The Democratic Biopolitics of PrEP

PrEP (Pre-Exposure Prophylaxis) is a relatively new drug-based HIV prevention technique and an important means to lower the HIV risk of gay men who are especially vulnerable to HIV. From the perspective of biopolitics, PrEP inscribes itself in a larger trend of medicalization and the rise of pharmapower. This article reconstructs and evaluates contemporary literature on biopolitical theory as it applies to PrEP, by bringing it in a dialogue with a mapping of the political debate on PrEP. As PrEP changes sexual norms and subjectification, for example condom use and its meaning for gay subjectivity, it is highly contested. The article shows that the debate on PrEP can be best described with the concepts ‘sexual-somatic ethics’ and ‘democratic biopolitics’, which I develop based on the biopolitical approach of Nikolas Rose and Paul Rabinow. In contrast, interpretations of PrEP which are following governmentality studies or Italian Theory amount to either farfetched or trivial positions on PrEP, when seen in light of the political debate. Furthermore, the article is a contribution to the scholarship on gay subjectivity, highlighting how homophobia and homonormativity haunts gay sex even in liberal environments, and how PrEP can serve as an entry point for the destigmatization of gay sexuality and transformation of gay subjectivity. ‘Biopolitical democratization’ entails making explicit how medical technology and health care relates to sexual subjectification and ethics, to strengthen the voice of (potential) PrEP users in health politics, and to renegotiate the profit and power of Big Pharma

Management and resistance in the digital newsroom

What happens when there is conflict between the profit motivations of a news outlet and the professional values of its journalists? Questions of managerial influence and journalistic autonomy have interested media scholars from the seminal work of Warren Breed onwards. However, there have only been a handful of studies since the introduction of audience metrics which, this research suggests, allow managers to more efficiently monitor and discipline their journalists. This article presents an ethnographic case study of a Reuters newswire bureau during a time of conflict between the management and journalists. The article outlines the strategies that management used to incentivize their journalists to change their reporting priorities. These included the strategic dissemination of audience metrics and praise, and the hiring and promotion of ‘appropriate’ journalists to positions of influence. These interventions changed who was considered a ‘good journalist’ at the newswire, disrupting existing hierarchies, and eventually changing the culture of the newsroom. The article draws on the insights of Pierre Bourdieu’s field theory to help explain how managerial power operates, and the role that individual journalists play producing and reinforcing newsroom norms

Chemical signatures of a warped protoplanetary disc

Circumstellar discs may become warped or broken into distinct planes if there is a stellar or planetary companion with an orbit that is misaligned with respect to the disc. There is mounting observational evidence for protoplanetary discs with misaligned inner discs and warps that may be caused by such interactions with a previously undetected companion, giving us a tantalising indication of possible planets forming there. Hydrodynamical and radiative transfer models indicate that the temperature varies azimuthally in warped discs due to the variable angle at which the disc surface faces the star and this impacts the disc chemistry. We perform chemical modelling based on a hydrodynamical model of a protoplanetary disc with an embedded planet orbiting at a 12$^{\circ}$ inclination to the disc. Even for this small misalignment, abundances of species including CO and HCO$^+$ vary azimuthally and this results in detectable azimuthal variations in submillimetre line emission. Azimuthal variations in line emission may therefore indicate the presence of an unseen embedded companion. Nonaxisymmetric chemical abundances should be considered when interpreting molecular line maps of warped or shadowed protoplanetary discs.Comment: Accepted to MNRAS. 18 pages, 14 figure

Relationship Between Exercise Motivation, Exercise Enjoyment, and Daily Cognition of Collegiate Student-Athletes

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Fingolimod: therapeutic mechanisms and ocular adverse effects.

