bluuebunny/crossref_metadata_2025 huggingface dataset:
EVALUASI DAMPAK PROGRAM DIKLAT GURU MUDA MADRASAH TERHADAP KINERJA MADRASAH
Authors: Yasri Yasri Yasri
Published: May 2018

Artikel ini mempresentasikan hasil evaluasi tentang dampak program pelatihan Teknis Fungsional Guru Muda Madrasah Terhadap Kinerja Alumni dan Madrasah. Pusat Pendidikan dan Pelatihan Tenaga Teknis Pendidikan dan Keagamaan secara rutin melaksanakan pendidikan dan pelatihan teknis Guru Muda Madrasah. Namun belum ada kajian tentang dampaknya terhadap alumninya dan madrasah. Penelitian ini menggunakan model Kirkpatrick Level Result yang dimodifikasi dan menggunakan metode gabungan (mixed method), yaitu metode studi kasus dan survei. Penelitian ini dilakukan di 58 Madrasah dengan 518 responden yang terdiri dari: alumni peserta pelatihan, teman sejawat alumni, dan Kepala Madrasah.Teknik pengambilan data dilakukan dengan cara angket dengan skala Likert, observasi, dan wawancara. Pengolahan data dilakukan dengan teknik kuantitatif dan kualitatif deskriptif. Hasil penelitian ini menunjukkan bahwa alumni pendidikan dan pelatihan mampu menyusun perangkat pembelajaran dengan lengkap sesuai regulasi yang berlaku, melaksanakan proses pembelajaran sesuai standar dan menyusun serta melaksanakan penilaian hasil belajar peserta didik, menjamin kualitas perencanaan, menyelesaikan pekerjaan rutin, memecahkan masalah, meningkatkan hubungan kerja dan kerjasama, mengimplementasi hasil Diklat, menerima dan memberi saran, sehingga Pendidikan dan Pelatihan Teknis Guru Muda Madrasah berdampak signifikan terhadap kinerja alumni dan kinerja madrasah.

Kata Kunci: Evaluasi dampak, program Diklat, kinerja alumni, dan kinerja madrasah
SOCIAL TRANSFORMATION OF MADRASAH IBTIDAIYAH AS TRENDSETTER MADRASAH IN PEKALONGAN
Authors: Istiyani Dwi , Sopiah Sopiah , Yusuf Musfirotun , Baihaki Ahmad
Published: May 2018

This study describes the system of Madrasah Ibtidaiyah in Pekalongan towards the process of social transformation, and the effort of strategy analysis of Madrasah Ibtidaiyah in conducting social transformation in order to become trendsetter madrasah. Madrasah, has encounter a transformation in the national education system. Madrasahs are no longer considered a complement to the national education system, but an integral part of the National Education System. By using qualitative method, this research will show two findings they are: (1) The system of Madrasah Ibtidaiyah toward social transformation process including vision impelementation system, academic standard requirement, student recruitment system, curriculum material development, teaching method system, evaluation system, environtment concelling, leadership system and decision making, risk management system of madrasah, and flat organization model system. (2) The social transformation strategy that can be done to become a trendsetter madrasah by ways of attaining madrasah’s visions and missions, enhancing the quality of human resources, and of the quality of students, improving the quality of subject materials, improving learning strategies and improving the environment.

Keywords: Transformation, social, Madrasah Ibtidaiyah, trendsetter
HUBUNGAN PRAKTIK TEOLOGI JABARIYAH DENGAN KEMISKINAN PADA NELAYAN DI KUALA LANGSA ACEH
Authors: Nasution ISMAIL FAHMI Arrauf
Published: May 2018

Artikel ini menggambarkan hubungan antara praktik teologi Jabariyah dan relevansinya dengan kemiskinan di Kuala Langsa, Aceh. Dalam ajaran Islam teologi merupakan sisi fundamental dalam beragama. Aplikasi beragama dalam dimensi empirik merupakan manifestasi dari pemahaman manusia terhadap kehendak Tuhan. Di dalam Islam, manusia dituntut untuk aktif mengembangkan potensi diri serta berupaya mengubah nasib. Namun faktanya, nelayan Kuala Langsa yang menjalankan agama berada di garis kemiskinan. Untuk itu, artikel ini mencari hubungan antara konsep teologi Jabariyah dengan tingkat kemiskinan di Kuala Langsa. Penelitian menggunakan pendekatan fungsional dalam melihat gejala beragama masyarkat. Peneliti mengobservasi keseharian praktik ekonomi dan beragama nelayan Kuala Langsa. Selain itu, peneliti mewawancarai juga nelayan Kuala Langsa untuk mengetahui tingkat pemahaman teologi. Hasilnya didapatkan hubungan antara pemahaman Jabariyah nelayan Kuala Langsa dengan kemiskinan di Kuala Langsa. Terdapat pemahaman fatalistik yang kuat pada nelayan Kuala langsa dalam memahami konsep takdir dan kemampuan manusia dalam berusaha.

