Public Health Commons^™

The Impact Of Perceptions About Influenza And The Yearly Influenza Vaccine On Vaccine Behaviors Among Undergraduate Students At The University Of South Carolina, Julia G. Fuller

Senior Theses

Background: Undergraduate students are at an increased risk for developing respiratory infections as a result of the proximity in which they live, study, and eat. Despite being a target population for the Centers for Disease Control and Prevention’s yearly flu vaccine, several studies of undergraduate populations have found vaccine uptake to be much lower than other at-risk populations. This study aims to understand how perceptions about influenza and the influenza vaccine affect University of South Carolina undergraduate students’ vaccine behavior. Methods: A cross-sectional study was completed using survey data from 165 undergraduate students at the University of South Carolina. The …

Magnet Recognition (Mr) And Hospital Quality Outcomes In The U.S.A– Analysis Based On 2017 Hospital Data, Abdulmalik Alhammad

Theses and Dissertations

The American Nurse Credentialing Center (ANCC) introduced Magnet Recognition (MR) in the U.S.A in 1994. Magnet Recognition was adopted based on the findings of a comprehensive study (conducted in 1983) that tried to identify factors explaining high rates of nurses’ retention in 41 hospitals in the U.S.A.

The objective is to compare MHs with the hospitals not recognized as “Magnet” (non-MHs) in terms of important outcomes of the health system and to examine whether the MHs themselves vary significantly in terms of the outcomes.

All the general specialty of MHs (367 hospitals) and their matched of non-MHs (380 hospitals) in …

Influences On Parents’ Food Shopping For Children’S Consumption In South Carolina, Nazratun Nayeem Monalisa

Theses and Dissertations

Background: The diets of children in the United States typically do not meet dietary guidelines. Energy-dense nutrient-poor (EDNP) foods dominate children’s diets, contributing excessive energy, sugar, sodium, and fat intake. Home is the major source of children’s energy intake. Parents oversee household food purchases including foods for children.

Objectives: This research aimed to 1) identify parents’ food and beverage purchases for their household and for 6-11-year old children; 2) understand how parents made food purchase decisions by adjudicating among different values; 3) understand children’s food choice construction, strategies to influence parents for desired items, and extent of children’s influence.

Methods: …

Rethinking The Customer Experience: An Empirical Comparison Of Airbnb And Hotels, Jing Li

Theses and Dissertations

Experience is at the heart of the tourism and hospitality industry. One of the fundamental objectives of this sector is to create memorable customer experiences. For years, the sharing economy has been an essential industry phenomenon. Distinct from the traditional sector, Airbnb emerged as a disruptive innovation and a dominant online sharing-economy platform and has had a significant impact on the traditional industry. Despite growing interest in customers’ experiences in tourism and hospitality, limited research has provided insight into what constitutes the customer experience with Airbnb, how it can be conceptualized, and how it should be measured. In addition, Airbnb …

Associations Of Maternal Resources With Care Behaviours Differ By Resource And Behaviour, Sulochana Basnet, Edward A. Frongillo Jr., Phuong Hong Nguyen, Spencer Moore, Mandana Arabi

Faculty Publications

Care is important for children's growth and development, but lack or inadequacy of resources for care can constrain appropriate caregiving. The objectives of this study were to examine whether maternal resources for care are associated with care behaviours specifically infant and young child feeding, hygiene, health-seeking, and family care behaviours. The study also examined if some resources for care are more important than others. This study used baseline Alive & Thrive household surveys from Bangladesh, Vietnam, and Ethiopia. Measures of resources for care were maternal education, knowledge, height, nourishment, mental well-being, decision-making autonomy, employment, support in chores, and perceived instrumental …

Adult Smokers’ Awareness And Interest In Trying Heated Tobacco Products: Perspectives From Mexico, Where Htps And E-Cigarettes Are Banned, Lizeth Cruz-Jiménez, Inti Barrientos-Gutiérrez, Liliana Coutiño-Escamilla, Katia Gallegos-Carrillo, Edna Arillo-Santillán, Jim Thrasher

