Objectives The emergence of immune checkpoint inhibitors has transformed treatment paradigms for various malignancies. Patients with cancer are at increased risk of complications and hospitalizations from influenza; therefore, it is recommended that they receive inactivated influenza vaccination. However, efficacy and safety of inactivated influenza vaccination in patients receiving immune checkpoint inhibitors is uncertain. The objective of this prospective case series was to evaluate the incidence of immune-mediated adverse events (imAEs) following inactivated influenza vaccination in patients receiving immune checkpoint inhibitors. Changes in cytokine and chemokine levels were also evaluated. Methods Patients receiving immune checkpoint inhibitors during the 2017–2018 influenza season were eligible for study participation. Peripheral blood samples were collected prior to administration of inactivated influenza vaccine and two post-vaccination time points. Evaluation of new or worsening imAEs occurred via patient questionnaire and review of medical records for 60 days following inactivated influenza vaccination. Baseline imAEs were evaluated from review of medical records for 60 days prior to inactivated influenza vaccination. Serum cytokines and chemokines were measured using a multiplex Luminex assay. Results Twenty-four patients were enrolled in this study. Seven patients experienced any grade imAE (one patient having 2) within 60 days following inactivated influenza vaccination. The majority were Grades 1–2, including rash ( n = 3), hypothyroidism, myalgia, and colitis ( n = 1 each). Two patients experienced severe imAEs (grade 3 nephritis and grade 4 diabetes). No significant changes ( p > 0.05) in serum cytokine or chemokine concentrations were observed. Conclusions Although small, our study suggests that inactivated influenza vaccine may be safely administered to patients receiving immune checkpoint inhibitors. The majority of imAEs following inactivated influenza vaccination were Grades 1-2 and did not require changes in immune checkpoint inhibitor therapy.
Recent trends in higher education financing have increased students’ need to borrow to afford college. This brief examines how federal student loan borrowing has changed from 2000 to 2016 by student race/ethnicity using logistic regression analysis and data from the National Postsecondary Student Aid Study (NPSAS). We find that the odds of borrowing have diverged over time across racial and ethnic subgroups even after controlling for institutional sector and students’ financial circumstances. This divergence in student loan borrowing has important implications for policymakers and researchers interested in closing racial gaps in college access and success.
Despite the presence of a historically male-dominated culture in leadership, gendermediated obstacles and challenges, black women in South Africa have the passion to develop professionally and move to higher levels as educational leaders. The current study assessed female students' perceptions regarding a joint pilot doctoral programme between the University of the Western Cape (UWC) and California State University, Fullerton's (CSUF) Higher Education programme, and their experiences while in the programme. Five participants described programme expectations, challenges, strengths, weaknesses and programme completion. Moreover, the research focused on the participants' future hopes, aspirations and their observations regarding any changes in their professional and academic growth. Students expressed that coming to CSUF after their experiences at UWC enabled them to learn from faculty members with expertise in student affairs, which has further developed their knowledge concerning student development strategies, philosophy and history. Recommendations for the programme centred on increased cohort meetings, expanded programme resources such as research, student support outside the classroom settings, and the improvement of programme funding in order to provide more financial support to students. The importance of professional development and formalised training programmes, expanding research dynamics, and teaching components with international collaborations are promising practices to address the challenges and obstacles that black women face in preparing to become leaders in South African higher education.
Cancer treatment costs in the United States are rising. Evidence suggests that increased costs do not always correlate with improved outcomes. Several organizations have developed tools and frameworks to assess cancer treatment value; however, many centers have reported difficulty in implementing these tools and effectively incorporating value-based decision making into clinical practice. After evaluating existing frameworks, the Carbone Cancer Center at UW Health set out to create a value-based tool that could be used to inform the decisions of clinicians and patients. This tool was piloted in metastatic or advanced non-small cell lung cancer, specifically in the second-line setting to assess the value of immune checkpoint inhibitors nivolumab, atezolizumab, and pembrolizumab. The results of the pilot suggest that atezolizumab is the best value of the three agents in this patient population. Challenges and opportunities for improvement that were identified during the pilot process have helped refine the tool for use in a variety of disease states within oncology.
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