Relapse after stem cell transplantation for Philadelphia chromosomeÀpositive (Ph+) acute lymphoblastic leukemia (ALL) remains a significant challenge. In this systematic review, we compare survival outcomes of second-generation tyrosine kinase inhibitors (TKIs) nilotinib and dasatinib with first-generation TKI imatinib when these agents are used after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in Ph+ ALL. In addition, we review the literature on TKI use to prevent relapse in patients who proceed to allo-HSCT beyond first complete response (>CR1). We performed database searches (inception to January 2018) using PubMed, Cochrane Library, and Embase. After exclusions, 17 articles were included in this analysis. Imatinib was used post-transplant either prophylactically or preemptively in 12 studies, 7 prospective studies and 5 retrospective studies. Overall survival (OS) for most prospective studies at 1.5 to 3 and 5 years ranged between 62% to 92% and 74.5% to 86.7%. Disease-free survival at 1.5 to 5 years was 60.4% to 92%. Additionally, imatinib failed to show survival benefit in patients who were >CR1 at the time of allo-HSCT. The cumulative OS for most retrospective studies using imatinib at 1 to 2 and 3 to 5 years was 42% to 100% and 33% to 40% respectively. Event-free survival at 1 to 2 and 3 to 5 years was 33.3% to 67% and 20% to 31% respectively. Dasatinib was used as maintenance treatment in 3 retrospective studies (n = 34). The OS for patients with Ph+ ALL using dasatinib as maintenance regimen after allo-HSCT at 1.4 to 3 years was 87% to 100% and disease-free survival at 1.4 to 3 years was 89% to 100%. Ninety-three percent of patients with minimal residual disease (MRD) positive status after allo-HSCT became MRD negative. Three prospective studies used nilotinib. In 2 studies where investigators studied patients with advanced chronic myeloid leukemia and Ph+ ALL, the cumulative OS and event-free survival at 7.5 months to 2 years were 69% to 84% and 56% to 84%, respectively. In the third study (n = 5) in patients with Ph+ ALL, nilotinib use resulted in OS at 5 years of 60%. Our review showed that use of TKIs (all generations) after allo-HSCT for patients in CR1 improved OS when given as a prophylactic or preemptive regimen. Limited data suggest that second-generation TKIs (ie, dasatinib) have a better OS, especially in patients with MRD-positive status. Imatinib did not improve OS in patients who were >CR1 at the time of allo-HSCT; for this population, no data were available with newer generation TKIs. The evaluation of survival benefit with newer generation TKIs and their efficacy in patients in >CR1 needs further study in large randomized clinical trials.

The volume of distribution, plasma clearance and urinary recovery of human follicle-stimulating hormone (FSH) after intravenous injection has been estimated in healthy men. A human FSH-anti FSH radioimmunoassay was used which, though not completely specific, discriminates against luteinizing hormone (LH) by at least 10:1 in terms of i.u.The half-life in the circulation was 24-38 min in three subjects who received the same dose. Urinary recovery, when expressed as a percentage of the injected dose, was 36\m=.\8\ m=+-\7\m=.\7 (S.D.) % in nine experiments with three different doses in six subjects. The time-course and percentage recovery were similar for all doses used.

PurposeThis paper intended to explore the knowledge and use of the digital verbs and tools by the students and teachers for conceptual understanding in the virtual and conventional learning environment. The study also explored the use of such digital tools for lower- and higher-order thinking.Design/methodology/approachA survey research method was used for the study. All the students and teachers of the faculty of education from one virtual and one conventional university were the population of this study. Teachers were selected through census sampling. Student enrollment in the faculty of education of the virtual university during Spring 2019 was 1,139 while the conventional university had 1,809 students. In total, 20% of the students from each of the two universities were sampled by using a convenient proportionate sampling technique. A questionnaire was developed by the researchers and validated by three experts before administration. The reliability of the instrument was a = 0.934. Mean, SD, parametric and nonparametric statistics were applied for data analysis.FindingsThe study reveals that the students of ODL are far better in using digital tools and activities that is, googling, collaborating and Skyping. They are good at understanding and application levels and are involved in higher-order thinking tasks, that is, publishing and podcasting as well. Unlike the students, the teachers of the virtual university are using digital tools of lower-order thinking. The authors infer that the students and teachers of the online universities are using these tools regularly because of the demands of the ODL environment. These findings suggest further research to explore the factors that hinder the use of higher-order thinking skills by the teachers in the online environment.Originality/valueThe study suggests the adoption of Bloom's digital taxonomy in teaching–learning processes, that is, curriculum, instructions and assessment for the millennials. The findings may motivate the online and conventional higher education institutions to adopt digital pedagogy for instructional purposes as the students of the digital age are already extensively involved with digital tools.

