Carfilzomib-induced thrombotic microangiopathy. A case report

Introduction Drug-induced thrombotic microangiopathy (DITMA) is an acquired condition resulting from exposure to a drug that induces the formation of platelet-rich thrombi in small arterioles or capillaries secondary to drug-dependent antibodies or direct tissue toxicity. Carfilzomib is a selective proteasome inhibitor approved to treat selected patients with Multiple Myeloma (MM). It is one of the drugs with the strongest evidence for a causal association with non-antibody-mediated DITMA. Case Report A 75-year-old man presented to the emergency department for the outbreak of vomit, asthenia, oliguria and dark stool emission. He was recently diagnosed with multiple myeloma, treated with lenalidomide, dexamethasone and carfilzomib. Laboratory exams were significant for microangiopathic haemolytic anaemia, thrombocytopenia and new-onset renal failure. ADAMTS-13 levels were in range, and no infectious signs were found both in blood nor in stool test. Management & Outcome A carfilzomib induced thrombotic microangiopathy was soon suspected. Thus, since daily haemodialysis and supportive care did not seem to get a fast enough recovery, the patient was treated with eculizumab with a good general outcome. Discussion Drug-induced thrombotic microangiopathy is a rare and often life-threatening acquired condition whose diagnosis can be challenging and whose therapy is not always limited to supportive treatment and drug avoidance. Carfilzomib, along with other proteasome inhibitors, is one of the described potential drugs which can trigger such a manifestation.

Management’s Fiduciary Responsibility Towards IT Governance In The Context Of The King III Code Of Corporate Governance In South Africa

The purpose of this study was to examine the extent to which South African listed companies trading on the Johannesburg Securities Exchange (JSE) are complying with IT governance imperatives in the context of the King III Code of Corporate Governance. Management information systems and usage of computers are now embedded in business processes to the extent that most firms will be dysfunctional should these tools become unavailable. The underlying theoretical setting for this study is anchored on the agency theory and the Porter’s competitive five forces model. Since there were inadequate constructs on the subject, a combination of research methods were used: desk-top review, exploratory study, and content analysis, by reviewing the annual financial statements of fifty JSE-listed companies (the main board) in South Africa. The general outcome of the study was that JSE-listed companies in South Africa were compliant with IT governance practices as prescribed in the King III Code of Corporate Governance. Most JSE-listed companies in South Africa utilized both generic and bespoke or owned-designed IT governance frameworks to meet IT governance requirements. The study also revealed that issues relating to IT governance were among priority issues for South African listed companies. The study concludes that JSE-listed companies in South Africa have indeed fulfilled their fiduciary responsibility towards IT governance.

Renewable Energy and Economic Growth

The global commitment to drastically curb greenhouse gas emissions towards a sustainable development is strongly connected to the development and usage of renewable energy (RE), such as solar and wind. Between 2006 and 2016, world's total RE consumption, excluding hydro-electricity, increased by almost 350%, and RE investment grew from US $47 billion in 2004 to 279.8 billion in 2017. The importance of RE has attracted a lot of attention from the economic literature as well, since a growing body of empirical research is investigating the relationships between RE and economic growth. The general outcome is the existence of a positive bi-directional (direct and reverse) link between RE consumption and real GDP, though it also emerges evidence showing no statistically significant relationship. This Chapter provides i) an overview of the recent world's trends of RE production and investment, ii) an extensive and detailed review of the recent advances in the RE-growth empirical literature, highlighting the main methodologies adopted and the main findings emerged.

Analysis of Practices for Assessing the Effectiveness of Civil servants in the Russian Federation

In this article, the authors analysed the methodology of improving the evaluation of the effectiveness of the state civil service in the Russian Federation. It includes a retrospective analysis of the development of the legal framework, attempts to introduce pilot projects on the evaluation of effectiveness and development of criteria in the state authorities of the Russian Federation, experience in the implementation of evaluation methods in the authorities of the constituent entities of the Russian Federation, as well as a general outcome on the application of the methods of effectiveness. The relevance of our article consists of analysis and study the evolution of methods of evaluating the effectiveness of state civil servants in the Russian Federation. On this basis, it is possible to highlight those essential criteria and processes which in the future will help to lay the ground for the development of new approaches in the field of evaluation of the effectiveness of state civil servants. The authors took into account modern trends and the focus on the development of quality skills and skills of contemporary state civil servants in the Russian Federation.