Faculty Publications

Background: We evaluated smokers’ perceptions of heated tobacco products (HTPs) in Mexico, where industry publically lobbied to introduce HTPs into this country that banned both HTPs and e-cigarettes. Methods: Online surveys (November 2018 to July 2019) were analyzed from adults who only smoked cigarettes (n = 2091) or who smoked and used e-cigarettes (“dual users” n = 1128). Logistic models regressed HTP awareness, interest to trying HTPs, and having seen HTPs for sale (only among aware participants) on sociodemographics and tobacco-related variables. Results: Of the 17.1% who were aware of HTPs, 52.7% reported having seen HTPs for sale. Of all …

Functional Blockade Of E-Selectin In Tumor-Associated Vessels Enhances Anti-Tumor Effect Of Doxorubicin In Breast Cancer, Yoshihiro Morita, Macall Leslie, Hiroyasu Kameyama, Ganesh L. Lokesh, Norihisa Ichimura, Rachel Davis, Natalie Hills, Nafis Hasan, Roy Zhang, Yuji Kondo, David G. Gorenstein, David E. Volk, Inna Chervoneva, Hallgeir Rui, Takemi Tanaka

Faculty Publications

Chemotherapy is a mainstay of treatment for solid tumors. However, little is known about how therapy-induced immune cell infiltration may affect therapy response. We found substantial CD45 immune cell density adjacent to E-selectin expressing inflamed vessels in doxorubicin (DOX)-treated residual human breast tumors. While CD45 level was significantly elevated in DOX-treated wildtype mice, it remained unchanged in DOX-treated tumors from E-selectin null mice. Similarly, intravenous administration of anti-E-selectin aptamer (ESTA) resulted in a significant reduction in CD45 immune cell density in DOX-treated residual tumors, which coincided with a delay in tumor growth and lung metastasis in MMTV-pyMT mice. Additionally, both …

Comparing Self-Reported Medication Adherence Measures With Hair Antiretroviral Concentration Among People Living With Hiv In Guangxi, China, Quan Zhang, Xiaoming Li Ph.D., Shan Qiao Ph.D., Zhiyong Shen, Yuejiao Zhou

Faculty Publications

Background: Antiretroviral adherence is essential to HIV treatment efcacy. Various self-reported measures are commonly used for assessing antiretroviral adherence. Limited data are available regarding the validity of those selfreported measures in comparison with long-term objective biomarkers of adherence measures such as hair measures.

Methods: Self-reported adherence (frequency, percentage, and visual analog scale [VAS]) and hair tenofovir concentration were evaluated at a single time point from 268 people living with HIV in China. The responses to each of three self-reported measures were converted into percentage and then dichotomized as “optimal” (100%) vs. “suboptimal” (less than 100%) adherence. Two composite adherence scores …

Test–Retest Reliability And Minimal Detectable Change Of Corticospinal Tract Integrity In Chronic Stroke, Allison F. Lewis, Makenzie Myers, Jenny Heiser, Jessica F. Baird, Jill C. Stewart

Faculty Publications

Diffusion tensor imaging (DTI) can be used to index white matter integrity of the corticospinal tract (CST) after stroke; however, the psychometric properties of DTI‐based measures of white matter integrity are unknown. The purpose of this study was to examine test–retest reliability as determined by intraclass correlation coefficients (ICC) and calculate minimal detectable change (MDC) of DTI‐based measures of CST integrity using three different approaches: a Cerebral Peduncle approach, a Probabilistic Tract approach, and a Tract Template approach. Eighteen participants with chronic stroke underwent DTI on the same magnetic resonance imaging scanner 4 days apart. For the Cerebral Peduncle approach, …

Icope A Multi-Level, Cluster Randomized, 36-Month, Parallel-Group Study To Assess The Efficacy Of Hiv Disclosure Intervention In Hiv Parental Disclosure Among Parents Living With Hiv In China, Xiaoming Li Ph.D., Shan Qiao Ph.D., Yuejiao Zhou

Faculty Publications

Objectives: Parents living with HIV who disclose their HIV status to their children could benefit from the parental HIV disclosure. However, it is also very challenging because of persistent stigma and discrimination against HIV. This report describes the study design and protocol of the “Interactive Communication with Openness, Passion, and Empowerment (iCOPE)” randomized controlled trial aimed at assisting parents living with HIV in conducting culturally and developmentally appropriate disclosure to their uninfected children in China through trainings among both parents living with HIV and healthcare providers.