Kata Kunci: Teologi, Jabariyah, Kemiskinan, Aceh
Clarence Glacken: Pioneer Environmental Historian
Authors: Rajan S. Ravi
Published: May 2018

Clarence Glacken's magnum opus Traces on the Rhodian Shore, first published in 1967, was an intellectual history about ideas of nature and culture from ancient Greece to the end of the eighteenth century. The Professional Geographer called it 'One of the best and most important books published by a geographer in the English-speaking world in the last hundred years'. Traces remains in print five decades after its initial publication, and is regarded as one of the foundational classics in the field of environmental history. Glacken himself is considered a path breaker in the discipline and is read widely by environmental historians. Little, however, is known about this pioneering scholar and especially, that he was prolific in his later years, having written an unpublished (and lost) sequel to Traces, and a full draft of another book. Drawing extensively upon the Glacken archives at the Bancroft Library at UC Berkeley, this paper describes his intellectual evolution as a scholar, and explores his contributions to the field of environmental history.
‘A Few Human Hearts in Catholic Breasts’: Angina Pectoris, Emotions, and Kate O'Brien's Mary Lavelle
Authors: O'Neill Margaret
Published: May 2018

This article reads Kate O'Brien's Mary Lavelle in a cultural historical framework of medicine and psychoanalysis to explore the significance of the heart condition angina pectoris in the text. The novel illuminates the complexities of the mind-body relationship, the connections between emotional trauma and bodily symptoms, and cultural constructions of masculinity and femininity within the historical conditions and medical models that have shaped them. Ultimately, Mary Lavelle undermines the primacy of objectivity and rationality encoded in ideals of masculinity that guide cultural and medical discourses. The novel furthermore speaks to the imperative to listen to the narratives spoken through patient's bodies.
Thermoelectric Efficiency of a Topological Nano-Junction
Authors: Álamo Manuel , Muñoz Enrique
Published: May 2018

We studied the non-equilibrium current, transport coefficients and thermoelectric performance of a nano-junction, composed by a quantum dot connected to a normal superconductor and a topological superconductor leads, respectively. We considered a one-dimensional topological superconductor, which hosts two Majorana fermion states at its edges. Our results show that the electric and thermal currents across the junction are highly mediated by multiple Andreev reflections between the quantum dot and the leads, thus leading to a strong nonlinear dependence of the current on the applied bias voltage. Remarkably, we find that our system reaches a sharp maximum of its thermoelectric efficiency at a finite bias, when an external magnetic field is imposed upon the junction. We propose that this feature can be used for accurate temperature sensing at the nanoscale.
An Energy Efficient Train Dispatch and Control Integrated Method in Urban Rail Transit
Authors: Bu Bing , Qin Guoying , Li Ling , Li Guojie
Published: May 2018

With the rapid development of urban rail transit, the energy consumption of trains is increasing dramatically. The shortage of electrical energy is becoming more and more serious. In this paper, a novel method is proposed to better use regenerative braking energy for energy saving. A ‘time slot and energy grid’ model is set up to analyze the utilization of regenerative energy among trains. Based on this model, an energy efficient strategy that integrates train dispatch with train control is designed. The running time of trains in sections, the dwell time of trains at stations and the headway can be adjusted to find the global optimal solution for energy saving. The operational data of Beijing Changping subway line and Beijing Yizhuang subway line are used in simulation to illustrate the effectiveness of the proposed method in different scenarios. Simulation results show that our approach can significantly improve the utilization of regenerative braking energy and minimize the energy consumption in different scenarios when compared with the existing method.
Duality Based Risk Mitigation Method for Construction of Joint Hydro-Wind Coordination Short-Run Marginal Cost Curves
Authors: Ilak Perica , Rajšl Ivan , Đaković Josip , Delimar Marko
Published: May 2018

This study analyzes the short-run hydro generation scheduling for the wind power differences from the contracted schedule. The approach for construction of the joint short-run marginal cost curve for the hydro-wind coordinated generation is proposed and applied on the real example. This joint short-run marginal cost curve is important for its participation in the energy markets and for economic feasibility assessment of such coordination. The approach credibly describes the short-run marginal costs which this coordination bears in “real life”. The approach is based on the duality framework of a convex programming and as a novelty combines the shadow price of risk mitigation, which quantifies the hourly cost of mitigating risk, and the water shadow price, which quantifies the marginal cost of electricity production. The proposed approach is formulated as a stochastic linear program and tested on the case of the Vinodol hydropower system and the wind farm Vrataruša in Croatia. The result of the case study is a family of 24 joint short-run marginal cost curves. The proposed method is expected to be of great interest to investors as it enables risk mitigation for investors with diverse risk preferences, from risk-averse to risk-seeking.
Electricity Price Forecasting Using Recurrent Neural Networks
Authors: Ugurlu Umut , Oksuz Ilkay , Tas Oktay
Published: May 2018

Accurate electricity price forecasting has become a substantial requirement since the liberalization of the electricity markets. Due to the challenging nature of electricity prices, which includes high volatility, sharp price spikes and seasonality, various types of electricity price forecasting models still compete and cannot outperform each other consistently. Neural Networks have been successfully used in machine learning problems and Recurrent Neural Networks (RNNs) have been proposed to address time-dependent learning problems. In particular, Long Short Term Memory (LSTM) and Gated Recurrent Units (GRU) are tailor-made for time series price estimation. In this paper, we propose to use multi-layer Gated Recurrent Units as a new technique for electricity price forecasting. We have trained a variety of algorithms with three-year rolling window and compared the results with the RNNs. In our experiments, three-layered GRUs outperformed all other neural network structures and state-of-the-art statistical techniques in a statistically significant manner in the Turkish day-ahead market.
Uniform Decomposition and Positive-Gradient Differential Evolution for Multi-Objective Design of Wind Turbine Blade
Authors: Wang Long , Han Ran , Wang Tongguang , Ke Shitang
Published: May 2018