The purpose of this paper is to investigate the role of servant leadership in organizations in Karachi and to investigate the level of knowledge sharing (KS) behavior among employees. The study based on quantitative design and the primary data has collected from the higher education sector through a survey questionnaire. Furthermore, multiple regressions have used for model testing. The findings of the study-enlightened benefits of knowledge sharing behavior that can be prevailed through a servant leadership model and encourage employees' participation. Four traits of servant leadership that are altruistic calling, emotional healing, and organizational stewardship have a positive impact on knowledge sharing behavior of employees. The findings of the study will be beneficial for the employees of the organization to understand the importance of servant leadership and its application in enterprises.Abstrak. Tujuan dari penelitian ini adalah untuk menyelidiki peran kepemimpinan pelayan dalam organisasi di Karachi dan untuk menyelidiki tingkat perilaku berbagi pengetahuan (KS) di antara karyawan. Penelitian ini didasarkan pada desain kuantitatif dan data primer telah dikumpulkan dari sektor pendidikan tinggi melalui kuesioner survei lebih lanjut, teknik regresi berganda telah digunakan untuk pengujian model. Temuan penelitian-manfaat terungkap perilaku berbagi pengetahuan yang dapat diatasi melalui model kepemimpinan yang melayani dan mendorong partisipasi karyawan. Empat sifat kepemimpinan pelayan yang panggilan altruistik, penyembuhan emosional dan pelayanan organisasi memiliki dampak positif pada perilaku berbagi pengetahuan karyawan. Temuan penelitian ini akan bermanfaat bagi karyawan organisasi untuk memahami pentingnya kepemimpinan pelayan & penerapannya di perusahaan.Kata Kunci: kepemimpinan pelayan, berbagi pengetahuan, prilaku karyawan

BACKGROUND The prevalence of nonalcoholic fatty liver disease (NAFLD) is significantly rising worldwide. Type-2 diabetes (T2D) is a major risk factor for NAFLD progression. AIM To assess the association of commonly used medications to advanced fibrosis (AF) in patients with biopsy-proven NAFLD and T2D. METHODS We used the International Classification of Disease 9 th Revision Clinical Modification coding system to identify patients with T2D and included patients who underwent liver biopsy for suspected NAFLD between January 1, 2000 to December 31, 2015. We compared demographics, clinical characteristics, and differences in pattern of medication use in patients who had biopsy-proven AF to those without it. A univariate and multivariate analysis was performed to assess the association of different classes of medication with the presence of AF. RESULTS A total of 1183 patients were included in the final analysis, out of which 32% ( n = 381) had AF on liver biopsy. Mean age of entire cohort was 52 years and majority were females (65%) and Caucasians (85%). Among patients with AF, 51% were on oral hypoglycemics, 30% were on insulin, 66% were on antihypertensives and 27% were on lipid lowering agents for the median duration of 19 mo, 10 mo, 26 mo, and 24 mo respectively. Medications associated with decreased risk of AF included metformin, liraglutide, lisinopril, hydrochlorothiazide, atorvastatin and simvastatin while the use of furosemide and spironolactone were associated with higher prevalence of AF. CONCLUSION In our cohort of T2D with biopsy proven NAFLD, the patients who were receiving metformin, liraglutide, lisinopril, hydrochlorothiazide, atorvastatin and simvastatin were less likely to have AF on biopsy, while patients who were receiving furosemide and spironolactone had a higher likelihood of having AF when they underwent liver biopsy. Future studies are needed to confirm these findings and to establish measures for prevention of NAFLD progression in patients with T2D.