Methods: A total of 791 parents living with HIV with children aged between 6 …

Agricultural And Finance Intervention Increased Dietary Intake And Weight Of Children Living In Hiv-Affected Households In Western Kenya, Lisa M. Butler, Shiva Bhandari, Phelgona Otieno, Sheri D. Weiser, Craig R. Cohen, Edward A. Frongillo Jr.

Faculty Publications

We tested whether a multisectoral household agricultural and finance intervention increased the dietary intake and improved the nutritional status of HIV-affected children. Two hospitals in rural Kenya were randomly assigned to be either the intervention or the control arm. The intervention comprised a human-powered water pump, microfinance loan for farm commodities, and training in sustainable farming practices and financial management. In each arm, 100 children (0-59 mo of age) were enrolled from households with HIV-infected adults 18-49 y old. Children were assessed beginning in April 2012 and every 3 mo for 1 y for dietary intake and anthropometry. Children in …

Gestational Infections And Obesity: Implications For Intellectual Disability Risk, Maggie S. J. Mccarter

Theses and Dissertations

Maternal body weight, measured as Body Mass Index (BMI) and infection during pregnancy are established risk factors of multiple adverse birth outcomes that are also associated with intellectual disability (ID) in children, but little is known of the interaction of these two factors. This retrospective cohort study sought to explore whether BMI is an effect modifier in the association between maternal infection during pregnancy and ID of the child, and to make comparisons between categories of gestational infection. The study sample (n= 124,047 after exclusion) was derived from Medicaid administrative data. After preliminary analysis of interaction, stratified logistic regression analysis …

Social, Economic, And Political Events Affect Gender Equity In China, Nepal, And Nicaragua: A Matched, Interrupted Time-Series Study, Tuan T. Nguyen, Ashley Darnell, Amy Weissman, Edward A. Frongillo Jr., Roger Mathisen, Karin Lapping, Timothy D. Mastro, Mellissa Withers

Faculty Publications

: Progress in gender equity can improve health at the individual and country levels.: This study's objective was to analyze recent trends in gender equity and identify historical and contextual factors that contributed to changes in gender equity in three countries: China, Nepal, and Nicaragua.: To assess gender equity trends, we used the Gender Gap Index (GGI) from the World Economic Forum's Global Gender Gap Report (2006-2017). The GGI incorporated data on economic participation, educational attainment, health, and political empowerment for almost 150 countries. We selected China, Nepal, and Nicaragua because of their major changes in GGI and diversity in …

Nutrition Intervention Using Behavioral Change Communication Without Additional Material Inputs Increased Expenditures On Key Food Groups In Bangladesh, Andrea M. Warren, Edward A. Frongillo, Phuong H. Nguyen, Purnima Menon

Faculty Publications

Background

Behavioral change communication (BCC) promotes skills and knowledge to improve infant and young child feeding, but without additional material inputs, recipients must develop strategies to translate knowledge into action. Using data from the Alive & Thrive initiative in Bangladesh (2010–2014), we aimed to test whether households receiving the intensive intervention (opposed to the nonintensive intervention) increased expenditures on key foods for mothers and children (e.g., foods that were promoted by the intervention and also changed in maternal and child diets).

Methods

The intensive intervention provided interpersonal counseling, community mobilization, and mass media campaigns to promote breastfeeding and complementary feeding. …

Effects Of The Affordable Care Act On The Receipt Of Colonoscopies Among The Insured Elderly, Minjee Lee, M Mahmud Khan, Heather M. Brandt, Ramzi G. Salloum, Brian Chen

Faculty Publications

BACKGROUND: The Affordable Care Act (ACA) waived deductibles and eliminated coinsurance for colonoscopies for Medicare beneficiaries beginning in January 1, 2011. This study investigated the effect of the ACA's directive to remove the financial barriers on the receipt of colonoscopies among the elderly insured, who are predominantly covered by Medicare. METHODS: Data from the 2008-2016 Behavioral Risk Factor Surveillance System (BRFSS) were used to examine the receipt of colonoscopies in two years prior to the implementation of the ACA (2008 and 2010) and three years after the change (2012, 2014, and 2016). Multivariate logistic regressions were estimated to examine the …

Mother-Child Dyadic Influences Of Affect On Everyday Movement Behaviors: Evidence From An Ecological Momentary Assessment Study, Chih-Hsiang Yang, Jimi Huh, Tyler B. Mason, Britni R. Belcher, Martina Kanning, Genevieve F. Dunton

Faculty Publications

Background

Research has shown that affect is associated with everyday movement behaviors in children and adults. However, limited work to date has investigated dyadic influences of momentary affect on moderate-to-vigorous physical activity (MVPA) and sedentary time among children and their mothers using ecological momentary assessment (EMA).

