),\ldots ,n+P_{k}(m)$ in a specified set primes of positive relative density $\unicode[STIX]{x1D6FF}$ , with $m$ bounded by $\log ^{L}n$ for some $L$ independent of the density $\unicode[STIX]{x1D6FF}$ . This improves slightly on a result from our previous paper, in which $L$ was allowed to depend on $\unicode[STIX]{x1D6FF}$ .

This article examines the incidence of liberal and “illiberal” democracy in Latin America from 1978 through 2004. It demonstrates, first, that illiberal democracy—which combines free and fair elections with systematic constraints on citizens’ rights—became the norm throughout the region. Second, it shows that regime transitions most often ended not in liberal democracy but in illiberal democracy. Third, rare events logit analysis reveals that two variables, hyperinflation and presidential elections, had significant impact on movement toward fuller democracy. As a form of short-term economic shock, hyperinflation generates widespread discontent; given the opportunity to vote, citizens elect reformist opposition candidates who, once in office, remove controls on civil liberties. This scenario substantially increases the likelihood of transition from illiberal to liberal democracy.

Clearly, structural priming is a valuable tool for probing linguistic representation. But we don't think that the existing results provide strong support for Branigan & Pickering's (B&P's) model, largely because the priming effects are more confusing and diverse than their theory would suggest. Fortunately, there are a number of other experimental tools available, and linguists are increasingly making use of them.