Critical international relations and the impact agenda

How should critical International Relations (IR) scholars approach the ‘impact agenda’? While most have been quite resistant to it, I argue in this essay that critical IR should instead embrace the challenge of impact – and that both IR as a field and the impact agenda more broadly would gain greatly from it doing so. I make this case through three steps. I show, firstly, that critical IR has till now been very much at the impact agenda’s margins, and that this situation contrasts strikingly with its well-established importance within IR teaching and research. I argue, secondly, that critical IR scholars both could and should do more impact work – that the current political conjuncture demands it, that many of the standard objections to doing so are misplaced, and indeed that ‘critical’ modes of research are in some regards better suited than ‘problem-solving’ ones to generating meaningful change – and offer a series of recommended principles for undertaking critically-oriented impact and engagement work. But I also argue, thirdly, that critical social science holds important lessons for the impact agenda, and that future impact assessments need to take these lessons on board – especially if critical IR scholarship is to embrace impact more fully. Critical IR, I submit, should embrace impact; but at the same time, research councils and assessments could do with modifying their approach to it, including by embracing a more critical and political understanding of what impact is and how it is achieved

Measles virus causes immunogenic cell death in human melanoma

Oncolytic viruses (OV) are promising treatments for cancer, with several currently undergoing testing in randomised clinical trials. Measles virus (MV) has not yet been tested in models of human melanoma. This study demonstrates the efficacy of MV against human melanoma. It is increasingly recognised that an essential component of therapy with OV is the recruitment of host anti-tumour immune responses, both innate and adaptive. MV-mediated melanoma cell death is an inflammatory process, causing the release of inflammatory cytokines including type-1 interferons and the potent danger signal HMGB1. Here, using human in vitro models, we demonstrate that MV enhances innate antitumour activity, and that MV-mediated melanoma cell death is capable of stimulating a melanoma-specific adaptive immune response

High hospital research participation and improved colorectal cancer survival outcomes: a population-based study

Objective: In 2001, the National Institute for Health Research (NIHR) Cancer Research Network (NCRN) was established, leading to a rapid increase in clinical research activity across the English NHS. Using colorectal cancer (CRC) as an example, we test the hypothesis that high, sustained hospital-level participation in interventional clinical trials improves outcomes for all CRC patients managed in those research-intensive hospitals. Design: Data for patients diagnosed with CRC in England in 2001-2008 (n=209,968) were linked with data on accrual to NCRN CRC studies (n=30,998). Hospital Trusts were categorised by the proportion of patients accrued to interventional studies annually. Multivariable models investigated the relationship between 30-day post-operative mortality and five-year survival and the level and duration of study participation. Results: Most of the Trusts achieving high participation were district general hospitals and the effects were not limited to cancer “centres of excellence”, although such centres do make substantial contributions. Patients treated in Trusts with high research participation (≥16%) in their year of diagnosis had lower post-operative mortality (p<0.001) and improved survival (p<0.001) after adjustment for casemix and hospital-level variables. The effects increased with sustained research participation, with a reduction in post-operative mortality of 1.5% (6.5% to 5%, p<2.2*10-6) and an improvement in survival (p<10 19; 5-year difference: 3.8% (41.0% to 44.8%)) comparing high participation for ≥4 years with 0 years. Conclusion: There is a strong independent association between survival and participation in interventional clinical studies for all CRC patients treated in the hospital, not only study participants. Improvement precedes and increases with the level and years of sustained participation

Patients report improvements in continuity of care when quality of life assessments are used routinely in oncology practice: Secondary outcomes of a randomised controlled trial.

INTRODUCTION AND AIM: In a randomised trial investigating the effects of regular use of health-related quality of life (HRQOL) in oncology practice, we previously reported an improvement in communication (objective analysis of recorded encounters) and patient well-being. The secondary aims of the trial were to measure any impact on patient satisfaction and patients' perspectives on continuity and coordination of their care. METHODS: In a prospective trial involving 28 oncologists, 286 cancer patients were randomised to: (1) intervention arm: regular touch-screen completion of HRQOL with feedback to physicians; (2) attention-control arm: completion of HRQOL without feedback; and (3) control arm: no HRQOL assessment. Secondary outcomes were patients' experience of continuity of care (Medical Care Questionnaire, MCQ) including 'Communication', 'Coordination' and 'Preferences to see usual doctor' subscales, patients' satisfaction, and patients' and physicians' evaluation of the intervention. Analysis employed mixed-effects modelling, multiple regression and descriptive statistics. RESULTS: Patients in the intervention arm rated their continuity of care as better than the control group for 'Communication' subscale (p=0.03). No significant effects were found for 'Coordination' or 'Preferences to see usual doctor'. Patients' evaluation of the intervention was positive. More patients in the intervention group rated the HRQOL assessment as useful compared to the attention-control group (86% versus 29%), and reported their doctors considered daily activities, emotions and quality of life. CONCLUSION: Regular use of HRQOL measures in oncology practice brought changes to doctor-patient communication of sufficient magnitude and importance to be reported by patients. HRQOL data may improve care through facilitating rapport and building inter-personal relationships

Future Intentions Regarding Quitting and Reducing Cigarette Use in a Representative Sample of Canadian Daily Smokers: Implications for Public Health Initiatives

