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Malnutrition and sarcopenia are prevalent in patients with head and neck squamous cell carcinoma (HNSCC). Pre-treatment sarcopenia and adverse oncological outcomes in this population are well described. The impact of myosteatosis and post-treatment sarcopenia is less well known. Patients with HNSCC (n = 125) undergoing chemoradiotherapy, radiotherapy alone and/or surgery were assessed for sarcopenia and myosteatosis, using cross-sectional computed tomography (CT) imaging at the third lumbar (L3) vertebra, at baseline and 3 months post-treatment. Outcomes were overall survival (OS) at 12 months and 5 years post-treatment. One hundred and one participants had a CT scan evaluable at one or two time points, of which sixty-seven (66 %) participants were sarcopenic on at least one time point. Reduced muscle attenuation affected 93 % (n = 92) pre-treatment compared with 97 % (n = 90) post-treatment. Five-year OS favoured those without post-treatment sarcopenia (hazard ratio, HR 0·37, 95 % CI 0·16, 0·88, P = 0·06) and those without both post-treatment myosteatosis and sarcopenia (HR 0·33, 95 % CI 0·13, 0·83, P = 0·06). Overall, rates of myosteatosis were high at both pre- and post-treatment time points. Post-treatment sarcopenia was associated with worse 5-year OS, as was post-treatment sarcopenia in those who had myosteatosis. Post-treatment sarcopenia should be evaluated as an independent risk factor for decreased long-term survival post-treatment containing radiotherapy (RT) for HNSCC.
To evaluate coronavirus disease 2019 (COVID-19) vaccine hesitancy among healthcare personnel (HCP) with significant clinical exposure to COVID-19 at 2 large, academic hospitals in Philadelphia, Pennsylvania.
Design, setting, and participants:
HCP were surveyed in November–December 2020 about their intention to receive the COVID-19 vaccine.
The survey measured the intent among HCP to receive a COVID-19 vaccine, timing of vaccination, and reasons for or against vaccination. Among patient-facing HCP, multivariate regression evaluated the associations between healthcare positions (medical doctor, nurse practitioner or physician assistant, and registered nurse) and vaccine hesitancy (intending to decline, delay, or were unsure about vaccination), adjusting for demographic characteristics, reasons why or why not to receive the vaccine, and prior receipt of routine vaccines.
Among 5,929 HCP (2,253 medical doctors [MDs] and doctors of osteopathy [DOs], 582 nurse practitioners [NPs], 158 physician assistants [PAs], and 2,936 nurses), a higher proportion of nurses (47.3%) were COVID-vaccine hesitant compared with 30.0% of PAs and NPs and 13.1% of MDs and DOs. The most common reasons for vaccine hesitancy included concerns about side effects, the newness of the vaccines, and lack of vaccine knowledge. Regardless of position, Black HCP were more hesitant than White HCP (odds ratio [OR], ∼5) and females were more hesitant than males (OR, ∼2).
Although most clinical HCP intended to receive a COVID-19 vaccine, intention varied by healthcare position. Consistent with other studies, hesitancy was also significantly associated with race or ethnicity across all positions. These results highlight the importance of understanding and effectively addressing reasons for hesitancy, especially among frontline HCP who are at increased risk of COVID exposure and play a critical role in recommending vaccines to patients.
In the family therapy literature there is increasing interest in the dialogical approach, particularly as it becomes well-grounded in psychotherapy research. One embodiment is ‘open dialogues’, which has developed over a 30-year period in Western Lapland, Finland. This paper outlines my experience of visiting Keropudas Hospital in Tornio, Finland, the birthplace of open dialogues. It explores the seven theoretical principles of open dialogues, associated elements of clinical practice, and the therapist use of self. The author utilises these aspects to reflect on dialogical moments through words and images based on three conceptual themes, which illustrate the relevance of open dialogues for family therapy practitioners and their contexts.
Continual low-level exposure of sheep to the helminth Teladorsagia circumcincta elicits a temporary protective immunity, where factors in the immune abomasal mucosa prevent penetration of infective larvae, but which is essentially lost within 6 weeks of cessation of parasite challenge. Here, a proteomic approach was used to identify proteins that are differentially regulated in immune compared to naïve sheep, as potential key mediators of immunity. Six naïve sheep and 12 sheep trickle-infected with T. circumcincta were treated with anthelmintic, and the naïve (control) and 6 immune sheep were killed 7 days later. The remaining 6 sheep (immune waning) were killed 42 days after anthelmintic treatment. Abomasal tissue samples were subjected to 2D-gel electrophoresis and densitometric analysis. Selected spots (n=73) were identified by peptide mass fingerprinting and confirmatory Western blotting was carried out for 10 proteins. Spots selectively up-regulated in immune versus control, but not immune waning versus control sheep, included galectin-15 and thioredoxin, which were confirmed by Western blotting. In immune sheep, serum albumin was significantly down-regulated and albumin proteolytic cleavage fragments were increased compared to controls. Unexpectedly, albumin mRNA was relatively highly expressed in control mucosa, down-regulated in immune, and was immunolocalized to mucus-producing epithelial cells. Thus we have identified differential expression of a number of proteins following T. circumcincta trickle infection that may play a role in host protection and inhibition of parasite establishment.
