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Pancreatic carcinoma (PC) is one of the leading causes of cancer-related deaths worldwide. Despite early detection and advances in therapeutics, the prognosis remains dismal. The outcome and therapeutic approach are dependent on the stage of PC at the time of diagnosis. The standard of care is surgery, followed by adjuvant chemotherapy. The advent of newer drugs has changed the landscape of adjuvant therapy. Moreover, recent trials have highlighted the role of neoadjuvant therapy and chemoradiotherapy for resectable and borderline resectable PC. As we progress towards a better understanding of tumor biology, genetics, and microenvironment, novel therapeutic strategies and targeted agents are now on the horizon. We have described the current and emerging therapeutic strategies in PC.

The competition for safari tourism in sub-Saharan Africa is intense. Aside from inter-country competition, there is also intra-country competition among game viewing lodges and resorts within each country. In this context, it is important to understand the strengths and weaknesses of each country for safari tourism. We empirically test the relationship between tourism performance and multiple tourism dimensions, namely, tourism Attractions (A), Basics (B), and Context (C). We test the Tourism A-B-C model (Manrai, Manrai, & Friedeborn, 2018) using data from Botswana, Kenya, Namibia, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe. The study, a first in the region, addresses tourism as an economic development driver and offers important insights, suggesting that tourism dimensions correlate with economic development, with the exception of situations where governments provide leadership in developing tourism, as in Kenya, or where they stress education, as in Zimbabwe. We also discuss research implications and directions for future research.

PurposeHeeding the call for insights into the Sub-Saharan African international marketing context, this study aims to empirically examine consumers' desires and motivations for buying counterfeit luxury goods. It examines influences on consumers' attitudes and purchase intentions related to counterfeit luxury goods in Rwanda, one of Sub-Saharan Africa's fastest-growing economies and growing luxury markets, developing and testing a model examining the effect of social context on personal attributes, providing evidence on economic and social-status factors as drivers for counterfeiting.Design/methodology/approachThe data were collected using an online survey administered in Rwanda to consumers who had previously purchased luxury goods and counterfeits. A total of 312 valid responses were analyzed using structural equation modeling.FindingsThis study found that normative and informational influences had a positive effect on Rwandan consumers' attitude toward purchasing counterfeit luxury products, with attitude influencing purchase intentions directly and indirectly, through mediating variable desire for status or through value consciousness and desire for status.Originality/valueThe study contributes to academic research − one of the first empirical studies to examine consumers' desires and motivations for buying counterfeit luxury goods in Sub-Saharan Africa, providing insights that benefit scholars and practitioners seeking to better understand a market where more than half of the world's fastest economies are located.

PurposeThe aim of this research is to investigate the factors influencing the adoption of digital payments by the semi-rural women in India.Design/methodology/approachThe study extended the factors of unified theory of acceptance and use of technology UTAUT-2, with perceived credibility and self-determination theory to understand the use behaviour of the rural Indian women. The study checked the mediating role of some constructs besides testing the direct relationship. The study was conducted in the rural parts of the adjoining areas of Delhi, where the women from different states, education and financial background live. The research model was empirically tested on 568 respondents using structural equation modelling (SEM) technique.FindingsThe research model was able to explain 72.6% variance in the user behaviour variable. Effort expectancy, habit, facilitating conditions as well as perceived competence emerged out to be significant determinants of use behaviour. Besides these direct relationships, two constructs, habit as well as facilitating conditions were found to partially mediate the relationship between behavioural intention and behaviour.Originality/valueThis study provides some very critical clues for the companies providing digital payment services, by highlighting the significant factors explaining the technology adoption by semi-rural women. The companies must devise suitable marketing strategies to inculcate trust in mind of perspective customers towards their companies as well as the service provided by them. The role of simple digital platform, that is easy to learn and use, is also an important element in determining the technology adoption.

The COVID-19 pandemic has been a catalyst for the implementation of decentralized clinical trials (DCTs) enabled by digital health technologies (DHTs) in the field while curtailing in-person interactions and putting significant demands on health care resources. DHTs offer improvements in real-time data acquisition remotely while maintaining privacy and security. Here, we describe the implications of technologies, including edge computing, zero-trust environments, and federated computing in DCTs enabled by DHTs. Taken together, these technologies—in the setting of policy and regulation that enable their use while protecting the users—extend the scope and accelerate the pace of clinical research.