Methods

Mothers and their children (eight to 12-years-old at baseline) from the Los Angeles metropolitan area participated in a longitudinal study with six semi-annual measurement waves across three years. During each measurement wave, mothers and children reported momentary negative and positive affect via a custom smartphone-based EMA application across seven days (randomly sampled up …

Development Of A Clinical-Academic-Community Collaboration To Improve Health Literacy, Daniela B. Friedman Ph.D., Michelle A. Arent, Brooks Yelton Ma, Lmsw, Mayank Sakhuja, Venice E. Haynes, Samuel Noblet, Heather M. Brandt Ph.D., Ches, William D. Isenhower, Abraham Wandersman, Diana Zona, Cyndi New, Delores Fedrick, Jonathan Scaccia, Larisa Bruner

Faculty Publications

Limited health literacy is associated with poor patient health outcomes and increased hospitalization rates. Patient-provider communication plays an important role in patient health literacy and the understanding of medical terminology. This study demonstrates how a collaboration between clinical, academic, and community partners was instrumental in the design and implementation of a clinic readiness assessment and a clinic-based pilot intervention to encourage patient-provider communication and improve patient health literacy. A state hospital association, academic research team, and community adult literacy center director collaborated to develop a 60-item clinic readiness assessment and an evidence-informed pilot intervention. The clinic readiness assessment captured clinics’ …

Association Of Patient-Centered Medical Home Designation And Quality Indicators Within Hrsa-Funded Community Health Center Delivery Sites, Nathaniel Bell, Rebecca Wilkerson, Kathy Mayfield-Smith, Ana Lopez-De Fede

Publications

Background: Patient-Centered Medical Home (PCMH) adoption is an important strategy to help improve primary care quality within Health Resources and Service Administration (HRSA) community health centers (CHC), but evidence of its effect thus far remains mixed. A limitation of previous evaluations has been the inability to account for the proportion of CHC delivery sites that are designated medical homes. Methods: Retrospective cross-sectional study using HRSA Uniform Data System (UDS) and certification files from the National Committee for Quality Assurance (NCQA) and the Joint Commission (JC). Datasets were linked through geocoding and an approximate string-matching algorithm. Predicted probability scores were regressed …

Community Social Determinants And Health Outcomes Drive Availability Of Patient-Centered Medical Homes, Nathaniel Bell, Rebecca Wilkerson, Kathy Mayfield-Smith, Ana Lopez-De Fede

Publications

The collaborative design of America’s patient-centered medical homes places these practices at the forefront of emerging efforts to address longstanding inequities in the quality of primary care experienced among socially and economically marginalized populations. We assessed the geographic distribution of the country’s medical homes and assessed whether they are appearing within communities that face greater burdens of disease and social vulnerability. We assessed overlapping spatial clusters of mental and physical health surveys; health behaviors, including alcohol-impaired driving deaths and drug overdose deaths; as well as premature mortality with clusters of medical home saturation and community socioeconomic characteristics. Overlapping spatial clusters …

Developing Implementation Research Capacity: Longitudinal Evaluation Of The King’S College London Implementation Science Masterclass, 2014-2019, Rachel Davis, Brian Mittman, Madelene Boyton, Aoife Keohane, Lucy Goulding, Jane Sandall, Graham Thornicroft, Nick Sevdalis

Faculty Publications

Background: Despite an increasing number of training opportunities in implementation science becoming available, the demand for training amongst researchers and practitioners is unmet. To address this training shortfall, we developed the King's College London 'Implementation Science Masterclass' (ISM), an innovative 2-day programme (and currently the largest of its kind in Europe), developed and delivered by an international faculty of implementation experts. Methods: This paper describes the ISM and provides delegates' quantitative and qualitative evaluations (gathered through a survey at the end of the ISM) and faculty reflections over the period it has been running (2014-2019). Results: Across the 6-year evaluation, …

Explainable Ai Using Knowledge Graphs, Manas Gaur, Ankit Desai, Keyur Faldu, Amit Sheth