Convergence performance and optimization efficiency are two critical issues in the application of commonly used evolution algorithms in multi-objective design of wind turbines. A gradient-based multi-objective evolution algorithm is proposed for wind turbine blade design, based on uniform decomposition and positive-gradient differential evolution. In the uniform decomposition, uniformly distributed reference vectors are established in the objective space to maintain population diversity so that the population aggregations, which are commonly observed for wind turbine blade design using gradient-free algorithms, are minimized. The positive-gradient differential evolution is introduced for population evolution to increase optimization efficiency by guiding the evolutionary process and significantly reducing searching ranges of each individual. Two-, three- and four-objective optimizations of 1.5 MW wind turbine blades reveal that the proposed algorithm can deliver uniformly distributed optimal solutions in an efficient way, and has advantages over gradient-free algorithms in terms of convergence performance and optimization efficiency. These advantages increase with the optimization dimension, and the proposed algorithm is more suitable for optimizations of small size populations, thus remarkably enhancing the design efficiency.
Pregnancy Trimester-Specific Exposure to Ambient Air Pollution and Child Respiratory Health Outcomes in the First 2 Years of Life: Effect Modification by Maternal Pre-Pregnancy BMI
Authors: Soh Shu-E , Goh Anne , Teoh Oon Hoe , Godfrey Keith M. , Gluckman Peter D. , Shek Lynette Pei-Chi , Chong Yap-Seng
Published: May 2018

Prenatal exposure to air pollution is associated with childhood respiratory health; however, no previous studies have examined maternal pre-pregnancy body mass index (BMI) as a potential effect modifier. We investigated whether maternal pre-pregnancy BMI modified the association of trimester-specific air pollution divided into quartiles of exposure (Q1–4) on respiratory health in the Growing Up in Singapore towards healthy Outcomes (GUSTO) study (n = 953) in 2-year-old children. For episodes of wheezing, children of overweight/obese mothers and who were exposed to particulate matter less than 2.5 μm (PM2.5) in the first trimester had an adjusted incidence rate ratio (IRR) (95% confidence interval (CI)) of 1.85 (1.23–2.78), 1.76 (1.08–2.85) and 1.90 (1.10–3.27) in quartile (Q) 2–4, with reference to Q1. This association is seen in the second trimester for bronchiolitis/bronchitis. The risk of ear infection in the first year of life was associated with exposure to PM2.5 in the first trimester with adjusted Odds Ratio (adjOR) (95% CI) = 7.64 (1.18–49.37), 11.37 (1.47–87.97) and 8.26 (1.13–60.29) for Q2–4, and similarly in the second year with adjOR (95% CI) = 3.28 (1.00–10.73) and 4.15 (1.05–16.36) for Q2–3. Prenatal exposure to air pollution has an enhanced impact on childhood respiratory health, and differs according to maternal pre-pregnancy BMI.
Function of the ERFL1a Transcription Factor in Wheat Responses to Water Deficiency
Authors: Gao Tian , Li Ge-Zi , Wang Chuan-Ren , Dong Jie , Yuan Sha-Sha , Wang Yong-Hua , Kang Guo-Zhang
Published: May 2018

The APETALA2/ethylene response factor (AP2/ERF) superfamily is involved in the responses of plants to biotic and abiotic stresses; however, the functions and mechanisms of some members of this family in plants are unclear. In our previous study, expression of TaERFL1a, a member of the AP2/ERF family, was remarkably induced in wheat seedlings suffering freezing stress. In this study, we show that its expression was rapidly upregulated in response to salt, cold, and water deficiency, suggesting roles in the responses to abiotic stresses. Further, transient barley stripe mosaic virus-induced gene silencing (BSMV-VIGS) resulted in significantly reduced tolerance to 20% PEG6000-stimulated water deficiency. Subcellular localization and transcriptional activation assays separately showed that TaERFL1a was targeted to the nucleus and possessed transcriptional activation activity. Yeast two-hybrid library screening identified six interacting proteins, and of these, the interactions between TaERFL1a and TaSGT1, and TaERFL1a and TaDAD2 proteins were further confirmed by yeast co-transformation and bimolecular fluorescent complementation (BiFC). Collectively, our results suggest that TaERFL1a is a stress-responsive transcription factor, which could be functionally related to proteins involved in the abiotic stress responses of plants.
Cytoprotective Effect of Epigallocatechin Gallate (EGCG)-5′-O-α-Glucopyranoside, a Novel EGCG Derivative
Authors: Han Sang , Kim Eunji , Hwang Kyeonghwan , Ratan Zubair , Hwang Hyunsik , Kim Eun-Mi , Kim Doman , Park Junseong , Cho Jae
Published: May 2018

Epigallocatechin gallate (EGCG) is a well-studied polyphenol with antioxidant effects. Since EGCG has low solubility and stability, many researchers have modified EGCG residues to ameliorate these problems. A novel EGCG derivative, EGCG-5′-O-α-glucopyranoside (EGCG-5′Glu), was synthesized, and its characteristics were investigated. EGCG-5′Glu showed antioxidant effects in cell and cell-free systems. Under SNP-derived radical exposure, EGCG-5′Glu decreased nitric oxide (NO) production, and recovered ROS-mediated cell viability. Moreover, EGCG-5′Glu regulated apoptotic pathways (caspases) and cell survival molecules (phosphoinositide 3-kinase (PI3K) and phosphoinositide-dependent kinase 1 (PDK1)). In another radical-induced condition, ultraviolet B (UVB) irradiation, EGCG-5′Glu protected cells from UVB and regulated the PI3K/PDK1/AKT pathway. Next, the proliferative effect of EGCG-5′Glu was examined. EGCG-5′Glu increased cell proliferation by modulating nuclear factor (NF)-κB activity. EGCG-5′Glu protects and repairs cells from external damage via its antioxidant effects. These results suggest that EGCG-5′Glu could be used as a cosmetics ingredient or dietary supplement.
Marine Microalgae with Anti-Cancer Properties
Authors: Martínez Andrade Kevin , Lauritano Chiara , Romano Giovanna , Ianora Adrianna
Published: May 2018