Fingolimod is an oral immunomodulating drug used in the management of relapsing-remitting multiple sclerosis (RRMS). We aim to review the published literature on ocular manifestations of fingolimod therapy and their possible underlying mechanisms. The therapeutic effects of fingolimod are mediated via sphingosine receptors, which are found ubiquitously in various organs, including lymphoid cells, central nervous system, cardiac myocytes, and smooth muscle cells. Fingolimod-associated macular oedema (FAME) is the most common ocular side effect but retinal haemorrhages and retinal vein occlusion can occur. The visual consequences appear to be mild and, in cases of FAME, resolution is often attained with discontinuation of therapy. However, in cases of retinal vein occlusion, discontinuation of fingolimod alone may not be sufficient and intra-vitreal therapy may be required. We also propose a pragmatic service pathway for monitoring patients on fingolimod therapy, which includes stratifying them by risk and visual acuity

Hazard Testing To Reduce Risk in the Development of Automated Planning Tools

PURPOSE: Hazard scenarios were created to assess and reduce the risk of planning errors in automated planning processes. This was accomplished through iterative testing and improvement of examined user interfaces. METHODS: Automated planning requires three user inputs: a computed tomography (CT), a prescription document, known as the service request, and contours. We investigated the ability of users to catch errors that were intentionally introduced into each of these three stages, according to an FMEA analysis. Five radiation therapists each reviewed 15 patient CTs, containing three errors: inappropriate field of view, incorrect superior border, and incorrect identification of isocenter. Four radiation oncology residents reviewed 10 service requests, containing two errors: incorrect prescription and treatment site. Four physicists reviewed 10 contour sets, containing two errors: missing contour slices and inaccurate target contour. Reviewers underwent video training prior to reviewing and providing feedback for various mock plans. RESULTS: Initially, 75% of hazard scenarios were detected in the service request approval. The visual display of prescription information was then updated to improve the detectability of errors based on user feedback. The change was then validated with five new radiation oncology residents who detected 100% of errors present. 83% of the hazard scenarios were detected in the CT approval portion of the workflow. For the contour approval portion of the workflow none of the errors were detected by physicists, indicating this step will not be used for quality assurance of contours. To mitigate the risk from errors that could occur at this step, radiation oncologists must perform a thorough review of contour quality prior to final plan approval. CONCLUSIONS: Hazard testing was used to pinpoint the weaknesses of an automated planning tool and as a result, subsequent improvements were made. This study identified that not all workflow steps should be used for quality assurance and demonstrated the importance of performing hazard testing to identify points of risk in automated planning tools

Influenza vaccine in chronic obstructive pulmonary disease among elderly male veterans

BACKGROUND: Prior studies have established those elderly patients with chronic obstructive pulmonary disease (COPD) are at elevated risk for developing influenza-associated complications such as hospitalization, intensive-care admission, and death. This study sought to determine whether influenza vaccination could improve survival among elderly patients with COPD. MATERIALS/METHODS: This study included Veterans (age ≥ 65 years) diagnosed with COPD that received care at the United States Veterans Health Administration (VHA) during four influenza seasons, from 2012–2013 to 2015–2016. We linked VHA electronic medical records and Medicare administrative files to Centers for Disease Control and Prevention National Death Index cause of death records as well as influenza surveillance data. A multivariable time-dependent Cox proportional hazards model was used to compare rates of mortality of recipients of influenza vaccination to those who did not have records of influenza vaccination. We estimated hazard ratios (HRs) adjusted for age, gender, race, socioeconomic status, comorbidities, and healthcare utilization. RESULTS: Over a span of four influenza seasons, we included 1,856,970 person-seasons of observation where 1,199,275 (65%) had a record of influenza vaccination and 657,695 (35%) did not have a record of influenza vaccination. After adjusting for comorbidities, demographic and socioeconomic characteristics, influenza vaccination was associated with reduced risk of death during the most severe periods of influenza seasons: 75% all-cause (HR = 0.25; 95% CI: 0.24–0.26), 76% respiratory causes (HR = 0.24; 95% CI: 0.21–0.26), and 82% pneumonia/influenza cause (HR = 0.18; 95% CI: 0.13–0.26). A significant part of the effect could be attributed to “healthy vaccinee” bias as reduced risk of mortality was also found during the periods when there was no influenza activity and before patients received vaccination: 30% all-cause (HR = 0.70; 95% CI: 0.65–0.75), 32% respiratory causes (HR = 0.68; 95% CI: 0.60–0.78), and 51% pneumonia/influenza cause (HR = 0.49; 95% CI: 0.31–0.78). However, as a falsification study, we found that influenza vaccination had no impact on hospitalization due to urinary tract infection (HR = 0.97; 95% CI: 0.80–1.18). CONCLUSIONS: Among elderly patients with COPD, influenza vaccination was associated with reduced risk for all-cause and cause-specific mortality

The role of drag and gravity on dust concentration in a gravitationally unstable disc