Publications

During the last decade, traditional data-driven deep learning (DL) has shown remarkable success in essential natural language processing tasks, such as relation extraction. Yet, challenges remain in developing artificial intelligence (AI) methods in real-world cases that require explainability through human interpretable and traceable outcomes. The scarcity of labeled data for downstream supervised tasks and entangled embeddings produced as an outcome of self-supervised pre-training objectives also hinders interpretability and explainability. Additionally, data labeling in multiple unstructured domains, particularly healthcare and education, is computationally expensive as it requires a pool of human expertise. Consider Education Technology, where AI systems fall along a …

Sex Differences In Becoming A Current Electronic Cigarette User, Current Smoker And Current Dual User Of Both Products: A Longitudinal Study Among Mexican Adolescents, Rosibel Rodríguez-Bolaños, Edna Arillo-Santillán, Inti Barrientos-Gutiérrez, Luis Zavala-Arciniega, Charity A. Ntansah, Jim Thrasher

Faculty Publications

This study aimed to assess sex differences in predictors for becoming a current exclusive electronic cigarette (e-cigarette) user, current exclusive smoker, or current dual user (concurrent smoking and e-cigarette use). This longitudinal study included 2399 females and 2177 males who had tried neither cigarettes nor e-cigarettes at baseline and attended 57 middle schools in the three largest cities in Mexico. We estimated multinomial logistic models stratified by sex. At follow-up, the prevalence of current exclusive e-cigarette use was 6.4% for males and 5.5% for females; current exclusive smoking was similar among males (3.6%) and females (3.5%); dual use was 2.4% …

Validity Study Of The R-Pla, A Resilience Scale For People Living With Hiv, Jinxiang Hu, Julianne M. Serovich, Monique J. Brown, Judy A. Kimberly, Yi-Hsin Chen

Faculty Publications

This study provides psychometric assessment of a resilience scale with a sample of women living with HIV. Baseline data were used from a longitudinal HIV disclosure study of 124 women aged between 18-63 collected between 2001 and 2004 in a large Midwestern city. The Rasch model was used to examine the psychometric properties of the resilience scale. Results indicated that the resilience instrument meets the Rasch model application assumptions. Evidence of validity suggested the resilience instrument demonstrated good item and person fit, as well as good item and person reliability. Most items showed measurement invariance across different age and racial …

Small Molecules That Inhibit Tnf Signalling By Stabilising An Asymmetric Form Of The Trimer, James O'Connell, John Porter, Boris Kroeplien, Tim Norman, Stephen Rapecki, Rachel E. Davis, David Mcmillan, Tracy Arakaki, Alex Burgin, David Fox Iii, Tom Ceska, Fabien Lecomte, Alison Maloney, Alex Vugler, Bruce Carrington, Benjamin P. Cossins, Tim Bourne, Alastair Lawson

Faculty Publications

Tumour necrosis factor (TNF) is a cytokine belonging to a family of trimeric proteins; it has been shown to be a key mediator in autoimmune diseases such as rheumatoid arthritis and Crohn's disease. While TNF is the target of several successful biologic drugs, attempts to design small molecule therapies directed to this cytokine have not led to approved products. Here we report the discovery of potent small molecule inhibitors of TNF that stabilise an asymmetrical form of the soluble TNF trimer, compromising signalling and inhibiting the functions of TNF in vitro and in vivo. This discovery paves the way for …

Child-Level Double Burden Of Malnutrition In The Mena And Lac Regions: Prevalence And Social Determinants, Hala Ghattas Ph.D., Yubraj Acharya, Zeina Jamaluddine, Moubadda Assi, Khalil El Asmar, Andrew D. Jones

Faculty Publications

Although the prevalence of obesity has rapidly increased in the low- and middle-income countries of the Middle East and North Africa (MENA) and Latin America and the Caribbean (LAC) regions, child undernutrition remains a public-health challenge. We examined region-specific sociodemographic determinants of this double burden of malnutrition, specifically, the co-occurrence of child stunting and overweight, using Demographic and Health Survey and Multiple Indicator Cluster Survey data (2003–2016) from 11 countries in the MENA (n = 118,585) and 13 countries in the LAC (n = 77,824) regions. We used multiple logistic regressions to model region-specific associations of maternal education and household …