Cancer is the leading cause of death globally and finding new therapeutic agents for cancer treatment remains a major challenge in the pursuit for a cure. This paper presents an overview on microalgae with anti-cancer activities. Microalgae are eukaryotic unicellular plants that contribute up to 40% of global primary productivity. They are excellent sources of pigments, lipids, carotenoids, omega-3 fatty acids, polysaccharides, vitamins and other fine chemicals, and there is an increasing demand for their use as nutraceuticals and food supplements. Some microalgae are also reported as having anti-cancer activity. In this review, we report the microalgal species that have shown anti-cancer properties, the cancer cell lines affected by algae and the concentrations of compounds/extracts tested to induce arrest of cell growth. We also report the mediums used for growing microalgae that showed anti-cancer activity and compare the bioactivity of these microalgae with marine anticancer drugs already on the market and in phase III clinical trials. Finally, we discuss why some microalgae can be promising sources of anti-cancer compounds for future development.
Decoupling Research of a Novel Three-Dimensional Force Flexible Tactile Sensor Based on an Improved BP Algorithm
Authors: Song Yang , Wang Feilu , Zhang Zhenya
Published: May 2018

Decoupling research on flexible tactile sensors play a very important role in the intelligent robot skin and tactile-sensing fields. In this paper, an efficient machine learning method based on the improved back-propagation (BP) algorithm is proposed to decouple the mapping relationship between the resistances of force-sensitive conductive pillars and three-dimensional forces for the 6 × 6 novel flexible tactile sensor array. Tactile-sensing principles and numerical experiments are analyzed. The tactile sensor array model accomplishes the decomposition of the force components by its delicate structure, and avoids direct interference among the electrodes of the sensor array. The force components loaded on the tactile sensor are decoupled with a very high precision from the resistance signal by the improved BP algorithm. The decoupling results show that the k-cross validation (k-CV) algorithm is a highly effective method to improve the decoupling precision of force components for the novel tactile sensor. The large dataset with the k-CV method obtains a better decoupling accuracy of the force components than the small dataset. All of the decoupling results are fairly good, and they indicate that the improved BP model with a strong non-linear approaching ability has an efficient and valid performance in decoupling force components for the tactile sensor.
A Wearable Sensor System for Lameness Detection in Dairy Cattle
Authors: Haladjian Juan , Haug Johannes , Nüske Stefan , Bruegge Bernd
Published: May 2018

Cow lameness is a common manifestation in dairy cattle that causes severe health and life quality issues to cows, including pain and a reduction in their life expectancy. In our previous work, we introduced an algorithmic approach to automatically detect anomalies in the walking pattern of cows using a wearable motion sensor. In this article, we provide further insights into a system for automatic lameness detection, including the decisions we made when designing the system, the requirements that drove these decisions and provide further insight into the algorithmic approach. Results from a controlled experiment we conducted indicate that our approach can detect deviations in cows’ gait with an accuracy of 91.1%. The information provided by our system can be useful to spot lameness-related diseases automatically and alarm veterinarians.
Diversification and Systemic Risk: A Financial Network Perspective
Authors: Frey Rüdiger , Hledik Juraj
Published: May 2018

In this paper, we study the implications of diversification in the asset portfolios of banks for financial stability and systemic risk. Adding to the existing literature, we analyse this issue in a network model of the interbank market. We carry out a simulation study that determines the probability of a systemic crisis in the banking network as a function of both the level of diversification, and the connectivity and structure of the financial network. In contrast to earlier studies we find that diversification at the level of individual banks may be beneficial for financial stability even if it does lead to a higher asset return correlation across banks.
CNT Foam-Embedded Micro Gas Preconcentrator for Low-Concentration Ethane Measurements
Authors: Lee Janghyeon , Lim Si-Hyung
Published: May 2018

Breath analysis has become increasingly important as a noninvasive process for the clinical diagnosis of patients suffering from various diseases. Many commercial gas preconcentration instruments are already being used to overcome the detection limits of commercial gas sensors for gas concentrations which are as low as ~100 ppb in exhaled breath. However, commercial instruments are large and expensive, and they require high power consumption and intensive maintenance. In the proposed study, a micro gas preconcentrator (μ-PC) filled with a carbon nanotube (CNT) foam as an adsorbing material was designed and fabricated for the detection of low-concentration ethane, which is known to be one of the most important biomarkers related to chronic obstructive pulmonary disease (COPD) and asthma. A comparison of the performance of two gas-adsorbing materials, i.e., the proposed CNT foam and commercial adsorbing material, was performed using the developed μ-PC. The experimental results showed that the synthesized CNT foam performs better than a commercial adsorbing material owing to its lower pressure drop and greater preconcentration efficiency in the μ-PC. The present results show that the application of CNT foam-embedded μ-PC in portable breath analysis systems holds great promise.
A Novel Strain Sensor with Large Measurement Range Based on All Fiber Mach-Zehnder Interferometer
Authors: Dong Xinran , Du Haifeng , Sun Xiaoyan , Luo Zhi , Duan Ji’an
Published: May 2018

