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In the past decade, immune checkpoint inhibitors (ICI) have been approved for treatment of genitourinary malignancies and have revolutionized the treatment landscape of these tumors. However, despite the remarkable success of these therapies in some GU malignancies, many patients' tumors do not respond to these therapies, and others may experience significant side effects, such as immune-related adverse events (iRAEs). Accordingly, biomarkers and improved prognostic tools are critically needed to help predict which patients will respond to ICI, predict and mitigate risk of developing immune-related adverse events, and inform personalized choice of therapy for each patient. Ongoing clinical and preclinical studies continue to provide an increasingly robust understanding of the mechanisms of the response to immunotherapy, which continue to inform biomarker development and validation. Herein, we provide a comprehensive review of biomarkers of the response to immunotherapy in GU tumors and their role in selection of therapy and disease monitoring. [ABSTRACT FROM AUTHOR]

Objective: An inner-city hospital purchased a local hotel to provide support, digital engagement, skill development groups and referrals to partner agencies. Being aware of the hotel's importance to the local community, we sought feedback on a model of care relevant to perceived gaps and needs in support for mental health. Methods: Four online focus groups included healthcare professionals, nominated opinion leaders from local Non-Government Organisations (NGOs), consumers and carers to reflect a range of views. Focus group data were qualitatively analysed. Results: Participants made useful suggestions about WHAT educational, preventative and therapeutic services were needed. They emphasised the importance of HOW people engage with the service, the balance between accessibility and security. Other themes included targeting people with limited health literacy, integration with existing services, building on site heritage and ongoing evaluation of objectives and needs. Conclusions: This pilot study demonstrated clear support for providing safe and welcoming access to services, with resources and access to services to improve their health and wellbeing built on principles of social justice and inclusion. Participants had constructive ideas of what was needed, and ongoing patient and public research is anticipated. [ABSTRACT FROM AUTHOR]

Objectives: Review the incidence and factors associated with respiratory compromise requiring intensive care unit level interventions in children with planned admission to the pediatric intensive care unit (PICU) following tonsillectomy or adenotonsillectomy (T/AT). Study design: Retrospective cohort study. Methods: Review of all patients with PICU admissions following T/AT from 2015 to 2020 at a tertiary care pediatric hospital. Patient demographics, underlying comorbidities, operative data, and respiratory complications during PICU admission were extracted. Results: Seven hundred and seventy-two patients were admitted to the PICU following T/AT, age 6.1 ± 4.6 years. All children were diagnosed with obstructive sleep apnea or sleep-disordered breathing (mean pre-operative apnea-hypopnea index 29 ± 26.5 and O2 nadir 77.1% ± 11.1). Neuromuscular disease, enteral feed dependence, and obesity were common findings (N = 240 (31%), N = 106 (14%), and N = 209 (27%) respectively). Overall, 29 patients (3.7%) developed respiratory compromise requiring PICU-level support, defined as new-onset continuous or bilevel positive airway pressure support (n = 25) or reintubation (n = 9). Three patients were diagnosed with pulmonary edema. Multivariable regression analysis demonstrated pre-operative oxygen nadir and enteral feed dependence were associated with respiratory compromise (OR = 0.97, 95% CI 0.94-0.99, P =.04; OR = 6.3, 95% CI 2.36-52.6, P =.001 respectively). Conclusions: Our study found respiratory compromise in 3.7% of patients with planned PICU admissions following T/AT. Oxygen nadir and enteral feeds were associated with higher respiratory compromise rates. Attention should be given to these factors in planning for post-operative disposition. [ABSTRACT FROM AUTHOR]

Objective: To define a new anatomic relationship in pediatric sinus surgery, assessing the maxillary roof as a constant safe landmark to avoid skull base injury in the pediatric population. Study Design: Retrospective analysis. Setting: Tertiary care children hospital. Subjects and Methods: A retrospective analysis was performed of all computed tomography scans of the sinuses and facial bones at the emergency department of a tertiary children's hospital over the course of a year. Radiographic measurements included the lowest cribriform plate and planum sphenoidale (PS) heights, or posterior skull base when not yet pneumatized, as well as the highest maxillary roof height. The nasal floor was used for reference. Statistics were performed via Shapiro-Wilks test with a P -value of.05 indicating statistical significance. Results: Three hundred and seven unique scans were reviewed (38.9% female; n = 122; P =.58). Age stratification was based on previously described sinus growth patterns. In all patients, the maximum maxillary height was inferior to the lowest measured cribriform lamella and PS (P <.001; CI, 98.5%-99%). Inter- and intrarater reliability and accuracy were verified through blinded review and re-review (ρ =.99 and.98 respectively, P ≤.001). The validity of sole coronal measurements due to incomplete sagittal reformatting was also confirmed (ρ = 1.00, P ≤.001). Conclusion: Despite variation in sinus growth and development in children, the current study demonstrated the validity of the maxillary sinus roof as a constant safe landmark in the pediatric population, offering a novel anatomic relationship for teaching safety in performing pediatric sinus surgery. Level of Evidence: 4 [ABSTRACT FROM AUTHOR]

BACKGROUND: The rate of aggressive acts perpetrated by psychiatric inpatients remains a pressing issue. To date, few studies have distinguished between incident severities. OBJECTIVE: The aims of the current study were to identify rates of inpatient aggression in an inpatient forensic psychiatric facility and describe the severity of the aggression reported for aggressive incidents. DESIGN: All documented acts of aggression at a 1,500-bed forensic hospital between 2009 and 2013 provided data about the time, location, and victims of aggressive acts. In total, 52,109 unique incidents were analyzed. RESULTS: The findings showed an increase in violence rates during meal, medication, and shift change times. Patients (n = 3,436, 62%) were victimized more often than staff members (n = 2,103, 38%). Fall and winter months showed more acts of aggression than summer and spring, but there were no mean differences between severity ratings by season. The results showed that the swing shift saw more severe aggressive incidents than the morning or overnight shifts, p = .001, and significantly more serious incidents occurred when there were staff members working over time, p = .050. CONCLUSIONS: The current study reports some key findings about aggression rates with a very large sample and presents some valuable data regarding the severity of aggressive acts. [ABSTRACT FROM PUBLISHER]

Despite concern with turnover in the U.S House of Representatives, few scholars have attempted to view turnover in histoncal perspective or in all its forms. Confusion over the basic facts has impeded attempts to explain and evaluate levels of turnover. We present a broad descriptive overview of turnover over the entire history of the U.S. House in terms of the levels of overall turnover, forms thereof, and patterns, particularly within party penods. The findings include that turnover has declined over the years but not in a continuous fashion and not evenly among the different forms, that general election defeat is not the primary form of turnover, that common methods of reporting turnover magnify the apparent importance of electorally based turnover, and that turnover vanes systematically by party period A research agenda is proposed for explanatory work on turnover including strategic retirement and the impact of partisan realignments on levels and forms of turnover. [ABSTRACT FROM PUBLISHER]