Chorioamnionitis: Case Definition & Guidelines For Data Collection, Analysis, And Presentation Of Immunization Safety Data, Alisa Kachikis, Linda O. Eckert, Christie Walker, Azucena Bardají, Frederick Varricchio, Heather S. Lipkind, Khady Diouf, Wan Ting Huang, Ronald Mataya, Mustapha Bittaye, Clare Cutland, Nansi S. Boghossian, Tamala Mallett Moore, Rebecca Mccall, Jay King, Shuchita Mundle, Flor M. Munoz, Caroline Rouse, Michael Gravett, Lakshmi Katikaneni, Kevin Ault, Nicola P. Klein, Drucilla J. Roberts, Sonali Kochhar, Nancy Chescheir

Faculty Publications

No abstract provided.

Neurodevelopmental Delay: Case Definition & Guidelines For Data Collection, Analysis, And Presentation Of Immunization Safety Data, Adrienne N. Villagomez, Flor M. Muñoz, Robin L. Peterson, Alison M. Colbert, Melissa Gladstone, Beatriz Macdonald, Rebecca Wilson, Lee Fairlie, Gwendolyn J. Gerner, Jackie Patterson, Nansi S. Boghossian, Vera Joanna Burton, Margarita Cortés, Lakshmi D. Katikaneni, Jennifer C.G. Larson, Abigail S. Angulo, Jyoti Joshi, Mirjana Nesin, Michael A. Padula, Sonali Kochhar, Amy K. Connery

Faculty Publications

No abstract provided.

Different Combinations Of Behavior Change Interventions And Frequencies Of Interpersonal Contacts Are Associated With Infant And Young Child Feeding Practices In Bangladesh, Ethiopia, And Vietnam, Sunny S. Kim, Phuong Hong Nguyen, Lan Mai Tran, Silvia Alayon, Purnima Menon, Edward A. Frongillo Jr.

Faculty Publications

Background: Social and behavior change communication interventions are integral to improving dietary and care practices, but evidence on the impact of the combination and intensity of these interventions in different contexts is scarce. Objectives: We examined the extent of and factors associated with intervention exposure: interpersonal communication (IPC) alone or with other interventions (i.e., mass media, community mobilization, or nutrition-sensitive agricultural activities), number of and factors associated with IPC contacts, and combinations of intervention components and number of contacts associated with infant and young child feeding (IYCF) practices. Methods: We used endline survey data from impact evaluations in Bangladesh, Ethiopia, …

Why Acute Ischemic Stroke Patients In The United States Use Or Do Not Use Emergency Medical Services Transport? Findings Of An Inpatient Survey, Sudha Xirasagar, Meng-Han Tsai, Khosrow Heidari, James W. Hardin, Yuqi Wu, Robert Wronski, Dana Hurley, Edward C. Jauch, Souvik Sen

Faculty Publications

Background: Patients with acute ischemic stroke (AIS) who use emergency medical services (EMS) receive quicker reperfusion treatment which, in turn, mitigates post-stroke disability. However, nationally only 59% use EMS. We examined why AIS patients use or do not use EMS.

Methods: During 2016–2018, a convenience sample of AIS patients admitted to a primary stroke center in South Carolina were surveyed during hospitalization if they were medically fit, available for survey when contacted, and consented to participate. The survey was programed into EpiInfo with skip patterns to minimize survey burden and self-administered on a touchscreen computer. Survey questions covered symptom characteristics, …

7-Epi-Clusianone, A Multi-Targeting Natural Product With Potential Chemotherapeutic, Immune-Modulating, And Anti-Angiogenic Properties, Wesley F. Taylor, Maria Yanez, Sara E. Moghadam, Mahdi Moridi Farimani, Sara Soroury, Samad N. Ebrahimi, Marzieh Tabefam, Ehsan Jabbarzadeh

Faculty Publications

Targeted therapies have changed the treatment of cancer, giving new hope to many patients in recent years. The shortcomings of targeted therapies including acquired resistance, limited susceptible patients, high cost, and high toxicities, have led to the necessity of combining these therapies with other targeted or chemotherapeutic treatments. Natural products are uniquely capable of synergizing with targeted and non-targeted anticancer regimens due to their ability to affect multiple cellular pathways simultaneously. Compounds which provide an additive effect to the often combined immune therapies and cytotoxic chemotherapies, are exceedingly rare. These compounds would however provide a strengthening bridge between the two …