Pre-cessation reduction is associated with quitting smoking. However, many smokers reduce the amount consumed but may not quit altogether. Using a representative sample of adult current daily smokers, this project explored future intentions of smokers regarding cigarette consumption. This information is important because it can provide a framework within which to plan tobacco cessation initiatives. A random digit dialing telephone survey was conducted of 889 Canadian current daily smokers, 18 years and older. The response rate was 65% (of households with a smoker in residence, 65% agreed to participate). Analyses focused on the 825 respondents who smoked at least 10 cigarettes per day at some point in their lives. As part of this survey, respondents were asked their future plans about their smoking (maintain, increase, reduce, quit). Of these 825 respondents, the majority of respondents had plans to change their cigarette use, with 55% planning to quit, 18.8% to reduce and 22.5% to maintain the amount they smoked (3.4% did not know and 2 respondents planned to increase). Most smokers who planned to reduce their smoking saw it as a step towards quitting smoking completely. These results present a picture of smokers, the majority of whom appear to be in some form of transition. Many smokers planned to reduce, of which the overwhelming majority saw their reduction as a step towards quitting. Opportunities exist to capitalize on these intentions to change in efforts to promote tobacco cessation

Gender Identity and Psychological Adjustment in Men with Serious Mental Illnesses

Masculine gender identity and its relationship with self-concept and psychological adjustment was studied for men with serious mental illnesses. Two hundred and thirty-eight men with serious mental illnesses from 15 psychosocial rehabilitation centers in Maryland and Northern Virginia rated a set of 47 masculine beliefs and attributes. Items were derived from a previous study (Keller, 1994) which generated a set of 78 beliefs about masculinity through a series of 9 focus groups with men in this population. Each of the 4 7 items in the present study was rated in terms of (a) how much each item was " like me" and (b) how important each item was to being a man. Test-retest correlations for the set of 47 items were r =.62 for ratings of how much "like me" items were and r =.92 for ratings of importance. Internal consistency (alpha) for the two sets of ratings were .93 and .94, respectively. Participants also completed (a) self-ratings of the words "masculine" and "feminine" (Spence, 1984) and (b) measures of psychiatric symptoms and psychological adjustment including the Brief Symptom Inventory, the Beck Depression Inventory, the Rosenberg Self-Esteem Scale, the Self-Efficacy Scale and the Internalized Shame Scale. Factor analysis of ratings for masculine beliefs and attributes revealed three dimensions (labeled morality, family, and toughness) which diverged from the patterns described in the general literature on masculinity. A cluster analysis based on factor scores for these dimensions failed to reveal subgroups of men distinguished by gender identity as defined through the factors. Degree of discrepancy between men's ratings of how much masculine beliefs and attributes were "like me" and ratings of the importance of those items to being a man was associated with higher global symptom severity (r =.21, p<.01), depression (r =.32, p<.01), and internalized shame (r =.26, p<.01), and with lower self-efficacy beliefs (r =.33, p<.01). Men who rated themselves as more masculine than feminine revealed significantly better adjustment, on the above measures, than men who rated themselves as neutral or more feminine than masculine. Divergence between the current factors and those from the general literature on masculinity, in terms of the dimensions of masculine beliefs and attributes found for this group of men, is discussed as a function of the losses and limitations inherent in the experience of serious mental illness. The inverse association between psychological adjustment and self-discrepancy on the set of masculine beliefs is presented as locus for further research and intervention

Endothelin-1 Predicts Hemodynamically Assessed Pulmonary Arterial Hypertension in HIV Infection.

BackgroundHIV infection is an independent risk factor for PAH, but the underlying pathogenesis remains unclear. ET-1 is a robust vasoconstrictor and key mediator of pulmonary vascular homeostasis. Higher levels of ET-1 predict disease severity and mortality in other forms of PAH, and endothelin receptor antagonists are central to treatment, including in HIV-associated PAH. The direct relationship between ET-1 and PAH in HIV-infected individuals is not well described.MethodsWe measured ET-1 and estimated pulmonary artery systolic pressure (PASP) with transthoracic echocardiography (TTE) in 106 HIV-infected individuals. Participants with a PASP ≥ 30 mmHg (n = 65) underwent right heart catheterization (RHC) to definitively diagnose PAH. We conducted multivariable analysis to identify factors associated with PAH.ResultsAmong 106 HIV-infected participants, 80% were male, the median age was 52 years and 77% were on antiretroviral therapy. ET-1 was significantly associated with higher values of PASP [14% per 0.1 pg/mL increase in ET-1, p = 0.05] and PASP ≥ 30 mmHg [PR (prevalence ratio) = 1.24, p = 0.012] on TTE after multivariable adjustment for PAH risk factors. Similarly, among the 65 individuals who underwent RHC, ET-1 was significantly associated with higher values of mean pulmonary artery pressure and PAH (34%, p = 0.003 and PR = 2.43, p = 0.032, respectively) in the multivariable analyses.ConclusionsHigher levels of ET-1 are independently associated with HIV-associated PAH as hemodynamically assessed by RHC. Our findings suggest that excessive ET-1 production in the setting of HIV infection impairs pulmonary endothelial function and contributes to the development of PAH