We have proposed a high sensitive photonic crystal fiber (PCF) strain sensor based on the Mach-Zehnder interferometer (MZI). The sensing head is formed by all-fiber in-line single mode-multimode-photonic-crystal-single mode fiber (SMPS) structure, using only the splicing method. Such a strain sensor exhibited a high sensitivity of −2.21 pm/με within a large measurement range of up to 5000 με and a large fringe visibility of up to 24 dB. Moreover, it was found that the strain sensitivity was weekly dependent of the length of PCF or MMF. In addition, the sensor exhibited the advantages of simplicity of fabrication, high sensitivity and larger fringe visibility.
Realising Serial Hybrid Energy Storage Systems (sHESS) by Implementing Switching Circuits on Battery Cell Level
Authors: Horsche Max , Sturm Michael , Jossen Andreas
Published: May 2018

One approach to influence the current flow through the battery pack is to implement switching circuits. Two switching elements are necessary for each cell-stage to be bypassed or activated. This allows active load management. Thus the utilisation of the battery pack can be maximised in every situation. Adaptive control algorithms allow several kinds of operating strategies. Furthermore, dynamic output voltage can be generated to serve the best output for the downstream voltage level. A battery pack with an additional connection at its central point allows the generation of sine-shaped output voltages. As consequence of individual load management, different types of batteries or even different kinds of energy storages can be interconnected to built serial hybrid electrical energy storages. This novel approach allows precisely tailored battery packs for each application to enhance performance and energy supply.
Ataxia–Telangiectasia Gene (ATM) Mutation Heterozygosity in Breast Cancer: A Narrative Review
Authors: Jerzak K.J. , Mancuso T. , Eisen A.
Published: May 2018

Background: Despite the fact that heterozygosity for a pathogenic ATM variant is present in 1%–2% of the adult population, clinical guidelines to inform physicians and genetic counsellors about optimal management in that population are lacking. Methods: In this narrative review, we describe the challenges and controversies in the management of women who are heterozygous for a pathogenic ATM variant with respect to screening for breast and other malignancies, to choices for systemic therapy, and to decisions about radiation therapy. Results: Given that the lifetime risk for breast cancer in women who are heterozygous for a pathogenic ATM variant is likely greater than 25%, those women should undergo annual mammographic screening starting at least by 40 years of age. For women in this group who have a strong family history of breast cancer, earlier screening with both magnetic resonance imaging and mammography should be considered. High-quality data to inform the management of established breast cancer in carriers of pathogenic ATM variants are lacking. Although deficiency in the ATM gene product might confer sensitivity to DNA-damaging pharmaceuticals such as inhibitors of poly (ADP–ribose) polymerase or platinum agents, prospective clinical trials have not been conducted in the relevant patient population. Furthermore, the evidence with respect to radiation therapy is mixed; some data suggest increased toxicity, and other data suggest improved clinical benefit from radiation in women who are carriers of a pathogenic ATM variant. Conclusions: As in the 2017 U.S. National Comprehensive Cancer Network guidelines, we recommend high-risk imaging for women in Ontario who are heterozygous for a pathogenic ATM variant. Currently, ATM carrier status should not influence decisions about systemic or radiation therapy in the setting of an established breast cancer diagnosis.
Aromatase Inhibitors in Premenopausal Women with Breast Cancer: The State of the Art and Future Prospects
Authors: Pistelli M. , Della Mora A. , Ballatore Z. , Berardi R.
Published: May 2018

Approximately 11% of patients with breast cancer (BCA) are diagnosed before menopause, and because in most of those patients the tumour expresses a hormone receptor, treatment with endocrine interventions can be applied in any setting of disease (early or advanced). In the past, hormonal treatment consisted only of the estrogen receptor modulator tamoxifen, associated with luteinizing hormone–releasing hormone (LHRH); more recently, aromatase inhibitors (AIS) have come into widespread use. The AIS interfere with the last enzymatic step of estrogen synthesis in which androgens are converted into estrogens. Initially, the AIS were used alone in postmenopausal patients to prevent disease recurrence, but together with LHRH analogs, they can be used in premenopausal patients to produce better estrogen suppression than can be achieved with tamoxifen plus a LHRH analog. Using a systematic review of the scientific literature (prospective and retrospective studies), we set out to assess the efficacy of AIS compared with other endocrine therapy in various disease settings (neoadjuvant, adjuvant, metastatic).
Factors Affecting Radiotherapy Prescribing Patterns in the Post-Mastectomy Setting
Authors: Koulis T.A. , Dang A. , Speers C. , Olson R.A.
Published: May 2018

Background: Radiation therapy (RT) after mastectomy for breast cancer can improve survival outcomes, but has been associated with inferior cosmesis after breast reconstruction. In the literature, RT dose and fractionation schedules are inconsistently reported. We sought to determine the pattern of RT prescribing practices in a provincial RT program for patients treated with mastectomy and reconstruction. Methods: Women diagnosed with stages 0–III breast cancer between January 2012 and December 2013 and treated with curative-intent rt were identified from a clinicopathology database. Patient demographic, tumour, and treatment information were extracted. Of the identified patients, those undergoing mastectomy were the focus of the present analysis. Results: Of 4016 patients identified, 1143 (28%) underwent mastectomy. The patients treated with mastectomy had a median age of 57 years, and 37% of them underwent reconstruction. Treatment with more than 16 fractions of rt was associated with autologous reconstruction [odds ratio (OR): 37.2; 95% confidence interval (CI): 11.2 to 123.7; p < 0.001], implant reconstruction (OR: 93.3; 95% CI: 45.3 to 192.2; p < 0.001), and treating centre. Hypofractionated treatment was associated with older age (OR: 0.94; 95% CI: 0.92 to 0.96; p < 0.001), and living more than 400 km from a treatment centre (OR: 0.37; 95% CI: 0.16 to 0.86; p = 0.02). Conclusions: Prescribing practices in breast cancer patients undergoing mastectomy are influenced by reconstruction intent, age, nodal status, and distance from the treatment centre. Those factors should be considered when making treatment decisions.
Intravenous Vitamin C in the Supportive Care of Cancer Patients: A Review and Rational Approach
Authors: Klimant E. , Wright H. , Rubin D. , Seely D. , Markman M.
Published: May 2018