Mohandas Karamchand Gandhi was born in Western India in 1869, a child of the Victorian age at the heyday of British imperial rule in India. He was assassinated by one of his own countrymen nearly eighty years later, in January 1948, just months after the subcontinent had gained political independence. During his long life, he had become known as Mahatma or ‘great soul’, and had risen from obscurity as a failed lawyer to become one of the most outstanding Indians active in the public life of his country and of the British Empire in the first half of the twentieth century. He is often spoken of as the ‘father’ of the new nation-state of India, but more seriously is recognized as a major practitioner of and thinker about nonviolence as a form of managing conflict and resisting injustice. Public interest in his career and thought has continued to develop into the next century, particularly as numerous groups have drawn on his example and attempted throughout the world to use nonviolence to resist multiple forms of political violence and control. There are therefore numerous reasons why it is timely to gather a collection of serious but accessible essays on his life and thought in a Cambridge Companion, designed to reach a wide readership, both inside and outside the world of education, who may know little about India but wish to know more about such a significant and intriguing figure.
This chapter deals with Gandhi’s life and work in India, from 1915, when he returned from South Africa, to his assassination in January 1948. This was the phase in his life when he became of central importance to the Indian nationalist movement, and a truly global political and moral figure. The chapter also provides readers with much of the historical evidence they need to know in order to progress to the following thematic chapters on aspects of his life and thought. One of the main messages of this collection of discussions about Gandhi is that, in his life, thinking and action were inseparable; this chapter considers both, alternating its vision between what Gandhi thought about his life and role and about the nature of the Indian nation for which he worked, and his specific activities. At the outset, it is helpful to consider the sources for this chapter, and also the broad chronological outline of Gandhi’s activities in these years.
The student of Gandhi’s life and thought has access to a wealth of published primary sources. Some of these are the books and pamphlets that Gandhi wrote himself. These are discussed in the following chapter on his key writings. Amongst them are his Autobiography, his original pamphlet on what he meant by home rule for India (Hind Swaraj: 1909), and his exposition of his so-called constructive programme (1941). We also have access to many of his letters, speeches, and articles in newspapers, as well as comments by his contemporaries in their written accounts of their times and their private papers, and the discussions on Gandhi’s role in politics and how to deal with him by the British rulers of India, now accessible in the archives of the imperial government in India and the UK.
The reader of this volume will have encountered many Gandhis. They have ranged chronologically from the boy growing up in conservative, Western India, under British imperial rule; to the diffident student in London and failed lawyer in Bombay; to the self-taught activist, public figure, and lawyer in South Africa; and finally to the influential leader of the Indian nationalist movement who was also, uniquely and surprisingly, the founder of several ashram communities, which he considered to be his best work and where he tried to work out the core elements of his spiritual vision of the good human life in the pursuit of Truth. The reader will also have encountered different aspects of Gandhi’s life and thinking, including his developing ideas on the nature of politics, the state and the nature of the Indian nation, his wrestling with a range of acute human problems as they were manifested in Indian society, and his attempts to envisage an economic foundation for moral human lives and societies. Undergirding all of these aspects of his life and thought was his particular understanding of the nature of true religion, and his passionate quest for Truth as the underlying principle of all life, as another name for a divine force that addressed him personally and prompted his actions.
Furthermore, it is evident that during and after Gandhi’s life, people appropriated him and his image, thereby creating further ‘Gandhis’. Many groups and individuals have understood him in the framework of their pre-existing ideas, used him to forward their own agendas, or found him an inspiration for change in situations he never encountered himself. We know, for example, that while he was alive, and particularly during the years he was a major leader in India and increasingly known as a Mahatma, peasant groups understood him as a miracle worker, as a semi-divine saviour, but also used his image as a means of coercion and local discipline using moral assumptions already present in their worlds.
The primary aim of the three Milan principles of hypothesising, circularity and neutrality was to proffer an effective methodology for interviewing families, with a secondary aim of casting off the stereotypical personal therapist qualities such as intuition, charisma and concern. The progression of the principles from the original Milan model through to contemporary approaches is intriguing. The following article consists of two sections. First it tracks the progression of the three principles through the Milan, post-Milan and postmodern approaches to family therapy. Given their recursive nature, they are revealed as responsive to developments in theory and practice, as well as the influence of the wider societal context. The second section of the article explores hypothesising, circularity and neutrality in the contemporary approach of dialogical family therapy. The relevance of the three principles to the therapeutic process, the therapeutic role and the therapeutic relationship is considered. Such an exploration does not seek definitive answers or ‘truths’, but seeks to conceptualise a vague ‘knowing’ that there is continual learning and growth in grappling with the tensions in this field, in remaining ever curious, in asking the questions …
This chapter sets the scene for the rest of this study, by looking at the subcontinent of South Asia and its connections with the world outside, over time. Although individuals and family groups made the decision to move abroad, and we need to understand their small-scale and local decisions, these were taken in the context of a widening environment, that of the British Empire in the nineteenth and early twentieth centuries, and of a world of independent nations bound together by new patterns of globalisation in the later twentieth and the present centuries. Particularly crucial in this widening environment was the impact of demand for various forms of labour and skill, and the political issues related to immigration of people with different ethnic origins from the majority in areas where they sought to go.
The subcontinent under British rule: the image of rural stability
The great land mass of the Indian subcontinent, equivalent to Europe in size, came under the political control of Britain in piecemeal fashion from the middle of the eighteenth century to the early nineteenth century. In theory, the ruling authority was until 1858 the East India Company (EIC), a trading company whose origins lay in a royal charter of 1600. But as it transformed itself in the early 1800s into an organisation for governance and military control, its trading activities declined as a component of its activities and profit.