Background Childhood immunization against hepatitis B is one of the most effective strategies for reducing the global burden of chronic hepatitis B infection and its sequelae. There are limited data from India on both the anti-Hep B antibody titres in children after vaccination and the age-related decline in the titres. This study was planned to estimate the proportion of children in the age group of 1–10 years who develop protective levels of anti-hepatitis B antibodies after childhood vaccination and to examine the change in antibody titres with age in these children. Methods A hospital-based cross-sectional study was carried out in children admitted to the hospital for various ailments. Basic demographic data, vaccination history and HBsAg status of the mother were recorded. All the enrolled children were evaluated for HBsAg and anti hepatitis B surface antibody (anti-HBS) titres. Institutional ethical clearance was obtained, and informed consent from the parents of the children was taken before drawing samples. Results We found that 68.86% Confidence Interval ((CI): 59.8–76.8%) of the children showed protective antibody titres after vaccination, while 31.14% (CI: 23.1–40.2%) of the children had titres less than 10 IU/L. Although 100% of children in the age group from birth to three years had titres more than 10 IU/L, this percentage showed a decline across the age groups, and 60% of children aged 9–10 years had titres less than 10 IU/L. Conclusion Childhood vaccination against hepatitis B is effective in 68% children, and the antibody levels showed a steady decline with increasing age.

In Search of a Better Equation Although many experts agree that we should reconsider the use of race in equations for estimated glomerular filtration rate and in medicine more generally, precisely ...

Diagnostic laboratories gather phenotypic data through requisition forms, but there is no consensus as to which data are essential for variant interpretation. The ClinGen Cardiomyopathy Variant Curation Expert Panel defined a phenotypic data set for hypertrophic cardiomyopathy (HCM) variant interpretation, with the goal of standardizing requisition forms. Phenotypic data elements listed on requisition forms from nine leading cardiomyopathy testing laboratories were compiled to assess divergence in data collection. A pilot of 50 HCM cases was implemented to determine the feasibility of harmonizing data collection. Laboratory directors were surveyed to gauge potential for adoption of a minimal data set. Wide divergence was observed in the phenotypic data fields in requisition forms. The 50-case pilot showed that although demographics and assertion of a clinical diagnosis of HCM had 86% to 98% completion, specific phenotypic features, such as degree of left ventricular hypertrophy, ejection fraction, and suspected syndromic disease, were completed only 24% to 44% of the time. Nine data elements were deemed essential for variant classification by the expert panel. Participating laboratories unanimously expressed a willingness to adopt these data elements in their requisition forms. This study demonstrates the value of comparing and sharing best practices through an expert group, such as the ClinGen Program, to enhance variant interpretation, providing a foundation for leveraging cumulative case-level data in public databases and ultimately improving patient care.

BACKGROUND/AIMS: Hematopoietic stem cell transplantation (HSCT) is an established curative modality for various hematological malignancies and other diseases. Hepatobiliary dysfunction and subsequent sequelae constitute a common cause of morbidity and mortality in post-transplant scenario. However, data among Indian HSCT recipients is lacking. METHODS: One hundred and one HSCT recipients (37 prospective and 64 retrospective) were followed up for hepatobiliary dysfunction in the post-transplant period. The causes for hepatobiliary dysfunction were categorized as sinusoidal obstruction syndrome (SOS), formerly known as veno-occlusive disease (VOD); acute and chronic graft-versus- host disease (GVHD); drug-induced liver injury (DILI); viral infections and miscellaneous causes including bacterial, fungal and unknown causes based on clinical and laboratory evidence. RESULTS: Among the 101 transplants, 56.44% (n = 57) were allogenic transplants, and 43.56% (n = 44) were autologous transplants. Hepatobiliary dysfunction was observed among 71 (70.30%) patients in first 30 days and overall, among 78 (77.23%) patients. Incidence of hepatobiliary dysfunction was higher among allogenic transplant patients compared to autologous transplants (91.23% vs. 59.09%, p

This research advances four propositions and a conceptual model of country and company characteristics influencing key International Business Decisions (IBDs). The IBDs in this study are country selection and evaluation, entry mode, segmentation-targeting-positioning, and the marketing mix – the first two in the international business domain, and the latter two in the international marketing field. The conceptual model and related four propositions are advanced, based on an extensive literature review and subsequent in-depth review of 169 published research papers on major IBDs and their determinants, namely, country characteristics, including opportunities, risks, and various distances between the host country and home country, and company characteristics, which include international business experience, assets/resources, and expansion/growth strategies. Managerial implications and directions for future research are discussed.