This article reviews intravenous vitamin C (IV C) in cancer care and offers a rational approach to enable medical oncologists and integrative practitioners to safely provide IV C combined with oral vitamin C to patients. The use of IV C is a safe supportive intervention to decrease inflammation in the patient and to improve symptoms related to antioxidant deficiency, disease processes, and side effects of standard cancer treatments. A proposed rationale, together with relevant clinical safety considerations for the application of IV C in oncologic supportive care, is provided.
Prescribing Practices of Endocrine Therapy for Ductal Carcinoma in Situ in British Columbia
Authors: Chaudhry A.T. , Koulis T.A. , Speers C. , Olson R.A.
Published: May 2018

Purpose: The mainstay of treatment for ductal carcinoma in situ (DCIS) involves surgery in the form of mastectomy or lumpectomy. Inconsistency in the use of endocrine therapy (ET) for DCIS is evident worldwide. We sought to assess the variation in ET prescribing for patients with DCIS across a population-based radiotherapy (RT) program and to identify variables that predict its use. Methods: Data from a breast cancer database were obtained for women diagnosed with DCIS in British Columbia from 2009 to 2014. Associations between ET use and patient characteristics were assessed by chi-square test and multilevel multivariate logistic regression. The Kaplan–Meier method, with propensity score matching and Cox regression analysis, was used to assess the effects of ET on overall survival (OS) and relapse-free survival (RFS). Results: For the 2336 dcis patients included in the study, ET use was 13% in dcis patients overall, and 17% in patients with estrogen receptor–positive (ER+) tumours treated with breast-conserving surgery and RT. Significant variation in ET use by treatment centre was observed (range: 8–23%; p < 0.001), and prescription of et by individual oncologists varied in the range 0–40%. After controlling for confounding factors, age less than 50 years [odds ratio (OR): 1.72; p = 0.01], treatment centre, er+ status (OR: 5.33; p < 0.001), and RT use (or: 1.77; p < 0.001) were significant predictors of ET use. No difference in OS or RFS with the use of et was observed. Conclusions: In this population-based analysis, 13% of patients with dcis in British Columbia received ET, with variation by treatment centre (8–23%) and individual oncologist (0–40%). Age less than 50 years, ER+ status, and rt use were most associated with ET use.
A New Predictive Scoring System Based on Clinical Data and Computed Tomography Features for Diagnosing EGFR-mutated Lung Adenocarcinoma
Authors: Cao Y. , Xu H.
Published: May 2018

Background: We aimed to develop a new EGFR mutation–predictive scoring system to use in screening for EGFR-mutated lung adenocarcinomas (LACS). Methods: The study enrolled 279 patients with LAC, including 121 patients with EGFR wild-type tumours and 158 with EGFR-mutated tumours. The Student t-test, chi-square test, or Fisher exact test was applied to discriminate clinical and computed tomography (CT) features between the two groups. Using a principal component analysis (PCA) model, we derived predictive coefficients for the presence of EGFR mutation in LAC. Results: The EGFR mutation–predictive score includes sex, smoking history, homogeneity, ground-glass opacity (GGO) on imaging, and the presence of pericardial effusion. The PCA predictive model took this form: sex × 16 + smoking history × 15 + GGO × 12 + pericardial effusion × 10 + emphysema × 11. Model scores ranged from 79 to 147. The area under the receiver operating characteristic curve was 0.752 [95% confidence interval (ci): 0.697 to 0.801] in the LAC population at the optimal cut-off value of 109, and the sensitivity and specificity were 68.4% (95% CI: 60.5% to 75.5%) and 74.4% (95% CI: 65.6% to 81.9%) respectively. Conclusions: The EGFR mutation risk scoring system based on clinical data and CT features is noninvasive and user-friendly. The model appears to frame a positive predictive value and was able to determine the value of repeating a biopsy if tissue is limited.
Male Oncology Research and Education Program for Men at High Risk for Prostate Cancer
Authors: Lorentz J. , Liu S.K. , Vesprini D.
Published: May 2018

Three groups of men are at high risk of developing prostate cancer: men with a strong family history of prostate cancer, men of West African or Caribbean ancestry, and men with a germline pathogenic variant in a prostate cancer–associated gene. Despite the fact that those men constitute a significant portion of the male population in North America, few recommendations for prostate cancer screening specific to them have been developed. For men at general population risk for prostate cancer, screening based on prostate-specific antigen (PSA) has remained controversial despite the abundance of literature on the topic. As a result, recommendations made by major screening authorities are inconsistent (ranging from no psa screening to baseline PSA screening at age 45), allowing physicians to pick and choose how to screen their patients. The Male Oncology Research and Education (more) program is an observational research program that serves as an academic platform for multiple research foci. For its participants, serum and dna are biobanked, medical information is collected, and contact for relevant research-related opportunities is maintained. This research program is paired with a specialized clinic called the more clinic, where men at high risk are regularly screened for prostate cancer in a standard approach that includes physical examination and serum psa measurement. In this article, we describe the goals, participant accrual to date, and projects specific to this unique program.
Factors Associated with Imaging in Patients with Early Breast Cancer After Initial Treatment
Authors: Enright K. , Desai T. , Sutradhar R. , Gonzalez A. , Powis M. , Taback N. , Booth C.M. , Trudeau M.E. , Krzyzanowska M.K.
Published: May 2018