We carry out three-dimensional smoothed particle hydrodynamics simulations to study the role of gravitational and drag forces on the concentration of large dust grains (St > 1) in the spiral arms of gravitationally unstable protoplanetary discs, and the resulting implications for planet formation. We find that both drag and gravity play an important role in the evolution of large dust grains. If we include both, grains that would otherwise be partially decoupled will become well coupled and trace the spirals. For the dust grains most influenced by drag (with Stokes numbers near unity), the dust disc quickly becomes gravitationally unstable and rapidly forms clumps with masses between 0.15–6M⊕. A large fraction of clumps are below the threshold where runaway gas accretion can occur. However, if dust self-gravity is neglected, the dust is unable to form clumps, despite still becoming trapped in the gas spirals. When large dust grains are unable to feel either gas gravity or drag, the dust is unable to trace the gas spirals. Hence, full physics is needed to properly simulate dust in gravitationally unstable discs. Dust trapping of large grains in spiral arms of discs stable to gas fragmentation could explain planet formation in very young discs by a population of planetesimals formed due to the combined roles of drag and gravity in the earliest stages of a disc’s evolution. Furthermore, it highlights that gravitationally unstable discs are not just important for forming gas giants quickly, it can also rapidly form Earth mass bodies

A Real-Time Contouring Feedback Tool for Consensus-Based Contour Training

PURPOSE: Variability in contouring structures of interest for radiotherapy continues to be challenging. Although training can reduce such variability, having radiation oncologists provide feedback can be impractical. We developed a contour training tool to provide real-time feedback to trainees, thereby reducing variability in contouring. METHODS: We developed a novel metric termed localized signed square distance (LSSD) to provide feedback to the trainee on how their contour compares with a reference contour, which is generated real-time by combining trainee contour and multiple expert radiation oncologist contours. Nine trainees performed contour training by using six randomly assigned training cases that included one test case of the heart and left ventricle (LV). The test case was repeated 30 days later to assess retention. The distribution of LSSD maps of the initial contour for the training cases was combined and compared with the distribution of LSSD maps of the final contours for all training cases. The difference in standard deviations from the initial to final LSSD maps, ΔLSSD, was computed both on a per-case basis and for the entire group. RESULTS: For every training case, statistically significant ΔLSSD were observed for both the heart and LV. When all initial and final LSSD maps were aggregated for the training cases, before training, the mean LSSD ([range], standard deviation) was -0.8 mm ([-37.9, 34.9], 4.2) and 0.3 mm ([-25.1, 32.7], 4.8) for heart and LV, respectively. These were reduced to -0.1 mm ([-16.2, 7.3], 0.8) and 0.1 mm ([-6.6, 8.3], 0.7) for the final LSSD maps during the contour training sessions. For the retention case, the initial and final LSSD maps of the retention case were aggregated and were -1.5 mm ([-22.9, 19.9], 3.4) and -0.2 mm ([-4.5, 1.5], 0.7) for the heart and 1.8 mm ([-16.7, 34.5], 5.1) and 0.2 mm ([-3.9, 1.6],0.7) for the LV. CONCLUSIONS: A tool that uses real-time contouring feedback was developed and successfully used for contour training of nine trainees. In all cases, the utility was able to guide the trainee and ultimately reduce the variability of the trainee\u27s contouring

PPARα and PPARγ activation is associated with pleural mesothelioma invasion but therapeutic inhibition is ineffective

Mesothelioma is a cancer that typically originates in the pleura of the lungs. It rapidly invades the surrounding tissues, causing pain and shortness of breath. We compared cell lines injected either subcutaneously or intrapleurally and found that only the latter resulted in invasive and rapid growth. Pleural tumors displayed a transcriptional signature consistent with increased activity of nuclear receptors PPARα and PPARγ and with an increased abundance of endogenous PPAR-activating ligands. We found that chemical probe GW6471 is a potent, dual PPARα/γ antagonist with anti-invasive and anti-proliferative activity in vitro. However, administration of GW6471 at doses that provided sustained plasma exposure levels sufficient for inhibition of PPARα/γ transcriptional activity did not result in significant anti-mesothelioma activity in mice. Lastly, we demonstrate that the in vitro anti-tumor effect of GW6471 is off-target. We conclude that dual PPARα/γ antagonism alone is not a viable treatment modality for mesothelioma