Background Physicians sometimes consider whether or not to perform diagnostic testing in healthy people, but it is unknown whether nonextreme values of diagnostic tests typically encountered in such populations have any predictive ability, in particular for risk of death. The goal of this study was to quantify the associations among population reference intervals of 152 common biomarkers with all-cause mortality in a representative, nondiseased sample of adults in the United States. Methods The study used an observational cohort derived from the National Health and Nutrition Examination Survey (NHANES), a representative sample of the United States population consisting of 6 survey waves from 1999 to 2010 with linked mortality data (unweighted N = 30 651) and a median followup of 6.1 years. We deployed an X-wide association study (XWAS) approach to systematically perform association testing of 152 diagnostic tests with all-cause mortality. Results After controlling for multiple hypotheses, we found that the values within reference intervals (10–90th percentiles) of 20 common biomarkers used as diagnostic tests or clinical measures were associated with all-cause mortality, including serum albumin, red cell distribution width, serum alkaline phosphatase, and others after adjusting for age (linear and quadratic terms), sex, race, income, chronic illness, and prior-year healthcare utilization. All biomarkers combined, however, explained only an additional 0.8% of the variance of mortality risk. We found modest year-to-year changes, or changes in association from survey wave to survey wave from 1999 to 2010 in the association sizes of biomarkers. Conclusions Reference and nonoutlying variation in common biomarkers are consistently associated with mortality risk in the US population, but their additive contribution in explaining mortality risk is minor.

Case Report, Growing teratoma syndrome (GTS) is rare. The optimum treatment strategy is complete surgical excision. We describe a 42-year-old woman with GTS who was treated with laparoscopic excisional surgery. Initially, we performed right salpingo-oophorectomy; she was diagnosed with grade 2 immature teratoma, which was treated with four courses of peplomycin, etoposide, and cisplatin chemotherapy. Postoperatively, her tumor marker (alpha-fetoprotein) was not elevated; however, 19 years later, she developed an enlarged mass in her pelvic cavity. Laparoscopic surgery revealed some of the enlarged tumors detected by preoperative magnetic resonance imaging in the pouch of Douglas. We resected the retroperitoneal tumors. The histological diagnosis was mature teratomas. We concluded that these tumors were GTS. No recurrent disease was observed 12 months thereafter. This case represents one of the longest reported interval periods before the development of GTS. Laparoscopic surgery is an effective alternative diagnostic and therapeutic approach in cases suggestive of GTS. Laparoscopic surgery might be feasible in cases of GTS, but further study will be needed, given that only a few reported cases have been managed laparoscopically.

Aging has pronounced effects on blood laboratory biomarkers used in the clinic. Prior studies have largely investigated one biomarker or population at a time, limiting a comprehensive view of biomarker variation and aging across different populations. Here we develop a supervised machine learning approach to study aging using 356 blood biomarkers measured in 67,563 individuals across diverse populations. Our model predicts age with a mean absolute error (MAE), or average magnitude of prediction errors, in held-out data of 4.76 years and an R2 value of 0.92. Age prediction was highly accurate for the pediatric cohort (MAE = 0.87, R2 = 0.94) but inaccurate for ages 65+ (MAE = 4.30, R2 = 0.25). Variability was observed in which biomarkers carry predictive power across age groups, genders, and race/ethnicity groups, and novel candidate biomarkers of aging were identified for specific age ranges (e.g. Vitamin E, ages 18-44). We show that predictors for one age group may fail to generalize to other groups and investigate non-linearity in biomarkers near adulthood. As populations worldwide undergo major demographic changes, it is increasingly important to catalogue biomarker variation across age groups and discover new biomarkers to distinguish chronological and biological aging.

Background Pulmonary and pleural involvement is fairly common in patients with lymphoma, especially in the setting of progressive or recurrent disease. Pleuropulmonary involvement in lymphoma may occur as a single pattern or as a combination of multiple patterns which can often mimic unrelated pathologies. Methods Review of our institutional database from 01 Jan 2015 to 04 Oct 2017 revealed 90 patients with pulmonary and/or pleural lesions attributable to lymphoma. These lesions were classified into various categories, and the pattern of involvement was evaluated. Results Pulmonary involvement was seen in 17.6% of patients with Hodgkin lymphoma (HL) and in 10.5% of patients with non-Hodgkin lymphoma (NHL), whereas pleural involvement was seen in 6.5% of patients with NHL. Almost all the patients in our study had findings belonging to multiple categories. Pulmonary involvement in patients with HL was seen in the form of nodules (51.6%), masses (51.6%), and direct extension from a mediastinal/hilar mass (45.2%). Patients with NHL had pulmonary involvement in the form of nodules (42.4%), direct extension from a mediastinal/hilar mass (25.4%), pulmonary masses (18.6%), and interstitial pattern (2.4%). Pleural thickening (61.5%), masses (30.8%), and effusion (15.4%) were the three patterns of pleural involvement. Conclusion Nodules and masses were the two commonest patterns of pulmonary involvement in patients with HL, whereas nodules were the commonest pattern noted in patients with NHL. Pulmonary masses were seen more commonly in patients with HL than in those with NHL. Pleural involvement was seen exclusively in patients with NHL.