Background: Overuse of surveillance imaging in patients after curative treatment for early breast cancer (EBC) was recently identified as one of the Choosing Wisely Canada initiatives to improve the quality of cancer care. We undertook a population-level examination of imaging practices in Ontario as they existed before the launch of that initiative. Methods: Patients diagnosed with ebc between 2006 and 2010 in Ontario were identified from the Ontario Cancer Registry. Records were linked deterministically to provincial health care databases to obtain comprehensive follow-up. We identified all advanced imaging exams [aies: computed tomography (CT), bone scan, positron-emission tomography] and basic imaging exams (bies: ultrasonography, chest radiography) occurring within the first 2 years after curative treatment. Poisson regression was used to assess associations between patient or provider characteristics and the rate of AIES. Results: Of 30,006 women with ebc, 58.6% received at least 1 BIE, and 30.6% received at least 1 AIE in year 1 after treatment. In year 2, 52.7% received at least 1 BIE, and 25.7% received at least 1 AIE. The most common AIES were chest CTS and bone scans. The rate of AIES increased with older age, higher disease stage, comorbidity, chemotherapy exposure, and prior staging investigations (p < 0.001). Imaging was ordered mainly by medical oncologists (38%), followed by primary care physicians (23%), surgeons (13%), and emergency room physicians (7%). Conclusions: Despite recommendations against its use, imaging is common in EBC survivors. Understanding the factors associated with aie use helps to identify areas for further research and is required to lower imaging rates and to improve survivorship care.
Adherence to, and Outcomes of, a Galactomannan Screening Protocol in High-Risk Hematology Patients
Authors: Harricharan S. , Biederman K. , Bombassaro A.M. , Lazo-Langner A. , Elsayed S. , Fulford A. , Delport J.A. , Xenocostas A.
Published: May 2018

Background: A twice-weekly galactomannan (GM) screening protocol was implemented in high-risk hematology inpatients. Study objectives were to determine adherence to the protocol, use of selected resources, and patient outcomes. Methods: This retrospective cohort study compared outcomes of interest before and after implementation of GM screening. Adults undergoing matched related allogeneic hematopoietic stem-cell transplantation or induction chemotherapy for acute leukemia were eligible. Patients could be enrolled more than once and were evaluated as episodes. Adherence to the GM protocol was assessed in post-implementation episodes. Use of broad-spectrum antifungals (BSAFS), consultations (infectious diseases, respirology), and diagnostic procedures (computed tomography imaging, bronchoalveolar lavage) were compared between phases, as were the patient outcomes of all-cause mortality and clinical success (alive and not taking a BSAF). Results: Of 182 episodes consecutively screened, 70 per phase were enrolled. Clinical characteristics and duration of assessment were similar for the phases. Full or partial adherence to the protocol was observed in 61 post-implementation episodes (87%), with full adherence in 40 episodes (57%). More episodes in the pre-implementation phase than in the post-implementation phase involved receipt of BSAFS, consultations, and diagnostics (27% vs. 7%, p = 0.02; 46% vs. 26%, p = 0.014; and 46% vs. 31%, p = 0.083 respectively). Although mortality was similar in the two phases, clinical success at the final assessment was observed in fewer pre-implementation than post-implementation episodes (79% vs. 98%, p < 0.001). Conclusions: Implementation of a GM screening protocol was feasible and associated with significantly fewer episodes involving receipt of BSAFS and consultations, and with significantly more episodes showing clinical success.
Barriers to Participation in Clinical Trials: a Physician Survey
Authors: Mahmud A. , Zalay O. , Springer A. , Arts K. , Eisenhauer E.
Published: May 2018

Background: Clinical trials are vital for evidence-based cancer care. Oncologist engagement in clinical trials has an effect on patient recruitment, which in turn can affect trial success. Identifying barriers to clinical trial participation might enable interventions that could help to increase physician participation. Methods: To assess factors affecting physician engagement in oncology trials, a national survey was conducted using the online SurveyMonkey tool (SurveyMonkey, San Mateo, CA, U.S.A.; http://www.surveymonkey.com). Physicians associated with the Canadian Cancer Clinical Trials Network and the Canadian Cancer Trials Group were asked about their specialty, years of experience, barriers to participation, and motivating interventions, which included an open-ended question inviting survey takers to suggest interventions. Results: The survey collected 207 anonymous responses. Respondents were predominantly medical oncologists (46.4%), followed by radiation oncologists (24.6%). Almost 70% of the respondents had more than 10 years of experience. Significant time constraints included extra paperwork (77%), patient education (54%), and extended follow-up or clinic visits (53%). Timing of events within trials was also a barrier to participation (55%). Most respondents favoured clinical work credits (72%), academic credits (67%), a clinical trial alert system (75%), a regular meeting to review trial protocols (65%), and a screening log to aid in patient accrual (67%) as motivational strategies. Suggested interventions included increased support staff, streamlined regulatory burden, and provision of greater funding for trials and easier access to ancillary services. Conclusions: The present study confirms that Canadian oncologists are willing to participate in clinical research, but face multiple barriers to trial participation. Those barriers could be mitigated by the implementation of several interventions identified in the study.
Ductal Carcinoma In Situ is Presumably not a Metastatic Disease: A Reply to “Commentary: Wherein the Authors Attempt to Minimize the Confusion Generated by Their Study ‘Breast Cancer Mortality after a Diagnosis of Ductal Carcinoma In Situ’ by Several Commentators Who Disagree with Them and a Few Who Don’t: A Qualitative Study”
Authors: Snodgrass Brett T.
Published: May 2018