Osteocalcin

В качестве общего итога современных биомедицинских исследований стало привычным обнаруживать корреляциенные связи «всего со всем». Четверть вековая история изучения остеокальцина - пример, подтверждающий эту тенденцию. За 25 лет научный статус вещества прогрессировал от белка с неизвестной функцией, просто присутствующего на второй по содержанию позиции в кости, до остеокина с влиянием, распространяющимся далеко за морфологические и узко определяемые функциональные границы кости, демонстрирующего, что кость через остеокальцин влияет на многие стороны жизни - в том числе на энергетический обмен, развитие и функцию мозга, репродуктивную способность. Известные сегодня свойства остеокальцина делают его перспективным объектом геронтологического изучения. As a general outcome of modern biomedical research, it has become customary to discover relationships “of everything with everything”. A quarter-century history of studying osteocalcin is an example of this trend. For 25 years, the scientific status of this substance has progressed from a protein with an unknown function that is nothing but the second most concentrated substance in bones to an osteokine, which extends its influence far beyond the morphological and one-dimensionally understood functional boundaries of the bone. It has become clear that osteocalcin mediates effects of the bone on multiple aspects of life, including energy metabolism, brain development and function, and reproduction. The state-of-the-art knowledge about osteocalcin properties makes it a promising object of gerontological study.

Food and Nutrition Policies in the Philippines

Objectives The objective of ths study is to identify and assess food and nutrition-related policies in the Philippines. It also aimed to identify gaps in the implementation of the identified policies. Methods To identify nutrition policies, two online public search engines were used – Official Gazette of the Republic of the Philippines and The LAWPHiL Project of the Arellano Law Foundation. Manual searching through the websites initially garnered 31 policies relating to food and nutrition. Excluded from the list are those which are primarily agriculture or industry in content. The remaining policies focused on nutrition promotion and enhancement of service delivery to improve nutrition outcomes. Results The Philippine government through its designate nutrition agencies have been responsive to the health needs of its people. Some policies have been lobbied for longer periods than others; while some which have already been enacted into national laws lacked updating. Common challenges to implementation are lack of monitoring and evaluation tools and resources, and lack of community awareness. Conclusions The general outcome of policy implementation is affected by political will on the local administrative level; thereby resulting to inconsistent action plans at the grassroots. Funding Sources N/A.

Renewable Energy and Economic Growth

The global commitment to drastically curb greenhouse gas emissions towards a sustainable development is strongly connected to the development and usage of renewable energy (RE), such as solar and wind. Between 2006 and 2016, world's total RE consumption, excluding hydro-electricity, increased by almost 350%, and RE investment grew from US $47 billion in 2004 to 279.8 billion in 2017. The importance of RE has attracted a lot of attention from the economic literature as well, since a growing body of empirical research is investigating the relationships between RE and economic growth. The general outcome is the existence of a positive bi-directional (direct and reverse) link between RE consumption and real GDP, though it also emerges evidence showing no statistically significant relationship. This Chapter provides i) an overview of the recent world's trends of RE production and investment, ii) an extensive and detailed review of the recent advances in the RE-growth empirical literature, highlighting the main methodologies adopted and the main findings emerged.

Reliability and Validity of an Equanimity Questionnaire: The Two-Factor Equanimity Scale (EQUA-S)

Background: Many studies have revealed the positive impact of mindfulness training on mental health and proposed equanimity as a general outcome in contemplative research. Despite recent interest, relatively few studies have examined equanimity empirically and measurement instruments are still lacking. The main goal of this study was to develop an Equanimity Scale (the EQUA-S) in a Western population with or without meditation experience, based on equanimity definitions and to investigate its relationships with relevant psychological constructs and health outcomes. Method: Adults from the general population (N = 265; 175 women and 89 men; Mage = 34.81) completed various measures: the EQUA-S, mindfulness, hyper-sensitivity, avoidance and fusion, impulsivity, personality, alexithymia, sensitivity to punishment and reward and frequency of problematics addictive behaviors. The dimensionality of the EQUA-S was examined using Factor Analyses. The convergent validity of this new scale was investigated using Pearson correlations.Results: Results of a factor analysis revealed two equanimity dimensions: an even-minded state of mind (E-MSM) component and a hedonic independence (HI) dimension. While the E-MSM was positively related to emotional stability, adaptive emotional regulation and several mindfulness-related abilities, HI was found to correlate negatively with addictive issues. Conclusion: The relationships with personality constructs and possible related cognitive processes will be discussed.

Firms’ leverage ratio and the Financial Instability Hypothesis: an empirical investigation for the US economy (1970–2014)

‘There are many ‘Minskian’ interpretations of how financial fragility builds up reflecting the unsolved tensions regarding the transition from micro to macro results in Minsky’s Financial Instability Hypothesis (FIH).’ Using firm-level and macroeconomic data to comply with the variety of FIH’s interpretations, we empirically assess the relations between leverage and financial fragility in the US economy (1970–2014). To evaluate firms’ financial fragility, we deploy Minsky’s scale—from the financially sounder to the more fragile firms: hedge, speculative and Ponzi. The main findings are the following: (i) the evolution of the aggregate leverage ratio does not account for the systemic financial fragility, measured by the frequency of speculative and Ponzi firms, and (ii) within the biggest firms, the leverage has increased along with the incidence of hedge financing, and for the smallest firms group the opposite has happened. We conclude that a positive relation between leverage and financial fragility cannot be deemed to be a general outcome.