Ductal carcinoma in situ (dcis) is presumably not a metastatic disease [...]
Pharmacologic Interventions for Fatigue in Cancer and Transplantation: A Meta-Analysis
Authors: Tomlinson D. , Robinson P. D. , Oberoi S. , Cataudella D. , Culos-Reed N. , Davis H. , Duong N. , Gibson F. , Götte M. , Hinds P. , Nijhof S. L. , van der Torre P. , Cabral S. , Dupuis L. L. , Sung L.
Published: May 2018

Background: Our objective was to determine whether, compared with control interventions, pharmacologic interventions reduce the severity of fatigue in patients with cancer or recipients of hematopoietic stem-cell transplantation (HSCT). Methods: For a systematic review, we searched medline, embase, the Cochrane Central Register of Controlled Trials, CINAHL, and PsychINFO for randomized trials of systemic pharmacologic interventions for the management of fatigue in patients with cancer or recipients of HSCT. Two authors independently identified studies and abstracted data. Methodologic quality was assessed using the Cochrane Risk of Bias tool. The primary outcome was fatigue severity measured using various fatigue scales. Data were synthesized using random-effects models. Results: In the 117 included trials (19,819 patients), the pharmacologic agents used were erythropoietins (n = 31), stimulants (n = 19), L-carnitine (n = 6), corticosteroids (n = 5), antidepressants (n = 5), appetite stimulants (n = 3), and other agents (n = 48). Fatigue was significantly reduced with erythropoietin [standardized mean difference (SMD): −0.52; 95% confidence interval (ci): −0.89 to −0.14] and with methylphenidate (SMD: −0.36; 95% CI: −0.56 to −0.15); modafinil (or armodafinil) and corticosteroids were not effective. Conclusions: Erythropoietin and methylphenidate significantly reduced fatigue severity in patients with cancer and in recipients of HSCT. Concerns about the safety of those agents might limit their usefulness. Future research should identify effective interventions for fatigue that have minimal adverse effects.
Neutrophil–Lymphocyte Ratio Predicts Response to Chemotherapy in Triple-Negative Breast Cancer
Authors: Chae S. , Kang K. M. , Kim H. J. , Kang E. , Park S. Y. , Kim J. H. , Kim S. H. , Kim S. W. , Kim E. K.
Published: May 2018

Background: The neutrophil–lymphocyte ratio (NLR) has been reported to correlate with patient outcome in several cancers, including breast cancer. We evaluated whether the NLR can be a predictive factor for pathologic complete response (PCR) after neoadjuvant chemotherapy (NAC) in patients with triple-negative breast cancer (TNBC). Methods: We analyzed the correlation between response to NAC and various factors, including the NLR, in 87 patients with TNBC who underwent NAC. In addition, we analyzed the association between the NLR and recurrence-free survival (RFS) in patients with TNBC. Results: Of the 87 patients, 25 (28.7%) achieved a PCR. A high Ki-67 index and a low NLR were significantly associated with PCR. The PCR rate was higher in patients having a high Ki-67 index (≥15%) than in those having a low Ki-67 index (35.7% vs. 0%, p = 0.002) and higher in patients having a low NLR (≤1.7) than in those having a high NLR (42.1% vs. 18.4%, p = 0.018). In multiple logistic analysis, a low NLR remained the only predictive factor for PCR (odds ratio: 4.274; p = 0.008). In the survival analysis, the RFS was significantly higher in the low NLR group than in the high NLR group (5-year RFS rate: 83.7% vs. 66.9%; log-rank p = 0.016). Conclusions: Our findings that the NLR is a predictor of PCR to NAC and also a prognosticator of recurrence suggest an association between response to chemotherapy and inflammation in patients with TNBC. The pretreatment NLR can be a useful predictive and prognostic marker in patients with TNBC scheduled for NAC.
Variation in Routine Follow-Up Care After Curative Treatment for Head-and-Neck Cancer: A Population-Based Study in Ontario
Authors: Brennan K. E. , Hall S. F. , Owen T. E. , Griffiths R. J. , Peng Y.
Published: May 2018

Background: The actual practices of routine follow-up after curative treatment for head-and-neck cancer are unknown, and existing guidelines are not evidence-based. Methods: This retrospective population-based study used administrative data to describe 5 years of routine follow-up care in 3975 head-and-neck cancer patients diagnosed between 2007 and 2012 in Ontario. Results: The mean number of visits per year declined during the follow-up period (from 7.8 to 1.9, p < 0.001). The proportion of patients receiving visits in concordance with guidelines ranged from 80% to 45% depending on the follow-up year. In at least 50% of patients, 1 head, neck, or chest imaging test was performed in the first follow-up year; that proportion subsequently declined (p < 0.001). Factors associated with follow-up practices included comorbidity, tumour site, treatment, geographic region, and physician specialty (p < 0.05). Conclusions: Given current practice variation and the absence of an evidence-based standard, the challenge in identifying a single optimal follow-up strategy might be better addressed with a harmonized approach to providing individualized follow-up care.
Follow-Up
Authors: Beswick A.
Published: May 2018

Time is important now. Time was, for a long time, only abstractly relevant—usually in the quiet moments following a holiday, or birthday, or funeral[...]